U.S. patent application number 17/660560 was filed with the patent office on 2022-08-18 for monopolar and bipolar functionality.
The applicant listed for this patent is Cilag GmbH International. Invention is credited to John Brady, Chad Frampton, Mark Glassett, Darcy Greep, Patrick J. Minnelli, Ion Nicolaescu, Matthew Schneider, Richard W. Timm.
Application Number | 20220257310 17/660560 |
Document ID | / |
Family ID | 1000006315817 |
Filed Date | 2022-08-18 |
United States Patent
Application |
20220257310 |
Kind Code |
A1 |
Minnelli; Patrick J. ; et
al. |
August 18, 2022 |
MONOPOLAR AND BIPOLAR FUNCTIONALITY
Abstract
Surgical devices, systems, and methods are provided for applying
monopolar energy and bipolar energy to tissue. In one embodiment, a
surgical device is provided with an end effector that has first and
second jaws movable between an open position and a closed position,
and a conductive member that extends through the end effector. The
conductive member has a retracted position in which the conductive
member is substantially disposed within the end effector and an
extended position in which the conductive member extends at least
partially distally beyond the end effector. The conductive member
is configured to conduct energy through tissue adjacent thereto at
least when the conductive member is in the extended position.
Inventors: |
Minnelli; Patrick J.;
(Harrison, OH) ; Greep; Darcy; (Cincinnati,
OH) ; Nicolaescu; Ion; (Cincinnati, OH) ;
Brady; John; (Cincinnati, OH) ; Frampton; Chad;
(American Fork, UT) ; Schneider; Matthew; (Blue
Ash, OH) ; Timm; Richard W.; (Cincinnati, OH)
; Glassett; Mark; (Madisonville, LA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Cilag GmbH International |
Zug |
|
CH |
|
|
Family ID: |
1000006315817 |
Appl. No.: |
17/660560 |
Filed: |
April 25, 2022 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
16375492 |
Apr 4, 2019 |
11376063 |
|
|
17660560 |
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|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 18/1445 20130101;
A61B 2018/126 20130101; A61B 2018/00589 20130101; A61B 2018/0063
20130101; A61B 18/1206 20130101; A61B 2018/00601 20130101; A61B
2018/1253 20130101 |
International
Class: |
A61B 18/14 20060101
A61B018/14; A61B 18/12 20060101 A61B018/12 |
Claims
1. A surgical device, comprising: a housing; an elongate shaft
extending from the housing and defining a longitudinal axis; an end
effector operatively connected to a distal end of the elongate
shaft, the end effector having first and second jaws, at least one
of which is movable between an open position in which the first and
second jaws are spaced apart from one another and a closed position
in which the first and second jaws cooperate to grasp tissue
therebetween, the first and second jaws being configured to conduct
energy through tissue grasped therebetween; a conductive member
extending longitudinally through the first jaw and having a hook on
a distal end thereof, the conductive member having a proximal-most
position in which the hook is disposed substantially within the
first jaw and is oriented toward the second jaw, and a distal-most
position in which the hook is positioned distally to a distal end
of the first jaw and is oriented away from the second jaw, the hook
having a spot treatment portion protruding from the first jaw in
the proximal-most position, the spot treatment portion being
configured to apply energy to tissue in the proximal-most position;
and wherein longitudinal translation of the conductive member is
configured to cause the hook to move between the proximal-most
position and the distal-most position.
2. The surgical device of claim 1, wherein at least part of the
conductive member is exposed to tissue adjacent to the first jaw in
the proximal-most position such that energy can be applied to the
tissue from the conductive member in the proximal-most
position.
3. The surgical device of claim 1, wherein longitudinal translation
of the conductive member is configured to automatically rotate the
hook from being oriented toward the second jaw to being oriented
away from the second jaw.
4. The surgical device of claim 3, wherein the first jaw includes a
helical cam slot formed therein, and the conductive member includes
a pin formed thereon and disposed within the cam slot such that
distal longitudinal translation of the conductive member causes
translation and rotation of the hook between the proximal-most
position oriented toward the second jaw and the distal-most
position oriented away from the second jaw.
5. The surgical device of claim 1, wherein energy is supplied to
the conductive member only in the distal-most position.
6. The surgical device of claim 1, wherein energy is supplied to
the first and second jaws only when the conductive member is in the
proximal-most position.
7. The surgical device of claim 1, wherein the first and second
jaws are configured to transect tissue grasped therebetween.
8. The surgical device of claim 1, further comprising an
electrically insulating sleeve extending along a proximal portion
of the conductive member and terminating proximal to the distal end
thereof.
9. A surgical method, comprising: positioning adjacent to tissue an
exposed portion of a hook on a distal end of a conductive member
partially disposed in a first jaw of an end effector on a distal
end of a surgical device when the hook is in a proximal-most
position relative to the first jaw; actuating an energy assembly to
supply energy to the conductive member to treat tissue located
adjacent to the exposed portion of the hook; distally translating
the conductive member through the first jaw to a distal-most
position to cause the hook disposed on the distal end of the
conductive member to move from the proximal-most position in which
the hook is disposed substantially within the first jaw and is
oriented toward a second jaw of the end effector to a distal-most
position in which the hook is positioned distally to a distal end
of the first jaw and is oriented away from the second jaw; and
actuating an energy assembly to supply energy to the conductive
member to treat tissue located adjacent to the hook.
10. The surgical method of claim 9, further comprising, after
actuating the energy assembly, proximally translating the
conductive member through the first jaw to cause the hook to move
from the distal-most position to the proximal-most position.
11. The surgical method of claim 9, further comprising actuating a
trigger assembly on the surgical device to cause at least one of
the first and second jaws to move to a closed position and grasp
tissue therebetween; and actuating an energy assembly on the
surgical device to supply energy to the first and second jaws to
seal tissue grasped therein.
12. The surgical method of claim 9, further comprising actuating a
cutting assembly on the surgical device to transect tissue grasped
between the first and second jaws.
13. A surgical method, comprising: positioning adjacent to tissue
an end effector, having first and second jaws, on a distal end of
an elongate shaft extending from a housing and defining a first
longitudinal axis; distally translating a conductive rod extending
through the elongate shaft and through the first jaw along the
first longitudinal axis to a proximal-most position, wherein in the
proximal-most position, the conductive rod contacts an electrode on
the first jaw to form part of a tissue contacting surface and an
electrical pathway of the first jaw; and actuating an energy
assembly to supply energy to the first and second jaws to create a
closed bipolar energy circuit allowing the first and second jaws to
conduct energy through tissue grasped therebetween.
14. The surgical method of claim 13, further comprising, after
actuating the energy assembly, distally translating the conductive
rod along the first longitudinal axis to a distal-most position,
wherein in the distal-most position, the conductive rod is
electrically isolated from the electrode on the first jaw and
extends distally from the end effector; and actuating the energy
assembly to supply energy to through the conductive rod to tissue
adjacent thereto.
15. The surgical method of claim 13, further comprising actuating a
trigger assembly on the housing to cause at least one of the first
and second jaws to move to a closed position and grasp tissue
therebetween.
16. The surgical method of claim 13, further comprising
articulating the end effector relative to the first longitudinal
axis of the elongate shaft via an articulation joint on a distal
end of the elongate shaft; wherein the conductive rod extends
through the articulation joint and is configured to flex with the
articulation joint during articulation of the joint.
17. The surgical method of claim 13, further comprising axially
translating the conductive rod when the articulation joint is
articulated such that the first longitudinal axis of the elongate
shaft intersects a second longitudinal axis of the end effector at
a non-zero angle.
18. The surgical method of claim 13, further comprising exposing at
least part of the conductive rod to tissue adjacent to the first
jaw in the proximal-most position such that energy can be applied
to the tissue from the conductive rod in the proximal-most
position.
19. The surgical method of claim 13, wherein the conductive rod has
a conductive spring thereon that is slidably engageable with the
electrode on the first jaw to allow energy to pass
therebetween.
20. The surgical method of claim 13, wherein the conductive rod has
a hook formed on a distal-most end thereof, and the first jaw is
configured to receive the hook in a distal end thereof
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 16/375,492 filed Apr. 4, 2019 and entitled
"Monopolar and Bipolar Functionality," the entire contents of which
is hereby expressly incorporated by reference herein.
FIELD
[0002] Surgical devices, systems, and methods are provided for
selectively applying monopolar energy and bipolar energy to
tissue.
BACKGROUND
[0003] Various surgical devices can be used for minimally-invasive
surgery to compress, transect, and seal different types of tissue.
In general, these devices can have an end effector with a pair of
opposed jaws that are configured to engage tissue therebetween and
a cutting mechanism that is configured to transect tissue engaged
by the opposed jaws. The end effectors can also be configured to
apply electrical energy to tissue engaged between the opposed jaws.
The application of electrical energy to the engaged tissue can seal
and coagulate the tissue, such as to seal tissue being cut by the
cutting mechanism to prevent or reduce bleeding.
[0004] However, various situations can arise during an operation in
which a user wants to apply energy to tissue without having to
first grasp tissue between the opposed jaws, such as being able to
selectively apply energy to spots of tissue in a controlled manner
without having to clamp and seal an entire section of tissue using
bipolar energy.
[0005] Accordingly, there remains a need for improved energy
delivery methods and devices for treating tissue.
SUMMARY
[0006] Methods, devices, and systems are provided herein for
selectively applying monopolar energy to tissue adjacent to a
surgical instrument and bipolar energy to tissue grasped by the
surgical instrument during minimally-invasive surgery.
[0007] In one aspect, a surgical device is provided that includes a
housing and an elongate shaft that extends from the housing and
defines a longitudinal axis. An end effector is operatively
connected to a distal end of the elongate shaft, and the end
effector has first and second jaws. At least one of the jaws is
movable between an open position in which the first and second jaws
are spaced apart from one another and a closed position in which
the first and second jaws cooperate to grasp tissue therebetween,
and the first and second jaws are configured to conduct energy
through tissue grasped therebetween. A conductive member extends
longitudinally through the first jaw, and it has a hook on a distal
end thereof. The conductive member has a proximal position in which
the hook is disposed substantially within the first jaw and is
oriented toward the second jaw and a distal position in which the
hook is positioned distally to a distal end of the first jaw and is
oriented away from the second jaw. Longitudinal translation of the
conductive member is configured to cause the hook to move between
the proximal position and the distal position.
[0008] The surgical device can have numerous variations. For
example, longitudinal translation of the conductive member can be
configured to automatically rotate the hook from being oriented
toward the second jaw to being oriented away from the second jaw.
In another example, at least part of the conductive member can be
exposed to tissue adjacent to the first jaw in the proximal
position such that energy can be applied to the tissue from the
conductive member in the proximal position. The first jaw can also
include a helical cam slot formed therein, and the conductive
member can include a pin formed thereon that is disposed within the
cam slot such that distal longitudinal translation of the
conductive member can cause translation and rotation of the hook
between the proximal position oriented toward the second jaw and
the distal position oriented away from the second jaw. In still
another example, energy can be supplied to the conductive member
only in the distal position. In another example, energy can also be
supplied to the first and second jaws only when the conductive
member is in the proximal position. In one example, the first and
second jaws can be configured to transect tissue grasped
therebetween. In another example, the surgical device can include
an electrically insulating sleeve that extends along a proximal
portion of the conductive member and terminates proximal to the
distal end thereof.
