CA2475737C - Tissue fusion/welder apparatus and method - Google Patents
Tissue fusion/welder apparatus and method Download PDFInfo
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- CA2475737C CA2475737C CA2475737A CA2475737A CA2475737C CA 2475737 C CA2475737 C CA 2475737C CA 2475737 A CA2475737 A CA 2475737A CA 2475737 A CA2475737 A CA 2475737A CA 2475737 C CA2475737 C CA 2475737C
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
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- 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
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- 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
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
-
- 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
- A61B18/1477—Needle-like probes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
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- 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
- A61B2018/00345—Vascular system
- A61B2018/00404—Blood vessels other than those in or around the heart
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- 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
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- 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
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/0063—Sealing
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- 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
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1412—Blade
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- 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
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
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- 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
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/143—Needle multiple needles
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- 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
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
- A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
Abstract
A tissue welding apparatus is adapted to fuse a first piece of tissue to a second piece of tissue which are disposed in a surface proximate relationship.
An elongate shaft carries a first jaw, and a second opposing jaw moveable relative to the first jaw. At least one penetrating member is carried by the first jaw and moveable relative to the second jaw to create a channel through the first piece of material and the second piece of material. A source of heat is coupled to the penetrating member for denaturing the tissue defining the channel. This denatured tissue forms a column binding the first piece of tissue to the second piece of tissue. A chemical agent can be carried to the tissue with the penetrating member.
An elongate shaft carries a first jaw, and a second opposing jaw moveable relative to the first jaw. At least one penetrating member is carried by the first jaw and moveable relative to the second jaw to create a channel through the first piece of material and the second piece of material. A source of heat is coupled to the penetrating member for denaturing the tissue defining the channel. This denatured tissue forms a column binding the first piece of tissue to the second piece of tissue. A chemical agent can be carried to the tissue with the penetrating member.
Description
TISSUE FUSIONNVELDER APPARATUS AND METHOD
Background of the Invention Surgery generally involves the cutting and fixing of tissue. The cutting is usually undertaken in one of two modalities, either cold cutting or hot cutting. Cold cutting is performed using a mechanical device such as a knife or scissors. Hot cutting involves the use of high frequency electrosurgical current, ultrasonic sound or heat. The fixation of cut tissue commonly involves the use of sutures, staples or clips. More recently, tissue adhesives have evolved as an occasional alternative.
The process of inhibiting blood flow from cut or severed tissue, commonly referred to as hemostasis, is often undertaken using power generated by an electrosurgical device. Various electrosurgical effects can be achieved, such as coagulation, fulguration and cauterization. Coagulation makes use of high frequency electrosurgical waveforms that are designed to desiccate tissue by vaporizing the cellular content and thereby restricting the flow of blood from the site. Fulguration is a form of coagulation that is more broadly applied to provide hemostasis over large areas. Cauterization is a well-known form of hemostasis and has been used for many years. A hot instrument applied to a portion of the severed or damaged tissue will normally arrest blood flow. The application of heat to the tissue fuses the cellular content and actually welds cellular content in a manner somewhat similar to metal welding.
Background of the Invention Surgery generally involves the cutting and fixing of tissue. The cutting is usually undertaken in one of two modalities, either cold cutting or hot cutting. Cold cutting is performed using a mechanical device such as a knife or scissors. Hot cutting involves the use of high frequency electrosurgical current, ultrasonic sound or heat. The fixation of cut tissue commonly involves the use of sutures, staples or clips. More recently, tissue adhesives have evolved as an occasional alternative.
The process of inhibiting blood flow from cut or severed tissue, commonly referred to as hemostasis, is often undertaken using power generated by an electrosurgical device. Various electrosurgical effects can be achieved, such as coagulation, fulguration and cauterization. Coagulation makes use of high frequency electrosurgical waveforms that are designed to desiccate tissue by vaporizing the cellular content and thereby restricting the flow of blood from the site. Fulguration is a form of coagulation that is more broadly applied to provide hemostasis over large areas. Cauterization is a well-known form of hemostasis and has been used for many years. A hot instrument applied to a portion of the severed or damaged tissue will normally arrest blood flow. The application of heat to the tissue fuses the cellular content and actually welds cellular content in a manner somewhat similar to metal welding.
Several procedures have evolved which us,e devices that provide both cutting and fixation in a single instrument. The most common of these devices comprises a surgical stapler that places two rows of titanium surgical staples and subsequently cuts the tissue between the rows. These devices are often referred to as "take-down" devices. They are used to divide body passages and provide concomitant fluid stasis.
An example of such devices is the commonly available gastro-intestinal anastamosis (GIA) type stapler. It comprises a jaw fitted with a cartridge holding four to six rows of staples in a deployable position, a hinged anvil sized and configured to deform the staples of the cartridge, and a shaft communicating with a handle held by a user. In use, the device is placed along, and compressed upon, a portion of tissue to be cut and stapled. The staples are subsequently urged through the tissue and against the anvil where they are deformed into a preferred folded-over condition. A sharp surgical blade is then moved forward between rows of staples to divide the tissue. Fluid stasis is accomplished by the overlapping rows of folded-over and compressed staples.
As one would imagine, it is not desirable to over-compress tissue or develop a condition where required nourishment to tissue is compromised. If too many staples are placed or if the staples are over-compressed, the included tissue may be deprived of nutrition and may subsequently necrose and cause serious complications. In addition, staples are typically formed of a material which is foreign to the body and may cause responses that will further complicate recovery or healing. Staples cannot be cut through or removed easily. Staples also cause problems with imaging technologies. They may show up as artifacts in MRI, CT scans and fluoroscopy.
Surgical clips are often used to occlude small vessels. They normally comprise a C-shaped metallic member that is highly compressed upon tissue. Nourishment to the residual portion of "clipped-off' tissue is completely interrupted. Even when a divided or repaired portion of tissue is sutured, special care is taken not to place the suture too tightly so that nourishment to the residual portion is interrupted.
Tissue adhesives, which provide hemostasis as well as the "gluing"
of tissue, have proven to be effective. However, they often require prior preparation from autologous materials. In addition, they do not have the full confidence of the medical community.
To avoid the complications of clips, staples, adhesives and sutures, attempts have been made to fuse or weld tissue. For instance, a vessel may be clamped tightly with a hemostat or grasper, and subsequently energized with an electrosurgical generator. This technique is commonly referred to as "buzzing the hemostat". The heat generated within the tissue may cause the proteins of the cellular content to fuse and create a fluid-tight arrangement.
This technique has proved to be relatively effective in small vessels; however, large vessels are not indicated for this approach. The relationship between the diameter of the vessel and the wall thickness has proven to be the limiting factor in tissue fusion and welding in most cases.
Hemostatic graspers are available that compress tissue and apply an electrosurgical discharge that mimics the energized hemostat.
It is the purpose of an electrosurgical generator is to supply a high voltage at a high frequency in order to produce an electric arc between an electrosurgical instrument and grounded tissue. This "electrosurgical effect"
(ESE) is especially suited to cut and coagulate tissue in a quick and effective manner. However, the ESE is not efFective to divide and provide hemostasis or fluid stasis in large vessels or conduits. While the ESE has been well adapted to seal small capillaries, it has not been effective to shut-off the fluid flow in a large conduit.
SUMMARY OF THE INVENTION
In view of the foregoing, the present invention comprises a device, and associated method, which is sized and configured to emulate the mechanical fixation of tissue. The present invention provides permanent fluid stasis in tissue by creating small, discrete tissue welds along a preferred pathway, and subsequently cutting relative to the welds. The welding or fusing of the tissue is accomplished by application of heat to selected and localized areas. In a preferred embodiment, a device according to the present invention may comprise an elongate shaft having a handle at the proximal end and a pair of jaws at the distal end. The jaws comprise a first portion having a plurality of penetrating electrodes or elements, and a second portion having an electrical contact/compression member.
With the intent of merely heating the tissue adjacent the electrodes, the jaws can be connected in an electrosurgical mono-polar, bi-polar or "quasi"
bi-polar configuration. The electrodes can also be energized with direct current or any other heating source, in order to achieve the desired heating and consequent fusing or welding of tissue.
In one aspect of the invention, the device includes a first member and a second member opposing the first member. The first member is sized and configured to push a plurality of needle electrodes or elements through the tissue, where they contact the second member thereby providing electrical continuity. Upon application of electrical or thermal energy, the tissue through which the electrodes have passed is heated to the point of desiccation and subsequent fusion of certain cellular components. The resulting fusion or weld is continuous through the layers of tissue and resembles a "rivet". A plurality of fusion "channels" arranged appropriately provides fluid stasis without the introduction of any foreign material.
In other aspects of the invention, the jaws can be provided by a hemostat; a chemical-releasing sleeve may also be employed. A device according to the present invention overcomes the limitations of existing devices by providing a multiple-use device as opposed to a single-fire or single-use device.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a laparoscopic device according to the present invention;
FIG. 2 is a perspective view of the distal portion of a laparoscopic device according to the present invention, in a closed condition with included tissue to be fused;
FIG. 3 is a perspective view of a portion of tissue that has been fused by the device of the present invention;
FIG. 4 is a perspective view of a portion of tissue that has been fused and divided by the device of the present invention;
FIG. 5A is a side elevation view of the distal portion of the device showing the electrodes and connector in a closed condition;
FIG. 5B is a side elevation view of the distal portion of the device showing the electrodes and connector in an open condition;
FIG. 5C is a side elevation view of the distal portion of the device showing electrodes and connector in an open, and tissue-receiving condition;
FIG. 5D is a side elevation view of the distal portion of the device showing the electrodes and connector in a closed, tissue-engaging condition;
FIG. 5E is a side elevation view of the distal portion of the present invention showing the electrodes and connector in an open, tissue-releasing condition;
FIG. 6A is an end elevation view of the distal portion of the device shown in Figure 5A;
FIG. 6B is an end elevation view of the distal portion of the device shown in Figure 5B;
FIG. 6C is an end elevation view of the distal portion of the device shown in Figure 5C;
FIG. 6D is an end elevation view of the distal portion of the device shown in Figure 5D;
FIG. 6E is an end elevation view of the distal portion of the device shown in Figure 5E;
FiG. 7 is a top plan view of a portion of a body conduit that has been fused using the present invention;
FIG. 8 is a top plan view of a portion of a body conduit that has been fused and divided using the present invention;
FIG. 9 is a cross section view of the fused or welded body conduit, taken along lines 9-9 of Fig 8.
FIG. 10 is an enlarged view of the cross secfiion illustrated in Fig. 9;
FIG. 11 is a perspective view of a fusion area produced by an embodiment of the present invention;
FIG. 12 is a top plan view of the fusion area shown in Fig. 11;
FIG. 13 is a top plan view similar to Fig. 8 and illustrating a nutritional pathway in a fused tissue portion;
FIG. 14 is a side elevation view of a distal jaw portion comprising a direct current power source;
FIG. 15 is a side elevation view of a distal jaw portion comprising a bi-polar electrosurgical power source;
FIG. 16 is a side elevation view of a distal jaw portion comprising a "quasi" bi-polar electrosurgical power source;
FIG. 17 is a side elevation view of the distal jaw portion comprising a direct heat source;
FIG. 18 is a side elevation view of a chemical releasing embodiment adapted for example for bonding enhancement;
g FIG. 19 is a side elevation view of a distal jaw portion configured with electrodes on both opposed jaw portions;
FIG. 20 is a side elevation view of a distal jaw portion having a mechanical cutting member;
FIG. 21 is a side elevation view of a distal jaw portion having an electrosurgical cutting member;
FIG. 22 is a side elevation view of a distal jaw portion sized and configured to fit through a small-bore cannula;
FIG. 23 is a top plan schematic view of a solid-state electronic switching arrangement for energizing the electrodes of a distal jaw portion;
FIG. 24 is a top plan schematic view of a mechanical switching arrangement for energizing the electrodes of a distal jaw portion;
FIG. 25 is a side elevation schematic view of a sequential mechanical switching arrangement for lifting and energizing the electrodes of a distal jaw portion;
FIG. 26 is a side elevation schematic view of a distal jaw portion having a permeable anvil;
FIG. 27 is a side elevation schematic view of a distal jaw portion having a sliding contact permeable anvil;
FIG. 28 is a side elevation view illustrating radio frequency electrosurgical cutting with a penetrating needle;
FIG. 29 is a side elevation view illustrating electrosurgical cutting and heating of a penetrating needle;
FIG. 30 is a side elevation view illustrating the direct heating of the penetrating needle;
FIG. 31 is a side elevation view of a hemostat having penetrating needles and being configured for operation in a mono-polar electrosurgical configuration;
FIG. 32 is a side elevation view of a hemostat having penetrating needles and being configured in a bi-polar electrosurgical configuration;
FIG. 33 is a side elevation view of a hemostat having penetrating needles and being configured in a direct heat configuration;
FIG. 34 is a side elevation view of a hemostat having penetrating needles and being configured for use with an external heat source;
FIG. 35 is a perspective view of a further embodiment of the invention having a chemical releasing sleeve;
FIG. 36 is a side elevation perspective view of a distal jaw portion arranged in a mono-polar electrosurgical configuration;
FIG. 37 is a side elevation schematic view of a distal jaw portion arranged in a bi-polar electrosurgical configuration;
FIG. 38 is a side elevation schematic view of a distal jaw portion arranged in a "quasi" bi-polar electrosurgical configuration; and FIG. 39 is a side elevation schematic view of a distal jaw portion arranged with a direct current, resistance-type configuration.
DETAILED DESCRIPTION
With reference to the drawings of Figure 1 and 2, a tissue welder 10 in one embodiment of the present invention is shown to include a handle 12, and an elongate shaft 14, and a distal portion 16. This distal portion 16 includes a pair of opposing jaws 21 and 23 which are adapted to compress tissue 18, having outer surfaces 19 that define deep inner portions 20.
