CA2244515A1 - Ultrasonic dissection and coagulation system - Google Patents

Abstract

An ultrasonic dissection and coagulation system for surgical use is provided. The system includes an ultrasonic instrument, a control module, and a pedal actuator. The ultrasonic actuator has a housing and an elongated body portion extending from the housing. An ultrasonic transducer supported within the housing is operatively connected to a cutting blade by a vibration coupler. The vibration coupler conducts high frequency vibration from the ultrasonic transducer to the cutting blade.
The cutting blade has a cutting surface which is angled with respect to the longitudinal axis of the elongated body portion and, thus, with respect to the axis of vibration. A clamp member having a tissue contact surface is positioned adjacent to the blade member and is movable from an open position in which the tissue contact surface is spaced form the cutting surface to a clamped position in which the tissue contact surface is in close juxtaposed alignment with the cutting surface to clamp tissue therebetween. The clamp member and the angled blade combine to enhance contact between tissue and the cutting surface of the blade member.

Description

PATEN r 20~2000 (1072S) ULTRASONIC DISSECTION
AND COAGULATION ~iY~

BACKGROUND
1. Technical Field S The present di~los~e relates to an ultrasonic di~jec~ and co~llqtion system for surgical use. More sl~eil;~ally, the present disclosure relates to an ultrasonic ir~h~ ellt inrhl~lin~ an angled blade and a clamp member particularly suited for pe.rull ~g dicsection and coagulation of tissue.

2. P~ und of Rel~ed Art Ull-r~onir hLhulllenl~ for surgical use and the benefits qCsQciqt~pd Ihe,~ are well known. For exarnple, the use of an ulll~sonic g~ or in conj~n~l;on with a surgical scalpel f:~ilitq-tes faster and easier cuKing of organic tissue and acceler~es blood vessel clotting in the area of the cut, i.e., accel. .ated coagul~ ~io~ Improved cutting results from i,~leasod body tissue to scalpel contact caused by the high frequency of vibration of the scalpel blade with respect to body tissue. Illl~u~d coq.~ tion results from heat generated by contact ~Iween the scalpel blade and the body tissue as the scalpel blade is vibrated at a high frequency.
Thus, in order to reap the advantages qCcoc~ d with ulhasOrlic energy, good blade to tissue contact is hll~l~
U.S. Patent No. 3,862,630 ("Rqlqmllth") ~isrloses an ultrasonic system inrlurling an ultrasonic motor, a tool member having a WUI~illg surface Oli. ll~d normal to the direction of ~"erh~nirql vibration ~n. ,~t d by the ulllas~ ic motor, and a clamp member eYtP~ing parallel to the tool member for COlllpl,;~ g tissue against the tool member. U.S. Patent No,. 5,322,055 ("Davison") ~jSCIQSPS an ulhasOnic surgical ins~ lllc.lt adapted for endoscopic use having a blade and a clamp movable in relation to the blade to capture tissue Ihe~e~t~.~. n. The blade and the clamp define a clamping region having a plane which is parallel to the lon~ih~linql axis of the surgical ir~ u..ent. During an en-~o copic proce~lulc movement of the h~ e.ll is limited to mo~..,le.lt along an axis parallel to the plane of the clarnping region Thus no additional blade force is illlposed on the body tissue as a result of movement of the i~l-u~l~en~
Acco-dil~ly a need exists for an improved ultrasonic surgical h~ ulle.ll which is easy to use and provides fast and easy cutting and improved CQqglll qti~n .

SUMMARY
In accordance with the present ~licclQsl re an ulliasonic tissue ~icsectnr is provided for dicc~ction and coaglllqtior- of tissue. The surgical h~llulllent inrl ~-lçs a housing and a vibration coupler supported within the housing operably coml~;led to an ull.~sonic gen. .~tor. An angled blade member is con~clPd to the distal end of the vibration coupler to conduct high frequency vibration to the blade m~.ll~r. The blade ~-,~ .-l~r has a cutting surface that forms an obtuse angle with respect to an axis t.~e to the lonEih--linql axis of the vibration coupler. The blade m~mher may also have a width that tapers in the distal direction. A clamp mPlnkr may be positi nPd adjacent to the blade Ille.ll~l and is movable from an open position to a clqml-ed position to capture tissue Ihe.~t~e~ .. The clamp ~-le.nbcr and angled blade member C~J~III'~;n~' tO enhance contact between the tissue and the blade mpmlxr during operation of the hlsllul~enl tO irnprove the performance of the h~l.ullle.ll.
In an qltçrnste e nho~imPnt the surgical instrument is operatively qCcoci~d with a control module and a remote actuator and has a housing and an elongated body portion e~SPrYli~ from the housing. An UlllaSOlUC trnC~ er ~ppo.~d within the housing is operatively connect~d to a cutting blade by a vibration coupler. The vibration coupler conducts high frequency vibration from the ul~lasonic lldnc-l~cel to the cutting blade. The cutting blade has a cutting surface which is angled with respect to the lon~ nql axis of the elongPt~d body portion and, thus, with respect to the axis of vibration. A clamp ~1" m~r having a tissue contact surface is pocitil~n~d ~ ent to the blade member and is movable via an actuator tube from an open position in which the tissue contact surface is spaced from the cutting surface to a c~qnlrecl position in which the tissue contact surface is in close juxtaposed qlignm~nt with the cutting surface to clamp tissue tl~,.eb.,~ ,en. Rec~--ce the cutting blade is angled with respect to the 1Q~;t~1~;nqI axis of the elc!r~g~t Cl body portion, the contact p~C;.aUl~ applied by the blade surface is i,~cl~a~ as the force applied to the u~llenl iS h~c.edsed.

BRIEF DESCR~ION OF THE DRAWINGS
Vatious plef~ d e,nbo~;~n~ ate described herein with reference to the drawings, wherein:
FIG. 1 is a pe.al)eclive view of one embodiment of the Illtr~onie tissue ~icSPctor in the open position;
FIG. 2 is a side cross-sectional view taken along section line 2-2 of FIG. 1;
FIG. 3 is a side cross ;~I;onql view taken along section line 3-3 of FIG. 1;
FIG. 3A is a front cross scc~ l view taken along section line 3A-3A
of FIG. 3;
FIG. 3B is a ctoss-sectional view of the blade melnber and cla np of an ~lt~ e e...ho~l;...~nl of the ultrasonic tissue dissoclol, FIG. 4 is a side cross-sectionq1 view of the p,,J~ ,al end of tbe ultrasonic tissue dic~-~r of FIG. 1;
FIG. 5 is a side cross-sectionql view of the distal end of the ulLIàsonic tissue dicse~-lùr of PIG. 1 shown in the clq-nped position;
S FIG. 5A is a cross-sectional view taken along section line 5A-SA of FIG. S;
FIG. 6 is a side cross-sectio~l view of the p~uxnnal end of an qltprn~e emboAimPnt of the ultrasonic tissue dicsector shown in the open position;
FIG. 7 is a partial side cross Se..l;O!l'l view of the distal end of the ultrasonic tissue dissPctor of FIG. 6 shown in the open position;
FIG. 7A is a cross-sectional view taken along section line 7A-7A of FIG. 7;
FIG. 7B is a cross-sectional view of the blade n.~.nbel and clarnp of an altPrnqt~ embodimpnt of the ultlasonic tissue dic~ctor;
lS FIG. 7C is a cross-sectional view of the distal end of another alternate embodimPnt of the ultrasonic tissue disse~;lur FIG. 8 is a side cross-sectionql view of the proximal end of the ulllasonic tissue dicc~ctor of FIG. 6 shown in the clq nped position;
FIG. 9 is a cross-sectionql view of the distal end of the ultrasonic tissue dicsector of FlG. 6 shown in the clqmped position;
FlG. 9A is a cross-~ctionql view taken along section line 9A-9A of FIG. 9;
FIG. 10 is a partial cross-sectionql view showing the ul~l~ sonic tissue dissector poc;tio~pd in a trocar cqnn~lq.

