ES2355872T3 - MEDICAL DEVICES AND SYSTEMS ASSISTED WITH FLUID. - Google Patents

Abstract

An electrosurgical device comprising: a distal part having a bipolar electrode configuration; a first electrode tip spaced from a second electrode tip, the first electrode tip serves as a first pole of the bipolar electrode configuration and the second electrode tip serves as a second pole of the bipolar electrode configuration; the first electrode tip is assembled next to a distal end of a first trunk and the second electrode tip is assembled next to a distal end of a second trunk; a first fluid passage in fluid communication with a first fluid outlet opening and a second fluid passage in fluid communication with a second fluid outlet opening: the first fluid outlet opening next to the first electrode tip and the second fluid outlet opening next to the second electrode tip; the first electrode tip comprises an electrically conductive spherical distal end surface; and the second electrode tip comprises an electrically conductive spherical distal end surface; in which: the first and second electrode tips are configured to slide on a tissue surface and rotate when the electrodes move along the tissue surface in the presence of a fluid supplied from the fluid outlet openings and an electric current supplied from the electrode tips.

Description

Medical devices and systems assisted with fluid.

Ambit

This invention generally relates to the field of medical devices, systems and methods for use in a body during surgery. More particularly, the invention It is related to electrosurgery devices, systems and methods for use in human body tissues during surgery, particularly open surgery and minimally surgery invasive, such as laparoscopic surgery.

Background

The electrosurgical devices configured for use with a dry tip they use electric power, more usually radiofrequency energy (RF), to cut the tissue or to cauterize blood vessels. During use, a voltage gradient at the tip of the device, which induces the tissue a flow of current and a generation of heat related. With sufficiently high levels of electrical energy,  the heat generated is sufficient to cut the tissue and, advantageously, to stop bleeding from the blood vessels cut.

The current electrosurgical devices of dry tip can cause tissue temperature in treatment significantly increase much more than 100 ° C, giving place to desiccation of the tissue, the glue of the tissue to the electrodes, tissue perforation, formation of carbonization and smoke generation. The maximum temperatures of the tissues as a result of an RF treatment of the tissue target can be as high as 320 ° C, and these temperatures as elevated can be transmitted to adjacent tissues by diffusion thermal The unwanted results of such transmission to Adjacent tissues include unintended thermal damage to the tissue.

The use of a saline solution according to the present invention to apply RF electrical energy to tissues inhibits such unwanted effects as the glued, the drying, smoke production and carbonization formation. A key factor is the inhibition of tissue desiccation, which is Produces when tissue temperature exceeds 100 ° C and all intracellular water boils, leaving the tissue extremely dry and much less electrically conductive. However, a flow uncontrolled or abundant saline can provide too much cooling at the electrode / tissue contact point. This cooling reduces the temperature of the target tissue that is is trying, and the rate at which coagulation occurs Thermal tissue is determined by the temperature of the tissue. This, in turn, it may result in more treatment time long to achieve the desired tissue temperature for the tissue treatment Long treatment times are not desirable for surgeons, since it is in the best interest of the patient, doctor and hospital, perform procedures Surgical as fast as possible.

The RF energy delivered to the tissue can be unpredictable and often not optimal when using generators of general use. Most general purpose RF generators they have modes for different waveforms (for example, cut, coagulation or a mixture of these two) and types of devices (for example, monopole, bipolar), as well as power levels that You can set in watts. However, once they have been chosen these adjustments, the real power delivered to the fabric and the heat generated associated can vary dramatically over time since that the impedance of the tissue changes with the course of RF treatment. This is because the power delivered by the Most generators are a function of the impedance of the tissue, with the power decreasing as the impedance already either decreases towards zero or increases significantly to several Thousands of ohms The current electrosurgical devices of dry tip, are not set to cope with a change in the power provided by a generator when the tissue impedance and the associated effect on tissues and it based on the surgeon's experience to overcome this limitation.

WO 00/78240 discloses a device Bipolar electrosurgical with fluid delivery and electrodes with blunt spherical caps.

Summary of the invention

A certain provision provides a tissue treatment system. The system includes radio frequency power provided by a source of power supply with a power level; an electrically fluid conductive supplied from a fluid source with a flow rate of fluid; and an electrosurgical device configured to provide radiofrequency power and fluid electrically conductive to tissue.

In certain provisions the fluid Conductive is an indicator of tissue temperature. The fluid conductive can relate the temperature of the tissue to the boiling, a boiling amount or a boiling start of the conductive fluid.

The conductive fluid can cool the tissue or dissipate heat from tissue. Alternatively or additionally, the conductive fluid dissipates heat from at least one of the tissue and conductive fluid by boiling so less a part of the fluid.

For other provisions, at least one of between the radiofrequency power level and the fluid flow conductive is used to boil the fluid electrically conductive In addition, in some provisions, the boiling effect may comprise at least one of start, increase, decrease and eliminate the boiling of the fluid electrically conductive

For other arrangements, the fluid electrically conductive works to limit the temperature of the tissue on the surface of the tissue at approximately one boiling temperature of electrically conductive fluid.

In general, electrically conductive fluid protects the tissue from drying out. In some provisions, the conductive fluid protects the tissue from desiccation by boiling of at least a part of the electrically conductive fluid. In other embodiments, the electrically conductive fluid protects the boiling desiccation tissue of at least one part of the conductive fluid at a temperature below the tissue drying temperature.

For some arrangements, the fluid electrically conductive is supplied to the tissues in the tissue surface and radiofrequency power is also supplies the tissues on the surface of the tissue. The power radio frequency reaches below the surface of the tissue at tissue through (through) the electrically conductive fluid on the surface of the tissue.

At least one of the power level radio frequency and conductive fluid flow rate can adjust based on a boiling of the conductive fluid. Further, for other provisions, the adjustment of at least one of the radiofrequency power level and fluid flow conductive based on a boiling of the conductive fluid comprises one of start, increase, decrease and eliminate boiling of electrically conductive fluid.

In certain provisions, a tissue treatment method, which comprises providing radio frequency power with a power level; provide an electrically conductive fluid with a fluid flow rate; Y provide an electrosurgical device configured to provide radiofrequency power and fluid electrically conductive to tissue.

Even more, a system for the tissue treatment, the system comprises power of radio frequency provided by a power supply with a power level; an electrically conductive fluid supplied from a fluid source with a fluid flow rate; a device electrosurgical configured to provide the power of radiofrequency and electrically conductive fluid to tissue; Y a fluid coupling that attaches to the tissue and the device electrosurgical, the coupling comprises the fluid conductive.

In certain provisions the coupling Fluid is an indicator of tissue temperature. The coupling  fluid can function as an indicator of the temperature of the tissue by using the boil; a quantity of boiling; or a boiling start of the fluid coupling.

For other arrangements, fluid coupling cools the tissue or dissipates heat from the tissue. Fluid coupling it can dissipate heat from at least one of the tissue and the fluid coupling by boiling at least one part of the fluid coupling. For other arrangements, the coupling fluid can limit the temperature of the tissue on the surface of the tissue at a boiling temperature of the coupling fluid.

The fluid coupling can protect the tissue of desiccation In some arrangements, fluid coupling protects the tissue from desiccation by boiling at least a part of the fluid coupling. In other embodiments, the fluid coupling protects the tissue from drying out by boiling at least a part of the fluid coupling to a temperature that protects the tissue from drying out.

For other provisions, at least one of between the radiofrequency power level and the fluid flow conductive is used to boil the coupling fluid. In addition, in some provisions, the effect of boil can be at least one of start, increase, decrease and eliminate boiling of the fluid coupling.

Conductive fluid can be provided to the tissue on the tissue surface, and radiofrequency power  it can also be provided to the tissue on the surface of the tissue. The radio frequency power can be provided to a area below tissue surface by (through) the fluid coupling on the tissue surface.

In certain provisions, a tissue treatment method, the method comprises the radio frequency power supply with a power level; provide an electrically conductive fluid with a flow rate of fluid; provide a configured electrosurgical device to provide radiofrequency power and fluid electrically conductive to tissue; and form a fluid coupling  which couples the tissue and the electrosurgical device. He fluid coupling comprises conductive fluid.

The fluid coupling can be used as a tissue temperature indicator. This can be done by boiling; a boiling amount of the fluid coupling; or a beginning of boiling of the fluid coupling.

For some provisions, the coupling fluid is used to cool the tissue or dissipate heat from the fabric by transferring heat to the fluid coupling. He fluid coupling can dissipate heat from at least one of between the tissue and the fluid coupling by boiling of by at least a part of the fluid coupling.

For other provisions, at least one of between the radiofrequency power level and the fluid flow conductive is adjusted based on a coupling boil fluid. In addition, for other provisions, the adjustment of at least one of the radiofrequency power level and the flow rate of conductive fluid based on a boiling fluid coupling includes one of start, increase, decrease and eliminate the boiling fluid coupling.

For other provisions, the temperature of the tissue on the surface of the tissue is limited to approximately one boiling temperature of the fluid coupling.

For other arrangements, the fabric is protected of drying with the fluid coupling. In addition, for others arrangements, the fabric is protected from drying with the fluid coupling by boiling at least one part of the fluid coupling. In addition, for other arrangements, the fabric it is protected from drying out with the fluid coupling by a boiling at least a part of the fluid coupling to a temperature that protects the tissue from drying out.

The tissue treatment method can further comprise supplying the conductive fluid to the tissue in the tissue surface; and provide the radio frequency power to the tissue on the surface of the tissue and below the surface of the tissue in the tissue through the fluid coupling.

In regards to specific devices, in certain provisions a device is provided Surgical tissue treatment comprising a handle that it has a proximal end and a distal end; a trunk that extends distally beyond the distal end of the handle, the trunk has a proximal end and a distal end; a tip of electrode, at least a part of the electrode tip is extends distally beyond the distal end of the trunk, the electrode tip extends distally beyond the distal end of the trunk comprising a superficial part spherical end and a cylindrical lateral surface part, the extreme spherical superficial part is distal of the part cylindrical lateral surface and comprises at least a part of the distal end surface of the surgical device; and one step of fluid directed to provide a fluid towards the part cylindrical side of the electrode tip.

In other provisions, a surgical device for the treatment of tissues comprising a handle that has a proximal end and a distal end; a trunk that extends distally beyond the end distal to the handle, the trunk has a proximal end and an end distal; an electrode tip, at least a part of the tip electrode extends distally beyond the end distal to the trunk, the electrode tip extends in the direction distal beyond the distal end of the trunk comprising a neck part and an enlarged head part, the enlarged part of head is distal of the neck part and includes minus a part of the distal end surface of the device surgical; and a directed fluid passage to provide a fluid towards the enlarged head part of the tip of electrode.

In even other provisions, it is provided a device for the treatment of tissues comprising a handle that has a proximal end and a distal end; a trunk which extends distally beyond the distal end of the handle, the trunk has a proximal end and a distal end; a electrode tip, the electrode tip comprises a part extreme spherical surface and a lateral superficial part cylindrical, the spherical end surface part is located distal of the cylindrical lateral surface part and comprises at least a part of the distal end surface of the device; a fluid passage can be connected to a fluid source; and one plurality of fluid outlet openings in communication of fluids with fluid passage, fluid outlet openings are located to provide a fluid from the source of fluid around the cylindrical lateral surface part of the electrode tip

In even other provisions, it is provided a device for the treatment of tissues comprising a handle that has a proximal end and a distal end; a trunk which extends distally beyond the distal end of the handle, the trunk has a proximal end and a distal end; a electrode tip comprising an extreme surface part distal rounded configured for blunt tissue dissection and a lateral surface part configured to seal the tissue of at least one of the flow of body fluids and air, the lateral surface part has a surface area greater than the surface area of the distal extreme superficial part; one step from fluid can be connected to a fluid source; and at least one fluid outlet opening in fluid communication with the passage of fluid, the fluid outlet opening is located for provide a fluid from the fluid source to the part lateral surface of the electrode tip and proximal to the part Extreme distal surface.

In accordance with the invention, a tissue treatment device comprising a first spaced electrode tip relative to a second tip of electrode, the first and second electrode tips can be connect to different terminals of a radio frequency generator to generate the flow of electric current between them; for the minus a fluid passage that can be connected to a source of fluid; at least one fluid outlet opening in fluid communication with the fluid passage, the opening of fluid outlet is configured to provide a fluid from the source of fluid to at least one of a surface of tissue and at least one of the first electrode tips and second; and the first and second electrode tips are configured to slide and rotate on the fabric and seal it in presence of a fluid supplied from the outlet opening of fluid and an electric current supplied from the tips of electrode.

Other methods for treating tissues may also comprise providing a tissue that has a tissue surface; supply radio frequency power with a power level; provide an electrically conductive fluid with a fluid flow rate; provide a surgical device configured to simultaneously provide radiofrequency power and electrically conductive fluid to the tissue; provide electrically conductive fluid to the tissue on the surface of the tissue; forming a fluid coupling comprising the electrically conductive fluid that couples the tissue and the surgical device; provide the radiofrequency power to the tissue at the tissue surface and below the tissue surface to the tissue through the fluid coupling; clog the tissue against at least one of the flow of body fluids and air by at least one of the collagen contraction and blood clotting in the tissue; and make a blunt dissection of the
tissue.

In other provisions, the methods for tissue treatment may also comprise providing a tissue that has a tissue surface; supply power of radiofrequency with a power level; provide a fluid electrically conductive with a fluid flow rate; provide a surgical device configured to provide simultaneously the radiofrequency power and the fluid electrically conductive to tissue, the surgical device it comprises a first electrode tip and a second tip of electrode; provide electrically conductive fluid to tissue on the surface of the tissue; form a fluid coupling comprising the electrically conductive fluid that couples the tissue and surgical device; provide the power of radiofrequency to tissue on tissue surface and below from the surface of the tissue to the tissue through the coupling fluid; slide the first electrode tip and the second tip electrode on the tissue surface; and seal the tissue against at least one of the flow of body fluids and the air by at least one of the contraction of the collagen and blood clotting in the tissue.

Brief description of the drawings

To better understand and appreciate the invention, reference is made to the following detailed description in relation to with the accompanying drawings, generated by hand and by computer:

Figure 1 is a block diagram that shows an arrangement of a control system that is not part of the invention, and an electrosurgical device;

Figure 2 is a schematic graph that describes the relationship between the RF power in the tissue (P), the saline flow rate (Q) and tissue temperature (T), when heat conduction to tissues is considered adjacent;

Figure 3 is a schematic graph that describes the relationship between the RF power in the tissue (P), the saline flow rate (Q) and tissue temperature (T), when heat conduction to tissues is not considered adjacent;

Figure 4 is a schematic graph that describes the relationship between the RF power in the tissue (P), the saline flow rate (Q) and tissue temperature (T), when considering the heat required to heat the tissue to the maximum temperature (T) 68;

Figure 5 is a graph showing the relationship between the boiling percentage of the saline solution and the saline flow rate (cc / min) for an example output of 75 watt RF generator;

Figure 6 is a schematic graph that describes the relationship between the impedance of the load (Z, in ohms) and the generator output power (P, in watts), for a 75 watt generator output example in one mode bipolar;

Figure 7 is a schematic graph that describe the relationship between time (t, in seconds) and the tissue impedance (Z, in ohms) after activation of the RF;

Figure 8 is a schematic view in perspective of a cannula that can be used with a device electrosurgical according to the present invention;

Figure 9 is an exploded schematic view. ordered of a set of an electrosurgical device of according to the present invention;

Figure 10 is a schematic view. longitudinal lateral cross section of the tip and trunk of the device of figure 9 taken along the line 10-10 of Figure 12;

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Figure 11 is a schematic view. longitudinal foreground in lateral cross section of the part of the tip of the device delimited by circle 45 that is shown in figure 10, taken along the line 10-10 of Figure 12;

Figure 12 is a schematic view from a distal end of the tip part of the delimited device by circle 45 shown in figure 10;

Figure 13 is a schematic side view of the tip and trunk of the device of figure 9 with a fluid coupling on a tissue surface of the tissues;

Figure 14 is a schematic side view in cross section close-up of a pointed part alternative;

Figure 15 is a schematic side view in close-up in section of the pointed part of figure 14 taken along line 15-15 of figure 14;

Figure 16 is a schematic side view in close-up in cross section of the pointed part of the Figure 14 arranged in a tissue crack;

Figure 17 is a schematic graph of the impedance Z versus time t showing changes in the impedance represented by impedance peaks;

Figure 18 is a schematic graph of the Z impedance versus% boiling fluid;

Figure 19 is a first schematic view. cross-sectional plane of the tube taken along the line 19-19 of Figure 15;

Figure 20 is a perspective view. foreground schematic of an alternative tip part;

Figure 21 is a schematic side view in sectional close-up of the pointed part of figure 20 taken along line 21-21 of figure 20;

Figure 22 is a schematic side view in close-up in cross section of the pointed part of the Figure 20 arranged in a tissue crack;

Figure 23 is a schematic front view in foreground perspective of the electrode for the tip part of figure 20;

Figure 24 is a schematic rear view in foreground perspective of the electrode for the tip part of figure 20;

Figure 25 is a schematic sectional view. cross-sectional foreground of a porous electrode with indentations;

Figure 26 is a schematic sectional view. cross-sectional foreground of a slit electrode semicircular;

Figure 27 is a schematic sectional view. cross-sectional foreground of a slit electrode with V shape;

Figure 28 is a schematic sectional view. cross-sectional foreground of a slit electrode with U shape;

Figure 29 is a perspective view foreground schematic of an alternative tip part;

Figure 30 is a schematic side view in close-up in section of the pointed part of figure 29 taken along line 30-30 of figure 29;

Figure 31 is a schematic front view in foreground perspective of the electrode for the tip part of figure 29;

Figure 32 is a schematic rear view in foreground perspective of the electrode for the tip part of figure 29;

Figure 33 is a schematic view in foreground perspective of an alternative pointed part;

Figure 34 is a schematic side view in close-up in section of the pointed part of figure 33 taken along line 34-34 of Figure 33;

Figure 35 is a schematic front view in foreground perspective of the electrode for the tip part of figure 33;

Figure 36 is a schematic rear view in foreground perspective of the electrode for the tip part of figure 33;

Figure 37 is a schematic view in foreground perspective of an alternative pointed part;

Figure 38 is a schematic side view in close-up in section of the pointed part of figure 37 taken along line 38-38 of figure 37;

Figure 39 is a schematic view in foreground perspective of an alternative pointed part;

Figure 40 is a schematic side view in close-up in section of the pointed part of figure 39 taken along line 40-40 of figure 39;

Figure 41 is a schematic view in front rear perspective on the electrode foreground for the pointed part of figure 39;

Figure 42 is a schematic view in front foreground perspective on the electrode for the pointed part of figure 39;

Figure 43 is a schematic side view of the pointed part of figure 39 with a fluid coupling in a tissue surface of the tissue;

Figure 44 is a schematic front view of the pointed part of figure 39 with a fluid coupling in a tissue surface of the tissue;

Figure 45 is a schematic side view of the pointed part of figure 39 with a fluid coupling in a tissue surface of the tissue;

Figure 46 is a schematic view in exploded perspective of a set of a device alternative electrosurgical according to the present invention;

Figure 47 is a schematic side view in cross section in the foreground of the pointed parts of the Figure 46 assembled with a fluid coupling on a surface tissue tissue;

Figure 48 is a schematic side view in cross section in the foreground of the pointed parts of the Figure 46 assembled with an alternative fluid coupling in a tissue surface of the tissue;

Figure 49 is a schematic view in exploded perspective of a set of a device alternative electrosurgical not in accordance with this invention;

Figure 50 is a schematic side view in cross section in the foreground of the pointed parts of the Figure 49 assembled with a fluid coupling on a surface tissue tissue;

Figure 51 is a schematic view in exploded perspective of a set of a device alternative electrosurgical not in accordance with this invention;

Figure 52 is a schematic side view in foreground perspective of a distal end of the device of figure 51;

Figure 53 is a schematic side view in foreground cross section of a distal end portion of the device of figure 51 assembled with a fluid coupling in a tissue surface of the tissue;

Figure 54 is a schematic view in perspective of an alternative electrosurgical device not of according to the present invention;

Figure 55 is a schematic view in perspective of an alternative electrosurgical device not of according to the present invention;

Figure 56 is a schematic view in close-up perspective of the device arms of the figure 55;

Figure 57 is a schematic view in foreground perspective of a distal end of the device of figure 55;

Figure 58 is a schematic view in foreground perspective of a distal end of the device of figure 55;

Figure 59 is a schematic view in perspective of an alternative electrosurgical device not of according to the present invention;

Figure 60 is a schematic view in close-up perspective of the device arms of the figure 59;

Figure 61 is a schematic view in foreground perspective of a distal end of the device of figure 59;

Figure 62 is a schematic view in foreground perspective of a distal end of the device of figure 59;

Figure 63 is a schematic view in foreground perspective of a distal end of a alternative electrosurgical device not in accordance with the present invention;

Figure 64 is a schematic view in foreground perspective of a distal end of the device of figure 63 with tissue;

Figure 65 is a schematic view in close-up perspective of the arms of a device alternative electrosurgical not in accordance with this invention;

Figure 66 is a schematic view in foreground perspective of a distal end of the device arms of figure 65 with collar retired;

Figure 67 is a schematic view in foreground perspective of a distal end of the device of figure 65;

Figure 68 is a schematic view in foreground perspective of a distal end of the device of figure 65 with an arm removed;

Figure 69 is a schematic view in foreground perspective of the device collar figure 65;

Figure 70 is a schematic view in foreground perspective of a distal end of a alternative electrosurgical device not in accordance with the present invention;

Figure 71 is a schematic view in foreground perspective of a distal end of the device of figure 70;

Figure 72 is a schematic view in foreground perspective of a distal end of a alternative electrosurgical device not in accordance with the present invention;

Figure 73 is a schematic side view in foreground of a distal end part of the device of the figure 72;

Figure 74 is a schematic view in perspective of an alternative electrosurgical device not of according to the present invention;

Figure 75 is a schematic view in perspective of a handle part of the device of figure 74 assembled with various components;

Figure 76 is a schematic side view in close-up of a part of the assembly of figure 75;

Figure 77 is a schematic side view in close-up of a part of the assembly of figure 75;

Figure 78 is a partial schematic view front in cross section of the electrical connections for the device of figure 74;

Figure 79 is a partial schematic view rear cross-section of the electrical connections for the device of figure 74;

Figure 80 is a schematic view in perspective of an alternative electrosurgical device not of according to the present invention;

Figure 81 is a schematic side view of a handle part of the device of figure 80 assembled with various components;

Figure 82 is a schematic view in perspective of an alternative electrosurgical device of according to the present invention;

Figure 83 is a schematic view in perspective of a handle part of the device of figure 82 assembled with various components;

Figure 84 is a schematic side view of a handle part of the device of figure 82 assembled with various components;

Figure 85 is a schematic side view of a handle part of the device of figure 82 assembled with various components;

Figure 86 is a schematic side view of a handle part of the device of figure 82 assembled with various components;

Figure 87 is a schematic view in perspective of an alternative electrosurgical device of according to the present invention;

Figure 88 is a schematic view in perspective of a handle part of the device of the figure 87;

Figure 89 is a schematic side view of a handle part of the device of figure 87;

Figure 90 is a schematic view in perspective of a handle part of a device alternative electrosurgical not in accordance with this invention; Y

Figure 91 is a schematic side view of the handle part of figure 90.

