CN106063721B

CN106063721B - Blood vessel sealing and separating device with spanning function for hyperfine dissection

Info

Publication number: CN106063721B
Application number: CN201610255127.7A
Authority: CN
Inventors: 丁伟江; 陈建疆; J·E·阿尔梅达
Original assignee: Covidien LP
Current assignee: Covidien LP
Priority date: 2015-04-24
Filing date: 2016-04-22
Publication date: 2020-11-06
Anticipated expiration: 2036-04-22
Also published as: CN205885520U; CN106063721A; WO2016169036A1

Abstract

An electrosurgical forceps includes an end effector having first and second jaw members disposed about a longitudinal axis. The first and second jaw members include proximal portions defining a gap therebetween and distal portions having first and second tissue contacting surfaces, respectively, the distal portion of the first jaw member and the distal portion of the second jaw member having cutting edges at opposite sides of the first and second tissue contacting surfaces. The end effector is configured to selectively transfer electrosurgical energy between a first tissue contacting surface of the first jaw member and a second tissue contacting surface of the second jaw member upon actuation thereof. At least one of the first and second jaw members is movable relative to the other between an open position, a first approximated position in which the first and second tissue contacting surfaces are generally opposed to one another, and a second approximated position in which the first and second tissue contacting surfaces are laterally offset relative to one another.

Description

Blood vessel sealing and separating device with spanning function for hyperfine dissection

Technical Field

The present disclosure relates to energy-based surgical instruments, and more particularly to energy-based surgical forceps configured for treating and/or cutting tissue.

Background

A forceps or hemostat is a clip-like device that relies on mechanical action between its jaws to grasp, clamp, and restrain tissue. Energy-based forceps utilize a mechanical clamping action and energy, such as electrosurgical energy, ultrasonic energy, optical energy, microwave energy, heat, and the like, to achieve hemostasis by heating tissue to coagulate and/or cauterize the tissue. Certain surgical procedures require simpler cauterization of tissue and rely on a specific combination of clamping pressure, precise energy control, and gap distance (i.e., the distance between opposing jaws when closed around tissue) to "seal" the tissue. Often, once the tissue is sealed, the surgeon must precisely slice the tissue along the newly formed tissue seal. Accordingly, a variety of tissue sealing instruments have been designed to incorporate a blade that is movable relative to a blade slot disposed in the jaws of the tissue sealing instrument to sever tissue after the tissue seal is formed.

However, tissue sealing instruments that include blades and blade wells are often disposable devices because the blades and blade wells may be difficult to clean and the blades may wear and dull with repeated use. The blade slot in the jaws of the tissue sealing instrument may reduce the sealing strength of the jaws and the width of the blade slot may increase the width of the jaws, which in turn may result in a reduction in the dissection capabilities of the tissue sealing instrument.

Disclosure of Invention

The present disclosure relates to reusable, energy-based surgical instruments having movable, opposing jaw members configured for grasping, sealing, dissecting and/or cutting blood vessels/tissues, and which do not require the use of blade and slotted jaw configurations, and which have a straddle-type sealing/cutting function for placing damage to tissue surrounding the treated blood vessels/tissues.

According to some aspects of the present disclosure, an electrosurgical instrument includes an end effector having first and second jaw members arranged about a longitudinal axis. The first jaw member includes a proximal portion and a distal portion having a first tissue contacting surface, and the second jaw member includes a proximal portion and a distal portion having a second tissue contacting surface. The proximal portion of the first jaw member and the proximal portion of the second jaw member define a gap therebetween, and the distal portion of the first jaw member and the distal portion of the second jaw member have a cutting edge at opposing sides of the first tissue contacting surface and the second tissue contacting surface. The end effector is configured to selectively transfer electrosurgical energy between a first tissue contacting surface of the first jaw member and a second tissue contacting surface of the second jaw member upon actuation thereof. At least one of the first and second jaw members is movable relative to the other between an open position, a first approximated position in which the first and second tissue contacting surfaces are generally opposed to one another, and a second approximated position in which the first and second tissue contacting surfaces are laterally offset relative to one another.

In some aspects, the proximal portions of the first and second jaw members extend along a longitudinal axis and the distal portions are twisted longitudinally and laterally relative to the longitudinal axis. In some aspects, the first tissue contacting surface and the second tissue contacting surface define a triangular gap therebetween when in the first approximated position.

