CN114901167A - Electrosurgical instrument with monopolar and bipolar energy capabilities - Google Patents

Abstract

The present invention discloses an electrosurgical instrument comprising an end effector including a first jaw, a second jaw and an electrical circuit. The first jaw includes a first conductive skeleton, a first insulating coating selectively covering portions of the first conductive skeleton, and a first jaw electrode including exposed portions of the first conductive skeleton. The second jaw includes a second conductive skeleton, a second insulating coating selectively covering portions of the second conductive skeleton, and a second jaw electrode including exposed portions of the second conductive skeleton. The circuit is configured to deliver bipolar RF energy and monopolar RF energy to the tissue through the first jaw electrode and the second jaw electrode. The monopolar RF energy shares a first electrical path and a second electrical path defined by the circuit for transmitting the bipolar RF energy.

Description

Electrosurgical instruments with monopolar and bipolar energy capabilities

CROSS-REFERENCE TO RELATED APPLICATIONS

This non-provisional application claims the benefit of U.S. Provisional Patent Application Serial No. 62/955,299, filed on December 30, 2019, entitled "DEVICES AND SYSTEMS FOR ELECTROSURGERY," under 35 U.S.C. § 119(e), the disclosure of which is set forth in its entirety at Incorporated herein by reference.

Background technique

The present invention relates to surgical instruments designed to treat tissue, including but not limited to surgical instruments configured to cut and secure tissue. The surgical instrument may include an electrosurgical instrument powered by a generator to effect tissue dissection, cutting and/or coagulation during a surgical procedure. Surgical instruments may include instruments configured to enable the use of surgical staples and/or fasteners to cut and staple tissue. The surgical instrument can be configured for open surgical procedures, but has applications in other types of surgical procedures, such as laparoscopic, endoscopic, and robotic-assisted procedures, and can include articulation relative to a shaft portion of the instrument. An end effector that moves to facilitate precise positioning within the patient.

SUMMARY OF THE INVENTION

In various embodiments, an electrosurgical instrument including an end effector is disclosed. The end effector includes a first jaw, a second jaw, and an electrical circuit. The first jaw includes a first electrically conductive skeleton, a first insulating coating selectively covering portions of the first electrically conductive skeleton, and a first jaw electrode including exposed portions of the first electrically conductive skeleton. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a second electrically conductive backbone, a second insulating coating selectively covering portions of the second electrically conductive backbone, and a second jaw electrode including exposed portions of the second electrically conductive backbone. The circuit is configured to deliver bipolar RF energy and monopolar RF energy to tissue through the first jaw electrode and the second jaw electrode. The monopolar RF energy shares a first electrical path and a second electrical path defined by the circuit for transmitting the bipolar RF energy.

In various embodiments, an electrosurgical instrument is disclosed that includes an end effector and an electrical circuit. The end effector includes at least two electrode sets, a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The end effector is configured to deliver a combination of bipolar RF energy and monopolar RF energy from at least two electrode sets to grasped tissue. The circuit is configured to transmit bipolar RF energy and monopolar RF energy. The monopolar RF energy shares the active and return paths defined by the circuit for transmitting the bipolar RF energy.

In various embodiments, an electrosurgical instrument including an end effector is disclosed. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a composite backbone of at least two different materials configured to selectively create electrically conductive portions and thermally insulating portions.

In various embodiments, a method for manufacturing a jaw of an end effector of an electrosurgical instrument is disclosed. The method includes preparing a composite skeleton of the jaws by fusing titanium powder with ceramic powder in a metal injection molding process and selectively coating the composite skeleton with an electrically insulating material to create a plurality of electrodes.

Description of drawings

The novel features of the various aspects are set forth with particularity in the appended claims. However, the described aspects regarding both organization and methods of operation can be best understood by reference to the following description in conjunction with the accompanying drawings, wherein:

1 illustrates an example of a generator for use with a surgical system in accordance with at least one aspect of the present disclosure;

2 illustrates one form of a surgical system including a generator and an electrosurgical instrument that can be used therewith in accordance with at least one aspect of the present disclosure;

3 shows a schematic diagram of a surgical instrument or tool in accordance with at least one aspect of the present disclosure;

4 is an exploded view of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure;

Figure 5 is a cross-sectional view of the end effector of Figure 4;

Figures 6-8 depict three different modes of operation of the end effector of Figure 4 before energy is applied to tissue;

Figures 9-11 depict three different modes of operation of the end effector of Figure 4 during energy application to tissue;

12 illustrates a method of manufacturing a jaw of an end effector in accordance with at least one aspect of the present disclosure;

13 illustrates a method of manufacturing a jaw of an end effector in accordance with at least one aspect of the present disclosure;

14 shows a partial perspective view of a jaw of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure;

Figure 15 shows steps in the process of manufacturing the jaws of Figure 14;

Figure 16 shows steps in the process of manufacturing the jaws of Figure 14;

Figures 17-19 illustrate steps in the process of manufacturing the jaws of Figure 14;

20 illustrates a cross-sectional view of a jaw of an end effector of an electrosurgical instrument taken through line 20-20 in FIG. 22 in accordance with at least one aspect of the present disclosure;

Figure 21 shows a cross-sectional view of the jaws of the end effector of the electrosurgical instrument taken through line 21-21 in Figure 22;

Figure 22 shows a perspective view of the jaws of the end effector of the electrosurgical instrument of Figure 20;

23 shows a cross-sectional view of a jaw of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure;

24 shows a partial perspective view of a jaw of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure;

25 illustrates a cross-sectional view of an end effector of an electrosurgical instrument according to at least one aspect of the present disclosure;

26 shows a partially exploded view of an end effector of an electrosurgical instrument according to at least one aspect of the present disclosure;

27 shows an exploded perspective assembly view of a portion of an electrosurgical instrument including an electrical connection assembly in accordance with at least one aspect of the present disclosure;

28 illustrates a top view of the electrical pathway defined in the surgical instrument portion of FIG. 27 in accordance with at least one aspect of the present disclosure;

29 shows a cross-sectional view of a flexible circuit according to at least one aspect of the present disclosure;

30 illustrates a cross-sectional view of a flex circuit extending through a coil bobbin in accordance with at least one aspect of the present disclosure;

31 illustrates a cross-sectional view of a flexible circuit extending through a coil bobbin in accordance with at least one aspect of the present disclosure;

32 illustrates a cross-sectional view of a flexible circuit extending through a coil bobbin in accordance with at least one aspect of the present disclosure;

33 shows a cross-sectional view of a flex circuit extending through a coil bobbin in accordance with at least one aspect of the present disclosure;

34 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure;

35 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector and various measured parameters of the end effector and tissue in accordance with at least one aspect of the present disclosure ;

36 is a schematic diagram of an electrosurgical system in accordance with at least one aspect of the present disclosure;

37 is a table illustrating a power regimen for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure;

38-40 illustrate a tissue treatment cycle applied by an end effector to a tissue treatment area in accordance with at least one aspect of the present disclosure;

41 illustrates an end effector applying therapeutic energy to tissue grasped by the end effector, the therapeutic energy being generated by a monopolar power source and a bipolar power source, in accordance with at least one aspect of the present disclosure;

42 shows a simplified schematic diagram of an electrosurgical system in accordance with at least one aspect of the present disclosure;

43 is a graph showing a power scheme for coagulating and cutting a tissue treatment area and corresponding temperature readings for the tissue treatment area in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure;

44 illustrates an end effector for treating an artery in accordance with at least one aspect of the present disclosure;

45 illustrates an end effector for treating an artery in accordance with at least one aspect of the present disclosure;

46 illustrates an end effector applying therapeutic energy to tissue grasped by the end effector, the therapeutic energy being generated by a monopolar power source and a bipolar power source, in accordance with at least one aspect of the present disclosure;

47 shows a simplified schematic diagram of an electrosurgical system in accordance with at least one aspect of the present disclosure;

48 is a graph illustrating a power scheme including a treatment portion and a non-treatment range for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure; and

49 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector, and the corresponding monopolar and bipolar impedances and their ratios, in accordance with at least one aspect of the present disclosure. Graph.

Detailed ways

The applicant of the present application has the following US patent applications filed on the same date as the present application and each of which is incorporated herein by reference in its entirety:

· Attorney docket number END9234USNP1/190717-1M named "METHOD FOR AN ELECTROSURGICAL PROCEDURE";

·Agent's file number END9234USNP2/190717-2 named "ARTICULATABLE SURGICAL INSTRUMENT";

·Agent's docket number END9234USNP3/190717-3 named "SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES";

·Attorney's docket number END9234USNP4/190717-4 named "SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLESURGICAL END EFFECTOR";

·Attorney's docket number END9234USNP5/190717-5 named "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZINGELECTRODES";

·Agent's file number END9234USNP6/190717-6 named "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT";

·Attorney docket number END9234USNP7/190717-7 named "ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES";

·Agent's docket number END9234USNP8/190717-8 named "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS";

·Attorney's docket number END9234USNP9/190717-9 named "ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWERSOURCES";

·The attorney's case number END9234USNP10/190717-10 named "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGYFOCUSING FEATURES";

·The attorney's case number END9234USNP11/190717-11 named "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLEENERGY DENSITIES";

·Attorney docket number END9234USNP13/190717-13 named "ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVE PORTIONS";

·The attorney's case number END9234USNP14/190717-14 named "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE INBIPOLAR AND MONOPOLAR MODES";

·The attorney's case number END9234USNP15/190717-15 named "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGYMODALITIES TO TISSUE";

·Agent's file number END9234USNP16/190717-16 named "CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USERINPUT";

· Attorney Docket No. END9234USNP17/190717-17 entitled "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE"; and

· Attorney's docket number END9234USNP18/190717-18 named "SURGICAL SYSTEM COMMUNICATION PATHWAYS".

The applicant of this patent application has the following U.S. Provisional Patent Applications filed on December 30, 2019, the disclosures of each of which are incorporated herein by reference in their entirety:

U.S. Provisional Patent Application Serial No. 62/955,294 entitled "USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATIONENERGY MODALITY END-EFFECTOR";

U.S. Provisional Patent Application Serial No. 62/955,292 entitled "COMBINATION ENERGY MODALITY END-EFFECTOR"; and

- US Provisional Patent Application Serial No. 62/955,306 entitled "SURGICAL INSTRUMENT SYSTEMS".

The applicant of this patent application owns the following US patent applications, the disclosures of each of these provisional patent applications are hereby incorporated by reference in their entirety:

U.S. Patent Application Serial No. 16/209,395, entitled "METHOD OF HUB COMMUNICATION", now U.S. Patent Application Publication No. 2019/0201136;

U.S. Patent Application Serial No. 16/209,403, titled "METHOD OF CLOUD BASED DATAANALYTICS FOR USE WITH THE HUB", now U.S. Patent Application Publication No. 2019/0206569;

U.S. Patent Application Serial No. 16/209,407, titled "METHOD OF ROBOTIC HUBCOMMUNICATION, DETECTION, AND CONTROL", now U.S. Patent Application Publication No. 2019/0201137;

U.S. Patent Application Serial No. 16/209,416, entitled "METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS", now U.S. Patent Application Publication No. 2019/0206562;

U.S. Patent Application Serial No. 16/209,423, titled "METHOD OF COMPRESSING TISSUEWITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THETISSUE WITHIN THE JAWS", now U.S. Patent Application Publication No. 2019/0200981;

U.S. Patent Application Serial No. 16/209,427, entitled "METHOD OF USING REINFORCEDFLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZE PERFORMANCE OF RADIOFREQUENCY DEVICES", now U.S. Patent Application Publication No. 2019/0208641;

U.S. Patent Application Serial No. 16/209,433, entitled "METHOD OF SENSING PARTICULATEFROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMP SPEED BASED ON THESENSED INFORMATION, AND COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEMTO THE HUB", now a U.S. patent application Publication No. 2019/0201594;

U.S. Patent Application Serial No. 16/209,447, titled "METHOD FOR SMOKE EVACUATIONFOR SURGICAL HUB", now U.S. Patent Application Publication No. 2019/0201045;

U.S. Patent Application Serial No. 16/209,453, entitled "METHOD FOR CONTROLLING SMARTENERGY DEVICES", now U.S. Patent Application Publication No. 2019/0201046;

U.S. Patent Application Serial No. 16/209,458, entitled "METHOD FOR SMART ENERGYDEVICE INFRASTRUCTURE", now U.S. Patent Application Publication No. 2019/0201047;

U.S. Patent Application Serial No. 16/209,465, entitled "METHOD FOR ADAPTIVE CONTROLSCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION", now U.S. Patent Application Publication No. 2019/0206563;

U.S. Patent Application Serial No. 16/209,478, entitled "METHOD FOR SITUATIONALAWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLEOF ADJUSTING FUNCTION BASED ON A SENSED SITUATION OR USAGE", now U.S. Patent Application Publication No. 2019/0104919;

U.S. Patent Application Serial No. 16/209,490, entitled "METHOD FOR FACILITY DATACOLLECTION AND INTERPRETATION", now U.S. Patent Application Publication No. 2019/0206564;

U.S. Patent Application Serial No. 16/209,491, entitled "METHOD FOR CIRCULAR STAPLERCONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS", now U.S. Patent Application Publication No. 2019/0200998;

U.S. Patent Application Serial No. 16/562,123, entitled "METHOD FOR CONSTRUCTING ANDUSING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES";

U.S. Patent Application Serial No. 16/562,135, entitled "METHOD FOR CONTROLLING ANENERGY MODULE OUTPUT";

U.S. Patent Application Serial No. 16/562,144, entitled "METHOD FOR CONTROLLING AMODULAR ENERGY SYSTEM USER INTERFACE"; and

- US Patent Application Serial No. 16/562,125 entitled "METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM".

Before describing various aspects of the electrosurgical system in detail, it should be noted that the illustrative examples are not limited in application or use to the details of construction and the arrangement of components shown in the drawings and description. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or carried out in various ways. Furthermore, unless otherwise indicated, the terminology and expressions used herein have been chosen for the convenience of the reader to describe illustrative examples and are not for the purpose of limitation. Furthermore, it should be understood that one or more of the aspects, expressions and/or examples of aspects described below may be combined with any one or more of the other aspects, expressions and/or examples of aspects described below.

Various aspects relate to an electrosurgical system that includes an electrosurgical instrument powered by a generator to effect tissue dissection, cutting, and/or coagulation during a surgical procedure. Electrosurgical instruments may be configured for use in open surgical procedures, but may also be used in other types of procedures, such as laparoscopic, endoscopic, and robotic-assisted procedures.

As described in more detail below, electrosurgical instruments typically include a shaft with a distally mounted end effector (eg, one or more electrodes). The end effector can be positioned against tissue such that electrical current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, electrical current is introduced into and returned from the tissue through the active and return electrodes of the end effector, respectively. During monopolar operation, electrical current is introduced into the tissue through the active electrode of the end effector and returned through a return electrode (eg, a ground pad) positioned separately on the patient's body. The heat generated by the electrical current flowing through the tissue can form a hemostatic seal within and/or between the tissue, and thus can be particularly useful for sealing blood vessels, for example.

FIG. 1 shows an example of a generator 900 configured to deliver multiple energy modalities to a surgical instrument. Generator 900 provides RF and/or ultrasound signals for delivering energy to surgical instruments. Generator 900 includes at least one generator output that can deliver multiple energy modalities (eg, ultrasound, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, etc.) through a single port, and These signals can be delivered to the end effector separately or simultaneously to treat tissue. Generator 900 includes processor 902 coupled to waveform generator 904 . Processor 902 and waveform generator 904 are configured to generate a variety of signal waveforms based on information stored in memory coupled to processor 902, which is not shown for clarity of the present disclosure. The digital information associated with the waveform is provided to a waveform generator 904, which includes one or more DAC circuits to convert the digital input to an analog output. The analog output is fed to amplifier 906 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to power transformer 908 . The signal is coupled to the secondary side in the patient isolation side through a power transformer 908 . A first signal of a first energy modality is provided to the surgical instrument between terminals labeled ENERGY ₁ and RETURN. A second signal of the second energy modality is coupled across capacitor 910 and provided to the surgical instrument between terminals labeled ENERGY ₂ and RETURN. It should be understood that more than two energy modes may be output, and thus the subscript "n" may be used to designate that up to n ENERGY _n terminals may be provided, where n is a positive integer greater than one. It should also be understood that up to "n" return paths RETURN _n may be provided without departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across terminals labeled ENERGY ₁ and RETURN paths to measure the output voltage therebetween. A second voltage sensing circuit 924 is coupled across the terminals labeled ENERGY ₂ and the RETURN path to measure the output voltage therebetween. As shown, the current sensing circuit 914 is placed in series with the RETURN branch on the secondary side of the power transformer 908 to measure the output current of either energy mode. If a different return path is provided for each energy mode, a separate current sensing circuit should be provided in each return leg. The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to respective isolation transformers 928 , 922 and the output of the current sensing circuit 914 is provided to another isolation transformer 916 . The outputs of isolation transformers 916 , 928 , 922 on the primary side of power transformer 908 (non-patient isolation side) are provided to one or more ADC circuits 926 . The digitized output of ADC circuit 926 is provided to processor 902 for further processing and calculations. The output voltage and output current feedback information can be used to adjust the output voltage and current provided to the surgical instrument, and to calculate parameters such as output impedance. Input/output communication between processor 902 and patient isolation circuitry is provided through interface circuitry 920 . The sensors may also be in electrical communication with the processor 902 through the interface circuit 920 .

In one aspect, the impedance can be determined by the processor 902 by sensing a first voltage 912 coupled across the terminal labeled ENERGY ₁ /RETURN or a second voltage coupled across the terminal labeled ENERGY ₂ /RETURN The output of the sense circuit 924 is determined by dividing the output of the current sense circuit 914 placed in series with the RETURN branch on the secondary side of the power transformer 908 . The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to separate isolation transformers 928 , 922 , and the output of the current sensing circuit 914 is provided to another isolation transformer 916 . Digitized voltage and current sense measurements from ADC circuit 926 are provided to processor 902 for use in calculating impedance. For example, the first energy modality ENERGY ₁ may be RF monopolar energy, and the second energy modality ENERGY ₂ may be RF bipolar energy. However, in addition to bipolar and monopolar RF energy modalities, other energy modalities include ultrasonic energy, irreversible and/or reversible electroporation and/or microwave energy, and the like. Furthermore, while the example shown in FIG. 1 shows that a single return path RETURN may be provided for two or more energy modalities, in other aspects, multiple return paths RETURN _n may be provided for each energy modality ENERGY _n .

As shown in FIG. 1 , a generator 900 including at least one output port may include a power transformer 908 having a single output and multiple taps to operate at one or more energy modes, eg, depending on the type of tissue treatment being performed. Power is provided to the end effector in the form of states (such as ultrasound, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, etc.). For example, the generator 900 may deliver energy at higher voltages and lower currents to drive ultrasonic transducers, lower voltages and higher currents to drive RF electrodes for sealing tissue, or coagulation waveforms to use For spot coagulation using monopolar or bipolar RF electrosurgical electrodes. The output waveform from generator 900 can be manipulated, switched or filtered to provide frequencies to the end effector of the surgical instrument. In one example, the connection of the RF bipolar electrode to the output of generator 900 would preferably be between the outputs labeled ENERGY ₂ and RETURN. In the case of a monopolar output, the preferred connections would be an active electrode (eg, a pencil or other probe) at the ENERGY ₂ output and a suitable return pad connected to the RETURN output.

Additional details are disclosed in US Patent Application Publication 2017/0086914, entitled "TECHNIQUES FOR OPERATINGGENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS," published March 30, 2017, which is incorporated herein by reference in its entirety.

2 illustrates one form of surgical system 1000 including generator 1100 and various surgical instruments 1104, 1106, 1108 that may be used therewith, where surgical instrument 1104 is an ultrasonic surgical instrument and surgical instrument 1106 is an RF electrosurgical instrument , and the multifunctional surgical instrument 1108 is a combination ultrasonic/RF electrosurgical instrument. Generator 1100 may be configured for use with a variety of surgical devices. According to various forms, the generator 1100 may be configurable for use with different types of surgical instruments including, for example, an ultrasonic surgical instrument 1104 , an RF electrosurgical instrument 1106 , and an integrated RF concurrent delivery from the generator 1100 . Multifunctional surgical instrument 1108 of energy and ultrasonic energy. Although in the form of FIG. 2 the generator 1100 is shown separate from the surgical instruments 1104 , 1106 , 1108 , in one form the generator 1100 may be integral with any of the surgical instruments 1104 , 1106 , 1108 formed to form an integrated surgical system. The generator 1100 includes an input device 1110 located on the front panel of the generator 1100 console. Input device 1110 may include any suitable device that generates signals suitable for programming the operation of generator 1100 . Generator 1100 may be configured for wired or wireless communication.