Figure 92 is a schematic view in perspective of a handle part of a device alternative electrosurgical not in accordance with this invention; Y

Figure 93 is a schematic side view of the handle part of figure 92.

Detailed description

Throughout this description, the reference numbers and similar letters indicate a structure corresponding for all the various views and said structure corresponding does not have to be explained separately. Further, any particular feature (s) of an example of particular embodiment can also be applied to any another example of embodiment (s) of this specification as appropriate. In other words, the characteristics between the different embodiments described herein They are interchangeable as appropriate and not exclusive.

The invention is provided in accordance with the device of claim 1. The invention is particularly useful during surgical interventions on the tissues of the body, in which it is desirable to coagulate and contract the tissue, to occlude the internal blood vessel passages (for example, arteries, veins), the airways (for example, bronchi, bronchioles), bile ducts and lymphatic ducts.

The disclosure includes procedures electrosurgical, which preferably use RF power and electrically conductive fluid, for tissue treatment. Preferably, a desired temperature range is achieved. of tissue by adjusting some parameters, such as the flow rate of conductive fluid, which affect the temperature at the point of tissue / electrode contact. Preferably, the device gets a desired tissue temperature by using a Desired boiling percentage of the conductive solution in the tissue / electrode contact point.

In one arrangement, the invention provides a control device, the device comprises a controller of flow that receives a signal that indicates the power applied to the system and adjusts the flow of conductive fluid from a source of fluid to an electrosurgical device. The disclosure also contemplates a control system comprising a controller of flow, a measuring device that measures the power applied to the system and a pump that supplies the fluid with a flow selected.

The disclosure will be generally explained by reference to figure 1. Figure 1 shows a diagram of blocks of an example arrangement of a system of the invention. Preferably, as shown in Figure 1, a electrically conductive fluid 24 from a source 1 of fluid to through a fluid pipe 2 to a pump 3, which has a fluid outlet pipe 4a that connects as pipe 4b of fluid inlet to an electrosurgical device 5. In a preferred arrangement, the fluid outlet line 4a and the 4b fluid inlet pipe are flexible and are made of a polymeric material, such as polyvinyl chloride (PVC) or of polyolefins (for example, polypropylene, polyethylene) and the conductive fluid comprises a saline solution. Plus preferably, the saline solution comprises a sterile solution and even more preferably a normal saline solution. Although the description of this report specifically describes the use of saline solution as fluid 24, other fluids can be used electrically conductive, as well as non-conductive fluids, of according to the invention.

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For example, in addition to the conductive fluid that comprises physiological saline (also known as "normal" saline solution, isotonic saline solution or solution 0.9% sodium chloride (NaCl), the conductive fluid can comprise a hypertonic saline solution, a saline solution hypotonic, Ringer's solution (a physiological water solution distilled containing certain amounts of sodium chloride, calcium chloride and potassium chloride), lactate solution Ringer (a sterile solution of water crystalloid electrolyte distilled containing certain amounts of calcium chloride, potassium chloride, sodium chloride and sodium lactate), solution from Ringer-Locke (isotonic water buffer solution distilled containing certain amounts of sodium chloride, potassium chloride, calcium chloride, sodium bicarbonate, magnesium chloride and dextrose), or any other solution of electrolytes In other words, a solution that drives the electricity through an electrolyte, a substance (salt, acid or base) that dissociates into electrically charged ions when dissolves in a solvent solution, such as water, which results to a solution comprising an ionic conductor.

While a conductive fluid is preferred, such as it will become more evident with the reading of this descriptive report, the fluid 24 may also comprise a fluid electrically not conductive. The use of a non-conductive fluid is less preferred than a conductive fluid since the nonconductive fluid does not conduct the electricity. However, the use of a non-conductive fluid still offers certain advantages over the use of an electrode dry that includes, for example, a smaller appearance of glued tissue to the electrode of the device 5 and cooling of the electrode and / or the tissue. Therefore, the include the use of a nonconductive fluid, such as water deionized

Going back to figure 1, the energy for heating the tissues is provided from a source of power, such as an electric generator 6, which provides preferably alternating current RF energy through a cable 7 to source output measuring device power, such as a power measuring device 8, which measures the electrical power of alternating current RF. In a arrangement example, preferably device 8 of power measurement does not disconnect, connect or alter the power of no way. The generator manufacturer provides preferably a power switch 15 connected to the generator 6 and is used to turn the generator on and off 6. The switch power 15 can comprise any switch for turn the power on and off, and is often provided in Shape of a foot switch or other easy-to-use switch, such as a switch 15a mounted on the device electrosurgical 5. Power switch 15 or 15a also It can work as a manual drive device for increase or decrease the rate of energy provided from the surgical device 5. Alternatively, internal circuits and the other components of generator 6 can be used to automatically increase or decrease the energy rate provided by surgical device 5. A cable 9 carries preferably the RF energy from the measuring device 8 of power to the electrosurgical device 5. The power, or any output of the power source, is preferably measured before the electrosurgical device arrives 5.

For the situation in which the effects of the capacitance and induction are negligible, from the law Ohm, the P power, or the power supply rate (for example joules / s), can be expressed by the product of the tension and the current (i.e., I x V), the resistance by the current at square (that is, I2 x R), or the voltage squared divided by resistance (i.e., V2 / R); where the current I can be measured in amps, voltage V can be measured in volts, the electrical resistance R can be measured in ohms and power P It can be measured in watts (joules / s). Since the power P is function of current I, voltage V and resistance R as indicated above, it should be understood that a change in power P is the reflection of a change of at least one of the variables of entry. Therefore, as an alternative, changes can be measured in such input variables, instead of the power P directly, with such changes in the input variables Mathematically corresponding to changes in power P, as has indicated above.

As for the frequency of the RF electrical energy, a range between and including approximately 9 kHz (kilohertz) is preferably provided within a frequency band (i.e. a continuous frequency range that extends between two limit frequencies). at 300 GHz (gigahertz). More preferably, RF energy is provided within a frequency band in the range between and including approximately 50 kHz (kilohertz) to 50 MHz (megahertz). Even more preferably, RF energy is provided within a frequency band in the range between and including approximately 200 kHz (kilohertz) to 2 MHz (megahertz). More preferably, RF energy is provided within a frequency band in the range between and including approximately 400 kHz (kilohertz) to 600 kHz (kilohertz). In addition, it should also be understood that, for any frequency band identified above, the frequency range can be further reduced in increments of 1 (one) hertz anywhere between the lower and lower limit frequencies.
higher.

While RF electrical energy is preferred, It should be understood that electrical energy (i.e. energy available by electric charge flow, usually through a driver or by self-propagation waves) can understand any frequency of the electromagnetic spectrum (it is that is, the entire range of radiation that extends in frequency from 1,023 hertz to 0 hertz) and that includes, but not limited to, gamma rays, x-rays, ultraviolet radiation, light visible, infrared radiation, microwave and any combination thereof.

Regarding the use of energy electric, tissue heating is preferably performed by resistance heating. In other words, the tissue temperature rise as a result of the flow of electrical current through the tissue, the electrical energy being absorbed from tension and transformed into thermal energy (heat for example) through the accelerated movement of ions in function of the electrical resistance of the tissue.

Heating with electrical energy can also be performed by diathermy (capacitance). In other words, the increase in tissue temperature due to the dissipation of electrical energy as a result of internal dielectric losses when the tissue is placed in a variable electric field, such as an alternating high frequency electromagnetic field (for example microwaves). The dielectric loss is the loss of electrical energy as heat in the polarization process in the presence of the applied electric field. In the case of an alternating current field, the
Energy is absorbed from the alternating current voltage and converted to heat during the polarization of the molecules.

However, it should be understood that energy provided to heat the tissue may comprise a surgical device other than devices electrosurgical, power supplies other than generators, forms of energy other than electrical energy and mechanisms other than resistance heating. For example, the supply of thermal energy to the tissue from the source of energy with a (for example, greater) temperature difference. This can be provided, for example, to the tissue from a heated device that heats the tissue through contact direct with the power source (conduction), heats it by contact with a flowing fluid (convection), or from a source of distance heat (radiation).

Also, for example, the power supply to the tissues can be provided by mechanical energy that transformed into thermal energy by the accelerated movement of molecules, such as by the mechanical vibrations provided, for example, by the power source, such as a transducer that it contains a piezoelectric substance (for example, an oscillator of quartz crystal) that converts high electrical current frequency in vibratory ultrasonic waves that can be used, for example, by an ultrasonic surgical device.

Also, for example, the power supply to tissues can be provided by radiant energy (it is that is, energy that is transmitted by radiation / waves) that is transformed into thermal energy by energy absorption radiant by the tissue. Preferably, the radiation / waves comprises the radiation / electromagnetic waves that include, but not limited to, radio waves, microwaves, radiation infrared, visible light radiation, ultraviolet radiation, rays X and gamma rays. More preferably, said radiant energy comprises energy with a frequency of 3 x 10 11 hertz to 3 x 10 16 hertz (i.e. frequency bands of infrared, visible and ultraviolet of the electromagnetic spectrum). Also preferably the electromagnetic waves are coherent. and electromagnetic radiation is emitted from the source of energy, such as a laser device.

A flow controller 11 includes preferably a selection switch 12 that can be set to achieve the desired boiling percentage levels of fluid (for example, 100%, 98%, 80% boiling). Preferably, the flow controller 11 receives a signal from input 10 of the power measurement device 8 and calculates a mathematically predetermined appropriate fluid flow rate based on the boiling percentage indicated by the selection switch 12. In a preferred arrangement, a switch 13 is provided of fluid so that the fluid system can be prepared (by example, remove the air) before starting the generator 6. The output signal 16 of the flow controller 11 is sent preferably to the pump motor 3 to regulate the flow rate of conductive fluid and thereby provide a fluid flow rate adequate that corresponds to the amount of power that supplies.

In an example of provision, disclosure comprises a flow controller 11 that is configured and arranged to be connected to an RF power source (e.g. generator 6), and a fluid source (eg fluid source 1), for example, a source of conductive fluid. The device of the disclosure receives information about the RF power level applied to an electrosurgical device 5, and adjusts the flow rate from fluid 24 to electrosurgical device 5, controlling with it the temperature in the place of treatment of the tissue.

In another example of arrangement, the elements of the system are physically included together in the same enclosure electronic. An arrangement of this type is shown by the enclosure in contour box 14 of figure 1. In the illustrated arrangement, the pump 3, the flow controller 11 and the power measurement device 8 are enclosed within a enclosure, and these elements are connected by connections electrical to allow signal 10 to pass from device 8 of power measurement to flow controller 11 and signal 16 pass from flow controller 11 to pump 3. Inside an enclosure other elements of a system may also be included, depending of factors such as the desired application of the system and the user requirements

Pump 3 can be any suitable pump used in surgical procedures to provide a saline solution or other liquid with a desired flow rate. Preferably, the pump 3 comprises a peristaltic pump. With a rotary peristaltic pump, a fluid is normally transmitted 24 within the limits of a flexible tube (for example, 4a) by contraction waves located externally in the tube that they are produced mechanically, usually spinning rollers that press the hose against a support so intermittent. As an alternative, with a linear peristaltic pump, normally a fluid 24 is transmitted within the limits of a flexible tube by externally placed contraction waves in the tube that are produced mechanically, usually by a series of fingers or compression inserts that tighten the tube flexible against intermittent support. Generally prefers to use peristaltic pumps since the mechanism of electromechanical force (for example, rollers driven by a electric motor) that does not make contact with fluid 24, reducing thus the probability of accidental contamination.

Alternatively, pump 3 can be a "syringe pump", with a built-in fluid supply. With such a pump, usually a full syringe is in a electromechanical force mechanism (for example, a cylinder driven by an electric motor) that acts on the piston of the syringe to force delivery of the fluid 24 contained in it. Alternatively, the syringe pump may comprise a pump double acting syringe with two syringes so that they can drag saline from a reservoir (for example, from a fluid source 1), either simultaneously or intermittently. With a double acting syringe pump, the pumping mechanism is generally capable of both infusion and extraction. Normally, while fluid 24 is being ejected from a syringe, the other syringe is receiving fluid 24 in it from a separate deposit. In this way, the fluid delivery 24 continues being continuous and uninterrupted, since the syringes work in Serie. Alternatively, it should be understood that a Multi-syringe pump with two syringes or any number of syringes, according to the disclosure.

In addition, fluid 24, such as a fluid conductive, it can also be supplied from a bag intravenous (IV) filled with saline (for example, from a source 1 of fluid) that flows under the influence (i.e. force) of gravity. In such a way, the fluid 24 can flow directly to electrosurgical device 5, or first to the pump 3 in between. Alternatively, fluid 24 from a source 1 of fluid, such as an IV bag can be supplied through a IV flow controller that can provide a desired flow rate by adjusting the cross-sectional area of a hole flow (for example, the internal passage of the connective tube with the 5) electrosurgical device while detecting the flow rate with a sensor such as an optical drip counter. Further, fluid 24 from a source 1 of fluid, such as a bag intravenous can be supplied by an activated device manually or automatically such as a flow controller, such as a roller clamp, which also adjusts the sectional area transverse of a flow hole and can be adjusted so manual, for example, by the user of the device in response to your visual observation (for example, boiling of fluid) at the tissue treatment site or a pump.

Similar pumps can be used in relation to with the disclosure, and the illustrated embodiments are only examples. The exact configuration of pump 3 is not critical for the disclosure. For example, pump 3 may include other types of infusion and extraction pumps. In addition, pump 3 can understand the pumps that can be classified as pumps pistons, rotary vane pumps (e.g. axial rotor, centrifugal rotor), cartridge pumps and diaphragm pumps. In some arrangement, the pump 3 can be replaced by any type of flow controller, such as a manual roller clamp which is used together with an intravenous bag, or in combination with the flow controller to allow the user to control the conductive fluid flow to the device. As an alternative, a Valve configuration can replace pump 3.

In addition, configurations can be used similar to the system in relation to the disclosure, and the Illustrated embodiments are examples only. For example, the fluid source 1, pump 3, generator 3, device 8 of power measurement or flow controller 11, or any other system component that is not expressly mentioned previously, you can comprise a part of the device electrosurgical 5. For example, in an exemplary embodiment the fluid source 1 may comprise a compartment of the electrosurgical device 5, which contains fluid 24, as indicated with reference character 1a. In another example of arrangement, the compartment can be connected so detachable to electrosurgical device 5, such as a boat which can be joined by threaded coupling with device 5. In even another example of arrangement, the compartment can be configured to hold a cartridge full of fluid 24, instead of the fluid directly.

Also, for example, with respect to alternatives for generator 6, a power source such as a  DC battery used together with a circuit inverter and a transformer to produce alternating current at a determined frequency, may comprise a part of the device electrosurgical 5, as indicated with the character of reference 6a. In one arrangement the battery element of the Power source can comprise a rechargeable battery. In even another example of arrangement, the battery element can connect detachably to electrosurgical device 5, just like for recharge. System components are will describe in more detail below. In memory of descriptive, it should be clear that any use of the terms "distal" and "proximal" are made as a reference from the user of the device, and not the patient.

The flow controller 11 controls the flow rate from fluid source 1. Preferably, the fluid flow rate since fluid source 1 is based on the amount of RF power from generator 6 to electrosurgical device 5. In other words, as shown in figure 2, preferably there is a relationship between the fluid flow rate Q and the RF power P indicated by the Y and X axes of the schematic graph, respectively. More precisely, as shown in Figure 2, the relationship between the fluid flow rate Q and the RF power P can Express yourself as a direct and linear relationship. The flow rate Q of fluid conductive 24, such as a saline solution, interacts with the RF P power and different heat transfer modes outside of the target tissue, as described herein.

Throughout this disclosure, when use the terms "solution boiling point saline "," evaporation point of the saline solution "and its variants, to which reference is actually made, for the purpose of explanation, is the boiling point of water (i.e. 100 ° C) in the saline solution since the difference between the point of boiling a normal saline solution (approximately 100.16 ° C) and the boiling point of water is negligible.

       \ newpage
    

Figure 2 shows a schematic graph that describes the relationship between the flow of saline solution, the RF power to tissue and boiling regimes as detailed below. Based on a simple model One-dimensional grouped parameters of heat transfer, the maximum tissue temperature can be estimated, and once it is has estimated the temperature of the tissue, it is continued directly if is hot enough to boil the Saline solution. The total electrical power of RF, P, which is converted to heat can be defined as:

one

       \ vskip1.000000 \ baselineskip
    

where P = the electrical power of Total RF that becomes hot.

Driving The term [ΔT / R] in equation (1) is the heat conducted to adjacent tissue, represented as 70 in Figure 2, where:

ΔT = (T-T \ infty) the difference of temperature between the maximum tissue temperature (T) and the normal temperature (T \ infty) of body tissue (° C). The normal body tissue temperature is generally 37 ° C;

Y

R = Thermal resistance of tissues surrounding, the relationship between the temperature difference and the heat flow (ºC / watts).

This thermal resistance can be estimated from the published data collected in experiments in human tissues (see, for example, Phipps, JH, " Thermometry studies with bipolar diathermy during hysterectomy ,") ( Thermometry studies with bipolar diathermy during hysterectomy), Gynecological Endoscopy, 3: 5-7 (1994)). As described by Phipps, Kleppinger bipolar forceps were used with an RF power of 50 watts, and the maximum tissue temperature reached 320 ° C. For example, using the energy balance of equation (1), and assuming that all the RF heat put into the tissue is conducted away, then R can be estimated:

       \ vskip1.000000 \ baselineskip
    

2

       \ vskip1.000000 \ baselineskip
    

However, it is not desirable to allow the tissue temperature reaches 320 ° C, since the tissue can be desiccate. At a temperature of 320 ° C, the fluid contained in the tissue usually evaporates, resulting in undesirable effects of tissue described herein. Instead, it is preferred to keep the maximum tissue temperature at no more than about 100 ° C to inhibit tissue desiccation. Assuming the solution saline boils at about 100 ° C, the first term in the equation (1) (ΔT / R) is equal to (100-37) / 6 = 10.5 watts Thus, based on this example, the quantity maximum heat conducted to adjacent tissues without any Significant risk of tissue drying is 10.5 watts.

Referring to figure 2, the power of RF in the tissue is represented on the X axis as P (watts) and the saline flow rate (cc / min) is represented on the Y axis as Q. When the flow of saline solution is equal to zero (Q = 0), there is a "phase offset" of RF power that changes the origin of the lines inclined 76, 78 and 80 to the right. This lag is heat led to adjacent tissues. For example, using the previous calculation for bipolar forceps, this power offset of RF is 10.5 watts. If the power increases above this level without saline flow, the maximum temperature of the tissue can rise well above 100 ° C, resulting in the desiccation of tissue by boiling water in the cells of the tissue.

Convection The second term [\ rhoc Q_ {1} ΔT] in equation (1) is the heat used to heat the saline flow without boiling the saline solution, represented as 72 in Figure 2, where:

\ rho

= density of saline fluid that heats up but not bulle (approximately 1.0 g / cm3);

c _ {\ rho}

= specific heat of the saline solution (approximately 4.1 watts-s / g ° C);

Q_ {1}

= Flow of the saline solution that is heated (cm3 / s); Y

ΔT

= Increase in saline temperature. Assuming that the saline solution is heated to temperature {} \ hskip0.2cm body before it reaches the electrode and the maximum saline temperature is similar to {} \ hskip0.2cm the maximum temperature of the fabric, this is the same ΔT than for the previous conduction calculation.

       \ newpage
    

The beginning of the boil can be predicted by equation (1) with the last term on the right to zero (not boiling) (\ rhoQ_ {b} h_ {v} = 0), and solving the equation (1) for Q_ {1} leads to:

3

This equation defines the line shown in the Figure 2 as the starting line of boiling 76.

Boiling The third term [\ rhoQ_ {b} h_ {v}] in equation (1) refers to the heat that is dedicated to converting water into a liquid saline solution into water vapor, and is represented as 74 in Figure 2 , where:

Q_ {b}

= volume of saline solution that bursts (cm3 / s); Y

h_ {v}

= heat of vaporization of the saline solution (approximately 2,000 watts-s / gm).

A flow rate of only 1 cc / min will absorb a significant amount of heat if fully boiled, or approximately \ rhoQ_ {b} h_ {v} = (1) (1/60) (2,000) = 33.3 watts The heat needed to heat the flow from the body temperature at 100 ° C is much lower, or \ rhoc {Q1} ΔT = (1) (4.1) (1/60) (100-37) = 4.3 watts. In other words, the factor most significant that contributes to heat transfer from a wet electrode device can be boiling fractional This disclosure acknowledges this fact and what explodes

Fractional boiling can be described. by the following equation (3):

4

If the ratio of Q_ {b} / Q_ {1} is 0.50 This is the 50% boiling line 78 shown in Figure 2. If the ratio is 1.0 this is line 80 of 100% boiling shown in figure 2.

As indicated previously in memory descriptive, the use of a fluid to couple the energy with the tissue inhibits such unwanted effects as the paste, the desiccation, smoke production and carbonization formation, and that one of the key factors is the inhibition of desiccation of tissue, which occurs when tissue temperature exceeds 100 ° C and all intracellular water evaporates, leaving extremely dry and much less conductive tissue electrically

As shown in Figure 2, a strategy or control mechanism that can be used for the device electrosurgical 5 is to adjust the power P and the flow rate Q of such so that the power P used with a corresponding flow rate Q is equal to or less than the power P needed to boil 100% of the fluid and do not exceed the power P necessary to boil 100% of the fluid. In other words, this control strategy focuses in using the electrosurgical device 5 in the areas of the Figure 2 identified as T <100ºC and T = 100ºC, and includes the line 80 of 100% boiling. In other words, this control strategy focuses on not using the device electrosurgical 5 only in the area of figure 2 identified as T >> 100 ° C.