In some aspects, the distal portion of the first jaw member and the distal portion of the second jaw member include complementarily-shaped leading ends having a geometry that is different from the geometry of the first and second tissue contacting surfaces. In some aspects, one of the complementary-shaped leading ends includes a convex portion and one of the complementary-shaped leading ends includes a concave surface. In certain aspects, the front end of the first jaw member comprises a convex surface and the front end of the second jaw member comprises a concave surface. The complementarily-shaped leading ends can be configured to mate when in a first approximated position and be laterally offset relative to one another when in a second approximated position.

Another electrosurgical instrument provided in accordance with some aspects of the present disclosure includes an end effector having first and second jaw members arranged about a longitudinal axis. The first jaw member defines a first tissue contacting surface and the second jaw member defines a second tissue contacting surface. At least one of the first and second jaw members is movable relative to the other between an open position, a first approximated position in which the first and second tissue contacting surfaces are generally opposed to one another, and a second approximated position in which the first and second tissue contacting surfaces are laterally offset relative to one another. The instrument further includes first and second shaft members that cooperate to define an end effector. The first jaw member is disposed on the distal end portion of the first shaft member and the second jaw member is disposed on the distal end portion of the second shaft member. The first and second shaft members are coupled together by a pivot pin assembly that extends through openings defined in respective cross portions of the first and second shaft members. At least one of the first and second shaft members is pivotable relative to the other of the first and second shaft members about two different axes that are generally mutually orthogonal and orthogonal to the longitudinal axis so as to allow movement of the at least one of the first and second jaw members between the open position, the first approximated position, and the second approximated position.

In some aspects, the pivot pin assembly includes a spring pin and a generally hemispherical pin head. The spring pin has: the pin includes a body portion, a resilient flange disposed at a first end of the body portion, and a tail portion extending from a second end of the body portion into an opening defined in the pin head. In some aspects, the flange is positioned against the second shaft member and the pin head is positioned in an opening of the intersection portion of the first shaft member. In some aspects, when the first and second shaft members are in the first approximate position, a distal gap between the intersecting portions of the first and second shaft members is open and a proximal gap defined between the intersecting portions is closed. In some aspects, when the first and second shaft members are in the second approximate position, a proximal gap between the intersecting portions of the first and second shaft members is open and a distal gap defined between the intersecting portions is closed.

The electrosurgical instrument may further include first and second handle members disposed at the proximal end portions of the first and second shaft members. In some aspects, the first handle member comprises a male rail and the second handle member comprises a tab stop. In some aspects, the electrosurgical instrument further comprises a connector assembly releasably engaged with the male rail of the first handle member. In certain aspects, the tab stop engages a switch disposed in the connector assembly when the first and second shaft members are in the first approximated position to automatically activate the source of electrosurgical energy.

According to some aspects of the present disclosure, a method of treating tissue comprises: locking together first and second handle members of an electrosurgical forceps to effect movement of the first and second jaw members from an open position to a first approximated position to grasp tissue between first and second tissue contacting surfaces disposed on distal portions of the first and second jaw members, wherein the proximal portions of the first and second jaw members define a gap therebetween and do not grasp tissue disposed in the gap; applying electrosurgical energy to tissue grasped between the first tissue contacting surface of the first jaw member and the second tissue contacting surface of the second jaw member to seal the tissue; and moving at least one of the first and second handle members laterally relative to the other to effect movement of the first and second jaw members from the first to the second approximated positions to cut tissue grasped between the first and second tissue contacting surfaces via the cutting edges disposed at opposite sides of the first and second tissue contacting surfaces.

Drawings

Various aspects and features of the disclosure are described herein with reference to the following drawings, in which corresponding reference numerals represent corresponding parts throughout, and in which:

FIG. 1 is a side view of an open electrosurgical forceps according to an embodiment of the present disclosure;

FIG. 2 is a side perspective view of the pliers of FIG. 1 with the parts separated;

FIG. 3A is an enlarged perspective view of a spring pin of the pivot pin assembly of the pliers of FIG. 2;

FIG. 3B is a cross-sectional view of the spring pin of FIG. 3A;

FIG. 3C is a cross-sectional view of the spring pin of FIG. 3A in a deflection direction;

FIGS. 4A and 4B are enlarged perspective views of the pliers of FIG. 1 along the portions shown labeled as detail areas 4A and 4B, respectively, in FIG. 1;

FIG. 5A is a side perspective view of the pliers of FIG. 1 in a first approximated position;

FIG. 5B is a cross-sectional view of the crossing portion of the pliers of FIG. 5A taken along line 5B-5B of FIG. 5A;

