WO2023139481A1 - Instrument chirurgical à ultrasons - Google Patents

Instrument chirurgical à ultrasons Download PDF

Info

Publication number
WO2023139481A1
WO2023139481A1 PCT/IB2023/050399 IB2023050399W WO2023139481A1 WO 2023139481 A1 WO2023139481 A1 WO 2023139481A1 IB 2023050399 W IB2023050399 W IB 2023050399W WO 2023139481 A1 WO2023139481 A1 WO 2023139481A1
Authority
WO
WIPO (PCT)
Prior art keywords
waveguide
end portion
horn
distal
surgical instrument
Prior art date
Application number
PCT/IB2023/050399
Other languages
English (en)
Inventor
Matthew S. COWLEY
Original Assignee
Covidien Lp
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 Covidien Lp filed Critical Covidien Lp
Publication of WO2023139481A1 publication Critical patent/WO2023139481A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • 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
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling

Definitions

  • the present disclosure relates to surgical instruments and, more particularly, to an ultrasonic surgical instrument.
  • Some surgical instruments have an end effector configured to apply energy to tissue to treat tissue.
  • An example of such a surgical instrument is an ultrasonic surgical instrument that utilizes ultrasonic energy, i.e., ultrasonic vibrations, to treat tissue. More specifically, a typical ultrasonic surgical instrument utilizes mechanical vibration energy transmitted at ultrasonic frequencies to coagulate, cauterize, fuse, seal, cut, desiccate, fulgurate, or otherwise treat tissue.
  • Such an ultrasonic surgical instrument is configured to transmit ultrasonic energy produced by, for example, an ultrasonic transducer (driven by an ultrasonic generator), along a waveguide to an end effector that is spaced-apart from the ultrasonic transducer.
  • the end effector may include a blade and a jaw member configured to clamp tissue against the blade to treat tissue.
  • a surgical instrument in one aspect of the present disclosure, includes an elongated body portion, a blade, and an ultrasonic horn.
  • the elongated body portion has a waveguide including a proximal end portion, and a distal end portion having a post extending radially outward therefrom.
  • the blade extends distally from the distal end portion of the waveguide.
  • the ultrasonic horn is configured to receive energy from an ultrasonic transducer for transmission through the waveguide to energize the blade.
  • the horn has a distal end portion including an inner side wall, and a cantilever beam.
  • the inner side wall at least partially defines an L-shaped slot in the distal end portion of the horn, and the cantilever beam extends from the inner side wall into the L-shaped slot.
  • the cantilever beam is configured to flex upon the L- shaped slot receiving the post of the waveguide.
  • the distal end portion of the horn may have a distal face defining an opening through which the proximal end portion of the waveguide is received.
  • the proximal end portion of the waveguide may include a proximal extension configured for receipt in the distal end portion of the horn via the opening.
  • the post may project radially outward from the proximal extension.
  • the L-shaped slot may include a longitudinal slot extending proximally from the opening, and a circumferential slot extending circumferentially from the longitudinal slot.
  • the longitudinal slot and the circumferential slot may be angled relative to one another such that the post is configured to be translated through the longitudinal slot and rotated from the longitudinal slot into the circumferential slot.
  • the inner side wall may have a distal-facing surface
  • the cantilever beam may have a proximal-facing surface in longitudinal alignment with the distal-facing surface.
  • the proximal-facing surface and the distal-facing surface may define the circumferential slot therebetween.
  • the post may be configured to be compressed between the proximal-facing surface and the distal-facing surface.
  • the proximal-facing surface and the distal-facing surface may be angled relative to a cross-section of the horn.
  • an ultrasonic surgical instrument includes an elongated body portion, a tool assembly, and an ultrasonic horn.
  • the elongated body portion has a support tube and a waveguide extending through the tube.
  • the tool assembly is coupled to a distal end portion of the support tube and the horn is coupled to the proximal end portion of the waveguide.
  • the horn has an inner side wall defining a channel configured for receipt of the proximal end portion of the waveguide.
  • the horn has a pair of bosses projecting circumferentially inward from opposite sides of the inner side wall.
  • the proximal end portion of the waveguide defines a pair of circumferential slots therein configured for receipt of the respective pair of bosses.
  • the distal end portion of the horn may have a distally-extending nub
  • the proximal end portion of the waveguide may have a recess configured for receipt of the nub
