JP5138738B2 - Blood vessel sealing device - Google Patents

Description

(Citation of related application)
This application is a continuation-in-part of US patent application Ser. No. 09 / 425,696, filed Oct. 22, 1999 by Philip Mark Tetlaff et al. This continuation-in-part application is a partially pending application of US patent application Ser. No. 09 / 178,027 filed Oct. 23, 1998 by Philip Mark Tetzluff et al. The entire contents of each of these applications are incorporated herein by reference.

(background)
The present disclosure relates to forceps used for open surgical procedures. More particularly, the present disclosure relates to forceps that apply a combination of mechanical clamping pressure and current to seal tissue.

Technical field)
A hemostatic agent or forceps is a simple pliers-like instrument that uses mechanical action between its jaws to clamp the vessel, which grips, tears, and / or clamps tissue Because of this, it is commonly used in open surgical procedures. Electrosurgical forceps utilize both mechanical clamping and electrical energy to heat the tissue and blood vessels to coagulate, cauterize and / or seal the tissue.

  Certain surgical procedures require sealing and cutting blood vessels or vascular tissue. Several academic papers disclose methods for sealing small blood vessels using electrosurgery. A paper entitled Studio Coagulation and the Development of an Automatic Computerized Bipolar Coagulator (J. Neurosurg., 75, July 1991) is a bipolar coagulator used to seal small blood vessels. Yes. This paper states that it is impossible to safely coagulate arteries with diameters greater than 2-2.5 mm. The second paper is titled “Automatically Controlled Bipolar Electrocoagulation—“ COA-COMP ”(Neurosurge. Rev. (1984), pp. 187-190), but electrosurgery to blood vessels to avoid scorching of blood vessel walls. Describes how to transmit force.

  By utilizing electrosurgical forceps, the surgeon can cauterize, coagulation / drying, reduce or delay bleeding, and / or by controlling the intensity, frequency and duration of electrosurgical energy applied to the tissue, and / or Or a blood vessel can be sealed. In general, the electrical configuration of electrosurgical forceps can be divided into two categories: 1) unipolar electrosurgical forceps; and 2) bipolar electrosurgical forceps.

  Unipolar forceps use one active electrode connected to a clamping end effector and a remote patient return electrode or pad, typically attached to the patient externally. . When electrosurgical energy is applied, the energy travels through the patient from the active electrode to the surgical site and to the return electrode.

  Bipolar electrosurgical forceps use two generally opposing electrodes. The electrodes are disposed on opposing inner surfaces of the end effector and both are electrically connected to the electrosurgical generator. Each electrode is charged to a different potential. Since tissue is a conductor of electrical energy, when an effector is used to grasp the tissue between the effectors, the electrical energy can be selectively transmitted through the tissue.

  In order to properly seal a large blood vessel, two main mechanical parameters (pressure applied to the blood vessel and gap distance between electrodes) must be properly controlled. Both of them affect the thickness of the vessel being sealed. More specifically, the correct application of pressure overcomes the expansion force during tissue heating to counteract the vessel wall and lower the tissue impedance to a value low enough to pass sufficient electrosurgical energy through the tissue. And to contribute to the end tissue thickness, which is an indicator of good sealing. The fused vessel wall has been determined to be optimal between 0.001 inch and 0.005 inch. Below this range, the seal can be broken or torn, and above this range, the lumen may not be properly or effectively sealed.

  As blood vessels become smaller, the pressure applied to the tissue tends to be less related, whereas the gap distance between the conductive surfaces becomes important for effective sealing. In other words, the opportunity for the two conductive surfaces to touch during activation increases as the blood vessel becomes smaller.

  The electrosurgical method can be coupled with an instrument that can apply a large closing force to the vessel wall and seal the large vessel using an appropriate electrosurgical output curve. The process of coagulating small blood vessels is believed to be fundamentally different from electrosurgical vascular sealing. For purposes herein, “coagulation” is defined as the process of drying tissue where the tissue cells have ruptured and dried. Vascular sealing is defined as the process of liquefying the collagen in a tissue so that it reforms into a fused mass. Therefore, clotting of small blood vessels is sufficient to permanently close them. Large blood vessels need to be sealed to ensure permanent closure.

A number of bipolar electrosurgical forceps have been proposed in the past for various open surgical procedures. However, some of these designs may not provide a uniformly reproducible pressure to the vessel and may result in an ineffective or non-uniform seal. For example, U.S. Pat. No. 2,176,479 to Willis, U.S. Pat. Nos. 4,005,714 and 4,031,898 to Hiltebrandt, U.S. Pat. No. 5,827,274 to Boebel et al. 5,290,287 and 5,312,433; Lottick U.S. Pat. Nos. 4,370,980, 4,552,143, 5,026,370, and 5, No. 116,332, US Pat. No. 5,443,463 to Stern et al., US Pat. No. 5,484,436 to Eggers et al. And US Pat. No. 5,951,549 to Richardson et al. The present invention relates to an electrosurgical instrument that coagulates, cuts and / or seals (hereinafter referred to as Patent Documents 1 to 13, respectively) .

  Many of these instruments include blade members or shear members that simply cut tissue in a mechanical and / or electromechanical manner and are relatively ineffective for vascular sealing purposes. . Other instruments rely only on the clamping pressure to obtain the proper sealing thickness and require clearance tolerances and / or parallelism and flatness requirements (which are consistently effective if properly controlled). It is not designed in consideration of the parameters that can guarantee tissue sealing. For example, it is known that it is difficult to sufficiently control the thickness of the sealed tissue that results from controlling only the clamping pressure for one of two reasons: ) If the applied force is too great, the two poles may touch and not transfer energy through the tissue, resulting in an ineffective seal; or 2) if the applied pressure is too low Thick and unreliable seals can occur.

