JP6482758B2 - Surgical instrument with modular clamp pad - Google Patents

Description

(priority)
This application claims priority to US Provisional Patent Application No. 61 / 410,603, entitled “Energy-Based Surgical Instruments”, filed Nov. 5, 2010, the disclosure of which is incorporated herein by reference. To do.

  This application also has priority to US Provisional Patent Application No. 61 / 487,846, entitled “Energy-Based Surgical Instruments”, filed May 19, 2011, the disclosure of which is incorporated herein by reference. Insist.

  This application is also a priority of US Non-Provisional Patent Application No. 13 / 274,830, entitled “Surgical Instrument with Modular Clamp Pad,” filed Oct. 17, 2011, the disclosure of which is incorporated herein by reference. Insist on rights.

  In some situations, endoscopic surgical instruments may be preferred over conventional open surgical devices because smaller incisions may reduce recovery time and complications after surgery. Thus, some endoscopic surgical instruments may be suitable for placing a distal end effector through a trocar cannula at a desired surgical site. These distal end effectors can engage tissue in a number of ways to achieve a diagnostic or therapeutic effect (eg, end cutter, grasper, cutter, stapler, clip applier, access device, Drug / gene therapy delivery devices and energy delivery devices using ultrasound, RF, lasers, etc.). The endoscopic surgical instrument may include a shaft operated by a clinician between the end effector and the handle portion. Such a shaft can facilitate positioning of the end effector within the patient by allowing insertion to a desired depth and rotation about the longitudinal axis of the shaft.

  As an example of an endoscopic surgical instrument, US Patent Publication No. 2006/0079874, entitled “Tissue Pad for Use with an Ultrasonic”, published April 13, 2006, the disclosure of which is incorporated herein by reference. Surgical Instrument ”, the disclosure of which is incorporated herein by reference, published on August 16, 2007, 2007/0191713, titled“ Ultrasonic Device for Cutting and Coagulating ”, the disclosure of which is hereby incorporated by reference. No. 2007/0282333, entitled “Ultrasonic Waveguide and Blade”, published December 6, 2007, the disclosure of which is incorporated herein by reference. Published, August 21, 2008, 2008/0200940, titled “Ultrasonic Device for Cutting and Coagulating”, the disclosure of which is incorporated herein by reference, published January 20, 2011 2011/0015660, entitled “Rotating Transducer Mount for Ultrasonic Surgical Instruments,” US Pat. No. 6,500,176, issued Dec. 31, 2002, the disclosure of which is incorporated herein by reference. The title “Electrosurgical Systems and Technologies for Sealing Tissue”, the disclosure of which is incorporated herein by reference. Murrell, published April 14, 2011, US Patent Publication No. 2011/0087218, include those disclosed under the heading "Surgical Instrument Comprising First and Second Drive Systems Actuatable by a Common Trigger Mechanism". In addition, such surgical tools are disclosed in US Patent Publication No. 2009/0143797, titled “Cordless Hand-held Ultrasonic Catching Cutting, published June 4, 2009, the disclosure of which is incorporated herein by reference. Cordless transducers such as those disclosed in “Device” may be included. In addition, surgical instruments are disclosed in US Pat. No. 6,783,524, entitled “Robotic Surgical Tool with Ultrasounding and Cutting Instrument” issued August 31, 2004, such as robot-assisted surgery. It can be used in the environment or can be adapted to be used.

  Several systems and methods have been created and used with respect to surgical instruments, but prior to the inventors, the present invention described in the appended claims has been created or used. It is thought that no one is.

DETAILED DESCRIPTION While the specification concludes with claims that particularly point out and distinctly claim the technology, the technology concludes the following description of specific embodiments with the accompanying drawings. On reading, it will be better understood, and in the drawings, like reference numerals identify the same elements.
1 is a perspective view of an exemplary surgical system having a surgical instrument and a generator. FIG. FIG. 3 is an exploded perspective view of an exemplary end effector shown in a closed position. FIG. 2B is an exploded perspective view of the end effector of FIG. 2A shown in an open position. 1 is a perspective view of an exemplary tabbed clamp arm assembly and an exemplary threaded transmission assembly having a plurality of sterilization holes. FIG. FIG. 4 is a side view of an exemplary handle assembly including the transmission assembly of FIG. 3 and the clamp arm assembly of FIG. 3 with a trigger shown in a loaded position. FIG. 4B is a side view of the handle assembly of FIG. 4A with the tabbed clamp arm assembly coupled to the transmission assembly and the trigger and clamp arm in the open position. FIG. 4B is a side view of the handle assembly of FIG. 4B with the trigger and clamp arm shown in the closed position. FIG. 6 is a perspective view of an alternative tabbed clamp arm assembly and an exemplary slotted transmission assembly. FIG. 4 is a perspective view of an exemplary cartridge containing the tabbed clamp arm assembly of FIG. 3. FIG. 3 is a side view of an exemplary ball snap clamp arm. FIG. 8 is a rear view of the ball snap clamp arm of FIG. 7 showing a pair of detents. FIG. 8 is a side view of the ball snap clamp arm of FIG. 7 snapped onto a ball and rod actuator. FIG. 10 is a side view of the ball snap clamp arm of FIG. 9 inside an exemplary outer sheath having a slot, with the clamp arm shown in an open position. FIG. 10B is a side view of the ball snap clamp arm and outer sheath of FIG. 10A, with the clamp arm shown in a closed position. FIG. 6 is a perspective view of an exemplary clamp arm assembly having an integral hinge. FIG. 12 is a side view of the clamp arm assembly of FIG. 11. FIG. 13 is a side cross-sectional view of the clamp arm assembly of FIG. 11 taken along 13-13. FIG. 12 is a front cross-sectional view of the clamp arm assembly of FIG. 11 showing an integral hinge coupled to the outer sheath and inner tubular actuating member. FIG. 12 is a perspective view of the clamp arm assembly of FIG. 11 aligned with an exemplary transmission assembly. 1 is a perspective view of an exemplary pinned end effector assembly. FIG. FIG. 3 is an enlarged perspective view of the distal end of the inner tube and waveguide. FIG. 18 is a side cross-sectional view showing the end effector assembly of FIG. 16 separated from the inner tube and waveguide of FIG. FIG. 18B is an enlarged side cross-sectional view of the end effector assembly, inner tube member, and waveguide of FIG. 18A shown coupled together. FIG. 5 is a side cross-sectional view of the slot and elastic tab assembly for the outer sheath and inner tubular actuation member, shown in an open position. The slot and elastic tab assembly of FIG. 19A, shown in a closed position.

  The drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the technology may be implemented in a variety of other ways, including not necessarily shown in the drawings. The accompanying drawings, which are incorporated in and form a part of this specification, illustrate several aspects of the technology and, together with the description, serve to explain the principles of the technology, however, It should be understood that the invention is not limited to the exact arrangement shown.

  The following description of specific embodiments of the technology should not be used to limit the scope of the technology. Other examples, features, aspects, embodiments, and advantages of the technology will be apparent to those skilled in the art from the following description, which is, by way of example, one of the best mode contemplated for carrying out the technology. Will be clear. As will be appreciated, the technology described herein is capable of various other obvious aspects, all without departing from the technology. Accordingly, the drawings and descriptions are to be regarded as illustrative in nature and not as restrictive.

I. Exemplary Ultrasonic Surgical System Overview FIG. 1 includes an ultrasonic surgical instrument (50), a generator (20), and a cable (30) that couples the generator (20) to the surgical instrument (50). A typical ultrasonic surgical system (10) is shown. In some variations, the generator (20) is an Ethicon Endo-Surgery, Inc. Includes GEN 300, sold by (Cincinnati, Ohio). In addition, or alternatively, generator (20) may be incorporated in US Patent Publication No. 2011/0087212, entitled "Surgent Generator for Ultrasonic," published April 14, 2011, the disclosure of which is incorporated herein by reference. and Electrosurgical Devices ". Although the surgical instrument (50) is described herein as an ultrasonic surgical instrument, it is understood that the teachings herein can be readily applied to a variety of surgical instruments. These surgical instruments should include end cutters, grippers, cutters, staplers, clip appliers, access devices, drug / gene therapy delivery devices, and energy delivery devices using ultrasound, RF, lasers, etc. And / or any combination thereof, as would be apparent to one of ordinary skill in the art in view of the teachings herein, but is not limited thereto. Furthermore, while this example is described with reference to a cabled surgical instrument (50), the surgical instrument (50) is incorporated herein by reference in its entirety. It should be understood that adaptations can be made with respect to cordless operations, such as those disclosed in US Patent Publication No. 2009/0143797, entitled "Cordless Hand-held Ultrasonic Catching Cutting Device", published April 4th. . For example, the surgical device (50) may include an integrated portable power source, such as a battery. In addition, the surgical device (50) is also disclosed in US Pat. No. 6,783,524, entitled “Robotic Surgical Tool with Ultrasound Customizing, published August 31, 2004, the disclosure of which is incorporated herein by reference. and can be used in or adapted to be used in a robot-assisted surgical environment, such as that disclosed in and Cutting Instrument.

  The surgical instrument (50) of this example includes an assembled handle assembly (60), an elongated transmission assembly (70), and a transducer (100). The transmission assembly (70) is coupled to the assembled handle assembly (60) at the proximal end of the transmission assembly (70) and extends distally from the assembled handle assembly (60). In this example, the transmission assembly (70) is configured as an elongated tubular assembly for endoscopic applications, but the transmission assembly (70) is alternatively incorporated herein by reference. Published on Dec. 6, 2007, U.S. Patent Publication No. 2007/0282333, titled "Ultrasonic Waveguide and Blade", and published on Aug. 21, 2008, No. 2008/0200940, titled "Ultrasonic Device for". It should be understood that short assemblies, such as those disclosed in “Cutting and Coagulating” can also be used. The transmission assembly (70) of this example is disposed on the outer sheath (72), the inner tubular actuation member (not shown), the waveguide (not shown), and the distal end of the transmission assembly (70). An end effector (80). In this embodiment, the end effector (80) includes a blade (82) mechanically and acoustically coupled to the waveguide and a clamp operable to pivot at the proximal end of the transmission assembly (70). The arm (84) includes a clamp pad (86) coupled to the clamp arm (84). Clamp arm (84) and related mechanisms are described in US Pat. No. 5,980,510, entitled “Ultrasonic Clamp Coagulator Apparatus Improved”, issued November 9, 1999, the disclosure of which is incorporated herein by reference. It should also be understood that it can be constructed and made operable in accordance with at least some teachings of “Clamp Arm Pivot Mount”.

  In some variations, the transducer (100) is compressed between a first resonator (not shown) and a second resonator (not shown) to form a stack of piezoelectric elements. Of piezoelectric elements (not shown). The piezoelectric element can be made from any suitable material, such as lead zirconate titanate, lead metaniobate, lead titanate, and / or any suitable piezoelectric crystal material, for example. The transducer (100) further includes an electrode, comprising at least one positive electrode and at least one negative electrode, configured to create a potential difference between one or more ends of one or more piezoelectric elements. The element converts power to ultrasonic shaking. When the transducer (100) of this example is activated, the transducer (100) is operable to create a linear vibration or a linear shaking at an ultrasonic frequency (such as 55.5 kHz). When the transducer (100) is coupled to the transmission assembly (70), these linear vibrations are transmitted to the end effector (80) through the internal waveguide of the transmission assembly (70). In this example, the blade (82) is coupled to the waveguide so that the blade (82) vibrates at the ultrasonic frequency. Therefore, when the tissue is fixed between the blade (82) and the clamp arm (84), the ultrasonic vibration of the blade (82) cuts the tissue and simultaneously denatures the protein in the adjacent tissue cells. By doing so, it is possible to provide a coagulation effect with relatively small diffusion of heat. Current can also be provided through blade (82) and clamp arm (84) to cauterize tissue. One exemplary suitable ultrasonic transducer (100), merely illustrative, is Ethicon Endo-Surgery, Inc. It should be understood that model number HP054, sold by (Cincinnati, Ohio), but any other suitable transducer can be used. Transducer (100) is a U.S. patent application Ser. No. 13 / 269,883, entitled “Surgical Instrument with Clutching Slip Ring Assembly to Power Ultrasonic, filed Oct. 10, 2011, the disclosure of which is incorporated herein by reference. Transducer ", U.S. Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333, 2008/0200940, 2011/0015660, U.S. Patent 6,500,176, Further construction can be made according to at least some teachings of US Patent Publication Nos. 2011/0087218 and / or 2009/0143797.

