DE69735955T2 - ULTRASONIC DEVICE FOR DISSEQUISITION AND COAGULATION - Google Patents

Description

BACKGROUND

1. TECHNICAL AREA

The The present disclosure relates to an ultrasound tissue dissection and coagulation system for surgical use. Especially The present disclosure relates to an ultrasonic instrument with an angled blade and a clamping element, in particular to perform of dissections and coagulation of tissue.

2. STAND OF THE TECHNOLOGY

ultrasonic instruments for surgical use and related benefits are well known. For example, facilitates the use of an ultrasonic generator a faster and easier in conjunction with a surgical scalpel Cutting organic tissue and speeding up the blood vessel closure in the area of the section, i. ensures accelerated coagulation. Improved cuts are the result of a larger body tissue scalpel contact due to the high Vibration frequency of the scalpel blade with respect to the body tissue is caused. An improved coagulation is the result of by the contact between the scalpel blade and the body tissue generated heat, when the scalpel blade vibrates at a high frequency. Consequently A good blade-tissue contact is important to those with the ultrasonic energy related Benefits to use.

The U.S. Patent No. 3,862,630 ("Balamuth") discloses an ultrasound system with an ultrasonic motor, an instrument element with a Work surface oriented perpendicular to the direction of mechanical vibration is, which is generated by the ultrasonic motor, and a clamping element, which extends parallel to the instrument element to the tissue to press against the instrument element. U.S. Patent No. 5,322,055 ("Davison") discloses a surgical Ultrasound instrument suitable for endoscopic use is and has a blade and a clamp in relation to the Blade is movable to catch the tissue in between. The blade and the clamp define a clamping area with a plane that parallel to the longitudinal axis of the surgical instrument. During an endoscopic Engagement is the movement of the instrument along the movement an axis parallel to the plane of the clamping area limited. Consequently becomes no additional result of the movement of the instrument Blade force on the body tissue expended.

PRESENTATION THE INVENTION

In an embodiment the invention provides an ultrasonic tissue dissector comprising: a Vibratory coupler, which is suitable to operate with an ultrasonic generator to be connected and having a longitudinal axis; a blade element, extending from a distal end portion of the vibration coupler extends and has a longitudinal axis, generally with the longitudinal axis the vibration coupler is aligned, wherein the blade element a cutting surface characterized in that: the cutting surface a linear cutting surface having an acute angle with respect to the longitudinal axis of the vibration coupler during forms the vibration of the vibration coupler; and the instrument a clamping member positioned adjacent to the blade member is and from a spaced from the cutting surface, open position the cutting surface in one in opposite Alignment with the blade element lying, clamped position is movable to between the clamping element and the linear cutting surface of the Blade element capture tissue.

In an embodiment is the ultrasound tissue dissector for dissection and coagulation provided by tissue. The surgical instrument includes a housing and a vibration coupler carried in the housing and operative with an ultrasonic generator is connected. An angled blade element is connected to the distal end of the vibration coupler to high frequency vibrations to lead to the blade element. The blade member has a cutting surface that is blunt Angle with respect to an axis transverse to the longitudinal axis of the vibration coupler forms. The blade member may also have a width extending in the distal direction tapers. One Clamping element can be positioned next to the blade elements and is movable from an open position to a clamped position, to catch tissue in between.

The Clamping element and the angled blade element increase together the contact between the tissue and the blade member during the activity instrument to improve the performance of the instrument.

In an alternative embodiment, the surgical instrument is operatively connected to a control module and a remote control and has a housing and an elongate body portion extending from the housing. An ultrasonic transducer carried in the housing is operatively connected to a cutting blade via a vibration coupler. The vibration coupler directs high frequency vibrations from the ultrasonic transducer to the cutting blade. The cutting blade points a cutting surface angled with respect to the longitudinal axis of the elongate body portion and thus with respect to the axis of vibration. A clamping member having a tissue contacting surface is positioned adjacent the blade member and is moveable via an actuating tube from an open position into which the tissue contacting surface is spaced from the cutting surface to a clamped position in which the tissue contacting surface is in close face with the cutting surface to pinch tissue between them. Since the cutting blade is angled with respect to the longitudinal axis of the elongated body portion, the contact pressure exerted by the blade surface is increased as the force applied to the instrument is increased.

SHORT DESCRIPTION THE DRAWINGS

Various preferred embodiments are described here with reference to the drawings:

1 Figure 3 is a perspective view of one embodiment of the ultrasonic tissue dissector in the open position;

2 FIG. 15 is a side cross-sectional view taken along section line 2-2 of FIG 1 ;

3 FIG. 15 is a side cross-sectional view taken along section line 3-3 of FIG 1 ;

3A is a front cross-sectional view taken along section line 3A-3A of 3 ;

3B Figure 10 is a cross-sectional view of the blade member and clip of an alternative embodiment of the ultrasonic tissue dissector;

4 FIG. 12 is a side cross-sectional view of the proximal end of the ultrasonic tissue dissector. FIG 1 ;

5 FIG. 12 is a cross-sectional view of the distal end of the ultrasonic tissue dissector. FIG 1 shown in the clamped position;

5a is a cross-sectional view taken along section line 5A-5A of 5 ;

6 Figure 3 is a side cross-sectional view of the proximal end of an alternative embodiment of the ultrasound tissue dissector shown in the open position;

7 is a partial side cross-sectional view of the distal end of the ultrasonic tissue dissector of 6 shown in the open position;

7A is a cross-sectional view taken along the line 7A-7A of 7 ;

7B Figure 10 is a cross-sectional view of the blade member and clip of an alternative embodiment of the ultrasonic tissue dissector;

7C Figure 10 is a cross-sectional view of the distal end of an alternative embodiment of the ultrasound tissue dissector;

8th FIG. 12 is a side cross-sectional view of the proximal end of the ultrasonic tissue dissector. FIG 6 shown in the clamped position;

9 FIG. 12 is a cross-sectional view of the distal end of the ultrasonic tissue dissector. FIG 6 shown in the clamped position;

9A FIG. 12 is a cross-sectional view taken along section line 9A-9A of FIG 9 ;

10 Fig. 10 is a partial cross-sectional view showing the ultrasonic tissue dissector positioned in a trocar cannula;

11 Fig. 12 is a perspective view of an alternative embodiment of the ultrasound tissue dissection and coagulation system wherein the ultrasound instrument is partially inserted through a cannula assembly;

12 is a perspective view of the ultrasonic instrument of 11 ;

13 is a perspective view of the clamp of 11 wherein the parts are shown disassembled;

14 is a perspective view of the elongated body portion de the ultrasonic instrument 11 wherein the parts are shown disassembled;

15 is a perspective view of the handle assembly of the ultrasonic instrument of 11 wherein the parts are shown disassembled;

16 is a perspective view of the rotary assembly of the ultrasonic instrument of 11 wherein the parts are shown disassembled;

17 is a partially cutaway side view of the ultrasonic instrument of 11 in the open position;

