巴西专利BR112013022126B1 electrosurgical instrument

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专利摘要:
ELECTROSURGICAL INSTRUMENT, ELECTROSURGICAL TISSUE SEALING METHOD, METHOD, METHOD OF JOINTING AND STABILIZING AN ELECTROSURGICAL EFFECTOR END Technological modalities provide a pivotable electrosurgical instrument and methods of performing electrosurgery with a joint capacity. The electrosurgical instrument includes an elongated rod having an effector end associated with a distal end thereof that is capable of delivering energy to a target tissue site. A swivel joint is placed between this rod and the effector end. Pivot joint pivot is controlled by a stabilized pivot actuator, which may include a rotationally stabilized disc residing within an opening. The effector end can take the form of forceps, including an upper and a lower jaw; the jaws are configured to grip target tissue and deliver energy, such as radio frequency energy. In some of these instruments, the effector end is adapted to seal tissue by applying radio frequency energy, and then cutting through the portion of sealed tissue.
公开号:BR112013022126B1
申请号:R112013022126-7
申请日:2012-03-14
公开日:2021-05-25
发明作者:Lawrence Kerver；Erik Walberg；Brian Tang；Brandon Loudermilk
申请人:Aesculap Ag；
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专利说明:

CROSS REFERENCE TO RELATED ORDERS
[001] This application is a continuation in part of US Patent Application No. 12/027, 231 of Kerveret al., entitled "METHOD AND APPARATUS FOR ARTICULATING THE WRIST OF A LAPAROSCOPIC GRASPING INSTRUMENT" OF A LAPAROSCOPIC GRAPPING INSTRUMENT filed February 6, 2008. The present application further claims priority to US Provisional Patent Application No. 61/382, 868 to Walberg et al., entitled "ARTICULABLE ELECTROSURGICAL INSTRUMENT" , filed on September 14, 2010. INCORPORATION BY REFERENCE
[002] All publications and patent applications mentioned in this specification are hereby incorporated by reference to the same extent as if each individual publication or patent application were specifically and individually indicated to be so incorporated by reference. FIELD OF THE INVENTION
[003] Technology refers to medical devices for use during laparoscopic procedures. More particularly, the technology relates to an electrosurgical instrument with a pivotable joint operable to pivot an effector end. BACKGROUND OF THE INVENTION
[004] Bipolar electrosurgical instruments apply radio frequency (RF) energy to a surgical site to cut, remove, or coagulate tissue. A particular application of these electrosurgical effects is to seal blood vessels or tissue layers. A typical instrument takes the form of a pair of opposing jaws or forceps, with one or more electrodes at each end of the jaw. In an electrosurgical procedure, the electrodes are placed in close proximity to one another as the jaws are closed at a target location such that the alternating current path between the two electrodes passes through tissue within the target location. The mechanical force exerted by the jaws and electrical current combine to create the desired surgical effect. By controlling the level of electrical and mechanical parameters, such as the pressure applied by the jaws, the gap between the electrodes, and the voltage, current, frequency and duration of electrosurgical energy applied to the tissue, the surgeon can coagulate, cauterize or seal the tissue for a therapeutic purpose.
[005] Electrosurgical procedures can be performed in an open environment, through conventional incisions, or they can be performed laparoscopically, through small incisions, typically 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 from a cold light source to illuminate the operative field. The laparoscope is typically inserted into a port in the body through a 5 mm or 10 mm cannula to visualize the operative field. Surgery is performed during a laparoscopic procedure with any of a number of tools that are typically disposed at the distal end of a stem and are operable by manipulating a handle or other actuator positioned at the proximal end of the stem.
[006] The laparoscopic operating environment is very limited spatially, improvements with respect to the manipulability of laparoscopic devices by surgeons, or more particularly, improvements in the range of motion that effector ends for electrosurgical device can activate would be advantageous in the field. SUMMARY OF THE INVENTION
[007] Modals of technology provided herein include a pivotable electrosurgical instrument and methods of performing electrosurgery with an instrument having a pivotable capability. Modalities of the electrosurgical instrument include an elongated rod having an effector end with a distal end thereof and a handle associated with a proximal end thereof, the effector end being capable of delivering radiofrequency energy to a target tissue site. In typical instrument embodiments, the effector end may take the form of forceps or a set of jaws, including a first jaw (a lower jaw, for example) and a second jaw (a lower jaw, for example). The set of jaws is configured to grip target tissue and to deliver energy such as radio frequency energy. In some of these instruments, the jaw set is particularly adapted to seal tissue by applying radio frequency energy, and then to cut through the portion of tissue sealed with a blade.
[008] Instrument modalities may additionally include a pivotable joint positioned between the stem and the effector end, the joint is configured to pivot the effector end angularly within a pivot arc, the pivotable joint including at least one pivotable link or flexible element , or alternatively, a set of one or more interconnected pivotal links, discs or bending elements. The instrument may additionally include a stabilized pivot actuator disposed close to the pivotable joint. Some instrument modalities may include a rod rotate actuator or rod rotate actuator. The rod rotator may be disposed close to the pivot joint, may be disposed generally at a position along a proximal portion of the rod, and may be associated with the handle portion of the device. In particular embodiments, the stabilized linkage actuator can be included within or in association with a stem rotator. The rod rotator itself is configured to rotate the rod relative to the handle, and because of the rod rotation, the effector end is also rotated. Advantages of the stabilized pivot actuator include allowing a surgeon to place lateral forces on the effector end, such as when using the effector end to retract tissue without having to manually operate a button or other device to lock and then unlock the angular orientation of the effector end. The stabilized articulation actuator can allow the surgeon to easily move between the different articulation angles without a separate locking action, however, the angular orientation of the effector end can be advantageously stabilized at the chosen articulation angle.
[009] The instrument may additionally include at least two force transfer members or member portions to translate the rotational movement of the actuator mechanism into pivotal movement of the effector end. The force transfer members are operatively connected at their ends proximal to the swivel actuator, and operatively connected at their distal ends through the swivel joint to the proximal portion of the effector end, thus allowing the rotational movement of the swivel actuator to be translated into a movement of articulation of the effector end. Force transfer members can be of any suitable shape, such as wires, cables, connecting rods, straps or portions thereof that can transfer tension and/or compressive forces. Instrument modalities described here, and example modalities shown in figures will refer to or describe cables, but it could be understood that any suitable force transfer member is included within the scope of opening. The stabilized swivel actuator can be configured to stabilize the swivel joint at an angle by stabilizing the force transfer cables, the stabilized angle of the swivel joint being one of a set of spaced apart angles within the swivel joint arch.
[010] In some embodiments of the instrument, a swivel-stabilized actuator includes a rotationally stabilized disc seated in an opening, and a finger-operated lever configured to rotate a rotationally stabilized disc. The finger-operated lever stabilizes the pivot joint in a pivoted position by transferring force from the actuator through the power transfer cables to the pivot joint. In some embodiments, the stabilized pivot actuator is mounted orthogonally or transversely to a central longitudinal axis of the instrument, as shown, for example, by the stem. Therefore, in these embodiments, the planes within the rotationally stabilized disc and the rotation of the finger-operated rotatable lever are orthogonal or transverse to the central longitudinal axis of the instrument. Typical finger-operated lever modalities include two opposing arms, each lever arm being connected to a power transfer cable, the lever is configured in such a way that its rotation moves a first transfer cable in a distal direction, thereby applying tension to the first transfer cable, and a second transfer cable in a proximal direction, the second cable thus being strain relieved.
[011] In some embodiments of the instrument, the rotationally stabilized disc includes at least one spring portion outwardly circumferentially tensioned against a wall of the circular opening, a circumferentially peripheral edge of the spring portion comprising one or more teeth, the wall of the circular opening comprising one or more pawls, the one or more teeth, and the one or more pawls configured to be mutually engaged. A rotational configuration in which teeth and pawls are very involved and represent a stable position of the linkage actuator. In some embodiments, the rotationally stabilized disc comprises two or more spring portions externally circumferentially tensioned against a wall of a circular opening, the spring portions being distributed at equidistant intervals on the circumferential periphery. In some embodiments, the distribution of spring portions provides a circumferentially balanced distribution of forces impinging on the stabilized disc. This balance of centripetal forces incident advantageously supports a smooth rotation of the disk about its center.
