JP2023508549A - Electrosurgical instruments with monopolar and bipolar energy capabilities - Google Patents

Abstract

An electrosurgical instrument is disclosed that includes an end effector that includes a first jaw, a second jaw, and electrical circuitry. The first jaw includes a first conductive skeleton, a first insulating coating selectively covering a portion of the first conductive skeleton, and an exposed portion of the first conductive skeleton. An electrode is provided. The second jaw includes a second conductive skeleton, a second insulating coating selectively covering a portion of the second conductive skeleton, and an exposed portion of the second conductive skeleton. An electrode is provided. A circuit is configured to transmit bipolar RF energy and monopolar RF energy to tissue through the first jaw electrode and the second jaw electrode. Monopolar RF energy shares a first electrical path and a second electrical path defined by an electrical circuit for transmitting bipolar RF energy.

Description

(Cross reference to related applications)
This nonprovisional application, pursuant to 35 U.S.C. , the disclosure of which is hereby incorporated by reference in its entirety.

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

SUMMARY In various embodiments, an electrosurgical instrument is disclosed that includes an end effector. The end effector includes a first jaw, a second jaw and an electrical circuit. The first jaw includes a first conductive skeleton, a first insulating coating selectively covering a portion of the first conductive skeleton, and an exposed portion of the first conductive skeleton. An electrode is provided. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw includes a second conductive skeleton, a second insulating coating selectively covering a portion of the second conductive skeleton, and an exposed portion of the second conductive skeleton. An electrode is provided. An electrical circuit is configured to transmit bipolar RF energy and monopolar RF energy to tissue through the first jaw electrode and the second jaw electrode. Monopolar RF energy shares a first electrical path and a second electrical path defined by an electrical circuit for transmitting bipolar RF energy.

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

SUMMARY In various embodiments, an electrosurgical instrument is disclosed that includes an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw comprises a composite skeleton of at least two different materials configured to selectively provide an electrically conductive portion and a thermally insulating portion.

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

The novel features of the various aspects are set forth with particularity in the appended claims. The forms described, however, both as to structure and method of operation, may best be understood by reference to the following description taken in conjunction with the accompanying drawings.
1 is a diagram of one example of a generator for use with a surgical system, in accordance with at least one aspect of the present disclosure; FIG. 1 is a diagram of one form of a surgical system comprising a generator and an electrosurgical instrument usable therewith, according to at least one aspect of the present disclosure; FIG. 1 is a schematic illustration of a surgical instrument or tool in accordance with at least one aspect of the present disclosure; FIG. 2 is an exploded view of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure; FIG. 5 is a cross-sectional view of the end effector of FIG. 4; FIG. 5 depicts three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue; FIG. 5 depicts three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue; FIG. 5 depicts three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue; FIG. 5A-5D illustrate three different modes of operation of the end effector of FIG. 4 during application of energy to tissue; 5A-5D illustrate three different modes of operation of the end effector of FIG. 4 during application of energy to tissue; 5A-5D illustrate three different modes of operation of the end effector of FIG. 4 during application of energy to tissue; FIG. 12 illustrates a method of manufacturing end effector jaws in accordance with at least one aspect of the present disclosure; FIG. 12 illustrates a method of manufacturing end effector jaws in accordance with at least one aspect of the present disclosure; FIG. 23 is a partial perspective view of jaws of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure; 15A-15C illustrate steps in a process for manufacturing the jaws of FIG. 14; 15A-15C illustrate steps in a process for manufacturing the jaws of FIG. 14; 15A-15C illustrate steps in a process for manufacturing the jaws of FIG. 14; 15A-15C illustrate steps in a process for manufacturing the jaws of FIG. 14; 15A-15C illustrate steps in a process for manufacturing the jaws of FIG. 14; 20 is a cross-sectional view of the jaws of an end effector of an electrosurgical instrument through line 20-20 of FIG. 22, in accordance with at least one aspect of the present disclosure; FIG. 21 is a cross-sectional view of the jaws of the end effector of the electrosurgical instrument through line 21-21 of FIG. 22; FIG. 21 is a perspective view of the jaws of the end effector of the electrosurgical instrument of FIG. 20; FIG. FIG. 32 is a cross-sectional view of a jaw of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure; FIG. 23 is a partial perspective view of jaws of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure; FIG. 22 is a cross-sectional view of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure; 2 is a partially exploded view of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure; FIG. 1 is an exploded perspective assembly view of a portion of an electrosurgical instrument including an electrical connection assembly, according to at least one aspect of the present disclosure; FIG. 28 is a top view of electrical pathways defined within the surgical instrument portion of FIG. 27 in accordance with at least one aspect of the present disclosure; FIG. 4 is a cross-sectional view of a flex circuit, according to at least one aspect of the present disclosure; FIG. FIG. 4 is a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure; FIG. 4 is a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure; FIG. 4 is a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure; FIG. 4 is a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure; FIG. 11 is a graph showing a power scheme for coagulating and cutting tissue treatment regions in a treatment cycle applied by an end effector, according to at least one aspect of the present disclosure; FIG. FIG. 10 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector and a number of measured parameters of the end effector and tissue, in accordance with at least one aspect of the present disclosure; 1 is a schematic diagram of an electrosurgical system, according to at least one aspect of the present disclosure; FIG. FIG. 11 is a table showing power schemes for coagulating and cutting tissue treatment regions in a treatment cycle applied by an end effector, in accordance with at least one aspect of the present disclosure; FIG. [00101] Fig. 10 illustrates a tissue treatment cycle applied by an end effector to a tissue treatment area, in accordance with at least one aspect of the present disclosure; [00101] Fig. 10 illustrates a tissue treatment cycle applied by an end effector to a tissue treatment area, in accordance with at least one aspect of the present disclosure; [00101] Fig. 10 illustrates a tissue treatment cycle applied by an end effector to a tissue treatment area, in accordance with at least one aspect of the present disclosure; FIG. 12 illustrates an end effector applying therapeutic energy to tissue grasped by the end effector, wherein the therapeutic energy is generated by a monopolar power source and a bipolar power source, according to at least one aspect of the present disclosure; 1 is a simplified schematic diagram of an electrosurgical system, according to at least one aspect of the present disclosure; FIG. FIG. 11 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector and corresponding temperature readings of the tissue treatment area, in accordance with at least one aspect of the present disclosure; [00101] Fig. 10 illustrates an end effector treating an artery, according to at least one aspect of the present disclosure; [00101] Fig. 10 illustrates an end effector treating an artery, according to at least one aspect of the present disclosure; FIG. 12 illustrates an end effector applying therapeutic energy to tissue grasped by the end effector, wherein the therapeutic energy is generated by a monopolar power source and a bipolar power source, according to at least one aspect of the present disclosure; 1 is a simplified schematic diagram of an electrosurgical system, according to at least one aspect of the present disclosure; FIG. FIG. 11 is a graph showing a power scheme including treatment portions for tissue treatment area coagulation and cutting, and a non-treatment area in a treatment cycle applied by an end effector, in accordance with at least one aspect of the present disclosure; 4 is a graph showing power schemes including coagulating and cutting tissue treatment areas in a treatment cycle applied by an end effector, and corresponding unipolar and bipolar impedances and their ratios, in accordance with at least one aspect of the present disclosure;

The assignee of this application owns the following U.S. patent applications filed on the same date as this application, each of which is hereby incorporated by reference in their entirety:
・Attorney reference number END9234USNP1/190717-1M entitled "METHOD FOR AN ELECTROSURGICAL PROCEDURE",
・Attorney reference number END9234USNP2/190717-2 entitled “ARTICULATABLE SURGICAL INSTRUMENT”,
・Attorney reference number END9234USNP3/190717-3, entitled “SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES”;
・Attorney reference number END9234USNP4/190717-4 entitled "SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR",
・Attorney reference number END9234USNP5/190717-5, titled "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES";
・Attorney reference number END9234USNP6/190717-6 entitled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT",
・Attorney reference number END9234USNP7/190717-7 entitled “ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES”,
・Attorney reference number END9234USNP8/190717-8 entitled "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS",
・Attorney Docket No. END9234USNP9/190717-9 entitled “ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWER SOURCES”;
・Attorney Reference No. END9234USNP10/190717-10 entitled "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES",
・Attorney reference number END9234USNP11/190717-11, entitled "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY DENSITIES",
・Attorney reference number END9234USNP13/190717-13 entitled "ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVE PORTIONS",
・Attorney Reference No. END9234USNP14/190717-14 entitled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES",
・Attorney Reference No. END9234USNP15/190717-15 entitled "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE",
・Attorney reference number END9234USNP16/190717-16 entitled "CONTROL PROGRAM ADAPTITION BASED ON DEVICE STATUS AND USER INPUT";
Attorney Docket No. END9234USNP17/190717-17, entitled "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE";

The applicant of this application owns the following U.S. provisional patent applications filed December 30, 2019, the disclosures of each of which are incorporated herein by reference in their entireties:
U.S. Provisional Patent Application No. 62/955,294 entitled "USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITY END-EFFECTOR";
- US Provisional Patent Application No. 62/955,292 entitled "COMBINATION ENERGY MODALITY END-EFFECTOR";
• US Provisional Patent Application No. 62/955,306 entitled "SURGICAL INSTRUMENT SYSTEMS".

The applicant of this application owns the following U.S. patent applications, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. Patent Application No. 16/209,395, now U.S. Patent Application Publication No. 2019/0201136, entitled "METHOD OF HUB COMMUNICATION";
U.S. Patent Application No. 16/209,403, now U.S. Patent Application Publication No. 2019/0206569, entitled "METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB";
U.S. Patent Application No. 16/209,407, now U.S. Patent Application Publication No. 2019/0201137, entitled "METHOD OF ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL";
U.S. Patent Application No. 16/209,416, now U.S. Patent Application Publication No. 2019/0206562, entitled "METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS";
U.S. patent application Ser.
U.S. patent application Ser.
・「ＭＥＴＨＯＤ ＯＦ ＳＥＮＳＩＮＧ ＰＡＲＴＩＣＵＬＡＴＥ ＦＲＯＭ ＳＭＯＫＥ ＥＶＡＣＵＡＴＥＤ ＦＲＯＭ Ａ ＰＡＴＩＥＮＴ，ＡＤＪＵＳＴＩＮＧ ＴＨＥ ＰＵＭＰ ＳＰＥＥＤ ＢＡＳＥＤ ＯＮ ＴＨＥ ＳＥＮＳＥＤ ＩＮＦＯＲＭＡＴＩＯＮ，ＡＮＤ ＣＯＭＭＵＮＩＣＡＴＩＮＧ ＴＨＥ ＦＵＮＣＴＩＯＮＡＬ ＰＡＲＡＭＥＴＥＲＳ ＯＦ ＴＨＥ ＳＹＳＴＥＭ ＴＯ ＴＨＥ ＨＵＢ」と題された、米国特許出願第１６／２０９，４３３号, current U.S. Patent Application Publication No. 2019/0201594,
U.S. Patent Application No. 16/209,447, now U.S. Patent Application Publication No. 2019/0201045, entitled "METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB";
U.S. Patent Application No. 16/209,453, now U.S. Patent Application Publication No. 2019/0201046, entitled "METHOD FOR CONTROLLING SMART ENERGY DEVICES";
U.S. Patent Application No. 16/209,458, now U.S. Patent Application Publication No. 2019/0201047, entitled "METHOD FOR SMART ENERGY DEVICE INFRASTRUCTURE";
U.S. patent application Ser.
・「ＭＥＴＨＯＤ ＦＯＲ ＳＩＴＵＡＴＩＯＮＡＬ ＡＷＡＲＥＮＥＳＳ ＦＯＲ ＳＵＲＧＩＣＡＬ ＮＥＴＷＯＲＫ ＯＲ ＳＵＲＧＩＣＡＬ ＮＥＴＷＯＲＫ ＣＯＮＮＥＣＴＥＤ ＤＥＶＩＣＥ ＣＡＰＡＢＬＥ ＯＦ ＡＤＪＵＳＴＩＮＧ ＦＵＮＣＴＩＯＮ ＢＡＳＥＤ ＯＮ Ａ ＳＥＮＳＥＤ ＳＩＴＵＡＴＩＯＮ ＯＲ ＵＳＡＧＥ」と題された、米国特許出願第１６／２０９，４７８号、現米国特許出願公開第２０１９／ 0104919,
U.S. Patent Application No. 16/209,490, now U.S. Patent Application Publication No. 2019/0206564, entitled "METHOD FOR FACILITY DATA COLLECTION AND INTERPRETATION";
U.S. Patent Application No. 16/209,491 entitled "METHOD FOR CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUAL AWARENESS", now U.S. Patent Application Publication No. 2019/0200998;
U.S. Patent Application No. 16/562,123, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES"
U.S. patent application Ser. No. 16/562,135 entitled "METHOD FOR CONTROLLING AN ENERGY MODULE OUTPUT";
U.S. Patent Application No. 16/562,144 entitled "METHOD FOR CONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE"; Patent Application No. 16/562,125.

Before describing various aspects of electrosurgical systems in detail, it is noted that the example embodiments are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and specification. want to be The example embodiments may be practiced or incorporated in other aspects, variations, and modifications, and may be practiced or carried out in various ways. Further, unless otherwise stated, the terms and expressions used herein are chosen for the convenience of the reader, for the purpose of describing example embodiments, and not for purposes of limitation thereof. In addition, one or more of the aspects, expressions of aspects and/or examples described below may be superimposed on other aspects, expressions of aspects and/or examples described below. It should be understood that any one or more can be combined.

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

As described in more detail below, electrosurgical instruments generally include a shaft having a distally attached end effector (eg, one or more electrodes). The end effector can be positioned relative to tissue such that an electrical current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, currents are introduced into the tissue by the active electrode of the end effector and returned from the tissue by the return electrode of the end effector, respectively. During unipolar operation, current is introduced into the tissue by the active electrode of the end effector and returned through a return electrode (eg, ground pad) separately located on the patient's body. Heat generated by current flowing through tissue may form hemostatic seals within and/or between tissues, and thus may be particularly useful for sealing blood vessels, for example.

FIG. 1 illustrates one example of a generator 900 configured to deliver multiple energy modalities to a surgical instrument. Generator 900 provides RF and/or ultrasonic signals for delivering energy to surgical instruments. The generator 900 is at least capable of delivering multiple energy modalities (eg, ultrasound, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others) through a single port. With one generator output, these signals can be delivered to the end effector individually or simultaneously to treat tissue. Generator 900 comprises a processor 902 coupled to a waveform generator 904 . Processor 902 and waveform generator 904 are configured to generate various signal waveforms based on information stored in memory coupled to processor 902, not shown for clarity of disclosure. . Digital information associated with the waveform is provided to a waveform generator 904 that includes one or more DAC circuits to convert the digital input to analog output. The analog output is provided to amplifier 906 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to power transformer 908 . The signal is coupled across the power transformer 908 to the secondary on the patient-isolated side. A first signal of a first energy modality is provided to the surgical instrument between terminals labeled ENERGY ₁ and RETURN. A second signal of the second energy modality is coupled across capacitor 910 and provided to the surgical instrument between terminals labeled ENERGY ₂ and RETURN. More than two energy modalities may be output, so the subscript "n" can be used to indicate that up to n ENERGY _n- terminals can be provided, where n is 2 or more. is a positive integer of . It will also be appreciated that up to 'n' return paths RETURN _n may be provided without departing from the scope of the present disclosure.

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

In one aspect, the impedance is controlled by the first voltage sensing circuit 912 coupled across the terminals labeled ENERGY ₁ /RETURN or the second voltage sensing circuit 924 coupled across the terminals labeled ENERGY ₂ /RETURN. may be determined by processor 902 by dividing the output of either by the output of current sensing circuit 914 placed in series with the RETURN leg on the secondary side of power transformer 908 . The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to separate isolation transformers 928 , 922 and the output of the current sensing circuit 914 is provided to another isolation transformer 916 . Digitized voltage and current sensing measurements from ADC circuitry 926 are provided to processor 902 for calculating impedance. As an example, the first energy modality ENERGY ₁ may be RF monopolar energy and the second energy modality ENERGY ₂ may be RF bipolar energy. Yet, in addition to bipolar and monopolar RF energy modalities, other energy modalities include ultrasound energy, irreversible and/or reversible electroporation, and/or microwave energy, among others. Also, although the example illustrated in FIG. 1 indicates that a single return path RETURN may be provided for more than one energy modality, in other aspects multiple return paths RETURN _n may be provided. , may be provided for each energy modality ENERGY _n .

As shown in FIG. 1, a generator 900 with at least one output port may, depending on the type of tissue treatment to be performed, generate power, e.g. A power transformer having a single output and having multiple taps to provide an end effector in the form of one or more energy modalities such as reversible electroporation and/or microwave energy. A device 908 can be included. For example, the generator 900 delivers high voltage, low current energy to drive an ultrasound transducer, low voltage, high current energy to drive an RF electrode to seal tissue, Alternatively, either monopolar or bipolar RF electrosurgical electrodes can be used to deliver energy with a coagulation waveform for spot coagulation. The output waveform from generator 900 can be induced, switched or filtered to provide frequencies to the end effector of the surgical instrument. In one embodiment, the connection to the output of the RF bipolar electrode generator 900 will preferably be located between the outputs labeled ENERGY ₂ and RETURN. For unipolar outputs, the preferred connections would be active electrodes (eg, pencil or other probes) to suitable return pads connected to the ENERGY ₂ and RETURN outputs.

Additional details can be found in U.S. Patent Application Publication No. 47/0891, published March 30, 2017, entitled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, which is incorporated herein by reference in its entirety. disclosed in No.

FIG. 2 shows one form of surgical system 1000 comprising a generator 1100 and various surgical instruments 1104, 1106, 1108 usable therewith, wherein surgical instrument 1104 is an ultrasonic surgical instrument. , surgical instrument 1106 is an RF electrosurgical instrument, and multi-function surgical instrument 1108 is a combined ultrasonic/RF electrosurgical instrument. Generator 1100 is configurable for use with various surgical instruments. According to various aspects, the generator 1100 is, for example, an ultrasonic surgical instrument 1104, an RF electrosurgical instrument 1106, and a multi-function surgical instrument that integrates RF and ultrasonic energy simultaneously delivered from the generator 1100. It may be configurable for use with different types of different surgical instruments, including surgical instrument 1108 . In the form of FIG. 2, generator 1100 is shown separate from surgical instruments 1104, 1106, 1108, but in one form, generator 1100 is attached to any of surgical instruments 1104, 1106, 1108. It may be formed integrally with the same to form an integrated surgical system. The generator 1100 includes an input device 1110 located on the front panel of the console of the generator 1100 . Input device 1110 may include any suitable device that generates signals suitable for programming the operation of generator 1100 . Generator 1100 may be configured for wired or wireless communication.