FIG. 11 is a p~.sye~liv~ view of an ~Ite~ tP embodimen~ of the ulllasonic ~i~cec~ion and co~ ion system with the ul~sollic u~ elll inserted partially through a cannula assembly;
FIG. 12 is a pe~ e view of the ultrasonic h~ lllelll of FIG. 11;
SFIG. 13 is a p.,.~cli~e view with parts sel)ala~d of the clamp of FIG. 11;
FIG. 14 is a pc.~e~ e view with parts separated of the elongated body portion of the ul~lasonic h~llull.c.lt of FIG. 11;
FIG. 15 is a p~.~cli~l~. view with parts separated of the handle 10assembly of the ultrasonic hbllulllel t of FIG. 11;
FIG. 16 is a p ~l~c(;./e view with parts separated of the rotation assembly of the ullr~sonic il~llulllent of FIG. 11;
FIG. 17 is a side partial cutaway view of the ultrasonic in~llun~.ll of FIG. 11 in the open position;
15FIG. 18 is an enlarged view of the inrlic~tçd area of detail of FIG. 17 illll~lldtillg the clamp in the open position;
FIG. 19 is a ~.~l ecti-/e view of the distal end of the elongated body portion of the UllldSOlllC il~llUIne-lt of FIG. Il with the clarnp in the open position;
FIG. 20 is a ~.~ec,ti~e partial cutaway view of the distal end of the 20elongated body portion of the ullldsollic ir~l.ulu~.lt of FIG. 11 with the clarnp in the open posltlon;
FIG. 21 is a front elevational view taken along line 21-21 of FIG. 18;
FIG. 22 is a side partial ~;uLdwdy view of the ultrasonic u~llulue~lt of FIG. 11 with the clamp in the cl~nlred (closed) poci~ion;
25FIG. 23 is an enlarged view of the in~ir~tçd area of detail of FIG. 22 illustrating the clamp in the closed position;

FIG.24 is a side cross seclion~l view of the distal end of the elongated body portion of the UllraSOniC in~llun,e.ll of FIG.11 in the cl~rnped position;
FIG.25 is a pel~ulive view of the ull.asor~ic h~ elll of FlG.11 with the elonga~d body portion partially rotated;
S FIG.26 is â side p~r~pe~ e view of another alte~rn~t~ embodimen~ of the ullràsonic il~l,u...enl in the open position;
FIG.27 is a pel~clive view of the elongated body portion of the ultrasonic insl.L~ nl shown in FIG.26;
FIG.28A is a side pe.~,~Live view of the clarnp of the ul~.asonic 10in~l-ull~nt shown in FIG.26;
FIG.28B is a side pel~cli~re view of the tissue contact surface of the clamp shown in FIG.28A;
FIG.28C is a side ~l~ e view of the distal end of the elonga~d body portion of the UlllaSOnlC il~l~ume~lt shown in FIG.26;
FIG.29 is a side p.,.~l;ve view of the elong?~ed body portion and rotation assembly of the ull.asol.ic il~l.ulll~,lll shown in FIG.26;
F M.30 is a side ~ I;ve view of the handle assembly and nc.l~lce[ assembly of the Ulllasolllc h~ttu~lelll shown in FIG.26;
FIG.31 is a side partial cross-secti~r~l view of the UlllaSOlllC
i~l.~nelll shown in FIG.26 in the open position;
FIG.31A is an enlarged pel~ti~le view of a C-clip locator for the vibration coupler;
FIG.32 is an enlarged view of the in-lica~ed area of detail of FIG.31 illustrating the clamp in the open position;
FIG.33 is a side pc ~c(;ve view of the distal end of the elongated body portion of the ultrasonic h~ ...el.~ shown in FIG.33;

FIG. 34 is a side p~ iYe, partial cutaway view of the distal end of the elongated body portion of the ullrasonic h~lrulllel~ shown in FIG. 33;
FIG. 35 is a side partial cross-sectior-ql view of the ulll~sonic c~t of FIG. 26 in the closed position;
S FIG. 36 is an enlarged view of the in~ ,q,ted area of detail of FIG. 35 illustrating the clarnp in the closed position;
FIG. 37 is a side cross-sectionql view of an alternate embodim~nt of the ulllasonic lr~ d~fer of FIG. 11;
FIG. 38A is a side view of a torque wrench assembly in en~ag~m~nt with the ultrasonic trS,n~c~r of FIG. 37A;
FIG. 38B is a side cross-sectional view taken along section line 38B-38B of FIG. 37;
Fig. 38C is a pe~ e view of the cam member of the torque wrench assembly shown in Fig. 38B; and Fig. 38D is a ~~ ire view of the driver member of the torque wrench assembly shown in Fig. 38B.

