Combination ultrasonic and electrosurgical instrument having curved ultrasonic blade

RELATED APPLICATION 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. is claimed.

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, for example, about 13 kilohertz (kHz), an ultrasonic blade denatures 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 can be controlled, for example, by surgeon technique and adjustment of power level, blade 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, issued Jun. 21, 1994, entitled "Clamp Coagulator/Cutting System for Ultrasonic Surgical Devices," the disclosure of which is incorporated herein by reference. Instruments, U.S. Pat. No. 5,873,873, issued Feb. 23, 1999, entitled "Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp," the disclosure of which is incorporated herein by reference. Mechanism", U.S. Patent No. 5,980,510, issued November 9, 1999, entitled "Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Arm Pivot Mount", the disclosure of which is incorporated herein by reference. U.S. Pat. No. 6,283,981, issued Sep. 4, 2001, entitled "Method of Balancing Asymmetric Ultrasonic Surgical Blades," which is incorporated herein by reference, Oct. 2001; U.S. Patent No. 6,309,400, issued Dec. 30, entitled "Curved Ultrasonic Blade having a Trapezoidal Cross Section," U.S. Patent No. 6,325,811, issued Dec. 4, 2001, the disclosure of which is incorporated herein by reference. No., title "Blades with Functional Balance Asymmetries for use with Ultrasonic Surgical Instruments", U.S. Patent No. 6,423,082, issued Jul. 23, 2002, entitled "Ultrasonic Surgical Blade with Improved Cutting and Coagulation Features", the disclosure of which is incorporated herein by reference, the disclosure of which is incorporated herein by reference. No. 6,773,444, issued Aug. 10, 2004, entitled "Blades with Functional Balance Asymmetries for Use with Ultrasonic Surgical Instruments," the disclosure of which is incorporated herein by reference. , U.S. Patent No. 6,783,524, issued Aug. 31, 2004, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument, the disclosure of which is incorporated herein by reference, U.S. Patent No. 8,057,498, issued Nov. 15, 2011, entitled "Ultrasonic Surgical Instrument Blades," the disclosure of which is incorporated herein by reference. , U.S. Patent No. 8,461,744, issued June 11, 2013, entitled "Rotating Transducer Mount for Ultrasonic Surgical Instruments," the disclosure of which is incorporated herein by reference, issued November 26, 2013 U.S. Patent No. 8,591,536, entitled "Ultrasonic Surgical Instrument Blades," the disclosure of which is incorporated herein by reference, U.S. Patent No. 8,623,027, issued January 7, 2014, entitled "Ergonomic Surgical Instruments," that U.S. Patent No. 9,095,367, issued Aug. 4, 2015, entitled "Flexible Harmonic Wavegides/Blades for Surgical Instruments," and in U.S. Patent Application Publication No. 2016/0022305, entitled "Ultrasonic Blade Overmold," published Jan. 28, 2016, the disclosure of which is incorporated herein by reference. ing.

Electrosurgical instruments utilize electrical energy to seal tissue and generally include a distally-mounted end effector that can be configured for bipolar or unipolar operation. During bipolar operation, current is imparted 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 traversing 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. Radio frequency energy is generally a form of electrical energy in the frequency range of approximately 300 kilohertz (kHz) to 1 megahertz (MHz). In use, electrosurgical devices can transmit low frequency RF energy through tissue, which causes ionic agitation or friction, in effect resistive heating, resulting in an increase in tissue temperature. A sharp boundary is formed between diseased and surrounding tissue, allowing the surgeon to operate with a high degree 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 U.S. Patent No. 6,500,176, entitled "Electrosurgical Systems and Techniques for Electrosurgical Systems and Techniques for Electrosurgical Systems and Techniques for Electrosurgical Systems and Techniques for Sealing Tissue", U.S. Pat. No. 7,112,201, issued September 26, 2006, entitled "Electrosurgical Instrument and Method of Use", the disclosure of which is incorporated herein by reference. U.S. Patent No. 7,125,409, issued Oct. 24, 2006, entitled "Electrosurgical Working End for Controlled Energy Delivery", U.S. Pat. No. 7,169,146, issued Jan. 30, 2007, entitled "Electrosurgical Probe and Method of Use," the disclosure of which is incorporated herein by reference. U.S. Patent No. 7,186,253, issued March 6, 2007, entitled "Electrosurgical Jaw Structure for Controlled Energy Delivery," issued March 13, 2007, the disclosure of which is incorporated herein by reference. No. 7,189,233, issued May 22, 2007, entitled "Electrosurgical Instrument," the disclosure of which is incorporated herein by reference, U.S. Patent No. 7,220,951, entitled "Surgical Sealing Surfaces and Methods of Use, U.S. Pat. No. 7,309,849, issued Dec. 18, 2007, entitled "Polymer Compositions," the disclosure of which is incorporated herein by reference. Exhibiting a PTC Property and Methods of Fabrication," U.S. Patent No. 7,311,709, entitled "Electrosurgical Instrument and Method of Use," issued December 25, 2007, the disclosure of which is incorporated herein by reference, the disclosure of which is hereby incorporated by reference. US Pat. No. 7,354,440, issued Apr. 8, 2008, entitled "Electrosurgical Instrument and Method of Use," the disclosure of which is incorporated herein by reference, 2008. It is disclosed in US Pat. No. 7,381,209, entitled "Electrosurgical Instrument," issued Jun. 3.

Additional examples of electrosurgical devices and related concepts are found in U.S. Pat. Drive Systems Actuatable by a Common Trigger Mechanism," U.S. Patent No. 9,161,803, entitled "Motor Driven Electrosurgical Device with Mechanical and Electrical Feedback," issued Oct. 20, 2015, the disclosure of which is incorporated herein by reference. , U.S. Patent Application Publication No. 2012/0078243, published March 29, 2012, entitled "Control Features for Articulating Surgical Device, U.S. Pat. No. 9,402,682, issued Aug. 2, 2016, entitled "Articulation Joint Features for Articulating Surgical Device," the disclosure of which is incorporated herein by reference. U.S. Patent No. 9,089,327, issued July 28, 2015, entitled "Surgical Instrument with Multi-Phase Trigger Bias," the disclosure of which is incorporated herein by reference, January 17, 2017. U.S. Patent No. 9,545,253, issued on February 21, 2017, entitled "Surgical Instrument with Contained Dual Helix Actuator Assembly," and U.S. Patent No. 9,572,622, issued February 21, 2017, the disclosure of which is incorporated herein by reference. , under the name "Bipolar Electrosurgical Features for Targeted Hemostasis".

Some instruments can provide ultrasound and RF energy processing capabilities through a single surgical device. Examples of such devices and related methods and concepts are disclosed in U.S. Patent No. 8,663,220, entitled "Ultrasonic Surgical Instruments," issued Mar. 4, 2014, the disclosure of which is incorporated herein by reference. U.S. Patent Application Publication No. 2015/0141981, published May 21, 2015, entitled "Ultrasonic Surgical Instrument with Electrosurgical Feature," which is incorporated herein by reference, It is disclosed in US Patent Application Publication No. 2017/0000541, entitled "Surgical Instrument with User Adaptable Techniques," published Jan. 5, 2017.

