WO2024061657A1 - Instrument et appareil d'électrochirurgie - Google Patents

Instrument et appareil d'électrochirurgie Download PDF

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Publication number
WO2024061657A1
WO2024061657A1 PCT/EP2023/074785 EP2023074785W WO2024061657A1 WO 2024061657 A1 WO2024061657 A1 WO 2024061657A1 EP 2023074785 W EP2023074785 W EP 2023074785W WO 2024061657 A1 WO2024061657 A1 WO 2024061657A1
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WO
WIPO (PCT)
Prior art keywords
electrode
arm
tissue
jaw
isolating portion
Prior art date
Application number
PCT/EP2023/074785
Other languages
English (en)
Inventor
George Christian ULLRICH
Steven Thomas
Warren Jones
Christopher Paul Hancock
Louis TURNER
Duncan James Foster FITZSIMONS
Original Assignee
Creo Medical Limited
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 Creo Medical Limited filed Critical Creo Medical Limited
Publication of WO2024061657A1 publication Critical patent/WO2024061657A1/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
    • A61B18/1442—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
    • 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
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • 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
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • 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
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • 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
    • A61B2018/00601—Cutting
    • 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
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00779—Power or energy
    • A61B2018/00785—Reflected power
    • 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
    • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
    • 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
    • A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/128—Generators therefor generating two or more frequencies
    • 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
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1457—Probes having pivoting end effectors, e.g. forceps including means for cutting having opposing blades cutting tissue grasped by the jaws, i.e. combined scissors and pliers
    • 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
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A61B2018/183—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves characterised by the type of antenna
    • A61B2018/1838—Dipole antennas
    • 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
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter

Definitions

  • the invention relates to an electrosurgical instrument for sealing and/or cutting tissue .
  • the electrosurgical instrument can be configured to grasp biological tissue and deliver microwave energy into the grasped tissue to seal the tissue by coagulation or cauterisation .
  • the electrosurgical instrument may be used to apply pressure to close one or more blood vessels before applying electromagnetic radiation (preferably microwave energy) to seal the blood vessel ( s ) .
  • the electrosurgical instrument may also be arranged to cut , e . g . separate or divide , the vessel or surrounding tissue after coagulation or sealing , e . g . using radiofrequency ( RF ) energy and/or a mechanical cutting element , such as a blade .
  • the invention may be applied to a vessel sealer for use in laparoscopic surgery or open surgery as well as to an endoscopic instrument .
  • the invention also relates to an electrosurgical apparatus for sealing and cutting tissue which comprises a generator unit for generating radiofrequency and/or microwave electromagnetic energy, and the electrosurgical instrument .
  • Electrosurgical instruments for delivering heat energy into grasped biological tissue are known .
  • it is known to deliver microwave energy from a bipolar electrode arrangement in the j aws of a forceps .
  • the microwave energy may be used to seal a vessel by thermal denaturation of extracellular matrix proteins (e . g . collagen) within the vessel wall .
  • the heat energy may also cauterise the grasped tissue and facilitate coagulation .
  • Such devices typically find application on the end of minimally invasive surgical laparoscopic tools but can equally find use in other clinical procedural areas such as gynaecology, endourology, gastrointestinal surgery, ENT procedures , or endoscopic procedures . Depending on the context of use , these devices can have differing physical construction, size , scale and complexity .
  • a gastrointestinal instrument might be nominally of 3 mm diameter mounted on to the end of a very long flexible shaft .
  • a laparoscopic instrument may be used on the end of an industry standard nominal 5mm or 10mm diameter rigid or steerable steel shaft .
  • US 6 , 585 , 735 describes an endoscopic bipolar forceps in which the j aws of the forceps are arranged to conduct bipolar energy through the tissue held therebetween .
  • EP 2 233 098 describes microwave forceps for sealing tissue in which the sealing surfaces of the j aws include one or more microwave antennas for radiating microwave energy into tissue grasped between the j aws of the forceps .
  • WO 2015 / 097472 describes electrosurgical forceps in which one or more pairs of non-resonant unbalanced lossy transmission line structures are arranged on the inner surface of a pair of j aws .
  • the present invention provides various types of electrosurgical instruments that can enable fine tissue cutting and dissection to be performed on tissue .
  • the electrosurgical instruments may provide additional functionality, such as sealing biological tissue , such as (blood ) vessels , using a confined microwave field that can yield a well-defined seal location with low thermal margin . With these additional functions , fewer device interchanges may be needed during a procedure .
  • the electrosurgical instruments disclosed herein may be used in any type of surgical procedure , but it is expected to find particular utility for non-invasive or minimally invasive procedures .
  • the device may be configured to be introduced to a treatment site through an instrument channel of a surgical scoping device , such as a laparoscope or an endoscope .
  • an electrosurgical instrument for sealing and/or cutting tissue which comprises an instrument shaft , a j oint , a first j aw, a second j aw, a first electrode , a second electrode , a first isolating portion, and an arm movable relative to the second j aw .
  • the instrument shaft comprises a ( coaxial ) transmission line for conveying microwave electromagnetic energy and/or radiofrequency electromagnetic energy .
  • the first j aw is attached to the instrument shaft via the j oint and includes a first surface .
  • the second j aw is attached to the instrument shaft via the j oint and includes a second surface .
  • the first and/or second electrodes are configured to emit microwave and/or radiofrequency electromagnetic energy .
  • the first isolating portion electrically isolates the first electrode from the second electrode .
  • the first j aw and the second j aw can be moved between an open position, in which the tissue can be inserted between the first surface and the second surface , and a closed position, in which the first and second surfaces are brought together to clamp, hold, and/or grasp tissue therebetween .
  • the arm In the closed position, the arm is configured to be moved between a press position, in which the arm and the first surface are brought together to press the tissue therebetween, and a retracted position, in which the arm is spaced away from the first surface .
  • pressure that is applied by the arm on the tissue which is clamped or grasped between the first j aw and the second j aw in the closed position can be varied relative to the pressure that is applied by the first j aw and the second j aw ( i . e . by the first surface and the second surface ) .
  • This means that different portions of the tissue can be subj ected to different pressures .
  • tissue that is clamped between the first surface and the second surface may be subj ected to a constant pressure ( e . g .
  • tissue that is arranged between the arm and the first surface may be subj ected to a different pressure .
  • the pressure applied to this part of the tissue may be increased by moving the arm towards or to the press position or reduced by moving the arm towards or to the relaxed position .
  • the first j aw and the second j aw are in the closed position and the arm is in the relaxed position .
  • the arm may be in the press position for increasing the pressure on the area subj ected to radiofrequency cutting while the first j aw and the second j aw either remain in the closed position or are slightly opened compared to the closed position so that tissue that has been cut is released from the electrosurgical instrument .
  • the invention provides a mechanism for varying the pressure during microwave sealing and radiofrequency cutting .
  • a pressure between the first and second j aws for microwave sealing may be less than a pressure between the arm and second j aw for RF cutting .
  • the same structure may be used to provide more pressure during RF cutting than during microwave sealing .
  • proximal and distal refer to the ends of the electrosurgical instrument , the shaft , and/or the coaxial transmission line further from and closer to a treatment site respectively .
  • the proximal end is closer to a generator unit for providing the RF and/or microwave energy
  • the distal end is closer to the treatment site , i . e . the patient .
  • conductive is used herein to mean electrically conductive , unless the context dictates otherwise .
  • longitudinal refers to the direction along the instrument channel parallel to the axis of the coaxial transmission line .
  • lateral refers to a direction that is perpendicular to the longitudinal direction .
  • inner means radially closer to the centre ( e . g . axis ) of the instrument channel .
  • outer means radially further from the centre ( axis ) of the instrument channel .
  • RF EM energy may mean a stable fixed frequency in a range 10 kHz to 300 MHz , preferably in a range from 100 kHz to 5MHz , and more preferably in a range from 360 to 440 kHz .
  • the microwave EM energy may mean electromagnetic energy having a stable fixed frequency in the range 300 MHz to 100 GHz .
  • the RF EM energy should have a frequency high enough to prevent the energy from causing nerve stimulation .
  • the magnitude of the RF EM energy and the duration for which it is applied may be selected to prevent the energy from causing tissue blanching or unnecessary thermal margin or damage to the tissue structure.
  • Preferred spot frequencies for the RF EM energy include any one or more of: 100 kHz, 250 kHz, 400 kHz, 500 kHz, 1 MHz, 5 MHz.
  • Preferred spot frequencies for the microwave EM energy include 915 MHz, 2.45 GHz, 5.8 GHz, 14.5 GHz, 24 GHz. 2.45 GHz and/or 5.8 GHz may be preferred.
  • the microwave electromagnetic energy and the radiofrequency electromagnetic energy may be conveyed along a common signal pathway through the instrument shaft.
