Connect public, paid and private patent data with Google Patents Public Datasets

Ultrasonic surgical procedures

Download PDF

Info

Publication number
US3794040A
US3794040A US17945971A US3794040A US 3794040 A US3794040 A US 3794040A US 17945971 A US17945971 A US 17945971A US 3794040 A US3794040 A US 3794040A
Authority
US
Grant status
Grant
Patent type
Prior art keywords
blood
tool
member
surface
tissue
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
Inventor
L Balamuth
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
ULTRASONIC SYSTEMS
Original Assignee
ULTRASONIC SYSTEMS
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Grant date

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/320068Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C65/00Joining or sealing of preformed parts, e.g. welding of plastics materials; Apparatus therefor
    • B29C65/02Joining or sealing of preformed parts, e.g. welding of plastics materials; Apparatus therefor by heating, with or without pressure
    • B29C65/08Joining or sealing of preformed parts, e.g. welding of plastics materials; Apparatus therefor by heating, with or without pressure using ultrasonic vibrations
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C65/00Joining or sealing of preformed parts, e.g. welding of plastics materials; Apparatus therefor
    • B29C65/74Joining or sealing of preformed parts, e.g. welding of plastics materials; Apparatus therefor by welding and severing, or by joining and severing, the severing being performed in the area to be joined, next to the area to be joined, in the joint area or next to the joint area
    • B29C65/743Joining or sealing of preformed parts, e.g. welding of plastics materials; Apparatus therefor by welding and severing, or by joining and severing, the severing being performed in the area to be joined, next to the area to be joined, in the joint area or next to the joint area using the same tool for both joining and severing, said tool being monobloc or formed by several parts mounted together and forming a monobloc
    • B29C65/7443Joining or sealing of preformed parts, e.g. welding of plastics materials; Apparatus therefor by welding and severing, or by joining and severing, the severing being performed in the area to be joined, next to the area to be joined, in the joint area or next to the joint area using the same tool for both joining and severing, said tool being monobloc or formed by several parts mounted together and forming a monobloc by means of ultrasonic vibrations
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/80General aspects of machine operations or constructions and parts thereof
    • B29C66/81General aspects of the pressing elements, i.e. the elements applying pressure on the parts to be joined in the area to be joined, e.g. the welding jaws or clamps
    • B29C66/814General aspects of the pressing elements, i.e. the elements applying pressure on the parts to be joined in the area to be joined, e.g. the welding jaws or clamps characterised by the design of the pressing elements, e.g. of the welding jaws or clamps
    • B29C66/8141General aspects of the pressing elements, i.e. the elements applying pressure on the parts to be joined in the area to be joined, e.g. the welding jaws or clamps characterised by the design of the pressing elements, e.g. of the welding jaws or clamps characterised by the surface geometry of the part of the pressing elements, e.g. welding jaws or clamps, coming into contact with the parts to be joined
    • B29C66/81411General aspects of the pressing elements, i.e. the elements applying pressure on the parts to be joined in the area to be joined, e.g. the welding jaws or clamps characterised by the design of the pressing elements, e.g. of the welding jaws or clamps characterised by the surface geometry of the part of the pressing elements, e.g. welding jaws or clamps, coming into contact with the parts to be joined characterised by its cross-section, e.g. transversal or longitudinal, being non-flat
    • B29C66/81415General aspects of the pressing elements, i.e. the elements applying pressure on the parts to be joined in the area to be joined, e.g. the welding jaws or clamps characterised by the design of the pressing elements, e.g. of the welding jaws or clamps characterised by the surface geometry of the part of the pressing elements, e.g. welding jaws or clamps, coming into contact with the parts to be joined characterised by its cross-section, e.g. transversal or longitudinal, being non-flat being bevelled
    • B29C66/81417General aspects of the pressing elements, i.e. the elements applying pressure on the parts to be joined in the area to be joined, e.g. the welding jaws or clamps characterised by the design of the pressing elements, e.g. of the welding jaws or clamps characterised by the surface geometry of the part of the pressing elements, e.g. welding jaws or clamps, coming into contact with the parts to be joined characterised by its cross-section, e.g. transversal or longitudinal, being non-flat being bevelled being V-shaped
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/80General aspects of machine operations or constructions and parts thereof
    • B29C66/82Pressure application arrangements, e.g. transmission or actuating mechanisms for joining tools or clamps
    • B29C66/822Transmission mechanisms
    • B29C66/8227Transmission mechanisms using springs
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/80General aspects of machine operations or constructions and parts thereof
    • B29C66/83General aspects of machine operations or constructions and parts thereof characterised by the movement of the joining or pressing tools
    • B29C66/832Reciprocating joining or pressing tools
    • B29C66/8322Joining or pressing tools reciprocating along one axis
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/80General aspects of machine operations or constructions and parts thereof
    • B29C66/84Specific machine types or machines suitable for specific applications
    • B29C66/861Hand-held tools
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/90Measuring or controlling the joining process
    • B29C66/95Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94
    • B29C66/951Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools
    • B29C66/9512Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools by controlling their vibration frequency
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/90Measuring or controlling the joining process
    • B29C66/95Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94
    • B29C66/951Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools
    • B29C66/9516Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools by controlling their vibration amplitude
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/320068Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491Surgical glue applicators
    • A61B2017/00504Tissue welding
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/90Measuring or controlling the joining process
    • B29C66/95Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94
    • B29C66/951Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools
    • B29C66/9513Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools characterised by specific vibration frequency values or ranges
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29CSHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C66/00General aspects of processes or apparatus for joining preformed parts
    • B29C66/90Measuring or controlling the joining process
    • B29C66/95Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94
    • B29C66/951Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools
    • B29C66/9517Measuring or controlling the joining process by measuring or controlling specific variables not covered by groups B29C66/91 - B29C66/94 by measuring or controlling the vibration frequency and/or the vibration amplitude of vibrating joining tools, e.g. of ultrasonic welding tools characterised by specific vibration amplitude values or ranges
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B29WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE, IN GENERAL
    • B29LINDEXING SCHEME ASSOCIATED WITH SUBCLASS B29C, RELATING TO PARTICULAR ARTICLES
    • B29L2023/00Tubular articles
    • B29L2023/005Hoses, i.e. flexible

Abstract

THE METHOD AND APPARATUS OF THE INVENTION USE ULTRASONIC ENERGY IN THE FORM OF MECHANICAL VIBRATORS TRANSMITTED BY A TOOL MEMBER TO CLOSE OF SMALL SEVERED BLOOD VESSELS, SUCH AS IN HUMANS, BY THE FORMATION OF CLOSURES AT THE TERMINAL PORTIONS THEREOF, AND STOP WHAT IS CALLED "OOZES," THAT REQUIRED CONSTANT MOPPING OR CLEANING TECHNIQUES DURING AN OPERATION THIS TOOL MEMBER MAY BE IN THE FORM OF A KNIFE ULTRASONICAL VIBRATED TO SIMULATEOUSLY SEVER AND CLOSE OFF RESPECTIVE TERMINAL PORTIONS OF THE SEVERED BLOOD VESSEL WHILE PERFORMING SURGICAL PROCEDURES. THE TOOL MEMBER, OF A PROPER CONFIGURATION, MAY ALSO JOIN TOGETHER LAYERS OF TISSUE, INCLUDING THE WALL OF UNSEVERED BLOOD VESSELS, AND WITH RESPECT TO THE LATTER IS FORESEEN AS REPLACING THE "TYING OFF" OF ARTERIES AND VEINS CURRENTLY NECESSARY IN SURGERY.

D R A W I N G

Description

United States Patent 1191 Balamuth 1451 Feb. 26, 1974 [73] Assignee: Ultrasonic Systems, lnc.,

Farmingdale, N.Y.

22 Filed: Sept. 10, 1971 211 Appl.No.: 179,459

Related US. Application Data [62] Division of Ser. No. 678,649, Oct. 27, 1967, Pat. No.

Banko 128/24 A 3,636,943 l/l972 Balamuth 128/24 A Primary Examiner-Channing L. Pace [5 7] ABSTRACT The method and apparatus of the invention use ultrasonic energy in the form of mechanical vibrations transmitted by a tool member to close of small severed blood vessels, such as in humans, by the formation of closures at the terminal portions thereof, and stop what is called oozes, that requires constant mopping or cleaning techniques during an operation. This tool member may be in the form of a, knife ultrasonically vibrated to simulateously sever and close off respective terminal portions of the severed blood vessels while performing surgical procedures. The tool member, of a proper configuration, may also join together layers of tissue, including the walls of unsevered blood vessels, and with respect to the latter is foreseen as replacing the tying off of arteries and veins currently necessary in surgery.

21 Claims, 29 Drawing Figures PATENIEnftazs I974 EAK TOOL VELOCITY FREQUENCY OF VIBRATION sum 1 0r 5 PRESSURE APPLIED WITH TOOL MECHANICAL VIBRATION ENERGY ABSORPTION IN TISSUE TOOL WORKING SURFACE CUTTING EDGE TOO-L TEMPERATURE OXYGEN FOR CLOTTING FRICTIONAL RUBBING HEAT DEVELOPMENT IN TISSUE TISSUE CLOSURE OR JOINING INVENTOR. LEWIS BA LAMUT H ATTORNE PATENTEDFEBZBIW 3.794040 sum 2 m5 GENERATOR MEANS INVENTOR. LEWIS BALAMUTH ATTORN PATENTEUFEBZBIQM 3.794.040

' sum 3 or 5 F/G.3B F/6.3A

INVENTOR. LEWIS BALAMUTH PATENTED 3. 794. 040

SHET 5 BF 5 58h F/G l0 /2A INVENTOR. LEWIS BALAMUTH ULTRASONIC SURGICAL PROCEDURES CROSS-REFERENCE TO RELATED APPLICATION This is a division of U.S. Pat. application Ser. No.

678,649, filed Oct 27, 1967 now U.S. Pat. No. 5

BACKGROUND AND SUMMARY OF THE INVENTION The present invention relates generally to improvements in surgical procedures whereby ultrasonic energy is utilized and more particularly to methods and apparatus for closing off the terminal portions of severed blood vessels to stop or prevent the flow of blood therefrom during the surgical procedure and the joining of layers of tissue in biological organisms such as humans.

The outstanding and unexpected results obtained by the practice of the method and appartus of the present invention, are attained by a series of features, steps and elements, working together in inter-related combination, and may be applied to biological organisms in general and particularly humans, and hence will be so illustrated and described with respect to humans.

Applicant has already participated in earlier developments which led to U. S. Pat No. 3,086,288 covering the use of an ultrasonically vibrating scalpel or knife. The aim of that invention was to increase the ease with which a surgical knife could be used to cut organic tissues.

We are concerned in the present invention with new discoveries by applicant which allow dramatic improvements in the operation of high frequency vibrated knives, and also extend the use of the side area or worklaries comprise an area which is as much as 100,000 times the area of the arteries and veins, and thus it is seen that many more capillaries are involved per incision than any other vessels. The severing of capillaries produces an ooze of blood which must be mopped up or swabbed during an operation, while the larger blood vessels involved must be clamped or tied off to prevent bleeding during the surgery. The attending of these bleeding problems takes up about 67 percent of the time of most operations. It is a major aim of this invention to reduce this lost time considerably and at the same time to reduce the total loss of blood and to promote the healing of the wounds created. This is accomplished by the design of ultrasonic instruments so as to enhance those uses of ultrasonic energy needed to accelerate the desired objective, namely to stop bleeding.

Ordinarily, bleeding stops by virtue of the interaction between small bodies in the blood stream called platelets and the oxygen in the air, whereby the platelets disintegrate and form a network of fibers called fibrin which slow up and finally stop the blood flow by the formation of suitable clots. Heat may be used to accelerate this process, and in fact both electric cautery and hot wire cautery are used in controlling bleeding in some procedures. But these types of cautery produce, in addition to rapid clotting, an extensive destruction to all tissue, thereby requiring a long time in the healing. By means of ultrasonic energy it is possible to promote the clotting with far less damage, as will be disclosed 0 herein, so that bleeding may be very quickly halted and ing surface of a knife to perform a useful function, es-

warm blooded animals and humans) is comprised of two great and complex systems of arteries and veins. The arteries carry blood from the heart and these arteries divide in a complex network of smaller arteries or arterials, which in their turn connect to an extraordinarily complex network of very fine blood carrying tubes called capillaries. These capillaries are in communication with all the cells of the body and they provide the nutrients needed to feed these cells and they also supply the white blood cells needed to dispose of wastes and, in general, to police the cells and their environment in respect to unwanted substances and agents. After doing their job, the blood cells find their way back to the heart by means of a similar network of capillaries which join up to veinules or small veins, which in turn connect to veins which ultimately bring the blood back to the heart. There is also a lymph system which participates in this process, wherein again small tubes containing lymph (a kind of blood plasma with white corpuscles and waste products) convey this lymph through various strainers called lymph nodes and then, ultimately by means of the thoracic duct the purified lymph flow back into a large vein in the neck.

Now when the body is cut into at any location, in general a number of the tubes or vessels carrying blood are severed in this region. This severance will include many capillaries, some small veins and arteries and in some cases even a regular artery or a vein or both. The capilat the same time, much quicker healing will take place.

Electric and hot-wire cautery as well as cryogenic techniques are not effective for the care of bleeding from veins and arteries and it is here that special tyingoff methods or hemistatic clamping techniques are used. It is a further aim of this invention to teach how tying-off and clamping techniques may be replaced by utilizing ultrasonic energy in the proper way.

