WO2023073675A1 - Hémostase de grande surface avec étanchéité de vaisseau - Google Patents

Hémostase de grande surface avec étanchéité de vaisseau Download PDF

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Publication number
WO2023073675A1
WO2023073675A1 PCT/IB2022/060503 IB2022060503W WO2023073675A1 WO 2023073675 A1 WO2023073675 A1 WO 2023073675A1 IB 2022060503 W IB2022060503 W IB 2022060503W WO 2023073675 A1 WO2023073675 A1 WO 2023073675A1
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WO
WIPO (PCT)
Prior art keywords
surgical instrument
sealing
jaw
electrodes
multifunction surgical
Prior art date
Application number
PCT/IB2022/060503
Other languages
English (en)
Inventor
James Dunning
Brian Lane
Erin WEHRLY
Prakash Manley
Original Assignee
Medtronic Advanced Energy Llc
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
Priority claimed from US17/702,133 external-priority patent/US20230139073A1/en
Application filed by Medtronic Advanced Energy Llc filed Critical Medtronic Advanced Energy Llc
Priority to CN202280071559.6A priority Critical patent/CN118159211A/zh
Publication of WO2023073675A1 publication Critical patent/WO2023073675A1/fr

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    • 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
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
    • A61B2017/00438—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping connectable to a finger
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • 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
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation
    • 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
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • 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
    • A61B2018/0091—Handpieces of the surgical instrument or device
    • A61B2018/00916—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
    • A61B2018/00922—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device by switching or controlling the treatment energy directly within the hand-piece
    • 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
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
    • 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
    • A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
    • A61B2090/065—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring contact or contact pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Definitions

  • the present technology is generally related to the field of surgical instruments.
  • the disclosure relates to a multi-function transection device for use in open surgical procedures.
  • Bipolar vessel sealing and dissection devices use advanced radiofrequency to seal blood vessels and other tissue structures, and are commonly used in open, laparoscopic, and thoracoscopic procedures. These devices are often used for sealing and dividing blood vessels and other tissue structures through a combination of radiofrequency energy and pressure. Common procedures in which bipolar vessel sealing and dissection devices are used include hysterectomies, colectomies, splenectomies, gastrectomies, pancreatectomies, nephrectomies, adhesiolysis and endometriosis resection, among others.
  • a typical bipolar vessel sealing device 100 is depicted in accordance with the prior art.
  • the device 100 can include a pair of jaws 102A/B configured to hold tissue layers together like a clamp. Radiofrequency energy from a generator 104 is delivered to the tissue through conductive surfaces 106A/B on the jaws 102AZB, specifically, the conductive surfaces 106AZB can include two electrical poles, hence the term “bipolar.”
  • a generator 104 is delivered to the tissue through conductive surfaces 106A/B on the jaws 102AZB, specifically, the conductive surfaces 106AZB can include two electrical poles, hence the term “bipolar.”
  • Ligasure® ImpactTM manufactured and sold by Medtronic, pic.
  • tissue is placed between the jaws 102A/B.
  • a clinician or user then squeezes a lever 108 to close the jaws 102A/B and presses a trigger 110 to activate the generator 104.
  • a high-frequency alternating current from the generator 104 causes hydrated tissue clamped between the jaws 102A/B to heat up, which in turn causes collagen and elastin molecules within the tissue to melt and fuse back together thereby creating a seal.
  • bipolar vessel sealing and dissection devices are well adapted at sealing and dividing tissues that can be positioned between the pair of jaws 102A/B.
  • transcoalition sealing device 150 is depicted in accordance with the prior art.
  • the transcoalition sealing device 150 can include a pair of electrodes 152A/B and a saline port 154 configured to deliver a combination of radiofrequency energy and saline to the tissue.
  • the saline is delivered at a rate matched to the power setting on the system pump generator 156.
  • One example of such a device is the AquamantysTM Sealer, manufactured and sold by Medtronic, pic.