  As mentioned above, a greater closing force is required between the opposing jaw members to properly and effectively seal large blood vessels. It is known that applying a large closing force between these jaws typically requires a large moment about each jaw about its pivot. This is a challenge because these jaw members are typically secured with pins (which are positioned to have a small moment arm relative to the pivot of each jaw member). Show. Large forces are undesirable with small moment arms because they can shear these pins. As a result, the designer can either design an instrument with metal pins and / or design an instrument that at least partially removes these closure forces to reduce the possibility of machine failure. You must compensate for these large closure forces. As can be appreciated, if metal pivot pins are used, these metal pins avoid this pin acting as an alternate current path between jaw members (which can adversely affect effective sealing). Must be insulated.

Increasing the closing force between the electrodes can have other undesirable effects. For example, thereby, the counter electrodes can be in intimate contact with each other, resulting in a short circuit, and a small closure force can cause premature movement of tissue during compression and prior to activation.

U.S. Pat. No. 2,176,479 US Pat. No. 4,005,714 U.S. Pat. No. 4,031,898 US Pat. No. 5,827,274 US Pat. No. 5,290,287 US Pat. No. 5,312,433 US Pat. No. 4,370,980 US Pat. No. 4,552,143 US Pat. No. 5,026,370 US Pat. No. 5,116,332 US Pat. No. 5,443,463 US Pat. No. 5,484,436 US Pat. No. 5,951,549

  Therefore, it allows a large closing force between the opposing jaw members, reduces the chance that the opposing jaw members will short circuit during activation, and assists in manipulating, grasping and holding the tissue before and during activation. There is a need to develop bipolar forceps that effectively seals vascular tissue and solves the above problems by providing a device that does.

(wrap up)
The present disclosure relates to a bipolar electrosurgical instrument for use in open surgery, which includes first and second shafts, one of which is connectable to a source of electrosurgical energy. Each shaft has a jaw member extending from its distal end and a handle disposed at its proximal end for moving the jaw member relative to each other from a first open position, wherein the jaw The members are disposed in a spaced relationship relative to each other with respect to the second closed position, wherein the jaw members cooperate to grasp tissue therebetween. The source of electrical energy provides first and second potentials on the individual jaw members so that the jaw members selectively conduct energy through the tissue held between them to effect a seal. Can do.

  Preferably, the first and second potentials are created at the jaw member through the first shaft. For example, in one embodiment, the first potential is provided by the lead having a terminal end that provides an electrical interface with a distal connector that couples the first jaw member to the first potential. It is transmitted through the shaft. The second potential is transmitted through the first shaft by a tube disposed in the first shaft that couples the second jaw member to the second potential.

  The first and second jaw members are connected around a pivot pin. Preferably, the distal connector is disposed between the jaw members and includes a series of flanges that are dimensioned to prevent the generation of stray currents from the electrically conductive sealing surfaces of the jaw members during activation.

  Preferably, the distal connector includes a spring washer or wave washer that acts as an electrical relay between the terminal end and the jaw member. In one embodiment, the spring washer includes a bevel to increase the electrical interface between the terminal end and the jaw member. That is, having a slope causes rotation of the spring washer relative to the terminal end during movement of the jaw member from the first position to the second position, which is self-cleaning, the terminal end Providing increased operational electrical contact between the section and the jaw members.

  Preferably, the distal connector is made from an insulative material and is disposed between the jaw members to electrically insulate the first potential and the second potential. In one embodiment, the distal connector includes therein a first surface having defined at least one recess dimensioned to receive at least a portion of the terminal end of the lead.

  Note that in another embodiment, one of the jaw members is between all angles of operation, i.e. when the jaw member is placed in the first position, the second position, and / or their Including a skirt dimensioned to prevent the terminal end from being exposed during operational movement between the terminals.

  Preferably, the lead includes an inner core made of a solid or multi-strand electrically conductive material, eg, a copper / aluminum wire, which is surrounded by an insulating non-conductive coating, eg, plastic. . In one embodiment, the terminal end or distal end of the electrically conductive material is flattened, i.e., "flat form" and substantially surrounds a boss extending from the surface of the distal connector. Dimensions. Preferably, the boss is designed to electrically insulate the terminal end of the lead from the pivot pin.

