US20080045942A1 - Electrosurgical instrument and method of use - Google Patents
Electrosurgical instrument and method of use Download PDFInfo
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- US20080045942A1 US20080045942A1 US11/925,092 US92509207A US2008045942A1 US 20080045942 A1 US20080045942 A1 US 20080045942A1 US 92509207 A US92509207 A US 92509207A US 2008045942 A1 US2008045942 A1 US 2008045942A1
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- engagement surface
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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
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00077—Electrical conductivity high, i.e. electrically conducting
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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
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
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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
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00107—Coatings on the energy applicator
- A61B2018/00148—Coatings on the energy applicator with metal
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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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
- A61B2018/00654—Sensing and controlling the application of energy with feedback, i.e. closed loop control with individual control of each of a plurality of energy emitting elements
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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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
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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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
- A61B2018/00797—Temperature measured by multiple temperature sensors
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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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00791—Temperature
- A61B2018/00809—Temperature measured thermochromatically
-
- 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
- A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
Definitions
- This invention relates to medical devices and techniques and more particularly relates to a working end of an electro surgical instrument that causes controlled ohmic heating of tissue across an engagement surface that modulates Rf power levels across localized micro-scale portions of the engagement surface, the system further adapted to focus conductive heating of tissue across the engagement surface.
- the prior art Rf devices also fail to provide seals with substantial strength in anatomic structures having walls with irregular or thick fibrous content, in bundles of disparate anatomic structures, in substantially thick anatomic structures, or in tissues with thick fascia layers (e.g., large diameter blood vessels).
- each face of opposing first and second jaws comprises an electrode and Rf current flows across the captured tissue between the opposing polarity electrodes.
- Rf jaws that engage opposing sides of tissue typically cannot cause uniform thermal effects in the tissue—whether the captured tissue is thin or substantially thick.
- the tissue surface becomes desiccated and resistant to additional ohmic heating. Localized tissue desiccation and charring can occur almost instantly as tissue impedance rises, which then can result in a non-uniform seal in the tissue.
- the typical prior art Rf jaws can cause further undesirable effects by propagating Rf density laterally from the engaged tissue thus causing unwanted collateral thermal damage.
- the commercially available Rf sealing instruments typically use one of two approaches to “control” Rf energy delivery in tissue.
- the Rf system controller can rapidly adjust the level of total power delivered to the jaws' engagement surfaces in response to feedback circuitry coupled to the active electrodes that measures tissue impedance or electrode temperature.
- the instrument jaws carry an electrode arrangement in which opposing polarity electrodes are spaced apart by an insulator material--which may cause current to flow within an extended path through captured tissue rather that simply between surfaces of the first and second jaws.
- Electrosurgical grasping instruments having jaws with electrically-isolated electrode arrangements in cooperating jaws faces were proposed by Yates et al. in U.S. Pat. Nos. 5,403,312; 5,735,848 and 5,833,690.
- FIGS. 1A-1D The illustrations of the wall of a blood vessel in FIGS. 1A-1D are useful in understanding the limitations of prior art Rf working ends for sealing tissue.
- FIG. 1B provides a graphic illustration of the opposing vessel walls portions 2 a and 2 b with the tissue divided into a grid with arbitrary micron dimensions—for example, the grid can represent 5 microns on each side of the targeted tissue.
- each micron-dimensioned volume of tissue must be simultaneously elevated to the temperature needed to denature proteins therein.
- tissue mass As will be described in more detail below, in order to create a “weld” in tissue, collagen, elastin and other protein molecules within an engaged tissue volume must be denatured by breaking the inter- and intra-molecular hydrogen bonds—followed by re-cross-linking on thermal relaxation to create a fused—together tissue mass. It can be easily understood that ohmic heating in tissue—if not uniform—can at best create localized spots of truly “welded” tissue. Such a non-uniformly denatured tissue volume still is “coagulated” and will prevent blood flow in small vasculature that contains little pressure. However, such non-uniformly denatured tissue will not create a seal with significant strength, for example in 2 mm. to 10 mm. arteries that contain high pressures.
- FIG. 1C shows the opposing vessel walls 2 a and 2 b being compressed with cut-away phantom views of opposing polarity electrodes on either side of the tissue.
- One advantage of such an electrode arrangement is that 100% of each jaw engagement surface comprises an “active” conductor of electrical current—thus no tissue is engaged by an insulator which theoretically would cause a dead spot (no ohmic heating) proximate to the insulator.
- FIG. 1D depicts vessel walls 2 a and 2 b engaged between opposing jaws surfaces with cut-away phantom views of opposing polarity (+) and ( ⁇ ) electrodes on each side of the engaged tissue.
- An insulator indicated at 10 is shown in cut-away view that electrically isolates the electrodes in the jaw.
- One significant disadvantage of using an insulator 10 in a jaw engagement surface is that no ohmic heating of tissue can be delivered directly to the tissue volume engaged by the insulator 10 (see FIG. 1D ).
- thermally-induced tissue welding relate to: (i) means for “non-random spatial localization” of energy densities in the engaged tissue et, (ii) means for “controlled, timed intervals” of power application of such spatially localized of energy densities, and (iii) means for “modulating the power level” of any such localized, time-controlled applications of energy.
- FIG. 2 illustrates a hypothetical tissue volume with a lower jaw's engagement surface 15 backed away from the tissue.
- the tissue is engaged under very high compression which is indicated by arrows in FIG. 2 .
- the engagement surface 15 is shown as divided into a hypothetical grid of “pixels” or micron-dimensioned surface areas 20 .
- FIG. 2 graphically illustrates that to create an effective tissue weld, the delivery of energy should be controlled and non-randomly spatially localized relative to each pixel 20 of the engagement surface 15 .
- the systems and methods corresponding to invention relate to creating thermal “welds” or “fusion” within native tissue volumes.
- tissue “welding” and tissue “fusion” are used interchangeably herein to describe thermal treatments of a targeted tissue volume that result in a substantially uniform fused-together tissue mass that provides substantial tensile strength immediately post-treatment.
- Such tensile strength is particularly important (i) for welding blood vessels in vessel transection procedures, (ii) for welding organ margins in resection procedures, (iii) for welding other anatomic ducts wherein permanent closure is required, and also (iv) for vessel anastomosis, vessel closure or other procedures that join together anatomic structures or portions thereof.
- tissue as disclosed herein is to be distinguished from “coagulation”, “sealing”, “hemostasis” and other similar descriptive terms that generally relate to the collapse and occlusion of blood flow within small blood vessels or vascularized tissue.
- any surface application of thermal energy can cause coagulation or hemostasis—but does not fall into the category of “welding” as the term is used herein.
- Such surface coagulation does not create a weld that provides any substantial strength in the affected tissue.
- tissue welding results from the thermally-induced denaturation of collagen, elastin and other protein molecules in a targeted tissue volume to create a transient liquid or gel-like proteinaceous amalgam.
- a selected energy density is provided in the targeted tissue to cause hydrothermal breakdown of intra- and intermolecular hydrogen cross-links in collagen and other proteins.
- the denatured amalgam is maintained at a selected level of hydration—without desiccation—for a selected time interval which can be very brief.
- the targeted tissue volume is maintained under a selected very high level of mechanical compression to insure that the unwound strands of the denatured proteins are in close proximity to allow their intertwining and entanglement.
- the intermixed amalgam results in “protein entanglement” as re-cross-linking or renaturation occurs to thereby cause a uniform fused-together mass.
- T d Temperature of thermal denaturation.
- the targeted tissue volume must be elevated to the temperature of thermal denaturation, T d , which ranges from about 50° C. to 90° C., and more specifically is from about 60° C. to 80° C.
- T d the temperature of thermal denaturation
- the optimal T d within the larger temperature range is further dependent on the duration of thermal effects and level of pressure applied to the engaged tissue.
- the process of heat diffusion describes a process of conduction and convection and defines a targeted volume's thermal relaxation time (often defined as the time over which the temperature is reduced by one-half).
- thermal relaxation time scales with the square of the diameter of the treated volume in a spherical volume, decreasing as the diameter decreases.
- tissue is considered to have a thermal relaxation time in the range of 1 ms.
- the thermal relaxation of tissue in an Rf application typically will prevent a uniform weld since the random current paths result in very uneven ohmic heating (see FIGS. 1C-1D ).
- Instrument engagement surfaces (iv) Instrument engagement surfaces.
- the instrument's engagement surface(s) must have characteristics that insure that every square micron of the instrument surface is in contact with tissue during Rf energy application. Any air gap between an engagement surface and tissue can cause an arc of electrical energy across the insulative gap thus resulting in charring of tissue. Such charring (desiccation) will entirely prevent welding of the localized tissue volume and result in further collateral effects that will weaken any attempted weld.
- the engagement surfaces corresponding to the invention are (i) substantially smooth at a macroscale, and (ii) at least partly of an elastomeric matrix that can conform to the tissue surface dynamically during treatment.
- the jaw structure of the invention typically has gripping elements that are lateral from the energy-delivering engagement surfaces. Gripping serrations otherwise can cause unwanted “gaps” and microscale trapped air pockets between the tissue and the engagement surfaces.
- the proposed high compressive forces can increase the thermal relaxation time of the engaged tissue practically by an infinite amount.
- the engaged tissue highly compressed to the dimension of a membrane between opposing engagement surfaces, for example to a thickness of about 0.001′′, there is effectively little “captured” tissue within which thermal diffusion can take place.
- the very thin tissue cross-section at the margins of the engaged tissue prevents heat conduction to tissue volumes outside the jaw structure.
- the high compressive forces at first cause the lateral migration of fluids from the engaged tissue which assists in the subsequent welding process. It has been found that highly hydrated tissues are not necessary in tissue welding. What is important is maintaining the targeted tissue at a selected level without desiccation as is typical in the prior art. Further, the very high compressive forces cause an even distribution of hydration across the engaged tissue volume prior to energy delivery.
- the high compressive forces insure that the engagement planes of the jaws are in complete contact with the surfaces of the targeted tissues, thus preventing any possibility of an arc of electrical energy a cross a “gap” would cause tissue charring, as described previously.
- One exemplary embodiment disclosed herein is particularly adapted for, in effect, independent spatial localization and modulation of Rf energy application across micron-scale “pixels” of an engagement surface.
- the jaw structure of the instrument defines opposing engagement planes that apply high mechanical compression to the engaged tissue.
- At least one engagement plane has a surface layer that comprises first and second portions of a conductive-resistive matrix—preferably including an elastomer such as silicone (first portion) and conductive particles (second portion) distributed therein.
- An electrical source is coupled to the working end such that the combination of the conductive-resistive matrix and the engaged tissue are intermediate opposing conductors that define first and second polarities of the electrical source coupled thereto.
- the conductive-resistive matrix is designed to exhibit unique resistance vs. temperature characteristics, wherein the matrix maintains a low base resistance over a selected temperature range with a dramatically increasing resistance above a selected narrow temperature range.
- the conductive-resistive matrix and jaw body corresponding to the invention further can provides a suitable cross-section and mass for providing substantial heat capacity.
- the retained heat of the matrix volume can effectively apply thermal energy to the engaged tissue volume by means of conduction and convection.
- the working end can automatically modulate the application of energy to tissue between active Rf heating and passive conductive heating of the targeted tissue to maintain a targeted temperature level.
- another system embodiment disclosed herein is adapted for causing a “wave” of ohmic heating to sweep across tissue to denature tissue constituents in its wake.
- This embodiment again utilizes at least one engagement plane in a jaw structure that carries a conductive-resistive matrix as described previously. At least one of the opposing polarity conductors has a portion thereof exposed in the engagement plane.
- the conductive-resistive matrix again is intermediate the opposing polarity conductors.
- the matrix defines an “interface” therein where microcurrents are most intense about the interface of the two polarities—since the matrix is not a simple conductor.
- the system of conductive-resistive matrices for Rf energy delivery allows for opposing electrical potentials to be exposed in a single engagement surface with a conductive matrix therebetween to allow 100% of the engagement surface to emit energy to tissue.
- the system of conductive-resistive matrices for Rf energy application to tissue allows for bi-polar electrical potential to be exposed in a single engagement surface without an intermediate insulator portion.
- the system of conductive-resistive matrices for energy application to tissue advantageously allows for the creation of “welds” in tissue within about 500 ms to 2 seconds.
- the system of conductive-resistive matrices for energy application to tissue provides “welds” in blood vessels that have very high strength.
- FIG. 1A is a view of a blood vessel targeted for welding.
- FIG. 1B is a greatly enlarged sectional view of opposing wall portions of the blood vessel of FIG. 1A taken along line 1 B- 1 B of FIG. 1A .
- FIG. 1C is a graphic representation of opposing walls of a blood vessel engaged by prior art electrosurgical jaws showing random paths of current (causing ohmic heating) across the engaged tissue between opposing polarity electrodes.
- FIG. 1D is a graphic representation of a blood vessel engaged by prior art electrosurgical jaws with an insulator between opposing polarity electrodes on each side of the tissue showing random paths of current (ohmic heating).
- FIG. 2 graphically represents a blood vessel engaged by hypothetical electrosurgical jaws under very high compression with an energy-delivery surface proximate to the tissue.
- FIG. 3A is a perspective view of a jaw structure of tissue-transecting and welding instrument that carries a Type “A” conductive-resistive matrix system corresponding to the invention.
- FIG. 3B is a sectional view of the jaw structure of FIG. 3A taken along line 3 B- 3 B of FIG. 3A showing the location of conductive-resistive matrices.
- FIG. 4 is a perspective view of another exemplary surgical instrument that carries a Type “A” conductive-resistive matrix system for welding tissue.
- FIG. 5 is a sectional view of the jaw structure of FIG. 4 taken along line 5 - 5 of FIG. 4 showing details of the conductive-resistive matrix.
- FIG. 6 is a graph showing (i) temperature-resistance profiles of alternative conductive-resistive matrices that can be carried in the jaw of FIG. 5 , (ii) the impedance of tissue, and (iii) the combined resistance of the matrix and tissue as measured by a system controller.
- FIG. 7A is an enlarged view of a portion of the conductive-resistive matrix and jaw body of FIG. 5 showing a first portion of an elastomer and a second portion of conductive particles at a resting temperature.
- FIG. 7B is another view the conductive-resistive matrix and jaw body of FIG. 7A after a portion is elevated to a higher temperature to modulate microcurrent flow therethrough thus depicting a method of the invention in spatially localizing and modulating Rf energy application from a conductive-resistive matrix that engages tissue.
- FIG. 8A is a further enlarged view of the conductive-resistive matrix of FIG. 7A showing the first portion (elastomer) and the second portion (conductive elements) and paths of microcurrents therethrough.
- FIG. 8B is a further enlarged view of matrix of FIG. 7B showing the effect of increased temperature and the manner in which resistance to microcurrent flow is caused in the method of spatially localizing and modulating Rf energy application.
- FIG. 9 is an enlarged view of an alternative conductive-resistive matrix similar to that of FIG. 7A that is additionally doped with thermally conductive, electrically non-conductive particles.
- FIG. 10 is an alternative jaw structure similar to that of FIGS. 5 and 7 A except carrying conductive-resistive matrices in the engagement surfaces of both opposing jaws.
- FIG. 11 is a greatly enlarged sectional view of the jaws of FIG. 10 taken along line 11 - 11 of FIG. 10 .
- FIG. 12 is a sectional view of another exemplary jaw structure that carries a Type “B” conductive-resistive matrix system for welding tissue that utilizes opposing polarity electrodes with an intermediate conductive-resistive matrix in an engagement surface.
- FIG. 13A is a sectional view of alternative Type “B” jaw with a plurality of opposing polarity electrodes with intermediate conductive-resistive matrices in the engagement surface.
- FIG. 13B is a sectional view of a Type “B” jaw similar to that of FIG. 13A with a plurality of opposing polarity electrodes with intermediate conductive-resistive matrices in the engagement surface in a different angular orientation.
- FIG. 13C is a sectional view of another Type “B” jaw similar to that of FIGS. 13A-13B with a plurality of opposing polarity electrodes with intermediate matrices in another angular orientation.
- FIGS. 14A-14C graphically illustrate a method of the invention in causing a wave of Rf energy density to propagate across and engaged tissue membrane to denature tissue constituents:
- FIG. 14A being the engagement surface of FIG. 12 engaging tissue membrane at the time that energy delivery is initiated causing localized microcurrents and ohmic tissue heating;
- FIG. 14B being the engagement surface of FIG. 12 after an arbitrary millisecond or microsecond time interval depicting the propagation of a wavefronts of energy outward from the initial localized microcurrents as the localized temperature and resistance of the matrix is increased;
- FIG. 14C being the engagement surface of FIG. 12 after another very brief interval depicting the propagation of the wavefronts of energy density outwardly in the tissue due to increase temperature and resistance of matrix portions.
- FIG. 15 is an enlarged sectional view of the exemplary jaw structure of FIG. 13A with a plurality of opposing polarity conductors on either side of conductive-resistive matrix portions.
- FIG. 16 is a sectional view of a jaw structure similar to that of FIG. 15 with a plurality of opposing polarity conductors that float within an elastomeric conductive-resistive matrix portions.
- FIG. 17 is a sectional view of a jaw structure similar to that of FIG. 16 with a single central conductor that floats on a convex elastomeric conductive-resistive matrix with opposing polarity conductors in outboard locations.
- FIGS. 18A-18C provide simplified graphic views of the method of causing a wave of Rf energy density in the embodiment of FIG. 17 , similar to the method shown in FIGS. 14 A- 14 C:
- FIG. 18A corresponding to the view of FIG. 14A showing initiation of energy delivery
- FIG. 18B corresponding to the view of FIG. 14B showing the propagation of the wavefronts of energy density outwardly
- FIG. 18C corresponding to the view of FIG. 14C showing the further outward propagation of the wavefronts of energy density to thereby weld tissue.
- FIG. 19 is a sectional view of another exemplary jaw structure that carries two conductive-resistive matrix portions, each having a different durometer and a different temperature coefficient profile.
- FIG. 20 is a sectional view of a jaw assembly having the engagement plane of FIG. 17 carried in a transecting-type jaws similar to that of FIGS. 3A-3B .
- FIG. 21 is a sectional view of an alternative jaw structure similar with a fully metallized engagement surface coupled to first and second polarity leads in adjacent portions thereof.
- FIG. 22 is an enlarged view of the fully metallized engagement surface of FIG. 21 showing the first and second polarity leads that are coupled to the metal film layer.
- FIG. 23 is a sectional view of a Type “D” working end corresponding to the invention with a conductive-resistive matrix having tapered cross-sectional dimension for focusing passive heating in the center of the engagement surface.
- FIG. 24 is a sectional view of an alternative Type “D” working end with a gradient matrix for focusing passive heating in the center of the engagement surface.
- FIG. 25 is a sectional view of an alternative Type “D” working end similar to that of FIG. 23 a with conductive-resistive matrix in the upper jaw.
- FIG. 26A is a perspective view of an alternative Type “D” instrument with an extendable blade member.
- FIG. 26B is a sectional view of the jaw structure of FIG. 26A taken along line 26 B- 26 B of FIG. 26A .
- FIG. 27 is a sectional view of an alternative jaw structure similar to that of FIG. 26B with additional electrodes in the engagement surface.
- FIG. 28 is a sectional view of an alternative jaw structure similar to that of FIG. 27 .
- FIG. 29 is a graph showing a power-impedance curve of a voltage source plotted against an impedance-temperature curve of a conductive-resistive matrix corresponding to the invention.
- FIGS. 3A and 3B illustrate a working end of a surgical grasping instrument corresponding to the invention that is adapted for transecting captured tissue and for contemporaneously welding the captured tissue margins with controlled application of Rf energy.
- the jaw assembly 100 A is carried at the distal end 104 of an introducer sleeve member 106 that can have a diameter ranging from about 2 mm. to 20 mm. for cooperating with cannulae in endoscopic surgeries or for use in open surgical procedures.
- the introducer portion 106 extends from a proximal handle (not shown).
- the handle can be any type of pistol-grip or other type of handle known in the art that carries actuator levers, triggers or sliders for actuating the jaws and need not be described in further detail.
- the introducer sleeve portion 106 has a bore 108 extending therethrough for carrying actuator mechanisms for actuating the jaws and for carrying electrical leads 109 a - 109 b for delivery of electrical energy to electrosurgical components of the working end.
- the jaw assembly 100 A has first (lower) jaw element 112 A and second (upper) jaw element 112 B that are adapted to close or approximate about axis 115 .
- the jaw elements can both be moveable or a single jaw can rotate to provide the jaw-open and jaw-closed positions. In the exemplary embodiment of FIGS. 3A and 3B , both jaws are moveable relative to the introducer portion 106 .
- the opening-closing mechanism of the jaw assembly 100 A is capable of applying very high compressive forces on tissue on the basis of cam mechanisms with a reciprocating member 140 .
- the engagement surfaces further provide a positive engagement of camming surfaces (i) for moving the jaw assembly to the (second) closed position to apply very high compressive forces, and (ii) for moving the jaws toward the (first) open position to apply substantially high opening forces for “dissecting” tissue.
- This important feature allows the surgeon to insert the tip of the closed jaws into a dissectable tissue plane—and thereafter open the jaws to apply such dissecting forces against tissues.
- Prior art instruments are spring-loaded toward the open position which is not useful for dissecting tissue.
- the transverse element 145 is adapted to slide within a channels 148 a and 148 b in the paired first and second jaws to thereby open and close the jaws.
- the camming action of the reciprocating member 140 and jaw surfaces is described in complete detail in co-pending Provisional U.S. patent application Ser. No. 60/347,382 filed Jan. 11, 2002 (Docket No. SRX-013) titled Jaw Structure for Electrosurgical Instrument and Method of Use, which is incorporated herein by reference.
- the first and second jaws 112 A and 112 B close about an engagement plane 150 and define tissue-engaging surface layers 155 A and 155 B that contact and deliver energy to engaged tissues from electrical energy means as will be described below.
- the jaws can have any suitable length with teeth or serrations 156 for gripping tissue.
- One preferred embodiment of FIGS. 3A and 3B provides such serrations 156 at an inner portion of the jaws along channels 148 a and 148 b thus allowing for substantially smooth engagement surface layers 155 A and 155 B laterally outward of the tissue-gripping elements.
- the axial length of jaws 112 A and 112 B indicated at L can be any suitable length depending on the anatomic structure targeted for transection and sealing and typically will range from about 10 mm. to 50 mm.
- the jaw assembly can apply very high compression over much longer lengths, for example up to about 200 mm., for resecting and sealing organs such as a lung or liver.
- the scope of the invention also covers jaw assemblies for an instrument used in micro-surgeries wherein the jaw length can be about 5.0 mm or less.
- the engagement surface 155 A of the lower jaw 112 A is adapted to deliver energy to tissue, at least in part, through a conductive-resistive matrix CM corresponding to the invention.
- the tissue-contacting surface 155 B of upper jaw 112 B preferably carries a similar conductive-resistive matrix, or the surface can be a conductive electrode or and insulative layer as will be described below.
- the engagement surfaces of the jaws can carry any of the energy delivery components disclosed in co-pending U.S. patent application Ser. No. 09/032,867 filed Oct. 22, 2001 (Docket No. SRX-011) titled Electrosurgical Jaw Structure for Controlled Energy Delivery and U.S. Prov. Patent Application Ser. No. 60/337,695 filed Dec. 3, 2001 (Docket No. SRX-012) titled Electrosurgical Jaw Structure for Controlled Energy Delivery, both of which are incorporated herein by reference.
- FIG. 4 an alternative jaw structure 100 B is shown with lower and upper jaws having similar reference numerals 112 A- 112 B.
- the simple scissor-action of the jaws in FIG. 4 has been found to be useful for welding tissues in procedures that do not require tissue transection.
- the scissor-action of the jaws can apply high compressive forces against tissue captured between the jaws to perform the method corresponding to the invention.
- the jaws of either embodiment 100 A or 100 B can carry the same energy delivery components, which is described next.
- the engagement gap g between the engagement planes ranges from about 0.0005′′ to about 0.050′′ for reduce the engaged tissue to the thickness of a membrane. More preferably, the gap g between the engagement planes ranges from about 0.001′′ to about 0.005′′.
- FIG. 5 illustrates an enlarged schematic sectional view of a jaw structure that carries engagement surface layers 155 A and 155 B in jaws 112 A and 112 B. It should be appreciated that the engagement surface layers 155 A and 155 B are shown in a scissors-type jaw (cf. FIG. 4 ) for convenience, and the conductive-resistive matrix, or variable resistive body, would be identical in each side of a transecting jaw structure as shown in FIGS. 3A-3B .
- the lower jaw 112 A carries a component described herein as a conductive-resistive matrix CM that is at least partly exposed to an engagement plane 150 that is defined as the interface between tissue and a jaw engagement surface layer, 155 A or 155 B.
- the conductive-resistive matrix CM comprises a first portion 160 a and a second portion 160 b.
- the first portion is preferably an electrically non-conductive material that has a selected coefficient of expansion that is typically greater than the coefficient of expansion of the material of the second portion.
- the first portion 160 a of the matrix is an elastomer, for example a medical grade silicone.
- the first portion 160 a of the matrix also is preferably not a good thermal conductor.
- Other thermoplastic elastomers fall within the scope of the invention, as do ceramics having a thermal coefficient of expansion with the parameters further described below.
- the second portion 160 b of the matrix CM is a material that is electrically conductive and that is distributed within the first portion 160 a.
- the second portion 160 b is represented (not-to-scale) as spherical elements 162 that are intermixed within the elastomer first portion 160 a of matrix CM.
- the elements 162 can have any regular or irregular shape, and also can be elongated elements or can comprise conductive filaments.
- the dimensions of particles 162 can having a scale ranging from about 1 nm to 100 microns across a principal axis thereof. Preferably, the particles 162 range between about 1 nm and 10 microns.
- the particles 162 range between about 1 nm and 1 microns in cross-section.
- the matrix CM can carry a conductive portion 160 b in the form of separates filaments or an intertwined filament akin to the form of steel wool embedded within an elastomeric first portion 160 a and fall within the scope the invention.
- the second portion 160 b can be of any form that distributes an electrically conductive mass within the overall volume of the matrix CM.
- the matrix CM is carried in a support structure or body portion 158 that can be of any suitable metal or other material having sufficient strength to apply high compressive forces to the engaged tissue.
- the support structure 158 carries an insulative coating 159 to prevent electrical current flow to tissues about the exterior of the jaw assembly and between support structure 158 and the matrix CM and a conductive element 165 therein.
- first and second portions 160 a and 160 b provide a matrix CM that is variably resistive (in ohms-centimeters) in response to temperature changes therein.
- the matrix composition with the temperature-dependent resistance is alternatively described herein as a temperature coefficient material.
- the matrix CM can be engineered to exhibit very large changes in resistance with a small change in matrix temperature. In other words, the change of resistance with a change in temperature results in a “positive” temperature coefficient of resistance.
- the matrix CM is engineered to exhibit unique resistance vs. temperature characteristics that is represented by a positively sloped temperature-resistance curve (see FIG. 6 ). More in particular, the first exemplary matrix CM indicated in FIG. 6 maintains a low base resistance over a selected base temperature range with a dramatically increasing resistance above a selected narrow temperature range of the material (sometimes referred to herein as a switching range, see FIG. 6 ).
