Bipolar forceps equipped with monopolar stretch section

<u style="single">Cross-reference with related applications</u> This application is filed by Lawes et al. On September 17, 2003 in the United States Preliminary Application No. 60 / 520,579 with the invention name "Bipolar Forceps Having Monopolar Extension". It claims the priority of (Patent Document 1), and the entire contents of the application are incorporated herein by reference.

<u style="single">Background</u> The disclosure relates to forceps for electrosurgery, and in particular, the disclosure comprises a monopolar stretch section that is selectively powered and / or stretchable to enhance the electrosurgical effect. It is associated with endoscopic bipolar electrosurgery forceps for coagulating tissue, closing tissue, and / or cutting tissue.

<u style="single">Technical field</u> Electrosurgical forceps utilize both mechanical clamping and electrical energy to heat tissue and blood vessels to coagulate tissue, cauterize tissue, and / or close tissue to stop bleeding. carry out. As an alternative to open forceps for use with open surgical procedures, a significant number of modern surgeons have used endoscopes and endoscopic instruments to remotely reach organs through smaller perforated incisions. I try to get closer. As a direct result, patients tend to benefit from smaller wounds and shorter healing times.

The endoscopic device is inserted into the patient's body through a cannula or port made with a hypodermic needle (trocar). The typical dimensional range of a cannula ranges from 3 mm to 12 mm. Smaller cannulas are usually preferred, and ultimately, design efforts are being set for instrument manufacturers who must seek ways to create endoscopic instruments that fit inside smaller cannsulas. That is not difficult to guess.

Many endoscopic surgical procedures require cutting or ligating blood vessels or vascular tissue. Due to the spatial problems inherent in the surgical cavity, when suturing blood vessels, or when performing other conventional methods of controlling bleeding, i.e., crossed blood vessels. Surgeons often had difficulty in clamping and / or tying blood vessels to stop blood circulation. By utilizing an electrosurgical incision shear, a combination of mechanical and electrosurgical incision movements can be used by a surgeon to make an incision in a tissue during a given surgical procedure. it can. By utilizing endoscopic electrosurgical forceps, the surgeon can cauterize, coagulate, and dry, and / or the intensity, frequency, and frequency of electrosurgical energy applied to the tissue by the jaw member. Bleeding can be easily reduced or slowed down by simply controlling the duration.

To treat larger blood vessels, surgeons may choose to seal the tissue or blood vessels. Tissue closure procedures are fundamentally different from mere vascular coagulation and vascular ablation. Therefore, as used herein, "coagulation" is defined as the process of drying tissue, in which case the histiocytes rupture and dry. "Vascular closure" or "tissue closure" is defined as the process of liquefying collagen in tissue, causing the tissue to reshape into a fused mass and at the same time create a limited boundary between adjacent tissue structures. In order to effectively close a larger blood vessel (or tissue), two dominant mechanical parameters must be controlled with high precision, that is, the pressure exerted on the blood vessel (tissue) is about 3 kg. /cm²From about 16kg / cm²The gap distance between the electrodes is preferably about 0.0254 mm (about 0.001 inch) to about 0.1524 mm (about 0.006 inch). Some examples of endoscopic vascular closure devices are common to this application and the applicant US Patent Application Nos. 10 / 116,944 (Patent Document 2), 10 / 179,863 (Patent Document 3), 10 / It is disclosed in 369,894 (Patent Document 4), 10 / 180,926 (Patent Document 5), and PCT / US01 / 11340 (Patent Document 6), and the entire contents of these documents are incorporated herein by reference.

<patcit num="1"><text>US Preliminary Application Serial Number 60 / 520,579</text></patcit><patcit num="2"><text>U.S. Patent Application No. 10 / 116,944</text></patcit><patcit num="3"><text>U.S. Patent Application No. 10 / 179,863</text></patcit><patcit num="4"><text>U.S. Patent Application No. 10 / 369,894</text></patcit><patcit num="5"><text>U.S. Patent Application No. 10 / 180,926</text></patcit><patcit num="6"><text>PCT / US01 / 11340</text></patcit><patcit num="7"><text>U.S. Patent Application Serial No. 10 / 460,926</text></patcit><patcit num="8"><text>U.S. Pat. No. 6,033,399</text></patcit><patcit num="9"><text>U.S. Pat. No. 6,187,003</text></patcit><patcit num="10"><text>US application serial number PCT / US01 / 11413</text></patcit>

<p> In general, the electrical composition of electrosurgery forceps can be classified into two types: (1) monopolar electrosurgery forceps and (2) bipolar electrosurgery forceps. .. The monopolar forceps utilize one active electrode attached to the clamp end end agonist and a return electrode for the remote patient that is attached outside the patient's body. When electrosurgical energy is applied, the energy propagates from the active electrode to the surgical site, through the patient's body and to the return electrode.</p><p> Bipolar electrosurgery forceps utilize two generally opposite electrodes, which are located on opposite surfaces inside the terminal agonist, both of which are electrically connected to the electrosurgery generator. ing. Each electrode is charged with a different potential. Since tissue is a conductor of electrical energy, electrical energy is selectively transmitted through the tissue when the tissue between the two agonists is gripped, closed, or incised using a terminal agonist.</p><p> Bipolar forceps harmonize with the advantages or advantages of monopolar instruments as one of the inherent drawbacks of using bipolar endoscopic forceps to cauterize, coagulate, incis, or close blood vessels and other tissues. Cannot (ie, the monopolar instrument has the ability to move through vascular tissue and then make an incision through a narrow tissue plane) and for some applications surgery to benefit from using the monopolar instrument The surgeon needs to replace the bipolar forceps with monopolar instruments during surgery. Similarly, during certain monopolar endoscopic applications, it may be advantageous to replace the monopolar instrument with bipolar forceps, eg, to close a larger tissue structure. Specifically, the gallbladder is dissected from the liver during a gallbladder resection, which is typically done with endoscopic monopolar instruments such as electrosurgery knives, electrosurgery pencils, loop electrodes, etc. Requires to be used. However, during the gallbladder resection procedure, it may be necessary to close the cystic duct or the gallbladder artery, which requires a bipolar vascular closure device. Need to replace. The surgeon may need to remove the monopolar instrument from the cavity during surgery and use the bipolar instrument and vice versa.</p><p> Therefore, by combining the advantages of both monopolar and bipolar operations, it is necessary to develop instruments that can reduce the need for surgeons to change instruments during certain surgical procedures.</p>

