electrosurgical device

专利摘要:
ELECTROSURGICAL DEVICE. Modality of the revealed technology related to a bipolar electrosurgical device for a laparoscopic environment, as well as methods for the use of such a device. Modalities of the device may include an opposing jaw assembly comprising at least a pair of bipolar electrodes on it, the jaw assembly configured for radio frequency energy to a target tissue. Jaw set mode, may have a diameter no larger than about 5mm. The device may additionally include a rod with a diameter that may be no more than about 5mm. Each jaw has a surface facing the tissue of each jaw that can include a complementary self-alignment configuration in relation to the longitudinal axis of the other jaw. Modalities of the device may additionally include a pinless rotation set formed of cooperatively rotating features of the first jaw and the second jaw that connect the jaws and allow the jaw to adjust to the pivot in a closed position.
公开号:BR112012003356B1
申请号:R112012003356-5
申请日:2011-02-04
公开日:2021-02-02
发明作者:Erik Walberg；Brandon Loudermilk
申请人:Aesculap Ag；
IPC主号:

专利说明:

CROSS REFERENCE TO RELATED REQUESTS
This application claims priority to US Provisional Patent Application No. 61 / 301,295 by Walberg, entitled “Laparoscopic radiofrequency surgical device”, as filed on February 4, 2010. This application is also a partial continuation of US Patent Application No. 11 / 743,579 by Eder et al., Entitled “Surgical Tool”, as filed on May 2, 2007, this application being a partial continuation of US Patent Application No. 11 / 382,652 by Eder et al, entitled “Device for cauterization of tissue, as filed on May 10, 2006 and claiming priority to Provisional Patent Application No. 60 / 746,256 by Eder et al., entitled “Surgical Tool”, as filed on May 2, 2006. INCORPORATION BY REFERENCE
All publications and patent applications mentioned in this specification are incorporated herein by reference to the same extent as if each such publication or patent application had been specifically indicated or individually to be then incorporated by reference. APPLICATION FIELD
The technology revealed refers to the systems and methods for electrosurgery. More particularly, the technology refers to an electrosurgical device suitable for laparoscopic surgery through a trocar with a 5mm port. FUNDAMENTALS
Electrosurgical instruments apply radiofrequency (RF) energy to a surgical site to cut, perform ablation or coagulate tissue. A particular request for these electrosurgical effects is to seal blood vessels or threads of tissue. A typical instrument takes the form of a set of forceps or pair of jaws, with one or more electrodes at each end of the jaw. In an electrosurgical procedure, the electrodes are placed in close proximity to each other as the jaws are closed over a tissue site such as the alternating current path between the two electrodes passes through the tissue within the target site. The mechanical force exerted by the jaws and the electric current combine to create the desired surgical effect. By controlling the level of the mechanical and electrical parameters, such as pressure applied by the jaws, the distance between the electrodes and the voltage, current, frequency and duration of the electrosurgical energy applied to the tissue, the surgeon can coagulate, cauterize or seal the tissue to a therapeutic end.
Electrosurgical procedures can be performed in an open environment, through conventional incisions, or they can be performed laparoscopically, through small incisions usually 0.5 cm-1.5 cm in length. A laparoscopic procedure may include the use of a telescopic rod lens system that is connected to a video camera and a fiber optic cable system that transmits light to illuminate the operating field. A laparoscope is usually inserted into a port on the body via a 5 mm or 10 mm cannula or trocar to view the operative field. Surgery is performed during a laparoscopic procedure with any of the various tools that are typically arranged at the distal end of a stem and are operable by manipulating a cable or an actuator positioned at the proximal end of the stem, and are sized so that they can pass through a door provided by the 5 mm or 10 mm cannula.
As electrosurgical tools are applied in laparoscopic procedures, challenges for the device to rise in relation to the dimensional restrictions imposed by the operating environment, including the smallness of a typical entry door, which includes the use of conventional 5 mm trocars internal diameter. The technology provided here addresses the need for improvements in the device's technology, which allows it to scale down from the device while maintaining adequate levels of mechanical strength and electrosurgical capacity. For example, it is generally desirable to extend the length of conventional forceps to allow sealing of longer tissue lengths. A forceps length increases, it becomes a challenge to exert an adequate level of strength, particularly from the distal end of the forceps. The present disclosure provides technologies that represent progress in accessing these challenges. SUMMARY OF THE REVELATION
Manifestations of the technology concern an electrosurgical device that is particularly suitable for laparoscopic procedures in which its distal insert, including a rod and an effector, can have a diameter no larger than about 5 mm. This 5 mm insertable profile allows the device to be inserted through a conventional 5 mm trocar. Commercially available trocars, which are conventionally referred to as "5 mm" generally have an internal diameter specification commonly expressed in units of inches, and in fact range in the range of about 0.230 inches to about 0.260 inches, despite 5 mm actually be equivalent to 0.197 inches. In the present description, therefore, "5 mm" or "about 5 mm", when referring to the insertable profile of the device or to the diameter of the rod or to the jaws in a closed configuration, refers to a diameter that is accommodated by the trocars of “5mm” available today. More particularly, closed rod and jaw embodiments disclosed herein typically have a diameter in the range of about 0.215 inches to about 0.222 inches.
Modes of the electrosurgical device have an end effector, such as a set of two opposing jaws or forceps, which include one or more pairs of bipolar electrodes arranged on the jaw tissue engagement surfaces, the device being adapted to effect sealing and cutting tissue. In some embodiments, the device includes a single pair of bipolar electrode, one electrode in each of the jaws. In these modalities, the electrodes are typically powered by a generator operating with a single radio frequency channel. Other embodiments of the device may include a plurality of pairs of bipolar electrodes, and an operation by means of a plurality of radio frequency channels. Some particular types of technology may take the form of non-electrical surgical devices whose operation takes advantage of the mechanical and dimensional aspects of the technology.
Modes of the electrosurgical device may have jaws that self-align in relation to the longitudinal axes when the jaws are approaching closure. Self-alignment, as used here, can be further understood to include lateral alignment, such that when the longitudinally aligned jaws converge on the closure, they meet opposite, their lateral engagement faces or the fabric meeting a another fully, from the respective proximal end to the distal end. The mutual alignment of the jaws can be particularly challenged when the jaws are closing around a piece of tissue, the presence of which can urge the jaws to tilt laterally out of alignment in such a way that they do not meet opposite. Thus, in these jaw adjustment modalities, the tissue engagement surfaces of each of the opposing jaws, respectively, have mutually complementary longitudinally oriented self-alignment characteristics that are sufficiently robust to be effective when there is an adequate amount surgically within the tissue. target within the space between the closing jaws. Aspects and details of the self-aligning jaw modalities are described below.
Jaw modalities can be rotatable in relation to each other by means of a pinless rotation mechanism that operates by means of cooperative features of the jaws that connect the jaws. The pinless swivel mechanism, in addition to securing the jaws together, allows the jaws to pivot between the open position and the closed position. Jaw adjustment modalities can pivot as a whole between an open and a closed position due to a jaw pivoting in relation to one stem, while the other jaw remains fixed with respect to the stem. The center of rotation of the pinless rotation system is not necessarily arranged in a position on a line corresponding to a central longitudinal axis of the stem. Particular modalities of the pinless rotation mechanism are displaced from that line. An advantage of this pivoting or rotational mechanism is that the force that is transferred to the mechanism of an actuator wire is increased by the angular momentum provided by the distance of displacement from the center of rotation of the longitudinal axis of the stem, or, more particularly, by the distance between the axis of the actuator wire inside the stem and the center of rotation.
In some embodiments, the rotating cooperative features of the pinless rotation mechanism of the jaws include a first jaw in which a proximal aspect of the jaw has a first arched track, and the second jaw in which a proximal aspect has a second arched track, the first and the second arched track being mutually complementary and slidably engaging with each other. In an arrangement of these rotating components, the arcuate aspect of the first mandible is generally external or female in relation to the arcuate aspect of the second mandible. Thus, the trail of the first jaw accommodates and generally involves the trailing portion of the second jaw, and the second jaw is rotatable within the space provided by the first jaw. The complementary rotating portions of the first and second jaws are dimensioned in such a way that their touching surfaces can be easily moved slidingly one after the other. In some of these embodiments, the second arcuate track resides substantially within a housing formed by the first arcuate track. Although the arched rails positioned proximally are rotating with each other, in some modalities, at least the proximal portion of the first mandible is fixed in relation to the stem, while the second mandible is pivotable in relation to the stem.
In some modalities of the pinless rotation mechanism, the first arcuate rail has two concentric surfaces facing each other, one smaller and one larger, and the second arcuate rail has two concentric surfaces facing each other, one smaller and one larger . The concentric surfaces of the two rails are interlocking surfaces between the rails. More particularly, the smaller concentric surfaces of the first and second tracks are respectively complementary to each other. The larger concentric surfaces of the first rail and the second rail, respectively, are complementary to each other. The second arcuate track resides substantially within a housing formed by the first arcuate track. In particular embodiments, the first jaw includes a back restraint strap for the smallest concentric surface of the first arched track and is positioned laterally across a surface of a first jaw housing within a portion of the housing overlapping and securing the surface smaller concentric part of the second mandible. This belt is configured to retain the proximal aspect of the second jaw within the housing provided by the first arcuate rail.
From a general perspective, in modalities of the device in which the rod and jaws are freely rotatable in relation to a portion of cable, designating one jaw as a lower jaw and the other jaw as an upper jaw may not be particularly significant. However, in some modalities of the device, by virtue of a convention, or by some designation, there may be a standard position of rotation of the jaws that particularizes one jaw as a lower jaw and the other as an upper jaw. Thus, in particular device modalities, and in the examples of device modalities described here, from the perspective of an operator of the device and with the jaws in a standard operating position, a first referenced jaw is a lower jaw and a second jaw referenced is an upper jaw.
Typical embodiments of an electrosurgical device as described herein can have a jaw that is pivotable in relation to the stem and a second jaw having at least a base portion that is fixed in relation to the stem. Modalities like these are described in detail here, and are shown as examples in the figures. Alternative modalities of the device, however, can be configured in such a way that both jaws are pivotable in relation to the stem.
Typical modalities of the device, as described in this document, are also configured in such a way that a jaw is a two-piece jaw, including a proximal base piece and a distal piece that is pivotable in relation to the proximal base piece, and a second jaw that is unitary. Modalities like these are described in detail here, and are described as examples in the figures. Alternative modalities of the device, however, can be configured in such a way that both jaws have two parts, with a distal portion that is pivotable in relation to a proximal base portion.
Modalities of an electrosurgical device as provided here may vary in terms of the distribution of resources between a first and a second mandible. Thus, in some modalities of the device (Modality A), a first jaw (a lower jaw, for example) is a two-piece jaw, having a proximal piece that is fixed in relation to the stem, a distal jaw piece that is pivotable in relation to the proximal part, and a pivotable set connecting the proximal part and the distal jaw piece and a second jaw (an upper jaw, for example) is unitary and pivotable in relation to the stem.
In alternative modalities of the device (Mode B), a first jaw (a lower jaw, for example) is unitary and fixed in relation to the stem, and a second jaw (an upper jaw, for example) is a 2-piece jaw, having a proximal jaw piece that is pivotable in relation to the nail, a distal jaw piece that is pivotable in relation to the proximal piece, and a pivotable assembly connecting the proximal jaw piece and the distal jaw piece. Examples of both modalities A and B are shown as examples in the figures.
In another aspect, Type A of the device can be described as having two jaws, a first jaw that is fixed with respect to the rod and having an electrode tray positioned pivotable on it, and a second jaw being pivotable in relation to the rod and having a tray fixed electrode inside it. Mode B of the device can be described as having two jaws, a first jaw that is fixed in relation to the rod and having a fixed electrode tray disposed in it, and a second jaw that is pivotable in relation to the rod, and having an electrode tray pivotable on it. Except for the variation associated with the distribution of mandible attributes between Modalities A and B, other characteristics of the devices of Modality A and Modality B are substantially similar. Most of the features shown in the figures included in this document are consistent with Mode A or common to both modes A and B. Figs. 5A - 5C exhibit Mode B in particular.
An additional modality (Modality C) of the device can be described as having two jaws, a first jaw that is fixed in relation to the rod and having a pivotable electrode tray positioned on it, and a second jaw that is pivotable in relation to the rod, and having a pivotable electrode tray on it. Still additional modalities have both jaws pivotable in relation to the stem. Thus, Modality D has two jaws that are pivotable in relation to the rod, this one has a first jaw having a pivotable electrode tray positioned inside it and a second jaw having a fixed electrode tray disposed on it. Mode E has two mandibles that are pivotable in relation to the stem, both mandibles having a pivotable electrode tray positioned inside them.
In some aspects of the disclosure, an embodiment of the device consists of a set of jaws as described here, but which are specifically absent from a rod, absent from a cable, or absent from either a rod or a cable. The set of jaws by these modalities can be properly fitted to a rodless device, or, alternatively, to a robotic device. These modalities may or may not be configured for electrosurgery. Some modalities include bipolar electrodes; some modalities can be configured for mechanical functions, without being enabled to deliver radio frequency energy. These modalities can also include several aspects of the technology disclosed here, such as having a diameter that is not greater than about 5 mm, having a pinless rotation mechanism to open and close the jaws or the jaws can include self-locking features. longitudinally aligned alignment.
Some embodiments of an electrosurgical device include a blade that is capable of separating radiofrequency-sealed tissue into two portions. Blade modalities may be positioned on a longitudinally arranged blade rail; the blade can be positioned in the starting position at a proximal end of the rail, at a distal end of the rail, or at any point along the rail between the distal and proximal ends of the rail. In various types of the device, when the jaws are in the open position, the proximal initial position of the blade is configured so that movement of the blade in a distal direction is prevented. In some modalities, the distal movement can be physically blocked by a distal blocking structure for the blade, in other modalities the distal movement can be prevented by a locking mechanism proximal to the blade.