FIG. 5C is a cross-sectional view of the jaw members of the forceps of FIG. 5A taken along line 5C-5C of FIG. 5A and including tissue disposed therebetween;

FIG. 6A is a side perspective view of the pliers of FIG. 1 in a second, approximated position;

FIG. 6B is a cross-sectional view of the crossing portion of the pliers of FIG. 6A taken along line 6B-6B of FIG. 6A;

FIG. 6C is a cross-sectional view of the jaw members of the forceps of FIG. 6A taken along line 6C-6C of FIG. 6A and including tissue disposed therebetween;

FIGS. 7A-7C are schematic views of a blood vessel and tissue in an initial state, after sealing, and after cutting, respectively;

FIG. 8A is a side view of an electrosurgical instrument including a forceps and connector assembly shown in a disassembled state according to another embodiment of the present disclosure;

FIG. 8B is a top view of the pliers of FIG. 8A;

FIG. 9 is an enlarged perspective view of the distal portion of the forceps of FIG. 8A;

FIG. 10 is a side view of the electrosurgical instrument of FIG. 8A in an assembled condition with the jaws in a first approximated position and tissue disposed between the jaw members of the jaws;

11A-11D are side perspective views of the jaw members of FIG. 10 during movement from a first to a second approximated position; and is

Fig. 12 is a schematic view of a workstation configured for use with the electrosurgical instrument of the present disclosure.

Detailed Description

In the present disclosure, the term "proximal" refers to the portion of a structure that is closer to the operator, while the term "distal" refers to the portion of the same structure that is further away from the operator. As used herein, the term "recipient" refers to a human patient or animal. The term "operator" refers to doctors (e.g., surgeons), nurses, and other clinicians or medical personnel and may include support personnel. The terms "generally," "approximately," and "approximately" should be understood as words of similar import that contemplate relatively little or no change in the correction factors.

Referring now to fig. 1, an electrosurgical instrument 1 according to an embodiment of the present disclosure is configured for grasping, electrically sealing, and mechanically dissecting tissue and/or blood vessels in surgical and/or laparoscopic procedures. Electrosurgical instrument 1 includes a reusable forceps 100, the reusable forceps 100 being releasably connectable to a source of electrosurgical energy 200 via

cables

101 and 103.

The forceps 100 includes a first elongate shaft member 110 pivotably coupled to a second elongate shaft member 120. The first elongate shaft member 110 includes a proximal portion 112 and a distal portion 114, respectively, and the second elongate shaft member 120 includes a proximal portion 122 and a distal portion 124, respectively. The

proximal end portions

112 and 122 of the first and

second shaft members

110 and 120 include first and

second handle members

130 and 140, respectively. The first and

second handle members

130, 140 are configured to allow an operator to effect movement of at least one of the first and

second shaft members

110, 120 relative to the other. The

distal end portions

114 and 124 of the first and

second shaft members

110 and 120 cooperate to define an end effector assembly 115, the end effector assembly 115 having opposing first and

second jaw members

150 and 160.

Each of the first and

second handle members

130 and 140 defines a

finger aperture

130a and 140a, respectively, therethrough for receiving a finger of an operator.

Finger apertures

130a and 140a facilitate movement of first handle member 130 and second handle member 140 relative to each other about "x" and "y" axes that are orthogonal to each other and to longitudinal axis "z". In some embodiments, first handle member 130 and second handle member 140 are each integrally formed with their

respective shaft members

110 and 120. Alternatively, each of first handle member 130 and second handle member 140 may be engaged with its

respective shaft member

110 and 120 by any suitable configuration, such as via mechanical engagement, molding, bonding, or the like.

As shown in fig. 2, in conjunction with fig. 1, the first shaft member 110 and the second shaft member 120 intersect at

intersection portions

116 and 126, respectively. The

cross portions

116 and 126 of the first and

second shaft members

110 and 120 define

openings

116a and 126a, respectively, therethrough for receiving a pivot pin assembly 170, the pivot pin assembly 170 for coupling the first and

second shaft members

110 and 120 together.

An insulating spacer 128 is disposed between the crossing

portions

116 and 126 of the first and

second shaft members

110 and 120. An insulating spacer 128 is secured to the inner surface 126b of the cross-over portion 126 and defines an opening 128a therethrough, the opening 128a being aligned with the

openings

116a and 126a of the

cross-over portions

116 and 126. The insulating spacer 128 is configured to extend between the intersecting

portions

116 and 126 of the first and

second shaft members

110 and 120 to electrically insulate the first and

second shaft members

110 and 120 from each other. The insulating washer 128 is formed of an electrically insulating material, such as ceramic or plastic, and may be secured to the second shaft member 120 by gluing, brazing, or other mechanical and/or chemical means known to those skilled in the art. Additionally or alternatively, the inner surface 126b of the cross portion 126 of the second shaft member 120, or a portion thereof, may include an insulating coating, such as a ceramic coating.