In all the ways whereby ultrasonic energy is used in this invention, the tool member supplying the energy executes vibrations of high frequency and small amplitude. Since the development of the ultrasonic knife, in part by present applicant, new alloys have become generally available which permit the maximum amplitude of vibration at a given frequency to be increased substantially. For example, in regular use a scalpel could be vibrated at 20 Kc/sec with a stroke of two to at most four thousandths of an inch. A larger stroke would cause a rapid fatigue failure of the ultrasonic motor driving the scalpel. With a new alloy of titanium (titanium with 6 Al 4V is one such) it is possible to go to strokes as high as 8 or 10 thousandths of an inch. This means that the rubbing action of a single stroke may be greatly enhanced, because the peak velocity achieved during the stroke is more than double the peak velocities previously attainable on a practical basis.

This improvement led applicant into the development of procedures and tools whereby such large ultrasonic motions could be put to work to stop capillary bleeding while cutting the surrounding tissue. In order to understand this, let us consider the transfer of energy which occurs during cutting. Wherever the tissue comes into contact with the cutting tool or scalpel, the tool member is moving to and fro at high frequency parallel to the surface of the tissue being severed. To the extent that there is good acoustic coupling between tissue and tool, there will be a transfer of shear waves into the tissue. But, tissue is of an acoustic nature as to be practically incapable of supporting high frequency shear waves. Therefore, the shear waves damp out very rapidly and dissipate their energy in the superficial tissue as heat. This promotes fibrin formation and clotting at the capillaries, while the damage to underlying tissue is minimal due to lack of penetration of this clotting energy. To the extent that the tool slips past the tissue during its to and fro motion, a rubbing action is set up, due to relative motion of tool and tissue and a frictional heat is generated at the tool tissue interface, again producing a heating and clotting action on the adjacent terminal portion of the opened capillaries and other blood vessels. Thus, entirely due to the ultrasonic to and fro motion of the tool, a coopeative dual effect is engendered whereby the ooze during an operation is effectively stopped while cutting.

Applicant has further found that the peak rubbing speed, which equals 1r fx the peak to and fro stroke (f frequency of tool) is relatively constant with respect to frequency. This is because the peak strain set up in the ultrasonic motor driving the cutting tool depends directly on the peak speed of the cutting tool and not on the peak frequency. Of course, this merely means that if one wishes to operate at a higher frequency, then one has to be content with a proportionately dimin-.

ished to and fro stroke of the tool. In any case, due to the cooperative effect, above outlined, essentially all of the energy of the tool is used in local, superficial heating, except for that used to actually sever the tissue itself. This latter component of energy is only a small fraction of the total energy used.

In actual practice, applicant has discovered that, by texturing or roughening the side walls of the cutting tool, the transfer of superficial cauterizing energy is increased so as such for certain surgical procedures it is preferable to use scalpels whose working surfaces or side faces are roughened rather than very smooth. The same principle applies to spatulate tools wherein no cutting is contemplated, but the tool is designed primarily to cauterize an already opened bed of blood vessels such as capillaries in a wound. In the case of the spatulate tool the amount of energy transfer may be increased by pressing the spatula tool working surface, while vibrating, with increased pressure against the wound to apply a compressive force for the transmission of the shear waves or increasing the frictional rubbing. Applicant has also discovered, that although it is not essential, it is nevertheless desirable to supply the cutting edge of a knife or scalpel with a set of small serrations. This further aids in clotting, and permits faster cutting, while at the same time halting capillary bleedmg.

Now, in addition to all of the above there are still additional aids arising from the use of ultrasonic energy during the cutting operation. This arises because the collagenous substances in the walls of the capillaries and also in those of veins are arteries, are capable of being joined or sealed together by the application of said high frequency energy. In fact, it is just this property which makes it possible to close off a vein or an artery by clamping it in a specially designed ultrasonic instrument, so that the walls of said blood vessel are briefly clamped while vibrating one or both of the tool jaws. Since this same principle applies to other soft body tissue such as the skin, this same type of tool may be used in place of the conventional suturing which is used in closing incisions in surgical procedures.

Thus, it may be seen that we are dealing with a highly complicated set of phenomena in practicing applicant's method of bloodless surgery. At this time, it is not known quantitatively just how large a role is played by each factor, such as shear wave absorption, frictional heat production and tissue sealing'The point is that by employing ultrasonic motors capable of producing generally higher strokes than previously available, the combination of effects permits for the first time, true bloodless surgical procedure by ultrasonic means. Where extremely fast procedures are essential, one may also resort to auxiliary heating of the vibrating tool member, but only to sub-cautery temperatures. This temperature is preferably above room temperature but below a temperature that would normally burn the tissue. This may be accomplished conventionally, or in accordance with the method disclosed in U. S. Pat. No. 3, 321,558 in which applicant is a co-inventor.

OBJECTIVES OF THE INVENTION An object of the present invention is to provide an improved method and apparatus for performing surgical procedures with ultrasonic energy.

Another object of the present invention is to provide an improved method and apparatus for securingv together layers of tissue in biological organisms, such as humans.

Yet another object of the present invention is to provide an improved method and apparatus for forming closures at the severed terminal portions of blood vessels in vivo, which blood vessels are in the general neighborhood of what are called capillaries, so as to prevent ooze, which requires contact mopping or cleansing during surgical operations.

A further object of the present invention is to provide improved method and apparatus for permanently or temporarily closing off blood vessels so as to replace the tying off of arteries and veins currently necessary in surgery.

Still another object of the present invention is to provide a method and apparatus of bloodless surgery which combines the surgical cutting of tissue and a closing off of the severed blood vessels to prevent the ooze associated with operations.

Yet still another object of the present invention is to provide a method and apparatus for simultaneously joining and trimming, as by cutting, a large blood vessel.

Yet still a further object of the present invention is to provide an improved method and apparatus for ultrasonically joining together layers of tissue.

Still a further object of the present invention is to provide an improved method and apparatus for increasing the flow of oxygen to the terminal portion of the severed blood vessel to expedite the clotting of the blood thereat.

Still yet a further object of the present invention is to provide an improved sealing apparatus for joining together layers of human tissue.

Still yet a further object of the present invention is to provide specially designed tools adapted to be ultrasonically vibrated and employed in surgical procedures.

Other objects and advantages of this invention will become apparent as the disclosure proceeds.

BRIEF DESCRIPTION OF THE DRAWINGS Although the characteristic features of this invention will be particularly pointed out in the claims, the invention itself, and the manner in which it may be made and used, may be better understood by referring to the following description taken in connection with the accompanying drawings forming a part hereof,-wherein like reference numerals refer to like parts throughout the several views and in which: g

FIG. I is a chart indicating the relationship of the principal factors affecting the practicing of the present invention for surgical procedures;

FIG. 2 is an assembled somewhat schematic view of an ultrasonic motor generator system of the type in which the motor is capable of being hand held and manipulated, for driving a tool member adapted to engage the biological organism for performing a surgical procedure, and which in the present instance the tool member is illustrated as a knife for severing blood vessels, the latter shown on a greatly enlarged scale for discussion purposes;

FIG. 3 is a side view of an ultrasonic tool member having a textured working surface in accordance with the present invention;

FIGS. 3A and 3B are end views of the tool member in FIG. 3 and illustrates two preferred ways of obtaining the textured working surface;

FIG. 4 is a greatly enlarged schematic representation of a portion of a tool member with its working surface in engagement with the terminal portion of a blood vessel for forming a closure thereat to prevent the flow of blood from said terminal portion;

FIG. 4A is an enlarged section view taken along line 4A4A of FIG. 4 to illustrate the interfacial contact between the tool'working surface andblood vessel for the transmission of frictional energy and shear waves for localized heating of the terminal portion;

FIG. 4B is a greatly enlarged schematic representation illustrating an ultrasonically vibrating tool member engaging a severed portion of tissue for simultaneously forming a plurality of closures at the terminal portions thereof;

FIG. 4C'is a greatly enlarged schematic representation illustrating the angular relationship between the tool member and blood vessel which defines a terminal plane that may define an extreme angle with the axis of the blood vessel and still obtain the desired results of the present invention;

FIG. 4D is an end view of the tool member and blood vessel of FIG. 4C;

FIGS. 5, 5A, 5B and 5C are enlarged schematic representations in cross-section of the method of forming a closure at the terminal portion of a blood vessel in which the side walls thereof are joined together;

FIG. 5D is an extremely enlarged view of a blood specimen to illustrate some of the important components thereof;

FIGS. 6 and 6A are enlarged schematic representations in cross-section of the method of forming a closure at the terminal portion of a blood vessel in which the closure is formed by partially converging the side walls thereof and forming a blood clot in the reduced opening;

FIGS. 7 and 7A are enlarged schematic representations in cross-section of the method of forming a closure at the terminal portion of a blood vessel in which the closure is formed by primarily forming a blood clot at the terminal portion thereof;

FIGS. 8 and 8A are side and end elevational views respectively, of a spatula tool member having a textured working surface for ultrasonic cautery;

FIG. 9 is an enlarged sectional view illustrating the forming of a plurality of closures on respective terminal portions in an open wound by the use of a spatula shaped tool;

FIG. 10 is a top longitudinal view, of one preferred form of ultrasonic system, of the type capable of being hand held and manipulated, for joining together layers of tissue, such as in humans;

FIG. Ill is a side longitudinal view, partly in crosssection, of the ultrasonic system of FIG. 10;

FIG. 12 is an enlarged schematic view, in crosssection, illustrating the application of the ultrasonic instrument illustrated in FIGS. 10 and 11 for securing together the walls of a blood vessel;

FIG. 12A is an enlarged schematic view, in crosssection, similar to FIG. 12 illustrating the actual joining of the overlapping wall portions;

FIG. 12B is a further enlarged schematic view, in cross-section, showing the actual bond obtained between the wall portions of the blood vessel;

FIG. 12C illustrates the ultrasonic system as used for simultaneously joining and cutting layers of tissue; and

FIG. 112D illustrates the ultrasonic system clamping means for intermittently joining overlapped layers of tissue.

DETAILED DISCUSSION OF THE DRAWINGS The high frequency transducer means may be either in the sonic or ultrasonic frequency range but for purposes of the present invention the word ultrasonic will be used to denote vibrations in the range of approximately 5,000 to 1,000,000 cycles per second. In addition the term blood vessel as used herein is intended to include any tubular member of the human body, but particularly capillaries, arterials, veinules, arteries and veins.

In performing the surgical procedures of the present invention there are several factors that have to be taken into consideration and analyzed in terms of a total or effective value to obtain the desired end results. The term total value" may be defined as the proper combination of these factors to obtain the desired end result.

Referring now to the drawings, FIG. I is a chart illustrating the relationship of the seven principal factors which are involved in the whole or in part for determining the total value associated with forming closures at the terminal portions of severed blood vessels, or joining together overlapping segments of layers of human tissue. The related factors are peak tool velocity, frequency of vibration, pressure applied with tool, tool working surface, cutting edge, tool temperature and oxygen for clotting. These factors vary with respect to the procedure being performed.

In the embodiments of the invention discussed below the working surface of the tool member is placed in engagement with at least one of the layers of tissue at a surface thereof such that a small compressive force is applied in a plane substantially normal to the engaged surface. While this compressive force is maintained the working surface of the tool member is vibrated at an ultrasonic rate to apply an additional energy producing force at the engaged surface. The compressive and energy producing forces are continued until the layers of tissue are secured together by the combined action of these forces.

When these layers of tissue form the walls of a blood vessel the forces are applied to the terminal surface thereof for producing localized heating in forming a closure to prevent the blood from escaping therefrom. The energy producing force may be divided into mechanical vibration energy absorption in tissue and frictional rubbing heat development in tissue both of which result in a localized heating of the walls of the blood vessel to obtain the tissue closure. The performing of surgical procedures as related to this aspect of the invention is discussed with reference to FIGS. 2 through 9, inclusive.

In contrast to this we have the joining of layers of tissue in overlapping relation to each other and in which case the compressive and vibrational forces are applied to one of the overlapped surfaces in a plane substantially normal thereto and in which case we primarily rely on mechanical vibration energy absorption in tissue to obtain the tissue joining. The performing of surgical procedures as related to this aspect of the invention is discussed with reference to FIGS. 10 through 12D, inclusive.

Referring again to the drawings, and with respect to FIG. 2, it will be seen that an apparatus 10 for ultrasonically performing surgical procedures on a biological organism, such as a human, may include an ultrasonic transducer or motor 11 for effecting the necessary high frequency vibrations of the tool member 13, such as a knife, having a sharp output edge or surface 15 with a working surface 16. The ultrasonic motor 11, as illustrated may be in the form of a driving member adapted for being hand held as by an operator 12, and generally comprising a tubular housing or casing 14 into which an insert unit 17 supporting the tool member 13 may be partially telescoped. The ultrasonic motor 11 is energized by an oscillation generator 18, with a power cable 19, connecting the two together. The generator is an oscillator adapted to produce electrical energy having an ultrasonic frequency.

The ultrasonic motor 11 may be one of a variety of electromechanical types, such as electrodynamic, piesoelectric and magnetostrictive. The ultrasonic motor for effecting surgical procedures through hand directed tools of suitable configuration, which are readily replaceable or inter-changeable with other work performing tools in acoustically vibrated material treating devices, may be of the type disclosed in U. S. Pat. Nos. Re 25,033, 3,075,288, 3,076,904 and 3,213,537, and wherein each work too] member is rigidly joined, in end-to-end relationship to a connecting body or acoustic impedance transformer and to a transducer which may form an insert unit or assembly which is removably supported in a housing containing a coil in surrounding relationship to the transducer and receiving alternating current for producing an alternating electromagnetic field.