Generator 1100 is configured to drive multiple surgical instruments 1104 , 1106 , 1108 . The first surgical instrument is an ultrasonic surgical instrument 1104 , comprising a handpiece (HP) 1105 , an ultrasonic transducer 1120 , a shaft 1126 and an end effector 1122 . End effector 1122 comprises an ultrasonic blade 1128 acoustically coupled to ultrasonic transducer 1120 and clamp arm 1140 . Handpiece 1105 includes a trigger 1143 to operate clamp arm 1140 and a combination of toggle buttons 1137, 1134b, 1134c to energize and drive ultrasonic blade 1128 or other functions. Toggle buttons 1137 , 1134 b , 1134 c can be configured to energize ultrasound transducer 1120 with generator 1100 .

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

Generator 1100 is also configured to drive multi-function surgical instrument 1108 . Multi-function surgical instrument 1108 includes handpiece 1109 (HP), shaft 1129 and end effector 1125 . End effector 1125 includes ultrasonic blade 1149 and clamp arm 1146 . Ultrasonic blade 1149 is acoustically coupled with ultrasonic transducer 1120 . Handpiece 1109 includes a trigger 1147 to operate clamp arm 1146 and a combination of toggle buttons 11310, 1137b, 1137c to energize and drive ultrasonic blade 1149 or other functions. Toggle buttons 11310, 1137b, 1137c are configured to energize the ultrasonic transducer 1120 using the generator 1100 and to energize the ultrasonic blade 1149 using the bipolar energy source also contained within the generator 1100. can do. Monopolar energy may be delivered to tissue in combination with bipolar energy or separately from bipolar energy.

Generator 1100 is configurable for use with various surgical instruments. According to various aspects, the generator 1100 is, for example, an ultrasonic surgical instrument 1104, an RF electrosurgical instrument 1106, and a multi-function surgical instrument that integrates RF and ultrasonic energy simultaneously delivered from the generator 1100. It may be configurable for use with different types of different surgical instruments, including surgical instrument 1108 . In the form of FIG. 2, the generator 1100 is shown separate from the surgical instruments 1104, 1106, 1108; Either one may be integrally formed to form an integrated surgical system. As discussed above, the generator 1100 includes an input device 1110 located on the front panel of the console of the generator 1100 . Input device 1110 may include any suitable device that generates signals suitable for programming the operation of generator 1100 . Generator 1100 may also include one or more output devices 1112 . Further aspects of generators for digitally generating electrical signal waveforms and surgical instruments are described in US Patent Application Publication No. 2017-0086914-(A1), the entirety of which is incorporated herein by reference. incorporated into the book.

FIG. 3 shows a schematic diagram of a surgical instrument or tool 600 that includes multiple motor assemblies that can be activated to perform various functions. In the illustrated example, a closure motor assembly 610 is operable to transition the end effector between an open configuration and a closed configuration, and an articulation motor assembly 620 articulates the end effector relative to the shaft assembly. is operable to allow In certain examples, multiple motor assemblies can be individually activated to produce firing, closing, and/or articulating motions in the end effector. Firing motion, closing motion, and/or articulation motion can be transmitted to the end effector via, for example, a shaft assembly.

In certain examples, closure motor assembly 610 includes a closure motor. The closure 603 may be operably coupled to a closure motor drive assembly 612, which, among other things, places the end effector in the closed configuration so as to transmit the closing motion generated by the motor to the end effector. It may be configured to move the closure member closed to transition. The closing motion may cause the end effector to transition from an open configuration to a closed configuration to capture tissue, for example. The end effector can be moved to the open position by reversing the direction of the motor.

In certain examples, articulation motor assembly 620 includes an articulation motor operably coupled to articulation drive assembly 622, which can be configured to transmit articulation motion generated by the motor to the end effector. In certain examples, the articulation may, for example, articulate the end effector with respect to the shaft.

One or more of the motors of surgical instrument 600 may include a torque sensor for measuring the output torque on the shaft of the motor. Forces on the end effector may be sensed in any conventional manner, such as by force sensors outside the jaws or by torque sensors on the motor that actuates the jaws.

In various embodiments, motor assemblies 610, 620 include one or more motor drivers that can include one or more H-bridge FETs. The motor driver may modulate the power transmitted from power supply 630 to the motor based on, for example, input from microcontroller 640 (“controller”) of control circuit 601 . In certain examples, microcontroller 640 may be employed to determine the current drawn by the motor, for example.

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

In certain examples, power supply 630 may be used to power microcontroller 640, for example. In certain examples, power source 630 may include batteries (or “battery packs” or “power packs”) such as, for example, lithium-ion batteries. In certain examples, the battery pack may be configured to be releasably attached to the handle to power surgical instrument 600 . Multiple battery cells connected in series may be used as power source 630 . In certain examples, power source 630 may be replaceable and/or rechargeable, for example.

In various examples, processor 642 may control motor drivers to control the position, direction of rotation, and/or speed of the motors of assemblies 610 , 620 . In certain examples, processor 642 may send signals to motor drivers to stop and/or disable the motors. The term "processor," as used herein, means any suitable microprocessor, microcontroller, or computer central processing unit (CPU) that combines the functions of a single integrated circuit or up to It should be understood to include other basic computing devices integrated on several integrated circuits. Processor 642 is a general-purpose programmable device that accepts digital data as input, processes that data according to instructions stored in memory, and provides results as output. This is an example of sequential digital logic since it has internal memory. Processors work with numbers and symbols represented in a binary number system.

In one example, processor 642 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In a particular example, microcontroller 620 may be, for example, the LM 4F230H5QR available from Texas Instruments. In at least one embodiment, Texas Instruments' LM4F230H5QR provides 256 KB of single-cycle flash memory up to 40 MHz or other non-volatile memory on-chip memory, performance up to 40 MHz, among other features readily available in product datasheets. 32 KB single-cycle SRAM, internal ROM with StellarisWare software, 2 KB EEPROM, one or more PWM modules, one or more QEI analog , ARM Cortex-M4F processor cores containing one or more 12-bit ADCs with 12 analog input channels. Other microcontrollers can be readily substituted for use with surgical instrument 600 . Accordingly, the present disclosure should not be limited in this context.

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

In particular examples, one or more mechanisms and/or sensors, such as, for example, sensor 645, may be employed to alert processor 642 to program instructions that should be used in a particular setting. For example, sensor 645 can alert processor 642 to use program instructions associated with end effector closure and articulation. In certain examples, sensor 645 may comprise a position sensor that may be employed to sense the position of a closing actuator, for example. Accordingly, the processor 642 uses program instructions associated with closing the end effector to activate the motor of the closure drive assembly 620 when the processor 642 receives a signal from the sensor 630 indicative of actuation of the closure actuator. can be done.

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

Accessing a surgical site located within the patient's abdomen by inserting a surgical end effector portion of a surgical instrument through a trocar placed in the patient's abdominal wall is common during various laparoscopic surgical procedures. It is customary. In its simplest form, a trocar is a pen-shaped instrument with a sharp triangular point at one end that is typically used within a hollow tube known as a cannula or sleeve to create an opening in the body. , through which a surgical end effector may be introduced. Such placement forms an access port within the body cavity through which a surgical end effector can be inserted. The inner diameter of the trocar cannula necessarily limits the size of the end effector and drive support shaft of the surgical instrument that can be inserted through the trocar.

Regardless of the particular type of surgical procedure being performed, once the surgical end effector is inserted into the patient through the trocar cannula, in order to properly position the surgical end effector relative to the tissue or organ to be treated: A surgical end effector must often be moved relative to a shaft assembly positioned within a trocar cannula. This movement or positioning of the surgical end effector relative to the portion of the shaft that remains within the trocar cannula is often referred to as the "articulation" of the surgical end effector. To facilitate such articulation of surgical end effectors, various articulation joints have been developed for attaching surgical end effectors to associated shafts. As can be expected in many surgical procedures, it is desirable to employ surgical end effectors that have as much joint range of motion as possible.

Due to the size constraints imposed by the size of the trocar cannula, the articulation joint components must be sized so that they are freely insertable through the trocar cannula. These size constraints also limit the size and construction of various drive members and components that operably interface with a motor and/or other control system supported within a housing that may be handheld, or It may comprise part of a larger automated system. In many cases, these drive members must operably pass through articulation joints to operably couple or operatively associate with the surgical end effector. For example, one such drive member is commonly employed to apply articulation control motion to surgical end effectors. In use, the surgical end effector is actuated to facilitate insertion through the trocar and then articulate the surgical end effector to a desired position when the surgical end effector enters the patient. The motion drive member can be deactivated to position the surgical end effector in the non-articulated position.

Thus, the aforementioned size constraints create many challenges for developing an articulation system capable of achieving a desired range of articulation, as well as the need to operate the various features of the surgical end effector. A variety of different drive systems are accommodated. Further, once the surgical end effector is positioned in the desired articulation position, the articulation system and articulation joints hold the surgical end effector in that position during actuation of the end effector and completion of the surgical procedure. It is necessary to be able to The placement of such articulation joints must also be able to withstand the external forces experienced by the end effector during use.

Various modes of one or more surgical devices are often used throughout a particular surgical procedure. A communication path extending between a surgical device and a centralized surgical hub, for example, can facilitate efficiency and enhance the success of a surgical procedure. In various examples, each surgical device within the surgical system includes a display that communicates the presence and/or operational status of other surgical devices within the surgical system. The surgical hub uses information received over the communication path to assess the compatibility of surgical devices for use with each other and to assess the compatibility of surgical devices for use during a particular surgical procedure. and/or optimize operating parameters of the surgical device. As described in more detail herein, operating parameters of one or more surgical devices may be detected, for example, patient demographics, a particular surgical procedure, and/or tissue thickness. can be optimized based on the specified environmental conditions.

4 and 5 show an exploded view (FIG. 4) and a cross-sectional view (FIG. 4) and cross-sectional view ( 5). For example, the end effector 1200 can actuate, articulate, and/or articulate with respect to the shaft assembly of the surgical instrument in a manner similar to the end effectors described in US Patent Application Attorney Docket No. END9234USNP2/190717-2. can be rotated. Additionally, end effector 1200 and other similar end effectors described elsewhere herein may be powered by one or more generators of the surgical system. An exemplary surgical system for use with surgical instruments is U.S. patent application Ser. /562,123, which is incorporated herein in its entirety.

6-8, the end effector 1200 comprises a first jaw 1250 and a second jaw 1270. As shown in FIG. At least one of first jaw 1250 and second jaw 1270 pivots toward and away from the other jaw to transition end effector 1200 between an open configuration and a closed configuration. is movable. Jaws 1250, 1270 are configured to grasp tissue between jaws 1250 and 1270 and apply at least one of therapeutic energy and non-therapeutic energy to tissue. Energy delivery to tissue grasped by jaws 1250, 1270 of end effector 1200 may be performed in a monopolar mode, a bipolar mode, and/or a combination mode of alternating or mixed bipolar and monopolar energy. is achieved by electrodes 1252, 1272, 1274 configured to Different energy modalities that can be delivered to tissue by end effector 1200 are described in more detail elsewhere in this disclosure.

In addition to electrodes 1252, 1272, 1274, patient return pads are used with the application of monopolar energy. Additionally, bipolar and monopolar energy are delivered using electrically isolated generators. In use, the patient return pad is capable of detecting unexpected power crossovers by monitoring power transfer to the return pad via one or more suitable sensors on the return pad. Unexpected power crossovers can occur when bipolar and monopolar energy modalities are used simultaneously. In at least one embodiment, bipolar mode uses a higher current (eg, 2-3 amps) than unipolar mode (eg, 1 amp). In at least one embodiment, the return pad includes control circuitry and at least one sensor (eg, current sensor) coupled thereto. In use, the control circuit can receive input indicative of an unexpected power crossover based on measurements of at least one sensor. In response, the control circuit can employ a feedback system to issue an alert and/or suspend the application of one or both of the bipolar and monopolar energy modalities to the tissue.

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

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

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

Further to the above, electrodes 1252, 1272, 1274 of jaws 1250, 1270 include angular profiles similar to those of jaws 1250, 1270. FIG. In the example of FIGS. 4 and 5, the electrodes 1252, 1272, 1274 are separated segments 1252a, 1252b, 1252c, 1272a, 1272b, 1272a, 1272b, 1272a, 1272b, 1272a, 1272b, 1252a, 1252b, 1252b, 1272b, 1252a, 1272b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252b, 1252c, 1272c, 1274a, 1274b, 1274c respectively.

When in the closed configuration, jaws 1250, 1270 cooperate to define a tip electrode 1260 formed of electrode portions 1261, 1262 at the distal ends of jaws 1250, 1270, respectively. The tip electrode 1260 can be energized to deliver monopolar energy to tissue in contact with the tip electrode 1260 . Both electrode portions 1261, 1262 can be activated simultaneously to deliver monopolar energy, as shown in FIG. 6, or alternatively, only one of electrode portions 1261, 1262 can be selectively can be activated to deliver monopolar energy to one side of the distal tip electrode 1260, for example, as shown in FIG.

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

In at least one embodiment, the jaws 1250, 1270 include a conductive skeleton 1253, 1273 that can be made of or at least partially made of a conductive material such as titanium, for example. Skeletons 1253, 1273 can be made of other conductive materials, such as aluminum, for example. In at least one embodiment, scaffolds 1253, 1273 are made by injection molding. In various embodiments, the scaffolds 1253, 1273 are selected with an insulating material to prevent thermal and electrical conduction in all but predetermined thin conductive zones forming the electrodes 1252, 1272, 1274, 1260. coated/coated. Skeletons 1253, 1273 act as electrodes with electron focusing where jaws 1250, 1270 incorporate isolation from one jaw to the other. The insulating material can be, for example, an insulating polymer such as polytetrafluoroethylene (eg, Teflon®). The energizable zones defined by electrodes 1252, 1272 are inside jaws 1250, 1270 and operate independently in bipolar mode to deliver energy to tissue grasped between jaws 1250, 1270. It is possible. On the other hand, the energizable zone defined by electrode tip 1260 and electrode 1274 is outside jaws 1250, 1270 and is operable to deliver energy to tissue adjacent the outer surface of end effector 1200 in monopolar mode. is. Both jaws 1250, 1270 can be energized to deliver energy in monopolar mode.

In various aspects, coating 1264 is selectively applied to the conductive scaffold resulting in selectively exposed metal interior portions that define three-dimensional geometric electron modulation (GEM) for focused dissection and coagulation. is a high temperature polytetrafluoroethylene (eg, Teflon®) coating. In at least one embodiment, coating 1264 includes a thickness of about 0.003 inches, about 0.0035 inches, or about 0.0025 inches. In various embodiments, the thickness of coating 1264 ranges from about 0.002 inches to about 0.004 inches, ranges from about 0.0025 inches to about 0.0035 inches, or ranges from about 0.0027 inches to about 0.0027 inches. It can be any value selected from the range of 0.0033 inches. Other thicknesses of coating 1263 capable of three-dimensional geometric electronic modulation (GEM) are contemplated by this disclosure.

Electrodes 1252, 1272, which cooperate to transmit bipolar energy through tissue, are offset to prevent short circuits. As energy flows between the offset electrodes 1252,1272, the tissue grasped between the offset electrodes 1252,1272 is heated to create a seal in the area between the electrodes 1252,1272. On the other hand, the areas of the jaws 1250, 1270 surrounding the electrodes 1252, 1272 are depleted by an insulating coating 1264 selectively deposited on such areas on the jaws 1250, 1270 but not on the electrodes 1252, 1272. It provides a non-conductive tissue-contacting surface. Electrodes 1252 , 1272 are thus defined by areas of metal jaws 1250 , 1270 that remain exposed after application of insulating coating 1264 to jaws 1250 , 1270 . Jaws 1250 , 1270 are formed entirely of electrically conductive material in this embodiment, but non-conductive areas are defined by electrically insulating coatings 1264 .

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

In at least one embodiment, a tissue-free lateral gap is defined between the offset electrodes 1252, 1272 in the closed configuration. In at least one embodiment, the lateral gap in the closed configuration ranges from about 0.01 inches to about 0.025 inches, ranges from about 0.015 inches to about 0.020 inches, or about 0.016 inches. Any distance selected from the range of inches to about 0.019 inches is defined between the offset electrodes 1252,1272. In at least one embodiment, the lateral gap is defined by a distance of approximately 0.017 inches.

In the example shown in FIGS. 4 and 5, the electrodes 1252, 1272, 1274 include widths that gradually narrow as each of the electrodes 1252, 1272, 1274 extends from the proximal end to the distal end. As a result, proximal segments 1252a, 1272a, 1274a each include a greater surface area than intermediate portions 1252b, 1272b, 1274b. Also, intermediate segments 1252b, 1272b, 1274b include larger surfaces than distal segments 1252c, 1272c, 1274c.

The angles and constricted profiles of jaws 1250, 1270 give the end effector 1200 in the closed configuration a bent finger shape or an angular hook shape. This shape allows the tip electrode 1260 (FIG. 10) to be used to precisely deliver energy to a small area of tissue by orienting the end effector 1200 so that the electrode tip 1260 is directed toward the tissue. becomes. In such an orientation, only electrode tip 1260 is in contact with tissue, which focuses energy delivery to the tissue.

Further, as shown in FIG. 8, the electrodes 1274 extend over the outer surface on the peripheral side 1275 of the second jaw 1270 such that they are in contact while the end effector 1200 is in the closed configuration. resulting in the ability to effectively separate the underlying tissue. To separate tissue, end effector 1200 is positioned at least partially on peripheral side 1275 that includes electrode 1274 . Activation of the monopolar energy mode through jaws 1270 causes monopolar energy to flow through electrodes 1274 and into tissue in contact with electrodes 1274 .

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

Electrodes 1252', 1272' differ from electrodes 1252'', 1272'' in that they define tissue contacting surfaces 1257, 1277 that are stepped or uneven. Conductive skeletons 1253', 1273' of jaws 1250', 1270' include enlarged or protruding portions that form the conductive tissue-contacting surfaces of electrodes 1252', 1272'. Coating 1264 partially wraps around the bulging or protruding portions forming electrodes 1252', 1272', leaving only the conductive tissue-contacting surfaces of electrodes 1252', 1272' exposed. Thus, in the embodiment shown in FIG. 9, tissue contacting surfaces 1257, 1277 each include a step that is a conductive tissue contact positioned between two insulating tissue contacting surfaces that gradually descend the step. Includes contact surfaces. In other words, each of the tissue contacting surfaces 1257, 1277 has a first partially conductive tissue contacting surface and a second partially conductive tissue contacting surface stepped down to the first partially conductive tissue contacting surface. and an insulating tissue-contacting surface. A method for forming electrodes 1252', 1272' will be described later in connection with FIG.