  The assembled handle assembly (60) of the present example includes a joint housing portion (62) and a lower portion (64). The junction housing portion (62) defines a cavity within the assembled handle assembly (60), receives the transducer (100) at the proximal end of the junction housing portion (62), and the junction housing portion ( 62) configured to receive the proximal end of the transmission assembly (70) at the distal end. In this example, a rotation knob (66) is shown for rotating the transmission assembly (70) and transducer (100), but it is understood that the rotation knob (66) is merely optional. Should do. The lower portion (64) of the assembled handle assembly (60) shown in FIG. 1 includes a trigger (68) and is configured to be grasped by a user using one hand. One exemplary alternative for the lower portion (64) is just one alternative variant, US Patent Publication No. 2011/0015660, entitled "Rotating," published January 20, 2011, the disclosure of which is incorporated herein by reference. This is shown in FIG. 1 of “Transducer Mount for Ultrasonic Surgical Instruments”. In some variations, a toggle button is disposed on the distal surface of the lower portion (64) to use the generator (20) to selectively activate the transducer (100) at various levels of operation. In addition, it is operable. For example, a first toggle button can activate a transducer (100) at a maximum energy level, while a second toggle button can activate a transducer (100) at a minimum, non-zero energy level. Can be activated. Of course, the toggle button can be configured for energy levels other than the maximum and / or minimum energy levels, as will be apparent to those skilled in the art in view of the teachings herein. Furthermore, only a single toggle button can be provided, or more than two toggle buttons can be provided.

  While the assembled handle assembly (60) has been described with reference to two separate parts (62, 64), the assembled handle assembly (60) is a combination of both parts (62, 64). It should be understood that it can be a unitary assembly. The assembled handle assembly (60) can alternatively be divided into a plurality of individual components, such as a separate trigger portion (operable by the user's hand or foot) and a separate mating housing portion (62). . Such a trigger portion can be operable to actuate the transducer (100) and can be remote from the junction housing portion (62). The assembled handle assembly (60) will be apparent to those skilled in the art in view of the durable plastic casing (61) (such as polycarbonate or liquid crystal polymer), ceramic, metal, and / or the teachings herein. Any other suitable material can be constructed. Other configurations for the assembled handle assembly (60) will also be apparent to those skilled in the art in view of the teachings herein. For example, in some variations, the trigger (68) can be omitted and the surgical instrument (50) can be actuated by control of a robotic system. In other variations, the surgical instrument (50) can be actuated when coupled to the generator (20).

  Still further, a surgical instrument (50) is disclosed in US Pat. No. 5,322,055, entitled “Clamp Coagulator / Cutting System,” issued June 21, 1994, the disclosure of which is incorporated herein by reference. for Ultrasonic Surgical Instruments ”, the disclosure of which is incorporated herein by reference, published February 23, 1999, No. 5,873,873, entitled“ Ultrasonic Clamping Apparatus Improving its disclosure ” No. 5,980,510, entitled “Ultrasonic Clamp Coag,” filed Oct. 10, 1997, which is incorporated herein by reference. larator Apparatus Improved Clamp Arm Pivot Mount, the disclosure of which is hereby incorporated by reference, No. 6,325,811, issued December 4, 2001, entitled “Blades with Functional Balance Measure Asymmetry Asymmetric Welth Asymmetric Welth Asymmetric Wetness Asymmetric Wetness Athlete Weight Asymmetrical Athletes Aimance Measure Aimance "Ultrasonic Surgical Instruments", the disclosure of which is incorporated herein by reference, U.S. Patent Publication No. 2006/0079874, entitled "Tissue Pad for Use with an Ultrasonic Instrument," the disclosure of which is incorporated herein by reference. Is incorporated herein by reference, 2007 No. 2007/0191713, titled “Ultrasonic Device for Cutting and Coagulating”, published August 16, 2007, the disclosure of which is incorporated herein by reference, No. 2007/2007, published December 6, 2007. No. 0822333, titled “Ultrasonic Waveguide and Blade”, the disclosure of which is incorporated herein by reference, published on August 21, 2008, No. 2008/0200940, titled “Ultrasonic Device for Cutting and Coagulating”. No. 2009/0143797, titled “Cordless Hand-held”, published June 4, 2009, the disclosure of which is incorporated herein by reference. "Ultrasonic Catering Cutting Device", the disclosure of which is incorporated herein by reference, published March 18, 2010, 2010/0069940, titled "Ultrasonic Device for Fingertip Control", the disclosure of which is hereby incorporated by reference. No. 2011/0015660, entitled “Rotating Transducer Mount for Ultrasonic Surgical Instruments,” published January 20, 2011, and / or the disclosure of which is incorporated herein by reference. US Provisional Application No. 61 / 410,603, entitled “Energy-Based Surgical Instrument”, filed May 5th. In accordance with at least some of the teachings of ments ", it can be constructed.

  Any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be used to describe other teachings, expressions, embodiments, examples, etc. described herein. It should be further understood that any one or more of them can be combined. The teachings, expressions, embodiments, examples and the like described below should therefore not be considered separately from one another. Various suitable ways in which the teachings herein can be combined will be readily apparent to those skilled in the art in view of the teachings herein. Such modifications and variations are intended to be included within the scope of the claims.

II. Exemplary End Effector Overview FIGS. 2A and 2B show exploded views of an exemplary end effector (200) shown in FIG. 2A in a closed position and FIG. 2B in an open position. In this example, end effector (200) includes blade (210), distal clamp pad (220), proximal clamp pad (230), clamp arm (240), inner tubular actuation member (260), and outer sheath. (280). The blade (210) is in accordance with the teachings of at least some of the blades (82) described above, or U.S. Patent Publication Nos. 2006/0079874, 2007/0191713, the disclosures of each of which are incorporated herein by reference. , 2007/0282333, 2008/0200940, 2011/0015660, and / or 2009/0143797. In this example, blade (210) is coupled to a transducer, such as transducer (100), and is configured to vibrate at an ultrasonic frequency. The coupling of such a blade (210) to the transducer can be via a waveguide (not shown). When the tissue is fixed between the blade (210) and the clamp arm (240), the ultrasonic vibration of the blade (210) cuts the tissue and simultaneously denatures proteins in adjacent tissue cells. , Heat diffusion is relatively small, can provide a solidification effect. Current can also be provided through blade (210) and clamp arm (240) to cauterize tissue. As shown, the blade (210) includes a cylindrical body portion (212) and a curved portion (214) at the distal end of the blade (210). Merely by way of example, blade (210) includes a solid titanium rod having a curved cuboid end. It should be understood that the blade (210) may be substantially straight and / or the blade (210) may have other geometries, such as A conical end, a triangular end, a cylindrical end, a substantially planar end, a cuboid body, and / or will become apparent to those skilled in the art in view of the teachings herein. Any other geometric shape may be mentioned. Still further, the blade (210) may include materials other than titanium, including aluminum, steel, iron, composite materials, alloys, and the like. Of course, other configurations for the blade (210) will be apparent to those skilled in the art in view of the teachings herein.

  The distal clamp pad (220) of this example includes Teflon® (from EI du Pont de Nemours and Company (Wilmington, Del.)), While the distal clamp pad (220) is Teflon. (Registered trademark) coated steel, or other low friction materials can be used as will be apparent to those skilled in the art in view of the teachings herein. . Distal clamp pad (220) extends through a T-shaped member (222) that extends from distal clamp pad (220) and can be inserted into a T-shaped recess (not shown) in clamp arm (240). And mounted on the clamp arm (240). The distal clamp pad (220) is pivotable to a position substantially parallel to and in contact with the blade (210). Thus, when the clamp arm (240) is actuated to the closed position shown in FIG. 2A, tissue is compressed and grasped between the distal clamp pad (220) and the blade (210). As shown, distal clamp pad (220) includes a non-smooth surface (224), such as a serrated configuration, to enhance tissue grasping by distal clamp pad (220). This serrated configuration, i.e., the teeth, provides a static friction that resists tissue movement relative to the blade (210). As will be appreciated by those skilled in the art, this serrated configuration is simply one of many tissue engaging surfaces that can be used to prevent movement of tissue relative to movement of blade (210). This is an example. Other exemplary embodiments include ridges, interlacing patterns, tread patterns, beads or sandblasted surfaces. In the illustrated embodiment, the distal clamp pad (220) is insertable at the distal end into the clamp arm (240) and is disposed distally of the proximal clamp pad (230).

  Proximal clamp pad (230) includes a substantially flat clamp pad, including Teflon®, but proximal clamp pad (230) is formed of Teflon®-coated steel. Other low friction materials can be used as will be apparent to those skilled in the art upon consideration of the teachings herein. Proximal clamp pad (230) extends through a dovetail shaped member (232) that extends from proximal clamp pad (230) and can be inserted into a dovetail shaped recess (not shown) of clamp arm (240). And mounted on the clamp arm (240). The proximal clamp pad (230) is also pivotable to a position that is substantially parallel to and in contact with the blade (210). Thus, when the clamp arm (240) is actuated to the closed position shown in FIG. 2A, tissue is compressed between the proximal clamp pad (230) and the blade (210). Of course, since the distal clamp pad (220) and the proximal clamp pad (230) are separate components, the materials for the distal clamp pad (220) and the proximal clamp pad (230) are different. It can be. Distal clamp pad (220) and proximal clamp pad (230) are disclosed in US Patent Publication No. 2006/0079874, entitled “Tissue”, published April 13, 2006, the disclosure of which is incorporated herein by reference. Further construction can be made according to at least some of the teachings of “Pad for Use with an Ultrasonic Surgical Instrument”.

  The inner tubular actuation member (260) of this example operates longitudinally within the outer sheath (280) and the blade (210) extends longitudinally through the inner tubular actuation member (260). A hollow cylindrical member configured to exist. The proximal end of the inner tubular actuating member (260) is coupled to a trigger, such as a trigger (68), which triggers the inner tubular actuating member (260) to act proximally when the trigger is depressed. Configured. When the trigger is released, the inner tubular actuation member (260) is actuated distally. The distal end (262) of the inner tubular actuation member (260) is disposed on the opposite side of the inner tubular actuation member (260) and is adapted to receive a pair of lower pins (252) of the clamp arm (240). A pair of actuation holes (264) configured. Thus, when the clamp arm (240) is coupled to the inner tubular actuating member (260) via the actuating hole (264) and the lower pin (252), due to the longitudinal movement of the inner tubular actuating member (260), The clamp arm (240) pivots about a pair of upper pins (254) on the clamp arm (240). Of course, other configurations and couplings for the inner tubular actuation member (260) will be apparent to those skilled in the art in view of the teachings herein.

  The outer sheath (280) of this example is also coupled to the casing of the handle assembly at the proximal end (not shown) of the outer sheath (280) and includes a blade (210), an inner tubular actuating member (260), And the waveguide associated with the blade (210) is a hollow cylindrical member configured to extend longitudinally therethrough. The outer sheath (280) is disposed on opposite sides of the outer sheath (280) and is configured to receive a pair of upper pins (254) of the clamp arm (240). 284) and having a distal end (282). As will be apparent to those skilled in the art, the upper hole (284) provides a pivot point around which the clamp arm (240) can pivot. The outer sheath (280) is further configured to be longitudinally secured to the inner tubular actuation member (260). Thus, when the inner tubular actuation member (260) is actuated longitudinally, the outer sheath (280) provides a mechanical base that allows the clamp arm (240) to pivot. Of course, the outer sheath (280) need not necessarily be fixed relative to the inner tubular actuation member (260). By way of example only, the inner tubular actuation member (260) can be secured and the outer sheath (280) can be actuated, or in other variations, the inner tubular member (260) and the outer sheath (280). ) Can be operable. Of course, other configurations for the outer sheath (280) will be apparent to those skilled in the art in view of the teachings herein.