Another control strategy that can be used for the electrosurgical device 5 is to operate the device 5 in the area of T <100 ° C, but at a temperature high enough to contract the tissue it contains type I collagen (for example, vessel walls blood, bronchi, bile ducts, etc.), which is contracts when exposed to approximately 85 ° C for a period of  0.01 second exposure, or when exposed to approximately 65 ° C for an exposure time of 15 minutes. An example of target temperature / time for tissue contraction is approximately 75 ° C with an exposure time of approximately 1 second. As explained herein, the determination of the high part of the scale (that is, when the fluid reaches 100 ° C) it can be done by changing the fluid fluid phase to steam. However, the determination at the lower end of the scale (for example, when the fluid reaches, for example, at 75 ° C for 1 second) requires a different mechanism since the fluid temperature is below the temperature of boil and there is no apparent phase change. With the purpose of determine when the fluid reaches a temperature that facilitates the tissue shrinkage, for example 75 ° C, can be added to the fluid a thermochromic material, such as a thermochromic dye (for example, leuco dye). The dye can be formulated to provide a first predetermined color for the fluid to temperatures below a temperature threshold, such as 75 ° C, then, when heated above 75 ° C, the dye provides a second color, such as transparent, returning transparent in this way the fluid (i.e. no color or color reduction) This color change can be gradual, progressive or instantaneous Therefore, a change in the color of the fluid, from a first color to a second color (or its absence) provides a visual indication for the device user electrosurgical 5 with respect to when a fluid temperature threshold below boiling. The thermochromic dyes are available, for example, Color Change Corporation, 1740 Cortland Court, Unit A, Addison, IL 60101.

It is also noted that the previous mechanism (is say, a change in fluid color due to a dye) It can also be used to detect when the fluid reaches a temperature that will facilitate tissue necrosis; as a rule In general, this varies from approximately 60 ° C for a time of exposure of 0.01 seconds and decreases to approximately 45 ° C to an exposure time of 15 minutes. An example of target temperature / time for tissue necrosis is approximately 55 ° C for an exposure time of approximately  1 second.

In order to reduce the clotting time, the use of electrosurgical device 5 is preferable in the zone of T = 100 ° C in Figure 2 to the use of the device electrosurgical 5 in the zone of T <100ºC. In consecuense, as shown in figure 2, another strategy or mechanism of control that can be used for the electrosurgical device 5 is to adjust the power P and the flow rate Q so that the power P used with a corresponding Q flow is equal to or less than the power P needed to start the boiling of the fluid but still less than the power P needed to boil 100% of the fluid. In other words, this control strategy focuses in the use of electrosurgical device 5 in the area of Figure 2 identified as T = 100 ° C, and includes the lines of the start of boiling 76 and line 80 of 100% boiling. In other words, this control strategy focuses on the use of the electrosurgical device 5 on or between the lines of the start of boiling 76 and line 80 of 100% boiling and does not use the electrosurgical device 5 in the areas of the Figure 2 identified as T <100ºC and T >> 100ºC.

For a consistent tissue effect, it is convenient to control the flow of saline solution so that always be on a "constant boiling% line" like, for example, the boiling start line 76 or the line 80% boiling or any boiling% line constant located in the middle (for example, line 78 of 50% of boiling) as shown in figure 2. Consequently, another control strategy that can be used for the device electrosurgical 5 is to adjust the power P and the flow rate Q of such so that the power P used with a corresponding flow rate Q aim at a line of constant boiling%.

It should be noted, from the equations above, that the slope of any line of% of constant boiling. For example, for the start line of boil 76, the slope of the line is given by (\ rhoc _ {\ rho} \ DeltaT), while the slope of the line 80 of 100% boiling is given by 1 / (\ rhoc _ {\ rho} \ DeltaT + \ rhoh_ {v}). As for the line 78 of 50% boiling, for example, the slope is given by 1 / (\ rhoc {\ rho} \ DeltaT + \ rhoh_ {v} 0.5).

Yes, with the device application 5 electrosurgical to the tissue, boiling of the fluid, this indicates that the temperature is below 100 ° C, according to is indicated in the area of figure 2, and the flow rate Q should be reduced to start boiling. The flow rate Q can then be reduced until the boiling of the fluid is first detected, moment in which the starting line of boiling 76 is exceeded and the overshoot point is determined on line 76. A from the determination of a point in the line of the beginning of boiling 76 for a particular power P and flow Q, and the known slope of line 76 as indicated above (it is that is, 1 / \ rhoc {{r \ rho} \ DeltaT), it is also possible to determine heat conducted to adjacent tissues 70.

On the contrary, if after the application of 5 electrosurgical device to the tissue, the boil is detected of the fluid, this indicates that the temperature is approximately equal at 100 ° C as indicated in the areas of Figure 2, and the flow rate Q should be increased to reduce the boil until the boil stop, at which point the line of the beginning of the boiling 76 is exceeded and the overshoot point is determined on line 76. As before, from the determination of a point in the line of the beginning of boiling 76 for a particular power P and flow Q, and the known slope of the line 76, it is also possible to determine the heat conducted to the adjacent tissues 70.

As for the detection of the boiling of the fluid, can be physically detected by the user (by example, visually at a glance) of the device Electrosurgical 5 in the form of bubbles or steam that develop from the fluid coupling at the point of contact electrode / tissue. Alternatively, a phase change like this (is that is, from liquid to steam or vice versa) can be measured with a sensor which preferably detects either an absolute change (for example, the existence or non-existence of boiling with binary response, such as yes or no) or a change of a physical quantity or intensity and converts the change into a useful input signal for a system of information collection. For example, the phase change associated with the beginning of the boil can be detected with a sensor pressure, such as a pressure transducer, located in the electrosurgical device 5. Alternatively, the phase change associated with the onset of boiling can be detected with a temperature sensor, such as a thermistor or thermocouple, located in electrosurgical device 5, such as next to the electrode. Also as an alternative, the phase change associated with the onset of boiling can be detected by a change in the electrical properties of the fluid itself. By example, a change in the electrical resistance of the fluid can be detected by an ohm meter; a change in amperage can be measured by an ammeter; as the change in tension can be detected by a voltmeter; and a change in power It can be determined by a power meter.

Another control strategy that can be used for the electrosurgical device 5 is to eliminate the term of heat conduction of equation (1) (ie, ΔT / R). Dice that the amount of heat dissipated to adjacent tissues can be difficult to predict exactly, as it may vary, by for example, by the type of fabric, it may be preferable, from a control point of view, assume the worst heat situation of zero conduction, and provide enough saline solution so that, if necessary, all RF power can be used to heat and boil the saline solution, providing this so that the maximum temperature of the fabric does not exceed 100ºC in a significant amount This situation is shown in the graph schematic of figure 3.

In other words, if the heat conducted to adjacent tissues 70 is overestimated, the power P needed to cross line 80 of 100% boiling will in turn be overestimated and line 80 of 100% boiling will be exceeded in the T >> 100 ° C zone of Figure 2, which is not desirable as explained above. Thus, assuming the worst situation of zero heat conduction cases provides a "safety factor" to avoid exceeding line 80 of 100% boiling. Assuming that heat conduction to adjacent tissues 70 is zero also provides the advantage of eliminating the only term in equation (1), which depends on the tissue, that is, depends on the type of tissue. Therefore, whenever \ rho, c _ {\ rho}, \ DeltaT and h_ {v} are known as indicated above, the line equation is known for any line of constant boiling%. Thus, for example, the 98% boiling line, the 80% boiling line, etc. they can be determined in response to a corresponding input in the selection switch 12. In order to favor flexibility, it should be understood that the input of the selection switch may preferably comprise any boiling percentage. Preferably, the boiling percentage may be selected in individual percentage increments (ie, 100%, 99%, 98%,
etc.)

With the determination of the start line of boil 76, 100% boiling line 80 or any line of constant boiling% in between, is usually desirable to control the flow rate Q so that it is always a certain line of constant boiling% for an effect of consistent tissue In such a situation, the flow controller 11 adjust the flow rate Q of fluid 24 to reflect changes in the power P supplied by generator 6, as explained in more detail below. For this use the flow controller 11 can be set on a constant boiling mode line, in which the boiling% is then selected in consequence.

As indicated above, it is desirable control the Q flow of saline solution so that it is always in a line of constant boiling% for a consistent effect in the tissue. However, the preferred boiling% line constant may vary depending on the type of device electrosurgical 5. For example, if with the use of device 5, the diversion through the saline solution is not a problem, then it may be preferable to work near or directly in, but not above, the boiling start line, such as in 76a in figure 3. This preferably keeps the tissue as hot as possible without causing drying. As an alternative, if with the use of device 5 the energy deviation electric (for example, from a jaw with a jaw opposite of certain compatible bipolar devices) by the Excess saline is a problem, so it can be preferable to run along a boiling line constant, such as line 78a in figure 3, the 50% line. This simple proportional control will have the flow rate determined by Equation (4), where K is the constant of proportionality:

5

In essence, when the power P increases, the Q flow will increase proportionally. Conversely, when the power P falls, the flow rate Q will decrease proportionally.

The proportionality constant K depends mainly of the fraction of saline that boils, as shows in equation (5), which is equation (3) solved for K after the elimination of P using equation (4), and Disregarding the driving term (ΔT / R):

6

Therefore, the present disclosure provides a method to control the boiling of the fluid, such as a conductive fluid, at the point of tissue / electrode contact. In a preferred arrangement, this provides a method to treat tissues without the use of tissue sensors, such as sensors of temperature or impedance. Preferably, the disclosure can control the boiling of conductive fluid at the point of tissue / electrode contact and thereby control the temperature of the fabric without the use of feedback loops.

When describing the control strategy of the present disclosure described so far, the approach has been led to a steady state situation. However the heat needed to heat the fabric to the maximum temperature (T) It can be incorporated into equation (1) as follows:

7

where \ rhoc _ {\ rho} V \ DeltaT / \ Deltat represents the necessary heat to heat the fabric to the maximum temperature (T) 68 and where:

\ rho

= Density of saline fluid that is heated but not bulle (approximately 1.0 g / cm3);

c _ {\ rho}

= specific heat of the saline solution (approximately 4.1 watts-s / g ° C);

V

= Volume of treated tissue

ΔT

= (T-T \ infty) the difference of temperature between the maximum tissue temperature (T) and the normal temperature {} \ Tskip0.2cm (T \ infty}) of the tissue body (ºC). Normal body tissue temperature is generally 37 ° C; Y

\ Deltat

= (t-t {infin}) the difference of time to get the maximum tissue temperature (T) and the normal temperature {} \ Tskip0.2cm (T \ infty}) of the tissue body (ºC).

The inclusion of the heat needed to heat the tissue at the maximum temperature (T) in the control strategy It is plotted in 68 in Figure 4. With respect to the control strategy, the effects of heat necessary to heat the fabric to the maximum temperature (T) 68 should be taken in account before addressing the flow adjustment Q to detect the boiling start line location 76. In others words, the flow rate Q should not be reduced in response to the fault of boiling before a state has been achieved so less quasi-stationary since the location of the boiling start line 76 will continue to move during the transitional period Otherwise, if the flow rate Q decreases during the transitional period, it may be possible to decrease the flow rate Q to a point beyond the boiling start line 76 and continue beyond line 80 of 100% boiling, which It is not desirable. In other words, when approaching the temperature (T) heat 68 decreases to zero so that the lines of constant boiling shift left towards the axis Y.

Figure 5 is an example of flow chart Q versus% boiling for a situation in which the power RF P is 75 watts. The boiling percentage% is represented on the X axis, and the flow rate Q (cc / min) of saline solution is represents on the Y axis. According to this example, 100% of boiling, the most desirable predetermined flow rate of solution Saline is 2 cc / min. Also according to this example, the Q flow rate versus% boiling at the remaining points of the graft It illustrates a nonlinear relationship as follows:

       \ vskip1.000000 \ baselineskip
    

TABLE 1 Boiling% and Q flow rate (cc / min) with power of 75 watt RF

8

       \ vskip1.000000 \ baselineskip
    

The typical RF generators used in the field have a power selector switch at 300 watts of power, and sometimes they have found that some can Select up to 400 watts of power. According to the previous methodology, at 0% boiling with a potency corresponding to 300 watts, the calculated Q flow is 69.7 cc / min and with a corresponding power of 400 watts the flow rate Q calculated is 92.9 cc / min. Therefore, when used with Typical RF generators in the field, a flow rate Q of fluid of approximately 100 cc / min or less with the present disclosure is sufficient for the vast majority of Applications.

As explained herein, the delivery of RF energy to the tissue can be unpredictable and varies with the time, even though the generator has "adjusted" in a fixed power The schematic graph of Figure 6 shows the general trends of the output curve of a typical generator of general use, with the output power changing as change the impedance Z of the load (the fabric plus the cables). The Z impedance (in ohms) of the load is represented on the X axis, and the output power P (in watts) of the generator is represented in the Y axis. In the illustrated arrangement the electrosurgical power (RF) is set to 75 watts in bipolar mode. As it is shown in the figure, the power will remain constant as it has set whenever the impedance Z is between two points of cut, low and high, of the impedance, that is, for example, between 50 ohms and 300 ohms in the illustrated arrangement. Under 50 ohm load impedance Z, the power P decreases, as shown by the low impedance ramp 28a. By above the impedance Z of the load of 300 ohms, the power P decreases, as shown by ramp 28b high impedance. Of particular interest for improved electrosurgery with saline solution is the low impedance cut-off point (ramp 28a low impedance) in which the power starts to drop to as the impedance Z falls further. This change in output is invisible to the user of the generator and is not evident when the Generator is in use, just like in an operating room.

Figure 7 shows the general trend of how changes in general the impedance of the tissue over time in Electrosurgery enhanced with saline solution. To the extent that tissue is heated, the tissue temperature coefficient and the saline solution in cells is such that tissue impedance decreases to a steady state temperature, in That time the impedance remains constant. In this way, the tissue heats up, decreases the impedance Z of the load, which could approach the cutting impedance Z of 50 ohms. If he fabric has been sufficiently heated, so that the low impedance cut-off point, the power P decreases at along the lines of ramp 28a of low impedance of the figure 6.

Combining the effects shown in Figure 6 and Figure 7 it is clear that when a use generator is used overall set with a "fixed" power, the real power delivered can change dramatically over time since the tissue is heated and the impedance decreases. Looking at figure 6, if the impedance Z drops from 100 to 75 ohms over time, the output of power does not change because the curve is "flat" in that area of impedances. However, if the impedance Z falls from 75 to 30 ohm the low impedance cutoff point is exceeded and "Turn the corner" on part of the low ramp 28a curve impedance and power output would be reduced spectacularly.

According to an example of provision of the invention, the control device, such as regulator 11 of flow, receives a signal indicating the drop in real power delivered to the tissue and adjusts the Q flow of saline solution to keep the tissue / electrode contact point at a temperature desired. In a preferred arrangement, the real power drop delivered P is detected by the measuring device 8 of power (shown in Figure 1), and the Q flow of saline solution it is reduced with the flow regulator 11 (also shown in the Figure 1). Preferably, this reduction of the flow rate Q of the saline solution allows tissue temperature to be maintained as hot as possible without drying out. If the control device  was not in operation and the flow rate Q could remain longer high, the tissue would get too cold with a power input lower. This would result in the temperature decrease of the tissue at the treatment site.

The flow controller 11 of Figure 1 can be a simple analog or digital device "connected by cables "that do not need programming by the user or the maker. The flow controller 11 may include as alternatively a processor, with or without a storage medium, in which is carried out the determination procedure by software, hardware or a combination of both. In another arrangement flow controller 11 may include hardware semi-programmable configured, for example, using a descriptive hardware language, such as Verilog. In another arrangement the flow controller 11 of Figure 1 is a computer-based controller with microprocessor with software integrated. In another arrangement, the flow controller 11 may include additional features, such as a mechanism of delay, such as a timer, to automatically maintain the saline flow for several seconds after the RF is deactivated to provide post-cooling tissue coagulation or "tempering", which can increase the strength of tissue closure. Also, in another provision, the flow controller 11 may include a delay mechanism, such as a timer, to automatically activate the flow of saline solution for several seconds before activating the RF to inhibit the possibility of undesirable effects such as bonding, drying, smoke production and carbonization formation. Also in another arrangement the flow controller 11 may include a waiting mechanism with low flow, such as a valve, which follows the flow of saline solution at a level of wait flow (which prevents the flow from going to zero when deactivates the RF power) below the flow level Surgical usually found while using the device electrosurgical 5.

An example of electrosurgical device of the present disclosure that can be used in conjunction with the system of the present disclosure is shown with the reference character 5a in figure 9, and more particularly in figures 9-13. Although several electrosurgical devices of this disclosure are described with reference to its use with the rest of the disclosure system, it should be understood that The description of the combination is for the purpose of illustrating the rest of the disclosure system only. In consecuense, It should be understood that the electrosurgical devices of the The present invention can be used alone or in combination with the rest of the system of the invention, or that a wide variety of electrosurgical devices in relation to the rest of the disclosure system. The devices electrosurgical disclosed in this report are configured preferably also both for open surgery and for laparoscopic For laparoscopic surgery, the devices are preferably configured to fit through a cannula of 5 mm or 12 mm trocar.

As shown in Figure 8, the device Electrosurgical 5a can be used in conjunction with a cannula as illustrated by reference character 19, during the laparoscopic surgery such as, for example, a cholecystectomy laparoscopic The cannula 19 comprises a proximal part 19a separated from a distal part 19b by a rigid trunk part elongated 19c. The proximal part 19a of the cannula 19 comprises preferably a head part 19d connected to the part of rigid log 19c, preferably by coupling screwed. Most importantly, cannula 19 has a working channel 19e that extends through the head part 19d and the part of trunk 19c from the proximal part 19a to the distal part 19b of cannula 19. In a particular arrangement, during insertion in cannula 19, electrosurgical device 5a is configured to enter the proximal end of working channel 19e, move along channel 19e distally, and then spread from the distal end of the working channel 19e. In the same arrangement, during retraction from cannula 19, the 5a electrosurgical device is configured to enter the distal end of working channel 19e, move along the channel 19e proximally, and then withdraw from the end proximal of working channel 19e.

Returning to figure 9, as shown in electrosurgical device 5a comprises a device monopolar electrosurgical. As shown in Figure 9, the 5a electrosurgical device preferably includes a trunk self-supporting rigid hollow 17, a proximal handle comprising some handle parts 20a, 20b and a pointed part, as shown with circle 45. The handle 20a, 20b is preferably made of a rigid, non-conductive material, which can be sterilized such as a polymer (for example, of polycarbonate). As shown in the Figures 10 and 11, the tip portion 45 includes an element of contact preferably comprising an electrode 25 which, as sample, comprises a solid ball that has a smooth surface and without interruptions. Also as shown in figures 10 and 11, the tip portion 45 also comprises a sheath 82 that has a uniform diameter along its longitudinal extension, a spring 88 and a distal part of the trunk 17. As shown in the Figure 10, the longitudinal axis 31 of the tip portion 45 may be configured with an angle A in relation to the longitudinal axis 29 from the proximal rest of the trunk 17. Preferably, the axis longitudinal 31 of the tip portion 45 is configured with an angle A, approximately 5 degrees to 90 degrees from the axis longitudinal 29 of the proximal rest of the trunk 17. More preferably, the longitudinal axis 31 of the tip portion 45 is set with an angle A, approximately 8 degrees to 45 degrees with respect to the longitudinal axis 29 of the proximal rest of the trunk 17.

As shown in figures 10 and 11, for the electrosurgical device 5a, electrode 25 generally It has a spherical shape with a spherical surface correspondingly, a part 42 thereof is exposed to tissue 32 (less than 180 degrees and more specifically about 100-120 degrees) at the distal end of the 5th device. When electrode 25 is in the form of a sphere, the sphere can have any suitable diameter. However, the sphere preferably has a diameter in the interval between e including about 1 mm to about 7 mm. Though, it has been found that when a sphere is greater than about 4 mm and less than about 2 mm tissue treatment may be negatively affected (in particular the time of tissue treatment) due to the surface of the electrode that is, respectively, very large or very small. In this way, more preferably the sphere has a diameter in the interval between e including approximately 2.5 mm to approximately 3.5 mm. Yet more preferably, the sphere has a diameter of approximately 3 mm

It is understood that shapes can be used other than a sphere for the contact element. Examples of such shapes include oblong or elongated shapes. However, as shown in figures 10 and 11, preferably a surface Extreme distal of the electrosurgical device 5a always offers a rounded blunt surface that is not pointed and is not sharp, as shown by electrode 25.

As shown in Figures 10 and 11, the electrode 25, is preferably located in a cavity 81 of a sheath 82 that provides a receptacle for electrode 25. Between other things, tube 82 guides the movement of electrode 25. Between other things, tube 82 also functions as a housing for retain electrode 25.

Also as shown in Figure 11, a part 44 of the electrode, is retained within cavity 81, while another part 43 extends distally through the fluid outlet opening provided by the hole Circular 26 fluid outlet. Also as shown, the case 82 is connected, preferably by silver welding, to the distal end 53 of the trunk 17. For device 5a, the electrode 25, sheath 82 and trunk 17 preferably understand, and more preferably at least essentially consist in, an electrically conductive metal, which is also preferably non corrosive, and more particularly steel stainless. Other metals include copper, titanium, gold, silver and platinum. In addition, the trunk 17 preferably comprises tube thick-walled hypodermic stainless steel.

As for cavity 81, the internal diameter of the cavity 81 surrounding electrode 25, it is preferably a slightly larger than the diameter of the sphere, normally approximately 0.25 mm. This allows the sphere to rotate freely within cavity 81. Accordingly, cavity 81 of the sheath 82 also preferably has a diameter in the range from about 1 mm to about 7 mm.

As best shown in Figures 11 and 12, in order to keep electrode 25 inside cavity 81 of the sheath 82, preferably the fluid outlet orifice 26, which ultimately provides a fluid outlet opening, of the cavity 81 at its distal end 83 comprises a distal zone pinched 86 which is reduced to a size smaller than the diameter of electrode 25, to prevent leakage of electrode 25 from the sheath 82. More preferably, the fluid outlet orifice 26 it comprises a diameter smaller than the diameter of the electrode 25.

