EP1458300A1 - Instrument chirurgical - Google Patents

Instrument chirurgical

Info

Publication number
EP1458300A1
EP1458300A1 EP02791916A EP02791916A EP1458300A1 EP 1458300 A1 EP1458300 A1 EP 1458300A1 EP 02791916 A EP02791916 A EP 02791916A EP 02791916 A EP02791916 A EP 02791916A EP 1458300 A1 EP1458300 A1 EP 1458300A1
Authority
EP
European Patent Office
Prior art keywords
electrode
electrodes
cutting blade
bipolar
tissue
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
EP02791916A
Other languages
German (de)
English (en)
Inventor
Charles Owen Goble
Mark George Marshall
Kester Julian Batchelor
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Gyrus Medical Ltd
Original Assignee
Gyrus Group Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from GBGB0130975.6A external-priority patent/GB0130975D0/en
Priority claimed from GB0206207A external-priority patent/GB0206207D0/en
Priority claimed from GB0215402A external-priority patent/GB0215402D0/en
Application filed by Gyrus Group Ltd filed Critical Gyrus Group Ltd
Publication of EP1458300A1 publication Critical patent/EP1458300A1/fr
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1402—Probes for open surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1412—Blade

Definitions

  • This invention relates to a bipolar electrosurgical cutting device such as a scalpel blade, and to an electrosurgical system comprising an electrosurgical generator and a bipolar electrosurgical cutting device.
  • a bipolar electrosurgical cutting device such as a scalpel blade
  • an electrosurgical system comprising an electrosurgical generator and a bipolar electrosurgical cutting device.
  • Such systems are commonly used for the cutting of tissue in surgical intervention, most commonly in “keyhole” or minimally invasive surgery, but also in “open” surgery.
  • Electrosurgical cutting devices generally fall into two categories, monopolar and bipolar.
  • a radio frequency (RF) signal is supplied to an active electrode which is used to cut tissue at the target site, an electrical circuit being completed by a grounding pad which is generally a large area pad attached to the patient at a location remote from the target site.
  • RF radio frequency
  • both an active and a return electrode are present on the cutting device, and the current flows from the active electrode to the return electrode, often by way of an arc formed therebetween.
  • the active electrode is covered with a porous, electrically-insulating layer, separating the active electrode from the tissue to be treated and causing arcing between the electrode and the tissue.
  • the insulating layer is said to be between 0.125 and 0.25 mm (0.005 and 0.01 inches) in thickness.
  • Stasz proposed a variety of cutting blade designs. These were designed with relatively small gaps between two electrodes such that arcing would occur therebetween when an RF signal was applied to the blade, the arcing causing the cutting of the tissue. Because arcing was designed to occur between the electrodes, the typical thickness for the insulating material separating the electrodes was between 0.025 and 0.075 mm (0.001 and 0.003 inches). The present invention seeks to provide a bipolar cutting blade which is an improvement over the prior art.
  • an electrosurgical system comprising a bipolar cutting blade, a handpiece to which the cutting blade is secured, and an electrosurgical generator for supplying a radio frequency voltage signal to the cutting blade, the cutting blade comprising first and second electrodes, and an electrical insulator spacing apart the electrodes, the spacing being between 0.25 mm and 3.0 mm, and the electrosurgical generator being adapted to supply a radio frequency voltage signal to the cutting blade which has a substantially constant peak voltage value, the relationship between the peak voltage value and the spacing between the electrodes being such that the electric field intensity between the electrodes is between 0.1 volts/ ⁇ m and 2.0 volts/ ⁇ m, the first electrode having a characteristic which is dissimilar from that of the second electrode such that the first electrode is encouraged to become an active electrode and the second electrode is encouraged to become a return electrode.
  • blade there is herein meant to include all devices which are designed such that both the active cutting electrode and the return electrode are designed to enter the incision made by the instrument. It is not necessary that the cutting device is only capable of making an axial incision, and indeed it will be shown below that embodiments of the present invention are capable of removing tissue in a lateral direction.