- the base resistance can be low, or the electrical conductivity high, between about 37° C. and 65° C, with the resistance increasing greatly between about 65° C. and 75° C. to substantially limit conduction therethrough (at typically utilized power levels in electrosurgery).
- the matrix CM has a first portion 160 a fabricated from a medical grade silicone that is doped with a selected volume of conductive particles, for example carbon particles in sub-micron dimensions as described above.
- a selected volume of conductive particles for example carbon particles in sub-micron dimensions as described above.
- the ration of silicone-to-carbon can range from about 10/90 to about 70/30 (silicone/carbon) to provide the selected range at which the inventive composition functions to substantially limit electrical conductance therethrough.
- the carbon percentage in the matrix CM is from about 40% to 80% with the balance being silicone. In fabricating a matrix CM in this manner, it is preferable to use a carbon type that has single molecular bonds.
- the particles or elements 162 can be a polymer bead with a thin conductive coating.
- a metallic coating can be deposited by electroless plating processes or other vapor deposition process known in the art, and the coating can comprise any suitable thin-film deposition, such as gold, platinum, silver, palladium, tin, titanium, tantalum, copper or combinations or alloys of such metals, or varied layers of such materials.
- One preferred manner of depositing a metallic coating on such polymer elements comprises an electroless plating process provided by Micro Plating, Inc., 8110 Hawthorne Dr., Erie, Pa. 16509-4654.
- the thickness of the metallic coating can range from about 0.00001′′ to 0.005′′.
- One aspect of the invention relates to the use of a matrix CM as illustrated schematically in FIG. 5 in a jaw's engagement surface layer 155 A with a selected treatment range between a first temperature (TE 1 ) and a second temperature (TE 2 ) that approximates the targeted tissue temperature for tissue welding (see FIG. 6 ).
- the selected switching range of the matrix as defined above can be any substantially narrow 1°-10° C. range that is about the maximum of the treatment range that is optimal for tissue welding.
- the switching range can fall within any larger tissue treatment range of about 50°-200° C.
- a preferred embodiment has a matrix CM that is engineered to have a selected resistance to current flow across its selected dimensions in the jaw assembly, when at 37° C., that ranges from about 0.0001 ohms to 1000 ohms. More preferably, the matrix CM has a designed resistance across its selected dimensions at 37° C. that ranges from about 1.0 ohm to 1000 ohms. Still more preferably, the matrix CM has with a designed resistance across its selected dimensions at 37° C. that ranges from about 25 ohms to 150 ohms.
- the entire surface area of engagement surface layer 155 A comprises the conductive-resistive matrix CM, wherein the engagement surface is defined as the tissue-contacting portion that can apply electrical potential to tissue.
- any instrument's engagement surface has a matrix CM that comprises at least 5% of its surface area. More preferably, the matrix CM comprises at least 10% of the surface area of engagement surface. Still more preferably, the matrix CM comprises at least 20% of the surface area of the jaw's engagement surface.
- the matrix CM can have any suitable cross-sectional dimensions, indicated generally at md 1 and md 2 in FIG. 5 , and preferably such a cross-section comprises a significant fracational volume of the jaw relative to support structure 158 . As will be described below, in some embodiments, it is desirable to provide a thermal mass for optimizing passive conduction of heat to engaged tissue.
- the interior of jaw 112 A carries a conductive element (or electrode) indicated at 165 that interfaces with an interior surface 166 of the matrix CM.
- the conductive element 165 is coupled by an electrical lead 109 a to a voltage (Rf) source 180 and optional controller 182 ( FIG. 4 ).
- the Rf source 180 can apply electrical potential (of a first polarity) to the matrix CM through conductor 165 —and thereafter to the engagement plane 150 through matrix CM.
- the opposing second jaw 112 B in FIG. 5 has a conductive material (electrode) indicated at 185 coupled to source 180 by lead 109 b that is exposed within the upper engagement surface 155 B.
- a first mode of operation referring to FIG. 5 , electrical potential of a first polarity applied to conductor 165 will result in current flow through the matrix CM and the engaged tissue et to the opposing polarity conductor 185 .
- the resistance of the matrix CM at 37° C. is engineered to approximate, or slightly exceed, that of the engaged tissue et.
- the engagement surface 155 A can modulate the delivery of energy to tissue et similar to the hypothetical engagement surface of FIG. 2 .
- the small sections of engagement surfaces represent the micron-sized surface areas (or pixels) of the illustration of FIG. 2 (note that the jaws are not in a fully closed position in FIG. 5 ).
- the preferred membrane-thick engagement gap g is graphically represented in FIG. 5 .
- FIGS. 7A and 8A illustrate enlarged schematic sectional views of jaws 112 A and 112 B and the matrix CM. It can be understood that the electrical potential at conductor 165 will cause current flow within and about the elements 162 of second portion 160 b along any conductive path toward the opposing polarity conductor 185 .
- FIG. 8A more particularly shows a graphic representation of paths of microcurrents mc m within the matrix wherein the conductive elements 162 are in substantial contact.
- FIG. 7A also graphically illustrates paths of microcurrents met in the engaged tissue across gap g. The current paths in the tissue (across conductive sodium, potassium, chlorine ions etc.) thus results in ohmic heating of the tissue engaged between jaws 112 A and 112 B.
- the flux of microcurrents mc m within the matrix and the microcurrents mc t within the engaged tissue will seek the most conductive paths—which will be assisted by the positioning of elements 162 in the surface of the engagement layer 155 A, which can act like surface asperities or sharp edges to induce current flow therefrom.
- ohmic heating of the shaded portion 188 of engaged tissue et in FIGS. 7B and 8B elevates its temperature to a selected temperature at the maximum of the targeted range. Heat will be conducted back to the matrix portion CM proximate to the heated tissue. At the selected temperature, the matrix CM will substantially reduce current flow therethrough and thus will contribute less and less to ohmic tissue heating, which is represented in FIGS. 7B and 8B .
- the thermal coefficient of expansion of the elastomer of first matrix portion 160 a will cause slight redistribution of the second conductive portion 160 b within the matrix—naturally resulting in lessened contacts between the conductive elements 162 . It can be understood by arrows A in FIG. 8B that the elastomer will expand in directions of least resistance which is between the elements 162 since the elements are selected to be substantially resistant to compression.
- the small surface portion of matrix CM indicated at 190 in FIG. 8A will function, in effect, independently to modulate power delivery to the surface of the tissue T engaged thereby. This effect will occur across the entire engagement surface layer 155 A, to provide practically infinite “spatially localized” modulation of active energy density in the engaged tissue.
- the engagement surface can be defined as having “pixels” about its surface that are independently controlled with respect to energy application to localized tissue in contact with each pixel. Due to the high mechanical compression applied by the jaws, the engaged membrane all can be elevated to the selected temperature contemporaneously as each pixel heats adjacent tissue to the top of treatment range. As also depicted in FIG. 8B , the thermal expansion of the elastomeric matrix surface also will push into the membrane, further insuring tissue contact along the engagement plane 150 to eliminate any possibility of an energy arc across a gap.
- any portion of the conductive-resistive matrix CM falls below the upper end of targeted treatment range, that matrix portion will increase its conductance and add ohmic heating to the proximate tissue via current paths through the matrix from conductor 165 .
- the mass of matrix and the jaw body will be modulated in temperature, similar to the engaged tissue, at or about the targeted treatment range.
- FIG. 9 shows another embodiment of a conductive-resistive matrix CM that is further doped with elements 192 of a material that is highly thermally conductive with a selected mass that is adapted to provide substantial heat capacity.
- elements 192 that may not be electrically conductive
- the matrix can provide greater thermal mass and thereby increase passive conductive or convective heating of tissue when the matrix CM substantially reduces current flow to the engaged tissue.
- the material of elements 162 can be both substantially electrically conductive and highly thermally conductive with a high heat capacity.
- the manner of utilizing the system of FIGS. 7A-7B to perform the method of the invention can be understood as mechanically compressing the engaged tissue et to membrane thickness between the first and second engagement surfaces 155 A and 155 B of opposing jaws and thereafter applying electrical potential of a frequency and power level known in electrosurgery to conductor 165 , which potential is conducted through matrix CM to maintain a selected temperature across engaged tissue et for a selected time interval.
- the low base resistance of the matrix CM allows unimpeded Rf current flow from voltage source 180 thereby making 100 percent of the engagement surface an active conductor of electrical energy.
- the engaged tissue initially will have a substantially uniform impedance to electrical current flow, which will increase substantially as the engaged tissue loses moisture due to ohmic heating.
- the impedance of the engaged tissue will be elevated in temperature and conduct heat to the matrix CM.
- the matrix CM will constantly adjust microcurrent flow therethrough—with each square micron of surface area effectively delivering its own selected level of power depending on the spatially-local temperature. This automatic reduction of localized microcurrents in tissue thus prevents any dehydration of the engaged tissue.
- the jaw assembly can insure the effective denaturation of tissue constituents to thereafter create a strong weld.
- the actual Rf energy applied to the engaged tissue et can be precisely modulated, practically pixel-by-pixel, in the terminology used above to describe FIG. 2 .
- the elements 192 in the matrix CM can comprise a substantial volume of the jaws' bodies and the thermal mass of the jaws, so that when elevated in temperature, the jaws can deliver energy to the engaged tissue by means of passive conductive heating—at the same time Rf energy delivery in modulated as described above. This balance of active Rf heating and passive conductive heating (or radiative, convective heating) can maintain the targeted temperature for any selected time interval.
- the above-described method of the invention that allows for immediate modulation of ohmic heating across the entirety of the engaged membrane is to be contrasted with prior art instruments that rely on power modulation based on feedback from a temperature sensor.
- power is modulated only to an electrode in its totality.
- the prior art temperature measurements obtained with sensors is typically made at only at a single location in a jaw structure, which cannot be optimal for each micron of the engagement surface over the length of the jaws. Such temperature sensors also suffer from a time lag.
- such prior art temperature sensors provide only an indirect reading of actual tissue temperature—since a typical sensor can only measure the temperature of the electrode.
- the system controller 182 coupled to voltage source 180 can acquire data from current flow circuitry that is coupled to the first and second polarity conductors in the jaws (in any locations described previously) to measure the blended impedance of current flow between the first and second polarity conductors through the combination of (i) the engaged tissue and (ii) the matrix CM.
- This method of the invention can provide algorithms within the system controller 182 to modulate, or terminate, power delivery to the working end based on the level of the blended impedance as defined above.
- the method can further include controlling energy delivery by means of power-on and power-off intervals, with each such interval having a selected duration ranging from about 1 microsecond to one second.
- the working end and system controller 182 can further be provided with circuitry and working end components of the type disclosed in Provisional U.S. patent application Ser. No. 60/339,501 filed Nov. 9, 2001 (Docket No. S-BA-001) titled Electrosurgical Instrument, which is incorporated herein by reference.
- the system controller 182 can be provided with algorithms to derive the temperature of the matrix CM from measured impedance levels—which is possible since the matrix is engineered to have a selected unique resistance at each selected temperature over a temperature-resistance curve (see FIG. 6 ). Such temperature measurements can be utilized by the system controller 182 to modulate, or terminate, power delivery to engagement surfaces based on the temperature of the matrix CM. This method also can control energy delivery by means of the power-on and power-off intervals as described above.
- FIGS. 10-11 illustrate a sectional views of an alternative jaw structure 100 C—in which both the lower and upper engagement surfaces 155 A and 155 B carry a similar conductive-resistive matrices indicated at CM A and CM B . It can be easily understood that both opposing engagement surfaces can function as described in FIGS. 7A-7B and 8 A- 8 B to apply energy to engaged tissue.
- the jaw structure of FIGS. 10-11 illustrate that the tissue is engaged on opposing sides by a conductive-resistive matrix, with each matrix CM A and CM B in contact with an opposing polarity electrode indicated at 165 and 185 , respectively. It has been found that providing cooperating first and second conductive-resistive matrices in opposing first and second engagement surfaces can enhance and control both active ohmic heating and the passive conduction of thermal effects to the engaged tissue.
- FIGS. 12 and 14 A- 14 C illustrate an exemplary jaw assembly 200 that carries a Type “B” conductive-resistive matrix system for (i) controlling Rf energy density and microcurrent paths in engaged tissue, and (ii) for contemporaneously controlling passive conductive heating of the engaged tissue.
- the system again utilizes an elastomeric conductive-resistive matrix CM although substantially rigid conductive-resistive matrices of a ceramic positive-temperature coefficient material are also described and fall within the scope of the invention.
- the jaw assembly 200 is carried at the distal end of an introducer member, and can be a scissor-type structure (cf. FIG. 4 ) or a transecting-type jaw structure (cf. FIGS. 3A-3B ). For convenience, the jaw assembly 200 is shown as a scissor-type instrument that allows for clarity of explanation.
- opposing polarity electrodes 220 and 225 in an engagement surface with an intermediate conductive-resistive matrix CM, it has been found that the dynamic “wave” of energy density (ohmic heating) can be created that proves to be a very effective means for creating a uniform temperature in a selected cross-section of tissue to thus provide very uniform protein denaturation and uniform cross-linking on thermal relaxation to create a strong weld. While the opposing polarity electrodes 220 and 225 and matrix CM can be carried in both engagement surfaces 255 A and 255 B, the method of the invention can be more clearly described using the exemplary jaws of FIG. 11 wherein the upper jaw's engagement surface 250 B is an insulator indicated at 252 .
- the first (lower) jaw 212 A is shown in sectional view with a conductive-resistive matrix CM exposed in a central portion of engagement surface 255 A.
- a first polarity electrode 220 is located at one side of matrix CM with the second polarity electrode 225 exposed at the opposite side of the matrix CM.
- the body or support structure 258 of the jaw comprises the electrodes 220 and 225 with the electrodes separated by insulated body portion 262 .
- the exterior of the jaw body is covered by an insulator layer 261 .
- the matrix CM is otherwise in contact with the interior portions 262 and 264 of electrodes 220 and 225 , respectively.
- FIGS. 14A-14C illustrate sequential views of the method of using of the engagement surface layer of FIG. 11 to practice the method of the invention as relating to the controlled application of energy to tissue.
- FIGS. 14A-14C depict exposed electrode surface portions 220 and 225 at laterally spaced apart locations with an intermediate resistive matrix CM that can create a “wave” or “front” of ohmic heating to sweep across the engaged tissue et.
- the upper jaw 212 B and engagement surface 250 B is shown in phantom view, and comprises an insulator 252 .
- the gap dimension g is not to scale, as described previously, and is shown with the engaged tissue having a substantial thickness for purposes of explanation.
- FIG. 14A provides a graphic illustration of the matrix CM within engagement surface layer 250 A at time T 1 —the time at which electrical potential of a first polarity (indicated at +) is applied to electrode 220 via an electrical lead from voltage source 180 and controller 182 .
- the spherical graphical elements 162 of the matrix are not-to-scale and are intended to represent a “region” of conductive particles within the non-conductive elastomer 164 .
- the graphical elements 162 thus define a polarity at particular microsecond in time just after the initiation of power application.
- the body portion carrying electrode 225 defines a second electrical potential ( ⁇ ) and is coupled to voltage source 180 by an electrical lead.
- the graphical elements 162 are indicated as having a transient positive (+) or negative ( ⁇ ) polarity in proximity to the electrical potential at the electrodes.
- the graphical elements 162 have no indicated polarity (see FIGS. 14B & 14C )
- the initiation of energy application at time T 1 causes microcurrents mc within the central portion of the conductive matrix CM as current attempts to flow between the opposing polarity electrodes 220 and 225 .
- the current flow within the matrix CM in turn localizes corresponding microcurrents mc′ in the adjacent engaged tissue et. Since the matrix CM is engineered to conduct electrical energy thereacross between opposing polarities at about the same rate as tissue, when both the matrix and tissue are at about 37° C., the matrix and tissue initially resemble each other, in an electrical sense.
- the highest Rf energy density can be defined as an “interface” indicated graphically at plane P in FIG.
- FIG. 14A provides a simplified graphical depiction of the interface or plane P that defines the “non-random” localization of ohmic heating and denaturation effects—which contrasts with all prior art methods that cause entirely random microcurrents in engaged tissue.
- the interface between the opposing polarities wherein active Rf heating is precisely localized can be controlled and localized by the use of the matrix CM to create initial heating at that central tissue location.
- the conductive-resistive matrix CM in that region is elevated in temperature to its switching range to become substantially non-conductive (see FIG. 6 ) in that central region.
- FIG. 14C illustrates the propagation of planes P and P′ at time T 3 —an additional arbitrary time interval later than T 2 .
- the conductive-resistive matrix CM is further elevated in temperature behind the interfaces P and P′ which again causes interior matrix portions to be substantially less conductive.
- the Rf energy densities thus propagate further outward in the tissue relative to the engagement surface 255 A as portions of the matrix change in temperature. Again, the highest Rf energy density will occur at generally at the locations of the dynamic planes P and P′.
- the lack of Rf current flow in the more central portion of matrix CM can cause its temperature to relax to thus again make that central portion electrically conductive.
- the increased conductivity of the central matrix portion again is indicated by (+) and ( ⁇ ) symbols in FIG. 14C .
- the propagation of waves of Rf energy density will repeat itself as depicted in FIGS. 14A-14C which can effectively weld tissue.
- FIG. 15 depicts an enlarged view of the alternative Type “B” jaw 212 A of FIG. 13A wherein the engagement surface 250 A carries a plurality of exposed conductive matrix portions CM that are intermediate a plurality of opposing polarity electrode portions 220 and 225 .
- This lower jaw 212 A has a structural body that comprises the electrodes 220 and 225 and an insulator member 266 that provide the strength required by the jaw.
- An insulator layer 261 again is provided on outer surfaces of the jaw excepting the engagement surface 255 A.
- the upper jaw (not shown) of the jaw assembly can comprise an insulator, a conductive-resistive matrix, an active electrode portion or a combination thereof. In operation, it can be easily understood that each region of engaged tissue between each exposed electrode portion 222 and 226 will function as described in FIGS. 14A-14C .
- FIG. 19 illustrates another Type “B” embodiment of jaws structure that again is adapted for enhanced passive heating of engaged tissue when portions of the matrix CM are elevated above its selected switching range.
- the jaws 212 A and 212 B and engagement surface layers 255 A and 255 B again expose matrix portions to engaged tissue.
- the upper jaw's engagement surface layer 255 B is convex and has an elastomeric hardness ranging between about 20 and 80 in the Shore A scale and is fabricated as described previously.
- FIG. 19 depicts a first polarity electrode 220 that is carried in a central portion of engagement plane 255 A but the electrode does not float as in the embodiment of FIG. 17 .
- the electrode 220 is carried in a first matrix portion CM 1 that is a substantially rigid silicone or can be a ceramic positive temperature coefficient material.
- the first matrix portion CM preferably has a differently sloped temperature-resistance profile (cf. FIG. 6 ) that the second matrix portion CM 2 that is located centrally in the jaw 212 A.
- passive heating will be conducted in an enhanced manner to tissue from electrode 220 and the underlying second matrix CM 2 which has a second selected lower temperature switching range, for example between about 60° C. to 70° C.
- This Type “B” system has been found to be very effective for rapidly welding tissue—in part because of the increased surface area of the electrode 220 when used in small cross-section jaw assemblies (e.g., 5 mm. working ends).
- FIGS. 21 and 22 illustrate an exemplary jaw assembly 400 that carries a Type “C” system that optionally utilizes at least one conductive-resistive matrix CM as described previously for (i) controlling Rf energy density and microcurrent paths in engaged tissue, and (ii) for contemporaneously controlling passive conductive heating of the engaged tissue.
- CM conductive-resistive matrix
- jaws 412 A and 412 B define respective engagement surfaces 455 A and 455 B.
- the upper jaw 412 B and engagement surface 455 B can be as described in the embodiment of FIGS. 17 and 19 , or the upper engagement surface can be fully insulated as described in the embodiment of FIGS. 14A-14C .
- upper engagement surface layer 455 B is convex and made of an elastomeric material as described above.
- Both jaws have a structural body portion 458 a and 458 b of a conductor that is surrounded on outer surfaces with an insulator layer indicated at 461 .
- the body portions 458 a and 458 b are coupled to electrical source 180 and have exposed surfaces portions 472 a and 472 b in the jaws' engagement planes to serve as an electrode defining a first polarity, as the surface portions 472 a and 472 b are coupled to, and transition into, the metallic film layer 475 described next.
- the matrix CM A preferably is substantially rigid but otherwise operates as described above.
- the metallic film layer 475 is shown as having an optional underlying conductive member indicated at 477 that is coupled to electrical source 180 and thus comprises an electrode that defined a second polarity.
- engagement surface 455 A entirely comprises the thin metallic film layer 475 that is coupled in spaced apart portions 480 A and 480 B to opposing polarities as defined by the electrical source.
- the entire engagement surface is electrically active and can cooperate with the upper jaw, in one aspect of the method of the invention, to create an electrical field between the jaws' engagement surfaces.
- intermediate portions 485 of the metallic film layer 475 that are intermediate the central and outboard metallic film portions coupled to the opposing polarities of the electrical source
- the thin dimension of the film 475 allows for very rapid adjustment in temperature and thus allows enhanced passive conductive heating of engaged tissue when the engaged tissue is no longer moist enough for active Rf density therein.
- One preferred manner of fabricating the intermediate portions 485 is to provide perforations or apertures 488 therein that can range in size from about 5 microns to 200 microns. Stated another way, the intermediate portions 485 can have apertures 488 therein that make the regions from about 1 percent to 60 percent open, no matter the size or shape of the apertures. More preferably, the intermediate portions 485 are from about 5 percent to 40 percent open.
- Type “D” conductive-resistive matrix system for tissue welding.
- FIGS. 23 to 28 illustrate exemplary Type “D” jaw structures that utilize a conductive-resistive matrix CM or variable resistive body in a different manner than described previously.
- the Type “D” system still controls Rf energy density and microcurrent paths in engaged tissue as described previously, but also provides means for a more “focused” application of passive conductive heating of engaged tissue.
- FIG. 23 illustrates a first exemplary jaw assembly 500 A that carries a Type “D” conductive-resistive matrix system CM that can comprise an elastomeric or non-elastomeric matrix of a positive temperature coefficient material.
- the jaw assembly 500 A is carried at the distal end of an introducer member, and can be a scissor-type structure (cf. FIG. 4 ) or a transecting-type jaw structure (cf. FIGS. 3A-3B ).
- the jaw assembly 500 A is shown as a scissor-type instrument to allow for simplified of explanation of the features corresponding to the invention.
- the jaw assembly 500 A depicts first and second jaws 512 A and 512 B that define engagement surfaces 555 A and 555 B.
- the jaw bodies are of an insulator material indicated at 556 .
- the upper (second) jaw 512 B carries a conductor or return electrode element 558 that is exposed in engagement surface 555 B which in turn is coupled to voltage source 180 and is indicated for purposes of explanation as having a negative (—) polarity.
- the lower (first) jaw 512 A carries an opposing polarity (+) electrode element 560 that is embedded within the interior of insulator material 556 that makes up the exterior body of jaw 512 A.
- the jaw has a thin surface conductor element 565 in engagement surfaces 555 A—that is not directly coupled to the voltage source 180 . Rather, the surface conductor element 565 is electrically/conductively coupled to the surface conductor 565 only by an intermediate conductive-resistive matrix CM that contacts both the active electrode 560 and the surface conductor 565 .
- the conductive-resistive matrix CM has a cross-section that diminishes in the direction of the surface conductor 565 . In FIG.
- the matrix CM is shown with triangular cross-section that tapers from a first region 580 that has an extended dimension to a second reduced dimension region 585 that conductively contacts the central portion 570 of surface conductor 565 .
- the conductive material 565 only functions as an electrode to actively conduct current to engaged tissue when the matrix CM is below its switching range. At other time intervals when the matrix CM is above its switching range, the surface conductor 565 will not provide current paths to the engaged tissue and passive heating of the matrix will be focused in the central portion 570 of the surface conductor 565 .
- the conductive-resistive matrix CM when the conductive-resistive matrix CM is below it switching temperature range, current will flow between the interior active electrode 560 and the surface conductor 565 . However, when the engaged tissue is elevated in temperature, which elevates the temperature of surface conductor 565 , the portion of the matrix CM proximate to surface conductor 565 will be heated to its switching range before the other portions of the matrix more proximate to the interior active electrode 560 . Thereafter, the conductive-resistive matrix CM will have a temperature that hovers about the upper end of its switching range, which also is the targeted tissue treatment range. Contemporaneously, the central matrix portion will focus its passive (conductive) heating at a selected location within the engagement surface 255 B.
- a centrally focused passive heating as depicted in the embodiment of FIG. 23 is very useful in tissue welding.
- the scope of the invention includes the use of a positive or negative temperature coefficient material volume CM intermediate an active electrode 560 and a surface conductor 565 that engages tissue wherein the surface area of the matrix material CM has a first greater surface area 580 in contact with the active electrode 560 and second lesser surface area 585 in contact with the conductor 565 in the engagement surface.
- the actual cross-section of the matrix volume CM can be any shape such as triangular, pyramid-shaped, “T”-shaped, or any curvilinear shape that tapers.
- the second lesser surface area 585 in contact with surface conductor 565 is less than about 50 percent of the first surface area 580 . More preferably, the second surface area 585 in contact with surface conductor 565 is less than about 25 percent of the first surface area 580 in contact with active electrode 560 .
- the jaws carry insulated projecting elements 572 that can be located anywhere in the engagement surfaces 555 A and 555 B or the jaw perimeters to prevent inadvertent contact between the opposing polarity electrodes when the jaws are moved toward the fully closed position.
- the central matrix portion CM 1 has a switching range and contact area with the surface conductor 565 to thus cause differential passive conductive heating across the engagements surface 555 A and conductor 565 , with the more focused passive heating in the central region 570 of the jaw surface.
- the central matrix portion CM 1 has a first greater surface area 580 in contact with interior electrode 560 and a second lesser surface area 585 in contact with surface conductor 565 .
- FIG. 25 another alternative jaw assembly 500 C is shown that has a lower jaw 512 A that is identical to the embodiment of FIG. 23 .
- the upper jaw 512 B has an engagement surface 555 B that carries an exposed conductive-resistive matrix CM 5 that is coupled to a return electrode 558 embedded at an interior of the upper jaw body that is fabricated of an insulator material 556 .
- Such an upper jaw was shown in FIGS. 10, 11 and 17 . In all other respects, the working end functions as described previously.
- FIGS. 26A-26B another alternative jaw assembly 500 D is shown that is a scissor-type instrument similar to the embodiment of FIG. 4 , except that the jaws carry a slot 590 for receiving an extendable transecting blade (not shown).
- FIG. 26B it can be seen that lower jaw 512 A has left and right sides 591 a and 591 b that each function exactly as the embodiment of FIG. 23 . In all respects, the embodiment of FIG. 26B functions as described above.
- FIG. 27 another alternative jaw assembly 500 E is shown that again has scissor-type first and second jaws 512 A and 512 B.
- This jaw structure again has a slot 590 in the jaws for receiving an extendable blade for transecting tissue in the embodiment of FIG. 26B .
