WO1999037225A1 - Dispositif electrochirurgical pouvant etre fixe sur un instrument - Google Patents

Dispositif electrochirurgical pouvant etre fixe sur un instrument Download PDF

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Publication number
WO1999037225A1
WO1999037225A1 PCT/US1999/001023 US9901023W WO9937225A1 WO 1999037225 A1 WO1999037225 A1 WO 1999037225A1 US 9901023 W US9901023 W US 9901023W WO 9937225 A1 WO9937225 A1 WO 9937225A1
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WO
WIPO (PCT)
Prior art keywords
electrosurgical
tissue
sheath
electrode arrangement
instrument
Prior art date
Application number
PCT/US1999/001023
Other languages
English (en)
Inventor
Mark A. Destefano
Glenn H. Stahl
W. Keith Stoneback
David C. Downey
Original Assignee
Surgical Laser Technologies, Inc.
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 Surgical Laser Technologies, Inc. filed Critical Surgical Laser Technologies, Inc.
Priority to AU24590/99A priority Critical patent/AU2459099A/en
Publication of WO1999037225A1 publication Critical patent/WO1999037225A1/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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • 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
    • A61B2018/1495—Electrodes being detachable from a support structure

Definitions

  • the present invention relates to electrosurgical devices, and in particular to electrosurgical devices which can be used in conjunction with other surgical devices without substantially altering the structure or operation of such other devices.
  • Surgeons have a wide variety of instruments to use in performing surgery.
  • Some instruments as for example scalpels, have no external power source other than the surgeon's own hand.
  • a number of other mechanical instruments have moving parts that are driven by an external power source.
  • atherectomy devices used for opening clogged blood vessels in cardiovascular surgery and debriders for use on polyps in ear, nose, and throat surgery.
  • Still other instruments deliver special forms of energy to the tissue to be treated.
  • Such other instruments include, for example, laser surgical systems, cryosurgical systems, and electrosurgical systems.
  • Electrosurgical systems can be particularly effective in stanching blood (“hemostasis”) from severed vessels (“bleeders”) of all sizes up to approximately 2 mm, as are often encountered in surgery. Hemostasis through ESU capability reduces the number of occasions that time-consuming and cumbersome ligatures must be used to tie off such bleeders. Electrosurgical systems can be especially effective for bleeders in areas difficult to reach and in minimally invasive procedures. If hemostasis is promptly effected, then the patient benefits from less blood loss, and the surgeon benefits from a clearer field of view.
  • U.S. Patent No. 4,375,218 to DiGeronimo discloses a combination scalpel and forceps, to which can be imparted monopolar ESU capability.
  • the scalpel is retractable to the interior surface of one of the arms of the forceps. Electric current can be passed through the forcep arms to the tips of the forceps, so that the tips, when gripping tissue, can coagulate the tissue under pressure.
  • the scalpel must be retracted before the forceps can be used for coagulation.
  • U.S. Patent No.4,640,279 to Beard discloses a combination surgical scalpel and monopolar electrosurgical instrument. The scalpel blade is electrically heated.
  • the tip of the electrode is canted away from scalpel blade, and the tip of the scalpel blade projects beyond the tip of the electrode.
  • the back of the blade is clipped to the shank of a parallel active electrosurgical electrode.
  • the shank of the electrode thus forms an axis of rotation with the back of the scalpel.
  • U.S. Patent No. 4,651,734 to Doss et al. discloses in combination a surgical instrument that uses pressure on the tissue to cut (e.g. scalpel) and a first electrosurgical electrode.
  • the first electrode is attached to the back of the scalpel by means of bulky clips which allow adjustment of the electrode.
  • the pressure- cutting means acts as a second electrosurgical electrode that is the bipolar counterpart to the first electrode.
  • the tip of the first electrode and the tip of the scalpel terminate abreast of each other.
  • An electrode assembly that can be detachably combined with an aspiration/irrigation cannula is disclosed in U.S. Patent No. 5,662,647 to Crow et al.
  • the electrode assembly slides within the cannula to reach the surgical site.
  • the patent also discloses an electrosurgical method employing the apparatus described in the patent.
  • the electrode assembly has the disadvantages that it uses up valuable space in the cannula, and does little to conform its structure to the structure of the cannula.
  • U.S. Patent No. 5, 164,945 to Long et al. discloses a tapered laser probe that has adjunctive ESU capability.
  • the mid-section of the probe has a zone encircling the taper that is coated with a conductive element that has enough resistance to generate ohmic heating from current supplied by electrical leads.
  • ohmic heating these devices heat a broad zone, rather than pass current in a more controlled fashion between two discrete contact points; these devices also - 3 -
  • U.S. Patent No . 5 , 647 , 867 to Neuberger et al discloses a side-firing laser probe that has an internally retractable loop scraper.
  • the laser first coagulates a broad swath of tissue; the scraper, being an ohmically heated wire, resects the tissue that has just been coagulated.
  • the scraper requires a significant amount of internal space within the device, and when in operation, neither the scraper nor the laser probe offers selective, spot coagulation.
  • the device is more suited to gross dissection of tissue and broad coagulation.
  • Alternative current pathways for a bipolar surgical cutting tool are disclosed in U.S. Patent No. 5,531,744 to Nardella et al.
  • U.S. Patent No. 4,862,890 to Stasz et al. discloses an electrode arrangement having a ceramic substrate that serves as an insulative layer between an active and a return electrode.
  • the substrate is tapered like a spatula, surrounded by an edge that is blunt, and not sharp.
  • Metallized patterns are placed onto the ventral and dorsal sides of the substrate, up to the blunt edge, which is ground to be free of metal traces. This arrangement cuts tissue by the flow of electrical energy from one metallized side of the substrate, over the blunt edge, to the other metallized side.
  • the blunt edge being ceramic and therefore able to withstand greater heat than a metal edge, provides incidental coagulation to the cut tissue, though it does so through thermal conduction, and not by electrical flow.
