JP2009213909A - Blood vessel sealing forceps equipped with bipolar electrode - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide bipolar forceps which can seal a blood vessel and tissue consistently and effectively, and cannot be damaged by continuous use and cleaning. <P>SOLUTION: The bipolar electric surgical instrument (hereafter referred to as forceps) includes end effectors 22, 24, facing each other, and a handle 16 to relatively move end effectors to each other. An electrode assembly 21 can be attached to and removed from forceps. The electrode assembly comprises a pair of electrodes attached to the distal end facing each other. Each of the electrodes can removably engage with one of the end effectors. As a result, the electrodes is present in such a relation as to face each other. At least one stopper member controls the distance between the electrode assembly and the facing electrode. The bipolar forceps include at least one stopper member which can selectively engage with at least one of the electrodes. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

(Cross-reference of related applications)
No. 09 / 425,696, filed Oct. 22, 1999 by Tezlaff et al. (This is filed by US Application No. 09 / 178,027, filed Oct. 23, 1998 by Tetzluff et al., And Frazier et al.). (The contents of all of these applications are hereby incorporated by reference in their entirety) which is a continuation of US application Ser. No. 09 / 177,950 filed Oct. 23, 1998. )

(background)
The present disclosure relates to electrosurgical forceps used for open and / or laparoscopic surgical procedures. More specifically, the present disclosure relates to bipolar forceps having a disposable electrode assembly for sealing, cauterizing, coagulating / drying, and / or cutting blood and vascular tissue.

(Technical field)
A hemostatic forceps or forceps is a simple pliers-like tool that uses mechanical movements between its jaws to tighten tissue, generally to grasp, dissect and / or clamp tissue Used in open surgical procedures. Electrosurgical forceps utilize both mechanical clamping action and electrical energy to provide hemostasis by heating tissue and blood vessels to coagulate, cauterize and / or seal the tissue.

  Using electrosurgical forceps, the surgeon can cauterize, coagulate / dry, and / or cut the tissue by controlling the intensity, frequency and duration of the electrosurgical energy applied to the tissue, and / or Alternatively, bleeding can simply be reduced or delayed. In general, the electrical configuration of electrosurgical forceps can be divided into two categories: 1) monopolar electrosurgical forceps; and 2) bipolar electrosurgical forceps.

  Monopolar forceps utilize one active electrode with a clamping end effector and a remote patient return electrode or pad that is externally attached to the patient. When electrosurgical energy is applied, this energy is transferred from the active electrode to the surgical site and through the patient to the return electrode.

  Bipolar electrosurgical forceps utilize two generally opposing electrodes, which are generally located on the inner opposing surface of the end effector, and these electrodes are both electrically connected to the electrosurgical generator. Is done. Each electrode is charged to a different potential. Since tissue is a conductor of electrical energy, this electrical energy can be selectively transmitted through the tissue when the end effector is used to clamp or grasp the tissue therebetween.

  The process of coagulating small blood vessels is fundamentally different from vascular seals. For purposes herein, the term coagulation is defined as the process by which tissue cells rupture and dry dry tissue. A vascular seal is defined as the process of liquefying the collagen in tissue so that the tissue crosslinks and reforms into a fused mass. Therefore, clotting of small blood vessels is sufficient to close them, but larger blood vessels need to be sealed to ensure permanent closure.

  Two key mechanical parameters (pressure applied to the vessel and gap distance between the electrodes (both of which affect the thickness of the sealed vessel)) to provide a proper seal for large vessels It must be precisely controlled. More specifically, the precise application of pressure causes the vessel walls to face each other, so that tissue impedance is lowered to a value low enough to pass sufficient electrosurgical energy through the tissue, during tissue heating. It is important to overcome the expansion force and to contribute to the final tissue thickness, which is a good seal indicator. In some examples, the fused vessel wall is optimally between 0.001 inch and 0.006 inch. Below this range, the seal can be torn or torn, and above this range, the lumen may not be properly or effectively sealed.

  A number of bipolar electrosurgical forceps have been previously proposed for various open surgical procedures. However, some of these designs may not provide a uniformly reproducible pressure on the blood vessel and may result in an ineffective or non-uniform seal. For example, U.S. Pat. Nos. 2,176,479 to Willis, U.S. Pat. Nos. 4,005,714 and 4,031,898 to Hiltebrandt, U.S. Pat. Nos. 5,827,274, 5, 290,287 and 5,312,433; Lottick US Pat. Nos. 4,370,980, 4,552,143, 5,026,370 and 5,116,332, Stern U.S. Pat. No. 5,443,463, U.S. Pat. No. 5,484,436 to Eggers et al., And U.S. Pat. No. 5,951,549 to Richardson et al. All coagulate, cut and It relates to an electrosurgical instrument for sealing. However, some of these designs may not provide a uniformly reproducible pressure on the vessel and may result in an ineffective or non-uniform seal.

  Many of these instruments comprise blade members or shear members that simply cut tissue in a mechanical and / or electromechanical manner and are relatively ineffective for vascular seal purposes. Other instruments rely only on clamping pressure to obtain the proper seal thickness, and gap tolerance and / or parallelism and flatness requirements (which are consistently effective if properly controlled) Is a parameter that can guarantee a good tissue seal). For example, it is known that it is difficult to properly control the thickness of the resulting sealed tissue by controlling only the clamping pressure for either of the following two reasons: 1) Application If the applied force is too great, the two poles may touch and energy may not transfer through the tissue, resulting in an ineffective seal; or 2) if the applied force is too low, it is thicker and more reliable A low-quality seal is produced.

  It has also been found that cleaning and sterilizing a number of prior art bipolar instruments is often impractical because the electrodes and / or insulators can be damaged. More specifically, it is known that electrically insulating materials (eg, plastics) can be damaged or impaired by repeated sterilization cycles.

  Thus, there is a need to develop bipolar forceps that can consistently and effectively seal blood vessels and tissues and are not damaged by subsequent use and lavage.