- the engagement surface 555 A of the lower jaw carries lateral conductive elements indicated at 592 (collectively) of an opposing ( ⁇ ) polarity from the spaced apart central conductive element 565 , making this embodiment function in the manner of the embodiments shown in FIGS. 17 , 18 A- 18 C, 19 , 20 and 24 .
- the material between the conductive element 565 and the lateral conductive elements 592 can be a conductive-resistive matrix (cf. FIG. 24 ) or an insulative material (see FIG. 27 ).
- FIG. 28 illustrates an alternative jaw assembly 500 F that is similar to the embodiment of FIG. 27 .
- the first and second jaws 512 A and 512 B are shown without a receiving slot for a blade.
- the engagement surface 555 A of the lower jaw 512 A again carries lateral conductive elements 588 coupled to the voltage source to define an opposing polarity from the spaced apart from central conductive element 565 which is also coupled to the voltage source.
- the jaw carries first and conductive-resistive matrices CM 1 and CM 2 .
- An insulative layer 589 is provided about the exterior surface of the jaw.
- the pyramidal cross-section central matrix CM 1 has first and second contact areas of greater and lesser dimensions, respectively, for contacting the interior electrode 560 and the surface conductor 565 .
- FIG. 29 first illustrates a typical power output-impedance curve for a radiofrequency generator (voltage source 180 ).
- FIG. 29 also illustrates a selected temperature-impedance curve for the conductive-resistive matrix CM corresponding to the invention. It can be easily understood that the voltage source 180 and matrix CM can be designed to provide a selected equilibrium temperature EQ which is indicated at the intersection of the curves.
- one preferred system of the invention comprises (i) a working end that carries a matrix as described above having a positive temperature coefficient of resistance that defines a selected temperature-impedance curve, and (ii) a voltage source that defines a selected power output-impedance curve wherein the temperature-impedance curve and power output-impedance curve define an equilibrium temperature at which the matrix dissipates power output from the voltage source to thereby maintain said equilibrium temperature within the matrix CM.
- Practicing the method of the invention thus consists of (i) providing the matrix CM and voltage source as described above, (ii) engaging tissue with the engagement surface, and (iii) applying electrosurgical energy to the tissue through the matrix material wherein the selected temperature-impedance curve and power output-impedance curve define the matrix's dissipation of power to thereby maintain a selected temperature in the engaged tissue.
- the equilibrium temperature EQ can be any temperature, and for the purposes of welding tissue can be between about 60° C. and 100° C. More preferably, the equilibrium temperature EQ is between about 65° C. and 85° C.
- the invention provides an electrosurgical system that insures that tissue will not be desiccated, and insures that sparks will not cross any gaps between the engagement surface and tissue which thereby prevents tissue from sticking to the engagement surface.
- the system provides a conductive-resistive matrix material CM that is exposed in an engagement surface that receives electrosurgical energy, or coupled to a conductor in the engagement surface, wherein the matrix material defines a positive temperature coefficient of resistance.
- the invention further provides a radiofrequency energy source or voltage source for generating the electrosurgical energy.
- the matrix CM is designed so that the combined impedance of engaged tissue and the matrix material CM is such that voltage developed across any gap of a selected dimension between the engagement surface and the tissue is less than the breakdown voltage required to cross of a gap having that selected dimension.
- the invention can provide a controller 182 coupled to the voltage source 180 that includes algorithms that convert energy delivery from a continuous mode to a pulsed mode upon the system reaching a selected parameter such as an impedance level.
- the controller 182 can alter energy delivery to a pulsed mode upon the combination of the matrix CM and the engaged tissue reaching a particular impedance level. It has been found that such a pulsed mode of energy delivery will allow moisture within the tissue to re-hydrate the engaged tissue to further prevent tissue desiccation, while still maintaining the targeted tissue temperature.
Abstract
An electrosurgical medical device and method for creating thermal welds in engaged tissue. In one embodiment, at least one jaw of the instrument defines a tissue engagement plane carrying a variable resistive body of a positive temperature coefficient material that has a selected decreased electrical conductance at each selected increased temperature thereof over a targeted treatment range. The variable resistive body can be engineered to bracket a targeted thermal treatment range, for example about 60° C. to 80° C., at which tissue welding can be accomplished. In one mode of operation, the engagement plane will automatically modulate and spatially localize ohmic heating within the engaged tissue from Rf energy application across micron-scale portions of the engagement surface. In another mode of operation, a variable resistive body will focus conductive heating in a selected portion of the engagement surface.
Description
- This application is a divisional of U.S. application Ser. No. 10/448,478 (Attorney Docket No. 021447-000510US), filed on May 30, 2003, which claimed benefit from Provisional U.S. Patent Application No. 60/384,496 (Docket No. SRX-018), filed Nov. 19, 2002, and was also a Continuation-in-Part of U.S. application Ser. No. 10/032,867 (Attorney Docket No.: 021447-000500US.SRX-011) filed Oct. 22, 2001, (now U.S. Pat. No. 6,929,644), the full disclosures all of which are incorporated herein by this reference.
- 1. Field of the Invention
- This invention relates to medical devices and techniques and more particularly relates to a working end of an electro surgical instrument that causes controlled ohmic heating of tissue across an engagement surface that modulates Rf power levels across localized micro-scale portions of the engagement surface, the system further adapted to focus conductive heating of tissue across the engagement surface.
- 2. Description of the Related Art
- In the prior art, various energy sources such as radiofrequency (Rf) sources, ultrasound sources and lasers have been developed to coagulate, seal or join together tissues volumes in open and laparoscopic surgeries. The most important surgical application relates to sealing blood vessels which contain considerable fluid pressure therein. In general, no instrument working ends using any energy source have proven reliable in creating a “tissue weld” or “tissue fusion” that has very high strength immediately post-treatment. For this reason, the commercially available instruments, typically powered by Rf or ultrasound, are mostly limited to use in sealing small blood vessels and tissues masses with microvasculature therein. The prior art Rf devices also fail to provide seals with substantial strength in anatomic structures having walls with irregular or thick fibrous content, in bundles of disparate anatomic structures, in substantially thick anatomic structures, or in tissues with thick fascia layers (e.g., large diameter blood vessels).
- In a basic bi-polar Rf jaw arrangement, each face of opposing first and second jaws comprises an electrode and Rf current flows across the captured tissue between the opposing polarity electrodes. Such prior art Rf jaws that engage opposing sides of tissue typically cannot cause uniform thermal effects in the tissue—whether the captured tissue is thin or substantially thick. As Rf energy density in tissue increases, the tissue surface becomes desiccated and resistant to additional ohmic heating. Localized tissue desiccation and charring can occur almost instantly as tissue impedance rises, which then can result in a non-uniform seal in the tissue. The typical prior art Rf jaws can cause further undesirable effects by propagating Rf density laterally from the engaged tissue thus causing unwanted collateral thermal damage.
- The commercially available Rf sealing instruments typically use one of two approaches to “control” Rf energy delivery in tissue. In a first “power adjustment” approach, the Rf system controller can rapidly adjust the level of total power delivered to the jaws' engagement surfaces in response to feedback circuitry coupled to the active electrodes that measures tissue impedance or electrode temperature. In a second “current-path directing” approach, the instrument jaws carry an electrode arrangement in which opposing polarity electrodes are spaced apart by an insulator material--which may cause current to flow within an extended path through captured tissue rather that simply between surfaces of the first and second jaws. Electrosurgical grasping instruments having jaws with electrically-isolated electrode arrangements in cooperating jaws faces were proposed by Yates et al. in U.S. Pat. Nos. 5,403,312; 5,735,848 and 5,833,690.
- The illustrations of the wall of a blood vessel in
FIGS. 1A-1D are useful in understanding the limitations of prior art Rf working ends for sealing tissue.FIG. 1B provides a graphic illustration of the opposingvessel walls portions - Now turning to
FIG. 1C , it is reasonable to ask whether the “power adjustment” approach to energy delivery is likely to cause a uniform temperature within every micron-scale tissue volume in the grid simultaneously—and maintain that temperature for a selected time interval.FIG. 1C shows theopposing vessel walls FIG. 1C graphically depicts current “paths” p in the tissue at an arbitrary time interval that can be microseconds (μs) apart. Such current paths p would be random and constantly in flux—along transient most conductive pathways through the tissue between the opposing polarity electrodes. The thickness of the “paths” is intended to represent the constantly adjusting power levels. If one assumes that the duration of energy density along any current path p is within the microsecond range before finding a new conductive path—and the thermal relaxation time of tissue is the millisecond (ms) range, then what is the likelihood that such entirely random current paths will revisit and maintain each discrete micron-scale tissue volume at the targeted temperature before thermal relaxation? Since the hydration of tissue is constantly reduced during ohmic heating—any regions of more desiccated tissue will necessarily lose its ohmic heating and will be unable to be “welded” to adjacent tissue volumes. The “power adjustment” approach probably is useful in preventing rapid overall tissue desiccation. However, it is postulated that any approach that relies on entirely “random” current paths p in tissue—no matter the power level—cannot cause contemporaneous denaturation of tissue constituents in all engaged tissue volumes and thus cannot create an effective high-strength “weld” in tissue. - Now referring to
FIG. 1D , it is possible to evaluate the second “current—path directing” approach to energy delivery in a jaw structure.FIG. 1D depictsvessel walls insulator 10 in a jaw engagement surface is that no ohmic heating of tissue can be delivered directly to the tissue volume engaged by the insulator 10 (seeFIG. 1D ). The tissue that directly contacts theinsulator 10 will only be ohmically heated when a current path p extends through the tissue between the spaced apart electrodes.FIG. 1D graphically depicts current paths p at any arbitrary time interval, for example in the μs range. Again, such current paths p will be random and in constant flux along transient conductive pathways. - This type of random, transient Rf energy density in paths p through tissue, when any path may occur only for a microsecond interval, is not likely to uniformly denature proteins in the entire engaged tissue volume. It is believed that the “current-path directing” approach for tissue sealing can only accomplish tissue coagulation or seals with limited strength.
- Now turning to
FIG. 2 , it can be conceptually understood that the key requirements for thermally-induced tissue welding relate to: (i) means for “non-random spatial localization” of energy densities in the engaged tissue et, (ii) means for “controlled, timed intervals” of power application of such spatially localized of energy densities, and (iii) means for “modulating the power level” of any such localized, time-controlled applications of energy. -
FIG. 2 illustrates a hypothetical tissue volume with a lower jaw's engagement surface 15 backed away from the tissue. The tissue is engaged under very high compression which is indicated by arrows inFIG. 2 . The engagement surface 15 is shown as divided into a hypothetical grid of “pixels” or micron-dimensionedsurface areas 20. Thus,FIG. 2 graphically illustrates that to create an effective tissue weld, the delivery of energy should be controlled and non-randomly spatially localized relative to eachpixel 20 of the engagement surface 15. - Still referring to
FIG. 2 , it can be understood that there are two modalities in which spatially localized, time-controlled energy applications can create a uniform energy density in tissue for protein denaturation. In a first modality, all cubic microns of the engaged tissue (FIG. 2 ) can be elevated to the required energy density and temperature contemporaneously to create a weld. In a second modality, a “wave” of the required energy density can sweep across the engaged tissue et that can thereby leave welded tissue in its wake. The authors have investigated, developed and integrated Rf systems for accomplishing both such modalities—which are summarized in the next Section. - The systems and methods corresponding to invention relate to creating thermal “welds” or “fusion” within native tissue volumes. The alternative terms of tissue “welding” and tissue “fusion” are used interchangeably herein to describe thermal treatments of a targeted tissue volume that result in a substantially uniform fused-together tissue mass that provides substantial tensile strength immediately post-treatment. Such tensile strength (no matter how measured) is particularly important (i) for welding blood vessels in vessel transection procedures, (ii) for welding organ margins in resection procedures, (iii) for welding other anatomic ducts wherein permanent closure is required, and also (iv) for vessel anastomosis, vessel closure or other procedures that join together anatomic structures or portions thereof.
- The welding or fusion of tissue as disclosed herein is to be distinguished from “coagulation”, “sealing”, “hemostasis” and other similar descriptive terms that generally relate to the collapse and occlusion of blood flow within small blood vessels or vascularized tissue. For example, any surface application of thermal energy can cause coagulation or hemostasis—but does not fall into the category of “welding” as the term is used herein. Such surface coagulation does not create a weld that provides any substantial strength in the affected tissue.
- At the molecular level, the phenomena of truly “welding” tissue as disclosed herein may not be fully understood. However, the authors have identified the parameters at which tissue welding can be accomplished. An effective “weld” as disclosed herein results from the thermally-induced denaturation of collagen, elastin and other protein molecules in a targeted tissue volume to create a transient liquid or gel-like proteinaceous amalgam. A selected energy density is provided in the targeted tissue to cause hydrothermal breakdown of intra- and intermolecular hydrogen cross-links in collagen and other proteins. The denatured amalgam is maintained at a selected level of hydration—without desiccation—for a selected time interval which can be very brief. The targeted tissue volume is maintained under a selected very high level of mechanical compression to insure that the unwound strands of the denatured proteins are in close proximity to allow their intertwining and entanglement. Upon thermal relaxation, the intermixed amalgam results in “protein entanglement” as re-cross-linking or renaturation occurs to thereby cause a uniform fused-together mass.
- To better appreciate the scale at which thermally-induced protein denaturation occurs—and at which the desired protein entanglement and re-cross-linking follows—consider that a collagen molecule in its native state has a diameter of about 15 Angstroms. The collagen molecule consists of a triple helix of peptide stands about 1000 Angstroms in length (see
FIG. 2 ). In other words—a single μm3 (cubic micrometer) of tissue that is targeted for welding will contain 10's of thousands of such collagen molecules. InFIG. 2 , each tissue volume in the grid represents an arbitrary size from about 1 μm to 5 μm (microns). Elastin and other molecules fro denaturation are believed to be similar in dimension to collagen. - To weld tissue, or more specifically to thermally-induce protein denaturation, and subsequent entanglement and re-cross-linking in a targeted tissue volume, it has been learned that the following interlinked parameters must be controlled:
- (i) Temperature of thermal denaturation. The targeted tissue volume must be elevated to the temperature of thermal denaturation, Td, which ranges from about 50° C. to 90° C., and more specifically is from about 60° C. to 80° C. The optimal Td within the larger temperature range is further dependent on the duration of thermal effects and level of pressure applied to the engaged tissue.
- (ii) Duration of treatment. The thermal treatment must extend over a selected time duration, which depending on the engaged tissue volume, can range from less than 0.1 second to about 5 seconds. As will be described below, the system of the in invention utilizes a thermal treatment duration ranging from about 500 ms second to about 3000 ms. Since the objectives of protein entanglement occur at Td which can be achieved in ms (or even microseconds)—this disclosure will generally describe the treatment duration in ms.
- (iii) Ramp-up in temperature: uniformity of temperature profile. There is no limit to the speed at which temperature can be ramped up within the targeted tissue. However, it is of utmost importance to maintain a very uniform temperature across the targeted tissue volume so that “all” proteins are denatured within the same microsecond interval. Only thermal relaxation from a uniform temperature Td can result in complete protein entanglement and re-cross-linking across an entire tissue volume. Without such uniformity of temperature ramp-up and relaxation, the treated tissue will not become a fused-together tissue mass—and thus will not have the desired strength.
- Stated another way, it is necessary to deposit enough energy into the targeted volume to elevate it to the desired temperature Td before it diffuses into adjacent tissue volumes. The process of heat diffusion describes a process of conduction and convection and defines a targeted volume's thermal relaxation time (often defined as the time over which the temperature is reduced by one-half). Such thermal relaxation time scales with the square of the diameter of the treated volume in a spherical volume, decreasing as the diameter decreases. In general, tissue is considered to have a thermal relaxation time in the range of 1 ms. In a non-compressed tissue volume, or lightly compressed tissue volume, the thermal relaxation of tissue in an Rf application typically will prevent a uniform weld since the random current paths result in very uneven ohmic heating (see
FIGS. 1C-1D ). - (iv) Instrument engagement surfaces. The instrument's engagement surface(s) must have characteristics that insure that every square micron of the instrument surface is in contact with tissue during Rf energy application. Any air gap between an engagement surface and tissue can cause an arc of electrical energy across the insulative gap thus resulting in charring of tissue. Such charring (desiccation) will entirely prevent welding of the localized tissue volume and result in further collateral effects that will weaken any attempted weld. For this reason, the engagement surfaces corresponding to the invention are (i) substantially smooth at a macroscale, and (ii) at least partly of an elastomeric matrix that can conform to the tissue surface dynamically during treatment. The jaw structure of the invention typically has gripping elements that are lateral from the energy-delivering engagement surfaces. Gripping serrations otherwise can cause unwanted “gaps” and microscale trapped air pockets between the tissue and the engagement surfaces.
- (v) Pressure. It has been found that very high external mechanical pressures on a targeted tissue volume are critical in welding tissue—for example, between the engagement surfaces of a jaw structure. In one aspect, as described above, the high compressive forces can cause the denatured proteins to be crushed together thereby facilitating the intermixing or intercalation of denatured protein stands which ultimately will result in a high degree of cross-linking upon thermal relaxation.
- In another aspect, the proposed high compressive forces (it is believed) can increase the thermal relaxation time of the engaged tissue practically by an infinite amount. With the engaged tissue highly compressed to the dimension of a membrane between opposing engagement surfaces, for example to a thickness of about 0.001″, there is effectively little “captured” tissue within which thermal diffusion can take place. Further, the very thin tissue cross-section at the margins of the engaged tissue prevents heat conduction to tissue volumes outside the jaw structure.
- In yet another aspect, the high compressive forces at first cause the lateral migration of fluids from the engaged tissue which assists in the subsequent welding process. It has been found that highly hydrated tissues are not necessary in tissue welding. What is important is maintaining the targeted tissue at a selected level without desiccation as is typical in the prior art. Further, the very high compressive forces cause an even distribution of hydration across the engaged tissue volume prior to energy delivery.
- In yet another aspect, the high compressive forces insure that the engagement planes of the jaws are in complete contact with the surfaces of the targeted tissues, thus preventing any possibility of an arc of electrical energy a cross a “gap” would cause tissue charring, as described previously.
- One exemplary embodiment disclosed herein is particularly adapted for, in effect, independent spatial localization and modulation of Rf energy application across micron-scale “pixels” of an engagement surface. The jaw structure of the instrument defines opposing engagement planes that apply high mechanical compression to the engaged tissue. At least one engagement plane has a surface layer that comprises first and second portions of a conductive-resistive matrix—preferably including an elastomer such as silicone (first portion) and conductive particles (second portion) distributed therein. An electrical source is coupled to the working end such that the combination of the conductive-resistive matrix and the engaged tissue are intermediate opposing conductors that define first and second polarities of the electrical source coupled thereto. The conductive-resistive matrix is designed to exhibit unique resistance vs. temperature characteristics, wherein the matrix maintains a low base resistance over a selected temperature range with a dramatically increasing resistance above a selected narrow temperature range.
- In operation, it can be understood that current flow through the conductive-resistive matrix and engagement plane will apply active Rf energy (ohmic heating) to the engaged tissue until the point in time that any portion of the matrix is heated to a range that substantially reduces its conductance. This effect will occur across the surface of the matrix thus allowing each matrix portion to deliver an independent level of power therethrough. This instant, localized reduction of Rf energy application can be relied on to prevent any substantial dehydration of tissue proximate to the engagement plane. The system eliminates the possibility of desiccation thus meeting another of the several parameters described above.
- The conductive-resistive matrix and jaw body corresponding to the invention further can provides a suitable cross-section and mass for providing substantial heat capacity. Thus, when the matrix is elevated in temperature to the selected thermal treatment range, the retained heat of the matrix volume can effectively apply thermal energy to the engaged tissue volume by means of conduction and convection. In operation, the working end can automatically modulate the application of energy to tissue between active Rf heating and passive conductive heating of the targeted tissue to maintain a targeted temperature level.
- Of particular interest, another system embodiment disclosed herein is adapted for causing a “wave” of ohmic heating to sweep across tissue to denature tissue constituents in its wake. This embodiment again utilizes at least one engagement plane in a jaw structure that carries a conductive-resistive matrix as described previously. At least one of the opposing polarity conductors has a portion thereof exposed in the engagement plane. The conductive-resistive matrix again is intermediate the opposing polarity conductors. When power delivery is initiated, the matrix defines an “interface” therein where microcurrents are most intense about the interface of the two polarities—since the matrix is not a simple conductor. The engaged tissue, in effect, becomes an extension of the interface of microcurrents created by the matrix—which thus localizes ohmic heating across the tissue proximate the interface. The interface of polarities and microcurrents within the matrix will be in flux due to lesser conductance about the interface as the matrix is elevated in temperature. Thus, a “wave-like” zone of microcurrents between the polarities will propagate across the matrix—and across the engaged tissue. By this means of engaging tissue with a conductive-resistive matrix, a wave of energy density can be caused to sweep across tissue to uniformly denature proteins which will then re-cross-link to create a uniquely strong weld.
- In general, the system of conductive-resistive matrices for Rf energy delivery advantageously provides means for spatial-localization and modulation of energy application from selected, discrete locations across a single energy-emitting surface coupled to a single energy source
- The system of conductive-resistive matrices for Rf energy delivery provides means for causing a dynamic wave of ohmic heating in tissue to propagate across engaged tissue.
- The system of conductive-resistive matrices for Rf energy delivery allows for opposing electrical potentials to be exposed in a single engagement surface with a conductive matrix therebetween to allow 100% of the engagement surface to emit energy to tissue.
- The system of conductive-resistive matrices for Rf energy application to tissue allows for bi-polar electrical potential to be exposed in a single engagement surface without an intermediate insulator portion.
- The system of conductive-resistive matrices for energy delivery allows for the automatic modulation of active ohmic heating and passive heating by conduction and convection to treat tissue.
- The system of conductive-resistive matrices for energy application to tissue advantageously allows for the creation of “welds” in tissue within about 500 ms to 2 seconds.
- The system of conductive-resistive matrices for energy application to tissue provides “welds” in blood vessels that have very high strength.
- Additional objects and advantages of the invention will be apparent from the following description, the accompanying drawings and the appended claims.
-
FIG. 1A is a view of a blood vessel targeted for welding. -
FIG. 1B is a greatly enlarged sectional view of opposing wall portions of the blood vessel ofFIG. 1A taken alongline 1B-1B ofFIG. 1A . -
FIG. 1C is a graphic representation of opposing walls of a blood vessel engaged by prior art electrosurgical jaws showing random paths of current (causing ohmic heating) across the engaged tissue between opposing polarity electrodes. -
FIG. 1D is a graphic representation of a blood vessel engaged by prior art electrosurgical jaws with an insulator between opposing polarity electrodes on each side of the tissue showing random paths of current (ohmic heating). -
FIG. 2 graphically represents a blood vessel engaged by hypothetical electrosurgical jaws under very high compression with an energy-delivery surface proximate to the tissue. -
FIG. 3A is a perspective view of a jaw structure of tissue-transecting and welding instrument that carries a Type “A” conductive-resistive matrix system corresponding to the invention. -
FIG. 3B is a sectional view of the jaw structure ofFIG. 3A taken along line 3B-3B ofFIG. 3A showing the location of conductive-resistive matrices. -
FIG. 4 is a perspective view of another exemplary surgical instrument that carries a Type “A” conductive-resistive matrix system for welding tissue. -
FIG. 5 is a sectional view of the jaw structure ofFIG. 4 taken along line 5-5 ofFIG. 4 showing details of the conductive-resistive matrix. -
FIG. 6 is a graph showing (i) temperature-resistance profiles of alternative conductive-resistive matrices that can be carried in the jaw ofFIG. 5 , (ii) the impedance of tissue, and (iii) the combined resistance of the matrix and tissue as measured by a system controller. -
FIG. 7A is an enlarged view of a portion of the conductive-resistive matrix and jaw body ofFIG. 5 showing a first portion of an elastomer and a second portion of conductive particles at a resting temperature. -
FIG. 7B is another view the conductive-resistive matrix and jaw body ofFIG. 7A after a portion is elevated to a higher temperature to modulate microcurrent flow therethrough thus depicting a method of the invention in spatially localizing and modulating Rf energy application from a conductive-resistive matrix that engages tissue. -
FIG. 8A is a further enlarged view of the conductive-resistive matrix ofFIG. 7A showing the first portion (elastomer) and the second portion (conductive elements) and paths of microcurrents therethrough. -
FIG. 8B is a further enlarged view of matrix ofFIG. 7B showing the effect of increased temperature and the manner in which resistance to microcurrent flow is caused in the method of spatially localizing and modulating Rf energy application. -
FIG. 9 is an enlarged view of an alternative conductive-resistive matrix similar to that ofFIG. 7A that is additionally doped with thermally conductive, electrically non-conductive particles. -
FIG. 10 is an alternative jaw structure similar to that ofFIGS. 5 and 7 A except carrying conductive-resistive matrices in the engagement surfaces of both opposing jaws. -
FIG. 11 is a greatly enlarged sectional view of the jaws ofFIG. 10 taken along line 11-11 ofFIG. 10 . -
FIG. 12 is a sectional view of another exemplary jaw structure that carries a Type “B” conductive-resistive matrix system for welding tissue that utilizes opposing polarity electrodes with an intermediate conductive-resistive matrix in an engagement surface. -
FIG. 13A is a sectional view of alternative Type “B” jaw with a plurality of opposing polarity electrodes with intermediate conductive-resistive matrices in the engagement surface. -
FIG. 13B is a sectional view of a Type “B” jaw similar to that ofFIG. 13A with a plurality of opposing polarity electrodes with intermediate conductive-resistive matrices in the engagement surface in a different angular orientation. -
FIG. 13C is a sectional view of another Type “B” jaw similar to that ofFIGS. 13A-13B with a plurality of opposing polarity electrodes with intermediate matrices in another angular orientation. -
FIGS. 14A-14C graphically illustrate a method of the invention in causing a wave of Rf energy density to propagate across and engaged tissue membrane to denature tissue constituents: -
FIG. 14A being the engagement surface ofFIG. 12 engaging tissue membrane at the time that energy delivery is initiated causing localized microcurrents and ohmic tissue heating; -
FIG. 14B being the engagement surface ofFIG. 12 after an arbitrary millisecond or microsecond time interval depicting the propagation of a wavefronts of energy outward from the initial localized microcurrents as the localized temperature and resistance of the matrix is increased; and -
FIG. 14C being the engagement surface ofFIG. 12 after another very brief interval depicting the propagation of the wavefronts of energy density outwardly in the tissue due to increase temperature and resistance of matrix portions. -
FIG. 15 is an enlarged sectional view of the exemplary jaw structure ofFIG. 13A with a plurality of opposing polarity conductors on either side of conductive-resistive matrix portions. -
FIG. 16 is a sectional view of a jaw structure similar to that ofFIG. 15 with a plurality of opposing polarity conductors that float within an elastomeric conductive-resistive matrix portions. -
FIG. 17 is a sectional view of a jaw structure similar to that ofFIG. 16 with a single central conductor that floats on a convex elastomeric conductive-resistive matrix with opposing polarity conductors in outboard locations. -
FIGS. 18A-18C provide simplified graphic views of the method of causing a wave of Rf energy density in the embodiment ofFIG. 17 , similar to the method shown in FIGS. 14A-14C: -
FIG. 18A corresponding to the view ofFIG. 14A showing initiation of energy delivery; -
FIG. 18B corresponding to the view ofFIG. 14B showing the propagation of the wavefronts of energy density outwardly; and -
FIG. 18C corresponding to the view ofFIG. 14C showing the further outward propagation of the wavefronts of energy density to thereby weld tissue. -
FIG. 19 is a sectional view of another exemplary jaw structure that carries two conductive-resistive matrix portions, each having a different durometer and a different temperature coefficient profile. -
FIG. 20 is a sectional view of a jaw assembly having the engagement plane ofFIG. 17 carried in a transecting-type jaws similar to that ofFIGS. 3A-3B . -
FIG. 21 is a sectional view of an alternative jaw structure similar with a fully metallized engagement surface coupled to first and second polarity leads in adjacent portions thereof. -
FIG. 22 is an enlarged view of the fully metallized engagement surface ofFIG. 21 showing the first and second polarity leads that are coupled to the metal film layer. -
FIG. 23 is a sectional view of a Type “D” working end corresponding to the invention with a conductive-resistive matrix having tapered cross-sectional dimension for focusing passive heating in the center of the engagement surface. -
FIG. 24 is a sectional view of an alternative Type “D” working end with a gradient matrix for focusing passive heating in the center of the engagement surface. -
FIG. 25 is a sectional view of an alternative Type “D” working end similar to that ofFIG. 23 a with conductive-resistive matrix in the upper jaw. -
FIG. 26A is a perspective view of an alternative Type “D” instrument with an extendable blade member. -
FIG. 26B is a sectional view of the jaw structure ofFIG. 26A taken alongline 26B-26B ofFIG. 26A . -
FIG. 27 is a sectional view of an alternative jaw structure similar to that ofFIG. 26B with additional electrodes in the engagement surface. -
FIG. 28 is a sectional view of an alternative jaw structure similar to that ofFIG. 27 . -
FIG. 29 is a graph showing a power-impedance curve of a voltage source plotted against an impedance-temperature curve of a conductive-resistive matrix corresponding to the invention. - 1. Exemplary jaw structures for welding tissue.