Although various types of ultrasonic surgical and electrosurgical instruments, including ultrasonic surgical and electrosurgical composite instruments, have been made and used, prior to the present inventors it is not within the scope of the appended claims. It is believed that no one has ever made or used the described invention.

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 shows a top perspective view of the end effector of the surgical instrument of FIG. 1 having a clamp arm providing a first electrode and an ultrasonic blade providing a second electrode; FIG.</figref><figref num="3">3 shows a bottom perspective view of the end effector of FIG. 2; FIG.</figref><figref num="4">2 shows a partially exploded perspective view of the surgical instrument of FIG. 1; FIG.</figref><figref num="5">2 shows 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 shows 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 shows a side view of the handle assembly of the surgical instrument of FIG. 1 with the side of the body of the handle assembly omitted to expose internal components including an actuation assembly with a trigger and an acoustic assembly with an ultrasonic transducer; FIG. It is</figref><figref num="8">2 shows a partial side cross-sectional view of the surgical instrument of FIG. 1 showing coupling of a shaft assembly including an ultrasonic waveguide with a handle assembly; FIG.</figref><figref num="9A">2 shows a schematic diagram of a portion of the surgical system of FIG. 1 showing the active and return paths of the ultrasonic and bipolar RF electrical circuits through the surgical instrument; FIG.</figref><figref num="9B">FIG. 11 shows the active path of the RF electrical circuit leading distally from the outer tube to the clamp arm and into the tissue, and the return path leading proximally from the tissue to the ultrasonic blade and into the waveguide; 9A shows a schematic view of the end effector of the surgical instrument of 9A. FIG.</figref><figref num="10">2 shows a perspective view of the ultrasonic blade of the surgical instrument of FIG. 1 having an electrically insulating material applied to its outer surface; FIG.</figref><figref num="11">11 illustrates a side cross-sectional view of the end effector of the surgical instrument of FIG. 1 incorporating the treated ultrasonic blade of FIG. 10; FIG.</figref><figref num="12">11 illustrates a cross-sectional side view of an exemplary node support element attached to the ultrasonic blade of FIG. 10 showing the overlap of the node support element with electrical insulating material on the ultrasonic blade; FIG.</figref><figref num="13">2 shows a perspective view of the inner tube of the ultrasonic instrument of FIG. 1 with electrically insulating material applied to the outer and inner surfaces; FIG.</figref><figref num="14">14 illustrates a cross-sectional perspective view of the end effector and shaft assembly of the surgical instrument of FIG. 1 incorporating the treated inner tube of FIG. 13; FIG.</figref><figref num="15">2 shows a perspective view of the inner tube of the ultrasonic instrument of FIG. 1 with an electrically insulating material applied to the inner surface; FIG.</figref><figref num="16">16 illustrates a cross-sectional perspective view of the end effector and shaft assembly of the surgical instrument of FIG. 1 incorporating the treated inner tube of FIG. 15; FIG.</figref><figref num="17">2 shows a perspective view of the clamp arm of the surgical instrument of FIG. 1 having electrically insulating material applied to its non-clamping outer surface; 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 descriptions 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. Let's be 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 position of the element placed closer to the surgeon and the term "distal" refers to the position of the element placed closer to the surgical end effector of the surgical instrument and further from the surgeon. point to 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 shows 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). As described in more detail below, the generator (12) provides ultrasonic energy for cutting tissue and bipolar electrosurgical RF energy (i.e., therapeutic levels of RF energy) for sealing tissue. is operable to power the surgical instrument (14) to deliver the In an exemplary configuration, generator (12) is configured to power surgical instrument (14) to deliver ultrasonic energy and bipolar electrosurgical RF energy simultaneously.

A. Overview of an Exemplary Surgical Instrument Having Ultrasound and Electrosurgical Mechanisms Surgical instrument (14) of the present example includes handle assembly (18) and extends distally from handle assembly (18). It includes a shaft assembly (20) and an end effector (22) disposed at the distal end of 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. A trigger (32) is coupled to the lower portion of body (24) and extends toward and from pistol grip (26) to selectively actuate end effector (22), as described in more detail below. Pivotable away. In other suitable variations of surgical instrument (14), handle assembly (18) may include, for example, a scissor grip configuration. An ultrasonic transducer (34) is housed within and supported by body (24), as described in more detail below. 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) faces and faces the ultrasonic blade (36) for sandwiching between the ultrasonic blade (36) and the ultrasonic blade (36). a clamp arm (38) configured to selectively pivot away therefrom. The ultrasonic blade (36) is adapted to drive (i.e., vibrate) the ultrasonic blade (36) at ultrasonic frequencies to cut and/or seal tissue positioned in contact with the ultrasonic blade (36). is acoustically coupled to an ultrasonic transducer (34) configured to: A clamp arm (38) is operably coupled to the trigger (32) such that the clamp arm (38) responsive to pivoting of the trigger (32) toward the pistol grip (26) causes the ultrasonic blade to move. It is configured to pivot towards (36) to a closed position (see Figure 16). Additionally, clamp arm (38) is configured to pivot away from ultrasonic blade (36) to an open position in response to pivoting of trigger (32) away from pistol grip (26). (see, for example, FIGS. 1 to 3). 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 the clamp side of the clamp arm (38) facing the ultrasonic blade (36) and extends distally along the clamp side. Clamp pads (40) are configured to engage corresponding tissue treatment portions of ultrasonic blade (36) to clamp tissue when clamp arm (38) is actuated to its closed position. . 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 with electrodes (42, 44). configured to apply The clamp arm electrode (42) may function as the active electrode while the blade electrode (44) functions as the return electrode, or 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. It may be configured to apply electrosurgical bipolar RF energy through electrodes (42, 44) after vibrating (36).

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) between the distal end (54) of inner tube (48). and the distal end of the inner tube (48) by means of a pivot pin (56) received in a through hole formed in the clevis arm (52) and the distal end (54) of the inner tube (48). (54) is pivotally connected. First and second clevis fingers (58) depend downwardly from clevis arm (52) and are pivotally connected to distal end (60) of outer tube (46). Specifically, each clevis finger (58) is a protrusion (58) that is rotatably received within a corresponding opening (64) formed in the side wall of the distal end (60) of the outer tube (46). 62).