  The clamp arm (240) includes an engagement portion (242) and a mounting portion (248) proximal to the engagement portion (242). The engagement portion (242) of this example has a substantially flat bottom surface that includes a T-shaped recess configured to receive a T-shaped member (222) of the distal clamp pad (220). , Including a curved member. The engagement portion (242) has a curvature that is substantially similar to the curvature of the blade (210) of the present example. Of course, if the blade (210) is straight, the engagement portion (242) can also be straight. The engagement portion (242) curves downward around the side of the blade (210) so that the engagement portion (242) can compress and cut tissue therein by the blade (210). It can be further configured to form a concave portion. The attachment portion (248) includes a body member (250), a pair of lower pins (252), and a pair of upper pins (254). The body member (250) includes a dovetail shaped recess (not shown) configured to receive the dovetail shaped member (232) of the proximal clamp pad (230). As described above, the lower pin (252) can be inserted into the actuation hole (264) of the inner tubular actuation member (260), and the upper pin (254) can be inserted into the upper hole (284) of the outer sheath (280). Can be inserted inside. Thus, when the pins (252, 254) are inserted into the holes (264, 284), the clamp arm (240) is coupled to the outer sheath (280) and the inner tubular actuating member (260) and the clamp arm ( 240) is pivotable relative to the blade (210). Of course, other configurations for the clamp arm (240) will be apparent to those skilled in the art in view of the teachings herein. In some variations, the pins (252, 254) can be separate pins that can be inserted through holes formed in the body member (232).

  Although only one exemplary end effector (200) is described herein, other end effectors can be used as well. For example, the clamp arm (240), distal clamp pad (220), proximal clamp pad (230), inner tubular actuation member (260), and / or outer sheath (280) are omitted from the end effector (200). be able to. One exemplary end effector, omitting the proximal clamp pad (230), inner tubular actuation member (260), and outer sheath (280), the disclosure of which is incorporated herein by reference, is hereby incorporated by reference. This is described in U.S. Patent Publication No. 2007/0191713, titled “Ultrasonic Device for Cutting and Coagulating”, published Aug. 16, 2007. Another exemplary end effector that merely omits the clamp arm (240), distal clamp pad (220), proximal clamp pad (230), and inner tubular actuating member (260), see its disclosure. U.S. Patent Publication No. 2008/0200940, entitled “Ultrasonic Device for Cutting and Coagulating”, published August 21, 2008, incorporated herein by reference. Still other configurations for the end effector (200) will be apparent to those skilled in the art in view of the teachings herein.

III. Exemplary Modular Clamp Pad Assembly In some situations, only the clamp arm (84), a portion of the inner tubular actuation member, and / or a portion of the outer sheath (72) may be removed from the surgical instrument (50). It may be preferable. For example, portions of the outer sheath (72), portions of the inner tubular actuation member, and / or the clamp arm (84) may become soiled during surgery. In such cases, it may be difficult to clean and re-sterilize the outer sheath (72) portion, inner tubular actuating member portion, and / or clamp arm (84) between uses. is there. Accordingly, it may be preferred to have a disposable clamp arm assembly that can be coupled and disconnected to the transmission assembly (70) of the surgical instrument (50). The transmission assembly (70) and / or surgical instrument (50) can be configured to be reusable, recyclable, and / or re-sterilizable. Therefore, the user can discard the used clamp arm assembly to re-sterilize the transmission assembly (70) and / or surgical instrument (50) and use a new clamp arm assembly for use in another procedure. Can be coupled onto the transmission assembly (70). In other situations, the clamp arm assembly can be replaced if the clamp arm (84) and / or the clamp pad (86) become worn, faulty, and / or become inoperable or unusable. However, it may be useful. In such situations, it may be useful to be able to replace the clamp arm assembly rather than the transmission assembly (70), blade (82), and / or surgical instrument (50). Of course, in some variations it may also be desirable to have a removable blade (82). Accordingly, various configurations for separable clamp arm assemblies are described below.

A. Exemplary Tabbed Clamp Arm Assembly FIG. 3 shows an exemplary tabbed clamp arm assembly (300) and an exemplary slotted transmission assembly (350). The transmission assembly (350) of this example extends distally from the handle assembly, such as the assembled handle assembly (60) described above, and includes an outer sheath (360) and an actuator (370). It should be understood that waveguides (not shown) and / or blades (not shown) also extend distally from the handle assembly, but are omitted for clarity. Waveguides and / or blades are disposed within the outer sheath (360). The waveguide and / or blade may be integrated into a handle assembly and / or a transducer, such as transducer (100), or the waveguide and blade may be removable from the handle assembly. . In some variations, the blade may be selectively coupleable to the waveguide, such as the blades described herein (82, 210, 394, 692, 794, 810, 930). it can. Only exemplary handle assemblies, transducers, waveguides, and / or blades are described in US patent application [Attorney Docket No. END6895USNP15.0587839], ________ application, the disclosure of which is incorporated herein by reference. entitled "Gear Driven Coupling Between Ultrasonic Transducer and Waveguide in Surgical Instrument", of __________ application, the first [Attorney Docket No. END6895USNP14.0587838] issue, entitled "Cam Driven Coupling Between Ultrasonic Transducer and Waveguide in Surgical Instrument", No. 13 / 269,870, filed Oct. 10, 011 and titled “Surgical Instrument with Modular Shaft and End Effect”, No. 13 / 269,899, filed Oct. 10, 2011, titled “ `` Ultrasonic Surgical Instrument with Modular End Effector '', filed Oct. 10, 2011, No. 13 / 269,883, titled “Surgical Instrument with Clutching Trump USA No. 2007/0191713, No. 2007/0282333 The No. 2008/0200940, the No. 2011/0015660, U.S. Patent No. 6,500,176, are disclosed in U.S. Patent Publication No. 2011/0087218, and / or the No. 2009/0143797.

  The outer sheath (360) of this example is an elongated tubular member that is coupled to the handle assembly at the proximal end. The outer sheath (360) includes a distal end (362) having a thread (364) and a plurality of holes (366) perpendicular to the longitudinal axis of the outer sheath (360). Distal end (362) and threading (364) are configured to threadably couple to threading (314) of outer sheath portion (310), complementary to threading (364). The hole (366) extends through the outer sheath (360) and provides a fluid passage to the interior of the outer sheath (360). Merely by way of example, the holes (366) may be formed around the cylindrical surface of the outer sheath (360) in a grid pattern, a staggered grid pattern, irregularly, or by considering the teachings herein. It can be arranged in any other manner as will be apparent to the merchant. The hole (366) allows the user to flush the interior of the transmission assembly (350) using fluid and sterilize and / or re-sterilize the transmission assembly (350). In some variations, the inner tubular actuation member can be disposed within the outer sheath (360), such as the inner tubular actuation member (780) shown in FIG. Such an inner tubular actuating member may also include a through-hole that allows fluid flow into both the inner tubular actuating member and the outer sheath (360). Such holes on the inner tubular actuation member can be aligned and / or offset with holes (366) in the outer sheath (360). Of course, the hole (366) is merely exemplary. Indeed, the outer sheath (360) and / or the inner tubular actuation member can be in longitudinal communication, a circumferential slot, a mesh, and / or fluid communication through the outer sheath (360) and / or the inner tubular actuation member. Any other form of aperture may be included.

  In some other variations, an outer tube (not shown) can be provided outside the outer sheath (360). This armor tube may also include holes similar to holes (366). In some variations, the sheath tube has a first fluid passage that can flow into the outer sheath (360) by aligning a hole in the sheath tube with a hole (366) in the outer sheath (360). From the position of the outer tube to the second position where the hole in the outer sheath (360) is offset from the hole (366) and within which the outer sheath (360) is substantially fluid-sealed. Can be made. Further, the sheath tube is inserted into a key slot (not shown) formed in the outer sheath (360), so that the sheath tube is placed in the outer sheath (in the first position or the second position). 360) and a key aligned in the rotational direction. Of course, other alignment mechanisms, such as detents, notches, etc., may also be provided, or alternatively. Still other configurations for the outer sheath (360) will be apparent to those skilled in the art in view of the teachings herein.

  The actuator (370) of this example includes an arcuate member that extends longitudinally through the outer sheath (360). In this example, actuator (370) includes a semi-tubular member in which slot (374) is formed immediately proximal to distal end (372) of actuator (370). Furthermore, although the actuator (370) is axially offset from the longitudinal axis of the outer sheath (360), this is merely optional. The slot (374) includes an opening formed through the actuator (370) and is configured to receive a tab (334) of the clamp arm (320), as described in more detail below. The Actuator (370) moves from slot (374) from a loading position (shown in FIG. 4A) where slot (374) is at a first distal location relative to distal end (362) of outer sheath (360). ) To the closed position (shown in FIG. 4C) at the third distal location, closer to the distal end (362) of the outer sheath (360) as compared to the first distal location. It is operable to operate longitudinally relative to the sheath (360). Actuator (370) can also be actuated to an open position (shown in FIG. 4B), located between a loading position and a closed position. It should be understood that such position with respect to the actuator is merely exemplary, and the actuator (370) is proximal to the distal end (362) of the outer sheath (360) and It may be operable to operate to various locations, distal. In some variations, the actuation device (370) may include a tubular member that is coaxial with the outer sheath (360), such as the inner tubular actuation member (780) shown in FIG. In other variations, the actuator (370) may simply include a planar member. Actuator (370) and / or slot (374) may further include a retention mechanism (not shown) for coupling to tab (334). For example, elastically biased locks, detents, T-shaped slots for receiving T-shaped tabs, other narrowed slots, snaps, clips, clamps, etc. can be provided. Still other configurations for actuator (370) and / or slot (374) will be apparent to those skilled in the art in view of the teachings herein.

  The clamp arm assembly (300) of this example includes an outer sheath portion (310) and a clamp arm (320) that is pivotally coupled to the outer sheath portion (310). The outer sheath portion (310) includes a tubular member (312) having a distal rod (316) that extends from the distal end of the tubular member (312). Tubular member (312) includes threading (314) that is complementary to threading (364) of outer sheath (360), and tubular member (312) is on the distal end (362) of outer sheath (360). Configured to be screwed together. In some variations, the tubular member (312) can be configured to be screwed into the outer sheath (360). Of course, alternative couplings to the outer sheath (360) for the tubular member (312) will be apparent to those skilled in the art in view of the teachings herein. Merely by way of example, adhesives, set screws, interference fit devices, clips, clamps, snaps, elastically biased locks, etc. can be provided. The rod (316) includes a pair of pins (318) extending distally from the tubular member (312) and extending outwardly from the rod (316). The pin (318) can be inserted into the clamp arm (320) such that the clamp arm (320) is pivotable relative to the outer sheath portion (310).

  The clamp arm (320) includes an actuation portion (330) and a clamp portion (340). The actuation portion (330) includes a tabbed member (332) having a tab (334) that extends downwardly from the tabbed member (332). Although the tabbed member (332) of the present example includes a cylindrical tube, it should be understood that the tabbed member (332) may have an alternative configuration, including: A rectangular tube, an egg-shaped member, a frame-shaped member, etc. are mentioned. Tab (334) extends from tabbed member (332) configured to be inserted into slot (374) of actuator (370) when actuator (370) extends to the open position. Including a rectangular protrusion. For example, actuating device (370) and / or tab (334) may cause tab (334) to enter slot (374) by bending one or both of actuating device (370) and / or tab (334). Can be made of an elastic material. In some variations, the tab (334) and / or the actuator (370) may include a cam surface (not shown) to assist in the insertion of the tab (334) into the slot (374). . The tab (334) is described below with respect to the clamp portion (340) and / or the actuator (370) from an open position where the clamp portion (340) forms a certain angle with respect to the blade (not shown). The clamping pad (344) is further sized to allow the clamp arm (320) to be actuated to a closed position that is parallel to and / or pressed against the blade. In some variations, the tab (334) can be T-shaped, and the slot (374) can include a T-shaped slot that allows the top of the T of the tab (334) to be loaded. In between, it becomes possible to enter the top of T of slot (374). During operation, the T base of the tab (334) is held within the T-shaped slot (374) by the T top of the tab (334). Of course, other configurations for tab (334) and slot (374) will be apparent to those skilled in the art in view of the teachings herein. Furthermore, other configurations for the actuating portion (330) can be used. For example, the tab (334) can be coupled to the actuator (370) via an elastically biased pin in the actuator (370) and / or tab (334). In other variations, tab (334) and / or actuator (370) may include a magnet to magnetically couple tab (334) and actuator (370). Still further, the actuator (370) can include a resilient snap-on mechanism to couple the tab (334) to the actuator. Still other variations will be apparent to those skilled in the art from consideration of the teachings herein.