In another embodiment, at least one non-conductive stop member is disposed on one conductive sealing surface of the jaw member. The stop member is designed to control / adjust the distance between the jaw members, i.e. the gap, when tissue is held between the jaw members during activation.
More specifically, the present invention can relate to the following items.
(Item 1)
A bipolar electrosurgical instrument for use in open surgery, comprising:
First and second shafts, each having a jaw member extending from its distal end and movement of said jaw member relative to each other disposed at its proximal end from a first position to a second position Wherein the jaw members are arranged in a spaced relationship relative to each other in the first position, wherein in the second position, A shaft with which the jaw members move together to grip tissue;
A source of electrical energy having first and second potentials, wherein the first potential is coupled to one of the jaw members, and the second potential is sealed by the jaw members; A source connected to the other of the jaw members so as to be able to selectively conduct energy through the tissue held therebetween, and
Wherein the first and second potentials are transmitted to the jaw members through the first shaft.
(Item 2)
The first electrical potential is transmitted through the first shaft by a lead having a terminal end that provides an electrical interface with a distal connector connecting one of the jaw members to the first electrical potential; A bipolar electrosurgical instrument for use in open surgery according to item 1.
(Item 3)
Item 3. The open surgery of item 2, wherein the second potential is transmitted through the first shaft by a tube disposed in the first shaft that couples the other jaw member to the second potential. Bipolar electrosurgical instrument for use in.
(Item 4)
The bipolar electrosurgical instrument for use in open surgery according to item 2, wherein the distal connector comprises a spring washer that acts as an electrical relay between the terminal end and the jaw member.
(Item 5)
5. A bipolar electrosurgical instrument for use in open surgery according to item 4, wherein the spring washer is dimensioned to increase the electrical interface between the terminal end and the jaw member.
(Item 6)
The spring washer is dimensioned to rotate relative to the terminal end during movement of the jaw member from the first position to the second position, and is self-cleaning, the terminal end and the jaw member; 6. A bipolar electrosurgical instrument for use in open surgery according to item 5, which provides increased electrical contact between the two.
(Item 7)
The use in open surgery of item 2, wherein the distal connector is manufactured from an insulating material and inserted between the jaw members to electrically insulate the first and second potentials. Bipolar electrosurgical instrument for.
(Item 8)
8. The use in open surgery of item 7, wherein the distal connector comprises a first surface having at least one recess that is dimensioned to receive at least a portion of the terminal end defined therein. Bipolar electrosurgical instrument for.
(Item 9)
At least one of the jaw members is dimensioned to prevent exposure of the terminal end when the jaw member is disposed between the first position, the second position and operative movement therebetween. A bipolar electrosurgical instrument for use in open surgery according to item 7, comprising a skirt that is
(Item 10)
A bipolar electrosurgical instrument for use in open surgery according to item 2, wherein the terminal end comprises a wire in flat form.
(Item 11)
Item 11. The use in open surgery of item 10, wherein the jaw members are connected by a pivot and the flat form wire is dimensioned to substantially surround a boss extending from the distal connector that houses the pivot. Bipolar electrosurgical instrument for.
(Item 12)
Item 3. The open of item 2, wherein the jaw members are connected by a pivot and the distal connector comprises a boss extending therefrom and designed to electrically insulate the terminal end from the pivot. Bipolar electrosurgical instrument for use in surgery.
(Item 13)
The lead is provided through the tube to the distal connector, and the lead comprises an insulating coating that surrounds the wire-like electrical conductor to insulate the wire-like electrical conductor from the tube during activation. A bipolar electrosurgical instrument for use in open surgery according to item 3.
(Item 14)
A bipolar electrosurgical instrument for use in open surgery, comprising:
First and second shafts, each having a jaw member extending from its distal end and movement of said jaw member relative to each other disposed at its proximal end from a first position to a second position Wherein the jaw members are arranged in a spaced relationship relative to each other in the first position, wherein in the second position, A shaft wherein the jaw members co-activate and grasp tissue therebetween, each of the jaw members including a conductive sealing surface;
The first potential connected to one of the jaw members and the jaw member to the other of the jaw members to selectively conduct energy through the tissue held therebetween for sealing. A source of electrical energy having a coupled second potential;
First and second potentials transmitted to the jaw member through the first shaft, wherein the first potential is a lead having a terminal end that provides an electrical interface with a spring washer And the spring washer acts as an electrical relay between the terminal end and the jaw member;
At least one non-conductive stop disposed on at least one electrically conductive sealing surface of the jaw member that controls the distance between the jaw members when tissue is held between the jaw members; An instrument comprising a member.
(Item 15)
Item 15. The open surgery of item 14, wherein the second potential is transmitted through the first shaft by a tube disposed in the first shaft that couples the other jaw member to the second potential. Bipolar electrosurgical instrument for use in.
(Item 16)
The bipolar electrosurgery for use in open surgery according to item 14, further comprising an insulator disposed between the jaw members to electrically insulate the first potential and the second potential. Instruments.
(Item 17)
15. A bipolar electrosurgical instrument for use in open surgery according to item 14, wherein the terminal end comprises a flat form wire.
(Item 18)
The spring washer is dimensioned to rotate relative to the terminal end during movement of the jaw member from the first position to the second position, and is self-cleaning, the terminal end and the jaw 15. A bipolar electrosurgical instrument for use in open surgery according to item 14, which provides increased electrical contact between members.
(Item 19)
A bipolar electrosurgical instrument for use in open surgery, comprising:
First and second shafts, each having a jaw member extending from its distal end and movement of said jaw member relative to each other disposed at its proximal end from a first position to a second position Wherein the jaw members are arranged in a spaced relationship relative to each other in the first position, wherein in the second position, A shaft wherein the jaw members co-activate and grasp tissue therebetween, each of the jaw members including a conductive sealing surface;
At least one stop member disposed on one of the electrically conductive surfaces of the at least one jaw member; and
Since the jaw member seals the first electric potential connected to one electrically conductive sealing surface of the jaw member and the other electrically conductive surface of the jaw member, the electrically conductive sealing A source of electrical energy having a second electrical potential coupled to selectively conduct energy through tissue held between the surfaces;
Wherein the first potential and the second potential are transmitted to the jaw member through the first shaft.

Various embodiments of the device of the present invention will be described with reference to the accompanying drawings.
It is a perspective view from the left of the forceps by this invention. 2 is an enlarged perspective view of the end effector assembly of the forceps of FIG. 1 shown in an open configuration. FIG. 2 is an enlarged perspective view of the end effector assembly of the forceps of FIG. 1 shown in a closed configuration. FIG. 1 is an exploded view of a forceps according to the present invention. FIG. FIG. 4B is an enlarged exploded view of the end effector assembly of FIG. 4A illustrating the electrical connection of the distal electrical connector for supplying electrical energy to the end effector assembly. FIG. 6 is an enlarged perspective view from above of a lower jaw member of a forceps with a distal connector seated thereon. It is a perspective view from the right of the forceps of FIG. 1 shown catching a tissue structure. FIG. 4B is an enlarged view of the region shown in detail in FIG. 4A showing a proximal electrical interface / connector for supplying electrical energy to the end effector assembly. FIG. 7 is a cross-sectional view of the forceps of FIG. 6, showing the electrical supply path of a first lead having a first potential and the proximal electrical interface of FIG. 7 with a second lead having a second potential. The electrical connection of is shown.