In the present example, inner tube (48) is longitudinally fixed relative to handle assembly (18), and outer tube (46) extends from inner tube (48) along the longitudinal axis of shaft assembly (20). and configured to translate relative to the handle assembly (18). As outer tube (46) translates distally, clamp arm (38) pivots about pivot pin (56) toward its open position. Proximal translation of outer tube 46 causes clamp arm 38 to pivot in the opposite direction toward its closed position. As described below with reference to FIG. 11, the proximal end of outer tube (46) is operably coupled to trigger (32), eg, via a linkage assembly, such that trigger (32) actuation causes the outer tube (46) to translate relative to the inner tube (48), 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 rotationally connected 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 rotationally secured to shaft assembly (20) by a retaining pin (66) extending through a 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 acoustically coupled at its proximal end to the ultrasonic transducer (34), for example by a threaded connection, and ultrasonic blade at its distal end, as shown in FIG. Acoustically coupled with (36). An ultrasonic blade (36) is shown, which is connected to waveguide (50) such that blade (36) extends directly distally from the distal end of waveguide (50). integrally formed. 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 Accordingly, the ultrasonic transducer (34), waveguide (50), and ultrasonic blade (36) together define an 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). , thereby cutting and/or sealing tissue. For example, blade (36) may cut tissue sandwiched between clamp arm (38) and the first treatment side of blade (36), or blade (36) may, for example, "reverse cut" During movement, it may cut tissue positioned in contact with a second treatment side disposed on the opposite side of blade (36). In some variations, waveguide (50) may amplify the ultrasonic vibrations delivered to blade (36). Further, waveguide (50) may include various mechanisms operable to control the gain of oscillation and/or suitable mechanisms for tuning waveguide (50) to a selected resonant frequency. obtain. Further exemplary arrangements of ultrasonic blades (36) and waveguides (50) are described in greater detail below.

Waveguide (50) is supported 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 positioned 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 most distal end by a node support element in the form of overmolded member (72), shown in FIG. 5 and described in more detail below with reference to FIG. Supported in acoustic nodes. The waveguide (50) has a retaining pin (66) passing through a lateral through hole (74) formed in an acoustic node located proximally of the waveguide (50), e.g., the most proximal acoustic node. is longitudinally and rotationally fixed within the shaft assembly (20).

In the present example, distal tip (76) of ultrasonic blade (36) is at a position corresponding to an antinode associated with resonant ultrasonic vibrations transmitted through waveguide (50). This configuration allows the acoustic assembly (100) of the instrument (14) to operate at the preferred resonant frequency f when the ultrasonic blade (36) is not under tissue load._ocan be adjusted to When the ultrasonic transducer (34) is energized by the generator (12) to transmit mechanical vibrations to the blade (36) through the waveguide (50), the distal tip (76) of the blade (36) , for example within a range of maximum amplitude of about 20-120 micrometers, optionally within a range of about 20-50 micrometers, for example a predetermined vibration frequency f of about 50 kHz_oand vibrate in the longitudinal direction. When the ultrasonic blade (36) is positioned in contact with tissue, the ultrasonic vibrations of the blade (36) are minimized by simultaneously cutting the tissue and denaturing proteins within adjacent tissue cells. 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). With this arrangement, the pivot pin hole (78) that receives the clamp arm pivot pin (56) is formed with the distal end (54) flush with the remaining proximal portion of the inner tube (48). It can be spaced further away from the longitudinal axis of the shaft assembly (20) than is possible. Advantageously, this results in an increased clearance between the proximal portion of the clamp arm electrode (42) and the proximal portion of the blade electrode (44), thereby reducing the force exerted on the blade (36) by, for example, tissue. The electrodes (42, 44) and their corresponding Reduce the risk of unwanted "short circuits" between active and return electrical paths. In other words, when ultrasonic blade (36) is used in a reverse cutting motion, ultrasonic blade (36) moves slightly away from the longitudinal axis of shaft assembly (20) toward pin (56). may tend to be biased toward Pivot pin holes (78) spaced further away from the longitudinal axis than pivot pin holes (78) which would otherwise not have the radial offset provided by distal end (54) of the present example. 78), the distal end (54) provides additional lateral clearance between the pivot pin (56) and the ultrasonic blade (36), thereby allowing the ultrasonic blade ( The risk of contact between the ultrasonic blade (36) and the pivot pin (56) is reduced or eliminated as the 36) deflects laterally during the reverse cutting operation. Additional clearance is electrically generated that would otherwise result from contact between the ultrasonic blade (36) and the pivot pin (56) when the end effector (22) is activated to apply RF electrosurgical energy. In addition to preventing short circuits, when the ultrasonic blade 36 is ultrasonically vibrating, the ultrasonic blade 36 would otherwise

B. Exemplary Handle and Shaft Assemblies FIG. 7 provides further details of the mechanisms housed within handle assembly (18) of surgical instrument (14), including acoustic assembly (100) and actuation assembly (102). indicates Acoustic assembly (100) is described in more detail below with reference to FIG. 9A. The actuation assembly (102) includes a trigger (32) and a series of links operably connecting the trigger (32) with the outer tube (46) and thus the clamp arm (38), thereby ) relative to the body (24) allows the clamp arm (38) to pivot relative to the ultrasonic blade (36). More specifically, trigger (32) is coupled to a first link (104) that pivots about pivot point (106). The first link (104) is pivotally connected at its inner bend portion to the distal end of the second link (108). The second link (108) is pivotable at its proximal end relative to the proximal arm (112) of the translating member (110). Arm (112) is rigidly connected at its distal end to yoke (114) of translation member (110). Yoke (114) at least partially surrounds the proximal end of outer tube (46) and is operatively connected thereto. Specifically, the yoke (114) abuts the distal end of a spring stack (116) held on a cylindrical spring retainer (118) (see FIG. 8) by a proximal retaining nut (120). touch. Spring stack (116), in this example, includes a linearly arranged array of adjacent wave springs. Spring retainer (118) is fixedly connected to the proximal end of outer tube (46).

Pulling trigger (32) toward pistol grip (26), as indicated by the directional arrow in FIG. 7, actuates outer tube (46) proximally, thereby closing clamp arm (38). be. Releasing trigger 32 also actuates the outer tube distally, thereby opening clamp arm 38 . Specifically, moving (e.g., by pulling) the trigger (32) toward the pistol grip (26) causes the first and second links (104, 108) to undergo their corresponding pivotal movements. Pivoting about the axis drives translation member (110) proximally along the longitudinal axis of shaft assembly (20). Proximal movement of translation member (110) causes yoke (114) to compress spring stack (116) proximally against retention nut (120), thereby compressing spring retainer (118) and outer tube (46). Drive proximally. As noted above, proximal translation of outer tube 46 causes clamp arm 38 to pivot toward its closed position.

In the present example, actuation assembly (102) further includes a compression spring (122) disposed at the proximal end of arm (112) of translation member (110) to distally attach translation member (110). force. When trigger (32) is released, compression spring (122) drives the translation member distally such that yoke (114) engages distal flange (124) of spring retainer (118). do. As spring retainer (118) is secured to outer tube (46), yoke (114) drives spring retainer and outer tube (46) distally together, clamping arm (38) against it. Return to open position.

Although not shown herein, it will be appreciated that actuation assembly (102) may be supplemented or replaced with a motor assembly configured to provide motorized actuation of clamp arm (38). An exemplary surgical device incorporating a motor assembly is disclosed in U.S. Patent Application Publication No. 2014/0239037, published Aug. 28, 2014, entitled "Staple Forming Features for Surgical Stapling Instrument," U.S. Patent Application Publication No. 2015/0374360, published Dec. 31, 2015, entitled "Articulation Drive Features for Surgical Stapler," the disclosure of which is incorporated herein by reference, by reference above. U.S. Patent No. 8,602,288, issued Dec. 10, 2013, entitled "Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds," and in U.S. Patent No. 9,161,803, entitled "Motor Driven Electrosurgical Device with Mechanical and Electrical Feedback," issued Nov. 20, 2015, incorporated above by reference.