In the illustrated example, the compressed tissue 18 has the configuration of a tube where one side of the tube is compressed into a surface proximate relationship with the other side of the tube in order to occlude the tube.
It will be appreciated that the invention is equally adapted to bond any two pieces of tissue disposed in a tissue proximate relationship.
One of the opposed jaws 21 is configured to have a plurality of penetrating members or needles 25. The opposite jaw 23 provides a stop or a contact member against which the penetrating members 25 can be moved.
Energy is delivered to, and through, the penetrating members 25 in such a manner that the tissue 18 contacted by each penetrating member 25 is deformed at a cellular level and fused or welded.
Operation of the tissue welder 10 can be best understood with reference to the progressive side views of Figures 5A-5E and the associated progressive end views 6A-6E, respectively.
More specifically, a portion of the tissue 18 is placed between the opposed jaws 21, 23 (Figures 5C and 6C) and lightly compressed (Figure 5D and 6D). As the compression occurs, the sharp needles 25 are urged through the compressed tissue 18 and into contact with, or in close proximity to, the opposing jaw 23. In a preferred embodiment, electrical current is introduced through the needles 25. These needles 25, in a preferred embodiment, are made from an electrically high resistance material so that the electrical current produces heat.
It follows that the tissue 18 in contact with the needles 25 is heated, preferably to a point where the cellular content is vaporized, and the protein components fused to form a contiguous structure through the tissue 18 adjacent to the needles 25.
When the needles 25 are removed and the jaws opened (Figures 5E and 6E), a plurality of fused columns or channels remain with lumens which represent needle entry and exit points. In a preferred embodiment, the fused columns are arranged in a pattern that is secure and fluid-flow arresting.
A preferred pattern may include, for instance, a first group 27 of two or three closely spaced rows of fused columns, spaced apart from a second group 30 of two or three closely spaced rows of fused columns as illustrated in Figure 7. A cutting or dividing member 32, in the form of a blade or an electrosurgical electrode, may be urged to divide the first group of rows 27 from the second group of rows 30 so as to sever the tissue 18 of the conduit, as illustrated in Figure 8. These divided portions 36, 38 are each sealed in a fluid tight manner by the respective groups of fused columns 27, 30.
It will be appreciated that there are at least three considerations which might be addressed in dividing a body passage such as an artery, a vein or a portion of colon, intestine or bowel. A first consideration is that of sealing the lumen so that the contents of the body passage are not released ~in an uncontrolled manner. The second consideration is that blood flow from an incision or cut be arrested or at least minimized. A third consideration is that adequate nutrition can be maintained within the divided or residual portions 36, 38 of the affected tissue 18.
Referring to Figures 9-13, fused columns 41 associated with the present invention are seen in an arrangement that provides a secure connection between the extreme tissue margins at intervals that permit nourishment flow to the residual portions 36, 38 (Figure 13). A closer look at the fused-columns 41 reveals that denatured cellular components have been fused or welded adjacent to the penetrating needles 25. The penetrating needles 25 heat the adjacent tissue only in the immediate area around the needles so that tissue further removed from the needles 25 remains in a natural condition.
Generally, a larger area 43 of thermal modification exists at each tissue surface 19, while a smaller area 45 of thermal modification exists at the larger and deeper portions 20 of the tissue 18. This provides the denatured column with an hourglass configuration. The sealing of the lumen 41 in the embodiment, requires only that the tissue be heated in proximity to the penetrating needles.
For comparison, it will be noted that devices of the prior art rely on a transfer of thermal-energy through the entire portion of tissue indiscreetly. One advantage of this embodiment is that thermal energy is localized in order to maximize the health, vitality and perfusion of the remaining tissue.
Additional embodiments of the invention are illustrated in Figures 14-17. In these embodiments, the opposed jaws include the jaw 21 which has a fixed relationship with the elongate shaft 14, and the jaw 23 which is hinged to the jaw 21 and moveable relative to the shaft 14. The first jaw 21 may be sized and configured to receive a cartridge containing a plurality of the metallic penetrating needles 25 or electrodes. In the embodiment of Figure 14, the needles 25 are in electrical continuity with one electrical pole of a direct-current power source 47. The second, movable jaw portion 23 is in electrical continuity with the opposite electrical pole of the same direct current power source 47.
The penetrating needles 25, in the preferred embodiment, are made of a metal that exhibits high electrical resistance. As electricity flows through the circuit made by contacting the needles of the first jaw 21 with the contact surface of the second jaw 23, heat is generated within the needles 25. It should be noted that all of the needles 25 need not be energized simultaneously. In fact, sequential activation may be preferred as it diminishes the amount of energy required at any one time for the desired effect.
In the embodiment of Figure 15, the tissue welder 10 is connected to an Electrosurgical Generator (ESG) 50. Most ESGs have a bi-polar (BP) connection, a mono-polar (MP) connection and a return-path (RP) connection.
Coupling the welder 10 to the BP function of the ESG connects one pole of a current flow path to the jaw 21, and connects an opposite pole of the current flow path to the jaw 23.
A monopolar connection involves a ground plate 52 as illustrated in Figure 16. In this embodiment a high frequency, high voltage alternating current from the generator 50 flows between the poles and through the contacting needles 25 of the first jaw. The current density existing in the needles 25 causes them to become hot and fuse the tissue 18.
In the embodiment of Figure 17, a heating element 54 is placed in contact with the penetrating needles 25. The heating element 54 may heat all of the penetrating needles together or may heat them sequentially or in groups such as rows. An electrical circuit or a mechanical motion may facilitate control of heat transfer to the penetrating needles. The selection of individual needles 25 or groups of needles will allow the included tissue to cool down between applications of heat through the tissue. The tissue 18 surrounding the fused-columns 41 will remain patent if it is not continuously exposed to the heat required to perform the fusion or tissue welding associated with the present invention.
With reference to Figure 18, a surgical retractor is shown to include a first tissue-penetrating member, such as the jaw 21, and a second non-penetrating member, such as the jaw 23. The independent first and second members may be used to mobilize or move tissue, and to hold it in a preferred position or condition. The second member 21 may, subsequently, be placed in position on the opposite side of the target tissue. When appropriately positioned, the first and second members may be energized to create heat within the penetrating needles 25. The penetration sites form fused or welded columns through the target tissue.
An additional advantage of the present invention can be appreciated from the embodiment of Figure 18 where a chemical releasing member 56 is placed upon each of the penetrating needles 25. As the needles 25 and the associated chemical releasing members 56 are forced into the tissue, a chemical 58 is drawn into the puncture sites. The chemical may include a thrombogenic material, a fibrogenic material, a coagulant, germicidal, anti-microbial material, an adhesive, or a lubricant material, for example. In a preferred embodiment, each of the chemical releasing members 56 contain a compressible foam that releases the chemical 58 as the foam is compressed.
An alternate embodiment of the present invention is seen in Figure 19 where the first jaw 21 is fitted with a first group 60 of the tissue penetrating needles 25, and the second jaw 23 is fitted with a second group 61 of the tissue penetrating needles 25. The first group 60 of the needles is arranged so that they do not interfere with a second group 61 of the needles. This arrangement of the needles 25 leaves a pattern of fused or welded lumens that is most appropriate for security and fluid-stasis, and that permits appropriate nutrition to the residual tissue.
Referring to Figure 20 and 21, a mechanical cutting member 63 can be employed with the tissue fusing needles 25 of the present invention. After fusion or welding of the target tissue has occurred and appropriate fluid stasis is achieved, the mechanical cutting member 63 can be advanced along an arrow 65 to divide the two fused or welded portions of tissue. The cutting member 63 in the illustrated embodiment comprises a sharpened surgical blade that is straight, curved or angled, and that can be advanced or retracted as required.
An additional embodiment may include an electrosurgical cutting electrode 64 (ESE), as shown in Figure 21. The ESE may be a wire, a blade, or a snare that is independently connected to the ESG 50. In the case of electrosurgical cutting, an electrosurgical coagulation mode or a blended waveform may be chosen that coagulates small remaining bleeders. Thus, the electrosurgical effect may be achieved independently of the electrode 64 with the heating of the penetrating needles 25. In an additional embodiment, the electrosurgical voltage may be broken-down or adjusted to perform the heating of the penetrating needles 25 prior to activation of the cutting electrode 64.
With reference to Figure 22, particular attention is drawn to the potential of different embodiments to be sized and configured for use in "small-bore" laparoscopy. Either or both of the opposed jaws 21,23, can be fitted with the tissue penetrating needle group 60, 61, which can be energized and subsequently heated to fuse or weld tissue as previously disclosed. The force required to occlude a body passage is generally available in small-bore laparoscopic instruments. However, there is often insufficient room in a small-bore instrument to facilitate either the application or the formation of staples. The present invention replaces staples of the prior art, with electrical heating of specific regions of tissue to the point of cellular fusion.
The method and apparatus used to energize the electrodes in various embodiments of the invention may differ significantly. For example, in Figure 23, a solid-state electronic switching arrangement 65 is illustrated for selectively energizing the electrodes or needles 25. The electrodes can be individually. and sequentially energized and of course can be energized all at once. As illustrated in Figure 23, small groups of the electrodes can be energized simultaneously with different groups being energized sequentially.
Figure 24 illustrates a mechanical switching arrangement wherein an energizing block 67 is moved among the electrodes or needles 25 to activate those needles in contact with the block 67. In such an embodiment, the electrodes or needles 25 tend to be energized in small groups, and sequentially from one end of the jaw 21 to the other end of the jaw 21. In a similar embodiment illustrated in Figure 25, the energizing block 67 is carried by a pusher 69 having an inclined plane 70. This plane 70 lifts the needles 25 from a withdrawn position to an exposed operative position, at which point the block sequentially energizes the electrodes or needles 25.
Looking now to Figure 26 and 27, a method of providing continuous contact between the penetrating needles 25 of the first jaw 21 and the contact surface of the second jaw 23 is shown where the second jaw 23 comprises a "honey-combed" structure 72. This structure allows the penetrating needles to enter into the second jaw portion without compressive resistance. As the second jaw 23 is compressed upon tissue, the honeycombed structure 72 is drawn or pushed axially, as shown by an arrow 74 in Figure 27, so that the penetrating needles are forced into electrical contact with the second jaw 23.
Figures 28-30 illustrate schematically the effect which electrosurgery and/or heat has on the compressed tissue 18. The application of high frequency electrosurgical waveforms 76 will vaporize the fluid within the cells of compressed tissue and cause them to literally explode. A blended signal that includes an overwritten waveform, will provide hemostasis or coagulation as the cutting occurs. In addition to the cutting and coagulation, heat, whether generated indirectly by electrosurgical current flow or directly by heating of an element, tends to dry the tissue and denatures the cellular structures. In the present context, this heat produces a denatured column which defines the continuous lumen 41 through the tissue 18.
With reference to Figures 31-34, a hemostatic clamp 76 is shown configured generally as a scissors-like device. The opposed tissue contacting surfaces are configured with tissue penetrating needle members 25, 61 adapted to penetrate interposed tissue. An electrosurgical instrument, either monopolar 78 (Figure 34) or bipolar 81 (Figure 33, may be used to contact the hemostatic clamp 76 and deliver current flow through it. A direct heat source 83 (Figure 32) or an external source 85 could also be used. Discharge of this energy creates heat in the small diameter needles 25, 61 where the current density is elevated.
A close look at Figure 35 reveals that a further embodiment may include a plurality of tissue penetrating needles 25 that are urged into and through tissue to be adhered. The needles 25 are configured to allow a small flow of blood into the puncture sites. The blood coagulates and forms a glue-like substance when mixed with other chemical components introduced to the site for example by a disposable chemical releasing sleeve 87. The jaw 23 can be covered by the sleeve 87 to provide increased continuity with the jaw 23 and the tissue 18.
Standard electrical schematics are seen in FIG. 36 where it is shown that an ES generator "mono-polar" circuit 90 comprises an active , electrode 96 and a passive electrode or "grounding-pad" 52. The current density at the active electrode 96 contact site is substantially greater than the current density at the attachment site of the passive electrode. For example, in a typical arrangement, the current density of the active electrode contact area might be two thousand times greater than the current density at the passive electrode site.
The elevated current density relationship produces a spark at the site of contact or near contact of the active electrode 96 with the tissue 18. However, the return path of the current flow is dissipated, dispersed or diluted due to the larger surface area of the return electrode or grounding pad 52.
The bi-polar arrangement, shown schematically in Figure 37, provides an electrical potential between two nearly identical active electrodes 92, 94. The current density associated with the two electrodes 92, 94 is nearly the same. Tissue may be grasped, for instance between the two bi-polar electrodes 92, 94, and cut and coagulated without the patient being a part of the electrical circuit as is the case with mono-polar electrosurgery.
A hybrid form of electrosurgery is illustrated in Figure 38 where an active electrode 96 is positioned adjacent to a return electrode path 98 upon a single instrument. To illustrate, an instrument having a metal shaft and an insulated metal electrode works by providing high current density at the active electrode 96 and less current density on the return path 98.
A more simple approach, illustrated schematically in Figure 39, involves use of direct current (D-C) such as that derived from a battery or rectifier 101. This D-C apparatus supplies one pole to one electrode members 103 and the opposite pole to the opposite electrode member 105. Needles 107, in the form of resistive electrode members communicate between the poles and generate heat.
It will be understood that many other modifications can be made to the various disclosed embodiments without departing from the spirit and scope of the concept. For example, various sizes of the surgical device are contemplated as well as various types of constructions and materials. It will also be apparent that many modifications can be made to the configuration of parts as well as their interaction. For these reasons, the above description should not be construed as limiting the invention, but should be interpreted as merely exemplary of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present invention as defined by the following claims.