The generator 1100 is configured to drive a plurality of surgical instruments 1104 , 1106 , 1108 . The first surgical instrument is ultrasonic surgical instrument 1104 and includes handpiece 1105 (HP), ultrasonic transducer 1120 , shaft 1126 and end effector 1122 . The end effector 1122 includes an ultrasonic blade 1128 and a clamp arm 1140 that are acoustically coupled to the ultrasonic transducer 1120 . Handpiece 1105 includes a combination of trigger 1143 for operating clamp arm 1140 and toggle buttons 1137, 1134b, 1134c for energizing the ultrasonic blade 1128 and actuating the ultrasonic blade or other functions. The toggle buttons 1137 , 1134b , 1134c may be configured to enable the generator 1100 to energize the ultrasound transducer 1120 .

Generator 1100 is also configured to drive a second surgical instrument 1106 . The second surgical instrument 1106 is an RF electrosurgical instrument and includes a handpiece 1107 (HP), a shaft 1127 and an end effector 1124 . The end effector 1124 includes electrodes in the gripping arms 1145, 1142b and returns through the electrical conductor portion of the shaft 1127. These electrodes are coupled to and powered by a bipolar energy source within generator 1100 . Handpiece 1107 includes a trigger 1145 for operating clamp arms 1145, 1142b and an energy button 1135 for actuating an energy switch to energize electrodes in end effector 1124. The second surgical instrument 1106 may also be used with a return pad to deliver monopolar energy to tissue.

Generator 1100 is also configured to drive multifunctional surgical instrument 1108 . The multifunction surgical instrument 1108 includes a handpiece 1109 (HP), a shaft 1129 and an end effector 1125. The end effector 1125 includes an ultrasonic blade 1149 and a clamp arm 1146. The ultrasonic blade 1149 is acoustically coupled to the ultrasonic transducer 1120 . Handpiece 1109 includes a combination of trigger 1147 for operating clamp arm 1146 and toggle buttons 11310, 1137b, 1137c for energizing and driving ultrasonic blade 1149 or other functions. Toggle buttons 11310 , 1137b , 1137c may be configured to power ultrasonic transducer 1120 with generator 1100 and ultrasonic blade 1149 with a bipolar energy source also contained within generator 1100 . Monopolar energy can be delivered to tissue in combination with bipolar energy or separately from bipolar energy.

Generator 1100 may be configured for use with a variety of surgical devices. According to various forms, generator 1100 may be configurable for use with different types of surgical instruments including, for example, ultrasonic surgical instrument 1104 , RF electrosurgical instrument 1106 , and RF integrated with simultaneous delivery from generator 1100 Multifunctional surgical instrument 1108 of energy and ultrasonic energy. Although in the form of FIG. 2 the generator 1100 is shown separate from the surgical instruments 1104 , 1106 , 1108 , in another form the generator 1100 may be associated with any of the surgical instruments 1104 , 1106 , 1108 Integrally formed to form a one-piece surgical system. As discussed above, the generator 1100 includes an input device 1110 located on the front panel of the generator 1100 console. Input device 1110 may include any suitable device that generates signals suitable for programming the operation of generator 1100 . Generator 1100 may also include one or more output devices 1112 . Additional aspects of generators and surgical instruments for digitally generating electrical signal waveforms are described in US Patent Application Publication US-2017-0086914-A1, which is incorporated herein by reference in its entirety.

3 shows a schematic diagram of a surgical instrument or tool 600 that includes multiple motor assemblies that can be activated to perform various functions. In the example shown, closure motor assembly 610 is operable to transition the end effector between an open configuration and a closed configuration, and articulation motor assembly 620 is operable to articulate the end effector relative to the shaft assembly. In some cases, multiple motor assemblies may be activated individually to cause firing motion, closing motion, and/or articulation in the end effector. The firing motion, closing motion, and/or articulation motion may be transmitted to the end effector, for example, through a shaft assembly.

In some cases, the closure motor assembly 610 includes a closure motor. The closure 603 may be operably coupled to a closure motor drive assembly 612, which may be configured to transmit the closure motion generated by the motor to the end effector, in particular for displacing the closure member for closure Thereby transitioning the end effector to the closed configuration. The closing motion may, for example, transition the end effector from an open configuration to a closed configuration to capture tissue. The end effector can be transitioned to the open position by reversing the direction of the motor.

In some cases, articulation motor assembly 620 includes an articulation motor operably coupled to articulation drive assembly 622 that can be configured to transmit articulation generated by the motor to end effector. In some cases, articulation allows the end effector to articulate relative to the axis, eg.

One or more of the motors of surgical instrument 600 may include a torque sensor to measure the output torque on the shaft of the motor. The force on the end effector may be sensed in any conventional manner, such as by a force sensor on the outside of the jaws or by a torque sensor of a motor used to actuate the jaws.

In various cases, the motor assemblies 610, 620 include one or more motor drivers, which may include one or more H-bridge FETs. The motor driver may regulate the power delivered from the power source 630 to the motor based on input from, for example, a microcontroller 640 ("controller") of the control circuit 601 . In some cases, microcontroller 640 may be used to determine, for example, the current drawn by the motor.

In some cases, microcontroller 640 may include a microprocessor 642 ("processor") and one or more non-transitory computer-readable media or storage units 644 ("memory"). In some cases, memory 644 may store various program instructions that, when executed, may cause processor 642 to perform various functions and/or calculations described herein. In some cases, one or more of memory units 644 may be coupled to processor 642, for example. In various aspects, microcontroller 640 may communicate over wired or wireless channels or a combination thereof.

In some cases, power source 630 may be used, for example, to supply power to microcontroller 640 . In some cases, power source 630 may include a battery (or "battery pack" or "power pack"), such as a lithium-ion battery. In some cases, the battery pack may be configured to be releasably mountable to the handle for powering the surgical instrument 600 . Multiple battery cells connected in series can be used as power source 630 . In some cases, power source 630 may be replaceable and/or rechargeable, for example.

In various cases, the processor 642 may control the motor drives to control the position, rotational direction, and/or speed of the motors of the assemblies 610, 620. In some cases, the processor 642 may send a signal to the motor driver to stop and/or deactivate the motor. It should be understood that the term "processor" as used herein includes any suitable microprocessor, microcontroller, or other that combines the functions of a computer's central processing unit (CPU) on one integrated circuit or at most several integrated circuits Basic computing device. Processor 642 is a multipurpose programmable device that receives digital data as input, processes the input according to instructions stored in its memory, and then provides results as output. Because the processor has internal memory, it is an example of sequential digital logic. The processor operates on numbers and symbols represented by the binary number system.

软件的内部ROM、2KB的EEPROM、一个或多个PWM模块、一个或多个QEI模拟、具有12个模拟输入信道的一个或多个12位ADC、以及易得的其他特征部。可容易地换用其他微控制器以用于与外科器械600一起使用。因此，本公开不应限于这一上下文。In one instance, the processor 642 may be any single-core or multi-core processor, such as those known under the tradename ARM Cortex from Texas Instruments. In some cases, microcontroller 620 may be, for example, an LM 4F230H5QR available from Texas Instruments. In at least one example, a Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that includes: 256KB of single-cycle flash or other non-volatile memory (up to 40MHz) on-chip memory, Prefetch buffer, 32KB of single-cycle SRAM, loaded with

Internal ROM for software, 2KB of EEPROM, one or more PWM modules, one or more QEI analogs, one or more 12-bit ADCs with 12 analog input channels, and other features readily available. Other microcontrollers can be easily swapped out for use with surgical instrument 600 . Therefore, the present disclosure should not be limited in this context.

In some cases, memory 644 may include program instructions for controlling each of the motors of surgical instrument 600 . For example, the memory 644 may include program instructions for controlling the closure motor and the articulation motor. Such program instructions may cause processor 642 to control closure and articulation functions according to input from an algorithm or control program of surgical instrument 600 .

In some cases, one or more mechanisms and/or sensors such as sensor 645 may be used to alert processor 642 of program instructions that should be used in a particular setting. For example, sensor 645 may alert processor 642 to use program instructions associated with closing and articulating the end effector. In some cases, sensor 645 may include, for example, a position sensor that may be used to sense the position of the closure actuator. Thus, if processor 642 receives a signal from sensor 630 indicative of actuation of the closure actuator, processor 642 may activate the motor of closure drive assembly 620 using program instructions associated with the closure end effector.

In some examples, the motor may be a brushless DC electric motor, and the corresponding motor drive signal may include a PWM signal provided to one or more stator windings of the motor. Also, in some examples, the motor driver may be omitted, and the control circuit 601 may directly generate the motor drive signal.

It is common practice during various laparoscopic surgical procedures to insert the surgical end effector portion of a surgical instrument through a trocar already installed in the patient's abdominal wall to access a surgical site located within the patient's abdomen. In its simplest form, a trocar is a pen-like instrument with a sharp, triangular point at one end that is typically used within a hollow tube (called a cannula or sleeve) to create an opening into the body that can be The surgical end effector is introduced through the opening. Such arrangements form an access port into a body cavity through which a surgical end effector can be inserted. The inner diameter of the cannula of the trocar necessarily limits the size of the end effector and drive support shaft of a surgical instrument that can be inserted through the trocar.

Regardless of the particular type of surgical procedure being performed, once the surgical end effector has been inserted into the patient through the trocar cannula, the surgical end effector must generally be moved relative to the shaft assembly positioned within the trocar cannula in order to The surgical end effector is correctly positioned relative to the tissue or organ to be treated. This movement or positioning of the surgical end effector relative to the portion of the shaft held within the trocar cannula is commonly referred to as "articulation" of the surgical end effector. Various articulation joints have been developed to attach surgical end effectors to associated shafts in order to facilitate such articulation of the surgical end effector. As may be desired, in many surgical procedures it is desirable to employ a surgical end effector with the greatest possible range of articulation.

Due to the dimensional constraints imposed by the size of the trocar cannula, the articulation joint components must be sized to be freely insertable through the trocar cannula. These dimensional constraints also limit the size and composition of the various drive components and components operable with motors and/or other control systems supported in housings that may be hand-held or form part of a larger automation system ground handover. In many cases, these drive members must be operably passed through the articulation joint in order to be operably coupled to or operably interfaced with the surgical end effector. For example, one such drive member is commonly used to apply articulation control motion to a surgical end effector. During use, the articulation drive member may be unactuated to position the surgical end effector in a non-articulating position to facilitate insertion of the surgical end effector through the trocar, and then once the surgical end effector has entered the patient Can be actuated to articulate the surgical end effector to a desired position.

Thus, the aforementioned dimensional constraints create many challenges for developing articulation systems that can achieve the desired range of articulation, but accommodate the various different drive systems necessary to operate the various features of the surgical end effector. Furthermore, once the surgical end effector has been positioned in the desired articulation position, the articulation system and articulation joint must be able to hold the surgical end effector in that position during actuation of the end effector and completion of the surgical procedure. Such articulation joint arrangements must also be able to withstand the external forces experienced by the end effector during use.

Various modalities of one or more surgical devices are commonly used throughout a particular surgical procedure. For example, a communication pathway extending between a surgical device and a centralized surgical center can facilitate the efficiency and increase the success of the surgical procedure. In various cases, each surgical device within the surgical system includes a display, wherein the display communicates the presence and/or operational status of other surgical devices within the surgical system. The surgical center may use the information received through the communication pathway to evaluate the compatibility of the surgical devices for use with each other, evaluate the compatibility of the surgical devices for use during a particular surgical procedure, and/or optimize the operating parameters of the surgical devices. As described in more detail herein, the operating parameters of one or more surgical devices may be optimized based on patient demographics, specific surgical procedures, and/or detected environmental conditions, such as tissue thickness.

FIGS. 4 and 5 show an exploded view (FIG. 4) and a cross-sectional view (FIG. 5) of an end effector 1200 of an electrosurgical instrument (eg, the surgical instrument described in US Patent Application Attorney Docket No. END9234USNP2/190717-2). ). For example, the end effector 1200 may be actuated, articulated and/or rotated relative to a shaft assembly of a surgical instrument in a manner similar to the end effector described in US Patent Application Attorney Docket No. END9234USNP2/190717-2. Additionally, the end effector 1200 and other similar end effectors described elsewhere herein may be powered by one or more generators of the surgical system. An exemplary surgical system for use with surgical instruments is described in U.S. Application No. 16/562,123, filed on September 5, 2019, and entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES," This text is incorporated herein in its entirety.

Referring to FIGS. 6-8 , the end effector 1200 includes a first jaw 1250 and a second jaw 1270 . At least one of the first jaw 1250 and the second jaw 1270 can be pivoted toward or away from the other jaw to transition the end effector 1200 between an open configuration and a closed configuration. The jaws 1250, 1270 are configured to grasp tissue between the two jaws to apply at least one of therapeutic energy and non-therapeutic energy to the tissue. Energy delivery to tissue grasped by jaws 1250, 1270 of end effector 1200 is accomplished by electrodes 1252, 1272, 1274 configured to be capable of monopolar mode, bipolar mode, and/or having alternating or A combined mode of mixed bipolar and monopolar energy delivers energy. The different energy modalities that can be delivered to tissue by the end effector 1200 are described in more detail elsewhere in this disclosure.

In addition to electrodes 1252, 1272, 1274, a patient return pad is employed for the application of monopolar energy. Additionally, electrically isolated generators are used to deliver bipolar and monopolar energy. During use, the patient return pad may detect accidental power crossings by monitoring power transmission to the return pad via one or more suitable sensors on the return pad. In situations where both bipolar and unipolar energy modes are used simultaneously, unexpected power crossovers can occur. In at least one example, bipolar mode uses a higher current (eg, 2 amp-3 amp) than unipolar mode (eg, 1 amp). In at least one example, the return pad includes a control circuit and at least one sensor (eg, a current sensor) coupled thereto. In use, the control circuit may receive an input indicative of an unexpected power crossing based on a measurement of the at least one sensor. In response, the control circuit may employ a feedback system to issue an alarm and/or suspend the application of one or both of the bipolar energy modality and the monopolar energy modality to the tissue.

In addition to the above, the jaws 1250, 1270 of the end effector 1200 include angular profiles, wherein multiple angles are defined between discrete portions of each of the jaws 1250, 1270. For example, a first angle is defined by portions 1250a , 1250b ( FIG. 4 ), and a second angle is defined by portions 1250b , 1250c of the first jaw 1250 . Similarly, the first angle is defined by portions 1270a, 1270b, and the second angle is defined by portions 1270b, 1270c of the second jaw 1270. In various aspects, the discrete portions of jaws 1250, 1270 are linear segments. Consecutive linear segments intersect at an angle such as a first angle or a second angle. The linear segments cooperate to form the general angular profile of each of the jaws 1250 , 1270 . The angular profile is generally curved away from the central axis.

In one example, the first angle and the second angle are the same or at least substantially the same. In another example, the first angle and the second angle are different. In another example, the first angle and the second angle include values selected from the range of about 120° to about 175°. In yet another example, the first angle and the second angle include values selected from the range of about 130° to about 170°.

Furthermore, the portions 1250a, 1270a, which are the proximal portions, are larger than the portions 1250b, 1270b, which are the intermediate portions. Similarly, middle portions 1250b, 1270b are larger than portions 1250c, 1270c. In other examples, the distal portion may be larger than the medial and/or proximal portion. In other examples, the intermediate portion is larger than the proximal and/or distal portions.

In addition to the above, the electrodes 1252 , 1272 , 1274 of the jaws 1250 , 1270 include angular profiles similar to those of the jaws 1250 , 1270 . In the example of FIGS. 4, 5, electrodes 1252, 1272, 1274 include discrete segments 1252a, 1252b, 1252c, 1272a, 1272b, 1272c, 1274a, 1274b, 1274c, respectively, which are defined at their respective intersections The first angle and the second angle, as described above.

When in the closed configuration, the jaws 1250, 1270 cooperate to define a tip electrode 1260 formed by electrode portions 1261, 1262 at the distal ends of the jaws 1250, 1270, respectively. The tip electrode 1260 can be energized to deliver monopolar energy to tissue in contact therewith. For example, both electrode portions 1261, 1262 may be activated simultaneously to deliver monopolar energy, as shown in FIG. 6, or alternatively, only one of the electrode portions 1261, 1262 may be selectively activated to electrode at the distal tip Monopolar energy is delivered on one side of 1260, as shown in Figure 10.

In the closed configuration, the angular profiles of jaws 1250, 1270 cause tip electrode 1260 to be on one side of a plane extending laterally between proximal portion 1252c and proximal portion 1272c. The angular profile may also cause the intersections between portions 1252b, 1252c, portions 1272b, 1272c, and portions 1274b, 1274c to be on the same side of the plane as end electrode 1260.

)。由电极1252、1272限定的可供能区在钳口1250、1270的内部上，并且可以双极模式独立地操作以将能量递送到抓持在钳口1250、1270之间的组织。同时，由电极末端1260和电极1274限定的可供能区在钳口1250、1270的外部上，并且可以单极模式操作以将能量递送到与端部执行器1200的外表面邻近的组织。钳口1250、1270两者都可被供能以便以单极模式递送能量。In at least one example, jaws 1250, 1270 include conductive skeletons 1253, 1273 that may be composed of or at least partially composed of a conductive material (eg, titanium). The skeletons 1253, 1273 may be constructed of other conductive materials (eg, aluminum). In at least one example, the skeletons 1253, 1273 are prepared by injection molding. In various examples, the skeletons 1253, 1273 are selectively coated/covered with insulating material to prevent thermal and electrical conduction in all but predefined thin energizable regions forming the electrodes 1252, 1272, 1274, 1260 . The skeletons 1253, 1273 act as electrodes with electron focusing, with the jaws 1250, 1270 having built-in isolation from one jaw to the other. The insulating material may be an insulating polymer such as Teflon (eg,

). The energizable regions defined by the electrodes 1252 , 1272 are on the interior of the jaws 1250 , 1270 and can operate independently in a bipolar mode to deliver energy to tissue grasped between the jaws 1250 , 1270 . Meanwhile, the energizable region defined by electrode tip 1260 and electrode 1274 is on the exterior of jaws 1250 , 1270 and can be operated in a monopolar mode to deliver energy to tissue adjacent the outer surface of end effector 1200 . Both jaws 1250, 1270 may be energized to deliver energy in a monopolar mode.

)涂层，其被选择性地施加到传导骨架，从而产生选择性暴露的金属内部部分，该金属内部部分限定用于聚焦解剖和凝固的三维几何电子调制(GEM)。在至少一个示例中，涂层1264包括约0.003英寸、约0.0035英寸或约0.0025英寸的厚度。在各种示例中，涂层1264的厚度可以是选自以下的任何值：约0.002英寸至约0.004英寸的范围、约0.0025英寸至约0.0035英寸的范围、或约0.0027英寸至约0.0033英寸的范围。本公开涵盖能够进行三维几何电子调制(GEM)的涂层1263的其他厚度。In various aspects, the coating 1264 is high temperature polytetrafluoroethylene (eg,

) coating, which is selectively applied to the conductive framework, resulting in selectively exposed metallic interior portions that define three-dimensional geometric electronic modulation (GEM) for focused dissection and coagulation. In at least one example, the coating 1264 includes a thickness of about 0.003 inches, about 0.0035 inches, or about 0.0025 inches. In various examples, the thickness of coating 1264 can be any value selected from the range of about 0.002 inches to about 0.004 inches, the range of about 0.0025 inches to about 0.0035 inches, or the range of about 0.0027 inches to about 0.0033 inches . The present disclosure encompasses other thicknesses of the coating 1263 capable of three-dimensional geometric electronic modulation (GEM).

Electrodes 1252, 1272 that cooperate to deliver bipolar energy through tissue are biased to prevent shorting of the circuit. As energy flows between the biasing electrodes 1252, 1272, the tissue grasped therebetween is heated, creating a seal at the area between the electrodes 1252, 1272. At the same time, the areas of the jaws 1250, 1270 surrounding the electrodes 1252, 1272 are selectively deposited on the jaws 1250, 1270, but not on the electrodes 1252, 1272 due to the insulating coating 1264 over such areas, to provide non- The conductive tissue contacts the surface. Thus, the electrodes 1252 , 1272 are defined by areas of the metal jaws 1250 , 1270 that remain exposed after the insulating coating 1264 is applied to the jaws 1250 , 1270 . While jaws 1250 , 1270 are typically formed of electrically conductive material in this example, non-conductive regions are defined by electrically insulating coating 1264 .

FIG. 6 illustrates the application of a bipolar energy pattern to tissue grasped between jaws 1250, 1270. In the bipolar energy mode, RF energy flows through the tissue along a path 1271 relative to a curved plane that extends in the center and bisects the jaws 1250, 1270 longitudinally such that the electrodes 1252, 1272 are on opposite sides of the curved plane (CL). (CL) Inclined. In other words, the area of tissue that actually receives bipolar RF energy will be only the tissue that contacts and extends between electrodes 1252, 1257. Thus, tissue grasped by the jaws 1250 , 1270 will not receive RF energy over the entire lateral width of the jaws 1250 , 1270 . Thus, this configuration can minimize thermal diffusion of heat caused by the application of bipolar RF energy to the tissue. This thermal spread minimization may in turn minimize potential collateral damage to tissue adjacent to the particular tissue area the surgeon wishes to engage/seal/coagulate and/or cut.