DETAILED D~ SCRIPTION OF T~ pR~.RR~n EMBODIM~TS
~l~r~.l.,d embodim~ntc of the plc~ lly disclosed ulll~ sonic ~licc~ction and coagulation system will now be desc.ibed in detail with lcf~lc.~ce to the drawings, in which like lcr,.ence numerals ~esienqt~ identicql or col,~l,onding rl~-.. - nl5 in each of the several views.
FIGS. 1-5 illustrate one embo~im~nt of the plesell~ly disclosed ull~asoluc tissue dissector shown generally as 10 in FIG. 1. Briefly, ul~lasonic tissue ~icsector 10 in~ des a handle assembly 12 inrlu-ling a movable handle rn~mher 14and a st~ionqry gripping lll.,nlbeA 16. A housing portion 18 is integrally formed with the stationary gripping member 16. Preferably, housing portion 18 and stationaryglipping .~ kr 16 are monr)lithirqlly constructed from two molded section~. A
generally cylindrical elon, ~ body portion 20 extends from the handle assembly 12 and is provided with an open distal end 22.
Referring to FIGS. 2-3, a ll.~nc hlcer 24 is ~ o.~d within housing portion 18 on support mr~hçrs 23 and is adapted to be COl n~ d to an ulllasollicge~ alor 25 (shown srkr-~ ;rally) via a power cable 26. A vibration coupler or horn 28 is positionpd in engAgPmen~ with trLq-nC~1vrer 24 and extends through elongated body portion 20. The vibration coupler 28 inrlw1es a tapered section 28a which is fixedly con~ cted at its distal end to a blade member 30 having a cutting surface 32.
The blade Ill,.ll~[ 30 extends from open distal end 22 of elongated body portion 20.
~l~rnqt~ly, the blade .lle~llber 30 and the vibration coupler 28 may be integrally co~ led. Blade me.llber 30 has a straight cutting surface 32 angled away from the longitv~inql axis of the couplcr 28 (and elon~q-ted body portion 20) such that cutting surface 32 forrns an obtuse angle with the transverse axis Y of the elongated body portion 20. T.ar~ e axis Y is also parallel to the transverse axis R of the vibration coupler 28. As shown in the ill~ A e-~.hod;..~ , the cutting surface 32 is angled downwardly and outwardly away from the central longihl~linql axis of elong~t.,d body portion 20 and away from the clamp and aetuqtion rod 34. Cutting surface 32 further defines a fixed acute angle e with respect to the lon~itu~inql axis of the elongatc~
body portion 20, which preferably ranges from about 15 degrees to about 70 degrees.
A base portion 33 of blade 30 a~ cent cutting surface 32 has a radius of curvature definiT~ a smooth surface to prevent inadvertent damage to tissue or organs at asurgical site. The base portion 33 should not extend below the outer surface of elongated body portion 20 to facilit~te passage through a cannula during an en~oscopic l rùced,l~e. Prefcrably, the base ponion 33 extends outwardly to a position aligned with the u,~tl -~no~ t- r of the vibration coupler 28.
FIG. 3A illu~lldt~,s a cross se~-linn~l view of the blade showing the blade having a generally planar cuKing surface 32. FIG. 3B illustrates an qlt~rnqt, PmhoAimPnt of the blade in which blade 30a has a top section having a triangularcross-section. Top walls 30b of blade 30a coll~.,.b_ toward a linear edge which defines the cutting surface 32a. Alternately, a series of linear edges may be provided to define the cutting surface.
Referring to FIGS. 2 and 3, ullracollic ge.~ lor 25 supplies elc~ al energy having ultrasonic f~lu.,-lcy to the (~nCrhlc~r 24 tO cause oscillqtion of the Ll n~Ju~cr 24 in a known manner. The llwncd"cer 24, which may be one of a variety of elec~lo~ ch~ 2l types, e.g~, electrodynamic, p,~lecl~ic, magnPIosni~h~_~ is con~ct~d in end-to-end relation with the vibration coupler 28 to cause oSc-~ nn of the vibration coupler and coll-,spo~ ing oscillo~inn of angled blade Illc,l~. 30.
An a~:lualiOn rod 34 has a proximal end movably sul)polt~ within housing portion 18. The ~ctll~q~i~n rod 34 extends through elongated body portion 20 and in~h~les a distal end pos;~ion~d :~dj~Pnt the distal end of elongated body portion 20. Preferably, actv~ion rod 34 and vibration coupler 28 are supported within body portion 20 by support spacers 36, although any conve.diGIlal support structure which allows for linear movement of the ac~ inn rod may be used. Support spacers 36 are po~;tion~d at each end of vibration coupler 28 and actl~ on rod 34 ~ e~t a node on the ~ lion coupler 28. Ad~itinn~l spacers 36 can also be provided and posi~io a~lj~Pnt other nodes on the vibration coupler 28. A clamp 38 having a clamping surface 40 is co~ t~ ~ to the distal end of the actnqtinn rod 34 by a pivot pin 42.
The clamp 38 also is pivotably connPcted to the distal end of elongated body portion 20 by a pivot pin 44 and is po~itionPd adjacent to the blade 30 such that upon linear adv~n~ of N~ qti~n rod 34, clamp surface 40 is moved into juA~sed aliEnm~o~t with cutting surface 32. Due to the angle of the clamp surface 40 andcutting surface 32, tissue is pulled proximally towards the cutting surface 32 when rlqmI~ed S The proximal end of the ar~a~ion rod 34 is frictionally received in a slidable coupling 46 position~d within the housing portion 18. Coupling 46 is -iclcd to linear movement by walls 48 of housing portion 18. Movable handle 14 is ope.ably co~ ~t~d to coupli~ 46 by link 50 which is pivohbly conn~t~l at one end to coupling 46 by pin 52 and pivotably COl~K~.t d at its ol)~Q~ile end to movable handle 14 by pin 54. Movable handle 14 is pivohbly co~n~tPd to housing portion 18 by pivot pin 56. A biasing ~ -b.,r 58 is po~;l;ol~fd within the housing to bias movable handle 14 dishlly (C~ullt~ .cloc~wise) to thereby mqint~in coupling 46 P.OAin.allY within housing portion 18 and mqint~in actn~qtjo~ rod 34 in a lctlaclcd position. When nc~qtil~n rod 34 is in the lCtla t,d position, clamp 38 is in an open position (see Fig. 3). Al'- -~t~ly, the clamp 38 can be biased to a clamping (closed) position.
In use, ulllasonic tissue ~ seclor 10 is grasped about the handle assembly 12 and moved to position the cutting surface 32 a~ljacen~ tissue 62 to be d andlor cca~l~te~l (See FIG. 3A). Because the movable handle 14 in the illnctrat~od embo~1im~nt is biased by biasing r.. ~,.. ~er 58 to the open position, ull~a;,onic tissue dksrctol 10 can be pOc;~ )~ without ope,~tion of movable handle 14.
Referring now to FIGS. 4 and 5, after ultrasonic tissue ~ics~ r 10 is plop.,.ly positionPd about body tissue 62, movable handle 14 is pivoted in a clockwise direction, as in~ir~ted by arrow "A" in FIG. 4, to advance slidable coupling 46 distally, via link 50. Movement of coupling 46 advances actuation rod 34 distally, as in~ik- ~ by arrow "B" in FIG. 5, to pivot clamp 38 clockwise about pivot pin 44 and clamp tissue 62 between cutting surface 32 and clamping surface 40. See FIG. 5A.The ul~racQ~ir gel~.at~3r may now be en~ i~d to cause linear osc~ ion of blade 30 with respect to clamp 38 to effect ~iccectiQn and/or cQaeul~tion of tissue 62.
FIGS. 6-9 illustrate an altPrn~t~ embodiment of the plese.,lly dicrlos~pd ulL~aSOlliC tissue ~licsector shown generally in FIG. 6 as 100. Referring to FIGS. 6 and 7, ultrasonic tissue rliccPctor 100 inrlv~l~Ps a handle assembly 112 inrlu~li~ a movable handle 114 and St~~ion~ry y,lilJphlg member 116. A housing portion 118 is integrally formed with the stationary glipping l~l....ber 116. Preferably, housing portion 118 and stationary g,ip~iag mPmher 116 are monolithir~lly constructed from two molded sections. A generally cylindrical e4ng~ted body portion 120 extends from the handle assembly 112 and is provided with an open distal end 122.
As illll5tratPd in FIGS. 6 and 7, a ~ c-]uccr 124 is ~u~Olhd within housing 118 on support lllC,~ 123 and is adapted to be conn~ed to an ulL,dsonic gene.ator (not shown) via a power cable 126. Vibration coupler 128 is positionPd in engage-~ with tranC~Iur~r 124 and extends through elongated body portion 120.
The vibration coupler 128 inrl~ es a tapered section 128a which is fixedly connF~t~d at its distal end to a blade l"~.n~r 130 having a cutting surface 132. Blade ~ ub~ r 130 extends from open distal end 122 of elong~ed body portion 120. Alternately, blade lll.,.llber 130 and vibration coupler 128 may be integrally cor~lluct~. Blade lllC.ll~. 130 has a generally straight cutting surface 132 which is angled away from the longih~Ain~l axis of the coupler 128 and elong~ted body portion 120 such that cutting surface 132 forms an obtuse angle with respect to a transverse axis Y of the elong~t~d body portion 120. Tldns~.se axis Y is also parallel to the transverse a~is R of the vibration coupler 28. As shown in the illustrated embo~lim~nt, the cutting surface 132 is angled downwardly and outwardly away from the central lor~