As best shown in Figure 12, the fluid outlet orifice 26 preferably has a diameter smaller than the diameter of electrode 25, which can be achieved at least with a fold 84 located at the distal end 83 of the cover 82 that goes into the case 82 and distal to part 44 of electrode 25 confined in cavity 81. When a fold 84 is used, the fold 84 may comprise a single continuous circular edge pattern. In this way, the part of contact element that extends distally through the fluid outlet opening (i.e. electrode part 43) provided by the fluid outlet orifice 26 has a complementary to the fluid outlet opening provided by the fluid outlet hole 26, here both Circular

However, as shown in Figure 12, the fold 84 may also comprise a discontinuous edge pattern circular in which the fold 84 is interrupted by at least one rectangular slot 85 with a hole formed at the distal end 83 of the sheath 82. Therefore, the fluid outlet opening located at the distal end of the device 5a may comprise a first part (for example, the circular hole portion 26 of fluid outlet) and a second part (for example, the part of groove 85 of fluid outlet hole). As shown in the Figure 12, preferably, the fold 84 comprises at least four fold sections that form a circular edge pattern separated by four different grooves 85 located radially in between 90 degrees from each other and also located around the first part of the fluid outlet opening. Slots 85 are preferably used to provide an escape or opening of fluid outlet next to electrode 25, when electrode 25 is fully seated (as will be explained later) and / or when electrode 25 is not being used (i.e. no load electrical) to keep the surface part 42 of the electrode surface of electrode 25. Preferably, the slots 85 have a width in the interval between and including about 0.1 mm to 1 mm, and more preferably they have a width in the interval between and including approximately 0.2 mm to 0.3 mm. As for the length, the slots 85 have preferably a length in the range between and including about 0.1 mm to 1 mm, and more preferably it has a length in the interval between and including approximately 0.4 mm to 0.6 mm.

As shown in Figure 12, the part of contact element that extends distally through the fluid outlet opening (i.e. electrode part 43) extends distally through the first part of fluid outlet opening (for example, circular part 26 of fluid outlet) and does not extend distally to through the second part of fluid outlet opening (by example, the groove portion 85 of fluid outlet orifice). From this way an edge 91 of the groove 85 is exposed to the tissues 32 to provide a tissue separation edge such as It is explained below.

It should be understood that the particular geometry of the fluid outlet opening provided by the orifice of fluid outlet located at the distal end of device 5a for the electrode, it is not decisive for the disclosure, and everything What is needed is the presence of a fluid outlet orifice supply the fluid 24 as necessary. For example, him fluid outlet orifice 26 may comprise an oval shape, while electrode 25, comprises in a different way, such As a round shape.

As shown in Figure 12, in addition to the slot 85 that provides a fluid outlet, at least one edge 91 of slot 85 can provide a separating edge of the tissue next to a blunt surface (for example, the part surface 42 of electrode 25) that can be used for blunt dissection when the electrosurgical device is manipulated 5a, particularly by turning (for example twisting), abrasion or impact When the edge 91 is used in this direction, it prefer that the edge comprises a sharp edge with an angle acute that has not been rounded by, for example, a chamfer.

Switching to the proximal end of the tip (which comprises electrode 25, spring 88 and sheath 82) of the device 5a and electrode 25, as shown in figure 11, preferably the part of the sheath 82 proximal to the electrode 25, it also has a pinched proximal area 87, which retains the electrode 25 in cavity 81 of sheath 82 and prevents the escape of electrode 25 of cavity 81 of sheath 82, such as a diameter smaller than the diameter of electrode 25.

While the area can only be used pinched distal 86 and pinched proximal area 87 to support electrode 25, in its position of use, the electrode can be further supported by a compression spring 88 as shown in figure 11. The use of spring 88 is preferred for provide a support of variable length within the length working spring 88 to exceed manufacturing tolerances  (for example the length) between the fixed supports (that is, the pinched areas 86 and 87) of sheath 82. As for the maintaining the correct position of spring 88, sheath 82 it also comprises an inner passage 89 as shown in the figure 11 (that is, the cavity of an elongated hollow structure, such as a tube or structure similar to a tube; normally cylindrical) which, in addition to providing a direct passage for the fluid, provides a guide tube for spring 88. In addition, the part surface 60 of electrode 25, which makes contact with the spring 88 may comprise a flat surface instead of a surface curvilinear to better seat the spring against the electrode 25.

In addition to the above, spring 88 provides A multitude of functions and advantages. For example, the configuration from the pinched distal zone 86, the pinched proximal area 87 and the spring 88 offer the possibility of moving electrode 25, in distal and proximal direction within the sheath 82. As shown in Figure 11, spring 88 is proximal to electrode 25 between a load bearing surface comprising the surface of electrode 60 and a second load bearing surface that it comprises the distal end 53 of the trunk 17. In this way, the spring 88 can be configured to provide a force of decompression to seat electrode 25 against the distal area pinched 86, in this case the perimeter edge 92 of the fold 84, before using the electrosurgical device 5a.

On the contrary, with the application of electrode 25 of device 5a against tissue surface 22 32 with enough force to overcome the compression force of the spring 88, spring 88 is compressed and electrode 25 retracts proximally away from the pinched distal zone 86, in this case the perimeter edge 92 of the fold 84, changing the position thereof. In the previous way, the contact element that comprises electrode 25 is retractable in cavity 81 of accommodation provided by cover 82 with the application of a force directed proximally against surface 42 of the part 43 of electrode 25 extending distally further beyond the distal opening 26 located at the distal end 83 of the housing and spring 88 functions as a member of predisposition by retraction.

By making the electrode 25 can be placed the previous way by means of spring 88, in various arrangements the electrosurgical device 5a may be provided with a damping mechanism that dampens the force of electrode 25 in the tissue 32 to be treated.

In addition, in various provisions of the electrosurgical device 5a, an electrode 25 that can placed as described above may comprise a fluid flow adjustment mechanism that gradually increases the area of the fluid outlet orifice 26 and the corresponding flow rate of fluid in response to progressive proximal retraction of the electrode 25. In this case electrode 25 functions as a valve to regulate the flow of fluid 24 through hole 26 of fluid outlet

In several arrangements, spring 88 can be used in conjunction with the pinched distal area 86 (for example, the fold 84 comprising a single circular pattern continuous) to provide a fluid seal between the electrode 25 and the pinched distal zone 86 that stops the flow of fluid from the electrosurgical device 5a. In this way, the electrosurgical device 5 can be used to provide both a wet electrode and a dry electrode (it is say, when the fluid flow is on and off, respectively) with the energy and fluid provided in a manner sequential also simultaneously. The incorporation of a Dry electrode function in the device of the current disclosure It may be convenient to provide a mechanism for cutting electrosurgical

In addition, in various provisions of the electrosurgical device 5a, an electrode 25, which can placed as described above may comprise a plunger mechanism that retracts to provide access for unclog the fluid outlet holes, such as holes 26 and 85 of fluid outlet, which can reach restrict the flow as a result of loose waste (by example, tissues, blood) that get stuck in it. For example, when a predisposing force, such as that of a device hand cleaning (for example a brush) or pushing the tip distal against a hard surface such as a separator, it is applied to surface 42 of electrode 25, which exceeds the force of compression of the spring 88 causing the spring 88 to compress and electrode 25 retracts, the tip of the cleaning device can be extended into the fluid outlet hole 26 for clean the fluid outlet hole 26, the perimeter edge 92, the groove 85 and the edge 91. In other words, an electrode 25, which can be placed as indicated, provides a method for unclog a fluid outlet orifice by increasing the cross-sectional area of the fluid outlet orifice for Provide access to it.

In addition, in various provisions of the electrosurgical device 5a, the spring 88 comprises a electrical conductor, particularly when electrode 25, is retracts to a position without contact (i.e. not in contact) with the cover 82.

In other provisions, the proximal area pinched 87 may comprise one or more folds similar to the pinched distal zone 86, such that electrode 25 is retains in the sheath 82 in both distal and proximal direction by folds In addition, in other arrangements the cover 82 can be dispose within trunk 17, instead of being connected to the distal end 53 of the trunk 17. In addition, still in other arrangements, the cover 82 can be formed unitary (i.e., as one piece or unit) with the trunk 17 as a piece unitary.

As best shown in Figures 10 and 11, the electrode 25 is retained in the sheath 82 such that a part 43 of electrode 25 extends distally beyond the distal end 83 of the sheath 82. As shown, preferably surface 42 of this exposed part 43 of electrode 25 is blunt and does not comprise any sharp corner. In addition, part 43 of the electrode 25 extending distally beyond the end distal 83 of sheath 82 is controlled by the shape of hole 26 fluid outlet in the sheath 82 in relation to the shape of the electrode 25. In other words, part 43 of electrode 25 which extends distally beyond distal end 83 of the sheath 82 is controlled by the surface contact of the electrode with edge 92.

As shown in Figures 10 and 11, in the sites where trunk 17 and sheath 82 are electrically conductive (for device 5a, preferably trunk 17 and the cover 82 are electrically conductive completely and not they comprise non-conductive parts), preferably an insulator electrical 90 (i.e., comprising non-conductive material or insulator), preferably surrounds trunk 17 and sheath 82 at along substantially its entire exposed length (for example, the part outside the limits of the handle 20), finishing a short distance (for example, at the proximal beginning of the fold 84 or less than about 3 mm) from the distal end 83 of the sheath 82. The insulation 90 preferably comprises a pipe of polymer wrap that can be contracted.

As with the other devices Electrosurgical described, a fluid inlet line 4b and a power supply, preferably comprising a generator 6 which preferably provides power of radio frequency through cable 9, are preferably coupled fluid and electric form, respectively, to the tip portion 45 of the electrosurgical device 5a.

As indicated above, device 5a It comprises a monopolar device. In other words, a first electrode, often known as the active electrode, comprises a electrode of the electrosurgical device 5a (for example, the electrode 25), while a second electrode, often known as the indifferent or return electrode, it comprises an electrode of dispersion of insert of earth located in the patient, normally in the back or other suitable anatomical place. Preferably, the two electrodes are electrically coupled to the Generator 6 to form an electrical circuit. Preferably, the active electrode is coupled to generator 6 via a cable insulated wire cable conductor 9 to outer surface 18 of the trunk 17 within the limits of the handle 20a, 20b, normally through a switch 15a.

In other arrangements, the trunk 17 can be make an electrical non-conductive material except for one part at its distal end 53 that comes into contact with the sheath 82. This part of the trunk 17 that makes contact with the sheath 82 must be electrically conductive In this provision, the driver of insulated wire cable wire 9 extends to this part electrically conductive trunk 17. In even others arrangements the trunk 17 may completely comprise a non-conductive material as where the wire conductor of the insulated wire cable 9 extends directly to the sheath 82.

With respect to the fluid coupling, the fluid 24 of fluid source 1 for use with a device Electrosurgical 5a preferably communicates from a source 1 of fluid through a flexible pipe 4b of poly (vinyl chloride) (PVC) fluid outlet to a flexible poly (vinyl chloride) (PVC) inlet pipe of fluid 4b connected to the electrosurgical device 5a. The outlet fluid line 4a and inlet fluid line 4b preferably connect through a configuration of mechanical clamping male and female, preferably comprising a Luer-Lok® connection from Becton, Dickinson and Company.  The internal step of the input line, then preferably fits tightly on the outer diameter of the trunk 17 to provide a snap fit seal In between. In addition, an adhesive can be arranged in between to Strengthen the shutter. The fluid 24 is then communicated. going down the internal passage 23 of the trunk 17 through the passage internal 89 and the cavity 81 of the sheath 82 in which it is ejected everywhere and on the exposed surface 42 of electrode 25. This provides a wet electrode to perform the electrosurgery

As shown in figure 13, during use of the electrosurgical device 5a, normally a fluid coupling 30 preferably comprising a band discrete located and preferably comprising a band of triangular shape or a part of cord that provides a film of fluid 24 between the surface 22 of the tissue 32 and the electrode 25. When the user of the electrosurgical device 5a places the electrode 25 at a tissue treatment site and moves the electrode 25 on the surface 22 of the tissue 32, the fluid 24 is ejected around and on surface 42 of electrode 25 in the distal end 83 of the sheath 82 and on the surface 22 of the tissue 32 through the coupling 30. The fluid 24, in addition to provide an electrical coupling between the device electrosurgical 5a and tissue 32, lubricates surface 22 of the tissue 32 and facilitates the movement of electrode 25 through the surface 22 of tissue 32. During electrode movement 25, electrode 25 normally slides along surface 22 of the tissue 32, but can also rotate when electrode 25 moves along the surface 22 of the fabric 32. Normally, the user of the 5a electrosurgical device slides the electrode through the surface 22 of the fabric 32 in round trip with a movement similar to painting while using liquid 24 as between other things, a lubricating coating. Preferably, the fluid thickness 24 between the distal end surface of the electrode 25 and surface 22 of tissue 32 at the edge external coupling 30 is in the interval between and including approximately 0.05 mm to 1.5 mm. More preferably, the fluid 24 between the distal end surface of electrode 25 and the surface 22 of the fabric 32 at the outer edge of the coupling 30 is in the range between and including approximately 0.1 mm to 0.3 mm Also preferably, in certain arrangements, the distal end tip of electrode 25 makes contact with the surface 22 of tissue 32 without any fluid 24 in the middle.

Another example of electrosurgical device the present disclosure that can be used in conjunction with the system of the present disclosure is shown with the reference character 5b in Figures 14-16. In these provisions, the electrical insulator 90 preferably ends proximally in the cover 82, where the cover 82 is connected to the distal end 53 of the trunk 17. In certain provisions in which cover 82 is unitary form with trunk 17, electrical insulator 90 preferably ends proximally with the proximal area pinched 87. In this way, in addition to the surface part ball 42 of electrode 25 and surface part 41 that narrow, here conical, of the cover 82 that is used for the tissue treatment 32 when exposed to it, a surface cylindrical 40 of a cylindrical part 39 of the sheath 82 and a part surface 47 that is enlarged from part 54 that is enlarged, here the two conical, of the cover 82 also function as surfaces of the electrodes for tissue treatment. In this way, the electrode exposed to tissue 32 now comprises a part cylindrical surface 40 and a surface part 47 that expands, in addition to the spherical surface part 42 and the surface part 41 which narrows, with the cylindrical surface portion 40 increasing substantially the surface area of the electrode. As a result, electrode 25 now also comprises surfaces that are in parallel and perpendicular to the longitudinal axis 31 of the part tip 45, and more particularly the case 82, of the device electrosurgical 5b. In the previous way, the use of the front end (for example, surfaces 41 and 42), the use of lateral (for example, surface 40 and 47) or oblique use (for example, surfaces 40, 41 and 42) of the electrosurgical device 5b

In the above manner, the tip portion 45 now comprises a first tissue treatment surface (for example, the spherical surface 42 of the distal end) and a second tissue treatment surface (for example, the lateral surface 40). As explained above, preferably the first tissue treatment surface is set up for blunt dissection, while the second surface Tissue treatment is configured for coagulation. Further, the tip portion 45 also comprises a third surface of tissue treatment (eg, surface 41) located between the first tissue treatment surface (for example, surface 42) and a second tissue treatment surface (for example, surface 40). In addition, the tip portion 45 also it comprises a fourth tissue treatment surface (for example, surface 47) located proximal and adjacent to the surface 40.

With device 5a, when electrode 25 is puts directly in contact with the surface 22 of the fabric 32, it may be possible for tissue 32 to occlude the flow of fluid that flows from the fluid outlet orifices 26, 85 located in the distal end of device 5a. Consequently, for the device 5b fluid outlet holes 93, 94 can be located on the cylindrical side part 39 of the sheath 82, since either proximal or next to electrode 25, and either as a complement or as an alternative to the fluid outlet orifices 26, 85.

As shown in Figures 14 and 15, so less a fluid outlet hole 93 is preferably formed on the longitudinal cylindrical lateral surface 40 and by the wall of the side part 39 of the sheath 82 next to the electrode 25 when electrode 25 is fully seated. In addition, preferably at least one fluid outlet orifice 94 is formed in the cylindrical side part 39 of sheath 82 proximal to electrode 25 when electrode 25 is fully seated.

Preferably, the holes 93, 94 comprise more than one hole that are equally radially spaced in a circular pattern around the longitudinal axis 31 of the part of tip 45, and more particularly the sheath 82. More preferably, holes 93, 94 comprise four discrete holes equidistant at 90 degrees around the cylindrical side part 39 of the sheath 82. Preferably, the holes 93, 94 have a diameter in the range between and including about 0.1 mm to 1 mm, and more preferably have a length in the range between and including approximately 0.2 mm to 0.6 mm. He electrode 25, which can be placed as indicated above, it can comprise not only a valve to regulate the flow of fluid from the fluid outlet holes, such as the fluid outlet orifice 26, but also comprise a valve that at the time that opens a fluid flow outlet closes Another fluid flow outlet. For example, when electrode 25 retracts proximally, fluid outlet hole 26 it opens while the fluid outlet orifice 93 closes. In other words, an electrode 25, which can be placed as described above can provide a mechanism for alter the size and / or location of the exit holes of fluid during the use of the electrosurgical device 5b which it may be necessary, for example, to direct the fluid to a place determined tissue or balance the fluid flow between fluid outlet points.

Thus, as shown in figures 14 and 15, surfaces 40, 41 and 47 of sheath 82, and surface 42 of electrode 25 are all surfaces of the active electrode and they can provide electrical power to the fabric 32. Some parts of this combined electrode surface can be wetted by the fluid flow from holes 26, 94 or 93, as well as from the hole grooves 85 in fold 84 next to electrode 25.

The holes 94, 93 in the cylindrical sheath 82 of the electrode surface are generally intended to ensure that fluid 24 is provided to the soft sides, less harsh, non-traumatic electrodes used to produce coagulation and hemostasis of the tissue (by example, surfaces 40 and 47) instead of blunt dissection (by example, surfaces 41 and 42). The most distal part of the device may have a rougher electrode surface, but also wet, which can perform blunt dissection, as well as coagulation of the tissue.

The electrode configuration shown in the Figures 14 and 15 is particularly useful for a surgeon who Performs a liver resection. Once the outer capsule of the liver is marked with a dry Bovie leaf along the line planned for resection the distal tip of the tip portion 45 is paints back and forth along the line, which has as result in hepatic parenchymal coagulation. To the extent that tissue coagulates under and around surfaces 40, 41 and 42 of the electrode, the electrode is used for blunt dissection in the coagulated parenchyma, with the edge 91 of the grooves 85 around of the fold 84 providing rough elements that they help interrupt tissue 32 and allow separation of fabric 32.

As shown in Figure 16, the device 5b can be used deeply in a crack 97 of tissue 32 for blunt dissection of tissue 32 and its coagulation to it weather. Blunt dissection is preferred to acute dissection, such as with a blade or scissors, since blunt dissection is less prone to tearing or damaging major or other blood vessels glasses. Once identified by blunt dissection, the vessels of larger size can be trimmed securely, tied with thread of suture or sealed with some other device. Yes the glasses more large are not "skeletonized" (separated from tissue) in First place without being damaged by blunt dissection, they may bleed profusely and it takes much longer to stop the hemorrhage. The device can also be used to coagulate in first without simultaneous roman dissection and then perform blunt dissection at a different stage.

This technique can also be used in others. parenchymal organs, such as the pancreas, kidney and lung. In addition, it can also be useful in muscle tissue and fat subcutaneous Its use can also extend to benign tumors, cysts or other tissue masses found in the areas urological or gynecological. It would also allow the removal of tumors with many vessels such as hemangiomas.

In figure 16 zone 99 identifies the part of the electrode that has the ability to perform coagulation and blunt dissection, and zone 98 identifies the part that is intended mainly for coagulation and hemostasis. 100 line indicates the depth of the area of tissue that coagulates, normally 3 mm to 5 mm deep.

For the devices described in this memory, the presence of various boiling fractions can be estimated visually with the naked eye, or by detecting changes in the electrical impedance Figure 17 shows a diagram of the electrical impedance Z versus time t. The 101 peaks of impedance shown in figure 17 occur with a frequency about one cycle per second and with an amplitude that is the same order that the impedance of the baseline. This frequency is shown in figure 17 as the interval 102 between the peaks successive impedance. The impedance is directly measurable dividing the voltage by the current as described previously. The use of electrical impedance to detect the beginning of tissue drying when the impedance rises spectacularly as a result of having warmed to the point  of smoke and carbonization, but not to detect the presence of the boil has been described above. As shown in the Figure 17, the impedance Z can change from a level of approximately 100 ohms without boiling, at a level of approximately 400 ohms or more with a large part of the fluid boiling conductive. The boiling percentages that are shown are examples such as impedance levels.

Figure 18 shows nature qualitative of boiling as boiling% increases, indicated by the small values of each of five examples of "regimes" of boiling. In each small value a part of tip 45 of device 5a is shown in the vicinity of the tissue 32. When the boil begins at regime 104, there is a few small vapor bubbles 37 in the conductive fluid 24, here saline solution, coupling 30. As the boiling rate in regime 106 there is a greater number of small bubbles 37. As the boiling percentage further increases to regime 107, bubbles 37 become much more big. With an even higher boiling rate in regime 108  intermittent wires of saline solution are formed and evaporated quickly. Finally, at the highest level of regime 109, some 36 drops of saline boil instantly with contact with the hot surface 22 of the fabric 32 and an arc is produced from metal to fabric 32.

Returning to figures 14 and 15, they are provided fluid outlet openings through through holes substantially linear, which supply the conductive fluid 24 to the place of treatment However, in an alternative provision, as shown in figure 19, fluid outlet openings in the case 82 can be provided by the holes in the form of tortuous and interconnected roads 59, which form in a material permeable to the passage of fluid 24, through it, such as a porous material The discrete and linear through holes 93, 94 it can be complemented or substituted by a plurality of paths  tortuous and interconnected 59 formed in the porous material that, among other things, it provides porous surfaces 40, 41 and 47 to more evenly distribute the fluid flow and supply conductive fluid 24 to tissue 32 at the treatment site. From according to the disclosure all or part of the cover 82 may comprising a material permeable to the passage of fluid 24 through it as described herein.