In at least one example, a lateral gap is defined between bias electrodes 1252, 1272 in a closed configuration with no tissue therebetween. In at least one example, a lateral gap is defined between the bias electrodes 1252, 1272 in the closed configuration by any distance selected from the range of about 0.01 inches to about 0.025 inches, the range of about 0.015 inches to about 0.020 inches, or in the range of about 0.016 inches to about 0.019 inches. In at least one example, the lateral gap is defined by a distance of about 0.017 inches.

In the example shown in FIGS. 4 and 5, the electrodes 1252, 1272, 1274 have a gradually narrowing width as each of the electrodes 1252, 1272, 1274 extends from the proximal end to the distal end. Accordingly, proximal sections 1252a, 1272a, 1274a include a greater surface area than intermediate portions 1252b, 1272b, 1274b, respectively. Also, the intermediate sections 1252b, 1272b, 1274b include a larger surface than the distal sections 1252c, 1272c, 1274c.

The angular and narrowed profiles of the jaws 1250, 1270 give the end effector 1200 a curved finger shape or angular hook shape in the closed configuration. By orienting the end effector 1200 such that the electrode tip 1260 points downward toward the tissue, this shape allows the use of the tip electrode 1260 (FIG. 10) to accurately deliver energy to a small portion of tissue. In such an orientation, only the electrode tip 1260 is in contact with the tissue, which focuses energy delivery to the tissue.

In addition, as shown in FIG. 8, electrodes 1274 extend on the outer surface on the peripheral side 1275 of the second jaw 1270, which provides it with the ability to effectively separate tissue in contact with the end effector 1200 when it is in a closed configuration . To separate tissue, the end effector 1200 is positioned at least partially on the peripheral side 1275 including the electrodes 1274 . Activation of the monopolar energy mode by jaw 1270 causes monopolar energy to flow through electrode 1274 into the tissue in contact therewith.

Figures 9-11 illustrate an end effector 1200' for delivering bipolar energy to tissue through electrodes 1252', 1272' (Figure 9) in a bipolar energy mode of operation, in a first monopolar operation Monopolar energy is delivered to the tissue through the electrode tip 1261 in the mode and/or through the external electrode 1274 in the second monopolar mode of operation. End effector 1200' is similar to end effector 1200 in many respects. Accordingly, for the sake of brevity, various features of end effector 1200' previously described with respect to end effector 1200 are not repeated herein at the same level of detail.

Electrodes 1252', 1272' differ from electrodes 1252", 1272" in that they define stepped or uneven tissue contacting surfaces 1257, 1277. The electrically conductive backbones 1253', 1273' of the jaws 1250', 1270' include projections or protrusions that form the electrically conductive tissue-contacting surfaces of the electrodes 1252', 1272'. The coating 1264 wraps partially around the projections or protrusions forming the electrodes 1252', 1272', leaving only the conductive tissue-contacting surfaces of the electrodes 1252', 1272' exposed. Thus, in the example shown in Figure 9, each of the tissue-contacting surfaces 1257, 1277 includes a step including a conductive tissue-contacting surface positioned between two insulating tissue-contacting surfaces that gradually descend the step. In other words, each of the tissue contacting surfaces 1257, 1277 includes a first partially conductive tissue contacting surface and a second insulating tissue contacting surface that is stepped down relative to the first partially conductive tissue contacting surface. The method for forming the electrodes 1252', 1272' is described later in conjunction with FIG. 12 .

Furthermore, in the closed configuration with no tissue therebetween, the bias electrodes 1252', 1272' overlap, thereby defining a gap between the opposing insulating outer surfaces of the jaws 1250', 1270'. Thus, this configuration provides electrode surfaces that are vertically offset from each other and laterally offset from each other when the jaws 1250', 1270' are closed. In one example, the gap is about 0.01 inches to about 0.025 inches. Furthermore, although overlapping, electrodes 1252', 1272' are separated by a lateral gap. To prevent short circuits, the lateral gap is less than or equal to a predetermined threshold. In one example, the predetermined threshold is selected from the range of 0.006 inches to 0.008 inches. In one example, the predetermined threshold is about 0.006 inches.

Referring again to Figures 7, 10, the tip electrodes 1260 are defined by uncoated electrode portions 1261, 1262 that immediately precede the circumferentially coated proximally coated portion to allow removal from the jaws Either or both 1250, 1270 perform end coagulation and incision opening creation. In some examples, the electrode portions 1261, 1262 are covered by a spring biased or compliant insulating housing that allows the electrode portions 1261 to be exposed only when the distal end of the end effector 1200 is pressed against the tissue to be treated , 1262.

Additionally, the segments 1274a , 1274b , 1274c define angular profiles extending along the peripheral side 1275 of the jaw 1270 . Sections 1274a, 1274b, 1274c are defined by uncoated linear portions on peripheral side 1275 that protrude from the angled body of skeleton 1273. Sections 1274a, 1274b, 1274c include outer surfaces that are flush with the outer surface of coating 1264 defined on peripheral side 1275. In various examples, horizontal planes extend through segments 1274a, 1274b, 1274c. The angular profile of electrodes 1274 is defined in a horizontal plane such that electrodes 1274 do not extend more than 45 degrees from the centerline of curvature to prevent unintended lateral thermal damage when electrodes 1274 are used to dissect or separate tissue.

Figure 14 shows jaws 6270 for use with an end effector (eg, 1200) of an electrosurgical instrument (eg, electrosurgical instrument 1106) to treat tissue using RF energy. Additionally, jaw 6270 can be electrically coupled to a generator (eg, generator 1100), and can be powered by the generator to deliver monopolar RF energy to tissue and/or to cooperate with another jaw of the end effector to Bipolar RF energy is delivered to tissue. Furthermore, the jaws 6270 are similar in many respects to the jaws 1250, 1270. For example, jaw 6270 includes an angular profile similar to that of jaw 1270 . Additionally, the jaws 6270 exhibit thermal mitigation improvements that can be applied to one or both of the jaws 1250, 1270.

In use, the jaws of an electrosurgical instrument's end effector are subjected to thermal loads that can interfere with the performance of its electrodes. To minimize thermal load interference without negatively affecting electrode tissue treatment capabilities, jaw 6270 includes an electrically conductive backbone 6273 having a thermally isolated portion and a thermally conductive portion integral with the thermally isolated portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In some examples, the thermal isolation portion includes internal gaps, voids, or dimples that effectively isolate the thermal mass of the outer surface of the jaws 6270 in direct contact with tissue without compromising the electrical conductivity of the jaws 6270 .

In the example shown, the thermally conductive portion defines a conductive outer layer 6269 that surrounds or at least partially surrounds the inner conductive core. In at least one example, the inner conductive core includes gap-setting members, which may extend between opposing sides of the outer layer 6269 in the form of struts, posts, and/or walls, with gaps, voids, or pockets extending between the gap-setting members.

In at least one example, the gap setting member forms the honeycomb lattice structure 6267 to transition to a closed configuration at the jaws (ie, the jaw 6270 and the other jaw of the end effector) to grip between the jaws Provides directional force capability (similar to jaws 1250, 1270 of Figure 6) while organizing. The directional force can be achieved by aligning the lattice 6267 in a direction that intersects the tissue-contacting surface of the jaws 6270 so that its honeycomb walls 6268 are positioned perpendicularly relative to the tissue-contacting surface.

Alternatively or additionally, the conductive inner core of the jaws 6270 can include micro air pockets that can be more uniformly distributed and shaped and have no predefined tissue relative to the external shape of the jaws to create a more uniform distribution within the jaws Stress-strain distribution. In various aspects, the electrically conductive backbone 6273 can be prepared by three-dimensional printing and can include three-dimensionally printed internal dimples that create an electrically conductive but commensurately thermally isolated core.

Still referring to FIG. 14 , an electrically conductive skeleton 6273 can be connected to an energy source (eg, generator 1100 ) and includes electrodes 6262 , 6272 , and 6274 defined on portions of outer layer 6273 that are selectively uncovered by coating 1264 . Thus, selective thermal and electrical conductivity of jaws 6270 controls/focuses energy interaction with tissue through electrodes 6272, 6274 while reducing thermal diffusion and thermal mass. The thermally isolated portion of the conductive skeleton 6273 limits the thermal load on the electrodes 6262, 6272 and 6274 during use.

Additionally, the outer layer 6273 defines gripping features 6277 that extend on opposite sides of the electrode 6272 and are at least partially covered by the coating 1264 . The gripping features 6277 improve the ability of the jaws 6270 to adhere to tissue and resist slippage of tissue relative to the jaws 6270.

In the example shown, wall 6268 extends diagonally from a first lateral side of jaw 6270 to a second lateral side of jaw 6270 . Walls 6268 meet at structural nodes. In the example shown, intersecting walls 6268 define pockets 6271 covered by outer layer 6269 from the top and/or bottom. Various methods for manufacturing the jaws 6270 are described below.

12, 13 illustrate methods 1280, 1281 for manufacturing jaws 1273", 1273"'. In various examples, one or more of jaws 1250 , 1270 , 1250 ′, 1270 ′ are fabricated according to methods 1280 , 1281 . The jaws 1273', 1273" are prepared by applying a coating 1264 (eg, having a thickness d) to its entire outer surface. The electrodes are then defined by selectively removing portions of the coating 1264 from the desired areas, To expose the outer surfaces of the skeletons 1273", 1273"' at such regions. In at least one example, the tapered portion of the skeleton 1273"' and its corresponding may be etched (FIG. 12) or by partial cutting (FIG. 13) Part of the coating to perform selective removal of the coating to form flush conductive and non-conductive surfaces. In the example shown in FIG. 12, electrodes 1272", 1274" are formed by etching. In the example shown in FIG. 13, electrodes 1274"' are formed by raised strips or ridges 1274d extending alongside backbone 1273"'. Ridge 1274D and a portion of coating 1264 directly overlying ridge 1274D are cut away, resulting in an outer surface of electrode 1274"' that is flush with the outer surface of coating 1264.

Thus, jaw 1270"' fabricated by method 1281 includes a tapered electrode 1274"' consisting of narrow raised electrically conductive portions 1274e extending beside skeleton 1273"' that can assist in focusing from skeleton 1273" ' energy delivered to tissue, wherein portion 1274e has a conductive outer surface flush with coating 1264.

In another manufacturing process 6200, jaws 6270 may be prepared as depicted in FIG. The electrically conductive skeleton 6273 is formed with narrow raised strips or ridges 6274e, 6274f that define electrodes 6272 and 6274. In the example shown, the backbone 6273 of the jaws 6270 includes ridges 6274e, 6274f having flat or at least substantially flat outer surfaces configured to define the electrodes 6272, 6274. In at least one example, the skeleton 6273 is prepared by 3D printing. Masks 6265, 6266 are applied to ridges 6274e, 6274f, and a coating 1264 similar to coating 1264 is applied to skeleton 6273. After coating, the masks 6265, 6266 are removed, exposing the outer surfaces of the electrodes 6272, 6274 that are flush with the outer surface of the coating 1264.

14 and 15, in various examples, the outer layer 6269 includes gripping features 6277 extending laterally on one or both sides of each of the electrodes 6272. The gripping features 6277 are covered by the coating 1264. In one example, the coating 1264 defines compressible features such that the gap between the jaws of the end effector varies according to the clamping load applied to the end effector 1200 . In at least one example, the coating 1264 on the jaws creates an insulator overlap of at least 0.010"-0.020" along the centerline of the jaws. The coating 1264 may be applied directly on the gripping features 6277 and/or the clamp-induced jaw realignment features.

In various aspects, the coating 1264 may comprise a coating material such as titanium nitride, diamond-like coating (DLC), chromium nitride, Graphit iC ^™ , and the like. In at least one example, the DLC is composed of an amorphous carbon-hydrogen network with diamond bonds between graphite and carbon atoms. The DLC coating 1264 can form a film with low friction and high hardness properties around the backbones 1253, 1273 (FIG. 6). The DLC coating 1264 may be doped or undoped, and is typically in the form of amorphous carbon (aC) or hydrogenated amorphous carbon (aC:H) containing a majority of sp3 bonds. Various surface coating techniques can be used to form the DLC coating 1264, such as the surface coating technology developed by Oerlikon Balzers. In at least one example, the DLC coating 1264 is generated using plasma assisted chemical vapor deposition (PACVD).

Still referring to FIG. 15, in use, electrical energy flows from the electrically conductive scaffold 6269 through the electrodes 6272 to the tissue. The coating 1264 prevents electrical energy from being transferred to the tissue from other areas of the outer layer 6269 covered with the coating 1264. As the surface of the electrode 6272 increases in temperature during tissue treatment, thermal energy transfer from the outer layer 6269 to the inner core of the backbone 6273 is slowed or diminished due to gaps, voids or pockets defined by the walls 6268 of the inner core.

Figure 16 shows a skeleton 6290 manufactured for use with the jaws of an end effector of an electrosurgical instrument. One or more of the skeletons 1253, 1273, 1253', 1273', 1273", 1273"' may comprise a material composition and/or may be fabricated in a similar manner to the skeleton 6290. In the example shown, the skeleton 6290 is constructed of at least two materials: an electrically conductive material, such as titanium, and a thermally insulating material, such as a ceramic material (eg, ceramic oxide). The combination of titanium and ceramic oxide produces jaw components with composite thermal, mechanical and electrical properties.

In the example shown, the composite skeleton 6290 includes a ceramic base 6291 formed, for example, by three-dimensional printing. Additionally, the composite framework 6290 includes a titanium crown 6292 fabricated separately from the ceramic base 6291 using, for example, three-dimensional printing. Base 6291 and crown 6292 include complementary attachment features 6294. In the example shown, the base 6291 includes posts or protrusions that are received in corresponding holes in the crown 6292. The attachment feature 6294 also controls retraction. Additionally or alternatively, the contact surfaces of the base 6291 and crown 6292 include complementary surface irregularities 6296 that are specifically designed for cooperative engagement with each other. Surface irregularities 6296 also resist shrinkage caused by the different material compositions of base 6291 and crown 6292. In various examples, the composite backbone 6290 is selectively coated with an insulating coating 1264, resulting in exposed portions of the crown 6292 that define electrodes, eg, as described above in connection with the jaws 1250, 1270.

)涂层可选择性地施加到复合骨架6295的金属区域以用于热隔离以及电绝缘。Figures 17 and 18 illustrate a manufacturing process for manufacturing a skeleton 6296 for use with the jaws of an end effector of an electrosurgical instrument. One or more of the skeletons 1253, 1273, 1253', 1273', 1273", 1273"' may comprise a material composition and/or may be fabricated in a similar manner to the skeleton 6295. In the example shown, the composite framework 6295 is produced by injection molding with ceramic powder 6297 and titanium powder 6298. The powders were fused together (FIG. 18) to form titanium-ceramic composite 6299 (FIG. 19). In at least one example, polytetrafluoroethylene (eg,

) coating can be selectively applied to the metal regions of the composite framework 6295 for thermal and electrical isolation.

20-22 illustrate jaws 1290 for use with an end effector (eg, 1200) of an electrosurgical instrument (eg, electrosurgical instrument 1106) to treat tissue using RF energy. Additionally, jaw 6270 can be electrically coupled to a generator (eg, generator 1100), and can be powered by the generator to deliver monopolar RF energy to tissue and/or to cooperate with another jaw of the end effector to Bipolar RF energy is delivered to tissue. Furthermore, the jaws 1290 are similar in many respects to the jaws 1250, 1270. For example, jaw 1290 includes an angular profile similar to the angular or curved profile of jaw 1270 .

Additionally, jaw 1290 is similar to jaw 6270 in that jaw 1290 also exhibits thermal mitigation improvements. Like jaw 6270, jaw 1290 includes a conductive skeleton 1293 having a thermally insulating portion and a thermally conductive portion integral with or attached to the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain examples, the thermally isolated portion of the conductive backbone 1293 includes a conductive inner core 1297 having internal gaps, voids or dimples that effectively isolate the definition of the jaws 1290 from tissue The thermal mass of the outer surface of the electrode 1294 in direct contact without compromising the conductivity of the jaws 1290. The thermally conductive portion defines a conductive outer layer 1303 that surrounds or at least partially surrounds the conductive inner core 1297 . In at least one example, the conductive inner core 1297 includes gap setting members 1299 that may extend between opposing sides of the outer layer 1303 of the jaws 1290 in the form of struts, posts, and/or walls, wherein the gaps, voids, or pockets are in the A gap setting member extends between the members.

Alternatively or additionally, the conductive inner core 1297 may include micro-dimples of air distributed in the conductive inner core 1297, which may be uniformly or non-uniformly distributed. The dimples may include predefined or random shapes, and may be dispersed at predetermined or random portions of the conductive core 1297 . In at least one example, the dimples are dispersed in a manner that produces a more uniform stress-strain distribution within the jaws 1290 . In various aspects, the skeleton 1293 can be prepared by three-dimensional printing and can include three-dimensional printed internal dimples that create an electrically conductive but commensurately thermally isolated core.

Thus, jaws 1290 include selective thermal and electrical conductivities that control/focus energy interaction with tissue, while reducing thermal diffusion and thermal mass. The thermally isolated portions of the conductive skeleton 1293 limit the thermal load on the electrodes of the jaws 1290 during use.

)。由于DLC涂层是导热的，因此仅组织接触表面1291的包括绝缘区域1298的部分是热隔离的。覆盖有DLC涂层和薄导电可供能区1294a、1294b、1294c的组织接触表面1291的部分是导热的。另外，仅薄导电可供能区1294a、1294b、1294c是电传导的。用DLC涂层或聚四氟乙烯(例如

)覆盖的组织接触表面1291的剩余部分是电绝缘的。FIG. 22 shows an expanded portion of the tissue contacting surface 1291 of the jaws 1290. In various aspects, the outer layer 1303 of the skeleton 1293 is selectively coated/covered by a first insulating layer 1264 comprising a first material (eg, DLC). In the example shown, the DLC coating renders the tissue-contacting surface 1291 electrically insulating except for an intermediate region extending along the length of the tissue-contacting surface 1291, which defines the electrodes 1294. In at least one example, the DLC coating extends around the backbone 1293, covering the jaws 1290 as much as the perimeter defined on opposite sides 1294', 1294" of the electrode 1294. The conductive regions 1294a, 1294b, 1294c remain exposed, and along the perimeter of the electrode 1294 Lengths alternate with insulating regions 1298. In various aspects, insulating regions 1298 comprise polytetrafluoroethylene having a high temperature (eg,

). Since the DLC coating is thermally conductive, only the portion of the tissue contacting surface 1291 that includes the insulating region 1298 is thermally isolated. Portions of the tissue contacting surface 1291 covered with the DLC coating and thin electrically conductive energizable regions 1294a, 1294b, 1294c are thermally conductive. Additionally, only the thin conductive energizable regions 1294a, 1294b, 1294c are electrically conductive. Coated with DLC or Teflon (e.g.

) covering the remainder of the tissue contacting surface 1291 is electrically insulating.

Conductive regions 1294a , 1294b , 1294c define energy concentration locations along jaw 1290 based on the geometry of regions 1294a , 1294b , 1294c . In addition, the size, shape and arrangement of the conductive regions 1294a, 1294b, 1294c and the insulating region 1298 cause the coagulation energy delivered by the electrodes 1294 to be directed to the tissue in the predefined treatment area, thereby preventing the transfer of both energy and heat from the treatment area. Parasitic leaching. In addition, thermally insulating conductive core 1297 resists heat transfer to portions of jaws 1290 that do not form a treatment area, which prevents inadvertent collateral thermal damage through accidental tissue contact with non-treatment areas of jaws 1290 .

)涂层选择性施加到电极1294的部分会产生选择性暴露的金属内部部分，该金属内部部分限定三维几何电子调制(GEM)以用于电极1294的导电区1294a、1294b、1294c处的聚焦解剖和凝固。如图22所示，区域1298选择性地沉积到电极1294上，从而产生治疗表面，该治疗表面具有交替的热传导和电传导区域以及热隔离和电绝缘区域，其被DLC涂层限定的导热但电绝缘的外周边区域围绕。Electrodes 1294 are selectively interrupted by regions 1298. High temperature PTFE (for example,

) coating selectively applied to portions of electrode 1294 results in selectively exposed metallic interior portions that define three-dimensional geometric electron modulation (GEM) for focused dissection at conductive regions 1294a, 1294b, 1294c of electrode 1294 and solidification. As shown in FIG. 22, regions 1298 are selectively deposited onto electrodes 1294, resulting in a treatment surface having alternating thermally and electrically conductive regions and thermally isolated and electrically insulating regions defined by the DLC coating for thermally conductive but electrically conductive An electrically insulating outer peripheral region surrounds.

