CA2194987A1 - Laser-assisted electrosurgery system - Google Patents
Laser-assisted electrosurgery systemInfo
- Publication number
- CA2194987A1 CA2194987A1 CA002194987A CA2194987A CA2194987A1 CA 2194987 A1 CA2194987 A1 CA 2194987A1 CA 002194987 A CA002194987 A CA 002194987A CA 2194987 A CA2194987 A CA 2194987A CA 2194987 A1 CA2194987 A1 CA 2194987A1
- Authority
- CA
- Canada
- Prior art keywords
- laser
- electrosurgical
- laser radiation
- energy
- distal end
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1402—Probes for open surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
- A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00452—Skin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00452—Skin
- A61B2018/00458—Deeper parts of the skin, e.g. treatment of vascular disorders or port wine stains
- A61B2018/00464—Subcutaneous fat, e.g. liposuction, lipolysis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1213—Generators therefor creating an arc
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Physics & Mathematics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Molecular Biology (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Otolaryngology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Plasma & Fusion (AREA)
- Optics & Photonics (AREA)
- Electromagnetism (AREA)
- Laser Surgery Devices (AREA)
Abstract
A laser and electrosurgical system (10) has a handpiece (12) with a proximal and distal end (13) and (14) from which laser radiation (17) and/or electrosurgical energy (18) is selectively or concurrently directed. The ends are along an axis; an electrode extends distally along the axis. Sources of laser and electrosurgical energy (18) are available and controlled. An initiation circuit (25) for the laser selectively delivers it before electrosurgery. Prior delivery to target tissue, the laser creates an ionized conductive pathway for electrosurgery. The combined concurrent application of laser and electrosurgery has a mechanism (27) to selectively distribute energy about the axis. A laser deflecting surface (28) or a beam deflector vibrate relative to the axis. A power switch (30) has levels for laser cut and ionization and/or a delay therebetween for electrosurgical coagulation. A wave guide (34) or an array thereof deliver radiation along the axis. A method has steps of directing selectively and concurrently laser and electrosurgery by aiming the axis, controlling laser and electrosurgical energy (18), delivering laser before electrosurgery, forming an ionized conductive pathway for the electrosurgery, distributing the laser about the axis in a predetermined pattern by deflecting the laser in a predetermined pattern generally along but slightly displaced from the axis to direct electrosurgical energy (18) in a predefined pattern on the patient's (11) target tissue. In another possible approach, there are additional steps of delivering the laser radition (17) as a beam and varying an ionized conductive pathway by refracting or diffracting the laser radiation (17) beam with the mechanism (27) having a beam pattern deflector.
Description
W096/04858 21 94 9 87 r~ r~
LASER-ASSISTED ELECTROSURGERY SYSTEM
1. Field of the Invention This invention relates to electrosurgery combined with laser radiation in a single surgical instnument, and more particularly the selective 5 and/or concurrent delivery from a surgical handpiece of laser energy and electrosurgery with superior benefits to those available separately.
LASER-ASSISTED ELECTROSURGERY SYSTEM
1. Field of the Invention This invention relates to electrosurgery combined with laser radiation in a single surgical instnument, and more particularly the selective 5 and/or concurrent delivery from a surgical handpiece of laser energy and electrosurgery with superior benefits to those available separately.
2. Background of the Disclosure Electrosurgery involves the application of radio frequency energy to achieve a tissue effect. The electrosurgical energy is generated by an electrosurgical generator which is applied to the tissue either by 10 monopolar or bipolar circuits. In monopolar, there is a small active electrode directed toward the tissue to be treated and to complete the circuit there is a large patient return electrode applied sv", ',~ to the patient's body. The power density through the patient return electrode is relatively small so that there is no tissue effect thereat. In bipolar, a pair of electrodes are spaced close together with tissue II,~,.L .,. In 15 certain circumstances the bipolar electrodes are moveable toward and away from one another.
Electrosurgery can be used for cutting, coagulating or a colllLJi,,aliv,, thereof called blend. Co~g~ ' n is often described as ~ ' : n of the tissue and fulguration of the tissue. Fulguration is the electrical arcing from the active electrode 20 toward various locations, on the patient's tissue, in the vicinity of the active electrode.
Typically when the arcs travel through air, they reach the tissue in a random, non-p,t.lk~ ,le manner. In many cases arcs leave the active electrode in a trajectory emanating generally along the axis of the active electrode, but b jefore they contact the tissue their paths may vary due to the impedance at the tissue near the active 25 electrode. The resulting fulguration is an uneven or randomly ~.vn~.. "t, ' or irregularly distributed delivery of the energy in each arc, thus producing an uneven or variable ~oPgl ' , of the tissue desiccated thereat. This is u"~ f~ ,, y from the point of view of producing a controlled and preferred level of eschar.
Ionized gases have been used to direct the electrosurgical energy in a more 30 controlled manner. U.S. Patent 4,781,175 deals particularly with that approach. A
diaacl~/~ Ikl! ~e of using ionized gas is the possibility of formation of embolisms within the blood of the patient being treated. In addition, there is the potential for the gas being ~ ~"i~di,~ d and fomming a plasma torch either through a leak in the electrosurgical W0 96/048s8 2 1 9 4 9 8 7 P~ ............................. 2~ ' handpiece or pencil or when delivered in a lc~,u...u~ OIJ;C procedure within the trocar which provides entry into the body cavity. Another problem with ionized gas is that the electrosurgery and the gas flow are essentially concurrent in the fonm of a plasma flame that is used to fulgurate and desiccate tissue at which it is aimed. The aiming or 5 positioning of the plasma flame on the desired target tissue is uncertain until activated.
Therefore, the pinpointing of the spot at which to initiate the eff~ct is not readily .It,l~:,,,,;,,aLIle until the electrosurgical energy is delivered.
U.S. Patent 5,011,483 discloses a device which is in the form of a handpiece housing from which electrosurgical and laser energy may be delivered . " _'y for10 selective use thereof. In connection with laycll ual,Opki procedures, an elongate hollow shaft is disclosed for a wave guide to conduct the laser energy. The wave guide may be flexible and one preferred form is a fiber optic. The disclosure of the reference is largely limited to the alternate use of laser or electrosurgery. There is no discussion or disclosure of concurrent delivery.
Japanese patent JP57-69853 relates to a laser device which radiates a laser beam to mark the position for subsequent application of laser surgery. No electrosurgery is disclosed and the use of a laser with electrosurgery even for pinpointing is not taught. Japanese patent JP57-69790 has a laser radiation apparatus wlth a laser oscillator including a light guide and a generator for radiating visible light 20 for positioning. These Japanese patents are used to direct the laser Qnergy and do not teach the concurrent use of laser energy and electrosurgery energy.
U.S. pntent 5,324,254 discloses a single Ic~ a~.O~ . instrument capable of supplying either laser radiation or electrosurgical energy. An electrosurgical electrode is provided at the distal end of the instrument for electrosurgical procedures. A side 25 port located near the proximate end of the instrument allows for the passage of a laser fiberoptic bundle, thereby allowing for laser surgery. The patent does not teach the concunrent use of laser energy and electrosurgical energy in a syncl,,u,,i~ed manner.
An article entitled How Lasers Miqht Control Uahtnina Strikes. appearing in Laser Focus ~vorld November 1993 pages 113 - 123 by Zhao Xin Miao and Daniels 30 Jean-Claude, discloses how lasers establish an ionized pathway for electric arc lloJI:~llli~ai~nl. Ordinary optical beams produce little ionkation in air or an essentially weak plasma which can be used to direct electrical discharges.
WO96104858 2 1 94987 1 "" 5 ~
'3-The application of any form of tmu ,pl lt ,i~, ionization to direct electrosurgical beams either statically or clJ"cl" 'Iy has not been disclosed in the prior l~,h, ,ùlùgy.
SUMMARY OF THE INVENTION
A laser and electrosurgical system allows a surgeon to provide cutbng, ~lA911' " 19, and/or a cc,r"bi" " ~ thereof on tissue of a paUent. The laser andelectrosurgical system preferably has a handpiece with a proximal end to be held _nd controlled by the surgeon. A distal end may be included on the handpiece from which laser radiation and/or electrosurgical energy may be selectively or concurrently directed 10 to the patient. The proximal and distal ends are most preferably along an axis. An electrosurgical electrode might extend from the distal end along the axis. A source energy for laser radiation most preferably is avaiiable at the proximal end and is controlled by the surgeon for delivery of laser radiation from the distal end toward the patient. A source of electrosurgical energy might also be available at the proximal end 15 and may be controlled by the surgeon for b~" lalll;s~iun of electrosurgical energy from the electrosurgical electrode toward the patient.
A retum path is provided for the electrosurgical energy. The return path is connected to receive at least a portion of the l,c." ""itb:d electrosurgical energy from the source of electrosurgical energy toward the patient. A retum input for the source 20 of electrosurgical energy is connected to the retum path for furnishing a complete circuit between the electrosurgical electrode, the patient, and the source of electrosurgical energy.
A control may be connected to the source energy for laser radiation and to the source of electrosurgical energy for the selective or concurrent application of laser 25 radiation and electrosurgical energy from the distal end.
The laser and electrosurgical system may have in the control an initiation circuit for the source energy for laser radiation, so laser radiation may be selectively delivered from the distal end slightly in advance of the delivery of the electrosurgical energy. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be 30 treated. The delivered laser radiation may also be used to create an ionized conductive pathway along which the electrosurgical energy will be guided.
The laser and electrosurgical system may be configured so the distal end and the electrosurgical electrode are preferably arranged ~eo."e,t,i~_l'y relative to the . , _, _ _, _,, _ _,, Wo961048~8 21 9 4 9 87 Ir~ r~l~
handpiece to provide laser radiation essentially alons the axis and from the distal end.
This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is formed by the laser radiation from the distal end to the patient substantially along the axis to direct the electrosurgical 5 energy.
The laser and electrosurgical system may provide a control which operates a Ille~,l.~lialll to selectively distribute, in a ple-let:~"i"ed pattem about the axis, the delivered laser radiation from the distal end.
The laser and electrosurgical system may include an ~ale~ ," ,c~".,'i~, radiation 10 deflecting surface arranged to vibrate relative to the axis. This preferably forms a pl edek~ ;ned pattem to achieve a varying ionlzed conductive pathway generally along but slightly displaced from the axis for thereby directing electrosurgical energy in the pl ~:delt~l l l lil led pattern to the patient.
The laser and electrosurgical system may be configured such that the laser 15 radiation is a beam ~nd the ",.~ lll includes a beam pattem deflector. The beam pattern deflector may be an acousto-optic modulator or ~, ~ l~el llel 1l of acousto-optic modulators to diffract, refract or reflect the beam.
The laser and electrosurgical system may include in the control for the source energy for laser radiation a power switch which may select between two levels of laser 20 r~diation energy delivery. The power switch may include a cutting laser radiation energy level and another level to provide for the ionized conductive pathway. The power switch may also include a time delay ",e-,l,al,i-", to interpose a preset time period between the initiation of cutting laser radiation and the subsequent delivery of electrosurgical energy for rO~31 ' " ~1 l. The time delay should be sufficient to provide 25 time for cutting with the Iwer radiation, followed by concurrent electrosurgical coagulation along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system may have the laser radiation energy within the visible, near-infrared and infrared light spectnum wavelengths. In one possible ~,OI "_ IrP~ the laser radiation source provides radiation of a ~ tl, in the range 30 of between 0.3 to 10.6 microns for eaLLI;.~ I;ng through air the ionized conductive pathway as substantially collimated.
A wave guide may be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis. An array of wave guides may Wo 96/048s8 2 1 9 4 9 8 7 ~ . c .
also be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis.
The laser and electrosurgical system may include a handpiece which is generally shaped like a pistol grip, where the pistol grip depends near the proximal end and is 5 therefore at an angle to the axis which extends from the distal end in the direction which the electrode is pointed.
The laser and electrosurgical system may have an electrosurgical electrode which is flexible and elongate for endoscùl,i., or l~p.~.u,cu,ui~, use within a cannula passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system may have its contro! located on the handpiece between the proximal and distal ends. The control may also be located on a foot pedal.