The present invention provides, for example:
(Item 1)
A movable electrode assembly for use with forceps, the forceps having opposing end effectors and a handle for moving the end effectors relative to each other, the electrode assembly comprising:
A cover plate having at least one portion removably engageable with at least a portion of the forceps;
An electrode housing having at least one portion removably engageable with at least a portion of the forceps;
A pair of electrodes attachable to the distal end of the housing, the electrodes being removably engageable with the end effector of the forceps so that the electrodes are disposed in opposing relation to each other An electrode; and
At least one stop member for controlling the distance between the opposing electrodes, the stop member being selectively engageable with the electrode;
An electrode assembly.
(Item 2)
The movable electrode assembly of claim 1, wherein each of the electrodes comprises a conductive sealing surface and an insulating substrate, and the stop member is removably attached to the insulating substrate. .
(Item 3)
A movable electrode assembly according to any of the preceding items, wherein the insulating substrate of each of the electrodes engages a complementary mechanical interface disposed on a corresponding end effector of the forceps. A movable electrode assembly comprising at least one mechanical interface.
(Item 4)
The movable electrode assembly according to any of the preceding items, wherein the mechanical interface of at least one of the substrates comprises at least one detent and the mechanical of the corresponding end effector A movable electrode assembly, wherein the interface comprises at least one complementary key-like socket for slidably and securely receiving the detent.
(Item 5)
A movable electrode assembly according to any of the preceding items, wherein the stop member is attached to at least one of the electrodes by thermal spraying.
(Item 6)
The movable electrode assembly according to any of the preceding items, wherein the stop member projects from about 0.001 inch to about 0.005 inch from the inwardly facing surface of the jaw member. assembly.
(Item 7)
A movable electrode assembly according to any of the preceding items, wherein the stop member projects from about 0.002 inches to about 0.003 inches from the inwardly facing surface of the jaw members. assembly.
(Item 8)
Bipolar electrosurgical instrument with the following:
Forceps having opposing end effectors and a handle for moving the end effectors relative to each other;
An electrode assembly removably attachable to the forceps, the electrode assembly comprising a pair of opposing electrodes attached to its distal end, each of the electrodes removably attached to one of the end effectors An electrode assembly that is engageable so that the electrodes exist in opposing relation to each other; and
At least one stop member for controlling the distance between the opposing electrodes, the stop member being selectively engageable with the electrode;
A bipolar electrosurgical instrument.
(Summary)
The present disclosure relates to a removable electrode assembly for use with forceps having opposing end effectors and a handle for moving the end effectors relative to each other. The electrode assembly includes a cover plate having at least a portion releasably engageable with at least a portion of the forceps and an electrode housing having at least a portion removably engageable with at least a portion of the forceps. A pair of electrodes are attached to the distal end of the housing. Preferably, the electrode is removably engaged with the end effector of the forceps such that the electrodes are disposed in opposing relation to each other. The instrument also includes at least one stop member that controls the distance between the opposing electrodes. Preferably, the stop member is selectively engageable with the electrode. This electrode assembly can be used with both open and laparoscopic surgical procedures.

  In one embodiment, the electrode comprises a conductive sealing surface and an insulating substrate, and the stop member is removably attached to the insulating substrate. Preferably, the insulating substrate of each electrode has at least one mechanical interface to engage a complementary mechanical interface (eg, notch) disposed on a corresponding end effector of the forceps. (For example, a detent).

  In another embodiment, the substrate comprises at least one detent and the corresponding end effector mechanical interface has at least one complementary key-like shape for slidably and securely housing the detent. A socket is provided.

  In yet another embodiment, the stop member is attached to the at least one electrode by thermal spraying and is extruded from about 0.001 inch to about 0.005 inch from the inward surface of the jaw member. Preferably, the stop member is extruded from about 0.002 inches to about 0.003 inches from the inward surface of the jaw members.

  Another embodiment of the present disclosure is directed to a bipolar electrosurgical instrument. The instrument includes forceps having opposing end effectors and a handle for moving the end effectors relative to each other, and an electrode assembly removably attached to the forceps. The electrode assembly includes a pair of opposing electrodes mounted at its distal end, which is removably engaged with one of the end effectors such that the electrodes exist in opposing relation to each other. . At least one stop member selectively engaged with the electrode controls the distance between the opposing electrodes.

FIG. 1 is a perspective view of a bipolar forceps according to the present disclosure. FIG. 2 is an enlarged perspective view of the distal end of the bipolar forceps shown in FIG. FIG. 3 is a perspective view of a disassembled part of the forceps shown in FIG. 4 is an enlarged side view of the disposable electrode assembly of FIG. 1 shown without a cover plate. FIG. 5 is an enlarged perspective view of the distal end of the disposable electrode assembly of FIG. 6 is a perspective view of an exploded part of the upper electrode of the disposable electrode assembly of FIG. FIG. 7 is a perspective view of an exploded part of the lower electrode of the disposable electrode assembly of FIG. FIG. 8 is a perspective view of the forceps of the present disclosure showing an operation movement of the forceps for sealing a tubular blood vessel. FIG. 9 is an enlarged partial perspective view of a sealing site of a tubular blood vessel. FIG. 10 is a longitudinal cross-sectional view of the sealing site taken along line 10-10 of FIG. 11 is a longitudinal cross-sectional view of the sealing site of FIG. 9 after separation of the tubular blood vessel. FIG. 12 is a perspective view of another embodiment of the present disclosure. 13 is an exploded view of the embodiment of FIG. FIG. 14 is an enlarged perspective view of the working end of the embodiment of FIGS. 12 and 13. FIG. 15 is another embodiment of a stop member. FIG. 15 is another embodiment of a stop member. FIG. 15 is another embodiment of a stop member. FIG. 16 is an embodiment of the present invention. FIG. 16 is an embodiment of the present invention.

(Detailed explanation)
With reference to FIGS. 1-3, a bipolar forceps 10 for use in conjunction with open and laparoscopic procedures comprises a mechanical forceps 20 and an electrode assembly 21. In the drawings and the following description, the term “proximal” traditionally means the end of the forceps 10 that is closer to the user, while the term “distal” is the end that is farther from the user. Means.