Further, in a closed configuration with no tissue between the offset electrodes 1252', 1272', the offset electrodes 1252', 1272' overlap to define a gap between the opposing insulating outer surfaces of the jaws 1250', 1270'. . This configuration thus provides electrode surfaces that are vertically offset from each other and laterally offset from each other when the jaws 1250', 1270' are closed. In one example, the gap is between about 0.01 inch and about 0.025 inch. Additionally, while overlapping, the electrodes 1252', 1272' are separated by a lateral gap. To prevent short circuits, the lateral gap is below a predetermined threshold. In one embodiment, the predetermined threshold is selected from a range of 0.006 inches to 0.008 inches. In one example, the predetermined threshold is approximately 0.006 inches.

Referring again to FIGS. 7 and 10, the tip electrode 1260 is defined by uncoated electrode portions 1261, 1262 immediately preceded by a circumferentially coated proximal coating portion to either of the jaws 1250, 1270. Allows tip coagulation and incision formation from either or both. In certain embodiments, electrode portions 1261, 1262 are spring-biased to allow exposure of electrode portions 1261, 1262 only when the distal end of end effector 1200 is pressed against tissue to be treated. wrapped or covered by a flexible insulating housing.

Additionally, segments 1274 a , 1274 b , 1274 c define an angular profile extending along peripheral side 1275 of jaw 1270 . Segments 1274 a , 1274 b , 1274 c are defined by uncoated linear portions projecting from the angled body of scaffold 1273 at peripheral side 1275 . Segments 1274 a , 1274 b , 1274 c have outer surfaces that are coplanar with the outer surface of coating 1264 defined on peripheral side 1275 . In various embodiments, the horizontal plane extends through segments 1274a, 1274b, 1274c. The angular profile of electrode 1274 is such that electrode 1274 extends more than 45 degrees from the centerline of curvature to prevent unintended lateral thermal damage while using electrode 1274 to cut or separate tissue. defined in a horizontal plane so as not to

FIG. 14 shows a jaw 6270 for use with an end effector (eg, 1200) of an electrosurgical instrument (eg, electrosurgical instrument 1106) for treating tissue using RF energy. Further, jaw 6270 can be electrically coupled to a generator (eg, generator 1100) to deliver monopolar RF energy to tissue and/or cooperate with another jaw of the end effector to deliver bipolar RF energy. It is energizable by a generator to deliver energy to tissue. Additionally, jaw 6270 is similar to jaws 1250, 1270 in many respects. For example, jaw 6270 includes an angular profile similar to that of jaw 1270 . In addition, jaw 6270 presents improved thermal relaxation that can be applied to one or both of jaws 1250, 1270.

During use, the end effector jaws of electrosurgical instruments are subjected to thermal loads that can interfere with the performance of their electrodes. To minimize heat load interference without adversely affecting the tissue treatment capabilities of the electrodes, jaws 6270 include a conductive skeleton 6273 having a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. include. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain embodiments, the thermally insulating portion defines internal gaps, voids, or pockets that effectively isolate the thermal mass of the outer surfaces of jaws 6270 that are in direct contact with tissue without compromising the electrical conductivity of jaws 6270. include.

In the illustrated embodiment, the thermally conductive portion defines an electrically conductive outer layer 6269 that surrounds or at least partially surrounds the inner electrically conductive core. In at least one embodiment, the inner conductive core comprises gap-setting members that may be in the form of posts, columns, and/or walls that extend between opposing sides of the outer layer 6269 so that gaps, voids, or pockets are formed. It extends between the gap setting members.

In at least one embodiment, the gap-setting member is configured such that the jaws (i.e., end effector jaw 6270 and another jaw) transition to a closed configuration (similar to jaws 1250, 1270 of FIG. 6) to force tissue between the jaws. A honeycomb lattice structure 6267 is formed to provide directional force capability when grasping the . Directional force can be achieved by aligning grid 6267 in a direction transverse to the tissue contacting surface of jaws 6270 such that honeycomb walls 6268 of grid 6267 are positioned perpendicular to the tissue contacting surface. can.

Alternatively, or additionally, the conductive inner core of jaws 6270 may contain air micropockets that conform to the jaw profile to create a more homogeneous stress-strain distribution within the jaws. It can be more homogeneously distributed and shaped in a non-predetermined structure. In various aspects, the conductive scaffold 6273 can be made by three-dimensional printing and can include three-dimensionally printed internal pockets that create a core that is electrically conductive but proportionally thermally insulated.

Still referring to FIG. 14, the conductive scaffold 6273 is connectable to an energy source (eg, generator 1100) and electrodes 6262 defined in portions of the outer layer 6273 that are selectively not covered by the coating 1264; 6272 and 6274. Jaws 6270 thus have selective thermal and electrical conductivity to control/focus energy interactions with tissue through electrodes 6272, 6274 while reducing heat diffusion and thermal mass. The thermally insulating portion of conductive skeleton 6273 limits the thermal load applied to electrodes 6262, 6272, and 6274 during use.

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

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

12 and 13 illustrate methods 1280, 1281 for manufacturing jaws 1273'', 1273'''. In various embodiments, one or more of jaws 1250, 1270, 1250', 1270' are manufactured according to methods 1280, 1281. Jaws 1273'', 1273''' are made by applying a coating 1264 (e.g., thickness d) over the entire outer surface. Electrodes are then defined by selectively removing portions of the coating 1264 from desired zones to expose the outer surface of the scaffold 1273'', 1273''' in such zones. In at least one embodiment, selective removal of the coating is accomplished by etching (FIG. 12) or partially cutting away tapered portions of scaffold 1273'' (FIG. 13) along with respective coating portions to form planar conductive surfaces and planar conductive surfaces. It can be done by forming a non-conductive surface. In the example shown in FIG. 12, electrodes 1272'', 1274'' are formed by etching. In the embodiment shown in FIG. 13, the electrodes 1274''' are formed from raised narrow strips or ridges 1274d that extend alongside the skeleton 1273'''. A portion of the ridge 1274D and the coating 1264 directly overlying the ridge 1274D are trimmed away, resulting in an outer surface of the electrode 1274'' that is coplanar with the outer surface of the coating 1264.

Thus, jaw 1270''' manufactured by method 1281 includes tapered electrode 1274''' consisting of narrow raised conductive portion 1274e extending alongside skeleton 1273''', which is aligned with skeleton 1273'''. Portion 1274e has an electrically conductive outer surface that is coplanar with coating 1264, which can help focus the energy delivered from ''' to the tissue.

In another manufacturing process 6200, jaws 6270 can be made as shown in FIG. Conductive skeleton 6273 is formed with narrow raised strips or ridges 6274e, 6274f that define electrodes 6272 and 6274. FIG. In the illustrated embodiment, skeleton 6273 of jaw 6270 includes ridges 6274e, 6274f having flat, or at least substantially flat, outer surfaces configured to define electrodes 6272,6274. In at least one embodiment, scaffold 6273 is made by 3D printing. Masks 6265 , 6266 are applied to ridges 6274 e , 6274 f and a coating 1264 similar to coating 1264 is applied to scaffold 6273 . After coating, the masks 6265, 6266 are removed to expose the outer surfaces of the electrodes 6272, 6274 that are flush with the outer surface of the coating 1264.

14 and 15, in various embodiments, the outer layer 6269 includes laterally extending gripping features 6277 on one or both sides of each of the electrodes 6272 . Gripping feature 6277 is covered by coating 1264 . In one embodiment, coating 1264 defines compressible features that change the gap between the jaws of the end effector 1200 in response to the clamping load applied to end effector 1200 . In at least one embodiment, the coating 1264 on the jaws provides at least 0.010 inch to 0.020 inch overlap of insulation along the centerline of the jaws. Coating 1264 may be applied directly over gripping features 6277 and/or clamp guide jaw realignment features.

In various aspects, the coating 1264 can include coating materials such as titanium nitride, Diamond-Like coating (DLC), chromium nitride, Graphit iC™, and the like. In at least one embodiment, the DLC consists of an amorphous carbon-hydrogen network with graphite and diamond bonds between carbon atoms. DLC coating 1264 can form a film around scaffolds 1253, 1273 (Fig. 6) with low friction and high hardness properties. DLC coating 1264 may be doped or undoped and is generally amorphous carbon (aC) or hydrogenated amorphous carbon (aC: H). Various surface coating techniques can be utilized to form the DLC coating 1264, such as the surface coating technique developed by Oerlikon Blazers. In at least one embodiment, DLC coating 1264 is produced using Plasma-assisted Chemical Vapor Deposition (PACVD).

Still referring to FIG. 15, in use, electrical energy flows from the conductive scaffold 6269 through the electrodes 6272 to tissue. Coating 1264 prevents electrical energy from being transferred to tissue from other areas of outer layer 6269 covered by coating 1264 . As the temperature of the surface of electrode 6272 increases during tissue processing, do the gaps, voids, or pockets defined by walls 6268 of the inner core slow the transfer of thermal energy from outer layer 6269 to the inner core of scaffold 6273? , or attenuated.

FIG. 16 shows a scaffold 6290 manufactured for use with end effector jaws of an electrosurgical instrument. One or more of scaffolds 1253, 1273, 1253', 1273', 1273'', 1273''' can include material compositions and/or are manufactured in a manner similar to scaffold 6290. can do. In the illustrated embodiment, skeleton 6290 is made of at least two materials, a conductive material such as titanium, and a thermally insulating material such as a ceramic material (eg, ceramic oxide). The combination of titanium and ceramic oxide yields a jaw component with complex thermal, mechanical and electrical properties.

In the illustrated embodiment, composite scaffold 6290 comprises a ceramic base 6291 formed, for example, by three-dimensional printing. Additionally, the composite scaffold 6290 includes a titanium crown 6292 that is fabricated separately from the ceramic base 6291 using, for example, three-dimensional printing. Base 6291 and crown 6292 include complementary mounting features 6294 . In the illustrated embodiment, base 6291 includes posts or projections that are received in corresponding openings in crown 6292 . Attachment feature 6294 also controls deflation. Additionally or alternatively, the contact surfaces of base 6291 and crown 6292 include complementary surface irregularities 6296 specifically designed to mate with each other. Surface asperities 6296 also resist shrinkage caused by different material compositions in base 6291 and crown 6292 . In various embodiments, the composite scaffold 6290 is selectively coated with an insulating coating 1264, leaving exposed certain portions of the crown 6292 that define the electrodes, for example, as described above with respect to the jaws 1250, 1270. coated.

17 and 18 illustrate a manufacturing process for making a scaffold 6296 for use with end effector jaws of an electrosurgical instrument. One or more of scaffolds 1253, 1273, 1253', 1273', 1273'', 1273''' can include material compositions and/or are manufactured in a manner similar to scaffold 6295. can do. In the illustrated embodiment, composite scaffold 6295 is manufactured by injection molding utilizing ceramic powder 6297 and titanium powder 6298 . The powders are fused together (Figure 18) to form a titanium-ceramic composite 6299 (Figure 19). In at least one embodiment, a polytetrafluoroethylene (eg, Teflon®) coating can be selectively applied to metal regions of the composite scaffold 6295 for thermal and electrical insulation.

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

Additionally, jaw 1290 is similar to jaw 6270 in that jaw 1290 also exhibits improved thermal relaxation. Similar to jaw 6270, jaw 1290 includes an electrically conductive skeleton 1293 having a thermally insulating portion and a thermally conductive portion integral with or attached to the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain embodiments, the thermally insulating portion of the conductive skeleton 1293 effectively isolates the thermal mass of the outer surface of the jaws 1290 defining the electrodes 1294 in direct contact with tissue without compromising the electrical conductivity of the jaws 1290. An electrically conductive inner core 1297 having internal gaps, voids, or pockets that The thermally conductive portion defines an electrically conductive outer layer 1303 that surrounds or at least partially surrounds the electrically conductive inner core 1297 . In at least one embodiment, the conductive inner core 1297 comprises gap setting members 1299 that may be in the form of posts, columns and/or walls extending between opposing sides of the outer layer 1303 of the jaws 1290 to provide gaps, A void, or pocket, extends between the gap setting members.

Alternatively or additionally, the conductive inner core 1297 may contain micro-pockets of air that may be uniformly or non-uniformly distributed within the conductive inner core 1297 . The pockets can have a predetermined or random shape and can be distributed in predetermined or random portions of the conductive inner core 1297 . In at least one embodiment, the pockets are distributed to create a more homogenous stress-strain distribution within jaws 1290 . In various aspects, scaffold 1293 can be made by three-dimensional printing and can include three-dimensionally printed internal pockets that create a core that is electrically conductive but proportionally thermally insulated.

Jaws 1290 thus have selective thermal and electrical conductivities that reduce heat diffusion and thermal mass while controlling/focusing energy interactions with tissue. The thermally insulating portion of conductive skeleton 1293 limits the thermal load applied to the electrodes of jaws 1290 during use.

22 shows an enlarged portion of tissue contacting surface 1291 of jaw 1290. FIG. In various aspects, the outer layer 1303 of the scaffold 1293 is selectively coated/coated with a first insulating layer 1264 comprising a first material such as DLC, for example. In the illustrated embodiment, the DLC coating electrically insulates tissue contacting surface 1291 except for an intermediate area extending along the length of tissue contacting surface 1291 that defines electrode 1294 . In at least one embodiment, the DLC coating extends around skeleton 1293 over jaw 1290 to perimeters defined on opposite sides 1294 ′, 1294 ″ of electrode 1294 . Conductive zones 1294 a , 1294 b , 1294 c remain exposed and alternate with insulating zones 1298 along the length of electrode 1294 . In various aspects, insulation zone 1298 comprises high temperature polytetrafluoroethylene (eg, Teflon®). Since the DLC coating is thermally conductive, only the portion of tissue contacting surface 1291 that includes insulating region 1298 is thermally insulated. The portions of the problem contact surface 1291 that are covered with the DLC coating and thin electrically conductive conductive zones 1294a, 1294b, 1294c are thermally conductive. Furthermore, only the thin conductive electrically conductive zones 1294a, 1294b, 1294c are electrically conductive. The remainder of tissue-contacting surface 1291, covered with either a DLC coating or polytetrafluoroethylene (eg, Teflon®), is electrically insulated.

Conductive zones 1294a, 1294b, 1294c define where energy is concentrated along jaw 1290 based on the geometry of zones 1294a, 1294b, 1294c. Additionally, the size, shape, and placement of conductive zones 1294a, 1294b, 1294c and insulating zone 1298 direct coagulation energy transmitted through electrodes 1294 into tissue within a predetermined treatment area, thereby prevent parasitic leaching of both energy and heat from In addition, thermally insulating conductive inner core 1297 resists heat transfer to portions of jaws 1290 that do not form a treatment area, thereby preventing injury due to inadvertent tissue contact with non-treatment areas of jaws 1290 . Careful collateral heat damage is prevented.

Electrodes 1294 are selectively interrupted by regions 1298 . Selective application of a high temperature polytetrafluoroethylene (e.g., Teflon) coating to portions of electrodes 1294 provides three-dimensional for incision and coagulation focused on conductive zones 1294a, 1294b, 1294c of electrodes 1294. A selectively exposed metal interior portion is provided that defines a geometry electronic modulation (GEM). A region 1298, as shown in FIG. 22, is selectively disposed on electrode 1294 to provide a thermally conductive and electrically conductive electrode surrounded by a thermally conductive but electrically insulating perimeter region defined by a DLC coating. A treated surface is provided having alternating conductive areas and thermally conductive and electrically insulating areas.

Referring to FIG. 22, jaw 1290 comprises an angular profile with multiple angles defined between separate portions 1290a, 1290b, 1290c, 1290d of jaw 1290. Referring to FIG. For example, a first angle (α1) is defined by portions 1290a, 1290b of first jaw 1250, a second angle (α2) is defined by portions 1290b, 1290c, and a third angle (α3) is defined by , portions 1290c, 1290d. In other examples, at least a portion of jaw 1290 includes a smooth curved profile with no angles. In various aspects, the discrete portions 1290a, 1290b, 1290c, 1290d of jaw 1290 are linear segments. Successive linear segments intersect at angles such as, for example, a first angle (α1), or a second angle (α2) and a third angle (α3). The linear segments cooperate to form a generally curved profile of each of jaws 1290 .

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

Further, due to the tapered profile of jaws 1290, proximal portion 1290a is larger than intermediate portion 1290b. Similarly, intermediate portion 1290b is larger than portion 1290d that defines the distal portion of jaw 1290. As shown in FIG. In other examples, the distal portion may be larger than the intermediate portion and/or the proximal portion. In other examples, the intermediate portion is larger than the proximal portion and/or the distal portion. Additionally, electrode 1294 of jaw 1290 comprises an angular profile similar to that of jaw 1290 .

Referring to FIG. 23, in certain aspects, jaw 1300 includes a solid conductive skeleton 1301 partially surrounded by DLC coating 1264 . Exposed regions of scaffold 1301 define one or more electrodes 1302 . This arrangement results in thermally conductive and electrically conductive portions of jaws 1300 , with thermal energy being delivered indiscriminately, but electrical energy being delivered exclusively through one or more electrodes 1302 .

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

Similar to jaws 1250, 1270, jaws 1450, 1470 include a generally angled profile formed from straight segments angled with respect to each other and, as shown in FIG. resulting in a symmetrical shape. Further, jaws 1450, 1470 include conductive scaffolds 1452, 1472 having constricting horns extending distally along the angular profile of jaws 1450, 1470. FIG. Conductive scaffolds 1452, 1472 can be made of a conductive material such as, for example, titanium. In certain aspects, each of the conductive skeletons 1453, 1473 includes a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain embodiments, the thermally insulating portion of the scaffold 1453, 1473 effectively isolates the thermal mass of the outer surface of the jaws 1452, 1472 in direct contact with tissue without compromising the electrical conductivity of the jaws 1450, 1470. An inner core is defined that includes interstices, voids, or pockets.

The thermally conductive portion comprises a conductive outer layer 1469, 1469' surrounding or at least partially surrounding the inner conductive core. In at least one embodiment, the inner conductive core can be in the form of a post, row, and/or wall extending between opposing sides of the outer layers 1469, 1469' of each of the jaws 1250, 1270. with a gap, void or pocket extending between the gap setting members. In at least one embodiment, the gap setting members form a honeycomb-like lattice structure 1467, 1467'.