  • the first important feature of the present invention is that the spacing between the electrodes and the electric field intensity therebetween is carefully controlled such that there is no direct arcing between the electrodes in the absence of tissue. For the purposes of this specification, the spacing between the electrodes is measured in terms of the shortest electrical path between the electrodes.
  • the "spacing" between the electrodes is the shortest available conductive path between the electrodes.
  • the electric field intensity between the electrodes is preferably between 0.15 volts/ ⁇ m and 1.5 volts / ⁇ m, and typically between 0.2 volts/ ⁇ m and 1.5 volts/ ⁇ m.
  • the spacing between the first and second electrodes is between 0.25 mm and 1.0 mm, and the electric field intensity between the electrodes is between 0.33 volts/ ⁇ m and 1.1 volts/ ⁇ m.
  • the electric field intensity is such that the peak voltage between the first and second electrodes is less than 750 volts. This ensures that the field intensity is sufficient for arcing to occur between the first electrode and the tissue, but not directly between the first and second electrodes. However, even where direct arcing between the electrodes is prevented, there is still a potential problem if the two electrodes are similar in design. In a bipolar cutting device only one of the electrodes will assume a high potential to tissue (and become the "active" electrode), with the remaining electrode assuming virtually the same potential as the tissue (becoming the "return” electrode). Where the first and second electrodes are similar, which electrode becomes the active can be a matter of circumstance.
  • the electrode first contacting tissue will usually become the return electrode, with the other electrode becoming the active electrode. This means that in some circumstances one electrode will be the active electrode, and at other times the other electrode will be the active electrode. Not only does this make the device difficult for the surgeon to control (as it will be uncertain as to exactly where the cutting action will occur), but as it is likely that any particular electrode will at some time have been active.
  • the present invention provides that the first electrode has a characteristic which is dissimilar from that of the second electrode, in order to encourage one electrode to assume preferentially the role of the active electrode.
  • the characteristic of the first electrode which is dissimilar from that of the second electrode conveniently comprises the cross-sectional area of the electrode, the cross-sectional area of the first electrode being substantially smaller than that of the second electrode. This will help to ensure that the first electrode (being of a smaller cross-sectional area) will experience a relatively high initial impedance on contact with tissue, while the relatively larger area second electrode will experience a relatively lower initial impedance on contact with tissue. This arrangement will assist in encouraging the first electrode to become the active and the second electrode to become the return.
  • the characteristic of the first electrode which is dissimilar from that of the second electrode alternatively or additionally comprises the thermal conductivity of the electrode, the thermal conductivity of the first electrode being substantially lower than that of the second electrode.
  • the rate of rise of the impedance is a factor influencing which electrode will become active.
  • the impedance will rise with desiccation of the tissue, and the rate of desiccation will be influenced by the temperature of the electrode.
  • the electrode temperature will rise quickly as little heat is conducted away from the part of the electrode at which energy is delivered. This will ensure a relatively fast desiccation rate, producing a correspondingly fast rise in impedance and ensuring that the first electrode remains the active electrode.
  • the characteristic of the first electrode which is dissimilar from that of the second electrode may further comprise the thermal capacity of the electrode, the thermal capacity of the first electrode being substantially lower than that of the second electrode. As before, a low thermal capacity helps to maintain the temperature of the first electrode at a relatively high level, ensuring that it remains the active electrode.
  • an electrosurgical system comprising a bipolar cutting blade, a handpiece to which the cutting blade is secured, and an electrosurgical generator for supplying a radio frequency voltage signal to the cutting blade, the cutting blade comprising first and second electrodes, and an electrical insulator spacing apart the electrodes, the spacing being between 0.25 mm and 1.0 mm, and the electrosurgical generator being adapted to supply a radio frequency voltage signal to the cutting blade which has a substantially constant peak voltage value, the peak voltage value being respectively between 250 volts and 600 volts, the first electrode having a characteristic which is dissimilar from that of the second electrode such that the first electrode is encouraged to become an active electrode and the second electrode is encouraged to become a return electrode.
  • the generator delivers the same peak voltages despite varying load conditions.