  • the primary - and only — instrument is the electrosurgical device itself, which is designed to be a cutter for use in open surgery. Moreover, this instrument does not offer selective, spot coagulation.
  • U.S. Patent No. 5,514,134 to Rydell et al. discloses a bipolar electrosurgical scissors.
  • a layer of non-conductive material is supplied to surfaces of the underlying blade members , thereby insulating and defining the coacting blade surfaces that act as bipolar electrodes.
  • the drawbacks of these devices are that they coagulate tissue that is being cut, whether it requires coagulation or not, and that, in insulating the coacting scissors blades with ceramic, they must alter the structure and functionality of the other instrument in order to accommodate the ESU adjunct.
  • U.S. Patent No. 5,389,104 to Hahnen et al. discloses an arthroscopic jaw arrangement housed by a hollow tube. An electrical current is supplied to the jaws through the tube and thus provides monopolar ESU capability to the jaws.
  • the tube is insulated by means of plastic or ceramic that is shrink- - 4 -
  • ESU device which can be economically manufactured, attached readily within the sterile field to other surgical instrumentation for safe, immediate, conjunctive use when necessary, and readily detached from the other instrumentation after the procedure and disposed of. Such use should allow a surgeon to selectively and precisely coagulate tissue.
  • Such concurrent use eliminates the need in the course of a surgical procedure for a separate, discrete device having ESU capability and reduces the time spent in surgery, thereby benefitting both the patient and the surgeon.
  • Such capability can be especially valuable when the other surgical instrument is a power- driven tissue cutter operating in a blood-rich environment.
  • the invention encompasses an ESU device by which electrical energy, typically at radio frequency, can be made available as an attachment to other surgical instrumentation and used concurrently with such other instrumentation. After such use, the ESU device may be readily detached and economically disposed of.
  • the invention includes an electrosurgical device for attachment to a surgical instrument, comprising an electrode arrangement having a first end for connection to an electrosurgical generator and a second end remote from the first end for engaging tissue to be electrosurgically treated, and a carrier for supporting the electrode arrangement and removably attaching it to a non-electrosurgical instrument at a location thereon adjacent an operative region thereof to bring the second end of the electrode arrangement into proximity with tissue being operated on by the non-electrosurgical instrument, whereby a person operating the non-electrosurgical instrument can treat tissue by a selected one of the electrode arrangement and the non-electrosurgical instrument.
  • the electrode can be wire, cable, or similar conductor of proper composition, gauge, and shape. Alternatively, the electrode can be a conductive film or layer placed on an insulative substrate.
  • the electrode has at its proximal end a connector (e.g. , a wire with a plug) by which the conductor can be connected to an ESU generator.
  • a connector e.g. , a wire with a plug
  • the distal end of the conductor comes in near contact or direct contact with the tissue and couples the electrical energy into the tissue.
  • the carrier by which the conductor is attached to the other instrumentation should generally conform to the surface to which it is attached and should minimize the amount by which it augments the cross-sectional dimensions of the other instrumentation, and thus not obstruct the surgeon's line of sight of the tissue being treated or interfere with the operation of such other instrumentation.
  • One form of carrier is a tape in which are embedded the conductors. The tape may be attached to the other instrumentation in the sterile field. Such tape would be sufficiently adhesive to resist the abrasion, heat and fluids encountered in surgery. Such tape would also act as an insulator to prevent the electrical energy from leaking from the conductor to the other instrumentation or elsewhere.
  • sheath is a sheath, shroud, or cover (called “sheath” hereinafter) of a polyimide or other plastic of similar strength, firmness, and electrical resistivity, which fits onto and over the other instrumentation.
  • the sheath has a distal end, a proximal end, and an intermediate shank or body portion. The distal end does not necessarily completely envelop the operative region of the other instrumentation for in most cases the operative region must not have any intermediary elements between the tissue and itself.
  • Within such sheath are embedded the conductors.
  • the sheath surrounds and secures the conductors and insulates them.
  • the sheath also protects the ensheathed surface of the underlying apparatus from bioburden and, thus, the underlying apparatus is easier to clean.
  • sheath as used herein may also be used to refer to the entire apparatus according to the invention, and therefore may encompass not only the distal end, proximal end, and intermediate body portion, but also a collar and connecting cables as described hereinbelow.
  • the material of the sheath can be rigid, semi-rigid, or malleable. It may even be thin-walled and supple, on the order of a prophylactic sheath, in which case silicone, which has very high compliance and flexibility, may be used. Where the underlying instrumentation itself may be flexed or bent during the procedure, the overlying sheath should conform and adapt to such changes.
  • a stable and snug fit of the sheath over the underlying instrumentation may be secured in any of several ways.
  • the cross-sectional shape of the sheath may be different from that of the underlying apparatus.
  • the cross-sectional dimensions of the sheath can be varied along the body of the sheath from the distal end to the proximal end. In both cases, a friction fit can be achieved between the sheath and the underlying instrumentation.
  • Ribs or protrusions may be provided on the inner surface of the body portion of the sheath, which serve both to hold the sheath in place longitudinally with respect to the underlying instrumentation and to prevent the sheath from shifting radially around the outer circumference of the underlying instrumentation.
  • the sheath will be designed on similar principles to conform and attach to the different shape.
  • the proximal end of the sheath may include a collar that helps secure the sheath to the other instrumentation.
  • the collar may, but need not, be thicker than the body of the sheath. A thicker collar enables easier manipulation by the operator, but the collar should not be so thick as to obstruct the operator's line of sight when using the underlying instrumentation or otherwise interfere with the manipulation and operation of the underlying instrumentation.
  • the means for applying the electrical energy varies according to whether monopolar or bipolar ESU capability is desired. If monopolar ESU capability is desired, then the conductors will supply the surgical site with electrical energy, which in turn will find a return through the patient's body to grounding pads attached to the patient. Such grounding pads are well known in the art for conducting the electrical energy. If bipolar ESU capability is desired, then at least one of the conductors can be a return conductor. Alternatively, the other instrumentation, if it itself is conductive, may be able to serve as a return conductor for both the monopolar and bipolar types.