[012] In some embodiments, the rotationally stabilized disk and the opening in which it sits are adapted to stabilize the rotation of the disk at any one of the positions of a set of stable positions spaced at intervals within an arc of disk rotation. In some of these embodiments, the rotational arc of rotation of the rotationally stabilized disc encompasses about 90 degrees, including about 45 degrees in any direction from a neutral position where the finger operable lever is orthogonal to the rod. The set of stable positions are typically spaced at regular intervals within the arc of rotation, as are the set of positions spaced about 15 degrees apart. Typically, one of the stable positions is a neutral position, where the finger-operated lever is orthogonal to the rod. In general, articulation aspects of the swivel joint correspond to rotational aspects of the rotationally stabilized disc. Thus, in some embodiments, the pivotal arc of the pivotable joint substantially corresponds to the pivotal arc of the rotationally stabilized disc. And, in some embodiments, the swivel joint is adapted to stabilize at a set of stable positions spaced apart substantially corresponding to the stable positions of the rotationally stabilized disc.
[013] In some embodiments, the rotationally stabilized disc and the opening in which it sits are configured such that the disc can be stabilized to a position by a level of resistance to disc rotation that can be overcome by applying torque to the finger-operated lever. In another aspect, the rotationally stabilized disc and the opening in which it sits are configured so that rotation of the disc through a stable position requires the application of a torque to the mechanism via the finger operable lever which is greater than the than the torque required to rotate the disc through portions of the arc between stable angular positions. For example, the torque required to rotate the rotationally stabilized disc with the finger operable lever through a stable position may range from about 2 to about 10 pounds. And, for example, the torque required to rotate the rotationally stabilized disc with the finger operable stabilizer lever through the rotating arc portions between stable positions can be less than about 2 pounds.
[014] In some of these instrument embodiments, the stabilized linkage actuator may additionally include a cable tensioning mechanism near the finger-operated lever. An example of a cable tensioning mechanism includes a spring plate as further described below and described herein. Spring plate modalities include two opposing arms, one of at least two power transfer cables being threaded through each rotatable finger operable lever arm, through the spring plate, and then ending close to the spring plate. As noted above, the power cables, or cables, move in opposite longitudinal directions as they drive the pivotal movement of the effector end, one movement distally and one movement proximally. The spring plate is configured to maintain tension on the power transfer cable that is moved in a distal direction, in the absence of a force provided by the spring, the distal moving power cable could accumulate a problematic degree of slack. In some spring plate embodiments, each disc spring arm includes a circumferentially outwardly facing open slot through which one of the force transfer cables is threaded. Additionally, each spring plate arm may include a circumferentially inwardly facing open slot configured to engage a spring plate retaining tab.
[015] In some of these embodiments of the instrument, each finger operable lever arm includes a spring plate retaining tab on a distally facing surface of the lever, and the spring plate comprises two opposing grooves facing circumferentially inward. The inwardly facing tabs and slots are configured to mutually engage in such a way as to stabilize the spring plate against side sliding when the finger operable lever is in a rotated position.
[016] In some embodiments, the linkage actuator is additionally configured to stabilize the effector end at a stable angle, the effector end stable angle being any one of a set of angles spaced at intervals within the effector end linkage arc . In some modalities of the electrosurgical instrument, the effector end is a set of forceps or mandible comprising a first mandible and a second mandible. The first and second jaws can also be referenced by terms such as an upper jaw and a lower jaw. Typically, the jaw set includes a plurality of bipolar electrodes configured to receive energy from an energy source and to deliver energy to the target location.
[017] In some embodiments of the electrosurgical instrument, the pivotable joint includes one or more pivotable connections intervening between a distal end of the elongated rod and a proximal end and the effector end. Some swivel joint arrangements include two or more interlocking pivot links. The property of having, for example, one or more pivotable connections intervening can also be understood as the pivot joint as a whole having two or more intervertebral spaces within which pivoting can take place, or as pivot joint as a whole having two or more locations pivoting joint interlocks. In a typical configuration, interlocking links of the pivot joint, as well as the distal end of the stem and the proximal end of the effector end, include ball-like or cylindrical projections engageable in complementary grooves.
[018] In various embodiments, the swivel joint is configured to pivot the effector end within an arc of about 90 degrees, the arc including about 45 degrees in either direction from a neutral position. In general, the pivot angle is considered to be the angle of a line tangent to the distal end of the pivot joint with respect to a line that corresponds to the central longitudinal axis of the stem. By virtue of the rotational stabilization mechanism and through the operation of the power transfer cables, the pivot joint is stabilized at a set of angles spaced at intervals within the arc of about 90 degrees. The set of angles that are spaced apart at intervals within the arc of rotation includes the set of angles spaced about 15 degrees apart.
[019] Typically, one of the stabilized angles is a neutral angle, established at zero degrees in relation to the central longitudinal axis of the rod. Finally, in some embodiments of the instrument, the pivot joint is adapted to be stabilized at a desired pivot angle.
[020] Modalities of the swivel joint and its distal connection to the effector end and its close connection to the stem are configured so that the various operational aspects of the instrument's effector end are not affected by the hinged position of the effector end. Thus, for example, the operation of opening and closing the jaws, and the force that can be applied through the jaws when closed, are both independent of the articulated position of the jaws. Similarly, blade movement occurs and all electrosurgical performance capabilities are unaffected by the pivotal position of the jaws.
[021] In some embodiments, an instrument with a set of jaws may additionally include a blade and a blade drive member configured collectively to be able to separate tissue at a target location into two portions when tissue is being gripped by the set. of jaws. The blade can be configured to reside in a resting position distal to the pivot joint, and be able to move distally within the jaw set. The blade drive member is typically disposed across the pivot joint, and operable across the joint in any pivot position. The blade drive member can be configured as a push and pull mechanism, and an actuator configured to control distal blade advance and proximal blade withdrawal can reside in the instrument handle.
[022] Some modalities of the electrosurgical instrument take a form that does not necessarily include a handle or a rod, instead, for example, the jaws can be mounted on any suitable base. Modalities such as these could, for example, be incorporated into a robotic device. These modalities include a jaw joint associated with a base, a jaw joint enabled to supply radio frequency energy to a target location, a pivot joint positioned distally to the base, a stabilized pivot actuator disposed in association with the base, a pivot joint positioned between the base and the set of jaws, and at least two force transfer cables to translate the rotational movement of the pivot actuator into pivotal movement of the set of jaws. In these embodiments, the pivotable joint is configured to pivot the jaw set angularly within a pivotal arc and the pivotable joint has at least one pivotable link positioned between a distal end of the rod and a proximal end of the jaw set. In typical embodiments, the force transfer cables are operatively connected at their ends proximal to the swivel actuator, and operatively connected at their distal end through the swivel joint to a proximal portion of the jaw set. In any of these embodiments, the stabilized linkage actuator is configured to stabilize the linkage joint at a stable angle by stabilizing the power transfer cables. The stable angle of the swivel joint can be any one of a set of angle spaced at intervals within the arc of the swivel joint.
[023] Modalities of the technology provided also include a tissue sealing method that includes moving a set of electrosurgical jaws in proximity to a target tissue location. The jaws are positioned at a distal end of a pivotable joint; the swivel joint is positioned distally to a rod of an electrosurgical device. Modalities of the method may include rotating a stabilized linkage actuator with a finger-operated lever. The method may further include articulating the jaw assembly with the pivotable joint in order to position a distal end of the jaws at a desired angle or pivotal position such as when the jaws are closed gripping the target tissue site. The method may additionally include gripping the target tissue site with the jaws. The method may additionally include providing radio frequency energy to the target tissue site from the jaws to seal the target tissue site. The method may further additionally include cutting through the newly sealed tissue location.
[024] Modalities of the method may include moving a set of jaws of an electrosurgical instrument in proximity to a target tissue site, the set of jaws being positioned on the instrument distal to a pivotable joint. The method may further include rotating a stabilized pivot actuator with a finger operable lever to a desired rotational position, and thereby pivoting the pivotable joint at a desirable pivotal angle. The method may further include stabilizing the stabilized pivot actuator in the desired rotational position, and thereby stabilize the pivotable joint at the desired pivot angle.
[025] The angular articulation of the swivel joint at an angle can be understood to refer to an angle associated with a line tangent to the distal end of the swivel joint with respect to the central longitudinal axis of the instrument shaft. Similarly, the angle of articulation associated with an effector end, such as a set of jaws, refers to an angle of a line associated with the common longitudinal axis of the jaws (as taken when the jaws are closed), as compared. to a line corresponding to the central longitudinal axis of an instrument shaft. In general, a desired joint angle or swivel joint or an end effector distal to the joint refers to an angle such that the jaws are closed, they will close around and grip the target tissue for electrosurgical engagement.