18 is an enlarged view of the ge showed detail of the 17 showing the clamp in the open position;

19 FIG. 15 is a perspective view of the distal end of the elongate body portion of the ultrasonic instrument of FIG 11 with the clamp in the open position;

20 is a partially cut away perspective view of the distal end of the elongated body portion of the ultrasonic instrument of 11 with the clamp in the open position;

21 FIG. 14 is a front plan view taken along the line 21-21 of FIG 18 ;

22 is a partially cutaway side view of the ultrasonic instrument of 11 with the clamp in the clamped (closed) position;

23 is an enlarged view of the indicated detail area of 22 showing the clamp in the closed position;

24 FIG. 12 is a side cross-sectional view of the distal end of the elongated body portion of the ultrasonic instrument of FIG 11 in the clamped position;

25 is a perspective view of the ultrasonic instrument of 11 wherein the elongate body portion is partially rotated;

26 Figure 4 is a side perspective view of another alternative embodiment of the ultrasound instrument in the open position;

27 is a perspective view of the elongated body portion of the in 26 shown ultrasound instrument;

28A is a side perspective view of the clamp of in 26 shown ultrasound instrument;

28B is a side perspective view of the tissue contact surfaces of the in 28A shown clamp;

28C is a side perspective view of the distal end of the elongated body portion of the in 26 shown ultrasound instrument;

29 is a side perspective view of the elongated body portion and the rotational arrangement of the in 26 shown ultrasound instrument;

30 is a side perspective view of the handle assembly and the transducer assembly of the in 26 shown ultrasound instrument;

31 is a side partial cross-sectional view of the in 26 shown ultrasonic instrument in the open position;

31A Fig. 10 is an enlarged perspective view of a C-clip positioner for the vibration coupler;

32 is an enlarged view of the indicated detail area of 31 showing the clamp in the open position;

33 is a side perspective view of the distal end of the elongated body portion of the in 33 shown ultrasound instrument;

34 is a side perspective and partially cutaway view of the distal end of the elongated body portion of the in 33 shown ultrasound instrument;

35 is a side partial cross-sectional view of the ultrasonic instrument of 26 in the closed position;

36 is an enlarged view of the indicated detail area of 35 showing the clamp in the closed position;

37 is a side cross-sectional view of an alternative embodiment of the ultrasonic transducer of 11 ;

38A FIG. 12 is a side view of a torque wrench assembly engaged with the ultrasonic transducer of FIG 37 ;

38B is a side cross-sectional view taken along section line 38B-38B of 38A ;

38C is a side perspective view of the cam member of in 38B shown torque wrench assembly; and

38D is a perspective view of the drive element of in 38B shown torque wrench assembly.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Preferred embodiments of the presently disclosed ultrasonic dissection and coagulation system will now be described in detail with reference to FIG the drawings are described in which like reference numerals designate identical or corresponding elements in each of the several views.

1 to 5 show an embodiment of the presently disclosed ultrasonic tissue dissector commonly associated with 10 in 1 is shown. Briefly, the ultrasonic tissue dissector includes 10 a handle assembly 12 with a movable handle element 14 and a stationary gripping element 16 , A housing section 18 is holistic with the stationary gripping element 16 educated. The housing section is preferred 18 and the stationary gripping element 16 constructed monolithically from two injection-molded sections. A generally cylindrical elongate body portion 20 extends from the handle assembly 12 and is with an open distal end 22 Mistake.

Regarding 2 to 3 is a converter 24 in the housing section 18 on support elements 23 worn and suitable to use with an ultrasonic generator 25 (shown schematically) via a power cable 26 to be connected. A vibration coupler or horn 28 is in engagement with the transducer 24 positioned and extends through the elongated body portion 20 , The vibration coupler 28 includes a tapered section 23a which is fixed at its distal end with a blade element 30 with a cutting surface 32 connected is. The blade element 30 extends from the open distal end 22 of the elongated body section 20 , Alternatively, the blade element 30 and the vibration coupler 28 be built holistically. The blade element 30 has a straight cutting surface 32 on, from the longitudinal axis of the coupler 28 (and the elongated body section 20 ) is angled away so that the cutting surface 32 an obtuse angle with the transverse axis Y of the elongate body portion 20 forms. The transverse axis Y is also parallel to the transverse axis R of the vibration coupler 28 , As shown in the illustrated embodiment, the cutting surface is 32 downwardly and outwardly away from the central longitudinal axis of the elongated body portion 20 and away from the clamp and the actuator rod 34 angled. The cutting surface 32 further defines a fixed acute angle θ with respect to the longitudinal axis of the elongate body portion 20 , which preferably ranges from about 15 ° to about 70 °. A base section 33 the blade 30 next to the cutting surface 32 has a radius of curvature defining a smooth (uniform) surface to prevent inadvertent damage to tissue or organs at the surgical site. The base section 33 should not fall under the outer surface of the elongated body section 20 extend to facilitate passage through a cannula during endoscopic surgery. Preferably, the base portion extends 33 outwards to a position with the outermost diameter of the vibration coupler 28 is aligned.

3A illustrates a cross-sectional view of the blade and shows the blade with a generally flat cutting surface 32 , 3B illustrates an alternative embodiment of the blade, wherein the blade 30a has an upper portion with a triangular cross-section. The upper walls 30b the blade 30a converge to a straight edge that defines the cutting surface 32a Are defined. Alternatively, a series of rectilinear edges may be provided to define the cutting surface.

Regarding 2 and 3 leads the ultrasonic generator 25 electrical energy at an ultrasonic frequency to the transducer 24 to, to the oscillation of the transducer 24 effect in a known manner. The converter 24 which may be one of a variety of electromechanical types, eg, an electrodynamic, piezoelectric, magnetostrictive transducer, is in end-to-end relationship with the vibration coupler 28 connected to the oscillation of the vibration coupler and the corresponding oscillation of the angled blade element 30 to effect.

An operating rod 34 has a proximal end that is movable in the housing section 18 is stored. The operating rod 34 extends through the elongated body portion 20 and includes a distal end adjacent the distal end of the elongate body portion 20 is positioned. The actuating rod is preferred 34 and the vibration coupler 28 in the body section 20 using load-bearing spacers 36 Although any conventional support structure that allows linear movement of the actuator rod can be used. The supporting spacers 36 are at each end of the vibration coupler 28 and the actuating rod 34 positioned next to a vibration node on the vibration coupler. Additional spacers 36 may also be provided, and adjacent to other nodes on the vibration coupler 28 be positioned. A clamp 38 with a clamping surface 40 is with the distal end of the actuator rod 34 over a pivot pin 42 connected. the clamp 38 is also rotatable with the distal end of the elongated body portion 20 over a pivot pin 44 connected and is next to the blade 30 positioned so that when linearly advancing the actuating rod 34 the clamping surface 40 in an opposite orientation with the cutting surface 33 is moved. Due to the angle of the clamping surface 40 and the cutting surface 32 the tissue becomes proximal to the cutting surface 32 pulled when pinched.

