Surgical instrument with stamped double-flag jaws and actuation mechanism

ES 2 535 652 T3

DESCRIPTION

Surgical instrument with double stamped marker jaws and actuation mechanism

Technical field

The present description relates generally to the field of surgical instruments. In particular, the description refers to an endoscopic electrosurgical forceps which is inexpensive to manufacture and which is capable of sealing and cutting relatively large tissue structures.

Background of Related Art

Instruments such as surgical forceps are commonly used in open and endoscopic surgical procedures to coagulate, cauterize, and seal tissue. Such forceps typically include a pair of jaws that can be controlled by a surgeon to grasp a target tissue, such as, for example, a blood vessel. The jaws can be approximated to apply a mechanical clamping force to the tissue, and are associated with at least one electrode to allow delivery of electrosurgical energy to the tissue. The combination of mechanical clamping force and electrosurgical energy has been shown to bond adjacent layers of captured tissue between the jaws. When adjacent layers of tissue include the walls of a blood vessel, sealing of the tissue can result in hemostasis, which can facilitate transection of the sealed tissue. A detailed discussion of the use of an electrosurgical forceps can be found in US Pat. 7,255,697 to Dycus et al.

A bipolar electrosurgical forceps typically includes opposing electrodes disposed on the gripping faces of the jaws. The electrodes are charged to opposite electrical potentials such that an electrosurgical current can be selectively transferred through tissue gripped between the electrodes. To effect a proper seal, particularly in relatively large vessels, two main mechanical parameters must be precisely controlled: the pressure applied to the vessel and the established separation distance between the electrodes.

Both pressure and separation distance influence the effectiveness of the resulting tissue seal. If a proper separation distance is not maintained, there is the possibility of opposing electrodes contacting each other, which can cause a short circuit and prevent energy from being transferred through the tissue. Also, if too low a force is applied, the fabric may have a tendency to move before a proper seal can be generated. The thickness of a typical effective tissue seal is optimally between about 0.0254 and 0.152 mm (0.001 and 0.006 inches). Below this range, the seal may be destroyed or torn, and above this range the vessel walls may not bond effectively. The closing pressures for sealing large tissue structures preferably fall within the range of about 3 kg / cm² at about 16 kg / cm².

Documents cited in processing include EP 0584787, which discloses a tool mechanism for an endoscopic surgical instrument that includes a pair of mutually opposing members movable toward and out of each other, and document US 2009/0182327 as the closest technique of appended claim 1.

Summary

In accordance with the present invention, a surgical instrument is provided comprising: a housing; an elongated stem including a proximal portion coupled to the housing and a distal portion opposite the proximal portion, the elongated stem defining a longitudinal axis; an end effector supported by the distal portion of the elongated stem, the end effector adapted to treat tissue and including first and second jaw members pivotally coupled to each other to move between open and closed configurations, wherein each of the jaw includes a pair of laterally spaced flanges, and wherein each flange includes a camming surface thereon; a blade that extends at least partially through the elongated shaft and is selectively movable in the longitudinal direction between the flanges of the jaw members, a blade of the blade being extensible through a tissue contacting portion of the jaw members ; and a drive rod that extends at least partially through the elongated shaft and is selectively movable in the longitudinal direction with respect to the blade and with respect to the elongated shaft, the drive rod carrying a cam pivot arranged to engage with the camming surface of each of the flanges to induce the jaw members to move between open and closed configurations, the drive rod substantially surrounding the blade on four lateral faces to limit movement of the blade in at least two orthogonal planes.

The present disclosure describes a surgical instrument for treating tissue that is inexpensive to manufacture and capable of sealing and cutting relatively large tissue structures. The surgical instrument includes a housing and an elongated shaft extending distally therefrom. The elongated stem includes a proximal portion coupled to the housing and a distal portion opposite the proximal portion, and defines a longitudinal axis. An actuator rod extends at least partially through the elongated stem, and is

ES 2 535 652 T3 selectively movable in the longitudinal direction with respect to the elongated stem. An end effector is supported by the distal portion of the elongated stem, and is adapted to treat tissue. The end effector includes an upper jaw member pivotally coupled to the distal portion of the elongated stem about a pivot axis, and the upper jaw member includes a first pair of laterally spaced flanges. The end effector also includes a lower jaw member pivotally coupled to the distal portion of the elongated stem about the pivot axis, and the lower jaw member includes a second pair of laterally spaced flanges. The first and second pairs of flanges of the jaw members are arranged in offset configuration, such that one flange of the upper jaw member is located on the laterally outer face of a corresponding flange of the lower jaw member, and the other flange of the upper jaw member is located on the laterally inner face of the other flange of the lower jaw member. Alternatively, the laterally spaced flanges of the jaw members may be arranged in a nested configuration in which both flanges of one of the jaw members are arranged on the inside of the laterally inner face of the flanges laterally spaced from the other of the jaw members. jaw. A cam mechanism, or some other cooperating arrangement, has been defined between some or all of the tabs and the actuator rod such that longitudinal movement of the actuator rod causes the jaw members to move between the open and open positions. closed.

The upper and lower jaw members can be constructed as substantially identical components, positioned laterally offset from each other. Each of the flanges may extend proximally from a tissue engaging portion of the jaw members, and the tissue engaging portions may be substantially curved. The curvature can be in the left or right direction relative to the longitudinal axis with respect to the jaw members that open and close in the up and down directions. The pivot axis may extend through each of the flanges in a direction substantially transverse to the longitudinal axis.

The jaw members may each be formed with a metal foil shaped to define the proximal flanges and a support portion to support a tissue engaging portion of the jaw member. The upper portion may be shaped like a U-shaped channel.

The actuator rod may extend through the jaw members on the laterally inner face of each of the flanges, and the actuator rod may have a general U-shaped profile. The surgical instrument may further include a blade selectively movable in a longitudinal direction with respect to the actuating rod, and the blade may be supported within the U-shaped profile such that the actuating rod provides restrictions to lateral movement of the actuator. the blade in a side close-up. The actuator rod may also include an inverted pleat disposed opposite a U-shaped connector portion of the actuator rod such that the blade is substantially surrounded by all four lateral faces, and such that the pleat Inverted and the U-shaped connector portion restrict the movement of the blade in a second lateral plane that is orthogonal to the first lateral plane.

In one embodiment, the actuator rod includes opposite side walls, arranged on each side and restricting a blade having a flat profile. A lower side wall connector portion may be provided to vertically support the blade, the connector portion extending between the side walls. In one embodiment, at least one horizontal (upper) flange extends from the or a respective side wall to laterally support the drive rod within the elongated stem. In one embodiment, the respective horizontal flanges project from respective side walls of the drive rod to abut against opposite walls within the elongated stem to laterally guide the drive rod. The at least one flange can be provided along a portion of the drive rod. A distal end portion of the actuating rod may include a fold to vertically restrain the blade in combination with the connector portion. The drive rod is configured to wrap and guide the flat blade from at least three sides, from a proximal end of the drive rod to a distal end.

In one embodiment, the drive rod is formed by shaping a piece of metal.

In one embodiment, the instrument comprises at least one lead conduit to which one or more leads have been fed during assembly to electrosurgically connect the end effector to an electrosurgical power source. The conduit may be disposed under the at least one flange of the actuator rod and adjacent a side wall of the actuator rod. In case there are conduits, the conduits may be arranged outside opposite side walls of the actuator rod and under opposite side flanges of the actuator rod.

