WO1997040759A1 - Instruments electrochirurgicaux du type a fil - Google Patents

Instruments electrochirurgicaux du type a fil Download PDF

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Publication number
WO1997040759A1
WO1997040759A1 PCT/US1997/007497 US9707497W WO9740759A1 WO 1997040759 A1 WO1997040759 A1 WO 1997040759A1 US 9707497 W US9707497 W US 9707497W WO 9740759 A1 WO9740759 A1 WO 9740759A1
Authority
WO
WIPO (PCT)
Prior art keywords
conductor
distal
sheath
proximal
electrosurgical instrument
Prior art date
Application number
PCT/US1997/007497
Other languages
English (en)
Inventor
Charles C. Hart
Original Assignee
Applied Medical Resources Corporation
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
Application filed by Applied Medical Resources Corporation filed Critical Applied Medical Resources Corporation
Publication of WO1997040759A1 publication Critical patent/WO1997040759A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1402—Probes for open surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00184—Moving parts
    • A61B2018/00196—Moving parts reciprocating lengthwise
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/1253—Generators therefor characterised by the output polarity monopolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1475—Electrodes retractable in or deployable from a housing

Definitions

  • the present invention relates generally to surgical instruments and, more particularly, to electrosurgical cutting and cauterizing instruments.
  • Electrosurgical instruments use electricity to cut and cauterize tissue.
  • a variety of electrosurgical instruments have existed in the prior art.
  • Such instruments typically utilize an electrosurgical generator, which produces a radio frequency output.
  • the electrosurgical instrument inputs the radio frequency output from the electrosurgical generator and generates a concentrated current density at a desired location.
  • a monopolar electrosurgical instrument uses only a single electrode, and the return path back to the generator is provided through the patient.
  • Bipolar electrosurgical instruments implement two electrodes at the surgical site, and the return path is provided through the second electrode.
  • the electrodes of typical electrosurgical cutting instruments have been formed into various shapes, including blades, hooks, snares, and loops. Each of these shapes may have a particular advantage associated therewith, but a user is faced with keeping each of these various shapes on hand at the surgical site.
  • the user To change from a blade-shaped to a hood-shaped electrode, for example, the user must remove the blade from the electrosurgical instrument and secure the hook to the electrosurgical instrument. Trauma to the surgical site can occur as a result of removal and reinsertion of the electrosurgical instrument. Precious time is required for each exchange of parts during a surgical procedure, and valuable space is consumed as a result of the various interchangeable parts which must be kept at hand near the surgical site.
  • the electrosurgical instrument of the present invention includes a movable and deformable electrode.
  • the electrode can be moved proximally and distally within a sheath, and further can be shaped at the surgical site to meet various cutting and cauterizing requirements.
  • the electrode may include a wire, which serves to provide current concentration at specific sites and which is shapable to meet various surgical requirements.
  • a radio frequency electrical signal is passed through the wire or wires to provide cutting and cauterizing effects at specific surgical sites.
  • the wire electrode is able to provide a high concentration of energy while maintaining a relatively low power setting.
  • an electrosurgical instrument includes a sheath and a conductor disposed within the sheath.
  • the sheath includes a proximal sheath end, a distal sheath end, an inside surface, and a sheath axis extending between the proximal sheath end and the distal sheath end.
  • the conductor includes a proximal conductor end and a distal conductor end.
  • the distal conductor end is movable between a first configuration and a second configuration.
  • the distal conductor end forms a loop, which is formable between a first configuration and a second configuration.
  • the loop has a first diameter in the first configuration and a second larger diameter in the second configuration.
  • the conductor can be moved proximally into the distal sheath end to form the first configuration and can be moved distally out of the distal sheath end to form the second configuration.
  • an electrosurgical instrument includes a sheath and a conductor disposed within the sheath.
  • the conductor comprises a first conductor and a second conductor.
  • the second conductor includes an inner side and an outer side. At least a portion of the inner side or the outer side is covered with a dielectric material.
  • At least one of the first conductor and the second conductor is movable in a direction along a sheath axis within the sheath.
  • a second configuration is obtained by movement of either or both of the conductors in a distal direction
  • a first configuration is obtained by movement of either or both of the conductors in a proximal direction.
  • a distal end of the first conductor contacts a distal end of the second conductor in the first configuration, and the two distal ends do not contact one another in the second configuration.
  • the first conductor includes a proximal first end and a distal first end
  • the second conductor includes a proximal second end and a distal second end.
  • the distal second end is coupled to the distal first end.
  • At least a portion of the distal end of the conductor is adapted to press against an inside surface of the sheath when the first conductor is moved relative to the second conductor. Movement of the first conductor relative to the second conductor moves the conductor between the first configuration and the second configuration.
  • the first conductor and the second conductor are substantially parallel to the sheath axis in the first configuration, and are curved in a substantially non-parallel direction to the sheath axis in the second configuration.
  • the first conductor and the second conductor together can be formed into a double bow shape in the second configuration.
  • the first conductor and the second conductor can be formed into a double U-shape in the second configuration.
  • the proximal second end of the second conductor is coupled to the sheath to thereby prevent movement of the second conductor relative to the sheath. Movement of the first conductor, relative to the sheath, operates to move the conductor between the first configuration and the second configuration.
  • an electrosurgical instrument includes a frame member and a sheath connected to the frame member.
