Combination ultrasonic and electrosurgical instrument having curved ultrasonic blade

This application claims the benefit of U.S. Provisional Patent Application No. 62/509,351, entitled "Ultrasonic Instrument With Electrosurgical Features," filed May 22, 2017, the disclosure of which is incorporated herein by reference.

Ultrasonic surgical instruments utilize ultrasonic energy for both precise cutting of tissue and controlled coagulation. The ultrasonic energy cuts and coagulates by vibrating the blade in contact with the tissue. By vibrating at a frequency of about 50 kilohertz (kHz), for example, ultrasonic blades denature proteins in tissue to form sticky clots. The pressure exerted by the blade surface on the tissue causes the vessel to collapse, allowing the clot to form a hemostatic seal. Accuracy of cutting and coagulation may be controlled, for example, by the surgeon's skill and adjustment of power level, cutting edge, tissue traction, and blade pressure.

Examples of ultrasonic surgical devices include HARMONIC ACE® Ultrasonic Shears, HARMONIC WAVE® Ultrasonic Shears, HARMONIC FOCUS® Ultrasonic Shears, and HARMONIC SYNERGY® Ultrasonic Blades. Both are manufactured by Ethicon Endo-Surgery, Inc. (Cincinnati, Ohio). Further examples of such devices and related concepts are disclosed in U.S. Pat. No. 5,322,055, "Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp," published Feb. 23, 1999, the disclosure of which is incorporated herein by reference. Mechanism", U.S. Patent No. 5,873,873, issued Nov. 9, 1999, entitled "Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Arm Pivot Mount," the disclosure of which is incorporated herein by reference. No. 5,980,510, U.S. Pat. No. 6,283,981, entitled "Method of Balancing Asymmetric Ultrasonic Surgical Blades," issued Sep. 4, 2001, the disclosure of which is incorporated herein by reference, the disclosure of which is incorporated herein by reference. No. 6,309,400, entitled "Curved Ultrasonic Blade having a Trapezoidal Cross Section," issued Oct. 30, 2001, the disclosure of which is incorporated herein by reference, Dec. 4, 2001. "Blades with Functional Balance Asymmetries for use with Ultrasonic U.S. Patent No. 6,325,811 entitled "Surgical Instruments," U.S. Patent entitled "Ultrasonic Surgical Blade with Improved Cutting and Coagulation Features," issued Jul. 23, 2002, the disclosure of which is incorporated herein by reference. No. 6,423,082, U.S. Pat. No. 6,773,444, entitled "Blades with Functional Balance Asymmetries for Use with Ultrasonic Surgical Instruments," issued Aug. 10, 2004, the disclosure of which is incorporated herein by reference, the disclosure of which is incorporated herein by reference. U.S. Patent No. 6,783,524, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument," issued Aug. 31, 2004, the disclosure of which is incorporated herein by reference; Published November 15, 2011, Ultrasonic U.S. Patent No. 8,057,498 entitled "Surgical Instrument Blades", U.S. Patent No. 8,057,498 entitled "Rotating Transducer Mount for Ultrasonic Surgical Instruments," issued Jun. 11, 2013, the disclosure of which is incorporated herein by reference. 8,461,744, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,591,536, entitled "Ultrasonic Surgical Instrument Blades," issued Nov. 26, 2013, the disclosure of which is incorporated herein by reference; , U.S. Patent No. 8,623,027, entitled "Ergonomic Surgical Instruments," issued Jan. 7, 2014; for Surgical U.S. Patent No. 9,095,367 entitled "Instruments" and U.S. Patent Application Publication No. 2016/0022305 entitled "Ultrasonic Blade Overmold," published Jan. 28, 2016, the disclosures of which are incorporated herein by reference. disclosed in No.

Electrosurgical instruments utilize electrical energy to seal tissue and generally include a distally-mounted end effector that can be configured for bipolar or monopolar operation. During bipolar operation, current is applied through the tissue by the active and return electrodes of the end effector. During unipolar operation, current is applied through the tissue by an active electrode of the end effector and a return electrode (eg, ground pad) separately located on the patient's body. Heat generated by current flowing through tissue may form hemostatic seals within and/or between tissues, and thus may be particularly useful for sealing blood vessels, for example. An end effector of an electrosurgical device may also include a cutting member movable relative to tissue and an electrode for cutting tissue.

Electrical energy applied by the electrosurgical device can be transferred to the instrument by a generator associated with the instrument. Electrical energy may be in the form of radio frequency (RF) energy, which is generally a fraction of electrical energy within the frequency range of approximately 300 kilohertz (kHz) to 1 megahertz (MHz). form. In use, electrosurgical devices are capable of transmitting low frequency RF energy through tissue, which causes ionic agitation or friction, actually resistive heating, resulting in an increase in tissue temperature. A sharp boundary is created between diseased and surrounding tissue, allowing the surgeon to operate with a high level of precision and control without sacrificing adjacent non-target tissue. The low operating temperature of RF energy can be useful in removing, shrinking, or sculpting soft tissue while simultaneously sealing blood vessels. RF energy works particularly well on connective tissue, which is composed primarily of collagen and contracts when exposed to heat.

One example of an RF electrosurgical device is the ENSEAL® Tissue Sealing Device by Ethicon Endo-Surgery, Inc. (Cincinnati, Ohio). Further examples of electrosurgical devices and related concepts are disclosed in the U.S. patent entitled "Electrosurgical Systems and Techniques for Sealing Tissue," issued Dec. 31, 2002, the disclosure of which is incorporated herein by reference. No. 6,500,176; U.S. Patent No. 7,112,201, entitled "Electrosurgical Instrument and Method of Use," issued September 26, 2006, the disclosure of which is incorporated herein by reference; "Electrosurgical Working End for Controlled Energy U.S. Patent No. 7,125,409, entitled "Electrosurgical Probe and Method of Use," issued Jan. 30, 2007, the disclosure of which is incorporated herein by reference; U.S. Patent No. 7,186,253, entitled "Electrosurgical Jaw Structure for Controlled Energy Delivery," issued Mar. 6, 2007, the disclosure of which is incorporated herein by reference; , U.S. Patent No. 7,189,233 entitled "Electrosurgical Instrument", issued March 13, 2007; "Surgical Sealing Surfaces and Methods of US Patent No. 7,220,951, entitled "Use"; "Polymer Compositions Exhibiting," issued Dec. 18, 2007, the disclosure of which is incorporated herein by reference. U.S. Patent No. 7,309,849, entitled "a PTC Property and Methods of Fabrication"; entitled "Electrosurgical Instrument and Method of Use," issued Dec. 25, 2007, the disclosure of which is incorporated herein by reference. U.S. Patent No. 7,311,709; U.S. Patent No. 7,354,440, entitled "Electrosurgical Instrument and Method of Use," issued Apr. 8, 2008, the disclosure of which is incorporated herein by reference; It is disclosed in US Pat. No. 7,381,209, entitled "Electrosurgical Instrument," issued Jun. 3, 2008, which is incorporated herein.