On the other hand, when jaw modalities are in the closed position, the proximal initial position of the blade can be configured to allow distal movement of the blade, the first and second jaws collectively forming a clearing through the path to the distal end of the blade rail. . The availability of space for the midway is, at least in part, due to the pinless aspect of the rotation mechanism in which the presence of a pin, for a pin-based jaw rotation mechanism, could otherwise occupy space, and hinder the way. The blade halfway includes grooves and cracks through various structures, as described below in the context of the figures. In typical modalities of a blade of the described configuration, the blade is distal turning towards a main V-shaped notch, which cuts the tissue as it is moved distally. At its proximal end, the blade is connected to a mechanical connection on the handle that keeps it in a proximally inclined position.
As mentioned above, dimensions of the electrosurgical device modalities are important aspects of the technology, insofar as the device modalities are intended to be compatible with trocars having an internal diameter of about 5 mm (in the conventional or commercial sense as described above). Thus, in particular modalities, the set of jaws, when closed, has a diameter of no more than about 5 mm when the device is in an insertable configuration. An insertable configuration for a device with opening jaws is one, for example, in which the jaw set is in a closed configuration, and in which the jaws of the device are aligned with the longitudinal axis of the stem. Thus, in particular modalities of the described technology, the stem has a diameter of no more than about 5 mm, and the set of jaws, when closed, provides a maximum diameter of about 5 mm.
Other dimensions and structural characteristics of the technology are directed towards characteristics and operational specifications of the device modalities that also need to accommodate the restrictions imposed by the requirement of a maximum diameter of 5 mm. For example, in particular embodiments, the jaws are at least about 2.5 cm long. In addition, some modalities of a device restricted to the diameter of 5 mm that has jaws with a length of at least about 2.5 cm are able to exert pressure in the range of about 14 lbs. at about 28 lbs. at the tip of the jaws and, in particular modalities, the jaws are capable of exerting a pressure of at least about 16 lbs. at its tips.
One approach to offering high surgical performance from a diameter-restricted electrosurgical device is 5 mm is to minimize the cross-sectional area that is occupied by components or materials that do not provide structural support projecting distally or contiguously to the jaws, and in particular to support its ability to deliver sufficient clamping force. Here are some examples of a material or component that could locate in this region that does not support distally designed, or that interrupts longitudinal structural continuity in a portion of the cross-sectional area of a device. One could consider a pin orthogonally positioned through a portion of the proximal aspect of the jaws, to be used, for example, as a structure on which other features can pivot or rotate. A pin of this nature, while performing an operational role, does not strengthen the ability of the jaws to exert a compressive force, nor does it reinforce the ability of the jaws to maintain their positions when the jaws encounter resistance provided by body structures within the operating space. laparoscopic. Typical types of device provided do not have a pin. Another example of a component that occupies a transverse area that does not provide structural support projected distally to the jaws refers to the actuator members and electrically conductive members. Some modalities of the device provided have connection members that serve both a physical actuation function and an electrically conductive function, thus conserving a transversal structural area. Because of these various aspects of the device's modalities, the transverse fraction of the device that does not provide structural support projecting distally can be minimized.
Thus, with respect to a transverse slice taken through a portion of the device that includes the pinless rotation mechanism, in some embodiments of the device, a ratio of the structural material that contributes to supporting the set of jaws for the total transverse area of the device is at least about 82%. A similar analysis of the distally directed structural support could make use of a volume-based constraint. For example, the central portion of the distal end of the device, at least the proximal aspect of the set of jaws, can include a certain length of the nail and / or jaws within the proximal and distal limits. If this given length is multiplied by the transverse area within the set of the proximal and distal limits, it can be understood that a measure of structural material can report structural material in terms of its volume and can be expressed as a percentage of the total volume of the portion of the device within limits.
As was summarized above, some modalities of the set of jaws are configured in such a way that the jaws align themselves with respect to their longitudinal axes, when the jaws are approaching the closure. Thus, in these types of jaw set, the tissue engagement surfaces of each of the opposing jaws, respectively, have mutually complementary longitudinally oriented self-alignment characteristics that prevent the lateral jaws from sliding as they close against each other. . Insofar as these features prevent or correct incipient lateral slips such as the nearby jaws, these features can be characterized as aspects of longitudinal and lateral alignment stabilization of tissue engagement surfaces.
Modalities of the self-aligning jaw characteristics can be arranged along the substantial entire length of the jaws. In another aspect, modalities of self-aligning jaw characteristics can occupy the substantial entirety of the available tissue engagement surfaces of the jaws. In various embodiments, the self-aligning characteristics can occupy either fully or substantially the length of the tissue engagement surfaces of the jaws; in other embodiments, the self-aligning characteristics may occupy only a portion of the length of the jaw tissue engagement surfaces. The structural characteristics associated with this approach to longitudinally aligning the jaws generally conserve the materials, costs or dimensions, which would otherwise be associated with achieving the manufacturing tolerances necessary to support a guarantee of collinear alignment of the two jaws when they close.
In particular embodiments, the self-aligning configuration of the tissue engagement surfaces of the jaws includes a V-shaped projection surface aligned in one jaw and a complementary longitudinally aligned V-shaped recess surface or recession in the other jaw. In some embodiments, the V-shaped projection is in the lower jaw and the V-shaped recession is in the upper jaw. The longitudinally aligned V-shaped projection surface in one jaw and the complementary longitudinally aligned V-shaped recoil surface in the other jaw, when the jaw set is closed, forms a common V-shaped interface with an internal angle in the band from about 90 degrees to about 175 degrees. In particular embodiments, the common V-shaped interface has an internal angle of about 150 degrees.
In a more general aspect, the self-aligning configuration of the modalities of the jaw tissue engagement surfaces, in a lateral cross section, forms a more complex tissue contact zone or interface than that of a single straight transverse line. Because it is non-linear, the width of the contact zone between the closed jaws and the pressed tissue is greater than the width of the tissue in a linear tissue contact zone would be. Thus, the width of the tissue seal created by the V-shaped configuration of the mandibular tissue engagement surfaces is greater than the width of a tissue seal created by flat tissue engagement surfaces would be. The arrangement just described, of the complementary V-shaped projection and V-shaped recession forming a V-shaped zone of tissue being contacted by such jaws, is just one example of self-aligning tissue engagement surfaces .
In some types of technology, the electrosurgical device has an insulating layer applied to aspects of at least one of the opposite jaws, the insulating layer forming a spatial gap between the upper and lower jaws that prevents any direct electrical connection between them. In various embodiments, each jaw tip has an electrically conductive surface on or within its tissue engagement surface, and an aspect of the insulating layer includes bands aligned along the electrically conductive surface of at least one of the forceps tips. The strips form a gap between the electrically conductive surfaces of the two jaws when the jaws are in a closed position. Such a gap is typically about 0.006 inches; more generally, the gap has a range of about 0.0045 inches to about 0.0075 inches. In various embodiments of the insulating layer, it may include a polymer, such as polyether-ether-ketone (PEEK), by way of example only. In other embodiments, the insulating layer may include a ceramic material, such as any of alumina or alumina-titania, just by way of example. Ceramic compositions can be advantageous for their relative hardness, incompressibility and / or overall durability. In some embodiments, the ceramic material is positioned at one or more locations on the surface of the device that are particularly subject to abrasive and / or compressive stress.
In some embodiments of the technology, the device includes a proximal portion for the stem, a jaw actuator mechanism associated with the cable portion and configured to actuate a jaw mechanical capacity and a jaw actuator wire connected proximally to the actuator mechanism and connected distally to the set of jaws. In several modalities, the mechanical capacity of the jaws includes the opening and closing of the set of jaws. In some embodiments, the actuator wire is configured to actuate an opening and closing of the jaws, pivoting a second jaw in relation to at least one proximal part of the first jaw, the proximal part of the first jaw being fixed in relation to the stem.
Additionally, in some embodiments, the same wire that serves as a mechanical actuator force transfer member is additionally configured to deliver RF energy to the jaws. From another perspective, embodiments of the device include an energy delivery wire extending distally from the cable portion to the jaw assembly. In some of these embodiments of the energy delivery wire, the energy delivery wire can be further configured to function as an actuator of mechanical capacity of the jaws, such as moving the jaws between an open position and a closed position.
Some embodiments of the jaw actuator wire include a single wire in the ring configuration that actually forms a paired or double wire connection between the actuator mechanism and an attachment location on at least one of the jaws. In these modalities, the ring wire has a more distal ring terminal or around the portion that is circulated around its attachment site to one of the mandibles. In embodiments in which at least the proximal part of the first mandible is fixed in relation to the stem and the second mandible is pivotable in relation to the stem, the actuator wire is attached to a proximal aspect of the second mandible.
In some embodiments, the actuator wire is configured as a push and pull mechanism, such that a push distally directed from the wire moves the jaws to their open positions, and a pull directed proximally from the wire moves the jaws. jaws to their closed positions. In some of these embodiments, the actuator wire is angled to support the jaws in their open position by virtue of a pull directed proximally by a spring associated with the jaw actuator.
In some embodiments, the jaw actuator includes a tilt member that maintains a push on the actuator wire, such a push causing the jaws to have a standard position to be held in the open position. Additionally, in some embodiments, the jaw actuator includes a manual lever that an operator can pull to perform a direct pull proximally to close the jaw. Additionally, in some of these modalities, the actuator wire and connections associated with proximal and distal wire attachments are collectively configured to be able to operationally support between about 80 and about 120 lbs. tension, in particular actuator wire modalities and their connections are configured to be able to withstand at least about 100 lbs. of tension.
In some embodiments of the device, each of the upper and lower jaws includes a portion of metal, and the entirety of each of these metal portions forms an electrode. In other words, in some modalities, there is no metal portion in any jaw that is not part of the electrode. In some embodiments, the device includes a single pair of bipolar electrode, one electrode in each of the jaws. In these single bipolar pair modes, the electrodes are powered by a generator operating on a single radio frequency channel. Other embodiments of the device may include a plurality of bipolar electrode pairs, and such a plurality of bipolar electrode pairs can be controlled by a plurality of operating radio frequency channels.
Some modalities of the electrosurgical device include a rotational stem actuator positioned proximal to the stem; rod rotor embodiments are typically associated with a cable portion of the device. In some embodiments, the rotational stem actuator is configured to be able to rotate freely both clockwise and counterclockwise, such rotation of the actuator being directly translatable for rotation of the stem, and in turn, rotation of the jaw set over its longitudinal axes. Free rotation in this context, whether in reference to a rotor of the rod, the rod or the jaws, by modalities of technology, refers to a rotation that can occur indefinitely in any direction, without stopping, and without a change of direction. Additionally, due to technology modalities, the rotation can occur freely, without consequence or compromise in relation to any mechanical or electrical capacity of the electrosurgical device modalities.
In some embodiments of the electrosurgical device, the set of two opposing jaws (including a first jaw and a second jaw) is configured so that the jaws can open at an angle in the range of about 30 degrees to about 40 degrees. In some, the set of two opposing jaws is configured in such a way that when the set is moving from an open to a closed position, a first point of mutual contact between the two jaws occurs at a distal end of each jaw. The set of jaws can be further configured in such a way that after the first point of mutual contact has been made and as the set moves forward towards a closed position, a pivot piece distal from the first pivot jaw within a plane of its longitudinal axis so that the proximal end of the first mandible comes into contact with the proximal end of the second mandible.
In some embodiments, the set of two opposing jaws is configured in such a way that when the set of jaws is moving from an open position to a closed position, a first point of mutual contact between the two jaws occurs at a distal end of each jaw. In some of these modalities, after the first point of mutual contact has been made and the jaw assembly is then moved forward to a closed position, a pivotable piece distal from the first pivotable jaw within a plane of its longitudinal axis so that the end proximal of the first mandible contact the proximal end of the second mandible.
Some modalities of the device and its closing dynamics can be understood in terms of the response of the jaws to the presence of target tissue within the range of the closing jaws. In some embodiments, for example, the set of jaws can be configured in such a way that when the set is moving to the closed position and has made an initial contact with the target tissue, a pivotable piece of the first pivot jaw then in response the presence of the target tissue as the mandibles advance towards the closed position to grab the tissue. The pivoting of the pivotable jaw piece can effect a substantially equivalent distribution of pressure along the clinging piece of the target tissue, particularly in comparison to the uneven pressure distribution that can occur in the absence of such intra-mandibular pivotability. In a device-related aspect, the pivotable jaw piece is configured to pivot towards a parallel relationship with the second jaw.
In various modalities, the pivotable jaw piece can be configured in such a way that it pivots around its pivotable connection within an arc having a pivotable range that varies between about 2 degrees to about 8 degrees. In particular embodiments, the pivotable jaw piece can be configured in such a way that it can pivot around its pivotable connection within an arc with a pivotable range of about 6 degrees. In another aspect, the pivotable jaw piece has an arc of a given pivotable band and is tilted in such a way that a distal end of the first jaw is inclined towards the second jaw within the arc of the pivotable band.
In some embodiments, the first jaw includes a proximal jaw piece fixed in relation to the nail, a pivotable distal jaw piece, and a pivotable assembly that connects the proximal jaw piece and the distal jaw piece. In several of these embodiments, the pivotable assembly can be positioned longitudinally in a substantially central location on the distal part. In some of these embodiments, a tissue engagement surface comprises the substantial totality of the distal and pivotable part of the first mandible. Thus, a central location on the distal part of the jaw also represents a central location in relation to a jaw tissue engagement surface. In another aspect of some embodiments, the substantial totality of the tissue engagement surface of the distal part of the first mandible comprises an electrode. Thus, a central location on the distal part of the first mandible represents a central location on the electrode. The centrality of the location of the pivotable assembly in the distal and pivotable jaw piece can be related to the ability of the distal piece to pivot in such a way that it distributes pressure evenly across the surface of the target tissue as the jaws close over the tissue. In some of these modalities, the pivotable assembly may include a shoulder that projects laterally on each of both sides of the distal pivotal jaw piece and an internally accessible receptacle on each side of the proximal fixed jaw piece, the shoulders projecting laterally and internally accessible receptacles being mutually compatible. Other arrangements and configurations that support an ability to pivot such as those described and displayed here are known in the art and can be considered to be within the scope of current technology.