(Detailed explanation)
1-4, a forceps 10 for use in conjunction with an open surgical procedure includes elongated shaft portions 12a and 12b, each having a proximal end 16a and 16b, and a distal end, respectively. 14a and 14b. In the drawings and in the following description, the term “proximal” refers to the end of the forceps 10 that is closer to the user, as is conventional, while the term “distal” is the end farther from the user. Part.

  The forceps 10 includes an end effector assembly 100 attached to the distal ends 14a and 14b of shafts 12a and 12b, respectively. As described in more detail below, the end effector assembly 100 includes a pair of opposing jaw members 110 and 120 that are pivotally connected about a pivot pin 150.

  Preferably, each shaft 12a and 12b includes handles 17a and 17b disposed at their proximal ends 16a and 16b, each of which defines a finger hole 18a and 18b, respectively, through which a user passes. Accommodates fingers. As can be appreciated, the finger holes 18a and 18b facilitate movement of the shafts 12a and 12b relative to each other, which in turn rotates the jaw members 110 and 120 from the open position (FIG. 2). The jaw members 110 and 120 are disposed in a spaced relationship relative to each other toward the gripping or closed position (FIG. 3), where the jaw members 110 and 120 are co-operating. Grab the tissue 400 between them (FIG. 6).

  Preferably, a ratchet 30 is provided to selectively lock the jaw members 110 and 120 relative to each other at various positions during rotation. As best shown in FIG. 6, a first ratchet interface, eg, 30a, is located within the interior of each ratchet 30a and 30b from the proximal end 16a of the shaft member 12a toward the second ratchet interface 30b. The facing surfaces extend side by side in a generally vertical manner so as to contact each other upon closure around the tissue 400. Preferably, each ratchet interface 30a and 30b includes a plurality of flanges 32a and 32b, which connect the ratchet interfaces 30a and 30b in at least one position from the inward facing surface of each ratchet interface 30a and 30b. Protrusively to project. In the embodiment shown in FIG. 6, these ratchet interfaces 30a and 30b connect at several different locations.

  Preferably, each position associated with the cooperating ratchet interfaces 30a and 30b retains a specific, ie constant strain energy, in the shaft members 12a and 12b, which in turn is specific to the jaw members 110 and 120. A natural closing force. It is devised that the ratchet 30 may include a scale or other visual indication that allows a user to easily and quickly confirm and control a desired amount of closing force between the jaw members. A design without a ratchet system or similar system may require the user to hold the jaw members 110 and 120 together by applying a constant force to the handles 17a and 17b, which results in inconsistent results obtain.

  As best shown in FIG. 1, one of the shafts, for example 12b, is designed to couple the forceps 10 to an electrosurgical energy supply generator, such as an electrosurgical power supply (not shown). A position shaft connector 19 is included. More specifically, the proximal shaft connector 19 is formed by a cover 19a and a flange 19b extending proximally from the shaft 12b. Preferably, the cover 19a and flange 19b are mechanically cooperating and attach the electrosurgical cable 210 to the forceps 10 so that the user can selectively apply electrosurgical energy as needed.

  The proximal end of the cable 210 includes a plug 200 having a pair of protrusions 202a and 202b that are dimensioned to electrically and mechanically engage the electrosurgical energy generator. As described in more detail below with respect to FIG. 8, the distal end of this cable 210 connects the proximal shaft connector 19 of the shaft 12b with a plurality of finger-like clamp members 77a and 77b and opposing fingers 76a and 76b. It is fixed by a cable crimp. The interior of the cable 210 houses a pair of leads 210a and 210b that conduct different electrical potentials from the electrosurgical generator to the jaw members 110 and 120, as will be described in more detail below.

  As best seen in FIGS. 2-4B, the two opposing jaw members 110 and 120 of the end effector assembly 100 move about the pin 150 from an open position to a closed position to grasp the tissue 400 therebetween. It can be rotated. Jaw members 110 and 120 are generally symmetrical and include similar element features that cooperate to allow easy rotation about pivot pin 150 to grip and seal tissue 400. . As a result, and unless otherwise noted, jaw member 110 and the associated operating features are first detailed herein, and similar element features for jaw member 120 are briefly summarized thereafter. .

  The jaw member 110 includes an insulated outer housing 114 that is dimensioned to mechanically engage an electrically conductive sealing surface 112 and a proximally extending flange 130 that includes: Dimensioned to seat the distal connector 300, described in more detail below with respect to FIGS. 4A, 4B and 5. Preferably, the outer insulating housing 114 extends along the entire length of the jaw member 110 and reduces the path of alternating current or stray current during the sealing and / or accidental firing of the tissue 400. The inwardly facing surface of the flange 130 includes an electrically conductive plate 134 (FIG. 4B) that conducts electrosurgical energy to the electrically conductive sealing surface 112 upon activation.

  Similarly, jaw member 120 includes similar elements: an outer housing 124 that engages an electrically conductive sealing surface 122; a proximally extending flange 140 that sits on an opposing surface of distal connector 300; Upon activation, it includes an electrically conductive plate 144 that conducts electrosurgical energy to the electrically conductive sealing surface 122.

  One of the jaw members, eg, 110, includes at least one stop member 150 disposed on the inner facing surface of the electrically conductive sealing surface 112 (and / or 122). Preferably, this stop member (s) is designed to facilitate grasping and manipulation of tissue 400 and the gap “G” between opposing jaw members 110 and 120 during sealing. (FIG. 6). A detailed discussion of these and other possible stop members 150, as well as various manufacturing and assembly processes for installation, placement, installation, and / or securing the stop members 150 to the electrically conductive sealing surfaces 112, 122 Doing is described in a co-pending, co-pending US patent application entitled “Bipolar electrosurgical forceps with non-conductive stop members,” which is incorporated herein by reference in its entirety. .