  • An electrical conductor is disposed within the sheath, and a movable positioner is disposed in close proximity to the frame member and is operatively coupled to the electrical conductor.
  • the movable positioner is adapted to move a distal end of the electrical conductor proximally into the sheath and distally out of the sheath.
  • the electrical conductor has a hook formed at a distal end of the electrical conductor.
  • the electrical conductor includes a first conductor and a second conductor, which is connected to the first conductor at a distal end of the second conductor. Movement of the first conductor relative to the second conductor can deform the electrical conductor into various shapes.
  • an electrosurgical instrument includes a retaining member having a proximal member end, a distal member end, and a member axis extending between the proximal member end and the distal member end.
  • the electrosurgical instrument further includes a first conductor and a second conductor.
  • a first loop is formed at a distal end of the first conductor
  • a second loop is formed at a distal end of a second conductor.
  • the first conductor and the second conductor can be moved in a first direction along the member axis to separate the first loop from the second loop.
  • the two conductors can be moved in a second direction along the member axis to move the first loop into contact with the second loop.
  • the retaining member includes a sheath for housing the first conductor and the second conductor.
  • the sheath includes a divider for insulating the first loop from the second loop. Distal movement of the first and second conductors along the member axis separates the first loop from the second loop, and proximal movement of the first and second conductors along the member axis moves the first loop into contact with the second loop. A portion of the distal end of the first conductor is secured to the retaining member, and a portion of the distal end of the second conductor is secured to the retaining member.
  • an electrosurgical instrument includes a retaining member, a first conductor, and a second conductor.
  • the first conductor is disposed at a distal end of the retaining member and includes a proximal first end a curved distal first end.
  • the second conductor is disposed at a distal end of the retaining member, and includes a proximal second end and a curved distal second end. At least one of the first conductor and the second conductor is adapted to be moved in a first direction along an axis of the retaining member to move the curved distal first end into contact with the curved distal second end.
  • At least one of the first conductor and the second conductor is adapted to be moved in a second direction along the axis of the retaining member to move the curved distal first end out of contact with the curved distal second end.
  • a first portion of the curved distal first end is transverse to the axis of the retaining member, and a second portion of the curved distal second end is transverse to the axis of the retaining member. The first portion and the second portion contact one another when the curved distal first end is moved into contact with the curved distal second end. The first and second portions do not contact one another when the curved distal first end is moved out of contact with the curved distal second end.
  • the curved distal first end and the curved distal second end comprise L-shapes in one embodiment.
  • an electrosurgical instrument includes a retaining member having a proximal member end, a distal member end, and a member axis extending between the proximal member end and the distal member end.
  • the electrosurgical instrument includes a first conductor disposed at the distal member end.
  • the first conductor includes a proximal first end and a distal first end.
  • the electrosurgical instrument further includes a second conductor disposed at the distal member end.
  • the second conductor includes a proximal second end and an angled distal second end.
  • the second conductor is adapted to be moved in a first direction along the member axis to move the angled distal second end out of contact with the distal first end, and is adapted to be moved in a second direction along the member axis to move the angled distal second end into contact with the distal first end.
  • the second conductor includes a cam, which is disposed proximally of the angled distal second end.
  • the retaining member comprises a sheath having a slot, which is parallel to the member axis. The slot is adapted to accommodate the cam therein when the second conductor is moved in the first direction.
  • an electrosurgical instrument includes a flexible tubular member having a proximal member end, a distal member end, and an intermediate portion between the proximal member end and the distal member end.
  • a member axis extends between the proximal member end and the distal member end.
  • a conductor is coupled to both the distal member end and the intermediate portion. The conductor is movable proximally along the member axis to thereby decrease a distance between the distal member end and the intermediate portion. The conductor is also movable distally along the member axis to thereby increase a distance between the distal member and the intermediate portion.
  • the flexible tubular member includes a weakened portion between the distal member end and the intermediate portion. The flexible tubular member is adapted to bend at the weakened portion when the conductor is moved proximally.
  • Figure 1 is a perspective view of an embodiment of the present invention illustrating a positionable conductive element in a first configuration
  • Figure 2 is a perspective view of the Figure 1 embodiment illustrating the positionable conductive element in a second configuration
  • Figure 3 is a perspective view of an embodiment illustrating the positionable conductive element in a third configuration
  • Figure 4 is a perspective view of a positionable conductive element having a dielectric material disposed over a first portion of the positionable conductive element;
  • Figure 5 is a perspective view of a positionable conductive element having a dielectric material disposed over a second portion of the positionable conductive element;
  • Figures 6A-6C are perspective views of an embodiment of the present invention illustrating proximal and distal movement of the positional conductive element in a monopolar mode
  • Figures 7A and 7B are perspective views of an embodiment of the present invention illustrating various loop configuration applications of a positionable conductive element
  • Figures 8A and 8B are perspective views of an embodiment of the present invention illustrating two movable conductive elements
  • Figures 9A-9C are perspective views of an embodiment of the present invention illustrating two movable loop-shaped conductive elements
  • Figures 10A and 10B are cross-sectional views illustrating a first implementation of the embodiment of Figures 9A-9C;
  • Figures IIA and IIB are cross-sectional views illustrating a second implementation of the embodiment of Figures 9A-9C;
  • Figure 12 is a perspective view of an embodiment of the present invention illustrating two bi-polar conductive elements
  • Figure 13 is a perspective view of an embodiment of the present invention illustrating two bi-polar conductive elements forming a parallel jaw
  • Figure 14 is a perspective view of an embodiment of the present invention illustrating another movable jaw formed by two bi-polar conductive elements
  • Figure 15A is a side-elevational view of a positionable conductive element having a dielectric material applied to a first portion thereof;
  • Figure 15B is a side-elevational view of a positionable conductive element having dielectric material applied to a second portion thereof;
  • Figure 16 is a side-elevational view of an embodiment of the present invention illustrating a conductive element in combination with a positionable sleeve;
  • Figure 17 is a side-elevational view of the embodiment of Figure 16 in a deployed configuration
  • Figure 18 is a cross-sectional view of the apparatus of Figure 16.