FIGS. 3A and 3B illustrate a working end of a surgical grasping instrument corresponding to the invention that is adapted for transecting captured tissue and for contemporaneously welding the captured tissue margins with controlled application of Rf energy. Thejaw assembly 100A is carried at the distal end 104 of anintroducer sleeve member 106 that can have a diameter ranging from about 2 mm. to 20 mm. for cooperating with cannulae in endoscopic surgeries or for use in open surgical procedures. Theintroducer portion 106 extends from a proximal handle (not shown). The handle can be any type of pistol-grip or other type of handle known in the art that carries actuator levers, triggers or sliders for actuating the jaws and need not be described in further detail. Theintroducer sleeve portion 106 has a bore 108 extending therethrough for carrying actuator mechanisms for actuating the jaws and for carrying electrical leads 109 a-109 b for delivery of electrical energy to electrosurgical components of the working end. - As can be seen in
FIGS. 3A and 3B , thejaw assembly 100A has first (lower)jaw element 112A and second (upper)jaw element 112B that are adapted to close or approximate about axis 115. The jaw elements can both be moveable or a single jaw can rotate to provide the jaw-open and jaw-closed positions. In the exemplary embodiment ofFIGS. 3A and 3B , both jaws are moveable relative to theintroducer portion 106. - Of particular interest, the opening-closing mechanism of the
jaw assembly 100A is capable of applying very high compressive forces on tissue on the basis of cam mechanisms with a reciprocatingmember 140. The engagement surfaces further provide a positive engagement of camming surfaces (i) for moving the jaw assembly to the (second) closed position to apply very high compressive forces, and (ii) for moving the jaws toward the (first) open position to apply substantially high opening forces for “dissecting” tissue. This important feature allows the surgeon to insert the tip of the closed jaws into a dissectable tissue plane—and thereafter open the jaws to apply such dissecting forces against tissues. Prior art instruments are spring-loaded toward the open position which is not useful for dissecting tissue. - In the embodiment of
FIGS. 3A and 3B , a reciprocatingmember 140 is actuatable from the handle of the instrument by any suitable mechanism, such as a lever arm, that is coupled to a proximal end 141 ofmember 140. The proximal end 141 and medial portion ofmember 140 are dimensioned to reciprocate within bore 108 ofintroducer sleeve 106. The distal portion 142 of reciprocatingmember 140 carries first (lower) and second (upper) laterally-extendingflange elements FIG. 3A ) that can be a blade or a cutting electrode. The transverse element 145 is adapted to slide within achannels member 140 and jaw surfaces is described in complete detail in co-pending Provisional U.S. patent application Ser. No. 60/347,382 filed Jan. 11, 2002 (Docket No. SRX-013) titled Jaw Structure for Electrosurgical Instrument and Method of Use, which is incorporated herein by reference. - In
FIGS. 3A and 3B , the first andsecond jaws engagement plane 150 and define tissue-engagingsurface layers serrations 156 for gripping tissue. One preferred embodiment ofFIGS. 3A and 3B providessuch serrations 156 at an inner portion of the jaws alongchannels jaws - In the exemplary embodiment of
FIGS. 3A and 3B , theengagement surface 155A of thelower jaw 112A is adapted to deliver energy to tissue, at least in part, through a conductive-resistive matrix CM corresponding to the invention. The tissue-contactingsurface 155B ofupper jaw 112B preferably carries a similar conductive-resistive matrix, or the surface can be a conductive electrode or and insulative layer as will be described below. Alternatively, the engagement surfaces of the jaws can carry any of the energy delivery components disclosed in co-pending U.S. patent application Ser. No. 09/032,867 filed Oct. 22, 2001 (Docket No. SRX-011) titled Electrosurgical Jaw Structure for Controlled Energy Delivery and U.S. Prov. Patent Application Ser. No. 60/337,695 filed Dec. 3, 2001 (Docket No. SRX-012) titled Electrosurgical Jaw Structure for Controlled Energy Delivery, both of which are incorporated herein by reference. - Referring now to
FIG. 4 , analternative jaw structure 100B is shown with lower and upper jaws havingsimilar reference numerals 112A-112B. The simple scissor-action of the jaws inFIG. 4 has been found to be useful for welding tissues in procedures that do not require tissue transection. The scissor-action of the jaws can apply high compressive forces against tissue captured between the jaws to perform the method corresponding to the invention. As can be seen by comparingFIGS. 3B and 4 , the jaws of eitherembodiment - It has been found that very high compression of tissue combined with controlled Rf energy delivery is optimal for welding the engaged tissue volume contemporaneous with transection of the tissue. Preferably, the engagement gap g between the engagement planes ranges from about 0.0005″ to about 0.050″ for reduce the engaged tissue to the thickness of a membrane. More preferably, the gap g between the engagement planes ranges from about 0.001″ to about 0.005″.
- 2. Type “A” conductive-resistive matrix system for controlled energy delivery in tissue welding.
FIG. 5 illustrates an enlarged schematic sectional view of a jaw structure that carries engagement surface layers 155A and 155B injaws FIG. 4 ) for convenience, and the conductive-resistive matrix, or variable resistive body, would be identical in each side of a transecting jaw structure as shown inFIGS. 3A-3B . - In
FIG. 5 , it can be seen that thelower jaw 112A carries a component described herein as a conductive-resistive matrix CM that is at least partly exposed to anengagement plane 150 that is defined as the interface between tissue and a jaw engagement surface layer, 155A or 155B. More in particular, the conductive-resistive matrix CM comprises afirst portion 160 a and asecond portion 160 b. The first portion is preferably an electrically non-conductive material that has a selected coefficient of expansion that is typically greater than the coefficient of expansion of the material of the second portion. In one preferred embodiment, thefirst portion 160 a of the matrix is an elastomer, for example a medical grade silicone. Thefirst portion 160 a of the matrix also is preferably not a good thermal conductor. Other thermoplastic elastomers fall within the scope of the invention, as do ceramics having a thermal coefficient of expansion with the parameters further described below. - Referring to
FIG. 5 , thesecond portion 160 b of the matrix CM is a material that is electrically conductive and that is distributed within thefirst portion 160 a. InFIG. 5 , thesecond portion 160 b is represented (not-to-scale) asspherical elements 162 that are intermixed within the elastomerfirst portion 160 a of matrix CM. Theelements 162 can have any regular or irregular shape, and also can be elongated elements or can comprise conductive filaments. The dimensions ofparticles 162 can having a scale ranging from about 1 nm to 100 microns across a principal axis thereof. Preferably, theparticles 162 range between about 1 nm and 10 microns. More preferably, theparticles 162 range between about 1 nm and 1 microns in cross-section. Also, the matrix CM can carry aconductive portion 160 b in the form of separates filaments or an intertwined filament akin to the form of steel wool embedded within an elastomericfirst portion 160 a and fall within the scope the invention. Thus, thesecond portion 160 b can be of any form that distributes an electrically conductive mass within the overall volume of the matrix CM. - In the
lower jaw 112A ofFIG. 5 , the matrix CM is carried in a support structure orbody portion 158 that can be of any suitable metal or other material having sufficient strength to apply high compressive forces to the engaged tissue. Typically, thesupport structure 158 carries aninsulative coating 159 to prevent electrical current flow to tissues about the exterior of the jaw assembly and betweensupport structure 158 and the matrix CM and aconductive element 165 therein. - Of particular interest, the combination of first and
second portions first portion 160 a of the non-conductive elastomer relative to the volume proportion ofsecond portion 160 b of the conductive nanoparticles orelements 162, the matrix CM can be engineered to exhibit very large changes in resistance with a small change in matrix temperature. In other words, the change of resistance with a change in temperature results in a “positive” temperature coefficient of resistance. - In a first preferred embodiment, the matrix CM is engineered to exhibit unique resistance vs. temperature characteristics that is represented by a positively sloped temperature-resistance curve (see
FIG. 6 ). More in particular, the first exemplary matrix CM indicated inFIG. 6 maintains a low base resistance over a selected base temperature range with a dramatically increasing resistance above a selected narrow temperature range of the material (sometimes referred to herein as a switching range, seeFIG. 6 ). For example, the base resistance can be low, or the electrical conductivity high, between about 37° C. and 65° C, with the resistance increasing greatly between about 65° C. and 75° C. to substantially limit conduction therethrough (at typically utilized power levels in electrosurgery). In a second exemplary matrix embodiment described inFIG. 6 , the matrix CM is characterized by a more continuously positively sloped temperature-resistance over the range of 50° C. to about 80° C. Thus, the scope of the invention includes any specially engineered matrix CM with such a positive slope that is suitable for welding tissue as described below. - In one preferred embodiment, the matrix CM has a
first portion 160 a fabricated from a medical grade silicone that is doped with a selected volume of conductive particles, for example carbon particles in sub-micron dimensions as described above. By weight, the ration of silicone-to-carbon can range from about 10/90 to about 70/30 (silicone/carbon) to provide the selected range at which the inventive composition functions to substantially limit electrical conductance therethrough. More preferably, the carbon percentage in the matrix CM is from about 40% to 80% with the balance being silicone. In fabricating a matrix CM in this manner, it is preferable to use a carbon type that has single molecular bonds. It is less preferable to use a carbon type with double bonds that has the potential of breaking down when used in a small cross-section matrix, thus creating the potential of a permanent conductive path within deteriorated particles of the matrix CM that fuse together. One preferred composition has been developed to provide a thermal treatment range of about 75° C. to 80° C. with the matrix having about 50-60 percent carbon with the balance being silicone. The matrix CM corresponding to the invention thus becomes reversibly resistant to electric current flow at the selected higher temperature range, and returns to be substantially conductive within the base temperature range. In one preferred embodiment, the hardness of the silicone-based matrix CM is within the range of about Shore A range of less than about 95. More preferably, an exemplary silicone-based matrix CM has Shore A range of from about 20-80. The preferred hardness of the silicone-based matrix CM is about 150 or lower in the Shore D scale. As will be described below, some embodiments have jaws that carry cooperating matrix portions having at least two different hardness ratings. - In another embodiment, the particles or
elements 162 can be a polymer bead with a thin conductive coating. A metallic coating can be deposited by electroless plating processes or other vapor deposition process known in the art, and the coating can comprise any suitable thin-film deposition, such as gold, platinum, silver, palladium, tin, titanium, tantalum, copper or combinations or alloys of such metals, or varied layers of such materials. One preferred manner of depositing a metallic coating on such polymer elements comprises an electroless plating process provided by Micro Plating, Inc., 8110 Hawthorne Dr., Erie, Pa. 16509-4654. The thickness of the metallic coating can range from about 0.00001″ to 0.005″. (A suitable conductive-resistive matrix CM can comprise a ceramicfirst portion 160 a in combination with compressible-particlesecond portion 160 b of a such a metallized polymer bead to create the effects illustrated inFIGS. 8A-8B below). - One aspect of the invention relates to the use of a matrix CM as illustrated schematically in
FIG. 5 in a jaw'sengagement surface layer 155A with a selected treatment range between a first temperature (TE1) and a second temperature (TE2) that approximates the targeted tissue temperature for tissue welding (seeFIG. 6 ). The selected switching range of the matrix as defined above, for example, can be any substantially narrow 1°-10° C. range that is about the maximum of the treatment range that is optimal for tissue welding. For another thermotherpy, the switching range can fall within any larger tissue treatment range of about 50°-200° C. - No matter the character of the slope of the temperature-resistance curve of the matrix CM (see
FIG. 6 ), a preferred embodiment has a matrix CM that is engineered to have a selected resistance to current flow across its selected dimensions in the jaw assembly, when at 37° C., that ranges from about 0.0001 ohms to 1000 ohms. More preferably, the matrix CM has a designed resistance across its selected dimensions at 37° C. that ranges from about 1.0 ohm to 1000 ohms. Still more preferably, the matrix CM has with a designed resistance across its selected dimensions at 37° C. that ranges from about 25 ohms to 150 ohms. In any event, the selected resistance across the matrix CM in an exemplary jaw at 37° C. matches or slightly exceeds the resistance of the tissue or body structure that is engaged. The matrix CM further is engineered to have a selected conductance that substantially limits current flow therethrough corresponding to a selected temperature that constitutes the high end (maximum) of the targeted thermal treatment range. As generally described above, such a maximum temperature for tissue welding can be a selected temperature between about 50° C. and 90° C. More preferably, the selected temperature at which the matrix's selected conductance substantially limits current flow occurs at between about 60° C. and 80° C. - In the
exemplary jaw 112A ofFIG. 5 , the entire surface area ofengagement surface layer 155A comprises the conductive-resistive matrix CM, wherein the engagement surface is defined as the tissue-contacting portion that can apply electrical potential to tissue. Preferably, any instrument's engagement surface has a matrix CM that comprises at least 5% of its surface area. More preferably, the matrix CM comprises at least 10% of the surface area of engagement surface. Still more preferably, the matrix CM comprises at least 20% of the surface area of the jaw's engagement surface. The matrix CM can have any suitable cross-sectional dimensions, indicated generally at md1 and md2 inFIG. 5 , and preferably such a cross-section comprises a significant fracational volume of the jaw relative to supportstructure 158. As will be described below, in some embodiments, it is desirable to provide a thermal mass for optimizing passive conduction of heat to engaged tissue. - As can be seen in
FIG. 5 , the interior ofjaw 112A carries a conductive element (or electrode) indicated at 165 that interfaces with an interior surface 166 of the matrix CM. Theconductive element 165 is coupled by an electrical lead 109 a to a voltage (Rf)source 180 and optional controller 182 (FIG. 4 ). Thus, theRf source 180 can apply electrical potential (of a first polarity) to the matrix CM throughconductor 165—and thereafter to theengagement plane 150 through matrix CM. The opposingsecond jaw 112B inFIG. 5 has a conductive material (electrode) indicated at 185 coupled tosource 180 by lead 109 b that is exposed within theupper engagement surface 155B. - In a first mode of operation, referring to
FIG. 5 , electrical potential of a first polarity applied toconductor 165 will result in current flow through the matrix CM and the engaged tissue et to the opposingpolarity conductor 185. As described previously, the resistance of the matrix CM at 37° C. is engineered to approximate, or slightly exceed, that of the engaged tissue et. It can now be described how theengagement surface 155A can modulate the delivery of energy to tissue et similar to the hypothetical engagement surface ofFIG. 2 . Consider that the small sections of engagement surfaces represent the micron-sized surface areas (or pixels) of the illustration ofFIG. 2 (note that the jaws are not in a fully closed position inFIG. 5 ). The preferred membrane-thick engagement gap g is graphically represented inFIG. 5 . -
FIGS. 7A and 8A illustrate enlarged schematic sectional views ofjaws conductor 165 will cause current flow within and about theelements 162 ofsecond portion 160 b along any conductive path toward the opposingpolarity conductor 185.FIG. 8A more particularly shows a graphic representation of paths of microcurrents mcm within the matrix wherein theconductive elements 162 are in substantial contact.FIG. 7A also graphically illustrates paths of microcurrents met in the engaged tissue across gap g. The current paths in the tissue (across conductive sodium, potassium, chlorine ions etc.) thus results in ohmic heating of the tissue engaged betweenjaws elements 162 in the surface of theengagement layer 155A, which can act like surface asperities or sharp edges to induce current flow therefrom. - Consider that ohmic heating (or active heating) of the shaded
portion 188 of engaged tissue et inFIGS. 7B and 8B elevates its temperature to a selected temperature at the maximum of the targeted range. Heat will be conducted back to the matrix portion CM proximate to the heated tissue. At the selected temperature, the matrix CM will substantially reduce current flow therethrough and thus will contribute less and less to ohmic tissue heating, which is represented inFIGS. 7B and 8B . InFIGS. 7B and 8B , the thermal coefficient of expansion of the elastomer offirst matrix portion 160 a will cause slight redistribution of the secondconductive portion 160 b within the matrix—naturally resulting in lessened contacts between theconductive elements 162. It can be understood by arrows A inFIG. 8B that the elastomer will expand in directions of least resistance which is between theelements 162 since the elements are selected to be substantially resistant to compression. - Of particular interest, the small surface portion of matrix CM indicated at 190 in
FIG. 8A will function, in effect, independently to modulate power delivery to the surface of the tissue T engaged thereby. This effect will occur across the entireengagement surface layer 155A, to provide practically infinite “spatially localized” modulation of active energy density in the engaged tissue. In effect, the engagement surface can be defined as having “pixels” about its surface that are independently controlled with respect to energy application to localized tissue in contact with each pixel. Due to the high mechanical compression applied by the jaws, the engaged membrane all can be elevated to the selected temperature contemporaneously as each pixel heats adjacent tissue to the top of treatment range. As also depicted inFIG. 8B , the thermal expansion of the elastomeric matrix surface also will push into the membrane, further insuring tissue contact along theengagement plane 150 to eliminate any possibility of an energy arc across a gap. - Of particular interest, as any portion of the conductive-resistive matrix CM falls below the upper end of targeted treatment range, that matrix portion will increase its conductance and add ohmic heating to the proximate tissue via current paths through the matrix from
conductor 165. By this means of energy delivery, the mass of matrix and the jaw body will be modulated in temperature, similar to the engaged tissue, at or about the targeted treatment range. -
FIG. 9 shows another embodiment of a conductive-resistive matrix CM that is further doped withelements 192 of a material that is highly thermally conductive with a selected mass that is adapted to provide substantial heat capacity. By utilizingsuch elements 192 that may not be electrically conductive, the matrix can provide greater thermal mass and thereby increase passive conductive or convective heating of tissue when the matrix CM substantially reduces current flow to the engaged tissue. In another embodiment (not shown) the material ofelements 162 can be both substantially electrically conductive and highly thermally conductive with a high heat capacity. - The manner of utilizing the system of
FIGS. 7A-7B to perform the method of the invention can be understood as mechanically compressing the engaged tissue et to membrane thickness between the first andsecond engagement surfaces conductor 165, which potential is conducted through matrix CM to maintain a selected temperature across engaged tissue et for a selected time interval. At normal tissue temperature, the low base resistance of the matrix CM allows unimpeded Rf current flow fromvoltage source 180 thereby making 100 percent of the engagement surface an active conductor of electrical energy. It can be understood that the engaged tissue initially will have a substantially uniform impedance to electrical current flow, which will increase substantially as the engaged tissue loses moisture due to ohmic heating. Following an arbitrary time interval (in the microsecond to ms range), the impedance of the engaged tissue—reduced to membrane thickness—will be elevated in temperature and conduct heat to the matrix CM. In turn, the matrix CM will constantly adjust microcurrent flow therethrough—with each square micron of surface area effectively delivering its own selected level of power depending on the spatially-local temperature. This automatic reduction of localized microcurrents in tissue thus prevents any dehydration of the engaged tissue. By maintaining the desired level of moisture in tissue proximate to the engagement plane(s), the jaw assembly can insure the effective denaturation of tissue constituents to thereafter create a strong weld. - By the above-described mechanisms of causing the matrix CM to be maintained in a selected treatment range, the actual Rf energy applied to the engaged tissue et can be precisely modulated, practically pixel-by-pixel, in the terminology used above to describe
FIG. 2 . Further, theelements 192 in the matrix CM can comprise a substantial volume of the jaws' bodies and the thermal mass of the jaws, so that when elevated in temperature, the jaws can deliver energy to the engaged tissue by means of passive conductive heating—at the same time Rf energy delivery in modulated as described above. This balance of active Rf heating and passive conductive heating (or radiative, convective heating) can maintain the targeted temperature for any selected time interval. - Of particular interest, the above-described method of the invention that allows for immediate modulation of ohmic heating across the entirety of the engaged membrane is to be contrasted with prior art instruments that rely on power modulation based on feedback from a temperature sensor. In systems that rely on sensors or thermocouples, power is modulated only to an electrode in its totality. Further, the prior art temperature measurements obtained with sensors is typically made at only at a single location in a jaw structure, which cannot be optimal for each micron of the engagement surface over the length of the jaws. Such temperature sensors also suffer from a time lag. Still further, such prior art temperature sensors provide only an indirect reading of actual tissue temperature—since a typical sensor can only measure the temperature of the electrode.
- Other alternative modes of operating the conductive-resistive matrix system are possible. In one other mode of operation, the
system controller 182 coupled tovoltage source 180 can acquire data from current flow circuitry that is coupled to the first and second polarity conductors in the jaws (in any locations described previously) to measure the blended impedance of current flow between the first and second polarity conductors through the combination of (i) the engaged tissue and (ii) the matrix CM. This method of the invention can provide algorithms within thesystem controller 182 to modulate, or terminate, power delivery to the working end based on the level of the blended impedance as defined above. The method can further include controlling energy delivery by means of power-on and power-off intervals, with each such interval having a selected duration ranging from about 1 microsecond to one second. The working end andsystem controller 182 can further be provided with circuitry and working end components of the type disclosed in Provisional U.S. patent application Ser. No. 60/339,501 filed Nov. 9, 2001 (Docket No. S-BA-001) titled Electrosurgical Instrument, which is incorporated herein by reference. - In another mode of operation, the
system controller 182 can be provided with algorithms to derive the temperature of the matrix CM from measured impedance levels—which is possible since the matrix is engineered to have a selected unique resistance at each selected temperature over a temperature-resistance curve (seeFIG. 6 ). Such temperature measurements can be utilized by thesystem controller 182 to modulate, or terminate, power delivery to engagement surfaces based on the temperature of the matrix CM. This method also can control energy delivery by means of the power-on and power-off intervals as described above. -
FIGS. 10-11 illustrate a sectional views of analternative jaw structure 100C—in which both the lower andupper engagement surfaces FIGS. 7A-7B and 8A-8B to apply energy to engaged tissue. The jaw structure ofFIGS. 10-11 illustrate that the tissue is engaged on opposing sides by a conductive-resistive matrix, with each matrix CMA and CMB in contact with an opposing polarity electrode indicated at 165 and 185, respectively. It has been found that providing cooperating first and second conductive-resistive matrices in opposing first and second engagement surfaces can enhance and control both active ohmic heating and the passive conduction of thermal effects to the engaged tissue. - 3. Type “B” conductive-resistive matrix system for tissue welding.
