WO1993022973A1 - Bladed endoscopic retractor - Google Patents

Bladed endoscopic retractor Download PDF

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Publication number
WO1993022973A1
WO1993022973A1 PCT/US1993/004296 US9304296W WO9322973A1 WO 1993022973 A1 WO1993022973 A1 WO 1993022973A1 US 9304296 W US9304296 W US 9304296W WO 9322973 A1 WO9322973 A1 WO 9322973A1
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WO
WIPO (PCT)
Prior art keywords
blades
retractor
control member
distal end
actuator
Prior art date
Application number
PCT/US1993/004296
Other languages
French (fr)
Inventor
Yong H. Zhu
Wolff M. Kirsch
Original Assignee
Loma Linda University Medical Center
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Loma Linda University Medical Center filed Critical Loma Linda University Medical Center
Priority to EP93911115A priority Critical patent/EP0641177A1/en
Publication of WO1993022973A1 publication Critical patent/WO1993022973A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B18/1442Probes having pivoting end effectors, e.g. forceps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/12Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
    • A61B1/121Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements provided with means for cleaning post-use
    • A61B1/122Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements provided with means for cleaning post-use using cleaning tools, e.g. brushes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/12Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
    • A61B1/126Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements provided with means for cleaning in-use
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2933Transmission of forces to jaw members camming or guiding means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2933Transmission of forces to jaw members camming or guiding means
    • A61B2017/2934Transmission of forces to jaw members camming or guiding means arcuate shaped guiding means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2939Details of linkages or pivot points
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2945Curved jaws
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005Cooling or heating of the probe or tissue immediately surrounding the probe
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595Cauterization
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00964Features of probes
    • A61B2018/0097Cleaning probe surfaces
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/1206Generators therefor
    • A61B2018/1246Generators therefor characterised by the output polarity
    • A61B2018/126Generators therefor characterised by the output polarity bipolar
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1405Electrodes having a specific shape
    • A61B2018/1425Needle
    • A61B2018/1432Needle curved
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/70Cleaning devices specially adapted for surgical instruments