  • Figure 19 is a cross-sectional view of the apparatus of Figure 17;
  • Figure 20A is a perspective view of an embodiment of the present invention illustrating a passive insulative sleeve in an extended position
  • Figure 20B is a perspective view of an embodiment of the present invention illustrating the passive insulative sleeve of Figure 20A in a retracted position;
  • Figure 21A is a perspective view of an embodiment of the present invention illustrating a passive insulative sleeve in an extended position
  • Figure 21B is a perspective view of an embodiment of the present invention illustrating the passive insulative sleeve of Figure 21A in a retracted position
  • Figure 22A is a perspective view of an embodiment of the present invention illustrating an active insulative sleeve in an extended position
  • Figure 22B is a perspective view of an embodiment of the present invention illustrating the active insulative sleeve of Figure 22A in a retracted position;
  • Figure 23A is a perspective view of an embodiment of the present invention illustrating an insulative sleeve in an extended position
  • Figure 23B is a perspective view of an embodiment of the present invention illustrating the insulative sleeve of Figure 23A in a retracted position.
  • Figure 1 illustrates an electrosurgical instrument 30 having a handle 32 and a dielectric sheath 34.
  • a portion 36 of the dielectric sheath 44 is shown removed for illustrative purposes only.
  • the dielectric sheath 34 preferably extends from a proximal sheath end 38 to a distal sheath end 41 without interruption.
  • the dielectric sheath 34 preferably comprises a dielectric material, which is adapted to insulate the conductive electrode or wire 43, other materials may also be implemented.
  • the cutaway portion 36 also illustrates an interior surface 45 of the dielectric sheath 34.
  • the distal sheath end 41 of the dielectric sheath 34 preferably comprises a strength and rigidity sufficient to support the positionable electrode end 47 when the positionable electrode end 47 is deformed, as discussed below with reference to Figure 2, for example.
  • the positionable electrode end 47 comprises a distal electrode end 50, a first electrode leg 52, and a second electrode leg 54.
  • the first electrode leg 52 is preferably coupled to the sliding positioner 56, and the second electrode leg 54 is preferably attached to an attachment point 58 on the interior surface 45 of the dielectric sheath 34.
  • a proximal end 61 of the handle 32 preferably comprises at least one electrical connector for supplying radio frequency current to the electrosurgical instrument 30.
  • the conductive electrode 43 and the positionable electrode end 47 are adapted to provide high-density current to specific surgical sites within a patient, for example. As shown in Figure 2, the positionable electrode end 47 is preferably shapable into different formations, to thereby vary the application of the radio frequency current to the surgical site. The radio frequency current is substantially discharged into adjacent tissue from the positionable electrode end 47.
  • the electrosurgical instrument 30 of the present invention may be implemented using either monopolar electrodes or bi-polar electrodes.
  • a radio frequency current is introduced into an active electrode, such as the conductive electrode 43, and is subsequently received by a receiver, such as a grounding pad or return electrode.
  • the electrical signal thus passes through the patient from the active electrode to the receiver or receptive electrode.
  • the receiver is configured to have a large surface area and is securely connected to the patient, according to the present invention, to ensure relatively low current density through the patient at the receiver. Low current density at the receiver serves to minimize cellular damage and cellular modification of tissue near the receiver.
  • bi-polar electrodes the receiver is placed adjacent to the active electrode, to thereby receive current therefrom.
  • the positionable electrode end 47 preferably comprises a flexible conductive element.
  • This flexible conductive element is preferably narrow to thereby maximize the current density and concentration of energy at the surgical site.
  • a dielectric coating 63 may be applied over portions of the positionable electrode end 47.
  • the dielectric coating 63 atenuates buildup or collection of charred tissue on the positionable electrode end 47. Additionally, the dielectric coating 63 serves to limit the exposed surface area of the positionable electrode end 47, to thereby further increase current density.
  • the positionable electrode end 47 can be selectively shaped or re-proportioned at the surgical site or during the operative procedure.
  • Figure 2 illustrates a first configuration of the positionable electrode end 47. Movement of the sliding positioner 56 in a distal direction moves the conductive electrode 43 in the distal direction, resulting in a bending or bowing of the positionable electrode end 47. Since the second electrode leg 54 is fixed to the dielectric sheath 34 at the attachment point 58, distal movement of the conductive electrode 43 results in movement of the distal electrode end 50 in a direction from the second electrode leg 54 to the first electrode leg 52, to thereby form a double bow shape.
  • Figure 3 illustrates another embodiment of the present invention, where the positionable electrode end 65 is movable between a U-shaped configuration, such as shown in Figure 1, and a double hook configuration.
  • the embodiment of Figure 3 is similar to the embodiment of Figure 2 with the movement of the second electrode leg 54 in the direction toward the first electrode leg 52 being enhanced.