  • a coaxial cable may provide the common signal pathway for conveying both the microwave energy and the radiofrequency energy.
  • the transmission line may comprise an inductive filter for blocking the microwave energy from the cutting element, and a capacitive filter for blocking the radiofrequency energy from the first and second electrodes.
  • the radiofrequency energy and microwave energy are conveyed along separate pathways within the instrument shaft (the transmission line includes separate pathways) , wherein the inductive filter and capacitive filter are provided at a proximal end of the instrument shaft, e.g. in a handle.
  • a coaxial cable is provided for conveying the microwave electromagnetic energy while two or more wires are provided for conveying the radiofrequency electromagnetic energy.
  • the instrument shaft may be dimensioned to fit within an instrument channel of a surgical scoping device.
  • the surgical scoping device may be a laparoscope or an endoscope.
  • Surgical scoping devices are typically provided with an insertion tube that is a rigid or flexible (e.g. steerable) conduit that is introduced into a patient's body during an invasive procedure.
  • the insertion tube may include the instrument channel and an optical channel (e.g. for transmitting light to illuminate and/or capture images of a treatment site at the distal end of the insertion tube) .
  • the instrument channel may have a diameter suitable for receiving invasive surgical tools .
  • the diameter of the instrument channel may be equal to or less than 13 mm, preferably equal to or less than 10 mm, and more preferably, especially for flexible insertion tubes, equal to or less than 5 mm.
  • the instrument shaft and the transmission line may be flexible so that they can be inserted into the instrument channel of the scoping device. Further, the transmission line may be arranged within a lumen of the shaft. The instrument shaft may cover and/or shield the transmission line. The transmission line may extend from a distal end to a proximal end of the electrosurgical instrument. In particular, the transmission line electrically connects the first electrode and the second electrode to the generator unit.
  • the electrosurgical instrument discussed herein may find applicability in other tissue welding techniques.
  • the energy delivery structure may be used as an alternative to staples.
  • staple guns are used to deliver 50 to 100 small staples that are fired simultaneously between jaws that can have a length of 70 mm or more, or from an annular jawed arrangements with diameters of 20 to 50 mm.
  • multiple antenna structures such as those discussed herein may be used to cover the required length.
  • the antenna structures may be arranged in any number of array forms to be activated simultaneously, sequentially or progressively in a suitable manner.
  • the first jaw and/or the second jaw may be movable relative to their instrument shaft.
  • the first jaw and/or the second jaw may be attached to the instrument shaft via the joint or a hinge.
  • the joint may include a pivot axis around which the first jaw and/or the second jaw may rotate.
  • the first jaw and/or the second jaw may be activated by one or more actuation rods or control wires respectively connected to the first jaw and/or the second jaw.
  • the one or more actuation rods or control wires may extend within the instrument shaft to a proximal end of the electrosurgical instrument.
  • the one or more actuation rods may be connected to a handle with which the first and/or second jaws can be actuated, e.g. opened and/or closed.
  • the electrosurgical instrument comprises an actuation mechanism which converts a back-and-forth movement of the actuation rod(s) or control wire(s) into a rotational movement of the first jaw and/or the second jaw.
  • both jaws can be movable, e.g. rotatable around a (common) pivot axle.
  • one of the jaws is fixed to the shaft and the other jaw is movable relative to the one jaw.
  • the first jaw and the second jaw are (maximally) spaced apart so that there is a free space between the first surface of the first jaw and the second surface of the second jaw.
  • tissue can be inserted between the first surface and the second surface in the open position.
  • the first jaw and the second jaw are moved towards the tissue such that the tissue is pushed into the space between the first surface and the second surface in the open position of the first jaw and the second jaw.
  • the tissue between the first surface and the second surface can be grasped and/or clamped between the first surface and the second surface. In this way, the tissue can be fixed between the first surface and the second surface in the closed position.
  • the first surface and the second surface are the faces of the first jaw and the second jaw, respectively, that face each other in the open and/or closed position.
  • the pair of jaws may be pivotable relative to each other about the pivot axis that lies transverse to a longitudinal axis of the coaxial transmission line.
  • the pair of jaws comprises a static jaw that is fixed relative to the instrument shaft, and a movable jaw that is pivotably mounted relative to the static jaw to open and close the gap between the opposing inner surfaces.
  • the energy delivery structure may be disposed on the inner surface of the static jaw.
  • both jaws are arranged to pivot with respect to the instrument shaft, e.g. in a symmetrical forceps-type or scissors-type arrangement. Relative movement of the pair of jaws may be controlled from a handle at a proximal end of the instrument shaft.
  • a control rod or control wires may pass through the instrument shaft to operably couple an actuation mechanism on the handle to the pair of jaws.
  • the pair of jaws may be arranged to move relative to one another in a manner that maintains the inner surfaces thereof in an aligned, e.g. parallel, orientation.
  • This configuration may be desirable for maintaining a uniform pressure on grasped tissue along the length of the jaws.
  • One example of such a closure mechanism is disclosed in WO 2015/097472.
  • the first jaw and/or the second jaw may have a Maryland configuration. This can include that the first jaw and the second jaw are not straight but bent/curved, e.g. forming an arc or an S-shape in a side view.
  • the press position is a position of the arm in which the arm is configured to press against tissue that is clamped or grasped between the first jaw and the second jaw in the closed position.
  • a contact surface of the arm e.g. an outer surface of the arm that is in contact with the tissue in the press position
  • the contact surface of the arm protrudes from the second surface in the press position and/or is closer to the first surface compared to the second surface in the press position.
  • An angle defined between the first surface and the second surface may be greater than an angle defined between the contact surface of the arm and the first surface in the press position.
  • the contact surface of the arm may be arranged further away from the first surface compared to the second surface (e.g. in the closed position) . So, the arm applies less pressure to the tissue in the relaxed position compared to the pressure that is applied between the first jaw and a second jaw in the closed position.
  • An angle defined between the first surface and the second surface may be smaller than an angle defined between the contact surface of the arm and the first surface in the relaxed position.
  • the arm may be actuated by a further control wire or actuation rod.
  • There may be a further actuation mechanism e.g. implemented with the joint
  • the arm In the press position, the arm may be (continuously) actuated to apply a (constant) pressure on the tissue.
  • the arm In the relaxed position, the arm may not be actuated so that the arm rests on the tissue (due to gravity) or (freely) moves away from the tissue depending on the orientation of the electrosurgical instrument.
  • the arm may be actuated away from the first jaw for providing the relaxed position. In this case, the arm may be positioned so that the contact surface does not contact the tissue that is clamped between the first jaw and the second jaw.
  • the arm is movable or rotatable with respect to the second jaw and/or the second surface for varying a distance between the contact surface of the arm and the first surface.
  • the position of the arm or the contact surface may be set differently to the position of the second jaw or the second surface.
  • the second jaw is rotatable around a pivot axis of the joint.
  • the arm is also rotatable around the pivot axis.
  • the second jaw and the arm are configured to be rotated independently from each other.
  • the arm may also be attached to the joint.
  • the arm may be pivotable around the pivot axis.
  • the arm may be freely movable with respect to the second jaw.
  • the arm is not (mechanically) coupled to the second jaw so that a movement of the second jaw does not result in a movement of the arm and vice versa.
  • the second jaw and the arm may be actuated completely separately from each other.
  • the arm may only be rotatably attached to the pivot axle.
  • the second jaw is only rotatably attached to the pivot axle. So, the arm and the second jaw can rotate independently from each other around the pivot axis .
  • the rotation around the same pivot axis and/or the attachment of the arm and the second jaw to the same pivot axle means that the contact surface of the arm and the second surface of the second jaw can form a common and/or flush surface along the extension of the second jaw irrespective of the position of the second jaw or the arm as long as both elements are arranged at the same position/angle .
  • the first jaw may also be pivotally coupled to the pivot axle.
  • the joint includes a pivot axle to which the first jaw, the second jaw, and/or the arm is rotatably attached.
  • the joint may rotatably support the pivot axle.
  • the second jaw includes a jaw slot and the arm includes an arm cam, wherein the arm cam is inserted in the jaw slot for providing movement of the arm relative to the second jaw between the retracted position and the press position.
  • the jaw slot and the arm cam may be provided in addition to the rotatable attachment of the arm to the pivot axle.
  • the arm may include one or more arm cams and/or the second jaw includes one or more jaw slots.
  • each arm cam is inserted in a respective jaw slot.
  • the jaw slot is an elongated slot having a width slightly greater than a diameter of the arm cam and a length significantly greater than the diameter of the arm cam so that the arm cam can slide within the jaw slot along the length of the jaw slot.
