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WO2016169040A1 - Pince écarteuse avec fermeture vasculaire pour dissection hyperfine - Google Patents

Pince écarteuse avec fermeture vasculaire pour dissection hyperfine Download PDF

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Publication number
WO2016169040A1
WO2016169040A1 PCT/CN2015/077341 CN2015077341W WO2016169040A1 WO 2016169040 A1 WO2016169040 A1 WO 2016169040A1 CN 2015077341 W CN2015077341 W CN 2015077341W WO 2016169040 A1 WO2016169040 A1 WO 2016169040A1
Authority
WO
WIPO (PCT)
Prior art keywords
members
intersection
shaft
jaw members
jaw
Prior art date
Application number
PCT/CN2015/077341
Other languages
English (en)
Inventor
Weijiang Ding
Jianjiang Chen
Original Assignee
Covidien Lp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Covidien Lp filed Critical Covidien Lp
Priority to PCT/CN2015/077341 priority Critical patent/WO2016169040A1/fr
Priority to CN201620350273.3U priority patent/CN205885521U/zh
Priority to CN201610256034.6A priority patent/CN106063722B/zh
Publication of WO2016169040A1 publication Critical patent/WO2016169040A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/2816—Pivots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00738—Aspects not otherwise provided for part of the tool being offset with respect to a main axis, e.g. for better view for the surgeon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2945—Curved jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595—Cauterization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/146—Scissors

Definitions

  • the present disclosure relates to energy-based surgical instruments and, more particularly, to energy-based surgical forceps configured for treating and/or cutting tissue.
  • a forceps or hemostat is a plier-like instrument which relies on mechanical action between its jaws to grasp, clamp, and constrict tissue.
  • Energy-based forceps utilize both mechanical clamping action and energy, e.g., electrosurgical energy, ultrasonic energy, light energy, microwave energy, heat, etc., to affect hemostasis by heating tissue to coagulate and/or cauterize tissue.
  • Certain surgical procedures require more than simply cauterizing tissue and rely on the unique combination of clamping pressure, precise energy control, and gap distance (i.e., distance between opposing jaws when closed about tissue) to “seal” tissue.
  • the surgeon has to accurately sever the tissue along the newly formed tissue seal.
  • many tissue sealing instruments have been designed to incorporate a blade that is movable with respect to a blade slot disposed in a jaw of the tissue sealing instrument to sever the tissue after forming a tissue seal.
  • Tissue sealing instruments that include a blade and blade slot, however, are typically single-use devices as the blade and blade slot may be difficult to clean, and the blade may wear and dull with repeated use.
  • the present disclosure is directed to reusable energy-based surgical instruments having movable, opposed jaw members that are configured for grasping, sealing, dissecting, and/or cutting tissue without the use of a blade and slot jaw configuration.
  • an electrosurgical forceps includes an end effector including a first jaw member having a first tissue contacting surface and a second jaw member having a second tissue contacting surface.
  • Each of the first and second jaw members have shear edges at opposed sides of the first and second tissue contacting surfaces.
  • the forceps is configured to selectively communicate electrosurgical energy between the first and second tissue contacting surfaces of the first and second jaw members upon actuation thereof.
  • At least one of the first and second jaw members is movable relative to the other between an open position, a first approximated position in which the first and second tissue contacting surfaces are substantially opposed and aligned with each other, and a second approximated position in which the first and second tissue contacting surfaces are laterally offset with respect to each other.
  • the first and second jaw members include proximal portions extending along a longitudinal axis and distal portions including the first and second tissue contacting surfaces.
  • Each of the first and second tissue contacting surfaces is longitudinally and laterally twisted with respect to the longitudinal axis.
  • the forceps includes first and second shaft members that cooperate to define the end effector.
  • the first jaw member is disposed on a distal end portion of the first shaft member and the second jaw member is disposed on a distal end portion of the second shaft member.
  • the first and second shaft members are coupled together by a pivot pin extending through openings defined in respective first and second intersection portions of the first and second shaft members. At least one of the first and second shaft members is pivotable with respect to the other of the first and second shaft members about two different axes.
  • first and second intersection portions of the first and second shaft members each include a substantially flat distal portion that are substantially flush with each other when the first and second jaw members are moved between the open position and the first approximated position.