  The mechanical forceps 20 includes a first member 9 and a second member 11, each of which has an elongated shaft 12 and 14, respectively. Each of the shafts 12 and 14 includes a proximal end 13 and 15 and a distal end 17 and 19, respectively. Each proximal end 13, 15 of each shaft portion 12, 14 includes a handle member 16 and 18 attached thereto, which allows the user to place at least one of the shaft portions 12 and 14 relative to the other. Can be moved. End effectors 22 and 24 extend from the distal ends 17 and 19 of each shaft portion 12 and 14, respectively. End effectors 22 and 24 are movable relative to each other with respect to movement of handle members 16 and 18.

  Preferably, the shaft portions 12 and 14 are secured to each other around the pivot axis 25 at a point proximal to the end effectors 22 and 24 so that movement of the handles 16, 18 from the open position to the end effector 22. And 24 are moved. Here, the end effectors 22 and 24 are arranged in a spaced relationship relative to each other with respect to the clamping or closed position, wherein the end effectors 22 and 24 have a tubular blood vessel 150 therebetween. Cooperate to grip (see FIG. 8). The pivot shaft 25 has a large surface area and is expected to suppress twisting and movement of the forceps 10 during operation. The forceps 10 can only be designed such that movement of one or both of the handles 16 and 18 moves one of the end effectors (eg, 22) relative to the other end effector (eg, 24).

  Referring most to FIG. 3, end effector 24 includes an upper jaw member or first jaw member 44 having an inward surface 45 and a plurality of mechanical interfaces disposed thereon, The interface is sized to removably engage a portion of the disposable electrode assembly 21 described in more detail below. Preferably, the mechanical interface comprises a socket 41, which is disposed at least partially through the inward surface 45 of the jaw member 44 and is attached to the upper electrode 120 of the disposable electrode assembly 21. Designed to accommodate complementary detents. Although the term socket is used herein, either a female or male mechanical interface can be used for the jaw member 44 and the mated mechanical interface is on the disposable electrode assembly 21. It is contemplated that

  In some cases, a mechanical interface 41 is manufactured along another side of the jaw member 44 to engage the complementary mechanical interface of the disposable electrode assembly 21 in a different manner (eg, from its side). May be preferred. The jaw member 44 also includes an opening 67 disposed at least partially through the inwardly facing surface 45 of the end effector 24, which opening is complementary to the electrode 120 of the disposable electrode assembly 21. Dimensioned to accommodate guide pin 124.

  End effector 22 includes a second or lower jaw member 42 having an inward surface 47 opposite to inward surface 45. Preferably, the jaw members 45 and 47 are dimensioned approximately symmetrically, but in some cases it is preferable to produce two asymmetric jaw members 42 and 44 depending on the particular purpose. possible. In exactly the same manner as described above for jaw member 44, jaw member 42 also includes a plurality of mechanical interfaces or sockets 43 disposed thereon, which are disposable electrode assemblies 21 as described below. Sized to removably engage a complementary portion disposed on the electrode 110. Similarly, jaw member 42 also includes an opening 65 disposed at least partially through inward surface 47, which is complementary guide pin 126 (disposed on electrode 110 of disposable electrode assembly 21. (See FIG. 4).

  Preferably, shaft members 12 and 14 of mechanical forceps 20 are designed to transmit certain desired forces to opposing inward surfaces 47 and 45 of jaw members 22 and 24, respectively, when clamped. . In particular, since the shaft members 12 and 14 work together effectively in a spring-like manner (ie, a spring-like bend), the length, width, height and deflection of the shaft members 12 and 14 are: It directly affects the total transmission force applied to the opposing jaw members 42 and 44. Preferably, the jaw members 22 and 24 are more rigid than the shaft members 12 and 14 and the strain energy stored in the shaft members 12 and 14 provides a constant closing force between the jaw members 42 and 44. provide.

  Each shaft member 12 and 14 also includes ratchet portions 32 and 34. Preferably, each ratchet (eg, 32) extends from the proximal end 13 of its respective shaft member 12 toward the other ratchet 34 in a substantially vertically aligned fashion, so that each ratchet 32 and 34 The inwardly facing surfaces contact each other as the end effectors 22 and 24 move from the open position to the closed position. Each ratchet 32 and 34 includes a plurality of flanges 31 and 33, respectively, that protrude from the inward surface of each ratchet 32 and 34 so that the ratchets 32 and 34 can be interlocked in at least one position. . In the embodiment shown in FIG. 1, ratchets 32 and 34 interlock in several different positions. Preferably, each ratchet position holds a specific (ie, constant) strain energy within the shaft members 12 and 14, which then applies a specific force to the end effectors 22 and 24, and thus the electrodes 120 and 110. introduce. Designs without a ratchet system or similar system require the user to hold the jaw members 42 and 44 together by applying a constant force to the handles 16 and 18, which results in inconsistent results. obtain.

  In some cases it may be preferable to provide other mechanisms for controlling and / or limiting the movement of jaw members 42 and 44 relative to each other. For example, a ratchet and pawl system can be used to align the movement of two handles to separate units, which in turn moves jaw members 42 and 44 separately relative to each other.

  Preferably, at least one of the shaft members (eg, 14) includes a protrusion 99 that facilitates manipulation of the forceps 20 during a surgical condition and, as described in more detail below, The attachment of the electrode assembly 21 to the surgical forceps 20 is facilitated.

  As best shown in FIGS. 2, 3 and 5, the disposable electrode assembly 21 is designed to operate in combination with the mechanical forceps 20. Preferably, the electrode assembly 21 comprises a housing 71 having a proximal end 77, a distal end 76 and an elongated shaft plate 78 disposed therebetween. The handle plate 72 is disposed near the proximal end 77 of the housing 71 and is dimensioned to removably engage the handle 18 of the mechanical forceps 20 and / or surround the handle 18. Similarly, shaft plate 78 is dimensioned to surround and / or removably engage shaft 14 and pivot plate 74 disposed near distal end 76 of housing 71 and pivot shaft 25. And dimensioned to surround at least a portion of the distal end 19 of the mechanical forceps 20. The electrode assembly 21 can be manufactured to engage the first member 9 or the second member 11 of the mechanical forceps 20 and any of its respective component parts 12, 16 or 14,18. .