The proximal end of the actuator rod 34 is under friction in a slidable coupler 46 recorded in the housing section 18 is positioned. The coupling piece 46 is from walls 48 of the housing section 18 restricted to a linear movement. The movable handle 14 is with the coupling piece 46 via a connecting link 50 operably connected, which via a pin 52 rotatable at one end with the coupling piece 46 is connected and via a pen 54 rotatably at its opposite end with the movable handle 14 connected is. The movable handle 14 is about a pivot pin 46 rotatable with the housing portion 18 connected. A biasing element 58 is positioned in the housing to the moving handle 14 distally (counterclockwise) to thereby bias the coupling piece 46 proximally in the housing section 18 to hold and the operating rod 34 to hold in a retracted position. When the operating rod 34 is in the retracted position, is the terminal 38 in an open position (see 3 ). Alternatively, the clamp 38 be biased in a clamped (closed) position.

In use, the ultrasonic tissue dissector 10 on the handle assembly 12 grabbed and moved so that the cutting surface 32 next to the tissue to be cut and / or coagulated 62 is positioned (see 3A ). Because the movable handle 14 in the illustrated embodiment of the biasing element 58 biased to the open position, the ultrasonic tissue dissector 10 without operation of the movable handle 14 be positioned.

Regarding 4 and 5 now becomes the movable handle 14 After the ultrasonic tissue dissector 10 suitable for the body tissue 62 was positioned in a clockwise direction, with the arrow "A" in 4 shown, turned to the slidable coupling piece 46 over the connecting link 50 advance distally. The movement of the coupling piece 46 pushes the operating rod 34 distal to, as indicated by the arrow "B" in 5 shown to the clamp 38 clockwise around the pivot pin 44 to turn and the tissue 62 between the cutting surface 32 and the clamping surface 40 pinch. Please refer 5A , The ultrasonic generator can now be powered to provide a linear oscillation of the blade 30 in terms of the blade 38 to cause the dissection and / or coagulation of the tissue 62 to accomplish.

The 6 to 9 illustrate an alternative embodiment of the presently disclosed ultrasound tissue dissector disclosed in U.S. Pat 6 generally with 100 is shown. Regarding 6 and 7 includes the ultrasonic tissue dissector 100 a handle assembly 112 with a movable handle 114 and a stationary gripping element 116 , A housing section 118 is holistic with the stationary gripping element 116 educated. The housing section is preferred 118 and the stationary gripping element 116 constructed monolithically from two injection-molded sections. A generally cylindrical elongate body portion 120 extends from the handle assembly 112 and is with an open distal end 122 Mistake.

As in 6 and 7 is illustrated, becomes a converter 124 in the case 118 on support elements 123 worn and is capable of using an ultrasonic generator (not shown) via a power cable 126 to be connected. A vibration coupler 128 is in engagement with the transducer 124 positioned and extends through the elongated body portion 120 , The vibration coupler 128 includes a tapered section 128a , which is fixed at its distal end with a blade element 130 with a cutting surface 132 connected is. The blade element 130 extends from the open distal end 122 of the elongated body section 120 , Alternatively, the blade element 130 and the vibration coupler 128 be built holistically. The blade element 130 has a generally straight cutting surface 132 extending from the longitudinal axis of the coupler 128 and the elongated body portion 120 away is angled so that the cutting surface 132 an obtuse angle with respect to a transverse axis Y of the elongate body portion 120 forms. The transverse axis Y is also parallel to the transverse axis R of the vibration coupler 128 , As shown in the illustrated embodiment, the cutting surface is 132 downwardly and outwardly away from the central longitudinal axis of the elongated body portion 120 and away from the clamp and the clamp actuator rod 134 angled. The cutting surface 132 defines a fixed acute angle θ with respect to the longitudinal axis of the elongated body portion 120 which ranges preferably from about 15 ° to about 70 °. A base section 133 the blade 130 next to the cutting surface 132 has a radius of curvature that defines a smooth (uniform) surface that prevents inadvertent damage to tissue or organs at the surgical site. The base section 133 should not fall under the outer surface of the elongated body section 120 extend to facilitate passage through a cannula during endoscopic surgery. Preferably, the base portion extends 133 by a distance to the outside, with the outermost diameter of the vibration coupler 128 is aligned.

7A illustrates a cross-sectional view of the blade and shows the blade with a generally flat cutting surface 132 , 7B shows an alternative embodiment of the blade, wherein the blade 130a has an upper portion with a triangular cross-section. Upper walls 130b of the blade 130a converge to a straight edge that defines the cutting surface 132a Are defined. Alternatively, a series of rectilinear edges may be provided to define the cutting surface.

7C shows a side cross-sectional view of another alternative embodiment of the blade. The blade 130b has a first surface 131b parallel to the longitudinal axis of the vibration coupler 128b (and the body section 120b ) on. A straight cutting surface 132b is from the longitudinal axis of the coupler 128b (and the elongated body section 120b ) angled away so that the cutting surface 132b an obtuse angle with the transverse axis Y of the elongate body portion 120 forms. The blade 130b Tapered in thickness to its distal end. Although in conjunction with the linear movable clamp 138b shown, the blade can 130b alternatively used in conjunction with a rotatable clamp.

Again with respect to 6 and 7 has an actuating rod 134 a proximal end that is movable in the housing section 118 is stored. The operating rod 134 extends through the elongated body portion 120 and includes a distal end adjacent the distal end of the elongate body portion 120 is positioned. The actuating rod is preferred 134 and the vibration coupler 128 in the body section 120 of supporting spacers 136 Although any conventional support structure that allows linear movement of the actuator rod can be used. The supporting spacers 136 are at each end of the vibration coupler 128 and the actuating rod 134 next to a vibration node of the vibration coupler 128 positioned. Additional spacers may also be provided and positioned adjacent to other nodes of vibration. A clamp 138 is connected to the distal end of the actuator rod 134 connected and includes a clamping surface 140 parallel to the cutting edge 132 of the blade element 130 is and is facing her. the clamp 138 is with respect to the blade element 130 movable from an open position to a clamped position to tissue between the cutting edge 132 and the clamping surface 140 capture. In the clamped position are the cutting edge 132 and the clamping surface 140 in a side-by-side orientation. Alternatively, the clamp 138 holistic with the operating rod 134 may be formed and may have a smooth texture, although a knurled or ribbed surface may be provided to facilitate gripping the tissue or to enhance coagulation. Due to the angle of the clamping surface 140 and the cutting surface 132 the tissue becomes proximal to the cutting surface 132 pulled when pinched.