Referring to FIG. 22 , the jaw 1290 includes an angular profile, wherein a plurality of angles are defined between discrete portions 1290a , 1290b , 1290c , 1290d of the jaw 1290 . For example, a first angle (α1) is defined by portions 1290a, 1290b, a second angle (α2) is defined by portions 1290b, 1290c, and a third angle (α3) is defined by portions 1290c, 1290d of the first jaw 1250. In other examples, at least a portion of jaw 1290 includes a smoothly curved profile without angles. In various aspects, the discrete portions 1290a, 1290b, 1290c, 1290d of the jaws 1290 are linear segments. Consecutive linear segments intersect at angles such as the first angle (α1) or the second angle (α2) and the third angle (α3). The linear segments cooperate to form the generally curved profile of each of the jaws 1290 .

In one example, the angles (α1, α2, α3) comprise the same or at least substantially the same values. In another example, at least two of the angles (α1, α2, α3) comprise different values. In another example, at least one of the angles (α1, α2, α3) includes a value selected from the range of about 120° to about 175°. In yet another example, at least one of the angles (α1, α2, α3) includes a value selected from the range of about 130° to about 170°.

Furthermore, due to the tapered profile of the jaws 1290, the portion 1290a, which is the proximal portion, is larger than the portion 1290b, which is the middle portion. Similarly, the middle portion 1290b is larger than the portion 1290d that defines the distal portion of the jaw 1290 . In other examples, the distal portion may be larger than the medial and/or proximal portion. In other examples, the intermediate portion is larger than the proximal and/or distal portions. Additionally, the electrodes 1294 of the jaws 1290 include an angular profile similar to the angular profile of the jaws 1290 .

Referring to FIG. 23 , in certain aspects, jaw 1300 includes a solid conductive skeleton 1301 partially surrounded by DLC coating 1264 . The exposed areas of the skeleton 1301 define one or more electrodes 1302 . This arrangement creates a thermally and electrically conductive portion of jaw 1300 in which thermal energy is delivered indiscriminately, but electrical energy is delivered only through one or more electrodes 1302 .

Referring now to FIGS. 24-26 , electrosurgical instrument 1500 includes end effector 1400 configured to deliver monopolar and/or bipolar energy to tissue grasped by end effector 1400 , as described in more detail below. End effector 1400 is similar to end effector 1200 in many respects. For example, the end effector 1400 includes a first jaw 1450 and a second jaw 1470 . At least one of the first jaw 1450 and the second jaw 1470 is movable relative to the other jaw to transition the end effector 1400 from the open configuration to the closed configuration to Grasp the organization in between. The grasped tissue can then be sealed and/or cut using monopolar and bipolar energy. As described in more detail below, the end effector 1400 utilizes GEM to adjust the energy density at the tissue treatment interface of the jaws 1450, 1470 to achieve the desired tissue treatment.

As with the jaws 1250, 1270, the jaws 1450, 1470 include a generally angular profile formed by linear portions angled relative to each other, resulting in a curved or finger-like shape, as shown in FIG. In addition, the jaws 1450 , 1470 include conductive skeletons 1452 , 1472 with narrowed horns extending distally along the angular profiles of the jaws 1450 , 1470 . The conductive frameworks 1452, 1472 may be constructed of a conductive material (eg, titanium). In certain aspects, each of the conductive backbones 1453, 1473 includes a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain examples, the thermally insulating portions of the skeletons 1453, 1473 define an inner core that includes internal gaps, voids, or pockets that effectively isolate the thermal mass of the outer surfaces of the jaws 1452, 1472 that are in direct contact with tissue The conductivity of the jaws 1450, 1470 is not compromised.

The thermally conductive portion includes conductive outer layers 1469, 1469' surrounding or at least partially surrounding the inner conductive core. In at least one example, the inner conductive core includes gap setting members that may extend between opposing sides of the outer layers 1469, 1469' of each of the jaws 1250, 1270 in the form of struts, posts, and/or walls, Wherein the gaps, voids or pockets extend between the gap setting members. In at least one example, the gap setting members form a honeycomb lattice structure 1467, 1467'.

In addition to the above, the conductive backbones 1453, 1473 include first conductive portions 1453a, 1473a extending distally along the angular profiles of the jaws 1450, 1470, At least a portion of the tapered body extends distally to the second conductive portion 1453b, 1473b of the tapered electrode. In at least one example, the first conductive portions 1453a, 1473a are thicker than the second conductive portions 1453b, 1473b in a lateral cross-section (eg, FIG. 25) of the tapered bodies of the backbones 1453, 1473. In at least one example, the second conductive portion 1453b, 1473b is integral with the first conductive portion 1453a, 1473a or is permanently attached to the first conductive portion such that electrical energy flows from the first conductive portion only through the second conductive portion 1453b, 1473b 1453a, 1473a flow to the tissue. The electrically insulating layers 1464, 1464' are configured to completely electrically insulate the first conductive portions 1453a, 1473a without electrically insulating the second conductive portions 1453b, 1473b. At least the outer surfaces of the second conductive portions 1453b, 1473b defining the electrodes 1452, 1472 are not covered by the electrically insulating layer 1464, 1464'. In the example shown, electrodes 1452, 1472 and electrically insulating layers 1464, 1464' define flush tissue treatment surfaces.

)涂层、DLC涂层和/或陶瓷涂层构成以用于绝缘和对焦炭粘附的耐受性。在各种示例中，较厚的第一导电部分1453a传导更多的潜在功率，具有对组织接触的第二导电部分1453b的较小电阻，从而在电极1452处产生更高的能量密度。As described above, the first conductive portions 1453a, 1473a are substantially thicker than the second conductive portions 1453b, 1473b and are wrapped with an electrically insulating layer 1464, 1464', which causes the second conductive portions 1453b, 1473b to become regions of high energy density . In at least one example, the electrically insulating layers 1464, 1464' are made of high temperature polytetrafluoroethylene (eg,

) coating, DLC coating and/or ceramic coating for insulation and resistance to coke adhesion. In various examples, the thicker first conductive portion 1453a conducts more potential power, with less resistance to the tissue-contacting second conductive portion 1453b, resulting in a higher energy density at the electrode 1452.

In various aspects, the outer surfaces of the electrodes 1452 , 1472 include continuous linear segments extending along the angled tissue treatment surfaces of the jaws 1450 , 1470 . The linear segments intersect at a predefined angle and have a width that gradually narrows as the linear segments extend distally. In the example shown in Figure 24, electrode 1452 includes segments 1452a, 1452b, 1452c, 1452c, 1452d, and electrode 1472 includes segments 1472a, 1472b, 1472c, 1472c, 1472d. The electrodes 1452 of the jaws 1450 are shown by dashed lines on the jaws 1470 of FIG. 24 to illustrate the lateral position of the electrodes 1452 relative to the electrodes 1452 in the closed configuration of the end effector 1400 . Electrodes 1452, 1472 are laterally offset from each other in the closed configuration. In the bipolar energy mode, electrical energy supplied by a generator (eg, generator 1100 ) flows from the first conductive portion 1453a to the electrode 1452 of the second conductive portion 1453b, and from the electrode 1452 to between the jaws 1450, 1470 grabbed organization. Bipolar energy then flows from the tissue to the electrode 1472 of the second conductive portion 1473b, and from the electrode 1472 to the first conductive portion 1473a.

In various aspects, as shown in FIGS. 24 and 25 , the second jaw 1470 also includes an electrode 1474 spaced from the backbone 1473 . In at least one example, electrode 1474 is a monopolar electrode configured to deliver monopolar energy to tissue grasped between jaws 1450, 1470 in a closed configuration. The return pad can be placed under the patient, for example, to receive monopolar energy from the patient. Like electrode 1472, electrode 1474 includes continuous linear segments 1474a, 1474b, 1474c, 1474d that extend distally from the electrode proximal end to the electrode distal end along the angular profile defined by the second jaw 1470 . Additionally, electrode 1474 is laterally offset from electrodes 1472, 1452.

Electrode 1474 includes a base 1474e in bracket 1480 that extends distally along the angular profile of second jaw 1470 from bracket proximal end 1480a to bracket distal end 1480b. The bracket 1480 is centrally positioned relative to the lateral edges 1470e , 1470f of the second jaw 1470 . Electrode 1474 also includes a tapered edge 1474f that extends from base 1474e beyond the sidewall of bracket 1480. Additionally, the brackets 1480 are partially embedded in valleys defined on the outer tissue treatment surface of the narrowed curved body. Bracket 1480 is spaced from the tapered body of skeleton 1473 by an electrically insulating coating 1464'. As shown in FIG. 24, the base 1480 has a width that gradually narrows as the base extends along the angular profile from the base proximal end 1480a to the base distal end 1480b.

In various examples, the carrier 1480 is constructed from a compliant substrate. In the uncompressed state, as shown in FIG. 25 , the sidewalls of the bracket 1480 extend beyond the tissue treatment surface of the jaws 1472 . As tissue is compressed between the jaws 1450, 1470, the compressed tissue exerts a biasing force on the sidewalls of the bracket 1480, thereby further exposing the tapered edge 1474f of the electrode 1474.

One or more of the jaws described in this disclosure include stop members or gap setting members that are features extending outwardly from one or both of the tissue treatment surfaces of the jaws of the end effector. The stop member helps maintain the separation or predetermined gap between the jaws in a closed configuration, wherein there is no tissue between the jaws. In at least one example, the sidewalls of bracket 1480 define such stop members. In another example, the stop member may be in the form of an insulating post or a laterally extending spring biased feature that allows the clearance and closed configuration between opposing jaws to vary based on clamping load.

Most electrosurgical generators use constant power mode. In constant power mode, the power output remains constant because the impedance increases. In constant power mode, the voltage increases as the impedance increases. The increased voltage results in thermal damage to the tissue. The energy output of the GEM focusing jaws 1250, 1270, eg, by controlling the size and shape of the electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474, as described above, and modulating the power level based on tissue impedance to produce low voltages plasma.

In some cases, the GEM maintains a constant minimum voltage required to cut at the surgical site. The generator (eg, 1100) regulates the power to maintain the voltage as close as possible to the minimum voltage required for cutting at the surgical site. To achieve arc plasma and cutting, current is driven by a voltage from tapered portions of electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474 to the tissue. In some examples, a minimum voltage of about 200 volts is maintained. Cutting with greater than 200 volts increased thermal damage, and cutting with less than 200 volts resulted in minimal arcing and drag in the tissue. Therefore, the generator (eg, 1100) adjusts the power to ensure that the minimum voltage that is likely to still form arc plasma and cut is utilized.

Referring primarily to FIG. 26 , surgical instrument 1500 includes end effector 1400 . Surgical instrument 1500 is similar in many respects to other surgical instruments described in US Patent Application Attorney Docket No. END9234USNP2/190717-2. Various actuation and articulation mechanisms described elsewhere in connection with such surgical instruments may similarly be used to articulate and/or actuate surgical instrument 1500 . For brevity, this paper does not repeat this mechanism.

The end effector 1400 includes an end effector frame assembly 11210 that includes a distal frame member 11220 rotatably supported in a proximal frame housing 11230. In the example shown, the distal frame member 11220 is rotatably attached to the proximal frame housing 11230 by an annular rib on the distal frame member 11220 that is received in an annular groove in the proximal frame housing 11230 Inside.

Electrical energy is delivered to the electrodes 1452, 1472, 1474 of the end effector 1400 by one or more flexible circuits extending distally through or beside the distal frame member 11220. In the example shown, the flex circuit 1490 is fixedly attached to the first jaw 1450 . More specifically, the flex circuit 1490 includes a distal portion 1492 that is fixedly attachable to an exposed portion 1491 of the first jaw 1450 that is not covered by the insulating layer 1464 .

The slip ring assembly 1550 within the proximal frame housing 11230 allows the end effector 1400 to rotate freely about the axis of the surgical instrument 1500 without tangling the wires that transmit electrical power to the circuits of the electrodes 1452, 1472, 1474. In the example shown, flex circuit 1490 includes electrical contacts 1493 that movably engage slip ring 1550a of slip ring assembly 1550 . Electrical energy is transferred from slip ring 1550a to conductive bobbin 1453 and then to electrodes 1452 through flex circuit 1490. Because the electrical contacts 1493 are not fixedly attached to the slip ring 1550a, rotation of the end effector 1400 about the axis of the surgical instrument 1500 is allowable without loss of electrical power between the electrical contacts 1493 and the slip ring 1550a connect. Additionally, similar electrical contacts transmit power to slip ring 1550a.

In the example shown in FIG. 26 , slip ring 1550a is configured to transmit bipolar energy to electrode 1452 of jaw 1450 . Slip ring 1550b cooperates with similar electrical contacts and electrodes 1472 to define a return path for bipolar energy. Additionally, slip ring 1550c cooperates with similar electrical contacts and electrodes 1474 to provide access for monopolar electrical energy into the tissue. Bipolar and monopolar electrical energy may be delivered to slip rings 1550a, 1550b by one or more electrical generators (eg, generator 1100). Bipolar and monopolar electrical energy can be delivered simultaneously or separately, as described in more detail elsewhere herein.

In various examples, slip rings 1550a, 1550b, 1550c are integrated electrical slip rings having mechanical features 1556a, 1556b, 1556c configured to couple slip rings 1550a, 1550b, 1550c to insulation Support structure 1557, or conductive support structure coated with insulating material, as shown in FIG. 26 . In addition, the slip rings 1550a, 1550b, 1550c are spaced apart sufficiently to ensure that if a conductive fluid fills the space between the slip rings 1550a, 1550b, 1550c, a short circuit will not occur. In at least one example, the core flat stamped metal shaft member includes a three-dimensional printed or overmolded non-conductive portion for supporting the slip ring assembly 1550 .

27 shows a portion of an electrosurgical instrument 12000 that includes a surgical end effector 12200 that may be coupled to a proximal shaft section by an articulation joint in various suitable manners. In some cases, surgical end effector 12200 includes an end effector frame assembly 12210 that includes a distal frame rotatably supported in a proximal frame housing attached to an articulation joint Component 12220.

The surgical end effector 12200 includes a first jaw 12250 and a second jaw 12270. In the example shown, the first jaw 12250 is pivotally secured to the distal frame member 12220 for selective pivotal travel relative thereto about a first jaw axis FJA defined by the first jaw pin 12221 . The second jaw 12270 is pivotally secured to the first jaw 12250 for selective pivotal travel relative to the first jaw 12250 about a second jaw axis SJA defined by the second jaw pin 12272 . In the example shown, the surgical end effector 12200 employs an actuator yoke assembly 12610 pivotally coupled to the second jaw 12270 by a second jaw attachment pin 12273 for actuation about the jaw The axis JAA travels pivotally, the jaw actuation axis being proximate to and parallel to the first and second jaw axes FJA and SJA. The actuator yoke assembly 12610 includes a proximal threaded drive shaft 12614 that is threadedly received in a threaded hole 12632 in the distal locking plate 12630. A threaded drive shaft 12614 is mounted to the actuator yoke assembly 12610 for relative rotation therebetween. The distal locking plate 12630 is supported for rotational advancement within the distal frame member 12220. Thus, rotation of the distal locking plate 12630 will cause axial travel of the actuator yoke assembly 12610.

In some cases, the distal locking plate 12630 includes a portion of the end effector locking system 12225. The end effector locking system 12225 also includes a double-acting rotary locking head 12640 that attaches to the various types of rotary drive shafts 12602 disclosed herein. The locking head 12640 includes a first plurality of radially disposed distal locking features 12642 adapted to lockingly engage a plurality of proximally facing radial grooves or recesses 12634 formed in the distal locking plate 12630. Rotation of the rotational locking head 12640 will cause the distal locking plate 12630 to rotate within the distal frame member 12220 when the distal locking feature 12642 is in locking engagement with the radial groove 12634 in the distal locking plate 12630. Also in at least one example, the rotational locking head 12640 further includes a second series of proximally facing proximal locking features 12644 adapted to lockingly engage a corresponding series of locking grooves provided in the distal frame member 12220 . A locking spring 12646 is used to bias the rotational locking head distally into locking engagement with the distal locking plate 12630. In various cases, the rotational locking head 12640 can be pulled proximally by an unlocking cable or other member in the manner described herein. In another arrangement, the rotational drive shaft 12602 can be configured to also move axially to move the rotational locking head 12640 axially within the distal frame member 12220. When proximal locking features 12644 in rotational locking head 12640 are in locking engagement with a series of locking grooves in distal frame member 12220, rotation of rotational drive shaft 12602 will cause surgical end effector 12200 to rotate about shaft axis SA.

In some cases, the first jaw 12250 and the second jaw 12270 open and close as follows. To open and close the jaws, as discussed in detail above, the rotational locking head 12640 is in locking engagement with the distal locking plate 12630. Thereafter, rotation of the rotational drive shaft 12602 in the first direction will rotate the distal locking plate 12630, which will axially drive the actuator yoke assembly 12610 in the distal direction DD and cause the first jaw 12250 and the second jaw 12270 is moved towards the open position. Rotation of the rotational drive shaft 12602 in the opposite second direction will axially drive the actuator yoke assembly 12610 proximally and pull the jaws 12250, 12270 toward the closed position. To rotate the surgical end effector 12200 about the shaft axis SA, the locking cable or member is pulled proximally to cause the rotational locking head 12640 to disengage from the distal locking plate 12630 and engage the distal frame member 12220. Thereafter, when the rotational drive shaft 12602 is rotated in the desired direction, the distal frame member 12220 (and the surgical end effector 12200) will rotate about the shaft axis SA.

Figure 27 further illustrates an electrical connection assembly 5000 for electrically coupling the jaws 12250, 12270 to one or more power sources such as the generators 3106, 3107 (Figure 36). The electrical connection assembly 5000 defines two separate electrical pathways 5001, 5002 extending through the electrosurgical instrument 12000, as shown in FIG. In the first configuration, the electrical paths 5001, 5002 cooperate to deliver bipolar energy to the end effector 12200, with one of the electrical paths 5001, 5002 serving as the return path. Furthermore, in the second configuration, the electrical pathways 5001, 5002 deliver the monopolar energy 12200 individually and/or simultaneously. Thus, in the second configuration, both the electrical paths 5001, 5002 can be used as supply paths. Additionally, electrical connection assembly 5000 may be used with other surgical instruments (eg, surgical instrument 1500 ) described elsewhere herein to electrically couple such surgical instruments to one or more power sources (eg, generators 3106 , 3107 ) catch.

In the example shown, the electrical paths 5001 , 5002 are implemented using a flex circuit 5004 that extends at least partially through the coil bobbin 5005 . As shown in FIG. 30 , the flex circuit 5004 includes two separate conductive trace elements 5006 , 5007 embedded in a PCB (printed circuit board) substrate 5009 . In some cases, the flex circuit 5004 can be attached to a core flat stamped metal shaft member with a 3D printed or overmolded plastic housing to provide full shaft fill/support.

In an alternative example, as shown in Figure 32, a flex circuit 5004' extending through coil bobbin 5005' may include conductive trace elements 5006', 5007' twisted in a helical profile in a PCB substrate 5009', the conductive traces The wire elements result in a reduction in the overall size of the flex circuit 5004' and, in turn, the inner/outer diameter of the coil bobbin 5005'. Figures 31 and 32 show other examples of flex circuits 5004", 5004"' extending through coil bobbins 5005', 5005" and including conductive trace elements 5006", 5007" and 5006"', 5007, respectively "', which includes alternative profiles for size reduction. For example, flex circuit 5004"' includes a folded profile, while flex circuit 5004' includes trace elements 5006", 5007" on opposite sides of PCB 5009".

In addition to the above, vias 5001, 5002 are defined by trace portions 5006a-5006g, 5007a-5007g, respectively. Trace portions 5006b, 5006c and trace portions 5007b, 5007c are in the form of a ring that defines ring assembly 5010 that maintains electrical connection through passages 5001, 5002 while allowing end effector 12200 to be relative to the axis of surgical instrument 12000 rotate. Additionally, trace portions 5006e, 5007e are provided on opposite sides of the actuator yoke assembly 12610. In the example shown, portions 5006e, 5007e are disposed around holes configured to receive second jaw attachment pins 12273, as shown in FIG. 27 . The trace portions 5006e, 5007e are configured to be able to make electrical contact with corresponding portions 5006f, 5007f provided on the second jaw 12270. Furthermore, when the first jaw 12250 is assembled with the second jaw 12270, the trace portions 5007f, 5007g become electrically connected.

Referring to FIG. 29 , the flex circuit 5014 includes spring biased trace elements 5016 , 5017 . The trace elements 5016, 5017 are configured to apply a biasing force against the corresponding trace element to ensure that the electrical connection therewith is maintained, particularly when the corresponding trace portions are moved relative to each other. One or more of the trace portions of vias 5001 , 5002 may be modified to include spring biased trace elements according to flex circuit 5014 .