Referring now to fig. 3A-3C, in conjunction with fig. 2, pivot pin assembly 170 includes a spring pin 172, an insulating washer 174, and a pin head 176. The spring pin 172 includes a body portion 172a, which includes a flange 172b at a first end thereof and a tail portion 172c having a smaller diameter than the body portion 172a extending from a second end of the body portion 172 a. The flange 172B is positioned against an insulating washer 174, which insulating washer 174 is positioned in a recess defined in the outer surface of the second shaft member 120 (fig. 5B). Alternatively, the insulating washer 174 can be replaced by an insulating coating on the second shaft member 120. The body portion 172a extends through

openings

126a and 128a defined in the cross portion 126 and the insulating washer 128 of the second shaft member 120, and the tail portion 172c extends through an opening 176a defined in a pin head 176, the pin head 176 being positioned in the opening 116a of the cross portion 116 of the first shaft member 110. The flange 172b is formed of a resilient material to allow the flange 172b to deflect as the first and

second shaft members

110, 120 move. The spring pin 172 maintains pressure between the first shaft component 110 and the second shaft component 120, which in turn helps to maintain proper alignment of the jaws during the sealing and cutting functions of the forceps 100.

Referring now to fig. 4A and 4B, in conjunction with fig. 1, the first and

second jaw members

150, 160 extend distally from the crossing portion 116 of the first shaft member 110 and the crossing portion 126 of the second shaft member 120. The proximal portion 150a of the first jaw member 150 and the proximal portion 160a of the second jaw member 160 extend longitudinally along an axis "z" from the

cross portions

116 and 126 and define a gap "G" therebetween_J".

Distal portions

150b and 160b of first and

second jaw members

150 and 160, respectively, include first and second

tissue contacting surfaces

152 and 162, respectively, with first and second

tissue contacting surfaces

152 and 162 twisted (e.g., bent, curled, bent, or otherwise shaped) to extend distally away from axis "z" longitudinally and laterally, and configured to mate when in a first approximated position.

The first and second

tissue contacting surfaces

152, 162 each include: leading

end portions

152a and 162a, the

leading end portions

152a and 162a being distal from trailing

end portions

152b and 162 b; and at least one cutting edge along side edges 154 and 164 of first and second

tissue contacting surfaces

152 and 162. In particular, as shown in fig. 4A, the concave side edges 154 of the first jaw member 150 can define a shear edge configuration, while the convex side edges 164 of the second jaw member 160 can define a shear edge configuration. The opposing sides, such as the convex side edge 154 of the first jaw member 150 and the concave side edge 164 of the second jaw member 160, may similarly define a shear edge configuration or may define a blunt rounded configuration. The first and second

tissue contacting surfaces

152, 162 have complementary geometries such that when the first and

second jaw members

150, 150 are in a first approximated position, the first and second

tissue contacting surfaces

152, 162 are opposed and aligned for tissue sealing (fig. 5C), and when in a second approximated position, the first and second

tissue contacting surfaces

152, 162 diverge laterally at a leading end portion 152a of the first and second

tissue contacting surfaces

152, 162 with increasing clearance for tissue cutting (fig. 6C).

The first shaft member 110 and the second shaft member 120 are a pair of electrodes formed of an electrically conductive material, e.g., a metal such as stainless steel, that are configured to conduct electrosurgical energy therethrough. An insulating coating, such as an insulating varnish, is disposed on the forceps 100, except for the

tissue contacting surfaces

152 and 162 and the cutting edges 154 and 164 of the first and

second jaw members

150 and 160, the insulating

washer

128 and 174, which themselves are formed of an insulating material, and the plugs (not shown) of the

cables

101 and 103, which are connectable to a source of electrosurgical energy (not shown).