The transducer in the ultrasonic motor 11 is longitudinally dimensioned so as to have lengths which are whole multiples of half-wavelengths of the compressional waves established therein at the frequency of the biased alternating current supplied so that longitudinal loops of motion as indicated by arrow 23, occur both at the end of the insert unit 17 to which the tool member 13 is rigidly connected and the knife edge. Thus,

the optimum amplitude of longitudinal vibration and hyper-accelerations of tool member 13 is achieved, and such amplitude is determined by the relationship of the masses of the tool member 13 and insert unit 17 which may be made effective to either magnify or reduce the amplitude of the vibrations received from the transducer.

The tool member 13 may be in the form of relatively flat metal spatula member, as shown in FIGS. 8 and 8A, hereinafter discussed in detail, to provide relatively wide surface areas for contact with the tissue to which the vibrations are to be applied for effecting the closure of severed blood vessels.

The tool member 13 may be permanently attached to the end of insert unit 17, for example, by brazing, solder or the like, or the tool may be provided with a threaded stud 20 adapted to be screwed into a tapped hole in the end of insert unit 17 for effecting the rigid connection of the tool to the stem. A base portion 21 is provided from which the stud 20 extends, from one end thereof, and from the other end a body 28 which is firmly secured thereto for the transmission of the ultrasonic vibrations. The body 28 may be brazed or welded to the base 21 of the tool member 13. A tapered surface 22 may be provided which connects the cutting edge 15 with the working surface 16.

As seen somewhat schematically in FIG. 2 the biological organism 25, such as a human, contains a layer of outer tissue or skin 26, an internal cellular structure 27 with a plurality of blood vessels 30 extending therethrough shown in an enlarged scale, as well as in the skin (not shown).

FIGS. 3, 3A and 3B illustrate various types of replaceable surgical implements, such as knives, that may be employed in accordance with the present invention. The knife 13a of FIG. 3 is similar to that illustrated in FIG. 2 and includes a base portion 21a, capable of supporting ultrasonic vibrations and adapted to be set into vibration in a given direction by the driving member. A threaded stud 20a extends from one end of the base 21a for engagement with the insert unit. The body portion 28a, in the form of a cutting blade, extends from the opposite end of the base 21a and includes a textured working surface 16a for enhancing the coupling action between the tool member 13a and the terminal portion of the severed blood vessels to be engaged. The cutting edge 15a may be serrated and have an outwardly tapered portion 22a between the cutting edge 15a and the substantially flat working surface 16a. The textured surface 16a may begin in close proximity to or start at the working edge 15a so that when cutting and sealing'small capillaries the rubbing action and transmission of shear waves begins immediately. The textured surface finish of 16a may vary from a micro finish in the range of 10 micro-inch to 10,000 micro-inch, but preferably in the range of 40 micro-inch to 200 microinch.

As illustrated in FIG. 3A the tool member 13a includes a body portion 28a having a coated textured layer of friction inducing material 29a which forms the working surface 16a and which may be of diamond or steel powder particles bonded to the body portion in any conventional manner well known in the art, to obtain the desired micro finish. The layer of coated material may be applied to both surfaces of the tool member and each surface may be of the same or different micro finish to obtain a debriding and superficial cauterizing.

The advantages are quicker healing as well as less damage to the tissue being treated.

FIG. 3B illustrates the obtainment of the working surface 16a byfinishing the metallic body 28a in any conventional manner to obtain the desired surface roughness. By providing the textured surface it is possible to control the rate of frictional heating of the blood vessels. The surface roughness is generally selected in accordance with the ultrasonic rate of vibration and the compressive force to be applied. This will in many instances relate to the particular surgeon performing the operation.

THEORY OF PRESENT INVENTION Whereasa scientific explanation of the theory based on the phenomena involved is disclosed below, it is to be clearly understood that the invention is by no means limited by any such scientific explanation.

Applicant has now discovered that mechanical vibrations properly applied may produce closures at the terminal ends of blood vessels to prevent the flow of blood therefrom and also join together layers of human tissue. With respect to forming the terminal closure it is possible to simultaneously cut through layers of tissue and seal off the terminal ends.

For purposes of illustration, we have in FIGS. 4 and 4A a single blood vessel 3012 having a wall 311; with a terminal portion 33b terminating in an end surface 3212, the latter in engagement with the working surface 16b of the tool member 13b which is being ultrasonically vibrated in the direction 23b.

At the interface of the working surface 16b and terminal surface 32b we have a transmission of both rubbing forces and mechanical vibrational energy to the blood vessel 30b which results in a localized heating of the terminal portion 33b. FIG. 4A illustrates the contour of the surfaces in engagement with each other and the transmission of the shear waves over the distance D. The pressure applied with the tool member, partially determines the degree of shear waves and rubbing vibrations transmitted to the terminal portion 33b of the blood vessel for a given textured tool. At point P shear vibration is developed in the tissue 31a, then at P the shear vibration has dropped almost to zero whereby the shear vibration energy is converted into heat in the tissue of the blood vessel. The smallness or minimal depth of penetration of P P is what makes for quick healing and cauterizing action of the tool member.

The shear wave pattern 35b extends the distance D, which is the distance from If to P along the blood vessel 30b to obtain the localized heating of the terminal portion. The coupling action at the working' surface 161) and'blood vessel 30b is enhanced by the application of the small compressive force, as indicated by arrow 36b, in a plane substantially normal to the plane defined by said terminal end surface 32b. At P in addition, to the extent that shear vibration is not induced in the tissue, there will be a slippage and a frictional rubbing action which will also produce heat practically instantaneously at P It is a combination of these effects which create the closure at the terminal portion of the blood vessel.

It will be appreciated that the relative amounts of shear vibration and frictional rubbing action will be determined or selected by the magnitude of the tool vibration and the tool surface in relation to the tissue surface. Many combinations are possible whereby either the frictional or the shear components may be emphasized.

' The extent that the rise in temperature occurs at the terminal portion 33b of the blood vessel 30b is related to the rubbing vibrations applied and this is related to the peak speed which is:

Vpeak=2rrfA A peak amplitude f frequency V peak velocity So that if f is raised, A is lowered and we can retain the same peak speed at all frequencies. This is why the more rubs per second the higher the frequency for the same output peak speed. Accordingly the working surface ll6b of the tool member 13b may be surface finished for sufficient roughness to allow increased friction against the tissue. This is quite different from a standard knife or scalpel which has polished sides.

The thickness of the tool member should also be held to a minimum so as to permit a .more rapid local temperature rise which is attributable to the shear production and absorption in the adjacent tissue and the temperature rise due to rubbing of tissue surface, which involves slippage between tool member and tissue surfaces. We can say that during the to and fro motion, neglecting the energy of cutting itself, when a knife is used we have:

Ultrasonic energy per stroke Ultrasonic shear energy produced per stroke Frictional rubbing energy per stroke.

Since, in both cases the energy absorbed goes into superficial heating of tissue and cutting tool, we can estimate the effects by considering all the energy to be fric' tional for ease of making approximate calculations.

Assuming an average force of friction, P, we have the power dissipated superficially at a tool tissue interface equal to:

S Stroke F average friction force P power Now V max. for a frequency of 20 lKc/sec and a stroke of 0.010 inch is approximately 50 FPS. Therefore P is approximately 15 watts, when F is between one half and one pound. Since this power is dissipated in a superficial region of the cutting, the heat capacity of the tissue and the tool are quite small. For example for a steel tool of dimension 1 inch X 0.125 inch X 0.010 inch the total heat capacity is only a few hundreths of a gram. In such a case it is possible to obtain local temperature rises of the order of hundreds of degrees centigrade under the condition outlined above. This is ample to stop ooze.

Accordingly the frequency and amplitude of vibration of said tool member is selected at a level wherein the transmitted shear waves are substantially maintained at the terminal portion 33b with only superficial penetration and heating of the remainder of the blood vessel 30b.

Accordingly, the frequency and amplitude of vibration is preferably selected at a level to provide a peak velocity of at least 10 feet per second along the working surface 16b of the tool member 13b and more generally the general range of approximately 40 feet per second to feet per second.

FIG. 4B shows a portion of the biological organism 25b with an outer layer of skin 26b and a plurality of blood vessels 30b extending through the cellular structure 27b and terminating against the working surface 16b of the tool member 13b. The tool member 13b is being vibrated at an ultrasonic rate in the direction of arrow 23b, which is in a plane substantially parallel to the plane defined by the terminal end portions 33b, to induce shear waves 35b, which penetrate the blood vessels 30b and surrounding tissue structure 27b. The high frequency vibration and amplitude of the tool member is selectedto obtain only a superficial penetration and resulting heating of the terminal portion 33b so that there is a minimum of damage to the underlying tissue area 31b and all of the blood vessels are simultaneously closed off. I

As illustrated in FIGS. 4C and 4D the terminal portion 33b has an end surface 32b that defines a plane 37b that may vary in angular relationship to the axis of the blood vessel 30b. In practice the angular engagement between the working surface 16b of the tool member 13b and the end surface 32b may not always be controlled during a surgical procedure since the blood vessels such as capillaries, veinules, veins, arterials and arteries extend in various directions throughout the body. The important consideration is that the ultrasonic longitudinal mechanical vibrations, as indicated by arrow 23b, are applied having a major component of vibration parallel to the terminal plane 37b and a component of compressive force, as indicated by arrow 36b, in a plane substantially perpendicular to the terminal plane 37b.

FIGS. 5, A, 5B, 5C, 6, 6A, 7 and 7A illustrate the actual surgical procedure in vivo of obtaining a closure at the terminal portion of a blood vessel using the ultrasonic instrument illustrated in FIG. 2, or a tool member illustrated in FIGS. 4, 4A and 4B. As explained with respect to the theory of the present invention in FIGS. 3, 3A, 3B, 3C and 3D the degree of shear waves and frictional rubbing may be controlled so that a predominant reliance on one or the other is produced.

In FIGS. 5, 5A, 5B and 5C the terminal closure 40c is formed primarily by producing a plastic flow of the wall of the blood vessel and continuing the flow for a period of time sufficient to obtain a joining of the severed ends together. Initially the cutting edge c of the tool member 13c is placed in engagement with the skin 260 of the body 250 and the tool member 130 is ultrasonically vibrated and a small compressive force in the direction of arrow 360 is applied to obtain a cutting of the skin 26c and progressively sever the tissue by a continued movement of the cutting edge 15c through the cellular material 270 until the wall 310 of the blood vessel 300 is engaged. The wall 310 for purposes of discussion is considered as layers of tissue 42c and 430, respectively.

As seen in FIG. 5A after the cutting edge 15c severs the tissue layer 42c a certain amount of blood 44c flows from within the blood vessel 30c into the opening 450 that has been formed. As the movement of the ultrasonic instrument is continued downwardly we have the engagement of the working surface 16c with the terminal end portion 330 of the blood vessel to apply a compressive force to the end surface to obtain a localized heating of the terminal portion by the application of the ultrasonic mechanical vibration.

The relative movement is continued so that the application of the mechanical vibrations are transmitted for a period of time sufficient for the localized heating to form the closure 400 at the terminal portion 33c. In this manner the terminal portion 33c is closed off by the formation of the closure 45c and the blood contained therein is prevented from escaping through the closure. The closure 45c is produced at least in part by the production of said shear waves and their conversion into heat coupled with the localized heating obtained by inducing frictional rubbing at the terminal portion 330. The extent of each factor will vary with the texture of the working surface and the degree of the compressive force applied by the working surface against the terminal portion.

FIG. 5D is an enlaged microscopic examination of the blood 44c and as illustrated the blood contains red corpuscles 46c, white corpuscles 47c and platelets 48c, the latter play an important role in the natural clotting of blood by producing fibrin when exposed to air. This natural clotting ability of blood is relied upon at least in part with respect to the formation of the closures illustrated in FIGS. 6, 6A, 7 and 7A.

FIGS. 6 and 6A illustrate the formation of the closure which is substantially formed by clotting of the blood at the terminal position. The working surface 16d is placed in engagement with the layers of wall 42d and 43d of the blood vessel 3011, which is of a size in the capillary range, with the blood 44d contained therein. The tool member 13d preferably has a textured surface to permit air and most importantly oxygen to be delivered past the layer of skin 26d to the terminal portion 33d of the blood vessel to obtain a clotting action. The tool member 16d acts as an ultrasonic pump and stimulates the flow of air to the work site. As the air reaches the work site we have the additional action of the conversion of the ultrasonic mechanical vibrations to obtain a localized heating by the conversion of the frictional motion into heat and the localized heating expediates the formation of the blood clot 50d which forms the closure 40d. Since the blood vessel is relatively small in diameter we have the formation of the closure 40d that is substantially formed by a clotting of the blood 44d therein. As seen in FIG. 6A the tool member is then removed leaving the opening of wound 45d and closures 40d formed on each respective end of the severed blood vessels.

FIGS. 7 and 7A illustrate the formation of a closure 40:: by partially closing the layers 42c and 43e of the wall 31c of the blood vessel 30:: at the terminal portions 33c by the localized heating and the remainder by forming a blood clot 502 of the blood 44c contained in the reduced area of the blood vessel. The ultrasonic tool member 136 transmits the mechanical vibration which produces a plastic flow of the wall 3le of said blood vessel which flow is continued for a period of time to obtain a reduced cross sectional area and during which same period of time the localized heating assists in the formation of the blood clot 50e which together with the reduced area forms the closure 40:: to prevent the blood from escaping therefrom. The tool member is then removed past the skin 262 leaving the opening 45c.