Referring to Figure 34, a graph 3000 illustrates a power scheme 3005' of a tissue treatment cycle 3001 applied by the end effector 1400 or any other suitable end effector of the present disclosure to tissue grasped by the end effector 1400 . The tissue treatment cycle 3001 includes a tissue coagulation stage 3006 that includes an eclosion section 3008 , a tissue warming section 3009 , and a sealing section 3010 . The tissue treatment cycle 3001 also includes a tissue transection or cutting phase 3007 .

Figure 36 shows an electrosurgical system 3100 that includes a control circuit 3101 configured to implement a power scheme 3005'. In the example shown, the control circuit 3101 includes a storage medium in the form of a memory 3103 and a controller 3104 of the processor 3102 . The storage medium stores program instructions for executing the power scheme 3005'. According to power scheme 3005', electrosurgical system 3100 includes generator 3106 configured to supply monopolar energy to end effector 1400, and generator 3107 configured to supply bipolar energy to end effector 1400. In the example shown, control circuit 3101 is depicted separately from surgical instrument 1500 and generators 3106, 3107. However, in other examples, control circuit 3101 may be integrated with surgical instrument 1500 , generator 3106 , or generator 3107 . In various aspects, power scheme 3005' may be stored in memory 3103 in the form of algorithms, equations, and/or look-up tables, or any other suitable format that is suitable. Control circuit 3101 may cause generators 3106, 3107 to supply monopolar and/or bipolar energy to end effector 1400 according to power scheme 3005'.

In the example shown, the electrosurgical system 3100 also includes a feedback system 3109 in communication with the control circuit 3101 . For example, feedback system 3109 may be a stand-alone system or may be integrated with surgical instrument 1500. In various aspects, the control circuit 3101 may employ the feedback system 3109 to perform predetermined functions, eg, to issue an alarm when one or more predetermined conditions are met. In some cases, feedback system 3109 may include, for example, one or more visual feedback systems, such as a display screen, backlights, and/or LEDs. In some cases, feedback system 3109 may include, for example, one or more audio feedback systems, such as speakers and/or buzzers. In some cases, feedback system 3109 may include, for example, one or more haptic feedback systems. In some cases, feedback system 3109 may include, for example, a combination of visual, audio, and/or haptic feedback systems. Additionally, the electrosurgical system 3100 also includes a user interface 3110 in communication with the control circuit 3101 . For example, user interface 3110 may be a stand-alone interface, or may be integrated with surgical instrument 1500.

Graph 3000 depicts power (W) on the y-axis and time on the x-axis. Bipolar energy curve 3020 spans tissue coagulation stage 3005 , and monopolar energy curve 3030 begins at tissue coagulation stage 3006 and ends at the end of tissue transection stage 3007 . Thus, the tissue treatment cycle 3001 is configured to be able to apply bipolar energy to tissue throughout the tissue coagulation phase 3006 but not during the tissue transection phase 3007 , and to apply monopolar energy to a portion of the coagulation phase 3006 and during the transection phase 3007 Apply to tissue as shown in Figure 34.

In various aspects, control circuitry 3101 may receive user input from user interface 3110 . User input causes control circuit 3101 to initiate execution of power scheme 3005 _' at time ti. Alternatively, initialization of execution of the power scheme 3005' may be automatically triggered by sensor signals from one or more sensors 3111 in communication with the control circuit 3101. For example, the power scheme 3005' may be automatically triggered by the control circuit 3101 in response to a sensor signal indicative of a predetermined gap between the jaws 1450, 1470 of the end effector 1400.

During the feather segment 3008 , the control circuit 3101 causes the generator 3107 to gradually increase the bipolar energy power supplied to the end effector 1400 to reach a predetermined power value P1 (eg, 100W), and throughout the remainder of the feather segment 3008 and tissue warming section 3009 to maintain bipolar energy power at or substantially at a predetermined power value P1. The predetermined power value P1 may be stored in the memory 3103 and/or may be provided by the user through the user interface 3110. During the sealing section 3010, the control circuit 3101 causes the generator 3107 to gradually reduce the bipolar energy power. Bipolar energy application ends at the end of the sealing section 3010 of the tissue coagulation stage 3006 and before the cutting/transection stage 3007 begins.

In addition to the above, for example, at t ₂ , the control circuit 3101 causes the generator 3107 to begin supplying monopolar energy power to the electrodes 1474 of the end effector 1400 . The application of monopolar energy to the tissue begins at the end of the feathering section 3008 and the beginning of the tissue warming section 3009. The control circuit 3101 causes the generator 3107 to gradually increase the monopolar energy power to reach a predetermined power level P2 (eg, 75W) and maintain or at least substantially within the remainder of the tissue warming segment 3009 and the first portion of the sealing segment 3010 The predetermined power level P2 is maintained. The predetermined power level P2 may also be stored in the memory 3103 and/or may be provided by the user through the user interface 3110.

During the sealing section 3010 of the tissue coagulation stage 3006 , the control circuit 3101 causes the generator 3107 to gradually increase the monopolar energy power supplied to the end effector 1400 . The onset of the tissue transection phase 3007 is driven by an inflection point in the monopolar energy curve 3030, where the previous gradual increase in monopolar energy experienced during the sealing segment 3010 is followed by a gradual rise to a predetermined maximum threshold power sufficient to transection the coagulated tissue Level P3 (eg 150W).

_At t4, the control circuit 3101 causes the generator 3107 to step up the monopolar energy power supplied to the end effector 1400 to a predetermined maximum threshold power level P3, and for a predetermined period of time (t4 _- t5 ₎ or until the tissue The end of the traverse phase 3007 maintains, or at least substantially maintains, the predetermined maximum threshold power level P3. In the example shown, the monopolar energy power is terminated by the control circuit 3101 at t5. Tissue transection continues mechanically as the jaws 1450, 1470 continue to apply pressure to the grasped tissue until the end of the tissue transection phase ₃₀₀₇ at t6. Alternatively, in other examples, the control circuit 3101 may cause the generator 3107 to continue supplying the monopolar energy capability to the end effector 1400 until the end of the tissue transection phase 3007 .

Control circuit 3101 may employ sensor readings of sensor 3111 and/or timer clocks of processor 3102 to determine when to cause generator 3107 and/or generator 3106 to start, increase, decrease according to a power scheme (eg, power scheme 3005') and/or terminate the supply of energy to the end effector 1400 . For example, the control circuit 3101 may operate by clocking one or more timers from one or more predetermined time periods (eg, t ₁ -t ₂ , t ₂ -t ₃ , t ₃ -t ₄ , t ₅ -t ₆ ) Counting down to execute the power scheme 3005', these predetermined time periods may be stored in the memory 3103. Although the power scheme 3005' is time based, the control circuit 3101 may adjust the individual sections 3008, 3009, 3010 and/or based on sensor readings received from one or more of the sensors 3111 (eg, tissue impedance sensors) A predetermined time period for either of stages 3006, 3007.

The end effector 1400 is configured to deliver three different energy modalities to grasped tissue. The first energy modality applied to the tissue during the feathering section 3008 includes bipolar energy but not monopolar energy. The second energy modality is a hybrid energy modality comprising a combination of monopolar energy and bipolar energy, and is applied to the tissue during the tissue warming phase 3009 and the tissue sealing phase 3010 . Finally, the third energy modality includes monopolar energy but not bipolar energy, and is applied to the tissue during cutting stage 3007 . In various aspects, the second energy modality includes a power level that is the sum 3040 of power levels of monopolar energy and bipolar energy. In at least one example, the power level of the second energy modality includes a maximum threshold Ps (eg, 120W).

In various aspects, the control circuit 3101 causes monopolar and bipolar energy to be delivered to the end effector 1400 from the two different generators 3106, 3107. In at least one example, energy from one of the generators 3106, 3107 can be detected using the return path of the other generator, or shorting to unintended tissue interaction with the other generator's attached electrodes. Therefore, parasitic losses of energy through the unintended return path can be detected by the generator connected to the return path. Unintentional conductive paths can be mitigated by implementing voltage, power, waveform, or timing between uses.

Integrated sensors within the flex circuit of surgical instrument 1500 can detect energization/shorting of electrodes/conductive paths when the potential should not be present, and prevent the ability of the conductive paths once inadvertent use is sensed. In addition, directional electronic gating elements that prevent crosstalk from one generator down to the source of another generator can also be utilized.

One or more of the electrodes described in this disclosure (eg, electrodes 1452 , 1472 , 1474 connected to jaws 1450 , 1470 ) can include a segmented pattern that has a ) are connected together when energized. However, when the electrodes are not energized, the segments are separated to prevent the circuit from shorting across the electrodes to other areas of the jaws.

In various aspects, thermally resistive electrode materials are used with end effector 1400 . The material may be configured to inhibit current flow through the electrode at or above a predetermined temperature level, but continue to allow energization of other portions of the electrode below the temperature threshold.

Figure 37 shows a table representing an alternative power scheme 3005" that may be stored in memory 3103 and executed by processor 3102 in a similar manner to power scheme 3005'. When executing power scheme 3005" , the control circuit 3101 is dependent on the jaw holes in addition to or instead of the time at which the generators 3106, 3107 set the power value. Therefore, the power scheme 3005" is a jaw hole based power scheme.

In the example shown, the jaw holes d ₀ , d ₁ , d ₂ , d ₃ , d ₄ from power scheme 3005 ″ correspond to time values t ₁ , t ₂ , t ₃ , t from power scheme 3005 ′ _4. Thus, the feathering segment corresponds to _a jaw hole from about d1 to about _d2 (eg, about 0.700" to about 0.500"). Additionally, the tissue warming segment corresponds to from about _d2 to about _d3 (eg, about 0.500" to about 0.300"). Further, the sealing section corresponds to a jaw hole from about _d2 to about _d3 (eg, about 0.030" to about 0.010"). Further , the tissue cutting stage corresponds to a jaw hole from about _d3 to about _d4 (eg, about 0.010" to about 0.003").

Accordingly, the control circuit 3101 is configured to cause the generator 3106 to begin supplying bipolar energy power to the end effector 1400 when readings from one or more of the sensors 3111 correspond to, for example, a predetermined jaw hole d1, by This initializes the feathered section. Likewise, the control circuit 3101 is configured to cause the generator 3106 to cease supplying bipolar energy power to the end effector 1400 when readings from one or more of the sensors 3111 correspond to, for example, a predetermined jaw hole d2, by This terminates the feathered segment. Likewise, the control circuit 3101 is configured to cause the generator 3107 to begin supplying monopolar energy power to the end effector 1400 when readings from one or more of the sensors 3111 correspond to, for example, a predetermined jaw hole d2, The warm-up section is thus initialized.

In the example shown, the jaw holes are defined by the distance between two corresponding reference points on the jaws 1450, 1470. When the jaws 1450, 1470 are in a closed configuration with no tissue therebetween, the corresponding fiducials touch each other. Alternatively, the jaw aperture may be defined by the distance between the jaws 1450 , 1470 measured along a line that intersects the jaws 1450 , 1470 and intersects centrally extending through the longitudinal axis of the end effector 1500 . Alternatively, the jaw holes may be defined by the distance between first and second parallel lines intersecting the jaws 1450, 1470, respectively. The distance extends perpendicular to the first and second parallel lines and extends through the intersection between the first parallel line and the first jaw 1450 and through the intersection between the second parallel line and the second jaw 1470 line measurement.

Referring to FIG. 35 , in various examples, electrosurgical system 3100 ( FIG. 36 ) is configured to be capable of performing tissue treatment cycle 4003 using power scheme 3005 . The tissue treatment cycle 4003 includes an initial tissue contact phase 4013 , a tissue coagulation phase 4006 and a tissue transection phase 4007 . Tissue contact stage 4013 includes open configuration section 4011, wherein tissue is not located between jaws 1450 and 1470, and correct orientation section 4012, wherein jaws 1450 and 1470 are properly positioned relative to the desired tissue treatment area. The tissue coagulation stage 4006 includes an eclosion section 4008, a tissue warming section 4009, and a sealing section 3010. Tissue transection stage 4007 includes a tissue cutting segment. Tissue treatment cycle 4003 involves the separate and simultaneous application of bipolar and monopolar energy to the tissue treatment area according to power scheme 3005 . Tissue treatment cycle 4003 is similar in many respects to tissue treatment cycle 3001, which is not repeated herein for brevity.

Figure 35 shows a graph 4000 representing a power scheme 3005 that is similar in many respects to the power scheme 3005'. For example, control circuit 3101 may execute power scheme 3005 in a manner similar to power scheme 3005' to deliver three different energy modalities to the tissue treatment area during three consecutive time periods of tissue treatment cycle 4001. In the feathering section 4008, a first energy modality including bipolar energy but not monopolar energy is applied to the tissue treatment area at t ₁ to t ₂ . In the tissue warming section 4009 and the tissue sealing section, a second energy modality, which is a hybrid energy modality comprising a combination of monopolar and bipolar energy, is applied to the tissue treatment area at t ₂ to t ₄ . Finally, in the tissue transection stage 4007, a third energy modality including monopolar energy but not bipolar energy 4010 is applied to the tissue at t ₄ to t ₅ . Furthermore, the second energy modality includes a power level that is the sum of the power levels of monopolar energy and bipolar energy. In at least one example, the power level of the second energy modality includes a maximum threshold (eg, 120W). In various aspects, the power scheme 3005 may be delivered to the end effector 1400 from two different generators 3106, 3107. For the sake of brevity, additional aspects of power scheme 3005 that are similar to aspects of power scheme 3005' are not repeated herein at the same level of detail.

In various aspects, control circuitry 3101 causes generators 3106, 3107 to cause generators 3106, 3107 based on one or more measured parameters including tissue impedance 4002, jaw motor speed 27920d, jaw motor force 27920c, jaw aperture 27920b of end effector 1400 and/or or current draw of a motor that achieves end effector closure) to adjust the bipolar and/or monopolar power levels of the power scheme 3005 applied by the end effector 1400 to the tissue treatment area. FIG. 35 is a graph 4000 showing the correlation between such measurement parameters and the power scheme 3005 over time.

In various examples, control circuit 3101 causes generators 3106, 3107 to be based on one or more parameters determined by one or more sensors 3111 (eg, tissue impedance 4002, jaw/closure motor speed 27920d, jaw/closure motor force 27920c, the jaw gap/bore 27920b of the end effector 1400 and/or the current draw of the motor) to adjust the power scheme (eg, power scheme 3005, 3005') applied by the end effector 1400 to the tissue treatment area power level. For example, the control circuit 3101 may cause the generators 3106, 3107 to adjust the power level based on the pressure within the jaws 1450, 1470.

In at least one example, the power level is inversely proportional to the pressure within the jaws 1450 , 1470 . The control circuit 3101 may utilize such an inverse correlation to select a power level based on the pressure value. In at least one example, the pressure value is determined using the current draw of a motor that achieves end effector closure. Alternatively, the inverse correlation utilized by the control circuit 3101 may be directly based on current draw as a proxy for pressure. In various examples, the greater the compression applied by the jaws 1450, 1470 to the tissue treatment area, the lower the power level set by the control circuit 3101, which helps minimize tissue adhesion and unintentional cutting.

Graph 4000 provides tissue impedance 4002, jaw/closure motor speed 27920d, jaw/closure motor force 27920c, jaw gap/bore 27920b of the end effector 1400 and/or the current of the motor affecting end effector closure Several cues of the measured parameters drawn, which can trigger activation, adjustment, and/or termination of bipolar energy and/or monopolar energy application to the tissue during tissue treatment cycle 4003.

The control circuit 3101 may rely on one or more of such prompts to perform and/or adjust the default power scheme 3005 in the tissue treatment cycle 4003 . In some examples, control circuitry 3101 may rely on sensor readings from one or more sensors 3111 to detect, for example, when one or more monitored parameters satisfy one or more predetermined conditions that may be stored in memory 3103 . One or more predetermined conditions may reach predetermined thresholds and/or detect meaningful increases and/or decreases in one or more of the monitored parameters. The fulfillment of the predetermined condition, or lack thereof, constitutes a trigger/confirmation point for performing and/or adjusting part of the default power scheme 3005 in the tissue treatment cycle 4003. Control circuitry 3101 may rely on hints only when executing and/or adjusting power schemes, or alternatively, use hints to direct or adjust timer clocks for time-based power schemes (eg, power scheme 3005').

For example, a sudden decrease (A ₁ ) in tissue impedance to a predetermined threshold (Z ₁ ), either alone or in conjunction with an increase (A ₂ ) in jaw motor force to a predetermined threshold (F ₁ ) and/or a decrease (A ₃ ) in jaw hole to The consistent occurrence of a predetermined threshold (dl) (eg, 0.5") may trigger the control circuit 3101 to initiate the feathering section 4008 of the tissue coagulation stage 4006 by activating the application of bipolar energy to the tissue treatment area. The control circuit 3101 may signal The generator 3106 is notified to begin supplying bipolar power to the end effector 1400.

Additionally, the reduction (B ₁ ) of the jaw motor speed to a predetermined value (v1 ) after activation of the bipolar energy triggers the control circuit 3101 to signal the generator 3106 to stabilize the power level (B ₂ ) of the bipolar energy At a constant or at least substantially constant value (eg, 100W).

In yet another example, the displacement at _t2 from the feathering section 4008 to the warming section 4009, which triggers the activation of monopolar energy application to the tissue treatment area (D1), is consistent with: jaw motor The force increases ( _C2 ) to a predetermined threshold (F2 ₎ , the jaw hole decreases (C3 ₎ to a predetermined threshold (eg, 0.03"), and/or the tissue impedance decreases (C1) to a predetermined value _Z2 . Conditions C1, C2 Satisfaction of one or both of C3, C3, or both of some cases causes the control circuit 3101 to cause the generator 3101 to begin applying monopolar energy to the tissue treatment area. In another example, at or about time Satisfaction of one or in some cases both or all of the conditions C1, C2, C3 of t2 triggers the application of monopolar energy to the tissue treatment area.

Activation of monopolar energy by generator 3107 in response to an activation signal from control circuit 3101 causes a mixture of monopolar and bipolar energy (D ₁ ) to be delivered to the tissue treatment area, which results in a change in impedance from Z ₂ to _A faster decrease (E1) of Z3 (compared to a steady decrease (C1) before activation of the monopolar energy) characterizes the shift in the impedance curve. In the example shown, tissue impedance Z ₃ defines the minimum impedance for tissue treatment cycle 4003 .

In the example shown, if (E ₁ ) a minimum impedance value Z ₃ and (E ₃ ) a predetermined maximum jaw motor force threshold (F ₃ ) and/or (E ₂ ) a predetermined jaw hole threshold range (eg, 0.01 "-0.003") consistent or at least substantially consistent, the control circuit 3101 determines that an acceptable seal is achieved. Satisfaction of one or both of the conditions E1 , E2 , E3 or all of the conditions in some cases signals the control circuit 3101 to shift from the warming section 4009 to the sealing section 4010 .

In addition to the above, beyond the minimum impedance value Z ₃ , at t ₄ the impedance level gradually increases to a threshold value Z 4 corresponding to the end of the sealing section 4010 . Satisfaction of threshold Z4 causes control circuit 3101 to signal generator 3107 to gradually increase the monopolar power level to initiate tissue transection phase 4007 and to signal generator 3106 to terminate application of bipolar energy to the tissue treatment area.

In various examples, the control circuit 3101 may be configured to be able to (G ₂ ) verify that as the (G ₁ ) impedance gradually increases from its minimum value Z ₃ , the jaw motor force decreases, and/or the unipolar energy is gradually increased The (G ₃ ) jaw motor force has been reduced to a predetermined threshold (eg, 0.01"-0.003") before the power level to cut tissue.

However, if the jaw motor force continues to increase, the control circuit 3101 may suspend the application of monopolar energy to the tissue treatment area for a predetermined period of time to allow the jaw motor force to begin to decrease. Alternatively, the control circuit may signal the generator 3107 to deactivate the monopolar energy and use only the bipolar energy to complete the seal.

In some cases, the control circuit 3101 may employ a feedback system 3109 to alert the user and/or provide instructions or recommendations to suspend the application of monopolar energy. In some cases, the control circuit 3101 may instruct the user to utilize a mechanical knife to transect tissue.

In the example shown, the control circuit 3101 maintains (H) a ramped up monopolar power until a spike (I) is detected in tissue impedance. Control circuit 3101 may cause generator 3107 to terminate (J) the application of monopolar energy to the tissue after detecting a spike (I ₎ in impedance level to Z5 following a gradual increase from _Z3 to _Z4 . The spike indicates the completion of the tissue treatment cycle 4003.

In various examples, the control circuit 3101 prevents the electrodes of the jaws 1450, 1470 from being energized until a suitable closure threshold is reached. The closure threshold may be based on a predetermined jaw hole threshold and/or a predetermined jaw motor force threshold, which may be stored in memory 3103, for example. In such examples, control circuitry 3101 may not act on user input through user interface 3110 requesting therapy cycle 4003 . In some cases, the control circuit 3101 may respond by alerting the user through the feedback system 3109 that an appropriate closure threshold has not been reached. The control circuit 3101 may also provide an override option to the user.