In some embodiments of the device, with reference to a manufacturing method, the proximal and distal parts of the two-piece jaw can be assembled in a suitable fitting manner. More particularly, in such embodiments, the fixed proximal jaw piece is sufficiently flexible that it can deflect to allow insertion of the projections laterally projecting from the distal pivotable jaw piece in a suitable fitting manner.
Another aspect for the pivoted inclination of the distal and pivotable part of a two-piece jaw refers to an inclination member that keeps the pivotable part in a standard pivot position. In some embodiments, for example, the distal pivotable part of the first jaw includes a tilt member that is configured to press against a shelf of the proximal jaw piece, and by means of such pressing tilt the distal pivotable part of the first jaw in such a way that the distal tip of the distal pivot piece is tilted towards the second mandible. More particularly, in some of these modalities, the tilting member takes the form of a spring bundle positioned in a recess within the distal pivotable part in an aspect of the distal pivotable part facing the fixed proximal part of the first mandible.
In another aspect, the technology provides a surgical device with a set of opposite jaws disposed distal to a rod, the set of jaws having a first jaw and a second jaw. Each of the opposing jaws has a longitudinal axis and a tissue engagement surface, and the tissue engagement surface of each jaw may have a complementary self-alignment configuration with respect to the longitudinal axis of the other jaw. In some modalities of the surgical technology provided, the set of jaws, when closed, has a diameter of no more than about 5 mm, and the nail has a diameter of no more than about 5 mm. Modalities of the surgical device may further include a pinless rotation mechanism formed from cooperative features of the first and second jaw rotating features. This pinless rotation mechanism allows the set of jaws to pivot between an open position and a closed position. The pinless rotation mechanism is configured in such a way that the pinless rotation mechanism creates a common center of rotation that is not necessarily positioned at a point on a line corresponding to a longitudinal central axis of the stem.
Modalities of the technology additionally refer to an electrosurgical sealing method in a laparoscopic environment. The method may include moving a set of jaws from an electrosurgical instrument to a proximity to the target tissue, the set of jaws comprising a first jaw and a second jaw. More particularly, moving towards an electrosurgical site may include advancing a distal portion of an electrosurgical device on a patient through a trocar at the site having an internal diameter of about 5 mm. The distal portion of the electrosurgical device, in this circumstance, includes a distal aspect of a stem and the set of jaws, including a first jaw and a second jaw, which are positioned at a distal end of the nail. Modalities of the method may include moving the jaws between an open position and a closed position. Moving the jaws between an open position opening and a closed position can include rotating cooperative structures of the first and second jaws, the first and second jaws not being connected by a pin. Moving the jaws to a closed position may also include grabbing the target tissue with the jaws. The method may also include delivering radiofrequency energy to the target tissue of the mandibles.
In some modalities of the method, moving the set of jaws in close proximity to the target tissue also includes rotating the jaws around their central longitudinal axes. Rotating the jaws can occur by rotating the device's stem around its central longitudinal axis. Rotating the stem of the device can occur by rotating a stem rotation actuator proximal to the stem. In various modalities of the method, modalities of the rod rotation actuator, the rod and the jaws can all have the ability to rotate freely in both clockwise and counterclockwise without stopping, or the need to reverse the direction.
In some modalities of the method, moving the jaws between an open position and a closed position includes rotating cooperative structures of the first and second jaws at their respective proximal ends, the first and second jaws not being connected by a pin. Moving the jaws between an open position and a closed position may include pivoting the jaws together around a center of rotation that is not necessarily in a line corresponding to a central longitudinal axis of the stem. In some modalities, moving the jaws between an open position and a closed position includes pivoting the jaws around a center of rotation that is not in a line that corresponds to a central longitudinal axis of the stem, and in some modalities, the center of rotation can be moved to a position beyond the stem diameter.
In another aspect, moving the jaws between an open position opening and a closed position opening can include at least one proximal piece of a first jaw remaining fixed in relation to the rod and a second pivoting jaw in relation to the rod. In some of these modalities, moving the jaws to the closed position may include a distal part of the first pivoting jaw in relation to the proximal part of the jaw and, therefore, pivoting in relation to the stem. In some embodiments, the pivot of the distal part of the first mandible with respect to the nail includes the distal end of the distal piece pivoting away from the second mandible and the proximal end of the distal piece pivoting towards the second mandible.
In some embodiments of the method, moving the jaws to a closed position includes pivoting a distal piece from the first jaw of a pivotable connection that is positioned in a substantially central portion of the distal piece. In some aspects of the method, there is an interaction between the jaws as they are closing and the target tissue that the jaws are closing around. Thus, in some embodiments, pivoting the distal part of the first mandible includes pivoting in response to the presence of the target tissue between the mandibles, in such a way that it distributes the pressure with substantial equivalence throughout the grabbed portion of the target tissue. Additionally, pivoting a distal piece of a first jaw from a connection positioned in a substantially central portion of the distal piece comprises pivoting in response to the presence of target tissue between the jaws, thus allowing the distal piece of the first jaw to pivot towards a parallel alignment in relation to the second mandible.
In some embodiments of the method, moving the jaws to a closed position includes mutually aligning the respective central longitudinal axes of the first and second jaws. In cases where the jaws are moving to a closed position in order to grab the tissue, moving the jaws to a closed position may include mutually aligning the respective central longitudinal axes of the first and second jaws in such a way as to resist to an effect of misalignment of the target tissue, occur on the jaws as they are closing.
In some embodiments of the method, moving the jaws to a closed position involves grasping the target tissue with a force in the range of about 14 lbs. (6.35 kg.) To about 28 lbs. (12.7 kg.). In addition, in some embodiments, moving the jaws to a closed position includes grabbing a portion of target tissue up to about an inch in length.
In some modalities of the opening method, opening and then closing the jaws includes transferring a force from a mechanical actuator to the jaws via an actuator wire. In some of these modalities, closing the jaws includes pulling the actuator wire in a proximal direction, and in some modalities, opening the jaws by pushing the actuator wire in a distal direction. In some embodiments of the method, delivering radiofrequency energy to the target tissue may include delivering energy to the jaws via the actuator wire.
In some embodiments of the method, moving the jaws to a closed position includes moving the jaws to a closed position in such a way that a first point of mutual contact between the two jaws occurs at a distal end of each jaw. In some of these modalities, moving the jaws to a closed position after the point of the first mutual contact has occurred includes pivoting a distal pivotable part of a first jaw within a plane of its longitudinal axis so that the proximal end of the first jaw comes into contact. contact with the proximal end of the second mandible.
In some modalities of the method, delivering radiofrequency energy to the target tissue includes energy through a wire that is additionally enabled to perform a mechanical function, such as acting on the jaws between an open and closed position. In various methods of the method, electrosurgically treating the tissue includes, in particular, sealing the edges of the target tissue together.
In some modalities of the method, after delivering radiofrequency energy to the target tissue, the method also includes separating the sealed tissue again into two sealed tissue segments. In several embodiments, separating the sealed target tissue back into two sealed tissue segments includes advancing a blade distally through the sealed target tissue.
Some modalities of the method include electrosurgically treating more than one site during a single procedure, or treating a prolonged target site with a series of sealing maneuvers. Thus, some modalities of the method also include identifying a second target location and then repeating the steps of grabbing and delivering energy, with the steps being directed to the second target location. BRIEF DESCRIPTION OF THE FIGURES
Fig. 1A is a perspective view of a modality of a laparoscopic electrosurgical device.
Fig. 1B is a side view of an embodiment of an electrosurgical device with the jaws in an open position.
Fig. 1C is a perspective view of an embodiment of an electrosurgical device with the jaws in a closed and locked position, and with the blade in a retracted proximal position.
Fig. 1D is a perspective view of an electrosurgical device with the jaws in a closed and locked position, and with the blade in a distally advanced position.
Fig. 2A is a transparent perspective view of a jaw set modality of an electrosurgical device, with the jaws in an open position.
Fig. 2B is a transparent perspective view of a lower jaw modality of a set of jaws of an electrosurgical device, with a blade moved distally to a position about halfway to its distal stop point.
Fig. 3A is a side view through the longitudinal midline of an embodiment of a set of jaws from an electrosurgical device, with the jaws in an open position.
Fig. 3B is a side view through the longitudinal midline of an embodiment of a set of jaws of an electrosurgical device, with the jaws in a closed position.
Fig. 3C is a side view through the longitudinal midline of a lower jaw modality of a set of jaws of an electrosurgical device.
Fig. 4A is a side view through the longitudinal midline of a modality of a set of jaws of an electrosurgical device, with the jaws in an open position, and still showing a blade in a raised and proximal maintenance position.
Fig. 4B is a side view through the longitudinal midline of a modality of a set of jaws of an electrosurgical device, with the jaws in a closed position, and still showing a blade in a proximal and lowered maintenance position ready to be distally advanced.
Fig. 4C is a side view through the longitudinal midline of a modality of a set of jaws of an electrosurgical device, with the jaws in a closed position, and still showing a blade in a distally advanced position.
Fig. 4D is a perspective view of an isolated blade from the stem and jaws.
Fig. 5A is a perspective view of an alternative embodiment of an electrosurgical device with the jaws in an open position.
Fig. 5B is a side view of one embodiment of an alternative embodiment of an electrosurgical device with the jaws closed to a position where the distal ends of the jaws are in contact.
Fig. 5C is a side view of an alternative electrosurgical device modality with the jaws in a completely closed position.
Fig. 6 is a perspective view from the distal point of view of an embodiment of a set of claws of an electrosurgical device with the jaws in a closed position, a cross-section showing a passage through which a blade can be distally advanced.
Fig. 7A is a side view of an embodiment of a set of jaws from an electrosurgical device, with the jaws in an open position.
Fig. 7B is a side view of a modality of a set of jaws of an electrosurgical device, with the jaws at an initial closing point, when the distal ends of the jaws made first contact with each other and a gap remains between the jaws in their proximal extremities.
Fig. 7C is a side view of an embodiment of a set of jaws from an electrosurgical device, with the jaws in a completely closed position, in which the jaws are in complete contact with each other from the distal tip to the proximal end.
Fig. 7D is a side view of a set of jaws of an electrosurgical device modality in a partially closed position, with the jaws as they would be positioned when closing around a relatively thick portion of target tissue, the jaws in an alignment parallel, relatively wide apart due to the presence of thick tissue between them.
Fig. 7E is a side view of a set of jaws of a modality of an electrosurgical device in a partially closed position, with the jaws as they would be when closing around a portion of relatively thin target tissue, the jaws in a parallel alignment , separated by a narrow gap, reflecting the presence of fine fabric between them.
Fig. 8 is a perspective and upward view of a set of jaws of an electrosurgical device modality with the jaws in an open position, the view showing, more specifically, an isolated upper jaw, an isolated distal pivotable part of a lower jaw and a ring actuator wire around an attachment point at the proximal end of the upper jaw.
Fig. 9A is a side view of an embodiment of a lower jaw isolated from an electrosurgical device, the lower jaw including a part of the proximal jaw that is fixed in relation to the stem and a part of the distal pivotable jaw mounted at a substantially central point of the distal part in the proximal mandible part.
Fig. 9B is a perspective and exploded view of a lower jaw modality isolated from a laparoscopic electrosurgical device, the lower jaw having a jaw piece proximal to a stem and distal pivotable jaw piece, the proximal and distal jaw pieces shown in an exploded relationship.
Fig. 9C is a bottom view of a lower jaw of an electrosurgical device modality, showing a connection between a proximal fixed jaw piece and a distal pivotable jaw piece.
Fig. 9D is an upward perspective view of an embodiment of a distal part of a lower jaw of an electrosurgical device.
Fig.10A is a semitransparent side view of a lower jaw modality of an electrosurgical device, showing a proximal jaw piece and distal pivotable jaw piece, the distal pivotable piece in its standard inclined position, the distal end of the piece from the pivotable mandible distal to its upper endpoint, towards an upper mandible (not shown).
Fig. 10B is a semitransparent side view of a lower jaw modality of an electrosurgical device, showing a pivotally connected proximal jaw piece and a distal pivotable jaw piece, the distal end of the pivotable distal pivotable jaw piece to its endpoint pivoted lower, the proximal end of the distal pivotable jaw piece pivoted towards its upper endpoint, such a position placing the lower jaw in a substantially parallel relationship with the upper jaw (not shown).
Fig. 11A is a side view of a lower jaw embodiment of an electrosurgical device similar to the view shown in fig. 10A, showing a spring bundle attached to an upper aspect of the proximal jaw piece, the spring pushing against the distal pivotable jaw piece in order to hold the distal pivotable piece in its standard inclined position, the distal end of the pivotable jaw piece distal to its upper endpoint.
Fig. 11B is a side view of a lower jaw embodiment of an electrosurgical device similar to the view shown in fig. 10B, showing a spring cage attached to an upper aspect of the proximal jaw piece, the spring fell as a result of the pressure being exerted on the distal end of the distal pivotable piece of the jaw, as could occur during jaw closure.
Fig. 12A is a proximal perspective view of a modality of distal tips of a closed set of jaws of an electrosurgical device, the distal tips aligned with longitudinal alignment characteristics, a V-shaped projection on the lower jaw and a shaped recession. of V over the upper jaw.
Fig. 12B is a proximal frontal view of a modality of the distal tips of a closed set of jaws of a laparoscopic electrosurgical device, the distal tips aligned with the complementary longitudinal alignment characteristics, a V-shaped projection on the lower jaw and a recession V-shaped over the upper jaw.
Fig. 12C is a proximal perspective view of a distal aspect of an electrosurgical device, with a set of jaws in an open position showing complementary longitudinal alignment characteristics, a V-shaped projection on the lower jaw and a recess in the form of a V over the upper jaw, as well as a longitudinally oriented central gap on both V-shaped surfaces that forms a half-pass for a blade that is distally advanceable when the jaws are in a closed position.