  • first intersection portion of the first shaft member includes a proximal portion including a lower sloped surface, an intermediate sloped surface that meets the lower sloped surface at an apex, and an upper recessed surface
  • second intersection portion of the second shaft member includes a proximal portion including a substantially flat upper surface and a lower sloped surface that is complementary in shape with the intermediate sloped surface of the intersection portion of the first shaft member.
  • the second intersection portion of the second shaft member includes an insulative shim electrically isolating the second intersection portion from the first intersection portion.
  • proximal end portions of the first and second shaft members include first and second handle members, respectively.
  • the first handle member includes a first guide member and the second handle member includes a second guide member.
  • Each of the first and second guide members includes a body portion extending generally vertically from an inner surface of its respective first and second handle member, a leg portion extending substantially perpendicularly from the body portion, and a gap defined between the leg portion and the inner surface of its respective first and second handle member.
  • the leg portions of the first and second guide members are longitudinally aligned and laterally offset with respect to each another.
  • first and second guide members when the first and second handle members are in the open position the first and second guide members are spaced apart, when the first and second handle members are in the first approximated position, the leg portions of the first and second guide members are aligned with inner boundaries of the gaps defined in the other of the first and second guide members, and when the first and second handle members are moved to the second approximated position, the leg portions are aligned with outer boundaries of the gaps.
  • the pivot pin is disposed between the first and second intersection portions of the first and second shaft members and includes a body portion having a first pin portion concentric with the body portion and extending therefrom into an opening defined in the first intersection portion of the first shaft member and a second pin portion eccentric with the body portion and extending therefrom into an opening defined in the second intersection portion of the second shaft member. At least one of the first and second shaft members rotates about the first pin portion when moved between the open position and the first approximated position, and rotates about the second pin portion when moved between the first approximated position and the second approximated position.
  • the forceps includes a lever disposed between the first and second shaft members.
  • the lever includes a distal end having a recess that mechanically engages a joint disposed on a proximal end of the body portion of the pivot pin, wherein movement of the lever effects corresponding rotational movement of the pivot pin.
  • the lever includes an oblong opening defined in a body portion of the lever, and the first shaft member includes a retaining pin extending through the oblong opening.
  • the second intersection section includes an insulative shim electrically isolating the second intersection section from the first intersection portion, and the insulative shim extends proximally along the second intersection section to electrically isolate the second intersection section from the lever.
  • the first and second jaw members include projections proximally spaced from the first and second tissue contacting surfaces.
  • the projections have complementary beveled surfaces and complementary flattened surfaces.
  • the beveled surfaces of the first and second jaw members are opposed to each other, and when the first and second jaw members are in the second approximated position, the flattened surfaces of the first and second jaw members are substantially aligned along a common plane.
  • a method of treating tissue includes: pivoting at least one of first and second jaw members of an electrosurgical forceps along a first axis to effect movement of the first and second jaw members from an open position to a first approximated position in which first and second tissue contacting surfaces of the first and second jaw members are substantially opposed and aligned with each other to grasp tissue therebetween; applying electrosurgical energy to the tissue grasped between the first and second tissue contacting surfaces of the first and second jaw members to seal the tissue grasped therebetween; and pivoting at least one of the first and second jaw members along a second axis to effect movement of the first and second jaw members from the first approximated position to a second approximated position in which the first and second tissue contacting surfaces are laterally offset with respect to each other to cut the tissue grasped therebetween via shear edges disposed at opposed sides of the first and second tissue contacting surfaces.