  • Heavy loading of the blade may otherwise make it stall (as load impedance approaches source impedance, the voltage may otherwise halve), while light loading may otherwise result in voltage overshoots and direct arcing between the electrodes.
  • the invention also resides in a bipolar cutting blade comprising first and second electrodes and an electrical insulator spacing apart the electrodes, the first electrode having a characteristic which is dissimilar from that of the second electrode such that the first electrode is encouraged to become an active electrode and the second electrode is encouraged to become a return electrode, the spacing between the electrodes being between 0.25 mm and 1.0 mm, such that when the electrodes are in contact with tissue and an electrosurgical cutting voltage is applied therebetween, arcing does not occur directly between the electrodes, there also being provided means for ensuring that the temperature of the second electrode does not rise above 70° C.
  • the means for ensuring that the temperature of the second electrode does not rise above 70° C conveniently comprises means for minimising the transfer of heat from the first electrode to the second electrode.
  • One way of achieving this is to ensure that the first electrode is formed from a material having a relatively poor thermal conductivity, preferably less than 20 W/m.K. By making the first electrode a poor thermal conductor, heat is not transferred effectively away from the active site of the electrode and across to the second electrode, thereby helping to prevent the temperature of the second electrode from rising.
  • the heat can be inhibited from transferring from the first electrode to the second electrode by making the electrical insulator separating the electrodes from a material having a relatively poor thermal conductivity, preferably less than 40 W/m.K. Again, this helps to prevent heat generated at the first electrode from transferring to the second electrode.
  • Another way of inhibiting the transfer of heat is to attach the first electrode to the electrical insulator in a discontinuous manner.
  • the first electrode is attached to the electrical insulator at one or more point contact locations, and/or is perforated with a plurality of holes such as to reduce the percentage contact with the electrical insulator.
  • a preferred material for the first electrode is tantalum.
  • tantalum When tantalum is used for the active electrode, it quickly becomes coated with a layer of oxide material. This tantalum oxide is a poor electrical conductor, helping to ensure that the first electrode maintains its high impedance with respect to the tissue, and remains the active electrode.
  • Another way of helping to ensure that the temperature of the second electrode does not rise above 70° C is to maximise the transfer of heat away from the second electrode. Thus any heat reaching the second electrode from the first electrode is quickly transferred away before the temperature of the second electrode rises inordinately.
  • One way of achieving this is to form the second electrode from a material having a relatively high thermal conductivity, preferably greater than 150 W/m.K.
  • the second electrode may conveniently be provided with additional cooling means to remove heat therefrom, such as a heat pipe attached to the second electrode, or a cooling fluid constrained to flow along a pathway in contact with the second electrode.
  • additional cooling means such as a heat pipe attached to the second electrode, or a cooling fluid constrained to flow along a pathway in contact with the second electrode.
  • a temperature differential in use, between the first and second electrodes of at least 50° C, and preferably of between 100 and 200° C.
  • a third electrode adapted to coagulate tissue. This coagulation electrode is conveniently attached to the second electrode with a further electrical insulator therebetween.
  • the further electrical insulator it is preferable to arrange that heat is easily transferred across the further electrical insulator. This can be achieved by making the further insulator from a material having a relatively high thermal conductivity, or more typically, if the further insulator is not a good thermal conductor, by ensuring that the further insulator is relatively thin, typically no more than around 50 ⁇ m. In this way the transfer of heat across the further electrical insulator is greater than 5 mW/mm 2 .K.
  • the second and third electrodes are formed as conductive electrodes on an insulating substrate.
  • both the second and third electrodes act as return electrodes when the blade is used to cut tissue with the first electrode.
  • a coagulating RF signal is applied between the second and third electrodes.
  • a bipolar cutting blade comprising first and second electrodes and an electrical insulator spacing apart the electrodes, the first electrode having a characteristic which is dissimilar from that of the second electrode such that the first electrode is encouraged to become an active electrode and the second electrode is encouraged to become a return electrode, the spacing between the electrodes being between 0.25 mm and 1.0 mm, such that when the electrodes are in contact with tissue and an electrosurgical cutting voltage is applied therebetween, arcing does not occur directly between the electrodes, there being additionally provided a third electrode adapted to coagulate tissue, the third electrode being separated from the second electrode by an additional insulator.