  In the embodiment shown in FIG. 2, the handle 18, the shaft 14, the pivot axis 25, and a portion of the distal end 19 are all sized to fit within corresponding channels disposed in the housing 71. For example, channel 139 is sized to receive handle 18, channel 137 is sized to receive shaft 14, and channel 133 receives pivot shaft 25 and a portion of distal end 19. It is such a dimension.

  The electrode assembly 21 also includes a cover plate 80 that is also designed to surround and / or engage the mechanical forceps 20 in a manner similar to that described with respect to the housing 71. More specifically, cover plate 80 includes a proximal end 85, a distal end 86 and an elongated shaft plate 88 disposed therebetween. The handle plate 82 is disposed near the proximal end 85 and is preferably sized to removably engage and / or surround the handle 18 of the mechanical forceps 20. Similarly, the shaft plate 88 is dimensioned to surround and / or removably engage the shaft 14 and the pivot plate 94 disposed near the distal end 86 includes the pivot axis 25 and the mechanical Designed to surround the distal end 19 of the forceps 20. Preferably, the handle 18, shaft 14, pivot axis 25 and distal end 19 are all corresponding channels (not shown) disposed in the cover plate 80 in a manner similar to that described above with respect to the housing 71. Dimensions that fit inside.

  As best shown with respect to FIGS. 3 and 4, the housing 71 and the cover plate 80 are designed to engage each other on the first member 11 (eg, the first member) of the mechanical forceps 20, Its respective component parts (eg handle 18, shaft 14, distal end 19 and pivot axis 25) are disposed therebetween. Preferably, the housing 71 and cover plate 80 comprise a plurality of mechanical interfaces that are arranged at various locations along the interior of the housing 71 and cover plate 80 to provide mechanical engagement with each other. More specifically, a plurality of sockets 73 are disposed near the handle plate 72, shaft plate 78 and pivot plate 74 of the housing 71 and removably remove a corresponding plurality of detents 83 extending from the cover plate 80. Dimension to engage. Either a male mechanical interface or a female mechanical interface or a combination of mechanical interfaces can be placed in the housing 71 with a mating mechanical interface placed on or in the cover plate 80 Is assumed.

  As best shown with respect to FIGS. 5-7, the distal end 76 of the electrode assembly 21 has two prong-like members 103 and 105 extending outwardly from its distal end 76 to provide electrodes 110 and 120. Branches to support each. More particularly, the electrode 120 is attached to the end 90 of the prong 105 and the electrode 110 is attached to the end 91 of the prong 103. Electrodes 110 and 120 may be attached to ends 91 and 90 in any known manner (eg, friction fit or snap fit engagement).

  A pair of wires 60 and 62 are connected to electrodes 120 and 110, respectively, as best shown in FIGS. Preferably, the wires 60 and 62 are bundled together to form a wire bundle 28 that extends from the terminal connector 30 (see FIG. 3) to the proximal end 77 of the housing 71. Along the interior of the housing 71 extends to the distal end 76. Wire bundle 28 separates into wires 60 and 62 near distal end 76, and wires 60 and 62 are connected to respective electrodes 120 and 110, respectively. In some cases, wires 60 and 62 are captured within electrode assembly 21 by capturing wires 60 and 62 or wire bundle 28 at various pinch points along the inner cavity of electrode assembly 21 and attaching cover plate 80. It may be preferable to surround

  This arrangement of the wires 60 and 62 is designed to be convenient for the user so that it hardly interferes with the operation of the bipolar forceps 10. As mentioned above, the proximal end of the wire bundle 28 is connected to the terminal connector 30, but in some cases it is preferable to extend the wires 60 and 62 to an electrosurgical generator (not shown). obtain. Alternatively, the wires 60 and 62 may remain separate and extend along the first member 9 and the second member 11.

  As best shown in FIG. 6, the electrode 120 includes a conductive sealing surface 126 and an electrically insulating substrate 121 that are attached to each other by snap-fit engagement or some other assembly method. (E.g., substrate 121 is overmolded to capture conductive seal surface 126). Preferably, the substrate 121 is made from a molded plastic material and is molded to mechanically engage a corresponding socket 41 disposed in the jaw member 44 of the end effector 24. This substrate 121 not only isolates the current, but also aligns the electrodes 120, both of which contribute to seal quality and consistency. For example, the placement and thickness of the electrode 120 can be controlled by overmolding the conductive surface 126 to the substrate 121.

  Preferably, the substrate 121 includes a plurality of branched detents 122 that compress during insertion into the socket 41 and expand after insertion to removably engage the socket 41. Formed as follows. It is envisioned that the snap fit engagement of electrode 120 and jaw member 44 accommodates a wider range of manufacturing tolerances. The substrate 121 also includes an alignment or guide pin 124 that is dimensioned to engage the aperture 67 of the jaw member 44.

  The conductive sealing surface 126 includes a wire crimp 145 designed to engage the distal end 90 of the prong 105 of the electrode assembly 21 and a corresponding wire connector attached to the wire 60 disposed within the electrode assembly. Electrically engage with. The sealing surface 126 also includes an opposing surface 125 that is designed to transmit an electrosurgical current to the tubular vessel or tissue when held against the tubular vessel or tissue 150. Is done.

  Electrode 110 comprises similar elements and materials for isolating electrosurgical current and for transmitting electrosurgical current to tissue 150. More particularly, the electrode 110 includes a conductive sealing surface 116 and an electrically insulating substrate 111 that are attached to each other by snap-fit engagement or some other assembly method. The substrate 111 includes a plurality of bifurcated detents 112 and alignment pins 126 (see FIG. 4) that engage a corresponding plurality of sockets 43 and openings 65 disposed on the jaw member 42. It is a size that fits. The conductive sealing surface 116 includes an extension 155 having a wire crimp 119 that engages the distal end 91 of the prong 103 and a corresponding wire that is attached to a wire 62 disposed within the housing 71. Electrically engages the connector. The sealing surface 116 also includes an opposing surface 115 that, when held against the tubular vessel or tissue 150, transmits an electrosurgical current to the tubular vessel or tissue.

  Alternatively, the electrodes 110 and / or 120 can be formed as a single piece and can comprise similar components for insulating and conducting electrical energy.