axis of elongated body portion 120 and;away from the clamp and clamp ar~ n rod 134. Cutting surface 132 defines a fixed acute angle e, with respect to the lon~ihldinql axis of elongated body portion 120 pl~fe.ably, from about 15 degrees to about 70 degrees. A base portion 133 of blade 130 adj~enr cutting surface 132 has a radius of curvature defming a smooth surface which pie~e.. l~ inad~ t~"ll damage to tissue or organs at a surgical site. Base portion 133 should not extend below the outer surface of elongqt~Pd body portion 120 to f~ilitqtP passage through a cannula during an endoscopic plOCedlll~;. Preferably, base portion 133 extends outwardb a ~lictqnl~e aligned with the ou~Prmost diqmpter of the vibration coupler 128.
FIG. 7A illustrates a cross-secti~ ql view of the blade showing the blade having a generally planar cutting surface 132. FIG. 7B illustrates an ~It~Prn~~
embodimPnt of the blade in which the blade 130a has a top section having a triangular cross-section. Top walls 130b of the blade 130a converge toward a linear edge which defines the cutting surface 132a. ~lt~rn~o'y, a series of linear edges may be provided to define the cutting surface.
FIG. 7C ill~s~ra~l~s a side cross-secriQnql view of another alt~rn~
embodimPnr of the blade. Blade 130b has a first surface 131b parallel to the lonvih~rlinql axis of the vibration coupler 128b (and body portion 120b). A straight cutting surface 132b is angled away from the lon~ih~ l axis of the coupler 128b (and elongated body portion 120b) such that cutting surface 132b forrns an obtuse angle with the tra~sverse axis Y of the elongated body portion 120. Blade 130b tapers in ~ L",5c toward its distal end. ~lrhough shown in conj~n~tion with linearly movable clamp 138b, blade 130b, altc.~ ly, may be used in conju~ inn with a pivotable clamp.
Referring again to FIGS. 6 and 7, an ~c~ ~tion rod 134 has a proximal end movably s.lp~o.t,d within housing portion 118. The lrtu~tion rod 134 extends through elongated body portion 120 and i~ludPs a distal end positionPd a~j~ent the distal end of elol~t;at~ body portion 120. Preferably, ~.;lngt;nn rod 134 and vil.~alion coupler 128 are ~lppu.led within body portion 120 by support spacers 136, ql~hnugh any conventional support structure which allows for linear movement of the ach~qtio~
rod may be used. Support spacers 136 are pos;'ionPd at each end of the vibrationcoupler 128 and ~tuqtion rod 134 a;ljacen~ a node on the vibration coupler 128.
~d~lition~l spacers can also be plo~ided and posilioned a~ljacen~ other nodes. Aclamp 138 is col~n~ct~.d to the distal end of t_e actvqtion rod 134 and jnrh~Ps clamp surface 140 which is parallel to and faces cutting edge 132 of blade nl~ 130.
The clamp 138 is movable with respect to the blade lll.,.ll~r 130 from an open position to a cl~mpPd position to capture tissue ~t~.,en the cutting edge 132 and the clamp surface 140. In the clqnlped position, cutting edge 132 and clarnp surface 140 are in ju~lapGsed qligTlmPn- ~ltP~tply~ clamp 138 may be formed integrally with the ~n~qti. n rod 134 and rnay have a smooth texture, although a knurled or ribbed surface may be provided to fyq~ilitqte ~las~ing of tissue or to enhqn~e coa~Jlq~ion.
Due to the angle of the clamp surface 140 and cutting surface 132, tissue is pulled proximally towards the cutting surface 132 when clq~nped.
The proximal end of the ~ct~ on rod 134 is frictionally received in a slidable coupling 146 positi~npd within the housing portion 118. The coupling 146 is l~,sl,i.;tcd to linear movement by walls 148 of housing portion 118. Movable handle 114 is operably connf~t~d to slidable coupling 146 by a link 150 which is pivotably colul~;ted at one end to the coupling 146 by pin 152 and pivotably conncclcd at its opposite end to movable handle 114 by pin 154. Movable handle 114 is pivotably connr~-~ed to housing portion 118 by pivot pin 156. A biasing member 158 is positioned within housing portion 118 to bias the movable handle 114 distally tothereby mqintqin coupling 146 distally within housing portion 118 and mqintqin actuation rod 134 in a distal position. When ar~lqtinn rod 134 is in its distal position, clamping surface 140 is spaced from cutting surface 132 to define the open position of the ullrasonic tissue dissector 100. Alternately, the clamp member can be biased to an open posltion.
In use, ultrasonic tissue dicsec~or 100 is grasped about the handle assembly 112 and moved to position the cutting surface 132 a~j~cert body tissue 162 to be ~licsected and/or coagulated (See FIGS. 7 and 7A). Because the movable handle in the illu~lLdt~d emhodimPnt is biased by biasing ule~ 158 to the open position, the clarnp is in the distal position and ullLasonic tissue dis~lor 100 can be positio about tissue without operation of movable handle 14.
Referring now to FIGS. 8 and 9, after ull[aso"ic tissue dissecLor 100 is properly po~;l;o~ about body tissue 162, movable handle 114 is pivoted in a clockwise direction, as in~lic~te~ by arrow "C" in FIG. 8 to move slidable coupling 146, via link 150, proximal!y within housing portion 118. Movement of courlin~ 146 moves actuqtinn rod 134 p~i,llally as inrli-~ted by arrow "D" in FIG. 9 to move clamping surface 140 into alienm~nt with cutting surface 132 to clarnp tissue 162 the.el~t~ n. The ullr~sonic gene,dLor may now be el~lgiL~,d to cause linear oscillqti~n of blade 130 with respect to clarnp 138 to effect ~licsection and/orco~ on of tissue 162.
FIG. 10 i~ stratçs endoscopic use of the ull,~.soruc tissue ~licsector. As shown, ullLdsonic tissue dicsector 10 (or alternately AiC~ctor 100) is inserted through body tissue 170 via cannula 198 into cavity 172 to access tissue.
FIG. 11 i~ ctrqtf~s another alternate embo~lim~r~t of Lhe ult,dsonic h~tlu,l,e,ll in conjul~liol with an ult~dsonic ~icsection and coagulation system shown generally as 200. Briefly, dics~l;orl and coagulation system 200 innludes llitracQnin il~llulllc"t 212, control module 214, and remote actuator 216. Control module 214 is operatively co~ F~t~l to ulll~soluc inC~nlmPnt 212 by cleclu;cally colhlu~;live cable 218 and rU~ ;nn~ to control the power and frequency of current su~pli~ to ulll~so.uc ,enl 212. Any suitable controller capable of delivering power to ultrasonic il~hu"lelll 212 can be used. Control module 214 does not form part of the invention and will not be further ~licclosed herein. Remote actuator 216, e.g., pedal actuator, is operatively co~ t~d to control module 214 by ele~l,ically con.l~ h,_ cable 220 and can be ae~l~qt~ to initiate the supply of power to ultrasonic instrument 212 via control module 214 to effect vibratory motion of ullla~oluc il~tlu~llent 212 to cut and coagulate tissue.
As illustrated in FIG. 12, ulll~sonic h~l~ne~ll 212 i~rllldes housing 222 and elo~,q-'ed body portion 224 elt~ n~ distally ~Il.,rtrl~n.. Housing 222 is preferably formed from molded housing half-sections 222a and 222b and inrl~ldes a barrel portion 226 having a lor~ihlrlinql axis aligned with the longih~inql a~is of body portion 224 and a st~ qry handle portion 228 eYter~i~ obliquely from barrelportion 226. Ultrasonic tr~n~lucer 230 is ~,",po.t d within and extends &om the proximal end of housing 222 and is col~n~ to control module 214 via cable 218.
Jaw assembly 232 is dispGs~d a~ljrent the distal end of clong~t d body portion 224 and is act~)~tPd by moving movable handle 236 with respect to st~tir)n~ry handleportion 228. Movable handle 236 and $l-tiOIu~.y handle portion 228 include o~nings 238 and 240, re~ ely, to f~ it~te gli~ing and actuation of ultrasonic ins~ .ellt212. Elongated body portion 224 is ~.-p~oit~ within rotatable knob 234 and may be selectively rotated by rotating knob 234 with respect to housing 222 to change the oriPnt~tion of jaw assembly 232.
FIGS. 13 and 14 illustrate elongated body portion 224 with parts separated. Elongated body portion 224 in~ des an outer tube 242 which is preferably cylindrical and has a pro~i"lally located annular flange 244 dimPn~ n~l to engage rotdhble knob 234 (FIG. 12) as described below. An elong~çd a~;luator tube 246, which is also preferably cylindrical, is Co~r~ d to be slidably received within outer tube 242 and inrl~ s a proximally located annular flange 248 di...~n~ioned to engage coupling ,n~.n~el 298 (FIG. lS) which is ~ tl,d within housing 222 (FIG. 12) andwill be desclibed in detail below. Vibration coupler 250 is rlim~ncionPd to extend through elongated actuator tube 246 and i~ des a proxirnal end 252 having a reduced ~ F trl portion 254 configured to operatively engage ultrasonic tranC~ucer 230 and a distal end 256 adapted to be operatively connPctçd to cutting jaw 258. A
plurality of silicon rings 251 can be molded or oth.,.wise ?tl~hPd to the nodal points along vibl~tion coupler 250 to seal flow of fluids, e.g., inc~lffl~-ion gas, etc., from b~ ,.,n vibration coupler 250 and actuator tube 246. Preferably, cutting jaw 258inrlud~Ps a proximal threaded e~tPncion which is d;~f ~ on~d to be received within ,aded distal end 256 of vibration coupler 250. ~l~rn~ ly, cutting jaw 258 can beformed jnt~grally with vibration coupler 2S0, or other a~t~-~h~Fll~ devices can be used.
A clamp 260 having a clamp body 262 and a tissue contact member 264 removably secured to clamF body 262 is operatively connected to the distal end of a.-Ludtor tube 246. Tissue contact member 264 is preferably co,~lposed of teflon and is preferably removably faetenPd to clamp body 262 by a tongue and groove faste~ing assembly (lef,.. ,nce numerals 261 and 265, le~pe~ ely), ~lthou~h other f~ ni~
~ssPmh!ips are also envisioned. Tissue contact r..ell.ber 264 filnrtionc to isolate clamp 260 which is preferably metallic from jaw 258, which is also preferably mPr~llir, to prevent metal to metal contact. Tissue contact member 264 also functions to griptissue positionPd ~t~een clamp 260 and blade surface 259 of cutting jaw 258 to prevent the tissue from moving with cutting jaw 258 during vibration. Pivot ulc.(pins) 266 located at the proxirnal end of clamp hody 262 are configured to be received within open-~g~ 268 formed in the distal end of outer tube 242. A guide slot 270 formed in the distal end of achuator tube 246 permits relative movement ~t~ n acluator tube 246 and clamp body 262 by allowing pins 266 to move in guide slot 270. A pair of ca~n~ , members 272 are also formed on clamp body 262 and are S pos;tion~d to be received within cam slots 274 forrned in the distal end of achuator hube 246. Mo~,~e.l-~.,l of actuator hube 246 and clamp 260 will be des,cribed in detail below.
Cutting jaw 258 inrhl~le5 a blade surface 259 that is angled downwardly towards its distal end to define a fLxed acute angle e of from about 10 degrees to about 20 degrees with respect to the lor~ih~inql axis of the elongated body portion 224 and to the axis of vibration. Angled blade surface 259 provides good visibility at the surgical site. Preferably, angle ~3 is about 12 degrees. It is also contemplated that greater angles can be utilized such as 20 to 30 degrees. Clamp 260 is movable from an open position in which tissue contact lu~,n~r 264 is spaced from blade surface 259 (FIGS. 17 and 18) to a c1qmpe(1 position in which tissue contact mem~r 264 is in j~l p o~d close alienmPn~ with blade surface 259 (FIGS. 12 and 13). Inthe clqmred position, note the positioni~ of tissue contact member 264 with respect to blade surface 259. Artuation of the clamp 260 from the open position to the c!~mred position will be described in detail below.
Referring now to FIGS. 15 and 16, the handle assembly and the rotation assembly will now be ~iccussecl- Housing half-sections 222a and 222b define a chqmher 276 configured to receive a portion of ultrasonic L,anc~ c~r 230. ~hqmher 276 has an opening 278 comm~nirvqti~ with the interior of housing 222. Ultrasonic trancducer 230 ir~rludes a bore 280 configl~red to receive proximal end 254 of vibration coupler 250. In the asie.. lbled con~i~ion~ proximal end 254 extends through opening 278 into bore 280. Movable handle 236 is pivotally co~ echd bc~.ee housing half se.,lions 222a and 222b about pivot pin 282 which extends through holes 284 formed in legs 286 of movable handle 236. A cam slot 288 formed in each leg 286 is co~ ,d to receive a protrusion 290 proje~;Lillg outwardly from coupling member 298.
As ~ st~ in FIG. 16, coupling member 298 operatively CQnnPc'c movable handle 236 to actuator tube 246 and is p,cre.ably formed from molded half-sections 298a and 298b to define a throughbore 300 t~imPncionpd to slidably receive the proximal end of vibration coupler 250. Coupling ..~ 298 has an iMer distally located annular groove 302 ~ n~d to receive annular flange 248 of actuator tube 246 and an outer proximally located annular groove 304. Groove 304 is pOa;~ P~I to receive an aMular rib 306 formed on the internal wall of a swivel mPmhPr 308 (FIG. 15). Swivel ",c."~r 308 is preferably formed from molded half-sections 308a and 308b and permits rotation of coupling ~ ll~r 298 relative to movable handle 236. Plul~ aiolls 290 project outwardly from sidewalls of swivel mPmbPr 308 and extend through cam slots 288 of movable handle 236.
Referring again to FIGS. 15 and 16, rotation knob 234 is preferably formed from molded half-sections 234a and 234b and includes a proximal cavity 310 for slidably sulJpGlling coupli~ l.,~ ~r 298 and a distal bore 312 dimensioned to receive outer tube 242. An annular groove 314 formed in bore 312 is positionPd to receive annular flange 244 of ûuter tube 242. The outer wall of knob 234 has a proximally located annular ring 316 ~;.n~ncj~-nrd to be rotatably received within annular slot 318 formed in opening 320 of housing 222, and a scalloped surface 322 to facilitate gli~ of rotatable knob 234. Annular ring 316 perrnits rotation of knob 234 with respect to housing 222 while pre~ellling axial movement with respect thereto. A pair of cylindrical rods 324 extend ~h.. ,en half-sections 234a and 234b through a l~ r opening 326 formed in coupling member 298. Rods 324 engage a pair of concave recesses 328 formed in fitting 330 which is fastened about vibration coupler 250, such that rotation of knob 234 causes rotation of vibration coupler 250 and thus rotation of blade 258 and clamp 260. Alternately, r~cesses 328 can be monolithically formed with vibration coupler 250.
S FIGS. 17-21 illustrate ulkdsonic in~llu~ ll 212 with clarnp 260 in the open position. The elQngat*d body 224 which inrllJdes clamp 260 and blade 258, and housing 222 which inrlvd~Ps handles 228 and 236, are pa~ g~Pd as an integral unit that Uil~ no assembly by the user prior to use, i.e., the vibration coupler 250, the clamp 260, and the blade 258 are non-det~h~bly connPct~d That is, the user needsonly to attach tr~nc~hl~P~ 230 to housing 222 to ready il~llull~ t 212 for use. In the open position, movable handle 236 is spaced l~al-.d~dly from s' ~;on~ handle portion 228 and protrusions 290 are po~;l;on~ in the lower proximal portion of cam slots 288. At the distal end of l)ll.~,cQni~ h~llulllc.lt 212, pivot mernbers 266 are posi~iorl~d near the distal end of guide slots 270 and c~mmi~ Ille.l~be.~ 272 are positioned in the upper distal portion of carn slots 274. Tissue contact member 264 of clamp 260 is spaced from blade surface 259 to define a tissue receiving area 332.
The proximal end of tissue receiving area 332 is defined by a pair of tissue receiving stops 335 which are pref~,~ably integrally formed with clamp body 262 and extendbelow blade surface 259. Preferably, the distal end of blade 258 is rounded to prevent inadvertent damage to tissue during use of ir~llunl~nl 212. Tissue contact surface 264 is also preferably formed with a concavity 261 to receive tissue therein.
Alternatively, the distal end of blade 258 may be formed having any shape which may be suitable to a particular surgical application, i.e., flat, po ~ ~, etc. Moreover, tissue contact surface 264 need not be for ned with a concavity but may be flat,angled, etc.