In one method of using electrosurgical forceps 100 of the present disclosure, the first jaw member 150 and the second jaw member 160 of the forceps 100 are placed around a desired tissue and/or vessel at a desired surgical site. As shown in fig. 1, in the open position, the first and

second jaw members

150, 160 are spaced apart from one another and are pivotable about an axis "x". By moving at least one of the first and

second handle members

130, 140 toward the other in the direction of arrow "a", the first and

second jaw members

150, 160 are moved to a first approximated position such that at least one of the first and

second handle members

130, 140 pivots about the pivot pin 170 and the first and

second handle members

130, 140 are closed to the first approximated position to grasp tissue "T" between the first and

second jaw members

150, 160, as shown in fig. 5A-5C. In the first approximated position, a distal gap "G" between the insulating washer 128 and the cross-over portion 116 of the first shaft member 110_D"open and proximal gap" G_PAnd closing. Distal to first jaw member 150 and second jaw

member 160The portions

150b and 160b grasp tissue "T" therebetween while tissue surrounding the boundary of the grasped tissue "T" is freely disposed in the gap "G" defined between the

proximal portions

150a and 160a of the first and

second jaw members

150 and 160_J"in (1).

With

cables

101 and 103 of jaw 100 connected to an electrosurgical energy source (not shown), the electrosurgical energy source may be subsequently activated to apply electrosurgical energy to tissue "T" grasped between first tissue contacting surface 152 of first jaw member 150 and second tissue contacting surface 162 of second jaw member 160 to seal tissue "T", while disposing gap "G" defined between

proximal portions

150a and 160a of first and

second jaw members

150 and 160_J"is not grasped or subjected to electrosurgical energy.

When sealing is completed and the source of electrosurgical energy (not shown) is turned off, first and

second handle members

130, 140 can be returned to the open position to release tissue "T" held between first

tissue contacting surfaces

152, 162 of first and

second jaw members

150, 160, or first and

second jaw members

150, 160 can be moved to a second, approximated position to cut tissue "T" disposed therebetween.

6A-6C, to move to the second approximated position, the second handle member 140 is moved laterally in the direction of arrow "B" to deflect the second handle member 140 about the "y" axis. When the "y" axis is rotated, a distal gap "G" between the

intersection portions

116 and 126 of the first and

second shaft members

110 and 120_D"closed and proximal gap" G_P"open up. At the same time, the first and

second jaw members

150, 160 are laterally displaced relative to one another. When such lateral movement between the first and

second jaw members

150, 160 is greater than the width of the first and

second jaw members

150, 160, the side edges 154, 164 of the first and

second jaw members

150, 160 configured as the cutting edges cut the tissue "T" defined between the first and

second jaw members

150, 160 and at the first jaw memberGap "G" defined between member 150 and

proximal portions

150a and 160a of second jaw member 160_JThe border tissue arranged in "is not cut. First handle member 130 and second handle member 140 can then be moved back to the open position. As shown in fig. 7A-7C, in the exemplary method described above, the vessel "V" may be a sealed "S" and a cut "C" and does not affect the tissue "T" surrounding the vessel "V".

Referring now to fig. 8A and 8B, an electrosurgical instrument 2 including forceps 100' and a connector assembly 200 is illustrated, according to another embodiment of the present disclosure. The forceps 100 ' includes a first elongate shaft member 110 ' pivotally connected to a second elongate shaft member 120 ' via a pivot pin assembly 170. The first shaft member 110 ' includes a first handle member 130 ', a cross portion 116, and a first jaw member 150 '. The second shaft member 120 ' includes a second handle member 140 ', a cross portion 126, and a second jaw member 160 '.

First handle member 130 'and second handle member 140' each define a

finger aperture

130a and 140a, respectively. First handle member 130' includes a male rail and optionally a proximally extending tail 134 configured to mate with connector assembly 200. The second handle member 140 ' includes a tab stop 142, the tab stop 142 being disposed on an inner surface 140a of the second handle member 140 ' extending toward the first handle member 130 '.

Connector assembly 200 includes a housing 202, the housing 202 including a lower surface 202a configured to matingly engage rail 132 and optionally tail 134 of first handle member 130 ', an upper surface 202b including a switch 204 extending outwardly toward second handle member 140 ' and generally aligned with tab stop 142, and a proximal end including a cable 206 extending therefrom and terminating at a plug 208 for electrically connecting forceps 100 ' to a source of electrosurgical energy (not shown).