[0009] In another aspect, a surgical device is provided that
includes a housing and an elongate shaft that extends from the
housing and defines a first longitudinal axis. An end effector
extends distally from the elongate shaft, and the end effector has
first and second jaws. At least one of the jaws is movable between
a spaced position for receiving tissue and a clamped position for
engaging tissue. The first and second jaws are also configured to
conduct energy through tissue grasped therebetween. A conductive
rod extends through the elongate shaft and through the first jaw,
and the conductive rod is axially translatable along the
longitudinal axis. The conductive rod is axially translatable
between a proximal position in which the conductive rod contacts an
electrode on the first jaw to form a closed bipolar energy circuit
that allows the first and second jaws to conduct energy through
tissue grasped therebetween, and a distal position in which the
conductive rod is electrically isolated from the electrode on the
first jaw. The conductive member extends distally from the end
effector to allow energy to be conducted through the conductive rod
to tissue adjacent thereto.
[0010] The surgical device can have any number of different
variations. For example, the surgical device can also include a
articulation joint on a distal end of the elongate shaft that is
configured to articulate the end effector relative to the first
longitudinal axis of the elongate shaft. The conductive rod can
also extend through the articulation joint and be configured to
flex with the articulation joint during articulation of the joint.
In another example, the conductive rod can be axially translatable
when the articulation joint is articulated such that the first
longitudinal axis of the elongate shaft intersects a second
longitudinal axis of the end effector at a non-zero angle. In still
another example, at least part of the conductive rod can also be
exposed to tissue adjacent to the first jaw in the proximal
position such that energy can be applied to the tissue from the
conductive rod in the proximal position. The conductive rod can
also have a conductive spring thereon that can be slidably
engageable with the electrode on the first jaw. In one example, the
conductive rod can have a hook formed on a distal-most end thereof,
and the first jaw can be configured to receive the hook in a distal
end thereof In another example, the hook of the conductive rod can
engage with the electrode on the first jaw in the proximal position
to form a tissue contacting surface of the first jaw. In still
another example, the first and second jaws can be configured to
transect tissue grasped therebetween. In some examples, the
conductive rod includes a cutting element.
[0011] In another aspect, a surgical method is provided that
includes distally translating a conductive member through a first
jaw of an end effector disposed on a distal end of a surgical
device. Distal translation causes a hook disposed on a distal end
of the conductive member to move from a retracted position in which
the hook is disposed substantially within the first jaw and is
oriented toward a second jaw of the end effector to an extended
position in which the hook is positioned distally to a distal end
of the first jaw and is oriented away from the second jaw. The
method also includes actuating an energy assembly to supply energy
to the conductive member to treat tissue located adjacent to the
hook.
[0012] The surgical method can have numerous variations. In one
example, the method can also include, after actuating the energy
assembly, proximally translating the conductive member through the
first jaw to cause the hook to move from the extended position to
the retracted position. In another example, the surgical method can
include actuating a trigger assembly on the surgical device to
cause at least one of the first and second jaws to move to a closed
position and grasp tissue therebetween. The method can also include
actuating an energy assembly on the surgical device to supply
energy to the first and second jaws to seal tissue grasped therein.
In still another example, the surgical method can include actuating
a cutting assembly on the surgical device to transect tissue
grasped between the first and second jaws.
BRIEF DESCRIPTION OF DRAWINGS
[0013] The embodiments described above will be more fully
understood from the following detailed description taken in
conjunction with the accompanying drawings. The drawings are not
intended to be drawn to scale. For purposes of clarity, not every
component may be labeled in every drawing. In the drawings:
[0014] FIG. 1 is a side view of one embodiment of a surgical
device;
[0015] FIG. 2 is a perspective view of a compression member of the
surgical device of FIG. 1;
[0016] FIG. 3 is another side view of the surgical device of FIG.
1;
[0017] FIG. 4A is a side view of an end effector and a shaft of
another embodiment of a surgical device;
[0018] FIG. 4B is a partially-transparent side view of the end
effector of FIG. 4A;
[0019] FIG. 4C is a partially-transparent perspective view of the
end effector of FIG. 4A;
[0020] FIG. 4D is a perspective view of the end effector of FIG. 4A
with open jaws;
[0021] FIG. 4E is a partially-transparent perspective view of the
end effector of FIG. 4A with a conductive member in the process of
translating distally and rotating;
[0022] FIG. 4F is a perspective view of the end effector of FIG. 4A
with the conductive member extended distally;
[0023] FIG. 4G is a partially-transparent perspective view of the
end effector of FIG. 4A with the conductive member extended
distally;
[0024] FIG. 4H is a front view of the end effector of FIG. 4A with
the conductive member extended distally;
[0025] FIG. 5A is a perspective view of an end effector with open
jaws and a shaft of another embodiment of a surgical device;
[0026] FIG. 5B is a partially-transparent side view of the end
effector of FIG. 5A;
[0027] FIG. 5C is a partially-transparent perspective view of the
end effector of FIG. 5A;
[0028] FIG. 5D is a partially-transparent perspective view of the
end effector of FIG. 5A with a conductive member in the process of
translating distally;
[0029] FIG. 5E is a perspective view of the end effector of FIG. 5A
with open jaws and the conductive member extended distally;
[0030] FIG. 5F is a perspective view of the end effector of FIG. 5A
with the conductive member extended distally;
[0031] FIG. 6A is a top down view of an end effector and an
articulatable shaft of another embodiment of a surgical device;
[0032] FIG. 6B is a partially-transparent top down view of the end
effector of FIG. 6A;
[0033] FIG. 6C is a partially-transparent side view of the end
effector of FIG. 6A;
[0034] FIG. 6D is a cross-sectional side view of the end effector
of FIG. 6A;
[0035] FIG. 6E is a partially-transparent top down view of the end
effector of FIG. 6A with a conductive member in the process of
translating distally;
[0036] FIG. 6F is a partially-transparent side view of the end
effector of FIG. 6A with the conductive member extended
distally;
[0037] FIG. 6G is a cross-sectional side view of the end effector
of FIG. 6A with the conductive member extended distally;
[0038] FIG. 7A is a cross-sectional side view of an end effector
and a shaft of another embodiment of a surgical device;
[0039] FIG. 7B is a bottom up view of a lower exterior surface of
the end effector of FIG. 7A;
[0040] FIG. 7C is a cross-sectional side view of the end effector
of FIG. 7A with a cutting element translated distally through a
full cutting stroke;
[0041] FIG. 7D is a cross-sectional view along the shaft toward the
end effector of the surgical device of FIG. 7A with a knife stop in
obstructing engagement with the cutting element;
[0042] FIG. 7E is a cross-sectional view along the shaft toward the
end effector of the surgical device of FIG. 7A with the knife stop
rotated counterclockwise out of obstructive engagement with the
cutting element;
[0043] FIG. 7F is a cross-sectional side view of the end effector
of FIG. 7A with the cutting element and a conductive member
extended distally;
[0044] FIG. 7G is a cross-sectional side view of a distal portion
of the end effector of FIG. 7A with the cutting element and the
conductive member extended distally;
[0045] FIG. 7H is a bottom up view of the lower exterior surface of
a distal portion of the end effector of FIG. 7A with the conductive
member extended distally;
[0046] FIG. 7I is a cross-sectional side view of the end effector
of FIG. 7A with the cutting element retracted proximally;
[0047] FIG. 7J is a cross-sectional side view of the end effector
of FIG. 7A with the cutting element and the conductive member
retracted proximally;
[0048] FIG. 8 is a bottom up view of a lower exterior surface of a
distal portion of another embodiment of a surgical device;
[0049] FIG. 9 is a bottom up view of a lower exterior surface of a
distal portion of another embodiment of a surgical device;
[0050] FIG. 10A is a cross-sectional side view of an end effector
and a shaft of another embodiment of a surgical device;
[0051] FIG. 10B is a bottom up view of a lower exterior surface of
the end effector of FIG. 10A;
[0052] FIG. 11A is a cross-sectional side view of an end effector
and a shaft of another embodiment of a surgical device; and
[0053] FIG. 11B is a bottom up view of a lower exterior surface of
the end effector of FIG. 11A.
DETAILED DESCRIPTION
[0054] Certain exemplary embodiments will now be described to
provide an overall understanding of the principles of the
structure, function, manufacture, and use of the devices and
methods disclosed herein. One or more examples of these embodiments
are illustrated in the accompanying drawings. Those skilled in the
art will understand that the devices and methods specifically
described herein and illustrated in the accompanying drawings are
non-limiting exemplary embodiments and that the scope of the
present invention is defined solely by the claims. The features
illustrated or described in connection with one exemplary
embodiment may be combined with the features of other embodiments.
Such modifications and variations are intended to be included
within the scope of the present invention.
[0055] Further, in the present disclosure, like-named components of
the embodiments generally have similar features, and thus within a
particular embodiment each feature of each like-named component is
not necessarily fully elaborated upon. Additionally, to the extent
that linear or circular dimensions are used in the description of
the disclosed systems, devices, and methods, such dimensions are
not intended to limit the types of shapes that can be used in
conjunction with such systems, devices, and methods. A person
skilled in the art will recognize that an equivalent to such linear
and circular dimensions can easily be determined for any geometric
shape. Sizes and shapes of the systems and devices, and the
components thereof, can depend at least on the anatomy of the
subject in which the systems and devices will be used, the size and
shape of components with which the systems and devices will be
used, and the methods and procedures in which the systems and
devices will be used.
[0056] Various exemplary methods, devices, and systems are provided
for applying energy to tissue in a monopolar treatment mode and a
bipolar treatment mode using a surgical instrument, such as a
minimally-invasive surgical instrument with an end effector that
has opposed jaws for grasping tissue. The energy can be delivered
to transect and/or seal tissue. While tissue sealing can be
accomplished by applying energy between the opposed jaws to grasped
tissue, it can also be beneficial to apply energy to target tissue
that is adjacent to the end effector and not grasped thereby, such
as by a "spot treatment." This can allow a user to conduct spot
coagulation, non-clamping sealing and/or hemostasis, marking
tissue, cutting or searing tissue, etc., during use. The energy
applied to tissue grasped between the opposed jaws can be applied
in a bipolar mode where the energy is applied by an energy
delivering electrode in one jaw and received by a return electrode
in the opposed jaw. In other aspects, spot energy can be applied to
tissue adjacent to the end effector or a portion thereof in a
monopolar mode. As such, various monopolar electrodes are provided
that can be advanced from end effectors of surgical instrument for
applying spot energy to target tissue, and retracted into the end
effectors for storage therein when energy delivery is not
necessary. When advanced, at least part of the monopolar electrode
can protrude distally from the end effector to deliver energy to
tissue adjacent thereto, and when retracted, the monopolar
electrode can be at least partially withdrawn proximally into the
end effector for storage such that at least a portion of the
electrode is protected by the end effector.