The jaw member may be adapted to electrosurgically treat tissue and may include electrical leads extending proximally therefrom to facilitate connection of the respective jaw members to an electrosurgical power source. At least one of the flanges of each of the jaw members may include an electrically insulating wire guide, disposed on a side face thereof, wherein the electrical wire of the respective jaw member extends through the guide to cable. The cable guides can be constructed of electrically insulating plastic molded onto the respective tabs.

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The laterally spaced flanges of the jaw members may be arranged in a nested configuration wherein both flanges of one of the jaw members are arranged within a laterally inner face of the laterally spaced flanges of the other jaw member. The blade may be constructed of a substantially flat piece of metal, and the drive rod may be constructed of folded metal to present a generally U-shaped profile extending around the four side faces of the blade. A more distal end of the actuator rod may extend around all four lateral faces of the blade and a proximal portion of the actuator rod may extend around less than four lateral faces of the blade.

In one embodiment, the elongated stem has a generally rectangular profile.

Brief description of the drawings

The accompanying drawings, which are incorporated in, and form a part of, the present disclosure, illustrate embodiments of the present disclosure and, together with the detailed description of the embodiments provided below, serve to explain the principles. of the description.

Figure 1 is a perspective view of an electrosurgical forceps according to one embodiment of the present disclosure including a housing, an elongated shaft, and an end effector;

Figure 2A is an enlarged perspective view of the end effector of Figure 1 shown with a pair of jaw members in an open configuration;

Figure 2B is an enlarged perspective view of the end effector of Figure 1 shown with the pair of jaw members in a closed configuration;

Figure 3 is a perspective view of the end effector and elongated shaft of Figure 1 with the parts separated;

Figure 4 is a cross-sectional view of the elongated stem of Figure 1 taken through a plane extending through an interconnection between the elongated stem and a rotary knob, which faces a proximal end of the locking members. jaw;

Figure 5 is a proximally oriented perspective view of a rotary knob depicting a cavity for receiving the elongated shaft of Figure 1;

Figure 6 is a perspective view, in cross section, of the rotary knob of Figure 5 mounted on an outer stem member of the elongated stem of Figure 1;

Figure 7 is a distally oriented perspective view of the rotary knob of Figure 5, depicting a slot for receiving a portion of the housing of Figure 1;

Figure 8 is a perspective view of the rotary knob of Figure 5 mounted in the housing of Figure 1;

Figure 9 is a cross-sectional perspective view of the assembled end effector with the elongated stem of Figure 1;

Figure 10 is a partial perspective view of a distal portion of a jaw actuation mechanism of the end effector of Figure 1;

Figure 11 is a partial perspective view of a distal portion of a blade actuation mechanism of the end effector of Figure 1;

Figure 12 is a perspective view of a lower jaw member of the end effector of Figure 1, showing a double flange at a proximal end thereof;

Figure 13 is a perspective view, in cross section, of the lower jaw member of Figure 12;

Figure 14 is a schematic view of the nested arrangement of the double flange of Figure 12 with a double flange of an upper jaw member;

Figure 15 is a schematic view of an alternate biased arrangement of double flanges of an alternate pair of jaw members;

Figure 16 is a partial perspective view of an alternate embodiment of a jaw actuation mechanism showing an alternate pair of jaw members with a nested arrangement of double flanges coupled to a reciprocating actuation rod via stamped joints. ;

Figure 17 is a perspective view of a proximal portion of the instrument of Figure 1 with a portion of the housing removed to show the internal components;

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Figure 18 is a partial side view of a proximal portion of the jaw actuation mechanism of Figure 10, showing a connection between the handle and the jaw actuation rod mechanism for imparting longitudinal movement to the jaw actuation rod. ;

Figure 19 is a perspective view of a proximal portion of the blade actuation mechanism of Figure 11, and

Figure 20 is a perspective view, in cross section, of the blade actuation mechanism of Figure 19;

Figure 21A is a side view of the proximal portion of the instrument of Figure 17, depicting a movable handle in a separate position from a stationary handle, corresponding to the open configuration of the end effector shown in Figure 2A, and a blade trigger in a spaced configuration relative to the stationary handle, corresponding to a proximal or non-actuated configuration of a blade relative to the jaw members;

Figure 21B is a side view of the proximal portion of the instrument of Figure 17 showing the movable handle in an intermediate position with respect to the stationary handle, corresponding to a first closed configuration of the end effector where the jaw members meet. with each other;

Figure 21C is a side view of the proximal portion of the instrument of Figure 17, showing the movable handle in an approximate configuration relative to the stationary handle, corresponding to a second closed configuration of the end effector where the jaw members engage. an appropriate pressure to seal a tissue;

Figure 21D is a side view of the proximal portion of the instrument of Figure 17, showing the blade trigger in an actuated configuration, corresponding to a distal or actuated position of the blade relative to the jaw members;

Figure 22 is a perspective view of an alternate embodiment of an end effector including upper and lower jaw members with free distal ends;

Figure 23 is a perspective view, in cross section, of an alternative embodiment of the lower jaw member of the end effector of Figure 22;

Figure 24 is a perspective view of the end effector of Figure 22 coupled to an outer stem member, illustrating a cable guide incorporated into a proximal portion of the upper and lower jaw members;

Figure 25 is an exploded perspective view of an alternate embodiment of a rotary knob constructed of two different components;

Figure 26 is a perspective view of an alternate embodiment of an outer stem member for connection to the rotary knob of Figure 25;

Figure 27 is a cross-sectional perspective view of the rotary knob of Figure 25 assembled with the outer stem member of Figure 26;

Figure 28 is a cross-sectional perspective view of the rotary knob of Figure 25 coupled to an alternate embodiment of a housing, illustrating stop elements and detent arms to define a "jaw up" configuration in addition to a configuration of jaws on the right and jaws on the left, and

Figure 29 is an alternate embodiment of a jaw drive mechanism that includes a single component blade arm configured for connection to the blade of Figure 3 without additional fasteners.

Detailed description

The present disclosure relates to electrosurgical apparatus and methods for performing electrosurgical procedures. More particularly, the present disclosure relates to electrosurgically sealing tissue. As is conventional, the term "distal" refers herein to an end of the apparatus that is furthest from an operator, and the term "proximal" refers herein to the end of the forceps 10 that is closest to the operator. operator.

Referring initially to Figure 1, one embodiment of an electrosurgical forceps 10 generally includes a housing 12 that supports various actuators therein to remotely control an end effector 14 through an elongated shaft 16. Although this configuration is typically associated with instruments for use in laparoscopic or endoscopic surgical procedures, various aspects of the present disclosure can be practiced with traditional opening instruments and also in connection with

ES 2 535 652 T3 endoluminal procedures.

Housing 12 is constructed with a left half housing 12a and a right half housing 12b. The left and right designation of the housing halves 12a, 12b refers to the respective directions as perceived by an operator using the forceps 10. The housing halves 12a, 12b may be constructed of strong plastic, and may be attached together by means of adhesives, ultrasonic welding or other suitable assembly methods.

To mechanically control the end effector 14, the housing 12 supports a stationary handle 20, a movable handle 22, a trigger 26, and a rotary knob 28. Movable handle 22 is operable to move end effector 14 between an open configuration (Figure 2A) where a pair of opposing jaw members 30, 32 are disposed spaced apart relative to each other, and a closed or closed configuration. clamping (Figure 2B) where the jaw members 30, 32 are closest to each other. The approach of the movable handle 22 to the stationary handle 20 serves to move the end effector 14 to the closed configuration, and the spacing of the movable handle 22 from the stationary handle 20 serves to move the end effector 14 to the open configuration. Trigger 26 is operable to extend and retract a knife blade 56 (see Figure 2A) through end effector 14 when end effector 14 is in the closed configuration. Rotary knob 28 serves to rotate elongated shaft 16 and end effector 14 about a longitudinal axis AA extending through the forceps.