As shown in fig. 9, in conjunction with fig. 8A, the first jaw member 150 'and the second jaw member 160' include: proximal portions 150a ' and 160a ', the proximal portions 150a ' and 160a ' extending from the first shaft member 110 ' and the second shaft

memberThe cross portions

116 and 126 of the member 120' extend longitudinally and define a gap "G" therebetween_J". The distal portions 150b ' and 160b ' include first and second tissue contacting surfaces 152 ' and 162 ' defining side edges 154 ' and 164 ', wherein at least one side edge 154 ' of each of the first and second tissue contacting surfaces 152 ' and 162 ' defines a shearing edge structure, such as a convex side edge 154 ' of the first tissue contacting surface 152 ' of the first jaw member 150 ' and a concave side edge 164 ' of the second tissue contacting surface 162 ' of the second jaw member 160 '. Tissue contacting surfaces 152 'and 162' and side edges 154 'and 164' configured as cutting edges are substantially similar to those described above with reference to forceps 100, however, in the present embodiment, a generally triangular gap "G" is defined along tissue contacting surfaces 152 'and 154' from leading ends 152a 'and 162 a' to trailing ends 152b 'and 162 b', respectively_T”。

The front ends 152a 'and 162 a' of the first and second jaw members 150 'and 160' are contoured and complementarily shaped to assist in aligning the first and second jaw members 150 'and 160'. As shown, the front end 152a 'of the first jaw member 150' includes a generally v-shaped convex surface 156 and the front end 162a 'of the second jaw member 160' includes a generally v-shaped concave surface 166. The complementary geometry of the leading ends 152a 'and 162 a' of the first and second jaw members 150 'and 160' helps maintain accurate jaw alignment and reduce the cutting force necessary to cut tissue during the sealing and cutting functions of the jaw 100.

Similar to the first and

second shaft members

110, 120 of the forceps 100, the first and second shaft members 110 ', 120' are a pair of electrodes. Accordingly, an insulative coating is disposed on the pliers 100 ', including the

surfaces

156 and 166 at the forward end portions 152a ' and 162a ' of the first and second jaw members 150 ' and 160 '. As described above, the forceps 100 ' is free of insulative coating at the tissue contacting surfaces 152 ' and 162 ' and the side edges 154 ' and 164 ' configured as cutting edges, at the plug 208, and at the insulating washer 128 and the insulating washer 174 of the first and second jaw members 150 ' and 160 '. Additionally, the rails 132 and/or tail 134 of the first handle member 130' may be free of an insulating coating for electrical connection with electrical contacts disposed in the connector assembly 200.

In one method of using electrosurgical instrument 2, connector assembly 200 is assembled to jaw 100 ', as shown in fig. 10, and first and second jaw members 150 ', 160 ' are positioned about a desired tissue and/or blood vessel at a desired surgical site and then moved to a first approximated position by locking first and second handle members 130 ', 140 ' together to grasp tissue "T" therebetween. Tissue contacting surfaces 152 'and 162' (fig. 9) of the first and second jaw members 150 'and 160' are generally opposed and parallel under the sealing force, and the tab stop 142 contacts the switch 204 of the connector assembly 200 to apply electrosurgical energy to tissue "T" grasped between the first and second tissue contacting surfaces 152 'and 162' of the first and second jaw members 150 'and 160', while disposed at the gap "G_J"boundary tissue of middle" T_B"is freely disposed in the proximal portions 150a 'and 160 a' of the first and second jaw members 150 'and 160'.

When sealing is complete, first and second handle members 130 ', 140' can be returned to the open position to release tissue "T" held between first and second tissue contacting surfaces 152 ', 162' of first and second jaw members 150 ', 160', or first and second jaw members 150 ', 160' can be moved to a second approximated position to cut tissue "T" disposed therebetween.

11A-11D, in conjunction with FIG. 10, to move to the second approximated position, pressure applied to the first and second handle members 130 ', 140 ' during sealing is released to restore the triangular gap "G" between the first and second jaw members 150 ', 160_T"(fig. 11A), and releases the tab stop 142 from the switch 204 (fig. 10) to stop the application of electrosurgical energy. The second handle member 140' is about an axis relative to the first handle member 130The "y" motion causes the convex surface 156 and the concave surface 166 of the first jaw member 150 'and the second jaw member 160' to slide relative to each other until the apex 150a of the convex surface 156 contacts the outer edge 166a of the concave surface 166, and then to drop under the residual pressure between the first jaw member 150 'and the second jaw member 160' (fig. 11C) such that the convex surface 156 and the concave surface 166 become laterally offset relative to each other. When the second jaw member 160 ' is elastically deflected, a stable lateral pressure is obtained between the first jaw member 150 ' and the second jaw member 160 '. The first handle member 130 'and the second handle member 140' are re-locked by rotating the first handle member 130 'and/or the second handle member 140' about the "x" axis to cut tissue disposed between the first tissue contacting surface 152 'and the second tissue contacting surface 162' from the leading ends 152a 'and 162 a' to the trailing ends 152b 'and 162 b' via the side edges 154 'and 164' configured as cutting edges (fig. 11D). The first and second handle members 130 ', 140' can then be released and moved back to the open position.