<p> The present invention relates to endoscopic forceps for treating tissue, having a housing, a shaft attached to the housing, and a first jaw member and a second jaw member attached to the distal end of the shaft. .. The forceps also correlate the first jaw member and the second jaw member with each other, and from the first position where the two jaw members are arranged at intervals from each other, the tissue sandwiched between the two jaw members in cooperation with each other. It is equipped with an actuator for moving it to the second position to be gripped. Electrosurgical energy sources are connected to each of the jaw members to allow them to selectively operate in bipolar mode, which allows the jaw members to pass through the interspersed tissue. It is capable of transmitting bipolar energy and processing tissue. The forceps further include a monopolar element housed within at least the first jaw member, the monopolar element being located distal to the first jaw member from a first position within the first jaw member. It can be selectively moved to a position. The monopolar element is connected to an electrosurgical energy source and can selectively operate independently of both jaw members.</p><p> In one embodiment according to the present disclosure, the forceps are provided with a knife, which is selectively inside a knife channel defined inside at least one of a first jaw member and a second jaw member. An incision is made in the tissue that is mobile and located between the first and second jaw members. It is advantageous that the knife actuator allows the user to selectively move the knife to make an incision in the tissue located between the jaw members. Since the electrosurgical energy source carries an electric potential to each jaw member, both jaw members can transfer bipolar energy through the tissue held between them to perform tissue closure.</p><p> The knife is designed to first make an incision in the tissue between the first and second jaw members and then extend distally from both jaw members to treat the tissue in a monopolar manner. Is advantageous. The forceps are equipped with a safety device (ie, a safety circuit or mechanical safety element), and the knife (or monopolar element) is electrically operated only when the knife (or monopolar element) extends from the distal ends of both jaw members. It is preferable to allow only the operation in. The safety device may also be configured to inactivate both jaw members by circuit or by utilizing a mechanical safety device.</p><p> In one embodiment, the first jaw member and the second jaw member each have an elongated slot, which extends substantially along the longitudinal direction of each of the jaw members, thus resulting in two. The elongated slots facing each other form a knife channel to allow the knife to reciprocate and divide the tissue between the jaw members.</p><p> In another embodiment, the forceps are vascular closure forceps, at least one of both jaw members comprising at least one non-conductive retaining member on top of which the tissue is the first jaw. Controls the distance between the jaw members when held between the members and the second jaw member. When the tissue is compressed between the jaw members, the retaining member maintains the clearance distance between the jaw members between about 0.0254 mm (about 0.001 inch) and about 0.1524 mm (about 0.006 inch). Is advantageous.</p><p> In yet another embodiment according to the present disclosure, the forceps include an actuator that moves the knife to make an incision in the tissue between the jaw members and the knife or separate monopolar element in the first jaw member. It operates to extend from the first position inside to the second position distal to the first jaw member. In yet another embodiment according to the present disclosure, the forceps include an actuator that moves both jaw members from position 1 to position 2 in correlation with each other to sandwich tissue between the jaw members. It operates so as to extend the monopolar element from the first position inside the first jaw member to the second position distal to the first jaw member.</p><p> In another embodiment according to the present disclosure, the first actuator may be designed to actuate both jaw members for gripping the tissue and may also include a second actuator, the second actuator. The actuator may be actuated to extend the monopolar element from a first position inside the first jaw member to a second position distal to the first jaw member.</p><p> The present invention also relates to endoscopic forceps, comprising a housing, a shaft attached to the housing, and a first jaw member and a second jaw member attached to the distal end of the shaft. The first jaw member is configured to extend distally in correlation with the second jaw member. The jaw members are correlated with each other from the first position where the jaw members are arranged at a correlation with each other to the second position where the jaw members cooperate so as to sandwich and grip the tissue between them. It is equipped with an actuator for movement. Since the bimaxillary members are connected to the electrosurgical energy source, the bimaxillary members can be selectively operated in bipolar mode, which allows the bimaxillary members to operate. Bipolar energy can be transferred through the tissue retained in the meantime.</p><p> The forceps also include a control switch, which, when selectively activated, inactivates the second jaw member and activates the first jaw member at the first potential. Simultaneously with each other, the control switch also activates the return electrode (return electrode) or return pad (return pad) placed adjacent to the patient at different potentials, and the first jaw member is selectively monopolar. Allows the organization to be processed. It is preferable to provide a safety device that limits the electrical operation of the control switch when both jaw members are placed in the second position.</p><p> The disclosure also relates to endoscopic forceps, the endoscopic forceps having a housing and a shaft attached to the housing. The shaft has a first jaw member and a second jaw member attached to its distal end. It is preferred that the first jaw member and the second jaw member each have a tapered distal end or an elongated distal end. The forceps also move from the first position, where the jaw members are correlated with each other, to the second position, where the jaw members work together to sandwich and grip the tissue between them. It is further equipped with an actuator that moves the elements in a correlation with each other. Electrosurgical Since the energy source is connected to each of the jaw members, both jaw members can be selectively operated in bipolar mode, from which both jaw members pass through the tissue held between them. It can transfer bipolar energy.</p><p> The forceps also include a control switch, which, when selectively activated, activates and differs from the first jaw member and the second jaw member at the first potential. The potential activates the return electrode. The return electrode is preferably placed adjacent to the patient, which allows the first and second jaw members to selectively process tissue in a "monopolar fashion". The forceps are equipped with a safety device, which preferably only allows the control switch to be electrically activated only when the jaw members are in the second position.</p><p> In another embodiment of the disclosure, the actuator applies a tightening pressure between the jaw members of approximately 3 kg / cm.²From about 16kg / cm²Can be selectively locked to maintain the range of about 7 kg / cm²From about 13kg / cm²These values are advantageous in providing effective and reliable tissue closure. In yet another embodiment, the forceps may further include a rotating assembly that rotates both jaw members about a longitudinal axis defined within the shaft. It is advantageous for the forceps to include a unilateral jaw member assembly, i.e., the first jaw member is movable with respect to the second jaw member and the second jaw member is substantially fixed. Is advantageous. As an alternative, the forceps may include bilateral jaw member assemblies, i.e., allowing both jaw members to move in correlation with each other.</p><p> The forceps are equipped with a spring along with the actuator or drive assembly to facilitate the operation of the movable handle and the tightening force is approximately 3 kg / cm.²From about 16kg / cm²It is preferable to ensure that it is maintained within the operating range of.</p><p> The disclosure also relates to a method of treating tissue with electrosurgical energy from an electrosurgical generator, which method comprises an endoscopic forceps with a housing and a shaft attached to the housing. Includes the stage of setting up. The shaft has a first jaw member and a second jaw member attached to its distal end. The forceps hold the jaw members from the first position, where the jaw members are spaced apart from each other, to the second position, where the jaw members work together to sandwich and grip the tissue between them. It is equipped with actuators that move in correlation with each other. The forceps further include a monopolar element, which is housed at least inside the first jaw member and from a first position inside the first jaw member to a second position distal to the first jaw member. It is selectively movable. The forceps are provided with return electrodes and are placed in contact with the patient's body tissue.</p><p> In this method, a monopolar element is connected to each of the jaw members, and a return electrode is connected to a generator for electrosurgery, a step of sandwiching and gripping a tissue between the jaw members, and a step of gripping both jaw members. The tissue is treated by selectively activating the tissue between the jaw members by the "bipolar method" and by selectively activating the monopolar element and the return electrode independently of the jaw members. It further includes the stage of processing by the "monopolar method".</p><p> After the step of selectively activating the bimaxillary member to process the tissue, the method preferably comprises the step of extending the monopolar element from the distal end of the bimaxillary member. It is advantageous that the step of selectively activating the monopolar element includes the step of inactivating both jaw members.</p><p> After the step of selectively activating the bimaxillary member to process the tissue, the method may include the step of releasing the tissue from the bimaxillary member.</p>