An example of such devices is the commonly available gastro-intestinal anastamosis (GIA) type stapler. It comprises a jaw fitted with a cartridge holding four to six rows of staples in a deployable position, a hinged anvil sized and configured to deform the staples of the cartridge, and a shaft communicating with a handle held by a user. In use, the device is placed along, and compressed upon, a portion of tissue to be cut and stapled. The staples are subsequently urged through the tissue and against the anvil where they are deformed into a preferred folded-over condition. A sharp surgical blade is then moved forward between rows of staples to divide the tissue. Fluid stasis is accomplished by the overlapping rows of folded-over and compressed staples.
As one would imagine, it is not desirable to over-compress tissue or develop a condition where required nourishment to tissue is compromised. If too many staples are placed or if the staples are over-compressed, the included tissue may be deprived of nutrition and may subsequently necrose and cause serious complications. In addition, staples are typically formed of a material which is foreign to the body and may cause responses that will further complicate recovery or healing. Staples cannot be cut through or removed easily. Staples also cause problems with imaging technologies. They may show up as artifacts in MRI, CT scans and fluoroscopy.
Surgical clips are often used to occlude small vessels. They normally comprise a C-shaped metallic member that is highly compressed upon tissue. Nourishment to the residual portion of "clipped-off' tissue is completely interrupted. Even when a divided or repaired portion of tissue is sutured, special care is taken not to place the suture too tightly so that nourishment to the residual portion is interrupted.
Tissue adhesives, which provide hemostasis as well as the "gluing"
of tissue, have proven to be effective. However, they often require prior preparation from autologous materials. In addition, they do not have the full confidence of the medical community.
To avoid the complications of clips, staples, adhesives and sutures, attempts have been made to fuse or weld tissue. For instance, a vessel may be clamped tightly with a hemostat or grasper, and subsequently energized with an electrosurgical generator. This technique is commonly referred to as "buzzing the hemostat". The heat generated within the tissue may cause the proteins of the cellular content to fuse and create a fluid-tight arrangement.
This technique has proved to be relatively effective in small vessels; however, large vessels are not indicated for this approach. The relationship between the diameter of the vessel and the wall thickness has proven to be the limiting factor in tissue fusion and welding in most cases.
Hemostatic graspers are available that compress tissue and apply an electrosurgical discharge that mimics the energized hemostat.
It is the purpose of an electrosurgical generator is to supply a high voltage at a high frequency in order to produce an electric arc between an electrosurgical instrument and grounded tissue. This "electrosurgical effect"
(ESE) is especially suited to cut and coagulate tissue in a quick and effective manner. However, the ESE is not efFective to divide and provide hemostasis or fluid stasis in large vessels or conduits. While the ESE has been well adapted to seal small capillaries, it has not been effective to shut-off the fluid flow in a large conduit.
SUMMARY OF THE INVENTION
In view of the foregoing, the present invention comprises a device, and associated method, which is sized and configured to emulate the mechanical fixation of tissue. The present invention provides permanent fluid stasis in tissue by creating small, discrete tissue welds along a preferred pathway, and subsequently cutting relative to the welds. The welding or fusing of the tissue is accomplished by application of heat to selected and localized areas. In a preferred embodiment, a device according to the present invention may comprise an elongate shaft having a handle at the proximal end and a pair of jaws at the distal end. The jaws comprise a first portion having a plurality of penetrating electrodes or elements, and a second portion having an electrical contact/compression member.
With the intent of merely heating the tissue adjacent the electrodes, the jaws can be connected in an electrosurgical mono-polar, bi-polar or "quasi"
bi-polar configuration. The electrodes can also be energized with direct current or any other heating source, in order to achieve the desired heating and consequent fusing or welding of tissue.
In one aspect of the invention, the device includes a first member and a second member opposing the first member. The first member is sized and configured to push a plurality of needle electrodes or elements through the tissue, where they contact the second member thereby providing electrical continuity. Upon application of electrical or thermal energy, the tissue through which the electrodes have passed is heated to the point of desiccation and subsequent fusion of certain cellular components. The resulting fusion or weld is continuous through the layers of tissue and resembles a "rivet". A plurality of fusion "channels" arranged appropriately provides fluid stasis without the introduction of any foreign material.
In other aspects of the invention, the jaws can be provided by a hemostat; a chemical-releasing sleeve may also be employed. A device according to the present invention overcomes the limitations of existing devices by providing a multiple-use device as opposed to a single-fire or single-use device.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a laparoscopic device according to the present invention;
FIG. 2 is a perspective view of the distal portion of a laparoscopic device according to the present invention, in a closed condition with included tissue to be fused;
FIG. 3 is a perspective view of a portion of tissue that has been fused by the device of the present invention;
FIG. 4 is a perspective view of a portion of tissue that has been fused and divided by the device of the present invention;
FIG. 5A is a side elevation view of the distal portion of the device showing the electrodes and connector in a closed condition;
FIG. 5B is a side elevation view of the distal portion of the device showing the electrodes and connector in an open condition;
FIG. 5C is a side elevation view of the distal portion of the device showing electrodes and connector in an open, and tissue-receiving condition;
FIG. 5D is a side elevation view of the distal portion of the device showing the electrodes and connector in a closed, tissue-engaging condition;
FIG. 5E is a side elevation view of the distal portion of the present invention showing the electrodes and connector in an open, tissue-releasing condition;
FIG. 6A is an end elevation view of the distal portion of the device shown in Figure 5A;
FIG. 6B is an end elevation view of the distal portion of the device shown in Figure 5B;
FIG. 6C is an end elevation view of the distal portion of the device shown in Figure 5C;
FIG. 6D is an end elevation view of the distal portion of the device shown in Figure 5D;
FIG. 6E is an end elevation view of the distal portion of the device shown in Figure 5E;
FiG. 7 is a top plan view of a portion of a body conduit that has been fused using the present invention;
FIG. 8 is a top plan view of a portion of a body conduit that has been fused and divided using the present invention;
FIG. 9 is a cross section view of the fused or welded body conduit, taken along lines 9-9 of Fig 8.
FIG. 10 is an enlarged view of the cross secfiion illustrated in Fig. 9;
FIG. 11 is a perspective view of a fusion area produced by an embodiment of the present invention;
FIG. 12 is a top plan view of the fusion area shown in Fig. 11;
FIG. 13 is a top plan view similar to Fig. 8 and illustrating a nutritional pathway in a fused tissue portion;
FIG. 14 is a side elevation view of a distal jaw portion comprising a direct current power source;
FIG. 15 is a side elevation view of a distal jaw portion comprising a bi-polar electrosurgical power source;
FIG. 16 is a side elevation view of a distal jaw portion comprising a "quasi" bi-polar electrosurgical power source;
FIG. 17 is a side elevation view of the distal jaw portion comprising a direct heat source;
FIG. 18 is a side elevation view of a chemical releasing embodiment adapted for example for bonding enhancement;
g FIG. 19 is a side elevation view of a distal jaw portion configured with electrodes on both opposed jaw portions;
FIG. 20 is a side elevation view of a distal jaw portion having a mechanical cutting member;
FIG. 21 is a side elevation view of a distal jaw portion having an electrosurgical cutting member;
FIG. 22 is a side elevation view of a distal jaw portion sized and configured to fit through a small-bore cannula;
FIG. 23 is a top plan schematic view of a solid-state electronic switching arrangement for energizing the electrodes of a distal jaw portion;
FIG. 24 is a top plan schematic view of a mechanical switching arrangement for energizing the electrodes of a distal jaw portion;
FIG. 25 is a side elevation schematic view of a sequential mechanical switching arrangement for lifting and energizing the electrodes of a distal jaw portion;
FIG. 26 is a side elevation schematic view of a distal jaw portion having a permeable anvil;
FIG. 27 is a side elevation schematic view of a distal jaw portion having a sliding contact permeable anvil;
FIG. 28 is a side elevation view illustrating radio frequency electrosurgical cutting with a penetrating needle;
FIG. 29 is a side elevation view illustrating electrosurgical cutting and heating of a penetrating needle;
FIG. 30 is a side elevation view illustrating the direct heating of the penetrating needle;
FIG. 31 is a side elevation view of a hemostat having penetrating needles and being configured for operation in a mono-polar electrosurgical configuration;
FIG. 32 is a side elevation view of a hemostat having penetrating needles and being configured in a bi-polar electrosurgical configuration;
FIG. 33 is a side elevation view of a hemostat having penetrating needles and being configured in a direct heat configuration;
FIG. 34 is a side elevation view of a hemostat having penetrating needles and being configured for use with an external heat source;
FIG. 35 is a perspective view of a further embodiment of the invention having a chemical releasing sleeve;
FIG. 36 is a side elevation perspective view of a distal jaw portion arranged in a mono-polar electrosurgical configuration;
FIG. 37 is a side elevation schematic view of a distal jaw portion arranged in a bi-polar electrosurgical configuration;
FIG. 38 is a side elevation schematic view of a distal jaw portion arranged in a "quasi" bi-polar electrosurgical configuration; and FIG. 39 is a side elevation schematic view of a distal jaw portion arranged with a direct current, resistance-type configuration.
DETAILED DESCRIPTION
With reference to the drawings of Figure 1 and 2, a tissue welder 10 in one embodiment of the present invention is shown to include a handle 12, and an elongate shaft 14, and a distal portion 16. This distal portion 16 includes a pair of opposing jaws 21 and 23 which are adapted to compress tissue 18, having outer surfaces 19 that define deep inner portions 20.
In the illustrated example, the compressed tissue 18 has the configuration of a tube where one side of the tube is compressed into a surface proximate relationship with the other side of the tube in order to occlude the tube.
It will be appreciated that the invention is equally adapted to bond any two pieces of tissue disposed in a tissue proximate relationship.
One of the opposed jaws 21 is configured to have a plurality of penetrating members or needles 25. The opposite jaw 23 provides a stop or a contact member against which the penetrating members 25 can be moved.
Energy is delivered to, and through, the penetrating members 25 in such a manner that the tissue 18 contacted by each penetrating member 25 is deformed at a cellular level and fused or welded.
Operation of the tissue welder 10 can be best understood with reference to the progressive side views of Figures 5A-5E and the associated progressive end views 6A-6E, respectively.
More specifically, a portion of the tissue 18 is placed between the opposed jaws 21, 23 (Figures 5C and 6C) and lightly compressed (Figure 5D and 6D). As the compression occurs, the sharp needles 25 are urged through the compressed tissue 18 and into contact with, or in close proximity to, the opposing jaw 23. In a preferred embodiment, electrical current is introduced through the needles 25. These needles 25, in a preferred embodiment, are made from an electrically high resistance material so that the electrical current produces heat.
It follows that the tissue 18 in contact with the needles 25 is heated, preferably to a point where the cellular content is vaporized, and the protein components fused to form a contiguous structure through the tissue 18 adjacent to the needles 25.
When the needles 25 are removed and the jaws opened (Figures 5E and 6E), a plurality of fused columns or channels remain with lumens which represent needle entry and exit points. In a preferred embodiment, the fused columns are arranged in a pattern that is secure and fluid-flow arresting.
A preferred pattern may include, for instance, a first group 27 of two or three closely spaced rows of fused columns, spaced apart from a second group 30 of two or three closely spaced rows of fused columns as illustrated in Figure 7. A cutting or dividing member 32, in the form of a blade or an electrosurgical electrode, may be urged to divide the first group of rows 27 from the second group of rows 30 so as to sever the tissue 18 of the conduit, as illustrated in Figure 8. These divided portions 36, 38 are each sealed in a fluid tight manner by the respective groups of fused columns 27, 30.
It will be appreciated that there are at least three considerations which might be addressed in dividing a body passage such as an artery, a vein or a portion of colon, intestine or bowel. A first consideration is that of sealing the lumen so that the contents of the body passage are not released ~in an uncontrolled manner. The second consideration is that blood flow from an incision or cut be arrested or at least minimized. A third consideration is that adequate nutrition can be maintained within the divided or residual portions 36, 38 of the affected tissue 18.
Referring to Figures 9-13, fused columns 41 associated with the present invention are seen in an arrangement that provides a secure connection between the extreme tissue margins at intervals that permit nourishment flow to the residual portions 36, 38 (Figure 13). A closer look at the fused-columns 41 reveals that denatured cellular components have been fused or welded adjacent to the penetrating needles 25. The penetrating needles 25 heat the adjacent tissue only in the immediate area around the needles so that tissue further removed from the needles 25 remains in a natural condition.
Generally, a larger area 43 of thermal modification exists at each tissue surface 19, while a smaller area 45 of thermal modification exists at the larger and deeper portions 20 of the tissue 18. This provides the denatured column with an hourglass configuration. The sealing of the lumen 41 in the embodiment, requires only that the tissue be heated in proximity to the penetrating needles.
For comparison, it will be noted that devices of the prior art rely on a transfer of thermal-energy through the entire portion of tissue indiscreetly. One advantage of this embodiment is that thermal energy is localized in order to maximize the health, vitality and perfusion of the remaining tissue.
Additional embodiments of the invention are illustrated in Figures 14-17. In these embodiments, the opposed jaws include the jaw 21 which has a fixed relationship with the elongate shaft 14, and the jaw 23 which is hinged to the jaw 21 and moveable relative to the shaft 14. The first jaw 21 may be sized and configured to receive a cartridge containing a plurality of the metallic penetrating needles 25 or electrodes. In the embodiment of Figure 14, the needles 25 are in electrical continuity with one electrical pole of a direct-current power source 47. The second, movable jaw portion 23 is in electrical continuity with the opposite electrical pole of the same direct current power source 47.
The penetrating needles 25, in the preferred embodiment, are made of a metal that exhibits high electrical resistance. As electricity flows through the circuit made by contacting the needles of the first jaw 21 with the contact surface of the second jaw 23, heat is generated within the needles 25. It should be noted that all of the needles 25 need not be energized simultaneously. In fact, sequential activation may be preferred as it diminishes the amount of energy required at any one time for the desired effect.