[0057] In an exemplary embodiment, a surgical device is provided
that has a housing with an elongate shaft extending distally
therefrom. An end effector having first and second jaw is
operatively connected to a distal end of the elongate shaft. At
least one of the first and second jaws is movable between an open
position in which the first and second jaws are spaced apart from
one another and a closed position in which the first and second
jaws cooperate to grasp tissue therebetween. In the closed
position, the first and second jaws can conduct energy through
tissue grasped therebetween. A conductive member extends
longitudinally through the first jaw, and it can have a retracted
or proximal position and an extended or distal position. In the
retracted position, the conductive member is substantially disposed
within the first jaw, and in the extended position, a distal end of
the conductive member is positioned distally to a distal end of the
first jaw. The conductive member can be configured to conduct
energy to tissue adjacent thereto. The conductive member can take a
variety of forms and can translate longitudinally in a variety of
ways, as discussed in detail below.
[0058] FIG. 1 illustrates one embodiment of a surgical device
configured to grasp and cut tissue. As shown, the illustrated
surgical device 100 generally includes a proximal housing portion
10, a shaft portion 12, and an end effector 14 for grasping tissue.
The proximal housing portion 10 can be any type of pistol-grip,
scissor grip, pencil-grip, or other type of handle known in the art
that is configured to carry various actuators, such as actuator
levers, knobs, triggers, or sliders, for actuating various
functions such as rotating, articulating, approximating, and/or
firing the end effector 14. In the illustrated embodiment, the
proximal housing portion 10 includes a stationary grip 22 and a
closure grip 20 that is movable relative to the stationary grip 22
to open and close jaws of the end effector 14. The shaft portion 12
extends distally from the proximal housing portion and has at least
one lumen 12a extending therethrough for carrying mechanisms for
actuating the end effector 14. The end effector 14 can have a
variety of sizes, shapes, and configurations. As shown in FIG. 1,
the end effector 14 includes a first upper jaw 16a and a second
lower jaw 16b disposed at a distal end 12d of the shaft portion 12.
The jaws 16a, 16b are moveable between an open position in which
the jaws 16a, 16b are spaced a distance apart, as shown in FIG. 1,
and a closed position in which the jaws 16a, 16b are moved toward
one another and are substantially opposed. When the jaws 16a, 16b
are in the closed position, a longitudinal axis of the upper jaw
16a can be substantially parallel to a longitudinal axis of the
lower jaw 16b and the jaws 16a, 16b can act to engage or grasp
tissue therebetween. In the illustrated embodiment, the upper jaw
16a pivots relative to the shaft portion 12 and relative to the
lower jaw 16b while the lower jaw 16b remains stationary, however
in other embodiments both jaws can pivot, or the lower jaw 16b can
pivot while the upper jaw 16a remains stationary.
[0059] While the illustrated jaws 16a, 16b have a substantially
elongate and straight shape, a person skilled in the art will
appreciate that one or both of the jaws 16a, 16b can curve in
various directions, such as being curved along a longitudinal
length thereof. The jaws 16a, 16b can have any suitable axial
length for engaging tissue, and the length can be selected based on
the targeted anatomical structure for transection and/or
sealing.
[0060] As indicated above, the surgical device 100 can have a
closure actuator that can be configured to open and close the jaws
16a, 16b of the end effector 14 such that the jaws can engage
tissue, move anatomical structures, or perform other surgical
functions. While the closure actuator can have various
configurations, in the illustrated embodiment the closure actuator
includes the closure grip 20 and the stationary grip 22. The
closure grip 20 can be pivotal toward and away from the stationary
grip 22. In particular, the closure grip 20 can have a first or
initial open position in which it is angularly offset and spaced
apart from the stationary grip 22 and the jaws 16a, 16b of the end
effector 14 are open. It can also have a second or final closed
position where it is positioned adjacent to, or substantially in
contact with, the stationary grip 22 and the jaws 16a, 16b of the
end effector 14 are substantially closed to engage tissue and apply
a force to tissue disposed therebetween. The closure grip 20 can be
biased to the first open position with the jaws 16a, 16b of the end
effector 14 being open, as shown in FIG. 1.
[0061] The closure grip 20 can use manual or powered components. In
manual embodiments the closure handle 20 is configured to be
manually moved (e.g., by a user directly or by a user indirectly
via robotic surgical control) to manually open/close the end
effector 14 using various components, e.g., gear(s), rack(s), drive
screw(s), drive nut(s), etc. disposed within the housing 10 and/or
shaft 12.
[0062] In powered embodiments, the closure handle 20 is configured
to be manually moved (e.g., by a user directly or by a user
indirectly via robotic surgical control), thereby causing the end
effector 14 to open/close either fully electronically or
electronically in addition to manual power. In this illustrated
embodiment, as shown in FIG. 3, the device 100 is powered and
includes a motor 48, a power source 52, and a processor 54, which
in this illustrated embodiment are each disposed in the housing 10.
Manual movement of the closure handle 20 is configured to cause the
processor 54 to transmit a control signal to be sent to the motor
48, which is configured to interact with various components of the
device 100 to cause the jaws 16a, 16b to open/close. The power
source 52 is configured to provide on-board power to the processor
54 and the motor 48. In other embodiments, the processor 54 and/or
the motor 48 can be configured to be powered instead, or
additionally, with an external power source. The device 100 can
include one or more sensors to facilitate powered end effector
opening and closing and/or other device features, such as tissue
cutting. Various embodiments of such sensors are further described
in U.S. Pat. No. 7,416,101 entitled "Motor-Driven Surgical Cutting
And Fastening Instrument With Loading Force Feedback" filed Jan.
31, 2006 and U.S. Pat. No. 9,675,405 entitled "Methods And Devices
For Controlling Motorized Surgical Devices" filed Apr. 8, 2014,
which are hereby incorporated by reference in their entireties.
Further description of embodiments of end effector opening and
closing is provided in U.S. Pat. No. 10,010,309 entitled "Surgical
Device With Overload Mechanism" filed Oct. 10, 2014, which is
hereby incorporated by reference in its entirety.
[0063] In at least some embodiments the closure grip 20 can also
interact with one or more locking features to lock the closure grip
20 relative to the stationary handle 22, as will be appreciated by
a person skilled in the art. For example, the locking feature can
automatically engage when the closure grip 20 substantially
contacts the stationary handle 22 or the locking feature can
automatically engage at each position the closure grip 20 is
pivoted through, such as via ratcheting.
[0064] The surgical device 100 can also have one or more additional
activators that can be separate from the closure actuator 20, such
as a cutting actuator 24 to advance a cutting assembly and one or
more sealing actuators 26 to apply energy to tissue. While the
actuators 24, 26 can have various configurations, the illustrated
actuators 24, 26 are buttons or triggers that can be depressed by a
user and can activate various elements in the device to advance the
cutting element and/or cause energy to be delivered to the jaws.
For example, the cutting actuator 24 can be in manual or electrical
communication with various gear(s), rack(s), drive screw(s), drive
nut(s), motor(s), and/or processor(s). The cutting assembly can be
configured to transect tissue captured between the jaws, and it can
be sized and shaped to transect or cut various thicknesses and
types of tissue. In one exemplary embodiment, as shown in FIG. 2,
the cutting assembly can include an I-beam compression member 28
that travels along a longitudinal axis Lc through slots formed in
each jaw to pull the jaws into a parallel orientation, to compress
tissue therebetween, and to transect tissue using a cutting element
on the distal end 28d thereof. As shown in FIG. 3, the housing
portion 10 of the surgical device 100 can include other components
for operating the device, such as the motor 48, a power source 50,
a generator 52, and/or the processor 54, as well as various sensors
(not shown).
[0065] The surgical device 100 includes a sealing actuator 26
configured to be actuated to cause energy, such as radiofrequency
(RF) or ultrasound energy, to be applied to tissue engaged by the
end effector 14. While the actuator 26 can have various
configurations, e.g., buttons, knobs, triggers, etc., the
illustrated actuator 26 is a button configured to be depressed. In
other embodiments, instead of including a cutting actuator 24 and a
sealing actuator 26, a surgical device can include a combined
cutting and sealing actuator configured to be actuated to
simultaneously cause cutting and sealing.
[0066] The device 100 includes various components configured to
facilitate the delivering of energy to tissue. These components can
be disposed at various locations in the device 100, such as in the
proximal housing portion 10 and/or in one or both of the jaws 16a,
16b. Actuating the sealing actuator 26 is configured to cause a
signal to be transmitted to the processor 54, which in response is
configured to cause delivery of energy from the generator 52 and/or
the power source 50 to tissue engaged by the end effector 14. The
generator 52 can be incorporated into the housing portion 10 or, as
in this illustrated embodiment as shown in FIG. 3, can be a
separate unit that is electrically connected to the surgical device
100. The generator 52 is any suitable generator known in the art,
such as an RF generator or an ultrasound generator.
[0067] The lumen 12a of the shaft 12 has disposed therein one or
more electrical paths 46, e.g., leads, conductive members, wires,
etc., configured to deliver electrical energy to the end effector
14 in response to actuation of the sealing actuator 26. The one or
more electrical paths 46 are operatively coupled to the generator
52 in this illustrated embodiment, with the generator 52 being
configured to supply energy to the one or more electrical paths 46.
Upon actuation of energy delivery, energy is configured to be
delivered to one or more electrodes in one or both of the jaws 16a,
16b via the one or more electrical paths 46 for delivering
electrical current to tissue grasped therebetween to effect
sealing, marking, cutting, etc. of the tissue. Further description
of embodiments of energy application by surgical devices is
provided in U.S. Pat. No. 10,010,366 entitled "Surgical Devices And
Methods For Tissue Cutting And Sealing" filed Dec. 17, 2014, U.S.
Pat. No. 7,169,145 entitled "Tuned Return Electrode With Matching
Inductor" filed Nov. 21, 2003, U.S. Pat. No. 7,112,201 entitled
"Electrosurgical Instrument And Method Of Use" filed Jan, 22, 2003,
and U.S. Patent Pub. No. 2017/0135712 entitled "Methods And Devices
For Auto Return Of Articulated End Effectors" filed Nov. 17, 2015,
which are hereby incorporated by reference in their entireties.
[0068] The device 100 has bipolar functionality in which energy
applied to tissue engaged by the end effector 14 is energy applied
by a delivery or active electrode 17a and received by a return
electrode 17b. One of the jaws 16a, 16b (the upper jaw 16a in this
illustrated embodiment) includes the active electrode 17a on a
tissue-facing surface thereof, and the other one of the jaws 16a,
16b (the lower jaw 16b in this illustrated embodiment) includes the
return electrode 17b on a tissue-facing surface thereof. The return
electrode 17b is electrically isolated from the active electrode
17a such that energy can be applied to tissue grasped between the
jaws 16a, 16b from the active electrode 17a and have a return path
through the return electrode 17b. The energy is thus configured to
be delivered to tissue grasped between the jaw 16a, 16b when the
end effector 14 is in the closed position.
[0069] While energy can be delivered to tissue grasped between the
opposed jaws 16a, 16b in the device 100 in a bipolar mode, energy
can also be delivered to tissue without having to grasp tissue by
advancing one or more monopolar electrodes from the end effector.
FIGS. 4A-4H illustrate an embodiment of a surgical device 200
similar to surgical device 100. All of the aforementioned features
of device 100 are present on device 200. In particular, surgical
device 200 has an end effector 214, an elongate shaft 212, and a
housing, which can be in the form of a handle (not shown). The
shaft 212 extends distally from the housing and has the end
effector 214 disposed on a distal end thereof, and it has at least
one lumen 212a extending therethrough for carrying mechanisms for
actuating the end effector 214. The end effector 214 has a first
upper jaw 216a and a second lower jaw 216b that is opposed thereto.