  • a movement of the arm cam in the jaw slot corresponds to a relative movement of the arm with respect to the second jaw. If the arm cam abuts against a first end of the jaw slot, the arm can be in the press position. If the arm cam abuts against a second opposite end of the jaw slot, the arm can be in the relaxed position. So, the length of the jaw slot determines the angular range or movement range within which the arm can move relative to the second jaw.
  • the arm is coupled to the second jaw so that a movement of the second jaw results in a movement of the arm.
  • the actuation of the arm results in a movement of the arm relative to the second jaw.
  • This configuration may be helpful for moving the arm relative to the second jaw, i.e. between the press position and the relaxed position, since the actuation of the arm is relative to the position of the second j aw .
  • the arm may also be attached to the joint.
  • the arm may be pivotable around the pivot axis.
  • the arm may be moved independently from the second jaw.
  • the arm may be pivotable with respect to the second jaw, i.e. is pivotally attached to the second jaw. In this arrangement, movement of the second jaw also moves the arm so that the arm can be moved relative to the second jaw.
  • the second jaw and/or the second surface include an opening through which the arm can be moved .
  • the opening of the second jaw may completely extend through the second jaw so that the arm can be moved from one side of the second jaw, through the opening, and to the other side of the second jaw.
  • the opening may be a through-hole which extends from the second surface to the other side of the second j aw .
  • the outer shape of the arm may match the shape of the opening . There may be a small gap between the outer perimeter of the arm and the inner surface of the opening . Alternatively, the inner surface of the opening may provide a sliding contact with the arm .
  • the second j aw may have a recess within which the arm can be received .
  • the opening corresponds to the open portion of the recess .
  • the arm may thus be movable through the second surface between the retracted position and the press position . For example , the arm abuts against a bottom surface of the recess in the relaxed position and protrudes from the recess in the press position .
  • the arm protrudes from an inner surface of the second j aw in the press position .
  • the arm can protrude from an outer surface of the second j aw ( e . g . back surface of the second j aw) .
  • the electrosurgical instrument further comprises a third electrode for radiofrequency cutting along a cutting line .
  • the first electrode and the second electrode are arranged on the first j aw .
  • sections of the first and second electrodes are exposed on the first surface to define a first sealing area and a second sealing area on the first surface .
  • the first sealing area is spaced from the second sealing area to form a gap therebetween on the first surface so that , in an embodiment , the tissue between the first sealing area and the second sealing area is not sealed upon the emission of the microwave electromagnetic energy .
  • the first and second sealing areas are configured to seal the tissue on either side of the gap using the emitted microwave electromagnetic energy .
  • the cutting line is positioned on the gap .
  • the first and second electrodes in the pair of j aws operate to provide two localised seals for a biological vessel/tissue gripped between the first and second j aws
  • the third electrode is operable to cut and/or divide the vessel between the two localised seals
  • the electrosurgical instrument may thus perform vessel/tissue sealing and vessel/tissue dividing .
  • Vessel/tissue sealing is typically the application of pressure to squash the walls of a biological vessel together , followed by the application of some form of thermal energy .
  • the thermal energy is applied by the first and second electrodes to the gripped tissue using the microwave electromagnetic energy .
  • the pressure to the tissue can be applied by the first and/or second electrodes ( e . g .
  • Vessel/tissue dividing is a process of cutting through a continuous biological vessel/tissue to separate it into two pieces . It is normally performed after a vessel/tissue is first sealed . Vessel/tissue dividing is performed by the third electrode , which is discussed in more detail below . As described above , the vessel/tissue dividing is locally offset from the vessel/tissue sealing . In particular , the vessel/tissue dividing occurs between the vessel/tissue seals . Stated differently, the instrument is configured such that vessel/tissue dividing occurs at a different location to vessel/tissue sealing .
  • the first surface includes the exposed sections of the first electrode and the second electrode .
  • the first electrode and/or the second electrode are arranged within and/or on the first j aw .
  • the first electrode and/or the second electrode are made from an electrically conductive material , such as metal , and may be connected to an inner conductor and an outer conductor of the coaxial cable , respectively .
  • the first electrode and the second electrode are electrically isolated from each other by the first isolating portion . Further , the sections of first electrode and the second electrode that are exposed on the first surface are spaced apart from each other , for example by an air gap or an exposed section of the first isolating portion .
  • the exposed sections of the first electrode and/or the second electrode may extend as lines and/or form areas on the first surface .
  • the exposed sections of the first electrode and the second electrode define two sealing areas laterally offset on the first surface , namely the first sealing area and the second sealing area .
  • the first sealing area and the second sealing area may be connected to each other on the first surface by the other parts of the exposed sections of the first electrode and the second electrode . This means that the first sealing area and the second sealing area may or may not be connected to each other on the first surface .
  • the first sealing area and the second sealing area are separated by a gap on the first surface .
  • the first sealing area includes a first set of exposed sections of the first electrode and the second electrode which extends alongside ( e . g . and spaced from, in a side-by-side manner ) the second sealing area, wherein the second sealing area includes a second set of exposed sections of the first electrode and the second electrode .
  • the first sealing area and/or the second sealing area define elongated structures ( e . g . rectangles or ellipses ) that are arranged side-by-side and separated by the gap on the first surface .
  • the exposed sections of the first electrode may form ( straight ) lines which are separated by the gap .
  • the exposed sections of the second electrode may form ( straight ) lines between which the exposed sections of the first electrode are positioned .
  • Exposed sections of the first isolating portion may be arranged between the ( straight ) lines of exposed sections of the first electrode and the second electrode .
  • the first sealing area and the second sealing area are each configured to emit microwave energy at the exposed sections of the first electrode and the second electrode .
  • the exposed section of the first electrode may be considered a dipole antenna for radiating microwave electromagnetic energy .
  • both the first sealing area and the second sealing area include two electrodes of different polarity or electrical potential .
  • the first sealing area and the second sealing area are configured to emit microwave energy to tissue that is close to or in contact with the exposed sections of the first electrode and the second electrode .
  • the exposed sections of the first electrode and the second electrode are arranged such that tissue that is clamped and/or grasped between the first surface and the second surface in the closed position is in contact with the exposed sections of the first electrode and the second electrode or in contact with the first sealing area and the second sealing area .
  • tissue that is clamped and/or grasped between the first surface and the second surface in the closed position is in contact with the exposed sections of the first electrode and the second electrode or in contact with the first sealing area and the second sealing area .
  • the first sealing area and the second sealing area have a double functionality . They can clamp or grasp tissue (with the second surface being the counterpart ) and emit microwave energy .
  • the greatest intensity of the emitted microwave energy is achieved in a portion of the tissue that is in contact with or directly above the exposed sections of the first electrode and the second electrode in the first sealing area and the second sealing area .
  • the intensity of the emitted microwave energy is highest at respective edges or corners of the exposed sections of the first electrode and the second electrode that face each other .
  • the intensity of the emitted microwave energy is highest above the interface of the first isolating portion and the first electrode ( at the first surface ) and at the interface of the first isolating portion and the second electrode ( at the first surface ) .
  • portions of the exposed sections of the first electrode that are away from the respective exposed sections of the second electrode exhibit a ( significantly) lower intensity of the emitted microwave energy .
  • These portions may be regarded as not corresponding to the first and/or second sealing areas since , due to the reduced intensity, no or insufficient microwave sealing can be achieved .
  • the intensity of the emitted microwave radiation is only sufficiently high to effect tissue sealing above the first sealing area and the second sealing area whereas the intensity of the emitted microwave energy is below a threshold for effecting tissue sealing in an area between the first sealing area and the second sealing area .
  • the threshold for effecting tissue sealing depends on the tissue .
  • an area between the first sealing area and the second sealing area can be established in which no or little ( e . g . only negligible ) tissue sealing is effected upon the emission of microwave energy .
  • a dimension of the gap is chosen such that effective tissue sealing can be achieved over the first sealing area and the second sealing area but not in an area therebetween .
  • the third electrode is configured to cut or divide tissue that is arranged between the first sealing area and the second sealing area .
  • the line of the cut or divide of the tissue may be considered the cutting line .
  • the third electrode may be arranged along the cutting line .
  • the cutting line is arranged between the first sealing area and the second sealing area, i . e . within the gap .
  • the cutting line is arranged in the middle between the first sealing area and the second sealing area so that a distance from the cutting line to the first sealing area is the same as a distance from the cutting line to the second sealing area .
  • the third electrode may therefore be configured to cut tissue that is not sealed .
  • the tissue is firstly sealed and then cut . Due to the arrangement of the cutting line in the gap, the third electrode cuts in a portion of the tissue that is not sealed although other portions of the tissue have been sealed due to the emission of microwave energy . This means that sealing and cutting of the tissue may be simultaneously conducted because little or no interaction between the sealing at the cutting is expected due to the spatial separation of the sealing at the cutting .
  • the electrosurgical instrument further comprises a second isolating portion .