FIGS. 12 and 14 A-14C illustrate anexemplary jaw assembly 200 that carries a Type “B” conductive-resistive matrix system for (i) controlling Rf energy density and microcurrent paths in engaged tissue, and (ii) for contemporaneously controlling passive conductive heating of the engaged tissue. The system again utilizes an elastomeric conductive-resistive matrix CM although substantially rigid conductive-resistive matrices of a ceramic positive-temperature coefficient material are also described and fall within the scope of the invention. Thejaw assembly 200 is carried at the distal end of an introducer member, and can be a scissor-type structure (cf.FIG. 4 ) or a transecting-type jaw structure (cf.FIGS. 3A-3B ). For convenience, thejaw assembly 200 is shown as a scissor-type instrument that allows for clarity of explanation. - The Type “A” system and method as described above in
FIGS. 5 and 7 A-7B allowed for effective pixel-by-pixel power modulation—wherein microscale spatial locations can be considered to apply an independent power level at a localized tissue contact. The Type “B” conductive-resistive matrix system described next not only allows for spatially localized power modulation, it additionally provides for the timing and dynamic localization of Rf energy density in engaged tissues—which can thus create a “wave” or “wash” of a controlled Rf energy density across the engaged tissue reduced to membrane thickness. - Of particular interest, referring to
FIG. 12 , the Type “B” system according to the invention provides an engagement surface layer of at least onejaw first polarity electrode 220 having exposedsurface portion 222 andsecond polarity electrode 225 having exposedsurface portion 226. Thus, the microcurrents within tissue during a brief interval of active heating can flow to and from said exposedsurface portions same engagement surface 255A. By providing opposingpolarity electrodes polarity electrodes engagement surfaces FIG. 11 wherein the upper jaw's engagement surface 250B is an insulator indicated at 252. - More in particular, referring to
FIG. 12 , the first (lower)jaw 212A is shown in sectional view with a conductive-resistive matrix CM exposed in a central portion ofengagement surface 255A. Afirst polarity electrode 220 is located at one side of matrix CM with thesecond polarity electrode 225 exposed at the opposite side of the matrix CM. In the embodiment ofFIG. 12 , the body orsupport structure 258 of the jaw comprises theelectrodes insulated body portion 262. Further, the exterior of the jaw body is covered by aninsulator layer 261. The matrix CM is otherwise in contact with theinterior portions electrodes - The jaw assembly also can carry a plurality of alternating opposing
polarity electrode portions FIGS. 13A-13C . Any of these arrangements of electrodes and intermediate conductive-resistive matrix will function as described below at a reduced scale—with respect to any paired electrodes and intermediate matrix CM. -
FIGS. 14A-14C illustrate sequential views of the method of using of the engagement surface layer ofFIG. 11 to practice the method of the invention as relating to the controlled application of energy to tissue. For clarity of explanation,FIGS. 14A-14C depict exposedelectrode surface portions FIG. 14A , theupper jaw 212B and engagement surface 250B is shown in phantom view, and comprises aninsulator 252. The gap dimension g is not to scale, as described previously, and is shown with the engaged tissue having a substantial thickness for purposes of explanation. -
FIG. 14A provides a graphic illustration of the matrix CM within engagement surface layer 250A at time T1—the time at which electrical potential of a first polarity (indicated at +) is applied toelectrode 220 via an electrical lead fromvoltage source 180 andcontroller 182. InFIGS. 14A-14C , the sphericalgraphical elements 162 of the matrix are not-to-scale and are intended to represent a “region” of conductive particles within the non-conductive elastomer 164. Thegraphical elements 162 thus define a polarity at particular microsecond in time just after the initiation of power application. InFIG. 14A , the bodyportion carrying electrode 225 defines a second electrical potential (−) and is coupled tovoltage source 180 by an electrical lead. As can be seen inFIG. 14A , thegraphical elements 162 are indicated as having a transient positive (+) or negative (−) polarity in proximity to the electrical potential at the electrodes. When thegraphical elements 162 have no indicated polarity (seeFIGS. 14B & 14C ), it means that the matrix region has been elevated to a temperature at the matrix switching range wherein electrical conductance is limited, as illustrated in that positively sloped temperature-resistance curve ofFIG. 6 and the graphical representation ofFIG. 8B . - As can be seen in
FIG. 14A , the initiation of energy application at time T1 causes microcurrents mc within the central portion of the conductive matrix CM as current attempts to flow between the opposingpolarity electrodes FIG. 14A , which results in highly localized ohmic heating and denaturation effects along that interface which extends from the matrix CM into the engaged tissue. Thus,FIG. 14A provides a simplified graphical depiction of the interface or plane P that defines the “non-random” localization of ohmic heating and denaturation effects—which contrasts with all prior art methods that cause entirely random microcurrents in engaged tissue. In other words, the interface between the opposing polarities wherein active Rf heating is precisely localized can be controlled and localized by the use of the matrix CM to create initial heating at that central tissue location. - Still referring to
FIG. 14A , as the tissue is elevated in temperature in this region, the conductive-resistive matrix CM in that region is elevated in temperature to its switching range to become substantially non-conductive (seeFIG. 6 ) in that central region. -
FIG. 14B graphically illustrates the interface or plane P at time T2—an arbitrary microsecond or millisecond time interval later than time T1. The dynamic interface between the opposing polarities wherein Rf energy density is highest can best be described as planes P and P′ propagating across the conductive-resistive matrix CM and tissue that are defined by “interfaces” between substantially conductive and non-conductive portions of the matrix—which again is determined by the localized temperature of the matrix. Thus, the microcurrent mc′ in the tissue is indicated as extending through the tissue membrane with the highest Rf density at the locations of planes P and P′. Stated another way, the system creates a front or wave of Rf energy density that propagates across the tissue. At the same time that Rf density (ohmic heating) in the localized tissue is reduced by the adjacent matrix CM becoming non-conductive, the matrix CM will begin to apply substantial thermal effects to the tissue by means of passive conductive heating as described above. -
FIG. 14C illustrates the propagation of planes P and P′ at time T3—an additional arbitrary time interval later than T2. The conductive-resistive matrix CM is further elevated in temperature behind the interfaces P and P′ which again causes interior matrix portions to be substantially less conductive. The Rf energy densities thus propagate further outward in the tissue relative to theengagement surface 255A as portions of the matrix change in temperature. Again, the highest Rf energy density will occur at generally at the locations of the dynamic planes P and P′. At the same time, the lack of Rf current flow in the more central portion of matrix CM can cause its temperature to relax to thus again make that central portion electrically conductive. The increased conductivity of the central matrix portion again is indicated by (+) and (−) symbols inFIG. 14C . Thus, the propagation of waves of Rf energy density will repeat itself as depicted inFIGS. 14A-14C which can effectively weld tissue. - Using the methods described above for controlled Rf energy application with paired electrodes and a conductive-resistive matrix CM, it has been found that time intervals ranging between about 500 ms and 4000 ms can be sufficient to uniformly denature tissue constituents re-cross-link to from very strong welds in most tissues subjected to high compression. Other alternative embodiments are possible that multiply the number of cooperating opposing
polarity electrodes -
FIG. 15 depicts an enlarged view of the alternative Type “B”jaw 212A ofFIG. 13A wherein the engagement surface 250A carries a plurality of exposed conductive matrix portions CM that are intermediate a plurality of opposingpolarity electrode portions lower jaw 212A has a structural body that comprises theelectrodes insulator member 266 that provide the strength required by the jaw. Aninsulator layer 261 again is provided on outer surfaces of the jaw excepting theengagement surface 255A. The upper jaw (not shown) of the jaw assembly can comprise an insulator, a conductive-resistive matrix, an active electrode portion or a combination thereof. In operation, it can be easily understood that each region of engaged tissue between each exposedelectrode portion FIGS. 14A-14C . - The type of engagement surface 250A shown in
FIG. 15 can have electrode portions that define an interior exposed electrode width ew ranging between about 0.005″ and 0.20″ with the exposedoutboard electrode surface - In the embodiment of
FIG. 15 , theelectrode portions insulator member 266 of the jaw body thus substantially preventing flexing of the engagement surface even though the matrix CM may be a flexible silicone elastomer.FIG. 16 shows an alternative embodiment wherein theelectrode portions -
FIG. 17 illustrates an alternative Type “B” embodiment that is adapted for further increasing passive heating of engaged tissue when portions of the matrix CM are elevated above its selected switching range. Thejaws FIG. 17 illustrates that afirst polarity electrode 220 is a thin layer of metallic material that floats on the matrix CM and is bonded thereto by adhesives or any other suitable means. The thickness of floatingelectrode 220 can range from about 1 micron to 200 microns. Thesecond polarity electrode 225 has exposedportions engagement planes FIG. 17 creates controlled thermal effects in engaged tissue by several different means. First, as indicated inFIGS. 18A-18C , the dynamic waves of Rf energy density are created between the opposingpolarity electrode portions engagement surface layer 255B cause microcurrents between the engagement surface layers 255A and 255B, as well as to the outboard exposed electrode surfaces exposedportions -
FIG. 19 illustrates another Type “B” embodiment of jaws structure that again is adapted for enhanced passive heating of engaged tissue when portions of the matrix CM are elevated above its selected switching range. Thejaws engagement surface layer 255B is convex and has an elastomeric hardness ranging between about 20 and 80 in the Shore A scale and is fabricated as described previously. - Of particular interest, the embodiment of
FIG. 19 depicts afirst polarity electrode 220 that is carried in a central portion ofengagement plane 255A but the electrode does not float as in the embodiment ofFIG. 17 . Theelectrode 220 is carried in a first matrix portion CM1 that is a substantially rigid silicone or can be a ceramic positive temperature coefficient material. Further, the first matrix portion CM, preferably has a differently sloped temperature-resistance profile (cf.FIG. 6 ) that the second matrix portion CM2 that is located centrally in thejaw 212A. The first matrix portion CM1, whether silicone or ceramic, has a hardness above about 90 in the Shore A scale, whereas the second matrix portion CM2 is typically of a silicone as described previously with a hardness between about 20 and 80 in the Shore A scale. Further, the first matrix portion CM1 has a higher switching range than the second matrix portion CM2. In operation, the wave of Rf density across the engaged tissue fromelectrode 220 to outboard exposedelectrode portions FIGS. 18A-18C . The rigidity of the first matrix CM1 prevents flexing of theengagement plane 255A. During use, passive heating will be conducted in an enhanced manner to tissue fromelectrode 220 and the underlying second matrix CM2 which has a second selected lower temperature switching range, for example between about 60° C. to 70° C. This Type “B” system has been found to be very effective for rapidly welding tissue—in part because of the increased surface area of theelectrode 220 when used in small cross-section jaw assemblies (e.g., 5 mm. working ends). -
FIG. 20 shows theengagement plane 255A ofFIG. 17 carried in a transecting-type jaws assembly 200D that is similar to that ofFIGS. 3A-3B . As described previously, the Type “B” conductive-resistive matrix assemblies ofFIGS. 12-19 are shown in a simplified form. Any of the electrode-matrix arrangements ofFIGS. 12-19 can be used in the cooperating sides of a jaw with a transecting blade member—similar to the embodiment shown inFIG. 20 . - 3. Type “C” system for tissue welding.
FIGS. 21 and 22 illustrate anexemplary jaw assembly 400 that carries a Type “C” system that optionally utilizes at least one conductive-resistive matrix CM as described previously for (i) controlling Rf energy density and microcurrent paths in engaged tissue, and (ii) for contemporaneously controlling passive conductive heating of the engaged tissue. - In
FIG. 21 , it can be seen thatjaws respective engagement surfaces 455A and 455B. Theupper jaw 412B and engagement surface 455B can be as described in the embodiment ofFIGS. 17 and 19 , or the upper engagement surface can be fully insulated as described in the embodiment ofFIGS. 14A-14C . Preferably, upper engagement surface layer 455B is convex and made of an elastomeric material as described above. Both jaws have astructural body portion body portions electrical source 180 and have exposedsurfaces portions 472 a and 472 b in the jaws' engagement planes to serve as an electrode defining a first polarity, as thesurface portions 472 a and 472 b are coupled to, and transition into, themetallic film layer 475 described next. - As can be seen in
FIG. 21 , theentire engagement surface 455A of thelower jaw 412A comprises any thin conductive metallic film layer indicated at 475. For example, the layer can be of platinum, titanium, gold, tantalum, etc. or any alloy thereof. The thin film metallization can be created by electroless plating, electroplating processes, sputtering or other vapor deposition processes known in the art, etc. The film thickness ft of themetallic layer 475 can be from about 1 micron to 100 microns. More preferably, themetallic film layer 475 is from about 5 to 50 microns. - The matrix CMA preferably is substantially rigid but otherwise operates as described above. The
metallic film layer 475 is shown as having an optional underlying conductive member indicated at 477 that is coupled toelectrical source 180 and thus comprises an electrode that defined a second polarity. - Of particular interest, referring to
FIG. 22 , it can be seen thatengagement surface 455A entirely comprises the thinmetallic film layer 475 that is coupled in spaced apartportions FIG. 22 ,intermediate portions 485 of the metallic film layer 475 (that are intermediate the central and outboard metallic film portions coupled to the opposing polarities of the electrical source) are made to have an altered resistance to current flow therethrough to thereby induce microcurrents to flow through adjacent engaged tissue rather than throughintermediate portions 485. This can be advantageous for precise control of localizing the microcurrents in engaged tissue. At the same time, the thin dimension of thefilm 475 allows for very rapid adjustment in temperature and thus allows enhanced passive conductive heating of engaged tissue when the engaged tissue is no longer moist enough for active Rf density therein. One preferred manner of fabricating theintermediate portions 485 is to provide perforations orapertures 488 therein that can range in size from about 5 microns to 200 microns. Stated another way, theintermediate portions 485 can haveapertures 488 therein that make the regions from about 1 percent to 60 percent open, no matter the size or shape of the apertures. More preferably, theintermediate portions 485 are from about 5 percent to 40 percent open. Theapertures 488 can be made in thefilm 475 by any suitable means, such as photo-resist methods. As shown inFIG. 22 , theintermediate portions 485 are not-to-scale and have a width w that ca range from about 0.005″ to 0.20″ in a typical electrosurgical jaw. - 4. Type “D” conductive-resistive matrix system for tissue welding. FIGS. 23 to 28 illustrate exemplary Type “D” jaw structures that utilize a conductive-resistive matrix CM or variable resistive body in a different manner than described previously. The Type “D” system still controls Rf energy density and microcurrent paths in engaged tissue as described previously, but also provides means for a more “focused” application of passive conductive heating of engaged tissue.
-
FIG. 23 illustrates a firstexemplary jaw assembly 500A that carries a Type “D” conductive-resistive matrix system CM that can comprise an elastomeric or non-elastomeric matrix of a positive temperature coefficient material. Thejaw assembly 500A is carried at the distal end of an introducer member, and can be a scissor-type structure (cf.FIG. 4 ) or a transecting-type jaw structure (cf.FIGS. 3A-3B ). InFIG. 23 , thejaw assembly 500A is shown as a scissor-type instrument to allow for simplified of explanation of the features corresponding to the invention. - Still referring to
FIG. 23 , thejaw assembly 500A depicts first andsecond jaws engagement surfaces jaw 512B carries a conductor or returnelectrode element 558 that is exposed inengagement surface 555B which in turn is coupled tovoltage source 180 and is indicated for purposes of explanation as having a negative (—) polarity. - The lower (first)
jaw 512A carries an opposing polarity (+)electrode element 560 that is embedded within the interior ofinsulator material 556 that makes up the exterior body ofjaw 512A. The jaw has a thinsurface conductor element 565 inengagement surfaces 555A—that is not directly coupled to thevoltage source 180. Rather, thesurface conductor element 565 is electrically/conductively coupled to thesurface conductor 565 only by an intermediate conductive-resistive matrix CM that contacts both theactive electrode 560 and thesurface conductor 565. Of particular interest, the conductive-resistive matrix CM has a cross-section that diminishes in the direction of thesurface conductor 565. InFIG. 23 , the matrix CM is shown with triangular cross-section that tapers from afirst region 580 that has an extended dimension to a secondreduced dimension region 585 that conductively contacts thecentral portion 570 ofsurface conductor 565. It can be understood theconductive material 565 only functions as an electrode to actively conduct current to engaged tissue when the matrix CM is below its switching range. At other time intervals when the matrix CM is above its switching range, thesurface conductor 565 will not provide current paths to the engaged tissue and passive heating of the matrix will be focused in thecentral portion 570 of thesurface conductor 565. - It can be understood that when the conductive-resistive matrix CM is below it switching temperature range, current will flow between the interior
active electrode 560 and thesurface conductor 565. However, when the engaged tissue is elevated in temperature, which elevates the temperature ofsurface conductor 565, the portion of the matrix CM proximate to surfaceconductor 565 will be heated to its switching range before the other portions of the matrix more proximate to the interioractive electrode 560. Thereafter, the conductive-resistive matrix CM will have a temperature that hovers about the upper end of its switching range, which also is the targeted tissue treatment range. Contemporaneously, the central matrix portion will focus its passive (conductive) heating at a selected location within theengagement surface 255B. It has been found that a centrally focused passive heating as depicted in the embodiment ofFIG. 23 is very useful in tissue welding. It should be appreciated that the scope of the invention includes the use of a positive or negative temperature coefficient material volume CM intermediate anactive electrode 560 and asurface conductor 565 that engages tissue wherein the surface area of the matrix material CM has a firstgreater surface area 580 in contact with theactive electrode 560 and secondlesser surface area 585 in contact with theconductor 565 in the engagement surface. The actual cross-section of the matrix volume CM can be any shape such as triangular, pyramid-shaped, “T”-shaped, or any curvilinear shape that tapers. In a preferred embodiment, the secondlesser surface area 585 in contact withsurface conductor 565 is less than about 50 percent of thefirst surface area 580. More preferably, thesecond surface area 585 in contact withsurface conductor 565 is less than about 25 percent of thefirst surface area 580 in contact withactive electrode 560. - As can be seen in
FIG. 23 , the jaws carry insulated projectingelements 572 that can be located anywhere in the engagement surfaces 555A and 555B or the jaw perimeters to prevent inadvertent contact between the opposing polarity electrodes when the jaws are moved toward the fully closed position. -
FIG. 24 illustrates anotherexemplary jaw structure 500B that corresponds to the invention. The positive temperature coefficient conductive-resistive matrix CM is again intermediateactive electrode 560 andsurface conductor 565 but this embodiment has a jaw that carries a plurality of matrix portions CM1 to CM3 that create a gradient in the temperature coefficients of resistance within adjacent matrix portions. The matrices CM1 to CM3 are graphically indicated (not-to-scale) to haveconductive particles 160 b of different dimensions/volumes within thenon-conductive portion 160 a of each matrix to provide varied temperature-resistance curves. It should be appreciated that any temperature coefficient material of any type can be used, or any combination of materials or material types can be used to fabricate the gradient. In this embodiment, the more outboard matrix CM3 that is exposed in theengagement surface 555A has a significantly greater resistance to current flow therethrough than the embedded matrix CM1 that defines that tapered cross-section between theinterior electrode 560 and the surface conductor. Also the overall matrix can have a substantially continuous gradient across the matrix volume and fall within the scope of the invention. - In the embodiment of
FIG. 24 , thesurface conductor 565 is directly coupled to thevoltage source 180 to define a polarity (−) therein that opposes the polarity of theinterior electrode 560. The embodiment ofFIG. 24 has its interior electrode 560 (indicated with positive (+) polarity) comprising a body portion of thelower jaw 512A with aninsulative coating 586 about most of its exterior surface. In theengagement surface 555A, the laterally outward portions indicated at 588 also are exposed portions of theinterior electrode 560 indicated as having positive (+) polarity. Theseelectrode portions 588 cooperate with theconductor 565 as described in the embodiments ofFIGS. 14A-14C andFIGS. 18A-18C . - In the embodiment of
FIG. 24 , the central matrix portion CM1 has a switching range and contact area with thesurface conductor 565 to thus cause differential passive conductive heating across the engagements surface 555A andconductor 565, with the more focused passive heating in thecentral region 570 of the jaw surface. As can be seen inFIG. 24 , the central matrix portion CM1 has a firstgreater surface area 580 in contact withinterior electrode 560 and a secondlesser surface area 585 in contact withsurface conductor 565. - The embodiment of
FIG. 24 further illustrates that matrix CM2 and matrix CM3 have surface areas that differ between the contacts with theinterior electrode 560 and thesurface conductor 565. These surface areas can be manipulated to advantage to cause “focused” active or passive heating at theengagement surface 555A, and the scope of the invention includes having any such surface area larger than the other. - Now turning to
FIG. 25 , another alternative jaw assembly 500C is shown that has alower jaw 512A that is identical to the embodiment ofFIG. 23 . However, theupper jaw 512B has anengagement surface 555B that carries an exposed conductive-resistive matrix CM5 that is coupled to areturn electrode 558 embedded at an interior of the upper jaw body that is fabricated of aninsulator material 556. Such an upper jaw was shown inFIGS. 10, 11 and 17. In all other respects, the working end functions as described previously. - Referring now to
FIGS. 26A-26B , anotheralternative jaw assembly 500D is shown that is a scissor-type instrument similar to the embodiment ofFIG. 4 , except that the jaws carry aslot 590 for receiving an extendable transecting blade (not shown). InFIG. 26B , it can be seen thatlower jaw 512A has left andright sides FIG. 23 . In all respects, the embodiment ofFIG. 26B functions as described above. - Referring now to
FIG. 27 , anotheralternative jaw assembly 500E is shown that again has scissor-type first andsecond jaws slot 590 in the jaws for receiving an extendable blade for transecting tissue in the embodiment ofFIG. 26B . In this embodiment, theengagement surface 555A of the lower jaw carries lateral conductive elements indicated at 592 (collectively) of an opposing (−) polarity from the spaced apart centralconductive element 565, making this embodiment function in the manner of the embodiments shown in FIGS. 17, 18A-18C, 19, 20 and 24. The material between theconductive element 565 and the lateralconductive elements 592 can be a conductive-resistive matrix (cf.FIG. 24 ) or an insulative material (seeFIG. 27 ). -
FIG. 28 illustrates analternative jaw assembly 500F that is similar to the embodiment ofFIG. 27 . The first andsecond jaws engagement surface 555A of thelower jaw 512A again carries lateralconductive elements 588 coupled to the voltage source to define an opposing polarity from the spaced apart from centralconductive element 565 which is also coupled to the voltage source. The jaw carries first and conductive-resistive matrices CM1 and CM2. An insulative layer 589 is provided about the exterior surface of the jaw. Again, the pyramidal cross-section central matrix CM1 has first and second contact areas of greater and lesser dimensions, respectively, for contacting theinterior electrode 560 and thesurface conductor 565. - Now referring to
FIG. 29 , the systems and method of the invention for controlled application of energy to tissue can be described in terms of equilibrium temperature and impedance characteristics that can be designed into the working end.FIG. 29 first illustrates a typical power output-impedance curve for a radiofrequency generator (voltage source 180).FIG. 29 also illustrates a selected temperature-impedance curve for the conductive-resistive matrix CM corresponding to the invention. It can be easily understood that thevoltage source 180 and matrix CM can be designed to provide a selected equilibrium temperature EQ which is indicated at the intersection of the curves. Thus, one preferred system of the invention comprises (i) a working end that carries a matrix as described above having a positive temperature coefficient of resistance that defines a selected temperature-impedance curve, and (ii) a voltage source that defines a selected power output-impedance curve wherein the temperature-impedance curve and power output-impedance curve define an equilibrium temperature at which the matrix dissipates power output from the voltage source to thereby maintain said equilibrium temperature within the matrix CM. Practicing the method of the invention thus consists of (i) providing the matrix CM and voltage source as described above, (ii) engaging tissue with the engagement surface, and (iii) applying electrosurgical energy to the tissue through the matrix material wherein the selected temperature-impedance curve and power output-impedance curve define the matrix's dissipation of power to thereby maintain a selected temperature in the engaged tissue. The equilibrium temperature EQ can be any temperature, and for the purposes of welding tissue can be between about 60° C. and 100° C. More preferably, the equilibrium temperature EQ is between about 65° C. and 85° C. - In another aspect of the invention, still referring to
FIG. 29 , the invention provides an electrosurgical system that insures that tissue will not be desiccated, and insures that sparks will not cross any gaps between the engagement surface and tissue which thereby prevents tissue from sticking to the engagement surface. The system provides a conductive-resistive matrix material CM that is exposed in an engagement surface that receives electrosurgical energy, or coupled to a conductor in the engagement surface, wherein the matrix material defines a positive temperature coefficient of resistance. The invention further provides a radiofrequency energy source or voltage source for generating the electrosurgical energy. Further, the matrix CM is designed so that the combined impedance of engaged tissue and the matrix material CM is such that voltage developed across any gap of a selected dimension between the engagement surface and the tissue is less than the breakdown voltage required to cross of a gap having that selected dimension. In other words, the source's power-impedance curve and the matrix's impedance-temperature curve—together with that potential impedance parameters of the engaged tissue—can be engineered to insure that no sparks will jump across a gap in the interface between the engagement surface and the tissue. - In another aspect of the invention, the invention can provide a
controller 182 coupled to thevoltage source 180 that includes algorithms that convert energy delivery from a continuous mode to a pulsed mode upon the system reaching a selected parameter such as an impedance level. For example, thecontroller 182 can alter energy delivery to a pulsed mode upon the combination of the matrix CM and the engaged tissue reaching a particular impedance level. It has been found that such a pulsed mode of energy delivery will allow moisture within the tissue to re-hydrate the engaged tissue to further prevent tissue desiccation, while still maintaining the targeted tissue temperature. - Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration. Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention. Further variations will be apparent to one skilled in the art in light of this disclosure and are intended to fall within the scope of the appended claims.
Claims (10)
1. An electrosurgical system, comprising:
an instrument body having a proximal end and a working end that has an engagement surface for engaging tissue;
a voltage source that defines a selected power output-impedance curve; and
a variable resistive body carried in the working end that is positioned intermediate said engagement surface and an interior electrode coupled to the voltage source, the variable resistive body having a positive temperature coefficient of resistance that defines a selected temperature-impedance curve;
wherein the temperature-impedance curve and power output-impedance curve are selected to define a selected equilibrium temperature at which the variable resistive body dissipates power output from the voltage source to thereby maintain said equilibrium temperature in the matrix.
2. The electrosurgical system of claim 1 , wherein the selected equilibrium temperature is between about 60° C. and 100° C.
3. The electrosurgical system of claim 1 , wherein the selected equilibrium temperature is between about 65° C. and 85° C.
4. An electrosurgical system for controlled application of energy to tissue, comprising:
an instrument with a working end that has an engagement surface for engaging tissue;
a voltage source that defines a selected power output-impedance curve; and
a variable resistive body carried in the working end that is positioned intermediate said engagement surface and an interior electrode coupled to the voltage source, the variable resistive body having a positive temperature coefficient of resistance that defines a selected temperature-impedance curve;
wherein the temperature-impedance curve and power output-impedance curve are selected to define a breakdown voltage across a gap of a selected dimension.
5. An electrosurgical system for controlled application of energy to tissue, comprising:
an instrument with a working end that has an engagement surface for engaging tissue;
a voltage source and controller for operatively coupled to the engagement surface;
a variable resistive body carried in the working end that is positioned intermediate said engagement surface and an interior working end electrode coupled to the voltage source, the variable resistive body having a positive temperature coefficient of resistance that defines a selected temperature-impedance curve;
wherein the controller defines means for modulating energy delivery between continuous modes and pulsed modes in response to the impedance of the variable resistive body.
6. The electrosurgical system of claim 5 , wherein the controller defines means for modulating energy delivery between continuous modes and pulsed modes in response to the impedance of the combination of variable resistive body and the engaged tissue.
7. An electrosurgical method, comprising the steps of:
providing an instrument with a working end that has an engagement surface for engaging tissue;
providing a voltage source that defines a power output-impedance curve;
providing a variable resistive body that is intermediate the engagement surface and the voltage source, the variable resistive body having a positive temperature coefficient of resistance and thereby defining a selected temperature-impedance curve; and
engaging tissue with the engagement surface and applying electrosurgical energy to the tissue through the variable resistive body;
wherein the selected temperature-impedance curve and power output-impedance curve will define a point at which the variable resistive body dissipates power to maintain a selected temperature in the engaged tissue.
8. The electrosurgical method of claim 7 , wherein the selected temperature is between about 60° C. and 100° C.
9. The electrosurgical method of claim 7 , wherein the selected temperature is between about 65° C. and 85° C.
10. An electrosurgical method, comprising the steps of:
providing an instrument with a working end that has an engagement surface for engaging tissue;
providing a voltage source operatively coupled to the working end;
providing a variable resistive body within the working end that is intermediate the engagement surface and an interior electrode coupled to the voltage source, the variable resistive body defining a positive temperature coefficient of resistance;
engaging tissue with the engagement surface and applying electrosurgical energy to the tissue through the variable resistive body;
wherein the combined impedance of the tissue and the variable resistive body is such that voltage developed across any gap between the engagement surface and the tissue is less than the breakdown voltage required to cross a selected gap dimension.