The jaws 216a, 216b can grasp tissue therebetween, transect grasped
tissue with a cutting element 218, and apply energy in a bipolar
mode to grasped tissue through active and return electrodes 219a,
219b in the jaws 216a, 216b. The handle includes a stationary grip
and a closure grip (not shown) that is pivotally movable relative
to the stationary grip to open and close upper and lower jaws 216a,
216b of the end effector 214. A cutting actuator (not shown) is
disposed on the housing to cause transection by the cutting element
218 of tissue grasped by the jaws 216a, 216b, and an energy
actuator (not shown) is disposed on the housing to cause delivery
of energy to the end effector 214. Various gear(s), rack(s), drive
screw(s), drive nut(s), motor(s), processor(s), conducting
member(s), etc. can be disposed within the handle and/or the shaft
212 to translate actuation of the closure grip and various
actuator(s) into actuation of functions on the end effector
214.
[0070] A monopolar electrode 230 extends longitudinally through at
least a portion of the end effector 214 and is longitudinally
translatable distally and proximally with respect thereto. The
electrode 230 can translate between a retracted position in which a
majority of the electrode 230 is retracted within the end effector
214, as illustrated in FIGS. 4A-4D, and an extended position in
which at least a distal end 230d of the electrode 230 protrudes
distally beyond a distal end 214d of the end effector 214, as
illustrated in FIGS. 4F-4H. Upon distal translation of the
electrode 230 and actuation of energy, as discussed below, the
electrode 230 can be used to spot seal, coagulate, mark, cut, etc.
tissue disposed adjacent to the distal end 214d of the end effector
214. While the illustrated electrode 230 extends through the end
effector and the shaft 212, it can extend parallel to but outside
of one or both of the end effector 214 and the shaft 212 in other
embodiments.
[0071] While the configuration can vary, in the illustrated
embodiment the electrode 230 has a general shape of an L with an
elongate rod 230s and a hook or bent tip 230t on a distal end
thereof that extends at an approximately right angle thereto. The
rod 230s extends proximally through a longitudinal electrode lumen
232 that extends through the lower jaw 216b to engage with one or
more conductive members, such as wires or other electrical leads,
in the handle of the surgical device 200 for receiving energy
therefrom.
[0072] The electrode 230 also has a non-conductive protective
sleeve 234 that insulates a majority of the electrode rod 230s as
it extends through the device 200 while terminating proximal to the
hook 230t. As such, the electrode 230 has an exposed,
electrically-active distal portion. The sleeve 234 can thus help
protect various components within the device 200 and any secondary
tissue from inadvertent electrical exposure while creating an
easily-identifiable active distal end on the electrode 230 for
treatment of any target tissue. In some embodiments, the end
effector 214, the shaft 212, and/or the handle thus do not need to
be electrically insulated, however one or more portions thereof can
be insulated as desired to prevent energizing unintended areas. The
sleeve 234 can be made from a variety of insulating materials, such
as PVC wire insulation.
[0073] In the retracted position, the hook 230t can be received in
a distal tip notch 217 on a distal end of the lower jaw 216b, and
it can extend toward the upper jaw 216a. As illustrated in FIGS. 4A
and 4B, at least a portion of the electrode 230, such as a corner
230c, can still protrude from the lumen 232 and the notch 217 such
that surrounding tissue can still be exposed to and spot treated by
the electrode 230 even in the retracted position. As such, a user
can perform minor tissue modifications, such as limited spot
coagulation, without having to extend the electrode. However, a
majority of the electrode 230 is received into the end effector 214
in the retracted position, and energy delivery from the electrode
230 can be selectively terminated so that no energy is delivered
therefrom. This can avoid any accidental energy application during
movement, treatment, etc. Furthermore, in other embodiments, the
electrode can be withdrawn entirely into the end effector. While
the notch 217 extends toward the upper jaw 216a, in other
embodiments the notch can be oriented in a variety of different
ways, such as parallel to a plane that passes through a tissue
contacting surface of the upper jaw 216a.
[0074] During extension of the electrode 230, the rod 230s and the
hook 230t can be rotatable about a longitudinal axis A1 of the
shaft, as illustrated in FIG. 4E. The hook 230t has a set
rotational movement during distal extension such that it protrudes
away from the upper jaw 216a upon full distal extension, as
illustrated during partial rotation and extension in FIG. 4E and
full rotation and extension in FIGS. 4F-4H, to provide increased
visibility and energy treatment accessibility when in the extended
position. The set rotational movement is caused by a pin 235
protruding from the rod 230s of the electrode 230 and/or the sleeve
234 and resting in a rotational guide slot 233 that is in
communication with the electrode lumen 232 through the lower jaw
216b, as illustrated in FIGS. 4C and 4G. The rotational guide slot
233 receives the pin 235 therein, and during distal translation
along axis Al, the pin 235 initially translates longitudinally
along the rotational guide slot 233. The slot 233 initially extends
parallel to the lumen 232 on a first side of the lower jaw 216b.
However, after initially extending parallel to the lumen 232, the
guide slot 233 begins to curve in a semi-circular helical or
corkscrew path around the electrode lumen 232. The helical path is
arranged such that, when the hook 230t of the electrode reaches a
distal extension at which it is rotationally clear of the distal
tip notch 217 in the lower jaw 216a, the pin 235 begins to curve
around the helical path of the guide slot 233. This causes rotation
of the hook 230t from its initial position protruding toward the
upper jaw 216a to its fully-extended position protruding away from
the upper jaw 216a, as illustrated by arrows indicating rotation
and distal translation in FIG. 4E. The hook 230t thus rotates
approximately 180 degrees. Upon complete rotation of the electrode
230, shown in FIGS. 4F-4H, the pin 235 comes to rest in the guide
slot 233 on a second side of the lower jaw 216b opposite to the
first side. In the illustrated embodiment, the guide slot 233
continues to extend distally parallel to the electrode lumen 232 on
the second side of the lower jaw 216b to the distal end of the
lower jaw 216b to allow continued distal extension of the electrode
230 if desired. However, in other embodiments, the pin 235 can come
to rest at a terminal distal end of the guide slot 233 proximal to
the distal end of the lower jaw 216b to assist in maintaining a
controlled distal protrusion distance of the electrode 230. Upon
retraction of the electrode 230, proximal translation of the
electrode 230 causes a corresponding proximal helical motion of the
pin 235 in the guide slot 233 such that the hook 230t translates
and rotates proximally to the stored, retracted position in the
lower jaw 216b. The pin 235 and the guide slot 233 thus act as a
type of camming mechanism to cause automatic rotation of the hook
230t during distal translation.
[0075] As such, energy can be delivered to tissue without having to
first grasp tissue by energizing the exposed corner portion 230c
when the electrode 230 is retracted in the end effector 214, or by
extending the hook 230t distally to the extended position while
rotating the hook 230t through an approximately 180 degree
automatic helical rotation to help improve visibility and exposure
of the energized hook 230t to tissue adjacent thereto to touch,
drag along, mark, cut, coagulate, etc. the tissue. In still other
embodiments, the electrode 430 can be selectively rotatable by a
user through a rotational mechanism on the handle, such as by using
a rotational knob, dial, etc. The hook 230t can thus protrude
radially outward in any of 360 degrees of rotation relative to the
rod 230s in some embodiments. The electrode 230 can be made from a
variety of electrically-conductive materials, such as metal.
[0076] Distal and proximal translation of the electrode 230 can be
controlled by a variety of different mechanisms. In the illustrated
embodiment, pivotal movement of the closure grip relative to the
stationary grip through a select range of motion causes distal and
proximal translation, similar to the mechanism discussed in U.S.
Patent App. No. [AMEND AFTER FILING], entitled "Monopolar And
Bipolar Functionality," filed concurrently herewith (Atty. Dkt.
No.: END9050USNP1 (047364-417F01US)), which is incorporated by
reference herein in its entirety. However, a variety of other
mechanisms can be used, such as by having a separate pivotal grip
or lever on the handle, by having a sliding mechanism on the
handle, by having a rotational knob positioned between the handle
and the shaft 212 that can cause axial rotation of the shaft 212 by
rotation of the knob and/or longitudinal translation of the
electrode 230 by distal and proximal translation of the knob
relative to the handle, by one or more buttons or switches on the
handle that can cause powered translation through one or more gear
mechanisms therein, etc.
[0077] Energy can be applied to the electrode 230 through various
mechanisms, as well. In the illustrated embodiment, energy can is
applied to the monopolar electrode 230 similar to energy applied to
electrodes 219a, 219b targeting grasped tissue in the end effector
214. An energy actuator on the handle of the device 200 can be
depressed, actuating delivery of energy through one or more
conductive members from a generator, similar to generator 52,
and/or a power source, similar to power source 50, to the electrode
230. In some embodiments, the device 200 can restrict energy from
being transmitted to the electrode 230 until the electrode 230 is
in the extended position, at which point depression of the actuator
226 can supply energy to electrode 230 and not electrodes 219a,
219b. For example, the device 200 can use a position sensor in the
handle that detects a proximal position of the rod 230s,
determining if it is in the retracted position (such that energy is
restricted to the electrode 230) or in the extended position (such
that energy is restricted to the electrodes 219a, 219b ). In other
embodiments, the device 200 can transition between monopolar and
bipolar modes upon actuation of the pivotal grip, lever, rotational
knob, etc. that causes the electrode 230 to extend distally. In
still other examples, this determination can be made through use of
various rotational, magnetic, switch, pressure, etc. sensors. A
user can also activate a button or switch on the handle of the
device 200 to transition between a monopolar and a bipolar mode.
Furthermore, in some embodiments, energy delivery can be directed
to the electrodes 219a, 219b and/or the electrode 230 through a
position of the energy actuator. In particular, the energy actuator
can have two ranges of motion, and it can apply energy to the
electrodes 219a, 219b when moved through an initial first range,
and it can apply energy to the electrode 230 when further depressed
and moved through a second range. This can be preferable, for
example, when limited spot treatment of tissue is desired when the
electrode 230 is not in the extended position but instead has the
small corner portion 230c exposed when it is in the retracted
position. In other embodiments, actuation can occur through an
entirely separate actuation mechanism than the actuation mechanism
for the electrodes 219a, 219b, such as a separate button, switch,
etc. on the handle. In still other embodiments, actuation
mechanisms can be limited to one actuator that is used both for
cutting and energy actuation. In various embodiments, energy
actuation can allow selective application of more than one
electrical waveform to the monopolar electrode 230, such as having
one continuous low-voltage waveform for tissue cutting and another
interrupted high-voltage waveform for tissue and blood coagulation.
When energy is applied to the electrode 230 in the monopolar mode,
energy applied to a target tissue can dissipate and return through
a ground pad placed on a patient's body, etc.
[0078] The device 200 can be used in a manner similar to device 100
when grasping tissue between the jaws 216a, 216b, transecting the
grasped tissue, and applying energy thereto. The electrode 230 can
initially be in the retracted position, and the device 200 can
operate in a bipolar mode. When spot application of energy is
desired, the electrode 230 can be translated from the retracted
position to the extended position, as discussed above. As the
electrode 230 extends distally, the hook 230t can rotate through
the helical path of the guide slot 233 such that the hook 230t
rotates approximately 180 degrees from facing toward the upper jaw
216a to facing away from the upper jaw 216a as it extends distally.