Additional examples of electrosurgical devices and related concepts can be found in "Surgical Instrument Comprising First and Second Drive Systems Actuatable by a Common Trigger Mechanism," published Jan. 27, 2015, the disclosure of which is incorporated herein by reference. U.S. Patent No. 8,939,974, entitled "Motor Driven Electrosurgical Device with Mechanical and Electrical Feedback," issued Oct. 20, 2015, the disclosure of which is incorporated herein by reference. US Patent Application Publication No. 2012/0078243, entitled "Control Features for Articulating Surgical Device," published Mar. 29, 2012, the disclosure of which is incorporated herein by reference; Articulation Joint Features for U.S. Patent No. 9,402,682 entitled "Articulating Surgical Device"; U.S. Patent entitled "Surgical Instrument with Multi-Phase Trigger Bias" issued Jul. 28, 2015, the disclosure of which is incorporated herein by reference. No. 9,089,327; U.S. Patent No. 9,545,253, entitled "Surgical Instrument with Contained Dual Helix Actuator Assembly," issued Jan. 17, 2017, the disclosures of which are incorporated herein by reference; No. 9,572,622 entitled "Bipolar Electrosurgical Features for Targeted Hemostasis," issued Feb. 21, 2017, which is incorporated herein.

Some instruments may provide ultrasound and RF energy treatment capabilities through a single surgical device. Examples of such devices and related methods and concepts are disclosed in U.S. Pat. U.S. Patent Application Publication No. 2015/0141981 entitled "Ultrasonic Surgical Instrument with Electrosurgical Feature," published May 21, 2015, which is incorporated herein by reference; and the disclosure of which is incorporated herein by reference. US Patent Application Publication No. 2017/0000541, entitled "Surgical Instrument with User Adaptable Techniques," published Jan. 5, 2017.

Various types of ultrasonic and electrosurgical instruments, including combined ultrasonic-electrosurgical instruments, have been made and used, but have previously been described by the inventors as set forth in the appended claims. It is believed that no one has ever made or used the invention of

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above, and the detailed description of the embodiments given below, It serves to explain the principles of the invention.

<figref num="1">1 illustrates a perspective view of an exemplary surgical system having a generator and a surgical instrument operable to treat tissue using ultrasonic energy and bipolar RF energy; FIG.</figref><figref num="2">2 illustrates a top perspective view of the end effector of the surgical instrument of FIG. 1 having a clamp arm providing a first electrode and a clamp arm providing an ultrasonic blade providing a second electrode; FIG.</figref><figref num="3">Figure 3 illustrates a bottom perspective view of the end effector of Figure 2;</figref><figref num="4">2 illustrates a partially exploded perspective view of the surgical instrument of FIG. 1; FIG.</figref><figref num="5">2 illustrates an enlarged exploded perspective view of the distal portion and end effector of the shaft assembly of the surgical instrument of FIG. 1; FIG.</figref><figref num="6">2 illustrates a side view of the distal portion of the inner tube of the shaft assembly of the surgical instrument of FIG. 1; FIG.</figref><figref num="7">2 illustrates a perspective view of a distal portion of the ultrasonic blade and shaft assembly of the surgical instrument of FIG. 1 with the clamp arm hidden from view; FIG.</figref><figref num="8">Figure 8 illustrates a top view of the distal portion of the ultrasonic blade and shaft assembly of Figure 7;</figref><figref num="9">Figure 8 illustrates a cross-sectional view of the ultrasonic blade of Figure 7 along line 9-9 of Figure 8;</figref><figref num="10">2 illustrates a schematic cross-sectional end view of the end effector of the surgical instrument of FIG. 1, showing a clamp pad and a clamp arm having first and second electrode portions on either side of the clamp pad, each electrode portion; and the side gap distance between each electrode portion and the respective outer side of the ultrasonic blade.</figref><figref num="11">11 illustrates a bottom view of an exemplary variation of the end effector of FIG. 10, the variation maintaining a uniform lateral width and uniform side gap distance along the tissue treatment portion of the ultrasonic blade, respectively. and a clamp arm having a second electrode portion.</figref><figref num="12">11 illustrates a bottom view of another exemplary variation of the end effector of FIG. 10, the variation having first and second electrode portions each maintaining uniform lateral widths and non-uniform side gap distances; FIG. including a clamp arm with</figref><figref num="13">11 illustrates a bottom view of another exemplary variation of the end effector of FIG. 10, the variation having a distally decreasing non-uniform lateral width and a distally increasing non-uniform side gap distance; and a clamp arm having first and second electrode portions.</figref><figref num="14">11 illustrates a bottom view of another exemplary variation of the end effector of FIG. 10, the variation including a clamp arm having first and second electrode portions having distal ends separated from each other; FIG.</figref>

The drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the invention may be embodied in various other ways, including those not necessarily depicted in the drawings. . The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several aspects of the present invention and, together with the description, serve to explain the principles of the invention. However, it is understood that the invention is not limited to the precise arrangements shown.

The following description of specific embodiments of the invention should not be used to limit the scope of the invention. Other embodiments, features, aspects, embodiments and advantages of the present invention will become apparent to those skilled in the art from the following description, which is illustrative of one of the best modes contemplated for carrying out the invention. Become. As will be realized, the invention is capable of other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and description are to be regarded as illustrative rather than restrictive in nature.

For clarity of this disclosure, the terms "proximal" and "distal" are used herein with respect to a surgeon or other operator gripping a surgical instrument having a distal surgical end effector. Defined. The term "proximal" refers to the location of the element closer to the surgeon and the term "distal" refers to the location of the element closer to the surgical end effector of the surgical instrument and further from the surgeon. Point. Also, to the extent spatial terms such as "top", "bottom", "vertical", "horizontal" are used herein with reference to the drawings, such terms are used for exemplary descriptive purposes only. It will be understood that neither limitation nor absolute is intended. In that regard, it is understood that surgical instruments such as those disclosed herein may be used in a variety of orientations and positions, not limited to those shown and described herein.

I. Exemplary Surgical System FIG. 1 illustrates an exemplary surgical system (10) including a generator (12) and a surgical instrument (14). Surgical instrument (14) is operatively connected to generator (12) via power cable (16). Generator 12 powers surgical instrument 14 to provide ultrasonic energy for cutting tissue and electrosurgical power for sealing tissue, as described in more detail below. It is operable to deliver bipolar RF energy (ie, therapeutic levels of RF energy). In an exemplary configuration, generator (12) is configured to power surgical instrument (14) to simultaneously deliver ultrasonic energy and bipolar electrosurgical RF energy.

A. Overview of an Exemplary Surgical Instrument with Ultrasound and Electrosurgical Features The surgical instrument (14) of the present example includes a handle assembly (18), a shaft assembly extending distally from the handle assembly (18). (20), and an end effector (22) disposed at the distal end of the shaft assembly (20). Handle assembly (18) includes a body (24) including a pistol grip (26) and energy control buttons (28, 30) configured to be operated by a surgeon. Trigger (32) is coupled to the lower portion of body (24) and extends toward and away from pistol grip (26) to selectively actuate end effector (22), as described in more detail below. is pivotable away from the In other suitable variations of surgical instrument (14), handle assembly (18) may include, for example, a scissor grip configuration. As will be described in more detail below, an ultrasonic transducer (34) is internally housed within and supported by body (24). In other configurations, the ultrasonic transducer (34) may be provided external to the body (24).

As shown in FIGS. 2 and 3, the end effector (22) extends toward and from an ultrasonic blade (36) for clamping tissue therebetween. and clamp arms (38) configured to selectively pivot apart. The ultrasonic blade (36) drives (i.e., vibrates) the ultrasonic blade (36) at ultrasonic frequencies to cut and/or seal tissue positioned in contact with the ultrasonic blade (36). ) is acoustically coupled with an ultrasonic transducer (34) configured as follows. Clamp arm (38) is configured such that clamp arm (38) pivots toward ultrasonic blade (36) to the closed position in response to pivoting of trigger (32) toward pistol grip (26). is operatively connected with the trigger (32) so as to be configured to: Additionally, clamp arm (38) moves away from ultrasonic blade (36) to an open position (see, eg, FIGS. 1-3) in response to pivoting of trigger (32) away from pistol grip (26). is configured to pivot to the Various suitable ways in which clamp arm (38) may be coupled with trigger (32) will be apparent to those skilled in the art in view of the teachings provided herein. In some variations, one or more resilient members may be incorporated to bias clamp arm (38) and/or trigger (32) toward the open position.