It is appreciated that the process although illustrated for a single blood vessel can be occurring simultaneously on a plurality of blood vessels. To increase the rate at which the closure is formed and reduce healing time the working surface of the tool member may be heated to a temperature level which is above room temperature, but below a temperature that would normally sear the terminal portion of the blood vessel. The temperature of the tool may be heated in any conventional manner, as for example, in accordance with US. Pat. No. 3,321,558.

There are instances in surgical procedures where it is desirable to be able to stop bleeding independently of having previously cut the tissue of the body. As for example, in gunshot wounds and other accidents it is often desirable to stop bleeding and accordingly spatula like tools in accordance with the present invention may be utilized.

FIGS. 8 and 8A illustrate one form of readily replaceable implement, in the form of a spatula like tool member 13f, having a body portion 28f with substantially flat parallel working surfaces 16f, that have been textured to a preselected micro finish to provide means for coupling the ultrasonic vibration to the terminal portions of the blood vessels. The surface finish is selected for the transmission of rubbing vibrations and shear waves to obtain the localized heating. One end of the spatula body portion 28f is fixedly secured to the base portion 21f, and the latter has a threaded stud 20f for securement to the ultrasonic driving member. The base portion 21f is preferably of a metallic material capable of supporting ultrasonic vibrations and adapted to be set into vibration in a given direction at ultrasonic frequencies. The body portion 28f may be in the order of 0.010 to 0.160 inches thick and be concave in configuration for strength reasons. It may also be designed to vibrate elliptically to permit intermittent separation of the tool member and terminal portions to promote the flow of air to theterminal portions for clotting.

As illustrated in FIG. 9 the spatula like tool member is illustrated for surgical procedures in which it is desired to form closures at terminal ends of blood vessels 30g separately from when the actual cutting is performed. Accordingly the spatula like tool 13g is inserted within the opening 45g of the body 25g such that the working surface 16g of the tool member 13g applies a compressive force against the terminal portions 33g of the severed blood vessels. The compressive force is applied in the direction of arrow 36g. The tool Hg is simultaneously vibrated, in a direction as indicated by arrow 23g, and' at an ultrasonic rate to transmit mechanical vibrations to the terminal portion 33g of the blood vessels to obtain a localized heating of at least some of the terminal portion. The application of said compressive force and mechanical vibrations are continued until a closure at the terminal portion is formed and the blood contained therein is prevented from escaping through the form closure. The thickness of the spatula tool member 133 may be narrower, as illustrated in FIG. 9, than the opening 45g in the body, such that only one surface 163 engages the severed blood vessels. If desired the width of the spatula body 28g may be substantially equal to that of the body opening 45g so that both terminal ends 33g of a respective blood vessel 303 is closed during one insertion of the tool member within the wound.

The localized heating to obtain the closures may be induced by frictional rubbing at the terminal portion 33g of the blood vessel 30g so that the closure is produced at least in part by frictional heating. By providing a textured surface to the tool member 13g the rate of frictional heating may be controlled when combined with the other factors to produce the terminal closure.

Depending upon the thickness of the spatula tool member either pure longitudinal vibration will be obtained or a flexural component of motion, as indicated by the arrow 51g, so as to obtain elliptical vibrational motion along the working surface 16g. This permits intermittent disengagement between the wall surface or terminal end of the blood vessel 33g and the working surface 16g so that air and in turn oxygen may be continuously supplied to the work site to assist in the clotting of the blood. I

FIGS. 10 and 11 illustrate one form 10h of the ultrasonic system for joining together in vivo, overlapping layers of organic tissue. The system includes a hand held instrument including an ultrasonic motor 11h, which may be the type as discussed with reference to FIG. 2, and include a tool member 13h having an enlarged portion 53h terminating in a working surface 16h that extends in a plane substantially normal to the direction of mechanical vibrations illustrated by the arrow 23h. The base 21h of the tool member 13h is secured to the insert portion 17h. Support means 55h is provided to act as an anvil or clamp so that the overlapped layers of tissue 42h and 43h of the wall 31h of the blood vessel 30h may be compressed between the vibratory working surface and a support surface.

The support means 55h includes a pair of legs 56h and 57h respectively, secured together at their lower end by bands 58h and provided with gripping means in the form of individual lugs 59h that extend outwardly from the upper end of the legs for engagement by the fingers of the surgeon or operator 12h in a manner hereinafter described. The leg 57h has a lower extension 60/: that terminates in a support arm 61h at substantially right angle to the extension 60h, and is provided with a support surface 62/1 in spaced relation to the working surface 16h of the tool member 13/1.

The legs 56h and 57h are in spaced relation to each other and may be contoured to conform to the cylindrical configuration of the ultrasonic transducer housing Mb. The generator 18h is connected to the transducer 11h by means of cable 19h in a conventional manner. As seen in FIG. 10 the cable 19h may enter the ultrasonic motor llh from the side so as to leave the rear end 63h free for engagement by the thumb or any other finger of the surgeon to permit manual control of the relative displacement between the overlapping working and support surfaces.

The support means 55h is mounted for relative movement, with respect to the ultrasonic motor 11h by providing a pair of slots 65h on each of the legs 56h and 57h, and which slots accept headed fasteners 66h which extend from the casing 14h through the slots 65h to permit free relative movement between the ultrasonic motor 11h and support means 55h. The lower end of the casing 14h is provided with an annular shoul der 67h which is adapted to receive spring means in the form of a spring 68h which is contained within the shoulder 67h at one end thereof and in engagement with the bands 5% at the opposite end thereof. The spring 63h applies a force in the direction of arrow 68h, so that the working surfaces of the support means and ultrasonic motor means are biassed away from each other whereby the force applied by the surgeon is required to bring the overlapping working and support surfaces together. If desired the spring may be coupled to the support and ultrasonic motor means so as to force them together with a predetermined static force which might be varied in a conventional manner not shown. In this manner once the static force is determined for the particular thickness of tissue the resultant permanent or temporary seal may be obtained. Accordingly the spring means may yieldably urge the support means 55h and transducer means 11h relative to each other to a position wherein the working and support surfaces 16h and 62h, respectively, are normally in engagement with each other under a predetermined static force, so that the support and transducer means are first separated for the placement of the layers of tissue 42h and 43h therebetween. In contrast to this the spring means may be adjusted such that the working and support surfaces are normally maintained in spacially fixed relation to each other, so that the layers 42h and 4311 are positioned between the surfaces which are brought together by the operation of the hand held instrument.

As previously explained during surgical procedures it becomes necessary to tie-off veins and arteries so as to prevent the flow of blood therethrough. In accordance with the invention the joining of the walls may be of a permanent or semi-permanent nature, and this is accomplished by properly selecting the frequency and amplitude of ultrasonic mechanical vibrations to produce an optimum flow of the collagenous elements contained in the overlapping portions of tissue. This collagenous material is similar to that normally found in the formation of scar tissue. In practice the ultrasonic instrument h may be employed to join together, at a select area the wall of a blood vessel and as seen in FIG. 10 the wall 31h may be considered to include the overlapping layers of tissue 42h and 43h.

As seen in FIGS. 12, 12A and 12B we have the blood vessel 30h exposed within an opening 45h within the organic body 25h. To produce a joining of the overlapping layers of wall tissue 4211 and 43h respectively, the arm 61h of the support means 55h is placed beneath the blood vessel 30h and the working surface 16h of the tool member 13h is brought into contact with the layer of tissue 42h. The working and support surfaces 16h and 62h are moved relative toward each other until the blood vessel 30h has the overlapping layers of tissue 42h and 43h in contact with each other as seen in FIG. 12A. Simultaneously therewith a small compressive force, in the direction of arrow 36h, is applied to the layers of tissue traversing the area of overlap.

The working surface of the tool member 13h is vibrated at an ultrasonic rage, as for example, in the frequency range of from Kc/sec to 100 Kc/sec and preferably in the range of 20 Kc/sec to 40 Kc/sec, so as to apply an additional recurring force to the overlapped layers of tissue, and produce a superficial heating at the interface of the overlapped layers. The vibrational force has a substantial component of vibration normal to the overlapped surfaces, as indicated by the arrow 23h. The frequency of the ultrasonic rate of vibration is selected in the above frequency range so as to preferably also produce an optimum flow of the collagenous elements in the overlapped layers of tissue. The energy is then continually applied until a closure or bond 40h is formed between the collagenous elements in the overlapping layers of tissue, as seen in FIG. 12B, and the blood is prevented from flowing past the closure. The closure 40h may be of a temporary nature or permanent one depending upon the proper control of the vibratory energy and static force to fuse together the superficially heated interface.

For certain applications it is desirable to join together the overlapping layers of tissue and at the same time cut off the excess material. As illustrated in FIG. 12C the support ann 61 j is provided with a cutting edge j and as the overlapped layers of tissue 42j and 43j are compressed between the working surface 16j and support surface 26j and joined together by the energy transmitted through the tool member l3j and the excess tissue layers 71j and 72j are cut off. If desired the cutting edge may be placed on the working surface l6j of the tool member l3j.

For those applications in which it is desired to intermittently join together overlapping layers of tissue we have the apparatus illustrated in FIG. 12D. The overlapping layers of tissue 42k and 43k are first clamped together by clamping means 75k which includes clamping members 76k and 77k which may form part of the ultrasonic instrument or may be the forward portion of a pair specially designed clamping instrument. The clamping means 75k is applied in close proximity to the area of overlap of the layers of tissue 42k and 43k to the joined together. The ultrasonic instrument 10k includes the support means 55k for engaging one side of the overlapped layers of tissue and which opposite side is engaged by the tool member 13k which is illustrated is provided with a circular working surface. By intermittently moving the ultrasonic instrument along the area of overlap a number of closures or bonds 30k, such as stitches may be formed.

While the invention has been described in connection with particular ultrasonic motor and tool member constructions, various other devices and methods of practicing the invention will occur to those skilled in the art. Therefore, it is not desired that the invention be limited to the specific details illustrated and described and it is intended by the appended claims to cover all modifications which fall within the spirit and scope of the invention.

I claim:

1. A method of preventing the flow of blood from a severed blood vessel in vivo, with the aid of a tool member having a working surface, comprising the steps of A. applying the working surface of said tool member against the terminal portion of said blood vessle to apply a compressive force thereto,

B. simultaneously vibrating the working surface of said tool member in a direction and at an ultrasonic rate to transmit mechanical vibrations to the terminal portion to obtain localized heating of at least some of said terminal portion,

C. continuing the application of said compressive force and mechanical vibrations until a closure at said terminal portion is formed, whereby the blood contained therein is prevented from escaping through said closure, and

D. providing said working surface of the tool member at a temperature level which is above room temperature, but below a temperature that would normally sear the terminal portion of the blood vessel, whereby the healing time is substantially reduced.

2. A method as claimed in claim 1, wherein said localized heating is obtained by inducing frictional rubbing at the terminal portion of said blood vessel by the application of said mechanical vibrations, whereby said closure is produced at least in part by said frictional heating.

3. A method as claimed in claim 1, further including the step of controlling the rate of frictional heating of the terminal portion of said blood vessel.

4. A method as claimed in claim 3, wherein said rate of frictional heating is controlled by texturing said tool working surface to a surface roughness selected in accordance with the ultrasonic rate of vibration and compressive force to be applied. V

5. A method as claimed in claim 1, wherein the application of said mechanical vibrations produce at least in part shear waves at the terminal portion, and the frequency and amplitude of vibration of said tool member is selected at a level wherein said transmitted shear waves are substantially maintained at the terminal portion with only superficial penetration and heating of the remainder of said blood vessel.

6. A method as claimed in claim 1, wherein said frequency and amplitude of vibration is selected at a level to provide a peak velocity of at least feet per second along the working surface of said tool member.

7. A method as claimed in claim 6, wherein said peak velocity is in the range of approximately 40 feet per second to 100 feet per second.

8. A method as claimed in claim 1, wherein said working surface is vibrated in an elliptical pattern.

9. A method as claimed in claim 1, wherein said mechanical vibrations are produced by vibrating the tool member to obtain longitudinal vibrations along said working surface, which working surface is maintained along a plane substantially parallel to the plane defined by the terminal portion of said blood vessel.

10. A method as claimed in claim 1, wherein said compressive force is applied along a line substantially perpendicular to the plane defined by the terminal portion of said blood vessel.

11. A method as claimed in claim 1, including the step of applying the working surface of a tool in the form of a knife wherein the working surface is a side wall of the tool member is in the form of a knife and said working surface comprising a side wall thereof.

12. A method as claimed in claim 11, wherein said knife is employed to sever the blood vessles and said working surface engages the terminal portions and simultaneously forms said closures.

13. A method as claimed in claim 1, including the step of applying said tool working surface simultaneously to a plurality of terminal portions of blood vessels.

14. A method of superfically cauterizing severed blood vessles of a wound in vivo, with the aid of a noncutting spatula like tool member having a working surface, comprising the steps of A. applying the working surface of said tool member against the terminal portion of said blood vessels, said tool member being at a temperature level which is above room temperature, but below a temperature that would normally sear the terminal portion of the blood vessel, whereby the healing time is substantially reduced,

B. retaining said tool member in a position relative to said severed blood vessels,

C. maintaining a compressive force applied along a line substantially perpendicular to the plane defined by the terminal portion of said blood vessels with said non-cutting spatula like tool member,

D. simultaneously vibrating the working surface of said tool member, at a peak velocity of at least 10 feet per second and, while maintaining said compressive force, in a direction and at an ultrasonic rate to transmit mechanical vibrations to the terminal portion, said localized heating is obtained by inducing friction rubbing at the terminal portion of said blood vessels by the application of said mechanical vibrations, and

E. continuing the retaining of said tool member in a position relative to said severed blood vessels and the application of said compressive force and mechanical vibrations until a superfic'al cauterization at said terminal portion is formed, whereby the blood contained therein is prevented from escap- 15. A method as claimed in claim 14, wherein the application of said mechanical vibrations produces at least in part shear waves at the terminal portion, and the frequency and amplitude of vibration of said tool member is selected at a level wherein said transmitted shear waves are substantially maintained at the terminal portion with only superficial penetration and heating of the remainder of said blood vessel.