  • the second and third electrodes are conveniently provided in a side-by-side arrangement with the additional insulator therebetween.
  • the second and third electrodes are provided as layers in a sandwich structure with the additional insulator therebetween.
  • the first, second and third electrodes are each provided as layers in a sandwich structure with layers of insulator therebetween.
  • a first one of the second and third electrodes is provided with a cut-out portion, and the other one of the second or third electrodes is provided with a protruding portion.
  • the cut-out portion of the one electrode accommodates the protruding portion of the other electrode, typically such that the protruding portion is flush with the electrode surrounding the cut-out portion.
  • the first, second and third electrodes are provided as layers in a sandwich structure with the first electrode being in the middle, there being layers of insulator between each of the electrodes.
  • the second and third electrodes are substantially semi-circular in cross-section, and the first electrode protrudes slightly beyond the periphery of the second and third electrodes.
  • a method of cutting tissue at a target site comprising providing a bipolar cutting blade comprising first and second electrodes and an electrical insulator spacing apart the electrodes, the first electrode having a characteristic which is dissimilar from that of the second electrode such that the first electrode is encouraged to become an active electrode and the second electrode is encouraged to become a return electrode; bringing the blade into position with respect to the target site such that the second electrode is in contact with tissue at the target site and the first electrode is adjacent thereto; supplying an electrosurgical cutting voltage to the cutting blade, the electrosurgical voltage and the spacing between the first and second electrodes being such that arcing does not occur in air between the first and second electrodes, but that arcing does occur between the first electrode and the tissue at the target site, current flowing through the tissue to the second electrode; and preventing heat build up at the second electrode such that the temperature of the second electrode does not rise above 70° C.
  • the method is such that both the first and second electrodes come into contact with tissue at the target site substantially
  • FIG. 1 is a schematic diagram of an electrosurgical system constructed in accordance with the present invention
  • FIG. 2 is a schematic cross-sectional view of an electrosurgical cutting blade constructed in accordance with the present invention
  • Figure 3 is a schematic diagram showing the lateral cutting action of the blade of Figure 2
  • Figure 4a to 4d are schematic cross-sectional views of alternative embodiments of electrosurgical cutting blades constructed in accordance with the invention
  • Figures 5a and 5b are schematic diagrams of electrosurgical cutting blades constructed in accordance with the present invention, incorporating cooling means
  • Figures 6a and 6b are schematic diagrams of electrosurgical cutting blades constructed in accordance with the present invention, incorporating an additional coagulation electrode.
  • a generator 10 has an output socket 10S providing a radio frequency (RF) output for an instrument 12 via a connection cord 14. Activation of the generator 10 may be performed from the instrument 12 via a connection in the cord 14, or by means of a footswitch unit 16, as shown, connected to the rear of the generator by a footswitch connection cord 18.
  • the footswitch unit 16 has two footswitches 16A and 16B for selecting a coagulation mode and a cutting mode of the generator 10 respectively.
  • the generator front panel has push buttons 20 and 22 for respectively setting coagulation and cutting power levels, which are indicated in a display 24. Push buttons 26 are provided as an alternative means for selection between coagulation and cutting modes.
  • the instrument 12 comprises a blade shown generally at 1 and including a generally flat first electrode 2, a larger second electrode 3, and an electrical insulator 4 separating the first and second electrodes.
  • the first electrode 2 is formed of stainless steel having a thermal conductivity of 18 W/m.K (although alternative materials such as Nichrome alloy may also be used).
  • the second electrode 3 is formed from a highly thermally-conducting material such as copper having a thermal conductivity of 400 W/m.K (alternative materials including silver or aluminium).
  • the surface of the second electrode 3 is plated with a biocompatible material such as a chromium alloy, or with an alternative non-oxidising material such as nickel, gold, platinum, palladium, stainless steel, titanium nitride or tungsten disulphide.
