CA2176754A1

CA2176754A1 - Bipolar ultrasonic surgery

Info

Publication number: CA2176754A1
Application number: CA002176754A
Authority: CA
Inventors: Michael Steve Klicek; Gregory J. Trudel
Original assignee: Individual
Current assignee: Valleylab Inc
Priority date: 1993-12-30
Filing date: 1994-10-26
Publication date: 1995-07-06
Also published as: EP0737045A1; FI946163A7; DE9490469U1; AU688384B2; WO1995017855A1; FI946163A0; JPH09500812A; AU7821794A

Abstract

An ultrasonic oscillator drives a tool at a set frequency. An amplitude control (47) runs the oscillator to set the vibration level. A frequency regulator (48) joins the amplitude and the oscillator. A handpiece supports a tranducer and a vibrating tool. A flue (17) surrounds the tool. Electrodes (42) associated with the flue (17) and/or the tool extend to be at or near the distal tip (18) of the tool and/or the flue (17) and provide bipolar electrosurgery with or without ultrasonic vibration of the tool. A method of performing ultrasonic surgery and bipolar electrosurgery has an ultrasonic handpiece with bipolar electrodes (42) associated with the tool or the flue (17).

Description

W0 95117855 2 1 7 6 7 ~ 4 BIPOLAR ULTRASONIC SURGERY
1. Field of the Invention This relates to bipolar electrosurgery in cu~"Li" ' with an ulL,~...,"i~ vibrated surgical tool, and more particularly, the use of one or more additional electrodes on the irrigation flue or the ultrasonic pipe tool to provide bipolar electrosurgical energy near the tip of th~ vibrating tool.

2. R~r~ round of the Disclosure U.S. Patent 4,674,498 has a vibrating scalpel with electric cautery driven with low frequency vibrations wherein the cutting is by the "t,~ ,Ol action of the sharp knife blade and the vibrations keep the blade free from sticking to the cauterized tissue and bodily fluid. Th~ sticking of tissue and fluid act to destroy the cauterized tissue causing the sOaled wound to open. The'498 patent discloses a low frequency heated vibrating scalpel.
U.S. 4,886,060 assigned to ~ "ad AB, a Swedish company, has a piezo el~,_L,i-.~lly driven ull,o~ ,lly vibrating tool and broadly claims an ultrasonic knife means used with a high frequency emitting source for energy to induce heat in the tissue at the tip of the ultrasonic knife for coagulating the tissue. The tool is electrical isolated from the co~ tion means ~electrosurgery) to prevent shortingthe piezo driver.
U.S. Patent 4,931,047 assigned to Valleylab, of Boulder, Colorado is an ultrasonic apparatus with a vibrating tip to cli~i, IL~.YI .,t~ tissue at a surgical site. The tip is connected to a radio frequency generator and supplies cutting or coagulating current or a blend thereof to the site. Surgical procedures can thereby be performed using ultrasonic r~oy~ oli~nl and electrosurgery or either approach i"d~pe"dt~"ll~
30 andlor alL~,,c,li-~ly. The electrosurgery is monopolar in that the energy from the tip passes through the patients tissue to a ground pad attached to the patient's body.