To electrically control end effector 14, housing 12 includes a switch 36 therein, which is operable by the user to initiate and terminate the supply of electrosurgical power to end effector 14. Switch 36 is in electrical communication with a source. of electrosurgical energy such as electrosurgical generator 40. Generator 40 may include devices such as the LIGASURE® Vessel Sealing Generator and the Force Triad® Generator sold by Covidien. A cable 42 extends between housing 12 and generator 40 and may include a connector (not shown) therein such that forceps 10 can be selectively coupled and uncoupled electrically from generator 40. In other embodiments (not shown) a battery powered instrument may be provided in which a generator and connector may be internal to, or integral with, the instrument.

Referring now to Figures 2A and 2B, end effector 14 can be moved from the open configuration (Figure 2A) in which tissue (not shown) can be received between jaw members 30, 32, to the closed configuration. (Figure 2B) in which the tissue can be clamped and sealed. Upper jaw member 30 and lower jaw member 32 are mechanically coupled to elongated stem 16 around pivot bolt 44. The upper jaw member 30 is electrically coupled to the cable 42, and thus to the generator 40 (see Figure 1) through a cable 46b that extends through the elongated stem 16. The lower jaw member 32 is also coupled to the generator 40 by means of another cable 46a (Figure 4) that extends through the elongated stem 16. Cables 46a, 46b provide an electrical path to a pair of electrically conductive tissue engagement sealing plates 48, 50 disposed on lower and upper jaw members 32, 30, respectively. The sealing plate 48 of the lower jaw member 32 opposes a sealing plate 50 of the upper jaw member 30 and, in some embodiments, the sealing plates 48 and 50 are electrically coupled to opposite terminals, for example positive or positive terminals. active (+) and negative or return (-), associated with generator 40. In this way, bipolar energy can be supplied through end effector 14. Alternatively, end effector 14 may be configured to deliver monopolar energy to tissue. In a monopolar configuration, end effector 14 supplies electrosurgical energy from an active terminal, for example (+), while a return pad (not shown) is generally placed on a patient and provides a return path to the opposite terminal, for example (-), from generator 40.

Jaw members 30, 32 can be pivoted about pivot bolt 44 to move end effector 14 to the closed configuration of Figure 2B where seal plates 48, 50 provide pressure to tissue gripped between them. In some embodiments, to provide an effective seal, pressure in the range of between about 3 kg / cm can be applied to the tissue.² and about 16 kg / cm² and, desirably, within a working range of 7 kg / cm² at 13 kg / cm². Also, in the closed configuration, a gap or gap distance "G" can be maintained between the sealing plates 48, 50 by means of a set of abutment members 54 disposed on, or adjacent to, the sealing plates 48, 50 The abutment members 54 contact the opposing surfaces of the opposing jaw members 30, 32, and prevent further approximation of the sealing plates 48, 50. In some embodiments, to provide an effective tissue seal, an appropriate gap distance of between about 0.0254 and 0.152 mm (0.001 inches to about 0.006 inches) and desirably between about 0.0508 and 0.127 mm ( 0.002 and approximately 0.005 inch). In some embodiments, the stop members 54 are constructed of an electrically non-conductive plastic material or other material molded onto the jaw members 30, 32, for example by a process such as overmolding or injection molding. In other embodiments, the stop members 54 are constructed of a heat resistant ceramic deposited on the jaw members 30, 32. Other methods of controlling the gap distance are contemplated including those described in commonly assigned US patent application 2014025073 entitled SEPARATION CONTROL BY OVERMOLDING TEETH AND STRONG STOPS.

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Electrosurgical energy can be delivered to tissue through electrically conductive sealing plates 48, 50 to seal the tissue. Once the tissue seal has been established, a knife blade 56 may be advanced through a blade channel 58 defined in the jaw members 30, 32 to transect the sealed tissue. Knife blade 56 is shown in Figure 2A extending from elongated shaft 16 when end effector 14 is in the open configuration. In some embodiments, a knife closure is provided to prevent extension of knife blade 56 through shower channel 58 when end effector 14 is in the open configuration, thereby preventing accidental or premature tissue transection.

Referring now to Figure 3, elongated stem 16 includes several longitudinal components that operatively couple end effector 14 to the various actuators supported by housing 12 (Figure 1). An outer stem member 60 defines an outer surface of elongated stem 16 and supports movement of other components therethrough, as described below. The outer stem member 60 can be constructed from a flat piece of metal. For the construction of the outer stem member 60, a stamping, punching, or similar metal processing process may be employed to initially generate a planar part that includes a suitable outer profile and any interior openings or fittings. The required folds, bends, or curves can then be formed by bending the flat piece with a folder or other suitable metalworking equipment. In some cases, folds, bends, and bends can be formed in metal components simultaneously with the profile and interior openings, or with the same equipment used to form the external profile and interior openings. Thus, a reference to a stamping process that includes the formation of a flat profile, as well as to impart any bends, kinks or kinks, etc., to the component in question can be understood. The outer stem member 60 can be formed by folding the flat piece into a generally rectangular profile such that two opposite longitudinal edges of the flat piece meet in a longitudinal seam 62 (see Figure 4). Longitudinal seam 62 may be joined by laser welding (or other suitable process) to join the two opposing longitudinal edges together so that they form a continuous rectangular profile. The seam 62 may be generally straight as shown, or alternatively, a hinge box, a dovetail joint, or other interconnections known in the metalworking art may be defined along the seam 62.

The outer stem member 60 defines a yoke 64 at a distal end thereof to receive the jaw members 30 and 32. Opposing vertical sidewalls 64a and 64b of the outer stem member 60 extend distally from the horizontal walls 64c and 64d, and include respective holes 66a, 66b extending therethrough. Holes 66a, 66b frictionally support pivot bolt 44 and maintain an orientation of pivot bolt 44 relative to outer stem member 60. Alternatively or additionally, pivot bolt 44 may be attached to outer stem member 60 by welding. laser or heat based, adhesives, chemical bonding, or other suitable processes.

At a proximal end of outer stem member 60, a pair of tabs 66c (only one of which is visible in Figure 3) is provided to couple outer stem member 60 to knob 28. The connection established between outer stem member 60 and rotary knob are described below with reference to Figures 5 and 6.

Pivot bolt 44 extends through a proximal portion of each of jaw members 30, 32 to pivotally support jaw members 30, 32 at the distal end of outer stem member 60. As further described In detail below with reference to Figure 12, a proximal portion of each of the jaw members 30, 32 has been configured as "double flag" (alternatively referred to as "double flange"). The dual marker configuration refers to two laterally spaced parallel flanges or "markers" 30a, 30b and 32a, 32b respectively, extending proximally from a distal portion of jaw members 30 and 32. A lateral cam slot 30c and a lateral pivot hole 30d extends through each of the markers 30a, 30b of the upper jaw member 30. Similarly, a side cam slot 32c and a side pivot hole 32d extend through each of the markers 32a, 32b of the lower jaw member 32. Pivot holes 30d, 32d receive pivot bolt 44 in an adjustable engagement relationship that allows jaw members 30, 32 to pivot about pivot bolt 44 to move end effector 14 between open and closed configurations ( Figures 2A and 2B, respectively).