  As best shown in FIG. 7, the substrate 111 also includes an elongate member 108 and a stop member 106 that corresponds to the corresponding elongate member 155 and interface 107 disposed on the conductive seal 116. Designed to engage with. To construct the electrode 110, the stop member 106 and the elongated member 108 are molded on the interface 107 and the elongated member 116 of the conductive seal 116. After construction, a wire crimp 119 is inserted into the distal end 91 of the prong member 103 and connected to the wire 62.

  When the tissue is compressed and electrosurgical energy is applied to the tissue, it is known that the impedance of the tissue decreases as the humidity level decreases. As a result, two mechanical factors (ie, the pressure applied between the opposing surfaces 47 and 45 and the gap distance between the opposing electrodes 110 and 120 (see FIG. 5)) are: It plays an important role in determining seal thickness and effectiveness. Jaw members 42 and 44 are constructed and provided at the end of the tissue sealing process such that opposing electrodes 110 and 120 are in the desired gap range (eg, 0.001 and 0.006 inches) (see FIG. 8). ) The material conditions and components associated with the assembly of electrode assembly 21 and mechanical forceps 20 are configured to be specific manufacturing tolerances to ensure that the gap between the electrodes does not change outside the desired range. .

  It is also known that the thickness of the tissue is very difficult to control by force alone, i.e., if the force is too great and the two electrodes come into contact, a poor seal is produced and no energy passes through the tissue. If the force is too small, the seal will be too thick. Applying the appropriate force is important for the following other reasons: to inhibit the vascular lumen; reduce the tissue impedance to a sufficiently low value and allow sufficient current to flow through the tissue. In order to overcome the force of expansion during tissue heating, in addition to contributing to creating the required end tissue thickness that is a good seal indication.

  It is also known that the size of the gap provides a tissue seal. For example, if the gap is too large (i.e., the jaw members do not compress the tissue sufficiently), the tissue will not adequately dissolve the collagen for efficient sealing. On the other hand, if this gap is too small (i.e., the jaw members compress too much tissue), electrosurgical energy will not cut tissue efficiently, which is also undesirable. In order to effectively seal tissue and overcome the above drawbacks, the gap distance (range) 151 (see FIG. 8) between the aperture electrodes 110 and 120 is preferably about 0.001. It is found to be between inches and about 0.006 inches, and more preferably between about 0.002 inches and about 0.005 inches.

  To ensure that the desired gap range is achieved after construction and that the correct force is applied to seal the tissue, the substrate 111 comprises at least one stop member 106, which Designed to limit and / or regulate the movement of the two electrodes 110 and 120 relative to each other. Preferably, the forceps 20 also limits and / or controls the distance between the end effectors 22 and 24 and / or the closing force applied between the opposing inner surfaces 47 and 45 of the end effectors 22 and 24. Then, in order to control the distance between the electrodes 110 and 120, at least one stop member (eg 101) (see FIG. 3) is provided. Since the stop member 106 is part of the disposable electrode assembly 21, this stop has further advantages depending on the material of the disposable electrode assembly 21. Preferably, “step” stop members are utilized due to ease of manufacture and simplification.

  Stop members may be placed at various points along the disposable electrode assembly to achieve the desired gap range described above, and / or the stop members may be other portions of the device (eg, handles 16, 18). , Jaw members 42, 44, and / or shafts 12, 14).

  Preferably, the seal surfaces 115 and 125 are relatively flat to avoid current concentrations at the sharp edges and to avoid arcing between vertices. When engaged, in addition to and due to the reactive force of tissue 150, jaw members 42 and 44 are preferably manufactured to withstand bending. For example, as shown initially in FIG. 3, jaw members 42 and 44 and corresponding electrodes 110 and 120 are preferably tapered along a width “W” for two reasons: 1) This taper applies a constant pressure in parallel to a constant tissue thickness; 2) The thick proximal portion of the electrode (eg, 110) is the reaction of the tissue Withstand bending due to force. The tapered shape of the electrode (eg, 110) is calculated by calculating a mechanically advantageous variation from the distal end to the proximal end of the electrode 110, and thereby adjusting the width of the electrode 110. It is determined.

  Preferably, at least one of the prong members (e.g., 105) is elastic or comprises a shrinkage relief portion 53 that includes two prong members 105 and 103 (and thus two relative to each other). Allows movement of the electrodes 120 and 110). As best shown in FIG. 3, the electrode assembly 21 can be removably attached to the mechanical forceps 20 by bending the prong 105 at the shrinkage relief portion 53 and by first moving the prong 105 toward the prong 103. Installed. The electrodes 110 and 120 are then slid between the opposing jaw members 42 and 44 at their opening so that the detents 112 and 122 and the guide pins 126 and 124 are moved into their corresponding sockets 43 and 41, respectively. Alternatively, they are arranged in alignment with the openings 65 and 67, respectively. Thus, the housing 71 is also arranged such that the shaft 14, handle 18 and pivot 25 are all located proximal to their corresponding channels 137, 139 and 133 disposed within the housing 71.

  When the shrinkage relief portion 53 is released, each electrode 110 and 120 is engaged with the jaw members 42 and 44, respectively, that is, the detents 112, 122, the engagement sockets 43, 41, and the housing 71 are Engage with the mechanical forceps 20. The cover plate 80 is then mounted on the housing 71 in the manner described above. Here, the bipolar forceps 10 is prepared for operation.

  In one embodiment, the electrode assembly 21 is attached to the mechanical forceps 20 in a different manner. For example, as best shown in FIG. 3, electrode assembly 21 is engaged with mechanical forceps 120 in the following four-step manner: 1) swivel electrode assembly 21 and cover plate 80 back; As a result, the tongue 99 engages the slot 100 with the electrode assembly 21; step 2) forwards the electrode assembly 21 and the cover plate 80 to engage the shaft 14 of the mechanical forceps 20 therebetween. 3) then engaging the detent 112 of the electrode 110 with the socket 43 of the jaw member 22; and 4) engaging the detent 122 of the electrode 120 with the socket 41 of the jaw member 24. The process.