16. A method as claimed in claim 14, wherein said peak velocity is in the range of approximately 40 feet per second to feet per second.

17. A method as claimed in claim 14, wherein said mechanical vibrations are produced by vibrating the tool member to obtain longitudinal vibrations along said working surface, which working surface is maintained along a plane substantially parallel to the plane defined by the terminal portion of said blood vessel.

18. A method as claimed in claim 14, wherein said closure is at least in part formed by a blood clot, and said localized heating expedites the formation of said blood clot.

19. A method as claimed in claim 14, wherein said closure is formed by partially closing the blood vessel by said localized heating and the remainder by clotting the blood contained in said reduced area of the blood vessel. I

20. A method as claimed in claim 14, wherein said ultrasonic mechanical vibrations are applied over an area to simultaneously close off a plurality of blood vessels.

21. A method as claimed in claim 14, wherein said mechanical vibration produces a plastic flow of the wall of said blood vessel and said flow is continued for a period of time sufficient to obtain a joining of the wall of said blood vessel to form said closure.

US3794040A 1967-10-27 1971-09-10 Ultrasonic surgical procedures Expired - Lifetime US3794040A (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US3636943A US3636943A (en) 1967-10-27 1967-10-27 Ultrasonic cauterization
US3794040A US3794040A (en) 1967-10-27 1971-09-10 Ultrasonic surgical procedures

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US3794040A US3794040A (en) 1967-10-27 1971-09-10 Ultrasonic surgical procedures
US3862630A US3862630A (en) 1967-10-27 1973-12-10 Ultrasonic surgical methods
US3898992A US3898992A (en) 1967-10-27 1974-07-08 Ultrasonic surgical methods

Publications (1)

Publication Number Publication Date
US3794040A true US3794040A (en) 1974-02-26

Family

ID=24723702

Family Applications (4)

Application Number Title Priority Date Filing Date
US3636943A Expired - Lifetime US3636943A (en) 1967-10-27 1967-10-27 Ultrasonic cauterization
US3794040A Expired - Lifetime US3794040A (en) 1967-10-27 1971-09-10 Ultrasonic surgical procedures
US3862630A Expired - Lifetime US3862630A (en) 1967-10-27 1973-12-10 Ultrasonic surgical methods
US3898992A Expired - Lifetime US3898992A (en) 1967-10-27 1974-07-08 Ultrasonic surgical methods

Family Applications Before (1)

Application Number Title Priority Date Filing Date
US3636943A Expired - Lifetime US3636943A (en) 1967-10-27 1967-10-27 Ultrasonic cauterization

Family Applications After (2)

Application Number Title Priority Date Filing Date
US3862630A Expired - Lifetime US3862630A (en) 1967-10-27 1973-12-10 Ultrasonic surgical methods
US3898992A Expired - Lifetime US3898992A (en) 1967-10-27 1974-07-08 Ultrasonic surgical methods

Country Status (1)

Country Link
US (4) US3636943A (en)

Cited By (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3862630A (en) * 1967-10-27 1975-01-28 Ultrasonic Systems Ultrasonic surgical methods
US4854320A (en) * 1983-10-06 1989-08-08 Laser Surgery Software, Inc. Laser healing method and apparatus
US4911161A (en) * 1987-04-29 1990-03-27 Noetix, Inc. Capsulectomy cutting apparatus
US5002051A (en) * 1983-10-06 1991-03-26 Lasery Surgery Software, Inc. Method for closing tissue wounds using radiative energy beams
US5041108A (en) * 1981-12-11 1991-08-20 Pillco Limited Partnership Method for laser treatment of body lumens
US5140984A (en) * 1983-10-06 1992-08-25 Proclosure, Inc. Laser healing method and apparatus
US5151099A (en) * 1989-03-28 1992-09-29 Young Michael J R Tool for removal of plastics material
US5154694A (en) * 1989-06-06 1992-10-13 Kelman Charles D Tissue scraper device for medical use
US5417654A (en) * 1994-02-02 1995-05-23 Alcon Laboratories, Inc. Elongated curved cavitation-generating tip for disintegrating tissue
US5507744A (en) * 1992-04-23 1996-04-16 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US5536266A (en) * 1991-08-24 1996-07-16 Orthosonics, Ltd. Tool for removal of plastics material
US5810810A (en) * 1992-04-23 1998-09-22 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US6063085A (en) * 1992-04-23 2000-05-16 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US6283935B1 (en) * 1998-09-30 2001-09-04 Hearten Medical Ultrasonic device for providing reversible tissue damage to heart muscle
US20060235376A1 (en) * 2003-02-04 2006-10-19 Cardiodex Ltd. Methods and apparatus for hemostasis following arterial catheterization
US20070055223A1 (en) * 2003-02-04 2007-03-08 Cardiodex, Ltd. Methods and apparatus for hemostasis following arterial catheterization
US20080167643A1 (en) * 2004-11-22 2008-07-10 Cardiodex Ltd. Techniques for Heating-Treating Varicose Veins
USRE40863E1 (en) * 1992-04-23 2009-07-21 Boston Scientific Scimed, Inc. Apparatus and method for sealing vascular punctures
US8366706B2 (en) 2007-08-15 2013-02-05 Cardiodex, Ltd. Systems and methods for puncture closure