Various embodiments of the device of the present invention will be described below with reference to the accompanying drawings. Here, with reference to FIGS. 1A to 1D, an embodiment of endoscopic forceps 10 for use in combination with various surgical procedures is illustrated. Therefore, although the vascular closure forceps are illustrated and described in the present specification, it is conceivable that other types of forceps or surgical scissors may be used, but both of the above instruments are cauterized, coagulated, and used. Alternatively, the tissue treatment is performed for other purposes and is configured for monopolar application examples as described herein. Further, although the drawings depict forceps 10 for use in connection with endoscopic surgical procedures, the present disclosure may be used for more conventional open surgical procedures. Therefore, although the forceps 10 are described herein in the context of an endoscopic instrument, the open revision of the forceps 10 has the same or similar motion components as those described above. , It is considered that it may have the characteristics described below.

The forceps 10 generally include a housing 20, a handle assembly 30, a rotating assembly 80, a trigger assembly 70, and a terminal actuator assembly 100, the components of which work together to grip the tissue and hold the tissue. Process and divide the organization. As such, the handle assembly 30, rotating assembly, trigger assembly 70, and end actuator assembly 100 are only schematically described herein. A more detailed description of all such collaborative components can be found in the pending US patent application serial number 10 / 460,926 (Patent Document 7), which is common to the applicant and the applicant. Is used here.

The forceps 10 include a shaft 12, which has a distal end 16 sized to mechanically fit into the terminal actuator assembly 100 and a proximal end 14 that mechanically fits into the housing 20. Have. In the drawings and subsequent descriptions, the word "proximal" still refers to the end of forceps 10 closer to the user, and the word "distal" refers to the user. It describes the end farther away from. Details on how the shaft 12 connects to the terminal actuator assembly 100 and how the proximal end connects to the housing 20 are described above by the applicant and the applicant. It is described in U.S. Patent Application Sequential No. 10 / 460,926 (Patent Document 7), which is commonly pending.

As best seen in Figure 1A, the forceps 10 also includes an electrosurgical cable that connects the forceps 10 to an electrosurgical energy source such as the generator 300. The cable 310 is internally branched into cable leads 310a, 310b, 310c, each of which transfers electrosurgical energy through forceps 10 to the terminal actuator assembly 100 through their respective feed paths, which is the United States. As described in more detail with respect to patent application serial number 10 / 460,926 (Patent Document 7). Preferably, generators such as those sold by Valleylab, a division of Tyco Healthcare LP based in Boulder, Colorado, USA, are used as an energy source for electrosurgery. However, as specific examples, FORCE EZ (registered trademark) electrosurgery generator, FORCE FX (registered trademark) electrosurgery generator, FORCE 1C (registered trademark) electrosurgery generator, FORCE 2 (registered trademark) Electrosurgery Generator, SurgiStat® II There is a generator for electrosurgery. One such system is described in US Pat. No. 6,033,399 (Patent Document 8), which is common to this case and the owner, the entire contents of which are incorporated herein by reference. Other systems are described in US Pat. No. 6,187,003 (Patent Document 9), which is common to this case and the owner, and the entire contents are also incorporated herein by reference.

The generator 300 is preferably equipped with various safety devices and performance characteristics, and specific examples thereof include isolated output and independent operation of accessories. An example of an electrosurgical generator 300 is ValleyLab's Instant Response® technology, which provides an advanced feedback system that detects tissue changes 200 times per second and is appropriate. It is preferable to adjust the voltage and current in order to maintain a good power.

The handle assembly 30 includes a fixed handle 50 and a movable handle 40. The fixed handle 50 is integrally attached to the housing 20, and the handle 40 is movable in correlation with the fixed handle 50. The rotating assembly 80 is preferably attached integrally with the housing 20 and can rotate about 180 degrees in any direction around the longitudinal axis A. Details of the handle assembly 30 and the details of the rotating assembly 80 are described in more detail with respect to US patent application serial number 10 / 460,926.

As mentioned above, the terminal actuator assembly 100 is attached to the distal end 16 of the shaft 12 and comprises a pair of opposing jaw members 110, 120. The movable handle 40 of the handle assembly 30 is finally connected to an internally located drive assembly (not shown), which work together mechanically together to provide both jaw members 110, 120. Move the jaw members 110, 120 from the open position where the jaw members 110, 120 are arranged so as to be spaced from each other to the clamp position or the closed position where the jaw members 110, 120 cooperate to grip the tissue between them.