A clamp pad (40) is secured to and extends distally along the clamping side of clamp arm (38) that faces ultrasonic blade (36). Clamp pads (40) are configured to engage and clamp tissue against corresponding tissue treatment portions of ultrasonic blade (36) when clamp arm (38) is actuated to its closed position. there is At least the clamp side of clamp arm (38) provides a first electrode (42), referred to herein as clamp arm electrode (42). Additionally, at least the clamp side of the ultrasonic blade (36) provides a second electrode (44), referred to herein as the blade electrode (44). As described in more detail below, electrodes (42, 44) direct electrosurgical bipolar RF energy provided by generator (12) to tissue electrically coupled to electrodes (42, 44). configured to apply The clamp arm electrode (42) may function as the active electrode, while the blade electrode (44) may function as the return electrode and vice versa. The surgical instrument (14) vibrates the ultrasonic blade (36) at the ultrasonic frequency, prior to vibrating the ultrasonic blade (36) at the ultrasonic frequency, and/or vibrates the ultrasonic blade (36) at the ultrasonic frequency. After vibrating (36), it may be configured to apply electrosurgical bipolar RF energy through electrodes (42, 44).

As shown in FIGS. 1-5, shaft assembly (20) extends along a longitudinal axis and includes an outer tube (46) and an inner tube (48) received within outer tube (46). and an ultrasonic waveguide (50) supported within the inner tube (48). As best seen in Figures 2-5, the clamp arm (38) is connected to the distal ends of the inner and outer tubes (46, 48). Specifically, clamp arm (38) includes a pair of proximally extending clevis arms (52) having, between them, a through hole formed in clevis arm (52) and an inner clevis arm (52). A pivot pin (56) received within the distal end (54) of tube (48) receives and is pivotally connected to the distal end (54) of inner tube (48). First and second clevis fingers (58) depend downwardly from clevis arm (52) and pivotally connect to distal end (60) of outer tube (46). Specifically, each clevis finger (58) is a protrusion (58) rotatably received within a corresponding opening (64) formed in the side wall of the distal end (60) of outer tube (46). 62).

In the present example, inner tube (48) is longitudinally fixed relative to handle assembly (18) and outer tube (46) extends along the longitudinal axis of shaft assembly (20). and configured to translate relative to the handle assembly (18). Upon distal translation of outer tube (46), clamp arm (38) pivots about pivot pin (56) toward its open position. As outer tube (46) translates proximally, clamp arm (38) pivots in the opposite direction toward its closed position. The proximal end of outer tube (46) is operatively connected to trigger (32), e.g., via a linkage assembly, such that actuation of trigger (32) causes outer tube (46) to move relative to inner tube (48). 46), thereby opening and closing the clamp arm (38). In other preferred configurations not shown here, the outer tube (46) may be longitudinally fixed and the inner tube (48) moves the clamp arm (38) between its open and closed positions. It may be configured to translate to move between.

Shaft assembly (20) and end effector (22) are configured to rotate together about the longitudinal axis relative to handle assembly (18). Retaining pin (66), shown in FIG. 4, extends laterally through proximal portion of outer tube (46), inner tube (48), and waveguide (50), thereby The components are rotatably connected with respect to each other. In the present example, a rotation knob (68) is provided at the proximal end portion of shaft assembly (20) to facilitate rotation of shaft assembly (20) and end effector (22) relative to handle assembly (18). . Rotation knob (68) is rotatably secured to shaft assembly (20) with retaining pin (66) extending through the proximal collar of rotation knob (68). It will be appreciated that in other suitable configurations, rotation knob 68 may be omitted or replaced with an alternative rotation actuation structure.

The ultrasonic waveguide (50) is connected to an ultrasonic transducer (34) at its proximal end and an ultrasonic blade (36) at its distal end, for example by a threaded connection, as shown in FIG. is acoustically coupled with Ultrasonic blade (36) is shown integrally formed with waveguide (50) such that blade (36) extends distally directly from the distal end of waveguide (50). ing. Thus, waveguide (50) acoustically couples ultrasonic transducer (34) with ultrasonic blade (36) and transmits ultrasonic mechanical vibrations from transducer (34) to blade (36). function as Thus, ultrasonic transducer (34), waveguide (50), and ultrasonic blade (36) together define acoustic assembly (100). In use, the ultrasonic blade (36) is positioned in direct contact with tissue to impart ultrasonic vibrational energy to the tissue, with or without the auxiliary clamping force provided by the clamp arm (38); Tissue may thereby be cut and/or sealed. For example, blade (36) may dissect tissue clamped between clamp arm (38) and first treatment side (204) of blade (36), or blade (36) may: For example, during a "back-cutting" motion, tissue positioned in contact with a second treatment side (206) disposed opposite blade (36) may be dissected. In some variations, waveguide (50) may amplify the ultrasonic vibrations delivered to blade (36). Further, waveguide (50) may include various features operable to control the gain of oscillation and/or features suitable for tuning waveguide (50) to a selected resonant frequency. obtain. Further exemplary features of ultrasonic blade 36 and waveguide 50 are described in greater detail below.

Waveguide (50) is held within inner tube (48) by a plurality of nodal support elements (70) positioned along the length of waveguide (50), as shown in FIGS. Supported. Specifically, node support elements (70) are arranged along waveguide (50) at locations corresponding to acoustic nodes defined by resonant ultrasonic vibrations transmitted through waveguide (50). Positioned longitudinally. The node support element (70) provides structural support for the waveguide (50) and acoustic isolation between the waveguide (50) and the inner and outer tubes (46, 48) of the shaft assembly (20). can provide In an exemplary variation, node support element (70) may include an O-ring. Waveguide (50) is supported at its distal-most acoustic node by a node support element in the form of overmolded member (72), shown in FIG. The waveguide (50) has a retaining pin (66) passing through a transverse through-hole (74) formed at an acoustic node located proximally of the waveguide (50), e.g., the most proximal acoustic node. ) is longitudinally and rotatably secured within the shaft assembly (20).

In the present example, distal tip (76) of ultrasonic blade (36) is located at a location corresponding to an antinode associated with resonant ultrasonic vibrations transmitted through waveguide (50). Such a configuration allows the acoustic assembly (100) of the instrument (14) to reach a preferred resonant frequency f when the ultrasonic blade (36) is not loaded by tissue._oallow it to be adjusted to When the ultrasonic transducer (34) is energized by the generator (12) to transmit mechanical vibrations through the waveguide (50) to the blade (36), the distal tip (76) of the blade (36) For example, given vibration frequency f of about 50kHz_oand is oscillated longitudinally within a peak-to-peak range of about 20-120 microns, eg, optionally about 20-50 microns. When the ultrasonic blade (36) is positioned in contact with tissue, the ultrasonic vibrations of the blade (36) simultaneously cut the tissue and denature proteins within adjacent tissue cells, thereby minimizing can provide a solidifying effect with thermal diffusion of