  • a gap is left between the distal ends of the conductors leading the electrical energy to the site. Electrical energy flows across the gap and, depending upon the waveform and electrical power density selected, the flow of energy may either cut or coagulate or fuse the tissue.
  • the size, shape, and location of the distal ends of the conductors will vary according to the nature of the tissue and the nature of the surgical effect that is desired.
  • the gap may be situated such that it is unable to reach the site to be cut or coagulated. Having a broader surface may materially enhance the operability and effectiveness of the instrumentation.
  • a single conductor may carry electrical energy to plural contact points, which may be deployed in any desired arrangement to apply the electrical energy to the surgical site.
  • Fig. 1 illustrates a full side view, a bottom view, and a cross- sectional view of a polyimide sheath over a debrider tip usable in ear, nose, and throat surgery.
  • Fig. 2 illustrates a side view, a bottom view, and a cross-sectional view of a sheath fitted over the distal portion of a debrider tip.
  • Fig. 3 illustrates a side view, a bottom view, and a cross-sectional view of a tape or flex circuit with two conductors applied to the distal portion of a debrider tip.
  • Fig. 4 illustrates a side view, a bottom view, and a cross-sectional view of a sheath over the distal portion of a debrider tip.
  • Fig. 5 illustrates a side view, a bottom view, and a cross-sectional view of a sheath with ribs and flat heads over a debrider tip.
  • Fig. 6 illustrates a side view, bottom view and cross-sectional view of a sheath over the distal portion of a debrider tip, where two round leads flank the bottom (dorsal) side.
  • Fig. 7 illustrates a side view and cross-sectional view of a sheath that has been fitted over a suction device.
  • Fig. 8 illustrates an end view of an ovate sheath before it is fitted over a debrider tip.
  • Fig. 9 illustrates a side view of a sheath having a sensor and contact points on a pectoral side of a debrider housing which is used as the return conductor.
  • a sheath made of polyethylene leads two conductors to the distal end of the other surgical apparatus to which it is attached and conforms.
  • the other surgical apparams is a debrider tip commonly used in ear, nose and throat surgery.
  • Each conductor terminates at the fore or distal end in a contact point; the contact points define a gap between themselves.
  • the electrical energy flows through the conductor leading to the surgical site, from a distal contact point across the gap to a contact point attached to a conductor leading the energy from the site.
  • the housing for the debrider tip is a cylindrical tube, typically terminating in a rounded distal end. Out of the distal end of the tip is cut out a window. The cut is at a shallow bevel. At the window, tissue is severed by the cutting mechanism within the debrider housing.
  • the debrider illustrated is a tip for the Hummer 1 (SSE4 arthroscopic shaving system), made by Stryker Corporation, Kalamazoo, Michigan, and has an outer tubular diameter of approximately 3.4 mm in its shank.
  • the Hummer 1 has counterparts in: the Hummer 2 also made by Stryker, the Wizard and the XPS Straightshot, made by Xomed Surgical Products, Inc.
  • the tube is manufactured to have a curved contour, and in some cases, the tips may be bent or reshaped in the course of the surgical procedure.
  • the debrider tip also typically aspirates the severed tissue.
  • the sheath adds no more than about 1 mm thickness at any given point to the outer diameter of the debrider tip. Minimizing the radial augmentation preserves the visibility of the surgical site. However, even with thicknesses up to 2 mm in special sectors, there can still be an adequate line of sight.
  • the debrider tips available in the market have similar tubular diameters and window locations at the distal end of the tip, it is contemplated that a single embodiment of the present invention may adapt and attach to the tips of various manufacturers which have the same or similar outer diameters. Where such tips share a similar tabular diameter but differ in the length by which the outer tubes extend from their respective handpieces, the multi-adaptable sheath would gauge its length from the shortest of the tips to which it adapts and attaches. If desired, the proximal region of the body of the sheath may have a portion which is folded or pleated like an accordion.
  • the accordion folds enable the length of the sheath to be increased by extending the folds, and thus the proximal region of the sheath may be made to abut the hub of the debrider.
  • the folded portion is free of internal ribs or protrusions, so as to be freely extendible.
  • the sheath is made of a polymeric material (e.g., polyimide, polyethylene). In the preferred embodiment, such material has the necessary strength to withstand the heat and abrasion encountered in surgery.
  • the sheath is no more than about 1 mm thick where the conductors are embedded, and is thinner elsewhere.
  • the sheath can tolerate a temperature range of -10 °C. to at least + 100 °C. and can withstand 30% to 100% relative humidity. Yet it is sufficiently malleable that it may adjust to reshaping of the debrider tip and can insulate against power levels up to 300 watts in monopolar mode, and up to 150 watts in bipolar mode. Yet the recommended maximum power in normal use is 18 watts.
  • the particular polymeric material selected is biocompatible and non-reflective.
  • the material is also sterilizable by ethylene oxide (EtO), which is in common use in the health care industry.
  • the collar may comprise an elastomeric material (e.g., polyurethane) or a rigid material with an elastomeric seal to hold it in place.
  • the collar compresses securely onto the tubular housing of the debrider tip. It also provides a strain relief for the conductors and connecting cables. Its wall is about 1 mm thick and about a little more than 2.3 mm long, and has an inside quasi-diametrical dimension of approximately 3 mm.
  • the sheath and collar can be shaped to be slightly ovate with a minor and a major axis. Their outer perimeter is preferably slightly eccentric to the circumference or other perimeter of the debrider tip. By pinching the sheath and collar, one can make their inside dimension to be roughly concentric with the outer dimension (e.g. tubular diameter) of the debrider tip. In this manner, the sheath and collar can be more easily fitted and attached. When the pinch is released, the sheath and collar will grip the debrider housing firmly along their minor axes.