Families Citing this family (314)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3918442A (en) * 1973-10-10 1975-11-11 Georgy Alexandrovich Nikolaev Surgical instrument for ultrasonic joining of biological tissue
US4188952A (en) * 1973-12-28 1980-02-19 Loschilov Vladimir I Surgical instrument for ultrasonic separation of biological tissue
EP0148250A1 (en) * 1983-07-06 1985-07-17 STASZ, Peter Electro cautery surgical blade
DE3533423C2 (en) * 1985-09-19 1990-02-22 Richard Wolf Gmbh, 7134 Knittlingen, De
JPS6266848A (en) * 1985-09-20 1987-03-26 Sumitomo Bakelite Co Surgical operation appliance
DE229003T1 (en) * 1985-11-08 1987-11-05 Swedemed Ab, Uppsala, Se Ultrasonic suction device.
US4724834A (en) * 1985-11-20 1988-02-16 Tomsky Gosudarstvenny Meditsinsky Institut Cryogenic-and-ultrasonic scalpel
US4832022A (en) * 1986-05-26 1989-05-23 Tomsky Gosudarstvenny Universitet Im. Kuibysheva Cryogenic ultrasonic scalpel
DE3751580D1 (en) * 1987-03-20 1995-12-07 Surgical Technology Group Ltd Device for use in surgical procedures for the purpose of tissue removal.
US5015227A (en) * 1987-09-30 1991-05-14 Valleylab Inc. Apparatus for providing enhanced tissue fragmentation and/or hemostasis
US4931047A (en) * 1987-09-30 1990-06-05 Cavitron, Inc. Method and apparatus for providing enhanced tissue fragmentation and/or hemostasis
US4887593A (en) * 1989-01-26 1989-12-19 Wiley Michael J Method and apparatus for electrosurgically resectioning an equine soft palate to alleviate occlusion of the breathing passageway
US5324297A (en) * 1989-01-31 1994-06-28 Advanced Osseous Technologies, Inc. Ultrasonic tool connector
US5318570A (en) * 1989-01-31 1994-06-07 Advanced Osseous Technologies, Inc. Ultrasonic tool
US5382251A (en) * 1989-01-31 1995-01-17 Biomet, Inc. Plug pulling method
US5019083A (en) * 1989-01-31 1991-05-28 Advanced Osseous Technologies, Inc. Implanting and removal of orthopedic prostheses
US5045054A (en) * 1990-02-06 1991-09-03 Advanced Osseous Technologies Inc. Apparatus for implantation and extraction of osteal prostheses
US5263957A (en) * 1990-03-12 1993-11-23 Ultracision Inc. Ultrasonic scalpel blade and methods of application
US5695510A (en) * 1992-02-20 1997-12-09 Hood; Larry L. Ultrasonic knife
US5261922A (en) * 1992-02-20 1993-11-16 Hood Larry L Improved ultrasonic knife
US5383883A (en) * 1992-06-07 1995-01-24 Wilk; Peter J. Method for ultrasonically applying a surgical device
US5322055B1 (en) * 1993-01-27 1997-10-14 Ultracision Inc Clamp coagulator/cutting system for ultrasonic surgical instruments
US5484434A (en) * 1993-12-06 1996-01-16 New Dimensions In Medicine, Inc. Electrosurgical scalpel
WO1995032669A1 (en) * 1994-06-01 1995-12-07 Perclose, Inc. Apparatus and method for advancing surgical knots
JPH0856953A (en) * 1994-08-02 1996-03-05 Ethicon Endo Surgery Inc Ultrasonic hemostatic and cutting instrument
US6669690B1 (en) * 1995-04-06 2003-12-30 Olympus Optical Co., Ltd. Ultrasound treatment system
US7887535B2 (en) * 1999-10-18 2011-02-15 Covidien Ag Vessel sealing wave jaw
US6887252B1 (en) 1996-06-21 2005-05-03 Olympus Corporation Ultrasonic treatment appliance
US6129735A (en) * 1996-06-21 2000-10-10 Olympus Optical Co., Ltd. Ultrasonic treatment appliance
US5906628A (en) * 1996-06-26 1999-05-25 Olympus Optical Co., Ltd. Ultrasonic treatment instrument
US5718717A (en) 1996-08-19 1998-02-17 Bonutti; Peter M. Suture anchor
CA2213948C (en) 1996-09-19 2006-06-06 United States Surgical Corporation Ultrasonic dissector
US20050143769A1 (en) * 2002-08-19 2005-06-30 White Jeffrey S. Ultrasonic dissector
EP1364618A1 (en) 1996-09-19 2003-11-26 United States Surgical Corporation Ultrasonic dissector
US6036667A (en) 1996-10-04 2000-03-14 United States Surgical Corporation Ultrasonic dissection and coagulation system
EP1698289B1 (en) * 1996-10-04 2008-04-30 United States Surgical Corporation Instrument for cutting tissue
JP2001524842A (en) 1996-10-04 2001-12-04 ユナイテッド ステイツ サージカル コーポレイション Ultrasonic dissection and coagulation system
US5931847A (en) * 1997-01-09 1999-08-03 Ethicon Endo-Surgery, Inc. Surgical cutting instrument with improved cutting edge
US5989275A (en) * 1997-02-28 1999-11-23 Ethicon Endo-Surgery, Inc. Damping ultrasonic transmission components
US5968060A (en) * 1997-02-28 1999-10-19 Ethicon Endo-Surgery, Inc. Ultrasonic interlock and method of using the same
US5810859A (en) * 1997-02-28 1998-09-22 Ethicon Endo-Surgery, Inc. Apparatus for applying torque to an ultrasonic transmission component
CA2236238A1 (en) 1997-04-28 1998-10-28 Brian Estabrook Methods and devices for controlling the vibration of ultrasonic transmission components
USH2037H1 (en) * 1997-05-14 2002-07-02 David C. Yates Electrosurgical hemostatic device including an anvil
USH1904H (en) * 1997-05-14 2000-10-03 Ethicon Endo-Surgery, Inc. Electrosurgical hemostatic method and device
US6024750A (en) 1997-08-14 2000-02-15 United States Surgical Ultrasonic curved blade
US6267761B1 (en) 1997-09-09 2001-07-31 Sherwood Services Ag Apparatus and method for sealing and cutting tissue
US6113558A (en) * 1997-09-29 2000-09-05 Angiosonics Inc. Pulsed mode lysis method
JP3766520B2 (en) * 1997-10-06 2006-04-12 オリンパス株式会社 Vascular anastomosis device
US6050996A (en) * 1997-11-12 2000-04-18 Sherwood Services Ag Bipolar electrosurgical instrument with replaceable electrodes
US6726686B2 (en) * 1997-11-12 2004-04-27 Sherwood Services Ag Bipolar electrosurgical instrument for sealing vessels
US7435249B2 (en) * 1997-11-12 2008-10-14 Covidien Ag Electrosurgical instruments which reduces collateral damage to adjacent tissue
US6228083B1 (en) 1997-11-14 2001-05-08 Sherwood Services Ag Laparoscopic bipolar electrosurgical instrument
US20030014052A1 (en) * 1997-11-14 2003-01-16 Buysse Steven P. Laparoscopic bipolar electrosurgical instrument
EP1049411B1 (en) 1998-01-19 2006-03-22 Michael John Radley Young Ultrasonic cutting tool
US6045551A (en) 1998-02-06 2000-04-04 Bonutti; Peter M. Bone suture
US6231578B1 (en) 1998-08-05 2001-05-15 United States Surgical Corporation Ultrasonic snare for excising tissue
JP4164235B2 (en) * 1998-10-23 2008-10-15 コビディエン アクチェンゲゼルシャフト Endoscopic bipolar electrosurgical forceps
US20030109875A1 (en) 1999-10-22 2003-06-12 Tetzlaff Philip M. Open vessel sealing forceps with disposable electrodes
US7582087B2 (en) * 1998-10-23 2009-09-01 Covidien Ag Vessel sealing instrument
US20040249374A1 (en) * 1998-10-23 2004-12-09 Tetzlaff Philip M. Vessel sealing instrument
US6585735B1 (en) * 1998-10-23 2003-07-01 Sherwood Services Ag Endoscopic bipolar electrosurgical forceps
US7267677B2 (en) 1998-10-23 2007-09-11 Sherwood Services Ag Vessel sealing instrument
ES2250379T3 (en) * 2001-04-06 2006-04-16 Sherwood Serv Ag Suturing instrument of vessels.
EP1182971B1 (en) 1999-04-15 2009-10-21 Ethicon Endo-Surgery, Inc. Ultrasonic transducer with improved compressive loading
US6117152A (en) * 1999-06-18 2000-09-12 Ethicon Endo-Surgery, Inc. Multi-function ultrasonic surgical instrument
US6254623B1 (en) 1999-06-30 2001-07-03 Ethicon Endo-Surgery, Inc. Ultrasonic clamp coagulator surgical instrument with improved blade geometry
US6447516B1 (en) 1999-08-09 2002-09-10 Peter M. Bonutti Method of securing tissue
US6635073B2 (en) 2000-05-03 2003-10-21 Peter M. Bonutti Method of securing body tissue
WO2002080784A8 (en) 1999-09-01 2003-04-17 Steven Paul Buysse Electrosurgical instrument reducing thermal spread
US7364577B2 (en) 2002-02-11 2008-04-29 Sherwood Services Ag Vessel sealing system
US6325811B1 (en) * 1999-10-05 2001-12-04 Ethicon Endo-Surgery, Inc. Blades with functional balance asymmetries for use with ultrasonic surgical instruments
JP4233742B2 (en) * 1999-10-05 2009-03-04 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. Connecting tissue pad and the curved clamp arm for use with ultrasonic surgical instruments
US6458142B1 (en) 1999-10-05 2002-10-01 Ethicon Endo-Surgery, Inc. Force limiting mechanism for an ultrasonic surgical instrument
US6432118B1 (en) * 1999-10-05 2002-08-13 Ethicon Endo-Surgery, Inc. Multifunctional curved blade for use with an ultrasonic surgical instrument
US20040199194A1 (en) * 2001-12-18 2004-10-07 Witt David A. Curved clamp arm tissue pad attachment for use with ultrasonic surgical instruments
US6379371B1 (en) 1999-11-15 2002-04-30 Misonix, Incorporated Ultrasonic cutting blade with cooling
EP1255495B1 (en) 2000-02-03 2011-10-19 Sound Surgical Technologies LLC Ultrasonic cutting and coagulation knife using transverse vibrations
US6352536B1 (en) * 2000-02-11 2002-03-05 Sherwood Services Ag Bipolar electrosurgical instrument for sealing vessels
US9138222B2 (en) 2000-03-13 2015-09-22 P Tech, Llc Method and device for securing body tissue
US7329263B2 (en) * 2000-03-13 2008-02-12 Marctec, Llc Method and device for securing body tissue
US8932330B2 (en) 2000-03-13 2015-01-13 P Tech, Llc Method and device for securing body tissue
US6368343B1 (en) 2000-03-13 2002-04-09 Peter M. Bonutti Method of using ultrasonic vibration to secure body tissue
US6443969B1 (en) 2000-08-15 2002-09-03 Misonix, Inc. Ultrasonic cutting blade with cooling
US6514267B2 (en) * 2001-03-26 2003-02-04 Iep Pharmaceutical Devices Inc. Ultrasonic scalpel
US20040115296A1 (en) * 2002-04-05 2004-06-17 Duffin Terry M. Retractable overmolded insert retention apparatus
EP1372506B1 (en) * 2001-04-06 2006-06-28 Sherwood Services AG Electrosurgical instrument which reduces collateral damage to adjacent tissue
US7101372B2 (en) * 2001-04-06 2006-09-05 Sherwood Sevices Ag Vessel sealer and divider
US7101373B2 (en) * 2001-04-06 2006-09-05 Sherwood Services Ag Vessel sealer and divider
US7101371B2 (en) * 2001-04-06 2006-09-05 Dycus Sean T Vessel sealer and divider
US7090673B2 (en) * 2001-04-06 2006-08-15 Sherwood Services Ag Vessel sealer and divider
US7083618B2 (en) * 2001-04-06 2006-08-01 Sherwood Services Ag Vessel sealer and divider
EP1372512B1 (en) * 2001-04-06 2005-06-22 Sherwood Services AG Molded insulating hinge for bipolar instruments
US7118570B2 (en) 2001-04-06 2006-10-10 Sherwood Services Ag Vessel sealing forceps with disposable electrodes
DE60139815D1 (en) * 2001-04-06 2009-10-15 Covidien Ag An apparatus for sealing and dividing of a vessel with a non-conductive end stop
US7118587B2 (en) * 2001-04-06 2006-10-10 Sherwood Services Ag Vessel sealer and divider
US6719765B2 (en) 2001-12-03 2004-04-13 Bonutti 2003 Trust-A Magnetic suturing system and method
US9155544B2 (en) 2002-03-20 2015-10-13 P Tech, Llc Robotic systems and methods
US20030204199A1 (en) * 2002-04-30 2003-10-30 Novak Theodore A. D. Device and method for ultrasonic tissue excision with tissue selectivity
KR101215983B1 (en) 2002-06-04 2012-12-27 사운드 써지칼 테크놀로지 엘엘씨 Ultrasonic device and method for tissue coagulation
US7094251B2 (en) 2002-08-27 2006-08-22 Marctec, Llc. Apparatus and method for securing a suture
US7291161B2 (en) * 2002-10-02 2007-11-06 Atricure, Inc. Articulated clamping member
US7270664B2 (en) 2002-10-04 2007-09-18 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US7276068B2 (en) 2002-10-04 2007-10-02 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US7931649B2 (en) 2002-10-04 2011-04-26 Tyco Healthcare Group Lp Vessel sealing instrument with electrical cutting mechanism
FR2846910B1 (en) 2002-11-08 2005-07-01 Jean Yves Stollmeyer business card holder and card COMBINED letter
US9848938B2 (en) 2003-11-13 2017-12-26 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US7799026B2 (en) * 2002-11-14 2010-09-21 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US20040102783A1 (en) * 2002-11-27 2004-05-27 Sutterlin Chester E. Powered Kerrison-like Rongeur system
US7033354B2 (en) 2002-12-10 2006-04-25 Sherwood Services Ag Electrosurgical electrode having a non-conductive porous ceramic coating
US20060052779A1 (en) * 2003-03-13 2006-03-09 Hammill Curt D Electrode assembly for tissue fusion
CA2518829C (en) * 2003-03-13 2011-09-20 Sherwood Services Ag Bipolar concentric electrode assembly for soft tissue fusion
US20060064086A1 (en) * 2003-03-13 2006-03-23 Darren Odom Bipolar forceps with multiple electrode array end effector assembly
US7497864B2 (en) 2003-04-30 2009-03-03 Marctec, Llc. Tissue fastener and methods for using same
US7753909B2 (en) * 2003-05-01 2010-07-13 Covidien Ag Electrosurgical instrument which reduces thermal damage to adjacent tissue
US7160299B2 (en) * 2003-05-01 2007-01-09 Sherwood Services Ag Method of fusing biomaterials with radiofrequency energy
US8128624B2 (en) * 2003-05-01 2012-03-06 Covidien Ag Electrosurgical instrument that directs energy delivery and protects adjacent tissue
JP5137230B2 (en) * 2003-05-15 2013-02-06 コヴィディエン・アクチェンゲゼルシャフト Method of sealing a tissue sealer and tissue with a non-conductive variable stop member
USD499181S1 (en) 2003-05-15 2004-11-30 Sherwood Services Ag Handle for a vessel sealer and divider
US7597693B2 (en) 2003-06-13 2009-10-06 Covidien Ag Vessel sealer and divider for use with small trocars and cannulas
US7150097B2 (en) 2003-06-13 2006-12-19 Sherwood Services Ag Method of manufacturing jaw assembly for vessel sealer and divider
US7150749B2 (en) * 2003-06-13 2006-12-19 Sherwood Services Ag Vessel sealer and divider having elongated knife stroke and safety cutting mechanism
US7857812B2 (en) * 2003-06-13 2010-12-28 Covidien Ag Vessel sealer and divider having elongated knife stroke and safety for cutting mechanism
US7156846B2 (en) 2003-06-13 2007-01-02 Sherwood Services Ag Vessel sealer and divider for use with small trocars and cannulas
US7232440B2 (en) * 2003-11-17 2007-06-19 Sherwood Services Ag Bipolar forceps having monopolar extension
US7367976B2 (en) 2003-11-17 2008-05-06 Sherwood Services Ag Bipolar forceps having monopolar extension
US7131970B2 (en) * 2003-11-19 2006-11-07 Sherwood Services Ag Open vessel sealing instrument with cutting mechanism
US7252667B2 (en) * 2003-11-19 2007-08-07 Sherwood Services Ag Open vessel sealing instrument with cutting mechanism and distal lockout
US7811283B2 (en) 2003-11-19 2010-10-12 Covidien Ag Open vessel sealing instrument with hourglass cutting mechanism and over-ratchet safety
US7500975B2 (en) * 2003-11-19 2009-03-10 Covidien Ag Spring loaded reciprocating tissue cutting mechanism in a forceps-style electrosurgical instrument
US7442193B2 (en) 2003-11-20 2008-10-28 Covidien Ag Electrically conductive/insulative over-shoe for tissue fusion
US7074494B2 (en) * 2004-02-19 2006-07-11 E. I. Du Pont De Nemours And Company Flame retardant surface coverings
US8182501B2 (en) * 2004-02-27 2012-05-22 Ethicon Endo-Surgery, Inc. Ultrasonic surgical shears and method for sealing a blood vessel using same
US7780662B2 (en) 2004-03-02 2010-08-24 Covidien Ag Vessel sealing system using capacitive RF dielectric heating
US7195631B2 (en) * 2004-09-09 2007-03-27 Sherwood Services Ag Forceps with spring loaded end effector assembly
WO2006030563A1 (en) * 2004-09-14 2006-03-23 Olympus Corporation Ultrasonic treatment implement, and probe, treatment section, and large-diameter section for ultrasonic treatment implement
US7540872B2 (en) 2004-09-21 2009-06-02 Covidien Ag Articulating bipolar electrosurgical instrument
US7384421B2 (en) 2004-10-06 2008-06-10 Sherwood Services Ag Slide-activated cutting assembly
US7955332B2 (en) * 2004-10-08 2011-06-07 Covidien Ag Mechanism for dividing tissue in a hemostat-style instrument
US7628792B2 (en) 2004-10-08 2009-12-08 Covidien Ag Bilateral foot jaws
US20060084973A1 (en) * 2004-10-14 2006-04-20 Dylan Hushka Momentary rocker switch for use with vessel sealing instruments
US7686827B2 (en) 2004-10-21 2010-03-30 Covidien Ag Magnetic closure mechanism for hemostat
US9463012B2 (en) 2004-10-26 2016-10-11 P Tech, Llc Apparatus for guiding and positioning an implant
US9173647B2 (en) 2004-10-26 2015-11-03 P Tech, Llc Tissue fixation system
US9271766B2 (en) 2004-10-26 2016-03-01 P Tech, Llc Devices and methods for stabilizing tissue and implants
US20060089646A1 (en) 2004-10-26 2006-04-27 Bonutti Peter M Devices and methods for stabilizing tissue and implants
US7479148B2 (en) * 2004-11-08 2009-01-20 Crescendo Technologies, Llc Ultrasonic shear with asymmetrical motion
US7686804B2 (en) 2005-01-14 2010-03-30 Covidien Ag Vessel sealer and divider with rotating sealer and cutter
US7909823B2 (en) * 2005-01-14 2011-03-22 Covidien Ag Open vessel sealing instrument
US9089323B2 (en) 2005-02-22 2015-07-28 P Tech, Llc Device and method for securing body tissue
US7285895B2 (en) * 2005-03-15 2007-10-23 Crescendo Technologies, Llc Ultrasonic medical device and method
US7491202B2 (en) * 2005-03-31 2009-02-17 Covidien Ag Electrosurgical forceps with slow closure sealing plates and method of sealing tissue
US20090204114A1 (en) * 2005-03-31 2009-08-13 Covidien Ag Electrosurgical Forceps with Slow Closure Sealing Plates and Method of Sealing Tissue
US20080209650A1 (en) * 2005-05-03 2008-09-04 Ultreo, Inc. Oral hygiene devices
EP1881779A4 (en) * 2005-05-03 2013-11-06 Ultreo Inc Oral hygiene devices employing an acoustic waveguide
US7837685B2 (en) * 2005-07-13 2010-11-23 Covidien Ag Switch mechanisms for safe activation of energy on an electrosurgical instrument
US7628791B2 (en) 2005-08-19 2009-12-08 Covidien Ag Single action tissue sealer
CA2561034C (en) 2005-09-30 2014-12-09 Sherwood Services Ag Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue
EP1769765B1 (en) 2005-09-30 2012-03-21 Covidien AG Insulating boot for electrosurgical forceps
US7922953B2 (en) 2005-09-30 2011-04-12 Covidien Ag Method for manufacturing an end effector assembly
US7879035B2 (en) * 2005-09-30 2011-02-01 Covidien Ag Insulating boot for electrosurgical forceps
US7789878B2 (en) * 2005-09-30 2010-09-07 Covidien Ag In-line vessel sealer and divider
US7722607B2 (en) * 2005-09-30 2010-05-25 Covidien Ag In-line vessel sealer and divider
US8152825B2 (en) * 2005-10-14 2012-04-10 Ethicon Endo-Surgery, Inc. Medical ultrasound system and handpiece and methods for making and tuning
US7594916B2 (en) 2005-11-22 2009-09-29 Covidien Ag Electrosurgical forceps with energy based tissue division
US7766910B2 (en) * 2006-01-24 2010-08-03 Tyco Healthcare Group Lp Vessel sealer and divider for large tissue structures
US8298232B2 (en) 2006-01-24 2012-10-30 Tyco Healthcare Group Lp Endoscopic vessel sealer and divider for large tissue structures
US8241282B2 (en) 2006-01-24 2012-08-14 Tyco Healthcare Group Lp Vessel sealing cutting assemblies
US8734443B2 (en) * 2006-01-24 2014-05-27 Covidien Lp Vessel sealer and divider for large tissue structures
US8882766B2 (en) 2006-01-24 2014-11-11 Covidien Ag Method and system for controlling delivery of energy to divide tissue
US8496657B2 (en) 2006-02-07 2013-07-30 P Tech, Llc. Methods for utilizing vibratory energy to weld, stake and/or remove implants
US7967820B2 (en) * 2006-02-07 2011-06-28 P Tech, Llc. Methods and devices for trauma welding
US7641653B2 (en) * 2006-05-04 2010-01-05 Covidien Ag Open vessel sealing forceps disposable handswitch
US7846158B2 (en) 2006-05-05 2010-12-07 Covidien Ag Apparatus and method for electrode thermosurgery
US20070260238A1 (en) * 2006-05-05 2007-11-08 Sherwood Services Ag Combined energy level button
US20080097501A1 (en) * 2006-06-22 2008-04-24 Tyco Healthcare Group Lp Ultrasonic probe deflection sensor
US7776037B2 (en) * 2006-07-07 2010-08-17 Covidien Ag System and method for controlling electrode gap during tissue sealing
US20080015575A1 (en) * 2006-07-14 2008-01-17 Sherwood Services Ag Vessel sealing instrument with pre-heated electrodes
US7744615B2 (en) * 2006-07-18 2010-06-29 Covidien Ag Apparatus and method for transecting tissue on a bipolar vessel sealing instrument
US8597297B2 (en) * 2006-08-29 2013-12-03 Covidien Ag Vessel sealing instrument with multiple electrode configurations
EP2073735B1 (en) * 2006-09-08 2010-11-24 Arbel Medical Ltd. Device for combined treatment
US8070746B2 (en) 2006-10-03 2011-12-06 Tyco Healthcare Group Lp Radiofrequency fusion of cardiac tissue
US7951149B2 (en) * 2006-10-17 2011-05-31 Tyco Healthcare Group Lp Ablative material for use with tissue treatment device
US20080208181A1 (en) * 2007-01-19 2008-08-28 Arbel Medical Ltd. Thermally Insulated Needles For Dermatological Applications
US8617185B2 (en) 2007-02-13 2013-12-31 P Tech, Llc. Fixation device
USD649249S1 (en) 2007-02-15 2011-11-22 Tyco Healthcare Group Lp End effectors of an elongated dissecting and dividing instrument
US20080234709A1 (en) * 2007-03-22 2008-09-25 Houser Kevin L Ultrasonic surgical instrument and cartilage and bone shaping blades therefor
US8911460B2 (en) * 2007-03-22 2014-12-16 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8142461B2 (en) * 2007-03-22 2012-03-27 Ethicon Endo-Surgery, Inc. Surgical instruments
US8226675B2 (en) * 2007-03-22 2012-07-24 Ethicon Endo-Surgery, Inc. Surgical instruments
US8267935B2 (en) 2007-04-04 2012-09-18 Tyco Healthcare Group Lp Electrosurgical instrument reducing current densities at an insulator conductor junction
US20100162730A1 (en) * 2007-06-14 2010-07-01 Arbel Medical Ltd. Siphon for delivery of liquid cryogen from dewar flask
WO2009007963A1 (en) * 2007-07-09 2009-01-15 Arbel Medical Ltd. Cryosheath
US8348967B2 (en) 2007-07-27 2013-01-08 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8882791B2 (en) * 2007-07-27 2014-11-11 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8257377B2 (en) * 2007-07-27 2012-09-04 Ethicon Endo-Surgery, Inc. Multiple end effectors ultrasonic surgical instruments
US8523889B2 (en) 2007-07-27 2013-09-03 Ethicon Endo-Surgery, Inc. Ultrasonic end effectors with increased active length
US8808319B2 (en) 2007-07-27 2014-08-19 Ethicon Endo-Surgery, Inc. Surgical instruments
US8252012B2 (en) * 2007-07-31 2012-08-28 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instrument with modulator
US8430898B2 (en) 2007-07-31 2013-04-30 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8512365B2 (en) * 2007-07-31 2013-08-20 Ethicon Endo-Surgery, Inc. Surgical instruments
US9044261B2 (en) * 2007-07-31 2015-06-02 Ethicon Endo-Surgery, Inc. Temperature controlled ultrasonic surgical instruments
US7877853B2 (en) 2007-09-20 2011-02-01 Tyco Healthcare Group Lp Method of manufacturing end effector assembly for sealing tissue
US7877852B2 (en) 2007-09-20 2011-02-01 Tyco Healthcare Group Lp Method of manufacturing an end effector assembly for sealing tissue
US8267936B2 (en) 2007-09-28 2012-09-18 Tyco Healthcare Group Lp Insulating mechanically-interfaced adhesive for electrosurgical forceps
US8251996B2 (en) * 2007-09-28 2012-08-28 Tyco Healthcare Group Lp Insulating sheath for electrosurgical forceps
US8235992B2 (en) * 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot with mechanical reinforcement for electrosurgical forceps
US8235993B2 (en) * 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with exohinged structure
US8241283B2 (en) * 2007-09-28 2012-08-14 Tyco Healthcare Group Lp Dual durometer insulating boot for electrosurgical forceps
US8236025B2 (en) * 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Silicone insulated electrosurgical forceps
US20090088748A1 (en) * 2007-09-28 2009-04-02 Tyco Healthcare Group Lp Insulating Mesh-like Boot for Electrosurgical Forceps
US8221416B2 (en) * 2007-09-28 2012-07-17 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with thermoplastic clevis
US20090088750A1 (en) * 2007-09-28 2009-04-02 Tyco Healthcare Group Lp Insulating Boot with Silicone Overmold for Electrosurgical Forceps
US20090088745A1 (en) * 2007-09-28 2009-04-02 Tyco Healthcare Group Lp Tapered Insulating Boot for Electrosurgical Forceps
US9023043B2 (en) * 2007-09-28 2015-05-05 Covidien Lp Insulating mechanically-interfaced boot and jaws for electrosurgical forceps
USD594983S1 (en) 2007-10-05 2009-06-23 Ethicon Endo-Surgery, Inc. Handle assembly for surgical instrument
EP2217157A2 (en) 2007-10-05 2010-08-18 Ethicon Endo-Surgery, Inc. Ergonomic surgical instruments
WO2009066292A1 (en) * 2007-11-21 2009-05-28 Arbel Medical Ltd. Pumping unit for delivery of liquid medium from a vessel
US7901423B2 (en) * 2007-11-30 2011-03-08 Ethicon Endo-Surgery, Inc. Folded ultrasonic end effectors with increased active length
US20090143806A1 (en) * 2007-11-30 2009-06-04 Ethicon Endo-Surgery, Inc. Ultrasonic surgical blades
US8057498B2 (en) * 2007-11-30 2011-11-15 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instrument blades
USD700699S1 (en) 2011-08-23 2014-03-04 Covidien Ag Handle for portable surgical device
US20110015624A1 (en) * 2008-01-15 2011-01-20 Icecure Medical Ltd. Cryosurgical instrument insulating system
US8764748B2 (en) * 2008-02-06 2014-07-01 Covidien Lp End effector assembly for electrosurgical device and method for making the same
US8623276B2 (en) * 2008-02-15 2014-01-07 Covidien Lp Method and system for sterilizing an electrosurgical instrument
EP2303168A1 (en) 2008-04-16 2011-04-06 Arbel Medical Ltd. Cryosurgical instrument with enhanced heat exchange
US8469956B2 (en) * 2008-07-21 2013-06-25 Covidien Lp Variable resistor jaw
US9089360B2 (en) 2008-08-06 2015-07-28 Ethicon Endo-Surgery, Inc. Devices and techniques for cutting and coagulating tissue
US8058771B2 (en) 2008-08-06 2011-11-15 Ethicon Endo-Surgery, Inc. Ultrasonic device for cutting and coagulating with stepped output
US8257387B2 (en) * 2008-08-15 2012-09-04 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US8162973B2 (en) * 2008-08-15 2012-04-24 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US20100042143A1 (en) * 2008-08-15 2010-02-18 Cunningham James S Method of Transferring Pressure in an Articulating Surgical Instrument
US9603652B2 (en) * 2008-08-21 2017-03-28 Covidien Lp Electrosurgical instrument including a sensor
US8784417B2 (en) * 2008-08-28 2014-07-22 Covidien Lp Tissue fusion jaw angle improvement
US8317787B2 (en) * 2008-08-28 2012-11-27 Covidien Lp Tissue fusion jaw angle improvement
US8795274B2 (en) * 2008-08-28 2014-08-05 Covidien Lp Tissue fusion jaw angle improvement
US20100057081A1 (en) * 2008-08-28 2010-03-04 Tyco Healthcare Group Lp Tissue Fusion Jaw Angle Improvement
US20100057118A1 (en) * 2008-09-03 2010-03-04 Dietz Timothy G Ultrasonic surgical blade
US20100063500A1 (en) * 2008-09-05 2010-03-11 Tyco Healthcare Group Lp Apparatus, System and Method for Performing an Electrosurgical Procedure
US8303582B2 (en) 2008-09-15 2012-11-06 Tyco Healthcare Group Lp Electrosurgical instrument having a coated electrode utilizing an atomic layer deposition technique
US20100069953A1 (en) * 2008-09-16 2010-03-18 Tyco Healthcare Group Lp Method of Transferring Force Using Flexible Fluid-Filled Tubing in an Articulating Surgical Instrument
US20100064524A1 (en) * 2008-09-17 2010-03-18 Mah Pat Y Vibrating peeler
US20100076430A1 (en) * 2008-09-24 2010-03-25 Tyco Healthcare Group Lp Electrosurgical Instrument Having a Thumb Lever and Related System and Method of Use
US8968314B2 (en) * 2008-09-25 2015-03-03 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US9375254B2 (en) * 2008-09-25 2016-06-28 Covidien Lp Seal and separate algorithm
US8535312B2 (en) * 2008-09-25 2013-09-17 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US8142473B2 (en) 2008-10-03 2012-03-27 Tyco Healthcare Group Lp Method of transferring rotational motion in an articulating surgical instrument
US8469957B2 (en) * 2008-10-07 2013-06-25 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US8636761B2 (en) * 2008-10-09 2014-01-28 Covidien Lp Apparatus, system, and method for performing an endoscopic electrosurgical procedure
US8016827B2 (en) * 2008-10-09 2011-09-13 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US8486107B2 (en) * 2008-10-20 2013-07-16 Covidien Lp Method of sealing tissue using radiofrequency energy
US20100281917A1 (en) * 2008-11-05 2010-11-11 Alexander Levin Apparatus and Method for Condensing Contaminants for a Cryogenic System
US8197479B2 (en) * 2008-12-10 2012-06-12 Tyco Healthcare Group Lp Vessel sealer and divider
US20100168741A1 (en) * 2008-12-29 2010-07-01 Hideo Sanai Surgical operation apparatus
US8114122B2 (en) 2009-01-13 2012-02-14 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US7967814B2 (en) 2009-02-05 2011-06-28 Icecure Medical Ltd. Cryoprobe with vibrating mechanism
WO2010099222A1 (en) 2009-02-24 2010-09-02 P Tech, Llc Methods and devices for utilizing bondable materials
US8162812B2 (en) * 2009-03-12 2012-04-24 Icecure Medical Ltd. Combined cryotherapy and brachytherapy device and method
GB0906930D0 (en) * 2009-04-23 2009-06-03 Orthosonics Ltd Improved bone resector
US8187273B2 (en) 2009-05-07 2012-05-29 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US9700339B2 (en) * 2009-05-20 2017-07-11 Ethicon Endo-Surgery, Inc. Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments
US20100298743A1 (en) * 2009-05-20 2010-11-25 Ethicon Endo-Surgery, Inc. Thermally-activated coupling arrangements and methods for attaching tools to ultrasonic surgical instruments
US20100305439A1 (en) * 2009-05-27 2010-12-02 Eyal Shai Device and Method for Three-Dimensional Guidance and Three-Dimensional Monitoring of Cryoablation
US8319400B2 (en) 2009-06-24 2012-11-27 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8246618B2 (en) 2009-07-08 2012-08-21 Tyco Healthcare Group Lp Electrosurgical jaws with offset knife
US8461744B2 (en) * 2009-07-15 2013-06-11 Ethicon Endo-Surgery, Inc. Rotating transducer mount for ultrasonic surgical instruments
US8663220B2 (en) * 2009-07-15 2014-03-04 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US9017326B2 (en) * 2009-07-15 2015-04-28 Ethicon Endo-Surgery, Inc. Impedance monitoring apparatus, system, and method for ultrasonic surgical instruments
USD630324S1 (en) 2009-08-05 2011-01-04 Tyco Healthcare Group Lp Dissecting surgical jaw
US8968358B2 (en) * 2009-08-05 2015-03-03 Covidien Lp Blunt tissue dissection surgical instrument jaw designs
US8133254B2 (en) 2009-09-18 2012-03-13 Tyco Healthcare Group Lp In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor
US8112871B2 (en) 2009-09-28 2012-02-14 Tyco Healthcare Group Lp Method for manufacturing electrosurgical seal plates
US8951248B2 (en) 2009-10-09 2015-02-10 Ethicon Endo-Surgery, Inc. Surgical generator for ultrasonic and electrosurgical devices
US9168054B2 (en) 2009-10-09 2015-10-27 Ethicon Endo-Surgery, Inc. Surgical generator for ultrasonic and electrosurgical devices
US8388647B2 (en) * 2009-10-28 2013-03-05 Covidien Lp Apparatus for tissue sealing
US9259234B2 (en) 2010-02-11 2016-02-16 Ethicon Endo-Surgery, Llc Ultrasonic surgical instruments with rotatable blade and hollow sheath arrangements
US8469981B2 (en) 2010-02-11 2013-06-25 Ethicon Endo-Surgery, Inc. Rotatable cutting implement arrangements for ultrasonic surgical instruments
US8531064B2 (en) * 2010-02-11 2013-09-10 Ethicon Endo-Surgery, Inc. Ultrasonically powered surgical instruments with rotating cutting implement
US8486096B2 (en) 2010-02-11 2013-07-16 Ethicon Endo-Surgery, Inc. Dual purpose surgical instrument for cutting and coagulating tissue
US8382782B2 (en) * 2010-02-11 2013-02-26 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments with partially rotating blade and fixed pad arrangement
US8961547B2 (en) * 2010-02-11 2015-02-24 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments with moving cutting implement
US8323302B2 (en) * 2010-02-11 2012-12-04 Ethicon Endo-Surgery, Inc. Methods of using ultrasonically powered surgical instruments with rotatable cutting implements
US8419759B2 (en) * 2010-02-11 2013-04-16 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instrument with comb-like tissue trimming device
US8579928B2 (en) 2010-02-11 2013-11-12 Ethicon Endo-Surgery, Inc. Outer sheath and blade arrangements for ultrasonic surgical instruments
US8951272B2 (en) 2010-02-11 2015-02-10 Ethicon Endo-Surgery, Inc. Seal arrangements for ultrasonically powered surgical instruments
US7967815B1 (en) 2010-03-25 2011-06-28 Icecure Medical Ltd. Cryosurgical instrument with enhanced heat transfer
US7938822B1 (en) 2010-05-12 2011-05-10 Icecure Medical Ltd. Heating and cooling of cryosurgical instrument using a single cryogen
GB201008510D0 (en) 2010-05-21 2010-07-07 Ethicon Endo Surgery Inc Medical device
US8080005B1 (en) 2010-06-10 2011-12-20 Icecure Medical Ltd. Closed loop cryosurgical pressure and flow regulated system
EP2409664B1 (en) * 2010-07-22 2013-10-30 W & H Dentalwerk Bürmoos GmbH Medicinal treatment device and method for regulating same
US8888809B2 (en) 2010-10-01 2014-11-18 Ethicon Endo-Surgery, Inc. Surgical instrument with jaw member
US8979890B2 (en) 2010-10-01 2015-03-17 Ethicon Endo-Surgery, Inc. Surgical instrument with jaw member
GB201017968D0 (en) 2010-10-23 2010-12-08 Sra Dev Ltd Ergonomic handpiece for laparoscopic and open surgery
US9113940B2 (en) 2011-01-14 2015-08-25 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
USD687549S1 (en) 2011-10-24 2013-08-06 Ethicon Endo-Surgery, Inc. Surgical instrument
USD680220S1 (en) 2012-01-12 2013-04-16 Coviden IP Slider handle for laparoscopic device
WO2013119545A1 (en) 2012-02-10 2013-08-15 Ethicon-Endo Surgery, Inc. Robotically controlled surgical instrument
US9439668B2 (en) 2012-04-09 2016-09-13 Ethicon Endo-Surgery, Llc Switch arrangements for ultrasonic surgical instruments
US9237921B2 (en) 2012-04-09 2016-01-19 Ethicon Endo-Surgery, Inc. Devices and techniques for cutting and coagulating tissue
US9241731B2 (en) 2012-04-09 2016-01-26 Ethicon Endo-Surgery, Inc. Rotatable electrical connection for ultrasonic surgical instruments
US9226766B2 (en) 2012-04-09 2016-01-05 Ethicon Endo-Surgery, Inc. Serial communication protocol for medical device
US9724118B2 (en) 2012-04-09 2017-08-08 Ethicon Endo-Surgery, Llc Techniques for cutting and coagulating tissue for ultrasonic surgical instruments
US9820768B2 (en) 2012-06-29 2017-11-21 Ethicon Llc Ultrasonic surgical instruments with control mechanisms
US9326788B2 (en) 2012-06-29 2016-05-03 Ethicon Endo-Surgery, Llc Lockout mechanism for use with robotic electrosurgical device
US9393037B2 (en) 2012-06-29 2016-07-19 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
US9226767B2 (en) 2012-06-29 2016-01-05 Ethicon Endo-Surgery, Inc. Closed feedback control for electrosurgical device
US9351754B2 (en) 2012-06-29 2016-05-31 Ethicon Endo-Surgery, Llc Ultrasonic surgical instruments with distally positioned jaw assemblies
US9283045B2 (en) 2012-06-29 2016-03-15 Ethicon Endo-Surgery, Llc Surgical instruments with fluid management system
US9198714B2 (en) 2012-06-29 2015-12-01 Ethicon Endo-Surgery, Inc. Haptic feedback devices for surgical robot
US9408622B2 (en) 2012-06-29 2016-08-09 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
US20140012282A1 (en) * 2012-07-05 2014-01-09 Michael H. Fritsch One step tympanostomy tube and method of inserting same
US9095367B2 (en) 2012-10-22 2015-08-04 Ethicon Endo-Surgery, Inc. Flexible harmonic waveguides/blades for surgical instruments
US9241728B2 (en) 2013-03-15 2016-01-26 Ethicon Endo-Surgery, Inc. Surgical instrument with multiple clamping mechanisms
US9675374B2 (en) * 2014-03-24 2017-06-13 Ethicon Llc Ultrasonic forceps
US9700333B2 (en) 2014-06-30 2017-07-11 Ethicon Llc Surgical instrument with variable tissue compression