  • transcoalition can be affected through a painting motion of the device 150 upon the tissue to be treated while pressing an activation button 158 to seal broad tissue planes or spot treat bleeding vessels up to about 1 mm in diameter.
  • transcoalition provides low temperature hemostasis, with temperatures generally at or below 100°C, thereby reducing the likelihood of burning char or smoke.
  • Bipolar vessel sealing devices 100 and transcoalition devices 150 have each proven extremely effective in this respect, particularly in comparison to manual dissection with sutures or electrocautery. Specifically, these devices have been found to reduce procedure times while reducing blood loss, hospital stays, recovery time, and postoperative pain. Moreover, these devices seal tissue without leaving any foreign objects, like sutures, staples or clips, in the body.
  • the techniques of this disclosure generally relate to a multifunction surgical instrument having a low-profile, ring handle configured to deliver both vessel dissection and sealing through a bipolar clamping mechanism and a combination of bipolar radiofrequency energy and saline to provide hemostatic sealing and coagulation of soft tissue and bone to address diffused bleeding during a surgical procedure.
  • One embodiment of the present disclosure provides a multifunction surgical instrument having a low-profile configuration to deliver both small vessel sealing through a bipolar clamping mechanism and transcollation sealing of diffused bleeding in a broad tissue plane
  • the multifunction surgical instrument including a reusable portion comprising a handle and an insertion portion, the insertion portion including a first jaw and a second jaw configured to transition between an open position and a closed position to serve as a clamp for sealing of tissue with a depth of up to about 7 mm, and a disposable electrode portion comprising a first conductive surface positioned in proximity to the first jaw and a second conductive surface positioned in proximity to the second jaw, the first and second conductive surfaces configured to emit a high- frequency alternating current sufficient to cause poaching of tissue clamped between the first and second jaws, and two or more electrodes and at least one saline port, wherein the two or more electrodes and the at least one saline port cooperate to affect transcollation sealing of diffused bleeding within a broad tissue plane.
  • the handle of the reusable portion defines a pair of rings, each of the rings shaped and sized to enable a clinician to pass a finger therethrough for manipulation of the multifunction surgical instrument.
  • the reusable portion is constructed of a metallic based material configured to withstand the temperature and pressure of an autoclave for sterilization.
  • the first and second jaws are configured to produce a clamping pressure within a range of about 3 kg/cm 2 and about 16 kg/cm 2
  • the disposable electrode portion further comprises a contact switch configured to automatically energize the first and second conductive surfaces upon application of a predefined quantity of pressure thereupon.
  • the first and second conductive surfaces are configured to emit a high frequency alternating current in the range of between about 200 kHz and about 3.3 MHz.
  • the multifunction surgical instrument further includes a blade configured to selectively transition distally-proximally along at least one of the first or second jaw. In one embodiment, the blade is actuated by a blade trigger.
  • At least a first electrode is positioned adjacent to the first conductive surface and at least a second electrode is positioned adjacent to the second conductive surface.
  • at least one saline port is configured to deliver saline at a rate matched to radiofrequency energy emitted by the two or more electrodes.
  • activation of at least one saline port and two or more electrodes are affected by applying pressure to both a sealing button and a contact switch in the closed position.
  • the two or more electrodes and the at least one saline port are configured to produce hemostatic sealing within the surgical site at a temperature at or below 100°C.
  • the multifunction surgical instrument further includes a light emitting diode configured to at least partially illuminate a surgical site.
  • a surgical instrument including a handle, a pair of jaws comprising a first jaw and a second jaw configured to transition between an open position and a closed position, a first conductive surface positioned in proximity to the first jaw and a second conductive surface positioned in proximity to the second jaw, the first and second conductive surfaces configured to emit a high-frequency alternating current sufficient to cause poaching of tissue clamped between the first and second jaws, and two or more electrodes and at least one saline port configured to affect transcollation sealing of diffused bleeding within a broad tissue plane.