  In another embodiment, the electrode assembly 21 engages the forceps 20 by a slide-on assembly technique. More specifically, the slide-on version includes a series of keyhole-like devices 541 disposed on the end effectors 22 and 24 that correspond to corresponding mechanical boundaries extending from each of the insulators 111 and 121, respectively. Engages with surfaces 112, 122 and 124. It is envisioned that the slide-on mounting feature facilitates removal and replacement of electrode assembly 21 and reduces manufacturing costs by minimizing the critical tolerance of detents 112, 122 and alignment pins 126.

  Furthermore, it is contemplated that the slide-on assembly method compared to the snap-on assembly method can improve the reliability of the forceps 20 due to low plastic deformation in the assembly. For example, snap-on technology requires deformation of the fork-like detents 112, 122 and facilitates positive engagement of the electrode assembly 21 with the end effectors 22 and 24. As will be appreciated, low active slide-on technology can reduce material deformation during construction and then extend the overall life of the device, prevent slipping of electrode assembly 21 and electrode assembly during operation. 21 separation is prevented.

  Further, if this slide-on assembly technique can engage the electrode assembly 21 in a low active manner during construction, once engaged, a uniquely designed key-like interface 541 is provided within the end effectors 22 and 24. It is contemplated to provide a more active connection that contributes to good “seating” of the electrode assemblies 21 of the present invention. Further, more active sheeting of the electrode assembly 21 prevents the electrode assembly 21 from slipping and prevents separation of the electrode assembly 21 during operation.

  FIG. 8 shows the bipolar forceps 10 during use, wherein the handle members 16 and 18 are moved closer together to apply a force that clamps to the tubular tissue 150 and is shown in FIGS. 9 and 10. Such a seal 152 is provided. Once sealed, the tubular vessel 150 is cut along the seal 152 to separate the tissue 150 and form a gap 154 therebetween, as shown in FIG.

  After the bipolar forceps 10 is used or the electrode assembly 21 is damaged, the electrode assembly 21 can be easily removed and / or replaced by reversing the above procedure, and the new electrode assembly 21 can be similarly Can be engaged with the mechanical forceps 20 in any manner. For example, the electrode assembly 21 can be released from the mechanical forceps 20 in the following four process modes: 1) releasing the detent 122 of the electrode 120 from the socket 41 of the jaw member 24; 2) moving the electrode 110 Releasing the stop 112 from the socket 43 of the jaw member 22; 3) releasing the electrode assembly 21 and the cover plate 80 from the shaft 14 of the mechanical forceps 20; and 4) pivoting the electrode assembly 21 and the cover plate 80. And, as a result, releasing the tongue 99 from the slot 100 in the electrode assembly 21.

  By making the electrode assembly 21 disposable, it is envisaged that the electrode assembly 21 is intended for single use only and therefore does not require cleaning or sterilization and therefore is not likely to be damaged. As a result, the functionality and consistency of key sealing components (eg, conductive surfaces 126, 116 and insulating surfaces 121, 111) ensures a uniform, good quality seal.

  FIGS. 12-14 illustrate another embodiment of the present disclosure for use with an endoscopic surgical procedure and include a bipolar forceps 210 having a drive rod assembly 211 connected to a handle assembly 218. The drive rod assembly 211 includes an elongated hollow shaft portion 212 having a proximal end 216 and a distal end 214. End effector assembly 222 is attached to distal end 214 of shaft 212 and includes a pair of opposing jaw members 280 and 282. Preferably, the handle assembly 218 is attached to the proximal end 216 of the shaft 212 and from the open position (where the jaw members 280 and 282 are positioned in spaced relation with respect to each other) or Activator 220 is provided for providing movement of jaw members 280 and 282 to a closed position (where jaw members 280 and 282 cooperate to grasp tissue 150 therebetween).

  As best shown in FIG. 13, activator 220 includes a movable handle 226 and a fixed handle 228 that is defined within the movable handle and at least one of the operator's fingers. The fixed handle 228 has an opening 232 for receiving the operator's thumb defined in the fixed handle. The movable handle 226 is selectively movable from a first position relative to the fixed handle 228 to a second position closer to the fixed handle 228 to close the jaw members 280 and 282. Preferably, the fixed handle 228 includes a channel 227 that extends proximally to receive a ratchet 230 connected to the movable handle 226. This structure allows for gradual closure of the end effector assembly 222 and locking engagement of the opposing jaw members 280 and 282. In some cases, it may be preferable to provide other mechanisms (eg, hydraulic systems, semi-hydraulic systems, and / or gearing systems) to control and / or limit movement of the handle 226 relative to the handle 228. .

  Fixed handle 228 includes a rotating assembly 223 for controlling the rotational movement of end effector assembly 222 about the longitudinal axis “A” of elongated shaft 212. Preferably, the rotating assembly 223 includes an upper knob portion 224a and a lower knob portion 224b, respectively, which are removably engaged with each other around a gear 252 attached to the shaft 212. The pair of handle sections 228a and 228b are engaged with each other by a plurality of mechanical interfaces to form a fixed handle 228. As best shown in FIG. 13, each handle section 228a and 228b is generally hollow so that a cavity 250 is accommodated therein to accommodate the various internal components that make up the forceps 210. ,It is formed. For example, the cavity 250 houses a PC board 258 that controls the electrosurgical energy transmitted to each jaw member 280 and 282 from an electrosurgical generator (not shown). More particularly, electrosurgical energy is generated from the electrosurgical generator and transmitted to the PC board by a cable 260 mounted through a wire port 229 disposed at the proximal end of the handle assembly 218. The PC board 258 converts the electrosurgical energy from the generator into two different electrical potentials that are transmitted to each jaw member 280 and 282 by separate terminal clips 264b and 264a, respectively. This will be described in more detail below with respect to FIG.