In certain provisions, the element of contact, here electrode 25 can also comprise a material permeable to the passage of fluid 24 through it, such as a material porous (for example, metals, polymers or ceramics) to provide the winding roads 59. In these provisions, the porous structure of electrode 25 allows fluid 24 not only pass around electrode 25 on porous outer surface 42 when ejected, it also allows fluid 24 to pass to through electrode 25, to be expelled. According to the disclosure of all or part of the electrodes or any particular electrode for tissue treatment 32 can comprising a material permeable to the passage of fluid 24 through it  as described herein.

When the contact element and the cover provide electrodes for tissue treatment and comprise a porous material, preferably the porous material comprises also a porous metal. Porous sintered metal is available in many materials (such as 316L stainless steel, titanium, Ni-chromium) and forms (for example, cylinders, disks, plugs) of companies like Porvair, located in Henderson, North Carolina.

Porous metal components can be formed by a sintered metal powder process or by molding by injection of a combination of two pieces of metal and a material that can burn to form pores that connect (open cell) with each other. With sintering, for example, normally solid particles of material are placed in a mold with heat and pressure such that the outer surface of  the particles soften and link each other with the pores that They comprise the interstices between the particles. As an alternative, when the porosity is formed by burning material, it is not the interstitium between particles that provides porosity as with sintering, but rather a partial gut of the material generally provided by the removal of a component with a lower melting temperature than temperature of burning

Although the electrode provided by the contact element and / or the cover preferably comprises a electrically conductive material, such as metal, can be use a non-conductive porous contact element and sheath of electricity, such as porous polymers and ceramics, to replace a cover and contact element electrically conductive Although porous polymers and ceramics are not generally conductive, can also be used to drive radio frequency energy through the porous surface and the thickness of ceramic and porous polymer to the fabric to be treated, in virtue of conductive fluid 24 contained within the plurality of interconnected winding roads 59.

Preferably, the winding roads in the porous materials have a pore size (cut dimension transverse) in the interval between and including approximately 2.5 micrometers (0.0025 mm) to 500 micrometers (0.5 mm) and more preferably it has a pore size in the interval between e including approximately 10 micrometers (0.01 mm) to 120 micrometers (0.12 mm). Even more preferably, the porous material has a pore size in the interval between and including approximately 20 micrometers (0.02 mm) to 80 micrometers (0.08 mm).

In addition to the possibility of providing a more uniform distribution of fluid 24, porous materials They can also provide other advantages. For example, when electrode surfaces, such as surfaces 40, 41, 42 and 47, in contact with the surface 22 of the fabric 32 are porous and dissipate fluid 24, tissue 32 is less apt to stick to surfaces 40, 41, 42 and 47 of the electrode compared to the situation in which surfaces 40, 41, 42 and 47 are not porous. In addition, by supplying fluid 24 to surfaces 40, 41, 42 and 47 through the winding roads 59, the fluid 24 heated or electrified can now be provided more evenly to surfaces 40, 41, 42 and 47, which can result in a wider tissue treatment area compared to when surfaces are not porous.

Preferably, the porous material provides the wick (i.e., sinking in the fluid by capillary or capillary action) of the fluid 24 in the pores of the porous material. In order to promote the wicking effect of the fluid 24 in the pores of the porous material, preferably the porous material and in particular the surface of the tortuous paths is hydrophilic. The porous material may be hydrophilic with or without further treatment (for example, surface treatment with plasma such as supercleaning , chemical attack or micro roughness, surface plasma modification of the molecular structure, surface chemical activation or crosslinking), or become hydrophilic by a coating disposed therein, such as a surfactant.

Although not preferable, it is not necessary for the fluid coupling 30 of fluid 24 is present between the metal electrode surfaces (for example, 40, 41, 42) and tissue 32 at all tissue treatment sites and can have points of direct contact with the fabric on the surfaces of the electrodes without any fluid coupling 30 between them. In such case, the convection cooling of the metal electrode by the saline flow is usually sufficient to maintain the metal electrode and tissue in contact with the electrode metallic at, or below, a temperature of 100 ° C. In others words, heat can also be dissipated first from the tissue 32 to conduction electrodes, then be dissipated from the electrodes to the fluid 24 by convection.

Preferably, the relationship between the material of the electrodes, in particular their surface, (for example, 40, 41, 42, 47), and fluid 24 along the various arrangements it should be such that the fluid 24 wet the surface of the electrodes to form a continuous film coating thin (for example, see figure 19A) and do not form streams or insulated circular cords (for example, with an angle of contact 8 of more than 90 degrees), which freely come out of the electrode surface The contact angle, the, is a Quantitative measure of the wetting of a solid by a liquid. It is defined geometrically as the angle formed by a liquid in the limit of three phases in which liquid, gas and solid are cut. In terms of the thermodynamics of the materials involved, the contact angle 8 implies interfacial free energies between the three phases given by the equation \ gamma_ {LV} cos ? = \ gamma_ {SV} - \ gamma_ {SL} where \ gamma_ {LV}, \ gamma_ {SV} and \ gamma_ {SL} refer to the energies interfacial points of contact liquid / vapor, solid / vapor and solid / liquid, respectively. If the contact angle the is less than 90 degrees the liquid is said to wet the solid. If the contact angle is more than 90 degrees the liquid does not wet. A contact angle? Of zero represents the complete humidification Therefore, preferably the angle of Contact is less than 90 degrees.

For clarity, while it is known that the contact angle the can be defined by the above equation, in reality the contact angle the is determined by several models for an approximation. According to the publication titled " Surface Energy Calculations " (September 13, 2001) by First Ten Angstroms (465 Dinwiddie Street, Portsmouth, Virginia, 23704), there are five models that are widely used to approximate a contact angle? and a series of others that have small followers. The five predominant models and their synonyms: (1) Zisman's critical wetting stress; (2) Girifalco, Good, Fowkes and Young combination rule; (3) Owens geometric mean, Wendt; (4) Wu harmonic mean; and (5) Lewis acid / base theory. Also according to the First Ten Angstroms publication, for well-known and well-characterized surfaces, there may be a 25% difference in the answers given for the contact angle? By the models. Also to clarify, any of the five previous predominant models, which calculates a contact angle? Within a particular range of contact angles? Or the necessary contact angle? Of a particular arrangement of the disclosure should be considered as that meet the requirements of the provision, even if the remaining four models calculate a contact angle? that does not meet the requirements of the arrangement.

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The effects of gravity and tension superficial tend to make the wick effect of fluid 24, here saline solution, around the circumference of the sheath cylindrical 82 to preferably cover the entire surface of the active electrode More specifically, the effects of gravity and the surface tension in the fluid 24 found in the electrode surfaces can be modeled by number Bond N_ {BO}.

Bond number N_ {BO} measures the relationship between gravitational forces and tension forces superficial and can be expressed as:

N_ {BO}

= gravitational force / tension force superficial

N_ {BO}

= \ rhoL2 g / \ sigma

where:

\ rho

= Density of saline fluid (approximately 1.0 g / cm3);

L

= drop diameter (cm)

g

= gravitational acceleration (980 cm / s2)

\sigma

= Surface tension (approximately 72.8 dynes) cm @ 20ºC)

For a Bond number N_ {BO} = 1, the diameter drop is equal to approximately 0.273 cm or approximately 2.7 mm, which is of the same order of magnitude as the preferred size of the electrode. For the purpose of the present invention, preferably the Bond number N_ {BO} for a drop of fluid 24 on an electrode surface 25 is preferably smaller of 1.

Another pointed part of an example device electrosurgical 5c of the present disclosure that may be used in conjunction with the system of the present disclosure shows with reference character 45 in the figures 20-24. As best shown in figures 20 and 21 the separate case 82 of provisions 5a and 5b has been removed tip part 45 of the device 5c. Consequently, the contact element, which still preferably comprises a electrode 25, is assembled directly with the trunk 17. The electrode 25 is preferably assembled (for example connected mechanically by pressure adjustment, a mechanical connector, threaded, welded, glued with adhesive) next to the distal end 53 of the trunk 17. In certain arrangements electrode 25 is preferably removably assembled in the trunk 17 of such that it can be removed from the trunk 17, preferably from manually by the human hand, so that the trunk 17 can be use with multiple different contact elements / electrodes, or the trunk 17 can be reusable and used with elements of contact / disposable electrodes.

As shown in Figures 20-24, electrode 25 preferably comprises an enlarged head portion comprising a spherical portion 43 and a corresponding spherical surface portion 42 located at the distal end of the device 5c that provides a smooth, contour outer surface. blunt. More specifically, as shown, the spherical part 43 and the spherical surface part 42 further provide a domed hemisphere, (i.e. less than a full sphere) and a hemispherical surface part preferably comprises approximately 180
degrees.

Also as shown in the figures 20-24, the enlarged head part of electrode 25 preferably it also comprises a cylindrical part 39 and a corresponding cylindrical surface part 40 located proximally and next to the spherical part 43 and the spherical surface part 42, respectively.

Continuing further with the figures 20-24, electrode 25 preferably comprises a connector part, preferably comprises a pin 46, which connects the rest of electrode 25 and trunk 17. Among others things, the connector part of electrode 25 is configured preferably to form a connection with a connector part trunk coincident 17. As shown, preferably the part pin 46 is configured to extend to cavity 50 of the trunk 17, which comprises a cylindrical receptacle and provides the matching connector part for pin 46. More preferably, the surface 48 of the pin portion 46 is set to pair against and form a tight fit with surface 52 of cavity 50 to provide the Connection.

Continuing with the figures 20-24, the pin portion 46 is preferably cylindrical and is proximal and next to a neck part 56. As shown, here the neck part 56 also comprises a cylindrical part 57 (having a cylindrical surface part corresponding 58) located proximally and next to a part 54 that expands (which has a corresponding surface part 47 that is expand). Here the part 54 that expands and the surface part corresponding 47 that expands are spherical, and more specifically comprise a domed hemisphere, and the part hemispherical surface preferably comprises approximately 180 degrees, located proximal and next to the cylindrical part 39 and the cylindrical surface part 40.

As shown in the figures 20-24, the cylindrical part 57 of the neck part 56 preferably has a cross-sectional dimension, here diameter, larger than the cross-sectional dimension, here also diameter, of the pin 46. In this way, in certain dispositions the proximal end of the neck part 56 can be together and in contact with the distal end 53 of the trunk 17.

Also as shown in the figures 20-24, electrode 25 comprises at least one slit 64 that provides an elongated channel for the flow of fluid for fluid distribution 24. The use of the device 5c, and in particular the slits 64, for the distribution of fluid 24 is generally preferred to outlet ports 93, 94 of fluid from device 5b in tissue cracks 97 particularly deep in which the tissue 32 can occlude the fluid flow from the fluid outlet orifices located in the cylindrical part 39 of electrode 25.

As shown, electrode 25 comprises preferably a plurality of directed grooves longitudinally 64 and, more specifically, four slits 64 equidistant at 90 degrees around pin 46 and / or the part of neck 56, both proximal to the cylindrical part 39. How to best shows in figure 24, in certain provisions, the slit 64 may comprise a first side wall 64a, a second opposite side wall 64b and a bottom wall 64c.

During use, when the fabric 32 covers and occludes the fluid outlet opening 55 of the slit 64 to a part of its longitudinal extension, thereby inhibiting that the fluid 24 out of them, fluid 24 of slit 64 still can be ejected from the electrosurgical device 5c after flowing longitudinally in channel 64 to a location at distance in which channel 64 is without occlusion and without inhibitions so that the fluid flow out of it.

However, in certain cases, it can be it is possible that the groove 64 can be occluded by the fabric 32 by complete along its longitudinal extension, which inhibits completely let the fluid flow out of the opening 55. With in order to overcome this problem, at least part of the electrode 25 may comprise a material permeable to the passage of fluid 24, through it, such as a porous material described previously.

As shown in Figure 25, in another arrangement of the electrosurgical device of the present disclosure as shown with the 5d reference character of the Figure 25, the walls 64a, 64b of the recess 64, the surface 48 of the shank part 46, and / or the surfaces of the shank part neck 56 of electrode 25 can be porous and connected by a plurality of tortuous paths 59 in the porous material. In consequently, instead of flowing out of the slit 64 from a opening 55 of direct fluid outlet, which can be occluded by tissue 32, fluid 24 may indirectly exit the slit 64 flowing first through the winding roads 59 of electrode 25 from the side walls 64a, 64b of the slit 64 and then exit electrode 25 from surface 58, which may be without tissue occlusion 32. Alternatively, if the adjacent surface 58 of electrode 25 is also occluded by the tissue 32, fluid 24 can continue to flow through the winding paths 59 of electrode 25 and exit at electrode 25 from the surface 64a, 64b of a groove 64 or a surface such as 40, 42, 47 or 58 that may be without tissue occlusion 32

When electrode 25 comprises a material porous, the groove 64 can be complemented or replaced by the plurality of interconnected tortuous passages 59 formed in the porous material, as shown in figure 25, with surfaces porous, such as 40, 42, 47 or 58 to distribute more evenly fluid flow and supply conductive fluid 24 to the place of tissue treatment. All or part of the electrodes They can be porous according to the disclosure.

In other provisions of the disclosure, the slit 64 may comprise cross-sectional shapes other than rectangular shapes. For example, as shown in Figures 26-28, slot 64 comprises a semicircular shape, a V shape or a U shape, respectively, or any combination thereof.

Going back to figure 21, in order to facilitate direct fluid communication of slit 64 with the internal passage 23 of the trunk 17, the slits preferably 64 of the device 5c are initiated within the limits of the trunk 17. In other words, within the cavity 50 of the trunk 17 proximal to the distal end 53. Preferably, the configuration of the grooves 64 in terms of geometry (e.g. width, depth) and / or the material and / or surface treatment of the electrode 25 can be arranged such that the voltage surface will act to retain the fluid collected in the slit 64 in which the force of gravity acts to remove the fluid of slit 64. However, while it is desirable that a certain predetermined amount of surface tension act to retain the fluid collected in the slit 64 in the presence of gravity, the surface tension must be balanced against the inhibition of fluid flow from the slit 64.

As indicated above, the use of device 5c, and in particular the slits 64, for the fluid distribution 24 is generally preferred to the holes 93, 94 fluid outlet of device 5b in cracks 97 of particularly deep tissue in which tissue 32 can occlude the fluid flow of the holes 93, 94 outlet of fluid located in the cylindrical part 39 of electrode 25. In addition, since holes 93, 94 are not present with a mechanism plunger, such as that provided for holes 26 and 85 of fluid outlet, holes such as 93, 94 that can be occluded simply by normal contact with the tissue / electrode, sooner or later they will get stuck irreversibly

As shown in Figure 21, with the device 5c the fluid outlet openings 73 are provided by the structure of the electrode 25 (i.e., slits 64) at the distal end 53 of the trunk 17 which is protected and sheltered from the contact and occlusion of the surface 22 of the fabric 32. The fluid outlet openings 73 of the device 5c are protected from occlusion of the surface 22 of the fabric 32 since the structure of the device 5c defining the openings 73 is at least partially configured so as not to contact the surface 22 of the fabric 32. More specifically, here the structure of the device defining the openings 73 is completely configured so as not to make contact with the surface 22 of the fabric 32. In other words, the openings 73 are arranged in the device 5c in a place removed from the surface 22 of the tissue. In addition, as shown, the openings 73 are particularly sheltered from occlusion of the surface 22 of the fabric 32 by a part of the trunk 17. Also as shown, when the openings 73 are formed substantially perpendicular to the surface 22 of the fabric 32 and in this way they move away from direct contact with tissue surface 22
32

Another pointed part of an example device electrosurgical 5e of the present disclosure that may be used in conjunction with the system of the present disclosure shows with reference character 45 in the figures 29-32. As best shown in Figures 31 and 32, the enlarged part 54 has been removed and the cylindrical part 39 has an equal cross-sectional dimension, here diameter, than the neck part 56. On the contrary, for the device 5c, the cylindrical part 39 has a sectional dimension transverse, also diameter, greater than the sectional dimension transverse, also diameter, of the neck part 56.

Also as shown in figures 31 and 32, the cylindrical part 39 further comprises a cylindrical part rectilinear (straight) 39a having a cylindrical surface part rectilinear 40a and a curvilinear cylindrical part 39b having a curvilinear cylindrical surface part 40b. As shown, the device comprises the shape of a hockey stick. The part cylindrical 39 for device 5c can be arranged so Similary.

Another pointed part of an example device electrosurgical 5f of the present disclosure that may be used in conjunction with the system of the present disclosure shows with reference character 45 in the figures 33-36. As best shown in Figures 35 and 36, the cylindrical part 39 has a cross-sectional dimension, here diameter, smaller than the cross-sectional dimension, here also diameter, of the neck part 56. As shown, the neck part 56 is proximal and next to a part 49 that narrows with a corresponding surface part 51 that is narrow, here both conical.

Also as shown in Figure 34, the cylindrical part 39 further comprises a rectilinear cylindrical part  39a having a rectilinear cylindrical surface part 40a and a curvilinear cylindrical part 39b having a surface part curvilinear cylindrical 40b. Also, as shown, the part cylindrical 39, and more specifically at least one of the rectilinear cylindrical part 39a and the curvilinear cylindrical part 39b, comprises a part of a hook. Preferably, as is shows both the straight cylindrical part 39a and the part Curvilinear cylindrical comprise parts of a hook. How I know shown in figures 35 and 36, the hook further comprises a L-shaped hook

Another pointed part of an example device 5g electrosurgical of the present disclosure that may be used in conjunction with the system of the present disclosure shows with reference character 45 in the figures 37-38. As shown, for the 5g device the cylindrical part 39, and more specifically both the part rectilinear cylindrical 39a as the curvilinear cylindrical part They comprise parts of a hook. Also as shown in the Figures 37 and 38, the hook further comprises a hook shaped J.

Another pointed part of an example device 5h electrosurgical of the present disclosure that may be used in conjunction with the system of the present disclosure shows with reference character 45 in the figures 39-42. As shown in Figures 39 and 40, the electrode 25 preferably comprises a finger portion 65 (which preferably comprises a cylindrical part 39 and a part cylindrical surface 40) having a distal end (which preferably comprises a spherical part 43 and a part spherical surface 42) which, among other things, is configured to blunt dissection or electrosurgical dissection of tissue 32. The electrosurgical dissection occurs when tension or force they are applied to tissues while also applying energy from RF The radio frequency energy heats the tissues, weakening them with it, and the tissue yields or breaks when it wish. Surgeons can refer to this type of dissection with a hook type electrode like "hook and cook". Further, finger part 65 is also preferably configured to function as a hook, particularly the surface part anterior (i.e. frontal) 66 of the finger part 65, which configure, among other things, to engage and limit fabrics 32.

As shown, the finger part 65 is rectilinear and forms an L-hook with an angle of approximately 90 degrees from the longitudinal axis 31 of the tip portion 45, particularly pin 45. However, the finger part may form at angles other than 90 degrees. For example, the part of 65 finger can be formed with any angle in the interval between and including approximately 60 degrees from the part of tip 45 at about 180 degrees from the tip part 45, or any other range of angles or angles in particular included in it (for example, 75º, 105º, 120º, 135º, 180º, 90º -135º, 90º -180º).

Among other things, electrode 25 preferably it comprises a knuckle part 61 comprising a rounded protuberance that has a raised projection on the part rear surface (rear) 62 of electrode 25. Also as shown, the knuckle part 61 also comprises a rounded protuberance that has a raised projection on the part lateral surface 75 of electrode 25. Among other things, the part superficial posterior of knuckle 62 and lateral superficial part of knuckle 75 formed by the knuckle part 61 are configured for coagulation and stasis (for example, hemostasis, aerostasis) of tissue 32.

The key to the 5g device is the dimension in cross section of the knuckle Z with the dimension in section transverse finger F. When comparing the dissection functions Rome or electrosurgical and coagulation / hemostasis, the part of coagulation / hemostasis of electrode 25 preferably comprises a surface greater than the blunt dissection part or Electrosurgical electrode 25.

As shown in Figure 36, preferably the cross-sectional dimension Z of the knuckle part 61 is greater than the F dimension in cross section of the finger part 65. Here, as shown, the dimensions Z and F in section transversal comprise the diameters. However, in others provisions in which the dimension Z and / or F in section transverse cannot be considered correctly as comprising a diameter, the dimension Z and / or F in cross section could Understand a width or thickness.

Preferably, the Z dimension in section transverse of the knuckle part 61 is in the interval between e including approximately 1.6 to 3.3 times larger than the dimension F in cross section of the finger part 65, with dimensions typical that include the ratios of 2.5 mm to 1.5 mm (1.6 times) and from 2.5 mm to 0.75 mm (3.3 times). Even more preferably, the Z dimension in cross section of the knuckle part 61 is in the interval between and including about 2 to 2.5 times greater than the F dimension in cross section of the finger part 65, with typical dimensions comprising 2.5 mm ratios at 1.25 mm (2 times) and from 2.5 mm to 1 mm (2.5 times).

From the previous dimensions, the proportion of the surface of the knuckle part 61 to the surface of the distal end (for example, surface 42) of the finger part 65 can be determined with an approximation using a formula for half the surface of a sphere. By previous dimensions, preferably the surface of the part of knuckle 61 is in the interval between and including approximately 2.8 times to 11 times greater than the surface of the distal end of finger part 65. More preferably the surface of the knuckle part 61 is in the interval between e including approximately 4 times to 6.2 times greater than the surface of the distal end of the finger part 65.

Also as shown in Figures 39 and 40, the neck part 56 preferably comprises a part cylindrical 57 located proximally and next to a spatula part 67. As shown, the spatula part 67 comprises a part substantially flat anterior surface 69 of electrode 25. In certain arrangements, electrode 25 may comprise one, any combination or all the features of the part of finger 65, the knuckle part 61 and the spatula part 67.

As for the use of the devices, so similar to device 5b, device 5c is particularly Useful for a surgeon who performs a liver resection. One time that the outer capsule of the liver is marked with a dry Bovie leaf along the planned resection line, the distal tip of the tip portion 45 is painted back and forth along the line, with a radiofrequency power and fluid flow 24 activated, which results in parenchymal coagulation hepatic. Once the tissue coagulates under and around the surface 42 of the electrode and, as the device 5c enters a crack 97, surface 40, surface 42 of electrode 25 is used for blunt dissection of coagulated parenchyma. The blunt dissection of the coagulated parenchyma is performed by abrasion or continuous division of the parenchyma with substantially movement same back and forth as in coagulation and with the device 5c substantially subject with the same orientation as for the coagulation of the hepatic parenchyma. However, with the dissection Rome, the surgeon usually applies more force to the tissue. In various provisions, once the liver parenchyma is coagula, blunt dissection can be performed with or without the power radio frequency (i.e. on or off) and / or with or without the presence of fluid 24.