In the embodiment of Figure 15, the tissue welder 10 is connected to an Electrosurgical Generator (ESG) 50. Most ESGs have a bi-polar (BP) connection, a mono-polar (MP) connection and a return-path (RP) connection.
Coupling the welder 10 to the BP function of the ESG connects one pole of a current flow path to the jaw 21, and connects an opposite pole of the current flow path to the jaw 23.
A monopolar connection involves a ground plate 52 as illustrated in Figure 16. In this embodiment a high frequency, high voltage alternating current from the generator 50 flows between the poles and through the contacting needles 25 of the first jaw. The current density existing in the needles 25 causes them to become hot and fuse the tissue 18.
In the embodiment of Figure 17, a heating element 54 is placed in contact with the penetrating needles 25. The heating element 54 may heat all of the penetrating needles together or may heat them sequentially or in groups such as rows. An electrical circuit or a mechanical motion may facilitate control of heat transfer to the penetrating needles. The selection of individual needles 25 or groups of needles will allow the included tissue to cool down between applications of heat through the tissue. The tissue 18 surrounding the fused-columns 41 will remain patent if it is not continuously exposed to the heat required to perform the fusion or tissue welding associated with the present invention.
With reference to Figure 18, a surgical retractor is shown to include a first tissue-penetrating member, such as the jaw 21, and a second non-penetrating member, such as the jaw 23. The independent first and second members may be used to mobilize or move tissue, and to hold it in a preferred position or condition. The second member 21 may, subsequently, be placed in position on the opposite side of the target tissue. When appropriately positioned, the first and second members may be energized to create heat within the penetrating needles 25. The penetration sites form fused or welded columns through the target tissue.
An additional advantage of the present invention can be appreciated from the embodiment of Figure 18 where a chemical releasing member 56 is placed upon each of the penetrating needles 25. As the needles 25 and the associated chemical releasing members 56 are forced into the tissue, a chemical 58 is drawn into the puncture sites. The chemical may include a thrombogenic material, a fibrogenic material, a coagulant, germicidal, anti-microbial material, an adhesive, or a lubricant material, for example. In a preferred embodiment, each of the chemical releasing members 56 contain a compressible foam that releases the chemical 58 as the foam is compressed.
An alternate embodiment of the present invention is seen in Figure 19 where the first jaw 21 is fitted with a first group 60 of the tissue penetrating needles 25, and the second jaw 23 is fitted with a second group 61 of the tissue penetrating needles 25. The first group 60 of the needles is arranged so that they do not interfere with a second group 61 of the needles. This arrangement of the needles 25 leaves a pattern of fused or welded lumens that is most appropriate for security and fluid-stasis, and that permits appropriate nutrition to the residual tissue.
Referring to Figure 20 and 21, a mechanical cutting member 63 can be employed with the tissue fusing needles 25 of the present invention. After fusion or welding of the target tissue has occurred and appropriate fluid stasis is achieved, the mechanical cutting member 63 can be advanced along an arrow 65 to divide the two fused or welded portions of tissue. The cutting member 63 in the illustrated embodiment comprises a sharpened surgical blade that is straight, curved or angled, and that can be advanced or retracted as required.
An additional embodiment may include an electrosurgical cutting electrode 64 (ESE), as shown in Figure 21. The ESE may be a wire, a blade, or a snare that is independently connected to the ESG 50. In the case of electrosurgical cutting, an electrosurgical coagulation mode or a blended waveform may be chosen that coagulates small remaining bleeders. Thus, the electrosurgical effect may be achieved independently of the electrode 64 with the heating of the penetrating needles 25. In an additional embodiment, the electrosurgical voltage may be broken-down or adjusted to perform the heating of the penetrating needles 25 prior to activation of the cutting electrode 64.
With reference to Figure 22, particular attention is drawn to the potential of different embodiments to be sized and configured for use in "small-bore" laparoscopy. Either or both of the opposed jaws 21,23, can be fitted with the tissue penetrating needle group 60, 61, which can be energized and subsequently heated to fuse or weld tissue as previously disclosed. The force required to occlude a body passage is generally available in small-bore laparoscopic instruments. However, there is often insufficient room in a small-bore instrument to facilitate either the application or the formation of staples. The present invention replaces staples of the prior art, with electrical heating of specific regions of tissue to the point of cellular fusion.
The method and apparatus used to energize the electrodes in various embodiments of the invention may differ significantly. For example, in Figure 23, a solid-state electronic switching arrangement 65 is illustrated for selectively energizing the electrodes or needles 25. The electrodes can be individually. and sequentially energized and of course can be energized all at once. As illustrated in Figure 23, small groups of the electrodes can be energized simultaneously with different groups being energized sequentially.
Figure 24 illustrates a mechanical switching arrangement wherein an energizing block 67 is moved among the electrodes or needles 25 to activate those needles in contact with the block 67. In such an embodiment, the electrodes or needles 25 tend to be energized in small groups, and sequentially from one end of the jaw 21 to the other end of the jaw 21. In a similar embodiment illustrated in Figure 25, the energizing block 67 is carried by a pusher 69 having an inclined plane 70. This plane 70 lifts the needles 25 from a withdrawn position to an exposed operative position, at which point the block sequentially energizes the electrodes or needles 25.
Looking now to Figure 26 and 27, a method of providing continuous contact between the penetrating needles 25 of the first jaw 21 and the contact surface of the second jaw 23 is shown where the second jaw 23 comprises a "honey-combed" structure 72. This structure allows the penetrating needles to enter into the second jaw portion without compressive resistance. As the second jaw 23 is compressed upon tissue, the honeycombed structure 72 is drawn or pushed axially, as shown by an arrow 74 in Figure 27, so that the penetrating needles are forced into electrical contact with the second jaw 23.
Figures 28-30 illustrate schematically the effect which electrosurgery and/or heat has on the compressed tissue 18. The application of high frequency electrosurgical waveforms 76 will vaporize the fluid within the cells of compressed tissue and cause them to literally explode. A blended signal that includes an overwritten waveform, will provide hemostasis or coagulation as the cutting occurs. In addition to the cutting and coagulation, heat, whether generated indirectly by electrosurgical current flow or directly by heating of an element, tends to dry the tissue and denatures the cellular structures. In the present context, this heat produces a denatured column which defines the continuous lumen 41 through the tissue 18.
With reference to Figures 31-34, a hemostatic clamp 76 is shown configured generally as a scissors-like device. The opposed tissue contacting surfaces are configured with tissue penetrating needle members 25, 61 adapted to penetrate interposed tissue. An electrosurgical instrument, either monopolar 78 (Figure 34) or bipolar 81 (Figure 33, may be used to contact the hemostatic clamp 76 and deliver current flow through it. A direct heat source 83 (Figure 32) or an external source 85 could also be used. Discharge of this energy creates heat in the small diameter needles 25, 61 where the current density is elevated.
A close look at Figure 35 reveals that a further embodiment may include a plurality of tissue penetrating needles 25 that are urged into and through tissue to be adhered. The needles 25 are configured to allow a small flow of blood into the puncture sites. The blood coagulates and forms a glue-like substance when mixed with other chemical components introduced to the site for example by a disposable chemical releasing sleeve 87. The jaw 23 can be covered by the sleeve 87 to provide increased continuity with the jaw 23 and the tissue 18.
Standard electrical schematics are seen in FIG. 36 where it is shown that an ES generator "mono-polar" circuit 90 comprises an active , electrode 96 and a passive electrode or "grounding-pad" 52. The current density at the active electrode 96 contact site is substantially greater than the current density at the attachment site of the passive electrode. For example, in a typical arrangement, the current density of the active electrode contact area might be two thousand times greater than the current density at the passive electrode site.
The elevated current density relationship produces a spark at the site of contact or near contact of the active electrode 96 with the tissue 18. However, the return path of the current flow is dissipated, dispersed or diluted due to the larger surface area of the return electrode or grounding pad 52.
The bi-polar arrangement, shown schematically in Figure 37, provides an electrical potential between two nearly identical active electrodes 92, 94. The current density associated with the two electrodes 92, 94 is nearly the same. Tissue may be grasped, for instance between the two bi-polar electrodes 92, 94, and cut and coagulated without the patient being a part of the electrical circuit as is the case with mono-polar electrosurgery.
A hybrid form of electrosurgery is illustrated in Figure 38 where an active electrode 96 is positioned adjacent to a return electrode path 98 upon a single instrument. To illustrate, an instrument having a metal shaft and an insulated metal electrode works by providing high current density at the active electrode 96 and less current density on the return path 98.
A more simple approach, illustrated schematically in Figure 39, involves use of direct current (D-C) such as that derived from a battery or rectifier 101. This D-C apparatus supplies one pole to one electrode members 103 and the opposite pole to the opposite electrode member 105. Needles 107, in the form of resistive electrode members communicate between the poles and generate heat.
It will be understood that many other modifications can be made to the various disclosed embodiments without departing from the spirit and scope of the concept. For example, various sizes of the surgical device are contemplated as well as various types of constructions and materials. It will also be apparent that many modifications can be made to the configuration of parts as well as their interaction. For these reasons, the above description should not be construed as limiting the invention, but should be interpreted as merely exemplary of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present invention as defined by the following claims.
Claims (31)
1. A tissue welding apparatus for fusing a first piece of tissue to a second piece of tissue disposed in a surface proximate relationship to the first piece of tissue, comprising:
an elongate shaft;
a first jaw carried by the shaft;
a second jaw carried by the shaft in an opposing relationship with the first jaw;
at least one penetrating member carried by the first jaw and adapted to move with the first jaw and relative to the second jaw into the first piece of material and the second piece of material to create a channel defined by the first piece of tissue and the second piece of tissue.
a source of heat coupled to the penetrating member the heat source having properties for heating the penetrating member and for denaturing the tissue defining the channel; wherein:
the denatured tissue forms a column bonding the first piece of tissue to the second piece of tissue.
an elongate shaft;
a first jaw carried by the shaft;
a second jaw carried by the shaft in an opposing relationship with the first jaw;
at least one penetrating member carried by the first jaw and adapted to move with the first jaw and relative to the second jaw into the first piece of material and the second piece of material to create a channel defined by the first piece of tissue and the second piece of tissue.
a source of heat coupled to the penetrating member the heat source having properties for heating the penetrating member and for denaturing the tissue defining the channel; wherein:
the denatured tissue forms a column bonding the first piece of tissue to the second piece of tissue.
2. The apparatus recited in Claim 1, wherein:
the second jaw has a fixed relationship with the shaft; and the first jaw has a movable relationship with the shaft and the second jaw.
the second jaw has a fixed relationship with the shaft; and the first jaw has a movable relationship with the shaft and the second jaw.
3. The apparatus recited in Claim 1, wherein the source of heat comprises an electrosurgical generator.
4. The apparatus recited in Claim 3, wherein at least the first jaw comprises an electrosurgical monopolar electrode.
5. The apparatus recited in Claim 3, wherein the first jaw and the second jaw comprise electrosurgical bipolar electrodes.
6. The apparatus recited in Claim 1, wherein the source of heat comprises a direct current electrical power source.
7. A tissue welding apparatus for fusing a first piece of tissue in a surface proximate relationship with a second piece of tissue, comprising:
an elongate shaft;
a first jaw carried by the shaft;
a second jaw carried by the shaft in an opposing relationship with the first jaw;
means carried by the first jaw for creating a plurality of tissue welds bonding the first piece of tissue to the second piece of tissue, the welds being disposed in a first row and a second row; and a cutter carried by the shaft and being movable between the first row and the second row to severe the first piece of tissue and the second piece of tissue between the first row of tissue welds and the second row of tissue welds.
an elongate shaft;
a first jaw carried by the shaft;
a second jaw carried by the shaft in an opposing relationship with the first jaw;
means carried by the first jaw for creating a plurality of tissue welds bonding the first piece of tissue to the second piece of tissue, the welds being disposed in a first row and a second row; and a cutter carried by the shaft and being movable between the first row and the second row to severe the first piece of tissue and the second piece of tissue between the first row of tissue welds and the second row of tissue welds.
8. The apparatus recited in Claim 7, wherein the first jaw is movable relative to the second jaw to engage at least the first piece of tissue.
9. The apparatus recited in Claim 8, wherein:
the first jaw has a movable relationship with the shaft; and the second jaw has a fixed relationship with the shaft.
the first jaw has a movable relationship with the shaft; and the second jaw has a fixed relationship with the shaft.
10. The apparatus recited in Claim 7, wherein the cutter is a blade.
11. The apparatus recited in Claim 7, wherein the cutter is an electrosurgical electrode.
12. A tissue welding apparatus for fusing a first piece of tissue in a surface proximate relationship with a second piece of tissue, comprising:
an operative member disposed generally on a side of the first piece of tissue opposite the second piece of tissue;
at least one penetrating member movable with the operative member relative to the first piece of tissue, the penetrating member being adapted to penetrate the first piece of tissue and the second piece of tissue;
the penetrating member being adapted for connection to a source of heat for heating the penetrating member in order to form a tissue weld bonding the first piece of tissue to the second piece of tissue; and a chemical agent carried by the penetrating member to facilitate a reaction between the chemical agent and at least one of the first piece of tissue and the second piece of tissue.
an operative member disposed generally on a side of the first piece of tissue opposite the second piece of tissue;
at least one penetrating member movable with the operative member relative to the first piece of tissue, the penetrating member being adapted to penetrate the first piece of tissue and the second piece of tissue;
the penetrating member being adapted for connection to a source of heat for heating the penetrating member in order to form a tissue weld bonding the first piece of tissue to the second piece of tissue; and a chemical agent carried by the penetrating member to facilitate a reaction between the chemical agent and at least one of the first piece of tissue and the second piece of tissue.