  FIG. 4A shows an exploded view of the various elements of forceps 10 and the internal working relationship between them. In more detail and in addition to the elements described above with respect to FIGS. 1-3 above, preferably the shaft 12a is hollow and defines a longitudinal channel 15a disposed therethrough, which includes therein It is a dimension which accommodates the tube 60a in the. Tube 60a includes a proximal end 64a, a distal end 62a, and at least one mechanical interface 61a disposed therebetween. The shaft 12a also includes a cover plate 50, which is designed for snap fit engagement within an aperture / cavity 45a defined through the outer surface of the shaft 12a. Cover plate 50 includes a series of opposing flanges 51a and 51b that are dimensioned to extend therefrom and secure tube 60a within shaft 12a as described below. A second flange 52 attaches the cover plate 50 to the shaft 12a.

  During assembly, the proximal end 64a of the tube 60a is slidably incorporated into the channel 15a. As a result, the mechanical interface 61a is supported to engage the cover plate 50. The cover plate 50 then snap fits into the cavity 45a so that the flanges 51a and 51b secure the tube 60a within the shaft 12a. The cavity 45a of the shaft 12a is disposed along the outer surface of the tube 60a to engage at least one detent (not shown) that engages a mechanical interface 61a that limits / prevents rotation of the tube 60a relative to the shaft 12a. It is envisaged that This synergistic relationship is illustrated by way of example with respect to detents 75a and 75b and interface (eg, notch) 61b of shaft 12b in FIG. In this case, the flanges 51a and 51b (which are very similar to the flanges 42a and 42b of the cover plate 40 in FIG. 8) hold the detents 75a and 75b with a stable engagement in the notch 61a in FIG. Thus, rotational movement and / or longitudinal movement of the tube 60a in the channel 15a is prevented.

  Preferably, the proximal end of tube 60a includes a slit-like interface 65a. This interface mechanically engages a corresponding knob 88a extending from the inner surface of the shaft 12a in the cavity 45a. The knob 88a is also envisioned to prevent rotational movement of the tube 60a within the shaft 12a. Alternatively, the slit 65a can be formed to allow radial contraction and expansion of the tube 60a to facilitate friction fit engagement between the tube 60a and the shaft 12a. Other interfaces are also envisioned to facilitate engagement of shaft 12a and tube 60a (eg, snap fit, spring lock, locking tab, screw-like interface, knobs and grooves, etc.).

  The distal end 62a of the tube 60a is preferably sized to engage the jaw member 120 (i.e., the distal end 62a is a simple and stable friction material for the tube 60a in the jaw member 120). A slit-like interface 66a that facilitates engagement, more specifically and as indicated above, the jaw member 120 has a proximally extending flange 130 having a sleeve 128 extending proximally from the flange 130. The sleeve 128 is dimensioned such that upon insertion of the sleeve 128 within the distal end 62a, the slit-like interface 66a expands radially outward to stably lock the jaw member 120 to the tube 60a. Again, other attachment methods that serve the same purpose are also envisioned (eg, snapping) Click, locking tabs, spring lock, screw-like interface, knobs and grooves, etc.).

  As can be appreciated by the present disclosure, the arrangement of the shaft 12b is slightly different from the shaft 12a best shown in FIGS. 4B, 7 and 8. More specifically, the shaft 12b is also hollow to define a channel 15b through the shaft and is sized to receive a tube 60b in the channel 15b. Tube 60b includes a proximal end 64b and a distal end 62b. These ends are attached in a manner substantially similar to their counterpart components with respect to the shaft 12a. For example, the proximal end 64b of the tube 60b is slidably incorporated into the channel 15b such that a mechanical interface 61b disposed on the outer surface of the tube 60b is supported for engagement with the cover plate 40. (FIGS. 4A and 8).

  Preferably, and because forceps 10 is uniquely designed to incorporate all of the electrical interfaces and connections within and along one shaft (eg, 12b), shaft 12b is described below. As can be seen, it includes a slightly larger cavity 45b that is defined to accommodate and secure the various electrical connections associated with the forceps 10. For example, the cover plate 40 has a slightly different dimension than the cover plate 50, mostly due to spatial considerations, which must incorporate the incorporation of various internally disposed electrical junctions. Adapted. However, the cover plate 40 will certainly snap into the top of the shaft 12b so that the pair of flanges 42a and 42b secure the tube 60b in the shaft 12b in a manner similar to that described above. For example, FIG. 8 shows a pair of detents 75a and 75b disposed within the cavity 45b of the shaft 12b. This cavity engages a number of corresponding mechanical interfaces 61b located along the outer surface of the tube 60b to limit / prevent rotation of the tube 60b relative to the shaft 12b. When assembled, each flange 42a and 42b is pushed into the corresponding groove 73a and 73b, respectively. These flanges effectively maintain / hold detents 75a and 75b with a stable engagement in notch 61b to prevent rotational and / or longitudinal movement of tube 60b in channel 15b.

  The end 64b of the tube 60b also includes a slit-like interface 65b. This interface mechanically engages a corresponding knob 88b extending from the inner surface of the shaft 12b in the cavity 45b. The knob 88a is also assumed to prevent rotational movement of the tube 60b in the shaft 12b. Alternatively, the slit 65b can be formed to allow radial contraction and expansion of the tube 60b to facilitate friction fit engagement between the tube 60b and the shaft 12b.