FIG. 8 provides further details of the shaft assembly (20) and optional components of the actuation assembly (102) discussed above, as well as the proximal end of the ultrasonic waveguide (50) and the distal end of the ultrasonic transducer (34). The ligation with the apex is shown. As noted above, outer tube (46) translates longitudinally relative to inner tube (48) and waveguide (50) to move clamp arm (38) between its open and closed positions. configured to move. In the same configuration, retaining pin (66) extends through proximal collar (134) of rotation knob (68) and laterally through outer tube, inner tube, and waveguide (50), Thereby, as described above, each of these components is rotationally fixed relative to each other. To accommodate longitudinal translation of outer tube (46) relative to the remaining components of shaft assembly (20), outer tube (46) has retaining pins (66) threaded therethrough, as shown in FIG. It includes a pair of elongated slots (136) extending inward. Additionally, a proximal portion of inner tube (48) may be radially supported within outer tube (46) by tube support element (138).

In the present example, when yoke (114) is driven to actuate outer tube (46) proximally to a certain force threshold, spring stack (116) resists compression, thereby causing yoke (114) to ) through retention nut (120) to outer tube (46), spring stack (116) is configured to provide a force-limiting mechanism. When clamp arm (38) encounters substantial resistance to further pivotal movement toward ultrasonic blade (36), outer tube (46) correspondingly substantially resists further proximal movement. resistance, and such resistance is further provided through retaining nut (120). When this resistance exceeds a predetermined force threshold, and the operator continues to urge trigger (32) toward pistol grip (26), spring stack (116) forces nut (120) and outer tube (46) into contact. is at rest, it begins to compress in response to further proximal movement of the yoke (114). The spring stack (116) thus absorbs forces above the force threshold. Retaining nut (120) may be selectively rotated relative to sleeve (126) by threaded engagement to compress spring stack (116) against yoke (114) with a desired amount of preload. The retaining nut (120) thereby allows adjustment of the predetermined force threshold by allowing adjustment of the preload.

C. Exemplary Ultrasound and Bipolar RF Electrical Circuitry FIGS. 9A and 9B show exemplary configurations of the ultrasound electrical circuit (140) and bipolar RF electrical circuit (142) of the surgical instrument (14). As shown in FIG. 9A, the generator (12) of the surgical system (10) is electrically coupled to and configured to energize each of the electrical circuits (140, 142), thereby providing surgical The instrument (14) enables the delivery of ultrasonic energy and electrosurgical bipolar RF energy to tissue. In various embodiments, generator 12 may energize ultrasound electrical circuitry 140 and RF electrical circuitry 142 simultaneously or selectively alternately. The structural components of the ultrasound electrical circuit (140) and the bipolar RF electrical circuit (142) are described below in corresponding order, followed by a description of the current flow through the circuits (140, 142). As described, the electrical circuits (140, 142) may share a common electrical return path.

As mentioned above, the acoustic assembly (100) of the surgical instrument (14) generally includes an ultrasonic transducer (34), an ultrasonic waveguide (50), and an ultrasonic blade (36). As shown in FIG. 9A, the ultrasonic transducer (34) of the present embodiment generally comprises a first resonator (or "endbell") (144) and a conically shaped second resonator (or "forebell"). ) (146) and a transducing portion disposed between the end bell (144) and the fore bell (146) and including a plurality of piezoelectric elements (148). Compression bolt (150) extends coaxially distally through endbell (144) and piezoelectric element (148) and is threadably received within the proximal end of forebell (146). A velocity transducer (152) (or "horn") extends distally from the forebell (146) and into the ultrasonic waveguide (50) via, for example, a threaded connection as shown in FIG. 9A. Connect with the proximal end. In exemplary variations, the ultrasound transducer (34) may be further configured according to any of the transducer configurations disclosed in the references incorporated herein by reference.

An active transducer electrode (154) is shown, which is positioned between the inner piezoelectric element (148) and the proximal piezoelectric element (148) and is connected to the generator (154) via the active transducer lead (156). 12) are electrically connected. A feedback transducer electrode (158) is shown, which is positioned between the endbell (144) and the proximal piezoelectric element (148) and is connected to the generator (12) via the feedback transducer lead (160). is electrically connected to An active RF lead (162) is shown, electrically coupled to the generator (12) and extending from the proximal portion of the outer tube (46). The positioning of active RF lead (162) relative to shaft assembly (20) is exemplary only, generator (12) may be positioned at any suitable location, such as along outer tube (46), or It will be appreciated that the clamp arm (38) may be electrically connected directly to the RF electrical circuit (142) so as to bypass the outer tube (46). Furthermore, in other embodiments, the active RF lead (162) may be electrically coupled to the inner tube (48) instead of the outer tube (46) so that the RF electrical circuit (142) is , passes through the inner tube (48) instead of the outer tube (46).

As shown in FIG. 9A, the ultrasound electrical circuit (140) leads distally through the active transducer lead (156) to the active transducer electrode (154) and into the piezoelectric element (148). including. The ultrasound electrical circuit (140) further includes a return electrical path leading proximally from the piezoelectric element (148) through the return transducer electrode (158) to the return transducer lead (160). The generator (12) directs a current through the active electrical path to the return electrical path, thereby energizing the ultrasonic transducer (34) to generate ultrasonic mechanical vibrations, which in turn lead to ultrasonic waves. It is transmitted through the wave tube (50) to the ultrasonic blade (36).

As shown in FIGS. 9A and 9B, the RF electrical circuit (142) runs from the active RF lead (162) to the outer tube (46) and through the outer tube (46) through the clevis fingers (58). It contains an active RF pathway leading distally to the clamp arm (38). In this embodiment, the flow of RF electrical energy through the RF active path is enabled by an electrical connection between outer tube 46 and clamp arm 38, such as by metal-to-metal contact. Active RF energy flows from clevis arm (52) into clamp arm electrode (42) and then into tissue (164). As described in more detail below, clamp arm electrode (42) may be in the form of a clamp-side surface of clamp arm (38) and is integrally formed with clamp arm (38), thereby clamping. It may be electrically connected to the rest of arm (38). In various embodiments, the entire clamp arm (38), including or not including the clamp pad (40), is made of a conductive material such as metal such that the entire clamp arm (38) functions as the clamp arm electrode (42). may be formed with

RF electrical circuitry (142) further includes a return electrical path that directs RF energy proximally from end effector (22) to handle assembly (18) via ultrasonic waveguide (50). As shown in FIG. 9B, when tissue (164) is electrically coupled to clamp arm electrode (42) and blade electrode (44) simultaneously, such as by direct or indirect contact, RF energy is directed to the active RF path. from through the tissue (164) to the return RF path via the blade electrode (44). From the blade electrode (44), RF energy returns proximally through the waveguide (50) and into the ultrasound transducer (34), as further described below. In this manner, tissue (164) is treated with bipolar RF energy provided by generator (12).