The laser and electrosurgic_l system may have a source of electrosurgical energy which includes an electrosurgical generator and a return path which is carried 15 on the handpiece for bipolar electrosurgery on the tissue ot the patient. Altematively, the return path may include a return pad connected to the patient for receiving electrosurgical energy during monopolar electrosurgery on the tissue of the patient.
A method for providing cutting, r~AD~' ,g, and/or a cu",L,i" n thereof on tissue of a patient with a laser and electrosurgical system may include the following 20 step of directing selectively and at least concurrently laser radiation and electrosurgical energy from a handpiece with its proximal and distal ends along an axis by aiming the distal end thereof along the axis from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling a source energy for laser radiation available at the proximal end of the handpiece by the 25 surgeon for first delivering laser radiation from the distal end. Controlling a source of electrosurgical energy available at the proximal end of the handpiece by the surgeon for 1, c., lall li~ >iui1 of electrosurgical energy from a electrosurgical electrode at the distal end may be yet another step of the method. Then the step of cur" leutil ,g a control to a source energy for laser radiation and to a source of electrosurgical energy so the 30 control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end.
The method oan also include the additional step of initiating the laser radiation delivered from the distal end concurrently or slightly in advance of the delivery of the W096/0485~ 2 1 9 4987 electrosurgical energy so that the laser radiation forms an ionized conductive pathway along which the electrosurgical energy will be guided for pinpointing the hrget tissue to be treated.
The method may include the additional step of guiding the electrosurgical 5 energy by arranging the distal end and the electrosurgical electrode geu~lletli~w!y relative to the handpiece for providing laser radiation essentially along the axis and from the distal end for the combined concurrent application of the laser radiation wnd the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end to the patient along the axis to direct the flow of 10 electrosurgical energy is preferably performed.
The method may include the additional step of distributing the laser radiation available at the proximal end for delivery about the axis in a ~., edete~ " ,i"ed pattern from the distal end with a " ,~ " ,. In one possible configuration, there is an added step in which the lln ~.h~lialll can deflect the laser radiation to create a varying ionized 15 conductive pathway with an ele~,bu"Itly"~ radiation deflecting suriace that vibrates in a p, edetel " ,i, led pattern generally along but slightly displaced from the axis to direct electrosurgical energy in a predefined pattern on the patient's target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or di~fracting the laser radiation 20 beam with the Illechwl;,.lll having a beam pattem deflector.
The method of initiating the laser radiation slightly in advanca of the delivery of the electrosurgical energy may be augmented with the additional steps of contrûlling the laser radiation initially with a switch having two levels of delivery. A first level of delivery may be a cutting level and a second level may be an ionizing conductive25 pathway level. This may provide for delaying the subsequent delivery of electrosurgical energy for co2gulation sufficiently for providing time for first cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method may also include the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectnJm . _!~.. Iytl ,:, provided by the source of laser radiation. There may also be the additional step of using a wave guide or an array of wave guides for delivery of the laser radiation from the proximal end to beyond the distal end and generally along the axis.
WO 96/04858 2 1 9 4 9 8 7 . ~
~
The method may include the additional step of using the handpiece, which is generally shaped like a pistol grip, by aiming along the axis extending from the distal end in the direction in which the electrode is pointed while having the pistol grip at an angle e:lyunulll 'Iy c~."lf~ clbl~ for surgery. The method may also include the 5 additional step of flexing into position an elongate electrosurgical electrode for dusGopiG or l_~_.u~ ,i.. use in a cannula placed through the patient's body walland into a cavity therein. There may be the additional step of using the control located on the handpiece between the proximal and distal ends, or using the control located on a foot pedal.
WO 96/04858 2 1 9 4 9 8 7 P~,ll~ _. 1~
EIRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a schematic drawing of the laser and electrosurgical system showing a monopol_r cu, ,9~, , of the elements.
Figure 2 is a schematic drawing of the laser and electrosurgical system showing 5 a bipolar cu, ,'il, ~ of the elements.
Figure 3 is a pulse timing graph which illustrates the timing between a laser pulse and successive electrosurgical pulses during a coAg~ ~' ) mode.
Figure 4 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an ele~,l,u,,,..~ radiation deflecting surface.
Figure 5 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an acousto-optic modulator.
Figure 6 is a schematic drawing of a portion of the l_ser and electrosurgical system which illustrates the use of a power switch.
Figure 7 is a pulse timing graph which illustrates the timing between a laser 15 pulse and successive electrosurgical pulses during a laser cut mode.
DETAILED DE aCH~ N OF THE INVENTION
A laser and electrosurgic_l system 10 is shown in ptl r -~e in Figure 1 and allows a surgeon to provide cutting, ~ o~' " ,g, and/or a ~,u"lLill ", thereof on 20 tissue of a patient 11. The laser and electrosurgical system 10 has a handpiece 12 with a proximal end 13 to be held and controlled by the surgeon. A distal end 14 on the handpiece 12 has a port 15 from which laser radiation and/or electrosurgical energy are selectively or concurrently directed to the patient 11 The proximaJ and distal ends 13 and 14 are along an axis "A". An electrosurgical electrode 16 extends from the distal 25 end 14 along the axis KA". A source energy for laser radiation 17 preferably manufactured by Coherent, Inc., located in Palo Alto, CA, and sold as model Infinity is connected to be available at the proximal end 13 and is controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11 A source of electrosurgical energy 18 preferably manufactured by Valleylab, located in Boulder, CO, 30 and sold as model Foroe 40, is connected electrically to be available at the proximal end 13andmaybecontrolledbythesurgeonlurl~c~,,a,,,;aaiunofelectrosUrgicalenergy from the electrosurgic~ll electrode 16 toward the patient 11.
Wo 96/048~8 2 1 9 4 9 8 7 1 - ' .
A retum path 19 is provided for the electrosurgical energy; the retum path 19 may be in a monopolar or bipolar circuit as s~.l ,t:" 'Iy shown in Figures 1 and 2, ,., ':ively. !~iF 'i 'Iy, in Figure 1 there is a return pad 20 and in hgure 2 there is a bipolar retum electrode 21 each to complete their respective circuits. The retum path 5 19 is connected to receive at least a portion of the ll c." ", lill~d electrosurgical energy from the source of electrosurgical energy 18 and then the patient 11. A retum input 22 for the source of electrosurgical energy 18 is connected to the retum path 19 for furnishing a complete circuit 23 between the electrosurgical electrode 16, the patient 11, and the source of electrosurgical energy 18.
A control 24 is connected to the source energy for laser radiation 17 and to thesource of electrosurgical energy 18 for the selective or concunrent application of laser radiation and electrosurgical energy from the distal end 14. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be treated when the laser radiation is within the visible spectrum. The delivered laser radiation is also used 15 to create an ionized conductive pathway along which the electrosurgicai energy will be guided .
The laser and electrosurgical system 10 has in the control 24 an initiation circuit 25 for the source energy for laser radiation 17, so laser radiation may be selectively delivered from the distal end 14 concurrently or slightly in advance of the delivery of the 20 electrosurgical energy. The laser energy will be modulated at a rate between 10 Hz.
and 31 kHz., and may be syn-.l"~,"i~d to deliver the pulse between zero and five" ,i~ .ul ~ ahead of the electrosurgical pulse. This allows the electrosurgical energy - to follow the ionized pathway created by the laser energy. In Figure 3, one possible pulse diagram is shown for the laser pulse and the electrosurgical pulse. The laser 25 pulse occurs at t, and the electrosurgical pulse occurs at t, + .000005 seconds.
When the laser is being used to create an ionized pathway, the laser energy must be controlled in order to avoid undesired tissue elfects. The duty cycle of the Iaser will be kept in the range of 10-5 to 105. Energy density delivered to any single area of tissue from the laser pulse should not exceed 26 J/cm2 for ~ ,.lyth:, 30 between 1.06 and 10.6 microns, and 17 J/cm2 for ~ .,ytll:. around and below .53 microns.
The laser and electrosurgical system 10 is configured so the distal end 14 and the electrosurgical electrode 15 are preferably anranged y~ ldd~ ly relative to the WO 96/04858 2 1 9 4 9 8 7 ~ s. ~
.
handpiece 12 to provide laser radiation essentially along the axis "A' and from the distal end 14. This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is fommed by the laser radiation from the distal end 14 to the patient 11 substantially along the axis "A~ to 5 direct the electrosurgical energy therealong.
The laser and electrosurgical system 10 provides a button 26 which operates a " le~.l IGI lial " 27, see Figure 4, to selectively distribute in a ,u, ed~ ,ed pattem about the axis "A~ the laser radiation from the distal end 14. The l"__hGi l;a"l 27 includes an e:__IIulllGyl,eli~i radiation deflecting surface 28 arranged to vibrate relative to the axis 10 "A". This forms a u,edele,,,,inad pattem to achieve a varying ionized conductive pathway generally along but slightly displaced from the axis "A~ for thereby directing electrosurgicalenergyintheluledetellllilledpattemtothepatient1l~ Thellle~hGlli~
27 may _" , I~'; . e,'~ include a beam pattem deflector 29. The beam pattern deflector 29 may be an acousto-optic modulator or GllGi lU_.I lel ~t of acousto-optic modulators to 15 diffract, refract or reflect the laser radiation.
In another alternate, the laser and electrosurgical system 10 includes in the control 24 for the source energy for laser radiation 17 a power switch 30 which may select between two levels of laser radiation energy delivery. This may be G~ VI 11~ led by changing the duty cycle of the laser. The power switch 30 includes a cutting laser 20 radiation energy level "C" and another level "I" to provide for the ionized conductive pathway. The power switch 30 also includes an electronic time delay Ille~,h GI li:~lll 31 to interpose a preset time period, shown in Fgure 7, between the initiation of cutting laser radiation 32 and the subsequent delivery of electrosurgical energy 33 for Pgl ' ~. The time delay should be sufficient to provide tima for cutting with the laser 25 radiation, followed by concurrent electrosurgical ~oPg~' ~ along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system 10 has the laser radiation energy within the range of visible, near-infrared and infrared light spectrum ~ llla. The laser radiation source 17 provides radiation of ~ tha in the range of between 0.3 to 30 10.6 microns for eaIGL,li~.l,i,lg through air the ionized conductive pathway GS
substantially collimated.
A wave guide 34, shown in Figure 1, is used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A". An W096/04858 2 1 9 4 9 8 7 P~ 'G
.
array of wave guides 35, shown in hgure 2 may " "_';/ ly be used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A".
The laser and electrosurgical system 10 includes on the handpiece 12 a pistol 5 grip 36 which depends near the proximal end 13 and is therefore at an angle 37 to the axis "A" which extends from the distal end 14 in the direction which the electrode 16 is pointed.
The laser and electrosurgical system 10 has ~ ly in Figure 2 an electrosurgical electrode support 38 which is flexible and eiongate for ~ "do,copic or 10 k~yc~ uscu~ ; use within a cannula (not shown) passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system 10 has its control located on the handpiecebetween the proximal and distal ends 13 and 14. The control may also be located on the pistol grip 36 or at a foot pedal 39.
A method for providing cutting, ~ 9~' " ,g, and/or a cv-,,L,i,-_~;o,, thereof ontissue of the patient 11 with a laser and electrosurgical system 10 includes the following step of directing selectively and at least concurrently laser radiation and electrosurgical energy from the handpiece 12 with its proximal and distal ends, 13 and 14, along an axis "A" by aiming the distal end 14 thereof along the axis "A" from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling the source energy for laser radiation 17 available at the proximal end 13 of the handpiece by the surgeon for first delivering laser radiation from the distal end 14. Controlling a source of electrosurgical energy available at the proximal end 13 of the handpiece 12 by the surgeon for llclllalllia~;vl, of electrosurgical energy from a electrosurgical electrode 16 at the distal end 14 may be yet another step of the method.
Then may follow the step of ccnnecting the control 24 to a source energy for laser radiation 17 and to a source of electrosurgical energy 18 so the control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end 14.
The method also includes the additional step of initiating the laser radiation delivered from the distal end 14 concurrently or slightly in advance of the delivery of the electrosurgical energy so that the laser radiation forms an ionized conductive pathway W0 96/W858 2 1 9 4 9 8 7 ~ 6 .
along which the electrosurgical energy will be guided for pinpointing the target tissue to be treated.