The tool supporting the tip is hollow having a bore and irrigation fluid passes through an annular space around the tool to the tip and is aspirated proximally therefrom through the bore thus removing surgical debris from the site. This aspiration technique is known in U.S. Patent 3,693,613.
U.S. Patent 5,015,227 assigned to Valleylab, of Boulder, Colorado pertains to an ultrasonic instrument that includes electrosurgical ~, ' " s The specifics WO95117855 ~6~
of that patent relate to a conductive O-ring to allow the switching at the handpiece of the electrosurgical energy nvt~ l,ala~ ,y the vibrations of the ultrasonic driver for the ~, ,. Ialllil~y tool.
Bipolar electrosurgery is typically accu" "~li~l ,ad by bringing two electrosurgical electrodâs into close proximity to the tissue to be treated and then activatins the r~lectrosurgical generator to desiccate the tisâue. The current is confined to the area bâtween the two electrodes. Having an ulLIv~vll "y vibrating tool interposed between or near the bipolar electrodes has not been done. The entire disclosures of the prior patents are illvVl,UVlalaV herein by reference and made a part hereof.
SUMMARY OF Tl-IE Ir~Vc,. I l C~
A bipolar ultrasonic surgical instrumânt may have a handpiece for manipulation by a surgeon connected to a bipolar source of electrosurgical radiofrequency enârgy. An electronic oscillator preferably drives the ultrasonic instrurr~ent at a ~JIvd.~tvl~";.~àd frequency. An ultrasonic driving circuit may permit thâ setting of the level of the ultrasonic vibration. A housing is most preferred for holding the handpiece (is held) by the surgeon proximally during use. Leads may connect the bipolar source of electrosurgical radio frequency energy and are carried by the housing.
A transducer is preferably within the housing for providing ultrasonic energy.
The transducer may be positioned along an axis thereof and may be selected for oscillating along the axis with motion sufficient for ultrasonic surgâry at around at least one preferred frequency and ~ v.,yll,. Pipe tools preferably attach to thetransducer so that each pipe tool oscillates around at least the one preferred frequency and ~.~./vlv.,u~l" each pipe tool may have a central borev there through connected to a source of aspiration. A distal tip on each pipe tool is preferably positioned away from the housing in position for ultrasonic surgery, bipolar electrosurgery or a Cvlllvi~a~iv~ thereof.
A flue may be coaxially disposed about the pipe tool and is preferably supported for cantilever extension from the housing. An annular space between the pipe tool and the flue may allow passago of irrigating fluid. Two or more electrodes âre prvferably associated with the pipe tool, flue or either of them and conr~ected in circuit with the leads for selected e..c:ly;~a~iul, of the electrodes.