  Unlike tube 60a, tube 60b is designed as an electrical duct to transmit electrosurgical energy to jaw member 110, which is described in more detail below with respect to FIGS. The distal end 62b of the tube 60b is preferably dimensioned to engage the jaw member 110. That is, the distal end 62b includes a slit-like interface 66b that facilitates a simple, tight friction fit engagement of the tube 60b with the jaw member 110. This is best shown in FIG. 4B, which shows the proximally extending flange 130 (from which the end sleeve 138 extends) of the jaw member 110. End sleeve 138 is dimensioned such that when inserting end sleeve 138 into distal end 62b, slit-like interface 66b extends radially outward and securely locks jaw member 110 to tube 60b. .

  As can be appreciated, the distal end 138 is made at least in part from an electrically conductive material so that upon actuation, electrosurgical potential is passed from the tube 60b through the distal sleeve 138 to the plate 134. And is conducted to the conductive sealing plate 112. As described above, the outer insulating housing 114 of the jaw member 110 effectively eliminates stray currents and accidental tissue burns over the intended electrical path.

  As best shown in FIG. 4B, jaw member 110 includes a raceway 135 extending proximally from flange 130, which includes a distal sleeve 138 at its proximal end. The end sleeve 138 is connected to the conductive tube 60b disposed within the shaft 12b as described above. Raceway 135 serves two purposes: 1) to provide electrical conduction from end sleeve 138 through conductive plate 134 to conductive sealing surface 112; and 2) described below. In order to provide a channel for guiding the lead 210a to the distal connector 300.

  The insulated outer housing 114 is sized to securely engage the conductive sealing surface 112. This can be achieved by stamping, overmolding, overmolding a stamped conductive sealing plate, and / or overmolding a metal injection molded sealing plate. Is predicted. All of these manufacturing techniques produce an electrode having a conductive surface 112 that is substantially surrounded by an insulated outer housing 114.

  It is anticipated that the jaw members may also include a second insulator (not shown) disposed between the conductive sealing surface 112 and the outer insulating housing 114. Insulated outer housing 114 and conductive sealing surface 112 (and other insulators, if used) preferably provide undesirable known effects (eg flashover, thermal diffusion) on tissue sealing. And a dimension that limits and / or reduces much of the stray current distribution).

  It is also anticipated that the conductive sealing surface 112 may comprise a pinch trim (not shown). This pinch trim facilitates secure engagement of the conductive surface 112 to the insulated outer housing 114 and also simplifies the entire manufacturing process. The conductive sealing surface 112 may include an outer peripheral edge having a radius, and the insulated outer housing 114 may be adjacent to the conductive sealing surface 112 and adjacent edges that are generally tangential to the radius. It is also contemplated to face along and / or face along this radius. Preferably, at the interface, the conductive surface 112 is raised relative to the insulated outer housing 114. These and other anticipated embodiments may be found in co-pending, co-pending, commonly assigned, application number 203-2898, entitled “ELECTROSURGITALINSTRUMENT WHICH REDUCES COLLATETAL DAMAGE TO ADJENT TISSUE” (Johns). ), And co-pending, co-pending and assigned application number 203-2657, entitled "ELECTROSURICAL INSTRUMENT WHICH IS DESIGNED TO REDUCE THE INCIDENCE OF FLASHON et al." (Jon) Have been discussed.

  As best shown in the exploded view of FIG. 4B, the inner circumference of the tube 60b preferably accommodates the lead 210a therethrough so that different potentials can be effectively transmitted to the jaw member 120. Dimensioned. More specifically and as described above, cable 210 accommodates two leads 210a and 210b having different potentials. The first lead 210a is disposed through the tube 60b and conducts a first electrical potential to the jaw member 120 as described in more detail below. The second lead 210b is electrically connected to the tube 60b at the proximal connector 80 (FIG. 7) (which comprises a series of electrical crimps 85, 87 and 89 for securing the lead 210b to the tube 60b). To interface. As a result, the tube 60b carries a second potential therethrough until it is finally connected to the jaw member 110 as described above.

  Lead 210a preferably includes an insulative coating 213 that surrounds an inner core or electrical conductor 211 (e.g., a wire) disposed in the lead and during operation this The electric conductor 211 is insulated from the tube 60b. It is envisioned that this wire 211 may be made from a solid or multi-strand electrically conductive material (eg, copper / aluminum) surrounded by an insulating non-conductive coating 213 (eg, plastic).

  Wire 211 includes a distal end 212 that is dimensioned to electrically connect with jaw member 120. Preferably, this end 212 is generally arcuate and “flat” to surround a corresponding boss 314 that extends upwardly from the distal connector 300 toward the jaw member 120 as described below. flat-formed) ". The distal connector 300 has at least two functions: (1) insulating the jaw member 110 from the jaw member 120; and (2) providing a persistent electrical connection of the lead 210a to the jaw member 120. It is assumed that

  More particularly, the distal connector 300 is generally shaped to conform to the overall profile of the electrically conductive faceplate 134 of the jaw member 110 and the electrically conductive faceplate 144 of the jaw member 120 and is therefore assembled. If so, the other outwardly facing outer surfaces 302 and 304 of the distal connector 300 join the corresponding faceplates 134 and 114 of the jaw members 110 and 120, respectively. It is envisioned that the outwardly facing outer surface 302 of the distal connector 300 acts as a sliding surface that facilitates the pivoting movement of the jaw member 120 about the pivot pin 151 relative to the jaw member 110. Preferably, the distal connector 300 is made from an insulating substrate such as plastic, or some other non-conductive material.