The proximal end of the actuator rod 134 becomes friction in a slidable coupler 146 recorded in the housing section 118 is positioned. The coupling piece 146 is from walls 148 of the housing section 118 restricted to a linear movement. The movable handle 114 is ready for operation with the slidable coupling piece 146 via a connecting link 150 connected, which at one end over a pin 152 rotatable with the coupling piece 146 is connected and at its opposite end via a pin 154 rotatable with the movable handle 114 connected is. The movable handle 114 is about a pivot pin 156 rotatable with the housing portion 118 connected. A biasing element 158 is in the housing section 118 positioned to the moving handle 114 to bias distally, so as to the coupling piece 146 in the housing section 118 to hold distal and the actuating rod 134 to hold in a distal position. When the operating rod 134 is in its distal position, is the clamping surface 140 from the cutting surface 132 spaced to the open position of the ultrasonic tissue dissector 100 define. Alternatively, the clamping member may be biased toward the open position.

In use, the ultrasonic tissue dissector 100 around the handle assembly 112 grabbed and moved to the cutting surface 132 next to the body tissue to be cut and / or coagulated 162 to position (see 7 and 7a ). Since the movable handle in the illustrated embodiment of the biasing member 158 biased to the open position, the clamp is in the distal position and the ultrasound tissue dissector 100 can without operating the movable handle 14 be positioned around the tissue.

With reference now to 8th and 9 becomes the movable handle 114 After the ultrasound tissue dissector fits around the body tissue 162 positioned in a clockwise direction as indicated by the arrow "C" in FIG 8th shown to the slidable coupling piece 146 over the connecting link 150 proximal in the housing 118 to move. The movement of the coupling piece 146 moves the actuating rod 134 proximally, as indicated by the arrow "D" in 9 shown to the clamping surface 140 in alignment with the cutting surface 132 to move, and so the tissue 162 clamp in between. The ultrasonic generator can now be powered to provide a linear oscillation of the blade 130 in relation to the clamp 138 to effect and thus the dissection and / or coagulation of the tissue 162 perform.

10 illustrates the endoscopic use of the ultrasound tissue dissector. As the ultrasound tissue dissector is shown 10 (or alternatively the dissector 100 ) via a cannula 198 through the body tissue 170 in a cavity 172 used to access tissue.

11 FIG. 12 illustrates another alternative embodiment of the ultrasound instrument in conjunction with one generally associated with FIG 200 designated ultrasonic dissection and coagulation system. Briefly, the dissection and coagulation system includes 200 an ultrasound instrument 212 , a control module 214 and a remote controller 216 , The control module 214 is via electrically conductive cables 218 Operatively with the ultrasound instrument 212 connected and has the function, the power and frequency of the ultrasonic instrument 212 to control supplied power. Any suitable controller that is capable of the ultrasonic instrument 212 Power can be used. The control module 214 is not part of the invention and will not be further disclosed here. The remote operator 216 , eg a pedal actuator, is via electrically conductive cables 220 operational with the control module 214 connected and can be actuated to supply power to the ultrasonic instrument 212 via the piston control module 214 to initiate the vibratory motion of the ultrasound instrument 212 to effect and thus cut tissue and coagulate.

As in 12 shown includes the ultrasonic instrument 212 a housing 222 and an elongated body portion 224 which extends distally from it. The housing 222 is preferably made of injection-molded housing half sections 222a and 222b formed and includes a drum section 226 with a longitudinal axis coinciding with the longitudinal axis of the body portion 224 is aligned, and includes a stationary handle portion 228 which slopes out of the barrel section 226 extends. An ultrasonic transducer 230 will be in the proximal end of the case 222 worn and extends from it and is with the control module 214 over a cable 218 connected. A claw arrangement 232 is next to the distal end of the elongated body portion 224 arranged and operated by the movable handle 236 with respect to the stationary grip portion 228 is moved. The movable handle 236 and the stationary grip portion 228 include openings 238 or 240, to grasp and operate the ultrasound instrument 212 to facilitate. The elongated body section 224 is in a rotatable button 234 supported and can be selectively rotated by the button 234 in relation to the housing 222 is rotated to the orientation of the jaw assembly 232 to change.

13 and 14 show the elongated body section 224 with disassembled parts. The elongated body section 224 includes an outer tube 242 , which is preferably cylindrical and a proximally placed annular flange 244 which is sized to rotate with the knob 234 ( 12 ) as described below. An elongated actuating tube 246 , which is also preferably cylindrical, is designed to be slidable in the outer tube 242 is received, and includes a proximal annular flange 248 which is dimensioned to engage with the coupling element 298 ( 15 ) intervene in the housing 222 ( 12 ) and will be described in detail below. The vibration coupler 250 is sized so that it extends through the elongated actuating tube 246 extends, and includes a proximal end 252 with a section 254 reduced diameter, which is designed to be operative with the ultrasonic transducer 230 to intervene, and with a distal end 256 which is suitable to operate with the cutting claw 258 to be connected. A variety of silicone rings 251 may be molded or otherwise formed at the nodes of vibration along the vibration coupler 250 be attached to the flow of fluids, such as insufflation gas, etc., between the vibration coupler 250 and the actuating tube 246 seal. The cutting claw preferably comprises 258 a proximal, threaded extension that is sized to fit into the threaded distal end 256 of the vibration coupler 250 is recorded. Alternatively, the cutting claw 258 holistic with the vibration coupler 250 be formed, or other fastening devices may be used.

A clamp 260 with a clamp body 262 and a tissue contact element 264 Removable on the clamp body 262 is operable with the distal end of the actuating tube 246 connected. The tissue contact element 264 is preferably made of teflon and is preferably removable by means of a spring and groove mounting arrangement on the clamp body 262 attached (reference numerals 261 respectively. 265 ), although other mounting arrangements are also contemplated. The tissue contact element 264 isolated the clamp 260 , which is preferably metallic, from the claw 258 which is also preferably metallic to a metal-to-metal contact. to prevent. The tissue contact element 264 also has the function between the clamp 260 and the blade surface 259 the cutting claw 258 positioned tissue to prevent the tissue from interfering with the cutting claw during vibration 258 to move. Turning elements (pins) 266 at the proximal end of the clamp body 262 lie, are designed so that they are in openings 268 be absorbed in the distal end of the outer tube 242 are formed. A guide slot 270 in the distal end of the actuating tube 246 is formed, allows the relative movement between the actuating tube 246 and the clamping bodies 262 by giving the pins 266 allowed in the guide slot 270 to move. A pair of cam elements 272 are also on the clamp body 262 are formed and positioned so that they are in cam slots 274 be absorbed in the distal end of the actuating tube 246 are formed. The movement of the actuating tube 246 and the clamp 260 will be described below.

The cutting claw 258 includes a blade surface 259 which is angled down to its distal end by a fixed acute angle θ of about 10 ° to about 20 ° with respect to the longitudinal axis of the elongate body portion 224 and to define the vibration axis. An angled blade surface 259 ensures good visibility at the surgical site. Preferably, the angle θ is about 12 °. It is also contemplated that larger angles may be used, such as 20 to 30 degrees. the clamp 260 is from an open position in which the tissue contact element 264 from the blade surface 259 is spaced ( 17 and 18 ), in a clamped position in which the tissue contact element 264 in an adjacent close alignment with the blade surface 259 located ( 23 and 24 ), movable. In the clamped position is the positioning of the tissue contact element 264 in relation to the blade surface 259 to notice. The operation of the clamp 260 from the open position to the clamped position will be described in detail below.