  • the low profile of the electrosurgical instrument 30 is maintained by setting the slide positioner 56 at a neutral position on the handle 32. In the neutral position, the electrosurgical instrument 30 can be inserted and moved to a surgical site through a small diameter trocar or incision. Upon presentation to the surgical site, the electrosurgical instrument 30 can be used to bluntly dissect or maneuver tissue or organs, without any application of electrical energy to the conductive electrode 43 and the positionable electrode end 47. Radio frequency current can be selectively transmitted through the conductive electrode 43. Application of the radio frequency current to the electrosurgical instrument 30 can be used for performing cutting, coagulation, cautery, and fderation procedures.
  • Movement of the sliding positioner 56 in a distal direction activates the positionable electrode end 47, curving the first electrode leg 52 to a first radius and curving the second electrode leg 54 to a second radius.
  • the shape of the positionable electrode end 47 is thus dynamically adjustable within a range that is suitable for low-profile insertion through a trocar and also deployable to a large profile or shape.
  • the large profile or shape of the positionable electrode end 47 when activated by distal movement of the sliding positioner 56, provides for a variety of relatively large shapes which would not otherwise be readily insertable through a trocar, for example.
  • the large-diameter hook-shape of the positionable electrode end 65 shown in Figure 3, for example, can be particularly useful for lifting and separating tissue or organs in a non-energized state. Subsequently, the positionable electrode end 47 can be energized to cut or coagulate the tissue or organs . Such cutting and coagulating operations may be performed using the positionable electrode end 47 in any of a variety of shapes, depending upon movement of the sliding positioner 56 by a hand of a user.
  • Figure 4 illustrates the embodiment of Figure 2 with a dielectric coating 63 applied to the positionable electrode end 47.
  • the dielectric coating 63 preferably comprises a high dielectric strength, but other materials may also be used.
  • the dielectric coating 63 can be used to insulate the positionable electrode end 47 over an entire length of the positionable electrode end 47 and, subsequently, selectively removed or thinned at appropriate locations 67.
  • the selective coating of portions of the positionable electrode end 47 can provide accuracy and can prevent adjacent tissue from inadvertently being damaged.
  • the exposed area 67 can be on an outer curved portion 67, such as shown in Figure 4.
  • an exposed area 70 can be on an inner curved portion, such as illustrated in Figure 5.
  • Placement of the exposed area 70 on the hook-shaped positionable electrode end 65 can provide a function similar to a curved scalpel, for example.
  • the shape of the positionable electrode end 65 can be varied to vary the shape of the exposed area 70, to thereby effectuate various shaped simulated blades or cutting surfaces.
  • Figure 6A-6C illustrate an embodiment where a positionable electrode end 72 is movable by a sliding positioner 74.
  • An additional conductive electrode 75 is provided in combination with the conductive electrode 43.
  • Proximal movement of the sliding positioner 74 retracts the positionable electrode end 72 into the dielectric sheath 34, as illustrated in Figure 6A.
  • the positionable electrode end 72 is moved distally out of the dielectric sheath 34, as illustrated in Figures 6B and 6C.
  • the positionable electrode end 72 is not deformable, but other configurations are possible. .
  • the positionable electrode end 72 may be deformable into shapes similar to those shown in Figures 2 and 3.
  • the positionable electrode end 72 can be used for blunt dissection of tissue using only the blunt distal sheath end 41, with the positionable electrode end 47 retracted.
  • the positionable electrode end 47 may be partially extended through the distal sheath end 41, as shown in Figure 6B, to provide partial electrode exposure for a different cutting and manipulative effect.
  • the positionable electrode end 47 preferably comprises a fine gauge wire, which facilitates a high current density at the active discharge site.
  • the proximal and distal movement of the positionable electrode end 47 allows for the use of a fine gauge wire for the positionable electrode end 47 while providing a substantially rugged and operable dielectric sheath 34.
  • the dielectric sheath 34 can be used to protect the fine gauge wire 47 until delicate cutting and cauterization effects are needed.
  • Figures 6A-6C comprises a connecting post 77, which is coupled to the handle 32.
  • a return path to an electrosurgical generator (not shown) is preferably provided through a large area dispersive pad or electrode (not shown) which is placed on the skin of the patient.
  • Figure 6A-6C illustrate a monopolar mode, the positionable electrode end 72 may also be implemented using a bi-polar mode, according to design preference.
  • Figures 7A-7B illustrate another embodiment of the present invention, where the conductive electrode 43 and the additional electrode leg 75 terminate in a positionable electrode end 76, which has the shape of a loop.
  • the shape and size of the loop-shaped positionable electrode end 76 can be adjusted by movement of the sliding positioner 74 on the handle 32.
  • proximal movement of the sliding positioner 74 on the handle 32 moves the conductive electrode 43 and the additional electrode leg 75 proximally, resulting in a smaller loop.
  • distal movement of the sliding positioner 74 on the handle 32 results in distal movement of the conductive electrode 43 and the additional electrode leg 75, to thereby form a larger loop.
  • the sliding positioner 74 can be fully moved proximally to completely retract the positionable electrode end 76 within the dielectric sheath 34.