13. The apparatus recited in Claim 12, further comprising:
a chemical releasing member disposed on the at least one penetrating member and having properties for carrying the chemical agent.
a chemical releasing member disposed on the at least one penetrating member and having properties for carrying the chemical agent.
14. The apparatus recited in Claim 12, wherein the chemical agent has properties for producing a mechanical reaction with at least one of the first piece of tissue and the second piece of tissue.
15. The apparatus recited in Claim 14, wherein the chemical agent includes at least one of an adhesive, a lubricant, and a coagulant.
16. The apparatus recited in Claim 12, wherein the chemical agent has properties for producing a chemical reaction with at least one of the first piece of tissue and the second piece of tissue.
17. The apparatus recited in Claim 16, wherein the chemical agent includes at least one of a thrombogenic, fibrogenic, germicidal, and microbial material
18. A method for welding a first piece of tissue to a second piece of tissue, comprising the steps of:
positioning the first piece of tissue relative to the second piece of tissue to produce a tissue interface;
creating at least one channel extending across the first piece of tissue, across the tissue interface, and into the second piece of tissue;
and denaturing at least a portion of the tissue defining the channel to create at least one fused column welding the first piece of tissue to the second piece of tissue.
positioning the first piece of tissue relative to the second piece of tissue to produce a tissue interface;
creating at least one channel extending across the first piece of tissue, across the tissue interface, and into the second piece of tissue;
and denaturing at least a portion of the tissue defining the channel to create at least one fused column welding the first piece of tissue to the second piece of tissue.
19. The method recited in Claim 18, wherein the denaturing step includes the step of denaturing the tissue to provide the fused column with an hourglass configuration.
20 The method recited in Claim 18, wherein the creating step includes the step of:
providing a source of electrosurgical power;
energizing at least one electrode with the electrosurgical power; and advancing the electrode through the first piece of tissue, across the tissue interface, and into the second piece of tissue to form the channel.
providing a source of electrosurgical power;
energizing at least one electrode with the electrosurgical power; and advancing the electrode through the first piece of tissue, across the tissue interface, and into the second piece of tissue to form the channel.
21 The method recited in Claim 20, wherein the energizing step includes a step of:
providing a plurality of the electrodes in the form of a plurality of needles; and energizing the needles to create a plurality of the channels.
providing a plurality of the electrodes in the form of a plurality of needles; and energizing the needles to create a plurality of the channels.
22. The method recited in Claim 21, wherein the step of energizing the needles includes the step of selectively energizing the needles.
23. The method recited in Claim 22, wherein the step of selectively energizing the needles includes the step of individually energizing the needles.
24. The method recited in Claim 23, wherein the step of individually energizing the needles includes the step of sequentially energizing the needles.
25. The method recited in Claim 18, wherein the denaturing step includes the step of heating at least the portion of the tissue defining the channel.
26. The method recited in Claim 18, further comprising the step of:
releasing a chemical into the channel.
releasing a chemical into the channel.
27. A method for fusing a first piece of tissue to a second piece of tissue, comprising the steps of:
positioning the first piece of tissue in proximity to the second piece of tissue at a tissue interface;
penetrating the first piece of tissue and at least a portion of the second piece of tissue with a penetrating member; and not earlier than the penetrating step, denaturing the tissue surrounding the penetrating member to form a column bonding the first piece of tissue to the second piece of tissue across the tissue interface.
positioning the first piece of tissue in proximity to the second piece of tissue at a tissue interface;
penetrating the first piece of tissue and at least a portion of the second piece of tissue with a penetrating member; and not earlier than the penetrating step, denaturing the tissue surrounding the penetrating member to form a column bonding the first piece of tissue to the second piece of tissue across the tissue interface.
28. The method recited in Claim 27, wherein the denaturing step includes the step of providing the column with the general configuration of an hourglass.
29. The method recited in Claim 28, wherein the column is one of the plurality of columns, each having a diameter which is least at the tissue interface in order to facilitate a flow of nutrients to the tissue between the columns.
30. The method recited in Claim 27 wherein the denaturing step occurs during the penetrating step.
31. The method recited in Claim 27, wherein the denaturing step occurs after the penetrating step.
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CA2475737C true CA2475737C (en) | 2010-08-10 |
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Families Citing this family (723)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7364577B2 (en) | 2002-02-11 | 2008-04-29 | Sherwood Services Ag | Vessel sealing system |
US6689131B2 (en) | 2001-03-08 | 2004-02-10 | Tissuelink Medical, Inc. | Electrosurgical device having a tissue reduction sensor |
US6558385B1 (en) | 2000-09-22 | 2003-05-06 | Tissuelink Medical, Inc. | Fluid-assisted medical device |
EP1946716B1 (en) | 2000-03-06 | 2017-07-19 | Salient Surgical Technologies, Inc. | Fluid delivery system and controller for electrosurgical devices |
US8048070B2 (en) | 2000-03-06 | 2011-11-01 | Salient Surgical Technologies, Inc. | Fluid-assisted medical devices, systems and methods |
US7811282B2 (en) | 2000-03-06 | 2010-10-12 | Salient Surgical Technologies, Inc. | Fluid-assisted electrosurgical devices, electrosurgical unit with pump and methods of use thereof |
DE60121229T2 (en) | 2001-04-06 | 2007-05-24 | Sherwood Services Ag | DEVICE FOR SEALING AND SHARING A VESSEL WITH NON-LASTING END STOP |
US11229472B2 (en) | 2001-06-12 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with multiple magnetic position sensors |
US7931649B2 (en) | 2002-10-04 | 2011-04-26 | Tyco Healthcare Group Lp | Vessel sealing instrument with electrical cutting mechanism |
US8475455B2 (en) | 2002-10-29 | 2013-07-02 | Medtronic Advanced Energy Llc | Fluid-assisted electrosurgical scissors and methods |
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 |
US7367976B2 (en) | 2003-11-17 | 2008-05-06 | Sherwood Services Ag | Bipolar forceps having monopolar extension |
US7727232B1 (en) | 2004-02-04 | 2010-06-01 | Salient Surgical Technologies, Inc. | Fluid-assisted medical devices and methods |
US8182501B2 (en) | 2004-02-27 | 2012-05-22 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical shears and method for sealing a blood vessel using same |
WO2005096980A1 (en) * | 2004-04-05 | 2005-10-20 | Ganz Robert A | Device and method for treating tissue |
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 |
JP5009159B2 (en) | 2004-10-08 | 2012-08-22 | エシコン・エンド−サージェリィ・インコーポレイテッド | Ultrasonic surgical instrument |
US7909823B2 (en) | 2005-01-14 | 2011-03-22 | Covidien Ag | Open vessel sealing instrument |
US7628791B2 (en) | 2005-08-19 | 2009-12-08 | Covidien Ag | Single action tissue sealer |
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 |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US20070194079A1 (en) | 2005-08-31 | 2007-08-23 | Hueil Joseph C | Surgical stapling device with staple drivers of different height |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | 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 |
US20070191713A1 (en) | 2005-10-14 | 2007-08-16 | Eichmann Stephen E | Ultrasonic device for cutting and coagulating |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US7621930B2 (en) | 2006-01-20 | 2009-11-24 | Ethicon Endo-Surgery, Inc. | Ultrasound medical instrument having a medical ultrasonic blade |
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 |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US20110006101A1 (en) | 2009-02-06 | 2011-01-13 | EthiconEndo-Surgery, Inc. | Motor driven surgical fastener device with cutting member lockout arrangements |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US8763879B2 (en) | 2006-01-31 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of surgical instrument |
US20110290856A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument with force-feedback capabilities |
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 |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | 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 |
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 |
JP4928856B2 (en) * | 2006-07-11 | 2012-05-09 | 東京医研株式会社 | Surgical device |
US10130359B2 (en) | 2006-09-29 | 2018-11-20 | Ethicon Llc | Method for forming a staple |
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 |
US7506791B2 (en) | 2006-09-29 | 2009-03-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with mechanical mechanism for limiting maximum tissue compression |
US7708180B2 (en) * | 2006-11-09 | 2010-05-04 | Ethicon Endo-Surgery, Inc. | Surgical fastening device with initiator impregnation of a matrix or buttress to improve adhesive application |
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 |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit 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 |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US8540128B2 (en) | 2007-01-11 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with a curved end effector |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
WO2008088982A1 (en) * | 2007-01-16 | 2008-07-24 | Board Of Regents, The University Of Texas System | Needle-electrode and tissue anchor system |
US9492220B2 (en) * | 2007-02-01 | 2016-11-15 | Conmed Corporation | Apparatus and method for rapid reliable electrothermal tissue fusion |
US9498277B2 (en) | 2007-02-01 | 2016-11-22 | Conmed Corporation | Apparatus and method for rapid reliable electrothermal tissue fusion and simultaneous cutting |
US8727197B2 (en) | 2007-03-15 | 2014-05-20 | Ethicon Endo-Surgery, Inc. | Staple cartridge cavity configuration with cooperative surgical staple |
US8911460B2 (en) | 2007-03-22 | 2014-12-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8057498B2 (en) | 2007-11-30 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument blades |
US8142461B2 (en) | 2007-03-22 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US20080243213A1 (en) * | 2007-04-02 | 2008-10-02 | Tomoyuki Takashino | Curative treatment system, curative treatment device, and treatment method for living tissue using energy |
US20080243121A1 (en) * | 2007-04-02 | 2008-10-02 | Tomoyuki Takashino | Curative treatment system, curative treatment device, and treatment method for living tissue using energy |
US11857181B2 (en) | 2007-06-04 | 2024-01-02 | Cilag Gmbh International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US8308040B2 (en) | 2007-06-22 | 2012-11-13 | 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 |
US8523889B2 (en) | 2007-07-27 | 2013-09-03 | Ethicon Endo-Surgery, Inc. | Ultrasonic end effectors with increased active length |
US8808319B2 (en) | 2007-07-27 | 2014-08-19 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US9044261B2 (en) | 2007-07-31 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Temperature controlled ultrasonic surgical instruments |
US8512365B2 (en) | 2007-07-31 | 2013-08-20 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8430898B2 (en) | 2007-07-31 | 2013-04-30 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US20090048589A1 (en) * | 2007-08-14 | 2009-02-19 | Tomoyuki Takashino | Treatment device and treatment method for living tissue |
US8623027B2 (en) | 2007-10-05 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Ergonomic surgical instruments |
EP2214562B1 (en) * | 2007-11-05 | 2016-04-27 | Erbe Elektromedizin GmbH | Surgical instrument for sealing blood vessels, and heat-curable adhesive as a medicament |
US10010339B2 (en) | 2007-11-30 | 2018-07-03 | Ethicon Llc | Ultrasonic surgical blades |
US8561870B2 (en) | 2008-02-13 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US8657174B2 (en) | 2008-02-14 | 2014-02-25 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument having handle based power source |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
BRPI0901282A2 (en) | 2008-02-14 | 2009-11-17 | Ethicon Endo Surgery Inc | surgical cutting and fixation instrument with rf electrodes |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US8752749B2 (en) | 2008-02-14 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Robotically-controlled disposable motor-driven loading unit |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US9770245B2 (en) | 2008-02-15 | 2017-09-26 | Ethicon Llc | 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 |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
ES2944288T3 (en) | 2008-03-31 | 2023-06-20 | Applied Med Resources | Electrosurgical system with means to determine the end of a treatment based on a phase angle |
US9089360B2 (en) | 2008-08-06 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
PL3476312T3 (en) | 2008-09-19 | 2024-03-11 | Ethicon Llc | Surgical stapler with apparatus for adjusting staple height |
US7857186B2 (en) | 2008-09-19 | 2010-12-28 | Ethicon Endo-Surgery, Inc. | Surgical stapler having an intermediate closing position |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8142473B2 (en) | 2008-10-03 | 2012-03-27 | Tyco Healthcare Group Lp | Method of transferring rotational motion in an articulating surgical instrument |
US8016827B2 (en) | 2008-10-09 | 2011-09-13 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
JP2010125157A (en) * | 2008-11-28 | 2010-06-10 | Olympus Corp | Ultrasonic incision device |
US8114122B2 (en) | 2009-01-13 | 2012-02-14 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US20110278343A1 (en) * | 2009-01-29 | 2011-11-17 | Cardica, Inc. | Clamping of Hybrid 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 |
CN102341048A (en) | 2009-02-06 | 2012-02-01 | 伊西康内外科公司 | Driven surgical stapler improvements |
US20120109151A1 (en) * | 2009-04-03 | 2012-05-03 | Ruprecht-Karls-Universität Heidelberg | System and Computer Assisted Surgery |
WO2010115508A2 (en) * | 2009-04-03 | 2010-10-14 | Deutsches Krebsforschungszentrum Stiftung des öffentlichen Rechts | Cutting tool for soft tissue surgery |
US20100280508A1 (en) * | 2009-05-01 | 2010-11-04 | Joseph Charles Eder | Method and Apparatus for RF Anastomosis |
US8187273B2 (en) | 2009-05-07 | 2012-05-29 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US9700339B2 (en) | 2009-05-20 | 2017-07-11 | Ethicon Endo-Surgery, Inc. | Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments |
US8701960B1 (en) | 2009-06-22 | 2014-04-22 | Cardica, Inc. | Surgical stapler with reduced clamp gap for insertion |