  The distal connector includes a series of flanges 322 and 326 extending toward the jaw member 120 and a series of second flanges 324 and 328 extending toward the jaw member 110. These flanges 322, 324, 326 and 328 are envisioned to insulate other operating elements of the forceps 10 and the patient from stray current spreading from the electrically conductive faceplates 134 and 144 during operation. Flanges 322 and 328 may also be dimensioned to limit / limit the expansion of tissue 400 beyond sealing surfaces 112 and 122 during operation. Flanges 326 and 324 are preferably sized to insulate the forceps during all angle actuation (swing of jaw members 110 and 120).

  As described above, the distal connector 300 includes a boss 314 that extends toward the jaw member 120 sized to secure the distal end 212 of the lead 210a. Preferably, this boss is designed to electrically insulate the distal end of the lead from the pivot. The boss 314 preferably defines an opening 316 therethrough for receiving the pivot pin 151 and allows pivoting movement of the jaw member 120 about the pivot 151 and pivoting movement of the boss 314 relative to the jaw member 110. To.

  A series of recesses 312, 318, and 319 are formed around and proximal to the boss 314 to secure the flat end piece 212, the wire 211, and the insulated portion of the lead 210a, respectively. This also secures the lead 210a to the distal connector and limits the movement of the lead 210a. In some cases, it may be preferred that a small amount of silicone or other non-conductive material be included in the junction between the wire and the end 212 as an additional and / or alternative insulation protection. It is also envisioned that the flange 326 may include a notch (not shown) disposed through the flange that facilitates assembly of the lead 210a on top of the distal connector 300. As can be appreciated, this eliminates the step of forming arcuate end 212 after insertion through channel 318. As noted above, a small amount of silicone or the like may be added to the top / notch of the notch for insulation after the end 212 is installed in the distal connector 300.

  The most proximal portion of the distal connector comprises a finger 320 that is dimensioned to be placed in a channel 137 formed in the raceway 135 so that the distal connector 300 is It moves with the jaw member 110 during turning. The channel 135 may be formed during the molding process and subsequently drilled after the raceway 135 is formed or by any other known forming method. The top end of the boss 314 is preferably dimensioned to be installed in a corresponding recess (not shown) formed in the faceplate 144. Similarly, although not shown, it is assumed that the opposite end of the boss 314 extends toward the face plate 134 and is installed in a recess 131 formed in the face plate 134. This recess 131 is assumed to facilitate engagement between the jaw member 110 and the distal connector 300.

  The distal connector 300 also includes a spring or wave washer 155 that is preferably dimensioned to surround a boss 314 at the top of the end 212. When assembled, the washer 155 is sandwiched / fastened between the end 212 and the conductive faceplate 144 of the jaw member 120. This washer 155 is envisioned to strengthen the connection between the distal end and the faceplate 144. More particularly, the washer 155 is preferably shaped such that the washer 155 provides a self-cleaning persistent electrical contact between the distal end 212 and the jaw member 120. This washer 155 is intended to “self-clean” due to frictional contact and relative movement of the washer 155 with respect to the distal end 212 during the pivoting of the jaw members 110 and 120. This self-cleaning action may be due to the washer rubbing, scratching and / or digging the end 212 and / or faceplate 144 during the pivoting of the jaw members 110 and 120.

  Each outer housing of jaw members 110 and 120 preferably includes a further recess or annular groove 129 that receives ring-like insulators 153b and 153a, respectively. Insulators 153a and 153b insulate pivot pin 150 from jaw members 110 and 120 when forceps 10 are assembled. Preferably, pivot pin 150 is peened to secure jaw members 110 and 120 during assembly and may include outer rims 151a and 151b, at least one of which is best shown in FIG. 4B. As described above, after the jaw members 110 and 120 are assembled around the pivot pin 150, they are peened or formed.

  At start-up, the first electrical potential is carried by lead 210a through tube 60b and to terminal end 212. The washer 155 of the distal connector 300 then conducts a first electrical potential to the face plate 144 that carries the first electrical potential to the sealing plate 122 disposed on the inward surface of the jaw member 120. . The second potential is carried by lead 210b, which is electrically interfaced with tube 60b (by crimp 85, 87 and 89) to provide the second potential and terminal sleeve 138 of jaw member 110. To tell. The terminal sleeve 138 is electrically connected to the sealing surface 112 across the face plate 134.

  FIG. 8 shows the connection of the cable 210 within the cavity 45b of the shaft 12b. As described above, a series of finger-like elements 77a and 77b and crimps 76a and 76b secure cable 210 within shaft 12b. Preferably, cable 210 is fixed at an angle alpha (α) with respect to a longitudinal axis “A” disposed along shaft 12b. Angling the cable 210 inward (ie, toward the shaft 12a) facilitates manipulation of the forceps 10 and cable 210 during surgery (ie, the angle of the cable 210 as it exits the forceps 10). It is envisioned that the attached arrangement tends to reduce cable entanglement and / or cable collision during operation).

  Preferably, at least one of the jaw members 110 and 120 comprises a skirt-like structure 126 and 136, respectively, which is used during all angle operations (ie, the jaw members 110 and 120 are the first ones). Dimensioned to prevent exposure of the terminal end 212 or wire 211, when positioned between the open position, the second closed position and / or the operational movement therebetween.

  By making the forceps 10 disposable, it is assumed that the forceps 10 are less likely to be damaged. This is because the forceps is intended for single use only and therefore does not require cleaning or sterilization. As a result, the functionality and consistency of critical sealing components (eg, conductive surfaces 112 and 122, stop member 150, and insulative housings 124 and 114) ensure a uniform, good quality seal.

  With reference to the foregoing and various drawings, those skilled in the art will recognize that certain modifications can be made to the disclosure without departing from the scope of the disclosure. For example, it may be preferable to include a tang that facilitates manipulation of the forceps 10 during surgery.