In addition to liver resections, the 5h device is particularly useful for a surgeon who performs a laparoscopic cholecystectomy (abbreviated "col. lap.") in the case of, for example, either acute cholecystitis or a intrahepatic gallbladder in which the device provides uses of multiple functions. More particularly, the device is useful for the surgeon for coagulation and dissection of a layer  of inflamed serous tissue 32 between the liver and gallbladder, which may include hard, highly vascular, fibrous tissue of connection between organs.

For coagulation, the 5h device can be placed in at least three different orientations. For the first orientation, as shown in figure 43, coagulation it can be done with the back surface part of knuckle 62 formed by the knuckle part 61. Like the device 5c, coagulation with the 5h device is performed with the power of radiofrequency and fluid flow 24 activated. Preferably, the power is applied in the generator coagulation mode and with a power level in the interval between and including approximately 10 watts to 60 watts. More preferably, the power level is in the interval between and including approximately 20 watts to 50 watts. Even more preferably, the power level is in the range between e including approximately 30 watts to 40 watts. With regard to the movement of the surface part 62 during coagulation, the coagulation can be performed with the surface part 62 stationary, or with a paint movement by movement from surface part 62 back and forth substantially to what length of longitudinal axis 29 or laterally from side to side.

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For the second orientation, as shown in Figure 44, coagulation can be performed with a combination of the superficial lateral part of knuckle 75 formed by the part of knuckle 61 and cylindrical surface part 40, and more specifically a cylindrical surface side part of the part cylindrical surface, of the finger part 65. For the third orientation, as shown in figure 45, coagulation is you can also perform with another combination of the knuckle part 61 and finger part 65. As shown in Figure 45, the coagulation can be performed with a cylindrical surface part rear of the cylindrical surface part 40 and a surface back of the knuckle part 61. In the various orientations, coagulation can be used to stop active bleeding (for example, such as a lesion in the spleen that comprises a tear of the splenic capsule) or a previous coagulation of the tissue before dissection with bloodless surgery.

When the surgeon has previously coagulated the tissue 32, the surgeon can dissect tissue 32 with traction simultaneous mechanics (i.e. the pulling or stretching process of the fabric 32 with a mechanical device) with the surface part anterior (i.e., front) 66 of the finger part 65 that is configures, among other things, to engage and retain tissue 32. More specifically, the surgeon can hook the tissue 32 for dissection against the surface part 66 of the part of finger 65 and apply traction on tissue 32, then dissect the tissue 32.

As tissue 32 has coagulated, the dissection Rome can be performed with or without the radio frequency power (it is say, on or off) and / or with or without the presence of fluid 24. When tissue 32 is dissected without fluid 24, but with the radio frequency power activated and with the generator set For the coagulation mode, the dissection process can denominated in the art as "hook and cook". While that dissection in this way is rapid, suffers from the problems of significant arc formation, smoke production and carbonization, and the possibility of involuntary perforation of the gallbladder wall. Alternatively, dissection without the Radio frequency power activated can eliminate problems arc formation, smoke production and carbonization, and the possibility of involuntary drilling, but it can lead to a hemorrhage if the tissue 32 is not sufficiently coagulated. In order to overcome the aforementioned problems, dissection of the tissue 32 with traction can be performed similarly to the coagulation (that is, in the presence of the power of radiofrequency and fluid 24). However, this alternative normally it takes more time than to "hook up and Cook".

As for the sequence of events for dissect tissue 32 with traction and with the use of technique "hook and cook" (that is, without fluid 24), the surgeon first couples the fabric 32 in the surface part 66 of the part of finger 65. Then, the surgeon applies traction to the coupled tissue 32. Once complete, the surgeon checks the correct position and then apply the radio frequency energy. With the application of radiofrequency power, the tissue 32 yields, it separates and breaks. Then, the surgeon deactivates the power of radiofrequency This process can then be repeated several times. when the surgeon dissects the tissue progressively 32 at along a length gradually.

Certain embodiments of the invention They can be specially configured for bipolar devices. For example, an example of an electrosurgical device of the present disclosure that can be used in conjunction with the system of The present disclosure is shown with reference character 5i in figures 46-48. With a bipolar device, the ground insert electrode located in the patient is removed and replaced by a second electric pole as part of the device. Then an electric current circuit is created alternates between the first and second electrical poles of the device. Consequently, alternating current no longer flows to through the patient's body to the ground insert electrode, but through a localized part of the tissue preferably between the poles of the bipolar device.

In certain embodiments, an example of Bipolar surgical device of the present invention can understand, among other things, multiple arms, substantially parallel As shown in Figure 46, the device Electrosurgical 5i preferably includes two rigid arms that they comprise rigid hollow logs 17a, 17b, a proximal handle comprising paired parts 20a, 20b of handle and some arm tip parts as shown in circles 45a, 45b. In this embodiment, the logs 17a, 17b comprise preferably thick-walled hypodermic tube. In this way, the logs 17a, 17b have sufficient rigidity to maintain their shape while using the device without folds or important curvature.

Preferably, the arms of the device 5i (comprising the logs 17a, 17b) are retained in the position relative to each other by a mechanical coupling device comprising a collar 95 and separation and / or rotation is prevented relative to each other. The collar 95 preferably comprises a polymer (for example, acrylonitrile-butadiene-styrene or polycarbonate) and is preferably located in the distal part of the arms. More preferably, collar 95 is proximal with respect to the distal ends 53a, 53b of the logs 17a, 17b. Preferably, collar 95 comprises two openings 96a, 96b, which preferably comprise opposite C shapes, configured to receive a portion of the logs 17a, 17b, which preferably they fit by elastic jump in them. Once collar 95 is connected to logs 17a, 17b, preferably by means of an elastic jump adjustment connection, collar 95 can be configured to slide along logs 17a, 17b to adjust or vary the location of collar 95 in the trunks 17a, 17b. Alternatively, the location of collar 95 can be fixed in relation to logs 17a, 17b by welding, for example.

The device 5i comprises a first part 45a of arm tip and a second part 45b of arm tip. As shown, preferably both the first tip portion 45a of arm as the second part 45b of arm tip are configured individually identical to the tip portion 45 of the device 5a. As a result, device 5i has two contact elements independent, spatially separated (by empty space) that preferably comprise electrodes 25a, 25b.

As shown in Figure 47, when the device 5i is in use electrodes 25a, 25b are spaced laterally next to the surface 22 of the tissue 32. The electrodes 25a, 25b are connected to an AC source and an alternating current electric field is created between the electrodes 25a and 25b. In the presence of alternating current, the polarity alternating electrodes between positive and negative charges changes with the flow of current from the positive to the negative charge.

Like device 5a, for the device 5i the fluid 24 communicates from a fluid source 1  inside the internal passage 23a, 23b of the logs 17a, 17b, through of internal passages 89a, 89b and cavities 81a, 81b of the covers 81a, 82b, in which he is ejected from around and on the surface 42a, 42b of electrodes 25a, 25b.

As with the use of device 5a, with the use of the device 5i between the surface 22 of the fabric 32 and electrodes 25a, 25b are provided fluid couplings 30a, 30b preferably comprising discrete bands, located and more preferably comprising a band or a triangular shaped cord part that provides a film of fluid 24. When the user of the electrosurgical device 5i place electrodes 25a, 25b at a tissue treatment site and moves electrodes 25a, 25b along surface 22 of tissue 32, fluid 24 is ejected around and on surfaces 42a, 42b of the electrodes 25a, 25b at the distal ends 83a, 83b of the covers 82a, 82b and on the surface 22 of the fabric 32 through the couplings 30a, 30b. At the same time, the electrical energy of RF, shown by electric field lines 130, is provided to tissues 32 on tissue surface 22 and below the surface 22 of the tissue in tissue 32 through the fluid couplings 25a, 25b.

As with device 5z, fluid 24, in addition of providing an electrical coupling between the device electrosurgical 5i and tissue 32, lubricates surface 22 of the tissue 32 and facilitates the movement of electrodes 25a, 25b by the surface 22 of the fabric 32. During the movement of the electrodes 25a, 25b, electrodes 25a, 25b are usually they slide along the surface 22 of the fabric 32, but they can also rotate when electrodes 25a, 25b move across surface 22 of tissue 32. Normally, the user of the device electrosurgical 5i slides electrodes 25a, 25b along the surface 22 of the fabric 32 in round trip with a movement similar to painting while using fluid 24 as, between other things, a lubricating coating. Preferably, the fluid thickness 24 between the distal end surface of the electrodes 25a, 25b and surface 22 of tissue 32 at the edge external of the couplings 30a, 30b is in the interval between e including approximately 0.05 mm to 1.5 mm. More preferably, fluid 24 between the distal end surface of the electrodes 25a, 25b and the surface 22 of the fabric 32 at the outer edge of the couplings 30a, 30b is in the range between and including approximately 0.1 mm to 0.3 mm. Also preferably, in certain embodiments, the distal end tip of electrode 25 makes contact with the surface 22 of the fabric 32 without any fluid 24 in the middle.

As shown in Figure 48, the coupling fluid for device 5i may comprise a bridge 27 of conductive fluid between electrodes 25a, 25b, resting on surface 22 of tissue 32 and forms a shunt between the electrodes 25a, 25b. In this scenario, a certain amount RF energy can be diverted and not enter tissue 32 and actually pass between electrodes 25a, 25b over bridge 27 of conductive fluid This loss of RF energy can slow down the tissue coagulation process and hemostasis production or desired tissue aerostasis.

In order to counteract the loss of energy across bridge 27, once enough energy has entered bridge 27 to boil liquid 24 of bridge 27, RF energy loss decreases accordingly with the loss of bridge 27. Preferably energy is provided to the fluid 24 of bridge 27 by means of heat dissipation from the fabric 32.

In this way, where a boiling% is created of the conductive fluid 24 of the bridge 27, the energy loss of radio frequency across bridge 27, may be reduced or be removed, because all the fluid 24 of the bridge 27 evaporates or a much of the boil creates enough interruption in the continuity of bridge 27 to interrupt the electrical circuit a across bridge 27. Therefore, a strategy to control the present invention is to reduce the presence of a shunt of conductive fluid, increasing the boiling% of the fluid conductive.

Another arrangement of a bipolar device is shown in 5j in figures 49 and 50. Similar to 5i device, 5j electrosurgical device includes preferably two rigid arms comprising trunks rigid self-supporting 17a, 17b, a proximal handle comprising some matched parts 20a, 20b of handle and first and first parts second arm tip as shown in circles 45a, 45b. However, as shown in Figure 50, unlike the device 5j, for device 5j the logs 17a, 17b can understand some solid rods (i.e. have no steps internal) that allow the electrical connection to a source of energy, but they have no internal steps to supply the fluid conductive through the covers 82a, 82b. Instead the fluid conductive 24 is preferably provided by means of a step internal 122 of a separate fluid pipe 120, which preferably it comprises either a metallic material (for example, hypodermic stainless steel or polymer tubes (for example, PVC pipes), which extends distally and substantially parallel to the arms along the side trunks 17a, 17b. In order to minimize the risk of blockage of the internal passage 122 at the distal end outlet opening 124 of the pipe 120 of fluid, as shown, preferably distal end 126 of the fluid pipe 120 is proximal and next to the end distal of the device 5j and more preferably, proximal to the spherical surface parts 42a, 42b of electrodes 25a, 25b, or other surfaces of the tissue treatment electrodes since electrode configurations vary.

Also as shown for the 5j device, outlet opening 124 for fluid pipe 120 preferably it is evenly spaced between the electrodes 25a, 25b such that the conductive fluid 24 ejected by the outlet opening 124 can form a coupling fluid comprising bridge 27 between tissue surface 22 and the surface 42a, 42b of each of the electrodes 25a, 25b. Yes a collar 95 is used with the device 5j preferably the collar contains a third C-shaped opening to give Fitting the fluid pipe 120 through it.

In certain arrangements, at least a part of the length of the two arms (comprising the trunks 17a, 17b and the covers 82a, 82b) or the two arms and the fluid pipe 120 of the device 5j can be located and housed within the cavity 132, normally an inner passage, of an elongated hollow tubular enclosure 128 as shown in Figure 49. The elongated tubular enclosure 128 may or may not be connected to the handle portions 20a, 20b. When the tubular enclosure is not connected to the handle portions 20a, 20b, similar to collar 95, the tubular enclosure 128 can be configured to slide along the logs 17a, 17b to adjust or vary the location of enclosure 128 in the logs 17a, 17b, or alternatively, may be fixed in relation to the logs 17a, 17b by welding, by
example.

The elongated tubular enclosure 128 can comprise, for example, a wrap, such as a film of shrink wrap polymer or polymer pipe contractile wrap, which can be formed and placed in the surface of the cavity 132 against the insulations 90a, 90b with the application of heat to them. In this way, the trunks of elongated members 17a, 17b or trunks 17a, 17b and pipe 120 of fluid, they remain in relative position with each other and they prevents them from separating from each other.

Another arrangement of a bipolar device is shown in 5k in figures 51-53. As shown in figures 51 and 53, the electrosurgical device 5k includes preferably a housing comprising parts paired 20a, 20b handle and elongated paired parts 134a, 134b of handle forming a hollow trunk. As shown better in figure 51, trunk parts 134a, 134b, preferably they comprise two elongated semicircular parts that they are connected respectively to parts 20a, 20b of handle, preferably as part of a unitary polymer molding (it is say, one piece).

As best shown in Figure 53, the electrodes 25a, 25b are preferably assembled directly with trunk parts 134a, 134b, next to the distal end of the parts 134a, 134b of trunk. As shown, preferably the electrodes 25a, 25b are mechanically assembled next to the end distal of the parts 134a, 134b of trunk by a reel configuration. More specifically, electrodes 25a, 25b preferably comprise locking parts that they comprise proximal parts 136a, 136b of circular flange and distal portions 138a, 138b of separate circular flange and connected by circular stems 140a, 140b in between which form the respective reel configurations.

The circular grooves 142a, 142b formed between the proximal circular portions 136a, 136b of flange and the circular distal portions 138a, 138b of flange provide a receptacle for receiving interlaced parts semicircular 144a, 144b of tongue of the end parts distal 146a, 146b of parts 134a, 134b of trunk.

During assembly, interlaced parts tongue of one of the trunk parts are first placed in a part of the grooves 142a, 142b of the electrodes 25a, 25b. In other words, for example, electrodes 25a, 25b can assemble first with interlaced semicircular parts 144a of the tongue of the distal end portion 146a of part 134a of trunk that then occupies a first semicircular part of the circular grooves 142a, 142b. Then, once the electrodes 25a, 25b have settled properly with respect to the first part, here 134a, of trunk, the intertwined parts of tongue of the second part, here 144b, of trunk trunk 134b, they are located in the remaining semicircular part of the grooves circular 142a, 142b. After the electrodes 25a, 25b are have settled correctly with respect to both parties 134a, 134b of trunk and all remaining components are located correctly, parts 134a, 134b of trunk and parts 20a, 20b of handle can be assembled together using, for example, an adhesive (for example cyanoacrylate) or welding.

As best shown in Figure 53, the electrodes 25a, 25b of device 5k preferably comprise spherical parts 43a, 43b and spherical surface parts corresponding 42a, 42b located at the distal end of the device that provide a smooth outer surface, of blunt contour. More specifically, as shown, the parts spherical 43a, 43b and spherical surface part 42a, 42b they also provide a domed hemisphere, (i.e. less than a full sphere) and the hemispheric surface part preferably it comprises about 180 degrees. Also like Shown in Figure 53, electrodes 25a, 25b preferably they also comprise cylindrical parts 39a, 39b and parts corresponding cylindrical surfaces 40a, 40b located proximal and next to the spherical parts 43a, 43b and the parts spherical 42a, 42b, respectively.

The electrodes 25a, 25b of the 5k device are preferably couple to generator 6 by means of conductors 38a, 38b of cable of insulated cables 21a, 21b. At its ends distal, conductors 38a, 38b can be coupled to electrodes 25a, 25b being inserted first in the internal passages 148a, 148b of the hollow metal tubes 150a, 150b, such as hypodermic tubes, then pressed the tubes 150a, 150b. The tubes 150a, 150b below are preferably inserted and they retain in proximal end receptacles 152a, 152b of the electrodes 25a, 25b by tightening adjustment. How Alternatively, the tubes 150a, 150b can be removed and the wire conductors 38a, 38b can be attached to the electrodes 25a, 25b by welding, soft welding, fasteners mechanical or other suitable methods.

For device 5k conductive fluid 24 it is preferably provided by an inner passage 122 of a separate fluid pipe 120, which preferably comprises either a metallic material (for example, hypodermic steel tube stainless) or polymer (for example, PVC pipes), which extends distally and in parallel substantially within of the internal passage of the trunk comprising the parts 134a, 134b of trunk.

Similar to device 5j, in order to minimize the risk of jamming of internal passage 122 in the distal end outlet 124 of the fluid line 120, as shown, preferably distal end 126 of the fluid pipe 120 is proximal to the distal end of the 5k device and more preferably, proximal to the parts spherical surface 42a, 42b and surface parts cylindrical 40a, 40b of electrodes 25a, 25b, or others tissue treatment electrode surfaces since the Electrode configurations vary.

Also similar to the 5j device, for device 5k the outlet opening 124 for the pipe 120 fluid is preferably evenly spaced between electrodes 25a, 25b such that the fluid conductive 24 ejected by the outlet opening 124 may form a fluid coupling comprising the bridge 27 between the surface 22 of the fabric and surface 42a, 42b of each of the electrodes 25a, 25b.

The effect of the bipolar devices of the present invention in the tissue can be varied by changing the separation distance between the contact elements. In consequence, as shown in figure 54, in contrast to certain provisions in which the separation distance does not can be adjusted, bipolar device 51 provides a adjustment mechanism to change the separation distance (either increasing or decreasing) between electrodes 25a, 25b. How I know shown in figure 54, the change in the separation distance between electrodes 25a, 25b is provided by a mechanism adjustable scissor type with two arms 117a, 117b articulated relatively to each other in the middle of a pivot 110 comprising preferably a pin. The device 51 can also comprise a hitching mechanism 111 that fixes so progressive position of electrodes 25a, 25b with each other during tissue treatment, by increasing or decreasing the distance of separation.

Also, as shown, arms 117a, 117b they are themselves preferably articulated in the pivots 110a and 110b, which preferably also comprise pins, which divide the arms 117a, 117b into proximal parts 118a, 118b of arm and distal parts 112a, 112b of arm. Distal parts 112a, 112b of arm are preferably connected by a link 113, which maintains the distal parts 112a, 112b of arm and the electrodes 25a, 25b substantially parallel to each other during the use of device 51. As shown, link 113 comprises a bar 114 fixed on the distal arm part 112b and having an elongated opening 116 therein. The link also includes a pin 115 attached to the distal arm part 112a that moves throughout and within the opening 116 during use of the device 51 with changing the separation distance between electrodes 25a, 25b. For device 51, the tip parts 45a, 45b, particularly may comprise the configuration disclosed with device 5i.

Another arrangement of a bipolar device is shown in 5m in figures 55-58. As shown better in figures 55 and 56 and similar to device 5i, the 5m electrosurgical device preferably includes two stationary stationary arms comprising hollow logs self-supporting rigid 17a, 17b. The trunks 17a, 17b of 5m device preferably comprise hypodermic tubes of thick walls that provide enough stiffness to maintain its shape while using the device without bends or curvatures significant. In certain provisions, logs 17a, 17b They can be malleable by hand.

As shown in the figures 55-58 and similar to the 5i device, preferably the arms of the 5m device (comprising the logs 17a, 17b) are retained in relative position with each other by means of a mechanical coupling device comprising a collar 95 and prevents them from separating from each other. Also like shown in figures 55-58, collar 95 is preferably located in a distal part of the arms. Plus preferably, collar 95 is positioned next to the ends distal 53a, 53b of the trunks 17a, 17b. As best shown in Figures 57 and 58, preferably collar 95 comprises two openings 96a, 96b, shown comprising C-shape, configured to receive a distal end of the arms of the trunks Once collar 95 is mechanically connected to the logs 17a, 17b, preferably with a socket connection by elastic jump or through slip, the location of the collar 95 can be additionally fixed in relation to logs 17a, 17b, for example, by glueing collar 95 to the insulators 90a, 90b of trunk. This glued with adhesive can be achieve, for example, either with the use of a separate adhesive or by autogenous connection of collar 95 to insulators 90a, 90b, for example, by welding such as welding by ultrasound

The collar 95 comprises an electrically insulating (dielectric) material. In some arrangements the electrically insulating material for collar 95 may comprise polymer, either thermoplastic or thermosetting, reinforced or unreinformed, with or without filler. Examples of polymer materials include, but are not limited to, polyacetal (POM), polyamide (PA), polyamidaimide (PAI), polyether ether ketone (PEEK), polyetherimide (PEI), polyethersulfone (PES), polyimide (PI), polyphenylenesulfide ( PPS), polyphthalamide (PPA), polysulfone (PSO), polytetrafluoroethylene (PTFE) and syndiotactic polystyrene (SPS). Preferably, the electrically insulating polymer comprises any liquid crystal polymer and, more particularly, an aromatic liquid crystal polyester that is reinforced with glass fiber, such as Ticona Vectra® A130, or polyetherimide fills 10% of Ultem® glass of General Electric Company Examples of reinforcing materials for polymers include, but are not limited to, glass fibers and boron fibers. Examples of fillers for polymers are mica, calcium carbonate and boron nitride. Reinforcement materials for the polymer material may be preferred for greater strength while fillers may be preferred for greater resistance to heat and / or thermal conductivity. Even other electrically insulating materials for collar 95 may be a ceramic such as nitride of
boron.

As explained above with reference to device 5i and figure 48, the fluid coupling in the tissue for the device 5i it may comprise a fluid bridge 27 conductive between electrodes 25a, 25b, which rests on the surface 22 of tissue 32 and forms a shunt between the electrodes 25a, 25b. As explained above, a certain amount of RF energy can be diverted so as not to enter the tissue 32 and actually pass between electrodes 25a, 25b through the bridge 27 of conductive fluid. This loss of RF energy can slow down the process of tissue coagulation and production of the desired hemostasis or aerostasis of the tissue. Also how do I know explained above, the loss of RF energy through the bridge 27, can be reduced or eliminated because all the fluid 24 of the bridge 27 evaporates or a large part of the boil creates sufficient interruption in the continuity of bridge 27 to interrupt the electrical circuit through bridge 27. From this mode, as indicated above a strategy to control the present disclosure is to reduce the presence of a referral from conductive fluid, increasing the boiling% of the fluid conductive.