Family Cites Families (20)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1586645A (en) * 1925-07-06 1926-06-01 Bierman William Method of and means for treating animal tissue to coagulate the same
US1881250A (en) * 1929-06-20 1932-10-04 Tomlinson George Milton Electrosurgical instrument
US2714890A (en) * 1953-08-06 1955-08-09 Vang Alfred Vibratory surgical instruments
US2730103A (en) * 1954-11-22 1956-01-10 Mackta Leo Magnetostrictive cutting tool
US3086288A (en) * 1955-04-20 1963-04-23 Cavitron Ultrasonics Inc Ultrasonically vibrated cutting knives
BE556940A (en) * 1956-04-26
US2985954A (en) * 1956-09-05 1961-05-30 Jones James Byron Method and apparatus employing vibratory energy for bonding metals
US3022814A (en) * 1957-02-04 1962-02-27 Jr Albert G Bodine Method and apparatus for sonic bonding
US2888928A (en) * 1957-04-15 1959-06-02 Seiger Harry Wright Coagulating surgical instrument
US3193424A (en) * 1961-10-31 1965-07-06 Olin Mathieson Process for adhesive bonding
US3308003A (en) * 1962-02-16 1967-03-07 Kleer Vu Ind Inc Ultrasonic sealing apparatus
US3184354A (en) * 1962-02-28 1965-05-18 West Point Mfg Co Method of splicing multifilament yarns by vibratory treatment
US3478744A (en) * 1964-12-30 1969-11-18 Harry Leiter Surgical apparatus
US3419447A (en) * 1965-03-22 1968-12-31 Uniroyal Inc Method and apparatus for bonding together two thermoplastic sheets by ultrasonic energy
US3433226A (en) * 1965-07-21 1969-03-18 Aeroprojects Inc Vibratory catheterization apparatus and method of using
US3636943A (en) * 1967-10-27 1972-01-25 Ultrasonic Systems Ultrasonic cauterization
US3565062A (en) * 1968-06-13 1971-02-23 Ultrasonic Systems Ultrasonic method and apparatus for removing cholesterol and other deposits from blood vessels and the like
US3528410A (en) * 1968-09-16 1970-09-15 Surgical Design Corp Ultrasonic method for retinal attachment
US3618594A (en) * 1970-04-06 1971-11-09 Surgical Design Corp Ultrasonic apparatus for retinal reattachment
US3636947A (en) * 1970-12-03 1972-01-25 Ultrasonic Systems Ultrasonic home dental instrument and method