  • Such ovateness will also allow the sheath to be attached to instruments of diameters smaller than that of the illustrated debrider, provided that the minor axis of the sheath is smaller than the diameter of the housing. - 10 -
  • the sheath can have internal ribs or flutes to aid in securing the sheath against rotation or slippage.
  • the ribs create a source of close contact or friction between the debrider tip and the sheath.
  • the ribs also serve to add structure and form to the sheath, which makes the sheath easier to handle.
  • the sheath may have an internal perimetric dimension (e.g. internal circumference) that decreases from the proximal end to the distal end, thus aiding in attaining a snug, secure fit.
  • the sheath in the preferred embodiment is about 80 mm long, thereby matching the Hummer 1 shaver tip, which has a length of about 80.4 mm along the tubular housing from its hub.
  • the collar will therefore lie fore of the point where the debrider tip enters the debrider handpiece.
  • the collar and sheath are open, so as to fit over the debrider tip.
  • the sheath is closed and bullet-shaped to conform to the fore end of the tip. A portion of the fore end of the sheath is cut out so as to conform to the window of the tip.
  • the edge of the cut-out of the sheath may be chamfered or radiused to be smooth, or it may be flat cut.
  • the cut-out measures about 11.5 mm in length and about 2.1 mm deep, and lies therefore not at the very perimeter of the window of the tip, but stands no closer than about 0.35 mm to the rim of the window.
  • the cut-out of the sheath should give ample berth to the window of the tip, lest the sheath may be drawn into the window and be destroyed by the debriding mechanism within the tip or interfere with the aspiration mechanism or lest there be inadvertent arcing to the housing.
  • the fit of the sheath at the distal end should be tight and snug. It should not slip or rotate.
  • a desirable property of the polyimide in the preferred embodiment is that it has enough elasticity to conform and compress the distal surface of the tip. In an embodiment where the internal dimension of the sheath is less at the distal end than at the proximal end, the snugness of the fit will be aided.
  • Embedded within the sheath are two conductors.
  • one of the conductors conducts radio frequency current to the surgical site, and the other one returns the current to the ESU generator.
  • Each conductor is a wire of 0.635 mm (0.028 inches) diameter (23 AWG).
  • Exemplary wires are copper or tinned copper, in either flat or round cross-section.
  • the wire should be robust enough to withstand powers of 300 watts if used in the monopolar mode and up to 150 watts if used in the bipolar mode, though recommended maximum power in normal use is 18 watts .
  • the wires start from the collar and lead to the contact points.
  • the connecting cables From the collar, there are two other wires, called the connecting cables, (one for each conductor) that extend to the ESU generator. Such wires may be up to 10 feet long. At the proximal ends of such wires are standard universal - 11 -
  • banana connectors that plug into the ESU generator. It is possible to make the connecting cables plug into the conductors or into the standard banana connector.
  • An exemplary ESU generator that can be used with the preferred embodiment is a Force IB, made by Valleylab of Boulder, Colorado.
  • Other ESU generators may be used with the present invention. Among such generators are those made by Conmed, Erbe, Everest, and Valley Forge Scientific. Such generators can be activated by foot pedals.
  • contact points are circular, rectangular or shaped pads resembling nodules or nubbins. They may be integrally joined to the conductors or clamped, welded, or soldered, which is the means utilized in the preferred embodiment. If they are flat, they may be formed simply from the ends of the conductors.
  • the contact tips may be flush with the distal surface of the sheath, or preferably will extend outward slightly from the distal surface. While the contact points may also be recessed from the distal surface of the sheath, such an arrangement is less preferred.
  • the contact points in the preferred embodiment are no further than about 3 mm from the distal tip of the sheath, and will lie on a slope of the sheath that gives them access to tissue lying in front of the tip and to tissue lying on the side of the device.
  • a coagulum of tissue can accumulate in the region of the sheath around the contact points. The coagulum can be reduced if energy is applied to burn it off.
  • Contact tips which extend outward from the distal surface appear to enhance the ready flow of energy between contact points and thus facilitate the reduction of coagulum.
  • the contact points have a minimum cross-sectional diameter of about 0.6 mm and are at a minimum about 0.8 mm away from each other.
  • the sheath should be as thin as possible while still providing proper insulation and support. Keeping the sheath thin makes for easier attachment and detachment and avoids interference with the surgeon's line of sight. - 12 -
  • the sheath adds, overall, no more than about 1 mm to the overall thickness at any given point on the tubular housing of the debrider tip.
  • the sheath is not of a uniform thickness.
  • the sheath is thicker, to provide necessary strength and electrical resistance.
  • the thickened side lies on the side (dorsal) opposite to the side (ventral) on which the window of the debrider is. In other embodiments, the thickened side may lie along the pectoral, or lateral, sides, shifted somewhat to the dorsal side, without significantly interfering with the line of sight.
  • the dorsal side of the sheath in the preferred embodiment are indicator marks to aid in measuring the distance in centimeters
  • the present invention is intended to be used in a single surgical procedure, and then discarded.
  • the materials used in manufacturing the invented device are commonly available, and the manufacture of the device through insert molding or extrusion or deposition of layers (as in flex circuits) is not labor-intensive.
  • the preferred embodiment of the sheath need not be used right away; it can stay on the shelf for at least one year and still be fully useable.
  • the present invention can therefore be economically disposed of after use, thus averting the risk of passing infection to another patient.
  • Those skilled in the art and knowledgeable in the health care industry understand that such device should be disposed of, and otherwise used, in accordance with the instructions for use and standard medical procedures.
  • the conductive means can be a film or layer placed on an insulative substratum.
  • the sheath can be of similar shape as in the preferred embodiment, but the thickening of the one side to accommodate the conductors may be lessened if a substratum and film are used.
  • the substratum can be painted on a strip of the sheath. Polymeric or ceramic coatings can be used in thicknesses of approximately 0.1 to 0.25 mm.