  • FIG. 1 is a side, perspective view of a surgical system including an open electrosurgical forceps connected to a source of electrosurgical energy in accordance with an embodiment of the present disclosure
  • FIGS. 2A and 2B are side, perspective views of the forceps of the surgical system of FIG. 1 with parts separated;
  • FIGS. 3A and 3B are enlarged, perspective views of portions of the forceps of FIG. 1, shown along the areas of detail 3A and 3B, respectively, identified in FIG. 1;
  • FIG. 4A is a side, perspective view of the forceps of the surgical instrument of FIG. 1 in a first approximated position
  • FIG. 4B is a perspective view, in partial cross-section, of a portion of the forceps of FIG. 4A;
  • FIG. 4C is an isolated view of tissue contacting surfaces of the forceps of FIG. 4A;
  • FIG. 4D is a side, schematic view of the tissue contacting surfaces of FIG. 4C taken along lines A-A and B-B;
  • FIG. 4E is a cross-sectional view of jaw members of the forceps of FIG. 4A, taken along line 4E-4E of FIG. 4A, and including tissue disposed between the jaw members;
  • FIG. 5A is a side, perspective view of the forceps of FIG. 1 in a second approximated position
  • FIG. 5B is a top view of the forceps of FIG. 5A;
  • FIG. 5C is an isolated view of tissue contacting surfaces of the forceps of FIG. 5A;
  • FIG. 5D is a side, schematic view of the tissue contacting surfaces of FIG. 5C taken along lines A-A and B-B;
  • FIG. 5E is a cross-sectional view of jaw members of the forceps of FIG. 5A, taken along line 5E-5E of FIG. 5A, and including tissue disposed between the jaw members;
  • FIG. 6 is a side, perspective view of a surgical system including an open electrosurgical forceps connected to a source of electrosurgical energy in accordance with another embodiment of the present disclosure
  • FIG. 7 is a side, perspective view of the forceps of FIG. 6 with parts separated;
  • FIG. 8A is a side, perspective view of the forceps of FIG. 6 in a first approximated position
  • FIG. 8B is a perspective view, with parts removed, of a portion of the forceps of FIG. 8A;
  • FIGS. 8C and 8D are cross-sectional views taken along lines 8C-8C and 8D-8D, respectively, of the forceps of FIG. 8A;
  • FIG. 8E is a cross-sectional view of jaw members of the forceps of FIG. 8A, taken along line 8E-8E of FIG. 8A, and including tissue disposed between the jaw members;
  • FIG. 9A is a side, perspective view of the forceps of FIG. 6 in a second approximated position
  • FIG. 9B is a perspective view, with parts removed, of a portion of the forceps of FIG. 9A;
  • FIGS. 9C and 9D are cross-sectional views taken along lines 9C-9C and 9D-9D, respectively, of the forceps of FIG. 9A;
  • FIG. 9E is a cross-sectional view of jaw members of the forceps of FIG. 9A, taken along line 9E-9E of FIG. 9A, and including tissue disposed between the jaw members;
  • FIG. 10 is a schematic illustration of a work station configured for use with an electrosurgical forceps of the present disclosure.
  • proximal refers to a portion of a structure closer to an operator
  • distal refers to a portion of the same structure further from the operator.
  • subject refers to a human patient or animal.
  • doctor refers to a doctor (e.g., a surgeon) , a nurse, and other clinicians or care providers, and may include support personnel.
  • doctor e.g., a surgeon
  • nurse e.g., a nurse
  • other clinicians or care providers e.g., a patient or animal
  • the terms “generally, ” “substantially, ” and “about” shall be understood as words of approximation that take into account relatively little to no variation in the modified term (s) (e.g., differing by less than 3%) .
  • an energy-based surgical system 10 in accordance with the present disclosure is configured for grasping, electrically sealing, and mechanically dissecting tissue and/or vessels in open and/or laparoscopic surgical procedures.
  • the energy-based surgical system 10 includes a reusable forceps 100 releasably connected to a source of electrosurgical energy 200 via cable 202 and 204.
  • the forceps 100 includes a first elongated shaft member 110 pivotably coupled to a second elongated shaft member 120.
  • the first elongated shaft member 110 includes proximal and distal end portions 112 and 114, respectively, and the second elongated shaft member 120 includes proximal and distal end portions 122 and 124, respectively.
  • the proximal end portions 112 and 122 of the first and second shaft members 110 and 120 include first and second handle members 130 and 140, respectively.
  • the first and second handle members 130 and 140 are configured to allow an operator to effect movement of at least one of the first and second shaft members 110 and 120 relative to the other.
  • the distal end portions 114 and 124 of the first and second shaft members 110 and 120 cooperate to define an end effector assembly 115 having opposed first and second jaw members 150 and 160.
  • the first and second handle members 130 and 140 each define a finger hole 130a and 140a, respectively, therethrough for receiving a finger of an operator. Finger holes 130a and 140a facilitate movement of the first and handle members 130 and 140 relative to each other.