- 19- .

Referring to FIGS. 22-24, when movable handle 236 is pivoted clockwise about pivot n~ ber 282 towards stationqry handle portion 228, in the direction indicated by arrow "A" in FIG. 22, c_m slot 288 engages protrusion 290 of swivel llh.nber 308 to advance coupling ~--e.--~. 298 distally within cavity 310 of rotation knob 234. Since actuator tube 246 is attPc~ Pd to coupling member 298 by aMular flange 248, actuator tube 246 is also advanced distally in the direction in lica~çd by arrow "B'' in FIG. 23. Movement of actuator tube 246 distally causes cam slots 274 to move into c ~g~ with c~ in~ members 272 to pivot clamp body 262 about pivot ~ be,~ 266, in the direction inAirated by arrow "C" in FIG.23, to move clamp member 262 and tissue contact member 264 into the cl~rnpPd position. In the c~ ped position, protrusions 290 are located in a central portion of cam slots 288, pivot ~ 266 are located near the proximal end of guide slots 270, and c~nmin~ m.~mher.c 272 are located in the proximal lower portion of cam slots 274.
Elongated body portion 224 can be freely rotated with respect to housing 222 by rotating rotation knob 234. As i~ ctratPd in FIG. 25, rotation ofknob 234 in the direction inAic~t~Pd by arrow "D" causes rotation of jaw assembly 232 in the direction in~ at~d by arrow "E". Knob 234 is positinnPd adj~ce~t housing 222 to facilit~ one handed operation of both movable handle 236 and rotation knob 234.
Referring again to FIG. 11, elongated body portion 224 is d;~ io~d to extend through a trocar assembly 340, and is preferably du..~r-cjon~d to extend through a 5mm trocar assembly. During use, elongated body portion 224 is slid through trocar assembly 340 with jaw assembly 232 in the cl~fnped or closed position to a position ~dj~cent to tissue (not shown) to be diCc~Pctpd and/or coag~ tPcl An optical unit (not shown) can also be positioned adj Ic~nt the surgical site to facilitate viewing of the pluce~ e. Jaw assembly 232 is opened and tissue to be dis~cc~ d and/or coagul~'ed is positinnPd within tissue receiving area 332 (See also FIG. 19).
Tissue receiving stops 335 prevent tissue from moving past the proximal end of blade surface 259. Next, jaw assembly 232 is closed to clamp tissue between tissue contact l.,el,l~r 264 and blade surface 259. Power is supplied to ullldsollic instrument 212 via control module 214 to initiate vibration of blade 258 to effect dic~l;oll and coagulation of tissue. Because of the angle of blade surface 259, the contact p~ 5 applied by blade surface 259 on the tissue being ~iiccectPd is incleased as the force applied to i~ ulll~ l 212 is incl~ai~,d. It is noted that after use, i~ L,ne,ll 212 can be autoclaved and used again.
FIG. 26 illustrates another alternate embodimPn~ of the ultrasonic instrument, shown generally as 412. UltlaSOniC illsl,.~.,.ent 412 inrlur~Pc housing 422 and elon~,q-t~Pd body portion 424 c-~- ndi~ distally from housing 422. Housing 422 is preferably formed from molded housing half-sections 422a and 422b and inrlll~es a barrel portion 426 having a lon~it~ nql axis aligned with the lon~it~ inql axis of body portion 424 and a st-~ionqry handle portion 428 e~tP~in~ obliquely &om barrel portion 426. Ulllasonic lliln~ cer 430 is ~-ppol~d within and extends from the PrOAiIIIaI end of housing 422 and inrludes a proximal fluted portion 431 configured to engage an ~ 'h.~ device to facilihte qll,~h.~.~..l and removal of ll,.ns~ cer 430 from il~lr~llcnt 412. Jaw assembly 432 is di~,o~ ~jacent the dishl end of elongated body portion 424 and is ~nl-q-~ecl by moving movable handle 436 with respect to stqtinnqry handle portion 428. Movable handle 436 and shtionary handle portion 428 include openi,l5s 438 and 440, l~s~ ly~ to f;~cilitq-t~ glil.ping and actuation of llll.ACOI~ lsl~uln.,nl 412. FlQnga~d body portion 424 is ~.lp~.t~
within rotahble knob 434 and may be selectively rohted by rotating knob 434 withrespect to housing 422 to change the orientation of jaw assembly 432.