Cited By (25)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3898992A (en) * 1967-10-27 1975-08-12 Ultrasonic Systems Ultrasonic surgical methods
US3862630A (en) * 1967-10-27 1975-01-28 Ultrasonic Systems Ultrasonic surgical methods
US5041108A (en) * 1981-12-11 1991-08-20 Pillco Limited Partnership Method for laser treatment of body lumens
US4854320A (en) * 1983-10-06 1989-08-08 Laser Surgery Software, Inc. Laser healing method and apparatus
US5002051A (en) * 1983-10-06 1991-03-26 Lasery Surgery Software, Inc. Method for closing tissue wounds using radiative energy beams
US5140984A (en) * 1983-10-06 1992-08-25 Proclosure, Inc. Laser healing method and apparatus
US4911161A (en) * 1987-04-29 1990-03-27 Noetix, Inc. Capsulectomy cutting apparatus
US5151099A (en) * 1989-03-28 1992-09-29 Young Michael J R Tool for removal of plastics material
US5154694A (en) * 1989-06-06 1992-10-13 Kelman Charles D Tissue scraper device for medical use
US5536266A (en) * 1991-08-24 1996-07-16 Orthosonics, Ltd. Tool for removal of plastics material
USRE40863E1 (en) * 1992-04-23 2009-07-21 Boston Scientific Scimed, Inc. Apparatus and method for sealing vascular punctures
US5507744A (en) * 1992-04-23 1996-04-16 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US6063085A (en) * 1992-04-23 2000-05-16 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US5810810A (en) * 1992-04-23 1998-09-22 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US5417654A (en) * 1994-02-02 1995-05-23 Alcon Laboratories, Inc. Elongated curved cavitation-generating tip for disintegrating tissue
US6719770B2 (en) 1998-09-30 2004-04-13 Tony R. Brown Ultrasonic device for providing reversible tissue damage to heart muscle
US6283935B1 (en) * 1998-09-30 2001-09-04 Hearten Medical Ultrasonic device for providing reversible tissue damage to heart muscle
US20060235376A1 (en) * 2003-02-04 2006-10-19 Cardiodex Ltd. Methods and apparatus for hemostasis following arterial catheterization
US20070055223A1 (en) * 2003-02-04 2007-03-08 Cardiodex, Ltd. Methods and apparatus for hemostasis following arterial catheterization
US20070213710A1 (en) * 2003-02-04 2007-09-13 Hayim Lindenbaum Methods and apparatus for hemostasis following arterial catheterization
US20100228241A1 (en) * 2003-02-04 2010-09-09 Cardiodex Ltd. Methods and apparatus for hemostasis following arterial catheterization
US8372072B2 (en) 2003-02-04 2013-02-12 Cardiodex Ltd. Methods and apparatus for hemostasis following arterial catheterization
US20080167643A1 (en) * 2004-11-22 2008-07-10 Cardiodex Ltd. Techniques for Heating-Treating Varicose Veins
US8435236B2 (en) 2004-11-22 2013-05-07 Cardiodex, Ltd. Techniques for heat-treating varicose veins
US8366706B2 (en) 2007-08-15 2013-02-05 Cardiodex, Ltd. Systems and methods for puncture closure

Also Published As

Publication number Publication date Type
US3636943A (en) 1972-01-25 grant
US3862630A (en) 1975-01-28 grant
US3898992A (en) 1975-08-12 grant

Similar Documents

Publication Publication Date Title
US3478744A (en) Surgical apparatus
US5947984A (en) Ultrasonic clamp coagulator apparatus having force limiting clamping mechanism
US5336234A (en) Method and apparatus for dilatation of a stenotic vessel
US5116343A (en) Device for disintegrating concretions disposed in body cavities
US7625370B2 (en) Tissue fusion/welder apparatus and method
US3212502A (en) Knotless adhesive impregnated sutures and method of use thereof
US6391042B1 (en) Pulsed ultrasonic device and method
US3433226A (en) Vibratory catheterization apparatus and method of using
US5776155A (en) Methods and devices for attaching and detaching transmission components
US6726698B2 (en) Pulsed ultrasonic device and method
US6315741B1 (en) Method and apparatus for medical procedures using high-intensity focused ultrasound
US4223676A (en) Ultrasonic aspirator
US20040236374A1 (en) Method and device for securing body tissue
US6051010A (en) Methods and devices for joining transmission components
US6562032B1 (en) Electrosurgical instrument with vibration
US5989274A (en) Methods and devices for improving blood flow to a heart of a patient
US20130012970A1 (en) Ultrasonic surgical instrument and cartilage and bone shaping blades therefor
US5417700A (en) Automatic suturing and ligating device
EP1138264A1 (en) Ultrasonic surgical blade with improved cutting and coagulation features
US6860880B2 (en) Electrothermal instrument for sealing and joining or cutting tissue
US20090318945A1 (en) Ultrasonic therapeutic devices
US7429266B2 (en) Method of using ultrasonic vibration to secure body tissue
US6669690B1 (en) Ultrasound treatment system
US20060211943A1 (en) Ultrasonic blade with terminal end balance features
US20100222714A1 (en) Hand activated ultrasonic instrument