  • the first and second handle members 130 and 140 are each monolithically formed with the respective shaft members 110 and 120. Alternatively, the first and second handle members 130 and 140 may each be engaged with respective shaft members 110 and 120 in any suitable configuration, e.g., via mechanical engagement, molding, adhesion, etc.
  • the first handle member 130 includes a first guide member 132 extending from an inner surface 130b of the first handle member 130 towards the second handle member 140.
  • the first guide member 132 includes a body portion 132a extending generally vertically towards the second handle member 140 and a leg portion 132b extending substantially perpendicularly from the body portion 132a such that the body portion 132a and the leg portion 132b have a general L-shaped configuration and define a gap 132c between the inner surface 130b of the first handle member 130 and the leg portion 132b of the first guide member 132.
  • the leg portion 132b includes a convex inner surface 132d although other configurations are also contemplated.
  • the second handle member 140 includes a second guide member 142 extending from an inner surface 140b of the second handle member 140 towards the first handle member 130.
  • the second guide member 142 includes a body portion 142a extending generally vertically towards the first handle member 130 and a leg portion 142b extending substantially perpendicularly from the body portion 142a such that the body portion 142a and the leg portion 142b have a general L-shaped configuration and define a gap 142c between the inner surface 140b of the second handle member 140 and the leg portion 142b of the second guide member 142.
  • the leg portion 142b includes a convex inner surface 142d although other configurations are also contemplated.
  • the first and second guide members 132 and 142 are disposed on the first and second handle members 130 and 140 with the body portions 132a and 142a longitudinally offset and laterally spaced with respect to one another and the leg portions 132b and 142b aligned such that the inner surfaces 132d and 142d slide past one another when the first and second handle members 130 and 140 are pivoted about an “x” axis between an open position (FIG. 1) and a first approximated position (FIG. 4A) .
  • the first shaft member 110 intersects the second shaft member 120 at intersection portions 116 and 126 of the first and second shaft members 110 and 120, respectively.
  • the intersection portion 116 of the first shaft member 110 defines an opening 116a therethrough.
  • An inner surface 116b of the intersection portion 116 includes a substantially flat distal portion 116c and a proximal portion 116d having a lower sloped surface 116e, an intermediate sloped surface 116f that meets the lower sloped surface 116e at an apex 116g, and an upper recessed surface 116h that extends concentrically around the opening 116a.
  • the intersection portion 126 of the second shaft member 120 includes an opening 126a defined through an inner surface 126b of the intersection portion 126.
  • the insulative shim 128 is configured to extend along the intersection portions 116 and 126 of the first and second shaft members 110 and 120 to electrically isolate the first and second shaft members 110 and 120 from each other.
  • the insulative shim 128 is formed from an electrically insulative material, such as a ceramic or plastic, and may be glued, brazed, or otherwise mechanically and/or chemically secured to the second shaft member 120, as is within the purview of those skilled in the art. Additionally or alternatively, the inner surface 126b of the intersection portion 126 of the second shaft member 120, or a portion thereof, may include an insulative coating, e.g., a ceramic coating.
  • the insulative shim 128 includes an inner surface 128d facing the intersection portion 116 of the first shaft member 110 that includes a substantially flat distal portion 128e and a proximal portion 128f having a substantially flat upper surface 128g and a lower sloped surface 128h that is complementary in shape with the intermediate sloped surface 116f of the intersection portion 116 of the first shaft member 110.
  • a pivot pin 170 is positioned through the openings 116a and 128c defined in the intersection portion 116 of the first shaft member 110 and the insulative shim 128 of the intersection portion 126 of the second shaft member 120 to couple the first and second shaft members 110 and 120 to one another.
  • the first and second handle members 130 and 140 are free to rotate about the “x” axis between open and approximated positions. When in a first approximated position, as shown in FIGS.
  • the distal portions 116c and 128e of the intersection portion 116 of the first shaft member 110 and the insulative shim 128 of the intersection portion 126 of the second shaft member 120 are substantially flush with each other and the intermediate sloped surface 116f of the first intersection portion 116 and the lower sloped surface 128h of the insulative shim 128 of the second intersection portion 126 abut such that a gap “G” is defined between the upper recessed surface 116h of the first intersection portion 116 and the upper surface 128g of the insulative shim 128 of the second intersection portion 126. Accordingly, when in this first approximated position, the first handle member 130 may be rotated about the “y” axis in the limited range defined by the gap “G. ”
  • the first and second jaw members 150 and 160 extend distally from the intersection portions 116 and 126 of the first and second shaft members 110 and 120.