Fig. 13A is a proximal perspective view, partially exposed, of an embodiment of an electrosurgical device that shows aspects of the proximal portion of a set of jaws through which jaw actuator cables pass; the jaw actuator cables also serve as an electrical conduit for the upper jaw.
Fig. 13B is a proximal perspective view of an embodiment of an electrosurgical device that shows aspects of the proximal portion of a set of jaws through which jaw actuator cables pass.
Fig. 13C is a distal transparent perspective view of an electrosurgical device modality that shows aspects of the proximal portion of a set of jaws through which jaw actuator cables pass.
Fig. 13D is a distal transparent perspective view of an electrosurgical device modality similar to fig.13C, showing aspects of the proximal portion of a set of jaws through which jaw actuator cables pass, with the cables in place.
Fig. 13E is a longitudinal section view, slightly offset from the midline, showing the cable paths through the distal portion of the axis and in the proximal aspect of the mandibles.
Fig. 13F is seen in a proximal perspective of the proximal end of a lower jaw that is inserted into the distal end of a nail, further showing engagement of the proximal end of the nail with a cable insulator unit.
Fig. 14A is a bottom perspective view of an upper jaw modality of an electrosurgical device showing an insulating layer of plastic overlapping the electrode.
Fig. 14B is a top perspective view of an upper jaw modality of an electrosurgical device showing an insulating layer of polymer overlapping the electrode.
Fig. 14C is a top perspective view of an embodiment of an upper mandible of an electrosurgical device showing an insulating layer of polymer overlapping the electrode, with the proximal portion of the mandible truncated to expose a cross section.
Fig. 15A is a top perspective view of an upper jaw modality of an electrosurgical device that shows ceramic points overlapping the electrode at abrasive stress points.
Fig. 15B is a top perspective view of an upper jaw modality of an electrosurgical device that shows ceramic points overlapping the electrode at abrasive stress points as they are embedded in a more extensive polymer layer.
Fig. 15C is a top perspective view of an embodiment of a pair of closed jaws of an electrosurgical device that shows ceramic points overlapping the electrode at abrasive stress points as they are embedded in a more extensive polymer layer.
Fig. 16A is an exposed perspective view of a cable of an embodiment of an electrosurgical device that shows aspects of the proximal end of a rotating rod.
Fig. 16B is a perspective view of an isolated proximal end of a rotating rod.
Fig. 16C is a sectional view of the midline of an isolated proximal end of a rotating rod.
Fig. 16D is a midline sectional view of a proximal portion of a rotating rod. DETAILED DESCRIPTION
Modalities of the technology described here provide several improvements in the electrosurgical devices available, such improvements allowing a reduction of the physical size of a device to a dimension that allows the practical use of an electrosurgical device within the limitations of a laparoscopic surgical environment. One of these limitations for working by laparoscopy concerns the 5 mm internal diameter opening provided by a commercially standard trocar. A device compatible with a 5 mm aperture limit must have an insertable configuration with a maximum diameter that is insertable there. These technological improvements are generally aimed at creating a high degree of efficiency in relation to the performance of the device per unit of volume or cross-sectional area. For example, a jaw assembly of a revealed device, despite its small physical size, is capable of delivering an adequate level of force to the tissue being trapped by the jaws, and the structure and material of the jaws are strong enough to maintain integrity during the delivery of such strength.
In one aspect, the technology includes maximizing the amount of structural material in specific areas as a percentage of the total amount of material in the device. The proximal aspect of the jaw assembly, for example, includes several components, some that contribute structural support to the jaws, and other components that perform other functions, such as mechanical or electrical functions. The technology, in this respect, is aimed at minimizing cross-sectional area or volume that does not directly support the jaws. Some components of conventional electrosurgical devices are usually dedicated to a single use, such as electrodes, power lines or actuator lines; in contrast, several components of the recently disclosed device modalities do double work both as structural and electrical components in technology modalities. In another example of material and volume efficiency, some structural components, such as a pin connecting the two jaws at their bases, are eliminated and replaced by a pinless mechanism that connects the upper and lower jaws of a jaw assembly.
Aspects of the technology in the form of modalities of the disclosed electrosurgical device and methods of using the device are illustrated in Figs. 1 - 16D. Regarding modalities A and B, as described above, most of the figures depict examples of Modality A, or they relate to aspects of technology that are common to both Modalities, A and B. Figs. 5A - 5C exhibit particularly examples according to Modality B. It should be understood that, in any reference to a lower jaw or an upper jaw when describing the figures, it is for a convenient visual reference in relation to a conventional positioning of the rotating jaws, and that the two jaws could be referred to more generally as a first jaw and a second jaw. Additionally, with respect to the orientation of the figures, in general a distal end of a device is on the left, and a proximal end of a device is on the right.
Figs. 1A - 1D provide several views of the modalities of a laparoscopic electrosurgical device as a whole. Fig. 1A is a perspective view of an embodiment of an electrosurgical device 1 as provided here, with a set of jaws 30 in an open position. Fig. 1B is a side view of an embodiment of an electrosurgical device 1 with the jaws 30 in the same open position as in fig. 1A. A cable 10 supports a jaw actuator handle 15 and blade actuator lever 16, and a stem rotor 12. A stem 20 extends distally from the cable, and supports an effector end, such as a set of jaws 30 at its distal end. In the modalities described and described here, the end effector takes the form of a forceps or pair of jaws 30, with a first jaw or lower jaw 40 and a second jaw or upper jaw 80. A pinless rotation assembly or mechanism 101 operates the pivoting of the jaws between an open position and a closed position.
The stem rotor 12 is configured to move freely both clockwise and counterclockwise, and in this movement, the stem rotates about its longitudinal axis. Rotation of the rod translates into rotation of the end effector 30 around its longitudinal axis. The jaw actuator handle 15 is operably connected to the end effector 30 by an actuation wire disposed inside the stem, which is configured to open and close the jaws. The actuation wire is configured as a push and pull mechanism, where in a push of the wire, it opens the jaws and a pull of the wire closes them. A tilt mechanism within the cable at the proximal end of the wire maintains a distal protective tilt that pushes the wire, keeping the jaws in a standard open position. A pull on the jaw actuator handle 15 pulls the actuator wire proximally, causing the jaws to pull. The jaw actuator handle is lockable in its proximally pulled position, thus locking the jaws in a closed position. A second pull on the jaw actuator grip releases the lock, thus allowing the jaws to open. The blade actuation lever 16, positioned in this distal mode for the jaw actuator handle, is mechanically connected to a blade arranged inside the stem. A pull on the blade actuation lever moves the blade forward distally, to effect a tissue separation after it has been sealed by radio frequency energy delivered to the tissue by means of bipolar electrodes within the jaw set. A radio frequency on / off button 24 is positioned at an upper proximal location on the cable.
Fig. 1C is a perspective view of an embodiment of an electrosurgical device 1 with the jaws 30 in a closed and locked position, and with the blade in a retracted proximal position. Fig. 1D is a perspective view of an electrosurgical device 1 with the jaws 30 in a closed and locked position, and with the blade in a distally advanced position. The blade itself is not visible in these figures, but the position in front of the blade 16 actuator lever described in Fig. 1C is an indication that the blade is in a retracted or initial position, and the position pulled back from the actuator lever of the blade in fig. 1D is an indication that the blade is in a forward position. Fig. 1C also shows the jaw actuator handle in a pulled back position, locked in the main cable piece 10. In this position, and normally only in this position, is the jaw actuator lever free to be pulled back, in in order to advance the blade distally.
Modes of electrosurgical devices, as described here, can be configured so that (1) provision of radiofrequency energy to seal portions of tissue and (2) the movement of the blade to cut or separate veiled portions of tissue are separate and independent operations . Distal movement of the blade from its proximal initial position is generally permitted only when the jaws are closed and in a locked position, locking occurring through engagement between the jaw actuator grip and elements within the handle. (As described below, in the context of the description in Fig. 4A, a jaw-based locking system also acts to prevent distal movement of the blade when the jaws are closed.) Once the jaws are in that locked position, the blade it is free to move through its full range of movement from proximal to distal. Although the blade is free to move when the jaws are closed and locked, its pattern and inclined position is its proximal initial position; pressure on the blade 16 actuator lever must be maintained for the blade to remain in its most distal position. More details related to the distal movement of the blade are provided below in the context of Figs. 4A - 4D.
Figs. 2A and 2B provide similarly transparent views of modalities of a set of jaws 30 in an open position; these figures show a pinless rotation mechanism or set 101 that comprises proximal aspects of both the lower jaw 40 and upper jaw 80. Fig. 2A is a transparent perspective view of a set of laparoscopic electrosurgical device jaws in an open position, with a blade 105 disposed in a proximal or initial position within a proximal space in the mandibles, and extending further into a distal portion of the nail. Fig. 2B is a transparent perspective view of a lower jaw of the jaw assembly of the laparoscopic electrosurgical device with a blade moved distally to a position about halfway from its distal stop point.
One embodiment of a pinless rotation assembly 101, as shown in Figs. 2A and 2B includes a first portion of the upper jaw arcuate rail 85 and a second portion of the lower jaw arcuate rail 45. In addition to the specific structures comprising the rotating assembly, identifier 101 in the figures generally designates a junction region of the invention that includes the proximal aspects of both the upper and lower jaw. Due to the transparency of the design, the arched track 45 of the lower jaw 40 is difficult to see, it is shown in greater solid detail in the figures below. Arched rail 85 of upper jaw 80 is processed as a solid. It is still visible in these figures the surface of an electrode tray or bipolar electrode 62, within the pivotable portion 60 of the lower jaw 40. Slide rail 108A is disposed centrally inside the electrode 62. A companion facing half of the entire electrode track. blade is similarly (not visible) disposed within the electrode portion of the upper jaw 80.
Figs. 3A - 3C provides a lateral view through the longitudinal midline of a modality of a set of jaws of a laparoscopic electrosurgical device; the blade is not shown in these views. Fig. 3A shows the jaws in an open position; Fig. 3B shows the jaws in a closed position. Fig. 3C shows the lower jaw 40 in isolation, without the upper jaw. Figs. 3A - 3C collectively focus on a mode of a pinless rotation assembly 101 that joins the upper jaw 80 and the lower jaw 40, and allows the jaws to pivot in relation to each other. More specifically, the pinless rotation set 101 allows the upper jaw to pivot in relation to the proximal base portion 50 of the lower jaw 40. Notably, the rotation set does not include a traversing pin. More particularly, these figures focus on arched rail portions of both jaws that cooperate to allow the jaws to open and close. A first arcuate track 45 is formed over a proximal aspect of a proximal portion 50 of the lower jaw 40. A second arcuate track 85 is formed over a proximal aspect of the upper jaw 80. Fig. 3C shows the lower jaw 40 in isolation by the appearance of intervention of the upper jaw, and provides the best view of a first arched track 45, with its upper and lower concentric surface 47 and smaller and larger concentric surface 46.
Both of the first and second arcuate tracks include concentric surfaces, one smaller and more central surface for the other, and the other larger and more peripheral surface for another. The first arcuate track 45 of the lower jaw 40 (more particularly of the proximal portion 50 of the lower jaw 40) has a larger concentric engagement surface 46 in its lower aspect, and has a smaller concentric surface 47 in its upper aspect. The second arched track 85 of the upper jaw 80 has a larger concentric engagement surface 86 in its lower aspect, and has a smaller concentric surface 87 in its upper aspect. As a whole, the second arcuate track 85 (of the upper jaw 80) is generally contained within a housing provided by the first arcuate track 45 (of the lower jaw 40). The first and second arched tracks are dimensioned so that the second arched track can rotate freely within the first arched track. The two larger concentric surfaces, that is, the lower surface 46 of the lower jaw and the lower surface 86 of the upper jaw are complementary. And the two smaller concentric surfaces, that is, the upper surface 47 of the lower jaw and the upper surface 87 of the upper jaw are complementary.
A detail of both the first and the second arched track, not seen in Figs. 3A - 3C, as long as they are seen from the side, is that their arched rails include a central groove to accommodate the passage of through a blade 105. Aspects of the arched rails and the blades through the path can be seen in Figs. 6 and 12 and will be described later. The arrangement of the complementary surfaces and the carcass of the second arcuate track within the first arcuate track allows the pivoting of the upper jaw 80 in relation to the lower jaw 40. A retaining band 42 of the proximal portion 50 of the lower jaw 40 is disposed laterally across the top from the upper and lower concentric surface 87. The retaining strip 42 securely holds the second arcuate rail within the first arcuate rail such that it cannot be lifted out of its housing.
It is also shown in Figs. 3A - 3C the location of a pivoting connection 75 between the distal jaw piece 60 and the proximal jaw piece 50; aspects of the pivotable connection 75 are described below in the context of Figs. 7A - 7C. It is also shown in Figs. 3A - 3C a tilt member 74, which is described below, in the context of Fig. 9D and Figs. 11A-11B.
Figs. 4A - 4D provide lateral views across the longitudinal midline of a set of jaws and several views of a tissue dissection blade, according to the disclosed technology. The focus of these figures refers to aspects of the blade and its proximal maintenance space that prevents distal movement of the blade when the mandibles are in an open position. Fig. 4A shows the modality of the device in an open position with a blade 105 in a raised and proximal maintenance position. Fig. 4B shows the modality of the device in the closed position, with the blade 105 in a proximal and lowered maintenance position, ready to be advanced distally. Fig. 4C shows the device in the closed position, with the blade in an advanced position distally. When the blade 105 is in a proximal maintenance position, its lower edge 105B rests on a shelf 95, a feature of the second arched track piece 85 of the upper jaw 80. (shelf 95 can also be seen in Figs. 3A and 3B) . When comparing the views of Fig.4A (jaws open) and Fig. 4B (jaws closed), it can be seen that when the jaws are open, shelf 95 is rotated to a raised position, and when the jaws are closed, shelf 95 is rotated to a lower position. The raised position of the shelf prevents distal movement of the blade; the lowered position of the shelf allows distal movement of the blade. Fig. 4D is a perspective view of an isolated blade from the stem and jaws. At its proximal end, the blade 105 is connected to a location 109 on the handle that is supported by a mechanical connection that holds the blade in a withdrawn or proximally inclined position.
The upper jaw pivot 80 pivots upwards, in order to move the adjusted jaw in an open position driven by the rotation of the second arcuate rail 85 within the housing of the first arcuate rail 45. As can be seen in fig. 4A, as the arcuate rail 85 rotates upwards (clockwise, in this view), its shelf 95 also rotates upwards, raising the blade 105 upwards. As the blade 105 is raised, its upper edge 105A is raised above the ceiling of the opening of the distal wing of the blade rail or passage through 106. Blade rail 106 is not visible in the side view of Figs. 4A and 4C, but can be seen in Figs. 5A and 5B. When the upper jaw 80 is closed in relation to the lower jaw 40 (as in fig. 4B), the second arcuate rail 85 and its blade shelf 95 is rotated downward, allowing blade 105 to launch into a position such that it has a path free on the slide rail 106. This relationship described and depicted between the blade, the shelf of the second rotating arcuate rail (of the upper jaw 80), and the blade rail thus creates a mechanism that prevents distal movement of the blade when the jaws are in an open position, allowing distal movement only when the jaws are in a closed position, as can be seen in fig. 4C.