[026] In some arrangements, rotating the stabilized articulation actuator occurs through rotation of a rotationally stabilized disc, and in which to stabilize the stabilized articulation actuator occurs by means of stabilizing a rotationally stabilized disc.
[027] Some embodiments of the method may additionally include articulation of the set of jaws in accordance with the rotation of the stabilized articulation actuator. And, in some embodiments, the method may further include stabilizing the set of jaws at a desired pivot angle in accordance with stabilizing the pivotable joint at the desired pivot angle.
[028] Some embodiments of the method include rotating a finger operable lever associated with the pivot actuator, thereby rotating the rotationally stabilized disc within the actuator. Some of these embodiments may additionally include tensioning the power transfer cables with a tensioning mechanism associated with the finger operable lever. The method may further include driving the movement of at least two power transfer cables in accordance with the rotation of the rotationally stabilized disc. In such embodiments, actuating the movement of at least two power transfer cables includes applying tension from the proximal end of one of the power transfer cables and relieving tension from another power transfer cable, the ends proximal parts of the force cables being operatively engaged to the stabilized linkage actuator.
[029] In typical embodiments of the method, pivoting joint or effector end refers to an ability to pivot within an arc of about 45 degrees in any direction from a centerline within a plane, thus providing a full swivel range of about 90 degrees. In some embodiments of the instrument, the pivotable joint includes one or more pivotable connections positioned between a distal end of an instrument shaft and a proximal end of the jaws. In these embodiments, pivoting the pivotable joint may include pivoting the one or more pivotable links relative to each other or relative to the distal end of the rod or the proximal end of the jaws.
[030] Moving the jaw set in proximity to a target tissue location can occur in several aspects, including a step of advancing the jaw set the jaws through a trocar into a laparoscopic operating space, and a step of rotating the jaws. jaws. Rotation, in this context, refers to rotating the jaws about their common central longitudinal axis, such axis defined by the jaws when in a closed position, or as represented by a common base portion of the jaws.
[031] In some embodiments, rotating the jaw set around its central longitudinal axis includes rotating from a neutral position within a range of up to about 180 degrees on either side of the neutral position. In various embodiments, in which rotating the set of jaws around its central longitudinal axis of the set of jaws occurs by rotating a rod of the electrosurgical instrument, which, in turn, can occur by rotating a rotary actuator of instrument stem.
[032] In various modalities of the method, stabilizing the set of jaws at the desired articulation angle is a step performed together, or simultaneously, with the articulation of the articulable joint to its desired articulation angle. Stabilizing the jaws at a desired angle of articulation, such as a desired angle to grip the target tissue, can occur in close or causal relationship to the stabilization of the swivel joint, stabilizing the force transfer members that control the angle of the swivel joint, and stabilizing a rotationally stabilized disc with the pivot stabilizer actuator.
[033] More particularly, stabilizing the stabilized pivot actuator in the desired position may include engaging teeth on the periphery of a rotationally stabilized disc with complementary pawls on an inner face of an opening in which the rotating disc is housed. In another aspect, stabilizing the stabilized pivot actuator may include rotating a lever of a stabilized pivot actuator through a portion of an arc of relatively low rotational resistance until the lever encounters a position of relatively high rotational resistance, such position being a articulated stability position. In yet another aspect, where stabilizing the stabilized pivot actuator may include rotating a lever of a stabilizer actuator through a portion of an arc that may include one or more regions of moderate rotational resistance and one or more regions of high rotational resistance, up to that the lever finds a particular position of high rotational resistance, where the jaws are in a desired pivotal position. In the context of the latter modality, rotating the lever through a region of low rotational resistance may include applying torque to the lever in the range of less than about 2 lbs. and rotating the lever through a region of high rotational resistance may include applying torque to the lever in the range of about 2 to about 15 lb. inches.
[034] Modalities of the method may additionally include other steps, such as grasping the target tissue with the jaw set, and such as opening the jaw set prior to the retention step. The method may further specifically include providing radio frequency energy to the target tissue location from the jaw set after the jaws have retained the target tissue location. Some modalities of the method may include multiple electrosurgical treatments once the jaws have entered the laparoscopic operating space. As such, the method may further include moving the set of jaws into proximity to a second location while maintaining the set of jaws at the anterior angle of articulation, and repeating the holding step and the power supply step, these steps being targeted. towards the second target location.
[035] In another aspect, the described method of articulating and stabilizing an effector end of an electrosurgical instrument can be understood as a series of articulation steps that can be combined with a series of stabilization steps to activate articulation and stabilization of an extremity effector at a desired pivot angle. Thus, pivoting the effector end may include rotating a finger operable lever, rotating a rotationally stabilized disc, moving translationally force transfer cables, pivoting a pivotable joint, and pivoting the effector end. Stabilizing the effector end may include stabilizing the rotationally stabilized disc to a desired rotational position, stabilizing the finger operable lever to the desired rotational position, stabilizing the force translation of transfer cables to a desired translational position, stabilizing the pivotable joint to a desired pivot angle, and stabilizing the effector end at the desired pivot angle. By embodiments of this method, rotating the finger operable lever can result in rotating the stabilized disc through one or more regions of relatively low rotational resistance and relatively high rotational resistance. Additionally, by means of this method, stabilizing the effector end may include stopping rotation of the stabilized disc to a position of relatively high rotational resistance. BRIEF DESCRIPTION OF THE FIGURES
[036] Figure 1 is a perspective diagram showing a pivotable joint of a pivotable electrosurgical instrument.
[037] Figure 2A is a plan view showing a pivotable joint of a pivotable electrosurgical instrument.
[038] Figure 2B is a plan view showing a pivotable joint of a pivotable electrosurgical instrument in which a pivotable joint comprises an intervening connection between the rod and the jaws.
[039] Figure 3 is a schematic view showing a top section of a joint joint control of a pivotable electrosurgical instrument.
[040] Figure 4 is a schematic perspective view showing a pivotable electrosurgical instrument.
[041] Figure 5 is another perspective view of a pivotable electrosurgical instrument.
[042] Figure 6 is a schematic perspective view of an indexing mechanism for a pivotable electrosurgical instrument.
[043] Figure 7 is a schematic perspective view of a latch mechanism of a pivotable electrosurgical instrument.
[044] Figure 8 is a schematic perspective view of an indexing mechanism and pawl for a pivotable electrosurgical instrument.
[045] Figure 9 is a schematic plan view of a step ball pawl mechanism for a pivotable electrosurgical instrument.
[046] Figure 10 is a schematic perspective view of the step ball pawl mechanism step for a pivotable electrosurgical instrument.
[047] Figure 11 is a second schematic perspective view of a step ball pawl mechanism for a pivotable electrosurgical instrument.
[048] Figure 12 is a schematic perspective view of a locking mechanism by pressing for a joint control of a pivotable electrosurgical instrument.
[049] Figure 13 is a schematic phantom perspective view of the push-in locking mechanism for a joint control mechanism in a pivotable electrosurgical instrument.
[050] Figure 14 is a schematic perspective view of a detent button for the push-in locking mechanism in an instrument control for a pivotable electrosurgical instrument.
[051] Figure 15 is a perspective, partially cut away, of a pivotable electrosurgical instrument, showing a drive member.
[052] Figure 16 is a perspective view of a blade drive assembly within a pivotable electrosurgical device.
[053] Figure 17 is a perspective view of one modality of a pivotable electrosurgical device, with an indexing mechanism near the rod, and a pivotable joint positioned distally to the rod and next to a set of jaws, the pivotable joint in a position of articulation. Other views of aspects of this modality are shown in Figures 18 - 28.
[054] Figure 18 is a perspective view of a proximal portion of a pivotable electrosurgical device depicted with a rod rotator shown transparently, one embodiment of a stabilized pivot actuator contained therein.
[055] Figure 19 is a partially exposed top view of a rod rotator portion of a pivotable electrosurgical device; one embodiment of a stabilized linkage actuator contained therein is shown with a finger lever in a neutral position.
[056] Figure 20 is a partially exposed top view of a rod rotator portion of a pivotable electrosurgical device; one embodiment of a stabilized linkage actuator is shown with a finger lever in a partially rotated position.
[057] Figure 21 is a top view of an isolated portion of a stabilized pivot actuator showing a rotationally stabilized disc, finger operable lever, and power transfer cables.
[058] Figure 22 is a slightly-angled, proximal-appearing top view of an exposed base portion of a swivel actuator, showing the receptacle portion in which the rotationally stabilized disc may be seated.