  • Proximal portions 150a and 160a of the first and second jaw members 150 and 160 extend longitudinally from the intersection portions 116 and 126 along axis “z”
  • distal portions 150b and 160b include first and second tissue contacting surfaces 152 and 162, respectively, that are twisted (e.g., curved, curled, bent, or otherwise shaped) to distally extend longitudinally and laterally away from the axis “z” defined by the proximal portions 150a and 160a of the first and second jaw members 150 and 160.
  • the first and second tissue contacting surfaces 152 and 162 each include a leading end portion 152a and 162a that is distal to a trailing end portion 152b and 162b, and shear edges 154 and 164 at opposed sides of the first and second tissue contacting surfaces 152 and 162, respectively. As detailed below, shear edges 154 and 164 are configured to shear against one another to cut tissue disposed therebetween.
  • the first and second tissue contacting surfaces 152 and 162 have a complementary geometry such that when the first and second jaw members 150 and 160 are in the first approximated position the first and second tissue contacting surfaces 152 and 162 are opposed and aligned for tissue sealing (e.g., FIGS.
  • first and second tissue contacting surfaces 152 and 162 diverge laterally with increased clearance at the leading end portions 152a and 162a of the first and second tissue contacting surfaces 152 and 162 for tissue cutting (e.g., FIGS. 5C and 5D) .
  • the first and second shaft members 110 and 120 are a pair of electrodes, formed from an electrically conductive material, e.g., a metal, such as a stainless steel, that are configured to conduct electrosurgical energy therethrough.
  • An insulative coating such as an insulative paint, is disposed over the forceps 100 except at the tissue contacting surfaces 152 and 162 and the shear edges 154 and 164 of the first and second jaw members 150 and 160, as well as the insulative shim 128, which itself is an electrically insulative material. Accordingly, the forceps 100 is coated with an insulative coating except at the tissue contacting surfaces 152 and 162 and the shear edges 154 and 164 of the first and second jaw members 150 and 160, as well as the insulative shim 128.
  • the forceps 100 is placed at a desired surgical site and the first and second jaw members 150 and 160 are positioned in an open position around desired tissue and/or vessel (s) . As shown in FIG. 1, in the open position, the first and second jaw members 150 and 160 are spaced apart from each other, and are pivotable about axis “x. ”
  • the first and second jaw members 150 and 160 are moved into the first approximated position by moving at least one of the first and second handle members 130 and 140 towards the other such that at least one of the first and second handle members 130 and 140 pivots about the pivot pin 170 about the “x” axis, and the first and second handle members 130 and 140 are closed to a first approximated position to grasp tissue “T” between the first and second jaw members 150 and 160 as shown in FIGS. 4A-4E.
  • the inner surfaces 132d and 142d of the leg portions 132b and 142b of the first and second guide surfaces 132 and 142 of the first and second handle members 130 and 140 slide past each other and may be latched together when the leg portions 132b and 142b are aligned with inner boundaries of the gaps 132c and 142c defined in the other of the guide members 132 and 142.
  • the source of electrosurgical energy 200 (FIG. 1) may then be activated to apply electrosurgical energy to tissue “T” grasped between the first and second tissue contacting surfaces 152 and 162 of the first and second jaw members 150 and 160.
  • the first and second handle members 130 and 140 may be returned to the open position (FIG. 1) to release tissue “T” held between the first and second tissue contacting surfaces 152 and 162 of the first and second jaw members 150 and 160, or the first and second jaw members 150 and 160 may be moved to a second, approximated position to cut the tissue “T” disposed therebetween. As shown in FIGS.
  • At least one of the first and second handle members 130 and 140 is moved laterally so that the leg portions 132b and 142b of the first and second handle members 130 and 140 are yawed around the “y” axis through the gaps 132c and 142c in the other of the guide members 132 and 142 and are aligned with outer boundaries of the gaps 132c and 142c.
  • the first and second jaw members 150 and 160 are laterally displaced relative to each other (FIG. 5E) .