As shown in FIG. 6, the distal end (54) of inner tube (48) may be radially outwardly offset relative to the remaining proximal portion of inner tube (48). This configuration is for the distal end (54) where the pivot pin hole (78) that receives the clamp arm pivot pin (56) is formed flush with the rest of the proximal portion of the inner tube (48). allows it to be spaced further away from the longitudinal axis of shaft assembly (20) than. Advantageously, this allows the ultrasonic blade (36) to respond to the normal force exerted on the blade (36) by tissue, for example during backcutting, by clamping arm (38) and pivot pin (38). 56) provides increased clearance between the proximal portion of the clamp arm electrode (42) and the blade electrode (44), thereby allowing the electrodes (42, 44) and their Reduce the risk of unwanted "short circuits" between the corresponding active and return electrical paths. In other words, when ultrasonic blade (36) is used in a back-cutting operation, ultrasonic blade (36) is slightly deflected away from the longitudinal axis of shaft assembly (20) and toward pin (56). may tend to Alternatively, by having the pivot pin holes (78) further spaced from the longitudinal axis than the pivot pin holes (78) without the radial offset provided by the distal end (54) of the present example, Distal end (54) provides additional lateral clearance between pivot pin (56) and ultrasonic blade (36), thereby allowing ultrasonic blade (36) to laterally move during back-cutting operations. Reduces or eliminates the risk of contact between the ultrasonic blade (36) and the pivot pin (56) when deflected. If not prevented from contact between the ultrasonic blade (36) and the pivot pin (56) when the end effector (22) is activated to apply RF electrosurgical energy, the resulting electrical In addition to preventing short-circuiting, the additional clearance allows the ultrasonic blades (36) to move when the ultrasonic blades (36) are in ultrasonic vibration.

B. Exemplary Ultrasonic Blades Figures 7-9 show further details of the ultrasonic blade (36) of the surgical instrument (14). An ultrasonic blade (36) extends distally beyond the distal ends (54, 60) of the inner and outer tubes and terminates in a distal tip (76) having filleted edges for tissue treatment. Including part. The tissue treatment portion of blade (36) is configured to contact and treat tissue with ultrasonic energy received through ultrasonic waveguide (50). As shown in FIG. 8, the tissue treatment portion of the blade (36) includes a proximal straight blade region (202) and a distal curved blade region (202) extending distally from the straight blade region (202). 204) and The straight blade region (202) extends parallel to the longitudinal axis defined by the shaft assembly (20) along which the waveguide (50) extends. The curved blade region (204) extends along a curved path that laterally deflects distally from the longitudinal axis. As best shown in FIG. 8, the lateral dimension of curved blade region (204) tapers distally toward distal tip (76). As shown in FIGS. 2 and 3, clamping arm (38) is designed to extend from ultrasonic blade (36) in that clamping arm (38) includes a proximal straight clamping portion and a distal curved clamping portion. can be shaped similar to the treatment portion of the . In an alternative configuration, ultrasonic blade (36) and clamp arm (38) may extend completely straight and parallel to the longitudinal axis.

An upper portion, wherein the tissue treatment portion of the ultrasonic blade (36) faces the clamp arm (38) (hidden from view) and is configured to compress tissue against the clamp arm (38); Includes primary treatment side (206). The tissue treatment portion further includes a lower secondary treatment side having a cutting edge (208) disposed opposite primary treatment side (206) and facing away from clamp arm (38). The cutting edge (208) is configured to cut tissue during the backcutting procedure. First and second lateral blade sides (210, 212) extend between the primary treatment side (206) and the cutting edge (208). As best shown in cross-section in FIG. 9, the primary treatment side (206) is convexly rounded. In addition, each of the first and second sides (210, 212) traverses the distal portion of the straight blade region (202) and the entirety of the curved blade region (204) along its curved path, It includes an extensive flat side (214) extending distally therethrough. As shown in FIG. 9, the broad flat side (214) depends downwardly from the rounded treatment surface of the primary treatment side (206) and has lateral side edges that are generally parallel to each other. Define the cross-section of (36).

The blade height of the ultrasonic blade (36) at a selected longitudinal location is the maximum transverse distance measured between the primary treatment side (206) and the cutting edge (208) at the selected location. defined by The blade width of the ultrasonic blade (36) at selected longitudinal locations is defined by the maximum transverse distance measured between the first and second outer portions (210, 212) at the selected locations. be done. As shown in FIGS. 7 and 8, the curved blade region (204) is such that at various longitudinal locations along it, including the blade tip (76), the blade height is greater than the corresponding blade width. Shaped to be large. In other configurations, the blade height may be less than or equal to the blade width.

C. Exemplary Configurations of Clamp Arm Electrodes FIG. 10 shows an end effector (22) of a surgical instrument (14) including an ultrasonic blade (36) and a clamp arm (38) having a clamp pad (40). ) shows a schematic cross-sectional end view of the tissue treatment portion of FIG. A clamp pad (40) extends distally along the centerline region of the clamp side of the clamp arm (38) to provide a clamp arm electrode (42). The clamp arm electrode (42) has a first electrode-side portion (280) extending distally along a first lateral side of the clamp pad (40) and an opposing second portion of the clamp pad (40). and a second electrode-side portion (282) extending distally along the outer portion. As shown in FIG. 10, each clamp arm electrode side portion (280, 282) abuts a corresponding outer portion of the clamp pad (40) from the outer lateral edge of the electrode side portion (280, 282). It is formed with a lateral electrode width (W) measured to the inner lateral edge of the electrode side portions (280, 282) shown. The clamp pad (40) defines a lateral gap distance (G1) between the inner lateral edge of each clamp arm electrode portion (280, 282) and the corresponding outer portion (210, 212) of the blade (36). As defined, it is formed with a lateral pad width that is greater than the lateral width of the ultrasonic blade (36). Clamp pad (40) projects beyond electrode side portions (280, 282) in a direction toward primary treatment side (266) of blade (36). This configuration defines a vertical gap distance (G2) between each electrode side portion (280, 282) and the clamping surface of the clamping pad (40) and thus the temporary treatment side (266) of the blade (36). .

Optimal sizing of the lateral electrode width (W) provides adequate electrode surface area for delivery of sufficient bipolar RF energy to seal tissue, while too small an electrode width (W) causes prevent unwanted electrical sparking or arcing. Optimal sizing of the gap distances (G1, G2) allows for peak efficiency of the end effector (22). For example, optimal sizing of the gap distances (G1, G2) will prevent unwanted electrical shorting between the ultrasonic blade (36) and the clamp arm (38) caused by too small a gap distance (G1, G2). prevent, and further prevent unwanted electrical sparking or arcing and consequent inefficient transmission of RF energy caused by gap distances (G1, G2) that are too large. In exemplary configurations, the lateral electrode width (W) of each clamp arm electrode side portion (280, 282) can be in the range of about 0.007 inch to about 0.018 inch, such as about 0.018 inch. The lateral gap distance (G1) corresponding to each electrode side portion (280, 282) can be in the range of about 0.002 inch to about 0.012 inch, such as about 0.007 inch or about 0.012 inch. Additionally, in various examples, the vertical gap distance (G2) corresponding to the electrode sides (280, 282) may be greater than 0 and uniform and equal to each other along the entire length of the electrode sides (280, 290). good.

Exemplary variations of clamp arm (38) and its dimensional configuration are described below, each of which is configured to function in a similar manner as clamp arm (38) and to provide surgical instrument (14) with a surgical instrument (14). suitable for use. Additionally, the lateral electrode widths (W) and gap distances (G1, G2) of additional clamp arm configurations described below may fall within the exemplary ranges given above. Various additional variations of clamp arm (38) incorporating any one or more of the exemplary clamp arm electrode features of the clamp arm described below will be readily apparent to those skilled in the art. It will be appreciated that it may be used in conjunction with the device (14).