Once the electrode 230 is extended in the monopolar mode, energy
can then be applied to target tissue by the exposed distal portion
of the electrode 230. The electrode 230 can then be translated to
the retracted position, again causing rotational movement of the
hook 230t to be stored in the retracted position in the end
effector 214, and a user can proceed with using the device 200 in
the bipolar mode. In embodiments in which the electrode 230 can be
actuated without first extending it, energy can be applied to the
electrode 230 in the retracted position, and the user can spot
treat limited portions of tissue as desired using the exposed
corner portion 230c. In various embodiments, the electrode 230 can
also be extended only when the jaws 216a, 216b are in the closed
position, only when the jaws 216a, 216b are in the opened position,
or either when the jaws 216a, 216b are opened or closed.
[0079] In other embodiments, rotation of the monopolar electrode is
not required when moving the electrode between a retracted position
and an extended position. Rather, extension of the electrode can
occur primarily through linear axial translation. FIGS. 5A-5F
illustrate a surgical device 300, similar to surgical devices 100,
200, that has an electrode 330 that is translated between retracted
and extended positions. The device 300 has an end effector 314, an
elongate shaft 312, and a housing such as a handle (not shown). The
shaft 312 extends distally from the housing and has the end
effector 314 disposed on a distal end thereof, and it has at least
one lumen 312a extending therethrough for carrying mechanisms for
actuating the end effector 314. The end effector 314 has a first
upper jaw 316a and a second lower jaw 316b that is opposed thereto.
The jaws 316a, 316b can grasp tissue therebetween, transect grasped
tissue with a cutting element 318, and apply energy in a bipolar
mode of operation to grasped tissue through active and return
electrodes 319a, 319b in the jaws 316a, 316b. The housing includes
a pivotal closure grip (not shown) that is pivoted to open and
close upper and lower jaws 316a, 316b and one or more actuators
(not shown) to cause transection of tissue grasped by the jaws
316a, 316b and delivery of energy to the end effector 314. Various
gear(s), rack(s), drive screw(s), drive nut(s), motor(s),
processor(s), conducting member(s), etc. can be disposed within the
handle and/or the shaft 312 to translate actuation of the closure
grip and various actuator(s) into actuation of functions on the end
effector 314, as described above.
[0080] The electrode 330 extends longitudinally through the end
effector 314 and is axially translatable distally and proximally,
similar to electrode 230. The electrode 330 can translate between a
retracted position in which a majority of the electrode 330 is
retracted within the end effector 314, as illustrated in FIGS.
5A-5C, and an extended position in which at least a distal end 330d
of the electrode 330 protrudes distally beyond a distal end 314d of
the end effector 314, as illustrated in FIGS. 5D-5F. When the
electrode 330 is in the retracted position, the electrode 330 forms
part of the bipolar electrical pathway of the jaws 316a, 316b, as
illustrated in FIG. 5A and discussed below. Upon distal translation
of the electrode 330, the electrode 330 can act as a monopolar
electrode, similar to electrode 230, as a result of electrically
decoupling itself from the bipolar electrode 319b, as discussed
below. Thus, similar to electrode 230, upon distal transition of
the electrode 330 and actuation of energy, the electrode 330 can be
used to spot seal, coagulate, mark, cut, etc. tissue disposed
adjacent to the end effector 314.
[0081] The electrode 330 has a general J shape with a proximal flat
extension 330s and a distal hook 330t. The flat extension 330s
extends along a tissue contacting surface of the lower jaw 316b of
the end effector 314 and is positioned on an opposite side of the
jaw 316b from the bipolar electrode 319b such that a cutting
element translation path 318p extends longitudinally between the
flat extension 330s and the bipolar electrode 319b and along a
center of the lower jaw 316b. The flat extension 330s is positioned
in an electrode channel 354 that has an opening at the distal end
of the lower jaw 316b to allow for distal and proximal translation
of the electrode 330 to distally extend at least partially out of
the channel 354 when the electrode 330 is in the monopolar mode.
The distal hook 330t is a curved hook that generally corresponds to
a curvature of the distal end of the lower jaw 316b (and thus the
curvature of the distal end 314d of the end effector 314), and it
curves such that a terminal end thereof protrudes proximally away
from the distal end 314d of the end effector 314 when in the
retracted position.
[0082] The electrode 330 can engage with one or more conductive
members that extend proximally through the shaft 312 and into the
handle to receive energy therefrom and are linearly translated
thereby. A conductive rod 340 extends proximally at least partially
through the shaft 312 to convey energy from an energy source, and
it extends at least partially distally into a first guide slot 350
in the lower jaw 316b. The conductive rod 340 mates with a planar
member 344 through a conductive engagement cap 342. The planar
member 344 extends at least partially distally through a second
guide slot 352 in the lower jaw 316b that is below and parallel to
at least a portion of the flat extension 330s of the electrode 330.
Further, planar member 344 engages with the flat extension 330s of
the electrode 330. As such, energy transmitted through the
conductive rod 340 from an energy source is conducted through the
planar member 344 and to the electrode 330. One or more of the
conductive rod 340, the conductive cap 342, the planar member 344,
and/or the electrode 330 can have a non-conductive protective
sleeve, similar to the sleeve 234, around at least a portion
thereof that insulates the conductive pathway of the electrode 330
as it passes through the device 300.
[0083] The conductive rod 340 and the planar member 344 also act to
linearly translate the electrode 330. Distal and proximal
translation of the rod 340 causes corresponding translation of the
distal-most end of the rod 340 with the conductive cap 342 through
the first guide slot 350, which in turn translates the planar
member 344 through the second guide slot 352. Translation of the
planar member 344 results in linear translation of the electrode
330 between the retracted, bipolar position and the extended,
monopolar position, as illustrated by arrows in FIG. 5D,
effectively allowing the device 300 to switch between bipolar and
monopolar modes. As the electrode 330 is translated distally, it
can translate along the electrode channel 354, as illustrated in
FIG. 5E.
[0084] When the electrode 330 is in the retracted position, it is
in electrical and physical engagement with the bipolar electrode
319b such that the two electrodes 319b, 330 effectively operate as
a unitary electrode. The electrode 330 forms part of a tissue
contacting surface of the lower jaw 316b such that, upon grasping
tissue by the jaws 316a, 316b and application of energy thereto in
the bipolar mode of operation, the electrode 330 is part of the
electrical path of the electrode 319b. The bipolar electrode 319b
has a flat tissue contacting surface that corresponds to and
extends opposite from the flat extension 330 in the lower jaw 316b.
The distal hook 330t can be received into a notch 317 formed in the
electrode 319b on the lower jaw 316b, as illustrated in FIG. 5E,
such that the electrode 330 and the bipolar electrode 319b are
generally flush with one another to form an uninterrupted tissue
contacting and conductive surface on either side of the cutting
element translation path 318p. The electrode 330 and the electrode
319b are thus electrically engaged in the retracted position
through contact between the distal hook 330t and the notch 317. In
the retracted position, the electrode 330 is therefore received
entirely within the end effector 314. In the illustrated
embodiment, the conductive rod 340 forms part of the bipolar
electrical path of the bipolar electrodes 319a, 319b when the
electrode 330 is engaged with the electrode 319b. For example, it
acts as a primary source of energy to the end effector 314 by
supplying energy to the electrode 319b through its engagement with
the electrode 330. As such, the lower electrode 319b can thus act
as the active electrode when the device is in the bipolar mode of
operation, and the upper electrode 319a can act as the return
electrode in the bipolar mode. When the electrode 330 is in the
extended position in this embodiment, as discussed below, energy
cannot be applied to the electrodes 319a, 319b because the
conductive rod 340 is electrically isolated from the electrode
319b. However, in other embodiments, one or more other conductive
members can be used to deliver energy to the electrodes 319a, 319b
during bipolar tissue treatment such that various electrical
connections to the rod 340 can be decoupled during bipolar
treatment while still being able to apply energy to the end
effector 314. In the illustrated embodiment, the electrodes 319b,
330 are made of the same material, however in other embodiments,
different materials can be used.
[0085] When the conductive rod 340 is translated distally to move
the electrode 330 into the extended, monopolar mode position, the
electrode 330 is decoupled from electrical engagement with the
electrode 319b such that the electrode 330 becomes electrically
isolated from the bipolar electrical path. As such, the conductive
rod 340 and the planar member 344 are also electrically isolated
from the bipolar electrical path, and one or more of the conductive
rod 340, conductive cap 342, planar member 344, guide slots 350,
352, and/or channel 354 are thus electrically insulated to help
create electrical isolation in the extended position. As the
electrode 330 is distally translated, the hook 330t moves distally
out of the notch 317 and out of contact with the electrode 319b,
breaking the electrical path formed between the electrodes 319b,
330. Any energy applied to the electrode 330 in this configuration
is thus received in the monopolar mode of operation, bypassing the
bipolar electrical pathway in the end effector 314. The electrode
330 can therefore be advanced linearly without any rotation
thereof
[0086] Distal and proximal translation of the conductive rod 340,
which causes translation of the electrode 330, can be controlled by
a variety of different mechanisms, similar to device 200. For
example, it can be controlled through pivotal movement of the
closure mechanism of the jaws 316a, 316b, through a separate
pivotal grip or lever on the housing, through a sliding mechanism
on the housing, through a knob positioned between the housing and
the shaft 312, through one or more buttons or switches on the
housing, etc.
[0087] Energy can be applied to the electrode 330 through a variety
of different mechanisms, similar to device 200. In the illustrated
embodiment, energy can be applied to the electrode 330 in the
monopolar mode similar to energy applied to electrodes 319a, 319b
in the bipolar mode. An energy actuator on the housing of the
device 300 can be depressed, actuating delivery of energy through
one or more conductive members from a generator and/or a power
source.
[0088] In use, the device 300 can be used similar to devices 100,
200 when grasping tissue between the jaws 316a, 316b, transecting
the grasped tissue, and applying energy thereto. The electrode 330
can initially be in the retracted position and engaged with the
bipolar electrode 319b in a bipolar mode. When spot application of
energy in the monopolar mode is desired, the electrode 330 can be
translated from the retracted position to the extended position, as
discussed above. As the electrode 330 extends distally, the
electrode 330 can break its electrical connection with the
electrode 319b such that the electrode 330 becomes electrically
isolated from the bipolar electrical path. Once the electrode 330
is extended, energy can then be applied in the monopolar mode to
target tissue by the tip 330t of the electrode 330 with the device
300. The electrode 330 can then be translated proximally to the
retracted position again, causing the electrode 330 to retract into
the end effector 314, reengage with the electrode 319b to form a
tissue contacting surface therewith on the lower jaw 316b, and
rejoin the bipolar electrical pathway. A user can then proceed with
using device 300 in the bipolar mode.