  • the second isolating portion electrically isolates the third electrode from the first electrode at least in the closed position .
  • the first isolating portion and/or the second isolating portion may be made from an electrically non-conductive material such as a ceramic ( e . g . Zirconia ) or plastic material ( e . g . Polyetheretherketon ( PEEK) ) .
  • the first isolating portion and/or the second isolation portion may be fixed to the first electrode and/or the second electrode and/or vice versa .
  • the first electrode may be sandwiched between the first isolating portion and the second isolating portion .
  • the second isolating portion may cover the side of the first electrode that faces the first surface except for the exposed sections of the first electrode .
  • the second isolating portion is arranged in the space formed by the U- shaped or V-shaped portions of the first electrode .
  • the third electrode may be an active electrode wherein one or more of the first , second, and fourth electrodes may act as a return electrode .
  • the third electrode may be electrically isolated from the first electrode by the second isolating portion in the closed position .
  • Optional embodiments relating to the position of the third electrode are discussed below .
  • the third electrode is arranged on the arm.
  • the third electrode (or radiofrequency electrode ) may be a ridge or bar made from an electrically conductive material that can be exposed on an isolating portion such as the third isolation portion described below .
  • the third electrode may provide or form the contact surface of the arm.
  • the third electrode can be arranged or configured to be the only part of the arm that is in contact with the tissue in the press position . In the press position in the absence of tissue , the third electrode may contact the second isolating portion between the first sealing area and the second sealing area and/or is parallel to the extension of the first sealing area and the second sealing area .
  • tissue can be sealed using microwave energy in the closed position of the j aws whereby the arm can be positioned away from the first surface - for example the arm is arranged outside of the opening ( an example of the retracted position) .
  • little or no pressure is applied on tissue over the area of the gap ( i . e . between the first sealing area and the second sealing area ) .
  • the arm is then moved through the opening so that the radiofrequency electrode presses the tissue against the first surface ( i . e . the press position ) , optionally onto the gap ( i . e . in an area between the first sealing area and the second sealing area ) .
  • first j aw and the second j aw may not be moved as the first and second j aws may remain in the closed position during both microwave sealing and radiofrequency cutting . This helps to reliably cut between the sealed areas of the tissue .
  • differing levels of pressure may be applied during sealing and cutting . For example , a higher pressure may improve a seal , but a lower pressure may improve a cut .
  • the third electrode includes a ridge protruding from the second isolating portion .
  • the third electrode may be a bar or rod made from an electrically conductive material (e . g . metal or metal alloy) that is arranged on the second isolating portion .
  • the third electrode can be permanently fixed to the second isolating portion .
  • the third electrode may be arranged on the second isolating portion so that tissue can contact the third electrode , especially in the closed position .
  • the third electrode may be arranged between the first sealing area and the second sealing area and/or parallel to the extension of the first sealing area and the second sealing area .
  • the arm includes a third isolating portion which is in contact with the third electrode in the press position of the arm ( in the absence of tissue between the first j aw and the second j aw and/or in the closed position ) .
  • tissue can be sealed using microwave energy in the closed position whereby the arm can be positioned away from the first surface ( e . g . the retracted position ) - for example the arm is arranged outside of the opening .
  • little or no pressure is applied on tissue over the area of the gap ( i . e . between the first sealing area the second sealing area ) and/or over the third/radiof requency electrode arranged on the second isolating portion .
  • the arm is then moved through the opening so that the arm presses the tissue against the third electrode arranged on the first j aw ( the press position ) . So the pressure on the tissue can be increased for radiofrequency cutting .
  • differing levels of pressure may be applied during sealing and cutting . For example , a higher pressure may improve a seal , but a lower pressure may improve a cut .
  • the third isolating portion may define the contact surface of the arm that faces the radiofrequency electrode .
  • the third isolating portion contacts the third electrode and/or extends parallel to the third electrode in the press position ( in the absence of tissue ) .
  • the third isolating portion may be made from the same electrically non- conductive material as the first isolating portion and/or the second isolating portion .
  • the electrically conductive part of the arm may support the third isolation portion .
  • the electrosurgical instrument includes a fourth electrode for emitting microwave energy which it is exposed on the second surface .
  • the second electrode may be symmetrical to the fourth electrode , respectively - both relative to the first and second surface in the closed position . More generally, the characteristics , features and preferred embodiment described in conj unction with the second electrode may equally apply for the fourth electrode and vice versa .
  • a fourth isolating portion may be arranged within the half-shell of the second j aw or fourth electrode .
  • the fourth isolating portion may contact the first electrode and/or the second electrode in the closed position and/or provide electrical isolation to the arm.
  • the fourth isolating portion may surround the opening .
  • the second j aw includes a fourth isolating portion which covers the opening and is flexible across the opening so that the third electrode is configured to deform the fourth isolating portion in the closed position or the arm deforms the fourth isolating portion in the press position of the arm .
  • the fourth isolating portion is made from silicone .
  • the fourth isolating portion may include the features as described above but additionally covers the opening .
  • the section of the fourth isolating portion that covers the opening may be thin and/or have the configuration of a membrane across the opening . This provides sufficient flexibility and/or softness of the fourth isolating portion over the opening so that the fourth isolating portion can be deformed .
  • the fourth isolating portion includes a membrane section providing a membrane that covers the opening .
  • the membrane section may be unitary component with the rest of the fourth isolating portion .
  • the membrane section or the complete fourth isolating portion may be made from silicone or a silicone-based material which provides the elasticity of the membrane section .
  • the fourth isolating portion that covers the opening allows that the arm is either completely made of electrically conductive material or that the portion of the arm that faces the radiofrequency electrode can be made from electrically conductive material .
  • the arm and the radiofrequency electrode are separate by the (membrane ) section of fourth isolating portion that covers the opening .
  • the fourth isolating portion may also be deformed in the closed position of the first j aw and the second j aw in that the radiofrequency electrode pushes the membrane section /the fourth isolating portion into the opening .
  • the second electrode covers the first electrode on the side of the first electrode facing away from the first surface and/or the first isolating portion is arranged between the first electrode and the second electrode .
  • the second electrode may completely cover the first electrode on one side of the first surface so that the second electrode shields the first electrode .
  • the second electrode may act and/or form a half-shell or channel in which the first electrode is arranged .
  • the second electrode and/or the fourth electrode may be a ground electrode .
  • the second electrode In the closed position, the second electrode is configured to shield microwave radiation that is emitted from the first electrode away from the first surface .
  • the first electrode may solely be configured to emit microwave energy through or on the first surface .
  • portions of the first electrode and/or the second electrode are plate-shaped and respectively include end faces , wherein optionally the end faces form the exposed sections .
  • the portions of the first electrode and/or the second electrode are U-shaped or V- shaped .
  • the portions of the first electrode and/or the second electrode that extend along sections of the first j aw where the first and second sealing areas are provided may be plate-shaped .
  • Other portions of the first electrode and/or the second electrode may have different configurations .
  • proximal and/or distal end portions of the first electrode and/or the second electrode may have shapes that deviate from a plate shape . This may be provided for forming distal and/or proximal end portions of the first j aw . End faces of the plate-shaped portions of the first electrode and/or the second electrode can be in the exposed sections on the first surface .
  • the plate-shaped portions of the first electrode and/or the second electrode may have a shape of the letter U, V, or variations thereof in a cross-sectional view of the first j aw .
  • the first electrode may be arranged within the shape defined by the U-shape or V-shape in a cross-sectional view .
  • the exposed sections of the first electrode and the second electrode at least partially extend parallel to each other, each includes two straight portions that extends parallel to each other, and/or each form a loop .
  • the exposed sections of the first electrode and the second electrode completely or partially extend parallel to each other on the first surface .
  • two portions of the exposed sections are straight which are connected by a connecting section - thus forming a loop .
  • Other shapes of the loops are possible .
  • the exposed sections of the first electrode may completely or partially extend parallel to the exposed section of the second electrode .
  • the straight portions of the exposed sections may form the first sealing area and the second sealing area . So , the distance between the straight portions of the exposed sections defines the width of the gap .
  • the first electrode and/or the second electrode each form a single section that is exposed on the first surface .
  • the cutting line is arranged between the straight portions of the exposed sections of the first electrode in the closed position .
  • the cutting line is arranged within the loop of the exposed sections of the first electrode in the closed position .
  • the cutting line may extend parallel between the straight portions of the exposed sections of the first electrode and/or the second electrode .
  • the cutting line is straight .
  • the cutting line extends within the loop formed by the exposed section of the first electrode .
  • the exposed section of the first electrode and the exposed section of the second electrode partially surround the cutting line .
  • first sealing area and the second sealing area define an angle of less than 180 ° with respect to each other .