  • first and second jaw members 150 and 160 When this lateral movement between the first and second jaw members 150 and 160 is larger than the width of the first and second jaw members 150 and 160, the shear edges 154 and 164 of the first and second jaws 150 and 160 cut the tissue “T” bound between the first and second jaw members 150 and 160. The first and second handle members 130 and 140 may then be moved back to the open position.
  • a surgical system 10’ in accordance with another embodiment of the present disclosure includes a forceps 100’ releasably connected to a source of electrosurgical energy 200 via cable 202 and 204.
  • Forceps 100’ includes a first elongated shaft member 110’ pivotably connected to a second elongated shaft member 120’ .
  • Proximal end portions 112’ and 122’ of the first and second shaft members 110’ and 120’ include first and second handle members 130’ and 140’ , respectively.
  • Distal end portions 114’ and 124’ of the first and second shaft members 110’ and 120’ cooperate to define an end effector assembly 115’ having opposed first and second jaw members 150’ and 160’ .
  • the first and second handle members 130’ and 140’ each define a finger hole 130a and 140a, and a ratchet portion 132’ , 142’ , respectively.
  • Each ratchet portion 132’ , 142’ extends from an inner surface 130b’ and 140b’ of its respective handle member 130’ and 140’ towards the other ratchet portion 132’ and 142’ in a generally vertically aligned manner such that inner facing surfaces 132a’ and 142a’ of each ratchet portion 132’ and 142’ abut one another when the first and second handle members 130’ and 140’ are approximated.
  • Each ratchet portion 132’ and 142’ includes a plurality of flanges 132b’ and 142b’ respectively, that project from the inner facing surface 132a’ and 142a’ of each ratchet portion 132’ and 142’ such that the ratchets portions 132’ and 142’ may interlock at one or more positions corresponding to a first approximated position of the first and second jaw members 150’ and 160’ .
  • These one or more approximated positions of the first and second jaw members 150’ and 160’ each impart a specific closure pressure to tissue grasped between the first and second jaw members 150’ and 160’ of the end effector 115’ , thus allowing for effective treatment of a wide range of tissue types and sizes.
  • the first shaft member 110’ intersects the second shaft member 120’ at intersection portions 116’ and 126’ of the first and second shaft members 110’ and 120’ , respectively.
  • the intersection portion 116’ of the first shaft member 110’ defines an opening 116a’ therethrough and the intersection portion 126’ of the second shaft member 120’ defines an opening 126a’ therethrough.
  • the insulative shim 128’ is configured to extend along the intersection portions 116’ and 126’ of the first and second shaft members 110’ and 120’ and proximally up the second shaft member 120’ to electrically isolate the first and second shaft members 110’ and 120’ from each other.
  • a pivot pin 170’ is disposed between the first and second intersection portions 116’ and 126’ of the first and second shaft members 110’ and 120’ , and a lever 180, which is in mechanical engagement with the pivot pin 170’ , extends proximally therefrom between the first and second shaft members 110’ and 120’ .
  • the pivot pin 170’ includes a body portion 172 having a first surface 172a facing the first shaft member 110’ that includes a first pin portion 174 substantially centered in the first surface 172a and extending therefrom and into engagement with the opening 116a’ defined in the intersection portion 116’ of the first shaft member 110’ .
  • the body portion 172 of the pivot pin 170’ has a second surface 172b facing the second shaft member 120’ that includes a second pin portion 176 offset or eccentric with the center of the second surface 172b and extending therefrom and into engagement with the opening 128c’ of shim 128’ of the second shaft member 120’ .
  • the first and second shaft members 110’ and 120’ are independently movable about respective first and second pin portions 174 and 176.
  • a proximal end of the body portion 172 of the pivot pin 170’ includes a joint 178 extending into a recess 180a defined in a distal end of the lever 180.
  • the lever 180 includes an elongated arcuate body portion 180b defining an oblong opening 180c therethrough.
  • the first shaft member 110’ includes a retaining pin 118 that extends through the oblong opening 180c defined in the lever 180. Accordingly, the range of movement of the lever 180 with respect to the first shaft member 110’ is defined by the length of the opening 180c.