US8246618B2 (en) | 2009-07-08 | 2012-08-21 | Tyco Healthcare Group Lp | Electrosurgical jaws with offset knife |
US8663220B2 (en) | 2009-07-15 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8133254B2 (en) | 2009-09-18 | 2012-03-13 | Tyco Healthcare Group Lp | In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor |
US8112871B2 (en) | 2009-09-28 | 2012-02-14 | Tyco Healthcare Group Lp | Method for manufacturing electrosurgical seal plates |
US9024237B2 (en) | 2009-09-29 | 2015-05-05 | Covidien Lp | Material fusing apparatus, system and method of use |
US8747404B2 (en) | 2009-10-09 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Surgical instrument for transmitting energy to tissue comprising non-conductive grasping portions |
CA2777105C (en) * | 2009-10-09 | 2018-03-27 | Ethicon Endo-Surgery, Inc. | Surgical instrument surgical instrument comprising first and second drive systems actuatable by a common trigger mechanism |
US8939974B2 (en) | 2009-10-09 | 2015-01-27 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising first and second drive systems actuatable by a common trigger mechanism |
US10172669B2 (en) | 2009-10-09 | 2019-01-08 | Ethicon Llc | Surgical instrument comprising an energy trigger lockout |
US8986302B2 (en) | 2009-10-09 | 2015-03-24 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US8906016B2 (en) | 2009-10-09 | 2014-12-09 | Ethicon Endo-Surgery, Inc. | Surgical instrument for transmitting energy to tissue comprising steam control paths |
US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
US8574231B2 (en) | 2009-10-09 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Surgical instrument for transmitting energy to tissue comprising a movable electrode or insulator |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8608046B2 (en) | 2010-01-07 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Test device for a surgical tool |
EP2526883A4 (en) * | 2010-01-22 | 2017-07-12 | Olympus Corporation | Treatment tool, treatment device, and treatment method |
US8951272B2 (en) | 2010-02-11 | 2015-02-10 | Ethicon Endo-Surgery, Inc. | Seal arrangements for ultrasonically powered surgical instruments |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
US8486096B2 (en) | 2010-02-11 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Dual purpose surgical instrument for cutting and coagulating tissue |
US8696665B2 (en) | 2010-03-26 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical cutting and sealing instrument with reduced firing force |
US8709035B2 (en) | 2010-04-12 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instruments with jaws having a parallel closure motion |
US8834518B2 (en) | 2010-04-12 | 2014-09-16 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instruments with cam-actuated jaws |
US8535311B2 (en) | 2010-04-22 | 2013-09-17 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument comprising closing and firing systems |
DE102010020664A1 (en) * | 2010-05-05 | 2011-11-10 | Aesculap Ag | Surgical system for connecting body tissue parts |
US8685020B2 (en) | 2010-05-17 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instruments and end effectors therefor |
GB2480498A (en) | 2010-05-21 | 2011-11-23 | Ethicon Endo Surgery Inc | Medical device comprising RF circuitry |
US8795276B2 (en) | 2010-06-09 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing a plurality of electrodes |
US8888776B2 (en) | 2010-06-09 | 2014-11-18 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing an electrode |
US8926607B2 (en) | 2010-06-09 | 2015-01-06 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing multiple positive temperature coefficient electrodes |
US9005199B2 (en) | 2010-06-10 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Heat management configurations for controlling heat dissipation from electrosurgical instruments |
US8764747B2 (en) | 2010-06-10 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument comprising sequentially activated electrodes |
US8753338B2 (en) | 2010-06-10 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing a thermal management system |
SG186344A1 (en) * | 2010-06-23 | 2013-01-30 | Univ Singapore | An articulating ablation and division device with blood flow sensing capability |
US9149324B2 (en) | 2010-07-08 | 2015-10-06 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising an articulatable end effector |
US8453906B2 (en) | 2010-07-14 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Surgical instruments with electrodes |
US20120016413A1 (en) | 2010-07-14 | 2012-01-19 | Ethicon Endo-Surgery, Inc. | Surgical fastening devices comprising rivets |
US8795327B2 (en) | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US8979844B2 (en) | 2010-07-23 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8979843B2 (en) | 2010-07-23 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US9011437B2 (en) | 2010-07-23 | 2015-04-21 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8702704B2 (en) | 2010-07-23 | 2014-04-22 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US9498278B2 (en) | 2010-09-08 | 2016-11-22 | Covidien Lp | Asymmetrical electrodes for bipolar vessel sealing |
US8360296B2 (en) | 2010-09-09 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling head assembly with firing lockout for a surgical stapler |
US9289212B2 (en) | 2010-09-17 | 2016-03-22 | Ethicon Endo-Surgery, Inc. | Surgical instruments and batteries for surgical instruments |
US8632525B2 (en) | 2010-09-17 | 2014-01-21 | Ethicon Endo-Surgery, Inc. | Power control arrangements for surgical instruments and batteries |
US9173698B2 (en) * | 2010-09-17 | 2015-11-03 | Aesculap Ag | Electrosurgical tissue sealing augmented with a seal-enhancing composition |
US9877720B2 (en) | 2010-09-24 | 2018-01-30 | Ethicon Llc | Control features for articulating surgical device |
JP5687462B2 (en) * | 2010-09-27 | 2015-03-18 | オリンパス株式会社 | Therapeutic treatment device |
US8733613B2 (en) | 2010-09-29 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9314246B2 (en) | 2010-09-30 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
US9204880B2 (en) | 2012-03-28 | 2015-12-08 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising capsules defining a low pressure environment |
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 |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US9517063B2 (en) | 2012-03-28 | 2016-12-13 | Ethicon Endo-Surgery, Llc | Movable member for use with a tissue thickness compensator |
US9414838B2 (en) | 2012-03-28 | 2016-08-16 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprised of a plurality of materials |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US9386988B2 (en) | 2010-09-30 | 2016-07-12 | Ethicon End-Surgery, LLC | Retainer assembly including a tissue thickness compensator |
US9055941B2 (en) | 2011-09-23 | 2015-06-16 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9433419B2 (en) | 2010-09-30 | 2016-09-06 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a plurality of layers |
US9211120B2 (en) | 2011-04-29 | 2015-12-15 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a plurality of medicaments |
US8893949B2 (en) | 2010-09-30 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Surgical stapler with floating anvil |
EP2621356B1 (en) | 2010-09-30 | 2018-03-07 | Ethicon LLC | Fastener system comprising a retention matrix and an alignment matrix |
US9307989B2 (en) | 2012-03-28 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorportating a hydrophobic agent |
US9016542B2 (en) | 2010-09-30 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising compressible distortion resistant components |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9332974B2 (en) | 2010-09-30 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Layered tissue thickness compensator |
US9282962B2 (en) | 2010-09-30 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Adhesive film laminate |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
US8979890B2 (en) | 2010-10-01 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument with jaw member |
ES2664081T3 (en) | 2010-10-01 | 2018-04-18 | Applied Medical Resources Corporation | Electrosurgical system with a radio frequency amplifier and with means for adapting to the separation between electrodes |
US8628529B2 (en) | 2010-10-26 | 2014-01-14 | Ethicon Endo-Surgery, Inc. | Surgical instrument with magnetic clamping force |
US8715277B2 (en) | 2010-12-08 | 2014-05-06 | Ethicon Endo-Surgery, Inc. | Control of jaw compression in surgical instrument having end effector with opposing jaw members |
US9113940B2 (en) | 2011-01-14 | 2015-08-25 | Covidien Lp | Trigger lockout and kickback mechanism for surgical instruments |
US8632462B2 (en) | 2011-03-14 | 2014-01-21 | Ethicon Endo-Surgery, Inc. | Trans-rectum universal ports |
CA2834649C (en) | 2011-04-29 | 2021-02-16 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising staples positioned within a compressible portion thereof |
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 |
US9844384B2 (en) | 2011-07-11 | 2017-12-19 | Covidien Lp | Stand alone energy-based tissue clips |
US9259265B2 (en) | 2011-07-22 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Surgical instruments for tensioning tissue |
US9044243B2 (en) | 2011-08-30 | 2015-06-02 | Ethcon Endo-Surgery, Inc. | Surgical cutting and fastening device with descendible second trigger arrangement |
US8833632B2 (en) | 2011-09-06 | 2014-09-16 | Ethicon Endo-Surgery, Inc. | Firing member displacement system for a stapling instrument |
US9050084B2 (en) | 2011-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck arrangement |
US9486220B2 (en) | 2011-09-28 | 2016-11-08 | Covidien Lp | Surgical tissue occluding device |
US9314292B2 (en) | 2011-10-24 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Trigger lockout mechanism |
JP6120331B2 (en) * | 2011-12-14 | 2017-04-26 | 国立大学法人滋賀医科大学 | Tissue suture device |
USD680220S1 (en) | 2012-01-12 | 2013-04-16 | Coviden IP | Slider handle for laparoscopic device |
EP2811932B1 (en) | 2012-02-10 | 2019-06-26 | Ethicon LLC | Robotically controlled surgical instrument |
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 |
BR112014024102B1 (en) | 2012-03-28 | 2022-03-03 | Ethicon Endo-Surgery, Inc | CLAMP CARTRIDGE ASSEMBLY FOR A SURGICAL INSTRUMENT AND END ACTUATOR ASSEMBLY FOR A SURGICAL INSTRUMENT |
US9198662B2 (en) | 2012-03-28 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator having improved visibility |
CN104379068B (en) | 2012-03-28 | 2017-09-22 | 伊西康内外科公司 | Holding device assembly including tissue thickness compensation part |
BR112014024098B1 (en) | 2012-03-28 | 2021-05-25 | Ethicon Endo-Surgery, Inc. | staple cartridge |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9119657B2 (en) | 2012-06-28 | 2015-09-01 | Ethicon Endo-Surgery, Inc. | Rotary actuatable closure arrangement for surgical end effector |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US9282974B2 (en) | 2012-06-28 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Empty clip cartridge lockout |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
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 |
JP6290201B2 (en) | 2012-06-28 | 2018-03-07 | 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. | Lockout for empty clip cartridge |
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 |
US11278284B2 (en) | 2012-06-28 | 2022-03-22 | Cilag Gmbh International | Rotary drive arrangements for surgical instruments |
US9101385B2 (en) | 2012-06-28 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Electrode connections for rotary driven surgical tools |
US8747238B2 (en) | 2012-06-28 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Rotary drive shaft assemblies for surgical instruments with articulatable end effectors |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US9561038B2 (en) | 2012-06-28 | 2017-02-07 | Ethicon Endo-Surgery, Llc | Interchangeable clip applier |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
US9204879B2 (en) | 2012-06-28 | 2015-12-08 | Ethicon Endo-Surgery, Inc. | Flexible drive member |
US20140005640A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical end effector jaw and electrode configurations |
US9226751B2 (en) | 2012-06-28 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Surgical instrument system including replaceable end effectors |
US9820768B2 (en) | 2012-06-29 | 2017-11-21 | Ethicon Llc | Ultrasonic surgical instruments with control mechanisms |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US20140005702A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with distally positioned transducers |
US9408622B2 (en) | 2012-06-29 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9393037B2 (en) | 2012-06-29 | 2016-07-19 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
BR112015007010B1 (en) | 2012-09-28 | 2022-05-31 | Ethicon Endo-Surgery, Inc | end actuator |
US9386985B2 (en) | 2012-10-15 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Surgical cutting instrument |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
US9375259B2 (en) * | 2012-10-24 | 2016-06-28 | Covidien Lp | Electrosurgical instrument including an adhesive applicator assembly |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US9386984B2 (en) | 2013-02-08 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Staple cartridge comprising a releasable cover |
US10265119B2 (en) | 2013-02-15 | 2019-04-23 | Covidien Lp | Electrosurgical forceps |
JP6382235B2 (en) | 2013-03-01 | 2018-08-29 | 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. | Articulatable surgical instrument with a conductive path for signal communication |
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 |
US20140246475A1 (en) | 2013-03-01 | 2014-09-04 | Ethicon Endo-Surgery, Inc. | Control methods for surgical instruments with removable implement portions |
US20140263552A1 (en) | 2013-03-13 | 2014-09-18 | Ethicon Endo-Surgery, Inc. | Staple cartridge tissue thickness sensor system |
US10226273B2 (en) | 2013-03-14 | 2019-03-12 | Ethicon Llc | Mechanical fasteners for use with surgical energy devices |
US9332987B2 (en) | 2013-03-14 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Control arrangements for a drive member of a surgical instrument |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
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 |
US9572577B2 (en) | 2013-03-27 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a tissue thickness compensator including openings therein |
US9844368B2 (en) | 2013-04-16 | 2017-12-19 | Ethicon Llc | Surgical system comprising first and second drive systems |
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 |
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 |
US20150053746A1 (en) | 2013-08-23 | 2015-02-26 | Ethicon Endo-Surgery, Inc. | Torque optimization for surgical instruments |
US9295514B2 (en) | 2013-08-30 | 2016-03-29 | Ethicon Endo-Surgery, Llc | Surgical devices with close quarter articulation features |
US9814514B2 (en) | 2013-09-13 | 2017-11-14 | Ethicon Llc | Electrosurgical (RF) medical instruments for cutting and coagulating tissue |
US9861428B2 (en) | 2013-09-16 | 2018-01-09 | Ethicon Llc | Integrated systems for electrosurgical steam or smoke control |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
US9526565B2 (en) | 2013-11-08 | 2016-12-27 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
GB2521228A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
GB2521229A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