In addition to the above, the conductive scaffold 1453, 1473 extends distally along the angular profile of the jaws 1450, 1470 from the first conductive portions 1453a, 1473a and the first conductive portions 1453a, 1473a. It includes a second conductive portion 1453b, 1473b that protrudes and defines a tapered electrode extending distally along at least a portion of the narrowing body of the scaffold 1453,1473. In at least one embodiment, the first conductive portions 1453a, 1473a are thicker than the second conductive portions 1453b, 1473b in a cross section (eg, FIG. 25) of the narrowing body of the scaffold 1453, 1473. . In at least one embodiment, the second conductive portions 1453b, 1473b are integral with or permanently attached to the first conductive portions 1453a, 1473a such that the electrical energy is transferred to the second It flows from the first conductive portions 1453a, 1473a to the tissue only through the conductive portions 1453b, 1473b. The electrically insulating layers 1464, 1464' are configured to fully electrically isolate the first conductive portions 1453a, 1473a, but not to isolate the second conductive portions 1453b, 1473b. At least the outer surfaces of the second conductive portions 1453b, 1473b that define the electrodes 1452, 1472 are not covered by the electrically insulating layer 1464, 1464'. In the illustrated embodiment, electrodes 1452, 1472 and electrically insulating layers 1464, 1464' define tissue treatment surfaces that are coplanar.

As described above, the first conductive portions 1453a, 1473a are generally thicker than the second conductive portions 1453b, 1473b and are wrapped with an electrically insulating layer 1464, 1464', thereby providing a second conductive layer 1464, 1464'. The conductive portions 1453b, 1473b of are the high energy density areas. In at least one embodiment, the electrically insulating layers 1464, 1464' are high temperature polytetrafluoroethylene (eg, Teflon®) coatings, DLC coatings, and/or ceramics for insulation and resistance to char attachment. consists of a coating. In various embodiments, the thicker first conductive portion 1453a conducts more potential power with less resistance to the second conductive portion 1453b in contact with tissue, resulting in higher energy at electrode 1452. Bring density.

In various aspects, the outer surfaces of the electrodes 1452, 1472 include continuous linear segments extending along the angled tissue treatment surfaces of the jaws 1450, 1470. The linear segments intersect at a predetermined angle and include widths that gradually narrow as the linear segments extend distally. In the example shown in FIG. 24, electrode 1452 includes segments 1452a, 1452b, 1452c, 1452c, 1452d and electrode 1472 includes segments 1472a, 1472b, 1472c, 1472c, 1472d. Electrodes 1452 of jaws 1450 are indicated by dashed lines on jaws 1470 in FIG. Electrodes 1452, 1472 are laterally offset from each other in the closed configuration. In the bipolar energy mode, electrical energy supplied by a generator (eg, generator 1100) passes from first conductive portion 1453a to electrode 1452 of second conductive portion 1453b and from electrode 1452 to jaws 1450, 1470. flow to the tissue grasped during Bipolar energy then flows from tissue to electrode 1472 on second conductive portion 1473b and from electrode 1472 to first conductive portion 1473a.

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

Electrode 1474 includes a base 1474e positioned within cradle 1480 that extends distally along the angular profile of second jaw 1470 from cradle proximal 1480a to cradle distal end 1480b. Cradle 1480 is centered relative to lateral edges 1470 e , 1470 f of second jaw 1470 . Electrode 1474 further includes a tapered edge 1474f extending from base 1474e beyond the side walls of cradle 1480 . Additionally, the cradle 1480 is partially embedded in a valley defined in the outer tissue treatment plane of the stenotic curve. Cradle 1480 is separated from the narrowing body of scaffold 1473 by an electrically insulating coating 1464'. As shown in FIG. 24, the base 1480 includes a width that gradually narrows as the base extends along the angular profile from the base proximal end 1480a to the base distal end 1480b.

In various embodiments, cradle 1480 comprises a compliant substrate. In the uncompressed state, the side walls of cradle 1480 extend beyond the tissue treatment surfaces of jaws 1472, as shown in FIG. As tissue is compressed between jaws 1450 and 1470 , the compressed tissue exerts a biasing force against sidewalls of cradle 1480 and further exposes tapered edge 1474 f of electrode 1474 .

One or more of the jaws described by the present disclosure include a stop or gap setting member, which is a feature that extends outwardly from one or both of the tissue treatment surfaces of the jaws of the end effector. . The stop member helps maintain a separation or predetermined gap between the jaws in a closed configuration with no tissue between the jaws. In at least one embodiment, sidewalls of cradle 1480 define such stop members. In another embodiment, the stop member is in the form of an insulating post or laterally extending spring-biased feature that allows the gap between the opposing jaws and the closure configuration to vary based on the clamp load. can be

Most electrosurgical generators use a constant power mode. In constant power mode, the power output remains constant as the impedance increases. In constant power mode, the voltage increases as the impedance increases. An increase in voltage causes thermal damage to tissue. The GEM controls the size and shape of electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474 and modulates power levels based on tissue impedance to create a low voltage plasma, for example, as described above. By doing so, the energy output of the jaws 1250, 1270 is concentrated.

In some cases, the GEM maintains a constant minimum voltage required for cutting at the surgical site. A generator (eg, 1100) modulates power to maintain a voltage as close as possible to the minimum voltage required for cutting at the surgical site. To obtain an arc plasma and cut, current is pushed into the tissue by voltage from the narrowing portions of the electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474. A minimum voltage of approximately 200 volts is maintained in certain embodiments. Cutting above 200 volts increases thermal damage, and cutting below 200 volts results in minimal arcing and resistance in the tissue. Therefore, the generator (eg, 1100) modulates power to ensure that it utilizes the minimum voltage that can still form and cut the arc plasma.

Referring primarily to FIG. 26, surgical instrument 1500 includes end effector 1400 . Surgical instrument 1500 is similar in many respects to other surgical instruments described in US Patent Application Attorney Docket No. END9234USNP2/190717-2. Various actuation and articulation mechanisms described elsewhere in connection with such surgical instruments may be utilized to articulate and/or actuate surgical instrument 1500 as well. For the sake of brevity, such mechanisms are not repeated here.

End effector 1400 comprises an end effector frame assembly 11210 comprising a distal frame member 11220 rotatably supported within a proximal frame housing 11230 . In the illustrated embodiment, the distal frame member 11220 is rotatably mounted to the proximal frame housing 11230 by an annular rib on the distal frame member 11220 received within an annular groove of the proximal frame housing 11230. .

Electrical energy is transmitted to the electrodes 1452, 1472, 1474 of the end effector 1400 by one or more flex circuits extending distally through or along the distal frame member 11220. be done. In the illustrated embodiment, flex circuit 1490 is fixedly attached to first jaw 1450 . More specifically, flex circuit 1490 includes distal portion 1492 that is fixedly attachable to exposed portion 1491 of first jaw 1450 that is not covered by insulating layer 1464 .

The slip ring assembly 1550 within the proximal frame housing 11230 allows free rotation of the end effector 1400 about the shaft of the surgical instrument 1500 without entangling the wires of the circuit that transmits electrical energy to the electrodes 1452, 1472, 1474. allow. In the illustrated embodiment, flex circuit 1490 includes electrical contacts 1493 that movably engage slip rings 1550 a of slip ring assembly 1550 . Electrical energy is transferred through flex circuit 1490 from slip ring 1550 a to conductive skeleton 1453 and then to electrode 1452 . Because electrical contacts 1493 are not fixedly attached to slip ring 1550a, rotation of end effector 1400 about the shaft of surgical instrument 1500 breaks the electrical connection between electrical contacts 1493 and slip ring 1550a. Acceptable without loss. Additionally, similar electrical contacts transmit electrical energy to slip ring 1550a.

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

In various embodiments, the slip rings 1550a, 1550b, 1550c couple the slip rings 1550a, 1550b, 1550c to an insulating support structure 1557, or a conductive support structure coated with an insulating material, as shown in FIG. A one-piece electrical slip ring having mechanical features 1556a, 1556b, 1556c configured to. Further, the slip rings 1550a, 1550b, 1550c are sufficiently spaced apart to ensure that no short circuits occur when conductive fluid fills the space between the slip rings 1550a, 1550b, 1550c. In at least one example, the core flat metal shaft member includes three-dimensionally printed or overmolded non-conductive portions for supporting the slip ring assembly 1550 .

FIG. 27 shows a portion of an electrosurgical instrument 12000 comprising a surgical end effector 12200 that can be coupled to proximal shaft segments by articulation joints in various suitable manners. In a particular example, surgical end effector 12200 comprises an end effector frame assembly 12210 comprising a distal frame member 12220 rotatably supported within a proximal frame housing attached to an articulation joint.

End effector 12200 comprises first jaw 12250 and second jaw 12270 . In the illustrated embodiment, first jaw 12250 is for selective pivotal movement relative to distal frame member 12220 about first jaw axis FJA defined by first jaw pin 12221; It is pivotally pinned to distal frame member 12220 . The second jaw 12270 pivots to the first jaw 12250 for selective pivotal movement relative to the first jaw 12250 about a second jaw axis SJA defined by a second jaw pin 12272. movably pinned. In the illustrated example, the surgical end effector 12200 pivots for pivotal movement about a jaw actuation axis JAA that is proximal and parallel to the first jaw axis FJA and the second jaw axis SJA. It employs an actuator yoke assembly 12610 pivotally connected to the second jaw 12270 by a jaw mounting pin 12273 . Actuator yoke assembly 12610 includes a proximal threaded drive shaft 12614 that is threadably received within a threaded hole 12632 in distal locking plate 12630 . A threaded drive shaft 12614 is attached to the actuator yoke assembly 12610 such that relative rotation occurs between the shaft 12614 and the assembly 12610 . Distal locking plate 12630 is supported for rotational movement within distal frame member 12220 . Thus, rotation of distal locking plate 12630 results in axial movement of actuator yoke assembly 12610 .

In certain examples, distal locking plate 12630 forms part of end effector locking system 12225 . The end effector locking system 12225 further comprises a dual-acting rotary lock head 12640 attached to various types of rotary drive shafts 12602 disclosed herein. The locking head 12640 is adapted to lockingly engage a plurality of proximally facing radial grooves or recesses 12634 formed in the distal locking plate 12630 . A distal locking feature 12642 is included. When distal locking feature 12642 is in locking engagement with radial groove 12634 in distal locking plate 12630, rotation of rotating locking head 12640 causes rotation of distal locking plate 12630 within distal frame member 12220. is triggered. Also, in at least one embodiment, the rotating locking head 12640 has a second series of proximal locking grooves adapted to lockingly engage a corresponding series of locking grooves provided in the distal frame member 12220. It further comprises a facing proximal locking feature 12644 . A locking spring 12646 functions to bias the rotating locking head distally into locking engagement with the distal locking plate 12630 . In various examples, the rotating locking head 12640 can be pulled proximally by an unlocking cable or other member in the manner described herein. In another configuration, the rotary drive shaft 12602 may also be configured to move axially to move the rotary locking head 12640 axially within the distal frame member 12220 . Rotation of rotary drive shaft 12602 causes surgical end effector about shaft axis SA when proximal locking feature 12644 of rotary locking head 12640 is in locking engagement with a series of locking grooves in distal frame member 12220. 12200 rotations will be provided.

In a particular example, the first and second jaws 12250, 12270 are opened and closed as follows. As discussed in detail above, rotating locking head 12640 is in locking engagement with distal locking plate 12630 to open and close the jaws. Thereafter, rotation of rotary drive shaft 12602 in a first direction rotates distal locking plate 12630, which axially drives actuator yoke assembly 12610 in distal direction DD, thereby moving first jaw 12250 and first jaw 12250 and 2 jaws 12270 are moved toward the open position. Rotation of the rotary drive shaft 12602 in the opposite second direction axially drives the actuator yoke assembly 12610 proximally to pull the jaws 12250, 12270 toward the closed position. To rotate surgical end effector 12200 about shaft axis SA, locking cable or member is pulled proximally to disengage rotational locking head 12640 from distal locking plate 12630 and distal frame member 12220. engage with. Thereafter, rotation of rotary drive shaft 12602 in a desired direction causes distal frame member 12220 (and surgical end effector 12200) to rotate about shaft axis SA.

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

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

Alternatively, as shown in FIG. 32, the flex circuit 5004' extending through the coil tube 5005' includes conductive trace elements 5006', 5007' twisted into the PCB substrate 5009' in a helical profile. , resulting in a reduction in the overall size of the flex circuit 5004', which in turn results in a reduction in the inner/outer diameter of the coil tube 5005'. 31 and 32 show conductive trace elements 5006''', 5007'', and 5006, respectively, extending through coil tubes 5005'', 5005''' and including alternative profiles for size reduction. Figures 5004'', 5004''' include other embodiments of flex circuits 5004'', 5007'''. For example, flex circuit 5004''' comprises a folded profile and flex circuit 5004'' includes trace elements 5006'', 5007'' on opposite sides of PCB 5009''.

In addition to the above, paths 5001, 5002 are defined by trace portions 5006a-5006g, 5007a-5007g, respectively. Trace portions 5006b, 5006c and trace portions 5007b, 5007c are of rings that define a ring assembly 5010 that maintains electrical connection through paths 5001, 5002 while permitting rotation of end effector 12200 relative to the shaft of surgical instrument 12000. form. Further, trace portions 5006e, 5007e are disposed on opposite sides of actuator yoke assembly 12610. FIG. In the illustrated embodiment, portions 5006e, 5007e are disposed about holes configured to receive second jaw mounting pins 12273, as shown in FIG. Trace portions 5006 e , 5007 e are configured to make electrical contact with corresponding portions 5006 f , 5007 f disposed on second jaw 12270 . Additionally, when the first jaw 12250 is assembled with the second jaw 12270, the trace portions 5007f, 5007g are electrically connected.

Referring to FIG. 29, flex circuit 5014 includes spring biased trace elements 5016,5017. Trace elements 5016, 5017 exert a biasing force against corresponding trace elements to ensure that they maintain electrical connection therewith, particularly as corresponding trace portions move relative to each other. It is configured. One or more of the trace portions of paths 5001 , 5002 may be modified to include spring-biased trace elements according to flex circuit 5014 .

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

FIG. 36 shows an electrosurgical system 3100 including control circuitry 3101 configured to implement power scheme 3005'. In the illustrated embodiment, control circuitry 3101 includes a controller 3104 having a storage medium in the form of memory 3103 and a processor 3102 . A storage medium stores program instructions for executing power scheme 3005'. Electrosurgical system 3100 includes generator 3106 configured to provide monopolar energy to end effector 1400 and generator 3107 configured to provide bipolar energy to end effector 1400 according to power scheme 3005′. including. In the illustrated embodiment, control circuitry 3101 is depicted separately from surgical instrument 1500 and generators 3106,3107. However, in other embodiments, control circuitry 3101 may be integrated with surgical instrument 1500 , generator 3106 , or generator 3107 . In various aspects, power scheme 3005' may be stored in memory 3103 as an algorithm, equation, and/or lookup table, or any other suitable format. Control circuitry 3101 may cause generators 3106, 3107 to supply monopolar and/or bipolar energy to end effector 1400 according to power scheme 3005'.

In the illustrated embodiment, electrosurgical system 3100 further includes feedback system 3109 in communication with control circuitry 3101 . Feedback system 3109 may be a stand-alone system or may be integrated with surgical instrument 1500, for example. In various aspects, the feedback system 3109 can be employed by the control circuit 3101 to perform predetermined functions, such as issuing an alert when one or more predetermined conditions are met. In particular examples, feedback system 3109 may comprise one or more visual feedback systems such as, for example, display screens, backlights, and/or LEDs. In particular examples, feedback system 3109 may comprise one or more audio feedback systems, eg, speakers and/or buzzers. In particular examples, feedback system 3109 may comprise, for example, one or more haptic feedback systems. In particular examples, feedback system 3109 may comprise a combination of visual, audio, and/or tactile feedback systems, for example. Additionally, electrosurgical system 3100 further includes a user interface 3110 in communication with control circuitry 3101 . User interface 3110 may be a stand-alone interface or may be integrated with surgical instrument 1500, for example.

Graph 3000 displays power (W) on the y-axis and time on the x-axis. Bipolar energy curve 3020 extends into tissue coagulation phase 3005 and unipolar energy curve 3030 begins at tissue coagulation phase 3006 and ends at the end of tissue transection phase 3007 . Thus, tissue treatment cycle 3001 applies bipolar energy to tissue throughout tissue coagulation phase 3006, but not tissue transection phase 3007, and as shown in FIG. configured to apply monopolar energy to tissue at a portion of the.

In various aspects, user input may be received by control circuitry 3101 from user interface 3110 . User input causes control circuit 3101 to initialize execution of power scheme 3005' at time _t1 . Alternatively, initialization of execution of power scheme 3005 ′ may be automatically triggered by sensor signals from one or more sensors 3111 in communication with control circuitry 3101 . For example, power scheme 3005 ′ may be automatically triggered by control circuit 3101 in response to a sensor signal indicative of a predetermined gap between jaws 1450 and 1470 of end effector 1400 .

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

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

During sealing segment 3010 of tissue coagulation phase 3006 , control circuit 3101 causes generator 3107 to gradually increase the monopolar energy power supplied to end effector 1400 . The initiation of the tissue transection phase 3007 is guided by an inflection point within the monopolar energy curve 3030, where following the previous gradual increase in monopolar energy experienced during sealing segment 3010, coagulation occurs. Step up to a predetermined maximum threshold power level P3 (eg, 150 W) sufficient to transect tissue.

At t ₄ , control circuit 3101 causes generator 3107 to step up the monopolar energy power delivered to end effector 1400 to a predetermined maximum threshold power level P3 for a predetermined time period (t ₄ -t ₅ ), or tissue The predetermined maximum threshold power level P3 is maintained, or at least substantially maintained, until the end of transection phase 3007 . In the illustrated embodiment, the monopolar energy power is terminated by control circuit 3101 at _t5 . Tissue severing continues mechanically as jaws 1450, 1470 continue to apply pressure to the grasped tissue until tissue severing phase 3007 ends at _t6 . Alternatively, in other embodiments, control circuitry 3101 may cause generator 3107 to continue supplying monopolar energy power to end effector 1400 until the end of tissue transection phase 3007 .

The sensor readings of sensor 3111 and/or the timer clock of processor 3102 tell generator 3107 and/or generator 3106 when to start, increase, and energize end effector 1400 according to a power scheme, such as power scheme 3005', for example. , decrease, and/or terminate. Control circuit 3101 controls one or more predetermined time periods (eg, t ₁ -t ₂ , t ₂ -t ₃ , t ₃ -t ₄ , t ₅ -t ₆ ), the power scheme 3005′ can be implemented. Although the power scheme 3005' is time-based, the control circuit 3101 can divide individual segments based on sensor readings received from one or more of the sensors 3111, such as, for example, tissue impedance sensors. The predetermined duration of any of steps 3008, 3009, 3010 and/or steps 3006, 3007 can be adjusted.