  • Onto the substratum can be applied a film or layer that is conductive. Such film or layer will contain particles or concatenations of electrically conductive substances. A molybdenum, copper, or nickel-base conductive coating of about 0.2 mm thickness can be used for this purpose.
  • a copper flat stock can be used, as in flex circuits.
  • the conductor may be etched to the desired shape.
  • an insulative superstratum is applied to the conductive film or layer.
  • a polyethylene sheath may serve as a substratum.
  • flex-circuit conductors and contact points are applied over the conductors.
  • flex circuits use a stock assembly of insulating layers surrounding a conductive layer.
  • ESU capability may be attached to a surgical suction device.
  • An exemplary suction device is a Frazier-style suction handpiece. The same principles applicable to the preferred embodiment can be used for the suction device.
  • the suction device is often used simultaneously with other surgical instrumentation. It will be readily apparent that, when the invention is used with a suction device, the distal end of the sheath must not obstruct the ability of the device to aspirate, and in the usual case the distal end of the sheath will be open at the fore end.
  • Attaching the ESU capability to a suction device can be advantageous in reducing the accumulation of coagulum on and between the contact points.
  • Tissue, especially blood, when subjected to the electrosurgical energy may stick or cling to the region where fher contact points are located. Such coagulum can diminish the effectiveness of the contact points.
  • the surgeon will find it beneficial if the suction device is first used to clear the tissue of blood and the sheath is then used to coagulate or stanch the tissue to be treated.
  • FIG. 1 is an illustration of the preferred embodiment of the present invention.
  • Sheath 1 has been fitted over debrider tip 2.
  • Sheath 1 has a distal end 6, a body portion 7, and a folded portion 8 near the proximal end of sheath 1.
  • a shank portion 7, folded portion 8 of the sheath 1, and the collar 9 fit snugly over tubular body 5 of debrider tip 2.
  • a cut-out area 3 defines a window 4, through which the cutting mechanism of the tip 2 is able to contact the tissue being treated.
  • the folded portion 8 is at the proximal end of the sheath 1. It should be understood that a particular embodiment of the present invention need not have a folded portion 8, in which case the body portion 7 can be regarded as extending to and connected with a collar 9.
  • the collar 9 may be joined to body portion 7 by fusion or bonding to the proximal end of the folded portion 8, or by any other suitable method of attachment.
  • the collar 9 is generally thicker than the folded portion 8 and body portion 7 of the sheath 1.
  • Two conductors 10 are embedded within the dorsal wall of the sheath. As can be seen in the cross-section in Figure 1 , the portion 15 of the wall encompassing the conductors is thicker than other portions of the wall.
  • the conductors 10 terminate in contact points 11.
  • the contact points 11 emerge from - 14 -
  • the distal portion 6 roughly midpoint on the slope between the fore end of the sheath and the dorsal wall.
  • connecting cables 12 are joined to the conductors 10.
  • the connecting cables 12 terminate at their proximal ends in a plug
  • the ribs 14 extend from the distal end 6 of the body portion 7 to the folded portion 8.
  • Figure 2 is an enlarged depiction of the distal end features of the sheath illustrated in Figure 1. At the distal end of the tip 2 and sheath 1 is shown a space 22, which is the closest that the cut-out comes to the window 4.
  • Figure 3 illustrates an embodiment of the present invention utilizing adhesive-backed flex circuit tape as the means by which the ESU capability is attached to the underlying apparatus.
  • Tape 41 is applied to the dorsal side of the debrider tip 42, with adhesive on one side of the tape.
  • the tape 41 lies in the region where the tubular body 45 of debrider tip 42 begins to round off at its distal end. If the tape 41 were to extend much onto the rounded contour, then there would be doubling over of the tape. Nevertheless, a flex circuit tape can be pre- fashioned to conform to even the most irregular underlying contours.
  • contact points 51 At the end of the distal portion 46 of the tape 41 are contact points 51.
  • Two contact points 51 are shown at the distal ends of the two conductors 50.
  • the conductors 50 are flat layers of conductive material, as can be seen in the cross-section. Sandwiching the conductive material are top and bottom pads 47 of insulative material.
  • the contact points 51 could conform to the flat dimensions of the conductors 50, or could be thickened so as to provide more robust electrodes.
  • the conductors 50 are exposed not only at their distal ends but also on their dorsal sides to enable coagulation on the dorsal side.
  • the tape is chamfered at 52 in order to expose the dorsal sides of the conductors.
  • Figure 4 is similar to Figure 2, differing principally in the that the two conductors 70 are flatter (and thus make for less bulge or thickening in the wall), and in that conductor 70a leading energy to the site has four contact points 71a that semi-surround the contact point 71b of conductor 70b that returns the energy from the site.
  • the contact points 71a and 71b do not assume the flat dimensions of the conductors, but are rounded. Having multiple contact points 71a and 71b expands the region over which ESU capability may be obtained. - 15 -
  • Figure 5 is similar to Figure 4, differing principally in that each conductor 90 has but one contact point 91.
  • the contact points 91 are tarned toward each other, so that they are closer to each other than the conductors 90 are to each other.
  • the sheath has two conductors 110, and each conductor has one contact point 111.
  • the conductors 110 are channeled through thickened portions 115 of the walls of the sheath where the pectoral and dorsal sides meet. Locating the two conductors 110 in the flanks of the sheath reduces some of the need for a thickening of the sheath wall that lies between the conductors.
  • the contact points 111 are shown as emerging from the distal portion of the sheath 101 with as much separation between themselves as there is separation between the two conductors 110.
  • the two contact points 111 could be tarned toward each other, as in Figure 5, and thus shorten the gap between the two points.
  • Figure 7 illustrates a sheath 120 that has been fitted over the tabular body 125 of a suction device 121.
  • the sheath need not, and preferably should not, have a bullet-shaped, closed distal portion, for in this embodiment the suction device has an open distal aperture. A semi-enclosed distal portion may interfere with the aspiration of the suction device.