Regarding 15 and 16 Now the handle assembly and the rotary assembly will be discussed. The housing half sections 222a and 222b define a chamber 276 which is designed to be a section of the ultrasonic transducer 230 take. The chamber 276 has an opening 278 on that with the interior of the case 222 communicates. The ultrasonic transducer 230 includes a hole 280 which is designed to be the proximal end 254 of the vibration coupler 250 take. When assembled, the proximal end extends 254 through an opening 278 into the hole 280 , The movable handle 236 is rotatable between the housing half sections 222a and 222b around a pivot pin 282 connected, passing through the holes 284 that stretches in the legs 286 of the movable handle 236 are formed. A cam slot 288 that in every leg 286 formed, is designed to give it a head start 290 picks up, from the coupling element 298 protrudes outwards.

As in 16 shown connects the coupling element 298 Operatively the moving handle 239 with the actuator tube 246 and is preferably injection molded half sections 298a and 298b shaped to a puncture 300 which is sized to fit the proximal end of the vibration coupler 250 slidably absorbs. The coupling element 298 has an inner, distally placed annular groove 302 which is sized to fit the annular flange 248 of the actuating tube 246 receives, and has an outer proximal annular groove 304 , The groove 304 is positioned so that it has an annular rib 306 picks up on the inner wall of a pivoting element 308 is formed ( 15 ). The pivoting element 308 is preferably injection molded half sections 308a and 308b formed and allowed the rotation of the coupling element 298 relative to the movable handle 236 , projections 290 stand outward from the side walls of the pivoting element 308 and extend through the cam slots 288 of the movable handle 236 ,

Again with respect to 15 and 16 is the knob 234 preferably from injection-molded half sections 234a and 234b shaped and includes a proximal cavity 310 to the coupling element 298 Slidable to carry, and a distal bore 312 that is sized to fit the outer tube 242 receives. The annular groove 314 that in the hole 312 is formed, is positioned so that it is the annular flange 244 of the outer tube 242 receives. The outer wall of the button 234 has a proximal annular ring 316 that is dimensioned so that he is in the opening 320 of the housing 322 formed annular slot 318 is rotatably received, as well as a scalloped surface 322 to grab the rotatable knob 234 to facilitate. The ring-shaped ring 316 allows the rotation of the button 234 in relation to the housing 222 while preventing its axial movement with respect thereto. A pair of cylindrical rods 324 extend between the half sections 234a and 234b through a rectangular opening 326 in the coupling element 298 is formed. The bars 324 grab with a pair of concave depressions 328 one in a holder 330 which is fixed around the vibration coupler 250, so that the rotation of the knob 234 a rotation of the vibration coupler 250 and thus a rotation of the blade 258 and the clamp 260 causes. Alternatively, the wells can 228 monolithic with the vibration coupler 250 be educated.

The 17 to 21 illustrate the ultrasound instrument 212 with the clamp 260 in the open position. The elongated body 224 that the clamp 260 and the blade 258 includes, and the housing 222 that holds the handles 228 and 236 are packaged as an integral unit that does not require assembly by the user before use, ie the vibration coupler 250 , the clamp 260 and the blade 258 are not removably connected. That is, the user only the converter 230 on the housing 222 must connect to the instrument 212 ready to use. In the open position is the movable handle 236 to the rear of the stationary grip section 228 spaced and the projections 290 are in the lower proximal section of the cam slots 288 positioned. At the distal end of the ultrasound instrument 212 are turning elements 266 near the distal end of the guide slots 270 positioned and cam elements 272 are in the upper distal section of the cam slots 274 positioned. The tissue contact element 264 the clamp 260 is from the blade surface 259 spaced to a tissue receiving area 332 define. The proximal end of the tissue receiving area 332 gets from a pair of tissue receiving stops 335 defined, which preferably holistically with the clamp body 262 are formed and located under the blade surface 259 extend. Preferred is the distal end of the blade 258 rounded to prevent inadvertent damage to the tissue during use of the instrument 212 to prevent. The tissue contact surface 264 is also preferred with a concavity 267 designed to receive tissue therein. Alternatively, the distal end of the blade 258 be shaped so that it has any shape that may be suitable for a particular surgical application, ie flat, pointed, etc. In addition, the tissue contact surface 264 not be formed with a concavity, but may be flat, angled, etc.

If related to 22 to 24 the movable handle 236 clockwise around the rotating element 262 to the stationary grip section 228 is rotated, in the with the arrow "A" in 22 designated direction, the cam slot engages 288 with the lead 290 of the rotary element 308 a to the coupling elements 298 distally in the cavity 310 the knob 234 advance. Because the actuating tube 246 over the annular flange 248 on the coupling element 298 attached is also the actuating tube 246 in the distal direction with the arrow "B" in 23 forwarded designated direction. The movement of the actuating tube 246 Distally, causing the cam slots 274 in engagement with the cam elements 272 move and so the clamp body 262 around the rotating elements 266 panning, in the direction indicated by the arrow "C" in 23 is designated to the clamping element 262 and the tissue contact element 264 to move to the clamped position. In the clamped position are the projections 290 in a central portion of the cam slots 288 positioned, the rotating elements 266 are near the proximal end of the guide slots 270 positioned and the cam elements 272 are in the proximal, lower portion of the cam slots 234 positioned.

The elongated body section 224 can be free with respect to the case 222 by turning the knob 234 to be turned around. As in 25 illustrated, causes the rotation of the knob 234 in the direction indicated by the arrow "D", a rotation of the jaw assembly 232 in the direction indicated by the arrow "E." The button 234 is next to the case 222 positioned to one-handed operation of both the movable handle 236 as well as the knob 234 to facilitate.

Again with respect to 11 is the elongated body section 224 so that it passes through a trocar assembly 340 extends, and is preferably sized to extend through a 5mm trocar assembly. In use is the elongated body section 224 with the claw arrangement 232 in the clamped or closed position through the trocar assembly 340 pushed into a position adjacent to the tissue to be cut and / or coagulated (not shown). An optical unit (not shown) may also be positioned adjacent the surgical site to facilitate monitoring of the procedure. The claw arrangement 232 is opened and the tissue to be cut and / or coagulated is in the tissue receiving area 332 positioned (see also 19 ). The tissue receiving stops 335 prevent tissue from attaching to the proximal end of the blade surfaces 259 move past. Then the claw assembly becomes 232 closed to the tissue between the tissue contact element 264 and the blade surface 259 pinch. Electricity is the ultrasonic instrument 212 via a control module 214 fed to the vibration of the blade 258 initiate dissection and coagulation of the tissue. Due to the angle of the blade surface 259 becomes the of the blade surface 259 Increased contact pressure exerted on the tissue to be cut when applied to the instrument 212 applied force is increased. It is noticed that after use the instrument 212 autoclaved and reused.