The method includes the additional step of guiding the electrosurgical energy by anranging the distal end 14 and the electrosurgical electrode 16 ge~ t~ lly relative 5 to the handpiece 12 for providing laser radiation essentially along the axis "A~ and from the distal end 14 for the combined concurrent application of the laser radiation and the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end 14 to the patient 11 along the axis ''A~ to direct the flow of electrosurgical energy is performed.
The method includes the additional step of distributing the laser radiation available at the proximal end for delivery about the axis ~A" in a p, t,.l~lt" " ,i"ed pattem from the distal end 14 with the l~ ,hmiall, 27. In one possible variation, there is an added step in which the l"e:ul,al,i~", 27 can deflect the laser radiation to create a varying ionized conductive pathway with an ~le-,l, u" ,..~u,, ,~ ti~, radiation deflecting surface 15 28 that vibrates in a ~n~:dtlt~:l",i"ed pattern generally along but slightly displaced from the axis "A" to direct electrosurgical energy in a predefined pattem on the patient's 11 target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or diffracting the laser radiation beam with the i"~.l,~li:.", 27 having a beam pattem 20 deflector 29.
The method of initiating the laser radiation slightly in advance of the delivery of the electrosurgical energy is augmented with the additional steps of controlling the laser radiation initially with the switch 30 having two levels of delivery. A first level of delivery IICn may be a cutting level and a second level 'l~ may be an ionizing conductive25 pathway level. This may provide for ds~ y il ,e subsequent delivery of electrosurgical energy for ~o~a~ , sufficiently for providing time for flrst cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method also includes the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectrum . '~ ~yth~ provided by the source of laser radiation 17. There may also be the additional step of using the wave guide 34 or the array of wave guides 35 for delivery of the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis ~A".
W0961048S8 ' ' 2 1 9 4 9 8 7 P~ '5 The method includes the additional step of using the handpiece, which is generally shaped like the pistol srip 36, by aiming along the axis ~Au extending from the distal end 14 in the direction in which the electrode 16 is pointed while having the pistol grip 16 at an angle 37 e:lyullullli~,~'j ~,u~ ull~iLle for surgery. The method also 6 includes the additional step of flexing into position the elongate electrosurgical electrode support 38 for c, ,.ius~.u~ui~ or lc,,uc.. u .cu,ui~. use in the cannula placed through the patient's body wall and into a cavity therein. There is the additional step of using the control 24 located on the handpiece 12 between the proximal and distal ends 13 and 14, or controlling with a foot pedal 39.
The claims which follow seek to cover the described ~",Lodi",~:";., and their eg~ ~: ' It~. The concept in its broadest scope covers the apparatus and methods for concurrent and simultaneous application of laser and electrosurgical energy. It is to be understood that the concept is subject to many ",- "' ,:. without departing fromthe spirit and scope of the claims as recited herein.
Electrosurgery can be used for cutting, coagulating or a colllLJi,,aliv,, thereof called blend. Co~g~ ' n is often described as ~ ' : n of the tissue and fulguration of the tissue. Fulguration is the electrical arcing from the active electrode 20 toward various locations, on the patient's tissue, in the vicinity of the active electrode.
Typically when the arcs travel through air, they reach the tissue in a random, non-p,t.lk~ ,le manner. In many cases arcs leave the active electrode in a trajectory emanating generally along the axis of the active electrode, but b jefore they contact the tissue their paths may vary due to the impedance at the tissue near the active 25 electrode. The resulting fulguration is an uneven or randomly ~.vn~.. "t, ' or irregularly distributed delivery of the energy in each arc, thus producing an uneven or variable ~oPgl ' , of the tissue desiccated thereat. This is u"~ f~ ,, y from the point of view of producing a controlled and preferred level of eschar.
Ionized gases have been used to direct the electrosurgical energy in a more 30 controlled manner. U.S. Patent 4,781,175 deals particularly with that approach. A
diaacl~/~ Ikl! ~e of using ionized gas is the possibility of formation of embolisms within the blood of the patient being treated. In addition, there is the potential for the gas being ~ ~"i~di,~ d and fomming a plasma torch either through a leak in the electrosurgical W0 96/048s8 2 1 9 4 9 8 7 P~ ............................. 2~ ' handpiece or pencil or when delivered in a lc~,u...u~ OIJ;C procedure within the trocar which provides entry into the body cavity. Another problem with ionized gas is that the electrosurgery and the gas flow are essentially concurrent in the fonm of a plasma flame that is used to fulgurate and desiccate tissue at which it is aimed. The aiming or 5 positioning of the plasma flame on the desired target tissue is uncertain until activated.
Therefore, the pinpointing of the spot at which to initiate the eff~ct is not readily .It,l~:,,,,;,,aLIle until the electrosurgical energy is delivered.
U.S. Patent 5,011,483 discloses a device which is in the form of a handpiece housing from which electrosurgical and laser energy may be delivered . " _'y for10 selective use thereof. In connection with laycll ual,Opki procedures, an elongate hollow shaft is disclosed for a wave guide to conduct the laser energy. The wave guide may be flexible and one preferred form is a fiber optic. The disclosure of the reference is largely limited to the alternate use of laser or electrosurgery. There is no discussion or disclosure of concurrent delivery.
Japanese patent JP57-69853 relates to a laser device which radiates a laser beam to mark the position for subsequent application of laser surgery. No electrosurgery is disclosed and the use of a laser with electrosurgery even for pinpointing is not taught. Japanese patent JP57-69790 has a laser radiation apparatus wlth a laser oscillator including a light guide and a generator for radiating visible light 20 for positioning. These Japanese patents are used to direct the laser Qnergy and do not teach the concurrent use of laser energy and electrosurgery energy.
U.S. pntent 5,324,254 discloses a single Ic~ a~.O~ . instrument capable of supplying either laser radiation or electrosurgical energy. An electrosurgical electrode is provided at the distal end of the instrument for electrosurgical procedures. A side 25 port located near the proximate end of the instrument allows for the passage of a laser fiberoptic bundle, thereby allowing for laser surgery. The patent does not teach the concunrent use of laser energy and electrosurgical energy in a syncl,,u,,i~ed manner.
An article entitled How Lasers Miqht Control Uahtnina Strikes. appearing in Laser Focus ~vorld November 1993 pages 113 - 123 by Zhao Xin Miao and Daniels 30 Jean-Claude, discloses how lasers establish an ionized pathway for electric arc lloJI:~llli~ai~nl. Ordinary optical beams produce little ionkation in air or an essentially weak plasma which can be used to direct electrical discharges.
WO96104858 2 1 94987 1 "" 5 ~
'3-The application of any form of tmu ,pl lt ,i~, ionization to direct electrosurgical beams either statically or clJ"cl" 'Iy has not been disclosed in the prior l~,h, ,ùlùgy.
SUMMARY OF THE INVENTION
A laser and electrosurgical system allows a surgeon to provide cutbng, ~lA911' " 19, and/or a cc,r"bi" " ~ thereof on tissue of a paUent. The laser andelectrosurgical system preferably has a handpiece with a proximal end to be held _nd controlled by the surgeon. A distal end may be included on the handpiece from which laser radiation and/or electrosurgical energy may be selectively or concurrently directed 10 to the patient. The proximal and distal ends are most preferably along an axis. An electrosurgical electrode might extend from the distal end along the axis. A source energy for laser radiation most preferably is avaiiable at the proximal end and is controlled by the surgeon for delivery of laser radiation from the distal end toward the patient. A source of electrosurgical energy might also be available at the proximal end 15 and may be controlled by the surgeon for b~" lalll;s~iun of electrosurgical energy from the electrosurgical electrode toward the patient.
A retum path is provided for the electrosurgical energy. The return path is connected to receive at least a portion of the l,c." ""itb:d electrosurgical energy from the source of electrosurgical energy toward the patient. A retum input for the source 20 of electrosurgical energy is connected to the retum path for furnishing a complete circuit between the electrosurgical electrode, the patient, and the source of electrosurgical energy.
A control may be connected to the source energy for laser radiation and to the source of electrosurgical energy for the selective or concurrent application of laser 25 radiation and electrosurgical energy from the distal end.
The laser and electrosurgical system may have in the control an initiation circuit for the source energy for laser radiation, so laser radiation may be selectively delivered from the distal end slightly in advance of the delivery of the electrosurgical energy. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be 30 treated. The delivered laser radiation may also be used to create an ionized conductive pathway along which the electrosurgical energy will be guided.
The laser and electrosurgical system may be configured so the distal end and the electrosurgical electrode are preferably arranged ~eo."e,t,i~_l'y relative to the . , _, _ _, _,, _ _,, Wo961048~8 21 9 4 9 87 Ir~ r~l~
handpiece to provide laser radiation essentially alons the axis and from the distal end.
This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is formed by the laser radiation from the distal end to the patient substantially along the axis to direct the electrosurgical 5 energy.
The laser and electrosurgical system may provide a control which operates a Ille~,l.~lialll to selectively distribute, in a ple-let:~"i"ed pattem about the axis, the delivered laser radiation from the distal end.
The laser and electrosurgical system may include an ~ale~ ," ,c~".,'i~, radiation 10 deflecting surface arranged to vibrate relative to the axis. This preferably forms a pl edek~ ;ned pattem to achieve a varying ionlzed conductive pathway generally along but slightly displaced from the axis for thereby directing electrosurgical energy in the pl ~:delt~l l l lil led pattern to the patient.
The laser and electrosurgical system may be configured such that the laser 15 radiation is a beam ~nd the ",.~ lll includes a beam pattem deflector. The beam pattern deflector may be an acousto-optic modulator or ~, ~ l~el llel 1l of acousto-optic modulators to diffract, refract or reflect the beam.
The laser and electrosurgical system may include in the control for the source energy for laser radiation a power switch which may select between two levels of laser 20 r~diation energy delivery. The power switch may include a cutting laser radiation energy level and another level to provide for the ionized conductive pathway. The power switch may also include a time delay ",e-,l,al,i-", to interpose a preset time period between the initiation of cutting laser radiation and the subsequent delivery of electrosurgical energy for rO~31 ' " ~1 l. The time delay should be sufficient to provide 25 time for cutting with the Iwer radiation, followed by concurrent electrosurgical coagulation along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system may have the laser radiation energy within the visible, near-infrared and infrared light spectnum wavelengths. In one possible ~,OI "_ IrP~ the laser radiation source provides radiation of a ~ tl, in the range 30 of between 0.3 to 10.6 microns for eaLLI;.~ I;ng through air the ionized conductive pathway as substantially collimated.
A wave guide may be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis. An array of wave guides may Wo 96/048s8 2 1 9 4 9 8 7 ~ . c .
also be used to deliver the laser radiation from the proximal end to beyond the distal end and generally along the axis.
The laser and electrosurgical system may include a handpiece which is generally shaped like a pistol grip, where the pistol grip depends near the proximal end and is 5 therefore at an angle to the axis which extends from the distal end in the direction which the electrode is pointed.
The laser and electrosurgical system may have an electrosurgical electrode which is flexible and elongate for endoscùl,i., or l~p.~.u,cu,ui~, use within a cannula passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system may have its contro! located on the handpiece between the proximal and distal ends. The control may also be located on a foot pedal.
The laser and electrosurgic_l system may have a source of electrosurgical energy which includes an electrosurgical generator and a return path which is carried 15 on the handpiece for bipolar electrosurgery on the tissue ot the patient. Altematively, the return path may include a return pad connected to the patient for receiving electrosurgical energy during monopolar electrosurgery on the tissue of the patient.
A method for providing cutting, r~AD~' ,g, and/or a cu",L,i" n thereof on tissue of a patient with a laser and electrosurgical system may include the following 20 step of directing selectively and at least concurrently laser radiation and electrosurgical energy from a handpiece with its proximal and distal ends along an axis by aiming the distal end thereof along the axis from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling a source energy for laser radiation available at the proximal end of the handpiece by the 25 surgeon for first delivering laser radiation from the distal end. Controlling a source of electrosurgical energy available at the proximal end of the handpiece by the surgeon for 1, c., lall li~ >iui1 of electrosurgical energy from a electrosurgical electrode at the distal end may be yet another step of the method. Then the step of cur" leutil ,g a control to a source energy for laser radiation and to a source of electrosurgical energy so the 30 control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end.