FIG. 11 shows an end effector (290) including an ultrasonic blade (36) and a clamp arm (292) according to a first exemplary variation of clamp arm (38) of FIG. Clamping arms (292) have first and second clamping arms (292) extending distally along a centrally located clamping pad (294) and respective outer sides of clamping pad (294). clamp arm electrode side portions (296, 298) and the clamp arm (38). The distal ends of the clamp arm electrode side portions (296, 298) are joined together by a distal electrode bridge portion (299). As shown, the lateral electrode width (W) of each electrode side portion (296, 298) is uniform and equal to the other along the entire length of the treatment portion of the ultrasonic blade (36). Similarly, the lateral gap distance (G1) corresponding to each electrode side portion (296, 298) is uniform and equal to the other along the entire length of the tissue treatment portion of ultrasonic blade (36). The lateral electrode width W and the lateral gap distance G may fall within the above ranges.

FIG. 12 shows an end effector (300) including an ultrasonic blade (36) and a clamp arm (302) according to a second exemplary variation of clamp arm (38) of FIG. The clamping arms (302) extend distally along a centrally located clamping pad (304) and a respective lateral side of the clamping pad (304), and the electrode bridge portion. 11 in that it includes first and second clamp arm electrode side portions (306, 308) joined at their distal ends by (309). The clamp arm (302) is such that the lateral electrode width (W) of each electrode side portion (306, 308) is uniform and equal to the other along the entire length of the tissue treatment portion of the ultrasonic blade (36). Further similar to clamp arm (292) in respect.

Clamp arm (302) is similar to clamp arm (292) in that the lateral gap distance (G1) of each electrode portion (306, 308) is non-uniform along the length of the tissue treatment portion of blade (36). ). Specifically, lateral clearance distance (G1) widens or increases distally along the distal portion of curved region (204) of blade (36). In this example, the lateral gap distance (G1) of the electrode side portion (308) increases distally at a greater rate than the lateral gap distance (G1) of the electrode side portion (306). Therefore, the lateral gap distances (G1) of the electrode side portions (306, 308) are not equal to each other throughout the distal portion of the curved region (204) of the blade (36). Specifically, at various longitudinal locations along the curved region (204) of the blade (36), the lateral gap distance (G1) of the electrode-side portion (308) is greater than that of the electrode-side portion (306). Greater than the lateral gap distance (G1). In another variation of the clamp arm (302), the lateral gap distances (G1) of the electrode side portions (306, 308) remain equal to each other throughout the curved blade area (204). As such, it may increase distally in the same proportion.

As shown in FIG. 12, the clamp arm (302) configuration described above extends laterally outward through the distal portion of the curved blade region (204), or clamp pad having an increasing width. This can be achieved by providing (304). The increased gap distance (G1) at the distal portion of the end effector (300), where the lateral deflection of the ultrasonic blade (36) is maximal, allows the ultrasonic blade (36) to move through the clamped tissue. and clamp arm (302) while maintaining electrical connection therebetween. To maintain a uniform lateral electrode width (W) across the extended area of the clamp pad (304), the lateral width of the clamp arm (302) is adjusted distally at the same time as the lateral width of the clamp pad (304). increase or spread to

FIG. 13 shows an end effector (310) including an ultrasonic blade (36) and a clamp arm (312) according to a third exemplary variation of clamp arm (38) of FIG. The clamping arms (312) extend distally along a centrally located clamping pad (314) and a respective outer side of the clamping pad (314), and the electrode bridge portion. 12 in that it includes first and second clamp arm electrode side portions (316, 318) joined at their distal ends by (319). The clamping arm (312) is configured such that the lateral gap distance (G1) of each electrode side portion (316, 318) increases distally along the distal portion of the curved blade region (204) to provide a gap distance (G1 ) are not equal to each other at all longitudinal locations throughout the curved blade region (204).

Clamp arm (312) is similar to clamp arm (302) in that the lateral electrode width (W) of each electrode side portion (316, 318) is non-uniform along the length of the tissue treatment portion of blade (36). ). Specifically, the lateral electrode width (W) tapers or decreases distally along the distal portion of the curved blade region (204). In other words, the lateral electrode width (W) decreases as the lateral gap distance (G1) increases. The rate of increase and decrease may be similar to each other. Additionally, the lateral electrode widths (W) of the electrode side portions (316, 318) may be substantially equal to each other at any given longitudinal location along the clamp arm (312). The narrow electrode-side portions (316, 318) of the clamp arm (302) deliver a concentrated level of bipolar RF energy in a clamp arm section having an increased gap distance (G1). This allows effective delivery of electrosurgical bipolar RF energy to tissue in larger gap segments, where the lateral width of clamp arm (312) is less than that of clamp arm (302) of FIG. Accommodates a greater degree of lateral deflection of the ultrasonic blade 36 as described above without requiring such outward splaying. Thus, clamp arm (312) may generally provide the same performance benefits as clamp arm (302) while maintaining a narrower profile.

FIG. 14 shows an end effector (320) including an ultrasonic blade (36) and a clamp arm (322) according to a fourth exemplary variation of clamp arm (38) of FIG. Clamp arm (322) includes first and second clamp arms (322) extending distally along a centrally located clamp pad (324) and respective outer sides of clamp pad (324). The clamp arms (292, 302, 312) are similar in that they include clamp arm electrode-side portions (326, 328). Additionally, the lateral electrode width (W) of each electrode side portion (326, 328) is uniform and equal to the other along the entire length of the tissue treatment portion of the ultrasonic blade (36).

Clamp arm (322) eliminates clamp arm (292, 302) in that clamp arm (322) omits the distal electrode bridge portion where clamp arm (322) joins the distal ends (327, 329) of electrode side portions (326, 328). , 312). Rather, in the present example, electrode distal ends (327, 329) are laterally separated from one another by clamp pads (324) that extend to the distal tip of clamp arm (322). Additionally, the electrode distal ends (327, 329) are aligned with the distal blade tip (76), although the distal ends (327, 329) are in other instances of the blade tip (76). It will be appreciated that it may terminate proximally or distally. Although not shown, the distal electrode bridge portions (299, 309, 319) are omitted to provide electrode distal ends similar to the distal ends (327, 329) of the clamp arm (322), described above. Any variation of the clamp arms (292, 302, 312) may be provided.

Each of the above clamp arms (292, 302, 312, 322) has first and second electrode side portions of equal width (W) along the entire length of the electrode side portion. However, alternative variations of clamping arms (292, 302, 312, 322) are provided along one or more longitudinally extending portions thereof, such as curved blade region (204). It may have electrode-side portions with unequal widths (W) along corresponding portions. Such variations in electrode width (W) correspond to the first lateral blade side (210) exhibited by the blade (36) and/or clamp arms (292, 302, 312, 322); provided to accommodate performance differences between their concave curved lateral sides and their respective convex curved lateral sides corresponding to the second lateral blade sides (212). can be For example, in use, the concave curved outer sides of blade (36) and clamp arms (292, 302, 312, 322) may provide a first degree of cutting and sealing treatment to tissue, but the blade ( 36) and the convex curved outer portions of clamp arms (292, 302, 312, 322) may provide a second degree of cutting and sealing treatment to tissue.