A distal portion of each of the jaw members 30, 32 extends distally of the outer stem member 60. The distal portion of each of the jaw members 30, 32 can be curved to facilitate manipulation of the tissue and provide a better “line of sight” to access organs and large tissue structures. As shown in Figure 3, the jaw members 30, 32 curve to the left from a user's perspective. As described in greater detail below with reference to Figure 8, for example, end effector 14 can be rotated about longitudinal axis AA such that jaw members 30, 32 curve to the right. In some alternative embodiments, as described below with reference to Figure 28, for example, an end effector 220 can be rotated to a stable orientation in which jaw members 222, 224 curve in an upward direction.

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A pair of cable guides 68 has been provided to protect cables 46a, 46b (Figure 4). The cable guides 68 are located adjacent the interior surfaces of the opposite vertical side walls 64a and 64b of the outer stem member 60. Adhesives, screws, or similar fastening mechanisms may be used to secure the cable guides 68 in such a way that the position of the cable guides 68 can be preserved. In some alternative embodiments, as described below with reference to Figure 23, the cable guides 68 can be eliminated, and structures can be incorporated into nearby components that can serve as cable guides.

Cable guides 68 are generally flat and can be constructed of metal, a lubricating plastic such as polytetrafluoroethylene (PTFE), or a similar material. The cable guides 68 can thus provide a bearing surface for the outer surfaces of the markers 32a and 32b of the lower jaw member 32 as the jaw members 30, 32 pivot about the pivot bolt 44. The cable guides 68 include a longitudinal passage 70 through which a respective one of the cables 46a, 46b (Figure 4) may extend to connect the sealing plates 48, 50 (Figure 2A) to the electrosurgical generator 40 (Figure 1). The passages 70 hold the cables against the side walls 64a, 64b of the yoke 64 to oppose the entanglement of the cables due to the movement of the various components within the elongated stem 16. A distal flare 72 is provided in passage 70 to provide clearance for cables to move with jaw members 30, 32 as jaw members 30, 32 pivot. Holes 74 are provided in cable guides 68 which they allow the passage of pivot bolt 44 therethrough, and grooves 76 are provided to guide the movement of a cam pivot 92 as described below with continued reference to Figure 3. The slots 76 are optional and can be excluded from the cable guides 68 in some alternative embodiments where the cam pivot 92 is sufficiently short. Holes 74 and slots 76 are disposed on a central axis of cable guides 68, and thereby, two identical cable guides 68, oriented oppositely, can provide proper alignment with holes 66a and 66b on the member. external stem 60.

A pair of cable conduits 78a and 78b may be provided to guide cables 46a and 46b (Figure 4) proximally of cable guides 68. Cable conduits 78a, 78b can be constructed of plastic tubing, and serve to protect cables 46a, 46b from sharp edges that can form on surrounding components. Cable ducts 78a, 78b may also provide some rigidity to facilitate feeding cables 46a, 46b into position during assembly.

A jaw drive rod 80 is received within the outer stem member 60 and is configured for longitudinal movement with respect to the outer stem member 60. The jaw drive rod 80 is constructed from one piece of flat metal, and can be formed by a stamping process similar to that of forming outer stem member 60 described above. The jaw actuation rod 80 generally has a U-shaped profile that includes side walls 82a, 82b and a U-shaped connector portion 82c. Horizontal tabs 84a and 84b project laterally from the respective side walls 82b and 82a, and laterally support the jaw actuating rod within the outer stem member 60. A distal portion 86 of jaw actuating rod 80 is configured to receive within outer stem member 60 and includes fittings for operatively coupling jaw actuating rod 80 to end effector 14. A proximal portion 88 of jaw actuation rod 80 is configured for reception within housing 12 (Figure 1), and includes fittings for operatively coupling jaw actuation rod 80 to actuators supported by it, by example the movable handle 22.

The distal portion 86 of the jaw actuating rod 80 includes a round hole 90 that extends through the side walls 82a, 82b to receive the cam pivot 92. The cam pivot 92 may be friction-coupled, welded, or otherwise clamped within hole 90 such that cam pivot 92 is fixedly coupled to jaw actuating rod 80 and protrudes laterally from each of side walls 82a and 82b. Distally from the hole 90, a longitudinal slot 96 is defined through the side walls 82a, 82b. Longitudinal slot 96 provides clearance for pivot bolt 44, thereby allowing reciprocating longitudinal movement of jaw drive rod 80 independent of pivot bolt 44.

An inverted crease 98 has been defined in the vicinity of hole 90 and slot 96. A portion of side wall 82b has been folded toward opposite side wall 82a such that a portion of jaw actuating rod 80 exhibits a generally closed profile in the vicinity of the inverted fold 98. As described in greater detail below with reference to Figure 4, the inverted fold 98 allows the jaw drive rod 80 to serve as a blade guide to guide the movement of a blade 102.

The proximal portion 88 of the jaw actuation rod 80 includes a set of laterally projecting collar stops 88a, 88b, and 88c, and a pair of laterally projecting spring stops 88d, 88e. Collar stops 88a, 88b, and 88c engage with drive collar 184, and spring stops 88d, 88e engage with spring armature 192, which, as described below with reference to Figure 18, collaborate to operatively coupling the jaw drive stem 80 to the movable handle 22.

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Blade 102 is a generally flat metal component that defines a profile that can be produced by a stamping process as previously described. Knife 102 supports sharp knife blade 56 at the most distal end thereof. The sharp edge of knife blade 56 can be applied to the distal end of knife 102 following the stamping process that forms the profile. For example, various manufacturing techniques such as grinding, forging, electrochemical etching, or other suitable manufacturing process may be employed to form sharp edges. A longitudinal slot 106 is defined with blade 102 to provide clearance for pivot bolt 44 and cam pivot 92. Proximal tabs 108a, 108b project from blade 102 and provide a mechanism for operatively coupling blade 102 to the trigger. 26. The connection between blade 102 and trigger 26 is described in detail below with reference to Figures 19 and 20.

Referring now to Figure 4, the various components of the elongated stem 16 have been shown assembled together and to the upper and lower jaw members 30, 32. The outer stem member 60 is attached to the rotary knob 28 by engagement of the tabs. 66c on outer stem member 60 with rotary knob 28 (see also Figure 6). Jaw drive rod 80 is located within outer stem member 60 such that horizontal flanges 84a and 84b of jaw drive rod 80 abut side walls 64a and 64b of outer stem member. 60. The cable guides 68 are located between the side walls 64a and 64b of the outer stem member 60 and the markers 32a, 32b of the lower jaw member 32, thereby providing lateral support to the lower jaw member 32. The markers 30a, 30b of the upper jaw member 30 are disposed laterally within the markers 32a, 32b of the lower jaw member 32. This arrangement of markers 30a, 30b laterally within the markers 32a, 32b can be described as a "nested" arrangement. Other arrangements are contemplated such as the "offset" arrangement described below with reference to Figure 15.

The blade 102 is centrally disposed within the jaw drive stem 80. The side walls 82a, 82b of the jaw drive stem 80 provide lateral support to the blade 102, and vertical support is provided by means of the connector portion. 82c U-shaped and inverted fold 98. The blade 102 is substantially surrounded at its distal end by the jaw drive stem 80 on all four side faces, and substantially surrounding the blade 102 at its distal end, the jaw drive stem 80 restricts the movement of the blade 102 in the four lateral directions. Free movement of blade 102 is allowed only in the longitudinal direction. Thus, the jaw drive stem 80 serves as a blade guide that urges the blade 102 toward a central position within the elongated stem 16, and thereby ensures proper alignment of the blade 102 as the blade moves. blade 102 alternately within blade channel 58 (Figure 2A). By substantially encircling blade 102 at its distal end, jaw drive rod 80 restricts movement of blade 102 in two orthogonal lateral planes, for example in a vertical and a horizontal plane. The jaw drive rod 80 can also serve to protect the blade 102 and other components from damage during assembly of the elongated shaft 16 and jaw members 30, 32.