  • the first and second jaw members 150’ and 160’ include proximal portions 150a’ and 160a’ that extend longitudinally from the intersection portions 116’ and 126’ of the first and second shaft members 110’ and 120’ , and distal portions 150b and 160b that include first and second tissue contacting surfaces 152 and 162 and shear edges 154 and 164, respectively, as described above.
  • the proximal portions 150a’ and 160a’ of the first and second jaw members 150’ and 160’ each include projections 156 and 166 having complementary beveled surfaces 156a and 166a and complementary flattened surface 156b and 166b such that when the first and second jaw members 150’ and 160’ are in a first approximated position the beveled surfaces 156a and 166a are opposed to each other, and when the first and second jaw members are in a second approximated position, the flattened surfaces 156b and 166b are aligned along the same plane.
  • the first and second shaft members 110’ and 120’ are a pair of electrodes, similar to the first and second shaft members 110 and 120 of the forceps 100. Accordingly, an insulative coating is disposed over the forceps 100’ except at the tissue contacting surfaces 152 and 162 and the shear edges 154 and 164 of the first and second jaw members 150’ and 160’ , as well as the insulative shim 128’ .
  • the forceps 100’ is placed at a desired surgical site and the first and second jaw members 150’ and 160’ are positioned in an open position around desired tissue and/or vessel (s) . As shown in FIG. 6, in the open position, the first and second handle members 130’ and 140’ as well as the first and second jaw members 150’ and 160’ are spaced apart from each other.
  • the first and second jaw members 150’ and 160’ are moved into the first approximated position by moving at least one of the first and second handle members 130’ and 140’ towards the other such that the first handle member 130’ pivots about the first pin portion 174 of the pivot pin 170’ , the flanges 132b’ and 142b’ of the ratchet portions 132’ and 142’ interlock, and the first and second tissue contacting surfaces 152 and 162 of the first and second jaw members 150’ and 160’ grasp tissue “T” therebetween, as shown in FIGS. 8A-8E.
  • the beveled surfaces 156a and 166a of the proximal portions 150a’ and 160a’ of the first and second jaw members 150’ and 160’ face each other in spaced relation.
  • the source of electrosurgical energy 200 (FIG. 6) may then be activated to apply electrosurgical energy to tissue “T” grasped between the first and second tissue contacting surfaces 152 and 162 of the first and second jaw members 150’ and 160’ .
  • the first and second handle members 130’ and 140’ may be returned to the open position (FIG. 6) to release tissue “T” held between the first and second tissue contacting surfaces 152 and 162 of the first and second jaw members 150’ and 160’ , or the first and second jaw members 150’ and 160’ may be moved to a second, approximated position to cut the tissue “T” disposed therebetween.
  • a proximal end of the level 180 is pushed down by the operator which, in turn, moves the recess 180a defined in the distal end of the lever 180 up.
  • the pivot pin 170’ is rotated.
  • Corresponding rotation of the second pin portion 176 of the pivot pin 170’ moves the second shaft member 120’ along substantially orthogonal axes “x” and “y. ”
  • the bevel surfaces 156a and 166a are pushed together and slide with respect to each other such the first and second jaw members 150’ and 160’ yaw around axis “y” causing the first and second tissue contacting surfaces 152 and 162 of the first and second jaw members 150’ and 160’ to laterally move relative to each other.
  • first and second jaw members 150’ and 160 When this lateral movement between the first and second jaw members 150’ and 160’ is larger than the width of the first and second jaw members 150’ and 160’ , the shear edges 154 and 164 of the first and second jaws 150’ and 160’ cut the tissue “T” bound between the first and second jaw members 150’ and 160’ .
  • the first and second handle members 130’ and 140’ may then be moved back to the open position.
  • the embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery. ”
  • Such systems employ various robotic elements to assist the operator and allow remote operation (or partial remote operation) of surgical instrumentation.
  • Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the operator during the course of an operation or treatment.
  • Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
  • the robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location.
  • one team of surgeons or nurses may prep a subject (e.g., a patient) for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system.
  • a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
  • the robotic arms of the surgical system are typically coupled to a pair of master handles by a controller.
  • the handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc. ) which may complement the use of one or more of the embodiments described herein.
  • the movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon.
  • the scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument (s) .
  • the master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions.
  • the master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon’s ability to mimic actual operating conditions.