  • a multifunction surgical instrument having a low-profile configuration to deliver both small vessel sealing through a bipolar clamping mechanism and transcollation sealing of diffused bleeding in a broad tissue plane
  • the multifunction surgical instrument including a reusable portion, constructed of a metallic based material configured to withstand a temperature and pressure of an autoclave for sterilization, the reusable portion comprising a handle and an insertion portion, the insertion portion including a first jaw and a second jaw configured to transition between an open position and a closed position to serve as a clamp for sealing of vessels or tissue with a diameter or maximum dimensions of up to about 7 mm, and wherein the handle of the reusable portion defines a pair of rings, each of the rings shaped and sized to enable a clinician to pass a finger therethrough for manipulation of the multifunction surgical instrument, a disposable electrode portion comprising a first conductive surface positioned in proximity to the first jaw and a second conductive surface positioned in proximity to the second jaw, the first and second conductive surfaces configured to emit
  • FIG. 1 is a perspective view depicting a conventional bipolar vessel sealing device, in accordance with the prior art.
  • FIG. 2 is a perspective view depicting a transcollation sealing device, in accordance with the prior art.
  • FIG. 3 A is a profile view depicting a disposable multifunction surgical instrument having a low-profile configuration to deliver both small vessel sealing through a bipolar clamping mechanism and transcollation sealing of diffused bleeding in a broad tissue plane, in accordance with an embodiment of the disclosure.
  • FIG. 3B is a close-up, perspective view depicting clamping jaws of a multifunction surgical instrument, in accordance with an embodiment of the disclosure.
  • FIG. 4A is a profile view depicting a reposable multifunction surgical instrument having a low-profile configuration to deliver both small vessel sealing through a bipolar clamping mechanism and transcollation sealing of diffused bleeding in a broad tissue plane, in accordance with an embodiment of the disclosure.
  • FIG. 4B is an exploded, profile view depicting the multifunction surgical instrument of FIG. 4A.
  • FIG. 5A is a close-up, perspective view depicting clamping jaws of a multifunction surgical instrument including a sliding blade, in accordance with an embodiment of the disclosure.
  • FIG. 5B is a close-up, perspective view depicting a multifunction surgical instrument including a blade actuator trigger, in accordance with an embodiment of the disclosure.
  • FIG. 5C is a close-up, perspective view depicting a multifunction surgical instrument including a contact switch configured to automatically energize a first and second pole of bipolar contacts upon transitioning of clamping jaws of the multifunction surgical instrument to a closed position, in accordance with an embodiment of the disclosure.
  • FIG. 6A is a close-up perspective view depicting the multifunction surgical instrument with clamping jaws clamped around a bundle of tissue within a surgical site, in accordance with an embodiment of the disclosure.
  • FIG. 6B is a close-up perspective view depicting the multifunction surgical instrument of FIG. 6A emitting high-frequency alternating current to the bundle of tissue, in accordance with an embodiment of the disclosure.
  • FIG. 6C is a close-up perspective view depicting the multifunction surgical instrument of FIG. 6B upon release of the bundle of tissue, in accordance with an embodiment of the disclosure.
  • FIG. 7 is a close-up perspective view depicting a multifunction surgical instrument having a mechanism configured to apply transcollation technology for coagulation of diffused bleeding within a broad tissue plane, in accordance with an embodiment of the disclosure.
  • FIG. 8 is a close-up perspective view depicting a multifunction surgical instrument applying transcollation technology to a broad tissue plane, in accordance with an embodiment of the disclosure.
  • a single, multi-function device or instrument provides both clamping and small-vessel (e.g., diameters of between about 1 mm and about 2 mm, and in some cases up to a diameter of about 7 mm, etc.) sealing and coagulation of diffused bleeding without the need for instrument changes or a larger incision.
  • a multifunction surgical instrument 200 having a low-profile, ring handle configured to deliver both vessel dissection and sealing through a bipolar clamping mechanism and a combination of bipolar radiofrequency energy and saline to provide hemostatic sealing and coagulation of soft tissue and bone to address diffused bleeding during a surgical procedure is depicted in accordance with an embodiment of the disclosure.
  • the instrument 200 can include a handle 202 and an insertion portion 204.