Finally, between times t ₄ and t ₅ , the monopolar energy is the only energy delivered to cut patient tissue. The force with which the jaws of the end effector are gripped may vary as the patient tissue is cut. Efficient and/or effective tissue cutting is identified by the surgical instrument and/or surgical center where the force ₂₇₉₅₂ for gripping the jaws is reduced from its steady state level maintained between times _t3 and t4. Inefficient and/or ineffective tissue cuts are identified by the surgical instrument and/or surgical center as the force 27954 for gripping the jaws increases from its steady state level maintained between times _t3 and t4 _. In such cases, the error may be communicated to the user.

38-42, surgical instrument 1601 includes an end effector 1600 that is similar in many respects to end effectors 1400, 1500, which end effectors are not repeated herein at the same level of detail for the sake of brevity . The end effector 1600 includes a first jaw 1650 and a second jaw 1670 . At least one of the first jaw 1650 and the second jaw 1670 is movable to transition the end effector 1600 from an open configuration to a closed configuration to grip between the first jaw 1650 and the second jaw 1670 Organization (T). Electrodes 1652, 1672 are configured to cooperate to deliver bipolar energy from bipolar energy source 1610 to tissue, as shown in FIG. Electrode 1674 is configured to deliver monopolar energy from monopolar energy source 1620 to tissue. Return pad 1621 defines a return path for monopolar energy. In at least one example, monopolar energy and bipolar energy are delivered to tissue simultaneously (FIG. 36) or in an alternating fashion, as shown in FIG. 36, for example, to seal and/or cut tissue.

42 shows a simplified schematic diagram of an electrosurgical system 1607 that includes a monopolar power source 1620 and a bipolar power source 1610 connectable to an electrosurgical instrument 1601 including an end effector 1600. The electrosurgical system 1607 also includes a conductive circuit 1602 that is selectively transitionable between a connected configuration with the electrode 1672 and a disconnected configuration with the electrode 1672 . The switching mechanism may consist of any suitable switch that can open and close the conductive circuit 1602, for example. In the connected configuration, the electrode 1672 is configured to cooperate with the electrode 1652 to deliver bipolar energy to tissue, wherein the conductive circuit 1602 defines a return path for the bipolar energy after passing through the tissue. In the open configuration, however, the electrodes 1672 are isolated and thus become an inert inner conductive and outer insulating structure on the jaws 1670. Thus, in the disconnected configuration, electrode 1652 is configured to deliver monopolar energy to tissue in addition to or separately from the monopolar energy delivered by electrode 1674. In an alternative example, electrode 1652, rather than electrode 1672, can transition between a connected configuration with conductive circuit 1602 and a disconnected configuration, allowing electrode 1672 to target tissue in addition to or separately from the monopolar energy delivered by electrode 1674 Delivers monopolar energy.

In various aspects, electrosurgical instrument 1601 also includes control circuitry 1604 configured to adjust the levels of monopolar and bipolar energy delivered to the tissue to minimize unintended thermal damage to surrounding tissue. The adjustment may be based on readings from at least one sensor, such as a temperature sensor, an impedance sensor, and/or a current sensor. In the example shown in Figures 41 and 42, the control circuit 1604 is coupled to temperature sensors 1651, 1671 on the jaws 1650, 1670, respectively. Control circuitry 1604 adjusts the levels of monopolar and bipolar energy delivered to the tissue based on temperature readings from sensors 1651, 1671.

In the example shown, the control circuit 1604 includes a storage medium in the form of a memory 3103 and a controller 3104 of the processor 3102 . The memory 3103 stores program instructions that, when executed by the processor 3102, cause the processor 3102 to adjust the monopolar energy and bipolar energy delivered to the tissue based on sensor readings received from one or more sensors (eg, temperature sensors 1651, 1671). Extreme energy level. In various examples, as described in more detail below, the control circuit 1604 may adjust the default power scheme 1701 based on readings from one or more sensors (eg, temperature sensors 1651 , 1671 ). Power scheme 1701 is similar in many respects to power scheme 3005', which for brevity is not repeated herein at the same level of detail.

FIG. 43 shows temperature-based adjustment of power scheme 1701 for energy delivery to tissue grasped by end effector 1600 . Graph 1700 depicts time on the x-axis and power and temperature on the y-axis. During the tissue feathering segment (t ₁ -t ₂ ), the control circuit 1604 causes the power level of the bipolar energy to gradually increase to a predetermined threshold (eg, 120W), which causes the temperature of the tissue grasped by the end effector 1600 to gradually increase Increase to a temperature within a predetermined range (eg, 100°C-120°C). The power level of the bipolar energy is then maintained at a predetermined threshold as long as the tissue temperature remains within the predetermined range. During the tissue warming segment (t ₂ -t ₃ ), the control circuit 1604 activates the monopolar energy and gradually reduces the power level of the bipolar energy while gradually increasing the power level of the monopolar energy to maintain the tissue temperature within the predetermined range Inside.

In the example shown, during the tissue sealing segment (t ₃ -t ₄ ), the control circuit 1604 detects that the tissue temperature has reached the upper limit of the predetermined range based on the readings of the temperature sensors 1651 , 1671 . The control circuit 1604 responds by gradually reducing the power level of the monopolar energy. In other examples, the reduction may be performed gradually. In some examples, the reduction value or the means used to determine the reduction value, such as a table or equation, may be stored in memory 3103 . In some examples, the reduction value may be a percentage of the current power level of the monopolar energy. In other examples, the reduction value may be based on a previous power level of the monopolar energy corresponding to a tissue temperature within a predetermined range. In some examples, the reduction may be performed in multiple steps spaced apart in time. After each downward step, the control circuit 1604 allows a predetermined period of time to pass before evaluating the tissue temperature.

In the example shown, the control circuit 1604 maintains the power level of the bipolar energy according to the default power scheme 1701, but reduces the power level of the monopolar energy to maintain the temperature of the tissue within a predetermined range while the tissue sealing is complete. In other examples, the reduction in the power level of the monopolar energy is combined or replaced by reducing the power level of the bipolar energy.

In addition to the above, an alarm may be issued by the feedback system 3109 to accomplish transection of tissue using a mechanical knife, eg, instead of monopolar energy to avoid unintended lateral thermal damage to surrounding tissue. In some examples, the control circuit 1604 may temporarily suspend monopolar energy and/or bipolar energy until the temperature of the tissue returns to a level within a predetermined temperature range. The monopolar energy can then be reactivated to perform transection of the sealed tissue.

44, the end effector 1600 is applying monopolar energy to a tissue treatment area 1683 at a blood vessel, such as an artery grasped by the end effector 1600. Monopolar energy flows from the end effector 1600 to the treatment area 1683 and ultimately to the return pad (eg, return pad 1621). The temperature of the tissue at the treatment area 1683 rises as monopolar energy is applied to the tissue. However, the actual thermal spread 1681 is greater than the expected thermal spread 1682 due, for example, to the constricted portion 1684 of the artery that inadvertently absorbs monopolar energy energy.

In various aspects, the control circuit 1604 monitors thermal effects at the treatment area 1683 that result from the application of monopolar energy to the treatment area 1683 . The control circuit 1604 can further detect a failure of the monitored thermal effect to follow a predetermined correlation between the applied monopolar energy and the thermal effect expected from the application of the monopolar energy at the treatment area. In the example shown, unintentional energy consumption at the constricted portion of the artery reduces thermal effects at the treatment area, which is detected by the control circuit 1604 .

In some examples, the memory 3103 stores a predetermined correlation algorithm, such as between the monopolar energy level applied to the tissue treatment area grasped by the end effector 1600 and the thermal effect expected from applying the monopolar energy to the tissue treatment area . The correlation algorithm may be in the form of, for example, an array, look-up table, database, mathematical equation or formula, or the like. In at least one example, the stored correlation algorithm defines a correlation between the power level of the monopolar energy and the expected temperature. Control circuitry 1604 can use temperature sensors 1651, 1671 to monitor the temperature of the tissue at treatment area 1683, and can determine whether the monitored temperature readings correspond to expected temperature readings at a particular power level.

The control circuit 1604 may be configured to be able to take certain actions if it is detected that the stored correlation cannot be met. For example, the control circuit 1604 may alert the user of a malfunction. Additionally or alternatively, the control circuit 1604 may reduce or suspend the delivery of monopolar energy to the treatment area. In at least one example, the control circuit 1604 can adjust or shift from monopolar energy to bipolar energy application to the tissue treatment area to confirm the presence of parasitic power draw. If parasitic power draw is confirmed, the control circuit 1604 may continue to use bipolar energy at the treatment area. However, if the control circuit 1604 rejects the presence of parasitic power draw, the control circuit 1604 may reactivate or re-increase the unipolar power level. Control circuitry 1604 may effect changes to unipolar and/or bipolar power levels, eg, by signaling unipolar power source 1620 and/or bipolar power source 1610 .

In various aspects, one or more imaging devices (eg, multispectral range 1690 and/or infrared imaging devices) may be used to monitor spectral tissue changes and/or thermal effects at the tissue treatment area 1691, as shown in FIG. 45 . Imaging data from one or more imaging devices can be processed to estimate the temperature at the tissue treatment area 1691. For example, a user may direct an infrared imaging device at the treatment area 1691 when monopolar energy is applied to the treatment area 1691 through the end effector 1600 . As the treatment area 1691 heats, its infrared thermal signature changes. Thus, changes in thermal characteristics correspond to changes in the temperature of the tissue at the treatment area 1691. Accordingly, the temperature of the tissue at the treatment area 1691 can be determined based on thermal signatures captured by one or more imaging devices. If the temperature estimated based on the thermal characteristics at the treatment area 1691 associated with a particular portion level is less than or equal to the expected temperature at the power level, the control circuit 1604 detects the difference in thermal effect at the treatment area 1691 .

In other examples, thermal signatures captured by one or more imaging devices are not converted into estimated temperatures. Instead, it is compared directly to the thermal signature stored into memory 3103 to assess whether power level adjustment is required.

In some examples, the memory 3103 stores the power level between the monopolar energy as applied to the tissue treatment area 1691 grasped by the end effector 1600 and the thermal characteristics expected from applying the monopolar energy to the tissue treatment area predetermined correlation algorithm. The correlation algorithm may be in the form of, for example, an array, look-up table, database, mathematical equation or formula, or the like. In at least one example, the stored correlation algorithm defines a correlation between the power level of the monopolar energy and the expected thermal signature or a temperature associated with the expected thermal signature.

Referring to Figures 46 and 47, an electrosurgical system includes an electrosurgical instrument 1801 having an end effector 1800 similar in many respects to end effectors 1400, 1500, 1600, which for the sake of brevity The device is not repeated at the same level of detail in this article. The end effector 1800 includes a first jaw 1850 and a second jaw 1870 . At least one of the first jaw 1850 and the second jaw 1870 is movable to transition the end effector 1800 from an open configuration to a closed configuration to grip between the first jaw 1850 and the second jaw 1870 Organization (T). Electrodes 1852, 1872 are configured to cooperate to deliver bipolar energy to tissue. Electrode 1874 is configured to deliver monopolar energy to tissue. In at least one example, monopolar energy and bipolar energy are delivered to tissue simultaneously or in an alternating fashion, as shown in FIG. 34, for example, to seal and/or cut tissue.

In the example shown, bipolar energy and monopolar energy are generated by separate generators 1880, 1881, and by connecting generator 1880 to electrodes 1852, 1872 and generator 1881 to electrode 1874 and return pad 1803, respectively The separate circuits 1882, 1883 are provided to the tissue. The associated power levels are the bipolar energy delivered to the tissue by the electrodes 1852, 1872 and set by the generator 1880, and the power level associated with the monopolar energy delivered to the tissue by the electrodes 1874 by the generator 1881 according to, for example, a power scheme. 3005' set.

In use, as shown in Figure 46, the end effector 1800 applies bipolar and/or monopolar energy to the tissue treatment area 1804 to seal, and in some cases, transect the tissue. However, in some cases, the energy is deflected from the intended target at the tissue treatment area 1804, resulting in site-specific thermal damage to the surrounding tissue. To avoid or at least reduce such occurrences, surgical instrument 1801 includes impedance sensors 1810, 1811, 1812, 1813 positioned between different electrodes and at different locations, as shown in Figure 46, to detect extra-site thermal damage .

In various aspects, the surgical system 1807 also includes a control circuit 1809 coupled to the impedance sensors 1810 , 1811 , 1812 , 1813 . Control circuitry 1809 may detect extra-site or unintended thermal damage based on one or more readings of impedance sensors 1810, 1811, 1812, 1813. In response, control circuitry 1809 may alert the user of extra-site thermal damage and instruct the user to suspend energy delivery to tissue treatment area 1804, or automatically suspend energy delivery while maintaining bipolar according to a predetermined power scheme (eg, power scheme 3005'). energy to complete the tissue seal. In some cases, the control circuitry 1809 may instruct the user to use a mechanical knife to transect the tissue to avoid further extra-site thermal damage.

Still referring to FIG. 46 , the impedance sensor 1810 is configured to measure the impedance between the bipolar electrodes 1852 , 1872 . Additionally, the impedance sensor 1811 is configured to measure the impedance between the electrode 1874 and the return pad 1803 . Additionally, impedance sensor 1812 is configured to measure the impedance between electrode 1872 and return pad 1803 . Additionally, impedance sensor 1813 is configured to measure the impedance between electrode 1852 and return pad 1803 . In other examples, additional impedance sensors are added in-line between unipolar circuit 1882 and bipolar circuit 1883, which can be used to measure impedance at various locations to detect extra-site thermal anomalies with greater specificity with respect to location and impedance path.

In various aspects, extra-site thermal injury occurs in tissue on one side (left/right) of the end effector 1800 . The control circuit 1809 can detect the side of the site where external thermal damage occurs by comparing the readings of the impedance sensors 1810, 1811, 1812, 1813. In one example, non-proportional changes in monopolar and bipolar impedance readings indicate extra-site thermal damage. Conversely, if a proportion in the impedance reading is detected, the control circuit 1809 remains free of extra-site thermal damage. In one example, as described in more detail below, extra-site thermal damage may be detected by the control circuit 1809 based on the ratio of bipolar impedance to unipolar impedance.

FIG. 48 shows a graph 1900 depicting time on the x-axis and power on the y-axis. Graph 1900 shows a power scheme 1901 that is similar in many respects to power scheme 3005' shown in FIG. 34, which for brevity is not repeated at the same level of detail. The control circuit 3101 causes the power scheme 1901 to be applied by the generators 1880 (GEN.2), 1881 (GEN.1) to effect the tissue treatment cycle by the end effector 1800. Power scheme 1901 includes therapy power components 1902 and non-therapeutic or sensing power components 1903 . The therapy power component 1902 defines monopolar and bipolar power levels similar to the monopolar and bipolar power levels described in connection with the power scheme 3005'. Sensing power components 1903 include monopolar 1905 and bipolar 1904 sensing pickups, which are delivered at various points throughout the tissue treatment cycle performed by end effector 1800 . In at least one example, the sensing pickups 1903, 1904 of the sensing power components are delivered at a predetermined current value (eg, 10 mA) or a predetermined range. In at least one example, three different sensing pickups are utilized to determine the location/orientation of the potential site-external thermal damage.

The control circuit 3101 can determine whether to transfer energy to a non-tissue therapy directed site during a tissue therapy cycle by causing the sensing pickups 1903, 1904 to deliver at predetermined time intervals. The control circuit 3101 can then evaluate the return path conductivity based on the delivered sense pickup. If it is determined that the energy is displaced from the target site, the control circuit 3101 may take one or more reactive measures. For example, the control circuit 3101 may adjust the power scheme 1901 applied by the generators 1880 (GEN.2), 1881 (GEN.1). The control circuit 3101 can suspend the application of bipolar and/or monopolar energy to the target site. Additionally, the control circuit 3101 may issue a warning to the user, such as through the feedback system 3109. However, if it is determined that no energy offset is detected, then the control circuit 3101 continues to execute the power scheme 1901 .

In various aspects, for example, the control circuit 3101 evaluates the return path conductance by comparing the measured return conductance to predetermined return path conductivities stored in the memory 3103 . If the comparison indicates that the measured and predetermined return path conductivities are different from the predetermined threshold, the control circuit 3101 ends the energy being diverted to the non-tissue therapy directed site and performs one or more of the reactive measures previously described.

49 is a graph 2000 showing a power scheme 2001 interrupted due to detected external thermal damage to the site at t3'. The power scheme 2001 is similar in many respects to the power schemes shown in Figures 34, 48, which are not repeated herein at the same level of detail for the sake of brevity. For example, control circuit 1809 causes generators 1880 (curve 2010 ), 1881 (curve 2020 ) to apply power scheme 2001 to effect a tissue treatment cycle by end effector 1800 . In addition to power scheme 2001, graph 2000 also depicts bipolar impedance 2011 (Z _bipolar ), unipolar impedance 2021 (Z _monopolar ), and the ratio of unipolar to bipolar impedance on the y-axis 2030 (Z _Unipolar /Z _Bipolar ). During normal operation, when both monopolar and bipolar energy are applied to tissue simultaneously, the values of bipolar impedance 2011 (Z _bipolar ) and monopolar impedance 2021 (Z _monopolar ) remain proportional, or at least substantially proportional . Thus, during normal operation, a constant or at least substantially constant impedance ratio 2030 (Z _unipolar /Z _bipolar ) of unipolar impedance 2021 to bipolar impedance 2011 is maintained within a predetermined range 2031 .

In various aspects, the control circuit 1809 monitors the impedance ratio 2030 to assess whether the monopolar energy is deflected to a non-tissue therapy directed site. The deflection changes the ratio of the detected values of bipolar impedance 2011 (Z _bipolar ) and unipolar impedance 2021 (Z _monopolar ), which changes the impedance ratio 2030 . Changes in the impedance ratio 2030 within the predetermined range 2031 may cause the control circuit 1908 to issue a warning. However, if the change extends to or below the lower threshold 2031 of the predetermined range, the control circuit 1908 may take additional reactive measures.

In the example shown, the impedance ratio 2030 (Z _monopolar /Z _bipolar ) remains constant, or at least substantially constant, for the initial portion of a treatment cycle involving mixed monopolar and bipolar energy application to tissue. However, at B1, a difference occurred where the unipolar impedance (Z _monopole ) dropped unexpectedly or disproportionately to the bipolar impedance (Z _bipolar ), indicating potential extra-site thermal damage. In at least one example, the control circuit 1809 monitors changes in the ratio of unipolar impedance to bipolar impedance (Z _unipolar /Z _bipolar ), and if the change lasts for a predetermined amount of time, and/or its value changes to or below a predetermined The lower threshold of range 2031, external thermal damage to the site is detected. At B1, since the detected impedance ratio 2030 is still within the predetermined range 2031, the control circuit 3101 only issues a warning via the feedback system 3109 that extra-site thermal damage has been detected and continues to monitor the impedance ratio 2030.

At t3 ′, the control circuit 3101 further detects that the impedance ratio 2030 has become a value at or below the lower threshold of the predetermined range 2031 . In response, the control circuit 3101 may issue another warning and, optionally, may instruct the user to suspend energy delivery to the tissue at B2, or automatically suspend energy delivery while maintaining or adjusting the power level of the bipolar energy to complete the tissue seal while Monopolar energy is not required. In some examples, the control circuit 1809 further instructs the user to employ a mechanical knife (t4') to transect the tissue to avoid further extra-site thermal damage. In the example shown, the control circuit 1809 further causes the generator 1880 to adjust its power level to complete the tissue seal without monopolar energy, and increases the amount of the assigned tissue seal segment from time t4 to time t4' period. In other words, the control circuit 1809 will increase bipolar energy delivery to the tissue to compensate for the loss of monopolar energy by increasing the bipolar power level and its delivery time.

Various aspects of the subject matter described herein are set forth in the Examples below.

Various aspects of the subject matter described herein are set forth in the Examples below.

Example set 1

Embodiment 1—An electrosurgical instrument that includes an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a tapered body extending from the proximal end to the distal end. The tapered body contains a conductive material. The tapered body includes a first conductive portion extending from the proximal end to the distal end, and a tape defining a tapered electrode protruding from the first conductive portion and extending distally along at least a portion of the tapered body the second conductive portion. The second conductive portion is integral with the first conductive portion. In a transverse cross-section of the tapered body, the first conductive portion is thicker than the second conductive portion. The second jaw also includes an electrically insulating layer configured to electrically insulate the first conductive portion from tissue without electrically insulating the second conductive portion. The first conductive portion is configured to transmit electrical energy to the tissue only through the second conductive portion.

Embodiment 2—The electrosurgical instrument of Embodiment 1, wherein the tapered electrode includes an outer surface that is flush with an outer surface of the electrically insulating layer.

Embodiment 3—The electrosurgical instrument of Embodiment 1 or 2, wherein the tapered electrode has a width that gradually narrows as the tapered electrode extends from the proximal end toward the distal end.