Definitions

  • the present invention relates to retractors used in surgery. More specifically, the invention relates to a bladed, expandable endoscopic retractor by which tissue, internal organs, or other internal body parts may be retracted to provide visualization and surgical access during endoscopic procedures.
  • Endoscopes are a thin, tube-like instrument featuring a light source, viewing lenses, and/or various other attachments such as irrigators, scissors, snares, brushes, or forceps.
  • Endoscopes may be flexible or rigid, and normally utilize optic fibers to transmit light to the internal cavity. The surgery is normally viewed by the surgeon through an ocular. Lenses are placed near the tip of the endoscope and the image thereon is transmitted via optic fibers or other lens systems, to the ocular or viewer. Other types of endoscopes utilize optical fibers to transmit electronic signals representing the internal image from the distal lens to a video monitor which is viewed by the surgeon.
  • endoscopic surgery is inadequate visualization of the internal structure required to properly complete the surgical procedure. Endoscopic surgery is thus difficult in areas which are typically difficult to reach, such as the gallbladder.
  • gallbladder surgery (or "cholecystectomy") the tissue and organs surrounding the gallbladder are examined with the endoscope and retracted in order to properly expose the organ which is to be removed.
  • endoscopic procedures in the abdominal cavity often require retraction.
  • endoscopic cholecystectomy requires retraction of the liver, which rests directly above the gallbladder.
  • retraction is relatively easy, as the surgery involves the exposure of the entire organ area.
  • a form of retraction which can be accomplished through ports is necessary.
  • retraction is currently accomplished by inflating the peritoneal cavity with carbon dioxide.
  • This method of retraction involves creating a small surgical port for introducing a gas source.
  • the gas is introduced into the body through a cannula, and a state of pneumoperitoneum occurs.
  • the gas inflates the peritoneal cavity so as to cause the skin and muscles to separate and rise above various organs and tissue, thus creating the exposure necessary to accomplish the- endoscopic surgery.
  • pneumoperitoneal retraction is effective in retracting only the muscles and tissue from above the organs. The organs themselves are not, to a great extent, retracted from each other.
  • a bladed retractor system for use in endoscopic surgery.
  • the invention permits safe and effective endoscopic retraction of internal organs and tissue during endoscopic surgery. Retraction is accomplished with the present invention through the use of supporting retractor blades which are manipulatable.
  • the blades are movably connected at one end to the inside of a tubular body designed for endoscopic use, and extend therefrom to free ends which may be used to retract the various organs and tissue.
  • two blades are movably connected to the insertion or distal end of a tubular body.
  • the body is an elongated member having a small outside dimension for endoscopic use.
  • the body has an opening at its distal end to allow maximum movement of the blades away from the body.
  • the blades which are primarily flat, thin supporting members, are manipulated by controls located at a control end' ⁇ ⁇ f the body which is opposite the insertion end of the body.
  • the blades when in the non-use position r rest substantially directly on top of one another and along a line virtually parallel to the longitudinal axis of the body, thereby aiding in the ease of installing the retractor into the patient's body.
  • One end of the blades is connected to a vertical pin mounted in a first control member inside the tubular body.
  • the first control member is rotatably attached to the inside of the tubular body.
  • the blades extend from the first control member through a second control member.
  • the second control member is a hollow box shaped member, and rides in a track which extends from the distal end of the body towards the proximal end of the body.
  • a shaft is positioned inside the second control member. The shaft is mounted perpendicular to the blades and extends between them.
  • the blades have a notch in them at a point near their passage through the second control member to accept the shaft.
  • An actuator is connected to the second control member and extends to a handle at the control end of the body. Movement of the retractor blades is accomplished by manipulating the handle.
  • the blades of this retractor embodiment rest primarily on top of one another, as the notch in each blade accepts the shaft of the second control member.
  • the blades lie along the longitudinal axis of the body of the retractor. In this position, the retractor may easily be inserted into the body.
  • the handle When it is desired to provide retraction, the handle is pushed upon and the second control member is pulled proximally along the track in the body. When this occurs, the shaft in the second control member forces the blades apart. At the same time, the second control member forces the blades downward, away from the longitudinal axis of the body.
  • a second embodiment of the present invention is substantially similar to the first.
  • the first and second control members are individually anipulatable so as to allow the user to separate and/or extend the blades separately.
  • the first control member is the same as in the first embodiment, except that an actuator extends from the member to a lockable handle at the control end of the body.
  • the second control member comprises a shaft which rides in tracks spaced 180° apart at the distal end of the body.
  • the second control member is spring biased towards the distal end of the body.
  • An actuator extends from the second control member to a handle at the control end of the body.
  • the blades rest in their non-use position on top of one another, along the longitudinal axis of the body, as in.the first embodiment.
  • the blades may be extended outwardly through a recess in the distal end of the body and/or spread apart from one another.
  • the actuator which extends to the first control member, allows the user to move the blades up or down, or, in other words, radially outward in a vertical plane from the longitudinal axis of the body.
  • the second control member may be actuated by its corresponding handle and the control end of the retractor body. Once again, pulling on the handle moves the second control member proximally, causing the blades to separate.
  • the endoscopic bladed retractor comprises a body, controls, and three blades.
  • the body of this retractor is also tubular and long, having a small outer dimension for endoscopic use.
  • the body also has openings at its distal or insertion end to allow the blades to extend outward.
  • the blades are thin, flat supporting members, each of which is rotatably connected to the body and spaced 120° from one another. Each blade is connected to a rotatable member which allows the blade to extend from a non-use position where the blade is located primarily along a line parallel to the longitudinal axis of the body, to a retraction position where the blade extends outward from the body.
  • Each member has an actuator connected to it which extends to a handl'e located on the control or proximal end of the body. Further, a locking mechanism is provided to allow each actuator, and thus each blade, to be securely fixed in any position. This retractor, when placed in the body, allows the user to individually select and adjust retraction in the inferior, lateral, and medial directions.
  • the bladed endoscopic retractor comprises two blades.
  • the body of this retractor is tubular and long, having an opening in the wall of the body at its insertion end to allow the blades to extend therethrough.
  • the blades are again primarily thin, flat supporting members, both of which extend from a proximal end located inside the body, to a distal end which extends outside of the body of the retractor.
  • the proximal end of the blades is located inside a second control member which is located proximal to the first control member.
  • the blades extend distally from the second control member to engage a first control member.
  • the first control member is rotatably connected to the inside of the distal end of the body.
  • the blades are connected to one another inside the first control members by a pin.
  • a spring bias is provided between the blades at. their proximal ends so that when they are in a non-use position, their distal ends are pressed against one another.
  • the second control member is movably positioned inside the body, thus allowing the control member to move along the longitudinal axis of the body.
  • the second control member has an internal cut out in which the proximal ends of the blades are mounted.
  • Actuators are connected to both the first and second control members and extend therefrom to the proximal or control end of the body.
  • Lockable handles are connected to the actuators at their proximal ends.
  • the blades in this fourth embodiment may be moved independently apart from one another and/or extended away from the longitudinal axis 'of the body.
  • this embodiment creates less of a risk that tissue inside the body will be damaged. This is because both the first and second control members are located a distance away from the end opening at the distal end of the retractor body. This lessens the chance that tissue which may be pressed into the end of the retractor and caught in the various controls.
  • the blades when deployed, effectively support the various surrounding organs and tissues by pushing them laterally apart and away from the operating area.
  • the blades may lift and separate the organs and tissues.
  • the retractor of the present invention safely provides counter traction for endoscopic surgical procedures. That is, due to a lack of precise depth perception, a significant danger in many forms of endoscopic surgical procedures is cuts or incisions that go too deep may injure vital tissues or organs. Therefore, in order to achieve accuracy in such surgical procedures, there is a need to move neighboring tissue away from the area of incision in order to avoid damage.
  • the retractor blades may also be used to tear or rip apart tissue and organs without the need to use a second instrument, thus serving as a dissector.
  • the blades are mounted to the body such that when rotated downward or otherwise extended, the body is tangential to the area of retraction, further avoiding any surgical interference.
  • the blades are sufficiently rigid so as not to excessively bend or flex when the body is advanced and the blades are used to push organs and tissue out of the way. This allows the blades to be pushed harder against the tissues or organs. This is particularly important, since during use, the blades are essentially cant.ilevered from the body. On the other hand, a slight flexing of the blades is desired so as to avoid damage to the tissues or organs. This is provided in the embodiments as described, by providing a slight curvature to the shape of the blades. This curvature not only provides slight flexibility, but can also be used to minimize or maximize retraction surface area.
  • the effective surface area of retraction is increased. If the blades are convex in the direction of retraction, the surface area of contact between the blades and the tissues and organs is minimized, thereby limiting damage to said tissues and organs.
  • an important advantage of the present invention is that the blades of the present retractor can safely provide counter traction for a wide variety of endoscopic surgical procedures.
  • the blades of the retractor are devoid of webbing or other mechanical linkages, thus, avoiding damage to the retracted tissue.
  • the blades are also slightly curved in shape to provide limited flexibility and minimize or maximize the retraction surface area.
  • Thepresentbladed endoscopic retractors provide positive retraction which does not have the dangers associated with continuous peritoneal insufflation.
  • the present invention can be placed with only slight initial insufflation to provide easy insertion of the device. After insertion, retraction can be maintained simply and safely «with the blades.
  • the present retractor is quite small and is easily introduced into the body through only a single small opening. Further, this method of retraction is much more effective in retracting larger organs than the insufflation method.
  • the invention allows the surgeon or a ' ssistant to manually retract an organ to any extent necessary, by merely manipulating the position of the blades with the controls. This is in contrast to the insufflation method, where the gas indiscriminately fills the body cavity. Further, these retractors are adaptable for use on organs of various sizes. By adjusting the blade size and position, the retractor can retract nearly any organ.
  • the retractor of the present invention provides a very advantageous solution to the problems associated with insufflation retraction during endoscopic surgery.
  • FIGURE 1 is a schematic view illustrating the manner in which the retractor of the present invention may be inserted through a small surgical port for use in endoscopic surgery.
  • FIGURE 2 is a perspective side view of the first embodiment of the bladed endoscopic retractor of the present invention illustrating the blades thereof in their non- separated, non-extended (non-rotated) position, suitable, for example, for endoscopic insertion.
  • FIGURE 3 is a partial enlarged side view of the distal end of the first embodiment.
  • FIGURE 4 is a partial enlarged top view of the distal end of the present invention illustrating the blades in a slightly separated position.
  • FIGURE 5 is a partial enlarged perspective view of the distal end of the present invention showing the blades in a slightly separated, non-extended position.
  • FIGURE 6 is an enlarged side view of the distal end of the present invention showing the blades in their separated, extended retraction position.
  • FIGURE 7 is an enlarged perspective view of the distal end of the present invention showing the blades in their separated, extended, retraction position.
  • FIGURE 8 is a partial side view of the second embodiment of the present invention.
  • FIGURE 9 is a side view of the second embodiment of the present retractor illustrating the blades tilted downwardly away from the longitudinal axis of the retractor body.
  • FIGURE 10 is an end view of the retractor of the second embodiment illustrating the blades in their non-extended position.
  • FIGURE 11 is a partial top view of the second embodiment of the present retractor, illustrating the blades in their non-extended position.
  • FIGURE 12 is a partial top view of the second embodiment of the present retractor, showing the blades in their separated, extended retraction position.
  • FIGURE 13 is a partial enlarged perspective end view of the third embodiment of the present invention.
  • FIGURE 14 is an enlarged end view of the retractor of
  • FIGURE 13 with the blades extended.
  • FIGURE 15 is a partial side view of the fourth embodiment of the present invention.
  • FIGURE 16 is a partial side view of the retractor of FIGURE 15 with the blades in their extended retraction position.
  • FIGURE 17 is a partial top view along LINE 17-17 of the distal end of the retractor of FIGURE 15.
  • FIGURE 18 is a partial top view of the distal end of the retractor of FIGURE 15 with the blades in their separated, extended retraction position.
  • FIGURE 1 there is shown a schematic view of a patient undergoing endoscopic surgery.
  • a small surgical port A is shown through which an endoscope 21 is inserted. This allows the surgeon to view the internal tissues and organs in the surgical area.
  • Other surgical devices may be inserted through similar surgical ports B and C in order to perform the desired procedure.
  • the retractor 20 of the present invention is shown inserted through yet another port D so as to be in the surgical region.
  • the retractor can be used to safely manipulate tissues or organs during surgery. It should be noted, however, that the principles of the present invention are not limited to any particular surgical procedure but may be applied to a wide variety of procedures and applications.
  • FIGURE 2 discloses a body 22 having various retractor blades 24 extending therefrom which are manipulatable by various controls 26.
  • the body 22 of the bladed endoscopic retractor 20 is a tube.
  • the body 22 may be of other shapes; however, a circular cross-section is preferred since it is most easily inserted into a cannula.
  • the outer diameter of the body 22 is preferably minimized so that the incision size required to insert the endoscopic retractor and the trauma to the patient's body is also minimized.
  • the length of the body 22 is dependent primarily upon the type of procedure in which the bladed endoscopic retractor 20 is to be used.
  • the body 22 has a proximal or control end 23 and a distal or insertion end 25.
  • the distal end 25 of the body 22 has an elongated opening 27 (FIGURE 3) extending from the end in a proximal direction along the underside of the body 22.
  • the proximal end 23 is the site of the various controls 26 which operate the retractor.
  • the body 22 is preferably made of a material, such as stainless steel, which will remain free from degradation, is easily sterilized, and is biocompatible.
  • Blades 24 are mounted within the body 22 near the distal end 25 so as to extend therefrom.
  • the blades 24, as shown in FIGURE 4, are primarily flat, elongated members.
  • the blades 24 may, of course, take on a variety of shapes depending upon the particular surgical procedure, so long as they will not cause trauma to internal tissues or organs, either during insertion or use.
  • the blades 24 taper at their proximal end 32 (FIGURE 3) where they are movably connected to the body 22.
  • the blades 24 each have a notch 21 (FIGURE 5) at a point near their exit from the body 22.
  • the notches 21 ⁇ ire slightly elongated and taper distally to a point where each notch is wide enough to accept a shaft 48 as described below in connection with FIGURE 5.
  • a pin 34 passes vertically through holes 36 in the proximal end of the blades 24.
  • the pin 34 is, in turn, mounted to a first control member 38.
  • the first control member 38 comprises a disc which is relatively thick and substantially cylindrical. The disc is housed inside the body 22 near its distal end 25. The diameter of the first control member 38 is less than the inner diameter of the body 22, so that it may rotate in the body 22.
  • the first control member 38 has a rectangular portion cut out of its middle section, inside of which the pin 34, which supports the blades 24, is mounted.
  • the first control member 38 also has a small arch 39 cut out of its bottom surface thus allowing the passage of an actuator 54, which will be described in more detail later.
  • Pins 40 are mounted opposite one another on each side of the first control member 38 and perpendicular to the direction that the pin 34 is mounted.
  • the pins 40 extend from the first control member 38 into small holes 42 in the body 22. This mounting allows the first control member 38 to rotate about the pins 40.
  • a second control member 44 is mounted distally of the first control member 38.
  • This second control member 44 is a hollow square body having a shaft 48 mounted therein. The shaft 48 is oriented perpendicular to the blades 24. As can be seen in FIGURE 5, the blades 24 pass through the second control member 44 on either side of the shaft 48.
  • the height of the second control member 44 is less than the height at which the blades 24 are connected at their proximal ends 32 to the first control member 38.
  • This differential provides for the generation of a movement acting about connection pin 40, as described in more detail below.
  • the second control member 44 rides in a track 50 in the inside of the body 22. The mounting of the second control member 44 on the track 50 allows the control member 44 to move along the inside of the body 22 in a direction parallel to the longitudinal axis of the body 22.
  • An actuator 54 is attached to the second control member 44 at its lower end on the proximal side, extends through the arch 39 in the first control member 38, and continues through the body 22 to its proximal end, where it is attached to a handle 56.
  • handles 43, 56 are both located outside of the proximal end 23 of the body 22.
  • the handles 43, 56 as illustrated are elongated and are of a dimension sufficient to permit manipulation by hand.
  • Each handle 43, 56 is preferably made from stainless steel.
  • Handle 43 is connected securely to the body 22.
  • Handle 56 is rotatably connected to handle 43 with a pin 66.
  • Handle 56 is also connected to actuator 54 by a pin 41.
  • the handles 43, 56 could, of course, be made of plastic or other durable material and could be attached to the actuator 54 with glue, screws or other means.