  • the electrical insulator 4 is formed from a ceramic material such as A1 2 0 3 which typically has a thermal conductivity of 30 W/m.K.
  • Other possible materials for the insulator 4 are available which have a substantially lower thermal conductivity. These include boron nitride, porcelain, steatite, Zirconia, PTFE, reinforced mica, silicon rubber or other ceramic materials such as foamed ceramics or mouldable glass ceramic such as that sold under the trademark MACOR.
  • a conductive lead 5 is connected to the first electrode 2, and a lead 6 is connected to the second electrode 3.
  • the RF output from the generator 10 is connected to the blade 1 via the leads 5 and 6 so that a radio frequency signal having a substantially constant peak voltage (typically around 400N) appears between the first and second electrodes 2 and 3.
  • a radio frequency signal having a substantially constant peak voltage typically around 400N
  • the RF voltage will cause arcing between one of the electrodes and the tissue surface.
  • the first electrode 2 is smaller in cross-sectional area, and has a lower thermal capacity and conductivity than that of the second electrode 3, the first electrode will assume the role of the active electrode and arcing will occur from this electrode to the tissue 7.
  • Electrical current will flow through the tissue 7 to the second electrode 3, which will assume the role of the return electrode. Cutting of the tissue will occur at the active electrode, and the blade may be moved through the tissue.
  • the blade 1 may be used to make an incision in the tissue 7, or moved laterally in the direction of the arrow 8 in Figure 3 to remove a layer of tissue.
  • Figure 2 shows a further design of blade in which the first electrode 2 is shaped so as to contact the insulator 4 only intermittently along its length, with regions 13 over which the electrode bows outwardly from the insulator 4. This helps to minimise further the transfer of heat from the first electrode 2, through the insulator 4, to the second electrode 3.
  • Figure 4b shows a further arrangement in which the first electrode 2 is provided with many perforations 15 such that it is in the form of a mesh.
  • Figure 4c shows another arrangement in which there is an additional corrugated electrode layer 17 located between the first electrode 2 and the insulator 4, As before, this assists in helping to prevent heat generated at the first electrode 2 from reaching the second electrode 3, so as to maintain the thermal differential therebetween.
  • Figure 4d shows a variation on the blade of Figure 2, in which the blade is formed as a hook 19.
  • the first electrode 2, the second electrode 3 and the insulator 4 are all hook-shaped, and the operation of the device is substantially as described with reference to Figure 2.
  • the hook electrode is particularly suited for parting tissue, whether used as a cold resection instrument without RF energisation, or as an RF cutting instrument. Tissue may be held in the angle 20 of the hook 19, while being manipulated or cut.
  • the second electrode 3 is constituted by a relatively large mass of copper which is capable of conducting heat away from the electrode tip.
  • the function of the electrode 3 can be -further enhanced by employing cooling means as illustrated in Figures 5a and 5b.
  • the second electrode 3 is attached to a heat pipe shown generally at 27.
  • the heat pipe 27 comprises a hollow closed tube 28 with a distal end 29 adjacent to the electrode 3, and a proximal end 30 within the handpiece of the instrument 12.
  • the tube 28 has a cavity 31 therein, containing a low boiling temperature liquid 32 such as acetone or alcohol.
  • heat from the electrode 3 causes the liquid 32 at the distal end 29 of the tube to vaporise, and this vapour subsequently condenses at the proximal end 30 of the tube because it is relatively cool with respect to the distal end 29. In this way, heat is transferred from the distal end of the electrode 3 to the proximal end thereof, from where it can be further dissipated by the handpiece of the instrument 12.
  • FIG. 5b shows an alternative arrangement in which the heat pipe of Figure 5a is replaced with a forced cooling system shown generally at 33.
  • the cooling system 33 comprises a tube 34, again with a distal end 29 and a proximal end 30.
  • the tube 34 includes a coaxial inner tube 35 defining an inner lumen 36 and an outer lumen 37.
  • the inner tube 35 is perforated towards the distal end of the tube, so that the inner and outer lumens 36 and 37 are in communication one with another.