The method oan also include the additional step of initiating the laser radiation delivered from the distal end concurrently or slightly in advance of the delivery of the W096/0485~ 2 1 9 4987 electrosurgical energy so that the laser radiation forms an ionized conductive pathway along which the electrosurgical energy will be guided for pinpointing the hrget tissue to be treated.
The method may include the additional step of guiding the electrosurgical 5 energy by arranging the distal end and the electrosurgical electrode geu~lletli~w!y relative to the handpiece for providing laser radiation essentially along the axis and from the distal end for the combined concurrent application of the laser radiation wnd the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end to the patient along the axis to direct the flow of 10 electrosurgical energy is preferably performed.
The method may include the additional step of distributing the laser radiation available at the proximal end for delivery about the axis in a ~., edete~ " ,i"ed pattern from the distal end with a " ,~ " ,. In one possible configuration, there is an added step in which the lln ~.h~lialll can deflect the laser radiation to create a varying ionized 15 conductive pathway with an ele~,bu"Itly"~ radiation deflecting suriace that vibrates in a p, edetel " ,i, led pattern generally along but slightly displaced from the axis to direct electrosurgical energy in a predefined pattern on the patient's target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or di~fracting the laser radiation 20 beam with the Illechwl;,.lll having a beam pattem deflector.
The method of initiating the laser radiation slightly in advanca of the delivery of the electrosurgical energy may be augmented with the additional steps of contrûlling the laser radiation initially with a switch having two levels of delivery. A first level of delivery may be a cutting level and a second level may be an ionizing conductive25 pathway level. This may provide for delaying the subsequent delivery of electrosurgical energy for co2gulation sufficiently for providing time for first cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method may also include the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectnJm . _!~.. Iytl ,:, provided by the source of laser radiation. There may also be the additional step of using a wave guide or an array of wave guides for delivery of the laser radiation from the proximal end to beyond the distal end and generally along the axis.
WO 96/04858 2 1 9 4 9 8 7 . ~
~
The method may include the additional step of using the handpiece, which is generally shaped like a pistol grip, by aiming along the axis extending from the distal end in the direction in which the electrode is pointed while having the pistol grip at an angle e:lyunulll 'Iy c~."lf~ clbl~ for surgery. The method may also include the 5 additional step of flexing into position an elongate electrosurgical electrode for dusGopiG or l_~_.u~ ,i.. use in a cannula placed through the patient's body walland into a cavity therein. There may be the additional step of using the control located on the handpiece between the proximal and distal ends, or using the control located on a foot pedal.
WO 96/04858 2 1 9 4 9 8 7 P~,ll~ _. 1~
EIRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a schematic drawing of the laser and electrosurgical system showing a monopol_r cu, ,9~, , of the elements.
Figure 2 is a schematic drawing of the laser and electrosurgical system showing 5 a bipolar cu, ,'il, ~ of the elements.
Figure 3 is a pulse timing graph which illustrates the timing between a laser pulse and successive electrosurgical pulses during a coAg~ ~' ) mode.
Figure 4 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an ele~,l,u,,,..~ radiation deflecting surface.
Figure 5 is a schematic drawing of a portion of the laser and electrosurgical system which illustrates the use of an acousto-optic modulator.
Figure 6 is a schematic drawing of a portion of the l_ser and electrosurgical system which illustrates the use of a power switch.
Figure 7 is a pulse timing graph which illustrates the timing between a laser 15 pulse and successive electrosurgical pulses during a laser cut mode.
DETAILED DE aCH~ N OF THE INVENTION
A laser and electrosurgic_l system 10 is shown in ptl r -~e in Figure 1 and allows a surgeon to provide cutting, ~ o~' " ,g, and/or a ~,u"lLill ", thereof on 20 tissue of a patient 11. The laser and electrosurgical system 10 has a handpiece 12 with a proximal end 13 to be held and controlled by the surgeon. A distal end 14 on the handpiece 12 has a port 15 from which laser radiation and/or electrosurgical energy are selectively or concurrently directed to the patient 11 The proximaJ and distal ends 13 and 14 are along an axis "A". An electrosurgical electrode 16 extends from the distal 25 end 14 along the axis KA". A source energy for laser radiation 17 preferably manufactured by Coherent, Inc., located in Palo Alto, CA, and sold as model Infinity is connected to be available at the proximal end 13 and is controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11 A source of electrosurgical energy 18 preferably manufactured by Valleylab, located in Boulder, CO, 30 and sold as model Foroe 40, is connected electrically to be available at the proximal end 13andmaybecontrolledbythesurgeonlurl~c~,,a,,,;aaiunofelectrosUrgicalenergy from the electrosurgic~ll electrode 16 toward the patient 11.
Wo 96/048~8 2 1 9 4 9 8 7 1 - ' .
A retum path 19 is provided for the electrosurgical energy; the retum path 19 may be in a monopolar or bipolar circuit as s~.l ,t:" 'Iy shown in Figures 1 and 2, ,., ':ively. !~iF 'i 'Iy, in Figure 1 there is a return pad 20 and in hgure 2 there is a bipolar retum electrode 21 each to complete their respective circuits. The retum path 5 19 is connected to receive at least a portion of the ll c." ", lill~d electrosurgical energy from the source of electrosurgical energy 18 and then the patient 11. A retum input 22 for the source of electrosurgical energy 18 is connected to the retum path 19 for furnishing a complete circuit 23 between the electrosurgical electrode 16, the patient 11, and the source of electrosurgical energy 18.
A control 24 is connected to the source energy for laser radiation 17 and to thesource of electrosurgical energy 18 for the selective or concunrent application of laser radiation and electrosurgical energy from the distal end 14. The advance delivery of the laser radiation may be used to pinpoint the target tissue to be treated when the laser radiation is within the visible spectrum. The delivered laser radiation is also used 15 to create an ionized conductive pathway along which the electrosurgicai energy will be guided .
The laser and electrosurgical system 10 has in the control 24 an initiation circuit 25 for the source energy for laser radiation 17, so laser radiation may be selectively delivered from the distal end 14 concurrently or slightly in advance of the delivery of the 20 electrosurgical energy. The laser energy will be modulated at a rate between 10 Hz.
and 31 kHz., and may be syn-.l"~,"i~d to deliver the pulse between zero and five" ,i~ .ul ~ ahead of the electrosurgical pulse. This allows the electrosurgical energy - to follow the ionized pathway created by the laser energy. In Figure 3, one possible pulse diagram is shown for the laser pulse and the electrosurgical pulse. The laser 25 pulse occurs at t, and the electrosurgical pulse occurs at t, + .000005 seconds.
When the laser is being used to create an ionized pathway, the laser energy must be controlled in order to avoid undesired tissue elfects. The duty cycle of the Iaser will be kept in the range of 10-5 to 105. Energy density delivered to any single area of tissue from the laser pulse should not exceed 26 J/cm2 for ~ ,.lyth:, 30 between 1.06 and 10.6 microns, and 17 J/cm2 for ~ .,ytll:. around and below .53 microns.
The laser and electrosurgical system 10 is configured so the distal end 14 and the electrosurgical electrode 15 are preferably anranged y~ ldd~ ly relative to the WO 96/04858 2 1 9 4 9 8 7 ~ s. ~
.
handpiece 12 to provide laser radiation essentially along the axis "A' and from the distal end 14. This geometry provides for the combined concurrent application of the laser radiation and the electrosurgical energy. The ionized pathway is fommed by the laser radiation from the distal end 14 to the patient 11 substantially along the axis "A~ to 5 direct the electrosurgical energy therealong.
The laser and electrosurgical system 10 provides a button 26 which operates a " le~.l IGI lial " 27, see Figure 4, to selectively distribute in a ,u, ed~ ,ed pattem about the axis "A~ the laser radiation from the distal end 14. The l"__hGi l;a"l 27 includes an e:__IIulllGyl,eli~i radiation deflecting surface 28 arranged to vibrate relative to the axis 10 "A". This forms a u,edele,,,,inad pattem to achieve a varying ionized conductive pathway generally along but slightly displaced from the axis "A~ for thereby directing electrosurgicalenergyintheluledetellllilledpattemtothepatient1l~ Thellle~hGlli~
27 may _" , I~'; . e,'~ include a beam pattem deflector 29. The beam pattern deflector 29 may be an acousto-optic modulator or GllGi lU_.I lel ~t of acousto-optic modulators to 15 diffract, refract or reflect the laser radiation.
In another alternate, the laser and electrosurgical system 10 includes in the control 24 for the source energy for laser radiation 17 a power switch 30 which may select between two levels of laser radiation energy delivery. This may be G~ VI 11~ led by changing the duty cycle of the laser. The power switch 30 includes a cutting laser 20 radiation energy level "C" and another level "I" to provide for the ionized conductive pathway. The power switch 30 also includes an electronic time delay Ille~,h GI li:~lll 31 to interpose a preset time period, shown in Fgure 7, between the initiation of cutting laser radiation 32 and the subsequent delivery of electrosurgical energy 33 for Pgl ' ~. The time delay should be sufficient to provide tima for cutting with the laser 25 radiation, followed by concurrent electrosurgical ~oPg~' ~ along the ionized conductive pathway to the laser cut tissue.
The laser and electrosurgical system 10 has the laser radiation energy within the range of visible, near-infrared and infrared light spectrum ~ llla. The laser radiation source 17 provides radiation of ~ tha in the range of between 0.3 to 30 10.6 microns for eaIGL,li~.l,i,lg through air the ionized conductive pathway GS
substantially collimated.
A wave guide 34, shown in Figure 1, is used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A". An W096/04858 2 1 9 4 9 8 7 P~ 'G
.
array of wave guides 35, shown in hgure 2 may " "_';/ ly be used to deliver the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis "A".
The laser and electrosurgical system 10 includes on the handpiece 12 a pistol 5 grip 36 which depends near the proximal end 13 and is therefore at an angle 37 to the axis "A" which extends from the distal end 14 in the direction which the electrode 16 is pointed.
The laser and electrosurgical system 10 has ~ ly in Figure 2 an electrosurgical electrode support 38 which is flexible and eiongate for ~ "do,copic or 10 k~yc~ uscu~ ; use within a cannula (not shown) passing through the patient's body wall and into a cavity therein.
The laser and electrosurgical system 10 has its control located on the handpiecebetween the proximal and distal ends 13 and 14. The control may also be located on the pistol grip 36 or at a foot pedal 39.
A method for providing cutting, ~ 9~' " ,g, and/or a cv-,,L,i,-_~;o,, thereof ontissue of the patient 11 with a laser and electrosurgical system 10 includes the following step of directing selectively and at least concurrently laser radiation and electrosurgical energy from the handpiece 12 with its proximal and distal ends, 13 and 14, along an axis "A" by aiming the distal end 14 thereof along the axis "A" from which laser radiation and electrosurgical energy may be at least in part concurrently directed. A further step might be controlling the source energy for laser radiation 17 available at the proximal end 13 of the handpiece by the surgeon for first delivering laser radiation from the distal end 14. Controlling a source of electrosurgical energy available at the proximal end 13 of the handpiece 12 by the surgeon for llclllalllia~;vl, of electrosurgical energy from a electrosurgical electrode 16 at the distal end 14 may be yet another step of the method.
Then may follow the step of ccnnecting the control 24 to a source energy for laser radiation 17 and to a source of electrosurgical energy 18 so the control is preferably arranged for the concurrent application of laser radiation and electrosurgical energy from the distal end 14.
The method also includes the additional step of initiating the laser radiation delivered from the distal end 14 concurrently or slightly in advance of the delivery of the electrosurgical energy so that the laser radiation forms an ionized conductive pathway W0 96/W858 2 1 9 4 9 8 7 ~ 6 .
along which the electrosurgical energy will be guided for pinpointing the target tissue to be treated.
The method includes the additional step of guiding the electrosurgical energy by anranging the distal end 14 and the electrosurgical electrode 16 ge~ t~ lly relative 5 to the handpiece 12 for providing laser radiation essentially along the axis "A~ and from the distal end 14 for the combined concurrent application of the laser radiation and the electrosurgical energy. Then the added step of ionizing a conductive pathway with laser radiation from the distal end 14 to the patient 11 along the axis ''A~ to direct the flow of electrosurgical energy is performed.