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US11/925,092 US20080045942A1 (en) | 2001-10-22 | 2007-10-26 | Electrosurgical instrument and method of use |
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US10/448,478 Division US7311709B2 (en) | 2001-10-22 | 2003-05-30 | Electrosurgical instrument and method of use |
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Cited By (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
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US9144455B2 (en) | 2010-06-07 | 2015-09-29 | Just Right Surgical, Llc | Low power tissue sealing device and method |
US20160074095A1 (en) * | 2014-09-15 | 2016-03-17 | Ethicon Endo-Surgery, Inc. | Methods and devices for creating thermal zones within an electrosurgical instrument |
US9498278B2 (en) | 2010-09-08 | 2016-11-22 | Covidien Lp | Asymmetrical electrodes for bipolar vessel sealing |
US20170128118A1 (en) * | 2012-02-08 | 2017-05-11 | Avenu Medical, Inc. | Intravascular arterial to venous anastomosis and tissue welding catheter |
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Families Citing this family (587)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7435249B2 (en) | 1997-11-12 | 2008-10-14 | Covidien Ag | Electrosurgical instruments which reduces collateral damage to adjacent tissue |
US6726686B2 (en) | 1997-11-12 | 2004-04-27 | Sherwood Services Ag | Bipolar electrosurgical instrument for sealing vessels |
WO2002080786A1 (en) | 2001-04-06 | 2002-10-17 | Sherwood Services Ag | Electrosurgical instrument which reduces collateral damage to adjacent tissue |
US6228083B1 (en) | 1997-11-14 | 2001-05-08 | Sherwood Services Ag | Laparoscopic bipolar electrosurgical instrument |
US7118570B2 (en) | 2001-04-06 | 2006-10-10 | Sherwood Services Ag | Vessel sealing forceps with disposable electrodes |
US7582087B2 (en) | 1998-10-23 | 2009-09-01 | Covidien Ag | Vessel sealing instrument |
US7364577B2 (en) | 2002-02-11 | 2008-04-29 | Sherwood Services Ag | Vessel sealing system |
US7267677B2 (en) | 1998-10-23 | 2007-09-11 | Sherwood Services Ag | Vessel sealing instrument |
US20030109875A1 (en) | 1999-10-22 | 2003-06-12 | Tetzlaff Philip M. | Open vessel sealing forceps with disposable electrodes |
US7252666B2 (en) * | 2000-02-14 | 2007-08-07 | Sherwood Services Ag | Arterial hole closure apparatus |
US7473253B2 (en) | 2001-04-06 | 2009-01-06 | Covidien Ag | Vessel sealer and divider with non-conductive stop members |
US11229472B2 (en) | 2001-06-12 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with multiple magnetic position sensors |
US8075558B2 (en) | 2002-04-30 | 2011-12-13 | Surgrx, Inc. | Electrosurgical instrument and method |
US7270664B2 (en) | 2002-10-04 | 2007-09-18 | Sherwood Services Ag | Vessel sealing instrument with electrical cutting mechanism |
US7276068B2 (en) | 2002-10-04 | 2007-10-02 | Sherwood Services Ag | Vessel sealing instrument with electrical cutting mechanism |
US7931649B2 (en) | 2002-10-04 | 2011-04-26 | Tyco Healthcare Group Lp | Vessel sealing instrument with electrical cutting mechanism |
US7799026B2 (en) | 2002-11-14 | 2010-09-21 | Covidien Ag | Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion |
WO2004082495A1 (en) | 2003-03-13 | 2004-09-30 | Sherwood Services Ag | Bipolar concentric electrode assembly for soft tissue fusion |
US7160299B2 (en) | 2003-05-01 | 2007-01-09 | Sherwood Services Ag | Method of fusing biomaterials with radiofrequency energy |
EP1617778A2 (en) | 2003-05-01 | 2006-01-25 | Sherwood Services AG | Electrosurgical instrument which reduces thermal damage to adjacent tissue |
WO2004103156A2 (en) | 2003-05-15 | 2004-12-02 | Sherwood Services Ag | Tissue sealer with non-conductive variable stop members and method of sealing tissue |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US7857812B2 (en) | 2003-06-13 | 2010-12-28 | Covidien Ag | Vessel sealer and divider having elongated knife stroke and safety for cutting mechanism |
US7156846B2 (en) | 2003-06-13 | 2007-01-02 | Sherwood Services Ag | Vessel sealer and divider for use with small trocars and cannulas |
USD956973S1 (en) | 2003-06-13 | 2022-07-05 | Covidien Ag | Movable handle for endoscopic vessel sealer and divider |
US7150749B2 (en) | 2003-06-13 | 2006-12-19 | Sherwood Services Ag | Vessel sealer and divider having elongated knife stroke and safety cutting mechanism |
US9848938B2 (en) | 2003-11-13 | 2017-12-26 | Covidien Ag | Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion |
US7367976B2 (en) | 2003-11-17 | 2008-05-06 | Sherwood Services Ag | Bipolar forceps having monopolar extension |
US7811283B2 (en) | 2003-11-19 | 2010-10-12 | Covidien Ag | Open vessel sealing instrument with hourglass cutting mechanism and over-ratchet safety |
US7131970B2 (en) | 2003-11-19 | 2006-11-07 | Sherwood Services Ag | Open vessel sealing instrument with cutting mechanism |
US7500975B2 (en) | 2003-11-19 | 2009-03-10 | Covidien Ag | Spring loaded reciprocating tissue cutting mechanism in a forceps-style electrosurgical instrument |
US7442193B2 (en) | 2003-11-20 | 2008-10-28 | Covidien Ag | Electrically conductive/insulative over-shoe for tissue fusion |
US8182501B2 (en) | 2004-02-27 | 2012-05-22 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical shears and method for sealing a blood vessel using same |
US7780662B2 (en) | 2004-03-02 | 2010-08-24 | Covidien Ag | Vessel sealing system using capacitive RF dielectric heating |
US7955331B2 (en) | 2004-03-12 | 2011-06-07 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument and method of use |
DE102005011869A1 (en) * | 2004-03-22 | 2005-10-13 | Erbe Elektromedizin Gmbh | Bipolar clamp |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
US7195631B2 (en) | 2004-09-09 | 2007-03-27 | Sherwood Services Ag | Forceps with spring loaded end effector assembly |
US7540872B2 (en) | 2004-09-21 | 2009-06-02 | Covidien Ag | Articulating bipolar electrosurgical instrument |
US7955332B2 (en) | 2004-10-08 | 2011-06-07 | Covidien Ag | Mechanism for dividing tissue in a hemostat-style instrument |
PL1802245T3 (en) | 2004-10-08 | 2017-01-31 | Ethicon Endosurgery Llc | Ultrasonic surgical instrument |
US7686804B2 (en) | 2005-01-14 | 2010-03-30 | Covidien Ag | Vessel sealer and divider with rotating sealer and cutter |
US7909823B2 (en) | 2005-01-14 | 2011-03-22 | Covidien Ag | Open vessel sealing instrument |
US7491202B2 (en) | 2005-03-31 | 2009-02-17 | Covidien Ag | Electrosurgical forceps with slow closure sealing plates and method of sealing tissue |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US7789878B2 (en) | 2005-09-30 | 2010-09-07 | Covidien Ag | In-line vessel sealer and divider |
EP1769765B1 (en) | 2005-09-30 | 2012-03-21 | Covidien AG | Insulating boot for electrosurgical forceps |
US7922953B2 (en) | 2005-09-30 | 2011-04-12 | Covidien Ag | Method for manufacturing an end effector assembly |
US7722607B2 (en) | 2005-09-30 | 2010-05-25 | Covidien Ag | In-line vessel sealer and divider |
US7879035B2 (en) | 2005-09-30 | 2011-02-01 | Covidien Ag | Insulating boot for electrosurgical forceps |
CA2561034C (en) | 2005-09-30 | 2014-12-09 | Sherwood Services Ag | Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue |
US20070191713A1 (en) | 2005-10-14 | 2007-08-16 | Eichmann Stephen E | Ultrasonic device for cutting and coagulating |
US7621930B2 (en) | 2006-01-20 | 2009-11-24 | Ethicon Endo-Surgery, Inc. | Ultrasound medical instrument having a medical ultrasonic blade |
US8241282B2 (en) | 2006-01-24 | 2012-08-14 | Tyco Healthcare Group Lp | Vessel sealing cutting assemblies |
US8882766B2 (en) | 2006-01-24 | 2014-11-11 | Covidien Ag | Method and system for controlling delivery of energy to divide tissue |
US8298232B2 (en) | 2006-01-24 | 2012-10-30 | Tyco Healthcare Group Lp | Endoscopic vessel sealer and divider for large tissue structures |
US8734443B2 (en) | 2006-01-24 | 2014-05-27 | Covidien Lp | Vessel sealer and divider for large tissue structures |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | 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 |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US7776037B2 (en) | 2006-07-07 | 2010-08-17 | Covidien Ag | System and method for controlling electrode gap during tissue sealing |
US8597297B2 (en) | 2006-08-29 | 2013-12-03 | Covidien Ag | Vessel sealing instrument with multiple electrode configurations |
US7909819B2 (en) * | 2006-09-01 | 2011-03-22 | Applied Medical Resources Corporation | Monopolar electrosurgical return electrode |
US8070746B2 (en) | 2006-10-03 | 2011-12-06 | Tyco Healthcare Group Lp | Radiofrequency fusion of cardiac tissue |
US7951149B2 (en) * | 2006-10-17 | 2011-05-31 | Tyco Healthcare Group Lp | Ablative material for use with tissue treatment device |
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 |
US8827133B2 (en) | 2007-01-11 | 2014-09-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling device having supports for a flexible drive mechanism |
USD649249S1 (en) | 2007-02-15 | 2011-11-22 | Tyco Healthcare Group Lp | End effectors of an elongated dissecting and dividing instrument |
US20080234709A1 (en) | 2007-03-22 | 2008-09-25 | Houser Kevin L | Ultrasonic surgical instrument and cartilage and bone shaping blades therefor |
US8226675B2 (en) | 2007-03-22 | 2012-07-24 | Ethicon Endo-Surgery, Inc. | 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 |
US8911460B2 (en) | 2007-03-22 | 2014-12-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8267935B2 (en) | 2007-04-04 | 2012-09-18 | Tyco Healthcare Group Lp | Electrosurgical instrument reducing current densities at an insulator conductor junction |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US11857181B2 (en) | 2007-06-04 | 2024-01-02 | Cilag Gmbh International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
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 |
US8882791B2 (en) | 2007-07-27 | 2014-11-11 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8257377B2 (en) | 2007-07-27 | 2012-09-04 | Ethicon Endo-Surgery, Inc. | Multiple end effectors ultrasonic surgical instruments |
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 |
US8348967B2 (en) | 2007-07-27 | 2013-01-08 | Ethicon Endo-Surgery, Inc. | Ultrasonic 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 |
US8252012B2 (en) | 2007-07-31 | 2012-08-28 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with modulator |
US8430898B2 (en) | 2007-07-31 | 2013-04-30 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US7877853B2 (en) | 2007-09-20 | 2011-02-01 | Tyco Healthcare Group Lp | Method of manufacturing end effector assembly for sealing tissue |
US7877852B2 (en) | 2007-09-20 | 2011-02-01 | Tyco Healthcare Group Lp | Method of manufacturing an end effector assembly for sealing tissue |
US8236025B2 (en) | 2007-09-28 | 2012-08-07 | Tyco Healthcare Group Lp | Silicone insulated electrosurgical forceps |
US8235992B2 (en) | 2007-09-28 | 2012-08-07 | Tyco Healthcare Group Lp | Insulating boot with mechanical reinforcement for electrosurgical forceps |
US8235993B2 (en) | 2007-09-28 | 2012-08-07 | Tyco Healthcare Group Lp | Insulating boot for electrosurgical forceps with exohinged structure |
AU2008221509B2 (en) | 2007-09-28 | 2013-10-10 | Covidien Lp | Dual durometer insulating boot for electrosurgical forceps |
US8267936B2 (en) | 2007-09-28 | 2012-09-18 | Tyco Healthcare Group Lp | Insulating mechanically-interfaced adhesive for electrosurgical forceps |
US8251996B2 (en) | 2007-09-28 | 2012-08-28 | Tyco Healthcare Group Lp | Insulating sheath for electrosurgical forceps |
US9023043B2 (en) | 2007-09-28 | 2015-05-05 | Covidien Lp | Insulating mechanically-interfaced boot and jaws for electrosurgical forceps |
US8221416B2 (en) | 2007-09-28 | 2012-07-17 | Tyco Healthcare Group Lp | Insulating boot for electrosurgical forceps with thermoplastic clevis |
EP2217157A2 (en) | 2007-10-05 | 2010-08-18 | Ethicon Endo-Surgery, Inc. | Ergonomic surgical instruments |
US7901423B2 (en) | 2007-11-30 | 2011-03-08 | Ethicon Endo-Surgery, Inc. | Folded ultrasonic end effectors with increased active length |
US10010339B2 (en) | 2007-11-30 | 2018-07-03 | Ethicon Llc | Ultrasonic surgical blades |
US8764748B2 (en) | 2008-02-06 | 2014-07-01 | Covidien Lp | End effector assembly for electrosurgical device and method for making the same |
BRPI0901282A2 (en) | 2008-02-14 | 2009-11-17 | Ethicon Endo Surgery Inc | surgical cutting and fixation instrument with rf electrodes |
US8636736B2 (en) * | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US8623276B2 (en) | 2008-02-15 | 2014-01-07 | Covidien Lp | Method and system for sterilizing an electrosurgical instrument |
ES2428719T3 (en) | 2008-03-31 | 2013-11-11 | Applied Medical Resources Corporation | Electrosurgical system with means to measure tissue permittivity and conductivity |
US8469956B2 (en) | 2008-07-21 | 2013-06-25 | Covidien Lp | Variable resistor jaw |
US9089360B2 (en) | 2008-08-06 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US8058771B2 (en) | 2008-08-06 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic device for cutting and coagulating with stepped output |
US20100036370A1 (en) * | 2008-08-07 | 2010-02-11 | Al Mirel | Electrosurgical instrument jaw structure with cutting tip |
US8162973B2 (en) | 2008-08-15 | 2012-04-24 | Tyco Healthcare Group Lp | Method of transferring pressure in an articulating surgical instrument |
US8257387B2 (en) | 2008-08-15 | 2012-09-04 | Tyco Healthcare Group Lp | Method of transferring pressure in an articulating surgical instrument |
US9603652B2 (en) | 2008-08-21 | 2017-03-28 | Covidien Lp | Electrosurgical instrument including a sensor |
US8795274B2 (en) | 2008-08-28 | 2014-08-05 | Covidien Lp | Tissue fusion jaw angle improvement |
US8317787B2 (en) | 2008-08-28 | 2012-11-27 | Covidien Lp | Tissue fusion jaw angle improvement |
US8784417B2 (en) | 2008-08-28 | 2014-07-22 | Covidien Lp | Tissue fusion jaw angle improvement |
US9107688B2 (en) | 2008-09-12 | 2015-08-18 | Ethicon Endo-Surgery, Inc. | Activation feature for surgical instrument with pencil grip |
WO2010030850A2 (en) * | 2008-09-12 | 2010-03-18 | Ethicon Endo-Surgery, Inc. | Ultrasonic device for fingertip control |
US8303582B2 (en) | 2008-09-15 | 2012-11-06 | Tyco Healthcare Group Lp | Electrosurgical instrument having a coated electrode utilizing an atomic layer deposition technique |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9375254B2 (en) | 2008-09-25 | 2016-06-28 | Covidien Lp | Seal and separate algorithm |
US8535312B2 (en) | 2008-09-25 | 2013-09-17 | Covidien Lp | Apparatus, system and method for performing an electrosurgical procedure |
US8968314B2 (en) | 2008-09-25 | 2015-03-03 | Covidien Lp | Apparatus, system and method for performing an electrosurgical procedure |
US8142473B2 (en) | 2008-10-03 | 2012-03-27 | Tyco Healthcare Group Lp | Method of transferring rotational motion in an articulating surgical instrument |
US8469957B2 (en) | 2008-10-07 | 2013-06-25 | Covidien Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8016827B2 (en) | 2008-10-09 | 2011-09-13 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8636761B2 (en) | 2008-10-09 | 2014-01-28 | Covidien Lp | Apparatus, system, and method for performing an endoscopic 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 |
US8486107B2 (en) | 2008-10-20 | 2013-07-16 | Covidien Lp | Method of sealing tissue using radiofrequency energy |
US8197479B2 (en) | 2008-12-10 | 2012-06-12 | Tyco Healthcare Group Lp | Vessel sealer and divider |
US8114122B2 (en) | 2009-01-13 | 2012-02-14 | Tyco Healthcare Group Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8356740B1 (en) | 2009-03-09 | 2013-01-22 | Cardica, Inc. | Controlling compression applied to tissue by surgical tool |
US8277446B2 (en) | 2009-04-24 | 2012-10-02 | Tyco Healthcare Group Lp | Electrosurgical tissue sealer and cutter |
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 |
US8344596B2 (en) | 2009-06-24 | 2013-01-01 | Ethicon Endo-Surgery, Inc. | Transducer arrangements for ultrasonic surgical instruments |
US8246618B2 (en) | 2009-07-08 | 2012-08-21 | Tyco Healthcare Group Lp | Electrosurgical jaws with offset knife |
US9017326B2 (en) | 2009-07-15 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Impedance monitoring apparatus, system, and method for ultrasonic surgical instruments |
US8461744B2 (en) | 2009-07-15 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Rotating transducer mount for ultrasonic surgical instruments |
US8663220B2 (en) | 2009-07-15 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
CN102596078B (en) * | 2009-08-11 | 2015-07-01 | 奥林巴斯医疗株式会社 | Medical treatment instrument, medical treatment device, and medical treatment method |
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 |
USRE47996E1 (en) | 2009-10-09 | 2020-05-19 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US9039695B2 (en) | 2009-10-09 | 2015-05-26 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
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 |
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 |
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 |
US10172669B2 (en) | 2009-10-09 | 2019-01-08 | Ethicon Llc | Surgical instrument comprising an energy trigger lockout |
US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US9168054B2 (en) | 2009-10-09 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | 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 |
US8579928B2 (en) | 2010-02-11 | 2013-11-12 | Ethicon Endo-Surgery, Inc. | Outer sheath and blade arrangements for ultrasonic surgical instruments |
US9259234B2 (en) | 2010-02-11 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with rotatable blade and hollow sheath arrangements |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
US8382782B2 (en) | 2010-02-11 | 2013-02-26 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with partially rotating blade and fixed pad arrangement |
US8419759B2 (en) | 2010-02-11 | 2013-04-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with comb-like tissue trimming device |
US8531064B2 (en) | 2010-02-11 | 2013-09-10 | Ethicon Endo-Surgery, Inc. | Ultrasonically powered surgical instruments with rotating cutting implement |
US8486096B2 (en) | 2010-02-11 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Dual purpose surgical instrument for cutting and coagulating tissue |
US8961547B2 (en) | 2010-02-11 | 2015-02-24 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with moving cutting implement |
US8323302B2 (en) * | 2010-02-11 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Methods of using ultrasonically powered surgical instruments with rotatable cutting implements |
US8951272B2 (en) | 2010-02-11 | 2015-02-10 | Ethicon Endo-Surgery, Inc. | Seal arrangements for ultrasonically powered surgical instruments |
US8696665B2 (en) | 2010-03-26 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical cutting and sealing instrument with reduced firing force |
US8496682B2 (en) | 2010-04-12 | 2013-07-30 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instruments with cam-actuated jaws |
US8623044B2 (en) | 2010-04-12 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Cable actuated end-effector for a surgical instrument |
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 |
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 |
WO2011156257A2 (en) | 2010-06-09 | 2011-12-15 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing an electrode |
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 |
US8790342B2 (en) | 2010-06-09 | 2014-07-29 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing pressure-variation electrodes |
US8926607B2 (en) | 2010-06-09 | 2015-01-06 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing multiple positive temperature coefficient electrodes |
US20110306967A1 (en) | 2010-06-10 | 2011-12-15 | Payne Gwendolyn P | Cooling configurations for electrosurgical instruments |
US8753338B2 (en) | 2010-06-10 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument employing a thermal management system |
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 |
US8834466B2 (en) | 2010-07-08 | 2014-09-16 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising an articulatable end effector |
WO2012006306A2 (en) | 2010-07-08 | 2012-01-12 | Ethicon Endo-Surgery, Inc. | Surgical instrument comprising an articulatable end effector |
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 |
US8613383B2 (en) | 2010-07-14 | 2013-12-24 | Ethicon Endo-Surgery, Inc. | Surgical instruments with electrodes |
US8795327B2 (en) * | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US20120022519A1 (en) | 2010-07-22 | 2012-01-26 | Ethicon Endo-Surgery, Inc. | Surgical cutting and sealing instrument with controlled energy delivery |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | 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 |
US8979844B2 (en) | 2010-07-23 | 2015-03-17 | 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 |
WO2012012674A1 (en) | 2010-07-23 | 2012-01-26 | 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 |
US9545253B2 (en) | 2010-09-24 | 2017-01-17 | Ethicon Endo-Surgery, Llc | Surgical instrument with contained dual helix actuator assembly |
US9089327B2 (en) | 2010-09-24 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Surgical instrument with multi-phase trigger bias |
US9877720B2 (en) | 2010-09-24 | 2018-01-30 | Ethicon Llc | Control features for articulating surgical device |
US9402682B2 (en) | 2010-09-24 | 2016-08-02 | Ethicon Endo-Surgery, Llc | Articulation joint features for articulating surgical device |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US9592050B2 (en) | 2010-09-30 | 2017-03-14 | Ethicon Endo-Surgery, Llc | End effector comprising a distal tissue abutment member |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US8888809B2 (en) | 2010-10-01 | 2014-11-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with jaw member |
US8979890B2 (en) | 2010-10-01 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument with jaw member |
JP6143362B2 (en) | 2010-10-01 | 2017-06-07 | アプライド メディカル リソーシーズ コーポレイション | Electrosurgical instrument with jaws and / or electrodes and electrosurgical amplifier |
CN103429182B (en) | 2010-10-01 | 2016-01-20 | 伊西康内外科公司 | There is the surgical instruments of jaw member |
US8628529B2 (en) | 2010-10-26 | 2014-01-14 | Ethicon Endo-Surgery, Inc. | Surgical instrument with magnetic clamping force |
US9089338B2 (en) | 2010-11-05 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Medical device packaging with window for insertion of reusable component |
US9526921B2 (en) | 2010-11-05 | 2016-12-27 | Ethicon Endo-Surgery, Llc | User feedback through end effector of surgical instrument |
WO2012061720A1 (en) | 2010-11-05 | 2012-05-10 | Ethicon Endo- Surgery, Inc. | Surgical instrument with modular end effector and detection feature |
US10959769B2 (en) | 2010-11-05 | 2021-03-30 | Ethicon Llc | Surgical instrument with slip ring assembly to power ultrasonic transducer |
US9510895B2 (en) | 2010-11-05 | 2016-12-06 | Ethicon Endo-Surgery, Llc | Surgical instrument with modular shaft and end effector |
US9039720B2 (en) | 2010-11-05 | 2015-05-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with ratcheting rotatable shaft |
US10085792B2 (en) | 2010-11-05 | 2018-10-02 | Ethicon Llc | Surgical instrument with motorized attachment feature |
US9649150B2 (en) | 2010-11-05 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Selective activation of electronic components in medical device |
US9247986B2 (en) | 2010-11-05 | 2016-02-02 | Ethicon Endo-Surgery, Llc | Surgical instrument with ultrasonic transducer having integral switches |
US9421062B2 (en) | 2010-11-05 | 2016-08-23 | Ethicon Endo-Surgery, Llc | Surgical instrument shaft with resiliently biased coupling to handpiece |
US20120116381A1 (en) | 2010-11-05 | 2012-05-10 | Houser Kevin L | Surgical instrument with charging station and wireless communication |
US9161803B2 (en) | 2010-11-05 | 2015-10-20 | Ethicon Endo-Surgery, Inc. | Motor driven electrosurgical device with mechanical and electrical feedback |
US9782214B2 (en) | 2010-11-05 | 2017-10-10 | Ethicon Llc | Surgical instrument with sensor and powered control |
US9381058B2 (en) | 2010-11-05 | 2016-07-05 | Ethicon Endo-Surgery, Llc | Recharge system for medical devices |
CN103391753B (en) | 2010-11-05 | 2016-12-14 | 伊西康内外科公司 | The use data of medical treatment device process |
US10881448B2 (en) | 2010-11-05 | 2021-01-05 | Ethicon Llc | Cam driven coupling between ultrasonic transducer and waveguide in surgical instrument |
US9017849B2 (en) | 2010-11-05 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Power source management for medical device |
US9017851B2 (en) | 2010-11-05 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Sterile housing for non-sterile medical device component |
US9011471B2 (en) | 2010-11-05 | 2015-04-21 | Ethicon Endo-Surgery, Inc. | Surgical instrument with pivoting coupling to modular shaft and end effector |
US9782215B2 (en) | 2010-11-05 | 2017-10-10 | Ethicon Endo-Surgery, Llc | Surgical instrument with ultrasonic transducer having integral switches |
US9072523B2 (en) | 2010-11-05 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Medical device with feature for sterile acceptance of non-sterile reusable component |
US9375255B2 (en) | 2010-11-05 | 2016-06-28 | Ethicon Endo-Surgery, Llc | Surgical instrument handpiece with resiliently biased coupling to modular shaft and end effector |
US9000720B2 (en) | 2010-11-05 | 2015-04-07 | Ethicon Endo-Surgery, Inc. | Medical device packaging with charging interface |
US10660695B2 (en) | 2010-11-05 | 2020-05-26 | Ethicon Llc | Sterile medical instrument charging device |
US20120116265A1 (en) | 2010-11-05 | 2012-05-10 | Houser Kevin L | Surgical instrument with charging devices |
US9597143B2 (en) | 2010-11-05 | 2017-03-21 | Ethicon Endo-Surgery, Llc | Sterile medical instrument charging device |
AU2011323178A1 (en) | 2010-11-05 | 2013-05-30 | Ethicon Endo-Surgery, Inc. | User feedback through handpiece of surgical instrument |
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 |
US8968305B2 (en) * | 2011-03-28 | 2015-03-03 | Covidien Lp | Surgical forceps with external cutter |