[059] Figure 23 is an exploded perspective view of a stabilized pivot actuator, showing a receptacle portion in which the rotationally stabilized disc is seated, an indexing disc, a finger operable lever for rotating the disc, and a plate spring located distally to the finger-operated lever.
[060] Figure 24 is a perspective view of an indexing disk constructed of; this mode comprises two outwardly inclined spring portions.
[061] Figure 25 is a perspective view of an isolated portion of aspects of a stabilized pivot joint actuator that includes a finger operable lever, a spring plate, and drive wires that communicate with the distally positioned pivot joint.
[062] Figure 26 is a perspective view of a spring plate portion of a stabilized linkage actuator.
[063] Figure 27 is a side view of a spring plate aligned against a finger operable lever.
[064] Figure 28 is a schematic diagram of one aspect of a method for pivoting a pivot joint and stabilizing it to a desired pivot angle. DETAILED DESCRIPTION OF THE INVENTION
[065] Aspects of the technology provided herein include a method and apparatus for articulating the joint of a pivotable electrosurgical instrument that would typically be used in a laparoscopic environment, but is also suitable for use in an open operating environment. Examples of electrosurgical devices that could incorporate the articulable characteristics as described herein include devices as described below, all of which are incorporated herein in their entirety: US Patent No. 7,862,565 entitled "METHOD FOR TISSUE CAUTERIZATION" (METHOD FOR TISSUE CATERIZATION) issued on 01/04/2011; US Patent No. 7,803,156 entitled "METHOD AND APPARATUS FOR SURGICAL ELECTROCAUTERY" issued September 28, 2010; US Patent No. 7,794,461 entitled "METHOD AND APPARATUS FOR SURGICAL ELECTROCAUTERY ” (METHOD AND APPARATUS FOR SURGICAL ELECTROCAUTERIZATION) issued on 14/09/2010; US Application No. 11/743,579, entitled "SURGICAL TOOL" filed 05/02/2007, published 07/17/2008 as US Publication No. 2008/0172052A1; US Application No. 11/382,652, entitled "APPARATUS FOR TISSUE CAUTERIZATION", filed 5/10/2006, published 11/16/06, as US Publication No. 2006/0259034A1; US Application No. 11/671,891, entitled "ELECTROCAUTERY METHOD AND APPARATUS" filed 02/06/2007, published 06/07/2007 as US Publication No. 2007/0129726A1; US Application No. 12 /121,734 entitled "ELECTROCAUTERY METHOD AND APPARATUS" filed on 05/15/2008, published on 09/11/2008 as US Publication No. 2008/0221565A1; US Application No. 12/062,516 entitled "ELECTROCAUTERY METHOD AND APPARATUS" filed 04/04/2008, published on 18/09/2008 as US Publication No. 2008/0228179A1; US Application No. 12/ 410.322, entitled "ELECTROCAUTERY METHOD AND APPARATUS" filed on 03/24/2009, published on 07/16/2009 as US Publication No. 2009/0182323A1; US Application No. 11/671,911, entitled "ELECTROCAUTERY METHOD AND APPARATUS" filed 02/06/2007, published 08/09/2007, US Publication No. 2007/0185482A1; US Application No. 12 /748. 229, entitled "IMPEDANCE MEDIATED POWER DELIVERY FOR ELECTROSURGERY" filed on 3/26/2010, and US Application No. 12/907,646, entitled "IMPEDANCE MEDIATED POWER DELIVERY FOR ELECTROSURGERY" (IMPEDANCE OF ENERGY SUPPLY MEDIATED BY ELECTROSURGERY) filed on 10/19/2010.
[066] The medical instrument described herein, a bipolar electrosurgical device by way of example, can be configured to seal tissue and/or to cut tissue, and has an actuating end, which can be articulated by operating a joint articulable. Instrument modalities typically have a set of opposing jaws that can be pivoted upward at an angle of approximately 45 degrees, both to the left and right from a centerline defined by the central longitudinal axis of the instrument shaft, for a range of total articulation of about 90 degrees. Technology aspects also provide an appropriate bend radius and support for a jaw actuating member and a cutting drive member. In some embodiments, a flexible support for the drive includes narrowly wound coil springs.
[067] Some modalities of the technology additionally include a mechanism and a method to control the degree of articulation with an actuator disposed on the handle of the articulated electrosurgical instrument. Technological modalities may further include a locking mechanism, or more generally, a stabilized joint actuator, to prevent movement of the pivotable joint while an operator, typically a surgeon, performs electrosurgical procedures with the device. Locking modalities also include an indexing feature with which a surgeon operator can index and choose the required amount of angle from predefined angles.
[068] Some modalities of the technology include, in the form of a distally positioned swivel wrist or joint, a pivotal vertebra assembly, links, hinges, or flexible elements that are interconnected by pins, or by a locking fit, or by applied tension by a force transfer member. Each vertebra is adapted to pivot relative to the longitudinal axis of the rod and jaw assembly, thus allowing for left and right articulation. The pivot angle is controlled by connecting or forcing force transfer members, such as wires or cables, which are arranged along both sides of the pivot joint. The connecting wires are routed proximally to the shaft and connected with tension to a control mechanism to a device handle, work by transferring force from the handle to the joint.
[069] Modalities of the joints or vertebrae collectively form an appropriate radius of curvature In distal swivel joint modalities, a radius of curvature that is sufficiently large allows a wire or power transfer cable to pass through the joint without bending. Also, in some embodiments, a tightly wound coil spring is within the wire path assembly. The narrowly wound coil spring provides additional support for the wire so that when the wire is moved back and forth, proximally or distally, it does not bend or twist.
[070] Control mechanism modalities on the handle include an indexing disc and finger-operated lever that receives the cables or wires transferring power from the joint. The indexing disc is pivotally mounted on the instrument handle and the shape of the control mechanism allows for concentric rotation about the pivot so that the longitudinal movement of wires or cables along the rod can be controlled based on the distance from the pivot to the point of attachment of wires or cables. The distances that the power transfer cables move control the position or angle of articulation, these distances are available as pre-set options according to the geometry of the joint and the indexing disc and its lever.
[071] Several modes of technology have a stabilized linkage actuator that includes indexing or locking features. This mechanism, in its various embodiments, can specify particular angles of articulation, and can stabilize the effector end distal to the joint at particular angles. Stabilized or lockable angles are located at intervals spaced apart within the arc of pivot rotation. In a first embodiment, a spring steel member is formed in a geometry that deflects when a force is applied, such as with a bundle of springs. An example of this embodiment, with a spring steel member is shown in Figure 6; other aspects of the locking and indexing mechanism are shown in Figures 7 and 8. The beam spring is housed within a circular carrier, with only the deflectable portion of the spring accessible and protruding from a circular carrier. A rotating member with a circular portion removed from its pivot area fits over the circular conveyor. A tooth pattern is also removed along the inside diameter of the circular portion of the rotating member. The rotating member includes arms that extend from its central body to which the cable or wires are attached. The similar spring beam projects into indentations created by the tooth pattern. The distance between the teeth and the distance from the attachment point of the cable or wires to the pivot point controls the pivot angle.
[072] In a second embodiment of a stabilized linkage actuator with indexing or locking features, a spring plunger is mounted within a circular carrier opposite a stepped ball. The spring plunger mates with the indentations created by the tooth patterns. Examples of this particular modality of a stabilized linkage actuator are shown in Figures 9 and 10.
[073] In a third embodiment of a stabilized linkage actuator with indexing or locking features, the rotating member described above does not have arms that extend from its central body. A wing is mounted on top of the rotating member. The wing is then manipulated to control rotation around the circular conveyor.
[074] In a fourth embodiment of a stabilized linkage actuator with indexing or locking features, a flexible plastic hinge, also known as an active hinge, is mounted close to the handle. The active plastic hinge uses a V-shape that fits into a slit in an outer casing that surrounds the living hinge. The tip of the V-shape protrudes from each groove. There are a series of grooves along the length of the outer shell. The housing engages with the cable and wires that control the joint articulation. The operator can adjust and lock the joint hinge by first pressing down on the active hinge to disengage the current lock position, then moving the outer casing from a proximal to a distal position or vice versa, which then , locks by re-engaging with the hinge active at any one of several predetermined distances established by the slots. These distances determine the angle at which the joint is hinged.
[075] In a fifth embodiment of a stabilized linkage actuator with indexing or locking features, the rotation mechanism described above rotates freely around the pivot. When an operator or surgeon determines the pivot angle, an indexing pin mounted on the top of the pivot is pressed, which locks the pivot angle and the pivot mechanism, thus preventing any further movement of both pivot and joint mechanisms. This can be accomplished using a wedge-like design that is anchored within a pivot pin, which in this modality is a tube. A minimum of a single groove is designed into a pivot pin. When the button is depressed, the button's inherent spring properties expand from the groove. The expansion material uses friction to prevent movement of the rotation mechanism. The button itself stays in place due to a wedge pattern at the top. An example of this particular embodiment of a locking and indexing mechanism is shown in Figures 12, 13 and 14, as further described below.
[076] In a sixth embodiment of the disclosed technology, an electrosurgical instrument stabilized articulation actuator includes a rotational or indexing position stabilizing the disc with spring piece arms that have teeth that can engage complementary pawls in a receptacle or opening within of which the disc is rotatably seated. This particular embodiment of a linkage actuator includes a non-locking mechanism. Pivot angles of a pivot joint are not locked in place, but are instead stabilized by a relatively high level of rotational resistance in the actuator which can, however, be replaced by a level of torque easily applied to an operable lever. by finger. Examples and views of this sixth embodiment are shown in Figures 17-28, and described further below.