  • a notched member 68 extends from handle 43 towards handle 56.
  • the notched member 68 is slightly curved and lies directly alongside handle 56.
  • the notches in the notched member 68 are engaged by a pin (not shown) extending outwardly from handle 56. In this manner, handle 56, and its corresponding actuator 54, may be locked into any position using the pin and notch lock.
  • the retractor 20 is inserted into the body. This is normally accomplished by introducing a state of slight pneumoperitoneum, and then sliding the retractor 20 into the body through a cannula.
  • the blades 24 should be in their non-use position; that is, aligned parallel to the axis of the body 22 with one on top of the other (FIGURE 3) .
  • the accommodate the shaft 48 in' " the second control member 44 so as to allow the blades 24 to lie nearly directly on top of one another in their non-use position. This is particularly advantageous since the blades 24 may thus be closed on top of one another, thus limiting the size of the cannula necessary to accept the retractor 20.
  • the retractor 20 may be properly aligned and operated. Placement of the retractor 20 may be aided by an endoscope. Once in place, handle 56 is pushed away from handle 43 along the notched member 68. In this fashion, actuator 54 pulls the second control member 44 towards the control end 23 of the body 22 along the track 50. When this occurs, the shaft 48 (FIGURE 5) in the second control member 44 forces the blades 24 apart. At the same time, because the height of the second control member 44 is lower than the connection of the blades 24 to the first control member 38, the blades 24 are forced downwardly and away from the longitudinal axis of the body 22 due to the movement force mentioned above.
  • the blades of the present retractor can assume a variety of positions with the degree of spreading being proportional to the rotation of the blades. When the appropriate deployment of the blades is accomplished, they can be locked in place for safe retraction. As shown in FIGURE 7, the blades 24 of the present retractor are relatively blunt and without sharp edges in order to avoid damage to the retracted tissue. In addition, as well illustrated in FIGURE 7, there are no connections or mechanical linkages located between the blades which would pinch or lacerate tissues. Therefore, the present retractor safely provides counter traction for many types of endoscopic surgical procedures in the peritoneal area. Once the surgical procedure has been completed and it is desired to remove the retractor 20, handle 43 is pulled in the direction of handle 56.
  • FIGURES 8-12 A second embodiment of the retractor 220 is illustrated in FIGURES 8-12.
  • This embodiment is similar to the first embodiment; however, in this embodiment, first and second control members 238, 244, are independently manipulatable.
  • the degree of separation or degree of spreading of the blades can be adjusted for retraction independently of the degree of downward rotation or extension of the blades away from the longitudinal axis of the body 222.
  • the retractor 220 comprises the body 222 having retractor blades 224 extending therefrom which are manipulatable by various controls 226.
  • the body 222 is similar in construction to the body 22 described above, having similar dimensions and materials.
  • the body 222 has a proximal or control end 223 and a distal or insertion end 225.
  • the body 222 once again, has a lower elongated recess 227 extending from the distal end 225 towards the proximal end 223.
  • the various controls 226 are again located at the proximal end 223 of the body 222/- "
  • the blades 224 extend from the distal end 225 of the body 222, and are similar in shape and material to those described above.
  • a notch 221 (FIGURE 12) is located in each of the blades 224 to facilitate the introduction of a shaft 248, as described more fully below.
  • the blades 224 rest in their non-use position on top of one another.
  • a pin 234 passes vertically through holes 236 in the proximal end of the blades 224.
  • the pin 234 is, in turn, mounted to a first control member 238.
  • Springs 235 (FIGURE 11) are attached to each blade 224 and to the inside of the body 222 so as to bias the blades 224 towards the center of the body 222 and against the shaft 248.
  • the blades 224 are connected at their proximal ends to a first control member 238 which is substantially similar to that described above, and thus will not be redescribed here.
  • An actuator 241 (FIGURES 8 and 9) is mounted to the proximal side of the first control member 238 at a point near the top middle of the control member 238.
  • the actuator 241 is preferably a long rod which extends from a handle 243 at the proximal end of the body 223, to a mounting member 245 on the first control member 238.
  • the mounting member 245 is, as shown in FIGURE 8, substantially U-shaped.
  • the actuator 241 is attached to the mounting member 245 with a pin 246 which passes through the actuator 241 and the mounting member 245.
  • a second control member 244 (FIGURES 8 and 9) is mounted distally of the first control member 238.
  • This second control member 244 comprises a shaft 248 mounted at both ends in a track 250.
  • the ends of the shaft 248 slide along the tracks 250, which are T-shaped grooves formed on the inside of the body 222.
  • the tracks 250 are spaced 180° from one another.
  • the shaft 248 extends between the tracks 250 and passes in between the blades 224. As can be seen in FIGURE 11, when the shaft 248 is at its furthest distal point in the tracks 250, the shaft passes through the notches 221 in the blades.
  • the mounting of the shaft 248 in the tracks 250 allows the shaft 248 to move along the inside of the b'ody 222 in a direction parallel to the axis of the body.
  • a spring 252 mounted on the distal side of the second control member 244 biases the shaft 248 toward its furthermost distal point on the tracks 250. As illustrated in FIGURE 8, the spring 252 is attached to the inside of the body 222 at a point distal of the tracks 250.
  • An actuator 254 (FIGURE 9) is attached to the shaft 248 at its lower end on the proximal side, extends through the arch 239 (FIGURE 10) in the first control member 238, and continues through the body 222 to its proximal end, where it is attached to a handle 256.
  • the actuators 241, 254 each extend through a guide member 258.
  • the guide members 258, as shown, are U-shaped members attached to the inside of the body 222 near its proximal end.
  • the guide members 258 each surround its corresponding actuator 241, 254, thus forming a tube through which the actuator 241, 254 passes.
  • Knobs 260 are attached to threaded shafts 262 which pass through circular holes 264 in the body 222.
  • the shafts 262 engage threaded bores in each guide member 258.
  • Each knob 260 may be tightened into the guide member 258 so as to force the actuator 241, 254 therein against the other side of the guide member 258, thus preventing the actuator 241, 254 from moving. Therefore, the position of the blades 224 may be locked into place for use during the surgical procedure.
  • the retractor 220 is inserted into the body. This is normally accomplished by introducing a state of slight pneumoperitoneum, and then sliding the retractor 220 into the body through a cannula.
  • the blades 224 should be in their non-use position shown in FIGURE 8; that is, aligned parallel to the axis of the body 222 with one on top of the other.
  • the notches 221 accommodate the shaft 248 so as to allow the blades 224 to lie nearly directly on top of one another in their non-use position. This is particularly advantageous since the blades 224 may thus be closed on top of one another, thus limiting the size of the cannula necessary to accept the retractor 220.
  • the retractor 220 may be properly aligned and operated. Placement of the retractor 220 may be aided by an endoscope.
  • the blades 224 may be spread apart by manipulating the second control member 244.
  • the knob 260 which tightens against the actuator 254 connected to the second control member 244, is loosened.
  • the handle 25.6 is pulled to move the actuator 254 proximally, thus the shaft 248 is moved towards the proximal end of the body 222. As shown in FIGURE 12, this forces the shaft 248 proximally between the blades 224, causing them to separate.
  • the knob 260 is tightened to lock the actuator 254 and the blades 224 into place.
  • the blades 224 may either be rotated from the longitudinal axis of the body 222 after the blades 224 have been separated, or the above separation step may be omitted.
  • the knob 260 which fixes actuator 241 is loosened.
  • the handle 243 on actuator 241 is pushed distally, forcing the first control member 238 to rotate.
  • the control member 238, in turn, rotates the blades 224 away from the longitudinal axis of the body 222 through recess 227.
  • the knob 260 may then be tightened to fix the actuator 241 and the blades 224 in this extended position.
  • the opening 227 in the distal end 225 of the body 222 is of such a width and length to allow the blades 224, which are spaced apart when being used, to move a greater distance radially outward than would be possible without the recess 227.
  • a recess could be provided in the top of the body 222; however, merely by turning the retractor 220 over, any "upward” retraction can easily be accomplished.
  • the blades 224 are moved downward before they are spaced apart, the range of motion is limited " , since the blades 224 will contact the track 250 which extends towards the distal end 225 of the body 222 (FIGURE 9) .
  • the angle at which the blades 224 extend from the body 222 before contacting the track 250 may be varied.
  • the blades 224 are closed together. This is accomplished by loosening the knob 260 connected to the actuator 254.
  • the spring 252 causes the shaft 248 to move distally until it falls into the notches 221 in the blades 224, at which time the blades 224 will be closed together.
  • the springs 235 bias the blades 224 toward one another so that they are closed together at the same time as the shaft 248 moves into the notches 221.
  • the knob 260 connected to the actuator 241 is then loosened so that the blades 224 move back to a line parallel to the longitudinal axis of the body 222.
  • the body 70 houses three blades 72, 74, 76.
  • a first blade 72 is designed to provide medial retraction
  • a second blade 74 is designed to provide inferior retraction
  • a third blade 76 is designed to provide lateral retraction. All three blades 72, 74, 76 are preferably flat, thin members. The exact length, width and shape of each blade 72, 74, 76, may, of course, be individualized for specific procedures. Further, it is contemplated that only one or two, or four or more blades may be utilized.
  • the three blades 72, 74, 76 are all mounted and controlled alike, the three blades being spaced 120° from one another in the body 70 near its distal or insertion end 102.
  • the first blade 72 is attached at one end to a block 80, comprising a small rigid member.
  • a U-shaped mounting pin 82 passes through a bore (not shown) in the block 80.
  • the pin 82 is connected at each of its ends to the inside of the body 70. This mounting allows the block 80, and thus the blade 72, to rotate about the pin 82.
  • the block 80 may be formed as part of the blade 72 so that the blade 72 in effect has a mounting end (see FIGURE 13) .
  • An actuator 86 is attached to the side of the block 80 facing the center of the body 70 (FIGURE 14) .
  • a pin (not shown) passes through the actuator 86 and a mounting member 90 on the block 80 configured to allow the actuator 86 to move relative to the block 80.
  • the actuator 86 extends the length of the body 70 to a handle (not shown) , similar to that described above in the second embodiment, located at the proximal or control end of the body.
  • the actuator 86 passes through a tubular guide member (not shown) .
  • a threaded shaft attached to a knob like that described in the above embodiment may again be used to lock the actuator 86, and thus prevent the blade 72 from moving.
  • a spring 100 (FIGURE 13) is mounted at one end of the block 80 on the same side as the actuator 86.
  • the spring 100 is mounted to the body 70 at its other end, and biases the blade 72 towards a position where the blade 72 lies along a line parallel to the longitudinal axis of the body 70.
  • the body 70 is shaped primarily like the body 22 described above. In this embodiment, however, there are three openings 104 located at the distal end 102 of the body 70.
  • the openings 104 extend from the distal end 102 along the body 70 towards its proximal end just past the block 80.
  • the openings 104 provide an area for the blades 72, 74, 76 to extend radially out of the body 70.
  • the retractor 20 is inserted into the patient's body as described above.
  • the blades 72, 74, 76 of the retractor 20 will be aligned along the axis of the retractor body 70 at this time.
  • the blades 72, 74, 76 may individually be extended so as to retract tissue and organs.
  • a given blade 72, 74, 7.6 is easily manipulated by using its respective actuator 86.
  • the locking knob is loosened so that the actuator 86 may be pushed inwardly using the handle on its end. This causes the block 80 to rotate about the pin 82, causing the blades 72, 74, 76 to move away from the longitudinal axis of the body 70 through its corresponding opening 104.
  • the locking knob is then tightened to fix the position of the blade 72, 74, 76.
  • all three blades 72, 74, 76 may be advantageously moved independently of one another. This allows the user to customize retraction in the lateral, inferior and medial directions.
  • the retractor 20 may be removed simply by loosening the locking knob, and allowing the spring 100 to bias the blades 72, 74, 76 back towards the axis of the body. When all blades 72, 74, 76 have returned to this position, the retractor 20 may be removed.
  • the bladed endoscopic retractor 120 in this embodiment is similar to the first embodiment described above, and comprises a body 122 and various retractor blades 124 extending therefrom which are manipulatable by various controls 126.
  • the body 122 of the retractor 120 is a tube.
  • the body 122 is similar in shape and dimension to that described in the above embodiments, and may be made of the same materials.
  • the body 122 once again has a proximal or control end 123 and a distal or insertion end 121.
  • the distal end 121 of the body 122 preferably has one large opening or recess 127 extending from the end proximally along the body 122.
  • the proximal end 123 of the body 122 is the site of the various controls 126 which operate the retractor.
  • the blades 124 are mounted within the distal end of the body 122 and extend therefrom.
  • the blades 124 have nearly the same shape and dimension as those in the above embodiments, except that in this case their proximal ends bend outwardly towards the sides of the body 122, as shown in FIGURES 15 and 16.
  • An S shaped spring 125 is mounted in between the blades 124 at their proximal ends.
  • the spring 125 as illustrated in FIGURES 17 and 18, is made of flat spring steel and is securely fastened to the end of one of the blades 124, extending distally until it contacts the other blade.
  • the spring 125 has the tendency to force the proximal ends of the blades 124 apart, and thus the distal ends of the blades 124 together.
  • the distal ends of the blades 124 rest in their non-use position against one another.
  • the blades 124 extend from their distal ends located outside the body, into the distal end 121 of the body 122 and then pass through a first control member 138 and terminate at their proximal ends inside a second control member 144.
  • a pin 164 passes through holes in the blades 124 at a point between the first and second control members 138, 144.
  • the pin- 164 is designed such that the blades 124 are securely retained on the pin 164, and yet the blades 124 have space on the pin 164to allow them to move slightly.
  • the first control member 138 is a disc which is relatively thick and substantially cylindrical.
  • the first control member 138 is housed inside the body 122 near its distal end 121 and just proximal to the proximal end of the opening 127 in the body 122.
  • the first control inember 138 is primarily of the same shape and dimension as the first control member 38 described in the first embodiment.
  • the first control member 138 has an hourglass cutout 139 (FIGURE 18) of its middle, through which the blades 124 extend.
  • the height of the cutout 139 being nearly the same as that of the blades 124.
  • the width of the cutout 139 is such that it allows the blades 124 to move apart from one another.
  • the blades 124 are connected to one another and the first control member 138.
  • One blade 124 has a U shaped member 160 which faces towards the other blade 124.
  • the other blade 124 has a flange 162 which extends into the opening of the U shaped member 160.
  • a pin 164 is located inside the cutout 139 in the first control member 138 and oriented perpendicular to the axis of the blades 124. This pin 164 extends through holes in the U shaped member 160 and flange 162.
  • pins 140 are mounted opposite one another on each side of the first control member 138 and perpendicular to the axis of the blades 124.
  • the pins 140 extend from the first control member 138 into small holes 142 in the body 122. This mounting allows the first control member 138 to rotate about the pins 140 inside the body 122.
  • an actuator 141 is mounted to the proximal side of the first control member 138 at a point near the top middle of the member 138.
  • the actuator 141 is preferably a long rod which extends from a handle 143 at the proximal end of the body 122 to a locking member 145 which is the same as that as disclosed in the second embodiment detailed above.
  • the second control member 144 is, as stated above, mounted proximally of the first control member 138.
  • This second control member 144 comprises an actuating block 148 mounted on a track 150.
  • the actuating block 148 is primarily circular on its outer surface.
  • a cutout 149 is provided in the block 148 to allow the acceptance of the proximal ends of the blades 124.
  • the cutout 149 extends from the distal facing side of the actuating block 148,'- " widening as it extends through the block where, near the proximal facing side of the block, the cutout has a fixed size.
  • the cutout 149 is of a height such that it allows the blades 124 to move up and down therein without contacting the top or bottom of the cutout.
  • the proximal ends of the blades 124 extend into the cutout 149 in the actuating block 148.
  • the shape of the proximal ends of the blades 124 allows the blades 124 to conform to the walls of the cutout inside the block 148.
  • the actuating block 138 is mounted upon a track 150.
  • the track 150 runs parallel to the blades 124.
  • An actuator 154 is mounted to the lower proximal face of the actuating block 148, and extends to a handle 156 located at the proximal end of the body 123 (FIGURE 15) .
  • the handles 143, 156 and their lockable mounting are primarily the same as that described in the second embodiment above, and therefore they will not be described here.
  • the retractor 120 is installed into the body in the area to be retracted with the blades 124 in their non-actuated position corresponding to that where th distal ends of the blades 124 are located side by side against one another and along the longitudinal axis of the body 123 (FIGURES 15 and 17) .
  • the various handles 143, 156 are used.
  • the second handle 156 is pulled, forcing the second control member 144 along the track 150 towards the proximal end of the body 122.
  • the first handle 143 When it is desired to move the blades 124 up or down away from the longitudinal axis of the body 122, the first handle 143 is used. The user pushes upon the first handle 143, forcing the first control member 138 to rotate about the pins 140. This causes the blades 124, which pass through the cutout 139 in the first control member 138 to be rotated downwardly. The distal ends of the blades 124 move away from the longitudinal axis of the body 122, extending through the opening 127 in the body 122, as seen in FIGURE 16. As can be seen, the opening 127 allows the blades 124 to move to a greater extent than is possible without the opening.
  • the movement of the blades is limited by the body 122. While an opening could be provided on both the top and bottom of the body 122, this would tend to compromise the structural integrity of the distal end 121 of the body 122. This same function can be accomplished merely by having one opening and turning the device over to provide retraction in the upward direction.
  • the above arrangement allows the blades 124 to independently be spread apart or moved up or down to any extent. This advantageously allows retraction to be individualized in either or both directions for the specific use to which the retractor 120 is being put.
  • this retractor 120 has numerous benefits. For example, it has no control member located very near the distal, open end of the body 122.