  • a self-contained pump 38 causes a cooling fluid 39 to be circulated up the inner lumen 36 to the distal end 29, ret-uming via the outer lumen 37 to be recirculated continuously.
  • the circulating fluid is heated by the electrode 3, and the heat is taken by the fluid to the proximal end 30 of the tube 34. In this way, the second electrode 3 is kept cool, despite the elevated temperature at the first electrode 2.
  • FIG. 6a a blade 1 is shown in accordance with the construction of Figure 4b, and like parts are designated with like reference numerals.
  • the third electrode 40 is attached to the second electrode 3, on the opposite side to the first electrode 2, and mounted on a further electrical insulator 41.
  • RF signals may be supplied to the third electrode 40 from the generator 10 via a lead 42.
  • the insulator 41 is formed from a thin layer of silicon rubber, alternative materials for the insulator 41 including polyamide, PEEK or PVC materials.
  • the thin layer ensures that heat can transfer across the silicon rubber layer and that the coagulation electrode 40 can benefit from the thermal conductivity properties of the second electrode 3. In this way, the coagulation electrode 40 can remain relatively cool despite any heat previously generated by the first electrode 2.
  • tissue is cut as previously described.
  • the third electrode 40 is placed in contact with the tissue 7, and a coagulating RF signal is applied between the second electrode 3 and the third electrode 40.
  • Figure 6b shows an alternative embodiment in which the second electrode 3 and third electrode 40 are metallised tracks on a substrate 43 of aluminium nitride material. As before, this material is electrically insulating yet a good thermal conductor, to allow for the conduction of heat away from the second and third electrodes.
  • Figure 7 shows an arrangement in which the first electrode 2 is located between the second and third electrodes 3 and 40.
  • Both the electrodes 3 and 40 are approximately semi-circular in cross-section, and form a generally cylindrical structure with the first electrode 2 protruding slightly from the central region thereof.
  • the insulating layer 4 separates the first electrode 2 from the second electrode 3, and the insulating layer 41 separates the first electrode 2 from the third electrode 40.
  • the generator 10 applies a cutting RF signal between the first electrode 2 and one or both of the second or third electrodes 3, 40.
  • the generator 10 applies a coagulating RF signal between the second electrode 3 and the third electrode 40.
  • the relatively large surface area of the electrodes 3 and 40 allows for effective coagulation of tissue, as well as for the conduction away of heat during cutting as previously described.
  • Figure 8 shows an alternative design of instrument in which the second and third electrodes 3 and 40 are provided side-by-side.
  • the first electrode 2 is substantially planar, and an insulating layer 4 separates the first electrode from the second and third electrodes 3 and 40 on the other side of the instrument.
  • the electrodes 3 and 40 are disposed in side-by-side arrangement, with an insulating section 41 therebetween.
  • the instrument can cut tissue with an RF signal between the first electrode 2 and one of the second or third electrodes 3, 40, or alternatively coagulate tissue with an RF signal between the second and third electrodes.
  • Figure 9 shows a further embodiment in which the first, second and third electrodes are provided as a series of layers in a "sandwich" arrangement.
  • the first electrode 2 is shown as the top layer in Figure 9, with the third electrode 40 as the bottom layer, with the second electrode 3 sandwiched therebetween.
  • Insulating layers 4 and 41 respectively serve to separate the first, second, and third electrodes.
  • This arrangement provides a relatively thick edge to the blade 1, which is designed to facilitate coagulation of tissue.
  • Figure 10 shows an arrangement which utilises features from both the sandwich and side-by-side electrode structures.
  • the electrodes are again provided in a sandwich arrangement, Figure 10 showing the first electrode 2 on the bottom rather than the top as shown in Figure 9.
  • the second electrode 3 is again in the middle of the sandwich, separated from the first electrode by an insulating layer 4.
  • the third electrode 40 is shown as the top electrode in Figure 10, but has a central recess though which a raised portion 50 of the second electrode 3 can protrude.
  • the second and third electrodes are separated by an insulator 41, and the top surface of the protrusion 50 is flush with the top of the third electrode 40.