Instead of increasing the boiling% of the bridge 27 of conductive fluid to reduce the presence of a fluid bypass between electrodes 25a, 25b, in certain applications can be advantageous to provide the device electrosurgical a dike between electrodes 25a, 25b, which reduce and preferably prevent the formation of bridge 27 of conductive fluid between electrodes 25a, 25b.

As best shown in Figures 57 and 58, the collar 95 of the 5m device preferably further includes a substantially flat part 154 of electrically separator sheet-shaped insulator, located laterally between the electrodes 25a, 25b. In addition to keeping electrodes 25a, 25b separated at a predetermined minimum separation distance (as dictated by the thickness of the separator part 154), the separator part 154 also provides a dike between the electrodes 25a, 25b, which reduces and preferably prevents formation  of the conductive fluid bridge 27 between the electrodes 25a, 25b

Also, as best shown in figures 57 and 58, the distal end surface 156 of the spacer part 154 preferably follow the contour of the extreme surfaces adjacent distal 158a, 158b of electrodes 25a, 25b of such so that the distal end surface 156 of the spacer part 154 is substantially flush, and preferably completely flush, with adjacent distal end surfaces 158a, 158b of electrodes 25a, 25b. In this way, the separating part 156 and electrodes 25a, 25b are better configured to slide along the tissue surface since there are no raised or embedded edges created between the distal end surface 156 of the part separator 154 and adjacent distal end surfaces 158a, 158b of electrodes 25a, 25b, which could hinder the sliding movement

Similar to device 5c, the electrodes 25a, 25b of device 5m are preferably assembled next to the distal ends 53a, 53b of the logs 17a, 17b by connecting parts, which preferably comprise pin parts 46a, 46b, which connect the rest of the electrodes 25a, 25b to the logs 17a, 17b. Among other things, the connecting part of electrodes 25a, 25b is configured preferably to form a connection with a connecting part paired with logs 17a, 17b. Also similar to device 5c, preferably pin portions 46a, 46b of the 5m device are configured to extend into cavities 50a, 50b, of the logs 17a, 17b, comprising receptacles cylindrical and provide paired connector parts for the spike parts 46a, 46b. Also similar to device 5c, preferably surfaces 48a, 48b of the pin parts 46a, 46b of the 5m device are configured to pair against and form a tight fit with the surfaces 52a, 52b of the cavities 50a, 50b to provide the Connection.

Similar to device 5c, the parts of pin 46a, 46b of the 5m device are preferably cylindrical and are proximal and adjacent to the parts of neck 56a, 56b. As best shown in Figures 57 and 58, some neck parts 56a, 56b comprise the cylindrical parts 57a, 57b which preferably have a cross-sectional dimension, here the diameter, larger than the cross-sectional dimension, here also the diameter of the spike parts 46a, 46b. This way, similar to device 5c, in certain arrangements, the proximal end of the neck portions 56a, 56b of the 5m device can be placed together and in contact with the distal ends 53a, 53b, of the trunks 17a, 17b.

As best shown in Figures 57 and 58, of similar to the slit 64 of the device 5c, the electrodes 25a, 25b of the 5m device preferably comprise at least slits 63a, 63b, which provide an elongated channel of fluid flow and an outlet for fluid distribution 24.

The electrodes 25a, 25b of the 5m device preferably comprise an enlarged head part. Every enlarged head part preferably comprises a part hemispherical lateral 160a, 160b with a hemispheric surface that preferably it comprises about 180 degrees. How I know best shown in figures 57 and 58, preferably the parts hemispherical 160a, 160b, they have their backs to each other in opposite relationship facing outward on opposite sides of the device. The hemispheric parts 160a, 160b meet preferably on the sides of parts 162a, 162b of transverse oriented cylindrical transitions that preferably provide a smooth transition between the parts hemispherical 160a, 160b and collar separator part 154. As shown, electrodes 25a, 25b and separator part 154 they can comprise flat support surfaces 164a, 164b that are They have opposite looking at each other. In alternative arrangements mean transition parts 162a, 162b of the electrodes 25a, 25b which results in the head part of electrodes 25a, 25b comprising only the parts hemispherical 160a, 160b, with a hemispheric surface that preferably comprises approximately 180 degrees.

In certain provisions the party separator 154 may comprise a thickness in the interval between e including approximately 0.5 mm to 10 mm, or in any 0.1 mm increment or interval between, or provide a separation distance between electrodes 25a, 25b thereof. For example, the separator part 154 comprises a thickness in the interval between and including approximately 1.5 mm and 4 mm.

As an alternative to adjusting the distance of separation between electrodes 25a, 25b by changing the thickness of the separator part 154, electrode parts 25a, 25b can be coat with a thin coating (for example 0.01-0.5 mm) electrically insulating comprising, for example, a polymer or ceramic material. As it is shown in Figures 59-62, a part of electrodes 25a, 25b for the 5n device, here the neck parts 56a, 56b, the average transition parts 162a, 162b and about half of each part of hemisphere 160a, 160b of the enlarged head part Shown with an electrically insulating coating 166 on they. As a result, the active electrode surface of tissue treatment is now limited to about quarter quarter surfaces 168a, 168b and distance from separation between electrode surfaces the treatment of tissues has increased the thickness of the middle transition parts 162a, 162b of electrodes 25a, 25b.

Another arrangement of a bipolar device is shown in 5th in figures 63-64. By way of similar to the 5n device, the active electrode surface of tissue treatment of electrodes 25a, 25b may be limited to about quarter sphere surfaces 168a, 168b (approximately 90 degrees) with the other electrode surfaces extending from the distal end of the insulators 90a, 90b of trunk that have electrically insulating coating 166 about them. However, unlike the 5n device, the part enlarged electrode head, 25a, 25b of the 5th device it comprises two substantially circular spheres (i.e., except where they join the neck parts 56a, 56b). The spheres can have any suitable diameter. However, the spheres have preferably a diameter in the range between and including approximately 0.5 mm to approximately 7 mm. Plus preferably the spheres have a diameter in the range between and including about 1.0 mm to about 4 mm. Even more preferably the spheres have a diameter in the interval between and including approximately 1.5 mm at approximately 3 mm. When lining 166 is missing in it, the active electrical surface of the spheres is of approximately 260 degrees.

Also different from the 5n device, the collar 95 of the 5th device does not include a separation part 154. With device 5o, electrodes 25a, 25b are separated for an air gap in between. As a result, as shown in figure 64, when electrodes 25a, 25b of device 5o they are pressed against the surface 22 of the fabric 22 and the fabric 32 against the electrodes 25a, 25b compress and form the grooves 170a, 170b, the 5th device is configured to allow the tissue 32 located next to the gap 172 between the electrodes 25a, 25b form a protrusion 174 of fabric with slopes down in the recesses 170a, 170b. Since the fluid 24 that can exist between electrodes 25a, 25b will tend to flow with the gravity down the slopes of the bump 174 of tissue and in adjacent grooves 170a, 170b, the possibility of forming a conductive fluid bridge 27 between electrodes 25a, 25b. In addition, even if a fluid bridge 27 conductive that forms between electrodes 25a, 25b (for example, where electrodes 25a, 25b of device 5o are not pressed against tissue 32 significantly enough to forming the recesses 170a, 170b) the coating 166 in the internal surfaces that look at the electrodes 25a, 25b reduces the possibility of such a bridge being directly electrified by electrodes 25a, 25b.

Another arrangement of a bipolar device is shown in 5p in figures 65-69. As shown better in figure 66, electrodes 25a, 25b now comprise Hollow metal tubes. More specifically, the extreme part distal tubes comprise approximately a 90 degree curve (within approximately ± 5 degrees) that forms two elbows in right angle and curving the distal end parts one towards the another as they extend distally. In addition, the distal ends of the tubes are arranged facing each other looking at each other. Consequently, electrodes 25a, 25b are substantially mirror images of each other.

As shown in figure 66, collar 95 has been removed to show better than preferably electrodes 25a, 25b comprise circular hypodermic steel tube stainless. When electrodes 25a, 25b comprise parts separated from the trunks 17a, 17b, electrodes 25a, 25b of the 5p device preferably connect to logs 17a, 17b with tightening adjustment of the internal diameter of the logs 17a, 17b with the internal diameter of the electrodes 25a, 25b. However, with in order to minimize the number of components and the assembly of the themselves, preferably a single piece of continuous tube provides both the trunk and the electrode. In other words, how do I know sample, preferably electrodes 25a, 25b, are provided  for the same piece of pipe used for logs 17a, 17b.

As best shown in the figures 67-69, preferably the 5p device includes a collar 95, which includes an insulating electric separator part 154 located laterally between electrodes 25a, 25b. Besides, the separator part 154 preferably includes at least one slit 176a, 176b, which provides an elongated flow channel of fluid and a fluid passage part for fluid distribution 24 from openings 178a, 178b. As shown, both distal end openings 180a, 180b of the pipes and openings 178a, 178b of the slits, 176b are placed in a position substantially inaccessible to direct contact with the tissue or otherwise configured away from direct contact with the tissue so as not to be occluded by the tissue with the use of 5p device

Preferably the separator part 154 includes outgoing 182a, 182b and more specifically outgoing configured to fit into distal end openings 180a, 180br and at least partially occlude the openings 180a, 180b. In this way the electrodes 25a, 25b are retained against the movement in relation to separator 154, as well as the rest of the collar 95.

In certain provisions, in order that heat can be transferred out of electrodes 25a, 25b by the separator part 154, preferably the material for the collar 95 has a thermal conductivity k_ {tc} at 300ºK (Kelvin degrees) equal to or greater than approximately 0.01 watts / cmK. More preferably, the material for collar 95 has a thermal conductivity k_ {tc} at 300ºK (Kelvin degrees) equal or greater  that approximately 0.16 W / cmºK. Even more preferably, the material for collar 95 has a thermal conductivity k_ {tc} at 300ºK (Kelvin degrees) equal to or greater than approximately 0.35 W / cmºK.

The use of openings 178a, 178b of the grooves 176a, 176b for fluid distribution 24 can be preferable to at least one outlet 184a, 184b of outlet fluid that can be disposed on the distal end side of the electrodes 25a, 25b proximal to the distal end (see Figure 66), particularly in the deep cracks of the tissue in which the tissue can occlude the flow of fluid from openings 184a, 184b. However, as shown in the figures 70-71 for the 5q device, in which the fluid outlet openings 184a, 184b are placed in a position substantially inaccessible to direct contact with the tissue or otherwise configured away from direct contact with the tissue so as not to be occluded by the tissue (such as the grooves shown on the inner side wall of electrodes 25a, 25b together with the internal radius of the bend of the elbow and the distal end of the electrode), openings 184a, 184b can be equally effective than openings 178a, 178b.

More particularly, as shown, the openings 184a, 184b in figures 70-71, for example, they are closer to the inner radius of the bend of the elbow than the other radius of the bend of the elbow, which helps in reducing the tissue occlusion. However, in other provisions the fluid outlet openings 184a, 186a may be closer to the outer radius of the bend of the elbow than the inner radius of the bend elbow, as shown in figure 66. Even in other arrangements the fluid outlet openings 184a, 186a can be equidistant from the outer radius of the elbow curve and the radius internal of the elbow curve, as shown in figure 73.

Another arrangement of a bipolar device is shown in 5r in figures 72-73. As shown, the distal end of the separator part 154 includes a slit 186 configured to allow tissue 32 to form a 174 extrusion of tissue in there to reduce the possibility of forming a bridge 27 of conductive fluid between the electrodes 25a, 25b as explained above.

The device of the present invention can include sets that control the power and / or flow of fluid in the tissue treatment part of the device. The ability to control the flow of fluid from the device can provide certain advantages over a device that does not has it. These advantages include reducing the amount of fluid at the site of tissue treatment and the probability of have to apply aspiration at the treatment site to remove the liquid

For device 5s of the figures 74-79, a single valve and switch set 190 of several functions and several positions comprises a button switch 192. Button 192 protrudes through an opening 194 formed in parts 20a, 20b of handle. Button 192 connects preferably integrally by molding a single polymer piece on a switch arm 196 extending in proximal sense that provides a part of a mechanism of fluid flow control, preferably formed by the interaction with the handle part 20a to connect (total flow, ie flow without regulation at full flow through the tubes) and disconnecting (without flow) the fluid flow 24 to the part of tissue treatment of the device.

More specifically, the control mechanism of fluid flow of valve / switch assembly 190 is provides with changing the separation distance between the proximal end part of switch arm 196 and section 200 wall of the handle part 20a, when arm 196 of the commutator moves proximally and distally along the track 206 formed and defined by the openings 208 of the ribs  210 of the handle part 20a, in response to button 192 which moves proximally and distally in the opening 194 of the button switch.

As shown in Figure 76, the pipe 4b of fluid is located between the proximal end portion 198 of the switch arm 196 and wall section 200 of part 20a mango As button 192 and arm 196 of the switch they move proximally by the force of the hand, decreasing with it the separation distance between the proximal end part 198 of arm 196 of the switch and wall section 200 of the handle part 20a, the fluid pipe 4b is tightened and compressed externally in between and its internal passage is occluded correspondingly to decrease and preferably stop by complete, the fluid flow. As exhibited by the previous fluid flow control mechanism, preferably the mechanism does not make contact with fluid 24, thus reducing the chance of accidental contamination.

Continuing with figure 76, preferably the fluid flow control mechanism of assembly 190 of valve / switch comprises a mechanism that supports the arm 196 in a fixed locked position while compressing and occludes the 4b fluid pipe. As shown, preferably the mechanism lock comprises a lock tab 202 of the part 20a of handle that holds arm 196 in its locked position by coupling a distal end portion 204 of arm 196 of switch.

Lock tab 202 is disengaged from the distal end 204 of switch arm 196 by pressing button 192. By pressing button 192, the distal end portion 204 of the switch arm is also separated from tab 202 and the tab 202 is disengaged from the distal end portion 204. How to best shown in figure 77, at the same time arm 196 of the commutator is forced distally by decompression of the elastic fluid pipe 4b in such a way that the tab 202 enters notch 212. Preferably the arm 196 of the switch is also forced distally by the decompression of a linear spring 228 which predisposes the proximal movement of the arm 196 to the switch off position against the pipe 4b of fluid with compression thereof, and, with decompression of the same, helps return switch 192 to its position of on with the arm being uncoupled from tab 202. How to shows, the spring 228 is supported on the arm 196 by a post circular 234 and is compressed between a flange 238 located at the base of post 234 and one of the ribs 210. With the decoupling of the extreme part is 204l from the arm 196 in relation to the flange 202, the button and arm 196 of the switch can be moved in distal direction until tab 202 engages at the end proximal 214 of notch 212.

Once the fluid flow 24 has been resumed, button 192 of the set switch valve / switch can now be pressed to activate flow of electrical current to electrodes 25a, 25b. As explained previously, electrodes 25a, 25b are preferably coupled to the generator 6 via conductors 38a, 38b of insulated cables 21a, 21b. Here, for example, active and return electrodes they comprise electrodes 25a, 25b.

As shown in the figures 78-79, electrode 25a is coupled directly to the generator 6, without any additional inclusion of a switch on / off with an associated control circuit in between. However, in addition to being directly coupled to generator 6, the electrical coupling of electrode 25b to generator 6 includes now the presence of two separate electrical contacts 216 and 218 which, in the open position, create an open control circuit between electrode 25b and generator 6. The wiring of this electrical control circuit with generator 6 is known in the technique and will be briefly explained below.

As best shown in the figures 77-79, contacts 216 and 218 are arranged in a platform 222 partially underlying button 192 of the switch 192 and arm 196. As best shown in Figure 78, the contact 216 comprises a domed contact covering the contact 218. In the open position, or without pressing, contact 216 remains separate from the underlying contact 218 under the vaulted configuration of contact 216, which results in a open control circuit between electrode 25b and generator 6. However, when button 192 of the set 190 switch of valve / switch is in its depressed position, post 220 press the vaulted contact 216 towards the contact with the contact 218, thus closing the control circuit between the electrode 25b and the generator 6. The presence of the control circuit closed formed by cable 21 is then detected by the generator 6 through a low voltage sensor that then provides the set power to electrodes 25a, 25b.

When a force of oppression is removed from the button 192 of the switch, contact 216 returns to its position domed prior to oppression as a result of their resilience or elastic memory, thus returning button 192 of the switch to its position without oppression, and reopening the control circuit between electrode 25b and generator 6. The presence of the open control circuit is then detected by the generator that then stops the power supply to electrodes 25a, 25b. Alternatively, when button 192 of the switch is not used and the doctor decides to activate the electrodes 25a, 25b, with a pedal switch, electrical power set at electrodes 25a, 25b only flows directly to through contact 218 to complete the electrical circuit.

It should be understood that set 190 of valve / switch is configured in such a way that the current electrical cannot be provided to electrodes 25a, 25b while the fluid flow is deactivated. As shown in figure 77, when the button 192 of the switch and the arm 196 of the switch are in their proximal position, post 220 is not overlaps the vaulted contact 216. Accordingly, if pressed the button 192 of the switch, the post 220 only makes contact with the platform 222 and the electrical circuit between electrodes 25a, 25b and generator 6 remains open.

It should also be understood that in the case of a single main fluid passage that can be branched in several steps secondary, preferably switch / valve assembly 190 It acts on the main fluid passage to reduce complexity. As shown in Figures 76-77, preferably the valve / switch assembly 190 is located proximal with respect to divider 240.

In other provisions one or more of the devices of the present disclosure may include some power switch and flow valve assemblies independent fluid instead of a part of a single set of Multi-position switch / valve. As shown in the Figures 80-81, the device 5t comprises a switch set 224 to turn the power on and off for the tissue treatment part of the device and a set 226 valve to turn on the fluid flow (total flow) and turn it off  (no flow) to the tissue treatment part of the device.

As best shown in Figure 81, the button 230 of the switch of the active switch assembly 224 and deactivates fluid flow in substantially the same way as the switch button 192 of the valve / switch set 190 (that is, with a distal and proximal movement). However, to difference of the 5s device, the proximal end portion 198 of the arm 196 of the 5t device switch includes a wheel 236 roller to help with compression and decompression of the 4b fluid pipe.

As for the power, button 232 of the valve set switch 226 turns on and off substantially in the same way as switch button 192 of valve / switch assembly 190 (i.e. in positions oppressed and unpressed). However, unlike the 190 set valve / switch, with the valve assembly 226 the power it can be activated and deactivated regardless of the flow of fluid. In other words, button 232 of the set switch Valve 226 may be in the power position "activated", while button 230 of the switch assembly 224 is in the fluid flow position "disabled". In this way, the 5t device can be configured to function as an electrosurgical device dry without fluid 24 that is supplied simultaneously from the tissue treatment part of the device.

In even another arrangement, as shown in Figures 82-86, the second valve assembly to activate and deactivate the flow of fluid to the part of tissue treatment of the device may comprise a set of pincer with pinch of roller. As best shown in the Figures 83-86, the 5u device includes a 242 caliper set with roller pinch and more specifically, a pinch set with roller pinch on ramp (instead of a parallel drive clamp).

As best shown in the figures 84-85, the clamp includes a housing provided by handles 20a, 20b, a roller wheel 244 having an axle 246 wheel center and a guide pin hub. As shown, the guide pin hub is provided by a pair of stumps opposite cylindrical, integrally formed 248a, 248b, but It can also be provided by a pin formed separately. The stumps 248a, 248b are inside and move along of a track 250 preferably provided and defined by the channels 252a, 252b of the opposite stump formed between the surfaces top guide 254a, 254b of the wheel and surfaces lower guides 256a, 256b of the wheel that extend longitudinally and parallel inwards from the parts side walls of the handles 20a, 20b. As shown, the upper guide surfaces 254a, 254b of the wheel are provided by a lip portion of the handles 20a, 20b, which partly define the opening 258 whereby the roller wheel extends partially while the guide surfaces lower 256a. 256b of the wheel are provided by the ribs 260a, 260b.

The handles 20a, 20b preferably also provide guide surfaces 272a, 272b of tubes, which by at least a part of them provides an area of clamp against which the plastic tube 4b is held by the roller 244. As best shown in the figures 84-85, tube guide surfaces 272a, 272b they are provided by the ribs 270a, 270b. During use, the fluid pipe 4b is squeezed and compressed externally between the outer perimeter surface 262 of roller wheel 244 and by at least a part of the tube guide surfaces 272a, 272b. In this arrangement, preferably surface 262 is serrated.

The stumps 248a, 248b support the movement of the roller wheel 244 in two opposite directions, here in the direction proximally and distally, along runway 250. How to best shows in figures 85-86, the distance of separation between the outer perimeter surface 262 of the wheel roller 244 and tube guide surfaces 272a, 272b, change what length of the proximal and distal travel of the roller wheel 244 a along track 250. More specifically, the distance of separation between the outer perimeter surface 262 of the wheel of roller 244 and the tube guide surfaces 272a, 272b is larger between the outer perimeter surface 262 of the roller wheel 244 and the distal end portions 274a, 274b of the surfaces 272a, 272b of tube guide provided by the end parts distal 264a, 264b of the ribs 270a, 270b, which enters the outer perimeter surface 262 of roller wheel 244 and the proximal end portions 276a, 276b of surfaces 272a, 272b of tube guide provided by proximal end parts 266a, 266b of the ribs 270a, 270b.

As shown in the figures 84-85, when axle 246 of roller wheel 244 opposes the distal end portions 274a, 274b of the tube guide surfaces 272a, 272b, preferably distance separation is configured in such a way that tube 4b can be decompressed and the inner passage of the tube 4b completely open for the total flow through you. On the contrary, as shown in Figure 86, when the axle 246 of the roller wheel 244 is opposes the proximal end portions 276a, 276b of the surfaces Tube guide 272a, 272b preferably the distance of separation is configured such that tube 4b is compressed and the inner passage of the tube 4b is completely blocked so that fluid flow through tube 4b is prevented.