  • the distal end portion of the horn may have a distal-most surface
  • the proximal end portion of the waveguide may have a proximal surface configured to interface with the distal-most surface
  • the nub may extend distally from the distal-most surface of the horn, and the recess may be formed in the proximal surface of the waveguide.
  • the nub may be distal of the pair of bosses.
  • the distal-most surface and the proximal surface may be planar.
  • each of the pair of circumferential slots may have a helical configuration.
  • parallel and perpendicular are understood to include relative configurations that are substantially parallel and substantially perpendicular up to about + or - 10 degrees from true parallel and true perpendicular.
  • FIG. 1 is a perspective view of an illustrative ultrasonic surgical instrument provided in accordance with the present disclosure, including a TAG assembly thereof disconnected from a handle assembly;
  • FIG. 2 is an exploded, perspective view of a shaft, a waveguide, and a tool assembly of the ultrasonic surgical instrument of FIG. 1;
  • FIG. 3 A is a perspective view of the waveguide of FIG. 2 shown disconnected from a horn of the TAG assembly of FIG. 2;
  • FIG. 3B is a side view of the waveguide partially connected with the horn
  • FIG. 3C is a side view of the waveguide fully connected with the horn
  • FIG. 4 is another side view of the waveguide and the horn fully connected to one another;
  • FIG. 5 is a perspective view illustrating another aspect of a horn and a waveguide shown disconnected from one another;
  • FIG. 6 is a side view of the horn and waveguide of FIG. 5 disconnected from one another; and [0030] FIG. 7 is a longitudinal cross-sectional view of the horn and waveguide of FIG. 5 shown fully connected to one another.
  • distal refers to that portion of the surgical instrument that is closer to the patient
  • proximal refers to that portion of the surgical instrument that is farther from the patient.
  • Ultrasonic dissectors function by transmitting kinetic energy from an ultrasonic transducer through a waveguide to a cutting blade or other suitable end effector. Because the transducer, waveguide, and/or blade can be separate parts, there must be a means to secure the parts together with enough compression force to enable the efficient transfer of kinetic energy therethrough. Typically, this is accomplished with threaded screws, such as a bolt and nut type connection.
  • the present disclosure provides a clocked slot and latch-type feature that uses material compliance to press the different parts together under sufficient compression. This connection makes the device easy to assemble, clean, and manufacture, while continuing to maintain the needed compression forces between the parts.
  • an ultrasonic surgical instrument 10 is illustrated and generally includes a handle assembly 12, an elongated body portion 14, and a tool assembly 16.
  • Tool assembly 16 includes a blade 13 and a clamp member or jaw member 15.
  • Handle assembly 12 supports a battery assembly 18 and an ultrasonic transducer and generator assembly (“TAG”) 20, and includes a rotatable nozzle 22, an activation button 24, and a clamp trigger 26.
  • Handle assembly 12 includes a body portion 28 defining a recess 32 in a proximal portion thereof dimensioned for releasable receipt of TAG 20 therein.
  • Battery assembly 18 is connected to a lower end of handle assembly 12 to define a fixed handgrip portion of handle assembly 12.
  • Suitable configurations both cordless and tethered, for providing power and ultrasonic energy, are also contemplated.
  • the generator assembly 45 of TAG 20 and/or battery assembly 18 may be removed from handle assembly 12 in favor of a remote generator and/or power source.
  • Battery assembly 18 and TAG 20 are each releasably secured to handle assembly 12 to facilitate disposal of the entire device, with the exception of battery assembly 18 and TAG 20.
  • TAG 20 includes a generator assembly 45 and an ultrasonic transducer assembly 47.
  • Elongated body portion 14 of ultrasonic surgical instrument 10 includes a waveguide 30, which extends distally from handle assembly 12 to tool assembly 16. A distal end portion of the waveguide 30 defines blade 13 of tool assembly 16. A proximal end portion 34 of the waveguide 30 is configured to engage TAG 20.
  • Elongated body portion 14 of ultrasonic surgical instrument 10 further includes an isolation tube 36 positioned about waveguide 30 to prevent the transfer of ultrasonic energy from waveguide 30 to an inner support tube 42 of elongated body portion 14.
  • the waveguide 30 and the inner support tube 42 are rotatably coupled to rotatable nozzle 22 such that rotation of nozzle 22 effects corresponding rotation of the inner support tube 42 and the waveguide 30.
  • Elongated body portion 14 further includes an actuator tube 66 coupled to inner support tube 42 and configured to rotate upon rotation of nozzle 22.
  • Inner support tube 42 of elongated body portion 14 is positioned about isolation tube 36 and includes a distal end having a pair of spaced clamp support arms 52.