[077] In the disclosed technology description and as shown in Figures 1-28, stabilized linkage actuator modalities may be included within or in association with a rod rotating portion of an electrosurgical instrument for model considerations. However, in other embodiments of the disclosed technology, these two functional actuators can be positioned in physically separate locations. In addition, other modalities of the disclosed technology, including a stabilized pivot actuator and an operatively connected pivotable joint can be included in a wide variety of devices, such as those that do not carry radio frequency energy, or in devices that do not have a rod, that don't have a handle or that don't have either a rod or a handle.
[078] In addition to the foregoing description, a more detailed explanation is now provided in connection with examples of the technology as depicted in Figures 1-28. Many electrosurgical features of device modalities, such as bipolar electrode pairs, are not shown in order to focus on features that provide articulability to the device. Details of the electrosurgical characteristics can be found in the patent applications identified above.
[079] Figure 1 is a perspective view of a distal portion of a modality of a pivotable electrosurgical device according to aspects of the technology; this shows a distal portion of the main rod 24 of the electrosurgical device and an effector end, in this example a jaw assembly 25, which includes a lower jaw 11 and an upper jaw 13. In a more general aspect, a jaw assembly can be described as having a first jaw 11 and a second jaw 13. Insofar as some embodiments the device has a rotatable rod and thus a rotatable set of jaws, the terms upper and lower may not have absolute meaning, but they may be useful in describing the jaws appearing in the figures, or how they may be so designated by marking or convention. In this modality, the upper jaw is pivotable away and toward the lower jaw about a pivot point 17, which typically includes a pin or an axle. In other modalities of technology, the lower jaws may be pivotable as openings, but in this particular modality, the lower jaw is fixed. Pivoting the upper jaw is achieved by transmitting tension to a jaw activating pin 18, which is movable in an activating slot 19. Typically, tension is applied through a cable attached to the jaw activating pin. In this example of an effector end, the jaw set or assembly 25 is configured for such laparoscopic procedures as sealing and cutting electrosurgical tissue. Accordingly, as shown in the lower jaw 11, a distal electrode 12 is provided, incorporated in the plastic carrier 15. A second, proximal electrode 16 is also shown. A cutting groove 14 is shown to receive a blade (not visible), during a tissue separation process that occurs in conjunction with tissue sealing. Also visible in Figure 1 and Figure 2 is a pivotable wrist or joint 22, as described further below.
[080] During laparoscopic electrosurgical procedures, it is desirable to be able to position the device's jaws from left to right within an arc of a plane of freedom of articulation to achieve the best angle of approach to a tissue site target, this capability is provided by a pivotable joint or joints 22 which include one or more pivot discs, links or vertebrae 21. In that particular embodiment of pivotable joint 22, two pivotable joints 21 are shown intervening between the distal end of the rod 24 and the proximal end of the jaw assembly 25. Pivoting is accomplished by a tensioning pair of cables (described further below) which distally ends where they are welded or bent in a groove to a cable termination point 20. Figure 1 additionally shows a groove clamp 23, which functions as a lock for an outer shaft rod tube or clamping mechanism for securing the swivel joint 22 to the tube.
[081] Figure 2A is a top or plan view of a distal portion of one modality of a pivotable electrosurgical device showing jaws 25 and rod 24 disposed at opposite ends of a pivotable joint 22. Figure 2B is a plan view, showing a pivotable joint of a pivotable electrosurgical instrument wherein a pivotable joint comprises an intervening connection between the rod and the jaws. Modalities of the swivel joint include interlocking pivots, active links or discs, the discs 21 are hinged to each other and include a series of ball-like or cylinder-like projections 27 which are enclosed in complementary grooves 28. The jaw assembly 25 of this embodiment shows a particular proximally more distally directed ball-like projection 29 associated with the jaw assembly 25 that is enclosed in a groove of a hinge connection, and the rod 24 includes a complementary distal opening groove 30 to receive a ball-like projection or cylindrical shape of an articulating disc. In some embodiments, the hinge range of the pivotable joint is contained within an arc of a plane, although a proximally disposed rod rotator may rotate the effector end as a whole. Some embodiments of the pivotable joint are stabilized at a desired pivot angle, thus also stabilizing the effector end at a desired pivot angle. A small segment of a handle 31 is shown in Figure 2A and 2B as an opening, the handle includes a coiled barrel sheath assembly and is used to operate a sliding blade within the jaw. As noted above, the coiled assembly allows the cable to twist with the device's hinge without bending.
[082] Modalities of a pivotable joint as provided herein include one or more pivotable connections intervening between the distal end of the stem and the proximal end of the effector end. An advantage associated with a plurality of links, for example two or more intervening pivotable links, is that the plurality can provide an increased range of pivot angles and the increased resolution and stability of pivot angles. An advantage of relatively few intervening connections, such as a connection, relates to ease of assembly and low manufacturing cost. Examples of swivel joints that include an intervening connection are shown in Figure 2B. Examples of swivel joints that include two intervening connections are shown in Figures 1 and 2A. An example of a swivel joint that includes three links is shown in Figure 15. An example of a swivel joint where the joint includes four links is shown in Figure 17. Modalities of a swivel link, such as those described and shown, are only an example of a suitable binding configuration, other suitable binding configurations are known in the art and may be included as embodiments of the technology.
[083] Figure 3 is a schematic partially sectional side view of one embodiment of a pivot control or actuation mechanism 32 for operating the pivot joint. A joint hinge control member or lever 33 is shown having two finger surfaces at opposite ends of the control member, these finger surfaces allow a surgeon to pivot the control member about a pivot point 35. Pre-control handles parallel tensioners 34a/34b (comprising Nitinol or other suitable cable materials) are attached to the respective points on the control member. This control member pivoting action 33 respectively applies voltage to, and extracts voltage from, the pair of control cables 34a/34b. Operation of the joint hinge control causes one cable of the paired cables to retract on the jaw assembly 25, while the other cable releases tension, thus causing the jaw assembly to move left or right, as desired.
[084] Figure 4 is a perspective view of a proximal portion of a pivotable electrosurgical device 10 in accordance with aspects of technology showing a housing 43 having a handle 44 and a jaw activation trigger 45 operating a four-bar pivotal system or another type of link 46 to transmit tension through the main rod 24 and thus operate the jaws to open and close them as desired. A blade actuator member 42 is also shown, whereby a blade can recoil through a cut groove 14 (shown in Figure 1). A stem rotator or the effector end rotational actuator 41 allows the stem to be rotated around a stem access, while the swivel joint control member 33 allows the joint mechanism to be operated. It is seen in Figure 4 that the joint pivot control mechanism 32 includes a control slot 40 which both guide and limit the travel of the joint pivot control member 33.
[085] Figure 5 is a perspective view of a proximal portion of an embodiment of the pivotable electrosurgical device 10 in which a rod rotator 51 is contained within a housing 57. This embodiment also includes a blade actuator 52, a member of the joint hinge control 53, a grip 54, and a jaw activation trigger 55.
[086] Figure 6 is a schematic perspective view of one embodiment of a joint actuation control mechanism of the pivotable electrosurgical device shown in Figure 5; the modality of the control mechanism includes an indexing capability. A base portion 66 of the indexing indexing linkage control mechanism supports a ring projection 65 which, in turn, accommodates the control member 53. Tensioned cables 34a/34b each have termination balls 64a/64b which serve as cable stops. Cables 34a/34b are threaded through control actuator member 53 via respective grooves 63a/63b. An indexing disk 97 includes a plurality of pawls 62. A flat spring 61 is arranged to engage within the pawls to provide a stop mechanism to hold the jaws in a selected position by preventing pivotal movement of the control member 53, except when desired by a device operator.
[087] Figures 7 and 8 provide detailed views of various features of the indexing linkage actuation mechanism shown in Figure 6. Figure 7 is a schematic perspective view of the base portion 66 of the linkage control mechanism showing an indexing mechanism. spring 61 in the seat of a recess 70 of the ring-like projection 65. Figure 8 is a schematic perspective view of the pivot control member 53 showing pawls 62 in greater detail.
[088] Figure 9 provides a top view of an alternative embodiment of an indexing pivot control or actuation mechanism 90 for a pivotable joint. A base portion 96 supports a pivot control member 93 which includes a plurality of pawls 92 formed on a pawl indexing disc 97. The control member and pawl indexing disc are rotatably mounted on a base frame 96 Control member operation 93 causes rotation of index disk 97 about a pivot point 91 and consequent engagement of a stepped ball 95 in one of a plurality of pawls 92 within the index ring. A ball piston mechanism 94 circumferentially opposite the stepped ball 95 remains biased over the stepped ball. Indexing control member 93 includes a pair of proximal attachment points 98a/98b to control cables extending distally to a wrist or pivot joint.