In an exemplary configuration, blade electrode (44) may be defined by a selected clamping surface of ultrasonic blade (36). In other configurations, the entire ultrasonic blade (36) may function as the blade electrode (44). In various such configurations, blade electrode (44) is electrically coupled with ultrasonic blade (36), and ultrasonic blade (36) is electrically coupled with ultrasonic waveguide (50). The ultrasonic waveguide (50) is then electrically coupled with the ultrasonic transducer (34). Thus, within the RF return path, RF energy travels proximally from the blade electrode (44) through the ultrasonic blade (36) to the ultrasonic waveguide (50) and finally to the ultrasonic transducer (34). flow to the side. As shown in FIG. 9A, upon entering the ultrasonic transducer (34), the return RF energy passes through the forebell (146) and the compression bolt (150), from the compression bolt (150) through the endbell (144) to the return transducer. It flows proximally to the electrode (158) and then to the return transducer lead (160). Thus, the RF electronics (142) and the ultrasound electronics (140) share a common electrical return path through the return transducer electrode (158) and the return transducer lead (160).

Although the exemplary configuration described above uses the clamp arm electrode (42) as the active electrode and the blade electrode (44) as the return electrode, the opposite is specified so that the blade electrode (44) is the active electrode, It will be appreciated that the clamp arm electrode (42) may serve as the return electrode. In such a configuration, the ultrasound electronics (140) and RF electronics (142) share a common active electrical path back to the generator (12) through the transducer leads (160) and transducer electrodes (158). share it. Further, in alternative arrangements, RF electrical circuit (142) may pass through inner tube (48) rather than outer tube (46), or RF electrical circuit (142) may pass through inner tube (46) and All of the outer tubes (48) may be bypassed together.

As described above, generator 12 simultaneously energizes ultrasonic electrical circuitry 140 and RF electrical circuitry 142 such that surgical instrument 14 emits ultrasonic energy and electrosurgical bipolar RF energy. It may be configured to allow simultaneous application to treat tissue. Additionally or alternatively, generator 12 alternately energizes ultrasonic electrical circuitry 140 and RF electrical circuitry 142 to generate one of ultrasonic energy or bipolar RF energy at a given time. It may be configured to allow only one to be selectively applied. For example, generator 12 may energize only RF electrical circuit 142 and deactivate ultrasonic blade 36 to seal tissue using bipolar RF energy. Alternatively, the generator (12) energizes only the ultrasonic electrical circuit (140) and deactivates the RF electrodes (42, 44) to cut and/or seal tissue using ultrasonic energy. good too.

Surgical instrument (14) prevents unwanted electrical shorting of the RF active and RF return paths of RF electrical circuit (142), for example, at locations proximal to clamp arm electrode (42) and blade electrode (44). Various mechanisms for blocking may be included. For example, the retaining pin (66) shown in FIG. 9A may be encased in an electrically insulating sheath (166) that prevents shorting between the outer tube (46) and the ultrasonic waveguide (50). Similarly, the clamp arm pivot pin (56) shown in FIG. 9B is an electrically insulating sheath that prevents transmission of electrical energy from the clamp arm (38) to the inner tube (48) containing the ultrasonic waveguide (50). may be placed inside. Additionally, ultrasonic blade (36), ultrasonic waveguide (50), outer tube (46), and/or inner tube (48), as described in more detail below with reference to FIGS. Selected portions of may be coated with a layer of electrically insulating material configured to prevent shorting of the RF electrical circuit (142).

D. Exemplary Electrically Insulating Material Layers As noted above, the surgical instrument (14) may include various mechanisms to prevent unwanted electrical shorting of the active and return paths of the RF electrical circuit (142). . For example, ultrasonic blade (36), clamp arm (38), ultrasonic waveguide (50), outer tube (46), and/or as described in more detail below with reference to FIGS. Alternatively, selected portions of inner tube 48 may be coated with an electrically insulating material to prevent such shorting. In exemplary variations, any of the layers of electrically insulating material described below may be thermally insulating. By way of example only, the insulating material layers described below may include parylene coatings.

Figures 10 and 11 show an exemplary electrically insulating material layer (350) applied to the outer surface of the ultrasonic blade (36). A layer of insulating material (350) extends from a proximal end (352) encapsulating at least a portion of distal node flange (51) of waveguide (50) to a distal end located distal to clamp arm pivot pin (56). It extends distally to the proximal end (354). The insulating material layer (350) may extend all the way around the covered portion of the ultrasonic blade (36). As shown in FIG. 11, the overmold member (72) overlaps the proximal end (354) of the layer of insulating material (350).

FIG. 12 shows another exemplary layer of electrically insulating material (360) applied to the outer surface of the ultrasonic blade (36). The insulating material layer (360) includes a proximal end (362) disposed just distal to the distal node flange (51) of the waveguide (50) except that the insulating layer (360) includes a proximal end (362). , is substantially the same as the insulating material layer (350) described above. Further, the waveguide (50) is a distally extending thin-walled overmold member (364) overlapping the proximal end (362) of the insulating material layer (360) by an axial overlap distance (O). An overmold member (364) is shown installed which is substantially identical to the overmold member (72) described above, except that it includes an annular flap (366). The portion of the overmolding member (364) that is proximal to the layer of insulating material (360) can adhere to the outer surfaces of the waveguide (50) and the ultrasonic blade (36), but the layer of insulating material does not. The portion of annular flap (366) that overlaps (360) does not adhere to the outer surface.

Annular flap (366) may be insulated from at least a portion of flap (366) for various axial lengths of proximal end (362) that fall within known tolerances experienced during the insulation layer application process. A suitable axial length is provided to ensure overlap with the proximal end (362) of the material layer (360). This configuration ensures effective insulation coverage of the portion of the ultrasonic blade (36) extending distally from the node flange (51) to a location just distal to the clamp arm pivot pin (56).

Figures 13 and 14 show another exemplary electrically insulating material layer (370) applied to the outer and inner surfaces of the inner tube (48) of the surgical instrument (14). Insulating layer (370) extends proximally from distal end (54) of inner tube (48) to any suitable location along each of the inner and outer surfaces of inner tube (48). . In the exemplary configuration shown, insulating layer (370) is limited to distal portions of the inner and outer surfaces of inner tube (48).

Figures 15 and 16 show another exemplary electrically insulating material layer (380) applied only to the inner surface of the inner tube (48). Insulating layer (380) extends proximally from distal end (54) of inner tube (48) to any suitable location along the inner surface of inner tube (48).

FIG. 17 shows another exemplary layer of electrically insulating material (390) applied to the outer surface of the non-clamping side of the clamp arms (38). An insulating layer (390) extends proximally from the distal tip of clamp arm (38) to the distal end of clevis arm (52), which is in electrical contact with clamp arm electrode (42). left uncovered so that they remain physically connected. In this embodiment, because the entire body of clamp arm (38) is formed of an electrically conductive material, the entire body of clamp arm (38) is also displaced when end effector (22) delivers bipolar RF energy to tissue. Since it is electrically energized, the presence of insulating layer 390 on the non-clamping side of clamp arm 38 is effective to allow clamp arm electrode 42 to reside in the clamping side configuration of clamp arm 38. , thereby increasing the efficiency of the bipolar RF energy delivered by the clamp surgical instrument (14).