FIG. 27 ill--strates elongated body portion 424 with parts separated.
Elongated body portion 424 inrhldes an outer tube 442 which is plefelably cylindrical and has a p~ ally located aMular flange 444 tlimPnciQ~pd to engaBe rotatable knob 434 (FIG. 26). An elongPted actuator tube 446, which is also preferably cylindrical, S is configured to be slidably received within outer tube 442 and inrl~ldes a proxi nally located annular flange 448 d;~ n~ onrd to engage coupling member 498 (FIG. 29) which is ~ul~polted within housing 422 (FIG. 26). .Althmlgh not shown, it is co~ lated that a portion of actuator tube 446 and a portion of outer tube 442 adj~cent flange 444 flares outwardly to provide additional clearance for vibration coupler 450. Vibration coupler 450 is d;.. -rn~:onrd to extend through elongated a~;~uatol tube 446 and inrl~des an enlarged proximal end 452 having a bore (not shown) configured to operatively engage ultrasonic tran~ducer 430. The distal end of ac~u&tor tube 446 inrl--des a pair of resilient arms 453 having distally locatedopenings 455. The oper~ s 455 are dimprcioned to receive protrusions 461 forrnedon an adaptor 457. Arms 453 are flexible outwardly and engage adaptor 457.
Cutting jaw 458 is monolithically formed with vibration coupler 450. Alternately, cutting jaw 458 and vibration coupler 450 can be forrned separately and f~s'enPdtogether using any known conne~-lor, e.g., screw threads, friction fit, etc. .Al~hough not shown, a plurality of sealing rings can be molded or o~ . ise at~ h~d to thenodal points along vibration coupler 450 to seal between vibration coupler 450 and actuator tube 446.
Referring also to FIGS. 28A-C, a clamp 460 is operably connected to adaptor 457. Clamp 460 preferably inrludPs a pair of loneit~din~lly eYtPn~lin~ rows of teeth 462 which are spaced from each other a ~lict~nre which permits cutting jaw 458 to be posi~ionPd between the rows of teeth 462. Teeth 462 function to grip tissue when the jaw assembly 432 is in a closed position to prevent tissue from moving with respect to cuKing jaw 458 during vibration of the cutting jaw.
Pivot members or pins 466 are formed at the proximal end of clamp 460 and are confi~lred to be received within open ended slots 468 in the distal end of outer tube 442. Slots 468 are open on one side thereof to permit clamp 460 to beretained therein. A lon~ihldinqlly e~h n~ guide slot 470 formed in adaptor 457 is dimPncion~ to slidably receive pivot pin 466 and permit relative movement bel~.~en adaptor 457 and clamp 460. A pair of c~ m~mbPrs 472 are also formed on clamp 462 and are posi~ionPd to be received in cam slots 474 formed in the adaptor 457.
Cutting jaw 458 inrl~l~les blade surface 459 which is flat and angled downwardly toward its distal end to define a fixed acute angle e of from about 10 degrees to about 20 degrees with respect to the lon~ih~linql axis of the elongated body portion 424 and to the axis of vibration. The angled blade surface provides for good visibility at the surgical site. Preferably, angle e is about 12 degrees, but greater angles such as 20 to 30 degrees are also envisioned. Alternately, blade surface 459 may be other than flat, e.g., sha.pencd, rounded, etc.
Clamp 460 is movable relative to cutting jaw 458 from an open position (FIG. 28C) in which tissue contact surface 464 of clamp 460 is spaced from bladesurface 459 to a closed or cl~ nred position (FIG. 35) in which tissue contact surface 464 is in jUA~ OSed closer ql~gnmPrl~ with blade surface 459. In the clqmped position, note the posi~ioning of tissue contact surface 464 with respect to blade surface 459. Actuation of clamp 460 from the open position to the clqmred position will be desc.il~d in detail below.
Referring to FIGS. 29 and 30, housing half-sections 422a and 422b define a chamber 476 configured to house a portion of ultrasonic tra~l~dl~cPr 430.

Chqmher 476 has an opening 478 com~ e with the interior of housing 422.
UlkaSOl~ic tran~lucer 430 inrl~es a cylindrical stem 480 configured to be r~ce;~ed in an opening in proximal end 454 of vibration coupler 450. In the assembled con~litior proximal end 454 extends through opening 478 into P~,qg~nlt~nt with cylindrical stem 480. Movable handle 436 is pivotally conn~c~d ~l~neen housing half-sections 422aand 422b about pivot pin ule.l,be.~ 482 which are monolithically forrned with housing half-sections 422a. A cam slot 488 formed in each leg 486 is configured to receive a protrusion 490 prùje-;ling outwardly from coupling lu.,.ll~r 498.
Coupling ulc.llber 498 operatively conn~cl~ movable handle 436 to actuator tube 446 and is preferably formed from molded half-sections 498a and 498b to define a throughbore 500 rl;~ ion~d to slidably receive the prùxuual end of vibration coupler 450. Coupling ln~.ll~l 498 has an inner distally located annular groove 502 ~ ol~d to receive annular flange 448 of actuator tube 446 and an outer P~OAmla11Y located aMular groove 504 po~;l;on~l to receive an annular projection 506 formed on the internal wall of swivel member 508. The pruje~;liol1 506 of swivel m~ lber 508 is movable through groove 504 to permit relative lon~ih)Ainql movement between coupling ule.ll~. 498 and swivel ule.llbe. 508. A
spring 463 is poF~ n~d between coupling member 498 and swivel ~..f-~.h ~ 508 to bias the swivel member 508 proximally with respect to coupling ~e~brl 498. Swivel member 508 is preferably formed from molded half-sections 508a and 508b and permits rotation of coupling U..,Ul~[ 498 relative to movable handle 436. Protrusions 490 project outwardly from sidewalls of swivel ulem~r 508 and extend through camslots 488 of movable handle 436.
Rotation knob 434 is preferably formed from molded half-sections 434a and 434b and inelude~ a proxitnal cavity 510 for slidably S~I~Olli.lg coupling ~~ m~r 498 and a distal bore 512 ~lim~ncion~d to receive outer tube 442. An annular groove 514 formed in bore 512 is posi~ion~d to receive aMular flange 444 of outer tube 442.
The outer wall of knob 434 has a proxi nally located annular ring 516 ~limPncioned to be rotatably received within annular slot 518 formed in housing 422, and a scalloped surface 522 to farili~qtP ~li~ing of rotatable knob 434. Annular ring 516 per nits rotation of knob 434 with respect to housing 422 while preventing axial movementwith respect thereto. A pair of rods or pins 524 extend ~Iw~en half-sections 434a and 434b through a rectqneulqr opening 526 formed in coupling ~ ber 498. Rods 524 engage a pair of flqttPnPd surfaces 528 formed on vibration coupler 450, such that rotation of knob 434 causes rotation of vibration coupler 450 and thus rotation of blade 458 and clamp 460. Alternately, to provide ~-liti~nal surface contact, instead of pins 524, a C-clip shown generally as 580 in FIG. 31A is provided. C-clip 580m~ by pins 586 has an opening 582 to receive the vibration coupler 450. The flats of vibration coupler 450 contact the four flat regions 590 of the C-clip 580.
A retainer ring (not shown) may be mounl I oo ;~s 4'~ of housing 422 (Fig. 32) to provide additional support for actuator tube 44~ . In t~liS
embodiment, tube 446 would extend proximally past ribs 492.
FIGS. 31-34 illustrate ullrdsollic i~ll~ l 412 with clamp 460 in the open position. The elongated body 424 which inrlu~es clamp 460 and blade 458, and housing 422 which inrludPs handles 428 and 436, are par~eed as an integral unit that requires no assembly by the user prior to use, i.e., vibration coupler 450, clamp 460, and blade 458 are non-~Pt~ qbly conl-rct,~d. That isl the user needs only to attach trqncducer 430 to housing 422 to ready i~ .cnl 412 for use. In the open positionmovable handle 436 is spaced lcal~.aldly from stationary handle portion 428 and protrusions 490 are positioned in the lower proximal portion of cam slots 488. At the distal end of ultrasonic il~tl,.lnelll 412, pivot members 466 are positioned near the distal end of guide slots 470 and cqmmine members 472 are positioned in the upper distal portion of cam slots 474. Tissue contact surface 464 of clamp 460 is spaced from blade surface 459 to define a tissue r.,ce;vmg area 532. The proximal end of tissue receiving area 532 is de~med by a pair of tissue receiving stops 535 which are preferably integrally formed with clamp 460 and extend below blade surface 459.
Preferably, the distal end of blade 458 is devoid of sharp edges which may causeinadvertent damage to tissue during use of ilbl~ e.~l 412. Alternately, the distal end of blade 458 may be formed having any shape which may be suitable to a particular surgical application, i.e., flat, pointed, etc.
Referring to FIGS. 35 and 36, when movable handle 436 is pivoted clockwise about pivot member 482 towards stationary handle portion 428, in the direction inAit~trd by arrow "G" in FIG. 35, cam slot 488 engages protrusion 490 of swivel member 508 to advance coupling l...,m~r 498 distally within cavity 510 ofrotation knob 434. Since actuator tube 446 is a~ Pd to coupling member 498 by annular flange 448, actuator tube 446 is also advanced distally in the directioninrlir~Pd by arrow "H" in FIG. 36. Movement of actuator tube 446 distally causescam slots 474 to move into e~agPmPn~ with c~nmin~ members 472 to pivot clamp body 462 about pivot members 466, in the direction i~ ir~ l by arrow "I" in FIG.36, to move clamp member 462 and tissue contact me.nber 464 into the clamped position. Spring 463 p~ t~ over clamping of tissue by perrni~ing relative movement ~I.. een swivel member 508 and coupling lll."ll~r 498 after a plr~ t~ d clamping pl~ has been applied against blade 458. In the cl~n pPd position, protrusions 490 are located in a central portion of cam slots 488, pivot members 466 are located near the proximal end of guide slots 470, and c~
mP~nhers 472 are located in the prv~il--al lower portion of cam slots 474.
Elongated body portion 424 can be freely rotated with respect to housing 422 by rotating rotation knob 434. Rotation of knob 434 in the direction inrlirqted by arrow "J" causes rotation of jaw assembly 432 in t-h-e direction ~ ir~tPd by arrow "K". Knob 434 is pos:~;o~ d adj~cent housing 422 to f~ it~te one handedoperation of both movable _andle 436 and rotation knob 434.
Referring now to FIG. 37, an ~l~crn,~t~ e~..h~;..,~nt of the ultrasonic ~I,.n.cd~Jcer is shown generally as 630. UlllaS~JlUC tranc~ltlc~Pr 630 inrl~ Ps a housing 631 having a proximal housing portion 632 and a distal housing portion 634.
Proximal housing portion 632 has a scalloped section 636 adjacent its p~u~ ul end and distal housing portion 634 has a radial portion 635 that extends inwardly topartially cover ~r~nC~cpr hom 638. Tr~nc~ucPr horn 638 includes a should~r portion 637 poc;l;on~d a~ n' to radial portion 635 of distal housing portion 634 to define a recess 651 for r~c~;ving a washer 639. Washer 639 ru.~clions to seal the space between radial portion 635 and tr~nc~uc~r horn 638 and, to prevent tr~ncd~lcer horn 638 from long;~ l contact with distal housing portion 634. ShouldPr portion 637 of tr~nc~1ucer horn 638 does, contact an inner wall of distal housing portion 634 to assist in m~in~ining the longitu~in~l alig11mPn~ of tranCA~cPr horn 638 within housing 631. The distal end of tPncduçer horn 638 inrlvdcs a threaded bore 644 ~ nciQ~Pdto engage a reduced ~i~m~ter portion of vibration coupler 650. A pair of spacers 640 are poc~ nPd ~t ._en tranC~ucer horn 638 and distal housing portion 634. Each spacer 640 inrllldes an aMular flange 648 which is sonically welded and herm~otic~lly sealed bel~.eel1 proximal and distal housing portions 632 and 634. The proxirnal end of each spacer 640 engages an O-ring of a pair of O-rings to coln~ s the O-rings to provide a seal between distal housing portion 634 and tranc~lcer horn 638 and toprovide radial support for trancd~lcer horn 638. The spacer O-ring co"lbh~ation further m~in-~inc tr~ncducer horn 638 in a position to c~,lnyress washer 639 in recess 641. Pi~ ek~l~ ic crystals 650 are secured in contact with the proxirnal end of tr~ncd-lcer horn 638 by a backing plate 652 and a screw (not shown) which is inserted CA 02244SlS 1998-08-OS