[089] Figure 10 is a perspective view of the index control mechanism for one embodiment of a pivot actuation mechanism 90 (as seen in the top view in Figure 9). Figure 11 is a more horizontally oriented perspective view of the control mechanism for the pivot joint in a pivotable electrosurgical device according to aspects of technology. The arrangement of the pivot control member 93 in connection with the indexing ring 97 is shown, and in particular shows the connection there is between a pair of pins 98a/98b. Figure 11 also shows a pair of 100a/100b grooves for receiving the control cables (not shown in this view).
[090] Figures 12-14 additionally show an embodiment of an indexing linkage actuation mechanism that includes an indexing pin. Figure 12 shows an indexing pin 120 that is engaged in a groove 121. Figure 13 is a phantom perspective view in cross-section showing the indexing pin 120 comprising a head portion 131 and a plurality of flared portions 130 that engage or disengaging with a lock block 133. Accordingly, this embodiment of the technology includes a jam lock in which the depression of pin 120 jams the widened portion of pin 130 in block 133 and thus prevents rotation of the actuation control mechanism. Figure 14 is a detailed view of the jam mechanism showing pin 120, head 131, and flares 130 in greater detail.
[091] Figures 15 and 16 depict aspects of an effector end drive member of modalities of a pivotable electrosurgical device. An effector end triggering member, in general, carries out a particular function associated with the effector end. In this modality of an electrosurgical device, the effector end is a set of jaws and, consequently, a drive member can control the opening and closing of the jaws. Figure 15 is a perspective, partially sectional view of a portion of a distal effector end portion of a pivotable electrosurgical device, showing a drive member in accordance with aspects of the technology. Figure 15 shows the swivel joint 22 of the device, while Figure 16 shows the band activating jaws 150, a closing pin 160, and cutting blade 161, a distal portion of which extends to the instrument handle, where an advancing actuator and recoils the residence of the blade. The operation of a drive member 150 that controls the opening and closing of the jaws and the blade operation by distally advancing and retracting are performed by distinct mechanisms, which operate independently.
[092] Drive members can be made of a circular wire (stainless steel or Nitinol), using closely wound coil springs for support. The drive members may also be stainless steel flat bands 150, as shown in Figures 15 and 16. Instead of the circular wire that serves as a drive member in some embodiments, this embodiment may include flat bands, and may support the bands with aspects of the internal structure of the links. Other embodiments may use flat polymer bands to provide additional support. These bands can be formed from polymers such as polytetrafluoroethylene (PTFE, TeflonTM) or fluorinated ethylene propylene (FEP). The support structure can also include PTFE or FEP to shrink tubing over the blade and/or jaw actuating band.
[093] One embodiment of a pivotable joint 22 is also shown in Figure 15. In this particular embodiment of pivotable joint 22, three pivotable connections 21 are shown intervening between the distal end of rod 24 and the proximal end of the jaw assembly 25.
[094] Figures 17-28 provide views of a particular modality of a pivotable electrosurgical device with a stabilized pivot actuator and associated methods for its use, in accordance with the sixth modality of technology, as noted above. In some of these embodiments, the stabilized pivot actuator is a substantially non-locking mechanism in which the rotational angles are stabilized by virtue of the high resistance relative to rotation required to move the mechanism out of the stable angle position, in contrast to the relatively resistance low found when rotating the mechanism between the angles representing the stable positions. In another aspect, it can be understood that moving through regions of relatively high rotational resistance is part of the normal procedure whereby the desired pivot angle is achieved. Stabilizable linkage actuator modalities cooperate with the effector end via cables to control and stabilize the final effector end linkage angle. Additional details of the stabilized linkage actuator are provided in the context of the description of Figure 20 below.
[095] The stabilized linkage actuator includes a cable tensioning mechanism 170 associated with a finger-operated lever crossbar that improves the linkage performance of the distal pivotable joint. The cable tensioning mechanism maintains a tension on the 34a/34b cables, and allows for greater tolerance in the dimensions or manufacturing specification range of both proximal and distal elements of the pivoting mechanism, as well as the length of the cables, and additionally serving to maintain or stabilize these elements in a functional configuration. In some embodiments, the cable tensioning mechanism 170 may comprise a spring plate, as shown in Figures 19-21, 23 and 25-27.
[096] Figure 17 is a perspective view of an embodiment of a pivotable electrosurgical device 10, with a pivotable pivot actuator close to the stem, and a distal pivotable joint 22 positioned distally to the stem 24 and close to an effector end in the form of a set of jaws 25. The distal pivotable joint 22 is in a pivoted position. The proximal portion of the device includes a housing 143 that adjoins a portion of the handle 44. The proximal portion further includes a jaw activating trigger 45 and a blade actuating member 42. The stabilized pivot actuator is not shown in this figure. ; it is included in the rod rotator apparatus 141. In this embodiment, the effector end 25 can pivot to each side of a neutral position, the pivot angle approaching a maximum of approximately 45 degrees to each side of a neutral position. A neutral position is one in which the central longitudinal axis of the effector end is parallel to the central longitudinal axis of the rod of the electrosurgical instrument.
[097] The pivot angles of the jaws relative to the stem are controlled by the stabilized pivot actuator, and reflect or approximate the angles determined by operating a lever of the stabilized pivot actuator. Consequently, the set of jaws can pivot either side from a neutral position within the range of about 45 degrees to a full pivotable range or arc of rotation of about 90 degrees. Additionally, in a certain way by the stabilized articulation actuator, the pivot angles assumed by the set of jaws are stabilized at spaced angle intervals. In some modalities, these spaced angles occur at 15-degree intervals.
[098] Figure 18 is a perspective view of a proximal portion of a pivotable electrosurgical device 10 shown with a rod rotator assembly 141 shown transparently; an embodiment of a stabilized linkage actuator 190 can be seen contained therein. Although embodiments of the device depicted in this series of figures show the stabilized pivot actuator included within a stem rotator assembly, the stabilized pivot actuator, while typically disposed proximal to the stem, is not necessarily housed within a rod rotator assembly.
[099] Figure 19 is a partially exposed top view of a rod rotator portion 141 of a pivotable electrosurgical device 10. One embodiment of a stabilized pivot actuator 190 is contained therein, and a finger operable lever is shown at a neutral position. Such a neutral position would secure the distal pivotable joint in a neutral or non-hinged position. The proximal portions of the tensioned link cables 34a/34b can be seen threaded through a central bar portion 235 of a finger operable lever 233 and a spring plate 170 proximate to the central bar. Details of this last arrangement are seen in the figures that follow.
[0100] Figure 20 is a partially exposed top view of a rod rotator portion of a pivotable electrosurgical device. One embodiment of a stabilized linkage actuator is shown with a finger lever 235 in a partially rotated position. The scale of the drawing is expanded over that of Figure 19, which allows a more detailed view of its characteristics. Particularly well viewed here are teeth 165 disposed on the periphery of the circumferentially inclined outer spring parts 164 of the indexing disk 162. These teeth engage a series of pawls 152 disposed on the inner face of the container 151. With rotation of the disc 162, the spring pieces deflect inwards, and then slip on nearby pawls available to them.
[0101] This particular modality of a stabilized linkage actuator has either two teeth 165 on each arm or a piece of indexing disc spring. There are two sets of corresponding tabs 152 on the inner face of the container, each series has eight tabs. This arrangement of teeth and matching pawls supports a total of seven stable rotatable positions, one central neutral position, and three positions on either side of the neutral position position. Stabilizable linkage actuator modalities may have fewer or more teeth and fewer or more pawls. Typically, however, the arrays results in an odd number of stable rotatable positions, that is, a central neutral position (at zero degrees, so the lever is at a position orthogonal to the rod), and an equal number. of stable rotated positions on each side of neutral. It can be seen that the two spring piece arms are arranged circumferentially opposite each other. This arrangement creates a stable centering of internally directed forces, which contributes to a rotational movement around the center lever engagement column 168. Stabilizer linkage actuator modalities include rotational stabilizing disc arrangements with more than two outwardly inclined arms which support the pawl engagement teeth, such arms generally distributed at equidistant intervals.
[0102] Stabilisable linkage actuator modalities make use of a variable resistance for rotation within the available arc of rotation. Positions in an arc of rotation that require a relatively high degree of force to move through positions that represent where the degree of rotation is stable, and such stabilized pivot actuator positions translate to pivot angle stability positions at the effector end . In contrast, the positions or portions of the arc of rotation that provide relatively little resistance to rotation are not rotationally stable, and generally represent a rotational zone intervening between the positions of rotational stability.
[0103] In general, the pivot arc of the stabilized linkage actuator is about the same as the linkage arc of the swivel joint and, by extension, the effector end linkage arc. For example, in some embodiments described herein, the entire stabilized pivot actuator and pivot joint/effector end exert exercise movement within an arc of about 90 degrees, i.e., arc of about 45 degrees on each side of a neutral position.