US8968293B2 (en) | 2011-04-12 | 2015-03-03 | Covidien Lp | Systems and methods for calibrating power measurements in an electrosurgical generator |
CA2834649C (en) | 2011-04-29 | 2021-02-16 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9259265B2 (en) | 2011-07-22 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Surgical instruments for tensioning tissue |
USD700699S1 (en) | 2011-08-23 | 2014-03-04 | Covidien Ag | Handle for portable surgical device |
US9044243B2 (en) | 2011-08-30 | 2015-06-02 | Ethcon Endo-Surgery, Inc. | Surgical cutting and fastening device with descendible second trigger arrangement |
US9763690B2 (en) | 2011-10-10 | 2017-09-19 | Ethicon Llc | Surgical instrument with transducer carrier assembly |
US9050125B2 (en) | 2011-10-10 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with modular end effector |
US8734476B2 (en) | 2011-10-13 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Coupling for slip ring assembly and ultrasonic transducer in surgical instrument |
USD687549S1 (en) | 2011-10-24 | 2013-08-06 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
US9421060B2 (en) | 2011-10-24 | 2016-08-23 | Ethicon Endo-Surgery, Llc | Litz wire battery powered device |
USD680220S1 (en) | 2012-01-12 | 2013-04-16 | Coviden IP | Slider handle for laparoscopic device |
JP6165780B2 (en) | 2012-02-10 | 2017-07-19 | 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. | Robot-controlled surgical instrument |
US20130253480A1 (en) | 2012-03-22 | 2013-09-26 | Cory G. Kimball | Surgical instrument usage data management |
AU2013200917A1 (en) | 2012-03-22 | 2013-10-10 | Ethicon Endo-Surgery, Inc. | Activation feature for surgical instrument with pencil grip |
US9364249B2 (en) | 2012-03-22 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Method and apparatus for programming modular surgical instrument |
CN104334098B (en) | 2012-03-28 | 2017-03-22 | 伊西康内外科公司 | Tissue thickness compensator comprising capsules defining a low pressure environment |
JP6305979B2 (en) | 2012-03-28 | 2018-04-04 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Tissue thickness compensator with multiple layers |
US20130267874A1 (en) | 2012-04-09 | 2013-10-10 | Amy L. Marcotte | Surgical instrument with nerve detection feature |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US9241731B2 (en) | 2012-04-09 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Rotatable electrical connection for ultrasonic surgical instruments |
US9237921B2 (en) | 2012-04-09 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US9724118B2 (en) | 2012-04-09 | 2017-08-08 | Ethicon Endo-Surgery, Llc | Techniques for cutting and coagulating tissue for ultrasonic surgical instruments |
US9226766B2 (en) | 2012-04-09 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Serial communication protocol for medical device |
US9788851B2 (en) | 2012-04-18 | 2017-10-17 | Ethicon Llc | Surgical instrument with tissue density sensing |
EP2844172B1 (en) | 2012-05-02 | 2017-10-04 | Ethicon LLC | Electrosurgical device for cutting and coagulating |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US20140005640A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical end effector jaw and electrode configurations |
US9283045B2 (en) | 2012-06-29 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Surgical instruments with fluid management system |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US9820768B2 (en) | 2012-06-29 | 2017-11-21 | Ethicon Llc | Ultrasonic surgical instruments with control mechanisms |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
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 |
WO2014047245A1 (en) | 2012-09-19 | 2014-03-27 | Ethicon Endo-Surgery, Inc. | Surgical instrument with contained dual helix actuator assembly |
CN104640510B (en) | 2012-09-19 | 2017-06-13 | 伊西康内外科公司 | Surgical instruments with the biasing of multiphase trigger |
CN104853688B (en) | 2012-09-28 | 2017-11-28 | 伊西康内外科公司 | Multifunctional bipolar tweezers |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
US10201365B2 (en) | 2012-10-22 | 2019-02-12 | Ethicon Llc | Surgeon feedback sensing and display methods |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US9566062B2 (en) | 2012-12-03 | 2017-02-14 | Ethicon Endo-Surgery, Llc | Surgical instrument with secondary jaw closure feature |
US9078677B2 (en) | 2012-12-03 | 2015-07-14 | Ethicon Endo-Surgery, Inc. | Surgical instrument with curved blade firing path |
US9050100B2 (en) | 2012-12-10 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Surgical instrument with feedback at end effector |
US9572622B2 (en) | 2012-12-10 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Bipolar electrosurgical features for targeted hemostasis |
US9445808B2 (en) | 2012-12-11 | 2016-09-20 | Ethicon Endo-Surgery, Llc | Electrosurgical end effector with tissue tacking features |
US20140194874A1 (en) | 2013-01-10 | 2014-07-10 | Ethicon Endo-Surgery, Inc. | Electrosurgical end effector with independent closure feature and blade |
US20140207124A1 (en) | 2013-01-23 | 2014-07-24 | Ethicon Endo-Surgery, Inc. | Surgical instrument with selectable integral or external power source |
US9149325B2 (en) | 2013-01-25 | 2015-10-06 | Ethicon Endo-Surgery, Inc. | End effector with compliant clamping jaw |
US9241758B2 (en) | 2013-01-25 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with blade compliant along vertical cutting edge plane |
US9610114B2 (en) | 2013-01-29 | 2017-04-04 | Ethicon Endo-Surgery, Llc | Bipolar electrosurgical hand shears |
US9220569B2 (en) | 2013-03-13 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Electrosurgical device with disposable shaft having translating gear and snap fit |
US9737300B2 (en) | 2013-03-13 | 2017-08-22 | Ethicon Llc | Electrosurgical device with disposable shaft having rack and pinion drive |
US10058310B2 (en) | 2013-03-13 | 2018-08-28 | Ethicon Llc | Electrosurgical device with drum-driven articulation |
US9107685B2 (en) | 2013-03-13 | 2015-08-18 | Ethicon Endo-Surgery, Inc. | Electrosurgical device with disposable shaft having clamshell coupling |
US9314308B2 (en) | 2013-03-13 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Robotic ultrasonic surgical device with articulating end effector |
US9402687B2 (en) | 2013-03-13 | 2016-08-02 | Ethicon Endo-Surgery, Llc | Robotic electrosurgical device with disposable shaft |
US9254170B2 (en) | 2013-03-13 | 2016-02-09 | Ethicon Endo-Surgery, Inc. | Electrosurgical device with disposable shaft having modular subassembly |
US9254171B2 (en) | 2013-03-14 | 2016-02-09 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with multi-stage actuator |
US9877782B2 (en) | 2013-03-14 | 2018-01-30 | Ethicon Llc | Electrosurgical instrument end effector with compliant electrode |
US20140276730A1 (en) | 2013-03-14 | 2014-09-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with reinforced articulation section |
US10226273B2 (en) | 2013-03-14 | 2019-03-12 | Ethicon Llc | Mechanical fasteners for use with surgical energy devices |
US9168090B2 (en) | 2013-03-14 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with restricted trigger |
US9241728B2 (en) | 2013-03-15 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with multiple clamping mechanisms |
CA2907309C (en) * | 2013-03-15 | 2022-08-02 | Lc Therapeutics, Inc. | Rf tissue ablation devices and methods of using the same |
US9237923B2 (en) | 2013-03-15 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Surgical instrument with partial trigger lockout |
US9510906B2 (en) | 2013-03-15 | 2016-12-06 | Ethicon Endo-Surgery, Llc | Tissue clamping features of surgical instrument end effector |
US9579118B2 (en) | 2013-05-01 | 2017-02-28 | Ethicon Endo-Surgery, Llc | Electrosurgical instrument with dual blade end effector |
US9566110B2 (en) | 2013-05-09 | 2017-02-14 | Ethicon Endo-Surgery, Llc | Surgical instrument with jaw opening assist feature |
US9237900B2 (en) | 2013-05-10 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Surgical instrument with split jaw |
US9629648B2 (en) | 2013-05-10 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Surgical instrument with translating compliant jaw closure feature |
US9579147B2 (en) | 2013-06-04 | 2017-02-28 | Ethicon Endo-Surgery, Llc | Electrosurgical forceps with translating blade driver |
US9504520B2 (en) | 2013-06-06 | 2016-11-29 | Ethicon Endo-Surgery, Llc | Surgical instrument with modular motor |
US9351788B2 (en) | 2013-06-06 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Surgical instrument having knife band with curved distal edge |
US9775667B2 (en) | 2013-06-18 | 2017-10-03 | Ethicon Llc | Surgical instrument with articulation indicator |
WO2015017992A1 (en) | 2013-08-07 | 2015-02-12 | Covidien Lp | Surgical forceps |
US9808249B2 (en) | 2013-08-23 | 2017-11-07 | Ethicon Llc | Attachment portions for surgical instrument assemblies |
US9295514B2 (en) | 2013-08-30 | 2016-03-29 | Ethicon Endo-Surgery, Llc | Surgical devices with close quarter articulation features |
US9220508B2 (en) | 2013-09-06 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Surgical clip applier with articulation section |
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 |
US9713469B2 (en) | 2013-09-23 | 2017-07-25 | Ethicon Llc | Surgical stapler with rotary cam drive |
US9526565B2 (en) | 2013-11-08 | 2016-12-27 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
US9861381B2 (en) | 2013-11-12 | 2018-01-09 | Ethicon Llc | Removable battery casing for surgical instrument |
US9949785B2 (en) | 2013-11-21 | 2018-04-24 | Ethicon Llc | Ultrasonic surgical instrument with electrosurgical feature |
US10004528B2 (en) | 2013-11-26 | 2018-06-26 | Ethicon Llc | Sleeve features for ultrasonic blade of a surgical instrument |
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 |
US9724120B2 (en) | 2013-12-17 | 2017-08-08 | Ethicon Endo-Surgery, Llc | Clamp arm features for ultrasonic surgical instrument |
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 |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
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 |
US20150297225A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
CN106456176B (en) | 2014-04-16 | 2019-06-28 | 伊西康内外科有限责任公司 | Fastener cartridge including the extension with various configuration |
BR112016023807B1 (en) | 2014-04-16 | 2022-07-12 | Ethicon Endo-Surgery, Llc | CARTRIDGE SET OF FASTENERS FOR USE WITH A SURGICAL INSTRUMENT |
US9757186B2 (en) | 2014-04-17 | 2017-09-12 | Ethicon Llc | Device status feedback for bipolar tissue spacer |
US10258363B2 (en) | 2014-04-22 | 2019-04-16 | Ethicon Llc | Method of operating an articulating ultrasonic surgical instrument |
US10667835B2 (en) | 2014-04-22 | 2020-06-02 | Ethicon Llc | Ultrasonic surgical instrument with end effector having restricted articulation |
KR102537276B1 (en) | 2014-05-16 | 2023-05-26 | 어플라이드 메디컬 리소시스 코포레이션 | Electrosurgical system |
KR102420273B1 (en) | 2014-05-30 | 2022-07-13 | 어플라이드 메디컬 리소시스 코포레이션 | Electrosurgical instrument for fusing and cutting tissue and an electrosurgical generator |
US9700333B2 (en) | 2014-06-30 | 2017-07-11 | Ethicon Llc | Surgical instrument with variable tissue compression |
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 |
US10231777B2 (en) | 2014-08-26 | 2019-03-19 | Covidien Lp | Methods of manufacturing jaw members of an end-effector assembly for a surgical instrument |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US10010309B2 (en) | 2014-10-10 | 2018-07-03 | Ethicon Llc | Surgical device with overload mechanism |
US10292758B2 (en) | 2014-10-10 | 2019-05-21 | Ethicon Llc | Methods and devices for articulating laparoscopic energy device |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US10136938B2 (en) | 2014-10-29 | 2018-11-27 | Ethicon Llc | Electrosurgical instrument with sensor |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
US10076379B2 (en) | 2014-12-15 | 2018-09-18 | Ethicon Llc | Electrosurgical instrument with removable components for cleaning access |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US10117706B2 (en) | 2014-12-19 | 2018-11-06 | Ethicon Llc | Electrosurgical instrument with integral tissue removal feature |
US9993284B2 (en) | 2014-12-19 | 2018-06-12 | Ethicon Llc | Electrosurgical instrument with jaw cleaning mode |
US10357311B2 (en) | 2014-12-19 | 2019-07-23 | Ethicon Llc | Electrosurgical instrument with removable jaw components |
US10111699B2 (en) | 2014-12-22 | 2018-10-30 | 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 |
US9848937B2 (en) | 2014-12-22 | 2017-12-26 | Ethicon Llc | End effector with detectable configurations |
US10092348B2 (en) | 2014-12-22 | 2018-10-09 | Ethicon Llc | RF tissue sealer, shear grip, trigger lock mechanism and energy activation |
US10420603B2 (en) | 2014-12-23 | 2019-09-24 | Applied Medical Resources Corporation | Bipolar electrosurgical sealer and divider |
USD748259S1 (en) | 2014-12-29 | 2016-01-26 | Applied Medical Resources Corporation | Electrosurgical instrument |
US10537667B2 (en) | 2015-01-28 | 2020-01-21 | Ethicon Llc | High temperature material for use in medical devices |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US10321950B2 (en) | 2015-03-17 | 2019-06-18 | Ethicon Llc | Managing tissue treatment |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
US10390825B2 (en) | 2015-03-31 | 2019-08-27 | Ethicon Llc | Surgical instrument with progressive rotary drive systems |
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 |
US10111698B2 (en) | 2015-04-16 | 2018-10-30 | Ethicon Llc | Surgical instrument with rotatable shaft having plurality of locking positions |
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 |
US10034684B2 (en) | 2015-06-15 | 2018-07-31 | Ethicon Llc | Apparatus and method for dissecting and coagulating tissue |
US11020140B2 (en) | 2015-06-17 | 2021-06-01 | Cilag Gmbh International | Ultrasonic surgical blade for use with ultrasonic surgical instruments |
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 |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
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 |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US10765470B2 (en) | 2015-06-30 | 2020-09-08 | Ethicon Llc | Surgical system with user adaptable techniques employing simultaneous energy modalities based on tissue parameters |
US10154852B2 (en) | 2015-07-01 | 2018-12-18 | Ethicon Llc | Ultrasonic surgical blade with improved cutting and coagulation features |
WO2017031712A1 (en) | 2015-08-26 | 2017-03-02 | Covidien Lp | Electrosurgical end effector assemblies and electrosurgical forceps configured to reduce thermal spread |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10271849B2 (en) | 2015-09-30 | 2019-04-30 | Ethicon Llc | Woven constructs with interlocked standing fibers |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US11058475B2 (en) | 2015-09-30 | 2021-07-13 | Cilag Gmbh International | Method and apparatus for selecting operations of a surgical instrument based on user intention |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
US10492820B2 (en) | 2015-10-16 | 2019-12-03 | Ethicon Llc | Ultrasonic surgical instrument with removable shaft assembly portion |
US10959771B2 (en) | 2015-10-16 | 2021-03-30 | Ethicon Llc | Suction and irrigation sealing grasper |
US10213250B2 (en) | 2015-11-05 | 2019-02-26 | Covidien Lp | Deployment and safety mechanisms for surgical instruments |
US20170164972A1 (en) | 2015-12-10 | 2017-06-15 | Ethicon Endo-Surgery, Llc | End effector for instrument with ultrasonic and electrosurgical features |
US10660692B2 (en) | 2015-12-10 | 2020-05-26 | Ethicon Llc | End effector for instrument with ultrasonic blade and bipolar clamp arm |
US20170164997A1 (en) | 2015-12-10 | 2017-06-15 | Ethicon Endo-Surgery, Llc | Method of treating tissue using end effector with ultrasonic and electrosurgical features |
US10314607B2 (en) | 2015-12-21 | 2019-06-11 | Ethicon Llc | Ultrasonic surgical instrument with tubular acoustic waveguide segment |
US10959806B2 (en) | 2015-12-30 | 2021-03-30 | Ethicon Llc | Energized medical device with reusable handle |
US10179022B2 (en) | 2015-12-30 | 2019-01-15 | Ethicon Llc | Jaw position impedance limiter for electrosurgical instrument |
US10470791B2 (en) | 2015-12-30 | 2019-11-12 | Ethicon Llc | Surgical instrument with staged application of electrosurgical and ultrasonic energy |
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 |
US10709469B2 (en) | 2016-01-15 | 2020-07-14 | Ethicon Llc | Modular battery powered handheld surgical instrument with energy conservation techniques |
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 |
WO2017130383A1 (en) * | 2016-01-29 | 2017-08-03 | オリンパス株式会社 | High-frequency treatment instrument |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | 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 |
US10314645B2 (en) | 2016-03-16 | 2019-06-11 | Ethicon Llc | Surgical end effectors with increased stiffness |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
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 |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure 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 |
US10172684B2 (en) | 2016-04-29 | 2019-01-08 | Ethicon Llc | Lifecycle monitoring features for surgical instrument |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
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 |
US10420580B2 (en) | 2016-08-25 | 2019-09-24 | Ethicon Llc | Ultrasonic transducer for surgical instrument |
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 |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US10537325B2 (en) | 2016-12-21 | 2020-01-21 | Ethicon Llc | Staple forming pocket arrangement to accommodate different types of staples |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
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 |
WO2018193492A1 (en) * | 2017-04-17 | 2018-10-25 | オリンパス株式会社 | Surgical tool |
US10980594B2 (en) | 2017-04-27 | 2021-04-20 | Ethicon Llc | Articulation drive feature in surgical instrument |
US10881451B2 (en) | 2017-04-27 | 2021-01-05 | Ethicon Llc | Lead screw assembly for articulation control in surgical instrument |
US10932845B2 (en) | 2017-04-27 | 2021-03-02 | Ethicon Llc | Detent feature for articulation control in surgical instrument |
US11166759B2 (en) | 2017-05-16 | 2021-11-09 | Covidien Lp | Surgical forceps |
US11033316B2 (en) | 2017-05-22 | 2021-06-15 | Cilag Gmbh International | Combination ultrasonic and electrosurgical instrument having curved ultrasonic blade |
US11259856B2 (en) | 2017-05-22 | 2022-03-01 | Cilag Gmbh International | Combination ultrasonic and electrosurgical instrument and method for sealing tissue in successive phases |
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 |
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 |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US11389161B2 (en) | 2017-06-28 | 2022-07-19 | Cilag Gmbh International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10603117B2 (en) | 2017-06-28 | 2020-03-31 | Ethicon Llc | Articulation state detection mechanisms |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US10820920B2 (en) | 2017-07-05 | 2020-11-03 | Ethicon Llc | Reusable ultrasonic medical devices and methods of their use |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US10932846B2 (en) | 2017-08-25 | 2021-03-02 | Ethicon Llc | Articulation section for shaft assembly of surgical instrument |
US10925602B2 (en) | 2017-08-29 | 2021-02-23 | Ethicon Llc | Endocutter control system |
US11160602B2 (en) | 2017-08-29 | 2021-11-02 | Cilag Gmbh International | Control of surgical field irrigation |
US10835310B2 (en) | 2017-08-29 | 2020-11-17 | Ethicon Llc | Electrically-powered surgical systems |
US10905493B2 (en) | 2017-08-29 | 2021-02-02 | Ethicon Llc | Methods, systems, and devices for controlling electrosurgical tools |
US10470758B2 (en) | 2017-08-29 | 2019-11-12 | Ethicon Llc | Suturing device |
US11504126B2 (en) | 2017-08-29 | 2022-11-22 | Cilag Gmbh International | Control system for clip applier |
US11013528B2 (en) | 2017-08-29 | 2021-05-25 | Ethicon Llc | Electrically-powered surgical systems providing fine clamping control during energy delivery |
US10905417B2 (en) | 2017-08-29 | 2021-02-02 | Ethicon Llc | Circular stapler |
US10912567B2 (en) | 2017-08-29 | 2021-02-09 | Ethicon Llc | Circular stapler |
US10905421B2 (en) | 2017-08-29 | 2021-02-02 | Ethicon Llc | Electrically-powered surgical box staplers |
US10912581B2 (en) | 2017-08-29 | 2021-02-09 | Ethicon Llc | Electrically-powered surgical systems with articulation-compensated ultrasonic energy delivery |
US10881403B2 (en) | 2017-08-29 | 2021-01-05 | Ethicon Llc | Endocutter control system |
US10898219B2 (en) | 2017-08-29 | 2021-01-26 | Ethicon Llc | Electrically-powered surgical systems for cutting and welding solid organs |
US10675082B2 (en) | 2017-08-29 | 2020-06-09 | Ethicon Llc | Control of surgical field irrigation by electrosurgical tool |
US10932808B2 (en) | 2017-08-29 | 2021-03-02 | Ethicon Llc | Methods, systems, and devices for controlling electrosurgical tools |
EP3675752A1 (en) | 2017-08-29 | 2020-07-08 | Ethicon LLC | Electrically-powered surgical systems for cutting and welding solid organs |
US10925682B2 (en) | 2017-08-29 | 2021-02-23 | Ethicon Llc | Electrically-powered surgical systems employing variable compression during treatment |
US10888370B2 (en) | 2017-08-29 | 2021-01-12 | Ethicon Llc | Methods, systems, and devices for controlling electrosurgical tools |
US10856928B2 (en) | 2017-08-29 | 2020-12-08 | Ethicon Llc | Electrically-powered surgical systems |
US10485527B2 (en) | 2017-08-29 | 2019-11-26 | Ethicon Llc | Control system for clip applier |
US10548601B2 (en) | 2017-08-29 | 2020-02-04 | Ethicon Llc | Control system for clip applier |
US11134975B2 (en) | 2017-08-31 | 2021-10-05 | Cilag Gmbh International | Apparatus and method to control operation of surgical instrument based on audible feedback |
US11490951B2 (en) | 2017-09-29 | 2022-11-08 | Cilag Gmbh International | Saline contact with electrodes |
US11033323B2 (en) | 2017-09-29 | 2021-06-15 | Cilag Gmbh International | Systems and methods for managing fluid and suction in electrosurgical systems |
US11484358B2 (en) | 2017-09-29 | 2022-11-01 | Cilag Gmbh International | Flexible electrosurgical instrument |
US20190125436A1 (en) | 2017-10-30 | 2019-05-02 | Acclarent, Inc. | Suction instrument with bipolar rf cuff |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US11751867B2 (en) | 2017-12-21 | 2023-09-12 | Cilag Gmbh International | Surgical instrument comprising sequenced systems |
US11123129B2 (en) | 2018-05-25 | 2021-09-21 | Cilag Gmbh International | Dual stage energy activation for electrosurgical shears |
US11020170B2 (en) | 2018-05-25 | 2021-06-01 | Cilag Gmbh International | Knife drive assembly for electrosurgical shears |
US11154346B2 (en) | 2018-05-25 | 2021-10-26 | Cilag Gmbh International | Firing and lockout assembly for knife for electrosurgical shears |
US11020169B2 (en) | 2018-05-25 | 2021-06-01 | Cilag Gmbh International | Method and apparatus for open electrosurgical shears |
US11039877B2 (en) | 2018-05-25 | 2021-06-22 | Cliag GmbH International | Latching clamp arm for electrosurgical shears |
US10898259B2 (en) | 2018-05-25 | 2021-01-26 | Ethicon Llc | Knife auto-return assembly for electrosurgical shears |
US10856931B2 (en) | 2018-05-25 | 2020-12-08 | Ethicon Llc | Compound screw knife drive for electrosurgical shears |
US10966781B2 (en) | 2018-05-25 | 2021-04-06 | Ethicon Llc | Electrosurgical shears with knife lock and clamp-actuated switch |
US11813016B2 (en) | 2018-07-12 | 2023-11-14 | Cilag Gmbh International | Electrosurgical shears with thumb ring knife actuator |
AU2019335013A1 (en) | 2018-09-05 | 2021-03-25 | Applied Medical Resources Corporation | Electrosurgical generator control system |
EP3880099A1 (en) | 2018-11-16 | 2021-09-22 | Applied Medical Resources Corporation | Electrosurgical system |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11350960B2 (en) | 2019-04-30 | 2022-06-07 | Cilag Gmbh International | Dual sterilization and temperature based sterilization detection |
US11202650B2 (en) | 2019-04-30 | 2021-12-21 | Cilag Gmbh International | Blade cooling gas/fluid storage |
US11123095B2 (en) | 2019-04-30 | 2021-09-21 | Cilag Gmbh International | Blade grounding mechanisms and alternative pin designs |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11179177B2 (en) | 2019-04-30 | 2021-11-23 | Cilag Gmbh International | Ultrasonic blade and clamp arm matching design |
US11413102B2 (en) | 2019-06-27 | 2022-08-16 | Cilag Gmbh International | Multi-access port for surgical robotic systems |
US11607278B2 (en) | 2019-06-27 | 2023-03-21 | Cilag Gmbh International | Cooperative robotic surgical systems |
US11612445B2 (en) | 2019-06-27 | 2023-03-28 | Cilag Gmbh International | Cooperative operation of robotic arms |
US11547468B2 (en) | 2019-06-27 | 2023-01-10 | Cilag Gmbh International | Robotic surgical system with safety and cooperative sensing control |
US11723729B2 (en) | 2019-06-27 | 2023-08-15 | Cilag Gmbh International | Robotic surgical assembly coupling safety mechanisms |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11241235B2 (en) | 2019-06-28 | 2022-02-08 | Cilag Gmbh International | Method of using multiple RFID chips with a surgical assembly |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11471181B2 (en) | 2019-08-30 | 2022-10-18 | Cilag Gmbh International | Ultrasonic surgical instrument with axisymmetric clamping |
CN114390911A (en) | 2019-08-30 | 2022-04-22 | 西拉格国际有限公司 | Ultrasonic surgical instrument with multiplanar articulation shaft assembly |
US11712261B2 (en) | 2019-08-30 | 2023-08-01 | Cilag Gmbh International | Rotatable linear actuation mechanism |
US11690642B2 (en) | 2019-08-30 | 2023-07-04 | Cilag Gmbh International | Ultrasonic surgical instrument with a multi-planar articulating shaft assembly |
US11612409B2 (en) | 2019-08-30 | 2023-03-28 | Cilag Gmbh International | Ultrasonic transducer alignment of an articulating ultrasonic surgical instrument |
US11457945B2 (en) | 2019-08-30 | 2022-10-04 | Cilag Gmbh International | Ultrasonic blade and clamp arm alignment features |