Abstract

A retractor (20) is provided for use during endoscopic surgery. Bladed instruments located inside the patient's body at an insertion end of the retractor are manipulated by controls (26) located outside the body at a control end. In three embodiments, the retractor comprises a tubular body (22) having an insertion and control end. Two blades (24) are movably connected in the insertion end of the body. The blades may be moved in various combinations, being extended away from the longitudinal axis of the retractor body and/or spread apart. The blades may be actuated with controls (38, 44) which extend from the control end of the body. In another embodiment, the retractor comprises a tubular body also having an insertion and control end. Three blades are movably attached to the insertion end of the body. The blades may be independently extended radially outward from the longitudinal axis of the retractor body. Each blade is actuable from a separate control located at the control end of the body.

Description

BIADED ENDOSCOPIC RETRACTOR
Field of the Invention The present invention relates to retractors used in surgery. More specifically, the invention relates to a bladed, expandable endoscopic retractor by which tissue, internal organs, or other internal body parts may be retracted to provide visualization and surgical access during endoscopic procedures.
Background of the Invention The field of endoscopic surgery has been advancing rapidly in recent years. In this form of surgery, procedures are performed inside of the body of a patient using instruments inserted through small endosurgical ports in the body. The surgery is performed with the aid of an endoscope, which is a thin, tube-like instrument featuring a light source, viewing lenses, and/or various other attachments such as irrigators, scissors, snares, brushes, or forceps. Endoscopes may be flexible or rigid, and normally utilize optic fibers to transmit light to the internal cavity. The surgery is normally viewed by the surgeon through an ocular. Lenses are placed near the tip of the endoscope and the image thereon is transmitted via optic fibers or other lens systems, to the ocular or viewer. Other types of endoscopes utilize optical fibers to transmit electronic signals representing the internal image from the distal lens to a video monitor which is viewed by the surgeon.
This form of surgery allows internal visualization of the body structure without the necessity of excessive dissection of tissue. Typical endoscopes often are in the 5 to 12 mm diameter range and thus require only very small incisions to insert them into the body.
This form of surgery has developed rapidly because of the numerous benefits arising in favor of the patient. Since there is only a small incision to permit entrance of the endoscope, endoscopic surgery results in less trauma to the body and faster patient recovery. For the benefits of endoscopic surgery to arise, however, all aspects of the surgery, such as the initial examination, retraction, and the surgical procedure itself, must be accomplished through small surgical incisions or ports.
The obvious difficulty associatedwith endoscopic surgery is inadequate visualization of the internal structure required to properly complete the surgical procedure. Endoscopic surgery is thus difficult in areas which are typically difficult to reach, such as the gallbladder. In gallbladder surgery, (or "cholecystectomy") the tissue and organs surrounding the gallbladder are examined with the endoscope and retracted in order to properly expose the organ which is to be removed.
Currently, endoscopic procedures in the abdominal cavity, otherwise known as laparoscopy, often require retraction. Specifically, endoscopic cholecystectomy requires retraction of the liver, which rests directly above the gallbladder. In an open surgery operation, retraction is relatively easy, as the surgery involves the exposure of the entire organ area. In order to obtain the benefits of endoscopic surgery, however, a form of retraction which can be accomplished through ports is necessary.
In an endoscopic procedure involving the gallbladder or other abdominal organs, retraction is currently accomplished by inflating the peritoneal cavity with carbon dioxide. This method of retraction involves creating a small surgical port for introducing a gas source. The gas is introduced into the body through a cannula, and a state of pneumoperitoneum occurs. The gas inflates the peritoneal cavity so as to cause the skin and muscles to separate and rise above various organs and tissue, thus creating the exposure necessary to accomplish the- endoscopic surgery.
Several problems are associated with pneumoperitoneal retraction, however. First of all, exposure remains adequate only while the required pneumoperitoneal state remains. Since endoscopic surgery normally requires the introduction of at least the endoscope, and more often several other tools, a number of surgical ports will most likely be created in the body. Each of these ports, which normally use a cannula to keep them open for access, in effect create an exhaust port for the gas. The risk that insufflation pressure may be lost increases the risk that the endoscopic procedure may go awry as adequate exposure for the endoscope is extinguished.
Further, there are many complications which are associated with persistent pneumoperitoneum during an endoscopic procedure. Acute cardiovascular collapse secondary to over-distension of the abdomen, vasovagal reflex activation, cardiac arrhythmia, pneumothorax, subcutaneous emphysema, alteration of large vein venous return, retinal hemorrhage, blindness, carbon dioxide embolism, and general patient discomfort have all been associated with persistent pneumoperitoneum. Lastly, pneumoperitoneal retraction is effective in retracting only the muscles and tissue from above the organs. The organs themselves are not, to a great extent, retracted from each other.
There is therefore a need for a device and method which provides retraction in conjunction with endoscopic procedures, which is effective in providing adequate visualization and access, and which is safe and has fewer side effects than current methods.
Summary of the Invention In accordance with one aspect of the present invention, there is provided a bladed retractor system for use in endoscopic surgery. The invention permits safe and effective endoscopic retraction of internal organs and tissue during endoscopic surgery. Retraction is accomplished with the present invention through the use of supporting retractor blades which are manipulatable. The blades are movably connected at one end to the inside of a tubular body designed for endoscopic use, and extend therefrom to free ends which may be used to retract the various organs and tissue.
In one embodiment, two blades are movably connected to the insertion or distal end of a tubular body. The body is an elongated member having a small outside dimension for endoscopic use. The body has an opening at its distal end to allow maximum movement of the blades away from the body. The blades, which are primarily flat, thin supporting members, are manipulated by controls located at a control end'~όf the body which is opposite the insertion end of the body. The blades, when in the non-use position r rest substantially directly on top of one another and along a line virtually parallel to the longitudinal axis of the body, thereby aiding in the ease of installing the retractor into the patient's body.
One end of the blades is connected to a vertical pin mounted in a first control member inside the tubular body. The first control member is rotatably attached to the inside of the tubular body. The blades extend from the first control member through a second control member. The second control member is a hollow box shaped member, and rides in a track which extends from the distal end of the body towards the proximal end of the body. A shaft is positioned inside the second control member. The shaft is mounted perpendicular to the blades and extends between them. The blades have a notch in them at a point near their passage through the second control member to accept the shaft.
An actuator is connected to the second control member and extends to a handle at the control end of the body. Movement of the retractor blades is accomplished by manipulating the handle.
In their non-use position, the blades of this retractor embodiment rest primarily on top of one another, as the notch in each blade accepts the shaft of the second control member. The blades lie along the longitudinal axis of the body of the retractor. In this position, the retractor may easily be inserted into the body.
When it is desired to provide retraction, the handle is pushed upon and the second control member is pulled proximally along the track in the body. When this occurs, the shaft in the second control member forces the blades apart. At the same time, the second control member forces the blades downward, away from the longitudinal axis of the body.
A second embodiment of the present invention is substantially similar to the first. However, in this embodiment, the first and second control members are individually anipulatable so as to allow the user to separate and/or extend the blades separately. In this embodiment, the first control member is the same as in the first embodiment, except that an actuator extends from the member to a lockable handle at the control end of the body.
The second control member comprises a shaft which rides in tracks spaced 180° apart at the distal end of the body. The second control member is spring biased towards the distal end of the body. An actuator extends from the second control member to a handle at the control end of the body.
The blades rest in their non-use position on top of one another, along the longitudinal axis of the body, as in.the first embodiment. When it is desired to provide retraction, the blades may be extended outwardly through a recess in the distal end of the body and/or spread apart from one another. The actuator, which extends to the first control member, allows the user to move the blades up or down, or, in other words, radially outward in a vertical plane from the longitudinal axis of the body. The second control member may be actuated by its corresponding handle and the control end of the retractor body. Once again, pulling on the handle moves the second control member proximally, causing the blades to separate.
In a third embodiment of the present invention, the endoscopic bladed retractor comprises a body, controls, and three blades. The body of this retractor is also tubular and long, having a small outer dimension for endoscopic use. The body also has openings at its distal or insertion end to allow the blades to extend outward. • The blades are thin, flat supporting members, each of which is rotatably connected to the body and spaced 120° from one another. Each blade is connected to a rotatable member which allows the blade to extend from a non-use position where the blade is located primarily along a line parallel to the longitudinal axis of the body, to a retraction position where the blade extends outward from the body. Each member has an actuator connected to it which extends to a handl'e located on the control or proximal end of the body. Further, a locking mechanism is provided to allow each actuator, and thus each blade, to be securely fixed in any position. This retractor, when placed in the body, allows the user to individually select and adjust retraction in the inferior, lateral, and medial directions.
In a fourth embodiment of the present invention, the bladed endoscopic retractor comprises two blades. The body of this retractor is tubular and long, having an opening in the wall of the body at its insertion end to allow the blades to extend therethrough.
The blades are again primarily thin, flat supporting members, both of which extend from a proximal end located inside the body, to a distal end which extends outside of the body of the retractor. The proximal end of the blades is located inside a second control member which is located proximal to the first control member. The blades extend distally from the second control member to engage a first control member. The first control member is rotatably connected to the inside of the distal end of the body.
The blades are connected to one another inside the first control members by a pin. A spring bias is provided between the blades at. their proximal ends so that when they are in a non-use position, their distal ends are pressed against one another. *
The second control member is movably positioned inside the body, thus allowing the control member to move along the longitudinal axis of the body. The second control member has an internal cut out in which the proximal ends of the blades are mounted.
Actuators are connected to both the first and second control members and extend therefrom to the proximal or control end of the body. Lockable handles are connected to the actuators at their proximal ends.
The blades in this fourth embodiment, like the second embodiment, may be moved independently apart from one another and/or extended away from the longitudinal axis 'of the body. Advantageously, this embodiment creates less of a risk that tissue inside the body will be damaged. This is because both the first and second control members are located a distance away from the end opening at the distal end of the retractor body. This lessens the chance that tissue which may be pressed into the end of the retractor and caught in the various controls.
In all of the embodiments of the present invention, the blades, when deployed, effectively support the various surrounding organs and tissues by pushing them laterally apart and away from the operating area. In addition, the blades may lift and separate the organs and tissues. Thus, the retractor of the present invention safely provides counter traction for endoscopic surgical procedures. That is, due to a lack of precise depth perception, a significant danger in many forms of endoscopic surgical procedures is cuts or incisions that go too deep may injure vital tissues or organs. Therefore, in order to achieve accuracy in such surgical procedures, there is a need to move neighboring tissue away from the area of incision in order to avoid damage. This is best accomplished by means of counter traction in which the neighboring tissues or organs are moved in one direction by a retractor device while another- instrument performs the cut or incision. This movement in opposite directions is referred to as counter traction. In this manner, the retractor blades may also be used to tear or rip apart tissue and organs without the need to use a second instrument, thus serving as a dissector.
Further, there are no obstructions or mechanical structures between the blades when they are extended and separated which might interfere with the surgical procedure. Therefore, a surgeon may clip, cut, or suture in the area between the blades. In this regard, it will be noted that the blades are mounted to the body such that when rotated downward or otherwise extended, the body is tangential to the area of retraction, further avoiding any surgical interference.
Also, the blades are sufficiently rigid so as not to excessively bend or flex when the body is advanced and the blades are used to push organs and tissue out of the way. This allows the blades to be pushed harder against the tissues or organs. This is particularly important, since during use, the blades are essentially cant.ilevered from the body. On the other hand, a slight flexing of the blades is desired so as to avoid damage to the tissues or organs. This is provided in the embodiments as described, by providing a slight curvature to the shape of the blades. This curvature not only provides slight flexibility, but can also be used to minimize or maximize retraction surface area. For example, if the blades are concave in the direction of retraction, the effective surface area of retraction is increased. If the blades are convex in the direction of retraction, the surface area of contact between the blades and the tissues and organs is minimized, thereby limiting damage to said tissues and organs.
Therefore, an important advantage of the present invention is that the blades of the present retractor can safely provide counter traction for a wide variety of endoscopic surgical procedures. In addition, the blades of the retractor are devoid of webbing or other mechanical linkages, thus, avoiding damage to the retracted tissue. The blades are also slightly curved in shape to provide limited flexibility and minimize or maximize the retraction surface area.
Thepresentbladed endoscopic retractors provide positive retraction which does not have the dangers associated with continuous peritoneal insufflation. The present invention can be placed with only slight initial insufflation to provide easy insertion of the device. After insertion, retraction can be maintained simply and safely«with the blades. Advantageously, the present retractor is quite small and is easily introduced into the body through only a single small opening. Further, this method of retraction is much more effective in retracting larger organs than the insufflation method. The invention allows the surgeon or a'ssistant to manually retract an organ to any extent necessary, by merely manipulating the position of the blades with the controls. This is in contrast to the insufflation method, where the gas indiscriminately fills the body cavity. Further, these retractors are adaptable for use on organs of various sizes. By adjusting the blade size and position, the retractor can retract nearly any organ.
Therefore, the retractor of the present invention provides a very advantageous solution to the problems associated with insufflation retraction during endoscopic surgery.
Brief Description of the Drawings FIGURE 1 is a schematic view illustrating the manner in which the retractor of the present invention may be inserted through a small surgical port for use in endoscopic surgery. FIGURE 2 is a perspective side view of the first embodiment of the bladed endoscopic retractor of the present invention illustrating the blades thereof in their non- separated, non-extended (non-rotated) position, suitable, for example, for endoscopic insertion.
FIGURE 3 is a partial enlarged side view of the distal end of the first embodiment.
FIGURE 4 is a partial enlarged top view of the distal end of the present invention illustrating the blades in a slightly separated position.
FIGURE 5 is a partial enlarged perspective view of the distal end of the present invention showing the blades in a slightly separated, non-extended position.
FIGURE 6 is an enlarged side view of the distal end of the present invention showing the blades in their separated, extended retraction position. FIGURE 7 is an enlarged perspective view of the distal end of the present invention showing the blades in their separated, extended, retraction position.
FIGURE 8 is a partial side view of the second embodiment of the present invention.
FIGURE 9 is a side view of the second embodiment of the present retractor illustrating the blades tilted downwardly away from the longitudinal axis of the retractor body.
FIGURE 10 is an end view of the retractor of the second embodiment illustrating the blades in their non-extended position.
FIGURE 11 is a partial top view of the second embodiment of the present retractor, illustrating the blades in their non-extended position. FIGURE 12 is a partial top view of the second embodiment of the present retractor, showing the blades in their separated, extended retraction position.
FIGURE 13 is a partial enlarged perspective end view of the third embodiment of the present invention. FIGURE 14 is an enlarged end view of the retractor of
FIGURE 13 with the blades extended.
FIGURE 15 is a partial side view of the fourth embodiment of the present invention.
FIGURE 16 is a partial side view of the retractor of FIGURE 15 with the blades in their extended retraction position.
FIGURE 17 is a partial top view along LINE 17-17 of the distal end of the retractor of FIGURE 15.
FIGURE 18 is a partial top view of the distal end of the retractor of FIGURE 15 with the blades in their separated, extended retraction position.
Detailed Description of the Illustrated Embodiment
Referring first to FIGURE 1, there is shown a schematic view of a patient undergoing endoscopic surgery. Thus, a small surgical port A is shown through which an endoscope 21 is inserted. This allows the surgeon to view the internal tissues and organs in the surgical area. Other surgical devices (not shown) may be inserted through similar surgical ports B and C in order to perform the desired procedure.
The retractor 20 of the present invention is shown inserted through yet another port D so as to be in the surgical region. Thus, the retractor can be used to safely manipulate tissues or organs during surgery. It should be noted, however, that the principles of the present invention are not limited to any particular surgical procedure but may be applied to a wide variety of procedures and applications. First Embodiment
Referring to FIGURE 2, there is shown one embodiment of the bladed endoscopic retractor 20 of the present invention. FIGURE 2 discloses a body 22 having various retractor blades 24 extending therefrom which are manipulatable by various controls 26. As illustrated, the body 22 of the bladed endoscopic retractor 20 is a tube. The body 22 may be of other shapes; however, a circular cross-section is preferred since it is most easily inserted into a cannula. The outer diameter of the body 22 is preferably minimized so that the incision size required to insert the endoscopic retractor and the trauma to the patient's body is also minimized. The length of the body 22 is dependent primarily upon the type of procedure in which the bladed endoscopic retractor 20 is to be used. The body 22 has a proximal or control end 23 and a distal or insertion end 25. The distal end 25 of the body 22 has an elongated opening 27 (FIGURE 3) extending from the end in a proximal direction along the underside of the body 22. The proximal end 23 is the site of the various controls 26 which operate the retractor. The body 22 is preferably made of a material, such as stainless steel, which will remain free from degradation, is easily sterilized, and is biocompatible.
Blades 24 are mounted within the body 22 near the distal end 25 so as to extend therefrom. The blades 24, as shown in FIGURE 4, are primarily flat, elongated members. The blades 24 may, of course, take on a variety of shapes depending upon the particular surgical procedure, so long as they will not cause trauma to internal tissues or organs, either during insertion or use. The blades 24 taper at their proximal end 32 (FIGURE 3) where they are movably connected to the body 22. The blades 24 each have a notch 21 (FIGURE 5) at a point near their exit from the body 22. The notches 21 ϋire slightly elongated and taper distally to a point where each notch is wide enough to accept a shaft 48 as described below in connection with FIGURE 5.
The blades 24, as illustrated in FIGURES 2-5, rest in their non-use position on top of one another. As shown in FIGURE 5, a pin 34 passes vertically through holes 36 in the proximal end of the blades 24. The pin 34 is, in turn, mounted to a first control member 38. The first control member 38 comprises a disc which is relatively thick and substantially cylindrical. The disc is housed inside the body 22 near its distal end 25. The diameter of the first control member 38 is less than the inner diameter of the body 22, so that it may rotate in the body 22. The first control member 38 has a rectangular portion cut out of its middle section, inside of which the pin 34, which supports the blades 24, is mounted. The first control member 38 also has a small arch 39 cut out of its bottom surface thus allowing the passage of an actuator 54, which will be described in more detail later.
Pins 40 (FIGURE 5) are mounted opposite one another on each side of the first control member 38 and perpendicular to the direction that the pin 34 is mounted. The pins 40 extend from the first control member 38 into small holes 42 in the body 22. This mounting allows the first control member 38 to rotate about the pins 40. A second control member 44 is mounted distally of the first control member 38. This second control member 44 is a hollow square body having a shaft 48 mounted therein. The shaft 48 is oriented perpendicular to the blades 24. As can be seen in FIGURE 5, the blades 24 pass through the second control member 44 on either side of the shaft 48. Referring to FIGURE 3, it can be seen that the height of the second control member 44 is less than the height at which the blades 24 are connected at their proximal ends 32 to the first control member 38. This differential provides for the generation of a movement acting about connection pin 40, as described in more detail below. As illustrated in FIGURE 5, the second control member 44 rides in a track 50 in the inside of the body 22. The mounting of the second control member 44 on the track 50 allows the control member 44 to move along the inside of the body 22 in a direction parallel to the longitudinal axis of the body 22. An actuator 54 is attached to the second control member 44 at its lower end on the proximal side, extends through the arch 39 in the first control member 38, and continues through the body 22 to its proximal end, where it is attached to a handle 56. Referring to FIGURE 2, handles 43, 56 are both located outside of the proximal end 23 of the body 22. The handles 43, 56 as illustrated are elongated and are of a dimension sufficient to permit manipulation by hand. Each handle 43, 56 is preferably made from stainless steel. Handle 43 is connected securely to the body 22. Handle 56 is rotatably connected to handle 43 with a pin 66. Handle 56 is also connected to actuator 54 by a pin 41. The handles 43, 56 could, of course, be made of plastic or other durable material and could be attached to the actuator 54 with glue, screws or other means.