Wo 95J17855 21 7 6 7 ~ 4 r~

The leads may includa switching systems added to selectively energiz6 the electrodes. The ultrasonic driving circuit may have an amplitude control connected to the electronic oscillator, a frequency regulator between the amplitude control and the electronic oscillator and a frequency control feedback loop in the frequency5 regulator for ..._.~Leli-~ y ths linear dynamics of the ultrasonic surgical instrument about the "ledt,t~ll";"àd frequency.
Tha two or more electrodes are preferably ~ vr ~ J with and r~
insulated from the pipe tool and are connected in circuit with the leads for selected ~ laly;~;ul, of the electrodes. The two or more electrodes may be movably 10 connected in circuit with the leads through a sliding electrical coupling between the electrodes and the leeds for alla,yi~iu" of the electrodes and for permitting ultrasonic vibration of the pipe tool. The two or more electrodes may be alternetively pcqOriAtpd with the flue and are connected in circuit with the leads for selected c. Ial yi~c.Liul I of the electrodes. At least one of the electrodes is preferably associated 15 with the flue and at least one of the electrodes may be AeqociAtPd with the pipe tool in an ~..,LuJi,,,~.,L and the electrodes are perhaps connected in circuit with the leads for selected u~ aLiul l of the electrodes.
The one or more electrodes associated with the pipe tool are each in one configuration movably connected in circuit with its respective lead through a 20 compliant electrical coupling between the electrode and the lead for all~ly;c~ll;ull of the electrode and for permitting ultrasonic vibration of the pipe tool. The one or more electrodes are possibly associated with and el~ y insulated from the pipe tool, the one or more electrodes are each connected in circuit with one of the leads snd the pipe tool is connected in circuit with the other of the leads for allowing 25 selected ~,~al ~ aLiul, of the electrodes. The one or more electrodes associated with the pipe tool are conceivably each movably connected in circuit with their respective lead through a compliant electrical coupling between the electrodes and the lead for G.laly;~lLiù" of the electrodes while for permitting ultrasonic vibration of the pipe tool. The two or more electrodes are perchance each Aqsn~ iAtPd with the pipe tool 30 by being carried on the outside thâreof or extending from the housing end thereof to . the distal tip. The two or more electrodes each may be in another ~ .,y~ .lL
associated with the pipe tool by being carried on the inside thereof for extending from the housing end therâof to thâ distal tip. The two or more electrodes sre Wo 9SI178SS = r~
2~67s4 possibly each associated a different approach with the pipe tool having at least one carried on the inside thereof and at least one carried on the outside thereof for extending from the housing end thereof to the distal tip. The two or more eiectrodes are perhaps each associated with the flue in still another way by being carried on the 5 outside thereof for extending from the housing support thereof distally. The two or more electrodes are cullu-.:Jr-~y each associated with the flue by being carriedalternately on the inside thereof for extending from the housing support thereofdistally. The two or more electrodes are maybe 2ach associated with the flue having at least one carried on the inside thereof and at least one carried on the outside 10 thereof in another c..,Ludi,ll~ for extending from the housing support thereof distally. The two or moro electrodes are perchance each associated with the pipetool having at least one carried on the inside thereof and at least one carried on the outside thereof for extending from the hûusing end thereof to the distal tip in still another ~.,,~,,~,_..,_.,I. The two or more electrodes may be respectively associated 15 with the flue and the pipe tool by being carried on the outside of each for extending frorn the housing distally to permit yet a further form of bipolar electrosur~qery with ultrasonic vibration.
The two or more electrodes are perhaps respectively associated with the flue and pipe tool by being carried on the inside of each for extending from the housing 20 support thereof distally. The two or more electrodes may be respectively associated with tha flue and the pipe tool by having at least one carried on the inside of either the flue or the pipe tool and contrary to at least one carried on the outside of the pipe tool or the flue for extending from the housing support thereof distally and having at least a bipolar circuit between the outside of one and the inside of the 25 other.