  • first sealing area and the second sealing area do not define a flat area (not considering the third electrode and the exposed second isolating portion) .
  • the area of the first surface on one side of the cutting device is inclined to an area of the first surface on the other side of the cutting device .
  • the exposed section of the second isolating portion provides a flat surface
  • the first and second sealing areas define an angle of less than 180 ° with the flat exposed section of the second isolating portion . In this case , only the first sealing area and the second sealing area are inclined .
  • the exposed section of the second isolation portion may be flat and/or define an angle with the first sealing area and the second sealing area .
  • the exposed section of the second isolation portion may include two surface areas , one of which forms a flat plane with the first sealing area and the other of which forms a flat plane with the second sealing area .
  • the cutting line may be arranged at that line where the two surface areas of the exposed section of the second isolation portion meet .
  • the two surface areas of the exposed section of the second isolation portion may be symmetrical to the cutting line and/or each define an angle with the respective first and second sealing areas .
  • the first electrode and the second electrode are arranged on the first j aw .
  • the first electrode protrudes from the first isolating portion .
  • the fourth electrode is arranged on the second j aw .
  • the second electrode and the fourth electrode are arranged on opposing sides of the first electrode in the closed position and are electrically connected to each other .
  • the first electrode has a dual functionality of emitting microwave energy and radiofrequency energy . This is a difference to the embodiments described above where the first electrode is configured to emit microwave energy only . Radiofrequency energy is emitted by the third electrode . So , in this embodiment , the third electrode and/or the second isolating portion can be omitted .
  • the second electrode and the fourth electrode may each provide half-shells for containing the microwave energy emitted by the first electrode therein .
  • the first electrode may be sandwiched between or ( completely) surrounded by the second electrode and the fourth electrode in a closed position .
  • the second j aw may include the fourth isolating portion which electrically isolates the first electrode from the fourth electrode in the closed position .
  • the first electrode may be a ridge or bar made from an electrically conductive material .
  • the first electrode protrudes from the first isolating portion . This means that the first electrode is not flush with the first isolating portion .
  • the second j aw comes into contact with the first electrode but not with the first isolating portion . This results in tissue clamped between the first j aw and the second j aw being compressed more at the first electrode compared to the first isolating portion .
  • a first face of the first isolating portion and a second face of the first isolating portion are arranged on opposing sides of the first electrode , wherein the first face and the second face define an angle of less than 180 ° .
  • the first face and the second face define an angle of 170 ° , 160 ° , or 150 ° .
  • the inclined configuration of the first face and the second face increases the exposure of the first electrode so that the pressure of the first electrode in the closed position on the clamped tissue is further increased .
  • the first face is a section of the first isolating portion that is exposed on the first surface on one side of the first electrode
  • the second face is a section of the first isolating portion that is exposed on the first surface on another side of the first electrode .
  • the arm and the second j aw respectively include conductive materials which form the fourth electrode .
  • the conductive material of the second j aw may have the shape of a half-shell except for the opening in which the conductive material of the arm can be arranged if the arm is appropriately positioned relative to the second j aw . In this position, the conductive materials of the arm and the second j aw may form a continuous half-shell except for a ( small ) gap between the arm and a perimeter of the opening .
  • an electrosurgical apparatus for sealing and cutting tissue which comprises a generator unit for generating radiofrequency and/or microwave electromagnetic energy and the electromagnetic electrosurgical instrument as described above .
  • the transmission line is configured to convey the radiofrequency and/or microwave electromagnetic energy from the generator unit to first electrode , the second electrode and/or the third electrode .
  • the generator unit may be configured to generate electromagnetic energy of a fixed single frequency or of a plurality of fixed single frequencies . Alternatively or additionally, the generator unit may be tuneable to generate electromagnetic energy of various frequencies , for example in a continuous range of frequencies between a minimum frequency and a maximum frequency .
  • the generator unit may be connected to a power supply which provides the energy for generating the radiofrequency electromagnetic energy and/or microwave electromagnetic energy .
  • the generator unit is electrically and/or electronically ( directly or indirectly) connected to the transmission line .
  • the generator unit generates the radiofrequency energy and/or microwave energy which is conveyed by the transmission line to the first to fourth electrodes where the radiofrequency energy and/or microwave energy is radiated into the treatment zone .
  • the generator unit is configured to simultaneously generate microwave electromagnetic energy of the first frequency and microwave electromagnetic energy of a second frequency .
  • the generator unit includes a generator that is configured to simultaneously generate electromagnetic energy of two different ( fixed ) frequencies .
  • the generator unit includes a first generator for generating electromagnetic energy of the first frequency and a second generator for generating electromagnetic energy of the second frequency .
  • the output of the first generator and output of the second generator can be combined using a multiplexer .
  • the multiplexer may be a diplexer and can combine the input from various sources into one output .
  • a multiplexer ( or diplexer ) is used to combine the output of first and second generators to a single output which is connected or coupled to the transmission line .
  • the generator unit is configured to simultaneously or alternatingly generate microwave electromagnetic energy of the first frequency and radiofrequency electromagnetic energy of a third frequency .
  • the generator unit may include a first generator for generating electromagnetic energy of the first frequency, a second generator for generating electromagnetic energy of the second frequency, and/or a third generator for generating electromagnetic energy of the third frequency .
  • the output of the first generator and the output of the second generator may be combined as described above using a multiplexer .
  • the output of the third generator may be combined with the output of the multiplexer using a combiner which can include a switch for alternatingly switching between outputting the output of the multiplexer and outputting the output of the third generator .
  • the combiner may include an additional multiplexer for combining the output of the multiplexer and the output of the third generator to simultaneously emit electromagnetic energy of the first frequency, the second frequency, and the third frequency . In this case , microwave sealing and radiofrequency cutting can be simultaneously effected .
  • Fig . 1 shows a schematic view of an embodiment of an electrosurgical apparatus
  • Fig . 2 shows a perspective view of an embodiment of an electrosurgical instrument ( in an open position ) of the electrosurgical apparatus shown in Fig . 1 ;
  • Fig . 3 shows a cross-sectional view of the electrosurgical instrument of Fig . 2 in a closed position ( upper image ) and a press position ( lower image ) ;
  • Fig . 4 shows a cross-sectional view of a further embodiment of an electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 in a closed position ( upper image ) and a press position ( lower image ) ;
  • Fig . 5 shows a cross-sectional view of a further embodiment of an electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 in a closed position ( upper image ) and a press position ( lower image ) ;
  • Figs . 6a and 6b show perspective views of a further embodiment of an electrosurgical instrument ( in an open position ) of the electrosurgical apparatus shown in Fig . 1 in different positions of a second j aw and an arm.
  • the present invention relates to an electrosurgical instrument and apparatus capable of delivering microwave energy to seal tissues (e . g . blood vessels ) and of cutting the tissue .
  • the electrosurgical instrument and apparatus may be used in open surgery, but may find particular use in procedures where there is restricted access to the treatment site .
  • the electrosurgical instrument of the invention may be adapted to fit within the instrument channel of a surgical scoping device i . e . laparoscope , endoscope , or the like .
  • Fig . 1 shows a schematic view of an electrosurgical apparatus 10 in which the electrosurgical instrument of the invention may be used .
  • Fig . 1 is a schematic diagram of a complete electrosurgical apparatus 10 that is an embodiment of the invention .
  • the electrosurgical apparatus 10 is arranged to treat biological tissue using radiofrequency (RF) and/or microwave electromagnetic (EM) energy delivered from an electrosurgical instrument 12 .
  • RF radiofrequency
  • EM microwave electromagnetic
  • the electromagnetic energy emitted by the electrosurgical instrument 12 into a treatment zone can be used to coagulate , cut , and/or ablate tissue in the treatment zone .
  • the electrosurgical apparatus 10 further comprises a generator unit 14 which can controllably supply radiofrequency and/or microwave electromagnetic energy to the electrosurgical instrument 12 .
  • the generator unit 14 may include a first generator 16 and a second generator 17 . Suitable generators for this purpose are described in WO 2012 /076844 , which is incorporated herein by reference .
  • the generator unit 14 may be arranged to monitor reflected signals received back from the electrosurgical instrument 12 in order to determine an appropriate power level for delivery . For example , the generator unit 14 may be arranged to calculate an impedance seen at the electrosurgical instrument 12 in order to determine an optimal delivery power level .
  • the electrosurgical apparatus 10 further comprises a surgical scoping device 19 , such as a bronchoscope , endoscope , gastroscope , laparoscope or the like .
  • the scoping device 18 may include a handpiece 20 and a flexible shaft 22 .
  • the handpiece 20 may include means for guiding the flexible shaft 22 through a cavity of a body .
  • the handpiece 20 can include means for moving a distal end of the flexible shaft 22 to change direction of the distal end of the flexible shaft 22 . This helps manoeuvring the flexible shaft 22 through the cavity of the body .