  • Spaced clamp support arms 52 are configured to pivotally engage jaw member 15 of tool assembly 16 to enable pivoting of jaw member 15 between an open position, in which jaw member 15 is spaced from blade 13, and a closed position, in which jaw member 15 is approximated relative to blade 13. Jaw member 15 is moved between the open and closed positions in response to actuation of clamp trigger 26.
  • Outer actuator tube 66 of elongated body portion 14 is slidably supported about inner support tube 42 (although actuator tube 66 may alternatively be slidably disposed within support tube 42) and is operably coupled to jaw member 15 such that jaw member 15 is pivoted from the open position to the closed position as actuator tube 66 is slid about inner support tube 42.
  • Actuator tube 66 is operably coupled with rotatable nozzle 22 such that outer actuator tube 66 is rotatably secured to, and slidable relative to, rotatable nozzle 22. Further, a proximal portion of outer actuator tube 66 is operably coupled with a drive mechanism 80 of handle assembly 12.
  • Handle assembly 12 includes drive mechanism 80 supported therein for linear movement relative to handle assembly 12.
  • Handle assembly 12 also includes the aforementioned clamp trigger 26, which is operably coupled with drive mechanism 80 such that, in use, when clamping trigger 26 is compressed towards battery assembly 18, outer actuator tube 66 is slid about support tube 42 (in a distal -to-proximal or proximal -to-distal direction) to pivot jaw member 15 from the open position to the closed position in relation to blade 13.
  • battery assembly 18 and TAG 20 are attached to handle assembly 12 and waveguide 30, respectively, and ultrasonic surgical instrument 10 is activated, e.g., via actuation of activation button 24, battery assembly 18 provides power to generator assembly 45 of TAG 20, which, in turn, generates an AC signal to drive the ultrasonic transducer assembly 47 of TAG 20.
  • the ultrasonic transducer assembly 47 converts the AC signal into high frequency mechanical motion.
  • This high frequency mechanical motion produced by the ultrasonic transducer assembly 47 is transmitted to blade 13 via waveguide 30 for application of such ultrasonic energy to tissue adjacent to or clamped between blade 13 and jaw member 15 of tool assembly 16 to treat the tissue.
  • the TAG 20 (FIG. 1) includes a horn 100 configured to be detachably engaged with the waveguide 30 in a manner that allows for the efficient transfer of ultrasonic energy from the ultrasonic transducer assembly 47 of the TAG 20 (see FIG. 1) to the waveguide 30.
  • the horn 100 has a distal end portion 102 having a distal face 104 that defines an opening 106 through which the proximal end portion 34 of the waveguide 30 is received.
  • the proximal end portion 34 of the waveguide 30 includes a proximal extension 70, and a pair of projections, such as, for example, posts 72 (only one of the posts is explicitly shown) that extend radially outward from opposite sides of the proximal extension 70.
  • the proximal extension 70 and the posts 72 may each have a cylindrical shape.
  • Other shapes for the proximal extension 70 and the posts 72 are contemplated, such as, for example, semi-hemispherical, rectangular, etc..
  • the proximal extension 70 of the waveguide 30 is configured for receipt in the distal end portion 102 of the horn 100 via the opening 106.
  • the distal end portion 102 of the horn 100 may be a cylinder having an inner side wall or cutout 108 that defines an L-shaped slot 110 in the horn 100 configured for receipt of the post 72.
  • the distal end portion 102 of the horn 100 may have another L-shaped slot (not explicitly shown) defined in an opposite side of the horn 100 that L-shaped slot 100 is located to receive the other post 72.
  • the L-shaped slot 110 includes a longitudinal slot 110a that extends proximally from the opening 106, and a circumferential slot 110b that extends from the longitudinal slot 110a in a generally circumferential direction about the horn 100.
  • the longitudinal and circumferential slots 110a, 110b may be angled relative to one another (e.g., perpendicular or otherwise angled at an obtuse or acute angle) such that the post 72 of the waveguide 30 is configured to be translated proximally through the distal opening 106, in turn, through the longitudinal slot 110a, and rotated from the longitudinal slot 110a into and through the circumferential slot 110b to lockingly secure the waveguide 30 with the horn 100 in a bayonet-type connection, as shown in FIGS. 3C and 4.
  • the distal end portion 102 of the horn 100 further includes a leg, such as, for example, a cantilever beam 112 that projects from the inner side wall 108 toward and into the longitudinal slot 110a.
  • the inner side wall 108 of the horn 100 has a distal-facing surface 114, and the cantilever beam 112 has a proximal-facing surface 116 that is in longitudinal alignment with the distal-facing surface 114.