A method of using a bipolar ultrasonic surgical instrument includes a handpiece for manipulation by a surgeon connected to a source of bipolar electrosurgical radio frequency energy. Providing an ultrasonic instrument oscillating at a ~ dut~..",;", d frequency is a step. Holding a hûusing for the handpiece during 30 use is a step. Connecting leads the bipolar source of electrosurgical radio frequency energy is a step. Oscillating a pipe tool attached to the instrument so that each pipe tool oscillates around at least one preferred frequency and wavelength is a step.
r~a;liu, ,;, ,~ a distal tip on the pipe tool away from tho housing for ultrasonic, bipolar W095/17855 21 767S4 ~ Il electrosurgery or a cu~ ;"aliu" thereof is a step. Disposing a flue coaxially about the pipe tool the flue supported for cantilever extension from the housing is 8 step.
Connecting two or more electrodes PesoriAtAd with the pipe tool, flue or either of them in circuit with the lesds for u.laly;~lLiull of the electrodes with radio frequency enersy is 8 step.
BRIEF D~ L rJ ~F THE DRAWINGS
Figure 1 is a perspective view of an ultrasonic surgical hsndpiece with part of the housing thereof removed so as to show the inside snd the cv")~.u"~"l:, therein and the leads to supply bipolar electrodes A u~ J with the flue and/or the ultrasonic pipe tool.
Figure 2 is 8 side view of 8 flue in cross section snd sn elongate tspered pip~
tool therein snd hss the bipolsr electrodes oriented scross from one another on the flue and or pipe tool ss would be seen if the cross section were tsken slong line 2-2 in Figure 1.
Figure 3 8 through j sre esch 8 cross sectionsl view of one of the various alternative bipolar electrode cu, _ IrPti~ns possible with the ultrasonic suryicsl handpiece as would be seen along 3-3 of Fisures 1 or 2.
Figure 4 is a schematic .~,,,,u__.,~Liu,, of at lesst one circuit used to supplyelectrosurgicsl energy st rsdio frequencies to bipolar electrodes ACq~riAtPd with the flue.
DETAILED~t~lr~ JOFTHr INYFNTION
The clsims are not limited to the structure for sn ultrasonic surgical handpiece10, a bipolar flue, pipe tool or sn bipolar ultrasonic surgical instrument to permit bipolar and/or ultrasonic sur~ery described snd illustrated by way of example snd ~,u__;fi~ 'y explsined. The clsims sre to be cullaid~l~d in view of the existingk, :3udyâ of skilled srtisans in the field prior to the inventions defined by the language of the claims herein, as amended or cOlla;d~ in view of k"o..k,dy~. of skilled artisans prior to these inventions. As used throughout this disclosure proximal or posterior has the meaning near the user and dist_l or anterior is near the patient.
r , Wo 95/17855 217 6 7 ~ 4 r. I.t The reference numbers as seen in the several figures are identical wherain the Cu~.,,uu,l~.,tD are the same.
Figure 1 is a ~lb,U~ hr~ view partially in section showing the ultrasonic surgical handpiece 10, including a housing 11 that encloses a llcllladuc~ t2, an5 electric coi~ 13 and a cul,l,cu~ member 14 sxtending axial II._.utl-luuu~l along an sxis A which represents the longitude for the ultrasonic surgical handpiece 10. In front of the housing 11 there is a nose cone 15 tapered from the housing 11 to adistal end 16 thereof to which mounts the extending flue 17 about the nose cone 15 to coaxially surround an axially vibrating metal ' _ llillg or cutting pipe tool 24.
10 The axially vibrating cutting pipe tool 24 is preferably metal, but might be otherwise, and distal tip 18 of pipe tool 24 extends longitudinally along axis A beyond the flue 17.
A CUSA System 200 with CEM made by Valleylab, 5920 Longbow Drive, Boulder, Colorado, may be used to drive the altered CUllluullt~ b disclosed herein.
15 That system provides ultrasonic and electrosurgery in a combined instrument and is cu..l,ll~ !y available. That system has been used only with monopolar electrosurgery. The disclosure herein teaches how to make that system into a bipolar electrosurgical ultrasonic instrument effective for open or l.,,,~.lu,cu~u;
procedures.
A manifold assembly 19 composed of two tubes 20 and 21 for irrigation and suction, respectively lies atop and along the housing 11 to reside parallel to axis A.
Tube 20 connects to the flue 17 near distal end 16 so as to feed sterile irrigation and cooling fluid down through the flue 17 for flow toward the distal tip 18. The vibration introduced into the distal tip 18 by means of the cu,lllc~.lil,u~ member 14 25 generates an acoustic wave or stress resulting in the Llll:~rullll~l~iùn of some ener~y into heat. The suction tube 21 draws fluid through at least one ul~._, I hola 18a (small of size and shown only in Figures 2, 4 and 5, as will be described h~ ,ill.,rLtll that provides a portal between the flue 17 and a central bore 22, see figure 3). The central bore 22 of the pipe tool 24 extends between the distal tip 18 and a cu,,llc~.liu,, 23 for tube 21.
In Figure 2 there is an enlarged side view in cross section of the flue 17 as would be seen along line 2-2 of Figure 1. In Figures 1 and 2, the flue 17 if elongste for l~..,. u .~ . use is shown shortened with a section missing as the preferred full ~ WO 95117855 217~ 7~ r "~