Figs. 5A - 5C provide views of an alternative modality (Modality B) of a laparoscopic electrosurgical device in which a set of jaws 130 includes a first jaw 140 that is unitary and fixed in relation to the stem and the second jaw 180 is a two-piece jaw which is pivotable in relation to the rod. More particularly, the two-piece (second) jaw of this embodiment has a proximal piece 150 that is pivotable in relation to the stem, a distal jaw piece 160 that is pivotable in relation to the proximal piece, and a pivotable assembly 155 connecting the piece of the proximal jaw and the distal jaw piece. Fig. 5A provides a perspective view of this type of device with the jaws in an open position. Fig. 5B provides a side view of the modality with the jaws closed to a point where the distal ends of the jaws are in contact. Fig. 5C provides a side view of the modality with the jaws in a completely closed position. Fig. 5A shows the jaws without a polymer coating, which provides a view of the troughs 84 inside the surface of the electrode 142. Similar troughs are present in the upper jaw of modality A.
Unlike the variation in the configuration of the jaws as just described, other aspects of modalities A and B are substantially the same. In particular, the dynamics of closing the Type B jaws are substantially the same as those of the
Mode A, which are described in detail below, in the context of Figs. 7A - 7E.
Fig. 6 provides distal views of a set of jaws of a modality of the laparoscopic electrosurgical device in the closed position, more particularly a cross-sectional view shows a passage of the blade or rail 106 through which a blade can be advanced distally. The transverse slice on the right side of fig. 6 reveals a section through the first arcuate track 45 (from the proximal portion 50 of the lower jaw 40) that substantially covers the second arcuate track 85 (from the upper jaw 80). A proximal transverse slice through the blade 105 can be seen within the groove 88 of the second arcuate track 85. The groove 88 is contiguous with the blade track 106 of the jaws, as best seen in fig. 12C. Fig. 6 also provides a view that allows a calculation of the proportion of the total transverse area of a critical portion of the device that provides support structure in front of the jaws. This portion of the device is a relevant place to consider for its structural content due to the fact that it includes the pinless pivoting mechanism by which the jaws pivot in relation to each other. In an otherwise more conventional structure, this area may include pins or other structures that do not transmit structural support to the jaws. In this area, therefore, modalities of a pinless rotation mechanism provide structural material content that might otherwise be missing. If a diameter of 0.218 inches is considered, which is consistent with the contiguous circular appearance of the base of the jaws, the cross-sectional area included in it is about 0.0373 square inches. Through this section the transverse area of the upper jaw is about 0.0151 square inches, and that of the lower jaw is about 0.0155 square inches. The summed area of the upper and lower jaws is about 0.0306 square inches, or about 82% of the total cross-sectional area. Figs. 7A - 7E provide lateral views of a set of jaws of a modality of a laparoscopic electrosurgical device in an open position, and in various states of partial or initial closure and complete closure. These figures focus on the pivotable relationship between the distal pivotable part or the portion 60 and the fixed or base proximal part 50 of the lower jaw 40, as enabled by the pivotable rotation mechanism or assembly 75. The pivotable relationship between the pivotable portion 60 and the base portion 50 throws out in a number of ways that the lower jaw 40 and upper jaw 80 approach each other as they close, particularly as they close around a portion of the target tissue to be treated electrosurgically. Fig. 7A shows the jaw modalities in an open position. The portion of the pivotable jaw 60 of the first jaw or lower jaw 40 is pivotable within its longitudinal axis at the pivotable connection 75 through an arc with a total rotational range of about 6 degrees. In various embodiments, the rotational range can be between about 2 degrees and about 8 degrees or more. In the open position as shown in fig. 7A, pivotable jaw piece 60 is pivoted to its maximum degree of rotation clockwise, with the distal end of the pivotable jaw piece in a raised position (the terms clockwise and counterclockwise are used in relation to the side view shown , with the distal end of the mandible on the left side of the image). This clockwise position is a standard or angled position as shown in the figure. 11A, showing the lower jaw 40 isolated from the upper jaw 80. This standard position can be maintained by pushing a spring or tilt mechanism arranged at the proximal end of an actuator wire (not shown).
The clockwise rotation or pivoting of the pivotable jaw piece 60 (of the lower jaw 40) results in its distal end or point 66 assuming a relatively high profile and its proximal aspect assuming a relatively low profile in relation to the proximal jaw piece 50. The differences in the profile are relatively subtle, but are apparent when the proximal aspect of the upper profile of the electrode surface 62 is seen in relation to the upper surface of the proximal aspect of the proximal jaw piece 50. In fig. 7A, for example, there is a relatively small linear profile of electrode 62 visible on the base provided by the proximal jaw piece 50. The height of this profile, indicative of the relative degree of pivoting of the pivotable jaw piece 60, will be noted in the descriptions associated with Figs. 7B - 7E, below. The relationship between the pivoting of the pivotable jaw piece 60 with respect to the base jaw base piece 50 is also apparent in Figs. 10A and 10B.
Fig. 7B shows an embodiment of a set of jaws at one point when they are moving towards a closed position, when the distal jaw tips (distal tip 96 of the upper jaw 80 and distal tip 66 of the lower jaw piece 60 ) come into contact with each other first. After the first contact of the tips of the mandibles, a gap remains in the region between the mandibles 111 at its proximal ends. As in fig. 7A, the pivotable part 60 is in its standard inclined position, pivoted to its maximum degree of rotation clockwise. In this position, after the first contact of the tips, no pressure has yet been applied to the tips of the jaws. As in fig.7A, there is a relatively small linear profile of electrode 62 visible on the base provided by the proximal jaw piece 50. Fig. 7C shows the jaw modalities in a completely closed position, with the jaws starting from the distal tip to the proximal end, in full contact with each other. This relative positioning of the mandibles can be understood as that which would occur when the mandibles are being closed without intervening tissue between them, or when intervening tissue is very thin. Thus, this relative configuration is similar to the one that arrived when the jaws are closed around a thin piece of fabric, as seen in fig. 7E (described below), but without the intermediate space occupied by the tissue. This position is reached by an anti-clockwise pivoting of the lower jaw pivotable piece 60 around the pivotable connection 75 such that the distal tip of the pivotable piece moved downward, and the proximal end of the pivotable piece moved upward . Consistent with this raised aspect of the proximal part of the pivotable mandible part 60, and in contrast to the view seen in fig. 7A and 7B, fig. 7C shows that there is a relatively high linear profile of electrode 62 visible on the base provided by the proximal jaw piece 50. Details of the pivotable connection 75, in its components that are associated with both the pivotable jaw piece 60 and the jaw piece of distal base 50 can be seen in Figs. 9A - 9D. Fig. 7D shows the modalities of the mandible in a partially closed position, with the mandibles as they would be when closing around a portion of the relatively thick portion of the target tissue (not shown), but with a thickness that does not exceed the effective capacity of the jaws. Intra-mandibular pivotability, as represented by the first jaw 40, provides an ability for a set of jaws to align in a partially or substantially parallel configuration as they close around a portion of tissue, a skill that provides an advantage over a set conventional jaws without such intra-mandibular pivotability. The configuration of the jaws, as shown in fig. 7D is one in which the target tissue thickness would likely exceed the therapeutically acceptable thickness limit for a conventional set of jaws, but which is well within therapeutically effective capacity.
A non-parallel closure of the mandibles, as is typical of conventional mandibles that do not have intra-mandibular pivotability or another compensation mechanism, can have therapeutically unsatisfactory consequences, such as the uneven distribution of pressure on the tissue along the contact line of the jaw. mandible, as well as the unequal distribution of radiofrequency energy, when delivered by electrodes. Modalities of a set of jaws, as provided here, however, can of course still continue to be confronted with a portion of the tissue target that exceeds its capabilities for parallel closure of the jaw engagement surfaces. However, as noted, the thickness of the tissue that would count for the configuration of the jaws, as seen in fig. 7D, is the one that demonstrates the therapeutic advantage of intra-mandibular pivotability of the lower jaw 40.
This relative positioning of the mandible modalities, as seen in fig. 7D, it happens for at least two reasons. First, the jaws are not completely closed at the level of the rotational assembly connecting the proximal aspects of the jaws. Second, as in fig. 7C, this position has been reached by an anti-clockwise pivot of the lower jaw pivotable piece 60 around the pivotable connection 75, at least partially through its angular rotation range. From the standard position of the pivotable part 60, this clockwise rotation moved the distal tip of the jaw piece 60 downward and the proximal end of the jaw piece 60 upward. Thus, and due to this configuration of the parallel jaw, pressure being applied to the tissue from the jaws is distributed with substantial regularity over the entire length of contact between the jaws and the tissues, and radiofrequency energy, when delivered, is also distributed with substantial longitudinal regularity or uniformity.
Fig. 7E shows the modalities of the mandible in a partially closed position, with the mandibles as they would when closing around a portion of the relatively thin target tissue, the mandibles in a parallel alignment, spaced by a narrow gap, reflecting the presence of thin fabric between them. This relative positioning of the jaws occurs for at least two reasons, as described above in a similar way in the context of Fig. 7D. First, the jaws are almost, but not completely, closed at the level of the rotational assembly connecting the proximal aspects of the jaws. Secondly, this position was achieved by counterclocking pivoting of the lower jaw pivotable piece 60 around the pivotable connection 75 through, or nearly through its angular rotation range. This clockwise rotation moved the distal tip of the jaw piece 60 slightly downward and the proximal end of the jaw piece 60 slightly upward. As can be seen in Figs. 7A and 7B, there is a relatively small linear profile of the electrode 62 visible on the base provided by the proximal jaw piece 50. Fig. 8 is a perspective and upward view of a set of jaws of a modality of a laparoscopic electrosurgical device in an open position. More specifically, it shows an isolated upper jaw 80 and an isolated distal pivotable jaw piece 60 from a lower jaw, and a ring actuator or cable 22 around a fixation point 99 at the proximal end of the upper jaw. An advantage provided by this provision concerns the ease of fabrication and assembly of this aspect of the device by the fact that a fixed solder point is not necessary. Another structural advantage is that the tension within the actuator wire is distributed over a portion of the ring length, rather than being focused on a fixation point. It can be seen that a distal push by the actuator wire 22 would pivot up the upper jaw 80 towards an open jaw position, and a proximal pull would cause a pivot down the upper jaw 80 towards a jaw position. . At its proximal end, the actuator wire 22 is connected to the jaw actuator handle 15, as shown in fig. 1. Figs. 9A - 9D provide several views of a lower jaw 40 of a modality of a laparoscopic electrosurgical device, which includes part of the proximal or base jaw 50 that is fixed in relation to the rod and part of the distal pivotable jaw 60 that is pivotably connected to the base piece. The focus of Figs. 9A - 9D refers to the modalities of a pivotable connection or set 75 that connects jaw parts 50 and 60. The pivotable proximal jaw piece and distal jaw piece are pivotally connected to the pivotable joint located at a substantially central location in the pivotable part and in a distal aspect of the proximal mandible part. Fig. 9A is a side view of an isolated lower jaw 40 from a laparoscopic electrosurgical device, the lower jaw including a proximal jaw piece 50, fixed in relation to the nail, and distal pivotable jaw piece 60 mounted at a substantially central point in a distal aspect of the proximal jaw piece. It can be seen that the pivotable assembly 75 includes a shoulder 71 of the pivotable jaw piece 60 rotatably arranged in a recess 48 of the base jaw piece 50. This is a bilateral arrangement, the shoulders 71 projecting outward on both sides of the piece of the pivotable jaw 60, and recesses 48 on both sides of the base jaw piece 50. This arrangement therefore represents a pivotable mechanism that does not include a traversing pin. This provision also provides an advantage in the ease of assembly, in which the parts can be assembled together. Fig. 9B is a perspective view of an isolated lower jaw 40 of a laparoscopic electrosurgical device showing a lower jaw 40 having a proximal jaw piece 50 and distal pivotable jaw piece 60 in an exploded relationship. Distal piece 60 is shown moved upwards 20 and moved distally from its mounted position within the proximal piece 50. A shoulder 71 is visible on one side of the pivotable jaw piece 60, and both of the receptacles or recesses 48 of the jaw piece bottom 50 are visible. The proximal aspect of the base jaw piece 50 is flexible enough that it can expand to accommodate the entry of the pivotable jaw piece 60. After engaging both shoulders 71 in their respective receptacles 48, the expanded base piece will recede back to its native configuration, thus holding the pivotable jaw piece in place. Also visible in this view is the pivot ridge 30, centrally disposed under the shoulders 71. When assembled, the pivot ridge is in contact with an upper surface of the base 50 jaw piece, and provides the elevation that allows pivoting to occur. Fig. 9C provides a bottom view of a lower jaw 40 of a laparoscopic electrosurgical device, showing a view of the connection between a proximal jaw piece 50 and assembled pivotable jaw piece 60. Bosses 71 of the pivotable jaw piece 60 are visible within recesses 48 of the lower-base jaw piece 50. Fig. 9D is an upward perspective view of an isolated distal pivotable piece 60 of a lower jaw 40 of a laparoscopic electrosurgical device . Bosses 71 are visible, as is pivot ridge 73. A tilt member such as spring bundle 74 is also visible which is positioned in a recess of the lower aspect of the pivotable jaw piece 60 of the lower jaw piece 50. a tilt member arranged in this position serves to maintain a tilt or pattern position of the pivotable part 60 such that its distal tip is pushed away from the distal end of the companion fixed jaw piece 50 of the lower jaw 40, and towards the distal tip of the upper jaw 80, as seen, for example, in fig. 7B. The proximal end 65 of the pivotable part 60 includes a longitudinal fissure arranged centrally, which is a part and contiguous with the blade track 108A in the lower wing, as seen from a top view perspective in Figs. 2A and 12C. Figs. 10A and 10B provide semitransparent side views of a lower jaw 40 of a modality of a laparoscopic electrosurgical device, showing a proximal base jaw piece 50 and pivotally connected to the distal pivotable jaw piece 60. Fig.10A shows the part of the distal jaw distal pivotable jaw 60 in its standard inclined position, the distal end of the distal pivotable jaw piece being pivoted to its upper endpoint, towards the upper jaw (not shown). This standard position is maintained as a slope by a spring, as best seen in Figs. 11A and 11B. This is the pivoted position of the distal jaw piece when the jaws are open, and is maintained as the jaws are closed to a point when the distal jaw ends first make contact with each other, such a contact representing a closing feature of the jaw. first tip of the jaws.
In contrast, Fig.10B shows the distal end of the distal pivotable jaw piece 60 pivoted towards its lower end point, the proximal end of the distal pivotable jaw piece being pivoted towards its upper end point, such a position would place the lower jaw in a generally parallel relationship with the upper jaw (not shown). This is the pivoted position of the distal jaw piece when the jaws are closed, or generally the position when the jaws are closed around the tissue, particularly when they closed around the thin tissue. A shoulder 71 and pivot ridge 73 over the pivotal jaw piece 60 can be seen. The shoulder 71 is positioned inside the receptacle or recess 48 of the base jaw piece 50. The arrangement of the shoulder and receptacle and the pivot ridge together form a connection or pivotable assembly 75.