II. Representative Combinations The following examples relate to various non-exhaustive ways in which the teachings herein can be combined or applied. It should be understood that the following examples are not intended to limit the scope of any claims, which may be presented at any time in this application or in any subsequent application. . No waiver is intended. The following examples are given for illustrative purposes only. It is believed that the various teachings herein can be arranged and applied in many other ways. It is also contemplated that in some variations certain features referred to in the examples below may be omitted. Accordingly, unless expressly indicated to the contrary at a later date by the inventors, or any assignee of the inventors' interest, any aspect or feature referred to below shall be considered as conclusive. should not be If claims containing further features other than those mentioned below are presented in this application, or in a subsequent application related to this application, those further features are deemed to be invalid for any reason relevant to patentability. should not be assumed to have been added by

<p>A surgical instrument comprising (a) an ultrasonic transducer, (b) a shaft extending distally to the ultrasonic transducer, and c) an end effector disposed at the distal end of the shaft. , the end effector is (i) an ultrasonic blade configured to be driven by an ultrasonic transducer using ultrasonic energy, comprising: (A) an upper treatment side; and (B) an upper treatment side. an ultrasonic blade comprising oppositely disposed lower treatment sides; (C) a first lateral side; and (D) a second lateral side disposed opposite the first lateral side; (ii) a clamping arm movable relative to the ultrasonic blade to clamp tissue therebetween, the clamping arm operable to seal the tissue using RF energy; An RF electrode is provided, the RF electrode comprising: (A) a first electrode-side portion, the first electrode-side portion extending laterally outward from the first outer portion of the ultrasonic blade; (B) a second electrode-side portion spaced apart from the first electrode-side portion, the second electrode-side portion being spaced apart by a lateral gap distance; A surgical instrument comprising: a second electrode side portion spaced laterally outwardly from a second lateral side of the sonic blade a second lateral gap distance; and a clamp arm.</p>

<p>The end effector further includes a clamp pad coupled to the clamp arm, a first electrode side portion extending along a first outer side of the clamp pad and a second electrode side portion extending along the clamp pad. The surgical instrument of Example 1, extending along the second lateral portion.</p>

<p>The surgical instrument of example 1 or 2, wherein the first lateral gap distance is equal to the second lateral gap distance along the curved distal portion of the ultrasonic blade.</p>

<p>The surgical procedure of any of Examples 1-3, wherein at least one of the first lateral gap distance or the second lateral gap distance is uniform along the curved distal portion of the ultrasonic blade. equipment.</p>

<p>5. According to any of Examples 1-4, wherein at least one of the first lateral gap distance or the second lateral gap distance is non-uniform along the curved distal portion of the ultrasonic blade. surgical instruments.</p>

<p>Any of Examples 1-5, wherein each of the first lateral gap distance and the second lateral gap distance is in the range of 0.002 inches to 0.012 inches along the curved distal portion of the ultrasonic blade. The surgical instrument according to .</p>

<p>Any of Examples 1-6, wherein the lateral width of at least one of the first electrode side portion or the second electrode side portion is uniform along the length of at least the distal portion of the clamp arm. A surgical instrument as described.</p>

<p>Any of Examples 1-7, wherein the lateral width of at least one of the first electrode side portion or the second electrode side portion is non-uniform along the length of at least the distal portion of the clamp arm. The surgical instrument according to .</p>

<p>The surgical instrument of any of Examples 1-8, wherein the lateral width of at least one of the first electrode side portion or the second electrode side portion increases distally.</p>

<p>The surgical instrument of example 8 or 9, wherein the lateral width of at least one of the first electrode side portion or the second electrode side portion decreases distally.</p>

<p>Examples 1-10, wherein the lateral width of each of the first electrode-side portion and the second electrode-side portion is in the range of 0.007 inch to 0.018 inch along the length of at least the distal portion of the clamp arm A surgical instrument according to any of the preceding claims.</p>

<p>An electrode bridge in which the RF electrode extends distally beyond the distal tip of the ultrasonic blade and electrically couples the distal end of the first electrode side portion with the distal end of the second electrode side portion. The surgical instrument of any of Examples 1-11, defining a portion.</p>

<p>13. Any of examples 1-12, wherein the ultrasonic blade includes a straight proximal portion and a curved distal portion, and the first and second electrode-side portions extend along the curved distal portion. A surgical instrument as described.</p>

<p>The RF electrodes include a first RF electrode, the ultrasonic blade provides a second RF electrode, the first and second RF electrodes operate to seal tissue using bipolar RF energy. A surgical instrument according to any of Examples 1-13, which is possible.</p>

<p>The surgical instrument of any of Examples 1-14, wherein the upper treatment side of the ultrasonic blade includes a convexly curved surface that provides a second RF electrode.</p>

<p>A surgical instrument comprising (a) an ultrasonic transducer, (b) a shaft extending distally to the ultrasonic transducer, and (c) an end effector disposed at the distal end of the shaft. wherein the end effector is (i) an ultrasonic blade configured to be driven by an ultrasonic transducer using ultrasonic energy, comprising: (A) an upper treatment side; and (B) an upper treatment side. (C) a first lateral portion; and (D) a second lateral portion disposed opposite the first lateral portion; and , (ii) a clamping arm movable relative to the ultrasonic blade to clamp tissue therebetween, the clamping arm operable to seal the tissue using RF energy; the RF electrode comprising: (A) a first electrode-side portion, the first electrode-side portion having a first width and extending from a first outer portion of the ultrasonic blade; a first electrode-side portion spaced laterally outwardly by a first lateral gap distance; and (B) a second electrode-side portion spaced apart from the first electrode-side portion, wherein The second electrode side portion has a second width and is spaced laterally outwardly from the second outer portion of the ultrasonic blade by a second lateral gap distance. a clamp arm, wherein at least one of the first width or the second width is non-uniform along the length of at least the distal portion of the clamp arm; The surgical instrument, wherein at least one of the lateral gap distance or the second lateral gap distance is non-uniform along the length of at least the distal portion of the clamp arm.</p>

<p>17. The surgical instrument of example 16, wherein each of the first width and the second width decreases distally.</p>

<p>18. The surgical instrument of example 16 or 17, wherein each of the first lateral gap distance and the second lateral gap distance increases distally.</p>

<p>A surgical instrument comprising (a) an ultrasonic transducer, (b) a shaft extending distally to the ultrasonic transducer, and (c) an end effector disposed at the distal end of the shaft. wherein the end effector comprises (i) an ultrasonic blade configured to be driven by an ultrasonic transducer using ultrasonic energy, having (A) a straight proximal blade portion and (B) a curved distal blade portion; (C) a first lateral portion; and (D) a second lateral portion disposed opposite the first lateral portion; a clamping arm movable relative to the ultrasonic blade for clamping therebetween, the clamping arm providing an RF electrode operable to seal tissue using RF energy; The RF electrode is (A) a first electrode-side portion, the first electrode-side portion being spaced laterally outwardly from a first outer portion of the ultrasonic blade by a first lateral gap distance. and (B) a second electrode-side portion separated from the first electrode-side portion, the second electrode-side portion being the second electrode-side portion of the ultrasonic blade. a second electrode-side portion spaced laterally outwardly from the outer portion by a second lateral gap distance, the clamp arm comprising a first lateral gap distance or a second lateral gap distance; at least one of the lateral gap distances is within the range of 0.002 inches to 0.012 inches along the curved distal blade portion.</p>