  The clamp portion (340) includes an arm (342), and in some variations, includes a clamp pad (344). The arm (342) and clamp pad (344) of this example are configured substantially in accordance with the clamp arm (240) and distal clamp pad (220) described above and shown in FIGS. 2A and 2B. It should be understood that the proximal clamp pad (230) can also be included in the clamp portion (340). Of course, the clamp portion (340) is disclosed in U.S. Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333, 2008/0200940, the disclosure of which is incorporated herein by reference. In accordance with at least some of the teachings of US Patent No. 2011/0015660, US Pat. No. 6,500,176, US Patent Publication No. 2011/0087218, and / or 2009/0143797, Alternatively, it can be constructed.

  Referring now to FIG. 4A, the transmission assembly (350) includes a trigger (382), a transducer (384), a casing (386), a rotation knob (388), a toggle button (390), a waveguide (392), and Coupled to a handle assembly (380) including a blade (394). Handle assembly (in this embodiment, including trigger (382), transducer (384), casing (386), rotation knob (388), toggle button (390), waveguide (392), and blade (394). 380) is the U.S. patent application [Attorney Docket No. END6895USNP15.0587839] of the ________________________________________________________________________________ No. 0587838], the title “Cam Drive Coupling Between Ultrasonic” "Randuducer and Waveguide in Surgical Instrument", filed October 10, 2011, No. 13 / 269,870, titled "Surgical Instrument with Modular Shaft and End Effector, 10th month, 11th year, 11th year, 11th application" No. 269,899, title "Ultrasonic Surgical Instrument Modular Stipulation Ripple" r ", U.S. Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333, 2008/0200940, 2011/0015660, U.S. Patent 6,500,176, It can be constructed according to at least some teachings of US Patent Publication Nos. 2011/0087218 and / or 2009/0143797.

  In this example, the trigger (382) is coupled to the actuation assembly (398), which is further coupled to the actuation device (370). Trigger (382) and actuation assembly (398) are disclosed in US Patent Publication No. 2006/0079874, entitled “Tissue Pad for Use with an”, published April 13, 2006, the disclosure of which is incorporated herein by reference. It can be constructed according to the teachings of at least part of the Ultrasonic Surgical Instrument. When the trigger (382) is pivoted distally (FIG. 4A), the actuating assembly (398) actuates the actuating device (370) distally to the loading position as described above. In this embodiment, the spring-loaded locking assembly (383) is inadvertently triggered by the user into the loading position (382) until user interaction (eg, pressing the release button) is provided. Actuating in the distal direction is prevented. In this example, the locking assembly (383) includes a safety button coupled to a spring-loaded lever arm that prevents the trigger (382) from pivoting in the distal direction. Of course, other locking assemblies will be apparent to those skilled in the art in view of the teachings herein. From this loading position, trigger (382) is pivotable proximally to an open position (FIG. 4B), where actuating assembly (398) actuates actuating device (370) proximally from the loading position. is there. Actuating the trigger (382) from the loading position to the open position engages the spring-loaded locking assembly (383) to prevent the trigger (382) from pivoting back to the loading position. Eventually, when trigger (382) is further pivoted in the proximal direction (FIG. 4C), actuating assembly (398) actuates actuating device (370) proximally to the closed position. Additional configurations for the trigger (382) and / or handle assembly (380) will be apparent to those skilled in the art in view of the teachings herein. For example, it should be understood that the loading position is merely optional; in some variations, the trigger (382) is simply pivoted to the open position to activate the actuator (370). Can then be extended, and then the tab (334) of the clamp arm (320) can be inserted into the slot (374) of the actuator (370).

  To assemble the clamp arm assembly (300) and transmission assembly (350), the user first disengages the locking assembly (383) and triggers (382) the handle assembly (380) shown in FIG. 4A. To extend the actuator (370) to the loading position. With the actuator (370) extended, the user inserts the blade (394) through the clamp arm assembly (300) and via the threading (314, 364) onto the transmission assembly (350). And screw the clamp arm assembly (300). At this point, tab (334) is also inserted into slot (374). The trigger (382) is then pivoted proximally toward the open position shown in FIG. 4B. It should be understood that re-engagement of the locking assembly (383) prevents the trigger (382) from pivoting back to the loading position. With tab (334) inside slot (374), the user can then use this surgical instrument to actuate clamp arm (320). For example, as shown in FIG. 4C, the user can clamp the clamp arm (320) against the blade (394) by actuating the trigger (382) proximally to the closed position. . Thus, when tissue is fixed and the transducer (384) is actuated between the blade (394) and the clamp arm (320), the ultrasonic vibration of the blade (394) is adjacent to the tissue at the same time it cuts the tissue. By denaturing proteins in tissue cells, it is possible to provide a coagulation effect with relatively little heat diffusion.

  In an alternative variation, the loading position for the actuator (370) can be located proximal to the distal end (362) of the outer sheath (360). In such a configuration, the trigger (382) is configured to have an alternative loading position where the trigger (382) pivots from a closed position to a proximal position. As the trigger (382) pivots to this alternative loading position, the actuator (370) retracts proximally relative to the position of the actuator (370) in the closed position. With the actuator (370) in this alternative loading position, the clamp arm assembly (300) can be coupled to the transmission assembly (350) via threading (314, 364). In this example, the blade (394) is first separated from the transmission assembly (350) while the clamp arm assembly (300) is coupled to the transmission assembly (350). The clamp arm (320) can then be pivoted downward beyond the closed position so that the tab (334) can be inserted into the slot (374). After coupling the clamp arm assembly (300) to the transmission assembly (350), the user then pivots the trigger (382) distally back to the closed and / or open position. The user can then install the blade (394) and use the surgical device.

  Referring back to this example, to remove the clamp arm assembly (300) from the transmission assembly (350), the user first places the actuator (370) into the open position via the trigger (382). Operate. The user then disengages the locking assembly (383) and actuates the actuator (370) to the loading position shown in FIG. 4A. The user then grasps the clamp arm (320) and removes the tab (334) out of the slot (374). In some variations with a locking or retention mechanism, a button, slider, and / or separate instrument can be used to release the tab (334) from the slot (374). Once tab (334) is removed from slot (374), the user then unscrews clamp arm assembly (300) from transmission assembly (350). The clamp arm assembly (300) can then be disposed of, cleaned, and / or recycled. In this example, the clamp arm assembly (300) is provided as a disposable unit. The transmission assembly (350), as well as the remainder of the surgical instrument, can also be disposed of, cleaned, and / or recycled. In this example, the user may re-sterilize the transmission assembly (350) by flowing a sterilizing fluid through the hole (366) in the outer sheath (360) before using the surgical device again. it can. A new clamp arm assembly (300) can then be attached to the transmission assembly (350) for use.

  FIG. 5 shows an exemplary alternative tabbed clamp arm assembly (400) and an exemplary alternative slotted transmission assembly (450). In this embodiment, the clamp arm assembly (400) is configured substantially according to the clamp arm assembly (300), but the threading (314) is omitted and a pair of bayonet pins (412) (shown in phantom). ) Extends inwardly from the inner surface of the outer sheath portion (410). It should be understood that the bayonet pin (412) may alternatively extend outwardly from the outer sheath portion (410). Of course, a single bayonet pin (412) or more than two bayonet pins (412) can be used as well. Still other configurations for the outer sheath portion (410) will be apparent to those skilled in the art in view of the teachings herein.

  The transmission assembly (450) is configured substantially according to the transmission assembly (350), but the threading (364) of the outer sheath (360) is omitted. Instead, the outer sheath (460) includes a pair of longitudinally extending bayonet slots (462) configured to receive the bayonet pins (412). By way of example only, the bayonet slot (462) is an L-shaped slot having an inlet portion (464) and a locking portion (466). In this example, the bayonet slot (462) is a recess formed in the surface of the outer sheath (460), but does not extend through the outer sheath (460). This is merely optional, and in some variations, the bayonet slot (462) extends through the outer sheath (460). In yet another variation, the bayonet slot (462) can be formed on the inner surface of the outer sheath (460) to receive the bayonet pin (412) on the outer surface of the outer sheath portion (410). As described above, each of the bayonet slots (462) includes an inlet portion (464) and a locking portion (466). The inlet portion (464) extends proximally from the distal end of the outer sheath (460). The locking portion (466) extends circumferentially from the inlet portion (464) at the proximal end of the inlet portion (464). In some variations, a plurality of locking portions (466) can extend from the inlet portion (464) to accommodate different depths for coupling the clamp arm assembly (400). Such multiple locking portions (466) may allow further modularity for coupling the clamp arm assembly to the transmission assembly (450). The bayonet pin (412) is retained within the lock portion (466) by further including a lock portion (466), a detent, a snap mechanism, an elastically biased lock, and / or any other retention mechanism. can do. Alternatively, the locking portion (466) can be omitted and the proximal end of the inlet portion (464) can include a detent, snap mechanism, elastically biased lock, and / or any other retention mechanism. Further inclusion may hold the bayonet pin (412) at the proximal end of the inlet portion (464). Such a retention mechanism may help retain the clamp arm assembly (400) within the lock portion (466) and / or the inlet portion (464) and / or such retention mechanism may include: Tactile feedback can be provided to the user indicating that the clamp arm assembly (400) is coupled to the transmission assembly (450). In yet a further alternative, the bayonet slot (462) may include a helical slot. Of course, other configurations for the transmission assembly (450) will be apparent to those of ordinary skill in the art in view of the teachings herein.

  To assemble the clamp arm assembly (400) and the transmission assembly (450), the user inserts the bayonet pin (412) into the bayonet slot until the bayonet pin (412) reaches the proximal end of the inlet portion (464). Insert in (462). The user then rotates the clamp arm assembly (400) to rotate the bayonet pin (412) into the locking portion (466). Such rotation can encompass zero to 180 degrees. For variations involving spiral slots, such rotation may be up to 360 degrees, or even more than 360 degrees. By way of example only, the helical slot rotates the clamp arm assembly (400) up to 1080 degrees of rotation. The user can use the surgical instrument by further coupling a tab to the actuator and slot.

  FIG. 6 shows a cartridge (500) that can be used to couple a sterile clamp arm assembly (300) to a transmission assembly (350). The cartridge (500) extends from the body (502), an opening (510) formed in the body (502), and the opening (510) into which the clamp arm assembly (300) is disposed. A recess (520). The body (502) may include a handle portion (504) with which the user grips and rotates the cartridge (500) to place the clamp arm assembly (300) on the transmission assembly (350). Can be combined. In some variations, the cartridge (500) may include a locking mechanism (not shown) that prevents the clamp arm assembly (300) from rotating within the cartridge (500). For example, protrusions, pushbutton brake pads, clips, clamps, snaps, elastically biased members, etc. can be provided. Made by Tyvek® (EI du Pont de Nemours and Company (Wilmington, Delaware) to cover the opening (510) before joining the clamp arm assembly (300) and transmission assembly (350). A removable cover (512), such as a cover, can be used. In some variations, the cover (512) may allow the blade (394) to pierce through the cover (512) to allow access to the clamp arm assembly (300) therein. A pierceable cover. In this example, the clamp arm assembly (300) is screwed onto the transmission assembly (350) by rotating the cartridge (500) relative to the transmission assembly (350). In other variations, such as the clamp arm assembly (400) and the transmission assembly (450), the cartridge (500) is rotated by a quarter turn (90 degrees) relative to the transmission assembly (450), The clamp arm assembly (400) can be coupled to the transmission assembly (450). Of course, other rotation angles for the cartridge (500) relative to the transmission assembly (350) can be used. Furthermore, other variations of the cartridge (500) will be apparent to those skilled in the art in view of the teachings herein. The cartridge (500) can be pulled directly from the sterilization package through the coupling action without compromising the sterility of the clamp arm assembly (300) to couple the clamp arm assembly (300) with the transmission assembly (350). You should understand what you can do. Of course, the clamp arm assembly (300) can still be coupled to the transmission assembly (350) without compromising sterility, even in the absence of the cartridge (500). Further, although this embodiment shows the clamp arm assembly (300) in a closed position for assembly, as will be apparent to those skilled in the art in view of the teachings herein, the clamp arm assembly Other configurations and / or orientations for (300) can be used with cartridge (500).