  • the body portion 127 of the sheath is fitted to be end-flush with the distal end of the suction device.
  • Four arcuate flat conductors 130 are depicted, each ending in its own contact point 131.
  • the sheath has four internal ribs 134 to help provide a snug fit over the tubular body 125.
  • the conductors 130 are exposed not only at their distal ends but also on their dorsal sides for a short distance, thus enabling coagulation on their dorsal sides, as well. Side portions 135 of the conductors 130 are exposed.
  • Figure 8 shows a cross-section of a sheath 141 before the sheath has been fitted over the debrider tip 142.
  • the sheath 141 has no internal ribs. Instead, the internal perimeter of the sheath at the body portion is essentially ovate or elliptical in shape. As such, the perimeter has a major axis 156 and a minor axis 157.
  • the major axis lies along the axis defined by the axis connecting the dorsal and ventral sides of the sheath.
  • the dorsal side encompasses the conductors 150 and has a thickened wall 155.
  • the minor axis 157 connects the pectoral sides of the sheath and runs normal to the major axis 156.
  • the debrider tip 142 has a tubular body with a circular cross-section.
  • the diameter of the debrider tip 158 is greater than the minor axis 157 and smaller than the major axis 156.
  • Sheath 141 is malleable, and by pinching sheath 141 along the major axis 156, the cross-section of the sheath can be forced into a circle of slightly larger diameter than the outer diameter of debrider tip 142, allowing the sheath to be slipped over the debrider tip. After the sheath is slipped over the debrider tip, the - 16 -
  • the center point of the tabular body of the debrider tip and the center point of the interior channel of the sheath should lie roughly on the same longitudinal axis.
  • Such capability may be added by way of a sensor 176 at the distal end of the carrier 161. This allows for visually locating the underlying instrument and the ESU capability. Like the contact points 171a, 171b, the sensor 176 may be protected from surgical rigors by the carrier 161.
  • the sensor 176 is connected to a control device 178 via a conductor 177 running parallel with the ESU conductors 170. Exemplary sensing devices are manufactured by Biosense, Inc. (Tel Aviv, Israel) and Visualization Technology, Inc. (Woburn, MA).
  • the contact points may be located in a variety of regions relative to the non-electrosurgical instrument. Referring to Figure 2, bringing the contact points 11 to bear when they are located on the dorsal side, opposite to the side including the window 4 may be difficult if, for example, the anatomical structure under operation is tight or the debrider tip 2 is curved. In such a circumstance (referring again to Figure 9) the contact points 171a, 171b may be located just below the edge of the window 164 at a first region 163a on either pectoral side of the housing 165. The contact points 171a and 171b may also be located on opposing sides of the window 164 so as to allow for coagulation from either side of window 164.
  • the contact points 171a, 171b may be located just proximal to the window 164, on the ventral side of the housing 165 at a second region 163b. In either case, the contact points 171a, 171b and the carrier 161 should not obstruct the surgeon's view of the surgical site. In order to reduce the bulk of the carrier 161 and also to gain greater flexibility in positioning a contact point 171 that delivers electrical energy to the tissue, it is possible to use the distal, shank and proximal portions of the debrider housing 165 as a return conductor. In this embodiment, both of the contact points 171a, 171b deliver electrical energy from the conductors 170a, 170b, respectively, to the tissue to be treated.
  • a single conductor may serve both contact points.
  • the contact points 171a, 171b may be located at the first region 163a, the second region 163b or any other region on the debrider housing 165 conducive for electrosurgical applications. Locating the contact points 171a, 171b in the first region 163a or the second region 163b allows the surgeon to more easily reach the tissue to be treated when the anatomical structure under treatment is tight or the debrider tip is curved.
  • a connecting cable 174 is attached to the proximal portion of the debrider tip 165 near the collar 169.
  • the connecting cable 174 will then retarn the current to the generator (not shown) and ground it. In this manner, a grounding pad, as used in conventional monopolar ESU is not necessary. In this manner, the retarn path of the current is controlled from errant passage through the body.
  • Each of the contact points 171a and 171b delivers electrical energy from conductor 170a to the tissue to be treated.
  • the rim of the window 164 adjacent the contact points 171a, 171b serves as the retarn contact point.
  • the retarn current will seek the path of least resistance, which given the voltage potential difference between the first region 163a and the generator, will be through the distal, shank and proximal portions of the debrider housing 165 to connecting cable 174 which leads to the ESU generator.
  • Connecting cable 174 collects the return current at junction 175 within collar 169.
  • Connecting cable 172 delivers current to the conductor 170a.
  • a single contact point 171a may be used in conjunction with the debrider housing 165 to provide bipolar ESU capability.
  • the single contact point 171a may reside at the first region 163a, the second region 163b or any other region on the debrider housing 165 that is conducive for electrosurgical applications.
  • magnetic resonance imaging MRI
  • Stainless steel, for example, can cause excessive interference with the magnetic field of an MRI and therefore is an undesirable material for surgical instruments used in these situations .
  • the non-electrosurgical instrument should be made of materials that do not interfere with and are virtually transparent to the magnetic fields generated by the MRI. Since the sheath is typically made with polymeric materials, it will not interfere with the magnetic fields of the MRI. However, the conductors and the contact points of the electrode arrangement of the ESU capability will be made of metallic, conductive materials. To this end, the conductors and contact points should thus make use of conductive materials that will cause minimal interference with and will be virtually transparent to the magnetic fields generated by the MRI. As stated above, titanium, for example, provides these characteristics.
  • the present invention is used in the following manner.
  • the device will have been packaged in sterile condition. It will be opened in the sterile field and attached to the debrider tip before the tip has been used in surgery.