US9968354B2 (en) | 2013-12-23 | 2018-05-15 | Ethicon Llc | Surgical staples and methods for making the same |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US9681870B2 (en) | 2013-12-23 | 2017-06-20 | Ethicon Llc | Articulatable surgical instruments with separate and distinct closing and firing systems |
US9642620B2 (en) | 2013-12-23 | 2017-05-09 | Ethicon Endo-Surgery, Llc | Surgical cutting and stapling instruments with articulatable end effectors |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9795436B2 (en) | 2014-01-07 | 2017-10-24 | Ethicon Llc | Harvesting energy from a surgical generator |
US9408660B2 (en) | 2014-01-17 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Device trigger dampening mechanism |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
US9839422B2 (en) | 2014-02-24 | 2017-12-12 | Ethicon Llc | Implantable layers and methods for altering implantable layers for use with surgical fastening instruments |
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 |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
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 |
US10004497B2 (en) | 2014-03-26 | 2018-06-26 | Ethicon Llc | Interface systems for use with surgical instruments |
US10201364B2 (en) | 2014-03-26 | 2019-02-12 | Ethicon Llc | Surgical instrument comprising a rotatable shaft |
US9733663B2 (en) | 2014-03-26 | 2017-08-15 | Ethicon Llc | Power management through segmented circuit and variable voltage protection |
US10092310B2 (en) | 2014-03-27 | 2018-10-09 | Ethicon Llc | Electrosurgical devices |
US10463421B2 (en) | 2014-03-27 | 2019-11-05 | Ethicon Llc | Two stage trigger, clamp and cut bipolar vessel sealer |
US10524852B1 (en) | 2014-03-28 | 2020-01-07 | Ethicon Llc | Distal sealing end effector with spacers |
US9737355B2 (en) | 2014-03-31 | 2017-08-22 | Ethicon Llc | Controlling impedance rise in electrosurgical medical devices |
US9913680B2 (en) | 2014-04-15 | 2018-03-13 | Ethicon Llc | Software algorithms for electrosurgical instruments |
JP6532889B2 (en) | 2014-04-16 | 2019-06-19 | エシコン エルエルシーEthicon LLC | Fastener cartridge assembly and staple holder cover arrangement |
BR112016023825B1 (en) | 2014-04-16 | 2022-08-02 | Ethicon Endo-Surgery, Llc | STAPLE CARTRIDGE FOR USE WITH A SURGICAL STAPLER AND STAPLE CARTRIDGE 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 |
US10561422B2 (en) | 2014-04-16 | 2020-02-18 | Ethicon Llc | Fastener cartridge comprising deployable tissue engaging members |
US20150297223A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US10327764B2 (en) | 2014-09-26 | 2019-06-25 | Ethicon Llc | Method for creating a flexible staple line |
US9757186B2 (en) | 2014-04-17 | 2017-09-12 | Ethicon Llc | Device status feedback for bipolar tissue spacer |
US20150324317A1 (en) | 2014-05-07 | 2015-11-12 | Covidien Lp | Authentication and information system for reusable surgical instruments |
KR20230076143A (en) | 2014-05-16 | 2023-05-31 | 어플라이드 메디컬 리소시스 코포레이션 | Electrosurgical system |
CA2949242A1 (en) | 2014-05-30 | 2015-12-03 | 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 |
US9700333B2 (en) | 2014-06-30 | 2017-07-11 | Ethicon Llc | Surgical instrument with variable tissue compression |
JP6358697B2 (en) * | 2014-07-03 | 2018-07-18 | 株式会社日本未来医療研究所 | Vitreous surgery instrument |
US10285724B2 (en) | 2014-07-31 | 2019-05-14 | Ethicon Llc | Actuation mechanisms and load adjustment assemblies for surgical instruments |
US10194976B2 (en) | 2014-08-25 | 2019-02-05 | Ethicon Llc | Lockout disabling mechanism |
US9877776B2 (en) | 2014-08-25 | 2018-01-30 | Ethicon Llc | Simultaneous I-beam and spring driven cam jaw closure mechanism |
US10194972B2 (en) | 2014-08-26 | 2019-02-05 | Ethicon Llc | Managing tissue treatment |
FR3025088B1 (en) * | 2014-09-01 | 2019-12-06 | Franck Sarrazin | VERSATILE ELECTRO-SURGICAL DEVICE. |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US10111679B2 (en) | 2014-09-05 | 2018-10-30 | Ethicon Llc | Circuitry and sensors for powered medical device |
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 |
JP6648119B2 (en) | 2014-09-26 | 2020-02-14 | エシコン エルエルシーEthicon LLC | Surgical stapling buttress and accessory materials |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
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 |
CN106794040A (en) | 2014-10-22 | 2017-05-31 | 柯惠有限合伙公司 | Operating forceps for grasping, processing and/or cutting tissue |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
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 |
MX2017008108A (en) | 2014-12-18 | 2018-03-06 | Ethicon Llc | Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge. |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US10004501B2 (en) | 2014-12-18 | 2018-06-26 | Ethicon Llc | Surgical instruments with improved closure arrangements |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US10092348B2 (en) | 2014-12-22 | 2018-10-09 | Ethicon Llc | RF tissue sealer, shear grip, trigger lock mechanism and energy activation |
US10159524B2 (en) | 2014-12-22 | 2018-12-25 | Ethicon Llc | High power battery powered RF amplifier topology |
US10111699B2 (en) | 2014-12-22 | 2018-10-30 | Ethicon Llc | RF tissue sealer, shear grip, trigger lock mechanism and energy activation |
US9848937B2 (en) | 2014-12-22 | 2017-12-26 | Ethicon Llc | End effector with detectable configurations |
KR20230093365A (en) | 2014-12-23 | 2023-06-27 | 어플라이드 메디컬 리소시스 코포레이션 | Bipolar electrosurgical sealer and divider |
USD748259S1 (en) | 2014-12-29 | 2016-01-26 | Applied Medical Resources Corporation | Electrosurgical instrument |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
US10321907B2 (en) | 2015-02-27 | 2019-06-18 | Ethicon Llc | System for monitoring whether a surgical instrument needs to be serviced |
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 |
US9993258B2 (en) | 2015-02-27 | 2018-06-12 | Ethicon Llc | Adaptable surgical instrument handle |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
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 |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US9895148B2 (en) | 2015-03-06 | 2018-02-20 | Ethicon Endo-Surgery, Llc | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10548504B2 (en) | 2015-03-06 | 2020-02-04 | Ethicon Llc | Overlaid multi sensor radio frequency (RF) electrode system to measure tissue compression |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
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 |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10321950B2 (en) | 2015-03-17 | 2019-06-18 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
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 |
US10314638B2 (en) | 2015-04-07 | 2019-06-11 | Ethicon Llc | Articulating radio frequency (RF) tissue seal with articulating state sensing |
US10117702B2 (en) | 2015-04-10 | 2018-11-06 | Ethicon Llc | Surgical generator systems and related methods |
US10130410B2 (en) | 2015-04-17 | 2018-11-20 | Ethicon Llc | Electrosurgical instrument including a cutting member decouplable from a cutting member trigger |
US9872725B2 (en) | 2015-04-29 | 2018-01-23 | Ethicon Llc | RF tissue sealer with mode selection |
US11020140B2 (en) | 2015-06-17 | 2021-06-01 | Cilag Gmbh International | Ultrasonic surgical blade for use with ultrasonic surgical instruments |
US10368861B2 (en) | 2015-06-18 | 2019-08-06 | Ethicon Llc | Dual articulation drive system arrangements for articulatable surgical instruments |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US10357303B2 (en) | 2015-06-30 | 2019-07-23 | Ethicon Llc | Translatable outer tube for sealing using shielded lap chole dissector |
US11129669B2 (en) | 2015-06-30 | 2021-09-28 | Cilag Gmbh International | Surgical system with user adaptable techniques based on tissue type |
US11051873B2 (en) | 2015-06-30 | 2021-07-06 | Cilag Gmbh International | Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters |
US11141213B2 (en) | 2015-06-30 | 2021-10-12 | Cilag Gmbh International | Surgical instrument with user adaptable techniques |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
US10154852B2 (en) | 2015-07-01 | 2018-12-18 | Ethicon Llc | Ultrasonic surgical blade with improved cutting and coagulation features |
US11058425B2 (en) | 2015-08-17 | 2021-07-13 | Ethicon Llc | Implantable layers for a surgical instrument |
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 |
US10357251B2 (en) | 2015-08-26 | 2019-07-23 | Ethicon Llc | Surgical staples comprising hardness variations for improved fastening of tissue |
MX2022006192A (en) | 2015-09-02 | 2022-06-16 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples. |
US10238390B2 (en) | 2015-09-02 | 2019-03-26 | Ethicon Llc | Surgical staple cartridges with driver arrangements for establishing herringbone staple patterns |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-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 |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US11033322B2 (en) | 2015-09-30 | 2021-06-15 | Ethicon Llc | Circuit topologies for combined generator |
US10327777B2 (en) | 2015-09-30 | 2019-06-25 | Ethicon Llc | Implantable layer comprising plastically deformed fibers |
US10285699B2 (en) | 2015-09-30 | 2019-05-14 | Ethicon Llc | Compressible adjunct |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10959771B2 (en) | 2015-10-16 | 2021-03-30 | Ethicon Llc | Suction and irrigation sealing grasper |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
WO2017071633A1 (en) * | 2015-10-30 | 2017-05-04 | 重庆西山科技股份有限公司 | Electric coagulation power handle, and electric coagulation planing tools and planing assembly |
US10213250B2 (en) | 2015-11-05 | 2019-02-26 | Covidien Lp | Deployment and safety mechanisms for surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10959806B2 (en) | 2015-12-30 | 2021-03-30 | Ethicon Llc | Energized medical device with reusable handle |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10179022B2 (en) | 2015-12-30 | 2019-01-15 | Ethicon Llc | Jaw position impedance limiter for electrosurgical instrument |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10575892B2 (en) | 2015-12-31 | 2020-03-03 | Ethicon Llc | Adapter for electrical surgical instruments |
US10716615B2 (en) | 2016-01-15 | 2020-07-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade |
US11229471B2 (en) | 2016-01-15 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization |
US11129670B2 (en) | 2016-01-15 | 2021-09-28 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization |
US11051840B2 (en) | 2016-01-15 | 2021-07-06 | Ethicon Llc | Modular battery powered handheld surgical instrument with reusable asymmetric handle housing |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
BR112018016098B1 (en) | 2016-02-09 | 2023-02-23 | Ethicon Llc | SURGICAL INSTRUMENT |
US20170224332A1 (en) | 2016-02-09 | 2017-08-10 | Ethicon Endo-Surgery, Llc | Surgical instruments with non-symmetrical articulation arrangements |
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 |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10555769B2 (en) | 2016-02-22 | 2020-02-11 | Ethicon Llc | Flexible circuits for electrosurgical instrument |
US11064997B2 (en) | 2016-04-01 | 2021-07-20 | Cilag Gmbh International | Surgical stapling instrument |
US10271851B2 (en) | 2016-04-01 | 2019-04-30 | Ethicon Llc | Modular surgical stapling system comprising a display |
US10307159B2 (en) | 2016-04-01 | 2019-06-04 | Ethicon Llc | Surgical instrument handle assembly with reconfigurable grip portion |
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 |
US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10368867B2 (en) | 2016-04-18 | 2019-08-06 | Ethicon Llc | Surgical instrument comprising a lockout |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10856934B2 (en) | 2016-04-29 | 2020-12-08 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting and tissue engaging members |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure for electrosurgical instruments |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10646269B2 (en) | 2016-04-29 | 2020-05-12 | Ethicon Llc | Non-linear jaw gap for electrosurgical instruments |
US10987156B2 (en) | 2016-04-29 | 2021-04-27 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting member and electrically insulative tissue engaging members |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
JP6957532B2 (en) | 2016-06-24 | 2021-11-02 | エシコン エルエルシーEthicon LLC | Staple cartridges including wire staples and punched staples |
USD847989S1 (en) | 2016-06-24 | 2019-05-07 | Ethicon Llc | Surgical fastener cartridge |
US10702270B2 (en) | 2016-06-24 | 2020-07-07 | Ethicon Llc | Stapling system for use with wire staples and stamped staples |
USD850617S1 (en) | 2016-06-24 | 2019-06-04 | Ethicon Llc | Surgical fastener cartridge |
USD826405S1 (en) | 2016-06-24 | 2018-08-21 | Ethicon Llc | Surgical fastener |
US10245064B2 (en) | 2016-07-12 | 2019-04-02 | Ethicon Llc | Ultrasonic surgical instrument with piezoelectric central lumen transducer |
US10893883B2 (en) | 2016-07-13 | 2021-01-19 | Ethicon Llc | Ultrasonic assembly for use with ultrasonic surgical instruments |
US10842522B2 (en) | 2016-07-15 | 2020-11-24 | Ethicon Llc | Ultrasonic surgical instruments having offset blades |
US10376305B2 (en) | 2016-08-05 | 2019-08-13 | Ethicon Llc | Methods and systems for advanced harmonic energy |
US10285723B2 (en) | 2016-08-09 | 2019-05-14 | Ethicon Llc | Ultrasonic surgical blade with improved heel portion |
USD847990S1 (en) | 2016-08-16 | 2019-05-07 | Ethicon Llc | Surgical instrument |
US10952759B2 (en) | 2016-08-25 | 2021-03-23 | Ethicon Llc | Tissue loading of a surgical instrument |
US10828056B2 (en) | 2016-08-25 | 2020-11-10 | Ethicon Llc | Ultrasonic transducer to waveguide acoustic coupling, connections, and configurations |
US10751117B2 (en) | 2016-09-23 | 2020-08-25 | Ethicon Llc | Electrosurgical instrument with fluid diverter |
US10603064B2 (en) | 2016-11-28 | 2020-03-31 | Ethicon Llc | Ultrasonic transducer |
US11266430B2 (en) | 2016-11-29 | 2022-03-08 | Cilag Gmbh International | End effector control and calibration |
US10682138B2 (en) | 2016-12-21 | 2020-06-16 | Ethicon Llc | Bilaterally asymmetric staple forming pocket pairs |
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 |
US10918385B2 (en) | 2016-12-21 | 2021-02-16 | Ethicon Llc | Surgical system comprising a firing member rotatable into an articulation state to articulate an end effector of the surgical system |
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 |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US10588631B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical instruments with positive jaw opening features |
US20180168648A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Durability features for end effectors and firing assemblies of surgical stapling instruments |
US10687810B2 (en) | 2016-12-21 | 2020-06-23 | Ethicon Llc | Stepped staple cartridge with tissue retention and gap setting features |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US20180168633A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments and staple-forming anvils |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
US10856868B2 (en) | 2016-12-21 | 2020-12-08 | Ethicon Llc | Firing member pin configurations |
US10959727B2 (en) | 2016-12-21 | 2021-03-30 | Ethicon Llc | Articulatable surgical end effector with asymmetric shaft arrangement |