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

In various aspects, the control circuit 3101 causes monopolar energy and bipolar energy to be delivered to the end effector 1400 from two different electrical generators 3106,3107. In at least one embodiment, energy from one of the generators 3106, 3107 is detected using the other generator's return path or utilizing the other generator's attached electrodes. , can be shorted against unintended tissue interactions. Thus, parasitic losses of energy through unintended return paths can be detected by generators connected to the return paths. Inadvertent conductive paths can be mitigated by affecting voltage, power, waveform, or timing between uses.

An integrated sensor within the flex circuit of surgical instrument 1500 prevents energization/shorting of the electrode/conductive path when potential should not be present, and the conductive path when inadvertent use is sensed can detect the ability to In addition, directional electronic gating elements that prevent crosstalk from one generator to the source of another generator can also be utilized.

One or more of the electrodes described by this disclosure (eg, electrodes 1452, 1472, 1474 associated with jaws 1450, 1470) are energized by a generator (eg, generator 1100). It may contain segmented patterns with segments that are sometimes linked together. However, when the electrodes are not energized, the segments are isolated so as not to short the circuit beyond the electrodes to other areas of the jaws.

In various aspects, thermally resistive electrode materials are utilized with the end effector 1400 . The material can be configured to inhibit electrical flow through the electrode above a predetermined temperature level, while still allowing energization of other portions of the electrode below a temperature threshold.

FIG. 37 shows a table representing an alternative power scheme 3005'' that may be stored in memory 3103 and executed by processor 3102 in a manner similar to power scheme 3005'. In implementing power scheme 3005 ″, control circuit 3101 relies on jaw opening in addition to or instead of time in setting the power values of generators 3106 , 3107 . Thus, power scheme 3005'' is a jaw opening based power scheme.

In the illustrated example, jaw openings d ₀ , d ₁ , d ₂ , d ₃ , d ₄ from power scheme 3005 ″ correspond to time values t ₁ , t ₂ , t ₃ , t from power scheme 3005 ′. ₄ . Accordingly, the feathering segment corresponds to a jaw opening of about d ₁ to about d ₂ (eg, about 0.700 inch to about 0.500 inch). Additionally, the tissue warming segment accommodates a jaw opening of about d ₂ to about d ₃ (eg, about 0.500 inch to about 0.300 inch). Additionally, the sealing segment accommodates a jaw opening of about d ₂ to about d ₃ (eg, about 0.030 inch to about 0.010 inch). Additionally, the tissue cutting step corresponds to a jaw opening of about d ₃ to about d ₄ (eg, about 0.010 inch to about 0.003 inch).

Thus, the control circuit 3101 provides the generator 3106 with bipolar energy power to the end effector 1400, for example, when readings from one or more of the sensors 3111 correspond to a predetermined jaw opening d1. , thereby initializing the feathering segment. Similarly, control circuit 3101 may cause generator 3106 to output bipolar energy power to end effector 1400, for example, when readings from one or more of sensors 3111 correspond to a predetermined jaw opening d2. It is configured to stop feeding and thereby terminate the feathering segment. Similarly, control circuitry 3101 provides monopolar energy power to end effector 1400 to generator 3107, for example, when readings from one or more of sensors 3111 correspond to a predetermined jaw opening d2. , thereby initializing the warming segment.

In the illustrated example, the jaw opening is defined by the distance between two corresponding reference points on the jaws 1450,1470. Corresponding reference points are in contact when jaws 1450, 1470 are in the closed configuration with no tissue between the jaws. Alternatively, the jaw opening is measured along a line that intersects jaws 1450, 1470 and perpendicularly to the longitudinal axis extending centrally through end effector 1500, jaws 1450 and 1470. can be defined by the distance between Alternatively, the jaw opening may be defined by the distance between first and second parallel lines that intersect the jaws 1450, 1470, respectively. The distance extends perpendicular to the first and second parallel lines, through the intersection between the first parallel line and the first jaw 1450, and between the second parallel line and the second parallel line. Measured along a line extending through the intersection with jaw 1470 .

Referring to FIG. 35, in various embodiments electrosurgical system 3100 ( FIG. 36 ) is configured to perform tissue treatment cycle 4003 using power scheme 3005 . Tissue treatment cycle 4003 includes initial tissue contact phase 4013 , tissue coagulation phase 4006 , and tissue transection phase 4007 . Tissue contacting stage 4013 includes an open configuration segment 4011 where no tissue is between jaws 1450 and 1470, and a properly oriented segment 4012 where jaws 1450 and 1470 are properly positioned relative to the desired tissue treatment area. . Tissue coagulation stage 4006 includes feathering segment 4008 , tissue warming segment 4009 and sealing segment 3010 . Tissue cutting step 4007 includes tissue cutting segments. Tissue treatment cycle 4003 includes applying bipolar energy and monopolar energy separately and simultaneously to the tissue treatment area according to power scheme 3005 . Tissue treatment cycle 4003 is similar in many respects to tissue treatment cycle 3001, which for the sake of brevity are not repeated here to the same level of detail.

FIG. 35 shows a graph 4000 representing a power scheme 3005 similar in many respects to power scheme 3005'. For example, control circuitry 3101 may implement power scheme 3005 in a manner similar to power scheme 3005′ to deliver three different energy modalities to the tissue treatment region during three consecutive periods of tissue treatment cycle 4001. can. A first energy modality, including bipolar energy but not monopolar energy, is applied to the tissue treatment region from t ₁ to t ₂ in feathering segment 4008 . A second energy modality, a mixed energy modality that includes a combination of monopolar and bipolar energies, is applied to the tissue treatment area from t ₂ to t ₄ in tissue warming segment 4009 and tissue sealing segment. Finally, a third energy modality that includes monopolar energy but not bipolar energy 4010 is applied to the tissue during tissue transection step 4007 from t ₄ to t ₅ . Additionally, the second energy modality includes a power level that is the sum of the power levels of monopolar energy and bipolar energy. In at least one embodiment, the power level of the second energy modality includes a maximum threshold (eg, 120W). In various aspects, the power scheme 3005 can be delivered to the end effector 1400 from two different electrical generators 3106, 3107. Additional aspects of power scheme 3005 that are similar to aspects of power scheme 3005′ are not repeated to the same level of detail herein for the sake of brevity.

In various aspects, the control circuit 3101 controls one or two parameters including tissue impedance 4002, jaw motor velocity 27920d, jaw motor force 27920c, jaw opening 27920b of end effector 1400, and/or motor current draw to effect end effector closure. Based on one or more measured parameters, cause generators 3106, 3107 to adjust the bipolar and/or monopolar power levels of power scheme 3005 applied by end effector 1400 to the tissue treatment region. FIG. 35 is a graph 4000 showing correlations between such measured parameters and power schemes 3005 over time.

In various embodiments, control circuit 3101 controls one or more parameters determined by one or more sensors 3111 (eg, tissue impedance 4002, jaw/closure motor speed 27920d, jaw/closure motor force 27920c, jaw gap/aperture 27920b of the end effector 1400, and/or current draw of the motor) to the generators 3106, 3107 to determine the power scheme (e.g., power scheme 3005, 3005') are adjusted. For example, control circuit 3101 can cause generators 3106, 3107 to adjust power levels based on the pressure in jaws 1450, 1470. FIG.

In at least one embodiment, the power level is inversely proportional to the pressure within jaws 1450,1470. Control circuit 3101 can utilize such inverse correlations to select power levels based on pressure values. In at least one embodiment, the current draw of the motor that results in end effector closure is employed to determine the pressure value. Alternatively, the inverse correlation utilized by control circuit 3101 can be based directly on current draw as a proxy for pressure. In various embodiments, the greater the compression applied by jaws 1450, 1470 onto the tissue treatment area, the lower the power level set by control circuitry 3101, which minimizes tissue sticking and inadvertent cutting. helps keep it down.

Graph 4000 plots at the measured parameters of tissue impedance 4002, jaw/closure motor velocity 27920d, jaw/closure motor force 27920c, jaw gap/opening 27920b of end effector 1400, and/or motor current draw resulting in end effector closure. A number of cues are provided that can trigger the initiation, adjustment, and/or termination of the application of bipolar and/or monopolar energy to tissue in tissue treatment cycle 4003 .

Control circuitry 3101 may rely on one or more of such cues in implementing and/or adjusting default power scheme 3005 in tissue treatment cycle 4003 . In particular embodiments, control circuitry 3101 is configured to detect when one or more monitored parameters meet one or more predetermined conditions, which may be stored in memory 3103, for example. can also rely on sensor readings of one or more sensors 3111 . The one or more predetermined conditions may be reaching a predetermined threshold and/or detecting a significant increase and/or decrease in one or more of the monitored parameters. can be Satisfaction, or lack thereof, of predetermined conditions constitute triggers/confirmation points for implementing and/or adjusting portions of default power scheme 3005 in tissue treatment cycle 4003 . Control circuitry 3101 may rely solely on cues in executing and/or adjusting power schemes, or alternatively derive or adjust timer clocks of time-based power schemes, such as power scheme 3005', for example. A queue can be used for

For example, if tissue impedance abruptly decreases (A ₁ ) to a predetermined threshold (Z ₁ ), alone or increases jaw motor force (A ₂ ) to a predetermined threshold (F ₁ ) and/or to a predetermined Upon coincidence with a decrease in jaw opening (A ₃ ) to a threshold (d ₁ ) (eg, 0.5 inches), control circuitry 3101 initiates the tissue coagulation phase by initiating application of bipolar energy to the tissue treatment region. 4006 can be triggered to start the feathering segment 4008 . Control circuit 3101 can signal generator 3106 to begin supplying bipolar power to end effector 1400 .

Further, a decrease (B ₁ ) in jaw motor speed to a predetermined value (v 1 ) following activation of bipolar energy triggers control circuit 3101 to keep the power level for bipolar energy constant, or at least substantially constant. Signal generator 3106 to stabilize (B ₂ ) at a value (eg, 100 W).

In yet another example, the transition from the feathering segment 4008 to the warming segment 4009 at _t2 , which triggers the initiation (D1) of application of monopolar energy to the tissue treatment area, is a predetermined threshold of jaw motor force an increase ( _C2 ) to ( _F2 ), a decrease ( _C3 ) in jaw opening to a predetermined threshold (e.g., 0.03 inch), and/or a decrease in tissue impedance ( _C1 ). When one of conditions C1, C2, C3, or in a particular example two, or in a particular example all, is met, control circuit 3101 instructs generator 3101 to deliver monopolar energy to the tissue treatment region. Start applying. In another example, at or near time t2, when one of conditions C1, C2, C3, or in a particular example two, or in a particular example all, are met, the tissue treatment region is of monopolar energy is triggered.

When monopolar energy is activated by generator 3107 in response to an activation signal by control circuit 3101, a mixture of monopolar and bipolar energy (D ₁ ) is delivered to the tissue treatment area, thereby providing monopolar energy. A shift in the impedance curve is induced, characterized by a faster decrease in impedance from _Z2 to _Z3 (E1) compared to the steady decrease (C1) before the activation of . In the illustrated example, tissue impedance Z ₃ defines the minimum impedance for tissue treatment cycle 4003 .

In the illustrated example, the control circuit 3101 determines that (E ₁ ) the minimum impedance value Z ₃ is within (E ₃ ) a predetermined maximum jaw motor force threshold (F ₃ ) and/or (E ₂ ) a predetermined jaw opening threshold range. (eg, 0.01 inch to 0.003 inch), or at least substantially match, it is determined that an acceptable seal has been achieved. Control circuit 3101 is instructed to shift from warming segment 4009 to sealing segment 4010 when one of conditions E1, E2, E3, or in a particular example two, or in a particular example all, is met. signal is sent.

In addition to the above, beyond the minimum impedance value _Z3 , the impedance level gradually increases to a threshold Z4 corresponding to the end of sealing segment 4010 at _t4 . When threshold Z4 is met, control circuit 3101 signals generator 3107 to step up the monopolar power level to begin tissue transection phase 4007, causing generator 3106 to apply bipolar energy to the tissue treatment area. signal to terminate the application of

In various embodiments, the control circuit 3101 increases the power level of the monopolar energy to cut tissue (G ₁ ) as the impedance gradually increases from its minimum value Z ₃ (G ₂ ) that the jaw motor force has decreased and/or (G ₃ ) that the jaw opening has decreased to a predetermined threshold (eg, 0.01 inch to 0.003 inch).

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

In certain examples, control circuitry 3101 may employ feedback system 3109 to alert a user and/or provide instructions or recommendations to pause application of monopolar energy. In certain examples, the control circuitry 3101 can instruct the user to utilize on a mechanical knife to transcribe tissue.

In the illustrated embodiment, control circuit 3101 maintains stepped monopolar power (H) until a spike (I) is detected in tissue impedance. The control circuit 3101 causes the generator 3107 to terminate (J) application of monopolar energy to the tissue upon detection of a spike in impedance level (I) into _Z5 following a gradual increase from _Z3 to _Z4 . can be done. A spike indicates completion of the tissue treatment cycle 4003 .

In various embodiments, control circuitry 3101 prevents the electrodes of jaws 1450, 1470 from being energized before the preferred closure threshold is reached. The closure threshold can be based on, for example, a predetermined jaw opening threshold and/or a predetermined jaw motor force threshold, which can be stored in memory 3103 . In such embodiments, control circuitry 3101 may not implement user input via user interface 3110 requesting treatment cycle 4003 . In certain examples, control circuitry 3101 may respond by alerting the user through feedback system 3109 that the preferred closure threshold has not been reached. Control circuit 3101 may also provide an override option to the user.

Finally, between times _t4 and _t5 , monopolar energy is the only energy delivered to cut patient tissue. While patient tissue is being cut, the force clamping the jaws of the end effector may vary. In 27952 cases where the force clamping the jaws decreases from its steady-state level maintained between times _t3 and _t4 , efficient and/or effective tissue cutting is achieved by the surgical instrument and/or Recognized by surgical hubs. In case 27954, in which the force clamping the jaws increases from its steady state level maintained between times _t3 and _t4 , inefficient and/or ineffective tissue cutting results in the surgical instrument and /or recognized by the surgical hub. In such instances, the error can be communicated to the user.

Referring to FIGS. 38-42, surgical instrument 1601 includes an end effector 1600 similar in many respects to end effectors 1400, 1500, which for the sake of brevity will be the same herein. Not repeated at levels of detail. End effector 1600 includes first jaw 1650 and second jaw 1670 . At least one of the first jaw 1650 and the second jaw 1670 transitions the end effector 1600 from the open configuration to the closed configuration to allow tissue (i.e. T) is movable to grip. Electrodes 1652, 1672 are configured to cooperate to deliver bipolar energy to tissue from bipolar energy source 1610, as shown in FIG. Electrode 1674 is configured to deliver monopolar energy from monopolar energy source 1620 to tissue. Return pad 1621 defines a return path for monopolar energy. In at least one embodiment, monopolar energy and bipolar energy are delivered to tissue simultaneously (FIG. 36) or alternately, as shown in FIG. 36, for example, to seal and/or cut tissue. be done.

FIG. 42 shows a simplified schematic diagram of an electrosurgical system 1607 including monopolar power source 1620 and bipolar power source 1610 connectable to electrosurgical instrument 1601 including end effector 1600 . The electrosurgical system 1607 further includes a conductive circuit 1602 selectively transitionable between a connected configuration with the electrode 1672 and a disconnected configuration with the electrode 1672 . A switching mechanism may comprise, for example, any suitable switch capable of opening and closing conductive circuit 1602 . In the connected configuration, electrodes 1672 are configured to cooperate with electrodes 1652 to deliver bipolar energy to tissue, and conductive circuit 1602 defines a return path for the bipolar energy after passing through tissue. However, in the cutting configuration, the electrodes 1672 are insulated, resulting in an inert, internally conductive and externally insulating structure on the jaws 1670 . Thus, in the cutting configuration, electrode 1652 is configured to deliver monopolar energy to tissue in addition to, or alternatively, monopolar energy delivered through electrode 1674 . Alternatively, instead of electrode 1672, electrode 1652 may be transitionable between a connected configuration and a disconnected configuration with conductive circuit 1602, and electrode 1672 may be used in addition to the monopolar energy delivered through electrode 1674. , or alternatively, monopolar energy can be delivered to the tissue.

In various aspects, electrosurgical instrument 1601 has controls configured to adjust the levels of monopolar and bipolar energy delivered to tissue to minimize unintended thermal damage to surrounding tissue. Further includes circuitry 1604 . Adjustments can be based on readings of at least one sensor, such as, for example, a temperature sensor, an impedance sensor, and/or a current sensor. 41 and 42, control circuit 1604 is coupled to temperature sensors 1651, 1671 on jaws 1650, 1670, respectively. The levels of monopolar and bipolar energy delivered to the tissue are adjusted by control circuitry 1604 based on the temperature readings of sensors 1651,1671.

In the illustrated example, control circuitry 1604 includes a controller 3104 having a storage medium in the form of memory 3103 and a processor 3102 . The memory 3103, when executed by the processor 3102, determines monopolar and bipolar energy delivered to tissue based on sensor readings received from one or more sensors, such as temperature sensors 1651, 1671, for example. Stores program instructions that cause processor 3102 to adjust the level of energy. In various embodiments, as described in more detail below, the control circuit 1604 selects a default power scheme based on readings from one or more sensors, such as temperature sensors 1651, 1671, for example. 1701 can be adjusted. Power scheme 1701 is similar in many respects to power scheme 3005', which for the sake of brevity are not repeated here to the same level of detail.

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

In the illustrated example, during the tissue sealing segment (t ₃ -t ₄ ), the control circuit 1604 determines based on the readings of the temperature sensors 1651, 1671 that the tissue temperature has reached the upper limit of the predetermined range. to detect Control circuit 1604 responds by stepping down the power level of the monopolar energy. In other examples, the reduction can be performed gradually. In certain embodiments, a reduction value or method for determining a reduction value, such as a table or equation, can be stored in memory 3103 . In certain examples, the reduction value may be a percentage of the current power level of monopolar energy. In other examples, the reduction value may be based on previous power levels of monopolar energy corresponding to tissue temperatures within a predetermined range. In certain embodiments, the reduction may be performed in multiple temporally spaced steps. After each decay step, control circuit 1604 allows a predetermined period of time to elapse before evaluating tissue temperature.

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

In addition to the above, to avoid unintended lateral thermal damage to surrounding tissue, feedback system 3109 may be configured to complete tissue transection using, for example, a mechanical knife instead of monopolar energy. You can issue an alert via In certain embodiments, control circuitry 1604 may temporarily pause monopolar and/or bipolar energy until tissue temperature returns to a level within a predetermined temperature range. The monopolar energy can then be reactivated to effect transection of the sealed tissue.

Referring to FIG. 44, end effector 1600 applies monopolar energy to tissue treatment region 1683 in a blood vessel, eg, an artery, grasped by end effector 1600 . Monopolar energy flows from end effector 1600 to treatment area 1683 and ultimately to a return pad (eg, return pad 1621). The temperature of the tissue in treatment region 1683 increases when monopolar energy is applied to the tissue. However, the actual heat spread 1681 is greater than the expected heat spread 1682 due, for example, to a constricted portion 1684 of the artery that inadvertently draws monopolar energy.