  • the insertion portion 204 can extend from a proximal end 206 near the handle 202 to a distal end 208 configured to define a therapeutic effect, such as sealing, clamping or coagulation of diffused bleeding at a surgical site.
  • distal refers to the portion of the instrument or component thereof that is being described that is further from a clinician or user
  • proximal refers to the portion of the instrument or component thereof that is being described that is closer to a clinician or user.
  • tissue is meant to include variously-sized vessels and broad planes of biological matter.
  • the term “clinician” refers to any individual configured to use or manipulate example embodiments described herein or alternative combinations thereof during a procedure.
  • the term “patient” or “subject,” as used herein is to be understood to refer to an individual or object in which the use of the device is to occur during a procedure, whether human, animal, or inanimate.
  • a clinician the involved parties collectively referred to as a "user” or “users”
  • the disclosure is not limited in this respect.
  • the multifunction surgical instrument 200 can be disposable, in that the entire handpiece is considered a consumable item to be disposed of at the conclusion of a surgical procedure. In other embodiments, the multifunction surgical instrument 200 can be reposeable, in that at least one portion of the instrument 200 is reusable, while other portions of the instrument 200 are disposable.
  • the multifunction surgical instrument 200 can include a reusable clamp portion 210 and a disposable electrode portion 212 configured to minimize waste, particularly when compared to a single use device.
  • the reusable clamp portion 210 can be constructed of a material (e g., a metal or metal alloy) configured to withstand the temperature and pressure of an autoclave and/or generally be unreacted of when submerged in a chemical bath for sterilization.
  • a material e g., a metal or metal alloy
  • the handle portion 202 can include a pair of rings 214A/B, generally shaped and sized to have the haptic qualities of a hemostat, thereby providing a familiarity to clinicians even without previous experience.
  • the pair of rings 214A/B can present openings measuring between about 0.75 inches and about 2 inches, thereby enabling a user or clinician to pass a finger therethrough for manipulation of the instrument 200.
  • the pair of rings 214A/B can present in easy to manipulate, low-profile alternative to traditional pistol grip designs (such as that depicted in FIGS. 1 and 2). Accordingly, embodiments of the present disclosure present a single, multifunction, low-profile instrument 200 designed to reduce visual obstruction during a surgical procedure, as well as to emulate the haptic qualities of a hemostat, scissors or other familiar surgical instrument.
  • the insertion portion 204 can define a pair of jaws 216A/B, each of which can include a conductive surface 218A/B, with each surface 218A/B representing an electrical pole.
  • the pair of jaws 216A/B can be represented by both the reusable clamp portion 210 and the disposable electrode portion 212, while the conductive surfaces 218A/B are represented solely by the disposable electrode portion 212.
  • the pair of jaws 216A/B and conductive surfaces 218A/B can transition between a closed position (as depicted in FIG. 3 A) and an open position (as depicted in FIG. 3B).
  • At least one of the jaws 216A/B can further include a blade 220, which can be configured to slide or otherwise transition distally and conversely proximally along the jaw 216, thereby enabling a smoother cut when sealing and dividing blood vessels or other tissue structures.
  • the instrument 200 can include a blade trigger 222 located on the handle portion 202 of the instrument 200. Accordingly, an applied pressure or other movement of the blade trigger 222 can affect corresponding movement of the blade 220.
  • the handle portion 202 can include a projection 224 or other surface configured to make contact with a contact switch 226, thereby selectively energizing the conductive surfaces 218A/B with a supply of radiofrequency energy.
  • the contact switch 226 can be a two-stage switch, having a first stage activated in the closed position below a defined clamping pressure threshold, and a second stage activated in the closed position above a defined clamping pressure threshold.
  • a defined clamping force upon the handle 202 can automatically activate bipolar sealing of the clamping mechanism when the contact switch 226 is in the second stage of activation.
  • a defined clamping pressure of the jaws 216A/B within the range of about 3 kg/cm 2 and about 16 kg/cm 2 can be sufficient to automatically activate the conductive surfaces 218A/B with radiofrequency energy; although other methods of activation are also contemplated.