Looking at the more detailed features of one embodiment of the present disclosure, as described with respect to FIGS. 1A to 3, the movable handle 40 comprises an opening 42 defined therein. This allows the user to grasp and move the handle 40 relative to the fixed handle 50. More specifically, the handle 40 selectively revolves around the swivel axis (pivot) (not shown) from the first position associated with the fixed handle 50 to the second position more proximal to the fixed handle 50. Movable, thereby moving both jaw members 110, 120 relative to each other.

The lower end of the movable handle 40 is provided with a flange 90, which reciprocates inside the fixed handle 50 as the handle 40 moves. The flange 90 is placed inside a predetermined channel (not shown) located inside the fixed handle 50 and locks the movable handle 40 relative to the fixed handle 50.

As best shown in FIG. 1C, the lock flange 44 is located above the top of the handle 40 and on the outer periphery of the handle 40. The lock flange 44 prevents the trigger assembly 70 from starting when the handle 40 is oriented in the non-actuated position, that is, when the jaw members 110, 120 are in the open state. Correctly recognizable, this prevents the tissue from being accidentally or prematurely sheared before the tissue closure is complete.

As described in detail in co-pending U.S. Patent Application Serial No. 10 / 460,926, the movable handle 40 has traditionally been due to the unique position of the turning center point with respect to the longitudinal axis A of the shaft 12. It is designed to provide significant mechanical advantages over the handle assembly of. In other words, by positioning the swivel center point above the drive element, the user gains a lever-like mechanical advantage to actuate both jaw members 110, 120 with less force. It is possible to exert the necessary force necessary to carry out proper and effective tissue closure while closing the tissue. It is recalled that the one-sided design of the end actuator assembly 100 also enhances the mechanical advantage.

As best seen in FIGS. 1A and 1D, the terminal actuator assembly 100 comprises opposing jaw members 110, 120, which work together to form a tissue intended for closure. Perform gripping effectively. The end agonist assembly 100 is designed as a one-sided assembly, i.e., the jaw member 120 is fixed with respect to the shaft 12, and the jaw member 110 swivels around a swivel pin 103 to grip the tissue.

More specifically, the one-sided end actuator assembly 100 has one stationary jaw member or fixed jaw member 120 attached in a fixed relationship to the shaft 12 and a swivel pin attached to the stationary jaw member 120. It is provided with a swivel jaw member 110 attached around 103. The reciprocating sleeve 60 is slidably arranged inside the shaft 12 and can be operated remotely by a drive assembly (not shown) that works with the handle 40 to open and close the jaw members 110, 120 as described above. ing. The swivel jaw member 110 includes a detent or protrusion 117 that extends from the jaw member 110 through an opening 62 located within the reciprocating sleeve 60 (FIG. 1D). As a result of the swivel jaw member 110 being actuated by sliding the sleeve 60 axially inside the shaft 12, the opening 62 abuts on the detent 117 on the swivel jaw member 110. When the sleeve 60 is pulled in the proximal direction, the jaw members are tightened around the tissue held between the jaw members 110 and 120, and when the sleeve 60 is pushed in the distal direction, the sleeve 60 is joined and gripped. , Open jaw members 110, 120.

Once actuated, the handle 40 moves around the turning center point towards the fixed handle 50 in a substantially arcuate fashion, thereby causing the drive flange (not shown) to resist the drive assembly (not shown). This in turn pulls the reciprocating sleeve 60 substantially proximally to close the jaw member 110 with respect to the jaw member 120. Further, the proximal rotation of the handle 40 releases the lock flange 44, i.e., "unlocks" the trigger assembly 70 to perform selective action. Such properties are illustrated and explained in detail with reference to US Application No. 10 / 460,926 (Patent Document 7), which is pending at the same time as this application and the applicant.

As best illustrated in FIGS. 5A-C, the knife channels 115a, 115b extend through the centers of the jaw members 110, 120, respectively, and when the jaw members 110, 120 are in the closed position, the blades. The 185 is capable of incising the tissue gripped between the jaw members 110, 120. More specifically, when the jaw members 110, 120 are closed, the blade 185 is only advanced through the tissue, so that the blade 185 acts through the tissue either by mistake or prematurely. It can be prevented from doing so. Simply installed, the knife channel 115 (consisting of half channels 115a, 115b) is blocked when the jaw members 110, 120 are opened and aligned for action in the distal position when the jaw members 110, 120 are closed. To.

As best illustrated in FIG. 1D, the jaw member 110 comprises a jaw member housing 116 provided with an insulating substrate or insulator 114 and a conductive surface 112. The insulator 114 is preferably sized so that it fits tightly into the conductive closure surface 112. This is by punching, by outer molding, by outer molding the punched conductive closure plate, by outer molding the metal injection molded closure plate, and / or otherwise conventional in the art. It may be achieved by a known method. It is recalled that the trigger lead 311 extending from the switch 200 is electrically connected to the closure plate 112.

The jaw member 110 having the conductive surface 112 is manufactured by such a manufacturing technique as a whole, but the conductive surface is substantially surrounded by the insulating surface 114. The insulator 114, the conductive closure surface 112, and the outer non-conductive jaw member housing 116 constrain most of the well-known and undesired effects associated with tissue closure, such as flashover, thermal diffusion, and stray current dissipation. And / or preferably set to dimensions that reduce it.

As best seen in FIG. 1D, the jaw member 110 further comprises a swivel flange 118 with protrusions 117. The protrusion 117 extends from the swivel flange 118 and has an arcuate inner surface sized to fit and engage the opening 62 of the sleeve 60 as it retracts. The swivel flange 118 is also sized to fit the swivel pin 113, allowing the jaw member 110 to rotate correlatively with the jaw member 120 when the reciprocating sleeve 60 retracts. The swivel pin 103 is also mounted on the stationary jaw member 120 inside the proximal portion of the jaw member 120.