Referring now to Figures 5 and 6, the rotary knob 28 has been configured as a single component. In some alternative embodiments, as described below with reference to Figure 25, for example, a rotary knob 260 may be provided that is comprised of multiple components joined together. Rotary knob 28 includes a distal opening 112 defined therein to receive outer stem member 60. Distal opening 112 is bounded by side walls 112a, 112b, 112c, and 112d, which define a generally rectangular profile corresponding to the rectangular profile of outer stem member 60. Distal opening 112 includes an interior platform 114 for seating a more proximal surface. of the outer stem member 60 and two side latch pockets 116 to receive the tabs 66c of the outer stem member 60. The tabs 66c are flexible and project laterally outward in a distal direction such that insertion of the proximal end of the outer stem member 60 into the distal opening 112 of the knob 28 induces the tabs to momentarily flex inward as they engage. the tabs 66c with the side walls 112a, 112b, and then return to the outward projecting orientation into the latch bags 116. The tabs 66c thereby engage the outer stem member 60 with the rotary knob 28. Due to the rectangular profile of the outer stem member 60 and opening 112, the rotational movement imparted to the rotary knob 28 about the longitudinal axis AA . (Figure 1) is transferred to outer stem member 60.

A passage 120 has been defined through the rotary knob 28 to allow longitudinal movement of the jaw drive stem 80 (Figure 3) therethrough. The passage 120 is configured such that the rotational movement imparted to the rotary knob 28 is transferred to the jaw drive stem 80. In one embodiment, a clear passage for cable 122 is also defined through knob 28 to allow passage of electrical cables (eg, 46a, 46b, Figure 4) that electrically connect sealing plates 48, 50 (Figure 2A ) to the electrosurgical generator 40 (Figure 1). The rotational movement imparted to the rotary knob 28 can thereby impart rotational movement to each of the components of the elongated shaft 16, and to the end effector 14, which is coupled thereto.

Referring now to Figures 7 and 8, a proximal end of rotary knob 28 is configured to engage housing 12. A circular groove 124 is defined around a circular protrusion 126 which

ES 2 535 652 T3 projects proximally from rotary knob 28. Circular groove 124 receives a wall (not visible) projecting into housing 12 to hold rotary knob 28 against the distal end of housing 12. The groove circular 124 guides the rotational movement of rotary knob 28 about longitudinal axis AA (Figure 1).

The rotational movement of the rotary knob 28 may be limited by a stop boss 130 projecting distally from the housing 12. The stop boss 130 is positioned to engage with the rotation stops 134 on the rotary knob 28 to prevent rotational movement. of the rotary knob beyond, for example, 180 degrees in any direction. Catches 136 project proximally from knob 28 to engage a distal surface of stop boss 130 prior to stop boss 130 engaging rotation stops. When the rotary knob 28 is rotated to a position where the stop boss 130 is located between a rotation stop 134 and a detent 136, the rotational position of the rotary knob 28 is relatively stable, and can be releasably held until it is released. Apply sufficient force to move retainers 136 on stop boss 130. Two radially opposite positions have been defined wherein the rotational position of the rotary knob 28 is relatively stable. These two radially opposite positions correspond to two orientations of the end effector 14 (Figure 1) in which the jaw members 30, 32 curve to the right and left from the user's perspective.

Referring now to Figure 9, end effector 14 is coupled to the distal end of elongated stem 16 by pivot bolt 44. Pivot bolt 44 is coupled to side walls 64a and 64b of yoke 64 defined at the end. distal of outer stem member 60. Thus, pivot bolt 44 represents a longitudinally stationary reference for longitudinal movements of jaw drive rod 80 and blade 102. Laterally inward of sidewalls 64a, 64b, pivot bolt 44 extends through cable guides 68, markers 32a, 32b of lower jaw member 32, and jaw member markers 30a and 30b. 30 top, side walls 82a, 82b of jaw drive stem 80, and blade 102. The jaw members 30, 32 are free to pivot about the pivot bolt 44, and the jaw drive stem 80 and blade 102 are freely translatable in the longitudinal direction about the pivot bolt 44.

Referring now to Figure 10, the jaw drive rod 80 is disposed in a distal position maintaining the end effector 14 in the open configuration. Since the jaw actuating rod 80 is coupled to the cam pivot 92, when the jaw actuating rod 80 is in the distal position, the cam pivot 92 is located in a distal position in cam grooves 30c and 32c defined at through the flags 30a, 30b, 32a, 32b of the jaw members 30, 32. Also, when the jaw actuation rod 80 is in the distal position, a distal most face 86a of the jaw actuation rod 80 extends to a tissue receiving region 14a of the end effector 14. Thereby, the jaw actuation rod Jaw drive 80 provides a stop to prevent tissue entry into elongated stem 16.

Jaw drive rod 80 may be pulled proximally relative to pivot bolt 44 (the stationary longitudinal reference) to move end effector 14 to the closed configuration (see Figure 2B). Since the longitudinal position of the pivot bolt 44 is fixed (by means of the outer stem member 60, which has been removed from the view of Figure 10 for clarity), and since the cam grooves 30c, 32c are disposed obliquely with respect to longitudinal axis AA, proximal retraction of cam pivot 92 through cam slots 30c, 32c induces jaw members 30, 32 to pivot towards each other about pivot bolt 44 . Conversely, when the end effector 14 is in the closed configuration, longitudinal translation of the jaw drive rod 80 in the distal direction induces the jaw members 30, 32 to pivot each outward toward the open configuration. .

Referring now to Figure 11, when the end effector 14 is in the closed configuration, the blade 102 is freely movable in the longitudinal direction within the jaw drive stem 80. The slot 106 in the blade 102 extends around both of pivot bolt 44 as well as cam pivot 92, and thus bolts 44, 92 do not interfere with reciprocal movement of blade 102. Blade 56, at the most distal end of blade 102, is centrally aligned by the most distal end of jaw drive rod 80 which includes inverted crease 98. Properly aligned, blade 104 easily enters the blade channel 58 defined in jaw members 30, 32. Knife portion 102 extending distally from jaw drive rod 80 can be freely curved, and thereby blade 104 follows the curvature of knife channel 58 through jaw members 30, 32 as described. reciprocating blade 102 in the longitudinal direction.

Referring now to Figures 12 and 13, the lower jaw member 32 is constructed of three major components. These components include a dual marker jaw insert 140, isolator 142, and seal plate 48. In some alternative embodiments, as described below with reference to Figure 22, for example, a jaw member 224 may be provided that is constructed with main components arranged so as to provide unique advantages.

Markers 32a, 32b of jaw member 32 define a proximal portion of jaw insert 140 of

ES 2 535 652 T3 dual marker, and a generally U-shaped channel 144 extends distally to support the tissue engaging portion of jaw member 32. The dual marker jaw insert 140 includes several planar surfaces, and may be constructed as a laminated metal component formed by a stamping process as described above. During such a stamping process, cam grooves 32c and pivot holes 32d can be punched into a flat part, and the part can subsequently be bent to form markers 32a, 32b and U-shaped channel 144. A lateral bend may also be applied to the jaw insert 140 to accommodate the curvature of the jaw member 32.

Insulator 142 can be constructed of an electrically insulating plastic such as polycarbonate (PC), acrylonitrile butadiene styrene (ABS), or a mixture (PC / ABS) of both. The electrically insulating plastic can be overmolded onto the jaw insert 140 by a single injection molding process. Various accessories can be molded into insulator 142 to facilitate attachment of sealing plate 48 to insert 140. For example, tabs may be provided that allow for snap-fit ​​fixation of seal plate 48, or ribs that allow ultrasonic welding of seal plate may be formed on insulator 142. Seal plate 50 may be constructed with an electrically conductive metal, and can be stamped from a flat rolled part.