[0104] Rotation of the indexing disk 162 by the finger operable lever 235 requires a relatively large force, for example, about 2 pound-inches and about 15 pound-inches, in order to rotate the index disk out of a stable position, which occurs when the indexing disc teeth are engaged in complementary tangs. Relatively little force, for example, less than about 2 pound-inches is required to rotate the indexing disc when the disc teeth are in position between the pawls. Even the relatively large force required to move the disk out of a stable angle position can be provided by normal levels of finger pressure, as applied to the finger-operated lever. It is noted that the relatively large force is a characterization of the force required to rotate the index disk from a stable position as being less than that required to rotate the index disk when these teeth are positioned between the recessed aspects of the pawls. However, the relatively large force is within the range of easy operability of the hand-operated finger lever. Insofar as the mechanism can be easily pushed through a stable angle position, and insofar as such movement is included in normal operation of the mechanism, the stabilized linkage actuator can be understood as a substantially non-locking system. .
[0105] Figure 20 also shows spring plate 170, as an example of a cable tensioning mechanism 170, and helps convey an understanding of its role. In this view, the disc 162 has been rotated clockwise from a neutral position so that the upper portion (in this view) of the bar lever 235 is moved proximally, and the lower portion of the bar has been moved distally. . By this action, the upper part (from this point of view) of the rope 34a is under a relatively greater degree of tension than the lower rope 34b. In the absence of a compensating mechanism, in this position, the cable 34b would accumulate slack, and create inaccuracy in the performance of pivoting the pivotable distal joint (not shown in this view). Spring plate 170, however, provides an offset that maintains a balance of tension between the two cables. It can be seen that the resilience of the spring plate is properly calibrated such that the proximal ends of the cables 34a and 34b, equipped with ball terminals 34c, are kept at a distance from the base provided by the bar lever 235. Additionally visible in this view are stabilization tabs 237, positioned on the proximal aspect of bar 235. These tabs stabilize the lateral position of the spring plate during rotation. An additional view of this aspect of the technology is seen in Figure 27.
[0106] Figure 21 provides a top view of an isolated portion of a stabilized linkage actuator 190 that includes a finger lever 233, indexing disk 162, and tension cables 34a and 34b. Figure 22 provides a top view at a slight angle of proximal appearance of an exposed base portion of a stabilized pivot actuator positioned within the stem rotator 141, showing the opening or receptacle portion 151 in which a rotational stabilizer disc may be seated. . Cross braces or spokes 144 are disposed at the bottom of the opening 151. The tongues 152 are disposed on the inner face of the container or opening 151.
[0107] Figure 23 is an exploded top view with a slight perspective of distal appearance of a stabilized knuckle actuator, showing the arrangement whereby indexing disk 162 which is rotatably seated in receptacle 151, which is housed in rotor shaft 141 Finger operable lever 233 is positioned above indexing disk 162, and spring plate 170 is positioned above disk. A center pin 166 rotatably holds the disc 162 within the receptacle, and secures the connection of the finger operable lever 233 within the assembled actuator. The lower portion of the pin 166 is secured in the receptacle at a hole 159, which passes through the indexing disk through the hole in the center disk 169 and the upper portion of the pin terminates within a center hole 239 in the lever.
[0108] Figure 24 is a perspective view of a rotational or indexing position stabilized disk 162 constructed in accordance with aspects of technology, this mode comprises two spring portions and arms 164 that are inclined in an outer circumferential direction. Teeth 165 are positioned on the periphery of spring pieces 164. A center hole is positioned to accommodate a center mounting pin (see Figure 23). Lever engagement columns 168 are positioned on the top surface of the disc to provide attachment locations for a finger operable lever.
[0109] Figure 25 is a perspective view of an isolated portion of the device showing the cooperative arrangement of a finger operable lever 233, a spring plate-shaped cable tension mechanism 170, and actuation wires 34a/34b which transit through cable transit holes 236 within the finger operable lever 233. Actuation cables 34a/34b communicate with a distally positioned swivel joint as seen in Figures 1, 2, 15 and 17.
[0110] Figure 26 is a front-facing perspective view of an aspect of a cable tensioning mechanism portion 170 of the device's stabilized pivot actuator. This particular embodiment of the cable tensioning mechanism comprises a spring plate with outwardly facing slots 172 that are configured to accommodate the proximal ends of the tensioning cables 34a/34b, as seen in Figure 25. Inwardly facing slots 174 are configured to accommodate stabilizer tabs positioned on a finger-operated lever, as seen in Figure 27. The open-facing aspect of these slots is advantageous in facilitating the assembly of an electrosurgical device, and does not incur any loss of performance compared to the performance that would be provided by a fully and circumferentially closed orifice configuration.
[0111] Figure 27 is a side view of a spring plate 170 aligned against a crossbar portion 235 of a finger operable lever. Shown in this view are stabilization tabs 237 positioned on the proximal side of the crossbar, and inserted into inwardly facing slots 174. When the finger operable lever is in a pivoted position, these tabs, in position within the inward facing slots to the inside, they prevent lateral sliding of the spring plate towards the arm pulled proximally from the lever. This dynamic can be seen in Figure 20, where the lower arm (in this view) of the spring plate is being held in place by a stabilizing tab against an edge provided by an inwardly facing groove.
[0112] The spring plate shown in Figures 26 and 27 is provided as an example of a cable tensioning mechanism, the spring plate arrangement with the finger operable lever crossbar is only one of several arrangements that are also included as modalities of technology. The cable tensioning mechanism can be secured to the finger operable lever, or it may be secured to the finger operable lever in an unfixed manner, as in the illustrated embodiment, where the tension of the 34a/34b cables together with balls terminals 34c, holds the spring plate attachment against the lever. Additional technology modalities include finger-operated lever and a cable tensioning mechanism as an integral element. The arrangement shown in Figure 27 is advantageous in terms of ease of assembly.
[0113] Figure 28 is a flowchart of one aspect of a method to articulate a swivel joint and stabilize it at a desired swivel angle. Steps illustrated in Figure 28 show motions that ultimately articulate an effector end, and show a transition from moving states to stabilized states that support the effector end at a particular hinge angle. The diagram represents the movement associated with articulation from a rotational movement of the rotational actuator, including the rotation of a finger operable lever and associated rotation of a rotationally stabilized disc, the translational movement (in proximal and distal directions) of cables. force transfer, and the articulating motion of a pivotable joint, and finally articulating motion of a set of jaws. The rotational position of the rotationally stabilized disc occurs within an opening, and includes the rotation of a set of teeth through an alternation of portions of a rotatable arch in which the teeth are fitted within (enveloped) or between the pawls (not involved) with a series of complementary tongues. A position where the teeth are engaged in a pawl (in some embodiments, two or more adjacent teeth on two or more adjacent pawls) represents a stable position that manifests as a point of rotational resistance that is felt by the operator rotating the finger-operated lever. Stabilization of the lever consequently stabilizes the translational movement of the power transfer cables, which in turn stabilize the articulated angle of the articulated joint, which in turn stabilizes the articulated angle of the jaws.
[0114] Unless otherwise defined, all technical terms used herein have the same meanings as commonly understood by one of ordinary skill in the art of surgery, including electrosurgery. Specific methods, devices and materials are described in that application, but any methods and materials similar or equivalent to those described herein may be used in practicing the present technology. While modalities of the technology have been described in some detail and by means of illustrations, such illustration is for the purpose of clarity of understanding only, and is not intended to be limiting. Various terms have been used in the description to convey an understanding of the technology, it will be understood that the meanings of these various terms extend to common grammatical or linguistic variations or forms thereof. It will also be understood that when the terminology refers to devices or equipment in which these terms and names are provided as contemporary examples, the technology is not limited by this 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 covered by a contemporary term that will be understood as it has now been described by contemporary terminology. Additionally, while some theoretical considerations may have been advanced in order to provide an understanding of the technology, the claims attached to the technology are not bound by such theory. In addition, any one or more features of any technology modality may be combined with any one or more features of any other form of technology modality, or with any technology described in patent applications or issued patents that have been incorporated by reference without departure from the scope of technology. Additionally, it should be understood that this technology is not limited to the modalities that have been established for the purposes of illustration, but should only be defined by a fair reading of the claims attached to the patent application, including the full range of equivalence in which each element thereof is titled.