[0089] The elongate shafts 212, 312 of devices 200, 300 are
generally rigid shafts, however articulation of the elongate shaft
and/or the end effector is possible while still allowing for an
electrode to translate between a retracted position and an extended
position to deliver monopolar energy therefrom even during
articulation. FIGS. 6A-6G illustrate a surgical device 400 similar
to devices 100, 200, 300 that has an electrode 430 that is
translated between retracted and extended positions. The device 400
has an end effector 414, an elongate shaft 412, and a housing,
which can be in the form of a handle (not shown). The shaft 412
extends distally from the housing and has the end effector 414
disposed on a distal end thereof, and it has at least one lumen
extending therethrough for carrying mechanisms for actuating the
end effector 414. The end effector 414 has a first upper jaw 416a
and a second lower jaw 416b that is opposed thereto. The jaws 416a,
416b can grasp tissue therebetween, transect grasped tissue with a
cutting element, and apply bipolar energy to grasped tissue through
active and return electrodes 419a, 419b in the jaws 416a, 416b. In
an embodiment in which the the housing is a handle, the handle
includes a pivotal closure grip (not shown) that is pivoted to open
and close upper and lower jaws 416a, 416b and one or more actuators
(not shown) to cause transection of tissue grasped by the jaws
416a, 416b and delivery of energy to the end effector 414. Various
gear(s), rack(s), drive screw(s), drive nut(s), motor(s),
processor(s), conducting member(s), etc. can be disposed within the
housing and/or the shaft 412 to translate actuation of the closure
grip and various actuator(s) into actuation of functions on the end
effector 414.
[0090] Furthermore, the shaft 412 is articulatable, using either
manually actuated or powered mechanisms. An articulation joint 440
is disposed along the shaft 412 distal to the handle and proximal
to the end effector 414 such that articulation of the end effector
414 relative to a longitudinal axis A2 of the shaft 414 proximal to
the articulation joint 440 is possible. Thus, a longitudinal axis
A3 of the end effector 414 can initially be coaxial with the
longitudinal axis A2, and it can then intersect the longitudinal
axis A2 at a non-zero angle during articulation. Articulation about
joint 440 can be achieved in a variety of ways, such as through use
of one or more articulation cables that extend along the shaft 412
and that can be linearly translated, axially rotated, etc., similar
to the mechanisms discussed in U.S. Patent Pub. No. 2018/0271553,
entitled "Surgical Instrument With Articulating And Rotating End
Effector And Flexible Coaxial Drive," filed on Mar. 24, 2017 and
incorporated by reference herein in its entirety.
[0091] The electrode 430 extends longitudinally through at least a
portion of the end effector 414 and the articulation joint 440 of
the shaft 412. The electrode 430 is longitudinally translatable
distally and proximally with respect to the end effector 414, and
at least a portion of the electrode 430 is articulatable such that
the electrode 430 can articulate with the joint 450 while still
being longitudinally translatable with respect to the end effector
414. The electrode 430 can translate between a retracted position
in which a majority of the electrode 430 is retracted within the
end effector 414 and the shaft 412, as illustrated in FIGS. 6A-6D,
and an extended position in which at least a distal end 430d of the
electrode 430 protrudes distally beyond a distal end 414d of the
end effector 414, as illustrated in FIGS. 6E-6G. In the retracted
position, the electrode 430 engages with the bipolar electrical
pathway of the end effector 414, similar to electrode 330. Upon
distal translation of the electrode 430, the electrode 430 can act
in the monopolar mode by electrically decoupling from engagement
with a bipolar pathway, as discussed below and again as similar to
electrode 330. Thus, upon distal translation of the electrode 430
and actuation of energy, the electrode 430 can be used to spot
seal, coagulate, mark, cut, etc. tissue disposed adjacent to the
distal end 414d of the end effector 414.
[0092] The electrode 430 has a general L shape with an elongate
active rod 430s and a hook or bent tip 430t on a distal end thereof
that extends at an approximately right angle thereto. The active
rod 430s extends proximally through a longitudinal electrode
channel 432 that extends through the second jaw 416b, and the
active rod 430s itself is conductive and extends proximally through
the articulation joint 440 and at least a portion of the shaft 412
to engage with one or more conductive members in the housing of the
surgical device 400 for receiving energy therefrom. The active rod
430s acts as a source of electrical energy for the end effector 414
generally, including for the bipolar electrodes 419a, 419b as
discussed below. At least a portion of the active rod 430s is
flexible such that at least the portion of the rod 430s extending
through the articulation joint 440 can articulate and flex with
articulation of the joint 440 while still being able to conduct
energy from the housing to the end effector 414. Furthermore,
distal and proximal translation of the active rod 430s, discussed
below, causes distal and proximal translation of the hook 430t and
moves the electrode 430 between the retracted and extended
positions. Thus, the rod 430s is sufficiently rigid to allow
translation thereof while being flexible enough to allow
translation even when the joint 440 has been articulated. The
illustrated electrode 430 has a unitary body, however in other
embodiments, one or more portions of the rod 430s and/or the hook
430t can be made from different materials and/or include different
segments to allow sufficient flexibility in the articulation joint
440 and sufficient rigidity and conductivity during use.
Additionally, the distal end 430d of the electrode 430 can have
different shapes in different embodiments, such as a straight
protruding tip.
[0093] The electrode 430 also can have a non-conductive protective
sleeve, similar to sleeve 234, that insulates a majority of the
active rod 430s as it passes through the device 400 and the shaft
412, while terminating proximal to the hook 430t. As such, the
electrode 430 can have an exposed, electrically-active distal
portion, and the sleeve can help protect various components within
the device 400 from inadvertent electrical exposure. As such, the
electrode channel 432 in the end effector 414 and the shaft 412
does not need to be electrically insulated. However, one or more
portions of the end effector 414, the shaft 412, and/or the housing
can be electrically insulated as desired to prevent energizing
unintended areas.
[0094] In the retracted position, the hook 430t can be received in
a distal tip notch 417 on a distal end of the second jaw 416b. As
illustrated in FIGS. 6C and 6D, at least a portion, such as the
distal end 430d of the electrode 230, can still be exposed to
surrounding tissue when received within the channel 432 and the
notch 417 such that surrounding tissue can be spot treated by the
electrode 430 even in the retracted position. This allows a user to
perform minor tissue modifications, such as limited spot
coagulation, without having to extend the electrode. However, a
majority of the electrode 430 is received into the end effector 414
and the shaft 412, and energy can be selectively terminated to the
electrode 430 so that no energy is delivered thereto. This can
avoid any accidental energy application during movement, treatment,
etc. In other embodiments, the electrode can be withdrawn entirely
into the end effector.
[0095] Furthermore, in the retracted position, the electrode 430
can be positioned in electrical engagement with the bipolar
electrical pathway of the end effector 414. Specifically, the
active rod 430s engages the lower electrode 419b, which is part of
the bipolar electrical path of the jaws 416a, 416b, as illustrated
in FIGS. 6C and 6D. Additionally, the active rod 430s is the
primary source of energy for the end effector 414 by conveying
energy from the housing and transmitting the energy to the lower
electrode 419b in the retracted position, as represented by arrows
in FIG. 6D. Energy is thus transmitted from the lower electrode
419b, through any tissue grasped by the end effector 414, and into
the upper electrode 419a, which serves as a return electrode for
the bipolar electrical pathway. Energy can then return proximally
through the shaft 412, such as through one or more conductive
members separate from the active rod 430s. Engagement between the
active rod 430s and the lower electrode 419b can be created through
a leaf spring 450 that is coupled to and protrudes from the active
rod 430s. The active rod 430s extends through the channel 432 in
the lower jaw 416b below the electrode 419b, and a proximal portion
of the channel 432 has an open upper surface in communication with
a lower surface of the electrode 419b. The leaf spring 450 extends
through the open upper surface of the channel 432 along the
proximal portion thereof and into slidable engagement with the
lower surface of the electrode 419b when the electrode 430 is in
the retracted position. Thus, energy applied to the active rod 430s
can pass through the leaf spring 450 and into the electrode 419b to
create the active electrode of the bipolar electrical pathway of
the jaws 416a, 416b. As illustrated in FIG. 6D, energy can also
pass through the entirety of the electrode 430, thus allowing for
spot treatment of tissue using the distal end 430d of the electrode
430 (preferably when tissue is not grasped by the end effector
414). In the illustrated embodiment, the distal end 430d of the
electrode 430 is thus always active when energy is being applied to
the electrodes 419a, 419b, such as to grasped tissue. However,
application of energy to the end effector 414 can be restricted
entirely to prevent any accidental tissue contact with the active
distal end 430d of the electrode 430, such as during movement of
the end effector 414.
[0096] As the electrode 430 is translated distally into the
extended position, the leaf spring 450 slides distally along the
lower surface of the electrode 419b until it reaches a distal
portion of the channel 432 with an insulating layer 452 formed
along at least an upper surface thereof. The distal portion of the
channel 432 thus does not communicate directly with the bipolar
electrode 419b, unlike the proximal portion of the channel 432, and
is instead electrically isolated therefrom. As the leaf spring 450
contacts the upper insulating layer 452, the spring 450 is
compressed entirely into the distal portion of the channel 432 and
out of contact with the bipolar electrode 419b, as illustrated in
FIGS. 6F and 6G. Because the upper insulating layer 452 acts as an
electrically isolating layer between the leaf spring 450 and the
electrode 419b, energy applied to the active rod 430s from the
handle is not conducted to the electrode 419b when the leaf spring
450 is in the distal portion of the channel 432. Energy is
consequently only conducted along the electrode 430 itself, as
illustrated by arrows in FIG. 6G. Thus, distal translation of the
electrode 430 prevents energy from being applied to the bipolar
electrodes 419a, 419b while still allowing energy to be applied
through the electrode 430 in the monopolar mode. In such a
monopolar mode, the hook 430t of the electrode 430 protrudes
distally from the end effector 414, and energy transmitted to the
active rod 430s can be applied to tissue adjacent to the hook 430t
of the electrode 430 while bypassing the electrodes 419a, 419b
entirely. Subsequent proximal translation of the active rod 430s
can reform the engagement between the leaf spring 450 and the
bipolar electrode 419b to return to the bipolar mode. Thus, the
active rod 430s can deliver energy across the articulation joint
440 in both monopolar and bipolar modes, articulate with the joint
440, and translate the electrode 430 distally and proximally while
limiting the need for additional components to be passed through
the articulation joint 440.
[0097] Distal and proximal translation of the active rod 430s,
which causes translation of the electrode 430, can be controlled by
a variety of different mechanisms, similar to devices 200, 300. For
example, it can be controlled through pivotal movement of the
closure mechanism of the jaws 416a, 416b, through a separate
pivotal grip or lever on the housing, through a sliding mechanism
on the housing, through a knob positioned between the housing and
the shaft 412, through one or more buttons or switches on the
handle, etc.
[0098] Energy can be applied to the electrode 430 through a variety
of different mechanisms, as well, similar to devices 200, 300. In
the illustrated embodiment, energy can be applied to the electrode
430 in the monopolar mode similar to applying energy to electrodes
419a, 419b in the bipolar mode through the active rod 430s. An
energy actuator on the housing of the device 400 can be depressed,
actuating delivery of energy through one or more conductive members
from a generator and/or a power source to the active rod 430s.