  • sealing of small vessels of up to about 1 -2 mm, and in some embodiments up to about 7 mm in diameter can be affected by positioning the vessel or tissue within the jaws 216A/B of the instrument 200 and applying a clamping force by squeezing on the handle 202, thereby closing the jaws 216A/B and energizing be conductive surfaces 218A/B.
  • FIG. 6A As depicted in FIG. 6A, when operating in the bipolar clamping dissection and sealing mode, sealing of small vessels of up to about 1 -2 mm, and in some embodiments up to about 7 mm in diameter, can be affected by positioning the vessel or tissue within the jaws 216A/B of the instrument 200 and applying a clamping force by squeezing on the handle 202, thereby closing the jaws 216A/B and energizing be conductive surfaces 218A/B.
  • a high-frequency alternating current causes hydrated tissue clamped between the jaws 216A/B to heat up, which in turn causes the native tissue proteins to denature (sometimes referred to as “poaching”), while water turns to vapor and escapes.
  • the high-frequency alternating current fuses the intimal walls of the vessel or tissue, resulting in complete lumen occlusion.
  • the blade 220 can be manipulated (e.g., via trigger 224) to affect a physical separation of the lumen.
  • an energy generator can provide radiofrequency controlled by an advanced algorithm for optimal tissue sealing.
  • the conductive surfaces 218A/B can be configured to emit a high-frequency electrical current (e.g., between about 200 kHz to about 3.3 MHz), or other frequency above a range that would tend to cause nerve or muscle stimulation.
  • the conductive surfaces 218A/B can be configured to monitor an electrical resistance of the tissue to determine exactly how much radiofrequency energy is needed to affect sealing.
  • At least one of the jaws 216A/B and/or conductive surfaces 218A/B can include a nonstick coating, for example in the form of a thin polymer, resulting in easier separation of the jaws 216A/B from the tissue (nonstick), less eschar at the surgical site, and with a decreased buildup of charred tissue on the instrument 200.
  • a nonstick coating for example in the form of a thin polymer, resulting in easier separation of the jaws 216A/B from the tissue (nonstick), less eschar at the surgical site, and with a decreased buildup of charred tissue on the instrument 200.
  • the instrument 200 can also employ transcollation technology for coagulation of diffused bleeding, thereby reducing the need for multiple instruments or exchange of instruments during a surgical procedure.
  • the instrument 200 can include two or more electrodes 228 A/B and at least one saline port 230 as a mechanism for affecting transcollation sealing.
  • the two or more electrodes 228 A/B and saline port 230 can be positioned in proximity to the distal and 208 of the insertion portion 204.
  • the reposable embodiment depicted in FIG.
  • the two or more electrodes 228 A/B can be positioned on the disposable electrode portion 212, for example adjacent to one of the conductive surfaces 218A/B.
  • a pair of electrodes 228A/B and a saline port 230 are positioned adjacent to the lower conductive surface 218B.
  • a first electrode 228 A can be positioned adjacent to a first conductive surface 218A, while a second electrode 228B can be positioned adjacent to a second electrode surface 218B.
  • the instrument 200 can include one or more light sources 232 (e.g., light emitting diodes or the like) configured to selectively aid in illumination of the surgical site (as depicted in FIG. 7).
  • light sources 232 e.g., light emitting diodes or the like
  • diffused hemostatic sealing when diffused hemostatic sealing is desired, a clinician can depress the transcollation sealing button 234 located on the handle portion 202 (as depicted in FIG. 3A) or on a body of the disposable electrode portion 212 (as depicted in FIG. 4B).
  • diffused hemostatic sealing can require both a combination of applied pressure to both the sealing button 234 and the contact switch 226 (e.g., positioning of the contact switch in the first stage of activation).
  • the instrument 200 must be in the closed position (e.g., wherein the jaws 216A/B are in close proximity to one another) to enable transcollation.