As summarized above, connection methods or pivotable assembly 75 provide a pivotable peak of about 2 degrees to about 8 degrees; Particular modes are configured to pivot within a range of about 6 degrees. The relationship between the pivot of the distal jaw piece 60 and the dynamics associated with opening and closing the jaws, with and without tissue being gripped between them, is described above in the context of Figs. 7A - 7E. Particularly clear in Figs. 10A and 10B is the difference in the elevation of the proximal aspect of the pivotable mandible 60 and its tissue engagement surface and comprising electrode 62 above the upper edge of the proximal portion of the base mandible part 50.
Figs. 11A and 11B provide side views of a lower jaw of a laparoscopic electrosurgical device that are similar to those shown in Figs. 10A and 10B, but which have a greater degree of transparency through the distal and pivotable part 60 of the lower jaw 40. These figures focus on an inclined member 74 in the form of a spring bundle attached to an upper aspect of the distal part of the part proximal and fixed jaw 50. Modalities of the technology include other arrangements that would serve the same tilting function. For example, the tilt member can include other types of springs, and could be attached to the pivotable part of the jaw, instead of the fixed part. In the example described, fig. 11A shows the spring bundle 74 attached to a superior aspect of the proximal jaw piece, the spring is in an expanded configuration, pushing against the pivotable jaw piece in order to keep the distal pivot piece in its standard inclined position through which the distal end of the distal pivotable jaw piece to its upper end point. In contrast, fig. 11B the collapsed or compressed configuration of the spring, the result of the pressure being exerted on the distal end of the distal pivotable part of the jaw, as would occur during the closing of the jaw. Figs. 12A - 12C provide several proximal views of the distal tips of the mandibles of a modality of the laparoscopic electrosurgical device. These views focus on complementary longitudinal alignment characteristics that prevent lateral slippage or misalignment when the jaws close, particularly when they close around a portion of the target tissue. Complementary V-shaped surfaces are used in the displayed examples of longitudinal characteristics that encourage self-alignment of the jaws, but those familiar with the technique will recognize that other complementary surfaces will serve the same purpose, and as functional equivalents, they are included as modalities of technology revealed. Fig. 12A is a proximal perspective view of the distal tips of a closed set of jaws, while Fig. 12B is a facing view. Upper jaw 80 shows a V-shaped recession over distal tip 96; distal piece 60 of the lower jaw 40 shows a V-shaped projection at its distal tip 66. The mutually complementary V-shaped profiles represent a profile that extends substantially across the length of the respective electrode surfaces, that is, the electrode surface 82 of the upper jaw 80 and surface of the electrode 62 of the pivotable part 60 of the lower jaw 40, respectively. The total length of the respective electrode surfaces is best seen in fig. 12C. Modalities of the technology include configurations where the mutually complementary jaw surfaces do not extend the total length of the jaws, and the shape of the complementary surfaces need not necessarily be of consistent shape along the length of the jaw. Fig. 12C is a proximal perspective view of a distal aspect of an open set of jaws of the laparoscopic electrosurgical device showing a V-shaped projection on the lower jaw, and a V-shaped recession on the upper jaw, as well as a gap longitudinally centrally oriented on both V-shaped surfaces that form a crossing passage for a blade that is distally advanceable when the jaws are in a closed position. Fig. 12C also shows insulating bands 92 arranged through the electrode tray or surface of the bipolar electrode 82 of the upper jaw 80. Additionally, longitudinal gaps arranged centrally are visible in both the upper and lower jaws. The gap 108A in the lower jaw piece 60 and the gap 108B in the upper jaw 80 collectively form a path through the distal passage 106 to / from blade 105 (not seen here, but shown in Fig. 2B). Figs. 13A - 15C all refer in various ways to the aspects of the junction between the proximal end of a jaw set and the distal end of a nail, and the isolated and separate electrical paths to the upper and lower jaws, respectively, by modalities of technology. Figs. 13A - 13F provide several views of an electrosurgical device modality that show aspects of the proximal portion of a set of jaws and the very distal portion of the stem through which the cables or wires of the jaw actuator pass. Fig. 13A provides an exposed proximal perspective view of an insulator or conduit unit 210 arranged at the bottom (in this view) of the distal end of the rod 20. This insulator unit 210 guides the twinned actuator wires (not shown) from the center from the stem to its eccentric position transversely in such a way that the wire is positioned for its attachment to a proximal location of the arched track 85 of the upper jaw 80 (see fig. 8). Sprouted wire channels 202 can be seen on the distal face of the plumbing unit 210. As noted above, actuator wire modes for the upper jaw 80 also transmit electrical current to the upper jaw 80. Another function of the wire isolator unit 210 is , thus, to isolate rod 20 and proximal base 50 of the lower jaw from the current being transmitted to the upper jaw. Fig. 13B is oriented from the same perspective as that of fig. 13A, but shows a plate holding cable 205 in place over an area where the cables emerge from a central transit through the stem and are diverted to an eccentric location, where they are attached to a proximal aspect of the pivotable upper jaw. Cable retention plate 205 secures cables through this portion of their path and also provides electrical insulation of the wires within this space. Fig. 13C is a transparent distal view showing a cable insulator unit with parallel cable channels. Figs. 13C and 13D provide both a view of the blade 105 and its path through the insulator unit 210, as well as the distal openings of the wire channels 202. Fig. 13D provides a view similar to that of Figs. 13C, but with cables 22 in place. Fig. 13E is a side view of a longitudinal section, slightly displaced from the midline, showing the cable paths 22 through the distal portion of the nail and in the proximal aspect of the mandibles. The closer the twin cables 22 can be seen to be channeled from their central position within the main body of the stem to a peripheral position at the very distal end of the stem. As the cable 22 passes through the proximal base of the jaws, it wraps around the attachment site 99 of the base of the upper jaw 80. Polymer layer 90 can be seen as an outline around a major portion of the arcuate rail portion 85 of the upper jaw 80, however the place where the cable is attached is not covered with polymer. The unprotected aspect of the cable 99 attachment location can also be seen in Figs. 14A, 14B, 15A and 15B. Other aspects of the upper jaw arcuate rail portion engaging surfaces of the lower jaw base portion 50 are coated with polymer 90 such that the upper and lower jaw surfaces are insulated from each other. Thus, twinned cable 22 makes direct electrical contact with the upper jaw 80 to exclude contact with the lower jaw part 50. The cable retention plate 205 (see fig. 13B) is formed from plastic, and so too serves as an insulating function. Fig. 13F is a proximal perspective view of the proximal end of a lower jaw piece 50 which is inserted into the distal end of a nail, also showing engagement of the proximal end of the nail with a cable insulator unit. Fig. 13E and Fig. 13F generally also show a distal aspect of the electrical path that provides radiofrequency energy for the upper jaw, to the exclusion of the lower jaw. The electrical path that provides radiofrequency to the lower jaw is stem 20 as a whole. Aspects of the proximal portions of the electrical paths to the upper and lower jaws are shown in Figs. 16A - 16D. Figs. 14A - 14C provide several non-transparent views of an insulating layer 91 that covers aspects of an upper jaw 80 of an electrosurgical device. Fig. 14A is a bottom perspective view of a type of an upper jaw that shows a plastic insulating layer overlapping the aspects of an electrode. Fig. 14B is a top perspective view of an upper mandible modality of an electrosurgical device showing an insulating layer of polymer overlapping peripheral and proximal aspects of the electrode. Fig. 14C is a top perspective view of an upper jaw embodiment showing an insulating layer of polymer overlapping the electrode with the proximal portion of a truncated jaw to expose a cross section. Figs. 4A - 14C show polymer layer 90 (indicator in bold) of a relatively light rendering, covering a major portion of the upper jaw 80; uncoated metal is shown in a darker rendering. These figures also provide a good view of aspects of the arched track portion 85 of the upper jaw 80, including the surface of the upper and lower arched track 87, the surface of the smaller and larger arched track 86, and a central groove 88, which is contiguous with the slide rail 106 (as also seen in fig. 12C).
In the figure. 14A, polymer coating 90 is seen across the entire contour of the exposed metal electrode surface 82 and the attachment location of actuator 99 in fig. 14A. The more lightly rendered polymer overlaps it also takes the form of insulating strips 92 that are arranged across the surface of electrode 82. The thickness of the polymer coating 90 is in the range of about 0.005 inches to about 0.015 inches. The polymer layer that takes the form of insulating strips 92 remains outside the broader surface of electrode 82 for about 0.004 inches to about 0.008 inches, but its total thickness is greater because it is positioned on a rail, as seen in fig. 5A (track 84 within the surface of electrode 142).
Figs. 14B and 14C show exposed or uncoated metal on the upper surface 83 of the upper jaw 80. Fig. 14B shows that the insulating layer 90 fully covers the proximal aspect of the upper jaw 80, including the surfaces of the arcuate rail portion 85. The receptacles 89 on the upper aspect of the mandible are filled with polymer 90, as the polymer fills these receptacles so that it is a continuous filling the side of the lower electrode of the mandible (as seen in fig. 14A) crosses for an exposure of top surface. Fig. 14C differs from fig. 14B, due to the fact that the proximal aspect of the mandible is truncated with a cross-sectional exposure 85C just distal with a smaller or higher concentric surface of the arched track 85. Figs. 14B and 14C also show band 89 anchorage receptacles in the upper jaw 80. These receptacles penetrate the metal and fill with polymer during the coating process, anchoring the coating against the electrode surface. On the bottom surface of the electrode, receptacles 89 are positioned inside the slide rail 108B (see fig. 14A). Peripheral anchoring recesses 91 are arranged around the edge of the jaw 80, also serving to stabilize polymer layer 90 in place. Figs. 15A - 15C provide several views of an insulating layer 90 that covers aspects of an upper jaw of an electrosurgical device and that includes ceramic reinforcement areas 93 in particular locations that may be subject to abrasive stress or erosion. These abrasive stressed locations are on the upper surface of the arched track 85 (more specifically the smaller concentric surface 86) of the upper jaw 80. When the jaws pivot, these locations rotate against the upper concentric surface of the arched track of the lower jaw (see Figs. 3A - 3C and Fig. 8.). The stress applied to this rotational engagement area of the upper and lower jaws comes from the tension that can be applied by the jaw actuator wire. Fig. 15A is a top perspective view of an upper jaw modality that has ceramic dots 93 overlapping the electrode at points of abrasive stress. This view does not include an overlapping polymer layer. Fig. 15B is a top perspective view of an upper jaw modality, showing ceramic points 93 overlapping the electrode on abrasive stress points as they are embedded in a more extensive polymer layer 90. Fig. 15C is a top perspective view of an embodiment of a pair of closed jaws that has ceramic dots 93 superimposing the electrode on points of abrasive stress as they are incorporated or disposed within a more extensive polymer layer 90. Figs. 16A - 16D show various views of the proximal portion of a rotating rod modality 20 and electrical and mechanical components associated with the rod that are housed in the cable 10 of an electrosurgical device. Fig. 16A is an exposed distal perspective view of a cable of a modality showing aspects of the proximal end of a rotating rod. Fig. 16B is a proximal perspective view of an isolated proximal end of a rotating rod. Fig. 16C is a cross-sectional side view of the midline of an isolated proximal end of a rotating rod. Fig. 16D is an exposed midline cross-sectional view of a portion of the rotating rod that is housed in the handle.
As seen in these various views, the proximal end of the rod 20 ends in an assembly associated with the proximal rod, which includes an actuation collar 307 around which it is slidably wrapped within a feed tube 313. Proximal to the actuation collar 307 are a control flange 303 and a control post 301. A jaw actuator engagement groove 305 is disposed between the control flange 303 and the control post 301. The actuating collar and its involved feed tube are disposed within the U-shaped proximal electrical connector partially clad 311. The actuating collar and supply tube are rotating and sliding inside the proximal electrical connector. Actuation of the rotation of the rod (and the actuation collar and supply tube) is controlled by the rotation actuator 12, as shown in Figs. 1A - 1D, but not shown in this view. The actuation of the distal-proximal slippage of the collar and feeding tube is controlled by a mechanical connection that is connected lately to the grip of the actuator of the jaw 15, as shown in Figs. 1B - 1D. The connection of the actuator of the jaw engages the assembly associated with the rod within the groove 305.
The proximal electrical connector 311 delivers radiofrequency electrical energy to the feed tube 313 through a secure, but sliding contact that is maintained regardless of the rotational position of the feed tube, and regardless of the distal to proximal translational position of the feed tube. Electric energy is transmitted through this path from a generator that is part of a larger electrosurgical system for cables 22 that end proximally inside the actuation collar 307 at a location for attaching the proximal cable 310. A plug on the collar 309 that fills a asymmetric space within a proximal aspect of the actuation collar 307 serves in various mechanical capacities, one of which is attached to hold cables 22 in their attachments to the location of attachment 310. The cables 22 end distally in an attachment to an upper jaw, such as shown in fig. 8.
Electrical energy is also transmitted to the distal electrical connector 315 of a system generator and electrical connector 315 delivers energy to the rod 20, which then conducts energy to the lower jaw 50. Through these approaches, electrical paths to the upper jaw and lower jaw, respectively, are segregated within the cable. Separate paths are maintained throughout the main body of the stem, where the electrical energy to the upper jaw transits through the germinated cables arranged centrally 22, and where the electrical energy to the lower jaw transits through the columnar stem 20. Segregation of these two paths in the junction of the stem and the jaws is described above in the context of Figs. 13A - 13F.
Unless otherwise stated, all technical terms used in this document have the same meanings as commonly understood by someone ordinarily versed in the technique of surgery, including electrosurgery. Specific methods, devices and materials are described in the present application, but any methods and materials similar or equivalent to those described here can be used in the practice of the present invention. While embodiments of the invention have been described in some detail and by means of figures, such figures are intended for the sake of clarity of understanding only and are not intended to be limiting factors. Several terms have been used in the description to convey an understanding of the invention, it will be understood that the meaning of these terms extends to common linguistic or grammatical variations or their forms. It will also be understood that when the terminology referring to devices or equipment, that these terms or names are provided as contemporary examples and the invention is not limited by such a literal scope. Terminology that is introduced at a later date that can reasonably be understood as a derivative of a contemporary term or designation of a hierarchical subset embraced by a contemporary term will be understood to have been described by the now contemporary terminology. In addition, while some theoretical considerations may have been advanced in favor of providing a knowledge of technology, the attached claims of the invention are not bound by such a theory. In addition, any one or more of the features of any embodiment of the invention can be combined with any one or more features of any other embodiment of the invention, without departing from the scope of the invention. In addition, it should be understood that the invention is not limited to the modalities that were established for the purpose of exemplification, but should be defined only by a fair reading of the claims attached to the patent application, including the full range of equivalence to which each element yours is titled.