Alternative configurations not shown here include an ultrasonic blade (36), a clamp arm (38), an outer tube (46), an inner tube (48), and/or an ultrasonic waveguide (50). , the shaft assembly (20) and/or the end effector (22) may be coated with a layer of electrically insulating material to prevent electrical shorting of the RF electrical circuit (142). .

II. Exemplary 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 claim, which may be presented at any time in this application or in any subsequent application after this 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 appear in this application, or in a subsequent application related to this application, then those further features are for any reason relevant to patentability. It should not be assumed as added.

<p>A surgical instrument comprising: (a) a shaft; (b) an ultrasonic transducer; and (c) a waveguide acoustically coupled with the ultrasonic transducer and extending distally through the shaft. and (d) an end effector disposed at the distal end of the shaft, the end effector being (i) an ultrasonic blade acoustically coupled to the waveguide, the ultrasonic transducer comprising: operable to drive the waveguide and the ultrasonic blade with ultrasonic energy; (ii) to the ultrasonic blade for sandwiching tissue between the ultrasonic blade; and (iii) a first RF electrode provided by the clamp arm, the first RF electrode electrically coupled with a first RF electrical path of the surgical instrument. , a first RF electrode, and (iv) a second RF electrode provided by the ultrasonic blade, the second RF electrode electrically coupled to a second RF electrical path of the surgical instrument. a second RF electrode, wherein the first and second RF electrodes are operable to seal tissue using bipolar RF energy; (e) a first An electrically insulating layer configured to prevent a short circuit between an RF electrical path and a second RF electrical path, the electrically insulating layer being an ultrasonic blade, waveguide, shaft, or clamp arm. an electrically insulating layer provided on at least a portion of at least one of the surgical instruments.</p>

<p>The surgical instrument of Example 1, wherein the first RF electrode comprises an active electrode and the first RF electrical pathway comprises an active pathway.</p>

<p>The surgical instrument of any one of Examples 1 or 2, wherein an electrically insulating layer is provided on a portion of the ultrasonic blade.</p>

<p>4. The surgical instrument of example 3, wherein the electrically insulating layer extends all the way around the portion of the ultrasonic blade.</p>

<p>A clamp arm is pivotally connected to the shaft with a pivot pin, and an electrically insulating layer is positioned at a proximal end proximally of the pivot pin and a distal end of the pivot pin. The surgical instrument of any one of Examples 1-4, extending longitudinally along the ultrasonic blade between the distal end and the distal end.</p>

<p>6. Any one of embodiments 1-5, wherein the ultrasonic blade extends distally from the distal-most acoustic node of the waveguide, and the electrically insulating layer encapsulates at least a portion of the distal-most acoustic node The surgical instrument according to 1.</p>

<p>7. Any one of embodiments 1-6, further comprising an annular overmold member surrounding the waveguide at its distalmost acoustic node, a distal portion of the annular overmold member overlapping a portion of the electrically insulating layer. The surgical instrument according to .</p>

<p>the shaft includes an outer tube and an inner tube, the waveguide extending through the inner tube, one of the outer tube or the inner tube being translated relative to the other of the outer tube or the inner tube; A translation tube operable to actuate the clamp arm relative to the ultrasonic blade, the first RF electrode electrically coupled with the translation tube such that the first RF electrical path passes through the translation tube. 8. The surgical instrument of any one of Examples 1-7, wherein the second RF electrical path passes through the ultrasonic blade and the waveguide.</p>

<p>9. Any one of Examples 1-8, wherein an electrically insulating layer is provided on the inner tube, the electrically insulating layer configured to prevent electrical shorting between the translation tube and the waveguide. The surgical instrument according to .</p>

<p>A surgical instrument according to example 9, wherein an electrically insulating layer is provided on the inner surface of the inner tube.</p>

<p>The surgical instrument of any one of Examples 1-10, wherein an electrically insulating layer is provided on a portion of the clamp arm.</p>

<p>In embodiment 11, wherein the clamp arm includes a clamping side and a non-clamping side, the clamping side configured to clamp tissue against the ultrasonic blade, and the electrically insulating layer provided on the non-clamping side. A surgical instrument as described.</p>

<p>The surgical instrument of any one of Examples 1-12, wherein the electrically insulating layer is also thermally insulating.</p>

<p>The surgical instrument of any one of Examples 1-13, wherein the electrically insulating layer comprises a coating.</p>

<p>The surgical instrument of any one of Examples 1-14, wherein the electrically insulating layer comprises parylene.</p>

<p>A surgical instrument comprising: (a) a shaft; (b) an ultrasonic transducer; and (c) a waveguide acoustically coupled to the ultrasonic transducer and extending distally through the shaft. and (d) an end effector disposed at the distal end of the shaft, the end effector being (i) an ultrasonic blade acoustically coupled to the waveguide, the ultrasonic transducer comprising: (ii) an ultrasonic blade operable to drive the waveguide and the ultrasonic blade with ultrasonic energy; and (ii) movable relative to the ultrasonic blade for sandwiching therebetween. and (iii) a first RF electrode provided by the clamp arm, the first RF transmission electrically coupled to the first RF electrical path of the surgical instrument. (iv) a second RF electrode provided by the ultrasonic blade, the second RF electrode electrically coupled to a second RF electrical path of the surgical instrument; a second RF electrode, wherein the first and second RF electrodes are operable to seal tissue using bipolar RF energy; (e) a first RF electrical path; an electrical insulation layer configured to prevent a short circuit between the and the second RF electrical path, the electrical insulation layer being disposed on at least a portion of the ultrasonic blade; A surgical instrument comprising:</p>

<p>A clamp arm is pivotally connected to the shaft with a pivot pin, and the electrically insulating layer has a proximal end located proximal to the pivot pin and a distal end located distal to the pivot pin. 17. The surgical instrument of example 16, extending longitudinally along the ultrasonic blade between the proximal end.</p>

<p>The surgical instrument according to any one of Examples 16-17, wherein an electrically insulating layer is also provided on a portion of the shaft.</p>

<p>A surgical instrument comprising: (a) a shaft; (b) an ultrasonic transducer; and (c) a waveguide acoustically coupled with the ultrasonic transducer and extending distally through the shaft. and (d) an end effector disposed at the distal end of the shaft, the end effector being (i) an ultrasonic blade acoustically coupled to the waveguide, the ultrasonic transducer comprising: operable to drive the waveguide and the ultrasonic blade with ultrasonic energy; (ii) to the ultrasonic blade for sandwiching tissue between the ultrasonic blade; and (iii) a first RF electrode provided by the clamp arm, the first RF electrode electrically coupled with a first RF electrical path of the surgical instrument. , a first RF electrode, and (iv) a second RF electrode provided by the ultrasonic blade, the second RF electrode electrically coupled to a second RF electrical path of the surgical instrument. a second RF electrode, wherein the first and second RF electrodes are operable to seal tissue using bipolar RF energy; (e) a first an electrical insulation layer configured to prevent a short circuit between the RF electrical path of and the second RF electrical path, the electrical insulation layer provided on at least a portion of the shaft; and a surgical instrument.</p>