  • transcollation can be affected through a range of instrument 200 configurations (e.g., between a closed position and the open position), thereby enabling transcollation over a variable distance between the first and second electrodes 228A/B to affect greater control over tissue desiccation.
  • a distance between the first and second electrodes 228A/B can be affected through manipulation of the handle rings 214A/B, thereby enabling medical personnel to selectively control an intensity and/or depth of the electrosurgical effect of the electrodes 228A/B.
  • a surgeon may establish a fixed distance between the electrodes 228A/B while manipulating the entire instrument 200, bringing the electrodes 228A/B into, and out of, contact with tissue to work the surgical site.
  • a surgeon may bring the electrodes 228A/B into substantially continuous contact with tissue, and manipulate a distance between the electrodes 228A/B.
  • a distance between the electrodes 228A/B can be sensed by the contact switch 226 (e.g., pressure switch, etc.), which in communication with a system pump generator can dictate the magnitude of energy transmitted to the electrodes 228A/B and volume of saline delivered to the port 230.
  • the contact switch 226 e.g., pressure switch, etc.
  • a system pump generator can dictate the magnitude of energy transmitted to the electrodes 228A/B and volume of saline delivered to the port 230.
  • a combination of radiofrequency energy provided by the electrodes 228A/B and saline provided by the one or more saline ports 230 can affect low temperature hemostasis to affect collation and general sealing within a broad tissue plane.
  • saline, or some other fluid or fluid like substance e.g., deionized water, glycol, etc.
  • the electrodes 228 A/B provide electrical current sufficient to poach the bathed region.
  • the one or more ports 230 deliver saline at a rate matched to the radiofrequency energy emitted by the electrodes 228A/B.
  • electrosurgical energy flows between the electrodes 228A/B forming a radiating pattern, which radiates between the electrodes 228A/B.
  • manipulation of the handle rings 214A/B enables a clinician to apply transcollation technology to the surgical site with the painting motion to seal broad tissue planes, to spot treat bleeding vessels up to about 1 mm in diameter, as well as to treat bleeding vessels that have retracted into surrounding tissue that cannot be easily grasped by the jaws 216A/B.
  • the transcollation technology can be configured to produce hemostatic sealing without burning, char or smoke, wherein the presence of saline maintains temperatures within the surgical site at or below about 100°C.
  • embodiments of the present disclosure enable clamping and small vessel sealing, as well as coagulation of diffused bleeding within a tissue plane without a need for instrument changes or a larger incision, thus resulting in improved visibility for clinicians, shorter surgical procedure times, and improved patient outcomes (e.g., faster recovery rates, greater hemoglobin retention, etc.).
  • the multifunction surgical instruments 200 of the present disclosure are particularly adept at surgeries which otherwise require multiple instruments, including for example, solid organ resection, spinal surgery, trauma procedures, an orthopedic reconstruction of the hip and knee, just to name a few.
  • embodiments of the present disclosure employ a low-profile ring handle configuration with a form factor similar to a hemostatic or other instrument which surgeons are accustomed. Accordingly, in addition to reduced surgical times, reduced cost, higher hemoglobin retention for the patient, and reductions in postsurgical blood loss, embodiments of the present disclosure provide improved visibility of the surgical site, as well as a haptic familiarity to surgeons, particularly in comparison to pistol grip handle designs (such as that depicted in FIGS. 1 and 2).
  • the described techniques may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored as one or more instructions or code on a computer-readable medium and executed by a hardware-based processing unit.
  • Computer-readable media may include non-transitory computer- readable media, which corresponds to a tangible medium such as data storage media (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer).
  • processors such as one or more digital signal processors (DSPs), general purpose microprocessors, application specific integrated circuits (ASICs), field programmable logic arrays (FPGAs), or other equivalent integrated or discrete logic circuitry.
  • DSPs digital signal processors
  • ASICs application specific integrated circuits
  • FPGAs field programmable logic arrays
  • processors may refer to any of the foregoing structure or any other physical structure suitable for implementation of the described techniques.