B. Exemplary Ball Snap Clamp Arm FIG. 7 illustrates an example including a clamp body (610), a ball cup recess (620), a rod opening (630), a pair of guide pins (640), and a clamp pad (650). A typical ball snap clamp arm (600) is shown. In this embodiment, the ball cup recess (620) is formed in the proximal end of the clamp body (610) and receives the ball (662) of the ball rod (660) shown in FIG. Configured to actuate a clamp arm (600). The rod opening (630) shown in FIG. 8 is formed through the proximal end of the clamp body (610) and receives the rod (664) of the ball rod (660) therethrough, but the ball cup collapses. It is also configured to prevent the ball (662) from slipping out of the recess (620) in the longitudinal direction. The clamp body (610) further includes a detent (632), and the rod (664) snaps through the detent (632) so as to enter and be maintained within the rod opening (630). be able to. In this embodiment, the clamp body (610) also includes a detent (622) around the ball cup recess (620) to place the ball (662) in the ball cup recess (620) as well. Can snap fit. In some variations, the clamp body (610) includes an elastic material so that slight deformation of the clamp body (610) causes the ball cup recess (620) and / or the rod opening (630) to enter the ball. (662) and / or the rod (664) can be snapped into. Thus, the user can couple and / or separate the ball snap clamp arm (600) from the ball rod (660). Ball rod (660) is operable to operate longitudinally relative to shaft (670) shown in FIGS. 10A and 10B. By way of example only, a trigger (not shown) of a handle assembly (not shown) can be pivoted to actuate the ball rod (660). Clamp pad (650) is coupled to the lower surface of clamp body (610), and when ball snap clamp arm (600) is actuated to the closed position shown in FIG. 10B, FIGS. Is operable to compress tissue against the blade (692) shown in FIG. The clamp pad (650) is in accordance with at least some teachings of the clamp pads (86, 220, 230, 344) described herein, in accordance with at least some teachings of US Patent Publication No. 2006/0079874, and And / or can be constructed in other ways.

  Referring now to FIGS. 10A and 10B, the guide pin (640) of this embodiment extends generally perpendicular to the longitudinal axis of the ball snap clamp arm (600) and is formed in the shaft (670). Configured to be slidably actuated within the slot (680). The shaft (670) extends from a handle assembly, such as the handle assembly (60, 380) described herein, in a distal direction and is formed with a pair of slots formed on opposing sides of the shaft (670). (680). The slot (680) of the present example includes a straight slot formed at a constant angle with respect to the longitudinal axis of the shaft (670), but the slot (680) may have other configurations such as a curved slot. It should be understood that The shaft (670) further includes an opening (not shown) on the distal end (672) through which the ball snap clamp arm (600) is inserted and the ball rod (660) (virtual line). Can be snapped onto. The shaft (670) may include an elastic material so that the distal end (672) is slotted by the guide pin (640) when snapping the ball snap clamp arm (600) onto the ball rod (660). (680) can be modified to allow entry. As shown in FIGS. 10A and 10B, a waveguide (690) (shown in phantom) with a blade (692) extends longitudinally through the shaft (670). The waveguide (690) and / or blade (692) of this example are disclosed in US Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333, 2008/0200940, Can be constructed according to at least some teachings of 2011/0015660, US Pat. No. 6,500,176, US Patent Publication No. 2011/0087218, and / or 2009/0143797.

  As shown in FIG. 10A, the ball snap clamp arm (600) is in an open position to allow tissue to enter between the blade (692) and the clamp pad (650). When the ball rod (660) is actuated proximally, the guide pin (640) slides inside the slot (680) and the ball snap clamp arm (600) rotates relative to the blade (692). Clamp the tissue between the ball snap clamp arm (600) and the blade (692). When the ball snap clamp arm (600) is in the closed position shown in FIG. 10B, a transducer (not shown) is actuated to transmit vibration along the waveguide (690) to the blade (692). be able to. When tissue is fixed between the blade (692) and the ball snap clamp arm (600), the ultrasonic vibration of the blade (692) cuts the tissue and simultaneously denatures proteins in adjacent tissue cells. By doing so, it is possible to provide a coagulation effect with relatively small diffusion of heat.

  After the user terminates the surgical device or if the clamp pad (650) and / or ball snap clamp arm (600) wears out, the user can remove from the ball rod (660) and shaft (670). The ball snap clamp arm (600) is removed in a snap manner. In the illustrated embodiment, the ball snap clamp arm (600) is a disposable component and the shaft (670), ball rod (660), waveguide (690), and blade (692) are reused. It is a possible component. In some variations, only the clamp pad (650) can be disposed and the remainder of the ball snap clamp arm (600) can be cleaned and reused or recycled. Further, the user can clean the shaft (670), ball rod (660), waveguide (690), and blade (692) and reuse it with a new ball snap clamp arm (600). it can. Still other arrangements relating to the shaft (670), ball rod (660), waveguide (690), blade (692), and / or ball snap clamp arm (600) can be used to teach the teachings herein. Upon consideration, it will be apparent to those skilled in the art.

C. Exemplary Integrated Hinge Clamp Arm FIGS. 11-14 include exemplary alternatives including a main body (710), a clamp pad (730), an upper integral hinge member (740), and a lower integral hinge member (750). A clamp arm (700) is shown. The main body (710) of this example includes a clamp portion (712) and a hinge portion (720) proximal to the clamp portion (712). Referring to FIG. 13, the clamp portion (712) includes a substantially planar lower surface (714) and a pair of T-shaped molded locks (716). The lower surface (714) may optionally include a surface feature (not shown) to increase the adhesion of the clamp pad (730), as will be discussed in more detail below. Such surface features include ball peened shot surfaces, jagged surfaces, dimples, divots, and / or other surface features that will be apparent to those skilled in the art in view of the teachings herein. Can be mentioned. The T-shaped molding lock (716) extends through from the upper surface of the clamp portion (712) to the lower surface (714) so that the injecting material is transferred from the lower surface (714) to the upper surface, Can flow through a T-shaped molding lock (716). In the illustrated embodiment, the main body (710) includes a pair of T-shaped molded locks (716), but a single T-shaped molded lock (716), or more than two T-shaped molded locks (716). It should be understood that can be included. Furthermore, the T-shaped molded lock (716) is not essentially limited to a T-shape. Indeed, other geometric configurations, including cylindrical plugs, L shapes, etc. will be apparent to those skilled in the art in view of the teachings herein.

  The hinge portion (720) is disposed proximal to the clamp portion (712) and, in this example, extends downward from the clamp portion (712). Merely by way of example, hinge portion (720) presents a C-shape oriented downward with respect to clamp portion (712). Each of the C-shaped legs further includes a channel (not shown) through which a fluid, such as an injection molding material, can flow. This channel couples the lower integral hinge member (750) to the clamp pad (730) via an insert molding material that flows into the channel and solidifies within the channel, as discussed in more detail below. In some variations, the main body (710) includes a metallic material, but other materials can be used as well, including plastic, glass, and the like. The main body (710) may be the first molding component prior to the insertion molding of the clamp pad (730) and / or the integral hinge (750). Still other modifications and / or configurations for the main body (710) will be apparent to those skilled in the art in view of the teachings herein.

  The clamp pad (730) of this example is an insert molded part molded on the main body (710). As shown in FIG. 13, when the clamp pad (730) is molded onto the main body (710), a portion of the molding material flows into the T-shaped molding lock (716). As the infusion material solidifies, the material inside the clamp pad (730) and the T-shaped molded lock (716) forms a single, homogeneous material continuum. Therefore, this T-shaped material is used to fix the clamp pad (730) to the main body (710). To remove the clamp pad (730) from the main body (710), the T-shaped molding lock (716) The internal material must be cut or broken. The clamp pad (730) can be further secured via the surface feature of the lower surface (714) described above. Of course, it should be understood that the T-shaped molded lock (716) is merely optional, and the clamp pad (730) is adhesive, mechanical fixture (screw, staple, bolt, etc.) Can be coupled to the main body (710) through other means, including and the like. In some variations, the clamp pad (730) includes Teflon®, but uses other low friction materials as will be apparent to those skilled in the art in view of the teachings herein. You can also Further, the clamp pad (730) is in accordance with the teachings of at least some of the clamp pads (86, 220, 230, 344, 650) described herein, and / or the disclosure thereof is hereby incorporated by reference. Can be constructed in accordance with at least some teachings of US Patent Publication No. 2006/0079874, entitled “Tissue Pad for Use with an Ultrasonic Surgical Instrument”, published April 13, 2006, or It can be omitted.

  As shown also in FIG. 13, the upper integrated hinge member (740) of the present embodiment extends proximally from the clamp pad (730) and is integrally formed with the clamp pad (730), thereby clamping the clamp. Pad (730) and upper hinge member (740) form a single, homogeneous material continuum. The upper hinge member (740) is an insert molded part that is molded with the clamp arm (730). The upper hinge member (740) is connected to the clamp pad (730) via the upper integral hinge (742), so that the upper hinge member (740) is connected to the clamp pad (730) and / or the main body (710). In contrast, it can be inclined upward or downward. As shown in FIGS. 11, 12, and 14, the upper hinge member (740) is arcuate with a pair of longitudinal upper slots (746) formed on both sides of the upper hinge member (740). Member (744). By way of example only, the upper slot (746) extends longitudinally through the side of the arcuate member (744) to provide an arcuate end (772) of the outer sheath (770) shown in FIG. ) Can be inserted into the upper slot (746). When the arcuate end (772) is inserted into the upper slot (746), the upper hinge member (740) is coupled to the outer sheath (770). Thus, the main body (710) and / or the clamp pad (730) can pivot relative to the outer sheath (770) via the integral hinge (742). The upper slot (746) or alternatively, the arcuate member (744) may be partially extended such that the upper slot (746) terminates at the distal wall before the distal end of the upper hinge member (740). It should be understood that it can only extend through. This distal wall can prevent the outer sheath (770) from extending out of the distal end of the upper hinge member (740), but this is merely optional. Not too much.

  In some variations, the upper slot (746) may include a snap mechanism (not shown) for snapping the arcuate end (772) into the upper slot (746). Alternatively, a single slot can be formed longitudinally through the central portion of the arcuate member (744) of the upper hinge member (740). Thus, a portion of the outer sheath (770) can be inserted into the single slot to couple the outer sheath (770) to the upper hinge member (740). Of course, two or more slots may be formed through the central portion of the arcuate member (744) as well. In other variations, a single slot may be formed at the proximal end of the upper hinge member (740), and an outer sheath (770) may be inserted into the distal slot and the upper hinge member (740). ) To the outer sheath (770). Additional configurations for the upper hinge member (740) will be apparent to those skilled in the art in view of the teachings herein.

  The lower integral hinge member (750) of this embodiment extends proximally from the bottom of the hinge portion (720) of the main body (710) and clamps via a channel formed in the hinge portion (720). It is formed integrally with the pad (730). The lower hinge member (750) is an insert molded part that is molded with the clamp arm (730). When material for the clamp pad (730) is injected into the mold, the material flows through the channel of the hinge portion (720) and solidifies inside the channel, thereby lowering the integral hinge member (750). And the clamp pad (730) forms a single, homogeneous material continuum. The lower hinge member (750) includes a lower integral hinge (754) so that the lower hinge member (750) is tilted upward or downward relative to the clamp pad (730) and / or the main body (710). be able to. Of course, the lower integral hinge member (750) can be a separate molded part, or in some variations, the lower integral hinge member (750) can be each from a corresponding hinge portion (720). It may include two separate members that extend. As shown in FIGS. 11, 12, and 14, the lower hinge member (750) is arcuate with a pair of longitudinal lower slots (756) formed on both sides of the lower hinge member (750). Member (754). By way of example only, the lower slot (756) extends longitudinally through the side of the arcuate member (754), thereby providing an arcuate end portion of the inner tubular actuation member (780) shown in FIG. (782) can be inserted into the lower slot (756). When the arcuate end (782) is inserted into the lower slot (756), the lower hinge member (750) is coupled to the inner tubular actuation member (780). Thus, the main body (710) and / or the clamp pad (730) can pivot relative to the inner tubular actuation member (780) via the integral hinge (752). The lower slot (756), or alternatively, the arcuate member (754) partially, such that the lower slot (756) terminates at the distal wall before the distal end of the lower hinge member (750). It should be understood that it can only extend through. This distal wall can prevent the inner tubular actuation member (780) from extending out of the distal end of the lower hinge member (750), but this is merely optional. There are only.