  • the proximal-facing surface 116 and the distal-facing surface 114 define the circumferential slot 110b therebetween.
  • a free end 118 of the cantilever beam 112 may be configured to flex or deform in a generally distal direction upon the post 72 of the waveguide 30 being rotated into the circumferential slot 110b.
  • the post 72 of the waveguide 30 is configured to be compressed or sandwiched between the proximal-facing surface 116 of the cantilever beam 112 and the distal-facing surface 114 when the post 72 of the waveguide 30 is received in the circumferential slot 110b to create an efficient ultrasonic energy transfer joint therebetween.
  • a width “W” (FIG.
  • the longitudinal slot 110a defined as a circumferential distance between the free end 118 of the beam 112 and the inner side wall 108 may be less than a diameter of the post 72 such that the beam 112 is flexed or deformed proximally upon proximal entry of the post 72 into the longitudinal slot 110b.
  • the beam 112 may extend up to surface 104 and act as a rigid surface, whereas the post 72 may be of a smaller cross section and act as a flexing member.
  • the proximal-facing surface 116 and/or the distal-facing surface 114 may be angled relative to a cross-section of the horn 100.
  • the proximal- facing and distal-facing surfaces 116, 114, and in turn the circumferential slot 110b may be angled slightly distally to help ensure that once the post 72 of the waveguide 30 is rotated into the circumferential slot 110b, the post 72 is prevented from backing out of the circumferential slot 110b without considerable torque.
  • the above-detailed engagement may be between the waveguide 30 and blade 13, in configurations where the blade 13 is removable from a body of the waveguide 30, e.g., to enable changing the blade 13.
  • the features of the components may be reversed, e.g., wherein the waveguide 30 defines the opening 106 and the horn 100 defines the post(s) 72, while still achieving the same engagement as detailed above.
  • FIGS. 5-7 another horn 200 and waveguide 300 are illustrated, which are similar to the horn 100 and waveguide 30 described above with reference to FIGS. 3A-3C and 4.
  • the horn 200 and waveguide 300 differ from the horn 100 and waveguide 30 in the manner in which the horn 200 and waveguide 300 are detachably coupled to one another.
  • the below-described features of the horn 200 and waveguide 300 may be reversed and/or such an engagement may alternatively or additionally be utilized to releasably secure the body of waveguide 300 with a blade, e.g., blade 13 (FIG. 1).
  • the horn 200 has a distal end portion 202 having an arcuate inner side wall 204 that defines a channel 206 configured for receipt of a proximal end portion 302 of the waveguide 300.
  • the distal end portion 202 of the horn 200 has a pair of protuberances or bosses 208a, 208b projecting radially inward from opposite sides of the inner side wall 204.
  • the bosses 208a, 208b may be recessed proximally from a distal-most surface 210 of the horn 200 and may be rectangular, rounded, or any other suitable shape.
  • the proximal end portion 302 of the waveguide 300 has a proximal extension 304 defining a pair of helically-shaped slots 306a, 306b (FIG. 7) therein configured for receipt of the respective bosses 208a, 208b.
  • the bosses 208a, 208b are maintained in the slots 306a, 306b by an interference fit with the slots 306a, 306b, whereby pressure and friction are generated between the horn 200 and waveguide 300 to prevent the horn 200 and waveguide 300 from rotating out of engagement.
  • the interference fit also creates sufficient pressure for efficient ultrasonic energy transfer between the horn 200 and waveguide 300.
  • the interference fit between the bosses 208a, 208b and the slots 306a, 306b allows for a broader and more symmetric interface between the distal-most surface 210 of the horn 200 and a proximal surface 308 of the waveguide 300, which is where the ultrasonic energy is transferred. This also improves ultrasonic balance as the energy is uniformly transferred across one face 210 or 308 to the other face 210 or 308.
  • the distal end portion 202 of the horn 200 has a nub 212 extending distally from the distal-most surface 210 of the horn 200.
  • the proximal surface 308 of the waveguide 300 defines a recess 312 proximally therein configured for receipt of the nub 212 of the horn 200 to maintain the waveguide 300 and horn 200 in a proper orientation, prevent the waveguide 300 and horn 200 from rotating out of engagement, and relieving pressure between the two interfacing surfaces 210, 308 of the respective horn 200 and waveguide 300.
  • the nub 212 may be semi-hemispherical, a radial bar, or any other suitable type of mating feature on any suitable surface in proximity to the boss 208a of the horn 200 when the horn 200 is engaged with the waveguide 300.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Mechanical Engineering (AREA)
  • Biomedical Technology (AREA)
  • Dentistry (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