The distal end portions 274a, 274b of the tube guide surfaces 272a, 272b are separated from the proximal end portions 276a, 276b of surfaces 272a, 272b of tube guide by transition surfaces 278a, 278b, which are provided by the transition rib parts 268a, 268b of the ribs 270a, 270b. Preferably compression of the pipeline initially begins between the surfaces of transition 278a, 278b and the outer perimeter surface 262 of the roller wheel 244 and increases as wheel 244 moves proximally along the proximal end parts 276a, 276b of the surfaces 272a, 272b of tube guide. With this configuration, the possibility of eliminating it can be considered minus the part of the distal end parts 274a, 274b of the tube guide surfaces 272a, 272b that do not contribute to the tube compression 4b. However, since the extreme parts distal 274a, 274b of the tube guide surfaces 272a, 272b guide the tube 4b to the divider 240, this may not be desirable.

As shown in the figures 84-86, both transition surfaces 278a, 278b and the proximal end portions 276a, 276b of the surfaces 272a, 272b tube guide offer inclined surfaces with slope proximally along their lengths respective that decreases the separation distance between the outer perimeter surface 262 of roller wheel 244 and the tube guide surfaces 272a, 272b when the wheel moves 244 proximally As shown, preferably the transition surfaces 278a, 278b and the end parts proximal 276a, 276b of the tube guide surfaces 272a, 272b they have different inclinations such that the distance of separation decreases at a faster rate along the transition surfaces 278a, 278b, compared to the parts proximal ends 276a, 276b of surfaces 272a, 272b of tube guide In this way, the compression of the tube 4b is not linear.  along the extension of the 244 wheel travel with a most compression occurring between the roller wheel 244 and transition surfaces 278a, 278b. Preferably, the inner passage of tube 4b is completely blocked when the wheel of roller 244 is compressing tube 4b against the proximal part of transition surfaces 278a, 278b, and added compression of tube 4b along the proximal end portions 276a, 276b of the tube guide surfaces 272a, 272b provides a additional security to ensure a complete blockage of the passage inside, even when there are variations in the tubes, such as the inner passage size.

It should be appreciated that, due to the slope of the transition part 268a, 268b of rib, when the wheel of roller 244 moves proximally in relation to the transition surfaces 278a, 278b the inner passage of the tube 4b It locks progressively. Thus, in addition to providing a on / off mechanism, the clamp assembly 242 with roller pinch can also be used to regulate the flow rate of fluid between two non-zero flow values. Must also it should be noted that the clamp assembly 242 with pinch of Device roller can be used in series in combination with another pinch set with pinch roller that normally provided as part of a set of IV (that is, IV bag, IV bag tip, drip chamber, tube connection, roller clamp, sliding clamp, luer connector). When used in this way, the pinch pinch assembly of IV set roller can be used to get a primary setting (important) for fluid flow, while the 242 pinch assembly with roller pinch of the device is can use to get a secondary adjustment (more precisely of minor importance) for the flow of fluid.

In another arrangement, as shown in the Figures 87-89 for the 5v device, the set 242 pinch with roller pinch may include a cover 280 which at least partially closes the opening 258 and / or hides the roller wheel 244. Among other things, cover 280 reduces the possibility of unwanted foreign fluid (for example, blood and other body fluids) enter the limits of the mango 20a, 20b through opening 258. In addition, cover 280 reduces the exposure of the internal mechanics of set 242 of pinch with pinch roller. In this way, cover 280 reduces the possibility of foreign bodies (e.g. gloves of practitioner rubber) enter the limits of the handle 20a, 20b a through opening 258 and engage, for example, between the stumps 248a, 248b and track 250.

As shown in the figures 88-89, preferably cover 280 overlaps and moves distally and proximally to roller wheel 244, and is configured to provide a button portion 282 of the switch when the wheel is covered inside the receptacle semicircular 284 and is inaccessible to direct manipulation. Preferably cover 280 is configured to close substantially opening 258 regardless of position of the wheel 244, preferably by means of a distal part of protection 286 and a proximal protection part 288. Preferably, the distal protection part 286 and a part proximal protection 288 have a length equal to or greater than the opening length 258 minus the length of part 282 of switch button

Also as shown, preferably the cover 280 comprises a distal guide portion 290 and a portion proximal guide 292 located below the distal part of protection 286 and a proximal protection part 288 on sides opposite of the wheel 244. As shown, the guide part 292 and the distal protection part 286 comprise pins rectangular guides and preferably move along a track 250 similar to wheel 244. Wheel 244 is partially extends into receptacle 284 which has a diameter slightly larger than wheel 244.

With the movement of the button part 282 of the commutator in the proximal direction by a force directed in the direction proximal applied by, for example, a finger, the inner surface 294 of the distal guide portion 290 makes contact with the surface 262 of wheel 244 and pushes the wheel proximally. By against, with the movement of the button part 282 of the switch distally by a force directed distally applied  for, for example, a finger, the inner surface 296 of the part distal guide 292 makes contact with the surface 262 of the wheel 244 and push the wheel distally. In this provision, the surface 262 of wheel 244 is preferably smooth and the wheel 244 preferably comprises a polymeric material self-lubricating, such as polyacetal.

In another arrangement, as shown in the Figures 90-91 for the 5w device, part 282 button switch cover 280 may include some side parts 298 covering opposite sides of the wheel 244. However, unlike the 5v provision, a part of the 280 cover for 5w device is not contained or guided directly on track 250 since the distal guide portion 290 and The proximal guide part 292 has been removed. Although the 280 cover for 5w layout still applies a force directional to wheel 244 to move wheel 244, cover 280 now joins wheel 244 and is transported along the track 250 through the stumps 248a, 248b of the wheel 244. How to sample, cover 280 includes two opposite openings 300 in C shape, which provide wheel hub receptacles for stumps 248a, 248b. As shown, the stumps 248a, 248b are found in openings 300.

Thus, with the movement of part 282 switch button proximally by a directed force proximal, the inner surface 302 of the cover 280 that defines the openings 300 make contact with the lateral surface cylindrical 304 of the stumps 248a, 248b and pushes the wheel in proximal sense Conversely, with the movement of part 282 switch button distally by a directed force distal, the inner surface 302 of the cover 280 defining the openings 300 also makes contact with the lateral surface cylindrical 304 of the stumps 248a, 248b and pushes the wheel in distal sense

In another arrangement, as shown in the Figures 92-93 for the device, part 282 of cover switch button 280 has been removed. Of this mode, roller wheel 244 will be exposed and can be operated directly and not by button part 282 of the switch.

While the various set provisions of switch described above have been mainly described  referring to bipolar devices, it should be understood that the various switch sets can be equally adaptable to other fluid-assisted medical devices, such as the monopolar devices of the present disclosure.

5i-5x bipolar devices they are particularly useful as non-binding tissue shutters since they don't grab the tissue. The devices 5i-5x are particularly useful for surgeons get hemostasis after dissection through of soft tissues, as part of a hip arthoplasty or on your knees. The tissue treatment parts can be painted above the raw surface 22 oozing from tissue 32 to close tissue 32 against bleeding, or focus on vessels larger individual bleeds to stop bleeding from cups.

5i-5x devices too They are useful to stop bleeding from the surface of a tissue bone cut as part of any orthopedic procedure that require the bone to be cut. Bipolar devices 5i-5x are particularly useful for these applications on a monopolar device 5a since it can be treat a much larger surface 22 of tissue 32 in a period of equivalent time and with a better controlled depth of treatment.

As is well known, bone or bone tissue, it is a particular form of dense connective tissue consisting of bone cells (osteocytes) embedded in a matrix of substance calcified intercellular. The bone matrix mainly contains collagen fibers and calcium carbonate minerals, phosphate calcium and hydroxyapatite. Among the many types of bones in the Human body are compact bones and spongy bones. He  compact bone is a hard, dense bone that forms the layers superficial bones and also bone trunks long They are made primarily of Havers systems that are covered by the periosteum. The compact bone contains some channels discrete nutrients through which blood vessels get access to Havers systems and the medullary cavity of Long bones For example, the Volkmann channels that are small channels found in the compact bone through those that pass the blood vessels of the periosteum and connect with the blood vessels of the Havers canals or the cavity medullary. Bipolar devices as described in this document can be particularly useful for the treatment of compact bones and to provide hemostasis and close the bleeding vessels (for example, by reduction to complete the closure) and other structures associated with the Volkmann channels and Havers systems. Unlike the compact bone, the bone reticular is spongy bone and constitutes the majority of short, flat and irregular bones and bone ends long The bone tissue network that constitutes the structure of the Reticular bone comprises many small trabeculae, which enclose partially many marrow-filled intercom spaces that is. Consequently, due to their trabecular structure, the Reticular bones are more amorphous than compact bones, and they have many more channels with various cell precursors blood mixed with capillaries, venules and arterioles. The Bipolar devices such as those described herein may be particularly useful for the treatment of reticular bone and to provide hemostasis and closure of structures bleeding such as the anterior micro-vessels (it is ie, capillaries, venules and arterioles), in addition to the veins and arteries These devices can be particularly useful for its use during knee, shoulder, hip orthopedic procedures and spine (for example, arthroplasty).

During a replacement procedure for knee, the condyle of the distal epiphysis of the femur and the plateau tibial in the proximal epiphysis of the tibia is often cut and makes it flatter with saw devices to provide in ultimately a more appropriate support structure for the prosthesis of the femoral condyle and the tibial prosthesis attached to it, respectively. The cut of these long bones has as result of hemorrhage of the reticular bone in each place. With the in order to close and stop the reticular bone hemorrhage, which has been exposed with the cut of the epiphysis of each long bone, it they can use the bipolar devices described in this memory. Subsequently, the respective prosthesis can be connect.

Changing to a replacement procedure for hip, the head and neck of the femur in the epiphysis is removed proximal femur, usually cutting with a device sierra, and the inter-trochanteric region of the femur is makes it flatter to provide a more supportive structure suitable for the femoral stem prosthesis then attached to the same. With respect to the hip, a reamer is often used ball to ream and expand the acetabulum of the unnamed bone (hip) to accommodate the insertion of a prosthetic cup acetabular in it, which will provide the receptacle in which fits the head of the femoral stem prosthesis. The cut of femur and reaming of the hip bone result in haemorrhage of the reticular bone in each place. In order to close and stop the bleeding of the reticular bone, which has been cut and exposed, the bipolar devices described in this memory From then on, as with the replacement of the knee, the respective prostheses can be joined.

The bipolar devices described in this memory can be used for tissue treatment connective, such as by reduction of intervertebral discs during spine surgery. The discs intervertebral are flexible tissue pads fibrocartilaginous firmly fixed between the vertebrae of the spine. The discs comprise a flat capsule and circular about 2.54 cm (1 inch) in diameter and approximately 0.635 cm (0.25 inches) thick, composed of a strong and fibrous outer membrane called a fibrous ring, which surrounds an elastic nucleus called the nucleus pulposus.

Under tension, it is possible that the nucleus pulposus swells and gets herded, pushing through a weak spot in the membrane of the fibrous ring of the disc and spinal canal. In Consequently, all or part of the material of the nucleus pulposus can leave the weak point, pressing against the nerves surrounding, which produces pain and immobility.

The bipolar devices described in this memory can be used to reduce intervertebral discs herniated and that stand out that, after the reduction towards the size normal, reduces pressure on surrounding nerves and relieves The pain and immobility. The devices described in this memory can be applied through a spinal posterior access under medical control, for any focused reduction of fibrous ring membrane.

When an intervertebral disc cannot be repaired and must be removed as part of a discectomy, the devices described herein may be particularly useful to close and stop reticular bone hemorrhage of opposite surfaces of the upper and lower vertebrae (by example, the surface towards the head of the vertebral body of the upper vertebra and the surface of a lower vertebra). When the disc is removed from the front of the patient, for example, as part of a previous procedure, thoracic procedure of spine, the devices described herein can be especially useful to close and stop the bleeding of Segmental vessels in the vertebral body.

The bipolar devices described in this memory can be used to close and stop bleeding of the epidural veins that bleed as a result of the extraction of tissue around the dura membrane for, for example, a laminectomy or other neurosurgery. Epidural veins can begin to bleed when the dura is retracted out of them as part of a decompression. Also, during a laminectomy,  the devices described herein can be used to close and stop the bleeding of the vertebral arch and, in particular, the vertebral arch blade.

One or more of the system features described above can be built in an RF generator personalized. This provision may provide one or more advantages. For example, this type of system can save space and reduce overall complexity for the user. This system too can allow manufacturers to increase the power delivered by low impedance loads, which further reduces the time for achieve the desired effects on the tissue. This changes the curve of Figure 5, by removing or reducing the slope of ramp 28a of low impedance of the power against the impedance.

As an alternative, for situations in which the 28a high impedance ramp can be overcome with the use of devices of the present disclosure, it may be desirable provide an impedance transformer 224 in a series circuit configuration between electrode (s) of device 5 and generator power output 6. In consequently, the impedance transformer 224 can be supplied with device 5, generator 6 or any of the cable connectors (for example, cable 21) that connect the device 5 and generator 6. The impedance transformer 224 is configured to match the load impedance supplied to generator 6 so that it is within the working range of generator 6 and, more preferably, in the working interval between low and high cut points.

To effectively treat thick tissues, It may be advantageous to have the ability to send RF power by impulses In some circumstances, the deep temperature in the tissue can increase rapidly beyond the point of drying at 100 ° C despite the point of contact electrode / tissue is boiling at 100 ° C. This manifests in form of "rattle", since the steam generated in depth in the tissue it bursts too fast and erupts towards the surface. In an arrangement of the invention, a switch on the control device or custom generator to allow the user to select an "impulse" mode of the RF power Preferably, the RF power system in This arrangement is further controlled by software.

In some provisions, it may be desirable control the temperature of the conductive fluid before it is released from the electrosurgery device. In a provision, a heat exchanger is provided for the solution flow saline saline to heat or cool the saline solution. He heat exchanger can be provided as part of the electrosurgical device or as part of another part of the system, such as within enclosure 14. Preheating of the saline solution to a predetermined level below the boiling reduces the transitory heating time of the device since the RF is initially on, reducing with it the time necessary to cause coagulation of the tissue. As an alternative, the prior cooling of the solution Saline is useful when the surgeon wishes to protect certain tissues at the electrode / tissue contact point and treat Only the deepest tissue. An example application of this arrangement is the treatment of varicose veins, in which it is desirable to avoid thermal damage on the skin's surface. To the at the same time, the treatment is provided by contracting the vessels underlying blood using thermal coagulation. For the both the temperature of the conductive fluid can be controlled before of release from the surgical device, to provide The desired treatment effect.

In another arrangement the flow controller is has been modified to provide a flow of saline solution that translates into more than 100% boiling at the treatment site of tissue. For example, controller selection switch 12 11 flow rate (shown in figure 1) may include the adjustments corresponding to 110%, 120% and higher percentages of boiling. These higher settings may be of value for a surgeon in situations such as when tissue is found thickness, in which the thickness of the tissue can increase the conduction out of the claws of the electrodes. Since the basic strategy control set aside heat conduction, the setting for the 100% boiling can result in 80% or 90% boiling, depending on the amount of driving. Taking into account the teachings of this memory, the flow controller switch can be adapted to any desirable flow configuration, for achieve the desired boiling of the saline solution in the place of tissue treatment

Some provisions of the disclosure may provide one or several advantages over current techniques and electrosurgical devices For example, disclosure preferably achieves the desired effect on the tissue (by example, coagulation, cutting and something similar) quickly. In a preferred arrangement, actively controlling the flow rate of the saline solution, both in quantity (Q vs. P) and in location (for example, using gutters to direct the fluid distally to the tissues, using holes to direct fluid flow or other similar methods) the device Electrosurgical can create an electrode / tissue contact point hot without desiccation and therefore a rapid effect of thermally induced tissue coagulation.

The use of the disclosed devices may produce significantly less blood loss during surgical procedures such as liver resection. The blood loss typical of a right hepatectomy may be in the range of 500-1000 cubic centimeters. The use of the devices described herein to perform the coagulation before liver transection can have as result in less blood loss in the interval of 50-300 cubic centimeters. This reduction in Blood loss can reduce or eliminate the need for blood transfusions, and therefore the cost and consequences  negative clinics associated with blood transfusions, such as Prolonged hospitalization and a greater chance of cancer recurrence The use of the device can also provide better closure of the bile ducts and reduce the incidence of postoperative biliary leaks, which is considered a major surgical complication.

The disclosure may, in some provisions, offer rapid tissue treatment without the need for use a temperature sensor built into the device or a Custom generator for special purposes. In a provision preferred, there is no built-in temperature sensor or other type of tissue sensor, nor is there any custom generator. Preferably, the disclosure provides a means to control the flow rate to the device such that the device and the flow controller can be used with a wide variety of general purpose generators. Any general purpose generator is useful in relation to the fluid delivery system and the flow controller to provide the desired power; he flow controller will accept the power and adjust constantly the flow of saline solution according to the control strategy Preferably, the generator is not actively controlled by disclosure, so that Standard generators are usable according to the disclosure. Preferably, there is no active return feed from the device and the control of the saline flow rate is "open loop". Thus, in this arrangement, the control The flow of saline solution does not depend on the feeding of return, but rather the measurement of the RF power that comes out to device.

For the purposes of the appended claims, the term "tissue" includes, but is not limited to, the organs (for example, liver, lung, spleen, gallbladder), tissues highly vascular (eg, liver, spleen), tissues soft and hard (for example, adipose, areolar bone, lymphoid associated with the bronchi, reticular, chondroid, ropes, cromafines, cicatricial, conjunctive, elastic, embryonic, endothelial, epithelial, erectile, fatty, fibrous, gelatinous, granular, glandular, homologous, indifferent, interstitial, lymphoid, lymphadenoid, mesenchymal, lymphoid associated with the mucosa, mucous, muscular, myeloid, nervous, bone, reticular, scar, sclerosus, skeletal, subcutaneous, splenic), and masses of tissue (for example, tumors).

While a preferred embodiment has been described of the present invention, it should be understood that they can be done various modifications, adaptations and modifications in it and the scope of the appended claims. The scope of the invention must, therefore, be determined not with reference to the description above, but must be determined with reference to the appended claims together with their full scope of equivalent. In addition, it should be understood that the claims annexes do not necessarily include the broadest scope of the invention that the applicant has the right to claim, or the only one way (s) in which the invention can be claimed, nor that All the indicated characteristics are necessary.

Claims (17)

1. An electrosurgical device that understands:

a distal part which has a bipolar electrode configuration;

a first spaced electrode tip relative to a second tip of electrode, the first electrode tip serves as a first pole of the bipolar electrode configuration and the second tip of electrode serves as a second pole of the configuration of the bipolar electrode;

the first tip electrode is assembled next to a distal end of a first trunk and the second electrode tip is assembled next to a distal end of a second trunk;

a first step of fluid in fluid communication with a first opening of fluid outlet and a second fluid passage in communication from fluids with a second fluid outlet opening:

the first fluid outlet opening next to the first electrode tip and the second fluid outlet opening next to the second tip of electrode;

the first tip electrode comprises a spherical distal end surface electrically conductive; Y

the second tip electrode comprises a spherical distal end surface electrically conductive;

in which: the first and second electrode tips are set to slide on a tissue surface and rotate when the electrodes move along the surface of the tissue in presence of a fluid supplied from the outlet openings of fluid and an electric current supplied from the tips of electrode.

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2. The device according to claim 1 in which: the first fluid outlet opening is configured to provide a fluid to the first electrode tip; and the second fluid outlet opening is configured to provide a fluid to the second electrode tip. 3. The device according to claim 2 in the one who:

the first tip electrode comprises a distal end surface that has a contact angle with a fluid supplied from the first fluid outlet opening in contact with it less than 90 degrees; Y

the second tip electrode comprises a distal end surface that has a contact angle with a fluid supplied from the second fluid outlet opening in contact with it less than 90 degrees.

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4. The device according to claim 1 in the one who:

the first spherical distal end surface of electrode tip comprises a spherical surface of approximately 180 degrees; Y

the second spherical distal end surface of electrode tip comprises a spherical surface of approximately 180 degrees.

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5. The device according to claim 1 in the one who:

the first spherical distal end of electrode tip is provided by an exposed surface part of a first electrically conductive ball; Y

the second spherical distal end of electrode tip is provided by an exposed surface part of a second electrically conductive ball.

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6. The device according to claim 1 in the one who:

the first tip electrode comprises a cylindrical surface; Y

the second tip Electrode comprises a cylindrical surface.

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7. The device according to claim 6 in the one who:

the first cylindrical surface of electrode tip is located in direction proximal next to the first spherical distal end surface of electrode tip; Y

the second cylindrical surface of electrode tip is located in direction proximal next to the second spherical distal end surface of electrode tip

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8. The device according to claim 1 in the one who:

the first tip electrode comprises a distal end surface that has a contact angle with a fluid supplied from the opening of fluid outlet in contact with it of less than 90 degrees; Y

the second tip electrode comprises a distal end surface that has a contact angle with a fluid supplied from the opening of fluid outlet in contact with it less than 90 degrees.

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9. The device according to claim 1 in the one who:

the first tip Electrode is part of a first arm; Y

the second tip Electrode is part of a second arm.

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10. The device according to claim 1, which also includes:

a set of valve to control a fluid flow.

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11. The device according to claim 10 in the one who:

at least one fluid passage is partially provided within a tube of plastic; and the valve assembly comprises a mechanism configured to at least one of compress and pinch the plastic tube to, at least in part, close the passage of fluid.

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12. The device according to claim 1, which also includes:

a set of switch to control the power, the switch set it has on and off positions;

a set of valve to control the flow of fluid, the valve has on and off positions;

a mechanism that prevents the switch assembly from being in the position of on while the valve assembly is in the off position.

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13. The device according to claim 1 in the one who:

the first tip electrode is mechanically connected to a distal end of the first trunk; the second electrode tip connects mechanically next to a distal end of the second trunk.

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14. The device according to claim 13 in the one who:

the first tip electrode is mechanically connected by a pressure adjustment or a mechanical connector; Y

the second tip electrode is mechanically connected by a pressure adjustment or a mechanical connector

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15. The device according to claim 1 in the one who:

the first tip electrode is welded or joined together with a distal end of the first trunk;

the second tip electrode is welded or attached next to a distal end of the second trunk.

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16. The device according to claim 1 in the one who:

the first trunk It is electrically conductive; Y

the second trunk is electrically conductive.

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17. The device according to claim 16 in the one who:

the first trunk electrically conductive is in electrical contact with the first electrode tip to conduct an electric current to the first electrode tip; Y

the second electrically conductive trunk is in electrical contact with the second electrode tip to conduct an electric current to The second electrode tip.