A notched member 68 extends from handle 43 towards handle 56. The notched member 68 is slightly curved and lies directly alongside handle 56. The notches in the notched member 68 are engaged by a pin (not shown) extending outwardly from handle 56. In this manner, handle 56, and its corresponding actuator 54, may be locked into any position using the pin and notch lock.
Referring to FIGURES 3-7, the operation of the retractor 20 as used to provide retraction in a cholecystectomy procedure will now be described. The retractor 20 is inserted into the body. This is normally accomplished by introducing a state of slight pneumoperitoneum, and then sliding the retractor 20 into the body through a cannula. When the retractor 20 is initially inserted, the blades 24 should be in their non-use position; that is, aligned parallel to the axis of the body 22 with one on top of the other (FIGURE 3) . As is now evident, the accommodate the shaft 48 in'" the second control member 44 so as to allow the blades 24 to lie nearly directly on top of one another in their non-use position. This is particularly advantageous since the blades 24 may thus be closed on top of one another, thus limiting the size of the cannula necessary to accept the retractor 20.
Once the retractor 20 is in the body, it may be properly aligned and operated. Placement of the retractor 20 may be aided by an endoscope. Once in place, handle 56 is pushed away from handle 43 along the notched member 68. In this fashion, actuator 54 pulls the second control member 44 towards the control end 23 of the body 22 along the track 50. When this occurs, the shaft 48 (FIGURE 5) in the second control member 44 forces the blades 24 apart. At the same time, because the height of the second control member 44 is lower than the connection of the blades 24 to the first control member 38, the blades 24 are forced downwardly and away from the longitudinal axis of the body 22 due to the movement force mentioned above. As can be seen from FIGURES 5-7, the rotation of the blades 24 away from the longitudinal axis of the body 22 is facilitated by the rotational mounting of the first control member 38 on the pins 40. In this embodiment, therefore, operation of the actuator 54 simultaneously spreads the blades apart and pushes them downward away from the longitudinal axis of the body 22. Deployment of the blades into this retraction position is accomplished by this simultaneous spreading of the blades 24 (FIGURE 7) and their downward rotation (FIGURE 6) away from the longitudinal axis of the body 22.
Therefore, the blades of the present retractor can assume a variety of positions with the degree of spreading being proportional to the rotation of the blades. When the appropriate deployment of the blades is accomplished, they can be locked in place for safe retraction. As shown in FIGURE 7, the blades 24 of the present retractor are relatively blunt and without sharp edges in order to avoid damage to the retracted tissue. In addition, as well illustrated in FIGURE 7, there are no connections or mechanical linkages located between the blades which would pinch or lacerate tissues. Therefore, the present retractor safely provides counter traction for many types of endoscopic surgical procedures in the peritoneal area. Once the surgical procedure has been completed and it is desired to remove the retractor 20, handle 43 is pulled in the direction of handle 56. Pulling handle 43 in this direction forces the second control member 44 towards the distal end 25 of the body 22. This allows the blades 24 close together, to a point where the shaft 48 is once again resting in the notches 21 and the blades 24 are nearly on top of one another. At the same time as the blades 24 are closed towards one another, because the second control member 44 has moved away from the first control member 38, causing the blades 24 to rotate back towards the longitudinal axis of the body 22. At this time the retractor 20 may be removed from the body. Second Embodiment
A second embodiment of the retractor 220 is illustrated in FIGURES 8-12. This embodiment is similar to the first embodiment; however, in this embodiment, first and second control members 238, 244, are independently manipulatable. Thus, the degree of separation or degree of spreading of the blades can be adjusted for retraction independently of the degree of downward rotation or extension of the blades away from the longitudinal axis of the body 222. In addition, these adjustments for separation and downward rotation-can be accomplished one at a time or simultaneously, if desired.
As illustrated in FIGURE 8, the retractor 220 comprises the body 222 having retractor blades 224 extending therefrom which are manipulatable by various controls 226.
The body 222 is similar in construction to the body 22 described above, having similar dimensions and materials. The body 222 has a proximal or control end 223 and a distal or insertion end 225. The body 222, once again, has a lower elongated recess 227 extending from the distal end 225 towards the proximal end 223. The various controls 226 are again located at the proximal end 223 of the body 222/-"
The blades 224 extend from the distal end 225 of the body 222, and are similar in shape and material to those described above. A notch 221 (FIGURE 12) is located in each of the blades 224 to facilitate the introduction of a shaft 248, as described more fully below.
The blades 224, as illustrated in FIGURES 8, 10 and 11, rest in their non-use position on top of one another. A pin 234 passes vertically through holes 236 in the proximal end of the blades 224. The pin 234 is, in turn, mounted to a first control member 238. Springs 235 (FIGURE 11) are attached to each blade 224 and to the inside of the body 222 so as to bias the blades 224 towards the center of the body 222 and against the shaft 248.
The blades 224 are connected at their proximal ends to a first control member 238 which is substantially similar to that described above, and thus will not be redescribed here.
An actuator 241 (FIGURES 8 and 9) is mounted to the proximal side of the first control member 238 at a point near the top middle of the control member 238. The actuator 241 is preferably a long rod which extends from a handle 243 at the proximal end of the body 223, to a mounting member 245 on the first control member 238. The mounting member 245 is, as shown in FIGURE 8, substantially U-shaped. The actuator 241 is attached to the mounting member 245 with a pin 246 which passes through the actuator 241 and the mounting member 245.
A second control member 244 (FIGURES 8 and 9) is mounted distally of the first control member 238. This second control member 244 comprises a shaft 248 mounted at both ends in a track 250. The ends of the shaft 248 slide along the tracks 250, which are T-shaped grooves formed on the inside of the body 222. The tracks 250 are spaced 180° from one another. The shaft 248 extends between the tracks 250 and passes in between the blades 224. As can be seen in FIGURE 11, when the shaft 248 is at its furthest distal point in the tracks 250, the shaft passes through the notches 221 in the blades.
The mounting of the shaft 248 in the tracks 250 allows the shaft 248 to move along the inside of the b'ody 222 in a direction parallel to the axis of the body. A spring 252 mounted on the distal side of the second control member 244 biases the shaft 248 toward its furthermost distal point on the tracks 250. As illustrated in FIGURE 8, the spring 252 is attached to the inside of the body 222 at a point distal of the tracks 250.
An actuator 254 (FIGURE 9) is attached to the shaft 248 at its lower end on the proximal side, extends through the arch 239 (FIGURE 10) in the first control member 238, and continues through the body 222 to its proximal end, where it is attached to a handle 256.
Referring to FIGURES 8 and 9, the actuators 241, 254 each extend through a guide member 258. The guide members 258, as shown, are U-shaped members attached to the inside of the body 222 near its proximal end. The guide members 258 each surround its corresponding actuator 241, 254, thus forming a tube through which the actuator 241, 254 passes.
Knobs 260 are attached to threaded shafts 262 which pass through circular holes 264 in the body 222. The shafts 262 engage threaded bores in each guide member 258. Each knob 260 may be tightened into the guide member 258 so as to force the actuator 241, 254 therein against the other side of the guide member 258, thus preventing the actuator 241, 254 from moving. Therefore, the position of the blades 224 may be locked into place for use during the surgical procedure.
Referring to FIGURES 8-12, the operation of the retractor 220 as used to provide retraction in a typical surgical procedure will now be described. The retractor 220 is inserted into the body. This is normally accomplished by introducing a state of slight pneumoperitoneum, and then sliding the retractor 220 into the body through a cannula. When the retractor 220 is placed, the blades 224 should be in their non-use position shown in FIGURE 8; that is, aligned parallel to the axis of the body 222 with one on top of the other. As is now evident, the notches 221 accommodate the shaft 248 so as to allow the blades 224 to lie nearly directly on top of one another in their non-use position. This is particularly advantageous since the blades 224 may thus be closed on top of one another, thus limiting the size of the cannula necessary to accept the retractor 220.
Once the retractor 220 is in the body, it may be properly aligned and operated. Placement of the retractor 220 may be aided by an endoscope. The blades 224 may be spread apart by manipulating the second control member 244. The knob 260, which tightens against the actuator 254 connected to the second control member 244, is loosened. The handle 25.6 is pulled to move the actuator 254 proximally, thus the shaft 248 is moved towards the proximal end of the body 222. As shown in FIGURE 12, this forces the shaft 248 proximally between the blades 224, causing them to separate. Once the blades 224 have been separated by the proper distance, the knob 260 is tightened to lock the actuator 254 and the blades 224 into place.
The blades 224 may either be rotated from the longitudinal axis of the body 222 after the blades 224 have been separated, or the above separation step may be omitted. To extend the blades 224, as illustrated in FIGURE 9, the knob 260 which fixes actuator 241 is loosened. The handle 243 on actuator 241 is pushed distally, forcing the first control member 238 to rotate. The control member 238, in turn, rotates the blades 224 away from the longitudinal axis of the body 222 through recess 227. The knob 260 may then be tightened to fix the actuator 241 and the blades 224 in this extended position.
The importance of the opening 227 in the distal end 225 of the body 222 is now apparent. The opening 227 is of such a width and length to allow the blades 224, which are spaced apart when being used, to move a greater distance radially outward than would be possible without the recess 227. Of course, a recess could be provided in the top of the body 222; however, merely by turning the retractor 220 over, any "upward" retraction can easily be accomplished. It should be noted that if the blades 224 are moved downward before they are spaced apart, the range of motion is limited", since the blades 224 will contact the track 250 which extends towards the distal end 225 of the body 222 (FIGURE 9) . Merely by adjusting the distance of the first control member 238 from the distal end 225 of the body 222, the angle at which the blades 224 extend from the body 222 before contacting the track 250 may be varied.
When it is desired to remove the retractor 220, the blades 224 are closed together. This is accomplished by loosening the knob 260 connected to the actuator 254. The spring 252 causes the shaft 248 to move distally until it falls into the notches 221 in the blades 224, at which time the blades 224 will be closed together. It will be noted that the springs 235 bias the blades 224 toward one another so that they are closed together at the same time as the shaft 248 moves into the notches 221. The knob 260 connected to the actuator 241 is then loosened so that the blades 224 move back to a line parallel to the longitudinal axis of the body 222. This accomplished by pulling the handle 243 so that the actuator 241 moves in a proximal direction, causing the first control member 238 to assume a more vertical position, thereby bringing the blades 224 into horizontal alignment with the body 222 of the retractor 220. At this time, the retractor 220 may be removed from the body through the cannula. Third Embodiment In another or third embodiment illustrated in FIGURES 13 and 14, the body 70 houses three blades 72, 74, 76. A first blade 72 is designed to provide medial retraction, a second blade 74 is designed to provide inferior retraction, and a third blade 76 is designed to provide lateral retraction. All three blades 72, 74, 76 are preferably flat, thin members. The exact length, width and shape of each blade 72, 74, 76, may, of course, be individualized for specific procedures. Further, it is contemplated that only one or two, or four or more blades may be utilized.
The three blades 72, 74, 76 are all mounted and controlled alike, the three blades being spaced 120° from one another in the body 70 near its distal or insertion end 102.
Therefore, only one mounting and control will be described herein.
The first blade 72 is attached at one end to a block 80, comprising a small rigid member. A U-shaped mounting pin 82, best seen in FIGURE 14, passes through a bore (not shown) in the block 80. The pin 82 is connected at each of its ends to the inside of the body 70. This mounting allows the block 80, and thus the blade 72, to rotate about the pin 82. It is contemplated that the block 80 may be formed as part of the blade 72 so that the blade 72 in effect has a mounting end (see FIGURE 13) .
An actuator 86 is attached to the side of the block 80 facing the center of the body 70 (FIGURE 14) . A pin (not shown) passes through the actuator 86 and a mounting member 90 on the block 80 configured to allow the actuator 86 to move relative to the block 80. The actuator 86 extends the length of the body 70 to a handle (not shown) , similar to that described above in the second embodiment, located at the proximal or control end of the body. The actuator 86, as described in the second embodiment, passes through a tubular guide member (not shown) . A threaded shaft attached to a knob like that described in the above embodiment may again be used to lock the actuator 86, and thus prevent the blade 72 from moving. A spring 100 (FIGURE 13) is mounted at one end of the block 80 on the same side as the actuator 86. The spring 100 is mounted to the body 70 at its other end, and biases the blade 72 towards a position where the blade 72 lies along a line parallel to the longitudinal axis of the body 70. The body 70 is shaped primarily like the body 22 described above. In this embodiment, however, there are three openings 104 located at the distal end 102 of the body 70. The openings 104 extend from the distal end 102 along the body 70 towards its proximal end just past the block 80. The openings 104 provide an area for the blades 72, 74, 76 to extend radially out of the body 70.
The operation of this third embodiment of the retractor 20 will now be described in conjunction with FIGURES 13 and 14.
The retractor 20 is inserted into the patient's body as described above. The blades 72, 74, 76 of the retractor 20 will be aligned along the axis of the retractor body 70 at this time. Once the retractor 20 is inside the patient's body, the blades 72, 74, 76 may individually be extended so as to retract tissue and organs. A given blade 72, 74, 7.6 is easily manipulated by using its respective actuator 86. The locking knob is loosened so that the actuator 86 may be pushed inwardly using the handle on its end. This causes the block 80 to rotate about the pin 82, causing the blades 72, 74, 76 to move away from the longitudinal axis of the body 70 through its corresponding opening 104. The locking knob is then tightened to fix the position of the blade 72, 74, 76. As can be seen, all three blades 72, 74, 76 may be advantageously moved independently of one another. This allows the user to customize retraction in the lateral, inferior and medial directions.
The retractor 20 may be removed simply by loosening the locking knob, and allowing the spring 100 to bias the blades 72, 74, 76 back towards the axis of the body. When all blades 72, 74, 76 have returned to this position, the retractor 20 may be removed.
Fourth Embodiment
Yet another embodiment of the present invention will now be described in conjunction with FIGURES 15-18. The bladed endoscopic retractor 120 in this embodiment is similar to the first embodiment described above, and comprises a body 122 and various retractor blades 124 extending therefrom which are manipulatable by various controls 126. As illustrated in FIGURE 15, the body 122 of the retractor 120 is a tube. The body 122 is similar in shape and dimension to that described in the above embodiments, and may be made of the same materials. The body 122 once again has a proximal or control end 123 and a distal or insertion end 121. The distal end 121 of the body 122 preferably has one large opening or recess 127 extending from the end proximally along the body 122. The proximal end 123 of the body 122 is the site of the various controls 126 which operate the retractor. As shown in FIGURES 15 and 18, the blades 124 are mounted within the distal end of the body 122 and extend therefrom. The blades 124 have nearly the same shape and dimension as those in the above embodiments, except that in this case their proximal ends bend outwardly towards the sides of the body 122, as shown in FIGURES 15 and 16. An S shaped spring 125 is mounted in between the blades 124 at their proximal ends. The spring 125, as illustrated in FIGURES 17 and 18, is made of flat spring steel and is securely fastened to the end of one of the blades 124, extending distally until it contacts the other blade. The spring 125 has the tendency to force the proximal ends of the blades 124 apart, and thus the distal ends of the blades 124 together.
As illustrated in FIGURES 15 and 17, the distal ends of the blades 124 rest in their non-use position against one another. The blades 124 extend from their distal ends located outside the body, into the distal end 121 of the body 122 and then pass through a first control member 138 and terminate at their proximal ends inside a second control member 144. A pin 164 passes through holes in the blades 124 at a point between the first and second control members 138, 144. The pin- 164 is designed such that the blades 124 are securely retained on the pin 164, and yet the blades 124 have space on the pin 164to allow them to move slightly. This may be accomplished by having the holes in the blades 124 be of a slightly larger diameter than the diameter of the pin 164, while having the ends of the pin 164 large enough to prevent the removal of the blades 124. The first control member 138 is a disc which is relatively thick and substantially cylindrical. The first control member 138 is housed inside the body 122 near its distal end 121 and just proximal to the proximal end of the opening 127 in the body 122. The first control inember 138 is primarily of the same shape and dimension as the first control member 38 described in the first embodiment. The first control member 138 has an hourglass cutout 139 (FIGURE 18) of its middle, through which the blades 124 extend. The height of the cutout 139 being nearly the same as that of the blades 124. The width of the cutout 139 is such that it allows the blades 124 to move apart from one another.
The blades 124 are connected to one another and the first control member 138. One blade 124 has a U shaped member 160 which faces towards the other blade 124. The other blade 124 has a flange 162 which extends into the opening of the U shaped member 160. A pin 164 is located inside the cutout 139 in the first control member 138 and oriented perpendicular to the axis of the blades 124. This pin 164 extends through holes in the U shaped member 160 and flange 162.
Once again, pins 140 are mounted opposite one another on each side of the first control member 138 and perpendicular to the axis of the blades 124. The pins 140 extend from the first control member 138 into small holes 142 in the body 122. This mounting allows the first control member 138 to rotate about the pins 140 inside the body 122.
As illustrated in FIGURES 15 and 16, an actuator 141 is mounted to the proximal side of the first control member 138 at a point near the top middle of the member 138. The actuator 141 is preferably a long rod which extends from a handle 143 at the proximal end of the body 122 to a locking member 145 which is the same as that as disclosed in the second embodiment detailed above.
The second control member 144 is, as stated above, mounted proximally of the first control member 138. This second control member 144 comprises an actuating block 148 mounted on a track 150. The actuating block 148 is primarily circular on its outer surface. As seen in FIGURES 17 and 18, a cutout 149 is provided in the block 148 to allow the acceptance of the proximal ends of the blades 124. The cutout 149 extends from the distal facing side of the actuating block 148,'-"widening as it extends through the block where, near the proximal facing side of the block, the cutout has a fixed size. The cutout 149 is of a height such that it allows the blades 124 to move up and down therein without contacting the top or bottom of the cutout.
As illustrated in FIGURES 15 and 17, the proximal ends of the blades 124 extend into the cutout 149 in the actuating block 148. The shape of the proximal ends of the blades 124 allows the blades 124 to conform to the walls of the cutout inside the block 148.
As stated above, the actuating block 138 is mounted upon a track 150. The track 150 runs parallel to the blades 124. An actuator 154 is mounted to the lower proximal face of the actuating block 148, and extends to a handle 156 located at the proximal end of the body 123 (FIGURE 15) .
The handles 143, 156 and their lockable mounting are primarily the same as that described in the second embodiment above, and therefore they will not be described here.
The operation of the retractor 120 will now be described. The retractor 120 is installed into the body in the area to be retracted with the blades 124 in their non-actuated position corresponding to that where th distal ends of the blades 124 are located side by side against one another and along the longitudinal axis of the body 123 (FIGURES 15 and 17) . When it. is desired to move the blades 124 in order to provide retraction, the various handles 143, 156 are used. In order to move the blades 124 apart from one another, the second handle 156 is pulled, forcing the second control member 144 along the track 150 towards the proximal end of the body 122. This causes the proximal ends of the blades 124 to be pressed towards one another as the width of the cutout 149 in the actuating block 148 of the second control member 144 decreases in size, as seen in FIGURE 18. This pressing of the blades 124 compresses the spring 125. As illustrated in this figure, the blades 124 are allowed to spread apart from one another through their rotatable connection at pin 164 in the first control member 138.
When it is desired to move the blades 124 up or down away from the longitudinal axis of the body 122, the first handle 143 is used. The user pushes upon the first handle 143, forcing the first control member 138 to rotate about the pins 140. This causes the blades 124, which pass through the cutout 139 in the first control member 138 to be rotated downwardly. The distal ends of the blades 124 move away from the longitudinal axis of the body 122, extending through the opening 127 in the body 122, as seen in FIGURE 16. As can be seen, the opening 127 allows the blades 124 to move to a greater extent than is possible without the opening. If the first control member 138 is moved such that it pushes the blades upward, the movement of the blades is limited by the body 122. While an opening could be provided on both the top and bottom of the body 122, this would tend to compromise the structural integrity of the distal end 121 of the body 122. This same function can be accomplished merely by having one opening and turning the device over to provide retraction in the upward direction. The above arrangement allows the blades 124 to independently be spread apart or moved up or down to any extent. This advantageously allows retraction to be individualized in either or both directions for the specific use to which the retractor 120 is being put. Lastly, this retractor 120 has numerous benefits. For example, it has no control member located very near the distal, open end of the body 122. This prevents tissue or other body material which might protrude slightly into the end of the body 122 from being damaged through operation of the retractor 120. Further, the mechanical operation of this retractor 120 is somewhat less complicated, allowing the cost of the device to be reduced. It will be understood that the above described arrangements of apparatus and the methods therefrom are merely illustrative of applications of the principles of this invention and many other embodiments and modifications may be made without departing from the spirit and scope of the invention.