L'invention concerne un instrument chirurgical à ultrasons comprenant un émetteur d'ultrasons et un guide d'ondes pour transférer l'énergie ultrasonore de l'émetteur d'ultrasons à un effecteur terminal. L'émetteur d'ultrasons a une partie d'extrémité distale définissant un canal à l'intérieur de celui-ci conçu pour la réception d'une partie d'extrémité proximale du guide d'ondes. La partie d'extrémité proximale du guide d'ondes et la partie d'extrémité distale de l'émetteur d'ultrasons sont reliées de manière amovible selon un ajustement avec serrage.
PCT/IB2023/050399 2022-01-21 2023-01-17 Instrument chirurgical à ultrasons WO2023139481A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US202263301527P 2022-01-21 2022-01-21
US63/301,527 2022-01-21

Publications (1)

Publication Number Publication Date
WO2023139481A1 true WO2023139481A1 (fr) 2023-07-27

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PCT/IB2023/050399 WO2023139481A1 (fr) 2022-01-21 2023-01-17 Instrument chirurgical à ultrasons

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20150305763A1 (en) * 2010-11-05 2015-10-29 Ethicon Endo-Surgery, Inc Cam driven coupling between ultrasonic transducer and waveguide in surgical instrument
US20190314056A1 (en) * 2018-04-12 2019-10-17 Ethicon Llc Mechanical lockout for ultrasonic surgical instrument
US20190314054A1 (en) * 2018-04-12 2019-10-17 Ethicon Llc Electrical lockout for ultrasonic surgical instrument
US20210030436A1 (en) * 2017-06-15 2021-02-04 Reach Surgical, Inc. Ultrasonic surgical instrument
US20210059705A1 (en) * 2019-09-03 2021-03-04 Covidien Lp Bi-stable spring-latch connector for ultrasonic surgical instruments

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20150305763A1 (en) * 2010-11-05 2015-10-29 Ethicon Endo-Surgery, Inc Cam driven coupling between ultrasonic transducer and waveguide in surgical instrument
US20210030436A1 (en) * 2017-06-15 2021-02-04 Reach Surgical, Inc. Ultrasonic surgical instrument
US20190314056A1 (en) * 2018-04-12 2019-10-17 Ethicon Llc Mechanical lockout for ultrasonic surgical instrument
US20190314054A1 (en) * 2018-04-12 2019-10-17 Ethicon Llc Electrical lockout for ultrasonic surgical instrument
US20210059705A1 (en) * 2019-09-03 2021-03-04 Covidien Lp Bi-stable spring-latch connector for ultrasonic surgical instruments

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