26 shows another alternative embodiment of the ultrasound instrument, generally with 412 designated. The ultrasound instrument 412 includes a housing 422 and an elongated body portion 424 which is distally from the housing 422 extends. The housing 422 is preferably made of injection-molded housing half sections 422a and 422b formed and includes a drum section 426 with a longitudinal axis coinciding with the longitudinal axis of the body portion 424 is aligned, and a stationary handle portion 428 which slopes out of the barrel section 426 extends. An ultrasonic transducer 430 is in the proximal end of the case 422 stored and extends therefrom, and includes a proximal grooved portion 431 designed to engage with a fixture to secure attachment and removal of the fixture converter 430 from the instrument 412 to facilitate. A claw arrangement 432 is next to the distal end of the elongated body portion 424 arranged and operated by the movable handle 436. with respect to the stationary grip portion 428 is moved. The movable handle 436. and the stationary grip portion 428 each include openings 438 and 440 to the gripping and the operation of the ultrasonic instrument 412 to facilitate. The elongated body section 424 is in the rotatable button 434 stored and can by the knob 434 selective with respect to the housing 422 be rotated to the orientation of the jaw assembly 432 to change.

27 shows the elongated body section 424 with disassembled parts. The elongated body section 424 includes an outer tube 442 which is preferably cylindrical and a proximal annular flange 444 which is sized to fit with the rotatable knob 434 engages ( 26 ). An elongated actuating tube 446 , which is also preferably cylindrical, is designed to be slidable in the outer tube 442 is received, and includes a proximal, annular flange 448 that is sized to fit with the coupling element 498 ( 29 ) engages in the housing 422 will be carried ( 26 ). Although not shown, it is contemplated that a portion of the actuating tube 446 and a portion of the outer tube 442 next to the flange 444 is widened to the outside, to an additional distance for the vibration coupler 450 provide. The vibration coupler 450 is sized so that it extends through the elongated actuating tube 446 extends, and includes an enlarged proximal end 452 with a bore (not shown) that is designed to be operative with the ultrasound transducer 430 intervenes. The distal end of the actuating tube 446 includes a pair of elastic arms 453 with distal openings 455 , The openings 455 are sized to give projections 461 record on an adapter 457 are formed. The poor 453 are flexible to the outside and grip with the adapter 457 one. The cutting claw 458 is monolithic with the vibration coupler 450 educated. Alternatively, the cutting claw 458 and the vibration coupler 450 can be molded separately and fastened together using any known connector, such as screw threads, friction fit, etc. Although not shown, a plurality of sealing rings can be attached to the nodes of vibration along the vibration coupler 450 molded or otherwise attached to between the vibration coupler 450 and the actuating tube 446 seal. Also with respect to 28A to 28C is a pinch 460 ready for use with the adapter 457 connected. the clamp 460 preferably comprises a pair of longitudinally extending rows of teeth 462 , which are spaced from each other by a distance, which is the cutting claw 458 allows between the rows of teeth 462 to be positioned. The teeth 462 have the function to grip the tissue when the jaw assembly 432 is in a closed position to prevent the tissue from moving relative to the cutting jaw 458 to move during the vibration of the cutting claw.

Turning elements or pins 466 are at the proximal end of the clamp 460 formed and are designed to fit in the open-ended slots 468 in the distal end of the outer tube 442 be recorded. The slots 468 are open on one side to it's pinch 460 to be allowed to be held in it. A longitudinally extending guide slot 470 that in the adapter 457 is formed, is such that it is the pivot pin 466 slidably receives and a relative movement between the adapter 457 and the clamp 460 allowed. A pair of cam elements 472 are also in trouble 462 are formed and positioned to fit in the cam slots 474 be included in the adapter 457 are formed.

The cutting claw 458 includes a blade surface 459 , which is flat and angled down to its distal end, by a fixed acute angle θ of about 10 ° to about 20 ° with respect to the longitudinal axis of the elongate body portion 424 and to form the vibration axis. The angled blade surface ensures good visibility at the surgical site. Preferably, the angle θ is about 12 °, but larger angles such as 20 to 30 ° are also considered. Alternatively, the blade surface 459 have a shape other than flat, such as sharpened, rounded, etc.

the clamp 460 is relative to the cutting claw 458 from an open position ( 28C ), in which the tissue contact surface 464 the clamp 460 from the blade surface 459 is spaced, in a closed or clamped position ( 35 ), in which the tissue contact surface 464 in close juxtaposition with the blade surface 459 is located, movable. In the clamped position is the positioning of the tissue contact surface 464 in relation to the blade surface 459 to notice. The operation of the clamp 460 from the open position to the clamped position will be described in detail below.

Regarding 29 and 30 define the housing half sections 422a and 422b a chamber 476 that is designed to cover a portion of the ultrasonic transducer 430 receives. The chamber 476 has an opening 478 on that with the interior of the case 422 communicates. Of the ultrasound transducer 430 includes a cylindrical shaft configured to be in an opening in the proximal end 454 of the vibration coupler 450 is recorded. When assembled, the proximal end extends 454 through the opening 478 in engagement with the cylindrical shaft 480 , The movable handle 436. is about the pivot elements 482 monolithic with the housing half sections 422a are formed, rotatably between the housing half sections 422a and 422b connected. A cam slot 488 that in every leg 486 formed, is designed to give it a head start 490 picks up the outside of the coupling element 498 protrudes.

A coupling element 498 Operatively connects the movable handle 436. with the actuating tube 446 and is preferably injection molded half sections 498a and 498b shaped to a puncture 500 to define that is the proximal end of the vibrating head 450 slidably receives. The coupling element 498 has an inner, annular distal groove 502 which is sized to fit the annular flange 484 of the actuating tube 446 receives, and has an outer, proximally located annular groove 504 which is positioned so that it has an annular projection 506 picks up on the inner wall of the pivoting element 508 is trained. The lead 506 of the pivoting element 508 is through the groove 504 through a relative longitudinal movement between the coupling element 498 and the pivoting element 508 to allow. A feather 463 is between the coupling element 498 and the pivoting element 508 positioned to the pivoting element 508 proximally with respect to the coupling element 498 pretension. The pivoting element 508 is preferably injection molded half sections 508a and 508b formed and allowed the rotation of the coupling element 498 relative to the movable handle 436. , projections 490 stand outward from the side walls of the pivoting element 508 and extend through the cam slots 488 of the movable handle 436. ,