权利要求:
Claims (14)
[0001]
1. An electrosurgical device comprising: a set of opposing jaws (30) disposed distal to a rod (20), the set of jaws comprising a first jaw (40, 180) and a second jaw (80, 10), each jaw comprising a tissue engagement surface with at least one bipolar electrode disposed on it, the jaw set configured to deliver radio frequency energy to a target tissue, where the jaw set, when closed, has a diameter no larger than about 5mm , and where the stem has a diameter of no more than about 5 mm; and a pinless rotation mechanism (101) comprising cooperatively rotating features of the first jaw and the second jaw that connects the jaws and allows the jaw to adjust to pivot between an open position and a closed position, where the rotation mechanism without pin creates a common center of rotation that is not necessarily positioned at a point in a row corresponding to a central longitudinal axis of the stem, characterized by the fact that the set of two opposite jaws is configured in such a way that when the set of jaws is moving from an open to a closed position, mutual contact between the two jaws occurs at a distal end of each jaw, and a) the first jaw (180) comprises two parts, a proximal part (150) pivotable in relation to the shank (20) and a distal part (160) pivotally connected to the proximal part, in which the second jaw (140) is unitary and fixed in relation to the shank (20) , or b) the first jaw (40) comprises a proximal piece (50) fixed in relation to the nail, a pivotable distal jaw piece (60) and a pivotable assembly (75) connecting to the proximal piece (50) and the distal mandible (60), and in which the second mandible (80) is unitary and pivotable in relation to the nail.
[0002]
2. Electrosurgical device according to claim 1, characterized by the fact that each of the opposing jaws (30) comprises a longitudinal axis and a tissue coupling surface, the tissue coupling surface of each jaw having a configuration of complementary self-alignment in relation to the longitudinal axis of the other mandible.
[0003]
3. Electrosurgical device according to claim 1 or 2, characterized by the fact that the cooperative features of the first jaw and the second jaw rotatively comprise: a proximal aspect of the first jaw having a first arcuate track (45); and a proximal aspect of the second jaw having a second arched track (85), the first and second arched track being mutually complementary and slidably coupled to each other, the second arched track residing substantially within a housing formed by the first arched track.
[0004]
4. Electrosurgical device according to claim 3, characterized by the fact that the first arcuate track (46, 47) comprises two concentric surfaces facing each other, one smaller and the other larger, and the second arcuate track (85) comprises two concentric surfaces (86, 87) facing each other, one smaller and one larger, and where the smaller concentric surfaces of the first and second tracks are complementary to each other and where the larger concentric surfaces of the first and second rail are complementary to each other, and in which the second arcuate rail resides substantially within a housing formed by the first arcuate rail.
[0005]
Device according to any one of claims 1 to 4, characterized in that it additionally comprises a blade (105) positioned on a longitudinally arranged blade rail (108A), in which the blade (105) can be positioned on the initial position at a proximal end of the rail, at a distal end of the rail, or at any point along the rail between the distal and proximal ends of the rail.
[0006]
6. Device according to claim 5, characterized by the fact that when the jaws are in the open position, the proximal initial position of the blade (105) is configured in such a way that the movement of the blade in a distal direction is blocked.
[0007]
7. Device according to claim 2, characterized by the fact that it comprises at least one, more or all of the following characteristics: the self-aligning configuration of the mandibular tissue coupling surfaces comprises complementary longitudinally aligned characteristics arranged along a substantial totality of a length of each jaw, the self-aligning configuration of the jaw tissue coupling surfaces comprises complementary longitudinally aligned aspects of the jaw which comprise a substantial totality of the tissue coupling surfaces of each jaw.
[0008]
8. Device according to claim 1, characterized by the fact that it additionally comprises: a handling portion (10) proximal to the stem (20); a jaw actuator (15) associated with a handling portion (10) configured to actuate a mechanical capacity of the jaws; and an actuator wire (22) connected proximally to the actuator mechanism and connected distally to the set of jaws.
[0009]
9. Device according to claim 8, characterized by the fact that it comprises at least one, more or all of the following characteristics: the actuator wire (22) is configured to actuate a jaw pivot between the open position and the position closed pivoting the second jaw (80) in relation to at least the proximal part (50) of the first jaw (40), the proximal part (50) of the first jaw (40) being fixed in relation to the rod (20), the wire actuator (22) is configured to actuate a jaw pivot between the open position and the closed position, and in which the actuator wire is additionally configured to deliver RF energy to at least one of the two opposite jaws, the actuator wire it is configured as a push and pull mechanism, in which a push directed distally from the wire moves the jaws to their open positions and a pull directed proximally from the wire moves the jaws to their closed positions.
[0010]
10. Device according to claim 1, characterized by the fact that it additionally comprises a handling portion (10) proximal to the stem (20) and an energy delivery wire (22) extending distally from the handling portion for the jaws, the energy delivery wire configured to perform a mechanical function in relation to a capacity of the jaws.
[0011]
11. Device according to claim 1, characterized by the fact that each of the first jaw and the second jaw comprises a metal portion and in which a substantial totality of the metal portion of the first jaw and a substantial totality of the portion of metal of the second mandible, each, comprise an electrode.
[0012]
12. Device according to claim 1, characterized by the fact that it additionally comprises a rotating rod actuator (12) positioned in association with a handling portion (10) of the device, in which the rotating rod actuator is configured to be able to rotate freely both clockwise and counterclockwise, such rotation of the actuator being translatable to the rotation of the stem.
[0013]
13. Device according to claim 1, characterized by the fact that the set of jaws is configured in such a way that when the set is moving towards the closed position and made an initial contact with the target tissue, a pivotable part of the first pivotable jaw then around a pivotable connection in response to the presence of the target tissue as the jaws further move towards the closed position to press the tissue.
[0014]
14. Device according to claim 13, characterized in that the pivoting of the pivotable jaw piece affects a substantially equivalent distribution of pressure along the pressed piece of the target tissue.