权利要求:
Claims (15)
[0001]
1. Electrosurgical instrument (10), comprising: an elongated rod (24) having an effector end (25) associated with a distal end thereof and a handle (44) associated with a proximal end thereof, the effector end (25) enabled to supply radio frequency energy to a target location; a pivotable joint (22) positioned between the rod (24) and the effector end (25), the joint (22) configured to pivot the effector end (25) angularly within a pivot arc, the pivotable joint (22) comprising at least one pivotable link (21) positioned between a distal end of the rod (24) and a proximal end of the effector end (25); a stabilized pivot actuator (190) disposed proximate the pivot joint (22) and adapted to control the pivot angle of the pivot joint (22); and at least two force transfer member portions operatively connected at their proximal end to the pivot actuator (190), and operatively connected at their distal end through the pivot joint (22) to a proximal portion of the effector end (25), thus allowing the rotational movement of the pivot actuator (190) to be translated into pivotal movement of the effector end (25), wherein the stabilized pivot actuator (190) is configured to stabilize the pivotable joint (22) at an angle stable by stabilizing the force transfer member portions, the stable angle of the pivot joint (22) being any one of a set of spaced apart angles within the joint pivot arch, wherein the pivot joint actuator (190) comprises: a rotationally stabilized disc (162) seated in an opening; a finger operable lever (233) configured to rotate the rotationally stabilized disc (162), the lever (233) comprising two opposing arms, each lever arm connected to one of the at least two force transfer member portions, the lever (233) configured such that its rotation moves a first transfer member portion in a proximal direction and a second member portion in a distal direction, characterized in that the stabilized pivot actuator (190) additionally comprises a force member tensioning mechanism associated with the rotatable finger operable lever (233), the force member tensioning mechanism configured to apply tension to the at least two force transfer member portions, wherein the tensioning mechanism The force member comprises a spring plate (170) comprising two opposing arms, at least one of the at least two rear member portions. an transfer of force being threaded through each arm of the lever operable by the rotatable finger, through the spring plate (170), and ending near the spring plate (170).
[0002]
2. Instrument according to claim 1, characterized in that it further comprises a rod rotator (51) disposed close to the pivotable joint (22), the rod rotator (51) configured to rotate the rod (24) in with respect to the handle (44), the stabilized linkage actuator (190) disposed within or in association with the rod rotator (51).
[0003]
3. Instrument according to claim 1, characterized in that the rotationally stabilized disc (162) comprises at least one spring portion (164) externally circumferentially tensioned against a wall of the circular opening, a circumferentially peripheral edge of the portion. spring (164) comprising one or more teeth (165), the circular opening wall comprising one or more pawls, the one or more teeth (165) and the one or more pawls configured to be mutually engageable.
[0004]
4. Instrument according to claim 1, characterized in that the rotationally stabilized disc (162) and the opening in which it rests are adapted to stabilize the rotation of the disc (162) to any position of a set of positions stables spaced at intervals within an arc of disk rotation.
[0005]
5. Instrument according to claim 4, characterized in that the rotational arc of the rotationally stabilized disc (162) encompasses about 90 degrees, including about 45 degrees in any direction from a neutral position where the finger operable lever (233) is orthogonal to rod (24).
[0006]
6. Instrument according to claim 4, characterized in that the pivotable joint (22) is adapted to stabilize to a set of stable positions at spaced intervals that substantially correspond to the stable positions of the rotationally stabilized disc (162).
[0007]
7. Instrument according to claim 1, characterized in that the rotationally stabilized disc (162) and the opening in which it rests are configured in such a way that the disc (162) can be stabilized to a position by a level of resistance to rotation of the disc (162) which can be overcome by applying torque to the finger operable lever (233).
[0008]
8. Instrument according to claim 1, characterized in that the rotationally stabilized disc (162) and the opening in which it rests are configured so that rotation of the disc (162) through a stable position requires applying a torque to the mechanism via a finger operable lever (233) that is greater than the torque required to rotate the disc (162) through portions of the arc between the stable angle positions.
[0009]
9. Instrument according to claim 1, characterized in that the pivot actuator (190) is additionally configured to stabilize the effector end (25) at a stable angle, the stable angle of the effector end (25) being any one of a set of angles spaced apart at intervals within the effector end pivot arc.
[0010]
10. Instrument according to claim 1, characterized in that at least one pivotable joint connection (22) and the distal end of the rod (24) and the proximal end of the effector end (25) comprises ball-like projections (27) engageable in complementary grooves (28).
[0011]
11. Instrument according to claim 1, characterized in that the pivotable joint (22) comprises a set of two or more interconnected connections (21) positioned between the distal end of the stem (24) and the proximal end of the end effector (25).
[0012]
12. Instrument according to claim 1, characterized in that the pivotable joint (22) is configured to pivot the effector end (25) within an arc of about 90 degrees, the arc of 90 degrees including about 45 degrees in any direction from a neutral position.
[0013]
13. Instrument according to claim 1, characterized in that the effector end (25) is a set of jaws (25), the instrument further comprising a blade (161) and a blade drive member collectively configured to be able to separate tissue at a target location into two portions when tissue is being gripped by the set of jaws (25).
[0014]
14. Instrument according to claim 13, characterized in that the blade (161) is configured to reside in a resting position distal to the pivotable joint (22) and is able to move distally within the set of jaws (25).
[0015]
15. Instrument according to claim 13, characterized in that the blade drive member is disposed through the pivotable joint (22), and is operable in any pivotal position, or is configured as a push and pull mechanism. pull.

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同族专利:

公开号 | 公开日

EP2688501B1|2015-08-26|

EP2688501A1|2014-01-29|

KR20140022844A|2014-02-25|

CA2828927A1|2012-09-27|

ES2550666T3|2015-11-11|

AU2012230520A1|2013-09-05|

CN103429184A|2013-12-04|

RU2013147153A|2015-04-27|

JP5864716B2|2016-02-17|

KR101561366B1|2015-10-16|

JP2014515652A|2014-07-03|

US20110230875A1|2011-09-22|

BR112013022126A2|2020-11-24|

WO2012126783A1|2012-09-27|

MX2013010732A|2013-12-06|

US8870867B2|2014-10-28|

CN103429184B|2016-08-17|

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法律状态:
2020-12-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

2020-12-22| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

2021-03-30| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

2021-05-25| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 14/03/2012, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

申请号 | 申请日 | 专利标题

US13/070,391|2011-03-23|

US13/070,391|US8870867B2|2008-02-06|2011-03-23|Articulable electrosurgical instrument with a stabilizable articulation actuator|

PCT/EP2012/054459|WO2012126783A1|2011-03-23|2012-03-14|Articulable electrosurgical instrument with a stabilizable articulation actuator|

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