  • the operator will then grasp the collar and draw it onto the fore end of the debrider tip. As the sheath and tip begin to rub, the operator pulls the sheath back, overcoming the friction between the sheath and the tip. If an ovate sheath is used, the operator pinches or squeezes the sheath and/or collar in order to make the sheath and/or collar roughly concentric with the debrider tip. The sheath is drawn back onto the debrider tip until the distal end of the sheath is in contact with the distal end of the debrider tip. The operator will check that the cut-out of the sheath lies around the window of the debrider tip. If there is some misalignment, the sheath will be adjusted until the cut out lies safely around and remote from the rim of the window.
  • the operator will assure that the conductors are not bent, that the contact points are intact, and that the collar is gripping the debrider tip at the body. Then the connecting cables from the collar may be connected or plugged directly or indirectly into the ESU generator.
  • a straight debrider tip will sever some blood vessels in the course of surgery through the cutting mechanism in the window.
  • the surgeon will identify where the vessel in question has been severed and will bring the window (ventral) side of the debrider tip to the vessel.
  • the surgeon will rotate the tip, and attached sheath, to the opposite (dorsal) side, apposing the contact points to the portion of the vessel that is to be coagulated and stanched.
  • the contact points jut out slightly from the sheath. The contact points are then gently pushed against the tissue, causing the tissue to be treated to lie between the jutting contact points.
  • the electrical energy is then applied at the appropriate power.
  • the bleeding should stop promptly after application of the electrical energy.
  • the apparent benefit from forming the surgical effect in this manner is that the path of the energy is direct from one bipolar point to the other, with less detour and therefore less collateral tissue damage, both in depth and in breadth.
  • the contact points are located more to the fore of the distal end of the sheath, it may be possible to avoid rotating the debrider tip in order to coagulate the tissue. Also, the contact points may be flush with the distal surface of the sheath. The same process may be repeated during the procedure. It is also feasible that tissue may be cut in this manner, with variations in the power and energy waveform. Furthermore, the device may be applied to tissue before the debrider removes the tissue. In this manner, the flow of blood may be anticipated and prevented. - 19 -
  • the device may be used to remove tags of tissue and seal up any remaining bleeders.
  • the leads are detached from the generator, and the sheath is removed from the debrider tip.
  • the sheath, along with the leads to the ESU generator, is then discarded according to standard medical procedures.
  • the debrider tip can be removed and resterilized, if desired.

Abstract

L'invention concerne un dispositif électrochirurgical (1) destiné à être fixé sur un instrument chirurgical. Ce dispositif comprend un agencement d'électrodes pourvu d'une première extrémité (13), destinée à être connectée à un générateur électrochirurgical, et d'une seconde extrémité (4), éloignée de la première extrémité et destinée à venir en contact avec le tissu devant être traité par électrochirurgie. Un support contient l'agencement d'électrodes, et le fixe de manière amovible à un instrument non électrochirurgical en un endroit adjacent à la région fonctionnelle dudit instrument non électrochirurgical, de manière qu'il soit possible d'amener la seconde extrémité de l'agencement d'électrodes à proximité du tissu en train d'être opéré par l'instrument non électrochirurgical. Un utilisateur de l'instrument non électrochirurgical peut choisir de traiter un tissu soit au moyen de l'agencement d'électrodes, soit au moyen de l'instrument non électrochirurgical.
PCT/US1999/001023 1998-01-26 1999-01-19 Dispositif electrochirurgical pouvant etre fixe sur un instrument WO1999037225A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU24590/99A AU2459099A (en) 1998-01-26 1999-01-19 Attachable electrosurgical device

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US7257398P 1998-01-26 1998-01-26
US60/072,573 1998-01-26
US5756898A 1998-04-09 1998-04-09
US09/057,568 1998-04-09

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Cited By (24)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1439793A2 (fr) * 2001-10-09 2004-07-28 Ethicon, Inc. Electrodes bipolaires a fonction auto-mouillante et pour environnement a champ sec destinees a la chirurgie endoscopique
US9078664B2 (en) 2012-06-20 2015-07-14 Gyrus Acmi, Inc. Bipolar surgical instrument with two half tube electrodes
WO2017066177A1 (fr) * 2015-10-16 2017-04-20 Ethicon Endo-Surgery, Llc Connexions de commande et électriques pour dispositif formant bistouri endoscopique à électrodes
US10265120B2 (en) 2017-06-28 2019-04-23 Ethicon Llc Systems and methods for controlling control circuits for an independent energy delivery over segmented sections
USD865175S1 (en) 2017-06-28 2019-10-29 Ethicon Llc Staple cartridge for surgical instrument
USD893717S1 (en) 2017-06-28 2020-08-18 Ethicon Llc Staple cartridge for surgical instrument
US10813640B2 (en) 2017-06-28 2020-10-27 Ethicon Llc Method of coating slip rings
US10888369B2 (en) 2017-06-28 2021-01-12 Ethicon Llc Systems and methods for controlling control circuits for independent energy delivery over segmented sections
US10888325B2 (en) 2017-06-28 2021-01-12 Ethicon Llc Cartridge arrangements for surgical cutting and fastening instruments with lockout disablement features
USD908216S1 (en) 2017-06-28 2021-01-19 Ethicon Llc Surgical instrument
US11013552B2 (en) 2017-06-28 2021-05-25 Cilag Gmbh International Electrosurgical cartridge for use in thin profile surgical cutting and stapling instrument
US11058477B2 (en) 2017-06-28 2021-07-13 Cilag Gmbh International Surgical cutting and fastening instruments with dual power sources