The method includes the additional step of distributing the laser radiation available at the proximal end for delivery about the axis ~A" in a p, t,.l~lt" " ,i"ed pattem from the distal end 14 with the l~ ,hmiall, 27. In one possible variation, there is an added step in which the l"e:ul,al,i~", 27 can deflect the laser radiation to create a varying ionized conductive pathway with an ~le-,l, u" ,..~u,, ,~ ti~, radiation deflecting surface 15 28 that vibrates in a ~n~:dtlt~:l",i"ed pattern generally along but slightly displaced from the axis "A" to direct electrosurgical energy in a predefined pattem on the patient's 11 target tissue. In another possible approach, there are additional steps of delivering the laser radiation as a beam and varying an ionized conductive pathway by refracting or diffracting the laser radiation beam with the i"~.l,~li:.", 27 having a beam pattem 20 deflector 29.
The method of initiating the laser radiation slightly in advance of the delivery of the electrosurgical energy is augmented with the additional steps of controlling the laser radiation initially with the switch 30 having two levels of delivery. A first level of delivery IICn may be a cutting level and a second level 'l~ may be an ionizing conductive25 pathway level. This may provide for ds~ y il ,e subsequent delivery of electrosurgical energy for ~o~a~ , sufficiently for providing time for flrst cutting with the laser radiation and thereafter enabling, with the switch, the concurrent electrosurgical fulguration along the later ionized conductive pathway to the coagulate.
The method also includes the additional step of using laser radiation in the 30 visible, near-infrared and infrared light spectrum . '~ ~yth~ provided by the source of laser radiation 17. There may also be the additional step of using the wave guide 34 or the array of wave guides 35 for delivery of the laser radiation from the proximal end 13 to beyond the distal end 14 and generally along the axis ~A".
W0961048S8 ' ' 2 1 9 4 9 8 7 P~ '5 The method includes the additional step of using the handpiece, which is generally shaped like the pistol srip 36, by aiming along the axis ~Au extending from the distal end 14 in the direction in which the electrode 16 is pointed while having the pistol grip 16 at an angle 37 e:lyullullli~,~'j ~,u~ ull~iLle for surgery. The method also 6 includes the additional step of flexing into position the elongate electrosurgical electrode support 38 for c, ,.ius~.u~ui~ or lc,,uc.. u .cu,ui~. use in the cannula placed through the patient's body wall and into a cavity therein. There is the additional step of using the control 24 located on the handpiece 12 between the proximal and distal ends 13 and 14, or controlling with a foot pedal 39.
The claims which follow seek to cover the described ~",Lodi",~:";., and their eg~ ~: ' It~. The concept in its broadest scope covers the apparatus and methods for concurrent and simultaneous application of laser and electrosurgical energy. It is to be understood that the concept is subject to many ",- "' ,:. without departing fromthe spirit and scope of the claims as recited herein.
Claims (6)
1. A laser and electrosurgical system 10 for a surgeon to use for cutting and coagulating tissue of a patient 11, the system 10 comprising:
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end 13 by a waveguide 34, and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable, and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12, and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11, and an initiation circuit 25 connected to the source of laser radiation 17 and connected to the source of electrosurgical energy 18, the initiation circuit 25 used for sequencing the delivery of laser radiation and electrosurgical energy to the patient 11, wherein the laser radiation has sufficient power to ionize a path between the distal end 14 and the tissue of the patient 11, and the electrode 16 is positioned near the path of the laser radiation such that the electrosurgical energy is conducted along the ionized path.
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end 13 by a waveguide 34, and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient 11;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable, and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12, and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11, and an initiation circuit 25 connected to the source of laser radiation 17 and connected to the source of electrosurgical energy 18, the initiation circuit 25 used for sequencing the delivery of laser radiation and electrosurgical energy to the patient 11, wherein the laser radiation has sufficient power to ionize a path between the distal end 14 and the tissue of the patient 11, and the electrode 16 is positioned near the path of the laser radiation such that the electrosurgical energy is conducted along the ionized path.
2. The laser and electrosurgical system 10 of Claim 1 wherein the source of laser radiation 17 provides radiation of a wavelength in the range of between 0.3 to 10.6 microns for establishing the ionized conductive pathway.
3. The laser and electrosurgical system 10 of Claim 1 wherein a waveguide 34 within the handpiece 12 delivers the laser radiation from the proximal end 13 to the distal end 14.
4. The laser and electrosurgical system 10 of Claim 1 wherein an array of wave guides 35 within the handpiece 12 deliver the laser radiation from the proximal end 13 to the distal end 14.
5. A laser and electrosurgical system 10 for a surgeon to use for cutting and coagulating tissue of a patient 11, the system 10 comprising:
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end by a waveguide 34 and the laser radiation transmitted from the proximal end to the distal end through a waveguide in the handpiece and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient, the source of laser radiation 17 having sufficient power to ionize a conductive pathway from the distal end 14 to the tissue of the patient 11 and wherein the electrode 16 is positioned near the path of the laser radiation;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12 and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11;
a control 24 connected to the source of laser radiation 17 and to the source of electrosurgical energy 18 for the selective application of laser radiation and electrosurgical energy from the distal end 14 and a power switch 30 in the control 24 for selecting between two levels of laser radiation energy delivery the power switch 30 including a cutting laser radiation energy level and an ionized conductive pathway level of laser radiation energy.
a handpiece 12 having a proximal end 13 to be held and controlled by the surgeon and a distal end 14 from which laser radiation and electrosurgical energy may be directed to the patient 11;
at least one electrosurgical electrode 16 on the handpiece 12 and extending from the distal end 14;
a source of laser radiation 17 connected to the proximal end by a waveguide 34 and the laser radiation transmitted from the proximal end to the distal end through a waveguide in the handpiece and controlled by the surgeon for delivery of laser radiation from the distal end 14 toward the patient, the source of laser radiation 17 having sufficient power to ionize a conductive pathway from the distal end 14 to the tissue of the patient 11 and wherein the electrode 16 is positioned near the path of the laser radiation;
a source of electrosurgical energy 18 connected to the proximal end 13 by an electrically conductive cable and the electrosurgical energy transmitted from the proximal end 13 to the electrode 16 by an electrically conductive element in the handpiece 12 and controlled by the surgeon for transmission of electrosurgical energy from the electrosurgical electrode 16 toward the patient 11;
a control 24 connected to the source of laser radiation 17 and to the source of electrosurgical energy 18 for the selective application of laser radiation and electrosurgical energy from the distal end 14 and a power switch 30 in the control 24 for selecting between two levels of laser radiation energy delivery the power switch 30 including a cutting laser radiation energy level and an ionized conductive pathway level of laser radiation energy.
6. The laser and electrosurgical system 10 of Claim 5 wherein the power switch 30 includes a time delay mechanism 31 to interpose a preset time period between the initiation of cutting laser radiation 32 and the subsequent delivery of electrosurgical energy 33 for coagulation, the preset time sufficient to provide time for cutting with the laser radiation, the power switch 30 thereafter enables concurrent electrosurgical coagulation along the ionized conductive pathway to the laser cut tissue.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/289,958 | 1994-08-12 | ||
US08/289,958 US5509916A (en) | 1994-08-12 | 1994-08-12 | Laser-assisted electrosurgery system |
Publications (1)
Publication Number | Publication Date |
---|---|
CA2194987A1 true CA2194987A1 (en) | 1996-02-22 |
Family
ID=23113924
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002194987A Withdrawn CA2194987A1 (en) | 1994-08-12 | 1995-07-10 | Laser-assisted electrosurgery system |
Country Status (7)
Country | Link |
---|---|
US (1) | US5509916A (en) |
EP (1) | EP0774925A1 (en) |
JP (1) | JPH09508556A (en) |
AU (1) | AU2750795A (en) |
CA (1) | CA2194987A1 (en) |
MX (1) | MX9701120A (en) |
WO (1) | WO1996004858A1 (en) |
Families Citing this family (596)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6447511B1 (en) | 1994-12-13 | 2002-09-10 | Symbiosis Corporation | Bipolar endoscopic surgical scissor blades and instrument incorporating the same |
US6780180B1 (en) | 1995-06-23 | 2004-08-24 | Gyrus Medical Limited | Electrosurgical instrument |
CA2224975A1 (en) * | 1995-06-23 | 1997-01-09 | Gyrus Medical Limited | An electrosurgical instrument |
US7267675B2 (en) * | 1996-01-05 | 2007-09-11 | Thermage, Inc. | RF device with thermo-electric cooler |
US7006874B2 (en) * | 1996-01-05 | 2006-02-28 | Thermage, Inc. | Treatment apparatus with electromagnetic energy delivery device and non-volatile memory |
US20040000316A1 (en) * | 1996-01-05 | 2004-01-01 | Knowlton Edward W. | Methods for creating tissue effect utilizing electromagnetic energy and a reverse thermal gradient |
US7115123B2 (en) * | 1996-01-05 | 2006-10-03 | Thermage, Inc. | Handpiece with electrode and non-volatile memory |
US7473251B2 (en) * | 1996-01-05 | 2009-01-06 | Thermage, Inc. | Methods for creating tissue effect utilizing electromagnetic energy and a reverse thermal gradient |
US20030212393A1 (en) * | 1996-01-05 | 2003-11-13 | Knowlton Edward W. | Handpiece with RF electrode and non-volatile memory |
US7229436B2 (en) * | 1996-01-05 | 2007-06-12 | Thermage, Inc. | Method and kit for treatment of tissue |
US7141049B2 (en) * | 1999-03-09 | 2006-11-28 | Thermage, Inc. | Handpiece for treatment of tissue |
US7022121B2 (en) | 1999-03-09 | 2006-04-04 | Thermage, Inc. | Handpiece for treatment of tissue |
US7189230B2 (en) | 1996-01-05 | 2007-03-13 | Thermage, Inc. | Method for treating skin and underlying tissue |
US5737384A (en) * | 1996-10-04 | 1998-04-07 | Massachusetts Institute Of Technology | X-ray needle providing heating with microwave energy |
US5989274A (en) | 1996-10-17 | 1999-11-23 | Ethicon Endo-Surgery, Inc. | Methods and devices for improving blood flow to a heart of a patient |
US6051010A (en) * | 1996-12-23 | 2000-04-18 | Ethicon Endo-Surgery, Inc. | Methods and devices for joining transmission components |
US5776155A (en) * | 1996-12-23 | 1998-07-07 | Ethicon Endo-Surgery, Inc. | Methods and devices for attaching and detaching transmission components |
US5989275A (en) * | 1997-02-28 | 1999-11-23 | Ethicon Endo-Surgery, Inc. | Damping ultrasonic transmission components |
US5968060A (en) * | 1997-02-28 | 1999-10-19 | Ethicon Endo-Surgery, Inc. | Ultrasonic interlock and method of using the same |
US5810859A (en) * | 1997-02-28 | 1998-09-22 | Ethicon Endo-Surgery, Inc. | Apparatus for applying torque to an ultrasonic transmission component |
US5957943A (en) * | 1997-03-05 | 1999-09-28 | Ethicon Endo-Surgery, Inc. | Method and devices for increasing ultrasonic effects |
US5938633A (en) * | 1997-07-09 | 1999-08-17 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical devices |
ES2132028B1 (en) * | 1997-07-16 | 2000-04-01 | Salat Carlos Bone | ENDOLUMINAL ELECTROCOAGULATOR FOR VARICOSE OPERATIONS. |
US6659105B2 (en) * | 1998-02-26 | 2003-12-09 | Senorx, Inc. | Tissue specimen isolating and damaging device and method |