When assembled, the conductive surface 112 and the insulator 114 preferably form a knife slot 115a oriented along the longitudinal axis defined through the interior for the reciprocating motion of the knife blade 185. As mentioned above, the knife channel 115a works with the corresponding knife channel 115b defined inside the stationary jaw member 120 to translate the knife blade 185 along the longitudinal axis along the preferred cutting plain. Effectively and accurately separate the tissue along the formed tissue closure.

The jaw member 120 comprises components similar to the jaw member 110, such as the jaw member housing 126, which is provided with an insulator 124 and a conductor closing surface 122 sized to fit tightly into the insulator 124. ing. Similarly, the conductive surface 122 and the insulator 124, when assembled, form a channel 115b oriented along the longitudinal axis defined through through for the reciprocating motion of the knife blade 185. As described above, when the jaw members 110, 120 close around the tissue 420, the knife channels 115a, 115b form a complete knife channel 115, with the knife 185 pointing distally in the longitudinal axial direction. The translational movement allows the tissue to be sheared along the tissue closure.

As described above, the jaw member 120 may include a series of locking members 150a-150c, the series of locking members 150a-150c being placed on the inward facing surface of the conductive closing surface 122. This facilitates gripping and manipulating the tissue and provides a gap G (FIG. 5A) between the opposing jaw members 110, 120 during tissue closure and incision. Can be facilitated. It is recalled that the series of locking members 150a-150c may be incorporated onto one or both of the jaw members 110, 120, depending on the particular purpose, to achieve the desired effect. In addition to the above-mentioned locking members and other locking members 150a to 150c that can be imagined, various manufacturing for attaching and / or attaching the locking members 150a to 150c to the conductive closing surfaces 112 and 122. A detailed description of the process and assembly process can be found in the co-pending US application serial number PCT / US01 / 11413 (Patent Document 10), which is common to this application and the assignee. Invite to.

The jaw member 120 is designed to be secured to the end of a rotating tube (not shown), which is part of the rotating assembly 80, so the rotation of the tube causes the end actuator assembly 100 to rotate. Give. The jaw member 120 is connected to a second potential by a rotating tube (not shown) connected to a lead 310c extended from the cable 310 on the proximal end side. For more information on mechanically and electromechanically engaging the jaw member 120 with the rotating assembly 80, see US Patent Application Serial No. 10 / 460,926, which is pending at the same time as this case and the owner in common, as described above. Has been described.

As mentioned above, the jaw members 110, 120 can be opened, closed, and rotated to handle the tissue until tissue closure is in the desired state. This allows the user to position and reposition the forceps 10 before activating and closing it. As illustrated in FIG. 1A, the end actuator assembly 100 is rotatable about the longitudinal axis A due to the rotation of the rotating assembly 80. Due to the unique feed path of the trigger lead 311 from the switch 200 through the rotating assembly 80 and finally along the shaft 12 to the jaw member 110, the user can move the end actuator assembly 100 both clockwise and counterclockwise. It can be rotated 180 degrees without causing entanglement or disproportionate distortion of the cable leads. Another cable lead 310c branched from the cable 310 is welded or clipped to the proximal end of a rotating tube (not shown) and is largely unaffected by the rotation of jaw members 110, 120. Correctly recognizable, this facilitates gripping and manipulating the tissue.

Again, as best illustrated in FIGS. 1A and 1C, the trigger assembly 70 is mounted on the top of the movable handle 40 and the knife assembly 180 (FIGS. 2, FIG. 3, FIG. 4 and FIGS. 5A-5C). In collaboration with, selectively translate the knife 185 through the tissue closure. More specifically, the trigger assembly 70 includes a finger actuator 71 and a swivel pin 73 that attaches the trigger assembly 70 to the housing 20. The finger actuator 71 is sized to abut the lock flange 44 above the handle 40 when the handle 40 is placed in the non-actuating position, i.e., when the jaw members 110, 120 are opened.

The trigger assembly 70 is designed to work with the drive bar 64 that connects to the knife assembly 180. Proximal actuation of the finger actuator 71 causes the trigger assembly 70 to rotate about the swivel pin 73, which in turn pushes the drive bar 64 distally, eventually piercing the knife 185 with tissue. The result is to make it. A spring (not shown) may be used to urge the knife assembly 180 to a retracted position so that the knife 185 and knife assembly 180 are automatically returned to their pre-start position after tissue shear. Further, when the handle 40 is activated and the flange 90 is sufficiently reciprocated inside the fixed handle 50, the lock flange 44 moves proximally, allowing the trigger assembly 70 to operate.

As best shown in FIG. 1A, the cable 310 is fed through the bottom surface of the housing 20 by a fixed handle 50. The first lead 310c extends directly from the cable 310 into the rotating assembly 80 and connects to the tube 60 (such as by a welded clip or spring clip) to conduct a second potential to the fixed jaw member 120. The second lead 310a and the third lead 310b extend from the cable 310 and connect to a hand switch or a joystick-shaped toggle switch 200. The switch 200 allows the user to selectively operate the forceps 10 in a variety of different orientations, i.e., in multiple orientations that simplify the action. When the switch 200 is pressed, the trigger lead 311 carries the first potential to the jaw member 110. More specifically, the trigger lead 311 extends from the switch 200 through the rotating assembly 80 along the top of the rotating tube (not shown) and finally connects to the movable jaw member 110. Correctly recognizable, there are many advantages to placing the switch 200 on forceps 10. For example, the switch 200 reduces the amount of electrical cables in the operating room and activates "visible lines", eliminating the possibility of activating the wrong instrument during the surgical procedure.

As described in detail above, the second potential is conducted to the jaw member 120 via a rotating tube (ie, lead 310c). The two potentials are preferably isolated from each other by an insulating sheath member or the like surrounding the trigger reed. The jaw members 110, 120 are preferably electrically insulated from each other, but as a result, bipolar electrosurgery energy can be effectively transferred through the tissue to form tissue closure.

Once the desired position of the closure site has been determined and the jaw members 110, 120 are properly installed, the handle 40 can be sufficiently squeezed to reciprocate the flange 90 to lock it inside the fixed handle 50. The handle 40 is now held in place with respect to the fixed handle, which in turn locks the jaw members 110, 120 to a tightening position around the tissue. At this point the forceps 10 are ready for the selective application of electrosurgical energy and subsequent tissue separation, that is, when the movable handle 40 reciprocates inside the fixed handle 50, it triggers as described above. The lock flange 44 moves to a position that allows the assembly 70 to operate.