  • the loop formed by the positionable electrode end 76 can be selectively insulated to provide specific discharge paths. Alternatively, the entire positionable electrode end 76 may be left uninsulated and used to cut, cauterize, or fulgurate, depending upon the relative engagement position of the positionable electrode end 76 to the adjacent tissue. For example, if only the edge 78 of the positionable electrode end 76 contacts tissue, a cut will be made at the discharge site 81. If either or both of the faces 83, 85 are used in close proximity or in contact with tissue, coagulation or fulguration will occur along the discharge path 87.
  • Figures 8A and 8B illustrate an electrosurgical instrument having a first electrode jaw 90 and a second electrode jaw 92. Portions of the first electrode jaw 90 and the second electrode jaw 92 are bent, sized, and configured to splay to an open condition as they are extended from the distal shaft end 41.
  • Figure 8A illustrates a configuration where the sliding positioner 94 is in a somewhat proximally retracted position, corresponding to the first electrode jaw 90 and the second electrode jaw 92 being drawn together.
  • the distal end of the first electrode jaw 90 and the distal end of the second electrode jaw 92 meet at a conductive junction 96. A high concentration of electrical discharge can be applied at this conductive junction 96.
  • the conductive junction 96 is useful in welding or bonding tissue placed therebetween. In the presently preferred embodiment, only the contacting surfaces of the conductive junction 96 are exposed and the remainder of the first electrode jaw 90 and the second electrode jaw 92 is covered with a dielectric coating. Alternatively, other portions of the first electrode jaw 90 and the second electrode jaw 92 may be exposed.
  • the conductive electrode 43 and the additional electrode leg 75 are connected together at the proximal end 61 to form a singular electrical path. In this mode, high current density at the conductive junction 96 performs the electrosurgical effect.
  • the conductive electrode 43 is separated and/or insulated from the additional electrode leg 75 throughout the instrument. Individual electrical paths, such as positive and negative, or, alternatively, active paths and return paths, are maintained. Radio frequency current is then preferably applied through the active electrode and the return electrode.
  • the sliding positioner 94 is moved distally, as are the conductive electrode 43 and the additional electrode leg 75.
  • the first electrode jaw 90 and the second electrode jaw 92 are moved distally to separate the conductive junction 96, and to expose the first uninsulated end 98 and the second uninsulated end 101.
  • the first electrode jaw 90 and the second electrode jaw 92 may be placed in the configuration of Figure 8B and, subsequently, closed together to form the configuration of Figure 8A with tissue or vessel being held between the first uninsulated end 98 and the second uninsulated end 101. Proximal movement of the sliding positioner 94 causes the first electrode jaw 90 and the second electrode jaw 92 to compress the tissue or vessel.
  • the first electrode jaw 90 and the second electrode jaw 92 can be energized to administer an electrosurgical effect to the captured tissue or vessel between the first uninsulated end 98 and the second uninsulated end 101.
  • the tissue or vessel can thus be welded, ligated, or affixed by application of the radio frequency current to the tissue or vessel.
  • Figures 9A-9C illustrate an embodiment where the conductive electrode 43 and the additional electrode leg 75 extend from the distal sheath end 41 of the dielectric sheath 34 and form a first independent loop 103 and a second independent loop 105.
  • the extensions of the electrodes 43, 75 beyond the dielectric sheath 34 thus form a first compression member 107 and second compression member 110.
  • the first compression member 107 and the second compression member 110 tend to bow outward from each other when urged distally by the sliding positioner 112 upon the handle 32.
  • the first independent loop 103 and the second independent loop 105 become traction members when urged proximally by the sliding positioner 112 on the handle 32.
  • a first centermost portion 113 and a second centermost portion 114 of the two compression members 107, 110 respectively, form return legs for each of the independent loops 103, 105.
  • the first compression member 107 and the second compression member 110 are secured to the dielectric sheath 34 at a first fixation point 116 and a second fixation point 118, respectively.
  • the first compression member 107 and the second compression member 110 can be fixed at other points within the surgical instrument, besides the first fixation point 116 and the second fixation point 118, so long as these two compression members 107, 110 are prevented from movement at their fixed ends.
  • the conductive electrode 43 and the additional electrode leg 75, and the first compression member 107 and the second compression member 110 may be constructed to be monopolar or bi-polar in operation.
  • the dielectric sheath 34 comprises a dividing wall 121, which operates as an insulative barrier and fixing member for the centermost portions 112, 114 in the bi-polar configuration.
  • the first and second compression members 107, 110 are urged apart to form a space 123 therebetween. Tissue may be engaged between the first and second compression members 107, 110, as the sliding positioner 112 is moved distally upon the handle 32. Distal movement of the sliding positioner 112 on the handle 32 moves the first and second compression members 107, 110 together, to thereby engage the tissue therebetween. Electrosurgical energy can be applied to the tissue between the two compression members 107, 110. Further distal movement of the sliding positioner 112 on the handle 32 adds additional compression to the tissue between the first compression member 107 and the second compression member 110.
  • the first centermost portion 113 and the second centermost portion 114 are secured to the dividing wall 121 at a first fixation point 125 and a second fixation point 127, respectively.
  • Figure 12 illustrates an embodiment of the present invention where the conductive electrode 43 and the additional electrode leg 75 extend beyond the distal sheath end 41 to form somewhat parallel electrode extensions.
  • the parallel electrode extensions can be alternately extended or retracted, as needed, by movement of the sliding positioner 130 on the handle 32.
  • the embodiment of Figure 12 comprises a bi-polar mode, having an active electrical connector 132 and a passive electrical connector 134.