US6540693B2 (en) | 1998-03-03 | 2003-04-01 | Senorx, Inc. | Methods and apparatus for securing medical instruments to desired locations in a patients body |
US6997885B2 (en) * | 1998-04-08 | 2006-02-14 | Senorx, Inc. | Dilation devices and methods for removing tissue specimens |
US6540695B1 (en) | 1998-04-08 | 2003-04-01 | Senorx, Inc. | Biopsy anchor device with cutter |
US20020156471A1 (en) * | 1999-03-09 | 2002-10-24 | Stern Roger A. | Method for treatment of tissue |
US6135998A (en) * | 1999-03-16 | 2000-10-24 | Board Of Trustees Of The Leland Stanford Junior University | Method and apparatus for pulsed plasma-mediated electrosurgery in liquid media |
WO2003053266A2 (en) * | 1999-06-30 | 2003-07-03 | Thermage, Inc. | Liquid cooled rf handpiece |
DE10118464A1 (en) * | 2001-04-07 | 2002-10-10 | Zeiss Carl Jena Gmbh | Electrical probe, preferably for eye surgery, has insulator as light conductor optically connected to light generating unit, electrodes with contacts for connecting electrical supply unit |
US20030139740A1 (en) * | 2002-01-22 | 2003-07-24 | Syneron Medical Ltd. | System and method for treating skin |
US6740081B2 (en) | 2002-01-25 | 2004-05-25 | Applied Medical Resources Corporation | Electrosurgery with improved control apparatus and method |
CA2547587C (en) * | 2002-11-27 | 2013-11-19 | Christopher Paul Hancock | Tissue ablating apparatus and method of ablating tissue |
US8021359B2 (en) * | 2003-02-13 | 2011-09-20 | Coaptus Medical Corporation | Transseptal closure of a patent foramen ovale and other cardiac defects |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
WO2005115235A1 (en) | 2004-05-26 | 2005-12-08 | Medical Device Innovations Limited | Tissue detection and ablation apparatus and apparatus and method for actuating a tuner |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US11890012B2 (en) | 2004-07-28 | 2024-02-06 | Cilag Gmbh International | Staple cartridge comprising cartridge body and attached support |
US8905977B2 (en) | 2004-07-28 | 2014-12-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser |
US20060047281A1 (en) | 2004-09-01 | 2006-03-02 | Syneron Medical Ltd. | Method and system for invasive skin treatment |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US8800838B2 (en) | 2005-08-31 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Robotically-controlled cable-based surgical end effectors |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US20070194079A1 (en) | 2005-08-31 | 2007-08-23 | Hueil Joseph C | Surgical stapling device with staple drivers of different height |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US20110290856A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument with force-feedback capabilities |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US8161977B2 (en) | 2006-01-31 | 2012-04-24 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US8763879B2 (en) | 2006-01-31 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of surgical instrument |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US20070225562A1 (en) | 2006-03-23 | 2007-09-27 | Ethicon Endo-Surgery, Inc. | Articulating endoscopic accessory channel |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
EP2049033B1 (en) * | 2006-08-02 | 2015-09-30 | Syneron Medical Ltd. | Directed current for hair removal |
US7740159B2 (en) | 2006-08-02 | 2010-06-22 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US20080078802A1 (en) | 2006-09-29 | 2008-04-03 | Hess Christopher J | Surgical staples and stapling instruments |
US10130359B2 (en) | 2006-09-29 | 2018-11-20 | Ethicon Llc | Method for forming a staple |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US8459520B2 (en) | 2007-01-10 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and remote sensor |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US20080169332A1 (en) | 2007-01-11 | 2008-07-17 | Shelton Frederick E | Surgical stapling device with a curved cutting member |
US20090001121A1 (en) | 2007-03-15 | 2009-01-01 | Hess Christopher J | Surgical staple having an expandable portion |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US8157145B2 (en) | 2007-05-31 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with electrical feedback |
US11672531B2 (en) | 2007-06-04 | 2023-06-13 | Cilag Gmbh International | Rotary drive systems for surgical instruments |
US7905380B2 (en) | 2007-06-04 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US7832408B2 (en) | 2007-06-04 | 2010-11-16 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a directional switching mechanism |
US8534528B2 (en) | 2007-06-04 | 2013-09-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US8331438B2 (en) * | 2007-06-05 | 2012-12-11 | Microsoft Corporation | Adaptive selection of picture-level quantization parameters for predicted video pictures |
US20090036958A1 (en) * | 2007-08-01 | 2009-02-05 | Primaeva Medical, Inc. | Methods and devices for treating tissue |
US8845630B2 (en) * | 2007-06-15 | 2014-09-30 | Syneron Medical Ltd | Devices and methods for percutaneous energy delivery |
US20080312647A1 (en) * | 2007-06-15 | 2008-12-18 | Primaeva Medical, Inc. | Methods and devices for treating tissue |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US8408439B2 (en) | 2007-06-22 | 2013-04-02 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulatable end effector |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
WO2009080273A1 (en) * | 2007-12-20 | 2009-07-02 | Farin Guenter | Plasma applicators for plasma-surgical methods |
EP2561819B1 (en) | 2008-01-17 | 2015-01-07 | Syneron Medical Ltd. | Hair removal apparatus for personal use |
WO2009093230A2 (en) * | 2008-01-24 | 2009-07-30 | Syneron Medical Ltd. | A device, apparatus, and method of adipose tissue treatment |
US8540133B2 (en) | 2008-09-19 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US8561870B2 (en) | 2008-02-13 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US7905381B2 (en) | 2008-09-19 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with cutting member arrangement |
US8453908B2 (en) | 2008-02-13 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US7766209B2 (en) | 2008-02-13 | 2010-08-03 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US8622274B2 (en) | 2008-02-14 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Motorized cutting and fastening instrument having control circuit for optimizing battery usage |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US8584919B2 (en) | 2008-02-14 | 2013-11-19 | Ethicon Endo-Sugery, Inc. | Surgical stapling apparatus with load-sensitive firing mechanism |
US8752749B2 (en) | 2008-02-14 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Robotically-controlled disposable motor-driven loading unit |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US7793812B2 (en) | 2008-02-14 | 2010-09-14 | Ethicon Endo-Surgery, Inc. | Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
BRPI0901282A2 (en) | 2008-02-14 | 2009-11-17 | Ethicon Endo Surgery Inc | surgical cutting and fixation instrument with rf electrodes |
US8459525B2 (en) | 2008-02-14 | 2013-06-11 | Ethicon Endo-Sugery, Inc. | Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device |
US8657174B2 (en) | 2008-02-14 | 2014-02-25 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument having handle based power source |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US20090206131A1 (en) | 2008-02-15 | 2009-08-20 | Ethicon Endo-Surgery, Inc. | End effector coupling arrangements for a surgical cutting and stapling instrument |
US20090206139A1 (en) | 2008-02-15 | 2009-08-20 | Ethicon Endo-Surgery, Inc. | Buttress material for a surgical instrument |
US10390823B2 (en) | 2008-02-15 | 2019-08-27 | Ethicon Llc | End effector comprising an adjunct |
US8608044B2 (en) | 2008-02-15 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Feedback and lockout mechanism for surgical instrument |
EP2265196B9 (en) | 2008-03-31 | 2013-10-02 | Applied Medical Resources Corporation | Electrosurgical system with means for measuring permittivity and conductivity of tissue |
US9314293B2 (en) * | 2008-07-16 | 2016-04-19 | Syneron Medical Ltd | RF electrode for aesthetic and body shaping devices and method of using same |
US20100017750A1 (en) * | 2008-07-16 | 2010-01-21 | Avner Rosenberg | User interface |
US8083120B2 (en) | 2008-09-18 | 2011-12-27 | Ethicon Endo-Surgery, Inc. | End effector for use with a surgical cutting and stapling instrument |
PL3476312T3 (en) | 2008-09-19 | 2024-03-11 | Ethicon Llc | Surgical stapler with apparatus for adjusting staple height |
WO2010032235A1 (en) | 2008-09-21 | 2010-03-25 | Syneron Medical Ltd. | A method and apparatus for personal skin treatment |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9050083B2 (en) | 2008-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8485413B2 (en) | 2009-02-05 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising an articulation joint |
US8414577B2 (en) | 2009-02-05 | 2013-04-09 | Ethicon Endo-Surgery, Inc. | Surgical instruments and components for use in sterile environments |
US8397971B2 (en) | 2009-02-05 | 2013-03-19 | Ethicon Endo-Surgery, Inc. | Sterilizable surgical instrument |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
BRPI1008667A2 (en) | 2009-02-06 | 2016-03-08 | Ethicom Endo Surgery Inc | improvement of the operated surgical stapler |
US8453907B2 (en) | 2009-02-06 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with cutting member reversing mechanism |
US20100211055A1 (en) * | 2009-02-18 | 2010-08-19 | Shimon Eckhouse | Method for body toning and an integrated data management system for the same |
US9278230B2 (en) | 2009-02-25 | 2016-03-08 | Syneron Medical Ltd | Electrical skin rejuvenation |
US20100217254A1 (en) * | 2009-02-25 | 2010-08-26 | Primaeva Medical, Inc. | Methods for applying energy to tissue using isolated energy sources |
US8066167B2 (en) | 2009-03-23 | 2011-11-29 | Ethicon Endo-Surgery, Inc. | Circular surgical stapling instrument with anvil locking system |
CN102378602A (en) * | 2009-04-01 | 2012-03-14 | 赛诺龙医疗公司 | A method and apparatus for liposuction |
WO2011034938A2 (en) * | 2009-09-15 | 2011-03-24 | Ceramoptec Industries, Inc. | Ablative/coagulative urological treatment device and method |
US8141762B2 (en) | 2009-10-09 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical stapler comprising a staple pocket |
US8899466B2 (en) | 2009-11-19 | 2014-12-02 | Ethicon Endo-Surgery, Inc. | Devices and methods for introducing a surgical circular stapling instrument into a patient |
US8136712B2 (en) | 2009-12-10 | 2012-03-20 | Ethicon Endo-Surgery, Inc. | Surgical stapler with discrete staple height adjustment and tactile feedback |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8267300B2 (en) | 2009-12-30 | 2012-09-18 | Ethicon Endo-Surgery, Inc. | Dampening device for endoscopic surgical stapler |
US8608046B2 (en) | 2010-01-07 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Test device for a surgical tool |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US8789740B2 (en) | 2010-07-30 | 2014-07-29 | Ethicon Endo-Surgery, Inc. | Linear cutting and stapling device with selectively disengageable cutting member |
US8672207B2 (en) | 2010-07-30 | 2014-03-18 | Ethicon Endo-Surgery, Inc. | Transwall visualization arrangements and methods for surgical circular staplers |
US8360296B2 (en) | 2010-09-09 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling head assembly with firing lockout for a surgical stapler |
US8632525B2 (en) | 2010-09-17 | 2014-01-21 | Ethicon Endo-Surgery, Inc. | Power control arrangements for surgical instruments and batteries |
US9289212B2 (en) | 2010-09-17 | 2016-03-22 | Ethicon Endo-Surgery, Inc. | Surgical instruments and batteries for surgical instruments |
US20120078244A1 (en) | 2010-09-24 | 2012-03-29 | Worrell Barry C | Control features for articulating surgical device |
US8733613B2 (en) | 2010-09-29 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US10123798B2 (en) | 2010-09-30 | 2018-11-13 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9307989B2 (en) | 2012-03-28 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorportating a hydrophobic agent |
US8864009B2 (en) | 2010-09-30 | 2014-10-21 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator for a surgical stapler comprising an adjustable anvil |
US20120080498A1 (en) | 2010-09-30 | 2012-04-05 | Ethicon Endo-Surgery, Inc. | Curved end effector for a stapling instrument |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9414838B2 (en) | 2012-03-28 | 2016-08-16 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprised of a plurality of materials |
US9232941B2 (en) | 2010-09-30 | 2016-01-12 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a reservoir |