Claims

WHAT IS CLAIMED IS:
1. An endoscopic retractor, comprising: a body having a distal end and a proximal end, said distal end being inserted into a patient's body and said proximal end remaining outside the patient,rs" body, said distal end defining a terminal plane for said body; a retracting member having distal and proximal ends, said proximal end of said retracting member being mounted for articulation on said distal end of said body, said distal end of said retracting member being adapted for retraction of tissues, organs, and the like; and an actuator connected to said retracting member at said distal end of said body and extending along said body to said proximal end thereof, said actuator being connected to said proximal end of said retracting member and being externally manipulable to cause said retracting member to assume a wide variety of angular positions with respect to the longitudinal axis of said body and achieve retraction in a wide variety of directions.
2. The endoscopic retractor of Claim 1, further comprising a control member rotatably mounted on said distal end of said body and engaging said proximal end of said retracting member
3. The endoscopic retractor of Claim 2 , wherein said control member is also mounted for movement in a direction parallel to the longitudinal axis of said body, said longitudinal movement occurring responsive to external manipulation of said actuator, whereby said retracting member may be adjusted to a variety of lateral positions.
4. The retractor of any of Claims l to 3 , wherein said retracting member comprises at least one blade having distal and proximal ends, said proximal end of said blade being mounted for articulation on said distal end of said body, said distal end of said blade extending proximally beyond said terminal plane of said body during retraction, so as to provide retraction in a direction away from said body with minimal interference from said body.
5. The retractor of any of Claims 1 to 4, wherein said distal end of said body is undercut to allow said blade to assume said variety of angular positions.
6. The retractor of any of Claims 1 to 5, comprising at least two blades, each of said blades being mounted at the proximal end thereof for articulation on said distal end of said body, such that upon manipulation of said actuator, said blades are spaced apart from one another.
7.. The retractor of Claim 6, wherein said blades in their spaced position define an open area between them without obstruction, whereby other surgical procedures may be performed therein.
8. The retractor of any of Claims 6 or 7, wherein said blades are mounted such that said blades assume said angular, spaced position simultaneously and proportional to a single movement of said actuator.
9. The retractor of any of Claims 6 to 8, wherein said blades are mounted such that their angular and spaced positions result from independent movements of said actuator.
10. The retractor of any of Claims 6 to 9, wherein said actuator comprises dual mechanisms, a first mechanism for causing extension of said blades and a second mechanism for causing said blades to be spaced apart.
11. The retractor of any of Claims 6 to 10, further comprising a plurality of control members, each of said control members engaging the proximal end of one of said blades, and wherein the retractor comprises a plurality of actuators, each of said actuators being connected to one of said control members, whereby said blades are independently manipulatable.
■ 12. The retractor of Claim 11, wherein the number of control members, blades and actuators is the same.
13. The retractor of any of Claims 6 to 12, wherein said proximal ends of said blades comprises a lever and said control member engages said lever to manipulate said blades.
14. The retractor of any of Claims 6 to 13, wherein said blades each have a distal end and a proximal end, said proximal end being mounted for rotation on said distal end of said body, said distal end extending proximally beyond said terminal plane of said body, said blades being closely aligned and conformed with one another to assume a longitudinal insertion position, and whereby movement of sSid actuator causes said control member to engage the proximal ends of said blades, whereby said blades are rotated to an extended position to provide retraction in a wide variety of angular positions with respect to the longitudinal axis of said body.
15. The retractor of any of Claims 2 to 14, wherein movement of said control member is in a proximal direction.
16. The retractor of any of Claims 6 to 15, wherein said control member is biased in a distal direction to cause said blades to return to the insertion position.
17. The retractor of any of Claims 6 to 16, wherein said control member engages one of said blades, causing both of said blades to rotate to the extended position.
18. The retractor of any of Claims 6 to 17, wherein said control member further comprises a shaft inserted between said blades, whereby said movement of said control member simultaneously causes said distal ends of said blades to separate.
19. The retractor of any of Claims 6 to 18, wherein said blades are biased toward their aligned insertion position.
20. The retractor of any of Claims 6 to 19, wherein said control member engages said blades at a point not along a line passing through a connection of said blades with said body and parallel to a longitudinal axis of said body, whereby movement of said actuator causes a moment about said control member whereby said blades are rotated.
21. The retractor of any of Claims 1 to 20, further comprising means by which said blade may be extended from an insertion position in which said blade is substantially parallel to said longitudinal axis of said body, to a second position where said blade is extended proximally beyond said terminal plane of said body during retraction, so as to provide retraction in a direction away from said body, and is at an angle to said longitudinal axis.
22. The retractor of any of Claims 1 to 21, further comprising: a first control member mounted at said distal end of said body; a second control member mounted on said body proximally of said first control member; and an actuator connected to both the first control member and the second control member, whereby movement of said actuator causes said first control member to engage the proximal ends of said blades, whereby said blades are articulated so as to provide retraction in a wide variety of angular positions with respect to the longitudinal axis of said body, and whereby movement of said actuator causes said second control member to engage the proximal ends of said blades, whereby said blades are spaced apart from one another.
23. The retractor of Claim 22, further comprising: a first actuator connected to said first control member whereby movement of said first actuator causes said first control member to engage the proximal ends of said blades, whereby said blades are articulated so as to provide retraction in a wide variety of angular positions with respect to the longitudinal axis of said body; and a second actuator connected to said second control member whereby movement of said second actuator causes said second control member to engage the proximal ends of said blades, whereby said blades are spaced apart from one another.
24. A blade for an endoscopic retractor, comprising: a proximal end for mounting to said retractor; and a distal end for providing retraction, said distal end being substantially paddle-shaped and without sharp . edges in order to avoid damage to tissues and organs being retracted, said blade being concave in the direction of retraction to increase the surface area of said retraction.
25. The retractor blade of Claim 24, wherein said blade is convex in the direction of retraction in order to minimize the surface area of contact between said blad'e and said tissues and organs being retracted, whereby damage to said tissues and organs is eliminated.
26. A method of providing retraction in endoscopic surgery, comprising: creating an opening in the body of a patient; inserting through said opening a retractor comprising a body having a distal and a proximal end, said distal end defining a terminal plane for said body, at least one blade having distal and proximal ends,.said distal end extending proximally beyond said terminal plane of said body, and an actuator, such that the distal end of said body is inside the patient and said proximal end remains outside the patient; positioning said blade to engage a selected internal organ or tissue within the patient's body; and manipulating said actuator, such that said blade assumes any of a wide variety of angular positions with respect to said body, such that said organ or tissue is displaced in any direction by said blade.
PCT/US1993/004296 1992-05-08 1993-05-07 Bladed endoscopic retractor WO1993022973A1 (en)

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US07/880,757 US5293863A (en) 1992-05-08 1992-05-08 Bladed endoscopic retractor
US07/880,757 1992-05-08

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Cited By (107)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1997021384A1 (en) * 1995-12-11 1997-06-19 Enrique Gerardo Segovia Cortes Laparo-lifter for simultaneously lifting the four quadrants of an abdominal cavity for laparoscopic surgery
WO2000067642A3 (en) * 1999-05-06 2001-04-26 Storz Karl Gmbh & Co Kg Retractor for use in endoscopic surgery
EP2221005A1 (en) * 2009-02-18 2010-08-25 University Of Dundee Endoscopic retractor
WO2011067778A1 (en) * 2009-12-02 2011-06-09 Johnson And Johnson Ltd. An improved ligation device adaptable for surgical intervention
WO2011146377A3 (en) * 2010-05-17 2012-01-12 Ethicon Endo-Surgery, Inc. Surgical instruments and end effectors therefor
US8453906B2 (en) 2010-07-14 2013-06-04 Ethicon Endo-Surgery, Inc. Surgical instruments with electrodes
US8496682B2 (en) 2010-04-12 2013-07-30 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
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
US8613383B2 (en) 2010-07-14 2013-12-24 Ethicon Endo-Surgery, Inc. Surgical instruments with electrodes
US8628529B2 (en) 2010-10-26 2014-01-14 Ethicon Endo-Surgery, Inc. Surgical instrument with magnetic clamping force
US8715277B2 (en) 2010-12-08 2014-05-06 Ethicon Endo-Surgery, Inc. Control of jaw compression in surgical instrument having end effector with opposing jaw members
US8747404B2 (en) 2009-10-09 2014-06-10 Ethicon Endo-Surgery, Inc. Surgical instrument for transmitting energy to tissue comprising non-conductive grasping portions
US8753338B2 (en) 2010-06-10 2014-06-17 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing a thermal management system
US8764747B2 (en) 2010-06-10 2014-07-01 Ethicon Endo-Surgery, Inc. Electrosurgical instrument comprising sequentially activated electrodes
US8790342B2 (en) 2010-06-09 2014-07-29 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing pressure-variation electrodes
US8795327B2 (en) 2010-07-22 2014-08-05 Ethicon Endo-Surgery, Inc. Electrosurgical instrument with separate closure and cutting members
US8795276B2 (en) 2010-06-09 2014-08-05 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing a plurality of electrodes
US8834518B2 (en) 2010-04-12 2014-09-16 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instruments with cam-actuated jaws
US8888776B2 (en) 2010-06-09 2014-11-18 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing an electrode
US8906016B2 (en) 2009-10-09 2014-12-09 Ethicon Endo-Surgery, Inc. Surgical instrument for transmitting energy to tissue comprising steam control paths
US8926607B2 (en) 2010-06-09 2015-01-06 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing multiple positive temperature coefficient electrodes
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
US8979843B2 (en) 2010-07-23 2015-03-17 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instrument
US9005199B2 (en) 2010-06-10 2015-04-14 Ethicon Endo-Surgery, Inc. Heat management configurations for controlling heat dissipation from electrosurgical instruments
US9011437B2 (en) 2010-07-23 2015-04-21 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instrument
US9044243B2 (en) 2011-08-30 2015-06-02 Ethcon Endo-Surgery, Inc. Surgical cutting and fastening device with descendible second trigger arrangement
US9149324B2 (en) 2010-07-08 2015-10-06 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an articulatable end effector
US9192431B2 (en) 2010-07-23 2015-11-24 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instrument
US9259265B2 (en) 2011-07-22 2016-02-16 Ethicon Endo-Surgery, Llc Surgical instruments for tensioning tissue
US9265926B2 (en) 2013-11-08 2016-02-23 Ethicon Endo-Surgery, Llc Electrosurgical devices
US9283027B2 (en) 2011-10-24 2016-03-15 Ethicon Endo-Surgery, Llc Battery drain kill feature in a battery powered device
US9295514B2 (en) 2013-08-30 2016-03-29 Ethicon Endo-Surgery, Llc Surgical devices with close quarter articulation features
US9375232B2 (en) 2010-03-26 2016-06-28 Ethicon Endo-Surgery, Llc Surgical cutting and sealing instrument with reduced firing force
US9408660B2 (en) 2014-01-17 2016-08-09 Ethicon Endo-Surgery, Llc Device trigger dampening mechanism
US9492224B2 (en) 2012-09-28 2016-11-15 EthiconEndo-Surgery, LLC Multi-function bi-polar forceps
US9526565B2 (en) 2013-11-08 2016-12-27 Ethicon Endo-Surgery, Llc Electrosurgical devices
US9554854B2 (en) 2014-03-18 2017-01-31 Ethicon Endo-Surgery, Llc Detecting short circuits in electrosurgical medical devices
US9554846B2 (en) 2010-10-01 2017-01-31 Ethicon Endo-Surgery, Llc Surgical instrument with jaw member
US9610091B2 (en) 2010-04-12 2017-04-04 Ethicon Endo-Surgery, Llc Electrosurgical cutting and sealing instruments with jaws having a parallel closure motion
US9737355B2 (en) 2014-03-31 2017-08-22 Ethicon Llc Controlling impedance rise in electrosurgical medical devices
US9757186B2 (en) 2014-04-17 2017-09-12 Ethicon Llc Device status feedback for bipolar tissue spacer
US9795436B2 (en) 2014-01-07 2017-10-24 Ethicon Llc Harvesting energy from a surgical generator
US9814514B2 (en) 2013-09-13 2017-11-14 Ethicon Llc Electrosurgical (RF) medical instruments for cutting and coagulating tissue
US9848937B2 (en) 2014-12-22 2017-12-26 Ethicon Llc End effector with detectable configurations
US9861428B2 (en) 2013-09-16 2018-01-09 Ethicon Llc Integrated systems for electrosurgical steam or smoke control
US9872725B2 (en) 2015-04-29 2018-01-23 Ethicon Llc RF tissue sealer with mode selection
US9877776B2 (en) 2014-08-25 2018-01-30 Ethicon Llc Simultaneous I-beam and spring driven cam jaw closure mechanism
US9913680B2 (en) 2014-04-15 2018-03-13 Ethicon Llc Software algorithms for electrosurgical instruments
US10092310B2 (en) 2014-03-27 2018-10-09 Ethicon Llc Electrosurgical devices
US10092348B2 (en) 2014-12-22 2018-10-09 Ethicon Llc RF tissue sealer, shear grip, trigger lock mechanism and energy activation
US10111699B2 (en) 2014-12-22 2018-10-30 Ethicon Llc RF tissue sealer, shear grip, trigger lock mechanism and energy activation
US10117667B2 (en) 2010-02-11 2018-11-06 Ethicon Llc Control systems for ultrasonically powered surgical instruments
US10117702B2 (en) 2015-04-10 2018-11-06 Ethicon Llc Surgical generator systems and related methods
US10130410B2 (en) 2015-04-17 2018-11-20 Ethicon Llc Electrosurgical instrument including a cutting member decouplable from a cutting member trigger
US10154852B2 (en) 2015-07-01 2018-12-18 Ethicon Llc Ultrasonic surgical blade with improved cutting and coagulation features
US10159524B2 (en) 2014-12-22 2018-12-25 Ethicon Llc High power battery powered RF amplifier topology
US10172669B2 (en) 2009-10-09 2019-01-08 Ethicon Llc Surgical instrument comprising an energy trigger lockout
US10179022B2 (en) 2015-12-30 2019-01-15 Ethicon Llc Jaw position impedance limiter for electrosurgical instrument
US10194973B2 (en) 2015-09-30 2019-02-05 Ethicon Llc Generator for digitally generating electrical signal waveforms for electrosurgical and ultrasonic surgical instruments
US10194976B2 (en) 2014-08-25 2019-02-05 Ethicon Llc Lockout disabling mechanism
US10194972B2 (en) 2014-08-26 2019-02-05 Ethicon Llc Managing tissue treatment
US10201382B2 (en) 2009-10-09 2019-02-12 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US10226273B2 (en) 2013-03-14 2019-03-12 Ethicon Llc Mechanical fasteners for use with surgical energy devices
US10245065B2 (en) 2007-11-30 2019-04-02 Ethicon Llc Ultrasonic surgical blades
US10245064B2 (en) 2016-07-12 2019-04-02 Ethicon Llc Ultrasonic surgical instrument with piezoelectric central lumen transducer
US10251664B2 (en) 2016-01-15 2019-04-09 Ethicon Llc Modular battery powered handheld surgical instrument with multi-function motor via shifting gear assembly
USD847990S1 (en) 2016-08-16 2019-05-07 Ethicon Llc Surgical instrument
US10285724B2 (en) 2014-07-31 2019-05-14 Ethicon Llc Actuation mechanisms and load adjustment assemblies for surgical instruments
US10285723B2 (en) 2016-08-09 2019-05-14 Ethicon Llc Ultrasonic surgical blade with improved heel portion
US10299810B2 (en) 2010-02-11 2019-05-28 Ethicon Llc Rotatable cutting implements with friction reducing material for ultrasonic surgical instruments
US10314638B2 (en) 2015-04-07 2019-06-11 Ethicon Llc Articulating radio frequency (RF) tissue seal with articulating state sensing
US10321950B2 (en) 2015-03-17 2019-06-18 Ethicon Llc Managing tissue treatment
US10335614B2 (en) 2008-08-06 2019-07-02 Ethicon Llc Devices and techniques for cutting and coagulating tissue
US10335183B2 (en) 2012-06-29 2019-07-02 Ethicon Llc Feedback devices for surgical control systems
US10335182B2 (en) 2012-06-29 2019-07-02 Ethicon Llc Surgical instruments with articulating shafts
US10342602B2 (en) 2015-03-17 2019-07-09 Ethicon Llc Managing tissue treatment
US10357303B2 (en) 2015-06-30 2019-07-23 Ethicon Llc Translatable outer tube for sealing using shielded lap chole dissector
US10376305B2 (en) 2016-08-05 2019-08-13 Ethicon Llc Methods and systems for advanced harmonic energy
US10398466B2 (en) 2007-07-27 2019-09-03 Ethicon Llc Ultrasonic end effectors with increased active length
US10420580B2 (en) 2016-08-25 2019-09-24 Ethicon Llc Ultrasonic transducer for surgical instrument
US10420579B2 (en) 2007-07-31 2019-09-24 Ethicon Llc Surgical instruments
US10426507B2 (en) 2007-07-31 2019-10-01 Ethicon Llc Ultrasonic surgical instruments
US10441310B2 (en) 2012-06-29 2019-10-15 Ethicon Llc Surgical instruments with curved section
US10441345B2 (en) 2009-10-09 2019-10-15 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US10441308B2 (en) 2007-11-30 2019-10-15 Ethicon Llc Ultrasonic surgical instrument blades
US10456193B2 (en) 2016-05-03 2019-10-29 Ethicon Llc Medical device with a bilateral jaw configuration for nerve stimulation
US10463421B2 (en) 2014-03-27 2019-11-05 Ethicon Llc Two stage trigger, clamp and cut bipolar vessel sealer
US10485607B2 (en) 2016-04-29 2019-11-26 Ethicon Llc Jaw structure with distal closure for electrosurgical instruments
US10517627B2 (en) 2012-04-09 2019-12-31 Ethicon Llc Switch arrangements for ultrasonic surgical instruments
US10524852B1 (en) 2014-03-28 2020-01-07 Ethicon Llc Distal sealing end effector with spacers
US10524872B2 (en) 2012-06-29 2020-01-07 Ethicon Llc Closed feedback control for electrosurgical device
US10537352B2 (en) 2004-10-08 2020-01-21 Ethicon Llc Tissue pads for use with surgical instruments
US10543008B2 (en) 2012-06-29 2020-01-28 Ethicon Llc Ultrasonic surgical instruments with distally positioned jaw assemblies
US10555769B2 (en) 2016-02-22 2020-02-11 Ethicon Llc Flexible circuits for electrosurgical instrument
US10575892B2 (en) 2015-12-31 2020-03-03 Ethicon Llc Adapter for electrical surgical instruments
US10595930B2 (en) 2015-10-16 2020-03-24 Ethicon Llc Electrode wiping surgical device
US10595929B2 (en) 2015-03-24 2020-03-24 Ethicon Llc Surgical instruments with firing system overload protection mechanisms
US10639092B2 (en) 2014-12-08 2020-05-05 Ethicon Llc Electrode configurations for surgical instruments
US10646269B2 (en) 2016-04-29 2020-05-12 Ethicon Llc Non-linear jaw gap for electrosurgical instruments
US10702329B2 (en) 2016-04-29 2020-07-07 Ethicon Llc Jaw structure with distal post for electrosurgical instruments
US10751117B2 (en) 2016-09-23 2020-08-25 Ethicon Llc Electrosurgical instrument with fluid diverter
US10842522B2 (en) 2016-07-15 2020-11-24 Ethicon Llc Ultrasonic surgical instruments having offset blades
US10893883B2 (en) 2016-07-13 2021-01-19 Ethicon Llc Ultrasonic assembly for use with ultrasonic surgical instruments
US10959806B2 (en) 2015-12-30 2021-03-30 Ethicon Llc Energized medical device with reusable handle
US11058447B2 (en) 2007-07-31 2021-07-13 Cilag Gmbh International Temperature controlled ultrasonic surgical instruments
US11266430B2 (en) 2016-11-29 2022-03-08 Cilag Gmbh International End effector control and calibration