<p>The shaft includes an outer tube and an inner tube, the waveguide extending through the inner tube, one of the outer tube or the inner tube being translated relative to the other of the outer tube or the inner tube , including a translation tube operable to actuate the clamp arm against the ultrasonic blade, the first RF electrode electrically coupled to the translation tube such that the first RF electrical path passes through the translation tube. and a second RF electrical path passes through the ultrasonic blade and the waveguide, an electrically insulating layer is provided on at least a portion of the inner tube, and an electrical path is provided between the translation tube and the waveguide. 20. A surgical instrument according to example 19, configured to prevent short circuits.</p><p>III. Miscellaneous Any one or more of the teachings, elements, embodiments, examples, etc. described herein may be combined with other teachings, elements, embodiments, examples, etc. described herein. It should be understood that any one or more of these may be combined. 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 be included within the scope of the claims.</p><p>Further, any one or more of the teachings, expressions, embodiments, examples, etc., described herein may be copied from U.S. Patent Application [Attorney Docket No. END8245USNP], entitled "Combination Ultrasonic and Electrosurgical Instrument Having Electrical Circuits With Shared Return Path", U.S. Patent Application [Attorney Docket No. Atty.Ref.END8245USNP1] filed on the same date as this case, entitled "Combination Ultrasonic and Electrosurgical Instrument Having Slip Ring Electrical Contact Assembly , U.S. Patent Application [Attorney Docket No. END8245USNP3], filed on the same date as this case, entitled "Combination Ultrasonic and Electrosurgical Instrument Having Curved Ultrasonic Blade, U.S. patent application filed on even date herewith [Attorney Docket No. END8245USNP4], entitled "Combination Ultrasonic and Electrosurgical Instrument Having Clamp Arm Electrode," U.S. patent application filed on even date herewith [Attorney Docket No. END8245USNP5]. ], entitled "Combination Ultrasonic and Electrosurgical Instrument Having Ving Waveguide With Distal Overmold Member," U.S. Patent Application [Attorney Docket No. END8245USNP6], filed on the same date as this case, entitled "Combination Ultrasonic and Electrosurgical System Having Generator Filter Circuitry," and /or U.S. Patent Application [Attorney Docket No. END8245USNP7], entitled "Combination Ultrasonic and Electrosurgical may be combined with any one or more of the teachings, expressions, embodiments, examples, etc. described in "System Having EEPROM and ASIC Components". 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 copied from U.S. Patent Application [Attorney Docket No. END8146USNP], entitled "Combination Ultrasonic and Electrosurgical Instrument with Clamp Arm Position Input and Method for Identifying Tissue State," U.S. Patent Application [Attorney Docket No. END8146USNP1] filed on even date herewith, entitled "Combination Ultrasonic and Electrosurgical Instrument with Adjustable Energy Modalities and Method." for Sealing Tissue and Inhibiting Tissue Resection", U.S. Patent Application [Attorney Docket No. END8146USNP2] filed on even date herewith, entitled "Combination Ultrasonic and Electrosurgical Instrument with Adjustable Clamp Force and Related Methods," U.S. Patent Application [Attorney Docket No. END8146USNP3], filed on same date as this application, entitled "Combination Ultrasonic and Electrosurgical Instrument with Adjustable Energy Modalities and Method for Limiting Blade Temperature," on same date as this application. U.S. patent application filed [Attorney Docket No. END8146USNP4], entitled "Combination Ultrasonic and Electrosurgical Instrument and Method for Sealing Tissue with Various Termination Parameters," and/or U.S. patent application filed on the same date herewith [Attorney Docket No. END8146USNP5], titled "Combination Ultrasonic and Electrosurgical Instrument and Method for Sealing Tissue in Successive Phases" can be combined with any one or more of the teachings, expressions, embodiments, examples, etc. described. 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>Variations of the above devices 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.). Similarly, those skilled in the art will appreciate the various teachings herein, U.S. Pat. Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity, U.S. Patent No. 5,817,084, entitled "Remote Center Positioning Device with Flexible Drive", U.S. Pat. No. 5,878,193, issued March 2, 1999, entitled "Automated Endoscope System for Optimal Positioning", the disclosure of which is incorporated herein by reference. 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, Aug. 31, 2004. U.S. Patent No. 6,783,524, issued April 2, 2002, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument," issued April 2, 2002, the disclosure of which is incorporated herein by reference. 6,364,888 entitled "Alignment of Master and Slave in a Minimally Invasive Surgical 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, the disclosure of which is incorporated herein by reference. U.S. Patent No. 7,691,098, entitled "Platform Link Wrist Mechanism," issued Apr. 6, 2010, the disclosure of which is incorporated herein by reference, Oct. 5, 2010; U.S. Patent No. 7,806,891, entitled "Repositioning and Reorientation of Master/Slave Relationship in Minimally Invasive Telesurgery," issued September 30, 2014, United States Patent No. 7,806,891, the disclosure of which is incorporated herein by reference. Patent No. 8,844,789 entitled "Automated End Effector Component Reloading System for Use with a Robotic System," U.S. Patent No. 8,820,605, issued September 2, 2014, entitled "Robotically-Controlled Surgical Instruments," 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 December 31, 2013, the disclosure of which is incorporated herein by reference, November 2013; U.S. Patent No. 8,573,461, entitled "Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements," published Dec. 5, 2013, issued Dec. 10, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,602,288 entitled "Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds," U.S. Patent No. 9,301,759, entitled "Robotically-Controlled Surgical Instrument with Selectively," issued Apr. 5, 2016, the disclosure of which is incorporated herein by reference. Articulatable End Effector," U.S. Patent No. 8,783,541, entitled "Robotically-Controlled Surgical End Effector System," July 9, 2013, issued July 22, 2014, the disclosure of which is incorporated herein by reference. U.S. Patent No. 8,479,969, entitled "Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot," U.S. Patent No. 8,800,838, issued Aug. 12, 2014, entitled "Robotically-Controlled Cable-Based Surgical End Effectors," the disclosure of which is incorporated herein by reference, and/or disclosure thereof. any of the various teachings of U.S. Patent No. 8,573,465, entitled "Robotically Controlled Surgical End Effector System with Rotary Actuated Closure Systems," issued Nov. 5, 2013, which is incorporated herein by reference; You will recognize that you can easily combine them.</p><p>Variations 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 can 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 components of the device may be selectively replaced or removed in any combination. After cleaning and/or replacement of particular parts, reassembly of some variation of the device 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>Merely by way of example, 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. Any other technique known in the art may be used to sterilize the device, 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 is understood not to be limited to the details of construction and operation shown and described in the specification and drawings.