  In some variations, the lower slot (756) may include a snap mechanism (not shown) for snapping the arcuate end (782) into the lower slot (756). Alternatively, a single slot can be formed longitudinally through the central portion of the arcuate member (754) of the lower hinge member (750). Thus, a portion of the inner tubular actuation member (780) can be inserted into the single slot to couple the inner tubular actuation member (780) to the lower hinge member (750). Of course, two or more slots may be formed through the central portion of the arcuate member (754) as well. In other variations, a single slot may be formed at the proximal end of the lower hinge member (750), and an inner tubular actuation member (780) may be inserted into the distal slot to provide a lower hinge member. An inner tubular actuation member (780) can be coupled to (750). Further configurations for the lower hinge member (750) will be apparent to those skilled in the art in view of the teachings herein.

  As shown in FIGS. 14 and 15, the clamp arm (700) includes an outer sheath (770), an inner tubular actuation member (780), a waveguide (790), and a blade (794), a transmission assembly (760). To join. The outer sheath (770) of this example includes an elongated tubular member having a proximal end (not shown) coupled to a handle assembly (not shown). The handle assembly is in accordance with the teachings of at least a portion of the handle assembly (60, 380) described herein, or the disclosure of which is incorporated herein by reference, filed October 10, 2011, U.S. Patent Application No. 13 / 269,883, title "Surgical Instrument with Clutching Slip Ring Assembly to Power Ultrasonic Transducer", U.S. Patent Application No. [Attorney Docket No. END6895USP18. "Surgical Instrument with Modular End Effect", _______ of the application [Attorney Docket No.END6895USN 15.0587839] issue, entitled "Gear Driven Coupling Between Ultrasonic Transducer and Waveguide in Surgical Instrument", of __________ application, the first [Attorney Docket No. END6895USNP14.0587838] issue, entitled "Cam Driven Coupling Between Ultrasonic Transducer and Waveguide in Surgical "Instrument", filed Oct. 10, 2011, No. 13 / 269,870, titled "Surgical Instrument with Modular Shaft and End Effect", October 2011 No. 13 / 269,899, titled “Ultrasonic Surgical Instrument Modular End Effect”, US Patent Publication Nos. 2006/0079874, 2007/0191313, 2007/0282333 Constructed according to at least some teachings of 2008/0200940, 2011/0015660, US Pat. No. 6,500,176, US 2011/0087218, and / or 2009/0143797 can do.

  The outer sheath (770) has a distal end (774) with a notch cut out in the upper portion of the outer sheath (770), as shown in FIG. The result is a pair of arcuate ends (772) that can be inserted into the upper slot (746) as described above. FIG. 15 also shows an outer sheath (770) that includes a plurality of holes (776) formed through the surface of the outer sheath (770). The holes (776) allow the fluid to enter the outer sheath (770), thereby flushing the outer sheath (770) with sterile fluid and washing the outer sheath (770). Of course, the hole (776) is merely optional and other openings can be used, including longitudinal slots, circumferential slots, meshes, and the like. Further, the outer sheath (770) may be constructed in accordance with the teachings of the outer sheath (360) described above and / or in other ways as will be apparent to those skilled in the art upon consideration of the teachings herein. can do.

  The inner tubular actuation member (780) of this example includes an elongated tubular member disposed within the outer sheath (770) and having a proximal end (not shown) coupled to the trigger of the handle assembly. This handle assembly and / or trigger is disclosed in U.S. Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333, 2008/0200940, 2011/0015660, U.S. Pat. , 500, 176, US Patent Publication No. 2011/0087218, and / or 2009/0143797. Inner tubular actuation member (780) has a distal end (784) that is notched in the lower portion of inner tubular actuation member (780), as shown in FIG. The result is a pair of arcuate ends (782) that can be inserted into the lower slot (756) as described above. Inner tubular actuation member (780) also includes a plurality of holes (not shown) formed through the surface of inner tubular actuation member (780). These holes can be constructed according to the teachings of at least some of the holes (776). For example, the holes in the inner tubular actuation member (780) allow the fluid to enter the inner tubular actuation member (780), thereby flushing the inner tubular actuation member (780) with a sterile fluid. The actuating member (780) can be cleaned. Of course, these holes are merely optional and other openings can be used, including longitudinal slots, circumferential slots, meshes, and the like. Inner tubular actuation member (780) may have other structures as will be apparent to those skilled in the art in view of the teachings herein.

  The waveguide (790) includes an elongated cylinder or tube that is coupled to a transducer (not shown) of the handle assembly. The transducer is operable to create a linear vibration or linear shaking at an ultrasonic frequency (such as 55.5 kHz). By coupling the transducer to the waveguide (790), these linear vibrations are transmitted through the waveguide (790) to the blade (794). This transducer is disclosed in U.S. Patent Application No. 13 / 269,883, filed October 10, 2011, entitled "Surgical Instrument with Clutching Slip Ring Assembly to Power Ultrasonic Transducer", U.S. Patent Publication No. 2006/0079874. 2007/0191713, 2007/0282333, 2008/0200940, 2011/0015660, US 6,500,176, US 2011/0087218, and / or It can be constructed in accordance with at least some teachings of 2009/0143797. The waveguide (790) of this example includes a threaded distal end (not shown) that threadably couples to the threaded proximal end of the blade (794). The axial position of the threaded coupling of the waveguide (790) to the blade (794) can be created by the transducer and correspond to the last antinode of ultrasonic vibration through the waveguide (790). This is merely an option. The blade (794) of this example includes a straight blade having a cuboid distal end operable to cut tissue when the transducer is actuated. The blade (794) of the present embodiment is a disposable blade that allows the user to separate the blade (794) and join a new blade (794) for a new procedure. The blade (794) is in accordance with the teachings of at least some of the blades (82) described above, U.S. Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333, 2008/0200940, Further constructions may be made in accordance with at least some teachings of 2011/0015660 and / or 2009/0143797 and / or in other ways.

  In the embodiment shown in FIG. 15, the user first couples the blade (794) to the waveguide (790) in a screwed manner. The user then couples the upper hinge member (740) to the outer sheath (770) and the lower hinge member (750) to the inner tubular actuation member (780). It should be understood that attachment of blade (794) to waveguide (790) can be performed after attachment of hinge members (740, 750). In some variations, the upper hinge member (740) slides over the outer sheath (770) and the lower hinge member (750) slides over the inner tubular actuation member (780). In other variations, the upper hinge member (740) is snapped onto the outer sheath (770) and the lower hinge member (750) is snapped onto the inner tubular actuating member (780). For example, one such exemplary snap-fit mechanism is an angled tab (not shown) formed on the outer sheath (770) and an angled tab (not shown) formed on the actuation member (780) ( (Not shown). The tabs are configured to snap fit into corresponding holes (not shown) formed in the upper hinge member (740) and in the lower hinge member (750). Of course, tabs can be formed on the upper hinge member (740) and lower hinge member (750), and holes can be formed in the outer sheath (770) and actuation member (780). Alternatively, the snap mechanism may include a pin that snaps into a hole formed in the end of the slot. Still other snap mechanisms will be apparent to those skilled in the art in view of the teachings herein. Such a mechanism for snapping the upper hinge member (740) to the outer sheath (770) and the lower hinge member (750) to the inner tubular actuation member (780) includes the outer sheath (770) and Laser cutting can be performed in the inner tubular actuation member (780). Alternatively, such a mechanism can be thixoformed and welded to the outer sheath (770) and / or the tubular actuation member (780). Still further, such a snap mechanism may be screwed, snapped, clipped, clamped, adhesively attached, and / or otherwise outer sheath (770) and / or tubular actuating member (780). Can be fixed to.

  Thus, when the clamp arm (700) is coupled to the transmission assembly (760), the inner tubular actuation member (780) is actuated longitudinally via the trigger of the handle assembly and the outer sheath (770) is secured. When held in place, the clamp arm (700) pivots relative to the blade (794). Therefore, the clamp arm (700) can be pivoted from the open position to the closed position to secure tissue between the clamp pad (730) and the blade (794). Thus, when the transducer is actuated and the tissue is fixed between the blade (794) and the clamp arm (700), the ultrasonic vibration of the blade (794) cuts the tissue at the same time as adjacent tissue cells. By denaturing the protein, it is possible to provide a coagulation effect with relatively small heat diffusion. Thus, the user can grasp and cut tissue using the clamp arm (700) coupled to the outer sheath (770) and the inner tubular actuating member (780). If the user terminates the clamp arm (700), the user can remove and dispose of the clamp arm (700). The user can then re-sterilize the transmission assembly (760) and / or handle assembly and install a new clamp arm (700). In some variations, the user can return the clamp arm (700) to the manufacturer for recycling. For example, the manufacturer can first cut the clamp pad (730), upper hinge (740), and lower hinge (750). The manufacturer can then re-sterilize the main body (710) and mold a new clamp pad (730), upper hinge (740), and lower hinge (750) on the main body (710). .

  In some variations, the outer sheath (770) is actuated while the inner tubular actuating member (780) remains fixed. In still other variations, the outer sheath (770) can be actuated proximally while the inner tubular actuating member (780) can be actuated distally, or vice versa. Of course, still other configurations for the clamp arm (700), outer sheath (770), and / or inner tubular actuating member (780) will be apparent to those of ordinary skill in the art in view of the teachings herein. It will be.

D. Exemplary Pinned End Effector Assembly FIGS. 16-18B illustrate an exemplary pinned end effector (800) for coupling to an inner tube (850) and a waveguide (860). As shown in FIG. 16, the pinned end effector (800) includes a blade (810), a distal inner tube portion (820), an outer sheath (830), and a clamp arm (840). The blade (810) is coupled to the waveguide (860) and is operable to cut tissue when the transducer is actuated, as discussed in more detail below. A cylindrical rod made of metal. The blade (810) may be in accordance with at least some teachings of the blades (82, 794) described herein, or US Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333. , No. 2008/0200940, No. 2011/0015660, and / or No. 2009/0143797. The blade (810) of this example further includes a threaded recess (812) at the proximal end, shown in FIGS. 18A and 18B, which is threaded in the waveguide (860). A threaded end (864) is configured to be screwed together. 18A and 18B also show a pin hole (816) formed through the blade (810), which is perpendicular to the longitudinal axis of the blade (810). Pin hole (816) is configured to receive through pin (838) therein. Additional configurations for blade (810) will be apparent to those skilled in the art in view of the teachings herein.

  The distal inner tube portion (820) is coaxial with the blade (810) and is located outside the blade (810). In this example, the distal inner tube portion (820) comprises a tubular member having a distal end upper pin (822) and an inwardly flared proximal end (824) shown in FIGS. 18A, 18B. Including. Upper pin (822) is configured to couple to clamp arm (840) with upper pin hole (842), thereby pivoting clamp arm (840) relative to distal inner tube portion (820). Can be moved. The inwardly flared proximal end (824) is inserted into a bushing (854) in communication with the inner tube (850) and the waveguide (860), as will be described in more detail below. Composed. In some variations, the inwardly flared proximal end (824) is configured to form an interference fit with the bushing (854), but this is merely optional. The distal inner tube portion (820) further includes a pin hole (826) coaxial with the pin hole (816), thereby allowing the pin (838), the pin hole (816), and the distal inner tube portion (820). ) And the blade (810) can be coupled to the distal inner tube section (820). Of course, other configurations for the distal inner tube portion (820) will be apparent to those skilled in the art in view of the teachings herein.

  With further reference to FIG. 16, the outer sheath (830) is coaxial with the distal inner tube portion (820) and the blade (810) and is disposed outwardly. In this example, outer sheath (830) includes a tubular member in which a lower pin hole (832) is formed through the distal end of outer sheath (830). The proximal end of the outer sheath (830) is configured to couple to a trigger in the handle assembly such that the outer sheath (830) is actuable longitudinally via the trigger. A merely exemplary structure for a handle assembly and / or trigger is described in U.S. Patent Application No. [Attorney Docket No. END6895 USNP 18.0587842], filed on the same date as this specification, the disclosure of which is incorporated herein by reference. entitled "Surgical Instrument with Modular End Effector", of __________ application, the first [Attorney Docket No. END6895USNP15.0587839] issue, entitled "Gear Driven Coupling Between Ultrasonic Transducer and Waveguide in Surgical Instrument", of __________ application, the first [agency Person reference number END6895USNP14.05878 No. 8], title “Cam Drive Coupling Between Ultrasonic Transducer and Waveguide in Surgical Instrument”, No. 13 / 269,870, filed on Oct. 10, 2011, title “Surth”. No. 13 / 269,899, titled “Ultrasonic Surgical Instrument with Modular End Effect”, US Patent Publication Nos. 2006/0079874, 2007/0191313, 2007/0282333, filed Oct. 10, No. 2008/020094 Nos, the No. 2011/0015660, U.S. Patent No. 6,500,176, are disclosed in U.S. Patent Publication No. 2011/0087218, and / or the No. 2009/0143797. The lower pin hole (832) is configured to receive the lower pin (844) of the clamp arm (840) so that the clamp arm (840) is actuated longitudinally by the outer sheath (830). Can pivot relative to the blade (810). The outer sheath (830) further includes a longitudinal slot (834) through which the pin (838) can translate when the outer sheath (830) is actuated longitudinally. As shown in FIG. 16, the pin (838) is flush with the outer surface of the outer sheath (830) so that the outer sheath (830), the distal inner tube portion (820), and the blade (810) are Are substantially fixed relative to each other via the pin (838), but the slot (834) allows some degree of longitudinal actuation of the outer sheath (830) relative to the pin (838). Should be understood. As with other components, other configurations for the outer sheath (830) will be apparent to those of ordinary skill in the art in view of the teachings herein.