[0099] The device 400 can be used in a manner similar to devices
100, 200, 300 when grasping tissue between the jaws 416a, 416b,
transecting the grasped tissue, and applying energy thereto. The
electrode 430 can be initially in the retracted position and
maintain an electrical connection with the bipolar electrode 419b
to provide energy thereto in a bipolar mode. The end effector 414
with the electrode 430 can be selectively articulated about the
joint 440 on the shaft 412. Minor spot applications of monopolar
energy can be conducted by the distal end 430d of the electrode 430
without extending it from the end effector 414. However, when more
substantive spot applications of energy are desired, the electrode
430 can be translated from the retracted position to the extended
position, as discussed above. As the electrode 430 extends
distally, the electrode 430 can break its electrical connection
with the bipolar electrode 419b such that the electrode 430 is
electrically isolated from the bipolar electrical path. Once the
electrode 430 is extended distally, monopolar energy can then be
applied to target tissue by the tip 430t of the electrode 430 with
the device 400 in the monopolar mode. The electrode 430 can then be
translated proximally to the retracted position again, causing the
electrode 430 to retract into the end effector 414, reengage its
electrical connection with the bipolar electrode 419b, and allow
energy to be applied to the bipolar electrical pathway again. A
user can then proceed with using device 400 in the bipolar
mode.
[0100] In other embodiments, a variety of different components in
the end effector can be used to extend and retract a monopolar
electrode and deliver energy thereto, limiting the need for
additional components to be added thereto. FIGS. 7A-7J illustrate a
surgical device 500 similar to surgical devices 100, 200, 300, 400.
While it has a monopolar electrode 530 that is translated between
retracted and extended positions, the electrode 530 is translated
by and supplied with energy through a cutting element 518 thereof.
The device 500 has an end effector 514, an elongate shaft 512, and
a housing that can be in the form of a handle (not shown). The
shaft 512 extends distally from the housing and has the end
effector 514 disposed on a distal end thereof, and it has at least
one lumen extending therethrough for carrying mechanisms for
actuating the end effector 514. The end effector 514 has a first
upper jaw 516a and a second lower jaw 516b that is opposed thereto.
The jaws 516a, 516b can grasp tissue therebetween, transect grasped
tissue with the cutting element 518, and apply energy in a bipolar
mode to grasped tissue through active and return electrodes 519a,
519b in the jaws 516a, 516b. The housing includes a pivotal closure
grip (not shown) that is pivoted to open and close upper and lower
jaws 516a, 516b and one or more actuators (not shown) to cause
transection of tissue grasped by the jaws 516a, 516b and delivery
of energy to the end effector 514. Various gear(s), rack(s), drive
screw(s), drive nut(s), motor(s), processor(s), conducting
member(s), etc. can be disposed within the handle and/or the shaft
512 to translate actuation of the closure grip and various
actuator(s) into actuation of functions on the end effector
514.
[0101] The cutting element 518 translates distally and proximally
along a cutting channel 524 that extends along a central
longitudinal axis A4 of the end effector 514 and into both the
upper and lower jaws 516a, 516b through the electrodes 519a, 519b.
When transecting and sealing tissue, the cutting element 518
transects tissue through a full cutting stroke by moving from a
proximal end to a distal end of the cutting channel 524, and the
electrodes 519a, 519b apply energy in the bipolar mode to grasped
tissue on either side of the cutting channel 524 to seal tissue
that is transected by the cutting element 518. The cutting element
518 has a distal cutting head or tip 520 and a proximal cutting
shaft 522. The cutting head 520 is a rectangular member with a
distal cutting surface 520d and a proximal engagement surface 520p.
The cutting surface 520d extends between the upper and lower jaws
516a, 516b in the cutting channel 524 to transect tissue as it
moves distally therethrough, and the proximal engagement surface
520p extends into the cutting channel 524 on the lower jaw 516b.
The cutting element 518 also has a proximal cutting shaft 522 that
extends proximally from the cutting head 520 into the shaft 512. As
such, the cutting head 520 translates distally and proximally
through the cutting channel 524 due to distal and proximal
translation of the cutting shaft 522.
[0102] Additionally, the monopolar electrode 530 extends
longitudinally through at least a portion of the end effector 514
and is longitudinally translatable distally and proximally with
respect thereto. The electrode 530 can translate between a
retracted position in which a majority of the electrode 530 is
retracted within the end effector 514, as illustrated in FIGS.
7A-7C and 7J, and an extended position in which at least a distal
end 530d of the electrode 530 protrudes distally beyond a distal
end 514d of the end effector 514, as illustrated in FIG. 7F-7I.
Upon distal translation of the electrode 530 and actuation of
energy, as discussed below, the electrode 530 can be used to spot
seal, coagulate, mark, cut, etc. tissue disposed adjacent to the
distal end 514d of the end effector 514.
[0103] The electrode 530 has a general J or L shape with an
elongate rod 530s and a hook or bent tip 530t on a distal end
thereof that extends toward the upper jaw 516a. The rod 530s
extends between a contact post 531a and a return post 531b through
a longitudinal electrode groove 532 that extends along a bottom
surface of the second jaw 516b beneath and parallel to the cutting
channel 524. The contact and return posts 531a, 531b extend from
the rod 530s toward the upper jaw 516a into the cutting channel 524
in the lower jaw 516b.
[0104] The electrode 530 also has a non-conductive protective
sleeve 534 that insulates a majority of the electrode rod 530s as
it passes through the groove 532 in the lower jaw 516b and the
return post 531b and terminating proximal to the hook 530t and the
contact post 531a. As such, the electrode 530 has an exposed,
electrically-active distal portion, including the contact post
531a, while the sleeve 534 can help protect various components
within the end effector 514 and any secondary tissue from
inadvertent electrical exposure.
[0105] When the electrode 530 is in the retracted position and the
device 500 is operating in a bipolar mode, the hook 530t of the
electrode 530 can be received in a distal tip notch 517 on a distal
end of the second jaw 516b. At least a portion of the electrode
530, such as a corner 530c, can still be exposed to surrounding
tissue when the hook 530t is received in the groove 532 and the
notch 517 such that surrounding tissue can be spot treated by the
electrode 530 even in the retracted position and can receive energy
from the cutting element 518 for such spot treatment, as described
below.
[0106] Also while in the retracted position, the contact post 531a
extends into the cutting channel 524 proximal to a distal terminal
end thereof, and the return post 531b extends into the cutting
channel 524 at a proximal terminal end. The contact and return
posts 531a, 531b are positioned in the cutting channel 524 at
distal and proximal ends of a full cutting stroke of the cutting
element 518 during a bipolar operation when the electrode 530 is
retracted. The proximal engagement surface 520p of the cutting head
520 contacts the return post 531b in an initial cutting position
before extending through the cutting channel 524 to transect
tissue, as illustrated in FIG. 7A. At the end of a full cutting
stroke as illustrated in FIG. 7C, the distal cutting surface 520d
contacts the contact post 531a after passing distally through the
cutting channel 524 and cutting tissue grasped between the two jaws
516a, 516b. Additionally, spot treatment of tissue with energy in
the monopolar mode is possible through the exposed corner portion
530c of the electrode when the cutting element 518 is in such a
distally engaged position, as illustrated in FIG. 7C. Energy can be
applied to the cutting element 518, which is a conductive member.
Because the cutting element 518 is in contact with the contact post
531a, which is also a conductive member, energy is thus conducted
through the cutting element 518 and into the exposed corner 530c of
the electrode 530 through the contact post 531a. Minor monopolar
treatment can thus be performed without extending the electrode
530. A spring-biased knife stop 526 is positioned on an upper
surface of the shaft 512 at a distal end thereof where the shaft
512 and the end effector 514 operably engage. The knife stop 526
obstructs distal translation of the cutting element 518 at the end
of a full cutting stroke by engaging a protrusion 522a on the
cutting shaft 522 of the cutting element 518. The protrusion 522a
is positioned proximally to the knife stop 526 along the cutting
shaft 522 in the elongate shaft 512 of the device 500 when the
cutting element 518 is in the initial, pre-cutting stroke position
in FIG. 7A. The protrusion 522a is positioned at a proximal
distance from the knife stop 526 such that, as the cutting element
518 translates distally during a cutting stroke, the protrusion
522a encounters and is distally obstructed by the knife stop 526 at
the end of the cutting stroke when the distal cutting surface 520d
contacts the contact post 531a, as illustrated in FIGS. 7C and 7D.
The knife stop 526 is rotationally positioned on the shaft 512 such
that clockwise and counterclockwise rotation of the knife stop 526
about the axis A4 is possible to allow the cutting element 518 to
proceed past a full cutting stroke, as discussed below. However,
the knife stop 526 is spring biased to remain in an obstructive
position with the cutting element 518 such that, without external
force being applied thereto, the knife stop 526 prevents the
cutting element 518 from extending further distally at the end of a
complete cutting stroke.
[0107] To extend the electrode 530 distally for use in spot
treatment and to transition the device 500 to a monopolar mode, the
cutting element 518 is first actuated to extend it to a full
cutting stroke, as discussed above and illustrated in FIG. 7C. When
the protrusion 522a of the cutting element 518 contacts the knife
stop 526, the knife stop 526 can be rotated clockwise or
counterclockwise out of obstructive engagement with the protrusion
522a, as illustrated by arrows in FIG. 7E. Rotation of the knife
stop 526 can be achieved through a variety of mechanisms, such as a
thumb switch on the housing or a rotational knob on the shaft 512.
When the knife stop 526 is rotated out of engagement, the cutting
element 518 can be extended distally past a full cutting stroke. As
such, the distal cutting surface 520d contacts the contact post
531a and translates the contact post 531a distally by applying a
linear distal force thereto, which distally translates the entire
electrode 530 into the extended position, as illustrated by an
arrow in FIG. 7F. The cutting surface 520d contacts and is
obstructed by the distal terminal end of the cutting channel 524
when the electrode 530 is fully distally translated, and the
cutting element is held in a distal-most engagement position with
the contact post 531a during monopolar treatment. The return post
531b is translated distally away from a proximal terminal end of
the cutting channel 524 with overall distal translation of the
electrode 530, as illustrated in FIG. 7F. Energy is then applied to
the cutting element 518, which is in contact with the contact post
531a. As illustrated by an arrow in FIG. 7G, energy is thus
conducted through the cutting element 518 and into the electrode
530 through the contact post 531a. Monopolar treatment can then be
performed on tissue adjacent to the hook 530t. To apply energy to
the electrode 530 either in the extended position or in the
retracted position for minor spot treatment, the cutting element
518 is thus extended distally through the jaws 516a, 516b and into
contact with the contact post 531a, which can occur when the jaws
516a, 516b are in the closed position.
[0108] To retract the electrode 530 and return the device 500 to
the bipolar mode, the cutting element 518 is retracted proximally,
as illustrated in FIG. 71. As the protrusion 522a translates
proximally past the knife stop 526, the knife stop 526 rotates back
into obstructive engagement with the cutting element 518 to prevent
subsequent distal translation of the electrode 530 by the cutting
element 518 without a new rotational force being applied thereto.
As the cutting element 518 translates proximally, the proximal
engagement surface 520p of the cutting head 520 contacts the return
post 531b in its distal, extended position in the cutting channel
524. The proximal engagement surface 520p translates the return
post 531b proximally to the proximal terminal end of the cutting
channel 524 as the cutting element 518 returns to its initial,
pre-cutting stroke proximal position. As the return post 531b is
translated proximally, it in turn translates the entire electrode
530 proximally to the retracted position, as illustrated in FIG.
7J. In another embodiment, the cutting element 518 can be used to
extend the electrode 530 as described above, however the electrode
530 can be returned to the retracted position through one or more
mechanisms, such as magnets in the lower jaw 516b, spring biasing,
etc. Thus, distal translation of the monopolar electrode 530 and
application of energy thereto can be accomplished through use of
the cutting element 518 without having to add a plurality of
additional components to the device 500.