A knob 434 is preferably injection molded half sections 434a and 434b formed and includes a proximal cavity 410 for slidably supporting the coupling element 498 and a distal bore 512 that is sized to fit the outer tube 442 receives. An annular groove 514 that in the hole 412 is formed, is positioned so that it is the annular flange 444 of the outer tube 442 receives. The outer wall of the button 434 has a proximal annular ring 516 which is dimensioned to be rotatable in the annular slot 518 recorded in the housing 422 is formed, and has a scalloped surface 522 to grab the rotatable knob 434 to facilitate. The ring-shaped ring 516 allows the rotation of the button 434 in relation to the housing 422 while preventing the axial movement in relation thereto. A pair of bars or pens 54 extend between the half sections 434a and 434b through a rectangular opening 526 in the coupling element 498 is formed. The bars 524 grab with a pair of flattened surfaces 528 one on the vibration coupler 450 are formed, so that the rotation of the knob 434 a rotation of the vibration coupler 450 and thus a rotation of the blade 458 and the clamp 460 caused. To provide additional surface contact is instead of the pins 524 alternatively a general with 580 in 31A designated C-clip provided. The C-clip 580 , of pins 186 is fastened, has an opening 582 on to the vibration coupler 450 take. The flattenings of the vibration coupler 450 touch the four flat areas 590 of the C-clip 580 ,

A retaining ring (not shown) may be on the ribs 492 of the housing 422 ( 32 ) are attached to an additional support for the actuating tube 464 provide. In this embodiment, the tube would 464 proximal to the ribs 492 vorbeierstrecken.

The 31 to 34 show the ultrasound instrument 412 with the clamp 460 in the open position. The elongated body 424 that the clamp 460 and the blade 458 includes, and the housing 422 that holds the handles 428 and 436. are packaged as a holistic unit that does not require assembly by the user before use, ie that the vibration coupler 450 , the clamp 460 and the blade 458 are not removably connected. That is, the user only the converter 430 on the housing 422 must connect to the instrument 412 ready to use. In the open position is the movable handle 436. to the rear of the stationary grip section 428 spaced and the projections 490 are in the lower proximal section of the cam support 488 positioned. At the distal end of the ultrasound instrument 412 are turning elements 466 near the distal end of the guide post 470 positioned and cam elements 472 are in the upper distal section of the cam support 474 positioned. The tissue contact surface 464 the clamp 460 is from the blade surface 459 spaced to a tissue receiving area 532 define. The proximal end of the tissue receiving area 532 gets from a pair of tissue receiving stops 535 defined, which prefers holistically with the clamp 460 are formed and under the blade surfaces 459 extend. Preferred is the distal end of the blade 458 free of sharp edges, which is an inadvertent damage to the fabric during use of the instrument 412 could cause. Alternatively, the distal end of the blade 458 be shaped so that it has any shape that may be suitable for a particular surgical application, ie, flat, pointed, etc.

Regarding 35 and 36 when the movable handle 436. clockwise around the rotating element 462 to the stationary grip section 428 is rotated, in the direction indicated by the arrow "G" in 35 designated direction, the cam slot engages 488 with the lead 490 of the rotary element 508 a to the coupling element 498 distally in the cavity 510 of the knob 434 advance. Because the actuating tube 446 on the coupling element 498 through the annular flange 448 attached is also the actuating tube 446 in the distal direction with the arrow "H" in 36 forwarded designated direction. The movement of the actuating tube 446 Distally, causing the cam slots 474 in engagement with the cam elements 472 move around the clamp body 462 around the rotating elements 466 to turn, in the direction indicated by the arrow "I" in 36 designated direction, and si the terminal element 462 and the tissue contact element 464 to move to the clamped position. The feather 463 prevents the over-clamping of the tissue by a relative movement between the rotating element 508 and the coupling element 498 after reaching a predetermined clamping pressure applied to the blade 458 was expended. In the clamped position are the projections 490 in the middle section of the cam slots 488 , the pivot pins 466 are near the proximal end of the guide slots 470 and the cam elements 472 are located in the proximal lower portion of the cam slots 474 ,

The elongated body section 424 can with respect to the case 422 by turning the knob 434 be turned freely. The rotation of the knob 434 in the direction indicated by the arrow "J" causes the rotation of the jaw assembly 432 in the direction indicated by the arrow "K" The button 434 is next to the case 422 positioned to one-handed operation of both the movable handle 436. as well as the knob 434 to facilitate.

With reference now to 37 is an alternative embodiment of the ultrasonic transducer, generally with 630 indicated. The ultrasonic transducer 630 includes a housing 631 with a proximal housing section 632 and a distal housing portion 634 , The proximal housing section 632 has a scalloped section 636 next to its proximal end and the distal housing section 634 has a radial section 635 which extends inward to partially the transducer horn 638 cover. The transducer horn 638 includes a shoulder portion 637 next to the radial section 635 of the distal housing section 634 is positioned to a recess 651 for receiving a washer 639 define. The washer 639 has the function of the space between the radial section 635 and the transducer horn 638 seal and the converter horn 638 before a longitudinal contact with the distal housing section 634 to preserve. The shoulder section 637 of the converter horn 638 contacts an inner wall of the distal housing portion 634 To help maintain the longitudinal alignment of the transducer horn 638 in the case 631 help. The distal end of the transducer horn 638 includes a threaded bore 644 , which is sized to fit with a section of reduced diameter of the vibration coupler 650 intervenes. A pair of spacers 640 are between the transducer horn 638 and the distal housing portion 634 positioned. Each spacer 640 includes an annular flange 648 between the proximal and distal housing sections 632 and 634 ultrasonically welded and hermetically sealed. The proximal end of each spacer 640 engages with an O-ring of a pair of O-rings to compress the O-rings, sealing between the distal housing section 634 and the transducer horn 638 to provide and a radial support for the transducer horn 638 provide. The spacer O-ring combination continues to hold the transducer horn 638 in a position to the washer 639 in the depression 641 to compress. Piezoelectric crystals 650 are in contact with the proximal end of the transducer horn 638 through a support plate 652 and a screw (not shown) fixed through an opening 656 in the support plate 652 into the threaded hole 658 is used, which in the proximal end of the transducer horn 638 is trained. Wires (not shown) from the crystals 650 extend to a connector 659 , with threaded engagement in an opening 661 in the proximal housing section 632 can be included.

The 38A and 38B illustrate a torque wrench assembly, generally with 670 is designated. The torque wrench assembly 670 includes an outer housing 672 and an inner drive element 674 , The inner drive element 674 has an opening 675 with an inner, scalloped wall 677 that is designed to fit with the scalloped section 636 of the housing 631 intervenes. The inner drive element 674 also includes a projection or a bump 676 (please refer 38D ), which is in a cylindrical recess 678 extending between the inner drive element 674 and the outer drive housing 672 is defined. A cam element 682 is in the depression 678 is positioned and will have one Urethane ring and washer assembly 682 with the bump 676 kept in contact. The cam element 682 includes protrusions 685 placed between the inner ribs of the outer casing 672 fit. The cam element 682 has an end face with a series of bevelled surfaces 687 and shoulders 689 ( 38C ). In use, when the opening 675 over the scalloped section 636 of the housing 631 is pushed and the outer housing 672 the torque wrench assembly 670 is grasped and rotated, the cam member 682 also turned. The inclined surfaces 687 on the cam element 682 glide over the bump 676 until a respective shoulder with the bump 676 engages, causing the inner drive element 674 is rotated to accordingly the transducer assembly 630 to turn. The inner drive element 674 will be with the cam element 682 Turn until the torque required to rotate the transducer assembly 630 with respect to the vibration coupler (not shown) exceeds the force necessary to the shoulders 689 over the bump 676 to force.