Embodiments disclosed herein may also be configured to work with robotic surgical systems and are commonly referred to as "Telesurgery". Such systems employ various robotic elements to assist the operator and to allow for remote operation (or partial remote operation) of the surgical instrument. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and they may be designed with robotic surgical systems to assist the operator during the course of surgery or treatment. Such robotic systems may include telesteerable systems, automated flexible surgical systems, teleflexible surgical systems, telearthroscopic surgical systems, wireless surgical systems, modular or selectively configurable teleoperated surgical systems, and the like.

Robotic surgical systems may employ one or more consoles located near the operating room or in remote locations. In this example, a team of surgeons or nurses may pre-operatively prepare a subject (e.g., a patient) and configure the robotic surgical system with one or more of the instruments disclosed herein, while another surgeon (or group of surgeons) remotely controls the instruments via the robotic surgical system. As can be appreciated, a high-level surgeon can perform multiple procedures at multiple locations without having to leave his/her remote console, which can be both economically advantageous and beneficial to a patient or series of patients.

The robotic arms of the surgical system are typically coupled to a pair of primary handles by a controller. The surgeon may be able to move the handle to cause corresponding movement of the working end of any type of surgical instrument (e.g., end effector, grasper, knife, scissors, etc.), which may be complementary to the application of one or more of the embodiments described herein. The movement of the main handle may be scaled to cause the working end to have a corresponding movement that is different, of a smaller magnitude, or of a larger magnitude than the movement performed by the surgeon's manipulator. The scaling factor or gear ratio may be adjusted to enable the operator to control the resolution of the working end of the surgical instrument.

The primary handle may include various sensors to provide feedback to the surgeon regarding various tissue parameters or tissue states, such as tissue resistance due to manipulation, cutting, or otherwise manipulation, pressure applied to the tissue by the instrument, tissue temperature, tissue impedance, and the like. As can be appreciated, such sensors provide enhanced tactile feedback to the surgeon that simulates real surgical conditions. The primary handle may also include a variety of different actuators for fine tissue manipulation or treatment, further enhancing the surgeon's ability to simulate real surgical conditions.

As shown in fig. 12, the medical workstation is shown generally as workstation 1000 and may generally include: a plurality of

robots

1002 and 1003; a control device 1004; and a surgical console 1005, the surgical console 1005 being coupled to the control device 1004. Surgical console 1005 may include: a display device 1006, said display device 1006 may particularly be arranged to display a three-dimensional image; and

manual input devices

1007 and 1008 whereby an operator (not shown), such as a surgeon, can remotely manipulate the

robots

1002 and 1003 in the first mode of operation.

According to any of the several embodiments disclosed herein and as will be described in detail below, each of the

robots

1002 and 1003 may include a plurality of members connected by links and attachment devices 1009 and 1011 (e.g., surgical tool "ST" supporting end effector 1100) to which they may be attached.

The

robots

1002 and 1003 may be driven by an electric device (not shown) connected to the control device 1004. The control means 1004 (e.g. a computer) may be arranged to activate the drive means, in particular by a computer program, to cause the

robots

1002 and 1003, their attachment means 1009 and 1011 and thus the surgical tool (including the end effector 1100) to perform the required movements according to the movements defined by the manual input means 1007 and 1008. The control means 1004 can also be arranged such that it regulates the movement of the

robots

1002 and 1003 and/or the drive means.

The medical workstation 1000 may be configured for use with the end effector 1100 in a minimally invasive manner on a patient 1013 lying on an operating table 1012 to be treated. The medical workstation 1000 may also include more than two

robots

1002 and 1003, additional robots similarly connected to the control device 1004 and remotely steerable by the surgical console 1005. Medical instruments or surgical tools (including end effector 1100) may also be attached to additional robots. The medical workstation 1000 may include a database 1014, the database 1014 being particularly coupled to the control device 1004, in which database 1014 pre-operative data and/or anatomical atlas, for example, for the patient/living body 1013 are stored.