Families Citing this family (230)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5501653A (en) * 1991-05-29 1996-03-26 Origin Medsystems, Inc. Abdominal wall lifting retractor with hinged cross-member
MX9202604A (en) * 1991-05-29 1994-05-31 Origin Medsystems Inc APPARATUS FOR MECHANICAL PROPERTY RETRACTION AND METHODS OF USE.
US5836871A (en) * 1991-05-29 1998-11-17 Origin Medsystems, Inc. Method for lifting a body wall using an inflatable lifting apparatus
US5490819A (en) * 1991-08-05 1996-02-13 United States Surgical Corporation Articulating endoscopic surgical apparatus
US5514157A (en) * 1992-02-12 1996-05-07 United States Surgical Corporation Articulating endoscopic surgical apparatus
DE4303274C2 (en) * 1993-02-05 1997-02-06 Wolf Gmbh Richard Endoscopic instrument
US5976130A (en) * 1994-12-13 1999-11-02 Symbiosis Corporation Bipolar push rod assembly for a bipolar endoscopic surgical instrument and instruments incorporating the same
US5681341A (en) * 1995-03-14 1997-10-28 Origin Medsystems, Inc. Flexible lifting apparatus
US5888247A (en) * 1995-04-10 1999-03-30 Cardiothoracic Systems, Inc Method for coronary artery bypass
WO1997010762A1 (en) * 1995-09-19 1997-03-27 Symbiosis Corporation A bipolar push rod assembly and bipolar endoscopic instruments incorporating same
US7445594B1 (en) * 1995-09-20 2008-11-04 Medtronic, Inc. Method and apparatus for temporarily immobilizing a local area of tissue
US6287322B1 (en) * 1995-12-07 2001-09-11 Loma Linda University Medical Center Tissue opening locator and everter and method
CA2197614C (en) 1996-02-20 2002-07-02 Charles S. Taylor Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery
US6290644B1 (en) 1996-02-20 2001-09-18 Cardiothoracic Systems, Inc. Surgical instruments and procedures for stabilizing a localized portion of a beating heart
US6852075B1 (en) * 1996-02-20 2005-02-08 Cardiothoracic Systems, Inc. Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery
US5894843A (en) 1996-02-20 1999-04-20 Cardiothoracic Systems, Inc. Surgical method for stabilizing the beating heart during coronary artery bypass graft surgery
DE19707374C2 (en) * 1997-02-25 2000-10-26 Storz Karl Gmbh & Co Kg Medical dissection spatula with expandable spatula jaw parts
US6312426B1 (en) * 1997-05-30 2001-11-06 Sherwood Services Ag Method and system for performing plate type radiofrequency ablation
US6969349B1 (en) * 1997-09-17 2005-11-29 Origin Medsystem, Inc. Device to permit offpump beating heart coronary bypass surgery
US6390976B1 (en) 1997-09-17 2002-05-21 Origin Medsystems, Inc. System to permit offpump beating heart coronary bypass surgery
US6338712B2 (en) 1997-09-17 2002-01-15 Origin Medsystems, Inc. Device to permit offpump beating heart coronary bypass surgery
EP1674044B1 (en) * 1997-10-09 2015-08-19 Aesculap AG Systems for organ resection
US6206826B1 (en) 1997-12-18 2001-03-27 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US6562037B2 (en) * 1998-02-12 2003-05-13 Boris E. Paton Bonding of soft biological tissues by passing high frequency electric current therethrough
US6331166B1 (en) * 1998-03-03 2001-12-18 Senorx, Inc. Breast biopsy system and method
US6261241B1 (en) * 1998-03-03 2001-07-17 Senorx, Inc. Electrosurgical biopsy device and method
US6344026B1 (en) 1998-04-08 2002-02-05 Senorx, Inc. Tissue specimen encapsulation device and method thereof
US6659105B2 (en) * 1998-02-26 2003-12-09 Senorx, Inc. Tissue specimen isolating and damaging device and method
US6540693B2 (en) 1998-03-03 2003-04-01 Senorx, Inc. Methods and apparatus for securing medical instruments to desired locations in a patients body
US6638234B2 (en) 1998-03-03 2003-10-28 Senorx, Inc. Sentinel node location and biopsy
US6497706B1 (en) 1998-03-03 2002-12-24 Senorx, Inc. Biopsy device and method of use
US6758848B2 (en) * 1998-03-03 2004-07-06 Senorx, Inc. Apparatus and method for accessing a body site
US6312429B1 (en) * 1998-09-01 2001-11-06 Senorx, Inc. Electrosurgical lesion location device
US6454727B1 (en) 1998-03-03 2002-09-24 Senorx, Inc. Tissue acquisition system and method of use
US6875182B2 (en) 1998-03-03 2005-04-05 Senorx, Inc. Electrosurgical specimen-collection system
US6517498B1 (en) 1998-03-03 2003-02-11 Senorx, Inc. Apparatus and method for tissue capture
US6540695B1 (en) * 1998-04-08 2003-04-01 Senorx, Inc. Biopsy anchor device with cutter
US6997885B2 (en) 1998-04-08 2006-02-14 Senorx, Inc. Dilation devices and methods for removing tissue specimens
US6514252B2 (en) 1998-05-01 2003-02-04 Perfect Surgical Techniques, Inc. Bipolar surgical instruments having focused electrical fields
US6030384A (en) * 1998-05-01 2000-02-29 Nezhat; Camran Bipolar surgical instruments having focused electrical fields
US6193718B1 (en) 1998-06-10 2001-02-27 Scimed Life Systems, Inc. Endoscopic electrocautery instrument
US6679851B2 (en) 1998-09-01 2004-01-20 Senorx, Inc. Tissue accessing and anchoring device and method
DE19915062C1 (en) * 1999-04-01 2001-02-08 Erbe Elektromedizin Surgical instrument
US6013028A (en) * 1999-04-23 2000-01-11 Integra Neurocare Llc Tissue spreading instrument for use in narrow passage
US6685632B1 (en) * 1999-05-04 2004-02-03 Cardiothoracic Systems, Inc. Surgical instruments for accessing and stabilizing a localized portion of a beating heart
US6231506B1 (en) 1999-05-04 2001-05-15 Cardiothoracic Systems, Inc. Method and apparatus for creating a working opening through an incision
US6283912B1 (en) * 1999-05-04 2001-09-04 Cardiothoracic Systems, Inc. Surgical retractor platform blade apparatus
US6626830B1 (en) 1999-05-04 2003-09-30 Cardiothoracic Systems, Inc. Methods and devices for improved tissue stabilization
US6258023B1 (en) 1999-07-08 2001-07-10 Chase Medical, Inc. Device and method for isolating a surface of a beating heart during surgery
US6511416B1 (en) * 1999-08-03 2003-01-28 Cardiothoracic Systems, Inc. Tissue stabilizer and methods of use
US6293946B1 (en) 1999-08-27 2001-09-25 Link Technology, Inc. Non-stick electrosurgical forceps
US6338738B1 (en) 1999-08-31 2002-01-15 Edwards Lifesciences Corp. Device and method for stabilizing cardiac tissue
US6406424B1 (en) * 1999-09-16 2002-06-18 Williamson, Iv Warren P. Tissue stabilizer having an articulating lift element
US6245070B1 (en) 1999-11-08 2001-06-12 James A. Marquis Forceps tissue removal device
US6684886B1 (en) * 2000-01-21 2004-02-03 Prospine, Inc. Intervertebral disc repair methods and apparatus
US6890342B2 (en) * 2000-08-02 2005-05-10 Loma Linda University Method and apparatus for closing vascular puncture using hemostatic material
US7678106B2 (en) * 2000-08-09 2010-03-16 Halt Medical, Inc. Gynecological ablation procedure and system
US6840935B2 (en) * 2000-08-09 2005-01-11 Bekl Corporation Gynecological ablation procedure and system using an ablation needle
US6758808B2 (en) 2001-01-24 2004-07-06 Cardiothoracic System, Inc. Surgical instruments for stabilizing a localized portion of a beating heart
WO2002085218A2 (en) 2001-04-20 2002-10-31 Power Medical Interventions, Inc. Bipolar or ultrasonic surgical device
US11229472B2 (en) 2001-06-12 2022-01-25 Cilag Gmbh International Modular battery powered handheld surgical instrument with multiple magnetic position sensors
CA2481607A1 (en) * 2001-07-31 2003-02-13 William Bauer Stapling device for closure of deep tissue
US6733498B2 (en) 2002-02-19 2004-05-11 Live Tissue Connect, Inc. System and method for control of tissue welding
US6780178B2 (en) * 2002-05-03 2004-08-24 The Board Of Trustees Of The Leland Stanford Junior University Method and apparatus for plasma-mediated thermo-electrical ablation
US8043286B2 (en) * 2002-05-03 2011-10-25 The Board Of Trustees Of The Leland Stanford Junior University Method and apparatus for plasma-mediated thermo-electrical ablation
CN1306910C (en) 2002-06-14 2007-03-28 洛马林达大学医学中心 Vascular wound closure device and method
DE60325243D1 (en) * 2002-08-02 2009-01-22 Warsaw Orthopedic Inc SYSTEMS AND TECHNIQUES FOR ILLUMINATING AN OPERATIONAL AREA
US20040260281A1 (en) * 2002-09-19 2004-12-23 Baxter Chester O. Finger tip electrosurgical medical device
US7931590B2 (en) 2002-10-29 2011-04-26 Maquet Cardiovascular Llc Tissue stabilizer and methods of using the same
US7736361B2 (en) * 2003-02-14 2010-06-15 The Board Of Trustees Of The Leland Stamford Junior University Electrosurgical system with uniformly enhanced electric field and minimal collateral damage
WO2004098382A2 (en) * 2003-05-01 2004-11-18 Sherwood Services Ag Suction coagulator with dissecting probe
US20050021028A1 (en) * 2003-06-18 2005-01-27 Daniel Palanker Electro-adhesive tissue manipulator
US7479104B2 (en) 2003-07-08 2009-01-20 Maquet Cardiovascular, Llc Organ manipulator apparatus
US8002798B2 (en) * 2003-09-24 2011-08-23 Stryker Spine System and method for spinal implant placement
US7955355B2 (en) 2003-09-24 2011-06-07 Stryker Spine Methods and devices for improving percutaneous access in minimally invasive surgeries
US9408592B2 (en) 2003-12-23 2016-08-09 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US20050148824A1 (en) * 2003-12-30 2005-07-07 Morejohn Dwight P. Transabdominal surgery system
US7179224B2 (en) * 2003-12-30 2007-02-20 Cardiothoracic Systems, Inc. Organ manipulator and positioner and methods of using the same
US7798960B2 (en) * 2004-02-09 2010-09-21 John C. Jaeger Speculum
US8182501B2 (en) 2004-02-27 2012-05-22 Ethicon Endo-Surgery, Inc. Ultrasonic surgical shears and method for sealing a blood vessel using same
US7749156B2 (en) * 2004-03-24 2010-07-06 Hoya Corporation Retractable treatment instrument for endoscope
US20050283149A1 (en) * 2004-06-08 2005-12-22 Thorne Jonathan O Electrosurgical cutting instrument
DE102004052204A1 (en) * 2004-10-19 2006-05-04 Karl Storz Gmbh & Co. Kg Deflectible endoscopic instrument
US20090204021A1 (en) * 2004-12-16 2009-08-13 Senorx, Inc. Apparatus and method for accessing a body site
US8343071B2 (en) 2004-12-16 2013-01-01 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US7427264B2 (en) * 2005-04-22 2008-09-23 Warsaw Orthopedic, Inc. Instruments and methods for selective tissue retraction through a retractor sleeve
US9339323B2 (en) 2005-05-12 2016-05-17 Aesculap Ag Electrocautery method and apparatus
US8728072B2 (en) 2005-05-12 2014-05-20 Aesculap Ag Electrocautery method and apparatus
US8696662B2 (en) 2005-05-12 2014-04-15 Aesculap Ag Electrocautery method and apparatus
US7803156B2 (en) 2006-03-08 2010-09-28 Aragon Surgical, Inc. Method and apparatus for surgical electrocautery
US7942874B2 (en) 2005-05-12 2011-05-17 Aragon Surgical, Inc. Apparatus for tissue cauterization
US9095325B2 (en) 2005-05-23 2015-08-04 Senorx, Inc. Tissue cutting member for a biopsy device
US20060271037A1 (en) * 2005-05-25 2006-11-30 Forcept, Inc. Assisted systems and methods for performing transvaginal hysterectomies
US20070088203A1 (en) * 2005-05-25 2007-04-19 Liming Lau Surgical assemblies and methods for visualizing and performing surgical procedures in reduced-access surgical sites
US8083664B2 (en) 2005-05-25 2011-12-27 Maquet Cardiovascular Llc Surgical stabilizers and methods for use in reduced-access surgical sites
US20060287584A1 (en) * 2005-06-16 2006-12-21 Javier Garcia-Bengochia Surgical retractor extensions
US20070005061A1 (en) * 2005-06-30 2007-01-04 Forcept, Inc. Transvaginal uterine artery occlusion
US8512333B2 (en) * 2005-07-01 2013-08-20 Halt Medical Inc. Anchored RF ablation device for the destruction of tissue masses
US8080009B2 (en) * 2005-07-01 2011-12-20 Halt Medical Inc. Radio frequency ablation device for the destruction of tissue masses
US7641651B2 (en) * 2005-07-28 2010-01-05 Aragon Surgical, Inc. Devices and methods for mobilization of the uterus
US8317725B2 (en) * 2005-08-05 2012-11-27 Senorx, Inc. Biopsy device with fluid delivery to tissue specimens
US7572236B2 (en) 2005-08-05 2009-08-11 Senorx, Inc. Biopsy device with fluid delivery to tissue specimens
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
US8574229B2 (en) 2006-05-02 2013-11-05 Aesculap Ag Surgical tool
US20070265613A1 (en) * 2006-05-10 2007-11-15 Edelstein Peter Seth Method and apparatus for sealing tissue
US9585714B2 (en) 2006-07-13 2017-03-07 Bovie Medical Corporation Surgical sealing and cutting apparatus
US7892174B2 (en) * 2006-07-19 2011-02-22 Zimmer Spine, Inc. Surgical access system and method of using the same
US8262569B2 (en) * 2006-07-19 2012-09-11 Zimmer Spine, Inc. Surgical access system and method of using the same
JP5149904B2 (en) * 2006-10-05 2013-02-20 エルベ・エレクトロメディティン・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング Cylindrical shaft equipment
US8177783B2 (en) 2006-11-02 2012-05-15 Peak Surgical, Inc. Electric plasma-mediated cutting and coagulation of tissue and surgical apparatus
US20080132766A1 (en) * 2006-12-05 2008-06-05 Zimmer Spine, Inc. Surgical Access System And Method Of Using Same
US8052710B2 (en) * 2006-12-15 2011-11-08 Parviz Kambin Endoscopic balloon tissue dissector and retractor
US9492220B2 (en) * 2007-02-01 2016-11-15 Conmed Corporation Apparatus and method for rapid reliable electrothermal tissue fusion
US20080188845A1 (en) * 2007-02-01 2008-08-07 Mcgreevy Francis T Tissue fusion instrument and method to reduce the adhesion of tissue to its working surfaces
US9498277B2 (en) * 2007-02-01 2016-11-22 Conmed Corporation Apparatus and method for rapid reliable electrothermal tissue fusion and simultaneous cutting
US20090138011A1 (en) * 2007-03-13 2009-05-28 Gordon Epstein Intermittent ablation rf driving for moderating return electrode temperature
US20090187183A1 (en) * 2007-03-13 2009-07-23 Gordon Epstein Temperature responsive ablation rf driving for moderating return electrode temperature
US8911460B2 (en) 2007-03-22 2014-12-16 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8142461B2 (en) 2007-03-22 2012-03-27 Ethicon Endo-Surgery, Inc. Surgical instruments
US20080287937A1 (en) * 2007-05-15 2008-11-20 Warsaw Orthopedic, Inc. Surgical Instrument for Illuminating and Monitoring a Surgical Site
US8808319B2 (en) 2007-07-27 2014-08-19 Ethicon Endo-Surgery, Inc. Surgical instruments
EP2796102B1 (en) 2007-10-05 2018-03-14 Ethicon LLC Ergonomic surgical instruments
US20090131956A1 (en) * 2007-11-08 2009-05-21 Jonathan Dewey Method and apparatus for passing suture through the labrum of a hip joint in order to secure the labrum to the acetabulum
US8241276B2 (en) * 2007-11-14 2012-08-14 Halt Medical Inc. RF ablation device with jam-preventing electrical coupling member
US8251991B2 (en) 2007-11-14 2012-08-28 Halt Medical Inc. Anchored RF ablation device for the destruction of tissue masses
US8353907B2 (en) 2007-12-21 2013-01-15 Atricure, Inc. Ablation device with internally cooled electrodes
US8998892B2 (en) 2007-12-21 2015-04-07 Atricure, Inc. Ablation device with cooled electrodes and methods of use
US8870867B2 (en) 2008-02-06 2014-10-28 Aesculap Ag Articulable electrosurgical instrument with a stabilizable articulation actuator
US20090306642A1 (en) * 2008-06-10 2009-12-10 Vankov Alexander B Method for low temperature electrosugery and rf generator
US20100121142A1 (en) * 2008-11-12 2010-05-13 Ouyang Xiaolong Minimally Invasive Imaging Device
US8137345B2 (en) 2009-01-05 2012-03-20 Peak Surgical, Inc. Electrosurgical devices for tonsillectomy and adenoidectomy
US8444642B2 (en) * 2009-04-03 2013-05-21 Device Evolutions, Llc Laparoscopic nephrectomy device
US9700339B2 (en) 2009-05-20 2017-07-11 Ethicon Endo-Surgery, Inc. Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments
US8663220B2 (en) 2009-07-15 2014-03-04 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US11090104B2 (en) 2009-10-09 2021-08-17 Cilag Gmbh International Surgical generator for ultrasonic and electrosurgical devices
KR20120139661A (en) 2010-02-04 2012-12-27 아에스쿨랍 아게 Laparoscopic radiofrequency surgical device
US8486096B2 (en) 2010-02-11 2013-07-16 Ethicon Endo-Surgery, Inc. Dual purpose surgical instrument for cutting and coagulating tissue
US9022998B2 (en) 2010-02-26 2015-05-05 Maquet Cardiovascular Llc Blower instrument, apparatus and methods of using
US8827992B2 (en) 2010-03-26 2014-09-09 Aesculap Ag Impedance mediated control of power delivery for electrosurgery
US8419727B2 (en) 2010-03-26 2013-04-16 Aesculap Ag Impedance mediated power delivery for electrosurgery
US8696561B2 (en) * 2010-04-01 2014-04-15 Tamatha Britt Fenster LEEP safety guard
GB2480498A (en) 2010-05-21 2011-11-23 Ethicon Endo Surgery Inc Medical device comprising RF circuitry
AU2011268433A1 (en) 2010-06-14 2013-01-10 Maquet Cardiovascular Llc Surgical instruments, systems and methods of use
CN102834045B (en) * 2010-07-09 2015-03-11 奥林巴斯医疗株式会社 Endoscope-holding device and endoscopic system
US9173698B2 (en) 2010-09-17 2015-11-03 Aesculap Ag Electrosurgical tissue sealing augmented with a seal-enhancing composition
US9877720B2 (en) * 2010-09-24 2018-01-30 Ethicon Llc Control features for articulating surgical device
WO2012170364A1 (en) 2011-06-10 2012-12-13 Medtronic, Inc. Wire electrode devices for tonsillectomy and adenoidectomy
US9339327B2 (en) 2011-06-28 2016-05-17 Aesculap Ag Electrosurgical tissue dissecting device
EP2811932B1 (en) 2012-02-10 2019-06-26 Ethicon LLC Robotically controlled surgical instrument
US20140005640A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical end effector jaw and electrode configurations
US20140005705A1 (en) 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical instruments with articulating shafts
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
KR102174907B1 (en) 2012-09-26 2020-11-05 아에스쿨랍 아게 Apparatus for tissue cutting and sealing
US9095367B2 (en) 2012-10-22 2015-08-04 Ethicon Endo-Surgery, Inc. Flexible harmonic waveguides/blades for surgical instruments
US20140135804A1 (en) 2012-11-15 2014-05-15 Ethicon Endo-Surgery, Inc. Ultrasonic and electrosurgical devices
CN103181793B (en) * 2012-12-06 2015-05-20 池永龙 Microendoscopic parenchyma poking device
CN103230286A (en) * 2013-01-11 2013-08-07 池永龙 Extendable endoscope operating casing pipe
US9827020B2 (en) 2013-03-14 2017-11-28 Stryker European Holdings I, Llc Percutaneous spinal cross link system and method
CA2846149C (en) 2013-03-14 2018-03-20 Stryker Spine Systems and methods for percutaneous spinal fusion
US9445863B2 (en) 2013-03-15 2016-09-20 Gyrus Acmi, Inc. Combination electrosurgical device
US9763730B2 (en) 2013-03-15 2017-09-19 Gyrus Acmi, Inc. Electrosurgical instrument
WO2014150754A1 (en) 2013-03-15 2014-09-25 GYRUS ACMI, INC. (d/b/a OLYMPUS SURGICAL TECHNOLOGIES AMERICA) Combination electrosurgical device
CN108078625B (en) 2013-03-15 2020-11-17 捷锐士阿希迈公司(以奥林巴斯美国外科技术名义) Offset surgical forceps
EP2974682B1 (en) 2013-03-15 2017-08-30 Gyrus ACMI, Inc. Combination electrosurgical device
US9901358B2 (en) * 2013-11-15 2018-02-27 Ethicon Llc Ultrasonic surgical instrument with integral blade cleaning feature
US9744050B1 (en) 2013-12-06 2017-08-29 Stryker European Holdings I, Llc Compression and distraction system for percutaneous posterior spinal fusion
US9408716B1 (en) 2013-12-06 2016-08-09 Stryker European Holdings I, Llc Percutaneous posterior spinal fusion implant construction and method
US10159579B1 (en) 2013-12-06 2018-12-25 Stryker European Holdings I, Llc Tubular instruments for percutaneous posterior spinal fusion systems and methods
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
US10258404B2 (en) 2014-04-24 2019-04-16 Gyrus, ACMI, Inc. Partially covered jaw electrodes
CN105411520B (en) * 2014-08-04 2017-03-22 河南科技大学第一附属医院 Medical gynecological examination device with locking mechanism
EP3335656B1 (en) 2014-08-20 2019-06-12 Gyrus ACMI, Inc. d/b/a/ Olympus Surgical Technologies America Multi-mode combination electrosurgical device
US10537402B2 (en) 2014-11-24 2020-01-21 The Board Of Regents Of The University Of Oklahoma Surgical cleaning tool, system, and method
US10245095B2 (en) 2015-02-06 2019-04-02 Ethicon Llc Electrosurgical instrument with rotation and articulation mechanisms
WO2016153630A1 (en) 2015-03-23 2016-09-29 GYRUS ACMI, INC. (d/b/a OLYMPUS SURGICAL TECHNOLOGIES AMERICA) Medical forceps with vessel transection capability
AU2016248226B2 (en) * 2015-04-15 2018-11-08 Conmed Corporation Surgical apparatus for argon beam coagulation
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
US10898256B2 (en) 2015-06-30 2021-01-26 Ethicon Llc Surgical system with user adaptable techniques based on tissue impedance
US11129669B2 (en) 2015-06-30 2021-09-28 Cilag Gmbh International Surgical system with user adaptable techniques based on tissue type
US10034704B2 (en) 2015-06-30 2018-07-31 Ethicon Llc Surgical instrument with user adaptable algorithms
US11141213B2 (en) 2015-06-30 2021-10-12 Cilag Gmbh International Surgical instrument with user adaptable techniques
US10959771B2 (en) 2015-10-16 2021-03-30 Ethicon Llc Suction and irrigation sealing grasper
US10531932B2 (en) 2015-12-10 2020-01-14 Kirwan Surgical Products Llc Tip Protector for Electrosurgical Forceps
US10716615B2 (en) 2016-01-15 2020-07-21 Ethicon Llc Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade
US11229471B2 (en) 2016-01-15 2022-01-25 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization
US11129670B2 (en) 2016-01-15 2021-09-28 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization
WO2017177098A1 (en) 2016-04-07 2017-10-12 GYRUS ACMI, INC. (d/b/a OLYMPUS SURGICAL TECHNOLOGIES AMERICA) Laparoscopic surgical device with flared tube
US10987156B2 (en) 2016-04-29 2021-04-27 Ethicon Llc Electrosurgical instrument with electrically conductive gap setting member and electrically insulative tissue engaging members
US10856934B2 (en) 2016-04-29 2020-12-08 Ethicon Llc Electrosurgical instrument with electrically conductive gap setting and tissue engaging members
US10952759B2 (en) 2016-08-25 2021-03-23 Ethicon Llc Tissue loading of a surgical instrument
US10898175B2 (en) 2016-10-04 2021-01-26 Jgmg Bengochea, Llc Retractor extension clip systems
US10603064B2 (en) 2016-11-28 2020-03-31 Ethicon Llc Ultrasonic transducer
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
US10603117B2 (en) 2017-06-28 2020-03-31 Ethicon Llc Articulation state detection mechanisms
US10820920B2 (en) 2017-07-05 2020-11-03 Ethicon Llc Reusable ultrasonic medical devices and methods of their use
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
US11298801B2 (en) 2017-11-02 2022-04-12 Gyrus Acmi, Inc. Bias device for biasing a gripping device including a central body and shuttles on the working arms
US11383373B2 (en) 2017-11-02 2022-07-12 Gyms Acmi, Inc. Bias device for biasing a gripping device by biasing working arms apart
US10667834B2 (en) 2017-11-02 2020-06-02 Gyrus Acmi, Inc. Bias device for biasing a gripping device with a shuttle on a central body
EP3735184A4 (en) 2018-01-05 2022-02-23 MITRX, Inc. Pursestring suture retractor and method of use
JP7244232B2 (en) * 2018-08-06 2023-03-22 周 中村 Endo-retractor instrument for percutaneous endoscopic surgery of the spine
EP3897400B1 (en) * 2018-12-21 2023-09-13 Smith & Nephew, Inc. Actuated retractor with tension feedback
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
US11723729B2 (en) 2019-06-27 2023-08-15 Cilag Gmbh International Robotic surgical assembly coupling safety mechanisms
US11547468B2 (en) 2019-06-27 2023-01-10 Cilag Gmbh International Robotic surgical system with safety and cooperative sensing control
US11723716B2 (en) 2019-12-30 2023-08-15 Cilag Gmbh International Electrosurgical instrument with variable control mechanisms
US11812957B2 (en) 2019-12-30 2023-11-14 Cilag Gmbh International Surgical instrument comprising a signal interference resolution system
US11779387B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Clamp arm jaw to minimize tissue sticking and improve tissue control
US11786291B2 (en) 2019-12-30 2023-10-17 Cilag Gmbh International Deflectable support of RF energy electrode with respect to opposing ultrasonic blade
US11759251B2 (en) 2019-12-30 2023-09-19 Cilag Gmbh International Control program adaptation based on device status and user input
US11660089B2 (en) 2019-12-30 2023-05-30 Cilag Gmbh International Surgical instrument comprising a sensing system
US11684412B2 (en) 2019-12-30 2023-06-27 Cilag Gmbh International Surgical instrument with rotatable and articulatable surgical end effector
US11779329B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Surgical instrument comprising a flex circuit including a sensor system
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
US20210196359A1 (en) 2019-12-30 2021-07-01 Ethicon Llc Electrosurgical instruments with electrodes having energy focusing features
US11452525B2 (en) 2019-12-30 2022-09-27 Cilag Gmbh International Surgical instrument comprising an adjustment system
US11696776B2 (en) 2019-12-30 2023-07-11 Cilag Gmbh International Articulatable surgical instrument
US11547286B2 (en) * 2020-01-22 2023-01-10 Brio13Inv. LLC Stylet assembly
CN112274101B (en) * 2020-10-30 2022-08-19 河北省中医院 Vaginal speculum