through an opening 656 in backing plate 652 into threaded bore 658 formed in theproximal end of tranC~v~er horn 638. Wires (not shown) from crystals 650 extend to a co~ ctor 659 which may be threadably l~cei~ed in an opening 661 in proximal housing portion 632.
S FIGS. 38A and 38B illustrate a torque wrench assembly shown generally as 670. Torque wrench assembly 670 inrlud~Pc outer housing 672 and inner drive member 674. Inner drive lll. lllbc. 674 has an opening 675 having an innersc~llopPd wall 677 collrlg.l-~d to ~..al,~gly engage scalloped section 636 of housing 631. Inner drive member 674 also inrl~ldps a proje~ lion or bump 676 (see Fig. 38D) which extends into a cylindrical recess 678 defined ~h.ee.l inner driver .n~ mber 674 and outer housing 672. A carn member 682 is positionpd within recess 678 and is m~intainPd in contact with bump 676 by a urethane ring and washer assc.,lbl~ 682.
Cam member 682 inrllld~Pc projections 685 which fit between inner ribs of outer housing 672. Cam member 682 has an end surface having a series of sloped surfaces 687 and shs~ pnc- 689 (Fig. 38C). In use, when opening 675 is slid over sc~11Oped section 636 of housing 631 and outer housing 672 of torque wrench assembly 670 is gripped and rotated, cam l.lc..lber 682 is also rotated. The sloped surfaces 687 on cam member 682 slide over bump 676 until a .~s~ sh-)uld~Pr engages bump 676, thereby rotating inner driver ,n~."ber 674 to concPql~Pntly rotate trancducer assembly 630. Inner driver 674 member will rotate with cam member 682 until the torque n~C~55~ry to rotate trancd~cPr assembly 630 with respect to the vibration coupler (not shown) exceeds the force l~.{uir~d to force the chou~ Prs 689 over bump 676.
It will be un~Pn~stood that various modifications may be made to the embollimpntc herein. For example, vibration coupler 50 and blade 58 may be 2S monolithically formed or a~t~h~d using sllu~ ul~ other than screw threads and the proximal end of ultrasonic trancduc~Pr 630 need not have a scalloped co~figuration but rather may be configured for engag~ t with any suitable torque wrench assembly. Further, the elQngate~l body portion of the device need not be ~lim~nciQn~d eo extend through a 5nun trocar assembly, but rather may be dim~ncioned to extend through any size trocar assembly, e.g., lOmm, 12mm, etc. Therefore, the above S description should not be corL,l,-,ed as limiting, but merely as exemplifi~ ionc Of p.cirelled embo~im~ontc. Those skilled in the art will envision other ms)difir~ionc within the scope and spirit of the claims a~ cl hereto.

Claims (63)

1. A surgical instrument for cutting body tissue comprising:
a) a vibration coupler adapted to be operably connected to an ultrasonic generator and having a longitudinal axis; and b) a blade member extending from a distal end portion of the vibration coupler, the blade member having a longitudinal axis generally aligned with the longitudinal axis of the vibration coupler and having a generally straight cutting surface forming an acute angle with respect to the longitudinal axis of the vibration coupler and forming an obtuse angle with respect to an axis perpendicular to a longitudinal axis of the vibration coupler.

2. A surgical instrument according to claim 1, further including a clamp member, the clamp member being movable from an open position spaced further from the cutting surface to a clamped position to capture tissue between the clamp and the cutting surface.

3. A surgical instrument according to claim 2, wherein the clamp member has a clamping surface, said clamping surface being parallel to the cutting surface when the clamp member is moved to the clamped position.

4. A surgical instrument according to claim 1, wherein the angle of the of the cutting surface with respect to the longitudinal axis of the vibration coupler is from about 30 degrees to about 70 degrees.

5. A surgical instrument according to claim 2, wherein the clamp member is moved linearly from the open position to the clamped position.

6. A surgical instrument according to claim 2, wherein the clamp member is pivoted from the open to the clamped position.

7. A surgical instrument according to claim 2, further including an actuation rod operably connected to the clamp member, the actuation rod being movable to move the clamp member from the open to the clamped position.

8. A surgical instrument according to claim 2, further comprising a biasing mechanism for biasing the clamp member to an open position with respect to the blade member.

9. A surgical instrument according to claim 1, wherein the cutting surface is planar.

10. A surgical instrument according to claim 1, wherein the cutting surface is linear.

11. A surgical instrument according to claim 1, wherein the blade member tapers in height towards its distal end.

12. An ultrasonic tissue dissector comprising:
a) an elongated body portion;
b) a vibration coupler adapted to be operably connected to an ultrasonic generator, the vibration coupler defining a longitudinal axis and positioned in the elongated body portion;

c) a blade member extending from a distal end portion of the vibration coupler and a clamp member positioned the blade member the blade member having a cutting surface disposed at a fixed acute angle to the longitudinal axis of the vibration coupler, the cutting surface extending downwardly and outwardly away from a central longitudinal axis of the elongated body portion and in a direction away from the clamp member in the distal direction and the clamp member having a tissue engaging surface movable between an open position spaced from the cutting surface of the blade member and a clamped position wherein the tissue engaging surface is moved toward the cutting surface.