  • the flexible shaft 22 may include a working channel through which elongated structures can be moved and, thus , positioned at the treatment zone within the cavity of the body .
  • the first generator 16 and the second generator 17 are each configured to generate electromagnetic energy of a fixed frequency .
  • the generator unit 14 is not limited thereto ; the first generator 16 and/or the second generator 17 can be configured to generate AC electromagnetic energy in a continuous range between a minimum frequency and a maximum frequency .
  • the frequency of the electromagnetic energy to be generated by the first generator 16 and/or the second generator 17 may be selected using an interface (not shown in the figures ) .
  • the generator unit 14 can include a combiner 26 which is configured to temporally switch between outputting the output of the first generator 16 or the output of the second generator 17 .
  • the combiner 26 may also be configured to combine the outputs of the first generator 16 and of the second generator 17 . In this case , the combiner 26 acts as a multiplexer or diplexer .
  • the generator unit 14 is thus capable of generating and controlling power to be delivered to the electrosurgical instrument 12 , e . g . via a transmission line 28 , which extends from the generator unit 14 through the surgical scoping device 19 and instrument channel to the distal tip of the instrument channel .
  • the generator unit 14 may have a user interface for selecting and/or controlling the power delivered to the electrosurgical instrument 12 , e . g . controlling the first and/or the second generators 16, 17 and/or the combiner 26.
  • the generator unit 14 may have a display for showing the selected energy delivery mode. In some examples, the generator unit 14 may allow for an energy delivery mode to be selected based on the size of the vessel to be sealed.
  • the electrosurgical instrument 12 can include the transmission line 28, an instrument shaft 30, a joint 32, a first jaw 34, a second jaw 36, and/or an arm 70 which will be discussed in further detail below.
  • the transmission line 28 may include a single coaxial cable that connects the generator unit 14 to the first jaw 34 and/or second jaw 34 for conveying the radiofrequency and/or microwave energy.
  • Fig. 2 shows a schematic perspective view of a distal end of an embodiment of the electrosurgical instrument 12.
  • the first jaw 34 and the second jaw 36 are rotatably or pivotally connected or coupled to the instrument shaft 30 which is dimensioned to fit within the instrument channel of the surgical scoping device 19.
  • the instrument shaft 30 comprises a tubular sheath that covers the transmission line 28 for carrying microwave and/or radiofrequency energy to the jaws 34, 36 together with various control wires or (actuation) rods that are arranged to control and/or physically manipulate the first and second jaws 34, 36, as discussed below.
  • the first jaw 34 and the second jaw 36 are operably coupled to the joint 32 that is mounted on a distal end of the instrument shaft 30. Both the first and second jaws 34, 36 may be arranged to pivot relative to the joint 32.
  • the joint 32 may be arranged to ensure that the jaws remain laterally aligned as they are moved together.
  • the pair of jaws 34, 36 comprises a static jaw that is fixed relative to the instrument shaft 30 or the joint 32.
  • the other jaw is pivotable or rotatable .
  • the joint 32 includes a pivot axle 44 which defines a pivot axis.
  • the first jaw 34 and the second jaw 36 can pivot around the pivot axis or pivot axle 44.
  • the pivot axle 44 is fixed to the joint 32 and the first jaw 34 and the second jaw 36 can rotate around the pivot axle 44.
  • the joint 32 may have a clevis structure and a slot 46 on arms of the clevis structure.
  • the slot 46 may have an elongate shape and can be a through-hole or a recess in an inner surface of the clevis structure.
  • the first jaw 34 and/or the second jaw 36 also include elongated slots (see Fig. 2) .
  • a control wire or actuation rod includes a cam 48 which is inserted in the slots 46 of the clevis structure and in the slots of the first jaw 34 and the second jaws 36.
  • the engagement of the cam 48 with the slots provides an actuation mechanism which translates a back-and-forth movement of the control wire (and thus of the cam 48) into a rotational movement of the first jaw 34 and the second jaw 36 around the pivot axle 44.
  • first jaw 34 and the second jaw 36 are intended to grip biological tissue (in particular a blood vessel) therebetween.
  • the first jaw 34 and the second jaw 36 are arranged to apply pressure to the biological tissue between the opposed surfaces of the jaws 34, 36 and deliver energy (preferably microwave and/or radiofrequency electromagnetic energy) into the tissue from the transmission line 28.
  • the first jaw 34 includes a first surface 50 which opposes a second surface 52 of the second jaw 36.
  • the first surface 50 and/or the second surface 52 may form an outer surface of the first jaw 34 and the second jaw 36, respectively, which can be brought in contact with each other in the closed position.
  • the first surface 50 and the second surface 52 may be considered pressure pads or pressure areas with which pressure can be applied to the tissue grasped between the first jaw 34 and the second jaw 36 (see for example Figs. 3 to 5 which show the closed position of the first jaw 34 and the second jaw 36) .
  • the first jaw 34 includes a first electrode 54, a second electrode 56, a first isolating portion 58, and/or a second isolating portion 60.
  • the first electrode 54 and the second electrode 56 are made from an electrically conductive material, such as metal or a metal alloy.
  • the second electrode 56 may form the outer surface of the first jaw 34 and/or may provide the connection to the pivot axle 44. Further, the slot of the first jaw 34 may be provided in the electrode second electrode 56.
  • the second electrode 56 may have a function of providing the stability of the first j aw 34 .
  • the second electrode 56 may have a form of a half-shell in a portion along the first surface 50 .
  • the second electrode 56 may surround the first electrode 54 , the first isolating portion 58 and/or the second isolating portion 60 . This means that the first electrode 54 , the first isolating portion 58 , and/or the second isolating portion 60 may be embedded in the half-shell of the second electrode 56 .
  • the shape of the second electrode 56 may also be considered as providing a recess or channel in which the first electrode 54 , the first isolating portion 58 and/or the second isolating portion 60 are arranged .
  • the first isolating portion 58 electrically isolates the first electrode 54 from the second electrode 56 .
  • the first isolating portion 58 may be made from an electrically non- conductive material such as ceramics ( e . g . including Zirconia ) , PEEK, silicone , and/or other plastic materials .
  • the first isolating portion 58 may be sandwiched between the first electrode 54 and the second electrode 56 .
  • the first electrode 54 and the second electrode 56 may have a U-shape or V-shape ( see Fig . 3 ) in a cross-sectional view along a section of the first j aw 34 . Further , the first electrode 54 and the second electrode 56 may have a plateshape ( see Fig . 3 ) along this section of the first j aw 34 . At a distal end of the first j aw 34 , the first electrode 54 and/or the second electrode 56 may have a different configuration so that the first electrode 54 and/or the second electrode 56 do not have an open end but a closed end . This means that the second electrode 56 can shield the first electrode 54 in all directions away from the first surface 50 .
  • the first electrode 54 and/or the second electrode 56 are exposed at the first surface 50 to allow for contact with the tissue clamped between the first j aw 34 and the second j aw 36 .
  • two sections of the first electrode 54 and the second electrode 56 are exposed on the first surface 50 which are spaced from each other by a gap .
  • the two exposed sections are straight and extend in a direction of extension of the first j aw 34 .
  • Each exposed section includes an exposed section of the first electrode 54 , the second electrode 56 , and the first isolating portion 58 .
  • the two exposed sections provide a first sealing area 62 and the second sealing area 64 which are spaced away by the gap in a direction perpendicular to the extension of the first j aw 34 .
  • the first sealing area 62 and the second sealing area 64 are each provided for the emission of microwave energy so that tissue is sealed at the first sealing area and the second sealing area 64 .
  • the intensity of the microwave energy that is emitted from the first electrode 54 and the second electrode 56 is highest at the sealing areas 62 and 64 .
  • the intensity of the emitted microwave energy is considerably lower in the area of the gap ( i . e . between the first sealing area 62 and the second sealing area 64 ) compared to the first sealing area 62 and the second sealing area 64 , for example 10% to 80% less than over the first sealing area 62 and the second sealing area 64 . This results in that tissue is effectively sealed at the first sealing area 62 and at the second sealing area 64 but not in the gap therebetween .
  • the first sealing area 62 and the second sealing area 64 may be provided by the end faces of the plate-shaped first electrode 54 , the second electrode 56 , and the first isolating portion 58 .
  • the exposed sections of the first electrode 54 , the second electrode 56 , and the first isolating portion 58 outside the first and second sealing areas 62 and 64 may form a loop at the first surface 50 which connects the first sealing area 62 with the second sealing area 64 on the first surface 50 . This loop may not be considered belonging to the first sealing area 62 or the second sealing area 64 since there is no separation by a gap .
  • the exposed sections of the first electrode 54 and second electrode 56 over the first sealing area 62 and the second sealing area 64 may form two parallel straight lines which are respectively separated by the gap .