In various aspects, control circuitry 1604 monitors thermal effects in treatment area 1683 resulting from the application of monopolar energy to treatment area 1683 . Control circuitry 1604 further detects that the monitored thermal effect did not follow a predetermined correlation between the applied monopolar energy and the thermal effect expected from the application of monopolar energy in the treatment area. be able to. In the illustrated embodiment, the inadvertent drawing of energy at the arterial stenosis reduces the thermal effect in the treatment area, which is detected by control circuitry 1604 .

In certain embodiments, memory 3103 stores monopolar energy levels applied to a tissue treatment area grasped by end effector 1600 and thermal effects expected to result from the application of monopolar energy to the tissue treatment area. stores a predetermined correlation algorithm between This correlation algorithm can be in the form of an array, lookup table, database, mathematical equation or formula, for example. In at least one embodiment, a stored correlation algorithm defines a correlation between monopolar energy power level and expected temperature. The control circuit 1604 can monitor the temperature of the tissue in the treatment region 1683 using temperature sensors 1651, 1671 to determine if the monitored temperature readings correspond to expected temperature readings at a particular power level. can determine whether

Control circuitry 1604 can be configured to take a particular action when it detects that the stored correlation has not been followed. For example, control circuit 1604 can warn the user of the failure to comply. Additionally or alternatively, control circuitry 1604 can reduce or suspend delivery of monopolar energy to the treatment area. In at least one embodiment, the control circuit 1604 can adjust the application to the tissue treatment area or switch the application from monopolar energy to bipolar energy to confirm the presence of parasitic power draw. Control circuitry 1604 can continue to use bipolar energy in the treatment area if parasitic power draw is identified. However, if the control circuit 1604 denies the existence of parasitic power draw, the control circuit 1604 can restart or re-increase the unipolar power level. Changes to unipolar and/or bipolar power levels can be accomplished in control circuit 1604 by, for example, signaling unipolar power supply 1620 and/or bipolar power supply 1610 .

In various aspects, as shown in FIG. 45, one or more imaging devices, such as, for example, a multispectral scope 1690 and/or an infrared imaging device, are utilized to detect spectral changes in tissue in a tissue treatment region 1691. and/or thermal effects can be monitored. Imaging data from one or more imaging devices can be processed to estimate temperature in tissue treatment region 1691 . For example, a user can aim an infrared imaging device at the treatment area 1691 while monopolar energy is being applied to the treatment area 1691 by the end effector of 1600 . As the treatment area 1691 heats up, its infrared heat signature changes. Thus, changes in the thermal signature correspond to changes in tissue temperature in treatment region 1691 . Accordingly, the temperature of tissue in treatment region 1691 may be determined based on thermal signatures captured by one or more imaging devices. Control circuit 1604 detects a thermal effect mismatch in treatment area 1691 if the temperature estimated based on the thermal signature in treatment area 1691 associated with a particular portion level is less than or equal to the expected temperature at the power level.

In other embodiments, thermal signatures captured by one or more imaging devices are not converted to estimated temperatures. Instead, the thermal signatures stored in memory 3103 are compared directly to assess whether power level adjustments are necessary.

In certain embodiments, memory 3103 stores power levels of monopolar energy applied by end effector 1600 to tissue treatment region 1691 and thermal signatures expected to result from application of monopolar energy to the tissue treatment region. stores a predetermined correlation algorithm between This correlation algorithm can be in the form of an array, lookup table, database, mathematical equation or formula, for example. In at least one embodiment, a stored correlation algorithm defines a correlation between monopolar energy power levels and expected temperature signatures or temperatures associated with expected temperature signatures.

46 and 47, the electrosurgical system includes an electrosurgical instrument 1801 having an end effector 1800 that is similar in many respects to end effectors 1400, 1500, 1600 and which are briefly described as follows: In order to do so, it is not repeated here with the same level of detail. End effector 1800 includes first jaw 1850 and second jaw 1870 . At least one of the first jaw 1850 and the second jaw 1870 transitions the end effector 1800 from the open configuration to the closed configuration such that tissue (tissue) between the first jaw 1850 and the second jaw 1870 is moved. T) is movable for gripping. Electrodes 1852, 1872 are cooperatively configured to deliver bipolar energy to tissue. Electrodes 1874 are configured to deliver monopolar energy to tissue. In at least one embodiment, monopolar energy and bipolar energy are delivered to tissue simultaneously or alternately, as shown in FIG. 34, for example, to seal and/or cut tissue.

In the illustrated embodiment, the bipolar and monopolar energies are generated by separate generators 1880, 1881 connecting generator 1880 to electrodes 1852, 1872 and generator 1881 to electrodes 1874 and return pad 1803, respectively. It is provided to the tissue by separate electrical circuits 1882,1883. Power levels associated with bipolar energy delivered to tissue by electrodes 1852, 1872 are set by generator 1880, and power levels associated with monopolar energy delivered to tissue by electrodes 1874 are set, for example, in power scheme 3005. ' is set by generator 1881 according to .

In use, as shown in FIG. 46, the end effector 1800 applies bipolar energy and/or monopolar energy to the tissue treatment region 1804 to seal and, in certain examples, transcribe tissue. do. However, in certain instances, the energy diverts from its intended target in tissue treatment region 1804 and causes off-site thermal damage to surrounding tissue. To avoid, or at least reduce, such thermal damage from occurring, surgical instrument 1801 may include, as shown in FIG. and impedance sensors 1810, 1811, 1812, 1813 positioned at different locations.

In various aspects, the surgical system 1807 further includes a control circuit 1809 coupled to the impedance sensors 1810, 1811, 1812, 1813. The control circuit 1809 can detect off-site or unintended thermal damage based on one or more readings of the impedance sensors 1810, 1811, 1812, 1813. In response, control circuit 1809 alerts the user of off-site thermal damage, maintains bipolar energy according to a predetermined power scheme (eg, power scheme 3005') to complete tissue sealing, and The user may be instructed to pause energy delivery to tissue treatment region 1804, or energy delivery may be automatically paused. In certain examples, the control circuitry 1809 can instruct the user to employ a mechanical knife to transect tissue and prevent further off-site thermal damage.

Still referring to FIG. 46, impedance sensor 1810 is configured to measure the impedance between bipolar electrodes 1852,1872. Additionally, impedance sensor 1811 is configured to measure the impedance between electrode 1874 and return pad 1803 . Additionally, impedance sensor 1812 is configured to measure the impedance between electrode 1872 and return pad 1803 . Additionally, impedance sensor 1813 is configured to measure the impedance between electrode 1852 and return pad 1803 . In another embodiment, an additional impedance sensor is added in series between the unipolar circuit 1882 and the bipolar circuit 1883 to detect off-site thermal anomalies with greater specificity with respect to location and impedance path. It can be used to measure impedance at various locations in order to

In various aspects, off-site thermal injury occurs in tissue on one side (left/right) of the end effector 1800 . By comparing the readings of impedance sensors 1810, 1811, 1812, 1813, control circuit 1809 can detect the side where off-site thermal damage occurred. In one example, non-proportional changes in unipolar and bipolar impedance readings are indicative of off-site thermal damage. Conversely, if proportionality in impedance readings is detected, control circuit 1809 maintains that no off-site thermal damage has occurred. In one embodiment, off-site thermal damage can be detected by the control circuit 1809 from the ratio of bipolar impedance to unipolar impedance, as described in more detail below.

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

Control circuitry 3101 can determine whether energy is diverted to non-tissue therapy directed sites during a tissue treatment cycle by sending sensing pings 1903, 1904 at predetermined time intervals. Control circuitry 3101 can then assess the return path conductivity based on the delivered sensing pings. If energy is determined to be diverted from the target site, the control circuit 3101 can take one or more responsive actions. For example, the control circuit 3101 can adjust the power scheme 1901 applied by the generators 1880 (GEN.2), 1881 (GEN.1). Control circuitry 3101 may suspend application of bipolar and/or monopolar energy to the target site. Additionally, the control circuit 3101 can alert the user through the feedback system 3109, for example. However, if control circuit 3101 determines that no energy divergence is detected, then control circuit 3101 continues execution of power scheme 1901 .

In various aspects, the control circuit 3101 evaluates the return path conductivity, eg, by comparing the measured return conductivity to a predetermined return path conductivity stored in memory 3103 . If the comparison indicates that the measured return path conductivity and the predetermined return path conductivity differ by more than a predetermined threshold, control circuitry 3101 concludes that energy is diverted to a non-tissue therapy directed site. and perform one or more of the response measurements described above.

FIG. 49 is a graph 2000 showing an interrupted power scheme 2001 at t3' due to detected off-site thermal damage. The power scheme 2001 is in many respects similar to the power schemes shown in FIGS. 34, 48 and for the sake of brevity will not be repeated here to the same level of detail. Control circuitry 1809 causes, for example, generators 1880 (curve 2010), 1881 (curve 2020) to apply power scheme 2001 to effect tissue treatment cycles through end effector 1800. FIG. In addition to the power scheme 2001, the graph 2000 also shows a bipolar impedance 2011 ( _Zbipolar ), a monopolar impedance 2021 ( _Zmonopolar ), and a ratio of monopolar to bipolar impedance 2030 ( _Zmonopolar / _Zbipolar ) on the y-axis. indicates During normal operation, the values of bipolar impedance 2011 ( _Zbipolar ) and monopolar impedance 2021 ( _Zmonopolar ) remain proportional, or at least substantially proportional. As a result, a constant, or at least substantially constant, impedance ratio 2030 of unipolar impedance 2021 to bipolar impedance 2011 ( _Zmonopolar / _Zbipolar ) will be maintained within a predetermined range 2031 during normal operation. .

In various aspects, control circuitry 1809 monitors impedance ratio 2030 to assess whether monopolar energy is diverted to non-tissue therapy directed sites. The diversion changes the proportionality of the detected values of bipolar impedance 2011 (Z _bipolar ) and unipolar impedance 2021 (Z _monopolar ), thereby changing impedance ratio 2030 . A change in impedance ratio 2030 within a predetermined range 2031 can cause control circuit 1908 to issue an alarm. However, if the change extends below the lower threshold of the predetermined range 2031, the control circuit 1908 can make additional response measurements.

In the illustrated example, the impedance ratio 2030 ( _Zmonopolar / _Zbipolar ) is constant, or at least substantially constant, for the initial portion of a treatment cycle involving the application of mixed monopolar and bipolar energies to tissue. remain. However, at B1, a mismatch occurs where the unipolar impedance (Z _monopolar ) drops unexpectedly or non-proportionally with the bipolar impedance (Z _bipolar ), indicating potential off-site thermal damage. In at least one embodiment, control circuit 1809 monitors a ratio change in the ratio of unipolar impedance to bipolar impedance (Z _monopolar /Z _bipolar ) such that the change persists for a predetermined period of time and/or a lower threshold of predetermined range 2031 . Detect off-site thermal damage if the value changes to: At B1, the detected impedance ratio 2030 is still within the predetermined range 2031, so the control circuit 3101 only issues a warning through the feedback system 3109 that offset thermal damage is being detected, and the impedance ratio 2030 continue to monitor

At t3', the control circuit 3101 further detects that the impedance ratio 2030 has changed to a value less than or equal to the lower threshold of the predetermined range 2031. In response, the control circuit 3101 can issue another alert, optionally instructing the user to pause energy delivery to tissue or automatically resume energy delivery at B2. while maintaining or adjusting the power level of the bipolar energy to complete tissue sealing without monopolar energy. In certain embodiments, control circuitry 1809 may further instruct the user to transect tissue using a mechanical knife (t4') to prevent further off-site thermal damage. In the illustrated embodiment, control circuitry 1809 further instructs generator 1880 to adjust its power level to complete tissue sealing without monopolar energy and to increase the duration of time allocated for the tissue sealing segment from time t4 to Increase until time t4'. In other words, control circuit 1809 increases bipolar energy delivery to tissue to compensate for the loss of monopolar energy by increasing the bipolar power level and its delivery time.

Various aspects of the subject matter described herein are illustrated in the following examples.

Various aspects of the subject matter described herein are illustrated in the following examples.

Example set 1
Example 1 - An electrosurgical instrument with an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw includes a tapered body extending from the proximal end to the distal end. The tapered body includes an electrically conductive material. The tapered body has a first conductive portion extending from the proximal end to the distal end and protruding from the first conductive portion and distally along at least a portion of the tapered body. and a second conductive portion defining an elongated tapered electrode. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion in the tapering cross-section of the body. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first conductive portion, but not the second conductive portion, from tissue. The first conductive portion is configured to transmit electrical energy to tissue only through the second conductive portion.

Example 2 - The electrosurgical instrument of Example 1, wherein the tapered electrode includes an outer surface that is coplanar with the outer surface of the electrically insulating layer.

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

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

Example 5 - The first jaw comprises a first electrode extending distally along at least a portion of the first jaw, the tapered electrode being the second electrode, the first electrode comprising , laterally offset from the second electrode in the closed configuration, according to example 1, 2, 3, or 4.

Example 6 - The electrosurgical instrument of Example 5, wherein the second jaw further comprises a third electrode spaced from the tapering body.

Example 7 - The electrical of Example 6, wherein the third electrode extends distally from the electrode proximal end to the electrode distal end along the angular profile defined by the second jaw. surgical instruments.

Example 8 - An example in which the third electrode comprises a base positioned within the cradle extending distally from the cradle proximal to the cradle distal end along the angular profile of the second jaw 8. The electrosurgical instrument according to 7.

Example 9 - The electrosurgical instrument of Example 8, wherein the cradle is centrally located with respect to the lateral edge of the second jaw.

Example 10 - The electrosurgical instrument of Example 8 or 9, wherein the third electrode further comprises a tapered edge extending from the base beyond the side walls of the cradle.

Example 11 - The electrosurgical instrument of Example 8, 9, or 10, wherein the cradle consists of a compliant substrate.

[00103] Example 12 - The electrosurgical instrument of Example 8, 9, 10, or 11, wherein the cradle is partially embedded in a valley defined within the tapering body.

Example 13 - The electrosurgical instrument of Example 8, 9, 10, 11, or 12, wherein the cradle is spaced from the tapered body by an electrically insulating coating.

Example 14 - Example 8, wherein the base includes a base proximal end, a base distal end, and a width that tapers as the base extends along the angular profile from the base proximal end to the base distal end , 9, 10, 11, 12, or 13.

Example 15 - An electrosurgical instrument with an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw includes an electrical conductor that includes a tapered angular profile extending from the proximal end to the distal end. The conductor has a first conductive portion extending from a proximal end to a distal end and a tapered electrode projecting from the first conductive portion and extending distally along at least a portion of the conductor. and a second conductive portion defining a . The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first conductive portion, but not the second conductive portion, from tissue. The first conductive portion is configured to transmit electrical energy to tissue only through the second conductive portion.

Example 16 - The electrosurgical instrument of example 15, wherein the tapered electrode includes a width that gradually narrows as the tapered electrode extends from the proximal end toward the distal end.

Example 17 - The first jaw comprises a first electrode extending distally along at least a portion of the first jaw, the tapered electrode being the second electrode, the first electrode comprising 17. An electrosurgical instrument according to example 15 or 16, which is laterally offset from the second electrode in the closed configuration.

Example 18 - The electrosurgical instrument of example 15, 16, or 17, wherein the second jaw further comprises a third electrode spaced from the electrical conductor.

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

Example 20 - A third electrode comprises a base positioned within the cradle extending distally from the cradle proximal and to the cradle distal end along at least a portion of the tapered angular profile, the cradle 20. The electrosurgical instrument of Example 19, comprising a compliant substrate.

Example set 2
Example 1 - An electrosurgical instrument with an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw includes a linear portion that cooperates to form an angular profile and a treatment surface that includes segments extending along the angular profile. The segments include different geometries and different conductivities. The segments are configured to produce variable energy densities along the treatment plane.

Example 2 - The electrosurgical instrument of Example 1, wherein the segment comprises a proximal segment and a distal segment. The proximal segment includes a first surface area. The distal segment includes a second surface area. The second surface area is less than the first surface area.

[0036] Example 3 - The electrosurgical instrument of Example 1 or 2, wherein at least one of the segments includes a conductive treatment region longitudinally interrupted by a non-conductive treatment region.

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

[0041] Example 5 - The electrosurgical instrument of Example 1, 2, 3, or 4, wherein at least one of the segments includes a width that tapers along its length.

[0043] Example 6 - The electrosurgical instrument of Example 1, 2, 3, 4, or 5, wherein the segment extends along the peripheral side of the second jaw.

Example 7 - The electrosurgical instrument of Example 1, 2, 3, 4, 5, or 6, wherein the segment is defined in the second jaw but not in the first jaw.

Example 8 - The second jaw comprises a conductive skeleton partially coated with a first material and a second material, the first material being thermally conductive but not electrically insulating, The electrosurgical instrument of example 1, 2, 3, 4, 5, 6, or 7, wherein the second material is thermally and electrically insulating.

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

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

Example 11 - An electrosurgical instrument with an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw includes a tapered body extending from the proximal end to the distal end. The tapering body includes a tissue contacting surface. The tissue contacting surface includes an insulating layer including a first material. The insulating layer extends on either side of an intermediate area that extends along the tapering length of the body. The tissue contacting surface further includes segments configured to provide variable energy density along the tissue contacting surface. The segments include conductive segments and insulating segments alternating with conductive segments along an intermediate area. The insulating segment includes a second material different than the first material.

Example 12 - The electrosurgical instrument of Example 11, wherein the electrically conductive segment comprises a proximal segment and a distal segment. The proximal segment includes a first surface area. The distal segment includes a second surface area. The second surface area is less than the first surface area.

Example 13 - The electrosurgical instrument of Example 11 or 12, wherein the second jaw comprises a conductive skeleton partially coated with the first material.

Example 14 - The electrosurgical instrument of Example 13, wherein the electrically conductive scaffold comprises an inner thermally insulating core and an outer thermally conductive layer at least partially surrounding the inner thermally insulating core.

Example 15 - Electrosurgery according to Example 11, 12, 13, or 14, wherein the variable energy density is predetermined based on selection of different geometries and different conductivities of the conductive segments equipment.

[00130] Example 16 - The electrosurgical instrument of Example 11, 12, 13, 14, or 15, wherein at least one of the segments includes a width that tapers along its length.

[00130] Example 17 - The electrosurgical instrument of example 11, 12, 13, 14, 15, or 16, wherein the segment extends along the peripheral side of the second jaw.

Example 18 - The electrosurgical application of Example 11, 12, 13, 14, 15, 16, or 17, wherein the segment is defined in the second jaw but not in the first jaw instrument.