  • a monopolar configuration can also be constructed, according to preference.
  • Figures 13 and 14 illustrate other embodiments of the present invention, which preferably operates in a bi-polar mode having an active electrical connector 132 and a passive electrical connector 134.
  • a sliding positioner 136 controls the first conductive electrode 43 and the additional electrode leg 75.
  • the additional electrode leg 75 transitions into a first extended electrode portion 138 having an L-shaped end 141.
  • the conductive electrode 43 transitions into a second extended electrode portion 143 having an L-shaped end 145.
  • the first extended electrode portion 138 and the second extended electrode portion 143 are entirely covered with a dielectric coating, except for the proximally facing surface 147 of the L-shaped end 141 and the distally facing surface 152 of the L-shaped end 145.
  • the conductive electrode 43 and the second extended electrode portion 143, as well as the L- shaped end 145, are positionable within the dielectric sheath 34 in response to movement of the sliding positioner 136 on the handle 32. Movement of the sliding positioner 136 proximally creates a gap between the proximally facing surface 147 and the distally facing surface 152. Distal movement of the sliding positioner 136 closes the gap. A vessel or other tissue can be compressed or held within the gap and supported by one of the extended electrode portions 138, 143. At any point during the holding, grasping, clamping, or compressing of a vessel or tissue, radio frequency energy may be transmitted and discharged between the proximally facing surface 147 and the distally facing surface 152 to accomplish an electrosurgical effect.
  • Figure 14 illustrates another embodiment of the present invention, where a sliding positioner 154 controls a movable jaw 156 via a cam 158 and a slot 161 within the dielectric sheath 34.
  • the conductive electrode 43 transitions into the movable jaw 156, and the additional electrode leg 75 transitions into a fixed jaw 163.
  • the fixed jaw 163 comprises a first electrically conductive region 165, and the movable jaw 156 comprises a second electrically conductive region 167.
  • Proximal and distal movement of the sliding positioner 154 affects closing and opening of the movable jaw 156, respectively.
  • Tissue may be held between the movable jaw 156 and the fixed jaw 163 and radio frequency current applied therethrough.
  • the embodiments of Figures 13 and 14 illustrate two examples of electrode extensions which are movable together.
  • Figures 15A and 15B illustrate dielectric sheaths 34 having positionable electrode ends 72 extending from the distal sheath end 41.
  • a dielectric coating 63 is applied to the positionable electrode end 72, and portions of the dielectric coating 63 can be subsequently removed from the positionable electrode end.
  • An exposed area 170, as shown in Figure 15A, or an exposed area 172, as shown in Figure 15B, for example, may be formed to transmit radio frequency current to the tissue.
  • the active regions 170, 172 for example, may be specifically dedicated to certain surgical procedures or to mimic certain surgical instruments.
  • Figures 16-19 illustrate an electrosurgical instrument 174 having a handle 176 and a sliding positioner 178 positioned thereon.
  • a dielectric sheath 181 extends from a distal end of the handle 176.
  • a flexible tubular member 183 extends through the dielectric sheath 181 and through a distal end 185 of the dielectric sheath 181.
  • the flexible tubular member 183 comprises a weakened portion 187, which is adapted to facilitate bending of the flexible tubular member 183, as illustrated in Figure 17.
  • a conductor 190 which is operatively coupled to the sliding positioner 178, extends from a proximal aperture 193 to a distal aperture 194 of the flexible tubular member 183.
  • a slot 196 extends between the proximal aperture 193 and the distal aperture 194 and, as presently embodied, comprises part of the weakened portion 187.
  • the weakened portion 187 comprises a number of creases 198.
  • the conductor 190 may be secured by other means to the flexible tubular member 183.
  • a band such as the band 201 can encircle the flexible tubular member 183 at a distal end 203, to thereby secure the conductor 190 to the flexible tubular member 183.
  • a similar band (not shown) may be used to secure the conductor 190 to a portion where the proximal aperture 193 would otherwise be used.
  • Distal movement of the sliding positioner 178 relaxes the conductor 190, to thereby form an elongate, low-diameter flexible tubular member 183, as illustrated in Figure 16.
  • Proximal movement of the sliding positioner 178 decreases a distance between the proximal aperture 193 and the distal aperture 194, resulting in the flexible tubular member 183 forming a hook shape.
  • Radio frequency current may be applied to the conductor 190 at any time during a surgical procedure.
  • Figures 20A-20B illustrate an electrical surgical probe 300 having a proximal end 301, a distal end 302, a handle 305, and an electrically insulative shaft 303.
  • the electrically insulative shaft 303 comprises a proximal section 306, a distal reduced-diameter second 307, and a distal slidable sleeve 312.
  • the proximal section 306 of the electrically insulative shaft 303 preferably comprises a majority of the length of the electrically insulative shaft 303.
  • the slidable sleeve 312 is adapted to slide over the distal reduced-diameter section 307 in both proximal and distal directions.
  • the slidable sleeve 312 can be moved to a distal position, as illustrated in Figure 20A where the distal end 321 covers the electrosurgical electrode 310. Additionally, the slidable sleeve 312 can be moved proximally, to thereby expose the electrosurgical electrode 310. Frictional engagement of the electrosurgical probe 300, as the electrosurgical probe 300 is inserted through a trocar seal, for example, moves the slidable sleeve 312 proximally to thereby expose the electrosurgical electrode 310. Withdrawal of the electrically insulative shaft 303 from a trocar, for example, moves the slidable sleeve 312 distally, to thereby cover the electrosurgical electrode 310.