Referring now to Figure 14, the markers 30a, 30b of the upper jaw member 30 are schematically represented in a nested configuration with respect to the markers 32a, 32b of the lower jaw member 32. The proximal portion of the upper jaw member 30 is narrower than the proximal portion of the lower jaw member 32, and therefore, a lateral spacing "S" between the markers 32a, 32b is sufficient to allow the markers 30a and 30b to are positioned between them. A pivot axis "P0" extends through an overlapping portion of markers 30a, 32a, and 30b, 32a such that the upper and lower jaw members 30, 32 can pivot about the common axis "P0. ”. In the nested configuration, the proximal portions of the upper and lower jaw members 30, 32 also share a common center line "CL-1" that is transverse to the pivot axis "P0".

An alternative to the nested configuration illustrated in Figure 14 is the offset configuration schematically illustrated in Figure 15. A proximal portion of the dual marker upper jaw member 150 includes markers 150a and 150b. A proximal portion of the dual marker lower jaw member 152 includes markers 152a and 152b, and has a width that is identical to the width of the proximal portion of the lower jaw member 150. To provide an overlapping portion of markers 150a, 152a, and 150b, 152b such that jaw members 150, 152 can pivot about common axis "P0", marker 150a of upper jaw member 150 is positioned. on a laterally outer face of the corresponding marker 152a of the lower jaw member 152, and the other marker 150b of the upper jaw member 150 is located on a laterally inner face of the corresponding marker 152b of the lower jaw member 152. In the offset configuration, a center line "CL-2" of the proximal portion of the jaw member Upper 150 is laterally offset from a center line "CL-3" of lower jaw member 152.

In embodiments where a distal tissue-engaging portion (shown in dashed lines) of jaw members 150, 152 is generally straight, for example without the lateral curve of jaw members 30, 32 (see, for example, Figure 2B), the offset configuration allows jaws 150 and 152 to be constructed as substantially identical components. The straight distal portions of the jaw members 150, 152 may be aligned along a common center line "CL-4" even though the proximal portions of the jaw members 150, 152 are aligned along their respective center lines. "CL2" and "CL-3". In general, a forceps with identically configured jaw members 150, 152 can be relatively inexpensive to manufacture.

Referring now to Figure 16, an alternate embodiment of actuation mechanism 160 is depicted. Actuation mechanism 160 employs a pair of stamped lever links 162, 164 to open and close a pair of jaw members 166, 168 An upper jaw member 166 includes a proximal flange 166a pivotally coupled to a lower lever link 162 about a pivot axis "P1". A lower jaw member 168 includes proximal flanges 168a pivotally coupled to an upper lever link 164 about a pivot axis "P2". Each of the proximal flanges 166a and 168a can also be constructed as stamped metal components, as previously described. Lever links 162, 164 are pivotally coupled to reciprocating drive rod 170 about respective pivot axes "P3" and "P4," and each of proximal flanges 166a, 168a is pivotally coupled about a bolt. pivot pin 172, which is disposed about a pivot axis "P5". Pivot bolt 172 is coupled to an outer stem member (not shown), and thus represents a fixed reference for movement of actuation mechanism 160.

The reciprocating drive rod 170 is movable in the distal longitudinal direction as indicated by arrow "D1" and in the proximal longitudinal direction, as indicated by arrow "D2". Since the

ES 2 535 652 T3 longitudinal position of the pivot bolt 172 is fixed, the longitudinal movement of the reciprocating drive rod 170 induces the joint 162 to simultaneously pivot about the axes "P1" and "P3", and induces the joint 164 to pivot simultaneously about axes "P2" and "P4". This simultaneous pivoting of links 162, 164 induces jaw members 166, 168 to pivot about axis "P5" between the closed configuration shown and an open configuration (not shown).

Dual marker jaw members 166, 168 include proximal flanges 166a, 168a arranged in a nested configuration (see Figure 14). Upper hinge 164 may also be characterized as "nested", or disposed laterally between markers on proximal flange 168a of lower jaw member 168. Proximal flange 166a of upper jaw member 166 is "nested" within the interior of the lower lever link 162. Each of the pivot joints 162, 164 and the proximal flanges 166a, 168a includes a generally U-shaped cross section to allow the pivot joints 162, 164 to intersperse with the proximal flanges 166a, 168a in this manner. This configuration provides a central channel 174 through which a centrally disposed blade or other drive component (not shown) can extend.

Actuation mechanism 160 allows jaw members 166, 168 to open or separate from each other to a greater degree than an actuation mechanism to open jaw members of similar size employing a single cam slot (see, for example, Figure 10). Actuation mechanism 160 also provides a tactile feel that some operators may prefer. Stamped lever links 162, 164 and proximal flanges 166a, 168a provide a relatively strong actuation mechanism 160, which allows jaw members 166, 168 to apply a relatively large force to tissue trapped therebetween.

Referring now to Figure 17, the connection of the movable handle 22 and the blade trigger 26 to the longitudinally movable components of the elongated shaft 16. The movable handle 22 can be manipulated to impart longitudinal motion to the drive rod. jaw 80 (Figure 10), and blade trigger 26 can be manipulated to impart longitudinal movement to blade 102 (Figure 11). As discussed above, the longitudinal movement of the jaw actuating rod 80 serves to move the end effector 14 between the open configuration of Figure 2A and the closed configuration of Figure 2B, and the longitudinal movement of the blade 102 it serves to move knife blade 56 through knife channel 58 (Figure 2A).

Movable handle 22 is operatively coupled to jaw drive rod 80 by means of linkage mechanism 176. Linkage mechanism 176 includes a yoke 178 defined at an upper end of movable handle 22. Clevis 178 is pivotally supported on the right half of the housing 12a by means of a pivoting boss 180. A complementary second pivot boss 180 (not shown) is provided in the left half of housing 12b (Figure 1) to support fork 178. Each of the two upper flanges 178a and 178b of fork 178 includes rounded drive surfaces. 182a and 182b thereon to engage respective ribs 184a and 184b of a drive collar 184 (Figure 18). Drive surfaces 182a, 182b are arranged along longitudinal axis AA such that pivotal movements of movable handle 22 about pivot bosses 180 induce corresponding longitudinal movements of drive collar 184 along longitudinal axis. AA.

Referring now to Figure 18, distal longitudinal motion can be imparted to linkage mechanism 176 by pushing distal rib 184a of drive collar 184 with movable handle 22 (Figure 17) as indicated by arrow D3. Distal rib 184a engages collar stops 88a (Figure 3), 88b, and 88c. Thus, distal longitudinal motion of drive collar 184 will be transmitted directly to jaw drive rod 80 to induce corresponding distal motion of jaw drive rod 80. Proximal longitudinal motion can be imparted to the connecting mechanism. 176 by pushing proximal rib 184b of drive collar 184 with movable handle 22 (Figure 17) as indicated by arrow D4. Proximal rib 184b mates with compression spring 188, which is bounded between proximal rib 184b and spring holder 192. Spring holder 192 mates with spring stops 88d (Figure 3) and 88e on the rod. jaw drive 80. Thus, proximal motion of drive collar 184 is transmitted to jaw drive rod 80 through compression spring 188 and spring maintainer 192.