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

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

Example set 3
Example 1 - An electrosurgical instrument with an end effector. The end effector includes a first jaw, a second jaw, and an electrical circuit. The first jaw includes a first conductive skeleton, a first insulating coating selectively covering a portion of the first conductive skeleton, and an exposed portion of the first conductive skeleton. An electrode is provided. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw includes a second conductive skeleton, a second insulating coating selectively covering a portion of the second conductive skeleton, and an exposed portion of the second conductive skeleton. An electrode is provided. An electrical circuit is configured to transmit bipolar RF energy and monopolar RF energy to tissue through the first jaw electrode and the second jaw electrode. Monopolar RF energy shares a first electrical path and a second electrical path defined by an electrical circuit for transmitting bipolar RF energy.

Example 2 - The electrosurgical instrument of Example 1, wherein the electrical circuit defines a third electrical path separate from the first electrical path and the second electrical path.

Example 3 - The electrosurgical instrument of Example 1 or 2, wherein the end effector comprises a cutting electrode electrically insulated from the first conductive skeleton and the second conductive skeleton.

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

Example 5 - The electrosurgery of Example 4, wherein the cutting electrode is configured to cut tissue using cutting monopolar RF energy after coagulation of the tissue is initiated using bipolar RF energy equipment.

Example 6 - The electrosurgical instrument of Example 3, 4, or 5, wherein the cutting electrode is centrally located in one of the first and second jaws.

[0043] Example 7 - The electrosurgical instrument of Example 4 or 5, wherein the end effector is configured to simultaneously deliver cutting monopolar RF energy and bipolar RF energy to tissue.

Example 8 - Examples 1, 2, 3, 4, 5, wherein the first jaw electrode comprises a first distal tip electrode and the second jaw electrode comprises a second distal tip electrode, An electrosurgical instrument according to 6 or 7.

Example 9 - A First Conductive Scaffold and a Second Conductive Scaffold Are Energized Simultaneously to Deliver Monopolar RF Energy to a Tissue Surface Through a First Distal Tip Electrode and a Second Distal Tip Electrode The electrosurgical instrument of Example 8.

Example 10 - According to Example 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the second jaw comprises a cutting electrode extending along a peripheral surface of the second jaw electrosurgical instruments.

Example 11 - An electrosurgical instrument comprising an end effector and electrical circuitry. The end effector comprises at least two electrode sets, a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The end effector is configured to deliver a combination of bipolar and unipolar RF energy from the at least two electrode sets to the grasped tissue. The electrical circuit is configured to transmit bipolar RF energy and unipolar RF energy. Monopolar RF energy shares active and return paths defined by electrical circuits to transmit bipolar RF energy.

Example 12 - The electrosurgical instrument of Example 11, wherein the at least two electrode sets comprise three electrical interconnections used together in an electrical circuit.

Example 13 - An electrosurgical instrument according to example 11 or 12, wherein the at least two electrode sets comprise three electrical interconnections that define at least a portion of an electrical circuit and another separate electrical circuit.

Example 14 - To Example 13, wherein a separate electrical circuit leads to the cutting electrodes of at least two centrally located electrode sets insulated in one of the first and second jaws. An electrosurgical instrument as described.

Example 15 - According to Example 14, wherein the cutting electrode is configured to cut tissue after initiating coagulation of the tissue using the second and third electrodes of the at least two electrode sets. An electrosurgical instrument as described.

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

Example 17 - An electrosurgical instrument with an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw comprises a composite skeleton of at least two different materials configured to selectively provide an electrically conductive portion and a thermally insulating portion.

Example 18 - The electrosurgical instrument of Example 17, wherein the composite scaffold comprises a titanium-ceramic composite.

Example 19 - The electrosurgical instrument of Example 17 or 18, wherein the composite scaffold comprises a ceramic base and a titanium crown attachable to the ceramic base.

Example 20 - The electrosurgical instrument of Example 17, 18, or 19, wherein the composite scaffold is partially coated with an electrically insulating material.

Example 21 - A method for manufacturing an end effector jaw of an electrosurgical instrument. The method involves making a composite jaw skeleton by fusing titanium powder with ceramic powder in a metal injection molding process and selectively coating the composite skeleton with an electrically insulating material to provide a plurality of electrodes. and including.

Example set 4
Example 1 - An electrosurgical instrument comprising a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw comprises a first electrically conductive skeleton and a first electrically insulating layer. A first electrically conductive skeleton includes a first thermally insulating core and a first thermally insulating core integral with and extending at least partially around the first thermally insulating core. a thermally conductive outer layer. A first electrode is defined by selective application of a first electrically insulating layer to the outer surface of the first thermally conductive outer layer. The second jaw is configured to define a second electrode. The second jaw comprises a second conductive skeleton and a second electrically insulating layer. A second electrically conductive skeleton includes a second thermally insulating core and a second thermally insulating core integral with and extending at least partially around the second thermally insulating core. a thermally conductive outer layer. A second electrode is defined by selective application of a second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

Example 2 - A first electrode is configured to transmit RF energy to a second electrode through tissue positioned between the first and second electrodes in a bipolar energy mode of operation The electrosurgical instrument of Example 1, wherein the electrosurgical instrument comprises:

Example 3 - The electrosurgical instrument of Example 1 or 2, wherein the first thermally insulating core comprises air pockets.

Example 4 - The electrosurgical instrument of Example 1, 2, or 3, wherein the first thermally insulating core comprises a lattice structure.

Example 5 - The second jaw comprises a third electrode, the third electrode being defined by selective application of the second electrically insulating layer to the outer surface of the second thermally conductive outer layer The electrosurgical instrument of example 1, 2, 3, or 4, wherein the electrosurgical instrument comprises:

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

Example 7 - The electrical of Example 1, 2, 3, 4, 5, or 6, wherein at least one of the first electrically insulating layer and the second electrically insulating layer comprises a diamond-like material. surgical instruments.

Example 8 - Examples 1, 2, 3, wherein the first jaw comprises a tissue contacting surface and the first thermally insulating core comprises a lattice structure comprising walls upstanding transversely to the tissue contacting surface. , 4, 5, 6, or 7.

Example 9 - The electrosurgical instrument of Example 8, wherein the orientation is perpendicular to the tissue contacting surface.

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

[00113] Example 11 - The electrosurgical instrument of Example 10, wherein the electrode is configured to transmit RF energy to tissue positioned against the electrode.

Example 12 - The electrosurgical instrument of Example 10 or 11, comprising a first electrically conductive portion, an air pocket.

Example 13 - The electrosurgical instrument of Example 10, 11 or 12, wherein the first conductive portion comprises a grid structure.

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

Example 15 - Example 10, 11, 12, 13, wherein the jaw comprises a tissue contacting surface and the first conductive portion comprises a lattice structure including walls upstanding transversely to the tissue contacting surface, or 15. The electrosurgical instrument according to 14.

Example 16 - The electrosurgical instrument of Example 15, wherein the orientation is perpendicular to the tissue contacting surface.

Example 17 - An electrosurgical instrument comprising jaws configured to define electrodes. The jaw comprises a conductive skeleton and an electrically insulating layer. The electrically conductive skeleton comprises a thermally insulating core and a thermally conductive outer layer integral with and extending at least partially around the thermally insulating core. The electrodes are defined by selective application of an electrically insulating layer to the outer surface of the thermally conductive outer layer.

Example 18 - The electrosurgical instrument of Example 17, wherein the thermally insulating core comprises a lattice structure.

Example 19 - The electrosurgical instrument of Example 18, wherein the jaws comprise a tissue contacting surface and the lattice structure includes upstanding walls transverse to the tissue contacting surface.

Example 20 - The electrosurgical instrument of Example 19, wherein the orientation is perpendicular to the tissue contacting surface.

Example set 5
Example 1 - An electrosurgical instrument with an end effector. The end effector has a first jaw and a second jaw. The first jaw includes a first electrode. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The second jaw includes a second electrode configured to deliver the first monopolar energy to tissue, a third electrode, and a connecting configuration with the third electrode and a cutting configuration with the third electrode. a conductive circuit selectively transferable between and. In the connected configuration, the third electrode is configured to cooperate with the first electrode to deliver bipolar energy to tissue. A conductive circuit defines a return path for the bipolar energy. In the cutting configuration, the first electrode is configured to deliver second monopolar energy to tissue.

[0043] Example 2 - The electrosurgical instrument of Example 1, further comprising a switching mechanism for alternating between connected and disconnected configurations.

Example 3 - The electrosurgical instrument of Example 1 or 2, further comprising a switching mechanism that alternates between delivering bipolar energy and a second monopolar energy to tissue via the first electrode.

[0043] Example 4 - The electrosurgical instrument of Example 1, 2, or 3, wherein the end effector is configured to simultaneously deliver bipolar energy and first monopolar energy to tissue.

Example 5 - The electrosurgical instrument of Example 1, 2, 3, or 4, wherein the end effector is configured to deliver an energy blend of bipolar energy and first monopolar energy to tissue .

Example 6 - The method of Example 5, wherein the levels of bipolar energy and first monopolar energy within the energy blend are determined based on at least one reading of a temperature sensor indicative of at least one temperature of tissue. electrosurgical instruments.

Example 7 - As in Example 5 or 6, wherein the levels of bipolar energy and first monopolar energy within the energy blend are determined based on at least one reading of an impedance sensor indicative of at least one impedance of tissue An electrosurgical instrument as described.

Example 8 - Levels of Bipolar Energy and First Monopolar Energy in the Energy Blend Reduce Detected Lateral Thermal Damage Beyond the Tissue Treatment Region Between the First and Second Jaws The electrosurgical instrument of example 5, 6, or 7, wherein the electrosurgical instrument is adapted to

Example 9 - Electrosurgical instrument with end effector and control circuitry. The end effector comprises a first jaw, a second jaw and at least one sensor. The first jaw includes a first electrode. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. the second jaw includes a second electrode configured to deliver monopolar energy to tissue and a third electrode configured to cooperate with the first electrode to deliver bipolar energy; Prepare. A control circuit is configured to implement a predetermined power scheme for sealing and cutting tissue in a tissue treatment cycle. The power scheme includes predetermined power levels for monopolar and bipolar energy. The control circuitry is further configured to adjust at least one of the predetermined power levels of the monopolar energy and the bipolar energy based on readings of the at least one sensor during the tissue treatment cycle.

Example 10 - The electrosurgical instrument of Example 9, wherein the predetermined power scheme includes simultaneous and separate application of bipolar and monopolar energy to tissue in a tissue treatment cycle.

Example 11 - Predetermined power scheme applies bipolar energy rather than monopolar energy in the feathering segment of the tissue treatment cycle, and bipolar and monopolar energy in the tissue warming and sealing segments of the tissue treatment cycle An electrosurgical instrument according to example 9 or 10, comprising the simultaneous application of

Example 12 - The electrosurgical instrument of Example 11, wherein the power scheme further comprises application of monopolar rather than bipolar energy to tissue in the tissue transection segment of the tissue treatment cycle.

Example 13 - The electrosurgical instrument of Example 9, 10, 11, or 12, wherein at least one sensor comprises an impedance sensor.

[00130] Example 14 - The electrosurgical instrument of Example 13, wherein the control circuit is configured to monitor an impedance ratio of unipolar tissue impedance to bipolar tissue impedance based on readings from the impedance sensor.

[00130] Example 15 - The electrosurgical instrument of Example 14, wherein a change in impedance ratio within a predetermined range causes the control circuit to issue an alert.

[0043] Embodiment 16 - The electrosurgical instrument of embodiment 15, wherein a change in impedance ratio below the lower threshold of the predetermined range causes the control circuit to adjust the predetermined power scheme.

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

Example 18 - A change in the impedance ratio below the lower threshold of the predetermined range further causes the control circuit to adjust the application of bipolar energy to the tissue to completely seal the tissue, Example 17 The electrosurgical instrument according to .

Example 19 - An electrosurgical instrument with an end effector and control circuitry. The end effector has a first jaw and a second jaw. A first jaw with a first electrode. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. Tissue at the target site. the second jaw includes a second electrode configured to deliver monopolar energy to tissue and a third electrode configured to cooperate with the first electrode to deliver bipolar energy; Prepare. A control circuit is configured to implement a predetermined power scheme for sealing and cutting tissue in a tissue treatment cycle. The power scheme includes predetermined power levels for monopolar and bipolar energy. The control circuit further detects the energy divergence from the target site and adjusts at least one of the predetermined power levels of the monopolar energy and the bipolar energy to mitigate the energy divergence. It is configured.

Example 20 - The electrosurgical instrument of Example 19, wherein the predetermined power scheme includes simultaneous and separate application of bipolar and monopolar energy to tissue in a tissue treatment cycle.

Example 21 - A given power scheme applies bipolar rather than monopolar energy in the feathering segment of the tissue treatment cycle, and bipolar and monopolar energy in the tissue warming and sealing segments of the tissue treatment cycle. An electrosurgical instrument according to example 19 or 20, including simultaneous application.

Example set 6
Example 1 - An electrosurgical system with an end effector and control circuitry. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The control circuitry is configured to cause simultaneous and separate application of two different energy modalities to tissue during a tissue treatment cycle including a tissue coagulation phase and a tissue transection phase.

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

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

Example 4 - The electrosurgical application of Example 2 or 3, wherein the control circuit is configured to initiate application of the monopolar energy modality to the tissue prior to completion of the tissue coagulation phase with the bipolar energy modality. system.

Example 5 - The electrosurgery of Example 2 or 3, wherein the control circuit is configured to activate application of the monopolar energy modality to the tissue prior to cessation of application of the bipolar energy modality to the tissue. system for.

Example 6 - The electrosurgery of Example 3, 4, or 5, wherein the control circuit is configured to cause simultaneous application of monopolar and bipolar energy modalities to the tissue during the tissue coagulation phase system for.

Example 7 - Examples 1, 2, 3, 4, wherein the control circuit comprises a processor and a storage medium, and application of two different energy modalities to the tissue is based on a default power scheme stored in the storage medium, The electrosurgical system according to 5 or 6.

Example 8 - An implementation further comprising at least one sensor, wherein the control circuit is configured to modify the default power scheme based on one or more sensor readings of the at least one sensor An electrosurgical system according to Example 7.

Example 9 - Electrosurgical instrument with an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. An end effector is configured to cause application of three different energy modalities to tissue during a tissue treatment cycle including a tissue coagulation phase and a tissue transection phase.

Example 10 - The electrosurgical instrument of Example 9, wherein the first energy modality comprises bipolar energy.

Example 11 - The electrosurgical instrument of Example 10, wherein the second energy modality comprises an energy mixture of monopolar and bipolar energy.

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

Example 13 - An electrosurgical instrument according to example 11 or 12, wherein initiation of monopolar energy application to tissue is configured to begin prior to completion of the tissue coagulation phase.

[00143] Example 14 - The electrosurgical instrument of Example 12 or 13, wherein activation of monopolar energy application to tissue is configured to begin prior to cessation of application of bipolar energy modality to tissue.

Example 15 - Further comprising a control circuit, the control circuit comprising a processor and a storage medium, wherein the application of the two different energy modalities to the tissue is based on a default power scheme stored in the storage medium, Example 9, 15. The electrosurgical instrument of 10, 11, 12, 13, or 14.

Example 16 - Further comprising at least one sensor, the control circuit configured to adjust the default power scheme during a tissue treatment cycle based on one or more sensor readings of the at least one sensor 16. The electrosurgical instrument of example 15, wherein

Example 17 - A First Generator Configured to Output Bipolar Energy, a Second Generator Configured to Output Monopolar Energy, and a First Generator and a Second Generator An electrosurgical system comprising a surgical instrument electrically coupled to a control circuit. A surgical instrument includes an end effector. The end effector has a first jaw and a second jaw. At least one of the first and second jaws moves to transition the end effector from the open configuration to the closed configuration to grasp tissue between the first and second jaws. It is possible. The control circuit comprises a processor and a storage medium, program instructions which, when executed by the processor, cause the processor to cause the first generator and the second generator to apply a predetermined power scheme to the end effector. a storage medium comprising: Power schemes include simultaneous and separate application of bipolar and monopolar energy to tissue in a tissue treatment cycle.

Example 18 - Further comprising at least one sensor, the control circuit configured to adjust the power scheme during a tissue treatment cycle based on one or more sensor readings of the at least one sensor 18. The electrosurgical system of Example 17, wherein the electrosurgical system comprises:

Example 19 - The power scheme applies bipolar energy but not monopolar energy to the tissue during the feathering segment of the tissue treatment cycle, and during the tissue warming and tissue sealing segments of the tissue treatment cycle, simultaneously applying bipolar energy and monopolar energy to tissue.

Example 20 - The electricity of Example 17, 18, or 19, wherein the power scheme further comprises applying monopolar energy, but not bipolar energy, to the tissue during the tissue transection segment of the tissue treatment cycle. surgical system.

Although several forms have been shown and described, it is not the applicant's intention to limit or limit the scope of the appended claims to such details. Many modifications, variations, alterations, permutations, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of this disclosure. Further, the structure of each element associated with the described form can be alternatively described as a means for providing the function performed by that element. Also, although materials are disclosed for particular components, other materials may be used. Accordingly, the above specification and appended claims are intended to cover all such modifications, combinations and variations as included within the scope of the disclosed forms. Please understand. The appended claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.

The foregoing detailed description uses block diagrams, flow diagrams, and/or examples to describe various aspects of devices and/or processes. To the extent such block diagrams, flow diagrams and/or embodiments include one or more functions and/or actions, it should be understood by those skilled in the art that such block diagrams, flow diagrams and/or Each function and/or operation included in the embodiments may be implemented individually and/or collectively by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will appreciate that all or part of some aspects of the forms disclosed herein can be implemented as one or more computer programs running on one or more computers ( For example, as one or more programs running on one or more computer systems), As one or more programs running on one or more processors (for example, can be equivalently implemented on an integrated circuit as one or more programs running on one or more microprocessors), as firmware, or substantially any combination thereof; and/or writing software and/or firmware code is within the skill of one of ordinary skill in the art in view of the present disclosure. Additionally, those skilled in the art will appreciate that the subject matter described herein may be distributed as one or more program products in a variety of forms, and may be distributed as one or more program products herein. Embodiments of the subject matter described in apply regardless of the particular type of signal-bearing medium used to actually carry out the distribution.