  • the electrically insulative shaft 303 serves to insulate and protect the electrosurgical electrode
  • the slidable sleeve 312 is retracted, and each time the electrosurgical probe 300 is withdrawn from the trocar, the slidable sleeve 312 is extended to cover the electrosurgical electrode 310, due to frictional engagement with the trocar seal.
  • the distance between the proximal end 320 of the slidable sleeve 312 and the distal end 321 of the slidable sleeve 312 assures that the slidable sleeve 312 is positioned as required to expose or cover the electrosurgical electrode 310, but only in response to complete insertion or complete withdrawal of the electrosurgical probe 300 from the trocar.
  • Figures 21A and 21B illustrate another embodiment of the present invention, where an elongate slidable sleeve 312 responds to each distal and proximal movement of the electrosurgical probe 300, relative to the trocar, through a much narrower range of motion.
  • the proximal end 320 of the elongate slidable sleeve 312 is extended in shape proximally to cover a longer portion of the electrically insulative shaft 303.
  • Figures 22A and 22B illustrate a manually slidable sleeve 312 controlled by a slidable positioner 313. Proximal movement of the sliding positioner 313 moves the manually slidable sleeve 312 proximally, and distal movement of the sliding positioner 313 moves the manually slidable sleeve 312 distally.
  • FIGS 23A and 23B illustrate a semi-automatic version of the electrosurgical probe 300.
  • Proximal movement of the sliding positioner 320 urges the dielectric sheath 312 distally to thereby cover the electrosurgical electrode 310.
  • Distal movement of the sliding positioner 320 urges the dielectric sleeve 312 proximally to thereby expose the electrosurgical electrode 310.
  • the electrosurgical electrode 310 is automatically covered by the dielectric sheath 312 whenever the electrosurgical probe 300 is withdrawn through a trocar as a result of frictional engagement with the trocar seal.
  • Figures 20A-23B illustrate several embodiments using a slidable sleeve.
  • the slidable sleeve and/or the electrosurgical electrode 310 may be controlled by one or more slidable positioners. Additionally, the slidable sleeve may be controlled independently by frictional forces. Combinations of manual and frictional control of the slidable sleeve are also possible.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Un instrument électrochirurgical comprend une électrode (47) mobile et déformable. L'électrode (47) peut être déplacée proximalement ou distalement à l'intérieur d'une gaine (34) puis mis en forme à l'endroit où doit être pratiquée la chirurgie pour s'adapter aux divers besoins de découpe et de cautérisation. L'électrode (47) peut comprendre un fil (43) qui sert à envoyer du courant à des endroits spécifiques et qui est façonnable/déformable pour s'adapter aux divers besoins en matière de chirurgie. On fait passer un signal radioélectrique dans le fil (43) pour assurer la découpe et la cautérisation en des endroits chirurgicaux spécifiques. L'électrode (43) à fil est capable de fournir une forte concentration d'énergie tout en maintenant un réglage de puissance relativement faible.
PCT/US1997/007497 1996-05-02 1997-05-01 Instruments electrochirurgicaux du type a fil WO1997040759A1 (fr)

Applications Claiming Priority (2)

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US1671296P 1996-05-02 1996-05-02
US60/016,712 1996-05-02

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Cited By (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5989264A (en) * 1998-06-11 1999-11-23 Ethicon Endo-Surgery, Inc. Ultrasonic polyp snare
EP2298204A1 (fr) * 2009-09-21 2011-03-23 Karl Storz GmbH & Co. KG Instrument médical pour l'électrochirurgie bipolaire
US7976501B2 (en) 2007-12-07 2011-07-12 Ethicon Endo-Surgery, Inc. Trocar seal with reduced contact area
US8100929B2 (en) 2007-06-29 2012-01-24 Ethicon Endo-Surgery, Inc. Duckbill seal with fluid drainage feature
WO2012012173A1 (fr) * 2010-06-30 2012-01-26 Salient Surgical Technologies, Inc. Dispositif électrochirurgical présentant une électrode en u et/ou des électrodes coplanaires
WO2012033629A3 (fr) * 2010-09-10 2012-05-10 Carefusion 2200, Inc. Gaine de protection
US8273060B2 (en) 2008-04-28 2012-09-25 Ethicon Endo-Surgery, Inc. Fluid removal in a surgical access device
US8579807B2 (en) 2008-04-28 2013-11-12 Ethicon Endo-Surgery, Inc. Absorbing fluids in a surgical access device
CN103584913A (zh) * 2013-10-21 2014-02-19 魏云海 一种多功能医用电凝器
US8690831B2 (en) 2008-04-25 2014-04-08 Ethicon Endo-Surgery, Inc. Gas jet fluid removal in a trocar