  • a medical work station is shown generally as work station 1000 and generally may include a plurality of robot arms 1002 and 1003; a control device 1004; and an operating console 1005 coupled with control device 1004.
  • Operating console 1005 may include a display device 1006, which may be set up in particular to display three-dimensional images; and manual input devices 1007 and 1008, by means of which an operator (not shown) , for example a surgeon, may be able to telemanipulate robot arms 1002 and 1003 in a first operating mode.
  • Each of the robot arms 1002 and 1003 may include a plurality of members, which are connected through joints, and an attaching device 1009 and 1011, to which may be attached, for example, a surgical tool “ST” supporting an end effector 1100, in accordance with any one of several embodiments disclosed herein, as will be described in greater detail below.
  • Robot arms 1002 and 1003 may be driven by electric drives (not shown) that are connected to control device 1004.
  • Control device 1004 e.g., a computer
  • Control device 1004 may be set up to activate the drives, in particular by means of a computer program, in such a way that robot arms 1002 and 1003, their attaching devices 1009 and 1011 and thus the surgical tool (including end effector 1100) execute a desired movement according to a movement defined by means of manual input devices 1007 and 1008.
  • Control device 1004 may also be set up in such a way that it regulates the movement of robot arms 1002 and 1003, and/or of the drives.
  • Medical work station 1000 may be configured for use on a patient 1013 lying on a patient table 1012 to be treated in a minimally invasive manner by means of end effector 1100. Medical work station 1000 may also include more than two robot arms 1002 and 1003, the additional robot arms likewise being connected to control device 1004 and being telemanipulatable by means of operating console 1005. A medical instrument or surgical tool (including an end effector 1100) may also be attached to the additional robot arm. Medical work station 1000 may include a database 1014, in particular coupled to with control device 1004, in which are stored, for example, pre-operative data from patient/living being 1013 and/or anatomical atlases.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Animal Behavior & Ethology (AREA)
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  • Otolaryngology (AREA)
  • Plasma & Fusion (AREA)
  • Ophthalmology & Optometry (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne une pince électrochirurgicale (100) qui comprend : un effecteur d'extrémité (115) comprenant un premier élément de mâchoire (150) ayant une première surface de contact avec des tissus (152) ; et un second élément de mâchoire (160) ayant une seconde surface de contact avec des tissus (162). Chacun des premier et second éléments de mâchoire (150, 160) présente des bords de cisaillement (154, 164) situés sur des côtés opposés des première et seconde surfaces de contact avec des tissus (152, 162). La pince (100) est configurée pour transmettre de manière sélective une énergie électrochirurgicale entre les première et seconde surfaces de contact avec des tissus (152, 162) des premier et second éléments de mâchoire (150, 160) lors de son actionnement. L'un au moins parmi les premier et second éléments de mâchoire (150, 160) est mobile par rapport à l'autre entre une position ouverte, une première position rapprochée dans laquelle les première et secondes surfaces de contact avec des tissus (152, 162) sont sensiblement face à face et alignées l'une avec l'autre, et une seconde position rapprochée dans laquelle les première et seconde surfaces de contact avec des tissus (152, 162) sont décalées latéralement l'une par rapport à l'autre.
PCT/CN2015/077341 2015-04-24 2015-04-24 Pince écarteuse avec fermeture vasculaire pour dissection hyperfine WO2016169040A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
PCT/CN2015/077341 WO2016169040A1 (fr) 2015-04-24 2015-04-24 Pince écarteuse avec fermeture vasculaire pour dissection hyperfine
CN201620350273.3U CN205885521U (zh) 2015-04-24 2016-04-22 电外科钳
CN201610256034.6A CN106063722B (zh) 2015-04-24 2016-04-22 超精细解剖用血管密封分隔钳

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WO2016169040A1 (fr) * 2015-04-24 2016-10-27 Covidien Lp Pince écarteuse avec fermeture vasculaire pour dissection hyperfine
US11540872B2 (en) * 2017-03-13 2023-01-03 Covidien Lp Electrosurgical instrument with trigger driven cutting function
WO2019028647A1 (fr) * 2017-08-08 2019-02-14 Covidien Lp Appareil électrochirurgical avec caractéristiques d'isolation de sécurité

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CN106063722A (zh) 2016-11-02
CN205885521U (zh) 2017-01-18

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