US8893949B2 (en) | 2010-09-30 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Surgical stapler with floating anvil |
US9314246B2 (en) | 2010-09-30 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
US9839420B2 (en) | 2010-09-30 | 2017-12-12 | Ethicon Llc | Tissue thickness compensator comprising at least one medicament |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9386988B2 (en) | 2010-09-30 | 2016-07-12 | Ethicon End-Surgery, LLC | Retainer assembly including a tissue thickness compensator |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US9861361B2 (en) | 2010-09-30 | 2018-01-09 | Ethicon Llc | Releasable tissue thickness compensator and fastener cartridge having the same |
CN103140178B (en) | 2010-09-30 | 2015-09-23 | 伊西康内外科公司 | Comprise the closure system keeping matrix and alignment matrix |
US8840003B2 (en) | 2010-09-30 | 2014-09-23 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with compact articulation control arrangement |
US9332974B2 (en) | 2010-09-30 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Layered tissue thickness compensator |
US9204880B2 (en) | 2012-03-28 | 2015-12-08 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising capsules defining a low pressure environment |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
USD650074S1 (en) | 2010-10-01 | 2011-12-06 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
EP2621389B1 (en) | 2010-10-01 | 2015-03-18 | Applied Medical Resources Corporation | Electrosurgical instrument with jaws and with an electrode |
US8632462B2 (en) | 2011-03-14 | 2014-01-21 | Ethicon Endo-Surgery, Inc. | Trans-rectum universal ports |
US9044229B2 (en) | 2011-03-15 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical fastener instruments |
US8926598B2 (en) | 2011-03-15 | 2015-01-06 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulatable and rotatable end effector |
US8857693B2 (en) | 2011-03-15 | 2014-10-14 | Ethicon Endo-Surgery, Inc. | Surgical instruments with lockable articulating end effector |
US8800841B2 (en) | 2011-03-15 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Surgical staple cartridges |
US8540131B2 (en) | 2011-03-15 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical staple cartridges with tissue tethers for manipulating divided tissue and methods of using same |
US20140025051A1 (en) * | 2011-03-25 | 2014-01-23 | Lutronic Corporation | Apparatus for optical surgery and method for controlling same |
JP6026509B2 (en) | 2011-04-29 | 2016-11-16 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Staple cartridge including staples disposed within a compressible portion of the staple cartridge itself |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
US9107663B2 (en) | 2011-09-06 | 2015-08-18 | Ethicon Endo-Surgery, Inc. | Stapling instrument comprising resettable staple drivers |
US9050084B2 (en) | 2011-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck arrangement |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
US9078653B2 (en) | 2012-03-26 | 2015-07-14 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge |
BR112014024098B1 (en) | 2012-03-28 | 2021-05-25 | Ethicon Endo-Surgery, Inc. | staple cartridge |
MX353040B (en) | 2012-03-28 | 2017-12-18 | Ethicon Endo Surgery Inc | Retainer assembly including a tissue thickness compensator. |
US9198662B2 (en) | 2012-03-28 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator having improved visibility |
JP6305979B2 (en) | 2012-03-28 | 2018-04-04 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Tissue thickness compensator with multiple layers |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
EP2866686A1 (en) | 2012-06-28 | 2015-05-06 | Ethicon Endo-Surgery, Inc. | Empty clip cartridge lockout |
US20140001234A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Coupling arrangements for attaching surgical end effectors to drive systems therefor |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
US8747238B2 (en) | 2012-06-28 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Rotary drive shaft assemblies for surgical instruments with articulatable end effectors |
US9028494B2 (en) | 2012-06-28 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Interchangeable end effector coupling arrangement |
US9125662B2 (en) | 2012-06-28 | 2015-09-08 | Ethicon Endo-Surgery, Inc. | Multi-axis articulating and rotating surgical tools |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US9101385B2 (en) | 2012-06-28 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Electrode connections for rotary driven surgical tools |
US9204879B2 (en) | 2012-06-28 | 2015-12-08 | Ethicon Endo-Surgery, Inc. | Flexible drive member |
US9119657B2 (en) | 2012-06-28 | 2015-09-01 | Ethicon Endo-Surgery, Inc. | Rotary actuatable closure arrangement for surgical end effector |
US9561038B2 (en) | 2012-06-28 | 2017-02-07 | Ethicon Endo-Surgery, Llc | Interchangeable clip applier |
US11202631B2 (en) | 2012-06-28 | 2021-12-21 | Cilag Gmbh International | Stapling assembly comprising a firing lockout |
US9649111B2 (en) | 2012-06-28 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Replaceable clip cartridge for a clip applier |
US10492876B2 (en) | 2012-09-17 | 2019-12-03 | Omniguide, Inc. | Devices and methods for laser surgery |
US9386985B2 (en) | 2012-10-15 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Surgical cutting instrument |
US9386984B2 (en) | 2013-02-08 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Staple cartridge comprising a releasable cover |
US10092292B2 (en) | 2013-02-28 | 2018-10-09 | Ethicon Llc | Staple forming features for surgical stapling instrument |
JP6345707B2 (en) | 2013-03-01 | 2018-06-20 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Surgical instrument with soft stop |
US20140249557A1 (en) | 2013-03-01 | 2014-09-04 | Ethicon Endo-Surgery, Inc. | Thumbwheel switch arrangements for surgical instruments |
BR112015021098B1 (en) | 2013-03-01 | 2022-02-15 | Ethicon Endo-Surgery, Inc | COVERAGE FOR A JOINT JOINT AND SURGICAL INSTRUMENT |
US20140263552A1 (en) | 2013-03-13 | 2014-09-18 | Ethicon Endo-Surgery, Inc. | Staple cartridge tissue thickness sensor system |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US9808244B2 (en) | 2013-03-14 | 2017-11-07 | Ethicon Llc | Sensor arrangements for absolute positioning system for surgical instruments |
US9572577B2 (en) | 2013-03-27 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a tissue thickness compensator including openings therein |
US9332984B2 (en) | 2013-03-27 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Fastener cartridge assemblies |
US9795384B2 (en) | 2013-03-27 | 2017-10-24 | Ethicon Llc | Fastener cartridge comprising a tissue thickness compensator and a gap setting element |
US9867612B2 (en) | 2013-04-16 | 2018-01-16 | Ethicon Llc | Powered surgical stapler |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
US9574644B2 (en) | 2013-05-30 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Power module for use with a surgical instrument |
US9775609B2 (en) | 2013-08-23 | 2017-10-03 | Ethicon Llc | Tamper proof circuit for surgical instrument battery pack |
JP6416260B2 (en) | 2013-08-23 | 2018-10-31 | エシコン エルエルシー | Firing member retractor for a powered surgical instrument |
US20140171986A1 (en) | 2013-09-13 | 2014-06-19 | Ethicon Endo-Surgery, Inc. | Surgical Clip Having Comliant Portion |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US9642620B2 (en) | 2013-12-23 | 2017-05-09 | Ethicon Endo-Surgery, Llc | Surgical cutting and stapling instruments with articulatable end effectors |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9681870B2 (en) | 2013-12-23 | 2017-06-20 | Ethicon Llc | Articulatable surgical instruments with separate and distinct closing and firing systems |
US9687232B2 (en) | 2013-12-23 | 2017-06-27 | Ethicon Llc | Surgical staples |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
CN106232029B (en) | 2014-02-24 | 2019-04-12 | 伊西康内外科有限责任公司 | Fastening system including firing member locking piece |
US9839422B2 (en) | 2014-02-24 | 2017-12-12 | Ethicon Llc | Implantable layers and methods for altering implantable layers for use with surgical fastening instruments |
US9913642B2 (en) | 2014-03-26 | 2018-03-13 | Ethicon Llc | Surgical instrument comprising a sensor system |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
US9820738B2 (en) | 2014-03-26 | 2017-11-21 | Ethicon Llc | Surgical instrument comprising interactive systems |
US9826977B2 (en) | 2014-03-26 | 2017-11-28 | Ethicon Llc | Sterilization verification circuit |
US9750499B2 (en) | 2014-03-26 | 2017-09-05 | Ethicon Llc | Surgical stapling instrument system |
CN106456158B (en) | 2014-04-16 | 2019-02-05 | 伊西康内外科有限责任公司 | Fastener cartridge including non-uniform fastener |
BR112016023807B1 (en) | 2014-04-16 | 2022-07-12 | Ethicon Endo-Surgery, Llc | CARTRIDGE SET OF FASTENERS FOR USE WITH A SURGICAL INSTRUMENT |
JP6636452B2 (en) | 2014-04-16 | 2020-01-29 | エシコン エルエルシーEthicon LLC | Fastener cartridge including extension having different configurations |
US20150297223A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US10299792B2 (en) | 2014-04-16 | 2019-05-28 | Ethicon Llc | Fastener cartridge comprising non-uniform fasteners |
US9801628B2 (en) | 2014-09-26 | 2017-10-31 | Ethicon Llc | Surgical staple and driver arrangements for staple cartridges |
AU2015258819B2 (en) | 2014-05-16 | 2019-12-12 | Applied Medical Resources Corporation | Electrosurgical system |
EP3369392A1 (en) | 2014-05-30 | 2018-09-05 | Applied Medical Resources Corporation | Electrosurgical seal and dissection systems |
US10045781B2 (en) | 2014-06-13 | 2018-08-14 | Ethicon Llc | Closure lockout systems for surgical instruments |
US10016199B2 (en) | 2014-09-05 | 2018-07-10 | Ethicon Llc | Polarity of hall magnet to identify cartridge type |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
BR112017005981B1 (en) | 2014-09-26 | 2022-09-06 | Ethicon, Llc | ANCHOR MATERIAL FOR USE WITH A SURGICAL STAPLE CARTRIDGE AND SURGICAL STAPLE CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US9943309B2 (en) | 2014-12-18 | 2018-04-17 | Ethicon Llc | Surgical instruments with articulatable end effectors and movable firing beam support arrangements |
BR112017012996B1 (en) | 2014-12-18 | 2022-11-08 | Ethicon Llc | SURGICAL INSTRUMENT WITH AN ANvil WHICH IS SELECTIVELY MOVABLE ABOUT AN IMMOVABLE GEOMETRIC AXIS DIFFERENT FROM A STAPLE CARTRIDGE |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US10420603B2 (en) | 2014-12-23 | 2019-09-24 | Applied Medical Resources Corporation | Bipolar electrosurgical sealer and divider |
USD748259S1 (en) | 2014-12-29 | 2016-01-26 | Applied Medical Resources Corporation | Electrosurgical instrument |
US10226250B2 (en) | 2015-02-27 | 2019-03-12 | Ethicon Llc | Modular stapling assembly |
US9931118B2 (en) | 2015-02-27 | 2018-04-03 | Ethicon Endo-Surgery, Llc | Reinforced battery for a surgical instrument |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
EP3726562B1 (en) | 2015-03-06 | 2023-12-20 | Micromass UK Limited | Ambient ionization mass spectrometry imaging platform for direct mapping from bulk tissue |
US10052044B2 (en) | 2015-03-06 | 2018-08-21 | Ethicon Llc | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
CN107636794B (en) | 2015-03-06 | 2020-02-28 | 英国质谱公司 | Liquid trap or separator for electrosurgical applications |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
CA2978165A1 (en) | 2015-03-06 | 2016-09-15 | Micromass Uk Limited | Improved ionisation of gaseous samples |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
WO2016142669A1 (en) | 2015-03-06 | 2016-09-15 | Micromass Uk Limited | Physically guided rapid evaporative ionisation mass spectrometry ("reims") |
GB2555921B (en) * | 2015-03-06 | 2021-09-15 | Micromass Ltd | Endoscopic tissue identification tool |
CN107667288B (en) | 2015-03-06 | 2022-02-01 | 英国质谱公司 | Spectral analysis of microorganisms |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10026599B2 (en) | 2015-03-06 | 2018-07-17 | Micromass Uk Limited | Rapid evaporative ionisation mass spectrometry (“REIMS”) and desorption electrospray ionisation mass spectrometry (“DESI-MS”) analysis of swabs and biopsy samples |
US10978284B2 (en) | 2015-03-06 | 2021-04-13 | Micromass Uk Limited | Imaging guided ambient ionisation mass spectrometry |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US9895148B2 (en) | 2015-03-06 | 2018-02-20 | Ethicon Endo-Surgery, Llc | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
KR101934663B1 (en) | 2015-03-06 | 2019-01-02 | 마이크로매스 유케이 리미티드 | An inlet instrument device for an ion analyzer coupled to a rapid evaporation ionization mass spectrometry (" REIMS ") device |