US11857283B2 (en) | 2019-11-05 | 2024-01-02 | Cilag Gmbh International | Articulation joint with helical lumen |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11779387B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Clamp arm jaw to minimize tissue sticking and improve tissue control |
US11786294B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Control program for modular combination energy device |
US11452525B2 (en) | 2019-12-30 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising an adjustment system |
US11744636B2 (en) | 2019-12-30 | 2023-09-05 | Cilag Gmbh International | Electrosurgical systems with integrated and external power sources |
US11786291B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Deflectable support of RF energy electrode with respect to opposing 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 |
US20210196363A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with electrodes operable in bipolar and monopolar modes |
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 |
US11779329B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a flex circuit including a sensor system |
US11696776B2 (en) | 2019-12-30 | 2023-07-11 | Cilag Gmbh International | Articulatable surgical instrument |
US11944366B2 (en) | 2019-12-30 | 2024-04-02 | Cilag Gmbh International | Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode |
US11812957B2 (en) | 2019-12-30 | 2023-11-14 | Cilag Gmbh International | Surgical instrument comprising a signal interference resolution system |
US11937863B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Deflectable electrode with variable compression bias along the length of the deflectable electrode |
US11660089B2 (en) | 2019-12-30 | 2023-05-30 | Cilag Gmbh International | Surgical instrument comprising a sensing system |
US11857247B2 (en) | 2020-07-17 | 2024-01-02 | Cilag Gmbh International | Jaw for surgical instrument end effector |
US20220031351A1 (en) | 2020-07-28 | 2022-02-03 | Cilag Gmbh International | Surgical instruments with differential articulation joint arrangements for accommodating flexible actuators |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
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 |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
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 |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11826047B2 (en) | 2021-05-28 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising jaw mounts |
US11931026B2 (en) | 2021-06-30 | 2024-03-19 | Cilag Gmbh International | Staple cartridge replacement |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
Citations (93)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1586645A (en) * | 1925-07-06 | 1926-06-01 | Bierman William | Method of and means for treating animal tissue to coagulate the same |
US1798902A (en) * | 1928-11-05 | 1931-03-31 | Edwin M Raney | Surgical instrument |
US2031682A (en) * | 1932-11-18 | 1936-02-25 | Wappler Frederick Charles | Method and means for electrosurgical severance of adhesions |
US3243753A (en) * | 1962-11-13 | 1966-03-29 | Kohler Fred | Resistance element |
US3651811A (en) * | 1969-10-10 | 1972-03-28 | Aesculap Werke Ag | Surgical cutting instrument |
US3730188A (en) * | 1971-03-24 | 1973-05-01 | I Ellman | Electrosurgical apparatus for dental use |
US4092986A (en) * | 1976-06-14 | 1978-06-06 | Ipco Hospital Supply Corporation (Whaledent International Division) | Constant output electrosurgical unit |
US4198957A (en) * | 1967-11-09 | 1980-04-22 | Robert F. Shaw | Method of using an electrically heated surgical cutting instrument |
US4271838A (en) * | 1978-04-05 | 1981-06-09 | Laschal Instruments Corp. | Suture cutter |
US4370980A (en) * | 1981-03-11 | 1983-02-01 | Lottick Edward A | Electrocautery hemostat |
US4375218A (en) * | 1981-05-26 | 1983-03-01 | Digeronimo Ernest M | Forceps, scalpel and blood coagulating surgical instrument |
US4492231A (en) * | 1982-09-17 | 1985-01-08 | Auth David C | Non-sticking electrocautery system and forceps |
US4590934A (en) * | 1983-05-18 | 1986-05-27 | Jerry L. Malis | Bipolar cutter/coagulator |
US4633874A (en) * | 1984-10-19 | 1987-01-06 | Senmed, Inc. | Surgical stapling instrument with jaw latching mechanism and disposable staple cartridge |
US4654511A (en) * | 1974-09-27 | 1987-03-31 | Raychem Corporation | Layered self-regulating heating article |
US4655216A (en) * | 1985-07-23 | 1987-04-07 | Alfred Tischer | Combination instrument for laparoscopical tube sterilization |
US4671274A (en) * | 1984-01-30 | 1987-06-09 | Kharkovsky Nauchno-Issledovatelsky Institut Obschei I | Bipolar electrosurgical instrument |
US4799479A (en) * | 1984-10-24 | 1989-01-24 | The Beth Israel Hospital Association | Method and apparatus for angioplasty |
US4910389A (en) * | 1988-06-03 | 1990-03-20 | Raychem Corporation | Conductive polymer compositions |
US4930494A (en) * | 1988-03-09 | 1990-06-05 | Olympus Optical Co., Ltd. | Apparatus for bending an insertion section of an endoscope using a shape memory alloy |
US4985030A (en) * | 1989-05-27 | 1991-01-15 | Richard Wolf Gmbh | Bipolar coagulation instrument |
US5009656A (en) * | 1989-08-17 | 1991-04-23 | Mentor O&O Inc. | Bipolar electrosurgical instrument |
US5085659A (en) * | 1990-11-21 | 1992-02-04 | Everest Medical Corporation | Biopsy device with bipolar coagulation capability |
US5086586A (en) * | 1991-04-23 | 1992-02-11 | General Motors Corporation | Vehicle side door flush glass system |
US5104025A (en) * | 1990-09-28 | 1992-04-14 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
US5106538A (en) * | 1987-07-21 | 1992-04-21 | Raychem Corporation | Conductive polymer composition |
US5122137A (en) * | 1990-04-27 | 1992-06-16 | Boston Scientific Corporation | Temperature controlled rf coagulation |
US5190541A (en) * | 1990-10-17 | 1993-03-02 | Boston Scientific Corporation | Surgical instrument and method |
US5201900A (en) * | 1992-02-27 | 1993-04-13 | Medical Scientific, Inc. | Bipolar surgical clip |
US5207691A (en) * | 1991-11-01 | 1993-05-04 | Medical Scientific, Inc. | Electrosurgical clip applicator |
US5217460A (en) * | 1991-03-22 | 1993-06-08 | Knoepfler Dennis J | Multiple purpose forceps |
US5290286A (en) * | 1991-11-12 | 1994-03-01 | Everest Medical Corporation | Bipolar instrument utilizing one stationary electrode and one movable electrode |
US5306280A (en) * | 1992-03-02 | 1994-04-26 | Ethicon, Inc. | Endoscopic suture clip applying device with heater |
US5308311A (en) * | 1992-05-01 | 1994-05-03 | Robert F. Shaw | Electrically heated surgical blade and methods of making |
US5382384A (en) * | 1991-11-06 | 1995-01-17 | Raychem Corporation | Conductive polymer composition |
US5389098A (en) * | 1992-05-19 | 1995-02-14 | Olympus Optical Co., Ltd. | Surgical device for stapling and/or fastening body tissues |
US5395369A (en) * | 1993-06-10 | 1995-03-07 | Symbiosis Corporation | Endoscopic bipolar electrocautery instruments |
US5403312A (en) * | 1993-07-22 | 1995-04-04 | Ethicon, Inc. | Electrosurgical hemostatic device |
US5417687A (en) * | 1993-04-30 | 1995-05-23 | Medical Scientific, Inc. | Bipolar electrosurgical trocar |
US5480398A (en) * | 1992-05-01 | 1996-01-02 | Hemostatic Surgery Corporation | Endoscopic instrument with disposable auto-regulating heater |
US5480397A (en) * | 1992-05-01 | 1996-01-02 | Hemostatic Surgery Corporation | Surgical instrument with auto-regulating heater and method of using same |
US5507106A (en) * | 1993-06-18 | 1996-04-16 | Fox; Marcus | Exercise shoe with forward and rearward angled sections |
US5593406A (en) * | 1992-05-01 | 1997-01-14 | Hemostatic Surgery Corporation | Endoscopic instrument with auto-regulating heater and method of using same |
US5595689A (en) * | 1994-07-21 | 1997-01-21 | Americhem, Inc. | Highly conductive polymer blends with intrinsically conductive polymers |
US5603825A (en) * | 1994-07-18 | 1997-02-18 | Costinel; Paul | Multi-stage apparatus for separating immiscible fluids |
US5611798A (en) * | 1995-03-02 | 1997-03-18 | Eggers; Philip E. | Resistively heated cutting and coagulating surgical instrument |
US5624452A (en) * | 1995-04-07 | 1997-04-29 | Ethicon Endo-Surgery, Inc. | Hemostatic surgical cutting or stapling instrument |
US5735848A (en) * | 1993-07-22 | 1998-04-07 | Ethicon, Inc. | Electrosurgical stapling device |
US5755717A (en) * | 1996-01-16 | 1998-05-26 | Ethicon Endo-Surgery, Inc. | Electrosurgical clamping device with improved coagulation feedback |
US5880668A (en) * | 1995-09-29 | 1999-03-09 | Littelfuse, Inc. | Electrical devices having improved PTC polymeric compositions |
US5891142A (en) * | 1996-12-06 | 1999-04-06 | Eggers & Associates, Inc. | Electrosurgical forceps |
US5897142A (en) * | 1996-12-19 | 1999-04-27 | Itt Automotive, Inc. | Push-to-release quick connector |
US6019758A (en) * | 1996-01-11 | 2000-02-01 | Symbiosis Corporation | Endoscopic bipolar multiple sample bioptome |
US6030384A (en) * | 1998-05-01 | 2000-02-29 | Nezhat; Camran | Bipolar surgical instruments having focused electrical fields |
US6032674A (en) * | 1992-01-07 | 2000-03-07 | Arthrocare Corporation | Systems and methods for myocardial revascularization |
US6039733A (en) * | 1995-09-19 | 2000-03-21 | Valleylab, Inc. | Method of vascular tissue sealing pressure control |
US6059778A (en) * | 1998-05-05 | 2000-05-09 | Cardiac Pacemakers, Inc. | RF ablation apparatus and method using unipolar and bipolar techniques |
US6174309B1 (en) * | 1999-02-11 | 2001-01-16 | Medical Scientific, Inc. | Seal & cut electrosurgical instrument |
US6176857B1 (en) * | 1997-10-22 | 2001-01-23 | Oratec Interventions, Inc. | Method and apparatus for applying thermal energy to tissue asymmetrically |
US6179835B1 (en) * | 1996-01-19 | 2001-01-30 | Ep Technologies, Inc. | Expandable-collapsible electrode structures made of electrically conductive material |
US6179837B1 (en) * | 1995-03-07 | 2001-01-30 | Enable Medical Corporation | Bipolar electrosurgical scissors |
US6187003B1 (en) * | 1997-11-12 | 2001-02-13 | Sherwood Services Ag | Bipolar electrosurgical instrument for sealing vessels |
US6190386B1 (en) * | 1999-03-09 | 2001-02-20 | Everest Medical Corporation | Electrosurgical forceps with needle electrodes |
US6193709B1 (en) * | 1998-05-13 | 2001-02-27 | Olympus Optical Co., Ltd. | Ultrasonic treatment apparatus |
US6227117B1 (en) * | 1997-10-20 | 2001-05-08 | Thomson-Csf | Retaining device, especially for the rear igniter of a missile |
US6334861B1 (en) * | 1997-09-10 | 2002-01-01 | Sherwood Services Ag | Biopolar instrument for vessel sealing |
US6352536B1 (en) * | 2000-02-11 | 2002-03-05 | Sherwood Services Ag | Bipolar electrosurgical instrument for sealing vessels |
US20020052599A1 (en) * | 2000-10-31 | 2002-05-02 | Gyrus Medical Limited | Electrosurgical system |
US20030018327A1 (en) * | 2001-07-20 | 2003-01-23 | Csaba Truckai | Systems and techniques for lung volume reduction |
US6511480B1 (en) * | 1998-10-23 | 2003-01-28 | Sherwood Services Ag | Open vessel sealing forceps with disposable electrodes |
US20030027028A1 (en) * | 2001-07-18 | 2003-02-06 | Davis Herbert John | Metal-cored bipolar separator and end plates for polymer electrolyte membrane electrochemical and fuel cells |
US6527767B2 (en) * | 1998-05-20 | 2003-03-04 | New England Medical Center | Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization |
US20030050635A1 (en) * | 2001-08-22 | 2003-03-13 | Csaba Truckai | Embolization systems and techniques for treating tumors |
US6533784B2 (en) * | 2001-02-24 | 2003-03-18 | Csaba Truckai | Electrosurgical working end for transecting and sealing tissue |
US20030055417A1 (en) * | 2001-09-19 | 2003-03-20 | Csaba Truckai | Surgical system for applying ultrasonic energy to tissue |
US20030069579A1 (en) * | 2001-09-13 | 2003-04-10 | Csaba Truckai | Electrosurgical working end with resistive gradient electrodes |
US20030078578A1 (en) * | 2001-10-22 | 2003-04-24 | Csaba Truckai | Electrosurgical instrument and method of use |
US20030078573A1 (en) * | 2001-10-18 | 2003-04-24 | Csaba Truckai | Electrosurgical working end for controlled energy delivery |
US20030078577A1 (en) * | 2001-10-22 | 2003-04-24 | Csaba Truckai | Electrosurgical jaw structure for controlled energy delivery |
US6554829B2 (en) * | 2001-01-24 | 2003-04-29 | Ethicon, Inc. | Electrosurgical instrument with minimally invasive jaws |
US20030088243A1 (en) * | 2001-11-02 | 2003-05-08 | Yuval Carmel | High efficiency electrosurgery probe |
US6843789B2 (en) * | 2000-10-31 | 2005-01-18 | Gyrus Medical Limited | Electrosurgical system |
US20050096651A1 (en) * | 2001-10-22 | 2005-05-05 | Surgrx, Inc. | Electrosurgical instrument |
US6890332B2 (en) * | 1999-05-24 | 2005-05-10 | Csaba Truckai | Electrical discharge devices and techniques for medical procedures |
US20060000823A1 (en) * | 2003-11-19 | 2006-01-05 | Surgrx, Inc. | Polymer compositions exhibiting a PTC property and methods of fabrication |
US7011657B2 (en) * | 2001-10-22 | 2006-03-14 | Surgrx, Inc. | Jaw structure for electrosurgical instrument and method of use |
US7041102B2 (en) * | 2001-10-22 | 2006-05-09 | Surgrx, Inc. | Electrosurgical working end with replaceable cartridges |
US7169146B2 (en) * | 2003-02-14 | 2007-01-30 | Surgrx, Inc. | Electrosurgical probe and method of use |
US7169147B2 (en) * | 2003-05-30 | 2007-01-30 | Olympus Winter & Ibe Gmbh | Ureter resectoscope |
US20070106295A1 (en) * | 2005-09-30 | 2007-05-10 | Garrison David M | Insulating boot for electrosurgical forceps |
US7220951B2 (en) * | 2004-04-19 | 2007-05-22 | Surgrx, Inc. | Surgical sealing surfaces and methods of use |
US7354400B2 (en) * | 2003-01-07 | 2008-04-08 | Hitachi Medical Corporation | Ultrasonographic method and ultrasonographic device |
US20090076506A1 (en) * | 2007-09-18 | 2009-03-19 | Surgrx, Inc. | Electrosurgical instrument and method |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
GB9204218D0 (en) * | 1992-02-27 | 1992-04-08 | Goble Nigel M | A surgical cutting tool |
JP3914266B2 (en) * | 1996-09-13 | 2007-05-16 | Tdk株式会社 | PTC thermistor material |
CN1148996C (en) * | 1999-05-14 | 2004-05-05 | 阿苏克技术有限责任公司 | Electrical heating device and resettable fuses |
-
2003
- 2003-05-30 US US10/448,478 patent/US7311709B2/en not_active Expired - Lifetime
-
2007
- 2007-10-26 US US11/925,092 patent/US20080045942A1/en not_active Abandoned
Patent Citations (99)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1586645A (en) * | 1925-07-06 | 1926-06-01 | Bierman William | Method of and means for treating animal tissue to coagulate the same |
US1798902A (en) * | 1928-11-05 | 1931-03-31 | Edwin M Raney | Surgical instrument |
US2031682A (en) * | 1932-11-18 | 1936-02-25 | Wappler Frederick Charles | Method and means for electrosurgical severance of adhesions |
US3243753A (en) * | 1962-11-13 | 1966-03-29 | Kohler Fred | Resistance element |
US4198957A (en) * | 1967-11-09 | 1980-04-22 | Robert F. Shaw | Method of using an electrically heated surgical cutting instrument |
US3651811A (en) * | 1969-10-10 | 1972-03-28 | Aesculap Werke Ag | Surgical cutting instrument |
US3730188A (en) * | 1971-03-24 | 1973-05-01 | I Ellman | Electrosurgical apparatus for dental use |
US4654511A (en) * | 1974-09-27 | 1987-03-31 | Raychem Corporation | Layered self-regulating heating article |
US4092986A (en) * | 1976-06-14 | 1978-06-06 | Ipco Hospital Supply Corporation (Whaledent International Division) | Constant output electrosurgical unit |
US4271838A (en) * | 1978-04-05 | 1981-06-09 | Laschal Instruments Corp. | Suture cutter |
US4370980A (en) * | 1981-03-11 | 1983-02-01 | Lottick Edward A | Electrocautery hemostat |
US4375218A (en) * | 1981-05-26 | 1983-03-01 | Digeronimo Ernest M | Forceps, scalpel and blood coagulating surgical instrument |
US4492231A (en) * | 1982-09-17 | 1985-01-08 | Auth David C | Non-sticking electrocautery system and forceps |
US4590934A (en) * | 1983-05-18 | 1986-05-27 | Jerry L. Malis | Bipolar cutter/coagulator |
US4671274A (en) * | 1984-01-30 | 1987-06-09 | Kharkovsky Nauchno-Issledovatelsky Institut Obschei I | Bipolar electrosurgical instrument |
US4633874A (en) * | 1984-10-19 | 1987-01-06 | Senmed, Inc. | Surgical stapling instrument with jaw latching mechanism and disposable staple cartridge |
US4799479A (en) * | 1984-10-24 | 1989-01-24 | The Beth Israel Hospital Association | Method and apparatus for angioplasty |
US4655216A (en) * | 1985-07-23 | 1987-04-07 | Alfred Tischer | Combination instrument for laparoscopical tube sterilization |
US5106538A (en) * | 1987-07-21 | 1992-04-21 | Raychem Corporation | Conductive polymer composition |
US4930494A (en) * | 1988-03-09 | 1990-06-05 | Olympus Optical Co., Ltd. | Apparatus for bending an insertion section of an endoscope using a shape memory alloy |
US4910389A (en) * | 1988-06-03 | 1990-03-20 | Raychem Corporation | Conductive polymer compositions |
US4985030A (en) * | 1989-05-27 | 1991-01-15 | Richard Wolf Gmbh | Bipolar coagulation instrument |
US5009656A (en) * | 1989-08-17 | 1991-04-23 | Mentor O&O Inc. | Bipolar electrosurgical instrument |
US5122137A (en) * | 1990-04-27 | 1992-06-16 | Boston Scientific Corporation | Temperature controlled rf coagulation |
US5104025A (en) * | 1990-09-28 | 1992-04-14 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
US5190541A (en) * | 1990-10-17 | 1993-03-02 | Boston Scientific Corporation | Surgical instrument and method |
US5085659A (en) * | 1990-11-21 | 1992-02-04 | Everest Medical Corporation | Biopsy device with bipolar coagulation capability |
US5217460A (en) * | 1991-03-22 | 1993-06-08 | Knoepfler Dennis J | Multiple purpose forceps |
US5086586A (en) * | 1991-04-23 | 1992-02-11 | General Motors Corporation | Vehicle side door flush glass system |
US5207691A (en) * | 1991-11-01 | 1993-05-04 | Medical Scientific, Inc. | Electrosurgical clip applicator |
US5382384A (en) * | 1991-11-06 | 1995-01-17 | Raychem Corporation | Conductive polymer composition |
US5290286A (en) * | 1991-11-12 | 1994-03-01 | Everest Medical Corporation | Bipolar instrument utilizing one stationary electrode and one movable electrode |
US6032674A (en) * | 1992-01-07 | 2000-03-07 | Arthrocare Corporation | Systems and methods for myocardial revascularization |
US5201900A (en) * | 1992-02-27 | 1993-04-13 | Medical Scientific, Inc. | Bipolar surgical clip |
US5306280A (en) * | 1992-03-02 | 1994-04-26 | Ethicon, Inc. | Endoscopic suture clip applying device with heater |
US5308311A (en) * | 1992-05-01 | 1994-05-03 | Robert F. Shaw | Electrically heated surgical blade and methods of making |
US5480398A (en) * | 1992-05-01 | 1996-01-02 | Hemostatic Surgery Corporation | Endoscopic instrument with disposable auto-regulating heater |
US5480397A (en) * | 1992-05-01 | 1996-01-02 | Hemostatic Surgery Corporation | Surgical instrument with auto-regulating heater and method of using same |
US5593406A (en) * | 1992-05-01 | 1997-01-14 | Hemostatic Surgery Corporation | Endoscopic instrument with auto-regulating heater and method of using same |
US5389098A (en) * | 1992-05-19 | 1995-02-14 | Olympus Optical Co., Ltd. | Surgical device for stapling and/or fastening body tissues |
US5417687A (en) * | 1993-04-30 | 1995-05-23 | Medical Scientific, Inc. | Bipolar electrosurgical trocar |
US5395369A (en) * | 1993-06-10 | 1995-03-07 | Symbiosis Corporation | Endoscopic bipolar electrocautery instruments |
US5507106A (en) * | 1993-06-18 | 1996-04-16 | Fox; Marcus | Exercise shoe with forward and rearward angled sections |
US5403312A (en) * | 1993-07-22 | 1995-04-04 | Ethicon, Inc. | Electrosurgical hemostatic device |
US5735848A (en) * | 1993-07-22 | 1998-04-07 | Ethicon, Inc. | Electrosurgical stapling device |
US5603825A (en) * | 1994-07-18 | 1997-02-18 | Costinel; Paul | Multi-stage apparatus for separating immiscible fluids |
US5595689A (en) * | 1994-07-21 | 1997-01-21 | Americhem, Inc. | Highly conductive polymer blends with intrinsically conductive polymers |
US5611798A (en) * | 1995-03-02 | 1997-03-18 | Eggers; Philip E. | Resistively heated cutting and coagulating surgical instrument |
US6350264B1 (en) * | 1995-03-07 | 2002-02-26 | Enable Medical Corporation | Bipolar electrosurgical scissors |
US6179837B1 (en) * | 1995-03-07 | 2001-01-30 | Enable Medical Corporation | Bipolar electrosurgical scissors |
US5716366A (en) * | 1995-04-07 | 1998-02-10 | Ethicon Endo-Surgery, Inc. | Hemostatic surgical cutting or stapling instrument |
US5624452A (en) * | 1995-04-07 | 1997-04-29 | Ethicon Endo-Surgery, Inc. | Hemostatic surgical cutting or stapling instrument |
US6179834B1 (en) * | 1995-09-19 | 2001-01-30 | Sherwood Services Ag | Vascular tissue sealing pressure control and method |
US6039733A (en) * | 1995-09-19 | 2000-03-21 | Valleylab, Inc. | Method of vascular tissue sealing pressure control |
US5880668A (en) * | 1995-09-29 | 1999-03-09 | Littelfuse, Inc. | Electrical devices having improved PTC polymeric compositions |
US6019758A (en) * | 1996-01-11 | 2000-02-01 | Symbiosis Corporation | Endoscopic bipolar multiple sample bioptome |
US5755717A (en) * | 1996-01-16 | 1998-05-26 | Ethicon Endo-Surgery, Inc. | Electrosurgical clamping device with improved coagulation feedback |
US6179835B1 (en) * | 1996-01-19 | 2001-01-30 | Ep Technologies, Inc. | Expandable-collapsible electrode structures made of electrically conductive material |
US5891142A (en) * | 1996-12-06 | 1999-04-06 | Eggers & Associates, Inc. | Electrosurgical forceps |
US5897142A (en) * | 1996-12-19 | 1999-04-27 | Itt Automotive, Inc. | Push-to-release quick connector |
US6334861B1 (en) * | 1997-09-10 | 2002-01-01 | Sherwood Services Ag | Biopolar instrument for vessel sealing |
US6227117B1 (en) * | 1997-10-20 | 2001-05-08 | Thomson-Csf | Retaining device, especially for the rear igniter of a missile |
US6176857B1 (en) * | 1997-10-22 | 2001-01-23 | Oratec Interventions, Inc. | Method and apparatus for applying thermal energy to tissue asymmetrically |
US6187003B1 (en) * | 1997-11-12 | 2001-02-13 | Sherwood Services Ag | Bipolar electrosurgical instrument for sealing vessels |
US6030384A (en) * | 1998-05-01 | 2000-02-29 | Nezhat; Camran | Bipolar surgical instruments having focused electrical fields |
US6059778A (en) * | 1998-05-05 | 2000-05-09 | Cardiac Pacemakers, Inc. | RF ablation apparatus and method using unipolar and bipolar techniques |
US6193709B1 (en) * | 1998-05-13 | 2001-02-27 | Olympus Optical Co., Ltd. | Ultrasonic treatment apparatus |
US6527767B2 (en) * | 1998-05-20 | 2003-03-04 | New England Medical Center | Cardiac ablation system and method for treatment of cardiac arrhythmias and transmyocardial revascularization |
US6511480B1 (en) * | 1998-10-23 | 2003-01-28 | Sherwood Services Ag | Open vessel sealing forceps with disposable electrodes |
US6174309B1 (en) * | 1999-02-11 | 2001-01-16 | Medical Scientific, Inc. | Seal & cut electrosurgical instrument |
US6190386B1 (en) * | 1999-03-09 | 2001-02-20 | Everest Medical Corporation | Electrosurgical forceps with needle electrodes |
US6890332B2 (en) * | 1999-05-24 | 2005-05-10 | Csaba Truckai | Electrical discharge devices and techniques for medical procedures |
US6352536B1 (en) * | 2000-02-11 | 2002-03-05 | Sherwood Services Ag | Bipolar electrosurgical instrument for sealing vessels |
US6893435B2 (en) * | 2000-10-31 | 2005-05-17 | Gyrus Medical Limited | Electrosurgical system |
US6843789B2 (en) * | 2000-10-31 | 2005-01-18 | Gyrus Medical Limited | Electrosurgical system |
US20020052599A1 (en) * | 2000-10-31 | 2002-05-02 | Gyrus Medical Limited | Electrosurgical system |
US6554829B2 (en) * | 2001-01-24 | 2003-04-29 | Ethicon, Inc. | Electrosurgical instrument with minimally invasive jaws |
US6533784B2 (en) * | 2001-02-24 | 2003-03-18 | Csaba Truckai | Electrosurgical working end for transecting and sealing tissue |
US20030027028A1 (en) * | 2001-07-18 | 2003-02-06 | Davis Herbert John | Metal-cored bipolar separator and end plates for polymer electrolyte membrane electrochemical and fuel cells |
US20030018327A1 (en) * | 2001-07-20 | 2003-01-23 | Csaba Truckai | Systems and techniques for lung volume reduction |
US20030050635A1 (en) * | 2001-08-22 | 2003-03-13 | Csaba Truckai | Embolization systems and techniques for treating tumors |
US20030069579A1 (en) * | 2001-09-13 | 2003-04-10 | Csaba Truckai | Electrosurgical working end with resistive gradient electrodes |
US20030055417A1 (en) * | 2001-09-19 | 2003-03-20 | Csaba Truckai | Surgical system for applying ultrasonic energy to tissue |
US20030078573A1 (en) * | 2001-10-18 | 2003-04-24 | Csaba Truckai | Electrosurgical working end for controlled energy delivery |
US7041102B2 (en) * | 2001-10-22 | 2006-05-09 | Surgrx, Inc. | Electrosurgical working end with replaceable cartridges |
US7189233B2 (en) * | 2001-10-22 | 2007-03-13 | Surgrx, Inc. | Electrosurgical instrument |
US20030078577A1 (en) * | 2001-10-22 | 2003-04-24 | Csaba Truckai | Electrosurgical jaw structure for controlled energy delivery |
US20030078578A1 (en) * | 2001-10-22 | 2003-04-24 | Csaba Truckai | Electrosurgical instrument and method of use |
US7011657B2 (en) * | 2001-10-22 | 2006-03-14 | Surgrx, Inc. | Jaw structure for electrosurgical instrument and method of use |
US20050096651A1 (en) * | 2001-10-22 | 2005-05-05 | Surgrx, Inc. | Electrosurgical instrument |
US7186253B2 (en) * | 2001-10-22 | 2007-03-06 | Surgrx, Inc. | Electrosurgical jaw structure for controlled energy delivery |
US20030088243A1 (en) * | 2001-11-02 | 2003-05-08 | Yuval Carmel | High efficiency electrosurgery probe |
US7354400B2 (en) * | 2003-01-07 | 2008-04-08 | Hitachi Medical Corporation | Ultrasonographic method and ultrasonographic device |
US7169146B2 (en) * | 2003-02-14 | 2007-01-30 | Surgrx, Inc. | Electrosurgical probe and method of use |
US7169147B2 (en) * | 2003-05-30 | 2007-01-30 | Olympus Winter & Ibe Gmbh | Ureter resectoscope |
US20060000823A1 (en) * | 2003-11-19 | 2006-01-05 | Surgrx, Inc. | Polymer compositions exhibiting a PTC property and methods of fabrication |
US7220951B2 (en) * | 2004-04-19 | 2007-05-22 | Surgrx, Inc. | Surgical sealing surfaces and methods of use |
US20070106295A1 (en) * | 2005-09-30 | 2007-05-10 | Garrison David M | Insulating boot for electrosurgical forceps |
US20090076506A1 (en) * | 2007-09-18 | 2009-03-19 | Surgrx, Inc. | Electrosurgical instrument and method |
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