13. An ultrasonic tissue dissector according to claim 12, further including an actuation rod operably connected to the clamp, the actuation rod being movable to move the clamp between the first and second positions.

14. An ultrasonic tissue dissector according to claim 13, wherein the clamp is moved linearly from the open to the clamped position.

15. An ultrasonic tissue dissector according to claim 13, wherein the clamp is pivoted from the open position to the clamped position.

16. An ultrasonic tissue dissector according to claim 13, further comprising a biasing mechanism for biasing the clamp member with respect to the blade member.

17. An ultrasonic tissue dissector according to claim 13, wherein the clamp is moved proximally into the clamped position.

18. An ultrasonic tissue dissector according to claim 12, wherein the cutting surface is planar.

19. A surgical instrument according to claim 12, wherein the cutting surface is linear.

20. A surgical instrument according to claim 12, further including a handle portion, the elongated body portion extending distally from the handle portion.

21. A surgical instrument according to claim 20, further including a transducer removably connected to the handle portion.

22. A surgical instrument according to claim 21, wherein the transducer includes an outer housing configured to engage a torque wrench.

23. A surgical instrument according to claim 21, wherein the transducer includes a transducer horn adapted to engage a proximal end of the vibration coupler.

24. A surgical instrument according to claim 23, wherein the transducer horn includes a threaded bore and the vibration coupler includes a threaded proximal end.

25. An ultrasonic system for dissecting tissue comprising:
a) an ultrasonic generator, b) a housing;
c) a vibration coupler operably connected to the ultrasonic generator, the vibration coupler positioned in the housing and defining a longitudinal axis and being adapted to vibrate in response to actuation of the ultrasonic generator;
d) a blade member positioned adjacent a distal end portion of the vibration coupler, the blade member having a linear cutting surface forming an obtuse angle with respect to an axis perpendicular to the longitudinal axis of the housing and the longitudinal axis of the vibration coupler and being positioned to vibrate in response to vibration of the vibration coupler; and e) a clamp positioned adjacent the blade member, the clamp having a tissue engaging surface movable between an open position spaced from the planar cutting surface of the blade member and a clamped position wherein the tissue engaging surface is moved closer to the linear cutting surface of the blade member.

26. An ultrasonic system for dissecting tissue according to claim 25, wherein the clamp is moved linearly from the open to the clamped position.

27. An ultrasonic system for dissecting tissue according to claim 25, wherein the clamp is pivoted from the open position to the clamped position.

28. An ultrasonic system for dissecting tissue according to claim 25, wherein the clamp is moved proximally into the clamped position.

29. An ultrasonic dissector according to claim 25, wherein the blade member tapers in thickness toward the distal end.

30. An ultrasonic dissector according to claim 25, wherein the cutting surface is planar.

31. An ultrasonic comprising:
a) a vibration coupler adapted to be operably connected to an ultrasonic generator and having a longitudinal axis; and b) a blade member extending from a distal end portion of the vibration coupler and having a longitudinal axis generally aligned with the longitudinal axis of the vibration coupler, the blade member having a linear cutting surface forming an acute angle .THETA. with respect to the longitudinal axis of the vibration coupler during vibration of the vibration coupler.

32. An ultrasonic instrument according to claim 31, further including a clamp member having a tissue engaging surface, the clamp member being movable from an open position in which the tissue engaging surface is spaced from the cutting surface to a clamped position in which the clamp member is in juxtaposed alignment with the blade member to capture tissue between the tissue engine surface and the cutting surface.

33. An ultrasonic instrument according to claim 32, wherein the tissue contact surface is parallel to the cutting surface when the clamp member is moved to the clamped position.

34. An ultrasonic instrument according to claim 33, wherein the tissue contact surface is removably fastened to the clamp member.

35. An ultrasonic instrument according to claim 31, wherein the angle .theta. is from about 10 degrees to about 20 degrees.

36. An ultrasonic instrument according to claim 35, wherein the angle .theta. is about 12 degrees.

37. An ultrasonic instrument according to claim 32, wherein the clamp member is pivoted from the open to the clamped position.

38. An ultrasonic instrument according to claim 31, further comprising a handle assembly and an actuator member operably connected to the handle assembly and to the clamp member, the handle assembly being movable to move the clamp member from the open position to the clamped position.

39. An ultrasonic instrument according to claim 38, wherein the clamp member includes a camming member positioned in a cam slot formed in the actuator member, the cam slot being movable relative to the camming member to pivot the clamp member between the open position and the clamped position.

40. An ultrasonic instrument according to claim 31, further comprising a rotatable collar operably associated with the vibration coupler, the clamp member, and the blade member such that rotation of the rotatable collar causes corresponding rotation of the vibration coupler, the clamp member and the blade member about the longitudinal axis of the vibration coupler.

41. An ultrasonic instrument according to claim 31, wherein the cutting surface is planar.

42. An ultrasonic instrument according to claim 32, wherein the vibration coupler, the blade member and, the clamp member are non-detachably connected and require no assembly prior to use.

43. An ultrasonic instrument according to claim 31, further including a handle portion, the vibration coupler extending distally from the handle portion.

44. An ultrasonic instrument according to claim 43, further including a transducer removably connected to the handle portion.

45. An ultrasonic instrument according to claim 44, wherein the transducer includes an outer housing configured to engage a torque wrench.

46. An ultrasonic instrument according to claim 44, wherein the transducer includes a transducer horn adapted to engage a proximal end of the vibration coupler.

47. An ultrasonic instrument according to claim 46, wherein the transducer horn includes a threaded bore and the vibration coupler includes a threaded proximal end configured to be received in the threaded bore.

48. An ultrasonic instrument comprising:
a) a handle assembly;
b) an elongated body portion extending distally from the handle assembly, the elongated body portion including 1) an outer tubular member;
2) a vibration coupler adapted to be operatively connected to an ultrasonic the vibration coupler being positioned within the outer tubular member, and 3) a blade member operatively associated with the vibration coupler, the blade member having a planar cutting surface disposed at a fixed acute angle to the longitudinal axis of the vibration coupler.

49. An ultrasonic instrument according to claim 48, wherein the elongated body portion further comprises a clamp member positioned adjacent the blade member, the clamp member having a tissue contact surface movable from an open position spaced from the cutting surface to a clamped position in juxtaposed alignment with the cutting surface to clamp tissue therebetween.

50. An ultrasonic instrument according to claim 49, wherein in the open position the clamp member and the blade member define a tissue receiving area, the clamp member having a tissue engaging member defining the proximal end of the tissue receiving area.

51. An ultrasonic instrument according to claim 50, wherein the handle assembly includes a handle movable between first and second positions, the movable handle being operatively associated with the clamp member to move the clamp member between the open and clamped positions as the movable handle is moved between the first and second positions.

52. An ultrasonic instrument according to claim 50, further comprising a tubular actuator member having a proximal end operatively connected to the movable handle and a distal end operatively connected to the clamp member.

53. An ultrasonic instrument according to claim 48, wherein the elongated body portion is dimensioned to be received within a 5mm trocar assembly.

54. An ultrasonic instrument according to claim 49, wherein the blade member, the vibration coupler, and the clamp member are non-detachably connected and require no assembly prior to use.

55. An ultrasonic instrument according to claim 48, wherein the fixed acute angle is from about 10 to about 20 degrees.

56. An ultrasonic instrument according to claim 55, wherein the fixed acute angle is about 12 degrees.

57. An ultrasonic instrument according to claim 48, further including a transducer removably connected to the handle assembly.

58. An ultrasonic instrument according to claim 57, wherein the transducer includes an outer housing connected to be engaged by a torque wrench.

59. An ultrasonic instrument according to claim 57, wherein the transducer includes a transducer horn adapted to engage a proximal end of the vibration coupler.

60. An ultrasonic instrument according to claim 59, wherein the transducer horn includes a threaded bore and the vibration coupler includes a threaded proximal end.

61. An ultrasonic instrument according to claim 58, wherein the outer housing of the transducer is scallop-shaped.

62. An ultrasonic instrument according to claim 57, wherein the transducer includes an outer housing and a transducer horn positioned within the outer housing, the transducer further including at lest one O-ring positioned between the outer housing and the transducer horn.

63. An ultrasonic instrument according to claim 62, further including at least one spacer positioned between the outer housing and the transducer horn to urge the at least one O-ring longitudinally into the transducer horn.