  Furthermore, the electrical connection is preferably combined with the lower shaft 12b and the device is intended for right-handed use, although the electrical connection depends on the particular purpose and / or left-handed user It is contemplated that other shafts 12a can be joined together to facilitate operation according to.

  It is contemplated that a shrink tube may be used over the proximal connector 80 and / or that various other solder or crimp connections 85, 87 and 89 associated with the proximal connector 80 interface with the lead wire 210b. The This provides additional insulation protection during assembly. The forceps 10 (and / or the electrosurgical generator used to connect to the forceps 10) may include a sensor or feedback mechanism (not shown) that is interposed between the jaw members 110 and 120. It is also contemplated to automatically select the appropriate amount of electrosurgical energy to effectively seal the particular size tissue 400 being grasped. The sensor or feedback mechanism may also measure impedance across the tissue during sealing and an indication that an effective seal has been created between jaw members 110 and 120 (visual and / or auditory). ).

  Although some embodiments of the present disclosure are illustrated in the drawings, the present disclosure is as broad as the art allows, and the present specification should be construed to read as well, It is not construed as limited to these embodiments. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims (15)

A bipolar electrosurgical instrument for use in open surgery, comprising:
First and second shafts, each having a jaw member extending from its distal end and a movement of the jaw member relative to each other disposed at its proximal end from a first position to a second position And a handle for performing
Here, in the first position, the jaw members are arranged in a spaced relationship relative to each other, wherein in the second position, the jaw members co-operate between them. Gripping tissue, each of the jaw members being adapted to be coupled to a source of electrical energy having a first potential and a second potential, wherein the first potential is connected to one of the jaw members; And the second potential is connected to the other of the jaw members, and the jaw member selectively conducts energy through the tissue held therebetween to effect tissue sealing;
Here, the first potential and the second potential are transmitted through the first shaft to the jaw member, and the first potential connects one of the jaw members to the first potential. is transmitted by lead wire having a terminal end portion of the distal connector interface for; and wherein a spring washer which acts as an electrical relay between the distal connector the terminal end and the jaw member A bipolar electrosurgical instrument. The opening according to claim 1, wherein the second potential is transmitted through the first shaft by a tube disposed within the first shaft connecting the other jaw member to the second potential. Bipolar electrosurgical instrument for use in surgery. The jaw members are connected by a pivot, and the distal connector includes a boss extending from the distal connector and designed to electrically insulate the terminal end from the pivot, and the spring washer The bipolar electrosurgical instrument for use in open surgery according to claim 1, wherein the boss surrounds the boss to increase the electrical interface between the terminal end and the jaw member. The spring washer is dimensioned to rotate relative to the terminal end during movement of the jaw member from the first position to the second position, and is self-cleaning, the terminal end and the jaw The bipolar electrosurgical instrument for use in open surgery according to claim 1, which provides increased electrical contact with a member. The open surgery of claim 1, wherein the distal connector includes an insulating substrate and is disposed between the jaw members to electrically insulate the first potential and the second potential. Bipolar electrosurgical instrument for use in. The bipolar electrical for use in open surgery according to claim 1, wherein the distal connector includes at least one recess dimensioned to receive at least a portion of the terminal end defined therein. Surgical instruments. At least one of the jaw members is dimensioned to prevent exposure of the terminal end when the jaw member is positioned during the first position, the second position and operative movement therebetween. A bipolar electrosurgical instrument for use in open surgery according to claim 5, comprising a skirt that is The bipolar electrosurgical instrument for use in open surgery according to claim 1, wherein the terminal end comprises a flat form wire. 9. For use in open surgery according to claim 8, wherein the jaw members are connected by a pivot and the flat form wire is dimensioned to substantially surround a boss extending from the distal connector that receives the pivot. Bipolar electrosurgical instrument. The lead is fed through the tube to the distal connector, and the lead includes an insulating coating that surrounds the wire-like electrical conductor to insulate the wire-like electrical conductor from the tube during activation. A bipolar electrosurgical instrument for use in open surgery according to Item 2. A bipolar electrosurgical instrument for use in open surgery, comprising:
First and second shafts, each pivotable about a pivot pin and extending from its distal end and disposed at its proximal end and second from a first position A handle for performing movement of the jaw members relative to each other to a position, wherein, in the first position, the jaw members are disposed in a spaced relationship relative to each other; Here, in the second position, the jaw members cooperate to grip tissue therebetween, each of the jaw members being adapted to connect to an electrical energy source and an electrically conductive sealing surface Wherein a first electric potential is connected to one of the jaw members and a second electric potential is connected to the other of the jaw members, the tissue passing through the tissue held between them. Can selectively transmit energy;
The terminal end at which the first potential and the second potential are transmitted through the first shaft to the jaw member, wherein the first potential electrically interfaces with one of the jaw members. And a spring washer disposed between the terminal end and one of the jaw members, the spring washer from the first position of the jaw member to the second Bipolar electric dimensioned to rotate relative to the terminal end during movement into position, providing self-cleaning, increased electrical contact between the terminal end and the jaw member Surgical instruments. The second potential is transmitted through the first of the first shaft by the arrangement tubing in the shaft connecting the other of said jaw member to said second potential, according to claim 11 Bipolar electrosurgical instrument for use in open surgery. 12. The bipolar electrosurgery for use in open surgery according to claim 11 , further comprising an insulator disposed between the jaw members to electrically insulate the first potential and the second potential. Instruments. The bipolar electrosurgical instrument for use in open surgery according to claim 11 , wherein the terminal end comprises a flat form wire. At least positioned distally with respect to the pivot pin and operably coupled to at least one of the jaw members to control a distance between the jaw members when tissue is held therebetween. 12. The bipolar electrosurgical instrument for use in open surgery according to claim 11 , further comprising a non-conductive stop member.

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