Proximal movement of jaw actuating rod 80 drags cam pivot 92 proximally to pivot jaw members 30, 32 toward each other to move end effector 14 to the closed configuration as described herein. above with reference to Figure 10. Once jaw members 30 and 32 are closed, jaw actuation rod 80 essentially bottoms out (i.e., further proximal movement of jaw actuation rod 80 is prevented since jaw members 30, 32 contact each other). Further proximal movement of movable handle 22 (Figure 17), however, will continue to move drive collar 184 proximally. This continued proximal movement of drive collar 184 compresses spring 188. When compressed, spring 188 imparts additional force to jaw drive rod 80, resulting in a closing force.

Additional ES 2 535 652 T3 applied to tissue captured between jaw members 30, 32 (see Figure 2B). Spring 188 also serves to bias jaw members 30, 32 and movable handle 22 into the open configuration.

A rotational spacer 196 is supported at the proximal end of jaw actuating rod 80. Rotating spacer 196 includes an inner passage (not shown) that receives the irregular cross section of jaw actuating rod 80. An outer surface of the rotary spacer 196 is generally cylindrical, and thus, the rotary spacer 196 can support the proximal end of the jaw drive rod 80 within the housing 12 (see Figure 17) through of the rotation of the elongated stem 80 about the longitudinal axis AA, for example the rotation induced by the rotation of the knob 28 (Figure 17). In some embodiments, for example when longitudinal translation is not required between the rotary spacer 196 and the spring maintainer 192, the rotary spacer 196 and the spring maintainer 192 may be manufactured in a single component as shown in dashed lines. . Spring maintainer 192 and single component rotation spacer 196 may be coupled to jaw drive stem 80 via a pin (not shown).

Referring again to Figure 17, trigger 26 is pivotally supported in housing 12 about a pivot boss 202 protruding from trigger 26. Trigger 26 is operatively coupled to blade 102 (Figure 11) by means of a blade connection mechanism 204 such that pivotal movement of trigger 26 induces longitudinal movement of blade 102. Blade connection mechanism 204 includes upper tabs 26a, 26b of trigger 26, link 208, and displaceable blade holder 210. Link 208 is pivotally coupled to tabs 26a, 26b and displaceable blade holder 210 as such. so that the pivotal movement of the trigger 26 induces the longitudinal movement of the movable blade holder 210.

Referring now to Figure 19, the movable blade holder 210 is longitudinally movable on the jaw drive rod 80 regardless of movement of the jaw drive rod 80. Thus, the jaw drive rod 80 can be considered as a stationary reference for the movement of the movable blade support 210. The movable blade holder 210 includes a bushing 212, a blade arm 216, and a cap 218.

Knife arm 216 includes a pivoting boss 216a, around which link 208 (see Figure 21C) has been coupled with knife arm 216. As described below with reference to Figure 21C, link 208 imparts longitudinal movement to the movable blade holder 210 in the distal direction of arrow A9. Guide arms 216b project laterally from the proximal end of blade arm 216, and engage with a guide slot 12c (respective (shown schematically in Figure 19 and visible in Figure 21C) defined in housing 12 to guide longitudinal movement of the movable blade holder 210.

The bushing 212 is coupled to the blade arm 216, and thereby, the bushing 212 is translated along with the knife bar 216. The bushing 212 includes indentations or notches 212a defined therein, which receive quick coupling arms 218a from cover 218. The cover 218 can thus be assembled with the bushing 212 in such a way that the cover 218 and the bushing 212 translate together, thereby, the entire movable blade holder 210, that is, the blade bar 216, the bushing 212 and cap 218, they can all be induced to translate together along jaw drive rod 80 in the direction of arrow A9. The movable blade holder 210 abuts a spring 219, which is compressed against the rotary knob 28 (shown schematically in Figure 19) when the movable blade holder 210 is translated in the direction of arrow A9. Spring 219 biases movable blade holder 210 proximally to a proximal position along jaw drive rod 80.

Referring now to Figure 20, the blade 102 is coupled to the movable blade holder 210 such that the longitudinal movement of the movable blade holder 210 is transmitted to the blade 102. The proximal tabs 108a, 108b projecting from the blade 102 are captured between bushing 212 and cap 218, and thereby blade 102 will translate with movable blade holder 210 in both proximal and distal directions. Proximal tabs 108a, 108b are free to rotate about longitudinal axis AA within bush 212, and thereby blade 102 can rotate alongside jaw drive rod 80 within movable blade holder. 210 when turning knob 28 is rotated as previously described.

Referring now to Figures 21A, 21B, 21C and 21D, a sequence of movements can be initiated by moving the movable handle 22 to induce movement in the jaw drive mechanism to close the jaws 30, 32, and by moving trigger 26 to induce movement in the blade actuation mechanism to translate blade 56 through jaws 30, 32. Initially, both the movable handle 22 and the blade trigger 26 are in the distal or non-actuated position as shown in Figure 21A. This arrangement of movable handle 22 and trigger 26 maintains end effector 14 in an open configuration (Figure 2A) where jaw members 30, 32 are substantially spaced from each other, and knife blade 56 is in a retracted or proximal position with with respect to the jaw members 30, 32. The initial distal position of trigger 22 is actively maintained by the influence of spring 219 on the trigger mechanism.

ES 2 535 652 T3 knife actuation. The distal position of the movable handle 22, however, is held only passively, for example by internal friction within the jaw actuation mechanism. When both movable handle 22 and blade trigger 26 are in the distal, non-actuated position, pivotal movement of blade trigger 26 in the proximal direction, that is, toward stationary handle 20, is impeded by interference between trigger 26 and handle. movable 22. This interference prevents advancement of the knife blade through jaw members 30, 32 when end effector 14 is in the open configuration.

The movable handle 22 can be moved from the distal position of Figure 21A to the intermediate position shown at 21B to move the jaw members 30, 32 to the closed configuration (Figure 2B). As movable handle 22 pivots about pivot boss 180 in the direction of arrow M1, actuation surface 182b engages proximal rib 184b of actuation collar 184. Drive collar 184, spring 188, and spring maintainer 192 are all proximally driven against spring stops 88d and 88e of jaw drive rod 80, and thus, jaw drive rod 80. it is actuated proximally in the direction of arrow M2. As previously discussed with reference to Figure 10, proximal movement of jaw actuating rod 80 serves to drive cam pivot 92 proximally through cam grooves 30c, 32c of jaw members 30, 32 and thereby pivoting the jaw members 30, 32 towards each other. Since the jaw members 30, 32 engage each other and no further pivoting movement of the jaw members 30, 32 can be achieved, the jaw actuation mechanism "bottoms out" and further proximal movement is prevented. of the cam pivot 92 and the jaw drive rod 80.

Movable handle 22 can be moved from the intermediate position of Figure 21B to the proximal or actuated position of Figure 21C to increase the pressure applied by the jaw members 30, 32. Since movable handle 22 pivots more about pivot boss 180 in the direction of arrow M3, actuation surface 182b presses proximal rib 184b of actuation collar 184 more distally against spring 188 in the direction of the arrow M4. Spring 188 is compressed against spring maintainer 192, and a tensile force is transmitted through jaw drive rod 80 to jaw members 30, 32. The tensioning force supplied by spring 188 ensures that jaw members 30, 32 apply appropriate pressure to seal the tissue. When the movable handle 22 is in the proximal or actuated position, electrosurgical energy can be selectively delivered to the end effector 14 to generate a tissue seal.