[0109] Distal and proximal translation of the cutting element 518
can be controlled by a variety of different mechanisms, similar to
devices 200, 300, 400. A cutting actuator on the housing can be
used to cause transection of tissue grasped in the jaws 516a, 516b
in the bipolar mode, and it can also be used to cause distal
extension of the cutting element 518 when transitioning to the
monopolar mode, such as having a first range of actuation motion
for tissue transection and a second range of actuation motion for
continued distal translation into the monopolar mode. However, a
variety of other mechanisms are possible, such as through a
separate pivotal grip, lever, or trigger on the housing, through a
sliding mechanism on the housing, through a knob on the housing or
the shaft 412, through one or more buttons or switches on the
handle, etc.
[0110] Energy can be applied to the electrode 530 through the
cutting element 518 by a variety of different mechanisms, similar
to devices 200, 300, 400. For example, energy can be applied to the
cutting element 518 in the monopolar mode similar to energy being
applied to electrodes 519a, 519b in the bipolar mode, such as
through the same conductive members. However, in other embodiments,
one or more separate conductive members can be present in the
housing and/or the shaft 512, some combination of the two can be
used, etc. In some embodiments, energy can be prevented from being
applied to the electrodes 519a, 519b when the electrode 530 is
extended. However, in other embodiments, energy can be applied to
the electrodes 519a, 519b even when the electrode 530 is extended
because the jaws 516a, 516b are in the closed position and thus any
energy applied to the electrodes 519a, 519b can be limited to the
end effector 514 and/or other components of the device 500 rather
than interfering with monopolar treatment. Actual actuation of
energy to the cutting element 518 can also be triggered in a
variety of ways, similar to the mechanisms discussed above. For
example, an energy actuator on the handle of the device 500 can be
depressed, actuating delivery of energy through one or more
conductive members from a generator and/or a power source to the
cutting element 518.
[0111] The device 500 can be used in a manner similar to devices
100, 200, 300, 400 when grasping tissue between the jaws 516a,
516b, transecting the grasped tissue, and applying energy thereto.
The electrode 530 can initially be in the retracted position, and
minor spot treatment of tissue can be performed by actuating the
cutting element 518 through a full cutting stroke and applying
energy thereto while the cutting element 518 is positioned distally
into contact with the contact post 534a of the electrode 530. When
a more complete spot application of energy is desired, the
electrode 530 can be translated from the retracted position to the
extended position by rotating the knife stop 526 out of obstructive
engagement with the cutting element 518 and advancing the cutting
element 518 distally to contact and force the contact post of the
electrode 530 distally. Once the electrode 530 is fully extended
and the device 500 is in monopolar mode, energy can be applied to
target tissue by the hook 530t of the electrode 530 by applying
energy to the cutting element 518, which conducts the energy
through the contact post 534a and into the electrode 530. The
electrode 330 can then be translated proximally to the retracted
position again by retracting the cutting element 518, which engages
the return post 534b on the electrode 530 and translates
proximally. A user can then proceed with using the device 500 in
the bipolar mode.
[0112] Furthermore, while hook 530t is in the form of a rod
extending toward the upper jaw 516a, the distal end of the
electrode is not limited thereto. For example, FIGS. 8 and 9
illustrate additional embodiments of distal ends of monopolar
electrodes on end effectors. FIG. 8 illustrates a distal end 630d
of an electrode 630, similar to electrode 530, that extends through
a lower jaw 616b, similar to lower jaw 516b. The distal end 630d is
in the form of a hook or tip that extends perpendicular to an
elongate rod of the electrode 630 and parallel to a plane passing
through a tissue contacting surface of the lower jaw 616b,
resembling a horizontal L. FIG. 9 illustrates a distal end 730d of
an electrode 730, similar to electrode 530, that extends through a
lower jaw 716b, similar to lower jaw 516b. The distal end 730d is
in the form of a proximally-curved T with curved arms that extend
in a plane parallel to a plane passing through a tissue contacting
surface of the lower jaw 716b.
[0113] While the electrode 530 is distally extendable, in some
embodiments a monopolar electrode can be fixed in a retracted
position such that use of the electrode is limited to minor spot
treatment by the exposed portion thereof. FIGS. 10A and 10B
illustrate a device 800, similar to device 500, that has an end
effector 814, an elongate shaft 812, and a handle (not shown). The
end effector 814 has a first upper jaw 816a and a second lower jaw
816b with electrodes disposed therein. Similar to end effector 514,
the end effector 814 has a cutting element 818 with a distal
cutting head 820 and a proximal cutting shaft 822. The cutting head
820 can translate distally and proximally in a cutting channel 824
through the end effector 814, and the proximal cutting shaft 822 is
obstructed by a knife stop 826 at a completion of a full cutting
stroke.
[0114] Furthermore, an electrode 830, similar to electrode 530,
extends through the lower jaw 816a and has an electrode rod 830s
and a hook or bent tip 830t on a distal end thereof that extends
toward the upper jaw 816a. The hook 830t is exposed to surrounding
tissue during bipolar operation of the device 800 such that
surrounding tissue can be spot treated by the electrode 830 without
distally extending the electrode 830. The rod 830s extends
proximally from a contact post 831a that extends at approximately n
right angle from the rod 830s toward the upper jaw 816a into the
cutting channel 824. The contact post 531a is positioned in the
cutting channel 824 at a distal end of a full cutting stroke of the
cutting element 818. The electrode 830 does not have a return post,
unlike electrode 530, because the electrode 830 is not translated.
A non-conductive protective sleeve 834 insulates a majority of the
electrode rod 830s as it passes through the lower jaw 816b, while
the hook 830t and the contact post 831a remain uninsulated and
exposed.
[0115] Thus, at the end of a full cutting stroke, the cutting head
820 contacts the contact post 831a after passing distally through
the cutting channel 824 and cutting tissue grasped between the two
jaws 816a, 816b, as illustrated in FIG. 10A. Minimal spot treatment
of tissue with monopolar energy can then be performed by the hook
830t when the cutting element 818 is in this fully extended distal
position. As such, energy can be applied to the cutting element
818, which then conducts the energy through the contact post 831a
and into the exposed portion of the hook 830t, as indicated by an
arrow in FIG. 10A. The electrode 830 is not configured to be
extended distally such that, after application of monopolar energy
to tissue adjacent to the exposed portion of the hook 830t, the
cutting element 818 can be retracted proximally and the device 800
can continue to be operated in a bipolar mode.
[0116] Additionally, while a comparatively small portion of the
electrode 830 is exposed in its fixed, retracted position of the
device 800, a larger portion of a monopolar electrode can be
exposed in a retracted position in other embodiments, such as for
use during liver procedures. FIGS. 11A and 11B illustrate a device
900, similar to device 800, that has an end effector 914, an
elongate shaft 912, and a handle (not shown). The end effector 914
has a first upper jaw 916a and a second lower jaw 916b with
electrodes disposed therein. Similar to end effector 914, the end
effector 914 has a cutting element 918 with a distal cutting head
920 and a proximal cutting shaft 922 extending proximally therefrom
that is obstructed by a knife stop 926 at completion of a full
cutting stroke in the end effector 914.
[0117] The end effector 914 also has an electrode 930, similar to
electrode 830, that extends through the lower jaw 916a. The
electrode 930 has an electrode rod 930s and a hook or bent tip 930t
on a distal end thereof, and the rod 930s extends proximally from a
contact post 931a. The contact post 931a extends at approximately a
right angle from the rod 930s toward the upper jaw 916a into the
cutting channel 924. It is positioned in the cutting channel 924 at
a distal end of a full cutting stroke of the cutting element 918,
similar to device 800. As such, the distal cutting head 920
contacts the contact post 931a at the end of the stroke. Energy can
thus be applied to the electrode 930 through the cutting element
918 and the contact post 931a, similar to the electrode 830 and as
indicated by an arrow in FIG. 11A. However, a non-conductive
protective sleeve 934 insulates the distal tip 930t and distal and
proximal portions 934d, 934p of the electrode rod 930s as it passes
through the lower jaw 816b, while a middle portion 934m of the
electrode rod 930s and the contact post 831a remain uninsulated and
the middle portion 934m remains exposed to surrounding tissue, as
illustrated in FIGS. 11A and 11B. As such, when energy is applied
to the electrode 930, monopolar treatment of tissue occurs to
tissue positioned adjacent to a bottom external surface of the
lower jaw 916b where the electrode rod 930s remains exposed to
tissue rather than at the hook 930t. Such a configuration allows
for coagulation and treatment of a larger tissue surface than
treatment through a distal end of the end effector 914 would allow.
However, in other embodiments, a monopolar electrode can be
provided that has both an exposed middle portion of an electrode
rod and an exposed distal end or hook thereof
[0118] The various housings and/or handles of the devices discussed
above can each be incorporated into one or more robotic surgical
systems such that robotic surgical control is possible for each of
the end effectors discussed herein. All of the devices disclosed
herein can be designed to be disposed of after a single use, or
they can be designed to be used multiple times. In either case,
however, the devices can be reconditioned for reuse after at least
one use. Reconditioning can include any combination of the steps of
disassembly of the devices, followed by cleaning or replacement of
particular pieces, and subsequent reassembly. In particular, the
devices can be disassembled, and any number of the particular
pieces or parts of the device can be selectively replaced or
removed in any combination. Upon cleaning and/or replacement of
particular parts, the devices can be reassembled for subsequent use
either at a reconditioning facility, or by a surgical team
immediately prior to a surgical procedure. Those skilled in the art
will appreciate that reconditioning of a device can utilize a
variety of techniques for disassembly, cleaning/replacement, and
reassembly. Use of such techniques, and the resulting reconditioned
device, are all within the scope of the present application.
[0119] It is preferred that devices disclosed herein be sterilized
before use. This can be done by any number of ways known to those
skilled in the art including beta or gamma radiation, ethylene
oxide, steam, and a liquid bath (e.g., cold soak). An exemplary
embodiment of sterilizing a device including internal circuitry is
described in more detail in U.S. Pat. Pub. No. 2009/0202387 filed
Feb. 8, 2008 and entitled "System And Method Of Sterilizing An
Implantable Medical Device." It is preferred that device, if
implanted, is hermetically sealed. This can be done by any number
of ways known to those skilled in the art.
[0120] Further, in the present disclosure, like-named components of
the embodiments generally have similar features, and thus within a
particular embodiment each feature of each like-named component is
not necessarily fully elaborated upon. Additionally, to the extent
that linear or circular dimensions are used in the description of
the disclosed systems, devices, and methods, such dimensions are
not intended to limit the types of shapes that can be used in
conjunction with such systems, devices, and methods. A person
skilled in the art will recognize that an equivalent to such linear
and circular dimensions can easily be determined for any geometric
shape. Sizes and shapes of the systems and devices, and the
components thereof, can depend at least on the anatomy of the
subject in which the systems and devices will be used, the size and
shape of components with which the systems and devices will be
used, and the methods and procedures in which the systems and
devices will be used.
[0121] One skilled in the art will appreciate further features and
advantages of the described devices and methods based on the
above-described embodiments. Accordingly, the present disclosure is
not to be limited by what has been particularly shown and
described, except as indicated by the appended claims. All
publications and references cited herein are expressly incorporated
herein by reference in their entirety.
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