  • This arrangement allows either the sides of the blade 1 or the top face as shown in Figure 10 to be used for the coagulation of tissue.
  • Figure 11 shows an arrangement in which the end of the blade 1 comprises a central first electrode 2 with insulating layers 4 and 41 on either side thereof.
  • the insulating layers 4 and 41 each have a slanting beveled distal end, as shown at 51 and 52 respectively.
  • a second elecfrode 3 is attached to the insulating layer 4, the beveled end 51 resulting in the second electrode being set back axially from the first electrode 2 in the axis of the blade.
  • a third electrode 40 is attached to the insulating layer 41, the beveled end 52 resulting in the third electrode also being axially set back from the first electrode 2.
  • the beveled ends 51 and 52 allow for a minimum separation (shown at "x" in Fig 11) of 0.25 mm between the first electrode and the second and third electrodes, while maintaining an overall slim profile to the blade 1.
  • the first electrode 2 can be flush with the ends of the first and second insulating layers 4 and 41, or may project slightly therefrom as shown in Figure 11. As described previously, the transfer of heat by the first electrode can be reduced by a number of techniques, including attaching it to the insulating layers in a discontinuous manner, or perforating it with a plurality of holes in order to reduce heat transfer.
  • the invention relies on the careful selection of a number of design parameters, including the spacing between the first and second electrodes, the voltage supplied thereto, the size and materials selected for the electrodes, and for the electrical insulator or insulators.
  • This careful selection should ensure that there is no direct arcing between the electrodes, that only one electrode is encouraged to be the active electrode, and that the return electrode is kept cool either by preventing heat reaching it and/or by transferring heat away from it should the heat reach the second electrode.
  • the relatively cool return electrode ensures that there is relatively little or no thermal damage to tissue adjacent the return of the instrument, while the tissue assists in the conduction of heat away from the return.

Abstract

L'invention concerne une lame de coupe électrochirurgicale (1) comprenant une première électrode (2), une seconde électrode (3) et un isolant électrique (4) disposé entre la première électrode (2) de la seconde électrode (3). La première et la seconde électrode (2, 3) présentent différentes caractéristiques (superficie de la section transversale, conductivité thermique, etc.), permettant à la première électrode (2) d'avoir la fonction d'une électrode active et à la seconde électrode (3) d'avoir la fonction d'une électrode de retour. La distance qui sépare la première électrode (2) de la seconde électrode (3) (comprise entre 0,25 mm et 3,0 mm) et la tension de crête fournie aux électrodes (2, 3) sont sélectionnées de façon que l'arc électrique ne se forme pas directement entre les électrodes, mais plutôt entre la première électrode (2) et le tissu visé. Cet agencement permet d'établir un différentiel thermique d'au moins 50 °C entre la première et la seconde électrode (2, 3), la seconde électrode (3) étant maintenue à une température inférieure à 70 °C. Pour obtenir ce résultat, il suffit d'isoler thermiquement la seconde électrode (3) par rapport à la première électrode (2) et/ou d'évacuer la chaleur de la seconde électrode (3) par conduction, par refroidissement forcé ou à l'aide d'un caloduc (27), par exemple.
EP02791916A 2001-12-27 2002-12-23 Instrument chirurgical Ceased EP1458300A1 (fr)

Applications Claiming Priority (7)

Application Number Priority Date Filing Date Title
GBGB0130975.6A GB0130975D0 (en) 2001-12-27 2001-12-27 A surgical instrument
GB0130975 2001-12-27
GB0206207 2002-03-15
GB0206207A GB0206207D0 (en) 2002-03-15 2002-03-15 A surgical instrument
GB0215402 2002-07-03
GB0215402A GB0215402D0 (en) 2002-07-03 2002-07-03 A surgical instrument
PCT/GB2002/005893 WO2003055402A1 (fr) 2001-12-27 2002-12-23 Instrument chirurgical

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WO2003055402A1 (fr) 2003-07-10
AU2002358220B2 (en) 2008-09-25
AU2002358220A1 (en) 2003-07-15
JP2005512726A (ja) 2005-05-12

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