It can be correctly recognized, but by combining the mechanical advantage of off-center turning motion with the auxiliary compressive force associated with the compression spring (not shown), it is approximately 3 kg / cm.²From about 16kg / cm²It ensures that a consistent, uniform, high-precision tightening pressure is easily and reliably generated around the tissue within the desired working pressure range of approximately 7 kg / cm.²From about 13kg / cm²Is more preferable. As described above, at least one jaw member, eg, jaw member 120, comprises a locking member, eg, locking member 150a, so that the two opposing jaw members 110, 120 move relative to each other. It may be restricted. It is preferable that the series of locking members be able to consistently produce a high precision clearance distance G during the closure procedure (FIG. 5A), but this void is from about 0.0254 mm (about 0.001 inch) to about 0.1524. It is in the range of mm (about 0.006 inches), but more preferably between about 0.0508 mm (about 0.002 inches) and about 0.0762 mm (about 0.003 inches). By controlling the intensity, frequency, and duration of electrosurgical energy applied to the tissue, the user can effectively close the tissue along a given tissue site.

As energy is selectively transferred to the terminal agonist assembly 100 through the tissue across the jaw members 110, 120, the tissue closure forms two tissue halves isolated from each other. At this point, if using other well-known vascular closure instruments, the user must remove the forceps 10 and replace it with a cutting instrument (not shown) to divide the tissue halves along the tissue closure. All of this must be time consuming and monotonous, and the tissue closure is due to misalignment or misplacement of the incision instrument along the ideal tissue cutting plane. It may result in inaccurate tissue division across.

The disclosure incorporates a knife assembly 180, which, when actuated via the trigger assembly 70, progressively and selectively divides the tissue in an accurate manner along the ideal tissue plane and tissue. The result is an effective and reliable division. The knife assembly 180 allows the user to quickly separate the tissue immediately after closure without the need to replace the cutting instrument through the cannula or needle port. As can be correctly recognized, precise tissue closure and tissue division are achieved using the same forceps 10.

Once the tissue has been divided into tissue halves, the jaw members 110, 120 can be opened by re-grasping the handle 40, thereby releasing the flange 90 from the fixed handle 50. Details regarding the release of the flange from the handle can be found in the co-pending US application serial number 10 / 460,926 common to this application and the applicant.

Focusing here on the operating characteristics of the present disclosure, as can be seen in most of the drawings, the forceps 10 are subjected to bipolar electrosurgical treatment of tissue (vascular closure as described above, or coagulation using other similar instruments. It is designed for monopolar treatment of (or by cauterization) and tissue. For example, FIGS. 1A to 1D and FIGS. 2 to 4 show an embodiment of forceps 10 provided with a monopolar element 154 capable of treating tissue by being selectively stretched and selectively activated. Illustrate. 5A-5C illustrate alternative embodiments disclosed herein, in which the knife 185 is extended from the distal end of the terminal actuator assembly 100 and then selectively energized to create tissue in a monopolar fashion. It shows that it can be treated. FIG. 6A illustrates another embodiment, in which the lower jaw member 120'extends distally from the upper jaw member 110' and the surgeon selectively energizes the lower jaw member 120'. The organization can be processed by the "monopolar method". FIG. 6B illustrates another embodiment, in which jaw members 110', 120' provide a tapered distal end that is selectively powered up at a single potential to provide tissue. Treat with "monopolar method".

1A to 1D and FIGS. 2 to 4 illustrate an embodiment of the terminal actuator assembly 100 that houses a monopolar element 154 that selectively extends inside one jaw member, such as the jaw member 120. Illustrate. More specifically, the monopolar element 154 is designed to move independently of the knife assembly 180, either by further proximal movement of the trigger assembly (FIGS. 1A, 2, 3) or. It may be extended by a separate actuator 450 (FIG. 4).

The monopolar element 154 is preferably connected to a reciprocating rod 65 that extends through an elongated notch 13 on the outer circumference of the shaft 12, as best seen in FIG. 1B. The drive rod 60 that operates the knife 185 penetrates the inner peripheral portion of the shaft 12. To extend the monopolar element 154, the jaw members 110, 120 are first closed and then the trigger assembly 70 (see FIG. 2) is used to advance the knife 185 distally. Best illustrated in Figure 1C, the trigger 71 is first advanced to translate the knife 185 distally to cut the tissue, ie this is the "cutting" stage (shown by a virtual line). There is). Then, as illustrated in FIG. 3, the trigger 71 can be further actuated in the proximal direction to extend the monopolar element, i.e., this is the "extension" stage (shown by virtual lines). ).

It is recalled that the trigger assembly can be designed so that the monopolar element 154 can be extended when the jaw members 110, 120 are in the open position. For example, the trigger 71 can be moved distally (or upwardly) from its original stationary neutral position, i.e., the pre-start position, to advance the monopolar element 154. As an alternative example, the monopolar element 154 can be advanced independently of the orientation of the jaw members 110, 120. For example, the design of the trigger assembly 70 can also move the trigger laterally (ie, in a direction orthogonal to the longitudinal axis A) to advance the monopolar element 154, or the trigger assembly 70 can be When the trigger 71 is moved to the most recent position (ie, beyond the "cut" position as described above) and / or the trigger 71 advances distally from the neutral or pre-actuated orientation. When made, the design can be made so that the monopolar element 154 can be extended. A return spring (not shown) may be provided to return the monopolar element to its non-extended position upon release of the trigger 71.

When the monopolar element 154 is extended, the generator 300 changes from the bipolar actuation mode (ie, the mode that inactivates the energy supply to the jaw members 110, 120) to the monopolar actuation mode (ie, the mode that activates the monopolar element 154). It is preferable that the forceps 10 are automatically switched to. As can be correctly recognized, the forceps 10 may also be configured (or as a substitute for the one described above) to be suitable for manual switching between bipolar actuation mode and monopolar actuation mode. As described above, when the forceps 10 are configured to be suitable for bipolar movement, the switch 200 is activated to transfer energy from the jaw member 110 through the tissue to the jaw member 120 to process the tissue. .. In monopolar mode, the switch 200 (or a separate switch, such as a footswitch) is activated to transfer energy to the monopolar element 154, which is placed through the tissue and further in contact with the patient or adjacent to the patient. It transmits to a return electrode 550, such as a return pad. The monopolar actuation mode allows the monopolar element 154 to rapidly treat an avascular tissue structure and / or quickly incise a narrow tissue plane.