  The clamp arm (840) of this example includes a body (846) having an upper pin hole (842) and a lower pin (844), and a clamp pad (848). In this example, the clamp arm (840) is positioned above the interior of the upper pin hole (842) when the outer sheath (830) actuates the lower pin (844) distally and / or proximally. Pivotable about pin (822). Thus, in the embodiment shown in FIG. 16, the outer sheath (830) is moved from an open position when the outer sheath (830) is actuated distally, and the outer sheath (830) is actuated proximally. Is operable to pivot the clamp arm (840) to the closed position. In some variations, the clamp arm (840) can be pivoted to an open position when the outer sheath (830) is actuated proximally, and the clamp arm (840) can be When (830) is actuated distally, it can be pivoted to a closed position. When the clamp arm (840) of the present example is in the closed position, the clamp arm (840) and / or the clamp pad (848) is pressed against the blade (810). When the clamp arm (840) is in the open position, the clamp arm (840) and / or the clamp pad (848) is opened at a fixed angle with respect to the blade (810), thereby causing the clamp arm (840). Tissue can be inserted between the blade and the blade (810). The clamp arm (840) is, of course, in accordance with the teachings of at least some of the clamp arms (84, 240, 320, 600, 700) disclosed herein and / or US Patent Publication No. 2006/0079874, No. 2007/0191713, No. 2007/0282333, No. 2008/0200940, No. 2011/0015660, No. 6,500,176, No. 2011/0087218, and / or Further construction can be made according to at least some of the teachings of US 2009/0143797. Still other configurations for the clamp arm (840) will be apparent to those skilled in the art in view of the teachings herein.

  Referring now to FIG. 17, the inner tube (850) includes a tubular member having a proximal end coupled to the handle assembly and a distal end (852) into which the bushing (854) is inserted. . The inner tube (850) further includes a pin hole (856) perpendicular to the longitudinal axis of the inner tube (850), and a second pin (858) can be inserted through the pin hole (856). . In some variations, the second pin (858) is inserted through the pin hole (856) in the inner tube (850) and the pin hole (866) in the waveguide (860) before the inner tube. (850). In other variations, the pin hole (856) may include a slot similar to the slot (834) of the outer sheath (830). Thus, the second pin (858) can be allowed to operate longitudinally relative to the inner tube (850). The second pin (858) of this example is also sized so that the second pin (858) is flush with the outer surface of the inner tube (850) when inserted therein. The bushing (854) communicates with the inner surface of the distal end (852) of the inner tube (850) and the outer surface of the distal end (862) of the waveguide (860), thereby allowing the waveguide (860) to move. The distal end (862) is supported within the inner tube (850). The bushing (854) also includes a pin hole (not shown) that is coaxial with the pin hole (856) so that the second pin (858) can be inserted therethrough. Of course, other configurations for the inner tube (850) and / or bushing (854) will be apparent to those skilled in the art in view of the teachings herein.

  The waveguide (860) of this example is threaded, coupled to the transducer at the proximal end of the waveguide (860) and protruding from the distal end (862) of the waveguide (860). Member (864). This transducer is a U.S. Patent Application No. 13 / 269,883, filed October 10, 2011, entitled “Surgical Instrument with Clutching Slip Ring Assembly to Power Ultrasonic Transducer,” the disclosure of which is incorporated herein by reference. US Patent Publication Nos. 2006/0079874, 2007/0191713, 2007/0282333, 2008/0200940, 2011/0015660, US Patent 6,500,176, US Patent It can be constructed according to at least some teachings of publications 2011/0087218 and / or 2009/0143797. The threaded member (864) of the present example is configured to project through the bushing (854) and threadably couple to the threaded recess (812) of the blade (810). Thus, when the waveguide (860) is coupled to the blade (810), the vibration created by the transducer is transmitted through the waveguide (860) to the blade (810), so that the blade (810) is also It also vibrates at the ultrasonic frequency produced by the transducer. The waveguide (860) also includes a pin hole (866) as shown in FIGS. 18A, 18B, and a second pin (858) is inserted through the pin hole (866), thus the second pin ( 858) couples the inner tube (850), bushing (854), and waveguide (860) together and secures each to the other. In some variations, the pins (838, 858) can be placed at the antinodes of the ultrasonic vibration wave transmitted through the waveguide (860), but this is merely optional. Not too much. Indeed, the pins (838, 858) can alternatively be placed in a wave node of an ultrasonic vibration wave transmitted through the waveguide (860). In yet a further configuration, the pin holes (816, 866) are guided relative to the pin holes (816, 866) when ultrasonic vibration waves are transmitted through the waveguide (860) and the blade (810). The tube (860) and blade (810) can be sized to allow translation. The pins (838, 858) of this example still remain in the pin holes (816, 866) when the end effector (800) is rotated relative to the inner tube (850) and the waveguide (860). It should be understood that by engaging, the blade (810) is screwed onto the waveguide (860). Other suitable configurations for the waveguide (860) will be apparent to those skilled in the art in view of the teachings herein.

  Referring now to FIGS. 18A and 18B, if the user desires to couple the end effector (800) to the waveguide (860) and the inner tube (850), the user first begins with the outer sheath ( 830), the inner tube (850) and the waveguide (860) are inserted. When the end effector (800) is slid proximally over the inner tube (850), the inwardly flared proximal end (824) of the distal inner tube portion (820) becomes the inner tube (850). Is inserted into the bushing (854). Furthermore, the threaded member (864) of the waveguide (860) abuts the threaded recess (812) of the blade (810). The user then continues until the end effector until the blade (810) is substantially acoustically coupled to the waveguide (860) via the threaded member (864) and threaded recess (812). Rotate (800). It should be understood that the pins (838, 858) need not be aligned. When blade (810) is coupled to waveguide (860), outer sheath (830) is coupled to a trigger within the handle assembly. An exemplary coupling mechanism for releasably coupling outer sheath (830) is described in US patent application Ser. No. 13 / 269,870, filed Oct. 10, 2011, entitled “Surgical Instrument with Modular Shaft and”. End Effector ". Once the outer sheath (830) is coupled to the trigger, the user then uses the surgical instrument to clamp and cut tissue using the clamp arm (840) and blade (810). be able to. After the user finishes the surgical device, the user removes the outer sheath (830) and unscrews the blade (810) from the waveguide (860). The user can then dispose of the used end effector (800) to re-sterilize the inner tube (850), waveguide (860), and / or handle assembly for use in another procedure. A new end effector (800) can be attached.

E. Exemplary Slot and Elastic Tab Assembly FIGS. 19A and 19B illustrate the distal outer sheath (910) and distal inner tube (920), outer sheath (950) and inner tube (960) of an end effector (not shown). ) Shows an exemplary alternative clamp arm coupling. The distal outer sheath (910) of this example has a pair of elastic tabs (912) at the proximal end and a pair of outer sheath slots (952) formed within the distal end of the outer sheath (950). ) Including a tubular member configured to be snapped into. The distal inner tube (920) likewise has a pair of resilient tabs (922) at the proximal end and a pair of inner tube slots (962) formed within the distal end of the inner tube (960). A tubular member is configured to be snapped into. The distal outer sheath (910) and the distal inner tube (920) are coupled at their respective distal ends to a clamp arm (not shown) so that the clamp arm is attached to the distal outer sheath (910) and And / or pivotable relative to the blade (930) via longitudinal actuation of the distal inner tube (920). For example, the distal outer sheath (910), distal inner tube (920), and / or clamp arm may include an end effector (800), a clamp arm (700), a transmission assembly (760), a clamp arm (600), a clamp According to at least some teachings of arm assembly (400), transmission assembly (450), clamp arm assembly (300), transmission assembly (350), end effector (200), end effector (80) and / or US patents Publication No. 2006/0079874, No. 2007/0191713, No. 2007/0282333, No. 2008/0200940, No. 2011/0015660, U.S. Pat. No. 6,500,176, U.S. Pat. / 0087218, and / or Of the No. 2009/0143797, in accordance with at least a portion of the teaching can be constructed.

  Outer sheath (950) includes a tubular member having a pair of outer sheath slots (952) at the distal end configured to receive elastic tabs (912) therein. The proximal end of the outer sheath (950) is coupled to a handle assembly (not shown). In some variations, the outer sheath (950) is actuable via a trigger (not shown) on the handle assembly. In other variations, the outer sheath (950) is fixedly coupled to the handle assembly. Inner tube (960) includes a tubular member having a pair of inner tube slots (962) at the distal end configured to receive elastic tabs (922) therein. The proximal end of the inner tube (960) is also coupled to the handle assembly. In some variations, the inner tube (960) is actuable via a trigger on the handle assembly. In other variations, the inner tube (960) is fixedly coupled to the handle assembly. In this example, the handle assembly includes an actuation device (940) operable to actuate both the outer sheath (950) and the inner tube (960) distally relative to the blade (930). . For example, FIG. 19B shows the outer sheath (950) and inner tube (960), shown in a closed position, prior to actuation by the actuator (940). When the actuator (940) is actuated by the user, the outer sheath (950) and inner tube (960) are parallel to the distal direction relative to the handle assembly and blade (930) as shown in FIG. 19A. Moving. In some variations, the actuator (940) is operable to cause the outer sheath (950) and inner tube (960) to extend distally relative to the blade (930) and handle assembly, Includes a slider. In other variations, the actuation device (940) is a push button operable to actuate the outer sheath (950) and inner tube (960) distally relative to the blade (930) and handle assembly. including. Of course, still other configurations for the outer sheath (950), inner tube (960), and actuator (940) will be apparent to those of ordinary skill in the art in view of the teachings herein. Let's go.

  The blade (930) of the present example can be selectively coupled to a waveguide (not shown) and is operable to cut tissue. In the embodiment shown in FIGS. 19A and 19B, the blade (930) includes a connector (932) configured to selectively couple to the waveguide. Only exemplary configurations for connector (932) include threading, luer locks, bayonet fittings, snaps, and the like. In some variations, the connector (932) is positioned longitudinally to correspond to the most distal wave node of the blade (930). The waveguide is coupled to a transducer, such as the transducer (100) described herein, so that ultrasonic vibrations are transmitted to the waveguide. When the blade (930) is coupled to the waveguide, the blade (930) also vibrates with ultrasound to cut tissue and simultaneously denature proteins in adjacent tissue cells to reduce heat diffusion. Provides a relatively small, coagulation effect.

  If the user desires to couple the distal outer sheath (910) to the outer sheath (950) and the distal inner tube (920) to the inner tube (960), first the user activates The device (940) is used to extend the outer sheath (950) and inner tube (960) distally relative to the blade (930). As shown in FIG. 19A, when the outer sheath (950) and the inner tube (960) are extended in the distal direction, the user can move the elasticity of the distal outer sheath (910) into the outer sheath slot (952). Insert tab (912) and insert elastic tab (922) of distal inner tube (920) into inner tube slot (962). When tabs (912, 922) are inserted into slots (952, 962), the user retracts outer sheath (950) and inner tube (960) proximally relative to blade (930). As such, an actuator (940) is used. As will be apparent to those skilled in the art, the distal outer sheath (910) and distal inner tube (920) are also proximal as a result of the coupling of tabs (912, 922) and slots (952, 962). Retreat in the direction. As shown in FIG. 19B, the actuator (940) retracts the outer sheath (950) and inner tube (960) such that the connection between the tabs (912, 922) and the slots (952, 962) overlap. Thus, the tab (912) is configured to substantially prevent disengagement from the slot (952). Furthermore, the actuator (940) retracts the inner tube (960) such that the connection between the tab (922) and the slot (962) is longitudinally aligned with the connector (932). Composed. The connector (932) of this example is sized and configured to substantially prevent the tab (922) from disengaging from the slot (962). In some variations, the connector (932) is disposed about the outer periphery of the connector (932) and is substantially a connector relative to the interior of the inner tube (960) and / or the distal inner tube (920). A sealing member (not shown) configured to fluid seal (932) may be included. Once the outer sheath (950) is coupled to the distal outer sheath (910) and the inner tube (960) is coupled to the distal inner tube (920), the user then uses the surgical instrument. be able to. If the user terminates the instrument, the distal outer sheath (910) and distal inner tube (920) can be disengaged and the end effector can be disposed of. In some variations, the blade (930) can be separated and disposed of as well. The user then cleans the surgical instrument, including the outer sheath (950) and inner tube (960), and then uses the distal outer sheath (910) and distal inner tube for use in new procedures. A new end effector with (920) can be coupled.