When the movable handle 22 is in the actuated or proximal position, a flange 22a of the movable handle 22 is received on a rail 20a supported within the stationary handle 20. The rail 20a serves to temporarily lock the movable handle 22 in a proximal position against the bias of spring 188, which biases movable handle 22 from the proximal position of Figure 21C to the intermediate position of Figure 21B. Thus, rail 20a allows pressure to be maintained on end effector 14 without actively maintaining pressure on movable handle 22. Flange 22a can be released from rail 20a by pivoting movable handle 22 proximally and releasing movable handle 22 so that moves under the influence of spring 188. The operation of rail 20a has been described in greater detail in US Patent Application Serial No. 11 / 595,194 to Hixon et al., Now US Patent No. 7,766,910. In some embodiments (not shown), flange 22a and rail 22a can be removed to provide an instrument without the temporary locking capability provided by these accessories.

When the movable handle 22 is in the driven or proximal position, the blade trigger 26 can be selectively moved from the distal position of Figure 21C to the proximal position of Figure 21D to advance the blade blade 56 distally through jaw members 30, 32. Blade trigger 26 may be pivoted in the direction of arrow M5, around pivot boss 202 to advance flange 26b of blade trigger 26 distally in the direction of arrow M6. Movement of flange 26b induces hinge 208 to pivot relative to flange 26b of trigger 26, and relative to blade arm 216 such that hinge 208 drags movable blade holder 210 distally in the direction of arrow M7. As previously described with reference to Figures 11 and 19-20, the distal movement of the displaceable blade holder 210 advances the blade blade 56 distally through the jaw members 30, 32.

Referring now to Figures 22-29, several alternative components are described, which may be replaced individually or in combination with the similarly named components described above in order to provide specific functionality to a surgical instrument. Referring to Figure 22, an alternate embodiment of an end effector 220 includes upper and lower jaw members 222 and 224, respectively, which are configured to facilitate blunt tissue dissection. Each jaw member 222, 224 has a free distal end with a shoulder 222a, 224a projecting distally from a less prominent portion 222b, 224b of the distal tip. When end effector 220 is in the closed configuration as shown, shoulders 222a, 224a can be pressed into tissue to be dissected. End effector 220 can then be moved to the open configuration to separate jaw members 222, 224 and tissue that has been gripped by shoulders 222a, 224a.

The ribs 222a, 224a can be made of an electrically insulating material, for example the insulator 230

ES 2 535 652 T3 as depicted in Figure 23. Upper jaw member 222 is constructed of three major components including a dual marker jaw insert 234, insulator 230, and sealing plate 238. Insulator 230 It can be molded into a U-shaped channel 236 of the dual marker jaw insert 234 and the sealing plate 238 in a single molding operation. Isolator 230 may completely surround U-shaped channel 236, and may include various accessories such as shoulder 224a (Figure 22) at the distal end thereof, and a lead guide 240 at a proximal end thereof.

Cable guide 240 is a portion of insulator 230 that has been molded into a side face of dual marker jaw insert 234, and onto cable 46b that couples sealing plate 238 to electrosurgical generator 40 (Figure 1) as per has been described previously. Cable guide 240 includes a hole 244 to provide clearance for a pivot bolt 44 (Figure 24), and is disposed on a single side face of upper jaw member 222. The lower jaw member 224 (Figure 22) may include a similar cable guide (not shown), which may be located on the opposite side face when the upper and lower jaw members 222, 224 are assembled with an outer stem member. 250 in a "skewed" arrangement as depicted in Figure 24. Cable guide 240 can thereby protect cable 46b from abrasion from outer stem member 250 as upper jaw member 222 pivots about pivot bolt 44.

Referring now to Figure 25, a rotary knob 260 is made from two different components 262 and 264. An exterior component 262 provides gripping surfaces 268 that can be engaged by an operator during use. The outer component 262 generally has a thin-walled construction to facilitate molding from a plastic or similar material. Internal wall portions 270 have been provided to engage an internal component 264 of rotary knob 260 in a snap-fit ​​manner. Inner component 264 includes a distal engagement portion 272 for engaging rotary knob 260 with outer stem member 250 (see Figure 27), and a circular boss 276 extending proximally therefrom. Circular protrusion 276 includes radially spaced retainers 278 projecting radially from an outer circumference thereof and a proximal extension 280 protruding longitudinally therefrom. The retainers 278 and proximal extension 280 define the rotational limits of the rotary knob 260 as described below with reference to Figure 28.

Referring now to Figures 26 and 27, outer stem member 250 may be coupled to rotary knob 260 in a snap-fit ​​manner. The outer stem member 250 includes a pair of rectangular openings 284 that extend through the vertical side walls 250a, 250b near a proximal end thereof. Rectangular openings 284 provide flexibility to the proximal end of outer stem member 250 such that a pair of fasteners 288 can be installed at a proximal end of side walls 250a, 250b toward distal engagement portion 272 of inner component 264 of the rotary knob 260. Distal engaging portion 272 includes tapered walls 272a, 272b to bias fasteners 288 laterally inward temporarily as outer stem member 250 is inserted longitudinally between walls 272a, 272b. Once the fasteners 288 have been inserted proximally beyond the walls 272a, 272b, the fasteners 288 will lock in place due to the elasticity of the outer stem member 250 pushing the fasteners laterally outward. The outer stem member 250 can thus be operatively coupled to the rotary knob 260.

Referring now to Figure 28, rotational movement of rotary knob 260 is limited by its connection to a housing 302, which includes right and left half-housings 302a, 302b, respectively. A stopper 304 projects laterally inward from half-housing 302b and is positioned to engage proximal extension 280 to prevent rotational movement of the knob beyond, in one embodiment, 180 degrees in either direction. A pair of retainers 278 extending from the outer circumference of knob 260 engage with a pair of cantilevered arms 306 projecting from housing 302b. Engagement of latches 278 with cantilevered arms 306 defines a relatively stable relationship between knob 260 and housing 302. In one embodiment, retainers 278 are radially spaced approximately 90 degrees such that at least three relatively stable positions can be defined within the rotational path allowed by proximal extension 280 and stop 304. These positions may correspond to a configuration wherein the jaw members 222 and 224 (Figure 22) curve to the left, in an upward direction, and to the right from a user's perspective. The components for limiting the rotation of the rotary knob 260 are all defined within the housing 302, and thereby, interference from foreign materials is limited.

Outer stem member 250, rotary knob 260, and housing 302 define a longitudinal passage through which jaw drive rod 80, blade 102, and cable conduits 78a and 78b can extend. The rotary knob 260 may also include an inner shelf (not shown) against which the spring 219 can be compressed (see Figure 21D for a representation of the spring 219 in a compressed state).

Referring now to Figure 29, a movable blade holder 310 can be operatively coupled to the blade 102 by relative rotation of the movable blade holder 310 with respect to the blade. The movable blade holder 310 includes a single component (compare to the movable blade holder 210 described above with reference to Figure 19, which includes both a cover 218 and a

ES 2 535 652 T3 bush 212 to catch the blade 102). An opening 312 in the movable blade holder 310 receives the proximal tabs 108a, 108b of the blade 102. Rotation of the movable blade holder 310 in the direction of arrow Q1 captures the proximal tabs 108a, 108b against a proximal shoulder of the holder. movable blade. Thus, the longitudinal movement between the movable blade holder 5 310 and the blade 102 can be transmitted.

While various embodiments of the description have been shown in the drawings, the description is not intended to be limited thereto, but rather the description is intended to be as broad in scope as the art allows and the description should be read carefully. the same way. Therefore, the above description should not be understood as limiting, but only as examples of particular embodiments. Those skilled in the art will envision other modifications within the scope of the appended claims.

Although the foregoing description has been made in some detail by way of example and illustration, for the sake of clarity or understanding, it will be obvious that various changes and modifications can be made within the scope of the appended claims.