EP3265822B1 (en) | 2015-03-06 | 2021-04-28 | Micromass UK Limited | Tissue analysis by mass spectrometry or ion mobility spectrometry |
EP3266035B1 (en) | 2015-03-06 | 2023-09-20 | Micromass UK Limited | Collision surface for improved ionisation |
GB2554180B (en) | 2015-03-06 | 2022-04-13 | Micromass Ltd | Spectrometric analysis |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
CN107567315B (en) | 2015-03-06 | 2020-09-29 | 英国质谱公司 | Chemically guided ambient ionization mass spectrometry |
US10045776B2 (en) | 2015-03-06 | 2018-08-14 | Ethicon Llc | Control techniques and sub-processor contained within modular shaft with select control processing from handle |
WO2016142674A1 (en) | 2015-03-06 | 2016-09-15 | Micromass Uk Limited | Cell population analysis |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
US10213201B2 (en) | 2015-03-31 | 2019-02-26 | Ethicon Llc | Stapling end effector configured to compensate for an uneven gap between a first jaw and a second jaw |
US10368861B2 (en) | 2015-06-18 | 2019-08-06 | Ethicon Llc | Dual articulation drive system arrangements for articulatable surgical instruments |
US11058425B2 (en) | 2015-08-17 | 2021-07-13 | Ethicon Llc | Implantable layers for a surgical instrument |
MX2022009705A (en) | 2015-08-26 | 2022-11-07 | Ethicon Llc | Surgical staples comprising hardness variations for improved fastening of tissue. |
JP6828018B2 (en) | 2015-08-26 | 2021-02-10 | エシコン エルエルシーEthicon LLC | Surgical staple strips that allow you to change the characteristics of staples and facilitate filling into cartridges |
US10166026B2 (en) | 2015-08-26 | 2019-01-01 | Ethicon Llc | Staple cartridge assembly including features for controlling the rotation of staples when being ejected therefrom |
MX2022006192A (en) | 2015-09-02 | 2022-06-16 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples. |
US10357252B2 (en) | 2015-09-02 | 2019-07-23 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
GB201517195D0 (en) | 2015-09-29 | 2015-11-11 | Micromass Ltd | Capacitively coupled reims technique and optically transparent counter electrode |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10736633B2 (en) | 2015-09-30 | 2020-08-11 | Ethicon Llc | Compressible adjunct with looping members |
US10478188B2 (en) | 2015-09-30 | 2019-11-19 | Ethicon Llc | Implantable layer comprising a constricted configuration |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
BR112018016098B1 (en) | 2016-02-09 | 2023-02-23 | Ethicon Llc | SURGICAL INSTRUMENT |
US10245029B2 (en) | 2016-02-09 | 2019-04-02 | Ethicon Llc | Surgical instrument with articulating and axially translatable end effector |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10456140B2 (en) | 2016-04-01 | 2019-10-29 | Ethicon Llc | Surgical stapling system comprising an unclamping lockout |
US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
US10413293B2 (en) | 2016-04-01 | 2019-09-17 | Ethicon Llc | Interchangeable surgical tool assembly with a surgical end effector that is selectively rotatable about a shaft axis |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US10485542B2 (en) | 2016-04-01 | 2019-11-26 | Ethicon Llc | Surgical stapling instrument comprising multiple lockouts |
US11454611B2 (en) | 2016-04-14 | 2022-09-27 | Micromass Uk Limited | Spectrometric analysis of plants |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10426469B2 (en) | 2016-04-18 | 2019-10-01 | Ethicon Llc | Surgical instrument comprising a primary firing lockout and a secondary firing lockout |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US10702270B2 (en) | 2016-06-24 | 2020-07-07 | Ethicon Llc | Stapling system for use with wire staples and stamped staples |
USD826405S1 (en) | 2016-06-24 | 2018-08-21 | Ethicon Llc | Surgical fastener |
USD847989S1 (en) | 2016-06-24 | 2019-05-07 | Ethicon Llc | Surgical fastener cartridge |
USD850617S1 (en) | 2016-06-24 | 2019-06-04 | Ethicon Llc | Surgical fastener cartridge |
CN109310431B (en) | 2016-06-24 | 2022-03-04 | 伊西康有限责任公司 | Staple cartridge comprising wire staples and punch staples |
US10675026B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Methods of stapling tissue |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US10835245B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Method for attaching a shaft assembly to a surgical instrument and, alternatively, to a surgical robot |
US10758230B2 (en) | 2016-12-21 | 2020-09-01 | Ethicon Llc | Surgical instrument with primary and safety processors |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
US10945727B2 (en) | 2016-12-21 | 2021-03-16 | Ethicon Llc | Staple cartridge with deformable driver retention features |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US10758229B2 (en) | 2016-12-21 | 2020-09-01 | Ethicon Llc | Surgical instrument comprising improved jaw control |
US10537324B2 (en) | 2016-12-21 | 2020-01-21 | Ethicon Llc | Stepped staple cartridge with asymmetrical staples |
US10856868B2 (en) | 2016-12-21 | 2020-12-08 | Ethicon Llc | Firing member pin configurations |
US10898186B2 (en) | 2016-12-21 | 2021-01-26 | Ethicon Llc | Staple forming pocket arrangements comprising primary sidewalls and pocket sidewalls |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10993715B2 (en) | 2016-12-21 | 2021-05-04 | Ethicon Llc | Staple cartridge comprising staples with different clamping breadths |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
CN110099619B (en) | 2016-12-21 | 2022-07-15 | 爱惜康有限责任公司 | Lockout device for surgical end effector and replaceable tool assembly |
US10893864B2 (en) | 2016-12-21 | 2021-01-19 | Ethicon | Staple cartridges and arrangements of staples and staple cavities therein |
US11160551B2 (en) | 2016-12-21 | 2021-11-02 | Cilag Gmbh International | Articulatable surgical stapling instruments |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US10568624B2 (en) | 2016-12-21 | 2020-02-25 | Ethicon Llc | Surgical instruments with jaws that are pivotable about a fixed axis and include separate and distinct closure and firing systems |
US10687810B2 (en) | 2016-12-21 | 2020-06-23 | Ethicon Llc | Stepped staple cartridge with tissue retention and gap setting features |
US10568626B2 (en) | 2016-12-21 | 2020-02-25 | Ethicon Llc | Surgical instruments with jaw opening features for increasing a jaw opening distance |
US20180168619A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling systems |
CN110087565A (en) | 2016-12-21 | 2019-08-02 | 爱惜康有限责任公司 | Surgical stapling system |
US10667809B2 (en) | 2016-12-21 | 2020-06-02 | Ethicon Llc | Staple cartridge and staple cartridge channel comprising windows defined therein |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US11141154B2 (en) | 2017-06-27 | 2021-10-12 | Cilag Gmbh International | Surgical end effectors and anvils |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US10588633B2 (en) | 2017-06-28 | 2020-03-17 | Ethicon Llc | Surgical instruments with open and closable jaws and axially movable firing member that is initially parked in close proximity to the jaws prior to firing |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
US11058424B2 (en) | 2017-06-28 | 2021-07-13 | Cilag Gmbh International | Surgical instrument comprising an offset articulation joint |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US11583274B2 (en) | 2017-12-21 | 2023-02-21 | Cilag Gmbh International | Self-guiding stapling instrument |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US11864812B2 (en) | 2018-09-05 | 2024-01-09 | Applied Medical Resources Corporation | Electrosurgical generator control system |
KR20210092263A (en) | 2018-11-16 | 2021-07-23 | 어플라이드 메디컬 리소시스 코포레이션 | electrosurgical system |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11241235B2 (en) | 2019-06-28 | 2022-02-08 | Cilag Gmbh International | Method of using multiple RFID chips with a surgical assembly |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
US20220031320A1 (en) | 2020-07-28 | 2022-02-03 | Cilag Gmbh International | Surgical instruments with flexible firing member actuator constraint arrangements |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11826047B2 (en) | 2021-05-28 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising jaw mounts |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
Family Cites Families (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPS5769853A (en) * | 1980-10-20 | 1982-04-28 | Tokyo Shibaura Electric Co | Lasre device |
JPS5769790A (en) * | 1980-10-20 | 1982-04-28 | Olympus Optical Co Ltd | Laser beam irradiator |
FR2513109A1 (en) * | 1981-09-24 | 1983-03-25 | Cilas | Laser scalpel for surgery - has focussing system in tubular housing flexibly joint to laser source and hand-held by operator |
DE3406294A1 (en) * | 1984-02-22 | 1985-09-05 | Hubmann, Max, Dr., 8520 Erlangen | Catheter |
US5192278A (en) * | 1985-03-22 | 1993-03-09 | Massachusetts Institute Of Technology | Multi-fiber plug for a laser catheter |
US4781175A (en) * | 1986-04-08 | 1988-11-01 | C. R. Bard, Inc. | Electrosurgical conductive gas stream technique of achieving improved eschar for coagulation |
DE3723674A1 (en) * | 1987-07-16 | 1989-01-26 | Biotronik Mess & Therapieg | CONTROLLABLE CATHETER FOR TRANSMITTING LASER RADIATION |
US5011483A (en) * | 1989-06-26 | 1991-04-30 | Dennis Sleister | Combined electrosurgery and laser beam delivery device |
US5195958A (en) * | 1990-05-25 | 1993-03-23 | Phillips Edward H | Tool for laparoscopic surgery |
US5267994A (en) * | 1992-02-10 | 1993-12-07 | Conmed Corporation | Electrosurgical probe |
US5401272A (en) * | 1992-09-25 | 1995-03-28 | Envision Surgical Systems, Inc. | Multimodality probe with extendable bipolar electrodes |
-
1994
- 1994-08-12 US US08/289,958 patent/US5509916A/en not_active Expired - Lifetime
-
1995
- 1995-07-10 WO PCT/IB1995/000546 patent/WO1996004858A1/en not_active Application Discontinuation
- 1995-07-10 AU AU27507/95A patent/AU2750795A/en not_active Abandoned
- 1995-07-10 EP EP95922694A patent/EP0774925A1/en not_active Withdrawn
- 1995-07-10 MX MX9701120A patent/MX9701120A/en not_active Application Discontinuation
- 1995-07-10 JP JP8507152A patent/JPH09508556A/en active Pending
- 1995-07-10 CA CA002194987A patent/CA2194987A1/en not_active Withdrawn
Also Published As
Publication number | Publication date |
---|---|
US5509916A (en) | 1996-04-23 |
JPH09508556A (en) | 1997-09-02 |
AU2750795A (en) | 1996-03-07 |
EP0774925A1 (en) | 1997-05-28 |
MX9701120A (en) | 1997-05-31 |
WO1996004858A1 (en) | 1996-02-22 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US5509916A (en) | Laser-assisted electrosurgery system | |
US5669907A (en) | Plasma enhanced bipolar electrosurgical system | |
EP0447121B1 (en) | Gas coagulation device | |
US6855145B2 (en) | Self-wetting, dry-field bipolar electrodes for endoscopic surgery | |
US5571101A (en) | Electrosurgical electrode for DCR surgical procedure | |
JP5870109B2 (en) | System and method for enabling incision and vessel and tissue sealing to improve cautery with electrosurgical conducting gas | |
US5281216A (en) | Electrosurgical bipolar treating apparatus | |
US9681907B2 (en) | Electrosurgical apparatus to generate a dual plasma stream and method thereof | |
US5122138A (en) | Tissue vaporizing accessory and method for an endoscope | |
US7611511B2 (en) | Bipolar medical instrument and electrosurgical system comprising such an instrument | |
JPS6459B2 (en) | ||
IL122713A (en) | Electrosurgical instrument | |
EP0921759A1 (en) | Planar ablation probe and method for electrosurgical cutting and ablation | |
US20100082026A1 (en) | Electrosurgical instrument and system | |
KR100360055B1 (en) | Apparatus for biological tissue treatment utilizing high frequency | |
US20160051313A1 (en) | Attachment for Electrosurgical System | |
US20160235462A1 (en) | System and Method for Plasma Sealing of Tissue | |
US9649143B2 (en) | Electrosurgical system to generate a pulsed plasma stream and method thereof | |
AU2018230707B2 (en) | Ultrapolar electrosurgery blade and ultrapolar electrosurgery blade assembly with conductive cutting edges and top and bottom conductive surfaces | |
EP2531131B1 (en) | Electrosurgical instrument | |
JP7039054B2 (en) | Ultrapolar telescopic and non-stretchable electrosurgery pencils with argon beam function and superpolar electrosurgery blade assemblies | |
US20140039486A1 (en) | Electrosurgical system | |
CN110121305B (en) | Accessory for an electrosurgical system | |
US8518034B2 (en) | Electrosurgical instrument and system |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AZWI | Withdrawn application | ||
EEER | Examination request |