It should be understood that various modifications can be made to the embodiments described herein. For example, the vibration coupler 50 and the blade 58 be formed monolithically or fastened using a different structure of screw threads, and the proximal end of the ultrasonic transducer 630 does not have to have a scalloped shape, but instead may be configured to engage any suitable torque wrench assembly. Further, the elongated body portion of the device need not be sized to extend through a 5 mm trocar assembly, but instead may be sized to extend through a trocar assembly of any size, eg, 10 mm, 12 mm, and so forth. Therefore, the above description should not be construed as limiting, but merely as an exemplification of preferred embodiments.

One Advantage of the present invention is an improved surgical To provide an ultrasound instrument that is easy to use, and a quick and easy cutting as well as an improved Coagulation provides.

Claims (15)

An ultrasonic tissue dissector comprising: a vibration coupler ( 28 . 128 . 250 ; 450 ) operable to be operatively connected to an ultrasonic generator and having a longitudinal axis; a blade element ( 30 . 130 . 258 . 458 ) extending from a distal end portion of the vibration coupler and having a longitudinal axis generally aligned with the longitudinal axis of the vibration coupler, the blade element 30 . 130 . 258 . 458 ) a cutting surface ( 32 . 132 . 259 . 459 ), characterized in that: the cutting surface ( 32 . 132 . 259 . 459 ) has a linear cutting surface which makes an acute angle with respect to the longitudinal axis of the vibration coupler ( 28 . 128 . 250 . 450 ) during vibration of the vibration coupler; and the instrument a clamping element ( 38 . 138 . 260 . 460 ), which next to the blade element ( 30 . 130 . 258 . 458 ) and from one of the cutting surface ( 32 . 132 . 259 . 459 ) spaced, open position in an opposing orientation with the blade element (FIG. 30 . 130 . 258 . 458 ), clamped position is movable to between the clamping element ( 38 . 138 . 260 . 460 ) and the linear cutting surface of the blade element ( 30 . 130 . 258 . 458 ) Capture tissue. A surgical ultrasonic tissue dissecting instrument according to claim 1, wherein said clamping member ( 38 . 138 . 260 . 460 ) has a clamping surface, wherein the clamping surface to the cutting surface ( 32 . 132 . 259 . 459 ) is parallel when the clamping member is moved to the clamped position. Ultrasonic tissue dissector according to one of the preceding claims, further comprising an actuating rod ( 34 . 134 . 264 ) operatively connected to the clamping element ( 38 . 138 . 260 . 460 ), the actuating rod ( 34 . 134 . 246 ) can be moved to the clamping element ( 38 . 138 . 260 . 460 ) to move from the open to the clamped position. An ultrasonic tissue dissector according to any one of the preceding claims, further comprising a biasing mechanism for biasing the clamping member ( 38 . 138 . 260 . 460 ) in an open position with respect to the blade element ( 30 . 130 . 258 . 458 ) full. Ultrasound tissue dissector according to one of the preceding claims, wherein the cutting surface ( 32 . 132 . 259 . 459 ) an obtuse angle with respect to a longitudinal axis of the vibration coupler ( 28 . 128 . 250 . 450 ) forms a vertical axis. Ultrasonic tissue dissector according to one of the preceding claims, an elongate body portion ( 20 . 120 . 224 . 424 ), wherein the vibration coupler ( 28 . 128 . 450 . 250 ) in the elongated body portion ( 20 . 120 . 224 . 424 ) is positioned, and further a handle portion ( 12 . 112 . 222 . 422 ), wherein the elongated body portion ( 20 . 120 . 224 . 424 ) distally of the handle portion ( 12 . 112 . 222 . 424 ). Ultrasound tissue dissector after one of the preceeding claims, further comprising a transducer removably connected to the handle portion, the transducer comprising an outer housing adapted to engage a torque wrench and a transducer horn adapted to engage a proximal end of the vibration coupler. An ultrasonic tissue dissector according to claim 7, wherein the transducer horn comprises a threaded bore and the Vibration coupler includes a threaded proximal end. Ultrasound tissue dissector according to one of the preceding claims, wherein the blade element ( 30 . 130 . 258 . 458 ) tapers in thickness to the distal end. Ultrasound tissue dissector according to one of the preceding claims, wherein the cutting surface ( 32 . 132 . 259 . 459 ) is even during the vibration of the vibration coupler. Ultrasonic tissue dissector according to one of the preceding claims, further comprising a handle assembly ( 12 . 112 . 222 . 422 ) and an actuator operatively connected to the handle assembly and the clamping member, the handle assembly (10). 12 . 112 . 222 . 422 ) can be moved to the clamping element ( 38 . 138 . 260 . 460 ) to move from the open position to the clamped position, and wherein the clamping element ( 38 . 138 . 260 . 460 ) comprises a cam member positioned in a cam slot formed in the actuator, the cam slot being movable relative to the cam member to move the clamping member (10). 38 . 138 . 260 . 460 ) between the open position and the clamped position. Ultrasound tissue dissector according to one of the preceding claims, further comprising a rotatable collar ( 234 . 434 . 522 ) operatively connected to the vibration coupler ( 28 . 128 . 250 . 450 ), the clamping element ( 38 . 138 . 260 . 460 ) and the blade element ( 30 . 130 . 258 . 458 ) is connected, so that the rotation of the rotatable collar ( 234 . 434 . 522 ) a corresponding rotation of the vibration coupler ( 28 . 128 . 250 . 450 ), of the clause ( 38 . 138 . 260 . 460 ) and the blade element ( 30 . 130 . 258 . 458 ) about the longitudinal axis of the vibration coupler ( 28 . 128 . 250 . 450 ) caused. Ultrasonic tissue dissector according to one of the preceding claims, wherein the vibration coupler ( 28 . 128 . 250 . 450 ), the blade element ( 30 . 130 . 258 . 458 ) and the clamping element ( 38 . 138 . 260 . 460 ) are not detachably connected and need no assembly before use. Ultrasonic tissue dissector according to one of the preceding Claims, further comprising a transducer comprising an outer case and a transducer horn, positioned inside the outer case is, wherein the converter further comprises at least one O-ring, the between the outer case and the transducer horn is positioned. Ultrasonic tissue dissector according to claim 14, further at least one spacer comprising, between the outer housing and the transducer horn is positioned around the at least one O-ring longitudinal to push into the transducer horn.