  • the separation of the first sealing area 62 and the second sealing area 64 by the gap is provided by the second isolating portion 60 .
  • the second isolating portion 60 separates the exposed sections of the first electrode 54 on the first surface 50 .
  • the second isolating portion 60 separates the first sealing area 62 from the second sealing area 64 .
  • the second isolating portion 60 may be received in a cavity formed by the U-shaped first electrode 54 .
  • the first electrode 54 forms a channel similar to the second electrode 56 .
  • the second isolating portion 60 may be embedded or arranged in this channel .
  • the second isolating portion 60 may have a flat or straight outer surface at the first surface 50 .
  • the exposed section of the second isolating portion 60 on the first surface 50 may be parallel to a lower surface of the second electrode 56 defining a lower surface of the first j aw 34 ( see Fig . 3 ) .
  • the first sealing area 62 and the second sealing area 64 may be inclined relative to each other and relative to the exposed section of the second isolating portion 60 .
  • the angle between a plane defined the exposed section of the second isolating portion 60 and a plane defined by the first and/or second sealing surface 62 , 64 may be between 5 ° to 45 ° .
  • the first sealing area 62 and the second sealing area 64 define the same angle with the exposed section of the second isolating portion 60 at the first surface 50 .
  • the inclined arrangement of the first sealing area 62 and the second sealing area 64 increases the respective surface areas without widening the first j aw 34 . Further, after cutting the tissue clamped between the first j aw 34 and the second j aw 36 , the cut tissue can be more easily released from the first j aw 34 compared to a flat ( i . e . non-inclined) first surface 50 .
  • the second isolating portion 60 may comprise a silicone- based material or silicone .
  • Other examples include polyimide , PTFE or FEP type materials . These types of materials are more flexible or softer compared to a ceramic material which helps to reduce the pressure on the tissue over the area of the gap ( i . e . between the first sealing area 62 and the second sealing area 64 ) . So the pressure on the tissue can be reduced in an area where the tissue is not sealed . In other words , the first j aw 34 and the second j aw 36 press and seal the tissue at the first sealing area 62 and the second sealing area 64 .
  • the second j aw 36 includes a fourth electrode 66 , a fourth isolating portion 68 , and/or the arm 70 .
  • the fourth electrode 66 is made from an electrically conductive material , such as metal .
  • the fourth electrode 66 may form the outer surface of the second j aw 36 and/or may provide the connection to the pivot axle 44 . Further, the slot of the second j aw 36 may be arranged on the fourth electrode 66 . Thus , the fourth electrode 66 may have a function of providing the stability of the second j aw 36 .
  • the fourth electrode 66 may have a form of a half-shell in a portion of the second surface 52 .
  • the fourth electrode 66 may surround the fourth isolating portion 68 . This means that the fourth isolating portion 68 may be embedded in the half-shell of the fourth electrode 66 .
  • the shape of the fourth electrode 66 may also be considered as providing a recess or channel in which the fourth isolating portion 68 arranged .
  • the fourth electrode 66 may be mirror-symmetric to the second electrode 56 .
  • the fourth electrode 66 may a U-shape ( see Fig . 3 ) in a cross-sectional view along a section of the second j aw 36 . Further , the fourth electrode 66 may have a plate-shape ( see Fig . 3 ) along this section of the second j aw 36 .
  • the fourth electrode 66 may have a different configuration so that fourth electrode 66 does not have an open end but a closed end . This means that fourth electrode 66 can shield the first electrode 54 in all directions away from the second surface 50 .
  • the second electrode 56 and the fourth electrode 66 may be electrically connected to each other, either directly or by being connected to the same conductor of the transmission line 28 .
  • the fourth isolating portion 68 is made from an electrically non-conductive material , optionally a silicone- based material or silicone .
  • Other examples include polyimide , PTFE or FEP type materials .
  • the sections of the fourth electrode 66 and of the fourth isolating portion 68 that are exposed to contact tissue in the closed position may define or form the second surface 52 .
  • tissue can be grasped between the first electrode 54 and the second electrode 56 on the first j aw 34 and the fourth electrode 66 on the second j aw 36 .
  • the arm 70 may include an arm support 72 , a third isolating portion 74 , and/or a third electrode 76 .
  • the arm support 72 may provide the stability of the arm 70 , can be made from an electrically conductive material , such as metal , and/or may be connected to the pivot axle 44 .
  • a control wire may be coupled to the arm 70 , optionally the arm support 72 , for rotating the arm 70 relative to the second j aw 36 and/or around the pivot axle 44 .
  • the fourth electrode 66 and the fourth isolating portion 68 may each include an opening or through-hole through which the arm 70 can be moved .
  • the dimensions and/or the shape of the opening may match the ones of the arm 70 so that , when the second j aw 36 and the arm 70 are arranged at the same angular position ( i . e . the arm 70 is in line with the second j aw 36 ) , there is a small gap or a sliding contact between the outer surface of the arm 70 and the inner surface of the opening .
  • the arm support 72 and the fourth electrode 66 may form a continuous half-shell in this position so that the arm support 72 forms a part of the shielding function of the fourth electrode 66 .
  • the arm support 72 and the fourth electrode 66 may be electrically connected to each other, either directly or by being connected to the same conductor of the transmission line 28 .
  • the third electrode 76 is configured to emit radiofrequency energy for tissue cutting and is electrically isolated from the fourth electrode 66 and/or the first electrode 54 .
  • the third electrode 76 may be an active electrode for delivering radiofrequency electromagnetic energy while the first electrode 54 , the second electrode 56 , and/or the third electrode 66 are return electrodes .
  • the third electrode 76 is connected to the transmission line 28 , optionally to the cable 42 .
  • the third electrode 76 is exposed on the third isolating portion 74 which in turn is attached to the arm support 72 .
  • the third electrode 76 is arranged to first contact tissue that is clamped between the first j aw 34 and the second j aw 36 if the arm 70 is brought into contact with the tissue .
  • the third electrode 76 protrudes from the third isolating portion 74 in a direction towards the first j aw 34 .
  • the third electrode 76 may be a ridge or bar made from an electrically conductive material , such a metal or a metal alloy .
  • the third isolating portion 74 is made from an electrically non-conductive material , such as a ceramic or plastic material .
  • the arm 70 may be freely moved relative to the second j aw 36 so that the arm 70 is in a retracted position . This can be used to reduce pressure between the third electrode 76 and the second isolating portion 60 in the closed position.
  • Fig. 3 upper image
  • the first jaw 34 and the second jaw 36 are moved towards each other to clamp tissue therebetween (not shown in Fig. 3) , i.e. Fig. 3 (upper image) shows the closed position of the first jaw 34 and the second jaw 36.
  • the arm 70 may not be actuated or can move freely so that the arm 70 does not apply pressure to the tissue and is slightly offset to the second jaw 36 defining the retracted position (see Fig. 3) .
  • the tissue may be sealed using microwave energy.
  • the arm 70 is actuated to be pressed against the second isolating portion 60 forming a press position (lower image of Fig. 3) .
  • the third electrode 76 emits radiofrequency energy to cut the tissue.
  • the pressure on the tissue between the third electrode 76 and the second isolating portion 60 can be selectively increased during radiofrequency cutting compared to the pressure applied during microwave sealing.
  • the first jaw 34 and the second jaw 36 may be moved away from the closed position (lower image of Fig. 3) to un-clamp the tissue allowing the cut tissue to be released.
  • the inclination of the first surface area 62 and the second surface area 64 improves the release of the cut tissue.
  • the embodiment of the electrosurgical instrument 12 shown in Fig. 4 includes the same features, characteristics, and/or optional embodiment as the embodiment of the electrosurgical instrument 12 shown in Figs. 2 and 3 except for the following differences .
  • the third electrode 76 is not arranged on the arm 70 but on the second isolating portion 60.
  • the third electrode 76 protrudes from the second isolating portion 60 towards the second jaw 36.
  • a contact surface of the arm 70 i.e. the surface of the arm 70 that is in contact with the tissue clamped between the first jaw 34 and the second jaw 36 is provided by the third isolating portion 74.
  • the functionality of the electrosurgical instrument 12 of the embodiment of Fig. 4 is similar to the functionality of the embodiment of the electrosurgical instrument 12 shown in Figs. 2 and 3.
  • the arm 70 is used to control the pressure applied to tissue between the third electrode 76 and the arm 70 , especially the third isolating portion 74 . As described above , pressure on the tissue between the third electrode 76 and the arm 70 can be varied by moving the arm 70 towards and away from the first j aw 34 as depicted in Fig . 4 .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 5 includes the same features , characteristics , and/or optional embodiment as the embodiment of the electrosurgical instrument 12 shown in Fig . 4 except for the following differences .