The instructions used to program the logic to implement the various disclosed aspects are stored in system memory such as dynamic random access memory (DRAM), cache, flash memory or other storage. can be stored. Additionally, the instructions may be distributed over a network or by other computer-readable media. Thus, a machine-readable medium can include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), including floppy diskettes, optical discs, compact discs, compact discs, compact disc, read-only memory, CD-ROM), as well as magneto-optical disc, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory -only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory or any other form of electrical, optical, acoustic or other It is not limited to tangible machine-readable storage used for the transmission of information over the Internet via propagated signals (eg, carrier waves, infrared signals, digital signals, etc.). Non-transitory computer-readable media thus includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

As used in any aspect herein, the term "control circuitry" includes, for example, hardwired circuits, programmable circuits (e.g., computer processors including one or more individual instruction processing cores, processing Unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic array (PLA), or field programmable gate It can refer to arrays (field programmable gate arrays, FPGAs), state machine circuits, firmware that stores instructions to be executed by programmable circuits, and any combination thereof. Control circuits may, collectively or individually, be, for example, integrated circuits (ICs), application-specific integrated circuits (ASICs), system on-chips (SoCs), desktop It can be embodied as a circuit forming part of a larger system such as a computer, laptop computer, tablet computer, server, smart phone or the like. Thus, as used herein, “control circuit” refers to an electrical circuit having at least one discrete electrical circuit, an electrical circuit having at least one integrated circuit, an electrical circuit having at least one application specific integrated circuit, A circuit, a general-purpose computing device configured with a computer program (e.g., a general-purpose computer configured with a computer program that executes, at least in part, a process and/or device described herein, or a process described herein) and/or a microprocessor configured by a computer program that at least partially executes the device); , communication switches, or opto-electrical equipment). Those skilled in the art will appreciate that the subject matter described herein may be implemented in analog or digital form, or some combination thereof.

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

As used in any aspect of this specification, the terms “component,” “system,” “module,” etc. refer to hardware, a combination of hardware and software, software, or software in execution. can refer to a computer-related entity that is

As used in any aspect herein, "algorithm" refers to a self-consistent sequence of steps leading to a desired result; , comparison, and manipulation of physical quantities and/or logical states, which may take the form of electrical or magnetic signals capable of being otherwise manipulated. It is common practice to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

The network may include packet switched networks. Communication devices can communicate with each other using a selected packet-switched network communication protocol. One exemplary communication protocol may include the Ethernet communication protocol, which may enable communication using the Transmission Control Protocol/Internet Protocol (TCP/Internet Protocol, IP). The Ethernet protocol conforms to or is compatible with the Ethernet standard entitled "IEEE 802.3 Standard" published December 2008 by the Institute of Electrical and Electronics Engineers (IEEE) and/or later versions of this standard. possible. Alternatively or additionally, the communication device may V.25 communication protocol can be used to communicate with each other. X. The V.25 communication protocol may conform to or be compatible with standards promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, communication devices may communicate with each other using a frame relay communication protocol. The frame relay communication protocol may conform to or be compatible with standards promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be able to communicate with each other using the Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol conforms to or is compatible with the ATM standard and/or later versions of this standard published in August 2001 by the ATM Forum under the title "ATM-MPLS Network Interworking 2.0". obtain. Of course, different and/or later developed connection-oriented network communication protocols are equally contemplated herein.

Unless expressly specified otherwise, the terms "processing," "computing," and "calculating" are used throughout the foregoing disclosure as is apparent from the foregoing disclosure. , "determining," "displaying," and the like refer to data represented as physical (electronic) quantities in the registers and memory of a computer system. the actions and processing of a computer system or similar electronic computing device that manipulates and transforms into other data similarly represented as physical quantities in memory or registers of or other such information storage, transmission, or display devices It will be understood that it refers to

As used herein, one or more components are “configured to,” “configurable to,” “operable/to operable/operative to, adapted/adaptable, capable to, conformable/conformed to)”, etc. Those skilled in the art will understand that "configured to" generally refers to active components and/or inactive components and/or standby components, unless the context requires otherwise. will be understood to include

The terms "proximal" and "distal" are used herein with reference to the clinician manipulating the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion located farther from the clinician. It will be further appreciated that for convenience and clarity, spatial terms such as "vertical," "horizontal," "above," and "below" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Those skilled in the art will appreciate that the terms used herein generally, and particularly in the appended claims (e.g., the appended claim text), are generally intended as "open" terms. (e.g., the term "including" is to be interpreted as "including but not limited to"; the term "having" is to be interpreted as "including but not limited to"); should be interpreted as "having at least" and the term "includes" should be interpreted as "includes but is not limited to" should be done, etc.). Moreover, where a particular number is intended in an introduced claim recitation, such intent is expressly recited in the claim; It will be understood by those skilled in the art that they do not. For example, as an aid to understanding, the appended claims that follow use the introductory phrases "at least one" and "one or more" to refer to May be included to introduce section descriptions. However, the use of such phrases when introducing claim recitations by the indefinite article "a" or "an" may be used even within the same claim to refer to "one or more" or "at least one". Any particular claim recitation containing such an introductory claim recitation, even if it contains an introductory phrase such as "three" and the indefinite article "a" or "an," shall refer to only one such recitation. should not be construed as being suggested to be limited to any patent claim that includes (e.g., "a" and/or "an" usually refer to "at least one" or "one or more") (which should be interpreted to mean The same holds true when using the definite article to introduce claim recitations.

In addition, even if a specific number is specified in an introduced claim statement, such statement should typically be construed to mean at least the stated number. It will be recognized by those skilled in the art that (e.g., where there is a statement simply "two statements" without other modifiers, generally there are at least two statements, or two or means three or more entries). Further, where notations like "at least one of A, B and C, etc." are used, such syntax is generally intended in the sense that one skilled in the art would understand the notation (e.g. , "a system having at least one of A, B and C" includes, but is not limited to, A only, B only, C only, both A and B, both A and C, B and C and/or all of A and B and C, etc.). Where notations like "at least one of A, B or C, etc." are used, such syntax is generally intended in the sense that one skilled in the art would understand the notation (e.g., "A , B, or C" includes, but is not limited to, A only, B only, C only, both A and B, both A and C, both B and C and/or systems having all of A and B and C, etc.). Moreover, typically any disjunctive word and/or phrase representing two or more alternative terms, whether within the specification, unless the context requires otherwise, It is to be understood that the possibility of including one of the terms, either of the terms, or both terms, whether in the claims or the drawings, is intended. It will be understood by those skilled in the art that . For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B."

With regard to the appended claims, those skilled in the art will understand that the operations recited herein can generally be performed in any order. Also, while the flow diagrams of various acts are shown in sequence, it should be understood that the various acts may be performed in an order other than that shown, or may be performed simultaneously. be. Examples of such alternative orderings include overlapping, interleaving, interrupting, reordering, incremental, preliminary, additional, simultaneous, reverse or other different orderings, unless the context requires otherwise. may contain. Further, terms such as "response to", "related to", or other past tense adjectives generally exclude such variations unless the context dictates otherwise. not intended.

Any reference to “an aspect,” “an aspect,” “exemplary,” “an example,” etc. means that at least one aspect includes the particular feature, structure or property described in connection with that aspect. The implications deserve special mention. Thus, the appearances of the phrases "in one aspect," "in an aspect," "in an example," and "in an example" in various places throughout this specification are not necessarily all referring to the same aspect. Moreover, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

As used herein, unless otherwise indicated, the term "about" or "approximately" as used in this disclosure means a tolerance to a particular value determined by one of ordinary skill in the art, unless otherwise specified. depends in part on how the value is measured or determined. In certain embodiments, the term "about" or "approximately" means 1, 2, 3, or 4 standard deviations. In certain embodiments, the term "about" or "approximately" refers to 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5% of a given value or range. , 4%, 3%, 2%, 1%, 0.5%, or 0.05%.

In this specification, unless otherwise indicated, all numerical parameters are to be understood as being preceded and modified in all instances by the term "about" and such numerical parameters refer to the numerical value of the parameter It has variability inherent in the underlying measurement method used to determine . At a minimum, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter set forth herein takes into account the reported significant digits and normal rounding techniques. By application should be interpreted at least.

Also, any numerical range recited herein includes all subranges subsumed within the stated range. For example, the range "1 to 10" includes all subranges between (and including) the stated minimum value of 1 and the stated maximum value of 10, i.e., All subranges with a minimum value greater than or equal to 1 and a maximum value less than or equal to 10 are included. Also, all ranges recited herein are inclusive of the stated range endpoints. For example, a range of "1-10" includes endpoints 1 and 10. It is intended that every maximum numerical limit given herein includes every lower numerical limit, and every minimum numerical limit given herein is intended to be inclusive thereof. is intended to include all higher numerical limits. Accordingly, Applicant reserves the right to amend the specification, including the claims, to include any expressly recited subranges subsumed within the expressly recited range. . All such ranges are inherently disclosed herein.

Any patent application, patent, non-patent publication, or other disclosure material referenced herein and/or listed in any application data sheet is, to the extent the incorporated material is not inconsistent with this specification, , incorporated herein by reference. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated herein by reference but is inconsistent with the current definitions, opinions, or other disclosures set forth herein, is deemed to be the incorporated material. Incorporated only to the extent not inconsistent with the current disclosure.

In summary, the many benefits that result from using the concepts described herein are described. The foregoing description of one or more aspects has been presented for the purposes of illustration and description. It is not intended to be exhaustive or to be limited to the precise forms disclosed. Modifications or variations are possible in light of the above teachings. One or more of the embodiments illustrate principles and practical applications, thereby enabling those skilled in the art to utilize the various forms, with various modifications, as appropriate for the particular application envisioned. are selected and described in order to It is intended that the claims presented herewith define the overall scope.

[Mode of implementation]
(1) An electrosurgical instrument comprising an end effector, the end effector comprising:
a first jaw,
a first conductive skeleton;
a first jaw comprising a first insulating coating selectively covering a portion of said first conductive skeleton; and a first jaw electrode comprising an exposed portion of said first conductive skeleton;
a second jaw, wherein at least one of the first jaw and the second jaw transitions the end effector from an open configuration to a closed configuration to move the first jaw and the second jaw; movable between the jaws to grasp tissue, the second jaw comprising:
a second conductive skeleton;
a second jaw comprising a second insulating coating selectively covering a portion of said second conductive skeleton; and a second jaw electrode comprising an exposed portion of said second conductive skeleton;
an electrical circuit configured to transmit bipolar RF energy and monopolar RF energy to the tissue through the first jaw electrode and the second jaw electrode, wherein the monopolar RF energy and an electrical circuit that shares a first electrical path and a second electrical path defined by said electrical circuit for transmitting bipolar RF energy.
Clause 2. The electrosurgical instrument of Clause 1, wherein the electrical circuit defines a third electrical path separate from the first electrical path and the second electrical path.
(3) An electrosurgical instrument according to Clause 2, wherein the end effector comprises a cutting electrode electrically insulated from the first conductive skeleton and the second conductive skeleton.
Clause 4. The electrosurgical instrument of Clause 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through the third electrical path.
5. Electrosurgery according to claim 4, wherein the cutting electrode is configured to cut the tissue with the cutting monopolar RF energy after coagulation of the tissue is initiated with the bipolar RF energy. equipment.

Clause 6. The electrosurgical instrument of Clause 3, wherein the cutting electrode is centrally located in one of the first jaw and the second jaw.
Clause 7. The electrosurgical instrument of Clause 4, wherein the end effector is configured to simultaneously deliver the cutting monopolar RF energy and the bipolar RF energy to the tissue.
Clause 8. The electrosurgical instrument of clause 1, wherein the first jaw electrode comprises a first distal tip electrode and the second jaw electrode comprises a second distal tip electrode.
(9) a first conductive scaffold and said second conductive scaffold for delivering said monopolar RF energy through said first distal tip electrode and said second distal tip electrode to a tissue surface; are energized simultaneously.
Clause 10. The electrosurgical instrument of clause 1, wherein the second jaw comprises a cutting electrode extending along a peripheral surface of the second jaw.

(11) An electrosurgical instrument comprising:
an end effector,
at least two electrode sets;
a first jaw and a second jaw, wherein at least one of the first jaw and the second jaw transitions the end effector from an open configuration to a closed configuration to move the first jaw; movable between the jaws and the second jaw to grasp tissue, the end effector directing bipolar and monopolar RF energy from the at least two electrode sets to the grasped tissue; an end effector configured to deliver a combination of
an electrical circuit configured to transmit said bipolar RF energy and said monopolar RF energy, said monopolar RF energy being an activity defined by said electrical circuit for transmitting said bipolar RF energy; an electrical circuit that shares a path and a return path.
Clause 12. The electrosurgical instrument of Clause 11, wherein the at least two electrode sets include three electrical interconnects used together in the electrical circuit.
Clause 13. The electrosurgical instrument of Clause 11, wherein the at least two electrode sets include three electrical interconnects that define at least a portion of the electrical circuit and another separate electrical circuit.
(14) The implementation wherein the separate electrical circuit is isolated within one of the first jaw and the second jaw and leads to a cutting electrode of the at least two centrally located electrode sets. An electrosurgical instrument according to aspect 13.
(15) the cutting electrode is configured to cut the tissue after coagulation of the tissue has been initiated using the second and third electrodes of the at least two electrode sets; An electrosurgical instrument according to embodiment 14.

Clause 16. The electrosurgical instrument of Clause 15, wherein the at least two electrode sets are configured to simultaneously deliver the monopolar RF energy and the bipolar RF energy to the tissue.
(17) An electrosurgical instrument comprising:
an end effector,
a first jaw;
and a second jaw, wherein at least one of said first jaw and said second jaw transitions said end effector from an open configuration to a closed configuration, said first jaw and said second jaw. a composite scaffold of at least two different materials movable to grasp tissue between jaws of at least two different materials, said second jaw configured to selectively provide an electrically conductive portion and a thermally insulating portion; An electrosurgical instrument comprising an end effector.
18. The electrosurgical instrument of claim 17, wherein the composite scaffold comprises a titanium-ceramic composite.
(19) The composite skeleton is
a ceramic base;
and a titanium crown attachable to the ceramic base.
(20) The electrosurgical instrument of Clause 17, wherein the composite scaffold is partially coated with an electrically insulating material.

(21) A method for manufacturing an end effector jaw of an electrosurgical instrument comprising:
creating a composite skeleton of the jaws by fusing titanium powder with ceramic powder in a metal injection molding process;
selectively coating the composite scaffold with an electrically insulating material to provide a plurality of electrodes.

Claims (21)

An electrosurgical instrument comprising an end effector, the end effector comprising:
a first jaw,
a first conductive skeleton;
a first jaw comprising a first insulating coating selectively covering a portion of said first conductive skeleton; and a first jaw electrode comprising an exposed portion of said first conductive skeleton;
a second jaw, wherein at least one of the first jaw and the second jaw transitions the end effector from an open configuration to a closed configuration to move the first jaw and the second jaw; movable between the jaws to grasp tissue, the second jaw comprising:
a second conductive skeleton;
a second jaw comprising a second insulating coating selectively covering a portion of said second conductive skeleton; and a second jaw electrode comprising an exposed portion of said second conductive skeleton;
an electrical circuit configured to transmit bipolar RF energy and monopolar RF energy to the tissue through the first jaw electrode and the second jaw electrode, wherein the monopolar RF energy and an electrical circuit that shares a first electrical path and a second electrical path defined by said electrical circuit for transmitting bipolar RF energy. The electrosurgical instrument of any preceding claim, wherein the electrical circuit defines a third electrical path separate from the first electrical path and the second electrical path. An electrosurgical instrument according to claim 2, wherein the end effector comprises a cutting electrode electrically insulated from the first conductive skeleton and the second conductive skeleton. An electrosurgical instrument according to claim 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through the third electrical path. The electrosurgical instrument of claim 4, wherein the cutting electrode is configured to cut the tissue with the cutting monopolar RF energy after coagulation of the tissue is initiated with the bipolar RF energy. An electrosurgical instrument according to claim 3, wherein the cutting electrode is centrally located in one of the first jaw and the second jaw. An electrosurgical instrument according to claim 4, wherein the end effector is configured to simultaneously deliver the cutting monopolar RF energy and the bipolar RF energy to the tissue. An electrosurgical instrument according to claim 1, wherein the first jaw electrode comprises a first distal tip electrode and the second jaw electrode comprises a second distal tip electrode. the first conductive scaffold and the second conductive scaffold simultaneously to deliver the monopolar RF energy through the first distal tip electrode and the second distal tip electrode to a tissue surface; An electrosurgical instrument according to claim 8, wherein the electrosurgical instrument is energized. An electrosurgical instrument according to any one of the preceding claims, wherein the second jaw includes a cutting electrode extending along a peripheral surface of the second jaw. An electrosurgical instrument comprising:
an end effector,
at least two electrode sets;
a first jaw and a second jaw, wherein at least one of the first jaw and the second jaw transitions the end effector from an open configuration to a closed configuration to move the first jaw; movable between the jaws and the second jaw to grasp tissue, the end effector directing bipolar and monopolar RF energy from the at least two electrode sets to the grasped tissue; an end effector configured to deliver a combination of
an electrical circuit configured to transmit said bipolar RF energy and said monopolar RF energy, said monopolar RF energy being an activity defined by said electrical circuit for transmitting said bipolar RF energy; an electrical circuit that shares a path and a return path. An electrosurgical instrument according to claim 11, wherein the at least two electrode sets include three electrical interconnects used together in the electrical circuit. An electrosurgical instrument according to claim 11, wherein the at least two electrode sets include three electrical interconnects that define at least a portion of the electrical circuit and another separate electrical circuit. 14. The method of claim 13, wherein the separate electrical circuit leads to cutting electrodes of the at least two centrally located electrode sets isolated within one of the first and second jaws. An electrosurgical instrument as described. 15. The cutting electrodes are configured to cut the tissue after coagulation of the tissue has been initiated using the second and third electrodes of the at least two electrode sets. The electrosurgical instrument according to . An electrosurgical instrument according to claim 15, wherein the at least two electrode sets are configured to simultaneously deliver the monopolar RF energy and the bipolar RF energy to the tissue. An electrosurgical instrument comprising:
an end effector,
a first jaw;
and a second jaw, wherein at least one of said first jaw and said second jaw transitions said end effector from an open configuration to a closed configuration, said first jaw and said second jaw. a composite scaffold of at least two different materials movable to grasp tissue between jaws of at least two different materials, said second jaw configured to selectively provide an electrically conductive portion and a thermally insulating portion; An electrosurgical instrument comprising an end effector. An electrosurgical instrument according to claim 17, wherein the composite scaffold comprises a titanium-ceramic composite. The composite skeleton is
a ceramic base;
and a titanium crown attachable to the ceramic base. An electrosurgical instrument according to claim 17, wherein the composite scaffold is partially coated with an electrically insulating material. A method for manufacturing an end effector jaw of an electrosurgical instrument comprising:
creating a composite skeleton of the jaws by fusing titanium powder with ceramic powder in a metal injection molding process;
selectively coating the composite scaffold with an electrically insulating material to provide a plurality of electrodes.

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