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同族专利:

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公开号 | 公开日

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WO2011097469A3|2011-12-15|

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EP2459093B1|2013-09-11|

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KR101786410B1|2017-10-17|

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JP2013518681A|2013-05-23|

---

EP2459093A2|2012-06-06|

---

BR112012003356A2|2016-02-16|

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US11058478B2|2021-07-13|

---

WO2011097469A2|2011-08-11|

---

CN102596080B|2016-04-20|

---

ES2436516T3|2014-01-02|

---

US20180185087A1|2018-07-05|

---

MX2012001235A|2012-05-23|

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KR20160073421A|2016-06-24|

---

EP2459093A4|2012-08-08|

---

AU2011212786C1|2014-10-16|

---

AU2011212786B2|2014-07-10|

---

KR20120139661A|2012-12-27|

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KR101733942B1|2017-05-08|

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CN102596080A|2012-07-18|

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JP2017119219A|2017-07-06|

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CA2766945A1|2011-08-11|

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AU2011212786A1|2012-02-02|

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US20110184404A1|2011-07-28|

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JP6337174B2|2018-06-06|

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RU2012103483A|2014-03-10|

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JP2015186579A|2015-10-29|

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JP6182564B2|2017-08-16|

---

US9918778B2|2018-03-20|

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KR20160073420A|2016-06-24|

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法律状态:
2019-01-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2020-07-21| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-12-08| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-02-02| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 04/02/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US30129510P| true| 2010-02-04|2010-02-04|

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US61/301,295|2010-02-04|

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PCT/US2011/023731|WO2011097469A2|2010-02-04|2011-02-04|Laparoscopic radiofrequency surgical device|

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