  • the third electrode 76 is again not arranged on the arm 70 but on the second isolating portion 60 .
  • the third electrode 76 again protrudes from the second isolating portion 60 towards the second j aw 36 .
  • a contact surface of the arm 70 i . e . the surface of the arm 70 that is in contact with the tissue clamped between the first j aw 34 and the second j aw 36 ) is however not provided by the third isolating portion 74 .
  • the third isolating portion 74 is replaced by a component having the same shape and dimensions as the third isolating portion 74 but is made from an electrically conductive material , such as metal .
  • the arm support 70 and the portion corresponding to the third isolating portion 70 can form a unitary or single component made from an electrically conductive material .
  • the fourth isolating portion 68 includes a membrane section 78 which covers the opening in which to arm 70 is movable .
  • This membrane section 78 is deformable and electrically isolates the third electrode 76 from the arm 79 , in particular the portion corresponding to the third isolating portion 70 .
  • the membrane section 78 is deformed in the closed position as the third electrode 76 pushes the membrane section 78 into the opening .
  • the membrane section 78 can be deformed by pushing the arm 70 through the opening towards the first j aw 34 .
  • the flexibility or softness of the membrane section 78 can be achieved by making the fourth isolating portion 68 from a silicone-based material or silicone and/or by making the membrane section 78 thin .
  • the membrane section 78 and the rest of the fourth isolating portion 68 can form a unitary or single component .
  • the embodiment of the electrosurgical instrument 12 shown in Figs . 6a and 6b includes the same features , characteristics , and/or optional embodiment as the embodiments of the electrosurgical instrument 12 shown in Figs . 2 to 5 except for the following differences .
  • the first j aw 34 only includes the first electrode 54 , the second electrode 56 , and the first isolating portion 58 .
  • the second isolating portion 60 is not present .
  • the first electrode 54 is arranged on the first isolating portion 58 and protrudes therefrom.
  • the first electrode 54 may be embedded within the first isolating portion 58 however , a section of the first electrode 54 protrudes from the first isolating portion 58 .
  • the first electrode 54 is arranged in the middle between the two sections of the second electrode 56 exposed on the first surface 50 .
  • the exposed sections of the second electrode 56 and of the first isolating portion 58 may be symmetrical to the first electrode 54 .
  • the first electrode 54 may divide the first surface 50 into a first face 80 and a second face 82 .
  • the first face 80 and the second face 82 may be symmetrical to the first electrode 54 .
  • the first face 80 as well as the second face 82 may each include an exposed section of the second electrode 56 and an exposed section of the first isolating portion 58 .
  • the first face 80 and the second face 82 define an angle of less than 180 ° with respect to each other .
  • the protruding effect of the first electrode 54 ( of increasing pressure on the tissue ) is further increased .
  • the first electrode 54 and the second electrode 56 are again configured to emit microwave electromagnetic energy . Further, the first electrode 54 is configured to emit radiofrequency energy . For example , the first electrode 54 acts as an active electrode while the second electrode 56 and the fourth electrode 66 act as a return electrode .
  • the arm 70 includes the arm support 72 and the third isolating portion 74 .
  • the third isolating portion 74 is configured to be in contact with the first electrode 54 in the press position.
  • Fig. 6a shows a retracted position of the arm 70 while Fig. 6b shows an intermediate position between the press position and a retracted position of the arm 70.
  • the second jaw 36 solely consists of the fourth electrode 66.
  • the second jaw 36 does not include any isolating portion such as the third isolating portion 74 or the fourth isolating portion 68.
  • the electrical isolation of the fourth electrode 66 with regard to the first electrode 54 is achieved by the lateral offset of the fourth electrode 66 with regard to the first electrode 54 in the closed position.
  • the first isolating portion 58 again provides the electrical isolation.
  • the second electrode 56 and the fourth electrode 66 may be on the same electrical potential.
  • the arm 70 is movable relative to the second jaw 36 - both the arm 70 as well as the second jaw 36 are rotatable around the pivot axle 44.
  • the second jaw 36 includes a jaw slot 84 and the arm 70 includes an arm cam 86.
  • the arm cam 86 is inserted in the elongated jaw slot 84 so that the arm 70 is not freely movable with respect to the second jaw 36. Rather, the length of the jaw slot 84 defines the angular range over which the arm 70 can move relative to the second jaw 36.
  • the arm cam 86 abuts against a first end of the jaw slot 84 defining the retracted position. This retracted position corresponds to the maximum rotation of the arm 70 away from the first jaw 34 relative to the second jaw 36.
  • Fig. 6b shows an intermediate position of the arm 70 relative to the second jaw 36 as the arm cam 86 is arranged approximately in the middle between the first end of the jaw slot 84 and an opposing second end of the jaw slot 84. In this orientation as well as in the press position, the arm 70 protrudes from the second jaw 36 towards the first jaw 34.
  • the pair of jaws 34, 36 comprises a static jaw (first jaw 34) that is fixed relative to the instrument shaft 30 or the joint 32.
  • the other jaw (the second jaw 36) is pivotable or rotatable .

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Abstract

Différents modes de réalisation de l'invention concernent un instrument d'électrochirurgie permettant de sceller et/ou de couper des tissus biologiques. L'instrument comprend une tige d'instrument comportant une chaîne cinématique pour acheminer l'énergie électromagnétique de micro-ondes et/ou de radiofréquence. L'instrument comprend une articulation, une première mâchoire fixée à la tige d'instrument par le biais de l'articulation et comprenant une première surface, et une seconde mâchoire fixée à la tige d'instrument par le biais de l'articulation et comprenant une seconde surface. L'instrument comprend une première électrode pour émettre de l'énergie à micro-ondes et/ou à radiofréquence, et une seconde électrode pour émettre de l'énergie de micro-ondes et/ou de radiofréquence. L'instrument comprend une première partie isolante isolant électriquement la première électrode de la seconde électrode, et un bras mobile par rapport à la seconde mâchoire. Les première et seconde mâchoires peuvent être déplacées entre une position ouverte, dans laquelle le tissu biologique peut être inséré entre la première surface et la seconde surface, et une position fermée, dans laquelle les première et seconde surfaces sont rapprochées pour serrer le tissu biologique. En position fermée, le bras est configuré pour se déplacer entre une position de pression, dans laquelle le bras et la première surface sont rapprochés pour presser le tissu biologique, et une position rétractée, dans laquelle le bras est éloigné de la première surface.
PCT/EP2023/074785 2022-09-23 2023-09-08 Instrument et appareil d'électrochirurgie WO2024061657A1 (fr)

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GB2213951.3 2022-09-23
GBGB2213951.3A GB202213951D0 (en) 2022-09-23 2022-09-23 Electrosurgical instrument and electrosurgical apparatus

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Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020107517A1 (en) * 2001-01-26 2002-08-08 Witt David A. Electrosurgical instrument for coagulation and cutting
US6585735B1 (en) 1998-10-23 2003-07-01 Sherwood Services Ag Endoscopic bipolar electrosurgical forceps
EP2233098A1 (fr) 2009-03-24 2010-09-29 Tyco Healthcare Group, LP Appareil pour l'étanchéité de tissus
WO2012076844A1 (fr) 2010-12-10 2012-06-14 Creo Medical Limited Appareil électrochirurgical pour application de rf et de micro-ondes
US20130018411A1 (en) * 2011-07-11 2013-01-17 Tyco Healthcare Group Lp Surgical Forceps
WO2015097472A1 (fr) 2013-12-23 2015-07-02 Creo Medical Limited Pince électrochirurgicale pour la distribution d'énergie radiofréquence (rf) et/ou micro-onde dans un tissu biologique
US20180280084A1 (en) * 2017-03-30 2018-10-04 Creo Medical Limited Electrosurgical instrument

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6585735B1 (en) 1998-10-23 2003-07-01 Sherwood Services Ag Endoscopic bipolar electrosurgical forceps
US20020107517A1 (en) * 2001-01-26 2002-08-08 Witt David A. Electrosurgical instrument for coagulation and cutting
EP2233098A1 (fr) 2009-03-24 2010-09-29 Tyco Healthcare Group, LP Appareil pour l'étanchéité de tissus
WO2012076844A1 (fr) 2010-12-10 2012-06-14 Creo Medical Limited Appareil électrochirurgical pour application de rf et de micro-ondes
US20130018411A1 (en) * 2011-07-11 2013-01-17 Tyco Healthcare Group Lp Surgical Forceps
WO2015097472A1 (fr) 2013-12-23 2015-07-02 Creo Medical Limited Pince électrochirurgicale pour la distribution d'énergie radiofréquence (rf) et/ou micro-onde dans un tissu biologique
US20180280084A1 (en) * 2017-03-30 2018-10-04 Creo Medical Limited Electrosurgical instrument

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