<p>20. The method of example 19, wherein the lateral width of at least one of the first electrode side portion or the second electrode side portion is in the range of 0.007 inches to 0.018 inches along the curved distal blade portion. surgical instruments.</p><p>III. Miscellaneous Any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be combined with other teachings, expressions, embodiments, examples, etc. described herein. It should be understood that any one or more of Accordingly, the above teachings, expressions, embodiments, examples, etc. should not be considered independently of each other. Various suitable ways in which the teachings herein can be combined will be readily apparent to those skilled in the art in view of the teachings herein. Such modifications and variations are intended to fall within the scope of the claims.</p><p>Further, any one or more of the teachings, expressions, embodiments, examples, etc., described herein may be incorporated by reference into the "Combination Ultrasonic and Electrosurgical Instrument Having Electrical Circuits With Shared Return U.S. Patent Application No. [Attorney Docket No. END8245USNP] entitled "Attorney Docket No. END8245USNP" entitled "Path"; Reference number END8245USNP1]; "Combination Ultrasonic and Electrosurgical Instrument Having Electrically Insulating U.S. Patent Application No. [Attorney Docket No. END8245USNP2] entitled "Combination Ultrasonic and Electrosurgical Instrument Having Curved Ultrasonic Blade" filed on even date herewith [Attorney Docket No. US Patent Application No. [Attorney Docket No. END8245USNP5] entitled "Combination Ultrasonic and Electrosurgical Instrument Having Waveguide With Distal Overmold Member," filed on even date herewith; No. [Attorney Docket No. END8245USNP6] entitled "Combination Ultrasonic and Electrosurgical System Generator Having Filter Circuitry"; and/or "Combination Ultrasonic and any one or more of the teachings, representations, embodiments, examples, etc. set forth in U.S. Patent Application No. [Attorney Docket No. END8245USNP7] entitled Electrosurgical System Having EEPROM and ASIC Components; It will also be appreciated that combinations are possible. The disclosure of each of these applications is incorporated herein by reference.</p><p>Further, any one or more of the teachings, expressions, embodiments, examples, etc., described herein may be incorporated by reference into the "Combination Ultrasonic and Electrosurgical Instrument with Clamp Arm Position Input and U.S. Patent Application No. [Attorney Docket No. END8146USNP] entitled "Method for Identifying Tissue State"; "Combination Ultrasonic and Electrosurgical Instrument with Adjustable Energy Modalities and Method for Sealing Tissue and Inhibiting Tissue Resection," filed on even date herewith. U.S. Patent Application No. [Attorney Docket No. END8146USNP1] entitled "Combination Ultrasonic and Electrosurgical Instrument with Adjustable Clamp Instrument", filed on even date herewith. U.S. Patent Application No. [Attorney Docket No. END8146USNP2] entitled "Force and Related Methods"; U.S. Patent Application No. [Attorney Docket No. END8146USNP3]; U.S. Patent Application No. [Attorney Docket No. END8146USNP4] entitled "Combination Ultrasonic and Electrosurgical Instrument and Method for Sealing Tissue with Various Termination Parameters," filed on even date herewith. ]; and/or "Combination Ultrasonic and Electrosurgical Instrument and Method for Sealing Any one or more of the teachings, expressions, embodiments, examples, etc., set forth in U.S. Patent Application Serial No. [Attorney Docket No. END8146USNP5] entitled "Tissue in Successive Phases". It will also be better understood what is possible. The disclosure of each of these applications is incorporated herein by reference.</p><p>Any patents, publications, or other disclosures referred to as being incorporated herein by reference are, in whole or in part, subject to the current definitions, opinions, or other statements set forth in this disclosure. should be understood to be incorporated herein only to the extent not inconsistent with the disclosure of . As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting statements incorporated herein by reference. Any content, or portion thereof, that conflicts with the current definitions, opinions, or other disclosures set forth herein, is hereby incorporated by reference, but the reference content and the current disclosure are hereby incorporated by reference. References shall be made only to the extent that there is no inconsistency between</p><p>Versions of the device described above may have application not only in conventional medical procedures and surgeries performed by medical professionals, but also in robot-assisted medical procedures and surgeries. By way of example only, various teachings herein can be readily incorporated into robotic surgical systems such as the DAVINCI system by Intuitive Surgical, Inc. (Sunnyvale, Calif.). Likewise, those skilled in the art will recognize that the various teachings herein can be readily combined with the various teachings of any of the following: the disclosure of which is incorporated herein by reference; No. 5,792,135, entitled "Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity," issued Aug. 11, 1998, incorporated herein by reference, 1998; "Remote Center US Patent No. 5,817,084 entitled "Positioning Device with Flexible Drive"; US Patent entitled "Automated Endoscope System for Optimal Positioning", issued Mar. 2, 1999, the disclosure of which is incorporated herein by reference. No. 5,878,193; U.S. Patent No. 6,231,565, entitled "Robotic Arm DLUS for Performing Surgical Tasks," issued May 15, 2001, the disclosure of which is incorporated herein by reference; U.S. Patent No. 6,783,524, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument," issued August 31, 2004; the disclosure of which is incorporated herein by reference, April 2002. "Alignment of Master and Slave in a Minimally Invasive Surgical U.S. Patent No. 6,364,888, entitled "Apparatus"; U.S. Patent No. 7,524,320, entitled "Mechanical Actuator Interface System for Robotic Surgical Tools," issued Apr. 28, 2009, the disclosure of which is incorporated herein by reference. No. 7,691,098 entitled "Platform Link Wrist Mechanism," issued Apr. 6, 2010, the disclosure of which is incorporated herein by reference; U.S. Patent No. 7,806,891, entitled "Repositioning and Reorientation of Master/Slave Relationship in Minimally Invasive Telesurgery," issued October 5, 2010; September 30, 2014, the disclosure of which is incorporated herein by reference. Published "Automated End Effector Component Reloading System for Use with a Robotic U.S. Patent No. 8,844,789 entitled "System"; U.S. Patent No. 8,820,605 entitled "Robotically-Controlled Surgical Instruments," issued September 2, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,616,431, entitled "Shiftable Drive Interface for Robotically-Controlled Surgical Tool," issued Dec. 31, 2013, the disclosure of which is incorporated herein by reference; No. 8,573,461 entitled "Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements," issued Nov. 5, 2013; the disclosure of which is incorporated herein by reference, Dec. 10, 2013. Published "Robotically-Controlled Motorized Surgical End Effector System with Rotary U.S. Patent No. 8,602,288 entitled "Actuated Closure Systems Having Variable Actuation Speeds"; "Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector" issued Apr. 5, 2016, the disclosure of which is incorporated herein by reference. U.S. Patent No. 9,301,759, entitled "Robotically-Controlled Surgical End Effector System," issued Jul. 22, 2014; 2013, the disclosure of which is incorporated herein by reference. "Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a U.S. Patent No. 8,479,969 entitled "Robot"; U.S. Patent Application entitled "Robotictically-Controlled Cable-Based Surgical End Effectors" issued Aug. 12, 2014, the disclosure of which is incorporated herein by reference. Publication No. 8,800,838; and/or U.S. Patent No. 8,573,465, entitled "Robotically-Controlled Surgical End Effector System With Rotary Actuated Closure Systems," issued Nov. 5, 2013, the disclosures of which are incorporated herein by reference. issue.</p><p>Versions of the devices described above can be designed to be disposed of after a single use, or they can be designed to be used multiple times. The variant may be reconditioned for reuse after at least one use in either or both cases. Reconditioning may involve any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular parts, and subsequent reassembly. In particular, several variations of the device may be disassembled, and any number of the particular parts or parts of the device may be selectively replaced or removed in any combination. After cleaning and/or replacement of certain parts, some variations of the device are reassembled for subsequent use, either at a reconditioning facility or by the user immediately prior to the procedure. can be done. Those skilled in the art will appreciate that reconditioning of the device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.</p><p>By way of example only, the variations described herein may be sterilized before and/or after treatment. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and device may then be placed in a radiation field that can penetrate the container, such as gamma rays, X-rays, or high energy electron beams. Radiation can kill bacteria on the device and in the container. The sterilized device may then be stored in the sterile container for later use. The device may also be sterilized using any other technique known in the art including, but not limited to, beta or gamma radiation, ethylene oxide, or steam.</p><p>While various embodiments of this invention have been shown and described above, suitable modifications by those skilled in the art will realize further adaptations of the methods and systems described herein without departing from the scope of this invention. can do. While some of such possible modifications have been mentioned, others will become apparent to those skilled in the art. For example, the examples, embodiments, shapes, materials, dimensions, ratios, steps, etc. described above are exemplary and are not required. Accordingly, the scope of the present invention should be considered in light of the following claims and understood not to be limited to the details of construction and operation shown and described in the specification and drawings.</p><p>[Embodiment] (1) A surgical instrument comprising: (a) an ultrasonic transducer; (b) a shaft extending distally to said ultrasonic transducer; and (c) an end effector disposed at a distal end of said shaft. wherein the end effector is (i) an ultrasonic blade configured to be driven by the ultrasonic transducer using ultrasonic energy, comprising: (A) an upper treatment side; and (B) (C) a first lateral portion; and (D) a second lateral portion disposed opposite said first lateral portion. and (ii) a clamping arm movable relative to the ultrasonic blade to clamp tissue between the ultrasonic blade, the clamping arm using RF energy. providing an RF electrode operable to seal tissue, said RF electrode being (A) a first electrode-side portion extending laterally outward from said first outer portion of said ultrasonic blade; (B) a second electrode-side portion spaced apart from said first electrode-side portion, wherein said ultrasonic wave is a second electrode-side portion spaced laterally outwardly from said second outer portion of the blade by a second lateral gap distance.</p><p>(2) The end effector further includes a clamp pad coupled to the clamp arm, the first electrode-side portion extending along a first outer side of the clamp pad, and the second 2. The surgical instrument according to embodiment 1, wherein the electrode side portion extends along the second outer side of the clamp pad.</p><p>(3) The surgical instrument of embodiment 1, wherein the first lateral gap distance is equal to the second lateral gap distance along the curved distal portion of the ultrasonic blade.</p><p>(4) The method of claim 1, wherein at least one of the first lateral gap distance or the second lateral gap distance is uniform along a curved distal portion of the ultrasonic blade. surgical instruments.</p><p>5. The method of claim 1, wherein at least one of the first lateral gap distance or the second lateral gap distance is non-uniform along a curved distal portion of the ultrasonic blade. surgical instruments.</p><p>(6) each of the first lateral gap distance and the second lateral gap distance is between 0.002 inches and 0.012 inches along the curved distal portion of the ultrasonic blade; A surgical instrument according to embodiment 1, which is within the scope.</p><p>(7) Embodiment 1, wherein the lateral width of at least one of said first electrode side portion or said second electrode side portion is uniform along the length of at least a distal portion of said clamp arm. The surgical instrument according to .</p><p>(8) Embodiment wherein the lateral width of at least one of said first electrode side portion or said second electrode side portion is non-uniform along the length of at least a distal portion of said clamp arm. 1. The surgical instrument according to 1.</p><p>(9) The surgical instrument of embodiment 8, wherein the lateral width of at least one of the first electrode side portion or the second electrode side portion increases distally.</p><p>(10) The surgical instrument of embodiment 8, wherein the lateral width of at least one of the first electrode side portion or the second electrode side portion decreases distally.</p><p>(11) each of the first electrode-side portion and the second electrode-side portion has a lateral width of 0.178 mm to 0.457 mm (0.007 inch to 0.018 mm) along the length of at least the distal portion of the clamp arm; inches).</p><p>(12) The RF electrode extends distally beyond the distal tip of the ultrasonic blade, and the distal end of the first electrode-side portion is the distal end of the second electrode-side portion. 2. The surgical instrument of embodiment 1, defining an electrically coupling electrode bridge portion.</p><p>(13) Embodiment 1, wherein the ultrasonic blade includes a straight proximal portion and a curved distal portion, and the first and second electrode-side portions extend along the curved distal portion. The surgical instrument according to .</p><p>(14) the RF electrodes comprise a first RF electrode, the ultrasonic blade provides a second RF electrode, the first and second RF electrodes using bipolar RF energy to stimulate tissue; 2. The surgical instrument of embodiment 1, operable to seal.</p><p>Clause 15. The surgical instrument of clause 14, wherein the upper treatment side of the ultrasonic blade includes a convexly curved surface that provides the second RF electrode.</p><p>(16) A surgical instrument comprising: (a) an ultrasonic transducer; (b) a shaft extending distally to said ultrasonic transducer; and (c) an end effector disposed at a distal end of said shaft. wherein the end effector is (i) an ultrasonic blade configured to be driven by the ultrasonic transducer using ultrasonic energy, comprising: (A) an upper treatment side; and (B) (C) a first lateral portion; and (D) a second lateral portion disposed opposite said first lateral portion. and (ii) a clamping arm movable relative to the ultrasonic blade to clamp tissue between the ultrasonic blade, the clamping arm using RF energy. providing an RF electrode operable to seal tissue, said RF electrode comprising: (A) a first electrode-side portion, said first electrode-side portion having a first width; , a first electrode-side portion spaced laterally outwardly from said first outer portion of said ultrasonic blade by a first lateral gap distance; and (B) said first electrode-side portion. a second electrode-side portion spaced from the second electrode-side portion having a second width and extending laterally outwardly from the second outer portion of the ultrasonic blade; a second electrode-side portion spaced apart by two lateral gap distances, wherein at least one of the first width or the second width is defined by the clamp uneven along the length of at least the distal portion of the arm, wherein at least one of the first lateral gap distance or the second lateral gap distance is at least the distal portion of the clamp arm; is uneven along the length of the surgical instrument.</p><p>(17) The surgical instrument of embodiment 16, wherein each of the first width and the second width decreases distally.</p><p>(18) The surgical instrument of embodiment 16, wherein each of the first lateral gap distance and the second lateral gap distance increases distally.</p><p>(19) A surgical instrument comprising: (a) an ultrasonic transducer; (b) a shaft extending distally to said ultrasonic transducer; and (c) an end effector disposed at a distal end of said shaft. wherein the end effector comprises (i) an ultrasonic blade configured to be driven by the ultrasonic transducer using ultrasonic energy, comprising (A) a straight proximal blade portion; ) an ultrasonic blade comprising a curved distal blade portion; (C) a first lateral portion; and (D) a second lateral portion disposed opposite said first lateral portion; ii) a clamping arm movable relative to said ultrasonic blade to clamp tissue therebetween, said clamping arm operating to seal tissue using RF energy; wherein said RF electrode is (A) a first electrode-side portion, said first electrode-side portion extending laterally from said first outer portion of said ultrasonic blade; (B) a second electrode-side portion spaced outwardly from said first electrode-side portion, said second electrode-side portion being spaced outwardly by a first lateral gap distance; a second electrode-side portion spaced laterally outwardly from the second outer portion of the ultrasonic blade by a second lateral gap distance. and arms, wherein at least one of the first lateral clearance distance or the second lateral clearance distance is 0.002 inches to 0.012 inches along the curved distal blade portion. inches).</p><p>(20) the lateral width of at least one of the first electrode-side portion or the second electrode-side portion is 0.007 inches to 0.018 inches along the curved distal blade portion; 20. The surgical instrument according to embodiment 19, which is within the scope of ).</p>