</p><p>[Embodiment] (1) 1. A surgical instrument comprising: (a) a shaft; (b) an ultrasonic transducer; and (c) a waveguide acoustically coupled to said ultrasonic transducer and extending distally through said shaft. (d) an end effector disposed at the distal end of the shaft, the end effector being (i) an ultrasonic blade acoustically coupled to the waveguide, the the ultrasonic transducer is operable to drive the waveguide and the ultrasonic blade with ultrasonic energy; and (ii) for sandwiching tissue between the ultrasonic blade. and (iii) a first RF electrode provided by said clamp arm, said first RF electrode being aligned with said first RF electrode of said surgical instrument. (iv) a second RF electrode provided by said ultrasonic blade, said second RF electrode being in electrical communication with said surgical RF electrode; a second RF electrode electrically coupled with a second RF electrical path of the instrument, wherein the first and second RF electrodes are configured to seal tissue using bipolar RF energy. and (e) an electrically insulating layer configured to prevent a short circuit between the end effector and (e) the first RF electrical path and the second RF electrical path, wherein the an electrically insulating layer provided on at least a portion of at least one of the ultrasonic blade, the waveguide, the shaft, or the clamp arm.</p><p>(2) said first RF electrode comprises an active electrode, said first RF electrical path comprises an active path, said second RF electrode comprises a return electrode, said second RF electrical path comprises a return path; The surgical instrument of embodiment 1, comprising:</p><p>(3) The surgical instrument of embodiment 1, wherein the electrically insulating layer is provided on a portion of the ultrasonic blade.</p><p>(4) The surgical instrument of embodiment 3, wherein the electrically insulating layer extends all the way around the portion of the ultrasonic blade.</p><p>(5) the clamp arm is pivotally connected to the shaft with a pivot pin, the electrically insulating layer comprising a proximal end located proximal to the pivot pin and the pivot arm; 4. The surgical instrument of embodiment 3, extending longitudinally along the ultrasonic blade between a distally disposed distal end of a pin.</p><p>(6) The ultrasonic blade extends distally from a distal-most acoustic node of the waveguide, and the electrically insulating layer encapsulates at least a portion of the distal-most acoustic node. A surgical instrument according to aspect 1.</p><p>(7) According to embodiment 1, further comprising an annular overmold member surrounding the waveguide at its distalmost acoustic node, a distal portion of the annular overmold member overlapping a portion of the electrically insulating layer. A surgical instrument as described.</p><p>(8) said shaft includes an outer tube and an inner tube, said waveguide extending through said inner tube, and one of said outer tube or said inner tube being located within said outer tube or said inner tube; a translation tube operable to translate with respect to the other to actuate the clamp arm relative to the ultrasonic blade, the first RF electrode connecting the first RF electrical path to the 2. The surgical instrument of embodiment 1, electrically coupled to the translation tube through the translation tube, the second RF electrical path passing through the ultrasonic blade and the waveguide. .</p><p>(9) An embodiment in which the electrically insulating layer is provided on the inner tube, the electrically insulating layer being configured to prevent an electrical short circuit between the translation tube and the waveguide. 8. Surgical instrument according to 8.</p><p>(10) The surgical instrument according to embodiment 9, wherein the electrically insulating layer is provided on the inner surface of the inner tube.</p><p>(11) The surgical instrument of embodiment 1, wherein the electrically insulating layer is provided on a portion of the clamp arm.</p><p>(12) The clamp arm includes a clamping side and a non-clamping side, the clamping side is configured to clamp tissue against the ultrasonic blade, and the electrical insulation layer is provided on the non-clamping side. 12. The surgical instrument according to embodiment 11, wherein</p><p>(13) The surgical instrument of embodiment 1, wherein said electrically insulating layer is also thermally insulating.</p><p>(14) The surgical instrument of embodiment 1, wherein the electrically insulating layer comprises a coating.</p><p>(15) The surgical instrument of embodiment 1, wherein the electrically insulating layer comprises parylene.</p><p>(16) 1. A surgical instrument comprising: (a) a shaft; (b) an ultrasonic transducer; and (c) a waveguide acoustically coupled to said ultrasonic transducer and extending distally through said shaft. (d) an end effector disposed at the distal end of the shaft, the end effector being (i) an ultrasonic blade acoustically coupled to the waveguide, the the ultrasonic transducer is operable to drive the waveguide and the ultrasonic blade with ultrasonic energy; and (ii) for sandwiching tissue between the ultrasonic blade. and (iii) a first RF electrode provided by said clamp arm, said first RF electrode being aligned with said first RF electrode of said surgical instrument. (iv) a second RF electrode provided by said ultrasonic blade, said second RF electrode being in electrical communication with said surgical RF electrode; a second RF electrode electrically coupled with a second RF electrical path of the instrument, wherein the first and second RF electrodes are configured to seal tissue using bipolar RF energy. and (e) an electrically insulating layer configured to prevent a short circuit between the end effector and (e) the first RF electrical path and the second RF electrical path, wherein the an electrically insulating layer disposed on at least a portion of said ultrasonic blade.</p><p>(17) The clamp arm is pivotally connected to the shaft using a pivot pin, and the electrically insulating layer includes a proximal end located proximal to the pivot pin and the pivot arm. 17. The surgical instrument of embodiment 16, extending longitudinally along the ultrasonic blade between a distally disposed distal end of a pin.</p><p>(18) The surgical instrument according to embodiment 16, wherein the electrically insulating layer is also provided on a portion of the shaft.</p><p>(19) 1. A surgical instrument comprising: (a) a shaft; (b) an ultrasonic transducer; and (c) a waveguide acoustically coupled to said ultrasonic transducer and extending distally through said shaft. (d) an end effector disposed at the distal end of the shaft, the end effector being (i) an ultrasonic blade acoustically coupled to the waveguide, the the ultrasonic transducer is operable to drive the waveguide and the ultrasonic blade with ultrasonic energy; and (ii) for sandwiching tissue between the ultrasonic blade. and (iii) a first RF electrode provided by said clamp arm, said first RF electrode being aligned with said first RF electrode of said surgical instrument. (iv) a second RF electrode provided by said ultrasonic blade, said second RF electrode being in electrical communication with said surgical RF electrode; a second RF electrode electrically coupled with a second RF electrical path of the instrument, wherein the first and second RF electrodes are configured to seal tissue using bipolar RF energy. and (e) an electrically insulating layer configured to prevent a short circuit between the end effector and (e) the first RF electrical path and the second RF electrical path, wherein the and an electrically insulating layer provided on at least a portion of the shaft.</p><p>(20) said shaft includes an outer tube and an inner tube, said waveguide extending through said inner tube, and one of said outer tube or said inner tube being connected to said outer tube or said inner tube; a translating tube operable to actuate the clamp arm relative to the ultrasonic blade, wherein the first RF electrode is configured such that the first RF electrical path is electrically coupled to the translation tube through the translation tube, wherein the second RF electrical path passes through the ultrasonic blade and the waveguide; and the electrically insulating layer extends through the inner tube. 20. The surgical instrument of embodiment 19, provided on at least a portion and configured to prevent electrical shorting between the translation tube and the waveguide.</p>