Although several embodiments of the present disclosure have been illustrated in the accompanying drawings and described herein, it is to be understood that the disclosure is not limited thereto since the disclosure is intended to be as broad in scope as the art will allow and that the specification is to be read likewise. Therefore, the above description should not be taken as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims

1. An electrosurgical instrument, comprising:

an end effector having first and second jaw members arranged about a longitudinal axis, the first jaw member including a proximal portion and a distal portion having a first tissue contacting surface, the second jaw member including a proximal portion and a distal portion having a second tissue contacting surface, the proximal portion of the first jaw member and the proximal portion of the second jaw member defining a gap therebetween, and the distal portion of the first jaw member and the distal portion of the second jaw member including shear edges at opposite sides of the first and second tissue contacting surfaces, the end effector being configured to selectively transfer electrosurgical energy between the first tissue contacting surface of the first jaw member and the second tissue contacting surface of the second jaw member upon actuation thereof, at least one of the first and second jaw members being movable relative to the other between an open position, a first approximated position in which the first and second tissue contacting surfaces are generally opposed to one another, and a second approximated position in which the first and second tissue contacting surfaces are laterally offset relative to one another; and

first and second shaft members cooperating to define an end effector, the first jaw member being disposed on a distal end portion of the first shaft member, the second jaw member being disposed on a distal end portion of the second shaft member, the first and second shaft members being coupled together by a pivot pin assembly extending through openings defined in respective intersecting portions of the first and second shaft members, at least one of the first and second shaft members being pivotable relative to the other of the first and second shaft members about two different axes that are generally orthogonal to each other and to the longitudinal axis so as to allow at least one of the first and second jaw members to move between the open position, the closed position, and the open position, The first and second access positions.

2. The electrosurgical instrument of claim 1, wherein the proximal portions of the first and second jaw members extend along the longitudinal axis and the distal portions of the first and second jaw members are twisted longitudinally and laterally relative to the longitudinal axis.

3. The electrosurgical instrument of claim 1, wherein the first and second tissue contacting surfaces define a triangular gap therebetween when in the first approximated position.

4. The electrosurgical instrument of claim 1, wherein the distal portions of the first and second jaw members include complementary shaped leading ends having a geometry that is different from a geometry of the first and second tissue contacting surfaces.

5. An electrosurgical instrument according to claim 4, wherein one of the complementary shaped leading ends comprises a raised portion and the other of the complementary shaped leading ends comprises a recessed surface.

6. The electrosurgical instrument of claim 4, wherein a leading end of the first jaw member comprises a convex surface and a leading end of the second jaw member comprises a concave surface.

7. An electrosurgical instrument according to claim 4, wherein the complementarily-shaped leading ends are configured to mate when in the first approximated position.

8. An electrosurgical instrument according to claim 4, wherein the complementarily-shaped leading ends are laterally offset relative to one another when in the second approximate position.

9. An electrosurgical instrument, comprising:

an end effector having first and second jaw members arranged about a longitudinal axis, the first jaw member including a proximal portion and a distal portion having a first tissue contacting surface, the second jaw member including a proximal portion and a distal portion having a second tissue contacting surface, at least one of the first and second jaw members being movable relative to the other between an open position, a first approximated position in which the first and second tissue contacting surfaces are generally opposed to one another, and a second approximated position in which the first and second tissue contacting surfaces are laterally offset relative to one another; and

10. The electrosurgical instrument of claim 9, wherein the pivot pin assembly includes a spring pin and a pin head, the spring pin having a body portion, a resilient flange disposed at a first end of the body portion, and a tail portion extending from a second end of the body portion into an opening defined in the pin head.

11. The electrosurgical instrument of claim 10, wherein the flange is positioned against the second shaft member, the pin head being positioned in an opening of the crossing portion of the first shaft member.

12. The electrosurgical instrument of claim 10, wherein when at least one of the first and second jaw members is moved to the first approximated position, a distal gap between the crossing portions of the first and second shaft members opens and a proximal gap defined between the crossing portions closes.

13. The electrosurgical instrument of claim 10, wherein when at least one of the first and second jaw members is moved to the second approximated position, a proximal gap between the crossing portions of the first and second shaft members opens and a distal gap defined between the crossing portions closes.

14. The electrosurgical instrument of claim 9, wherein the proximal end portion of the first shaft member and the proximal end portion of the second shaft member comprise a first handle member and a second handle member, respectively.

15. The electrosurgical instrument of claim 14, wherein the first handle member comprises a male rail and the second handle member comprises a tab stop.

16. The electrosurgical instrument of claim 15, further comprising a connector assembly releasably engaged with the male rail of the first handle member.

17. The electrosurgical instrument of claim 16, wherein the tab stop engages a switch disposed in the connector assembly when at least one of the first and second jaw members is moved to the first approximated position.