It is also recalled that the trigger assembly 70 may be of electrical configuration to transfer electrical energy to the monopolar element 154 when stretched, as can be correctly recognized. For example, the configuration of the trigger assembly 70 may be such that the trigger 71 (FIG. 1C) is moved to the most proximal position to extend and activate the monopolar element 154. An automatic safety circuit 460 (or mechanical safety lock (not shown)) that prevents the switch 200 from inputting energy to the jaw members 110 and 120 when the monopolar element 154 is extended may be adopted.

FIG. 4 illustrates another embodiment of the present disclosure, in which the monopolar element 154 can be selectively extended using a second actuator 450. As mentioned above, the knife 185 is advanced by activating the trigger 71 approximately proximally. The monopolar element 154 can be selectively advanced independently of the knife 185 and can be extended regardless of whether the jaw members 110, 120 are arranged in an open or closed shape. Recall that the electrical configuration of the actuator 450 may be such that the monopolar element 154 is activated automatically after extension or manually by the actuation switch 200 or another switch (not shown). Will be done. As described above, the safety circuit 460 can be adopted to inactivate the jaw members 110 and 120 when the monopolar element 154 is extended, and then the switch 200 can be operated to input energy to the monopolar element 154. .. If a separate actuation switch is used for the monopolar element, the safety circuit will deactivate the switch 200.

5A-5C illustrate alternative embodiments disclosed herein, in which the knife 185 is extended distally beyond jaw members 110, 120 and then separately energized to tissue. Can be treated. In this example, when the knife 185 extends beyond the jaw members 110, 120, the knife 185 becomes a monopolar element.

For example, according to the operating sequence illustrated in FIGS. 5A-5C, the knife 185 is first placed in the neutral position during the period of close grip and the period of the tissue closure process. When the jaw members 110, 120 close around the tissue, an elongated knife channel 115 (defined by the upper and lower knife channels 115a, 115b, respectively) is formed and penetrates the tissue between the jaw members 110, 120. Allows the knife 185 to be selectively translated. When the trigger 71 is activated, the knife bar 64 urges the knife 185 distally to force it through the tissue to the distal end of the knife channel 115. Stoppers 119 are provided to temporarily limit the movement of the knife 185 and provide realistically recognizable feedback to the user about the end of the cutting process. When the trigger 71 is further activated, the knife 185 overcomes the deterrent involved in the stopper 119 and is further extended out of the knife channel 115 by being urged by the knife bar, forcing the jaw members 110, 120. Beyond the distal end.

Once the knife 185 extends beyond the jaw members 110, 120, the safety device or switch deactivates the energy circuit for the jaw members 110, 120, activates the energy circuit for the knife 185, and upon activation of the switch 200, the knife. Energize 185 and leave jaw members 110 and 120 in neutral. For example, the stopper 119 can act as a safety switch, and when urged by the knife 185 out of the knife channel 115 or away from the knife channel 115, the stopper 119 is relative to the jaw members 110, 120. Stop the circuit and activate the circuit for the monopolar knife 185 and the return electrode 550. A separate reed 69 may be used to electrically conduct with the generator 300. As you can see, the knife 185 can be used in a monopolar fashion to treat tissue. When the trigger 71 is released, the knife 185 is automatically retracted into the knife channel 115 and returned to its pre-actuated position, as shown in FIG. 5A. At the same time, the stopper 119 reverts to its initial position and temporarily blocks the knife channel 115 for subsequent operation.

FIG. 6A illustrates another embodiment of forceps 10'according to the present invention, the lower jaw member 120'is designed to extend beyond the distal end of the jaw member 110'. To switch the movement from bipolar mode to monopolar mode, the surgeon activates a switch or control that energizes the jaw member 120'to the first potential and activates the return pad 550 to the second potential. Energy is transferred from the jaw member 120'through the tissue to the return pad 550 to process the tissue. The distal end of jaw member 120'may act as a monopolar element to process tissue and thus be shaped to enhance electrosurgical effectiveness.

FIG. 6B exemplifies another schematic embodiment of the forceps 10 according to the present disclosure, where the shapes of the distal ends of the jaw members 110, 120 are tissue when arranged in monopolar mode. More specifically, when the distal tips 112a ", 122a" are elongated or tapered and the forceps 10 "are placed in monopolar mode. It is preferable to increase the energy supply. When arranged in bipolar mode, the tapered ends 112a ", 122a" do not treat the tissue sandwiched between the conductive plates 112 ", 122".

It is preferable to provide a control switch 500 that adjusts the transition between the bipolar mode and the monopolar mode. The control switch 500 is connected to the generator 300 via cables 360 and 370. A series of leads 510, 520, 530 are connected to the jaw members 110, 120, and the return electrode 550, respectively. As best seen in the table depicted in Figure 6C, the leads 510, 520, 530 are each endowed with an electric potential or each remain neutral, which is the specific "forceps 10". Determined by "mode". For example, in bipolar mode, the reed 510 (then the jaw member 110 ) is energized at the first potential and the reed 520 (then the jaw member 120) is energized at the second potential. Will be done. As a result, electrosurgical energy is transferred from the jaw member 110 "through the tissue to the jaw member 120". The return electrode 550 remains off or neutral.

In monopolar mode, both jaw members 110 "and 120" are energized at the same potential, and the return pad 550 is powered on at the second potential, forcing current from the jaw members 110 "and 120". It will flow through the tissue to the return electrode 550. This allows the jaw members 110 ", 120" to be treated in a monopolar manner, which is suitable for treating avascular tissue structures and / or narrow tissue, as described above. It is advantageous to allow a quick incision of the flat surface. As can be seen, the leads 510, 520, 530 can be disabled when the forceps 10 "is turned off, i.e. idle.

The general working components and the inter-cooperative relationships between these components have been largely described in relation to the vascular closure forceps 10, but with other instruments, the surgeon can use either the bipolar or monopolar tissue. Can also be used that is configured to allow selective treatment. Specifically, there are bipolar type gripping / coagulation equipment, bipolar type cauterization equipment, bipolar type incision shears and the like.