Embodiment 4—The electrosurgical instrument of Embodiment 1, 2, or 3, wherein electrical energy is delivered to the tissue through the outer surface of the tapered electrode.

Embodiment 5—The electrosurgical instrument of Embodiments 1, 2, 3, or 4, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, wherein the tapered electrode is The second electrode, and wherein the first electrode is laterally offset from the second electrode in the closed configuration.

Embodiment 6—The electrosurgical instrument of Embodiment 5, wherein the second jaw further comprises a third electrode spaced from the tapered body.

Embodiment 7—The electrosurgical instrument of Embodiment 6, wherein the third electrode extends distally from the electrode proximal end to the electrode distal end along an angular profile defined by the second jaw.

Embodiment 8—The electrosurgical instrument of Embodiment 7, wherein the third electrode includes a base positioned in the cradle extending distally from the proximal end of the cradle along the angular profile of the second jaw to the distal end of the bracket.

Embodiment 9—The electrosurgical instrument of Embodiment 8, wherein the bracket is centrally positioned relative to the lateral edge of the second jaw.

Embodiment 10—The electrosurgical instrument of Embodiment 8 or 9, wherein the third electrode further comprises a tapered edge extending from the base beyond the sidewall of the cradle.

Embodiment 11—The electrosurgical instrument of Embodiments 8, 9, or 10, wherein the carrier is comprised of a compliant substrate.

Embodiment 12—The electrosurgical instrument of Embodiments 8, 9, 10, or 11, wherein the carrier is partially embedded in a valley defined in the tapered body.

Embodiment 13—The electrosurgical instrument of Embodiments 8, 9, 10, 11, or 12, wherein the carrier is spaced from the tapered body by an electrically insulating coating.

Embodiment 14—The electrosurgical instrument of Embodiments 8, 9, 10, 11, 12, or 13, wherein the base includes a base proximal end, a base distal end, and a The proximal end extends to a tapered width at the distal end of the base.

Embodiment 15 - An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a conductive body that includes a tapered angular profile extending from the proximal end to the distal end. The conductive body includes a first conductive portion extending from the proximal end to the distal end, and a second conductive portion defining a tapered electrode protruding from the first conductive portion and extending distally along at least a portion of the conductive body. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion. The second jaw also includes an electrically insulating layer configured to electrically insulate the first conductive portion from tissue without electrically insulating the second conductive portion. The first conductive portion is configured to transmit electrical energy to the tissue only through the second conductive portion.

Embodiment 16—The electrosurgical instrument of Embodiment 15, wherein the tapered electrode has a width that gradually narrows as the tapered electrode extends from the proximal end toward the distal end.

Embodiment 17—The electrosurgical instrument of Embodiment 15 or 16, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, wherein the tapered electrode is the second electrode, and wherein the first electrode is laterally offset from the second electrode in the closed configuration.

Embodiment 18—The electrosurgical instrument of Embodiment 15, 16, or 17, wherein the second jaw further comprises a third electrode spaced from the conductive body.

Embodiment 19—The electrosurgical instrument of Embodiment 18, wherein the third electrode extends distally along at least a portion of the tapered angular profile.

Embodiment 20—The electrosurgical instrument of Embodiment 19, wherein the third electrode includes a base positioned in the yoke extending distally from the proximal end of the yoke along at least a portion of the tapered angular profile to the distal end of the cradle, and wherein the cradle is constructed of a compliant substrate.

Example set 2

Embodiment 1—An electrosurgical instrument that includes an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a linear portion that cooperates to form an angular profile and a treatment surface that includes a segment extending along the angular profile. Sections include different geometries and different conductivities. The segments are configured to generate variable energy densities along the treatment surface.

Embodiment 2—The electrosurgical instrument of Embodiment 1, wherein the segments include a proximal segment and a distal segment. The proximal section includes a first surface area. The distal section includes a second surface area. The second surface area is smaller than the first surface area.

Embodiment 3—The electrosurgical instrument of Embodiment 1 or 2, wherein at least one of the segments comprises a conductive treatment area longitudinally interrupted by a non-conductive treatment area.

Embodiment 4—The electrosurgical instrument of Embodiment 1, 2, or 3, wherein the variable energy density is predetermined based on selection of different geometries and different conductivities of the segments.

Embodiment 5—The electrosurgical instrument of Embodiment 1, 2, 3, or 4, wherein at least one of the segments has a tapering width along its length.

Embodiment 6—The electrosurgical instrument of Embodiment 1, 2, 3, 4, or 5, wherein the segment extends along a peripheral side of the second jaw.

Embodiment 7—The electrosurgical instrument of Embodiments 1, 2, 3, 4, 5, or 6, wherein the segment is defined in the second jaw instead of the first jaw.

Embodiment 8—The electrosurgical instrument of Embodiments 1, 2, 3, 4, 5, 6, or 7, wherein the second jaw includes an electrically conductive backbone partially coated with the first material and the second material, wherein the first material is thermally conductive but electrically insulating, and wherein the second material is thermally insulating and electrically insulating.

Embodiment 9—The electrosurgical instrument of Embodiment 8, wherein the first material comprises diamond-like carbon.

Embodiment 10—The electrosurgical instrument of Embodiment 8 or 9, wherein the second material comprises polytetrafluoroethylene.

Embodiment 11 - An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a tapered body extending from the proximal end to the distal end. The tapered body includes a tissue-contacting surface. The tissue-contacting surface includes an insulating layer comprising a first material. The insulating layers extend on opposite sides of the intermediate region extending along the length of the tapered body. The tissue-contacting surface also includes a section configured to generate variable energy density along the tissue-contacting surface. The segments include conductive segments and insulating segments that alternate with conductive segments along an intermediate region. The insulating section includes a second material different from the first material.

Embodiment 12—The electrosurgical instrument of Embodiment 11, wherein the conductive segment includes a proximal segment and a distal segment. The proximal section includes a first surface area. The distal section includes a second surface area. The second surface area is smaller than the first surface area.

Embodiment 13—The electrosurgical instrument of Embodiment 11 or 12, wherein the second jaw includes an electrically conductive backbone partially coated with the first material.

Embodiment 14—The electrosurgical instrument of Embodiment 13, wherein the electrically conductive backbone includes an inner thermally insulating core and an outer thermally conductive layer that at least partially surrounds the inner thermally insulating core.

Embodiment 15—The electrosurgical instrument of Embodiments 11, 12, 13, or 14, wherein the variable energy density is predetermined based on selection of different geometries and different conductivities of the conductive segments.

Embodiment 16—The electrosurgical instrument of Embodiments 11, 12, 13, 14, or 15, wherein at least one of the segments has a tapering width along its length.

Embodiment 17 - The electrosurgical instrument of Embodiments 11, 12, 13, 14, 15, or 16, wherein the segment extends along a peripheral side of the second jaw.

Embodiment 18—The electrosurgical instrument of Embodiments 11, 12, 13, 14, 15, 16, or 17, wherein the segments are defined in the second jaw instead of the first jaw.

Embodiment 19—The electrosurgical instrument of Embodiments 11, 12, 13, 14, 15, 16, 17, or 18, wherein the first material comprises diamond-like carbon.

Embodiment 20—The electrosurgical instrument of Embodiments 11, 12, 13, 14, 15, 16, 17, 18, or 19, wherein the second material comprises polytetrafluoroethylene.

Example set 3

Embodiment 1—An electrosurgical instrument that includes an end effector. The end effector includes a first jaw, a second jaw, and an electrical circuit. The first jaw includes a first electrically conductive skeleton, a first insulating coating selectively covering portions of the first electrically conductive skeleton, and a first jaw electrode including exposed portions of the first electrically conductive skeleton. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a second electrically conductive backbone, a second insulating coating selectively covering portions of the second electrically conductive backbone, and a second jaw electrode including exposed portions of the second electrically conductive backbone. The circuit is configured to deliver bipolar RF energy and monopolar RF energy to tissue through the first jaw electrode and the second jaw electrode. The monopolar RF energy shares a first electrical path and a second electrical path defined by the circuit for transmitting the bipolar RF energy.

Embodiment 2—The electrosurgical instrument of Embodiment 1, wherein the electrical circuit defines a third electrical pathway separate from the first electrical pathway and the second electrical pathway.

Embodiment 3—The electrosurgical instrument of Embodiment 1 or 2, wherein the end effector includes a cutting electrode that is electrically isolated from the first and second electrically conductive backbones.

Embodiment 4—The electrosurgical instrument of Embodiment 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through the third electrical pathway.

Embodiment 5—The electrosurgical instrument of Embodiment 4, wherein the cutting electrode is configured to be capable of cutting tissue with cutting monopolar RF energy after coagulation of the tissue has been initiated by bipolar RF energy.

Embodiment 6—The electrosurgical instrument of Embodiment 3, 4, or 5, wherein the cutting electrode is centrally located in one of the first jaw and the second jaw.

Embodiment 7—The electrosurgical instrument of Embodiment 4 or 5, wherein the end effector is configured to simultaneously deliver cutting monopolar RF energy and bipolar RF energy to tissue.

Embodiment 8—The electrosurgical instrument of Embodiments 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw electrode comprises a first distal tip electrode, and wherein the second jaw electrode comprises A second distal tip electrode.

Embodiment 9—The electrosurgical instrument of Embodiment 8, wherein the first electrically conductive backbone and the second electrically conductive backbone are simultaneously energized to connect the single unit through the first distal tip electrode and the second distal tip electrode. Extreme RF energy is delivered to the tissue surface.

Embodiment 10—The electrosurgical instrument of Embodiments 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the second jaw includes a dissection electrode extending along a peripheral surface of the second jaw .

Embodiment 11 - An electrosurgical instrument comprising an end effector and an electrical circuit. The end effector includes at least two electrode sets, a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The end effector is configured to deliver a combination of bipolar RF energy and monopolar RF energy from at least two electrode sets to grasped tissue. The circuit is configured to transmit bipolar RF energy and monopolar RF energy. The monopolar RF energy shares the active and return paths defined by the circuit for transmitting the bipolar RF energy.

Embodiment 12—The electrosurgical instrument of Embodiment 11, wherein the at least two electrode sets include three electrical interconnects used together in an electrical circuit.

Embodiment 13—The electrosurgical instrument of Embodiment 11 or 12, wherein the at least two electrode sets include three electrical interconnects that define at least a portion of an electrical circuit and another separate electrical circuit.

Embodiment 14—The electrosurgical instrument of Embodiment 13, wherein a separate electrical circuit leads to the cutting electrodes of the at least two electrode sets, the cutting electrodes being isolated and centered on one of the first jaw and the second jaw among those.

Embodiment 15—The electrosurgical instrument of Embodiment 14, wherein the cutting electrode is configured to be capable of cutting tissue after coagulation of the tissue has been initiated using the second and third electrodes of the at least two electrode sets.

Embodiment 16—The electrosurgical instrument of Embodiment 14 or 15, wherein the at least two electrode sets are configured to simultaneously deliver monopolar RF energy and bipolar RF energy to tissue.

Embodiment 17—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a composite backbone of at least two different materials configured to selectively create electrically conductive portions and thermally insulating portions.

Embodiment 18—The electrosurgical instrument of Embodiment 17, wherein the composite framework comprises a titanium-ceramic composite.

Embodiment 19—The electrosurgical instrument of Embodiment 17 or 18, wherein the composite framework includes a ceramic base and a titanium crown attachable to the ceramic base.

Embodiment 20—The electrosurgical instrument of Embodiment 17, 18, or 19, wherein the composite backbone portion is coated with an electrically insulating material.

Embodiment 21 - A method for making jaws of an end effector of an electrosurgical instrument. The method includes preparing a composite skeleton of the jaws by fusing titanium powder with ceramic powder in a metal injection molding process and selectively coating the composite skeleton with an electrically insulating material to create a plurality of electrodes.

Example set 4

Example 1 - An electrosurgical instrument comprising a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw includes a first electrically conductive skeleton and a first electrically insulating layer. The first electrically conductive skeleton includes: a first thermal isolation core; and a first thermally conductive outer layer integral with the first thermal isolation core and extending at least partially around the first thermal isolation core. The first electrode is defined by selectively applying the first electrically insulating layer to the outer surface of the first thermally conductive outer layer. The second jaw is configured to define a second electrode. The second jaw includes a second electrically conductive skeleton and a second electrically insulating layer. The second electrically conductive skeleton includes: a second thermal isolation core; and a second thermally conductive outer layer integral with the second thermal isolation core and extending at least partially around the second thermal isolation core. The second electrode is defined by selectively applying the second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

Embodiment 2—The electrosurgical instrument of Embodiment 1, wherein the first electrode is configured to transmit RF energy through tissue positioned between the first electrode and the second electrode in a bipolar energy mode of operation to second electrode.

Embodiment 3—The electrosurgical instrument of Embodiment 1 or 2, wherein the first thermal isolation core includes an air pocket.

Embodiment 4—The electrosurgical instrument of Embodiment 1, 2, or 3, wherein the first thermally isolated core comprises a lattice structure.

Embodiment 5—The electrosurgical instrument of Embodiments 1, 2, 3, or 4, wherein the second jaw includes a third electrode, and wherein the third electrode is selectively applied by applying a second electrically insulating layer to the The outer surface of the second thermally conductive outer layer is defined.

Embodiment 6—The electrosurgical instrument of Embodiment 5, wherein the third electrode is configured to deliver RF energy to tissue in contact with the third electrode in a monopolar energy mode of operation.

Embodiment 7—The electrosurgical instrument of Embodiments 1, 2, 3, 4, 5, or 6, wherein at least one of the first electrically insulating layer and the second electrically insulating layer comprises a diamond-like material.

Embodiment 8—The electrosurgical instrument of Embodiments 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw includes a tissue-contacting surface, and wherein the first thermally insulating core includes a lattice structure, The lattice structure includes walls that stand in a direction transverse to the tissue contacting surface.

Embodiment 9—The electrosurgical instrument of Embodiment 8, wherein the direction is perpendicular to the tissue contacting surface.

Embodiment 10 - An electrosurgical instrument comprising jaws configured to define electrodes. The jaw includes a first electrically conductive portion, a second electrically conductive portion, and an electrically insulating layer. The first electrically conductive portion is configured to resist heat transfer therethrough. The second electrically conductive portion is integral with the first electrically conductive portion and extends at least partially around the first electrically conductive portion. The second electrically conductive portion is configured to define a heat sink. The electrode is defined by selectively applying the electrically insulating layer to the outer surface of the second electrically conductive portion.

Embodiment 11—The electrosurgical instrument of Embodiment 10, wherein the electrodes are configured to transmit RF energy to tissue positioned against the electrodes.

Embodiment 12—The electrosurgical instrument of Embodiment 10 or 11, wherein the first electrically conductive portion comprises an air pocket.

Embodiment 13—The electrosurgical instrument of Embodiments 10, 11, or 12, wherein the first electrically conductive portion comprises a lattice structure.

Embodiment 14—The electrosurgical instrument of Embodiments 10, 11, 12, or 13, wherein the electrically insulating layer comprises a diamond-like material.

Embodiment 15—The electrosurgical instrument of Embodiments 10, 11, 12, 13, or 14, wherein the jaws include a tissue-contacting surface, and wherein the first electrically conductive portion includes a lattice structure included in the Erect the wall in a direction transverse to the tissue-contacting surface.

Embodiment 16—The electrosurgical instrument of Embodiment 15, wherein the direction is perpendicular to the tissue contacting surface.

Embodiment 17 - An electrosurgical instrument comprising jaws configured to define electrodes. The jaws include an electrically conductive skeleton and an electrically insulating layer. The electrically conductive framework includes: a thermally insulating core; and a thermally conductive outer layer integral with the thermally insulating core and extending at least partially around the thermally insulating core. The electrodes are defined by selectively applying the electrically insulating layer to the outer surface of the thermally conductive outer layer.

Embodiment 18—The electrosurgical instrument of Embodiment 17, wherein the thermally isolated core comprises a lattice structure.

Embodiment 19—The electrosurgical instrument of Embodiment 18, wherein the jaws include a tissue-contacting surface, and wherein the lattice structure includes walls that stand in a direction transverse to the tissue-contacting surface.

Embodiment 20—The electrosurgical instrument of Embodiment 19, wherein the direction is perpendicular to the tissue contacting surface.

Example set 5

Embodiment 1—An electrosurgical instrument that includes an end effector. The end effector includes a first jaw and a second jaw. The first jaw includes a first electrode. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a second electrode configured to deliver the first monopolar energy to tissue, a third electrode, and a conductive circuit capable of being in a connected configuration with the third electrode and disconnected from the third electrode Selective transition between configurations. In the connected configuration, the third electrode is configured to cooperate with the first electrode to deliver bipolar energy to tissue. The conductive circuit defines a return path for the bipolar energy. In the disconnected configuration, the first electrode is configured to deliver the second monopolar energy to tissue.

Embodiment 2—The electrosurgical instrument of Embodiment 1, further comprising a switching mechanism for alternating between the connected configuration and the disconnected configuration.

Embodiment 3—The electrosurgical instrument of Embodiment 1 or 2, further comprising a switching mechanism for alternating between delivery of bipolar energy and second monopolar energy to tissue through the first electrode.

Embodiment 4—The electrosurgical instrument of Embodiments 1, 2, or 3, wherein the end effector is configured to simultaneously deliver bipolar energy and the first monopolar energy to tissue.

Embodiment 5—The electrosurgical instrument of Embodiments 1, 2, 3, or 4, wherein the end effector is configured to deliver a mixture of bipolar energy and a first monopolar energy to tissue.

Embodiment 6—The electrosurgical instrument of Embodiment 5, wherein the levels of the bipolar energy and the first monopolar energy in the energy mix are determined based on at least one reading of a temperature sensor indicative of at least one temperature of the tissue.

Embodiment 7—The electrosurgical instrument of embodiment 5 or 6, wherein the levels of the bipolar energy and the first monopolar energy in the energy mix are determined based on at least one reading of an impedance sensor indicative of at least one impedance of the tissue .

Embodiment 8—The electrosurgical instrument of embodiment 5, 6, or 7, wherein the levels of bipolar energy and first monopolar energy in the energy mix are adjusted to reduce excess of the first and second jaws Detected lateral thermal damage to the tissue treatment area between the mouths.

Embodiment 9—An electrosurgical instrument comprising an end effector and a control circuit. The end effector includes a first jaw, a second jaw, and at least one sensor. The first jaw includes a first electrode. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a second electrode configured to deliver monopolar energy to tissue, and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuit is configured to execute a predetermined power regime to seal and cut tissue during a tissue treatment cycle. The power scheme includes predetermined power levels for monopolar energy and bipolar energy. The control circuit is further configured to be capable of adjusting at least one of the predetermined power levels of the monopolar energy and the bipolar energy based on readings of the at least one sensor during the tissue treatment cycle.

Embodiment 10—The electrosurgical instrument of Embodiment 9, wherein the predetermined power regimen includes simultaneous and separate application of bipolar energy and monopolar energy to tissue during a tissue treatment cycle.

Embodiment 11 - The electrosurgical instrument of embodiment 9 or 10, wherein the predetermined power scheme includes applying bipolar energy to the tissue rather than monopolar energy during the feathering section of the tissue treatment cycle, and wherein the Bipolar and monopolar energy are simultaneously applied to the tissue in the tissue warming section and the tissue sealing section.

Embodiment 12—The electrosurgical instrument of Embodiment 11, wherein the power scheme further comprises applying monopolar energy rather than bipolar energy to the tissue in the tissue transecting segment of the tissue treatment cycle.

Embodiment 13—The electrosurgical instrument of Embodiments 9, 10, 11, or 12, wherein the at least one sensor comprises an impedance sensor.

Embodiment 14—The electrosurgical instrument of Embodiment 13, wherein the control circuit is configured to monitor an impedance ratio of monopolar tissue impedance to bipolar tissue impedance based on readings from the impedance sensor.

Embodiment 15—The electrosurgical instrument of Embodiment 14, wherein a change in the impedance ratio within a predetermined range causes the control circuit to issue an alert.

Embodiment 16—The electrosurgical instrument of Embodiment 15, wherein a change in the impedance ratio at or below the lower threshold of the predetermined range causes the control circuit to adjust the predetermined power scheme.

Embodiment 17—The electrosurgical instrument of Embodiment 15 or 16, wherein the change in the impedance ratio at or below the lower threshold of the predetermined range causes the control circuit to suspend the application of monopolar energy to the tissue.

Embodiment 18—The electrosurgical instrument of Embodiment 17, wherein the change in the impedance ratio at or below the lower threshold of the predetermined range further causes the control circuit to adjust the application of bipolar energy to the tissue to complete the sealing of the tissue.