  In some variations, the distal outer sheath (910) and the outer sheath (950) include rotational couplings such as bayonets and slots, luer locks, and the like. The distal inner tube (920) as well as the inner tube (960) may also include rotatable couplings such as bayonets and slots, luer locks, and the like. One or more labels (not shown) may be provided on the distal outer sheath (910), outer sheath (950), distal inner tube (920), and / or inner tube (960). The initial insertion position and / or locking position for this rotary coupling can be indicated. To couple the distal outer sheath (910) to the outer sheath (950) and the distal inner tube (920) to the inner tube (960), the user uses the actuator (940) to The outer sheath (950) and inner tube (960) are extended distally relative to the blade (930). The user then inserts the distal outer sheath (910) and the distal inner tube (920) into the receiving portion of the rotary joint, and the distal outer sheath (910) and the distal inner tube (920). Is rotated to engage the rotary coupling. The user then uses actuator (940) to retract outer sheath (950) and inner tube (960) to the closed position and use the surgical instrument. If the user terminates the instrument, the distal outer sheath (910) and distal inner tube (920) can be disengaged and the end effector can be disposed of. In some variations, the blade (930) can be separated and disposed of as well. The user then cleans the surgical instrument, including the outer sheath (950) and inner tube (960), and then uses the distal outer sheath (910) and distal inner tube for use in new procedures. A new end effector with (920) can be coupled.

  Similar to the other components described herein, the distal outer sheath (910), distal inner tube (920), blade (930), actuator (940), outer sheath (950), and / or Alternatively, the inner tube (960) may have other configurations as will be apparent to those skilled in the art in view of the teachings herein. Indeed, in some variations, the distal outer sheath (910) and outer sheath (950) can be omitted. In other variations, the distal inner tube (920) and inner tube (960) may be omitted.

  Although particular configurations of exemplary surgical instruments have been described, various other ways in which surgical instruments can be constructed will be apparent to those skilled in the art in view of the teachings herein. It will be. By way of example only, the surgical instruments referred to herein are US Pat. Nos. 6,500,176, 6,783,524, 7,416,101, 7,738, No. 971, No. 6,783,524, U.S. Patent Publication No. 2006/0079874, No. 2007/0191713, No. 2007/0282333, No. 2008/0200940, No. 2009/0209990, No. It can be constructed in accordance with at least some teachings of 2009/043797, 2010/0069940, and / or US Provisional Application No. 61 / 410,603.

  Any patent, publication, or other disclosure material that is incorporated herein by reference is inconsistent with the existing definition, description, or other disclosure material described in this disclosure. It is to be understood that this document is incorporated herein in whole or in part only to the extent that it does not. Therefore, to the extent necessary, a disclosure as expressly set forth herein will supersede any conflicting material incorporated herein by reference. Any material or portion thereof that is incorporated herein by reference, but that contradicts the existing definitions, descriptions, or other disclosure material described herein is incorporated into the material and the existing disclosure. It shall be incorporated only to the extent that no contradiction arises with the material.

  Embodiments of the present invention have application in conventional endoscopes and open surgical instruments, as well as in robot-assisted surgery. For example, the various teachings of the present specification can be found in US Pat. No. 6,783,524, entitled “Robotic Surgical Tool with Ultrasound Customizing, published August 31, 2004, the disclosure of which is incorporated herein by reference. It will be appreciated by those skilled in the art that it can be easily combined with the various teachings of "and Cutting Instrument".

  Embodiments of the devices disclosed herein can be reconditioned for reuse after at least one use. Reconditioning can include any combination of equipment disassembly steps followed by specific part cleaning or replacement steps and subsequent reassembly steps. In particular, embodiments of the device disclosed herein can be disassembled, and any number of specific pieces or parts of the device can be selectively replaced, in any combination, or Can be removed. Upon cleaning and / or replacement of particular parts, embodiments of the apparatus can be reassembled for subsequent use, at a reconditioning facility, or by a surgical team immediately prior to surgery. Those skilled in the art will appreciate that reconditioning of the device can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting reconditioned device, are all within the scope of this application.

  By way of example only, the embodiments described herein can be processed prior to surgery. Initially, new or used instruments can be obtained and cleaned as needed. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument can then be placed in a radiation field that can penetrate the container, such as gamma radiation, x-rays, or high energy electrons. This radiation can kill bacteria on the instrument and in the container. The sterilized instrument can then be stored in this sterile container. This sealed container can keep the instrument sterile until it is opened in the medical facility. The device is also not limited, but the device can also be sterilized using any other technique known in the art, including beta or gamma radiation, ethylene oxide, Or steam, but is not limited thereto.

  While various embodiments of the invention have been illustrated and described, further adaptations of the methods and systems described herein may be made by appropriate modifications by those skilled in the art without departing from the scope of the invention. Can be achieved. While some of such possible modifications have been described, other modifications will be apparent to those skilled in the art. For example, the above-described examples, embodiments, geometric shapes, materials, dimensions, ratios, processes, and the like are illustrative and not essential. Accordingly, the scope of the present invention should be considered in terms of the following claims, and is not limited to the details of construction and operation shown and described in the present specification and drawings. As understood.

Embodiment
(1) an ultrasonic surgical instrument operable to cut tissue,
(A) a body assembly comprising a transmission assembly extending distally from the body assembly, the transmission assembly comprising:
i. A waveguide;
ii. A blade coupled to the distal end of the waveguide;
iii. An inner member;
iv. An outer sheath disposed around at least a portion of the inner member;
v. An ultrasonic transducer coupled to the waveguide and operable to vibrate the blade;
(B) a clamp arm assembly that is selectively coupled to the transmission assembly and includes a clamp arm, the clamp arm assembly operable to pivot with respect to the blade; Including
Ultrasonic surgical wherein at least one of the inner member or the outer sheath is configured to be actuated longitudinally and the at least one of the inner member or the outer sheath is selectively coupled to the clamp arm Instruments.
The surgical arm of claim 1, wherein the clamp arm assembly further includes an outer sheath portion, the outer sheath portion configured to selectively couple to the outer sheath of the transmission assembly. Instruments.
(3) The clamp arm includes a tab, the inner member includes a slot, and the tab selectively attaches the clamp arm to the inner member through insertion of the tab into the slot. The surgical instrument of embodiment 2, wherein the surgical instrument is configured to couple.
The surgical sheath of claim 3, wherein the outer sheath portion includes threading, the outer sheath includes complementary threading, and the outer sheath portion is threadably coupled to the outer sheath. Instruments.
5. The surgical instrument of embodiment 3, wherein the outer sheath portion includes a bayonet and the outer sheath includes a slot.

6. The surgical instrument of embodiment 3, wherein the inner member is coupled to a trigger and the trigger is pivotable relative to the body assembly.
(7) The trigger is operable to actuate the inner member from a first position relative to the distal end of the outer sheath to a second position relative to the distal end of the outer sheath. Embodiment 7. The surgical instrument of embodiment 6.
The surgical instrument of claim 1, wherein the inner member includes a rod, the rod having a ball coupled to a distal end of the rod.
(9) The embodiment wherein the clamp arm includes a ball recess formed in a proximal end of the clamp arm, the ball recess configured to removably couple to the ball. The surgical instrument according to claim 8.
The surgical instrument of claim 9, wherein the ball recess includes a detent operable to snap onto the rod.

(11) The outer sheath includes a slot, the clamp arm includes a pin extending outward from the clamp arm, and the inner member slidably operates the pin within the slot. The surgical instrument of embodiment 9, wherein the surgical instrument is operable.
(12) The clamp arm includes an upper living hinge and a lower living hinge, the upper integral hinge is selectively coupled to the outer sheath, and the lower integral hinge is The surgical instrument of embodiment 1, wherein the surgical instrument is selectively coupled to the inner member.
(13) The embodiment, wherein the clamp arm further includes a main body and a clamp pad, and the upper integral hinge, the lower integral hinge, and the clamp pad are formed of a single, homogeneous material continuum. A surgical instrument according to claim 12.
14. The surgical instrument of embodiment 13, wherein the clamp arm further includes a molded lock formed within the main body, and the clamp pad is coupled to the main body via the molded lock. Appliances.
(15) The upper integral hinge includes an upper slot, the lower integral hinge includes a lower slot, at least a portion of the outer sheath is insertable into the upper slot, and at least a portion of the inner member is The surgical instrument of embodiment 12, wherein the surgical instrument is insertable into the lower slot.

(16) A clamp arm assembly that can be selectively coupled,
(A) an outer sheath portion selectively connectable to the outer sheath of the transmission assembly;
(B) a clamp arm hingedly coupled to the distal end of the outer sheath portion,
i. A clamp part to which a clamp pad is coupled; and
ii. A clamp arm having an insertable member, including a mounting portion, and
The insertable member is insertable into a slot formed in an actuating member such that the actuating member pivots the clamp arm relative to the outer sheath portion via the insertable member. A clamp arm assembly operable.
17. The clamp arm assembly of embodiment 16, wherein the outer sheath portion includes a bayonet configured to be inserted into a slot formed in the outer sheath.
18. The clamp arm assembly of embodiment 16, wherein the outer sheath portion includes threading and the outer sheath portion is configured to threadably couple to the outer sheath.
(19) a surgical instrument,
(A) a body assembly,
i. An ultrasonic transducer;
ii. A waveguide coupled to the ultrasonic transducer;
iii. A blade coupled to the waveguide at a proximal end of the blade; and
iv. A tubular member disposed about at least a portion of the waveguide and having a slot formed proximal to a distal end of the tubular member;
v. An actuating device operable to actuate the tubular member distally relative to the blade;
(B) an end effector including a distal member having an elastic tab, wherein the elastic tab extends proximally from a proximal end of the distal member and is inserted into the slot of the tubular member An end effector that is possible,
When the actuator is in the first position, the slot is substantially aligned with the proximal end of the blade, and when the actuator is in the second position, the slot is in the blade. A surgical instrument distal to the proximal end.
(20) The body assembly further includes an inner tubular member that is coaxial with the tubular member and disposed within the tubular member, the inner tubular member being proximal to a distal end of the inner tubular member. And wherein the end effector further includes an inner distal member having a second elastic tab, the second elastic tab being in a proximal direction from a proximal end of the inner distal member. And can be inserted into the second slot of the inner tubular member, and the actuating device is further operable to actuate the inner tubular member distally relative to the blade. Embodiment 20. The surgical instrument of embodiment 19, wherein

Claims (3)

An ultrasonic surgical instrument operable to cut tissue,
(A) a body assembly;
(B) a transmission assembly extending distally from the body assembly,
i. A waveguide;
ii. A blade coupled to the distal end of the waveguide;
iii. An inner member, the inner side member includes a rod, said rod having a ball coupled to the distal end, and an inner side member,
iv. An outer sheath disposed about at least a portion of the inner member and defining a longitudinal axis;
(C) a clamp arm assembly selectively coupled to the transmission assembly and including a clamp arm, wherein the clamp arm is operable to pivot relative to the blade; A ball recess formed in a proximal end of the clamp arm, the ball recess configured to removably couple to the ball;
An ultrasonic surgical instrument, wherein the inner member is configured to operate longitudinally.   The surgical instrument of claim 1, wherein the ball recess includes a detent operable to snap onto the rod.   The outer sheath includes a slot, the clamp arm includes a pin extending outwardly from the clamp arm, and the inner member operates to slidably actuate the pin within the slot The surgical instrument of claim 1, which is possible.

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