US8740883B2 (en) 2010-09-30 2014-06-03 Carefusion 2200, Inc. Detachable handle mechanism for use in instrument positioning
US8776800B2 (en) 2010-09-30 2014-07-15 Carefusion 2200, Inc. Sterile drape having multiple drape interface mechanisms
US8870747B2 (en) 2008-04-28 2014-10-28 Ethicon Endo-Surgery, Inc. Scraping fluid removal in a surgical access device
US8920417B2 (en) 2010-06-30 2014-12-30 Medtronic Advanced Energy Llc Electrosurgical devices and methods of use thereof
USD735852S1 (en) 2008-04-28 2015-08-04 Ethicon Endo-Surgery, Inc. Fluid remover
USD736926S1 (en) 2008-04-28 2015-08-18 Ethicon Endo-Sugery, Inc. Trocar housing
US9358041B2 (en) 2008-04-28 2016-06-07 Ethicon Endo-Surgery, Llc Wicking fluid management in a surgical access device
US9498107B2 (en) 2010-08-06 2016-11-22 Carefusion 2200, Inc. Clamping system
WO2017042169A1 (fr) * 2015-09-07 2017-03-16 Creo Medical Limited Anse électrochirurgicale
US9974599B2 (en) 2014-08-15 2018-05-22 Medtronic Ps Medical, Inc. Multipurpose electrosurgical device
US11235111B2 (en) 2008-04-28 2022-02-01 Ethicon Llc Surgical access device

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US5197964A (en) * 1991-11-12 1993-03-30 Everest Medical Corporation Bipolar instrument utilizing one stationary electrode and one movable electrode
US5318564A (en) * 1992-05-01 1994-06-07 Hemostatic Surgery Corporation Bipolar surgical snare and methods of use
US5354296A (en) * 1993-03-24 1994-10-11 Symbiosis Corporation Electrocautery probe with variable morphology electrode
US5366476A (en) * 1993-04-02 1994-11-22 Laparomed Corporation Handle for laparoscopic instrument
US5415656A (en) * 1993-09-28 1995-05-16 American Medical Systems, Inc. Electrosurgical apparatus

Cited By (28)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5989264A (en) * 1998-06-11 1999-11-23 Ethicon Endo-Surgery, Inc. Ultrasonic polyp snare
US8100929B2 (en) 2007-06-29 2012-01-24 Ethicon Endo-Surgery, Inc. Duckbill seal with fluid drainage feature
US7976501B2 (en) 2007-12-07 2011-07-12 Ethicon Endo-Surgery, Inc. Trocar seal with reduced contact area
US8690831B2 (en) 2008-04-25 2014-04-08 Ethicon Endo-Surgery, Inc. Gas jet fluid removal in a trocar
US8273060B2 (en) 2008-04-28 2012-09-25 Ethicon Endo-Surgery, Inc. Fluid removal in a surgical access device
USD878606S1 (en) 2008-04-28 2020-03-17 Ethicon Llc Fluid remover
US9033929B2 (en) 2008-04-28 2015-05-19 Ethicon Endo-Surgery, Inc. Fluid removal in a surgical access device
US9827383B2 (en) 2008-04-28 2017-11-28 Ethicon Llc Surgical access device
US8579807B2 (en) 2008-04-28 2013-11-12 Ethicon Endo-Surgery, Inc. Absorbing fluids in a surgical access device
US9358041B2 (en) 2008-04-28 2016-06-07 Ethicon Endo-Surgery, Llc Wicking fluid management in a surgical access device
US11235111B2 (en) 2008-04-28 2022-02-01 Ethicon Llc Surgical access device
USD736926S1 (en) 2008-04-28 2015-08-18 Ethicon Endo-Sugery, Inc. Trocar housing
USD735852S1 (en) 2008-04-28 2015-08-04 Ethicon Endo-Surgery, Inc. Fluid remover
US8870747B2 (en) 2008-04-28 2014-10-28 Ethicon Endo-Surgery, Inc. Scraping fluid removal in a surgical access device
EP2298204A1 (fr) * 2009-09-21 2011-03-23 Karl Storz GmbH & Co. KG Instrument médical pour l'électrochirurgie bipolaire
US8906012B2 (en) 2010-06-30 2014-12-09 Medtronic Advanced Energy Llc Electrosurgical devices with wire electrode
US8920417B2 (en) 2010-06-30 2014-12-30 Medtronic Advanced Energy Llc Electrosurgical devices and methods of use thereof
US9445858B2 (en) 2010-06-30 2016-09-20 Medtronic Advanced Energy Llc Bipolar electrosurgical device
CN103153221A (zh) * 2010-06-30 2013-06-12 美敦力先进能量有限公司 具有u形电极和/或共面电极的电外科装置
WO2012012173A1 (fr) * 2010-06-30 2012-01-26 Salient Surgical Technologies, Inc. Dispositif électrochirurgical présentant une électrode en u et/ou des électrodes coplanaires
US9498107B2 (en) 2010-08-06 2016-11-22 Carefusion 2200, Inc. Clamping system
WO2012033629A3 (fr) * 2010-09-10 2012-05-10 Carefusion 2200, Inc. Gaine de protection
US8776800B2 (en) 2010-09-30 2014-07-15 Carefusion 2200, Inc. Sterile drape having multiple drape interface mechanisms
US8740883B2 (en) 2010-09-30 2014-06-03 Carefusion 2200, Inc. Detachable handle mechanism for use in instrument positioning
CN103584913A (zh) * 2013-10-21 2014-02-19 魏云海 一种多功能医用电凝器
US9974599B2 (en) 2014-08-15 2018-05-22 Medtronic Ps Medical, Inc. Multipurpose electrosurgical device
WO2017042169A1 (fr) * 2015-09-07 2017-03-16 Creo Medical Limited Anse électrochirurgicale
US11172985B2 (en) 2015-09-07 2021-11-16 Creo Medical Limited Electrosurgical snare

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