US11065048B2 (en) 2017-06-28 2021-07-20 Cilag Gmbh International Flexible circuit arrangement for surgical fastening instruments
US11103301B2 (en) 2017-06-28 2021-08-31 Cilag Gmbh International Surgical system coupleable with staple cartridge and radio frequency cartridge, and having a plurality of radio-frequency energy return paths
US11129666B2 (en) 2017-06-28 2021-09-28 Cilag Gmbh International Shaft module circuitry arrangements
US11160604B2 (en) 2017-06-28 2021-11-02 Cilag Gmbh International Surgical end effector to adjust jaw compression
US11272976B2 (en) 2017-06-28 2022-03-15 Cilag Gmbh International Surgical end effector for applying electrosurgical energy to different electrodes on different time periods
US11278346B2 (en) 2017-06-28 2022-03-22 Cilag Gmbh International Systems and methods of displaying surgical instrument status
US11298128B2 (en) 2017-06-28 2022-04-12 Cilag Gmbh International Surgical system couplable with staple cartridge and radio frequency cartridge, and method of using same
US11826043B2 (en) 2021-04-30 2023-11-28 Cilag Gmbh International Staple cartridge comprising formation support features
US11857184B2 (en) 2021-04-30 2024-01-02 Cilag Gmbh International Surgical instrument comprising a rotation-driven and translation-driven tissue cutting knife
US11918275B2 (en) 2021-04-30 2024-03-05 Cilag Gmbh International Electrosurgical adaptation techniques of energy modality for combination electrosurgical instruments based on shorting or tissue impedance irregularity
US11931035B2 (en) 2021-04-30 2024-03-19 Cilag Gmbh International Articulation system for surgical instrument
US11944295B2 (en) 2021-04-30 2024-04-02 Cilag Gmbh International Surgical instrument comprising end effector with longitudinal sealing step

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5685877A (en) * 1995-09-19 1997-11-11 Anthony Pagedas Mutiple tool laparoscopic surgical instrument
US5707402A (en) * 1995-05-09 1998-01-13 Team Medical, L.L.C. Directed energy surgical method and assembly

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5707402A (en) * 1995-05-09 1998-01-13 Team Medical, L.L.C. Directed energy surgical method and assembly
US5685877A (en) * 1995-09-19 1997-11-11 Anthony Pagedas Mutiple tool laparoscopic surgical instrument

Cited By (27)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1439793A4 (fr) * 2001-10-09 2006-01-04 Ethicon Inc Electrodes bipolaires a fonction auto-mouillante et pour environnement a champ sec destinees a la chirurgie endoscopique
EP1439793A2 (fr) * 2001-10-09 2004-07-28 Ethicon, Inc. Electrodes bipolaires a fonction auto-mouillante et pour environnement a champ sec destinees a la chirurgie endoscopique
US9078664B2 (en) 2012-06-20 2015-07-14 Gyrus Acmi, Inc. Bipolar surgical instrument with two half tube electrodes
US10548655B2 (en) 2015-10-16 2020-02-04 Ethicon Llc Control and electrical connections for electrode endocutter device
WO2017066177A1 (fr) * 2015-10-16 2017-04-20 Ethicon Endo-Surgery, Llc Connexions de commande et électriques pour dispositif formant bistouri endoscopique à électrodes
US11013552B2 (en) 2017-06-28 2021-05-25 Cilag Gmbh International Electrosurgical cartridge for use in thin profile surgical cutting and stapling instrument
US11129666B2 (en) 2017-06-28 2021-09-28 Cilag Gmbh International Shaft module circuitry arrangements
USD893717S1 (en) 2017-06-28 2020-08-18 Ethicon Llc Staple cartridge for surgical instrument
US10813640B2 (en) 2017-06-28 2020-10-27 Ethicon Llc Method of coating slip rings
US10888369B2 (en) 2017-06-28 2021-01-12 Ethicon Llc Systems and methods for controlling control circuits for independent energy delivery over segmented sections
US10888325B2 (en) 2017-06-28 2021-01-12 Ethicon Llc Cartridge arrangements for surgical cutting and fastening instruments with lockout disablement features
USD908216S1 (en) 2017-06-28 2021-01-19 Ethicon Llc Surgical instrument
US10265120B2 (en) 2017-06-28 2019-04-23 Ethicon Llc Systems and methods for controlling control circuits for an independent energy delivery over segmented sections
US11058477B2 (en) 2017-06-28 2021-07-13 Cilag Gmbh International Surgical cutting and fastening instruments with dual power sources
US11065048B2 (en) 2017-06-28 2021-07-20 Cilag Gmbh International Flexible circuit arrangement for surgical fastening instruments
US11103301B2 (en) 2017-06-28 2021-08-31 Cilag Gmbh International Surgical system coupleable with staple cartridge and radio frequency cartridge, and having a plurality of radio-frequency energy return paths
USD865175S1 (en) 2017-06-28 2019-10-29 Ethicon Llc Staple cartridge for surgical instrument
US11160604B2 (en) 2017-06-28 2021-11-02 Cilag Gmbh International Surgical end effector to adjust jaw compression
US11272976B2 (en) 2017-06-28 2022-03-15 Cilag Gmbh International Surgical end effector for applying electrosurgical energy to different electrodes on different time periods
US11278346B2 (en) 2017-06-28 2022-03-22 Cilag Gmbh International Systems and methods of displaying surgical instrument status
US11298128B2 (en) 2017-06-28 2022-04-12 Cilag Gmbh International Surgical system couplable with staple cartridge and radio frequency cartridge, and method of using same
US11896221B2 (en) 2017-06-28 2024-02-13 Cilag GmbH Intemational Surgical cartridge system with impedance sensors
US11857184B2 (en) 2021-04-30 2024-01-02 Cilag Gmbh International Surgical instrument comprising a rotation-driven and translation-driven tissue cutting knife
US11826043B2 (en) 2021-04-30 2023-11-28 Cilag Gmbh International Staple cartridge comprising formation support features
US11918275B2 (en) 2021-04-30 2024-03-05 Cilag Gmbh International Electrosurgical adaptation techniques of energy modality for combination electrosurgical instruments based on shorting or tissue impedance irregularity
US11931035B2 (en) 2021-04-30 2024-03-19 Cilag Gmbh International Articulation system for surgical instrument
US11944295B2 (en) 2021-04-30 2024-04-02 Cilag Gmbh International Surgical instrument comprising end effector with longitudinal sealing step

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