  Referring to FIG. 14, the rod assembly 211 includes a drive rod 270 having a proximal end 271 and a distal end 272. The piston 238 is attached to the proximal end 271 of the drive rod 270 and includes a generally rounded head portion 239 and a notch 241 positioned between the head portion 239 and the proximal end of the piston 238. Preferably, U link flanges 249a and 249b of arm 240 are dimensioned to receive head 239 therebetween when arm 240 is assembled between handle sections 228a and 228b (see FIG. 6). ) The movement of the handle 226 toward the fixed handle 228 provides a pivoting movement of the upper end 245 of the arm 240 at the pivot point 255, which in turn is from a first position (the piston 238 is located far from the end effector assembly 222). , Providing movement of piston 238 to a second position (piston 238 is closer to end effector assembly 222). As will be described in more detail below, movement of the piston 238 between the first position and the second position provides a linear movement of the drive rod 270 which in turn is directed toward each other and from each other. The jaw members 280 and 282 are moved away.

  By placing the generally round head 239 between the U link flanges 249a and 249b, the user can effectively use the rotating assembly 223 without disturbing the linear movement of the piston 238.

  The end effector assembly 222 includes a first jaw 280, a second jaw 282, and an electrically insulating yoke 284 disposed therebetween. Preferably, jaw member 280 and jaw member 282 are movable from an open position to a closed position by movement of handle assembly 218 as described above. It is contemplated that either or both jaw members 280 and 282 may be movable relative to each other. The first jaw member 280 has a first flange 281 (extending from the first jaw member) and a cam slot 286 (positioned through the first jaw member). Similarly, the second jaw 282 has a second flange 283 (extending from the second jaw member) and a cam slot 288 (positioned through the second jaw member).

  End effector assembly 222 also includes an outer nose portion 294 and an inner nose portion 296 that engage jaw members 282 and 280, respectively. The first pivot axis 305 is positioned on the outer nose portion 294 and is dimensioned to engage a corresponding pivot hole 289 positioned on the flange 283. The second pivot 303 is sized to engage a corresponding pivot hole 287 disposed on the inner nose portion 296 and positioned on the flange 281. The center of rotation for the first jaw member 280 is the first pivot hole 287 and the center of rotation for the second jaw member 282 is the second pivot hole 289. Preferably, each nose portion 294 and 296 is made from an electrically conductive material and transmits electrosurgical energy to the respective jaw members 282 and 280, as described in further detail below.

  As described above with respect to FIG. 13, electrosurgical energy is transferred from the electrosurgical generator to the connector assembly 315, which converts the energy into a first pole and a second pole. Is provided. A pair of end clips 264 a and 264 b are connected to the PC board 258 and transmit alternating first and second poles to the drive rod assembly 211, respectively. Clip 264a connects to shaft 212 and leads the first pole to jaw member 282, and clip 264b connects to piston 238, which in turn connects to drive rod 270. The second pole is guided along the drive rod 270 to the jaw member 280. Both the drive rod 270 and the shaft 212 are made from a conductive material, and preferably the insulating sleeve 275 is positioned between the drive rod 270 and the shaft 212 to prevent the forceps 210 from shorting the circuit. .

  As best shown in FIG. 14, the inner nose portion 296 is electrically connected to the drive rod 270 and the outer nose portion 294 is electrically connected to the shaft 212. Inner nose portion 296 and outer nose portion 294 capture yoke 284 along flanges 283 and 281. The yoke 284 moves axially along the axis “A” in the space between the inner portion 296 and the outer portion 294, and the spacer stake 319 at the distal end of the nose portions 296 and 294. Maintain separation. The stake 319 is dimensioned to engage and lock the inner nose portion 296 and the outer nose portion 294 together, which in turn locks the jaw members 280 and 282 at the top of the yoke 284. In some cases, it may be preferable to dimension the stake 319 such that the stake 319 acts as a stop member and controls the gap distance between the opposing jaw members 280 and 282 relative to each other. . In this case, the stake 319 is formed from an electrically insulating material such as plastic. Nose portions 294 and 296 provide lateral support for flanges 281 and 283 and help to ensure that detents 290 and 292 remain in cam slots 286 and 288, respectively.

  The end effector assembly 222 also includes an inner insulator 302 and an outer insulator 300 for maintaining electrical insulation between the poles. The outer insulator 300 insulates the outer nose portion 294 from the inner nose portion 296 and the drive rod 270, which conduct second-polar electrosurgical energy. Inner insulator 302 insulates inner nose portion 296 from outer nose portion 294 and shaft 212 (which conducts first pole electrosurgical energy). As such, the outer nose portion 294 may provide electrical continuity between the shaft 212 and the jaw member 282, while the inner nose portion 296 may provide electrical contact between the drive rod 270 and the jaw member 280. Can provide continuity.

  Preferably, the spring contact 298 is used to maintain an electrical connection between the drive rod 270 and the inner nose portion 296 during the axial movement of the drive rod. A donut-shaped spacer 308 may also be used to ensure linear movement of the drive rod 270 within the sleeve 275 and prevent accidental shorting of the forceps 210.

  Referring back to FIG. 14, the yoke 284 is preferably formed from an electrically insulating material such as plastic. The first side 291 of the yoke 284 faces the first flange 281, and the second side 293 of the yoke 284 faces the second flange 283. When the yoke 84 is disposed between the flanges 281 and 283, the yoke 284 electrically insulates the first jaw member 80 from the second jaw member 282. In this way, bipolar electrosurgical current can be conducted through the tissue 350 sandwiched between the jaws 280 and 282 without a short circuit of the flanges 281 and 283.

  To achieve the desired gap range (eg, about 0.001 to about 0.006 inches, preferably about 0.002 inches to about 0.003 inches) and apply the desired force to seal the tissue The at least one jaw member 280 and / or 282 includes a stop member 339 that limits movement of the two opposing jaw members 280 and 282 relative to each other. As explained above, in some cases this stake 319 is dimensioned so that the stake 319 acts like a stop member and limits the movement of the two opposing jaw members 280 and 282 relative to each other. It may be preferable to decide. Preferably, stop member 339 and / or stake 319 are made from an insulating material and dimensioned to limit the opposite movement of jaw members 280 and 282 within the gap range described above.