US10695055B2 (en) | 2016-12-21 | 2020-06-30 | Ethicon Llc | Firing assembly comprising a lockout |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
MX2019007311A (en) | 2016-12-21 | 2019-11-18 | Ethicon Llc | Surgical stapling systems. |
US11090048B2 (en) | 2016-12-21 | 2021-08-17 | Cilag Gmbh International | Method for resetting a fuse of a surgical instrument shaft |
US10993715B2 (en) | 2016-12-21 | 2021-05-04 | Ethicon Llc | Staple cartridge comprising staples with different clamping breadths |
US10945727B2 (en) | 2016-12-21 | 2021-03-16 | Ethicon Llc | Staple cartridge with deformable driver retention features |
US10888322B2 (en) | 2016-12-21 | 2021-01-12 | Ethicon Llc | Surgical instrument comprising a cutting member |
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 |
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 |
US10973516B2 (en) | 2016-12-21 | 2021-04-13 | Ethicon Llc | Surgical end effectors and adaptable firing members therefor |
US11033325B2 (en) | 2017-02-16 | 2021-06-15 | Cilag Gmbh International | Electrosurgical instrument with telescoping suction port and debris cleaner |
US10799284B2 (en) | 2017-03-15 | 2020-10-13 | Ethicon Llc | Electrosurgical instrument with textured jaws |
US11497546B2 (en) | 2017-03-31 | 2022-11-15 | Cilag Gmbh International | Area ratios of patterned coatings on RF electrodes to reduce sticking |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
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 |
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 |
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 |
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 |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
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 |
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 |
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 |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity 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 |
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 |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of 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 |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity 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 |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
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 |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
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 |
US20180368844A1 (en) | 2017-06-27 | 2018-12-27 | Ethicon Llc | Staple forming pocket arrangements |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
EP3420947B1 (en) | 2017-06-28 | 2022-05-25 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10603117B2 (en) | 2017-06-28 | 2020-03-31 | Ethicon Llc | Articulation state detection mechanisms |
US11478242B2 (en) | 2017-06-28 | 2022-10-25 | Cilag Gmbh International | Jaw retainer arrangement for retaining a pivotable surgical instrument jaw in pivotable retaining engagement with a second surgical instrument jaw |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US11484310B2 (en) | 2017-06-28 | 2022-11-01 | Cilag Gmbh International | Surgical instrument comprising a shaft including a closure tube profile |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
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 |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US10820920B2 (en) | 2017-07-05 | 2020-11-03 | Ethicon Llc | Reusable ultrasonic medical devices and methods of their use |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11590345B2 (en) | 2017-08-08 | 2023-02-28 | Pulse Biosciences, Inc. | Treatment of tissue by the application of energy |
US10850095B2 (en) | 2017-08-08 | 2020-12-01 | Pulse Biosciences, Inc. | Treatment of tissue by the application of energy |
US10857347B2 (en) | 2017-09-19 | 2020-12-08 | Pulse Biosciences, Inc. | Treatment instrument and high-voltage connectors for robotic surgical system |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US11484358B2 (en) | 2017-09-29 | 2022-11-01 | Cilag Gmbh International | Flexible electrosurgical instrument |
US11033323B2 (en) | 2017-09-29 | 2021-06-15 | Cilag Gmbh International | Systems and methods for managing fluid and suction in electrosurgical systems |
US11490951B2 (en) | 2017-09-29 | 2022-11-08 | Cilag Gmbh International | Saline contact with electrodes |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
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 |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
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 |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
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 |
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 |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
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 |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
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 |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US11179152B2 (en) | 2017-12-21 | 2021-11-23 | Cilag Gmbh International | Surgical instrument comprising a tissue grasping system |
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 |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
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 |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
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 |
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 |
AU2019335013A1 (en) | 2018-09-05 | 2021-03-25 | Applied Medical Resources Corporation | Electrosurgical generator control system |
AU2019381617A1 (en) | 2018-11-16 | 2021-05-20 | Applied Medical Resources Corporation | Electrosurgical system |
US11571569B2 (en) | 2019-02-15 | 2023-02-07 | Pulse Biosciences, Inc. | High-voltage catheters for sub-microsecond pulsing |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | 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 |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11723729B2 (en) | 2019-06-27 | 2023-08-15 | Cilag Gmbh International | Robotic surgical assembly coupling safety mechanisms |
US11607278B2 (en) | 2019-06-27 | 2023-03-21 | Cilag Gmbh International | Cooperative robotic surgical systems |
US11413102B2 (en) | 2019-06-27 | 2022-08-16 | Cilag Gmbh International | Multi-access port for surgical robotic systems |
US11547468B2 (en) | 2019-06-27 | 2023-01-10 | Cilag Gmbh International | Robotic surgical system with safety and cooperative sensing control |
US11612445B2 (en) | 2019-06-27 | 2023-03-28 | Cilag Gmbh International | Cooperative operation of robotic arms |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11350938B2 (en) | 2019-06-28 | 2022-06-07 | Cilag Gmbh International | Surgical instrument comprising an aligned rfid sensor |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
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 |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
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 |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
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 |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
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 |
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 |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11937863B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Deflectable electrode with variable compression bias along the length of the deflectable electrode |
US11812957B2 (en) | 2019-12-30 | 2023-11-14 | Cilag Gmbh International | Surgical instrument comprising a signal interference resolution system |
US11452525B2 (en) | 2019-12-30 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising an adjustment system |
US11779387B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Clamp arm jaw to minimize tissue sticking and improve tissue control |
US11786291B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Deflectable support of RF energy electrode with respect to opposing ultrasonic blade |
US11944366B2 (en) | 2019-12-30 | 2024-04-02 | Cilag Gmbh International | Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode |
US11911063B2 (en) | 2019-12-30 | 2024-02-27 | Cilag Gmbh International | Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade |
US11684412B2 (en) | 2019-12-30 | 2023-06-27 | Cilag Gmbh International | Surgical instrument with rotatable and articulatable surgical end effector |
US20210196361A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with monopolar and bipolar energy capabilities |
US11660089B2 (en) | 2019-12-30 | 2023-05-30 | Cilag Gmbh International | Surgical instrument comprising a sensing system |
US11744636B2 (en) | 2019-12-30 | 2023-09-05 | Cilag Gmbh International | Electrosurgical systems with integrated and external power sources |
US11779329B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a flex circuit including a sensor system |
US11950797B2 (en) | 2019-12-30 | 2024-04-09 | Cilag Gmbh International | Deflectable electrode with higher distal bias relative to proximal bias |
US11696776B2 (en) | 2019-12-30 | 2023-07-11 | Cilag Gmbh International | Articulatable surgical instrument |
US11937866B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Method for an electrosurgical procedure |
US11786294B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Control program for modular combination energy device |
US11832916B2 (en) | 2020-01-29 | 2023-12-05 | Covidien Lp | System and methods for identifying vessels within tissue |
US11844562B2 (en) | 2020-03-23 | 2023-12-19 | Covidien Lp | Electrosurgical forceps for grasping, treating, and/or dividing tissue |
US11534167B2 (en) * | 2020-05-28 | 2022-12-27 | Covidien Lp | Electrotaxis-conducive stapling |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | 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 |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
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 |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
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 |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
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 |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
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US20220304692A1 (en) * | 2021-03-26 | 2022-09-29 | Covidien Lp | Surgical staple cartridge |
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Family Cites Families (33)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4041952A (en) | 1976-03-04 | 1977-08-16 | Valleylab, Inc. | Electrosurgical forceps |
FR2647683B1 (en) | 1989-05-31 | 1993-02-12 | Kyocera Corp | BLOOD WATERPROOFING / COAGULATION DEVICE OUTSIDE BLOOD VESSELS |
US5665100A (en) | 1989-12-05 | 1997-09-09 | Yoon; Inbae | Multifunctional instrument with interchangeable operating units for performing endoscopic procedures |
US5531744A (en) | 1991-11-01 | 1996-07-02 | Medical Scientific, Inc. | Alternative current pathways for bipolar surgical cutting tool |
US5207691A (en) | 1991-11-01 | 1993-05-04 | Medical Scientific, Inc. | Electrosurgical clip applicator |
US5665085A (en) | 1991-11-01 | 1997-09-09 | Medical Scientific, Inc. | Electrosurgical cutting tool |
US5443463A (en) | 1992-05-01 | 1995-08-22 | Vesta Medical, Inc. | Coagulating forceps |
US5403312A (en) | 1993-07-22 | 1995-04-04 | Ethicon, Inc. | Electrosurgical hemostatic device |
US5810811A (en) | 1993-07-22 | 1998-09-22 | Ethicon Endo-Surgery, Inc. | Electrosurgical hemostatic device |
US5709680A (en) | 1993-07-22 | 1998-01-20 | Ethicon Endo-Surgery, Inc. | Electrosurgical hemostatic device |
US5693051A (en) | 1993-07-22 | 1997-12-02 | Ethicon Endo-Surgery, Inc. | Electrosurgical hemostatic device with adaptive electrodes |
US5688270A (en) | 1993-07-22 | 1997-11-18 | Ethicon Endo-Surgery,Inc. | Electrosurgical hemostatic device with recessed and/or offset electrodes |
US5458598A (en) | 1993-12-02 | 1995-10-17 | Cabot Technology Corporation | Cutting and coagulating forceps |
US5571216A (en) * | 1994-01-19 | 1996-11-05 | The General Hospital Corporation | Methods and apparatus for joining collagen-containing materials |
US6302898B1 (en) * | 1994-06-24 | 2001-10-16 | Advanced Closure Systems, Inc. | Devices for sealing punctures in body vessels |
US5573535A (en) | 1994-09-23 | 1996-11-12 | United States Surgical Corporation | Bipolar surgical instrument for coagulation and cutting |
US6152920A (en) * | 1997-10-10 | 2000-11-28 | Ep Technologies, Inc. | Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body |
US5674220A (en) | 1995-09-29 | 1997-10-07 | Ethicon Endo-Surgery, Inc. | Bipolar electrosurgical clamping device |
US5891142A (en) | 1996-12-06 | 1999-04-06 | Eggers & Associates, Inc. | Electrosurgical forceps |
USH1904H (en) | 1997-05-14 | 2000-10-03 | Ethicon Endo-Surgery, Inc. | Electrosurgical hemostatic method and device |
US6083223A (en) * | 1997-08-28 | 2000-07-04 | Baker; James A. | Methods and apparatus for welding blood vessels |
US5908420A (en) | 1997-10-03 | 1999-06-01 | Everest Medical Corporation | Surgical scissors with bipolar distal electrodes |
US6464699B1 (en) * | 1997-10-10 | 2002-10-15 | Scimed Life Systems, Inc. | Method and apparatus for positioning a diagnostic or therapeutic element on body tissue and mask element for use with same |
US6126658A (en) | 1998-02-19 | 2000-10-03 | Baker; James A. | Radiofrequency medical instrument and methods for vessel welding |
US6273886B1 (en) * | 1998-02-19 | 2001-08-14 | Curon Medical, Inc. | Integrated tissue heating and cooling apparatus |
US6010516A (en) | 1998-03-20 | 2000-01-04 | Hulka; Jaroslav F. | Bipolar coaptation clamps |
US6030384A (en) | 1998-05-01 | 2000-02-29 | Nezhat; Camran | Bipolar surgical instruments having focused electrical fields |
US6086586A (en) * | 1998-09-14 | 2000-07-11 | Enable Medical Corporation | Bipolar tissue grasping apparatus and tissue welding method |
US6174309B1 (en) | 1999-02-11 | 2001-01-16 | Medical Scientific, Inc. | Seal & cut electrosurgical instrument |
US6183490B1 (en) * | 1999-03-08 | 2001-02-06 | Augustin Korbar | Piercing system |
US6152923A (en) | 1999-04-28 | 2000-11-28 | Sherwood Services Ag | Multi-contact forceps and method of sealing, coagulating, cauterizing and/or cutting vessels and tissue |
US6770070B1 (en) * | 2000-03-17 | 2004-08-03 | Rita Medical Systems, Inc. | Lung treatment apparatus and method |
AU2002254712A1 (en) | 2001-04-20 | 2002-11-05 | Power Medical Interventions, Inc. | Bipolar or ultrasonic surgical device |
-
2003
- 2003-01-16 EP EP03710688.7A patent/EP1474045B1/en not_active Expired - Lifetime
- 2003-01-16 JP JP2003567238A patent/JP2005516714A/en active Pending
- 2003-01-16 CA CA2475737A patent/CA2475737C/en not_active Expired - Lifetime
- 2003-01-16 WO PCT/US2003/001586 patent/WO2003068046A2/en active Application Filing
- 2003-01-16 US US10/504,279 patent/US7625370B2/en not_active Expired - Fee Related
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2009
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EP1474045A2 (en) | 2004-11-10 |
EP1474045A4 (en) | 2009-09-16 |
JP2005516714A (en) | 2005-06-09 |
CA2475737A1 (en) | 2003-08-21 |
WO2003068046A2 (en) | 2003-08-21 |
US20050165444A1 (en) | 2005-07-28 |
US7625370B2 (en) | 2009-12-01 |
EP1474045B1 (en) | 2016-12-07 |
US20100049194A1 (en) | 2010-02-25 |
US8551089B2 (en) | 2013-10-08 |
WO2003068046A3 (en) | 2004-02-26 |
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