The disclosure also relates to a method of treating tissue with electrosurgical energy from an electrosurgical generator 300, which method is an endoscopic forceps 10 comprising a housing 20 to which a shaft 12 is attached. Includes the stage of setting up. The shaft 12 includes a first jaw member 110t and a second jaw member 120, which are attached to the distal ends of the shaft 12. The forceps are further provided with an actuator assembly or a handle assembly 30, in which the jaw members 110, 120 work together from a first position in which the jaw members 110, 120 are spaced apart from each other. This is for moving both jaw members to the second position where the tissue sandwiched between them is gripped. The forceps also include a monopolar element 154, which is housed at least inside the first jaw member 110 and is located distal to the first jaw member 110 from the first position inside the first jaw member 110. It can be selectively moved to two positions. A return electrode 550 is provided and is placed in contact with the patient's body tissue.

In this method, the monopolar element 154 is connected to each of the jaw members 110 and 120, and the return electrode 550 is connected to the electrosurgical generator 300, and the tissue is sandwiched and gripped between the jaw members. And, at the stage of selectively activating the jaw members 110 and 120 and treating the tissue between the jaw members 110 and 120 by the bipolar method, and returning to the monopolar element 154 regardless of the jaw members 110 and 120. It further includes the step of activating the electrode 550 and treating the tissue in a monopolar manner.

After the step of selectively activating the jaw members 110, 120 to process the tissue, the method further comprises the step of extending the monopolar element 154 from the distal end of the jaw members 110, 120. preferable. It is advantageous that the step of selectively activating the monopolar element 154 includes the step of deactivating the jaw members 110, 120.

After the step of selectively activating the jaw members 110, 120, the method may include a step of releasing tissue from the jaw members 110, 120.

Those skilled in the art will appreciate that some modifications can be made to the present disclosure without departing from the scope of the present invention by referring to the above-mentioned contents and a large number of drawings. For example, it may be preferable to add a function other than the above to the forceps 10 for arranging the end actuator assembly 100 in the axial direction with respect to the elongated shaft 12, such as an assembly for articulation.

It is recalled that the design of the forceps 10 may be such that the entire forceps or part of the forceps is disposable, depending on a particular purpose or in order to achieve a particular result. For example, the end actuator assembly 100 may be selectively and freely matable with the distal end 16 of the shaft 12 and / or the proximal end 14 of the shaft 12 is the housing 20 and the handle assembly 30. It may be possible to selectively and freely fit the mating. In either of the above two examples, the forceps 10 are "partially disposable" or "replaceable", i.e. new, i.e. different end agonist assembly 100 (or end agonist assembly 100 and shaft 12). ) Is expected to be selectively replaced with the old end agonist assembly 100 as needed. Correctly recognizable, the electrical connections disclosed in this case must be modified in order to turn the above instrument into this re-installable forceps.

Further, it is recalled that the switch 200 may be deactivated during the incision process. By deactivating the switch 200 when the trigger 71 is activated, the forceps are prevented from being unintentionally activated during the incision process. It is recalled that the switch 200 may be located elsewhere on the forceps 10, for example on a fixed handle 40, a rotating assembly 80, a housing 20, and so on.

Although some embodiments of the present disclosure have been illustrated in the drawings, it is intended that the content of the disclosure should not be limited to them, but should be as broad as the technology allows. The contents of the specification should be read with the same interpretation. Therefore, the above description should not be construed as restrictive, but merely as a presentation of specific examples of preferred embodiments. Those skilled in the art will be able to envision another amendment that falls within the scope and essence of each claim of the appended claims.

<figref num="1A">FIG. 5 is a side view of an endoscopic forceps illustrating a housing, shaft, terminal actuator assembly, and trigger assembly in position 1 according to the present disclosure.</figref><figref num="1B">It is an enlarged sectional view taken along the line 1B-1B of FIG. 1A.</figref><figref num="1C">It is an enlarged side view of the trigger assembly of FIG. 1A.</figref><figref num="1D">FIG. 1 is an enlarged side view illustrating an embodiment of the terminal actuator assembly of FIG. 1A, showing the monopolar element extending relative to the distal end of the terminal actuator assembly.</figref><figref num="2">It is a side view showing that the trigger assembly is in the second position and the knife is advanced inside the end actuator assembly.</figref><figref num="3">FIG. 5 is a side view illustrating that the trigger assembly is in the third position and the monopolar element extends from the distal end of the terminal actuator assembly.</figref><figref num="4">FIG. 5 is a side view illustrating an alternative embodiment of the present invention in which a second actuator correlatesly advances a monopolar element to the distal end of a terminal actuator assembly.</figref><figref num="5A">An embodiment of a terminal actuator assembly is illustrated to show that the first jaw member is moved correlatively with respect to the second jaw member before advancing the knife through the terminal actuator assembly. It is an enlarged side view.</figref><figref num="5B">It is an enlarged side view which illustrates the terminal actuator assembly and shows that the knife is moved relative to each other through the terminal agonist assembly to divide the tissue.</figref><figref num="5C">It is an enlarged side view which illustrates the terminal actuator assembly and shows that the knife extends relative to the outside from the distal end of the terminal agonist assembly.</figref><figref num="6A">FIG. 6 is an enlarged side view illustrating another embodiment of the end actuator assembly, showing the first jaw member extending beyond the second jaw member.</figref><figref num="6B">It is a schematic diagram illustrating another embodiment of a terminal actuator assembly and showing that a series of electrical connections to a control switch and a generator allows both bipolar and monopolar activities.</figref><figref num="6C">FIG. 6B is a table illustrating various modes of forceps operation using the terminal actuator configuration.</figref>

Code description

10 Endoscopic forceps 12 Shaft 20 Housing 30 Handle assembly 40 Movable handle 44 Lock flange 50 Fixed handle 60 Reciprocating sleeve 70 Trigger assembly 80 Rotating assembly 90 Flange 100 Terminal actuator assembly 110 1st jaw member 117 Detent protrusion 120th 2 Flange member 300 Electrosurgical generator 310 Cable 550 Detent