  In another embodiment, the stop member may be dimensioned for selective and replaceable attachment to the jaw member depending on the particular purpose. For example, as best shown in FIGS. 15A-15C, the stop member is formed through a series of openings 441 and 443 defined through the inner surfaces 115, 125 and insulators 116, 126, respectively, of the jaw member. It can be dimensioned as a plug 439 that is selectively attached to the inwardly facing surfaces 115 and 125. The gap plug 439 is preferably designed for snap fit engagement through the openings 441 and 443 of at least one of the jaw members (eg, 120) and projects a distance “R” from its inner surface 125. To be dimensioned (FIG. 15C). As can be appreciated, this gap plug 439 provides a minimum gap distance “G” between opposing inwardly facing surfaces 115 and 125 when jaw members 110 and 120 cooperate to grasp tissue therebetween. (FIG. 8) is produced.

  During operation and / or sealing, a user may selectively engage one or more gap plugs 439 as needed to produce a desired gap distance between jaw members 110 and 120. is assumed. As can be appreciated, the total gap distance “G” can be easily and selectively changed by replacement / exchange of a specific size gap plug.

  Preferably, the stop members 139, 239, 339 and / or 439 are made of an insulating material (eg, parylene, nylon and / or ceramic) and allow a specific opposite movement of the jaw members 110 and 120 in a specific gap range. The dimensions are limited to It is envisioned that stop members 139, 239, 339, and / or 439 may be disposed on one or both of jaw members 110 and 120, depending on the particular purpose or to achieve a particular result. Preferably, these stop members 139, 239, 339 and / or 439 may be any known geometric or polynomial configuration (eg, triangular, linear, circular, elliptical, depending on the particular purpose). Scallops, etc.). Further, it is contemplated that any combination of different stop members 139, 239, 339 and / or 439 can be constructed along the sealing surfaces 115 and 125 to achieve the desired gap distance. Preferably, non-conductive stop members 139, 239, 339 and / or 439 are molded on jaw members 110 and 120 (eg, overmolded, injection molded, etc.) or stamped on jaw members 110 and 120. Or deposited on jaw members 110 and 120 (eg, deposition). These stop members 139, 239, 339 and / or 439 can also be slidably attached to the jaw members and / or attached to the conductive surfaces 115 and 125 in a snap-fit manner.

  Other techniques for attaching the stop members 139, 239, 339 and / or 439 are also contemplated. For example, one technique involves thermally spraying ceramic material onto the surfaces of jaw members 110 and 120 to form stop members 139, 239, 339 and / or 439. Several thermal spray techniques are contemplated, including depositing a wide range of refractory insulating materials on conductive surfaces 115 and 125 to produce stop members 139, 239, 339, and / or 439. (For example, light velocity oxyfuel deposition, plasma deposition, etc.).

  From the foregoing and with reference to the various drawings, those skilled in the art will recognize that certain modifications can also be made to the present disclosure without departing from the scope of the present disclosure. For example, it is preferred that electrodes 110 and 120 face each other in parallel and thus face in the same plane, but in some cases, electrodes 110 and 120 face each other at the distal end, resulting in It may be preferred that additional closing forces on the handles 16 and 18 are required to slightly deflect the electrodes in the same plane.

  Although it is preferred to place the electrodes 110 and 120 vertically, in some cases it is preferred to have the electrodes 110 and 120 facing each other juxtaposed either vertically or transversely to suit a particular purpose. .

  Although it is preferred that the electrode assembly 21 comprises a housing 71 and a cover plate 80 to engage the mechanical forceps 20 therebetween, in some cases, the disposable electrode assembly 21 causes the mechanical forceps 20 to be engaged. It may be preferable that only one piece (eg, housing 71) is required to engage.

  Although only one embodiment of the present disclosure has been described, the present disclosure is as broad as the art allows, and the present specification should be construed to read in a similar manner, so the present disclosure is not limited thereto. Is not to be interpreted. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

  Various embodiments of the target device are described herein with reference to the accompanying drawings.

Claims (10)

  Bipolar electrosurgical instrument with the following:
  Forceps having opposing end effectors and a handle for moving the end effectors relative to each other;
  An electrode assembly removably attachable to the forceps, the electrode assembly comprising a pair of opposing electrodes attached to its distal end, each of the electrodes removably attached to one of the end effectors An electrode assembly that is engageable so that the electrodes exist in opposing relation to each other; and
  At least one stop member for controlling the distance between the opposing electrodes, wherein the stop member is selectively engageable with at least one of the electrodes;
A bipolar electrosurgical instrument.   The at least one opening is defined in at least one of the electrodes, the opening being dimensioned for selectively engaging a complementary stop member through the opening. A bipolar electrosurgical instrument according to claim 1.   The bipolar electrosurgical instrument according to claim 1, wherein each of the electrodes is sized to engage a corresponding mechanical interface disposed on a respective end effector. A bipolar electrosurgical instrument with an interface.   4. The bipolar electrosurgical instrument according to claim 3, wherein at least one of the electrodes of the electrode assembly comprises a conductive surface and an insulating substrate, the conductive surface and the insulating substrate mating together. Engages to form the electrode, the at least one stop member is selectively engageable with the conductive surface, and the insulating substrate is selectively engageable with the end effector. A bipolar electrosurgical instrument.   The bipolar electrosurgical instrument of claim 4, wherein the mechanical interface of the insulating substrate comprises at least one detent and the corresponding end effector mechanical interface includes the detent. A bipolar electrosurgical instrument comprising at least one complementary key-like socket for slidably and securely receiving.   The bipolar electrosurgical instrument according to claim 1, wherein the at least one stop member is about 0.001 inch to about 0.005 inch from an inwardly conductive surface of at least one of the electrodes. Protruding, bipolar electrosurgical instrument.   The bipolar electrosurgical instrument according to claim 1, wherein the at least one stop member is about 0.002 inches to about 0.003 inches from an inwardly conductive surface of at least one of the electrodes. Protruding, bipolar electrosurgical instrument.   The electrode assembly is bifurcated at the distal end of the electrode assembly, thereby forming two deflectable prongs, each of the deflectable prongs supporting an electrode at the distal end of the prong. The bipolar electrosurgical instrument according to claim 1.   The bipolar electrosurgical instrument according to claim 8, wherein the deflectable prongs are selectively deflectable to facilitate engagement of the electrodes and respective end effectors of the forceps.   The method described herein.