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4763669A (en) * 1986-01-09 1988-08-16 Jaeger John C Surgical instrument with adjustable angle of operation
WO1989011827A1 (en) * 1988-06-03 1989-12-14 Nierman David M Biopsy forceps
EP0449663A2 (en) * 1990-03-29 1991-10-02 United States Surgical Corporation Abdominal cavity organ retractor
US5152279A (en) * 1991-11-15 1992-10-06 Wilk Peter J Retractor and associated method for use in laparoscopic surgery
WO1993007816A1 (en) * 1991-10-16 1993-04-29 Implemed, Inc. Generic endoscopic instrument

Family Cites Families (34)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1770653A (en) * 1929-12-12 1930-07-15 Molony Martin High-frequency vesical electrode with insulating tip
US3044461A (en) * 1960-01-21 1962-07-17 Murdock Barbara Procto-sigmoidoscope
GB1043700A (en) * 1963-09-03 1966-09-21 Allen And Hanburys Surgical En Improvements relating to medical instruments
US3316912A (en) * 1963-09-20 1967-05-02 Gene C Wilkins Fecal impaction remover
US3685518A (en) * 1970-07-29 1972-08-22 Aesculap Werke Ag Surgical instrument for high-frequency surgery
DE2324658B2 (en) * 1973-05-16 1977-06-30 Richard Wolf Gmbh, 7134 Knittlingen PROBE FOR COAGULATING BODY TISSUE
CH587664A5 (en) * 1974-09-05 1977-05-13 Fischer Fa F L
US4074718A (en) * 1976-03-17 1978-02-21 Valleylab, Inc. Electrosurgical instrument
US4178920A (en) * 1977-10-03 1979-12-18 American Hospital Supply Corporation Urological instrument with deflecting element
US4307720A (en) * 1979-07-26 1981-12-29 Weber Jr Jaroy Electrocautery apparatus and method and means for cleaning the same
US4492231A (en) * 1982-09-17 1985-01-08 Auth David C Non-sticking electrocautery system and forceps
US5085657A (en) * 1983-03-14 1992-02-04 Ben Simhon Haim Electrosurgical instrument
US4543090A (en) * 1983-10-31 1985-09-24 Mccoy William C Steerable and aimable catheter
CA1237482A (en) * 1984-03-09 1988-05-31 Frank B. Stiles Catheter for effecting removal of obstructions from a biological duct
JPS61209647A (en) * 1985-03-14 1986-09-17 須广 久善 Incision opening retractor for connecting blood vessel
US4909789A (en) * 1986-03-28 1990-03-20 Olympus Optical Co., Ltd. Observation assisting forceps
US4744363A (en) * 1986-07-07 1988-05-17 Hasson Harrith M Intra-abdominal organ stabilizer, retractor and tissue manipulator
US4753223A (en) * 1986-11-07 1988-06-28 Bremer Paul W System for controlling shape and direction of a catheter, cannula, electrode, endoscope or similar article
US4872456A (en) * 1987-11-12 1989-10-10 Hasson Harrith M Template incision device
US4921485A (en) * 1988-09-28 1990-05-01 Griffiths John D Catheter for use in the surgical correction of a nasolacrimal duct obstruction
US5052402A (en) * 1989-01-31 1991-10-01 C.R. Bard, Inc. Disposable biopsy forceps
US5013312A (en) * 1990-03-19 1991-05-07 Everest Medical Corporation Bipolar scalpel for harvesting internal mammary artery
US5002543A (en) * 1990-04-09 1991-03-26 Bradshaw Anthony J Steerable intramedullary fracture reduction device
US5282799A (en) * 1990-08-24 1994-02-01 Everest Medical Corporation Bipolar electrosurgical scalpel with paired loop electrodes
US5125896A (en) * 1990-10-10 1992-06-30 C. R. Bard, Inc. Steerable electrode catheter
US5209747A (en) * 1990-12-13 1993-05-11 Knoepfler Dennis J Adjustable angle medical forceps
US5152748A (en) * 1991-03-04 1992-10-06 Philippe Chastagner Medical catheters thermally manipulated by fiber optic bundles
US5197962A (en) * 1991-06-05 1993-03-30 Megadyne Medical Products, Inc. Composite electrosurgical medical instrument
US5195506A (en) * 1991-10-18 1993-03-23 Life Medical Products, Inc. Surgical retractor for puncture operation
US5197964A (en) * 1991-11-12 1993-03-30 Everest Medical Corporation Bipolar instrument utilizing one stationary electrode and one movable electrode
DE4138115A1 (en) * 1991-11-19 1993-05-27 Delma Elektro Med App MEDICAL HIGH FREQUENCY COAGULATION INSTRUMENT
US5192280A (en) * 1991-11-25 1993-03-09 Everest Medical Corporation Pivoting multiple loop bipolar cutting device
US5290285A (en) * 1992-04-23 1994-03-01 Kirwan Surgical Products, Inc. Electrocautery device having two electrically active areas of the terminal end spaced from each other
US5295990A (en) * 1992-09-11 1994-03-22 Levin John M Tissue sampling and removal device

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4763669A (en) * 1986-01-09 1988-08-16 Jaeger John C Surgical instrument with adjustable angle of operation
WO1989011827A1 (en) * 1988-06-03 1989-12-14 Nierman David M Biopsy forceps
EP0449663A2 (en) * 1990-03-29 1991-10-02 United States Surgical Corporation Abdominal cavity organ retractor
WO1993007816A1 (en) * 1991-10-16 1993-04-29 Implemed, Inc. Generic endoscopic instrument
US5152279A (en) * 1991-11-15 1992-10-06 Wilk Peter J Retractor and associated method for use in laparoscopic surgery

Cited By (138)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1997021384A1 (en) * 1995-12-11 1997-06-19 Enrique Gerardo Segovia Cortes Laparo-lifter for simultaneously lifting the four quadrants of an abdominal cavity for laparoscopic surgery
WO2000067642A3 (en) * 1999-05-06 2001-04-26 Storz Karl Gmbh & Co Kg Retractor for use in endoscopic surgery
US6705989B2 (en) 1999-05-06 2004-03-16 Karl Storz Gmbh & Co. Kg Retractor for use in endoscopic surgery and medical instrument for introducing a retractor and method for the use of a retractor in endoscopic surgery
US10537352B2 (en) 2004-10-08 2020-01-21 Ethicon Llc Tissue pads for use with surgical instruments
US10398466B2 (en) 2007-07-27 2019-09-03 Ethicon Llc Ultrasonic end effectors with increased active length
US11058447B2 (en) 2007-07-31 2021-07-13 Cilag Gmbh International Temperature controlled ultrasonic surgical instruments
US10426507B2 (en) 2007-07-31 2019-10-01 Ethicon Llc Ultrasonic surgical instruments
US10420579B2 (en) 2007-07-31 2019-09-24 Ethicon Llc Surgical instruments
US10245065B2 (en) 2007-11-30 2019-04-02 Ethicon Llc Ultrasonic surgical blades
US10441308B2 (en) 2007-11-30 2019-10-15 Ethicon Llc Ultrasonic surgical instrument blades
US10888347B2 (en) 2007-11-30 2021-01-12 Ethicon Llc Ultrasonic surgical blades
US10265094B2 (en) 2007-11-30 2019-04-23 Ethicon Llc Ultrasonic surgical blades
US10433865B2 (en) 2007-11-30 2019-10-08 Ethicon Llc Ultrasonic surgical blades
US10433866B2 (en) 2007-11-30 2019-10-08 Ethicon Llc Ultrasonic surgical blades
US10463887B2 (en) 2007-11-30 2019-11-05 Ethicon Llc Ultrasonic surgical blades
US10335614B2 (en) 2008-08-06 2019-07-02 Ethicon Llc Devices and techniques for cutting and coagulating tissue
EP2221005A1 (en) * 2009-02-18 2010-08-25 University Of Dundee Endoscopic retractor
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
US10441345B2 (en) 2009-10-09 2019-10-15 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US8747404B2 (en) 2009-10-09 2014-06-10 Ethicon Endo-Surgery, Inc. Surgical instrument for transmitting energy to tissue comprising non-conductive grasping portions
US10201382B2 (en) 2009-10-09 2019-02-12 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US8574231B2 (en) 2009-10-09 2013-11-05 Ethicon Endo-Surgery, Inc. Surgical instrument for transmitting energy to tissue comprising a movable electrode or insulator
US10172669B2 (en) 2009-10-09 2019-01-08 Ethicon Llc Surgical instrument comprising an energy trigger lockout
US10265117B2 (en) 2009-10-09 2019-04-23 Ethicon Llc Surgical generator method for controlling and ultrasonic transducer waveform 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
CN103354732B (en) * 2009-12-02 2015-09-30 强生有限公司 Can be used in the modified model apparatus for ligating that surgery is got involved
WO2011067778A1 (en) * 2009-12-02 2011-06-09 Johnson And Johnson Ltd. An improved ligation device adaptable for surgical intervention
CN103354732A (en) * 2009-12-02 2013-10-16 强生有限公司 An improved ligation device adaptable for surgical intervention
AU2010325619B2 (en) * 2009-12-02 2013-09-19 Johnson And Johnson Ltd. An improved ligation device adaptable for surgical intervention
US10299810B2 (en) 2010-02-11 2019-05-28 Ethicon Llc Rotatable cutting implements with friction reducing material for ultrasonic surgical instruments
US10117667B2 (en) 2010-02-11 2018-11-06 Ethicon Llc Control systems for ultrasonically powered surgical instruments
US9375232B2 (en) 2010-03-26 2016-06-28 Ethicon Endo-Surgery, Llc Surgical cutting and sealing instrument with reduced firing force
US9610091B2 (en) 2010-04-12 2017-04-04 Ethicon Endo-Surgery, Llc Electrosurgical cutting and sealing instruments with jaws having a parallel closure motion
US8496682B2 (en) 2010-04-12 2013-07-30 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instruments with cam-actuated jaws
US9808308B2 (en) 2010-04-12 2017-11-07 Ethicon Llc Electrosurgical cutting and sealing instruments with cam-actuated jaws
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
US9456864B2 (en) 2010-05-17 2016-10-04 Ethicon Endo-Surgery, Llc Surgical instruments and end effectors therefor
WO2011146377A3 (en) * 2010-05-17 2012-01-12 Ethicon Endo-Surgery, Inc. Surgical instruments and end effectors therefor
US8888776B2 (en) 2010-06-09 2014-11-18 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing an electrode
US8926607B2 (en) 2010-06-09 2015-01-06 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing multiple positive temperature coefficient electrodes
US8790342B2 (en) 2010-06-09 2014-07-29 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing pressure-variation electrodes
US8795276B2 (en) 2010-06-09 2014-08-05 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing a plurality of electrodes
US9737358B2 (en) 2010-06-10 2017-08-22 Ethicon Llc Heat management configurations for controlling heat dissipation from electrosurgical instruments
US9005199B2 (en) 2010-06-10 2015-04-14 Ethicon Endo-Surgery, Inc. Heat management configurations for controlling heat dissipation from electrosurgical instruments
US8753338B2 (en) 2010-06-10 2014-06-17 Ethicon Endo-Surgery, Inc. Electrosurgical instrument employing a thermal management system
US8764747B2 (en) 2010-06-10 2014-07-01 Ethicon Endo-Surgery, Inc. Electrosurgical instrument comprising sequentially activated electrodes
US9149324B2 (en) 2010-07-08 2015-10-06 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an articulatable end effector
US8613383B2 (en) 2010-07-14 2013-12-24 Ethicon Endo-Surgery, Inc. Surgical instruments with electrodes
US8453906B2 (en) 2010-07-14 2013-06-04 Ethicon Endo-Surgery, Inc. Surgical instruments with electrodes
US10278721B2 (en) 2010-07-22 2019-05-07 Ethicon Llc Electrosurgical instrument with separate closure and cutting members
US8795327B2 (en) 2010-07-22 2014-08-05 Ethicon Endo-Surgery, Inc. Electrosurgical instrument with separate closure and cutting members
US9192431B2 (en) 2010-07-23 2015-11-24 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instrument
US10524854B2 (en) 2010-07-23 2020-01-07 Ethicon Llc Surgical instrument
US9011437B2 (en) 2010-07-23 2015-04-21 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
US9554846B2 (en) 2010-10-01 2017-01-31 Ethicon Endo-Surgery, Llc Surgical instrument with jaw member
US8628529B2 (en) 2010-10-26 2014-01-14 Ethicon Endo-Surgery, Inc. Surgical instrument with magnetic clamping force
US8715277B2 (en) 2010-12-08 2014-05-06 Ethicon Endo-Surgery, Inc. Control of jaw compression in surgical instrument having end effector with opposing jaw members
US9259265B2 (en) 2011-07-22 2016-02-16 Ethicon Endo-Surgery, Llc Surgical instruments for tensioning tissue
US10433900B2 (en) 2011-07-22 2019-10-08 Ethicon Llc Surgical instruments for tensioning tissue
US10166060B2 (en) 2011-08-30 2019-01-01 Ethicon Llc Surgical instruments comprising a trigger assembly
US9044243B2 (en) 2011-08-30 2015-06-02 Ethcon Endo-Surgery, Inc. Surgical cutting and fastening device with descendible second trigger arrangement
US9414880B2 (en) 2011-10-24 2016-08-16 Ethicon Endo-Surgery, Llc User interface in a battery powered device
US9421060B2 (en) 2011-10-24 2016-08-23 Ethicon Endo-Surgery, Llc Litz wire battery powered device
US9283027B2 (en) 2011-10-24 2016-03-15 Ethicon Endo-Surgery, Llc Battery drain kill feature in a battery powered device
US9333025B2 (en) 2011-10-24 2016-05-10 Ethicon Endo-Surgery, Llc Battery initialization clip
US9314292B2 (en) 2011-10-24 2016-04-19 Ethicon Endo-Surgery, Llc Trigger lockout mechanism
US10517627B2 (en) 2012-04-09 2019-12-31 Ethicon Llc Switch arrangements for ultrasonic surgical instruments
US10543008B2 (en) 2012-06-29 2020-01-28 Ethicon Llc Ultrasonic surgical instruments with distally positioned jaw assemblies
US10524872B2 (en) 2012-06-29 2020-01-07 Ethicon Llc Closed feedback control for electrosurgical device
US10335183B2 (en) 2012-06-29 2019-07-02 Ethicon Llc Feedback devices for surgical control systems
US10441310B2 (en) 2012-06-29 2019-10-15 Ethicon Llc Surgical instruments with curved section
US10335182B2 (en) 2012-06-29 2019-07-02 Ethicon Llc Surgical instruments with articulating shafts
US9492224B2 (en) 2012-09-28 2016-11-15 EthiconEndo-Surgery, LLC Multi-function bi-polar forceps
US10881449B2 (en) 2012-09-28 2021-01-05 Ethicon Llc Multi-function bi-polar forceps
US10226273B2 (en) 2013-03-14 2019-03-12 Ethicon Llc Mechanical fasteners for use with surgical energy devices
US9295514B2 (en) 2013-08-30 2016-03-29 Ethicon Endo-Surgery, Llc Surgical devices with close quarter articulation features
US9814514B2 (en) 2013-09-13 2017-11-14 Ethicon Llc Electrosurgical (RF) medical instruments for cutting and coagulating tissue
US9861428B2 (en) 2013-09-16 2018-01-09 Ethicon Llc Integrated systems for electrosurgical steam or smoke control
US9526565B2 (en) 2013-11-08 2016-12-27 Ethicon Endo-Surgery, Llc Electrosurgical devices
US9949788B2 (en) 2013-11-08 2018-04-24 Ethicon Endo-Surgery, Llc Electrosurgical devices
US9265926B2 (en) 2013-11-08 2016-02-23 Ethicon Endo-Surgery, Llc Electrosurgical devices
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
US10463421B2 (en) 2014-03-27 2019-11-05 Ethicon Llc Two stage trigger, clamp and cut bipolar vessel sealer
US10092310B2 (en) 2014-03-27 2018-10-09 Ethicon Llc Electrosurgical devices
US10524852B1 (en) 2014-03-28 2020-01-07 Ethicon Llc Distal sealing end effector with spacers
US10349999B2 (en) 2014-03-31 2019-07-16 Ethicon Llc Controlling impedance rise in electrosurgical medical devices
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
US9757186B2 (en) 2014-04-17 2017-09-12 Ethicon Llc Device status feedback for bipolar tissue spacer
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
US10639092B2 (en) 2014-12-08 2020-05-05 Ethicon Llc Electrode configurations for surgical instruments
US9848937B2 (en) 2014-12-22 2017-12-26 Ethicon Llc End effector with detectable configurations
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
US10092348B2 (en) 2014-12-22 2018-10-09 Ethicon Llc RF tissue sealer, shear grip, trigger lock mechanism and energy activation
US10342602B2 (en) 2015-03-17 2019-07-09 Ethicon Llc Managing tissue treatment
US10321950B2 (en) 2015-03-17 2019-06-18 Ethicon Llc Managing tissue treatment
US10595929B2 (en) 2015-03-24 2020-03-24 Ethicon Llc Surgical instruments with firing system overload protection mechanisms
US10314638B2 (en) 2015-04-07 2019-06-11 Ethicon Llc Articulating radio frequency (RF) tissue seal with articulating state sensing
US10117702B2 (en) 2015-04-10 2018-11-06 Ethicon Llc Surgical generator systems and related methods
US10130410B2 (en) 2015-04-17 2018-11-20 Ethicon Llc Electrosurgical instrument including a cutting member decouplable from a cutting member trigger
US9872725B2 (en) 2015-04-29 2018-01-23 Ethicon Llc RF tissue sealer with mode selection
US10357303B2 (en) 2015-06-30 2019-07-23 Ethicon Llc Translatable outer tube for sealing using shielded lap chole dissector
US10154852B2 (en) 2015-07-01 2018-12-18 Ethicon Llc Ultrasonic surgical blade with improved cutting and coagulation features
US10610286B2 (en) 2015-09-30 2020-04-07 Ethicon Llc Techniques for circuit topologies for combined generator
US10687884B2 (en) 2015-09-30 2020-06-23 Ethicon Llc Circuits for supplying isolated direct current (DC) voltage to surgical instruments
US11033322B2 (en) 2015-09-30 2021-06-15 Ethicon Llc Circuit topologies for combined generator
US10194973B2 (en) 2015-09-30 2019-02-05 Ethicon Llc Generator for digitally generating electrical signal waveforms for electrosurgical and ultrasonic surgical instruments
US10624691B2 (en) 2015-09-30 2020-04-21 Ethicon Llc Techniques for operating generator for digitally generating electrical signal waveforms and surgical instruments
US10595930B2 (en) 2015-10-16 2020-03-24 Ethicon Llc Electrode wiping surgical device
US10179022B2 (en) 2015-12-30 2019-01-15 Ethicon Llc Jaw position impedance limiter for electrosurgical instrument
US10959806B2 (en) 2015-12-30 2021-03-30 Ethicon Llc Energized medical device with reusable handle
US10575892B2 (en) 2015-12-31 2020-03-03 Ethicon Llc Adapter for electrical surgical instruments
US10537351B2 (en) 2016-01-15 2020-01-21 Ethicon Llc Modular battery powered handheld surgical instrument with variable motor control limits
US10251664B2 (en) 2016-01-15 2019-04-09 Ethicon Llc Modular battery powered handheld surgical instrument with multi-function motor via shifting gear assembly
US10299821B2 (en) 2016-01-15 2019-05-28 Ethicon Llc Modular battery powered handheld surgical instrument with motor control limit profile
US10555769B2 (en) 2016-02-22 2020-02-11 Ethicon Llc Flexible circuits for electrosurgical instrument
US10702329B2 (en) 2016-04-29 2020-07-07 Ethicon Llc Jaw structure with distal post for electrosurgical instruments
US10646269B2 (en) 2016-04-29 2020-05-12 Ethicon Llc Non-linear jaw gap for electrosurgical instruments
US10485607B2 (en) 2016-04-29 2019-11-26 Ethicon Llc Jaw structure with distal closure for electrosurgical instruments
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
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
US11266430B2 (en) 2016-11-29 2022-03-08 Cilag Gmbh International End effector control and calibration

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CN1083693A (en) 1994-03-16
EP0641177A1 (en) 1995-03-08
AU4237093A (en) 1993-12-13
US5293863A (en) 1994-03-15
US5423814A (en) 1995-06-13

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