Embodiment 19—An electrosurgical instrument comprising an end effector and a control circuit. The end effector includes a first jaw and a second jaw. The first jaw includes a first electrode. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. Tissue is located at the target site. The second jaw includes a second electrode configured to deliver monopolar energy to tissue, and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuit is configured to execute a predetermined power regime to seal and cut tissue during a tissue treatment cycle. The power scheme includes predetermined power levels for monopolar energy and bipolar energy. The control circuit is further configured to detect the energy excursion from the target site and adjust at least one of the predetermined power levels of monopolar energy and bipolar energy to mitigate the energy excursion.

Embodiment 20—The electrosurgical instrument of Embodiment 19, wherein the predetermined power regimen includes simultaneous and separate application of bipolar energy and monopolar energy to tissue during a tissue treatment cycle.

Embodiment 21 - The electrosurgical instrument of embodiment 19 or 20, wherein the predetermined power scheme includes applying bipolar energy to the tissue rather than monopolar energy during the feathering section of the tissue treatment cycle, and wherein the Bipolar and monopolar energy are simultaneously applied to the tissue in the tissue warming section and the tissue sealing section.

Example set 6

Embodiment 1—An electrosurgical system that includes an end effector and a control circuit. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The control circuit is configured to simultaneously and independently apply two different energy modalities to the tissue during a tissue treatment cycle including a tissue coagulation phase and a tissue transection phase.

Embodiment 2—The electrosurgical system of Embodiment 1, wherein the first energy modality is a monopolar energy modality.

Embodiment 3—The electrosurgical system of Embodiment 2, wherein the second energy modality is a bipolar energy modality.

Embodiment 4—The electrosurgical system of Embodiment 2 or 3, wherein the control circuit is configured to activate application of the monopolar energy modality to tissue prior to completion of the tissue coagulation phase by the bipolar energy modality.

Embodiment 5—The electrosurgical system of Embodiment 2 or 3, wherein the control circuit is configured to activate the application of the monopolar energy modality to the tissue prior to deactivation of the bipolar energy modality application to the tissue.

Embodiment 6—The electrosurgical system of Embodiment 3, 4, or 5, wherein the control circuit is configured to enable simultaneous application of the monopolar energy modality and the bipolar energy modality to the tissue during the tissue coagulation phase.

Embodiment 7—The electrosurgical system of Embodiments 1, 2, 3, 4, 5, or 6, wherein the control circuit includes a processor and a storage medium, and wherein the application of the two different energy modalities to the tissue is based on storage Default power scheme in storage medium.

Embodiment 8—The electrosurgical system of Embodiment 7, further comprising at least one sensor, and wherein the control circuit is configured to modify the default power scheme based on one or more sensor readings of the at least one sensor.

Embodiment 9—An electrosurgical instrument that includes an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The end effector is configured to apply three different energy modalities to tissue during a tissue treatment cycle including a tissue coagulation phase and a tissue transection phase.

Embodiment 10—The electrosurgical instrument of Embodiment 9, wherein the first energy modality comprises bipolar energy.

Embodiment 11—The electrosurgical instrument of Embodiment 10, wherein the second energy modality comprises an energy mix of monopolar energy and bipolar energy.

Embodiment 12—The electrosurgical instrument of Embodiment 11, wherein the third energy modality includes monopolar energy but does not include bipolar energy.

Embodiment 13—The electrosurgical instrument of Embodiment 11 or 12, wherein the activation of the monopolar energy application to the tissue is configured to be able to begin prior to completion of the tissue coagulation phase.

Embodiment 14—The electrosurgical instrument of Embodiment 12 or 13, wherein the activation of the monopolar energy application to the tissue is configured to be able to begin prior to the deactivation of the bipolar energy modality application to the tissue.

Embodiment 15—The electrosurgical instrument of Embodiments 9, 10, 11, 12, 13, or 14, further comprising a control circuit, wherein the control circuit includes a processor and a storage medium, and wherein the two different energy modalities direct the tissue The application is based on the default power scheme stored in the storage medium.

Embodiment 16—The electrosurgical instrument of Embodiment 15, further comprising at least one sensor, wherein the control circuit is configured to adjust the default power scheme during the tissue treatment cycle based on one or more sensor readings of the at least one sensor.

Embodiment 17 - An electrosurgical system comprising a first generator configured to output bipolar energy, a second generator configured to output monopolar energy, electrically coupled to the first generator and the second generator The generator's surgical instrument and control circuitry. The surgical instrument includes an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The control circuit includes a processor and a storage medium including program instructions that, when executed by the processor, cause the processor to cause the first generator and the second generator to apply a predetermined power scheme to the end effector. The power regimen includes simultaneous and separate application of bipolar and monopolar energy to the tissue during a tissue treatment cycle.

Embodiment 18—The electrosurgical system of Embodiment 17, further comprising at least one sensor, wherein the control circuit is configured to adjust the power scheme during the tissue treatment cycle based on one or more sensor readings of the at least one sensor.

Embodiment 19—The electrosurgical system of embodiment 17 or 18, wherein the power scheme includes applying bipolar energy to the tissue rather than monopolar energy during the feathering section of the tissue treatment cycle, and wherein the The bipolar and monopolar energy are simultaneously applied to the tissue in the tissue warming section and the tissue sealing section.

Embodiment 20—The electrosurgical system of Embodiments 17, 18, or 19, wherein the power protocol further comprises applying monopolar energy rather than bipolar energy to the tissue in the tissue transecting section of the tissue treatment cycle.

While various forms have been illustrated and described, it is not the intention of the applicants to restrict or limit the scope of the appended claims to such details. Numerous modifications, variations, changes, substitutions, combinations and equivalents of these forms may be made without departing from the scope of the present disclosure, and many modifications, variations, changes, substitutions, Combinations and Equivalents. Also, alternatively, the structure of each element associated with the described form may be described as a means for providing the function performed by the element. Additionally, where materials are disclosed for certain components, other materials may also be used. Therefore, it is to be understood that the foregoing detailed description and the appended claims are intended to cover all such modifications, combinations and variations as fall within the scope of the present disclosure. The appended claims are intended to cover all such modifications, variations, changes, substitutions, alterations and equivalents.

The foregoing detailed description has illustrated various forms of apparatus and/or methods using block diagrams, flowcharts, and/or examples. So long as such block diagrams, flowcharts and/or examples include one or more functions and/or operations, those skilled in the art will understand each function and/or operation in such block diagrams, flowcharts and/or examples or operations may be implemented individually and/or collectively by a variety of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein can be implemented as one or more computer programs running on one or more computers (eg, as a program running on one or more computer systems) one or more programs), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as Indeed any combination of them is equivalently implemented in whole or in part in an integrated circuit, and it would be within the skill of those skilled in the art to design circuitry and/or code software and/or hardware in light of this disclosure. In addition, those skilled in the art will recognize that the mechanisms of the subject matter described herein can be distributed as one or more program products in a variety of forms, and that the illustrative forms of the subject matter described herein are applicable regardless of use in actual implementation. What is the specific type of signal bearing medium distributed.

Instructions for programming logic to perform the various disclosed aspects may be stored in memory in the system, such as dynamic random access memory (DRAM), cache, flash memory, or other memory. Furthermore, the instructions may be distributed over a network or through other computer-readable media. Thus, a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (eg, a computer), but is not limited to floppy disks, optical disks, compact disk read only memory (CD-ROM), and magneto-optical disks , read only memory (ROM), random access memory (RAM), erasable programmable read only memory (EPROM), electrically erasable programmable read only memory (EEPROM), magnetic or optical cards, flash memory, or A tangible, machine-readable storage device used in transmitting information over the Internet via electrical, optical, acoustic, or other forms of propagated signals (eg, carrier waves, infrared signals, digital signals, etc.). Accordingly, non-transitory computer-readable media includes any type of tangible machine-readable media suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

As used in any aspect herein, the term "control circuitry" may refer to, for example, hardwired circuitry, programmable circuitry (eg, a computer processor that includes one or more individual instruction processing cores, processing units, processing devices, microcontrollers, microcontroller units, controllers, digital signal processors (DSPs), programmable logic devices (PLDs), programmable logic arrays (PLAs), field programmable gate arrays (FPGAs), state machines Circuitry, firmware that stores instructions for execution by programmable circuitry, and any combination thereof. The control circuits may be implemented collectively or individually as circuitry forming part of a larger system, such as an integrated circuit (IC), an application specific integrated circuit (ASIC), a system on a chip (SoC), a desktop computer, a laptop computer, a tablet computer , servers, smartphones, etc. Thus, as used herein, "control circuit" includes, but is not limited to, an electronic circuit having at least one discrete circuit, an electronic circuit having at least one integrated circuit, an electronic circuit having at least one application specific integrated circuit, forming a general-purpose computer configured by a computer program Electronic circuitry of an apparatus (eg, a general-purpose computer configured by a computer program at least partially implementing the methods and/or apparatus described herein, or a microcomputer configured by a computer program at least partially implementing the methods and/or apparatus described herein) processors), electronic circuits that form memory devices (eg, random access memory), and/or electronic circuits that form communication devices (eg, modems, communication switches, or optoelectronic devices). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital fashion, or some combination thereof.

As used in any aspect herein, the term "logic" may refer to applications, software, firmware and/or circuitry configured to perform any of the foregoing operations. Software may be embodied as a software package, code, instructions, sets of instructions, and/or data recorded on a non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions or a set of instructions and/or data hard-coded (eg, non-volatile) in a memory device.

As used in any aspect herein, the terms "component," "system," "module," etc. may refer to a computer-related entity, hardware, a combination of hardware and software, software, or software in execution.

As used in any aspect herein, an "algorithm" refers to an organized sequence of steps leading to a desired result, wherein "step" refers to the manipulation of physical quantities and/or logical states that may (but need not necessarily be) ) take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared and otherwise manipulated. Often used to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, etc. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

The network may include a packet-switched network. The communication devices may be capable of communicating with each other using the selected packet-switched network communication protocol. An exemplary communication protocol may include an Ethernet communication protocol that may enable communication using Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard titled "IEEE 802.3 Standard" published by the Institute of Electrical and Electronics Engineers (IEEE) in December 2008 and/or later versions of this standard. Alternatively or additionally, the communication devices may be able to communicate with each other using the X.25 communication protocol. The X.25 communication protocol may conform to or be compatible with standards published by the International Telecommunication Union Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be able to communicate with each other using a frame relay communication protocol. The Frame Relay communication protocol may conform to or be compatible with standards published by the Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an asynchronous transfer mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard named "ATM-MPLS Network Interworking 2.0" published by the ATM Forum in August 2001 and/or a later version of the standard. Of course, different and/or later developed connection-oriented network communication protocols are also contemplated herein.

Unless explicitly stated otherwise in the above disclosure, it is understood that in the above disclosure, discussions using terms such as "processing," "estimating," "calculating," "determining," "displaying," refer to computer systems or similar The acts and processes of electronic computing devices that manipulate data represented as physical (electronic) quantities within the registers and memory of a computer system and convert it into data similarly represented as computer system memory or registers or other such information storage, transmission or Displays other data of physical quantities within the device.

One or more components may be referred to herein as "configured to be able", "configurable to be able", "operable/operable", "adapted/adaptable", "capable", "possible" Conform/Conform to" etc. Those skilled in the art will recognize that unless the context dictates otherwise, "configured to be able" may generally encompass active state components and/or inactive state components and/or standby state components.

The terms "proximal" and "distal" are used herein with respect to a clinician manipulating the handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician, and the term "distal" refers to the portion located away from the clinician. It should also be understood that, for brevity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein in connection with the drawings. However, surgical instruments are used in many orientations and orientations, and these terms are not intended to be limiting and/or absolute.

Those of skill in the art will recognize that the terms used herein, in general, and in the appended claims in particular (eg, the body of the appended claims) are generally intended to be "open" terms (eg, the term "" Including" should be interpreted as "including but not limited to", the term "having" should be interpreted as "having at least", the term "including" should be interpreted as "including but not limited to", etc.). It will also be understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present . For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases "at least one" and "one or more" to introduce claims. However, use of such phrases should not be taken to imply that introduction of a claim expression by the indefinite articles "a" or "an" limits any particular claim containing such introduced claim expression to containing only one such expression even when the same claim includes the introductory phrases "one or more" or "at least one" and phrases such as "a" or "an" (eg, "an" and/or "an" should generally be When interpreted as an indefinite article meaning "at least one" or "one or more"); this also applies to the use of the definite article for introducing claim expressions.

Additionally, even if a specific number of an introduced claim recitation is explicitly recited, one skilled in the art will recognize that such recitation should generally be construed to mean at least the recited number (eg, in the absence of other modifiers, a reference to "" The "naked narration of two narrations" generally means at least two narrations, or two or more narrations). Furthermore, in those cases where a convention similar to "at least one of A, B, and C, etc." is used, such constructions are, in general, intended to have the meaning that those skilled in the art would understand the convention ( For example, "a system having at least one of A, B, and C" would include, but not be limited to, having A only, B only, C only, A and B together, A and C together, B and C together, and/or A , B and C together etc.). In those cases where a convention similar to "at least one of A, B, or C, etc." is used, such constructions are generally intended to have the meaning that those skilled in the art would understand the convention (eg, "A system having at least one of A, B, or C" shall include, but is not limited to, having A only, B only, C only, A and B together, A and C together, B and C together, and/or A, B systems such as with C). It will also be understood by those skilled in the art that, generally, unless the context dictates otherwise, the presentation of two or more alternative terms in the detailed description, claims, or drawings, inflectional words and/or phrases should be construed as The possibility of including one of the terms, either of the terms, or both of the terms is encompassed. For example, the phrase "A or B" will generally be understood to include the possibilities of "A" or "B" or "A and B".

With regard to the appended claims, those skilled in the art will understand that the operations recited therein can generally be performed in any order. Additionally, although various operational flowcharts are presented in one or more sequences, it should be understood that the various operations may be performed in other orders than shown, or may be performed concurrently. Unless the context dictates otherwise, examples of such alternative orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reversed, or other altered orderings. Furthermore, terms like "responsive to," "related to," or other past-tense adjectives are generally not intended to exclude such variations unless the context dictates otherwise.

It is worth mentioning that any reference to "an aspect", "an aspect", "an example", "an example" means that the particular feature, structure or characteristic described in connection with the said aspect is included in at least one aspect. in one aspect. Thus, the appearances of the phrases "in one aspect," "in an aspect," "in an example," "in an example" in various places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

In this specification, unless otherwise stated, the terms "about" or "approximately" as used in this disclosure refer to an acceptable error for a particular value as determined by one of ordinary skill in the art, depending in part on how Measure or determine a value. In certain embodiments, the term "about" or "approximately" means within 1, 2, 3, or 4 standard deviations. In certain embodiments, the term "about" or "approximately" means 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, Within 4%, 3%, 2%, 1%, 0.5% or 0.05%.

In this specification, unless otherwise indicated, all numerical parameters should in all instances be understood to be referenced by or modified by the term "about", wherein the numerical parameter has the underlying measurement used to determine the value of the parameter The inherently differentiating characteristics of technology. To the minimum extent and without attempting to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter described herein should at least be construed in light of the reported number of significant digits and by applying customary rounding.

Any numerical range recited herein includes all subranges subsumed within the recited range. For example, the range "1 to 10" includes all subranges between the listed minimum value of 1 and the listed maximum value of 10, inclusive, that is, having a minimum value equal to or greater than 1 and a minimum value equal to or greater than 1 less than the maximum value of 10. Furthermore, all ranges recited herein are inclusive of the endpoints of the recited range. For example, the range "1 to 10" includes the endpoints 1 and 10. Any upper numerical limitation listed in this specification is intended to include all smaller limitations included therein and any lower numerical limitation listed in this specification is intended to include all larger numerical limitations included therein. Accordingly, Applicants reserve the right to amend this specification, including the claims, to expressly recite any sub-ranges subsumed within the expressly recited ranges. All such ranges are inherently described in this specification.

Any patent applications, patents, non-patent publications or other publications mentioned in this specification and/or listed in any Application Data Sheet are incorporated herein by reference to the extent that the incorporated material is not inconsistent herein. Accordingly, and to the extent necessary, the disclosure expressly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, purportedly incorporated herein by reference, but which conflicts with existing definitions, statements, or other disclosed material set forth herein, will not arise only between the incorporated material and the existing disclosed material merged to the extent of conflict.

In summary, a number of benefits have been described that result from employing the concepts described herein. The foregoing detailed description has been presented in one or more forms for the purposes of illustration and description. These detailed descriptions are not intended to be exhaustive or to be limited to the precise forms disclosed. Modifications or variations of the present invention are possible in light of the above teachings. The form or forms was chosen and described in order to illustrate principles and practical application, to thereby enable one of ordinary skill in the art to utilize various forms and modifications as are suited to the particular use contemplated. The claims filed herewith are intended to define the full scope.

Claims (21)

1. An electrosurgical instrument comprising an end effector, the end effector comprising:

a first jaw, the first jaw comprising:

a first electrically conductive backbone;

a first insulating coating selectively covering portions of the first electrically conductive backbone; and

a first jaw electrode comprising an exposed portion of the first electrically conductive skeleton;

a second jaw, wherein at least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw, the second jaw comprising:

a second electrically conductive skeleton;

a second insulating coating selectively covering portions of the second electrically conductive skeleton; and

a second jaw electrode comprising an exposed portion of the second electrically conductive skeleton; and

an electrical circuit configured to be capable of transmitting bipolar RF energy and monopolar RF energy to the tissue through the first jaw electrode and the second jaw electrode, wherein the monopolar RF energy shares first and second electrical paths defined by the electrical circuit for transmitting the bipolar RF energy.

2. An electrosurgical instrument according to claim 1, wherein the electrical circuit defines a third electrical pathway separate from the first and second electrical pathways.

3. The electrosurgical instrument of claim 2, wherein the end effector comprises a cutting electrode electrically insulated from the first and second electrically conductive scaffolds.

4. The electrosurgical instrument of claim 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through the third electrical path.

5. The electrosurgical instrument of claim 4, wherein the cutting electrode is configured to cut the tissue with the cutting monopolar RF energy after coagulation of the tissue has been initiated by the bipolar RF energy.

6. The electrosurgical instrument of claim 3, wherein the cutting electrode is centrally located in one of the first and second jaws.

7. The electrosurgical instrument of claim 4, wherein the end effector is configured to deliver the cutting monopolar RF energy and the bipolar RF energy to the tissue simultaneously.

8. The electrosurgical instrument of claim 1, wherein the first jaw electrode comprises a first distal tip electrode, and wherein the second jaw electrode comprises a second distal tip electrode.

9. The electrosurgical instrument of claim 8, wherein first and second electrically conductive scaffolds are simultaneously energized to deliver the monopolar RF energy to a tissue surface through the first and second distal tip electrodes.

10. The electrosurgical instrument of claim 1, wherein the second jaw comprises a dissection electrode extending along a peripheral surface of the second jaw.

11. An electrosurgical instrument, comprising:

an end effector, the end effector comprising:

at least two electrode sets;

a first jaw; and

a second jaw, wherein at least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw, and wherein the end effector is configured to deliver a combination of bipolar RF energy and monopolar RF energy from the at least two electrode sets to the grasped tissue; and

circuitry configured to be capable of transmitting the bipolar RF energy and the monopolar RF energy, wherein the monopolar RF energy shares an active path and a return path defined by the circuitry for transmitting the bipolar RF energy.

12. The electrosurgical instrument of claim 11, wherein the at least two electrode sets comprise three electrical interconnects used together in the circuit.

13. The electrosurgical instrument of claim 11, wherein the at least two electrode sets comprise three electrical interconnects defining at least a portion of the electrical circuit and another separate electrical circuit.

14. The electrosurgical instrument of claim 13, wherein the separate electrical circuit leads to a cutting electrode of the at least two electrode sets, the cutting electrode being isolated and centrally located in one of the first and second jaws.

15. The electrosurgical instrument of claim 14, wherein the cutting electrode is configured to cut the tissue after coagulation of the tissue has been initiated using the second and third electrodes of the at least two electrode sets.

16. The electrosurgical instrument of claim 15, wherein the at least two electrode sets are configured to deliver the monopolar RF energy and the bipolar RF energy to the tissue simultaneously.

17. An electrosurgical instrument, comprising:

an end effector, the end effector comprising:

a first jaw; and

a second jaw, wherein at least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw, and wherein the second jaw comprises a composite scaffold of at least two different materials configured to selectively create an electrically conductive portion and a thermally isolated portion.

18. The electrosurgical instrument of claim 17, wherein the composite backbone comprises a titanium ceramic composite.

19. The electrosurgical instrument of claim 18, wherein the composite scaffold comprises:

a ceramic base; and

a titanium crown attachable to the ceramic base.

20. The electrosurgical instrument of claim 17, wherein the composite backbone portion is coated with an electrically insulating material.

21. A method for manufacturing jaws of an end effector of an electrosurgical instrument, the method comprising:

preparing a composite skeleton of the jaws by fusing titanium powder with ceramic powder in a metal injection molding process; and

selectively coating the composite skeleton with an electrically insulating material to produce a plurality of electrodes.

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