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  • 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

Instrument chirurgical multifonction ayant une configuration à bas profil pour administrer à la fois une étanchéité de petit vaisseau à travers un mécanisme de serrage bipolaire et une étanchéité de transcollation de saignement diffusé dans un plan de tissu large, l'instrument chirurgical multifonction comprenant une première mâchoire et une seconde mâchoire conçues pour la transition entre une position ouverte et une position fermée pour servir de pince pour l'étanchéité du tissu, et une portion d'électrode jetable comprenant une première surface conductrice positionnée à proximité de la première mâchoire et une seconde surface conductrice positionnée à proximité de la seconde mâchoire, la première et la seconde surface conductrice conçues pour émettre un courant alternatif à haute fréquence, et deux ou plusieurs électrodes et au moins un orifice salin, les deux ou plusieurs électrodes dans le au moins un orifice salin coopérant pour affecter l'étanchéité de transcollation de saignement diffusé à l'intérieur d'un plan de tissu large.
PCT/IB2022/060503 2021-11-01 2022-10-31 Hémostase de grande surface avec étanchéité de vaisseau WO2023073675A1 (fr)

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CN202280071559.6A CN118159211A (zh) 2021-11-01 2022-10-31 利用血管封闭进行大面积止血

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US202163274454P 2021-11-01 2021-11-01
US63/274,454 2021-11-01
US17/702,133 2022-03-23
US17/702,133 US20230139073A1 (en) 2021-11-01 2022-03-23 Large area hemostasis with vessel sealing

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Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6059776A (en) * 1997-09-23 2000-05-09 Gatto; Dom L. Electrosurgical laser shears
EP1767163A1 (fr) * 2005-09-22 2007-03-28 Sherwood Services AG Pince bipolaire avec un activateur final composé d'un réseau d'électrodes multiples
EP2275050A1 (fr) * 2001-09-05 2011-01-19 Salient Surgical Technologies, Inc. Dispositifs, procédés et systèmes chirurgicaux assistés par un fluide
EP2428177A1 (fr) * 2010-09-08 2012-03-14 Tyco Healthcare Group, LP Électrodes asymétriques pour la fermeture de récipients bipolaire
WO2016088017A1 (fr) * 2014-12-01 2016-06-09 Suresh Srinivasan IYER Instrument électrochirurgical bipolaire
WO2017024124A1 (fr) * 2015-08-04 2017-02-09 Lc Therapeutics, Inc. Dispositifs d'ablation de tissu et leurs procédés d'utilisation
EP3581125A1 (fr) * 2015-06-30 2019-12-18 Ethicon LLC Système chirurgical comportant des techniques d'utilisateur adaptables basées sur le type de tissus
US20200107845A1 (en) * 2018-10-03 2020-04-09 Covidien Lp Multi-function surgical transection instrument

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6059776A (en) * 1997-09-23 2000-05-09 Gatto; Dom L. Electrosurgical laser shears
EP2275050A1 (fr) * 2001-09-05 2011-01-19 Salient Surgical Technologies, Inc. Dispositifs, procédés et systèmes chirurgicaux assistés par un fluide
EP1767163A1 (fr) * 2005-09-22 2007-03-28 Sherwood Services AG Pince bipolaire avec un activateur final composé d'un réseau d'électrodes multiples
EP2428177A1 (fr) * 2010-09-08 2012-03-14 Tyco Healthcare Group, LP Électrodes asymétriques pour la fermeture de récipients bipolaire
WO2016088017A1 (fr) * 2014-12-01 2016-06-09 Suresh Srinivasan IYER Instrument électrochirurgical bipolaire
EP3581125A1 (fr) * 2015-06-30 2019-12-18 Ethicon LLC Système chirurgical comportant des techniques d'utilisateur adaptables basées sur le type de tissus
WO2017024124A1 (fr) * 2015-08-04 2017-02-09 Lc Therapeutics, Inc. Dispositifs d'ablation de tissu et leurs procédés d'utilisation
US20200107845A1 (en) * 2018-10-03 2020-04-09 Covidien Lp Multi-function surgical transection instrument

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