lon~th ol ~ho fiuo 17 would not tit on th~ pQ~e without r~ducln~ the Cro-J octlon of tilo unr~sonk ~ur~lcei handpl ice 10 to ~n extr~nt ~uch that de~aD would be iost or to ~
dogr~e o that th dlamsbr to lan~th ! ' '' ''1!, would bo dlritortQd ~nd ny 1, ot the rolri$~e bn~u o~ thr handpleoo 1 Q &~ 17 nd cut~ing di~tal Up 18 6 could not be ~ ~
In op~rritlon tnri dl~tel tlp 1818 mr~ workln9 nd ot ri~ ebn~rit~ tapered hollow metd plpe tool 24, pre~irab~y m-do o~ tltanlum a!loy tubin~ o~ on~ quarter Inch, or ~13 mllllmGten, ou~sWe dlamster and rJn ~nslde dlam~ter of about .o7a inch, or2 mnllmeterrJ, tor hl~h tr-n6th, li~htwal~ht low~r d~nslty th~n the to, "6cU~,g membor, nd 10 ~ inert Th~ plp3 tool 24, whon part of the cou tlc vlbrator, b d-sl9nad tO
vibr~t~ ~t ~ pr~Qrrad ~r~u~ncy o~ N eyeb~ pr~r ~ocond ~o th~t th~ dl~tai Up 19 ~ 11y ~lono r~ti~ A wlU~ ~n ~tcurt~ion or peak to po~k strok~ ot about 20D I ' ~ (.003 Inch~s) lor th~ r~n r~lonoat~ I _ plp~ tod - ~ Irri~on flow throu~h tube 20 p~8S8~ wlthln an r~nnulrir ~pace 16 betw~en the nue 17 ind the olonoatr~ pipo too~ U p~cklna up h~at th~r~from T h -Irrloation nuld 18 ucked through tho i~l~ , `r~ 9t, hole ~8e shown In Fi~ur i 2 noarthe dlstal ~9p 18 snd r~tumed througn ~ 23 to tube 21 n~ the nose con- 15 Thus, irrl~nt flows ~nd ean whlle coolin~ ri~d the movemont of dr~brls, ~uch s eut tissue end blood up ~rom th~ ~uroleai site throu~h e ntr~ bor~ 22 for r~mova~
20 L~ _ n uitr~onlcvlbrr~tlons o~ d~Jt~l t~p 181ra~ment Hs-u~ whlch It t ontactg The xcut~lon orsmplltude and froquency ofth~ 1, r d nd to some ~t~nt uc ad~whb~e as will be oxplained ht~r~ln ~o that the vibraUons ~t~ In acco~d w~th th~ gsu661~n or humonlc desl~n o~ ~lon~at~ plptl tool 24 and the r~ d~ ot tht~ sùr6~cai prot edur~ bolng pr~t ~ead 1~ avold t ;lur~, ~ por~on ot 25 tn~l Ylbratlno plp~ tool 2418 shspod wltn a t~us~lun r umed protlle whloh tosults In ~n ~ss~ntlally nst tr~ss 1 ` h~ tho Inerr~sed ~ , ot lne ~ end In the plp- tool 2~ for ' , mQdo of Utanlum lloy wlth th~ tat~d pretctr~d L , th0 axl~ ~psn of osch ~ _ ~t tho fr quency o 23 klloherk 18 about 8 7 Inche~ Tha owrall lensth o~ the plpo tod 24 b thu3 rlbout 12 Inches tor 614 90 . ~ _ and 16 Inchss for ~/4 Numerou~ ~h~pes, ~ well 8 1r~ thoreor, hsv~ been; ~
treat0d ond used rls ~ ! Ther h~ve be0n ~nompt~ by ult~b wo 95/178~5 7, ~ ~ 6~ 5 4 r~

shaping to extend the zone of maximum elastic stress in the axial direction and thereby make ~qreater O~ c possible, see U.S. Patent No. 2,984,154. Since the specific technical ~,," ' ~ cu,lDL~ d four quantities of the resonance element, namely input, node and output cross section and the ~I_.lalll;~ l ratio, the 5 sûlution of the resulting problem in variation leads to a function that is Gaussian in profile for the tapered part of the vibrating pipe tool 24.
Tubes 25 and 26 provide circulating coolant to the ultrasonic surgical handpiece 10 as shown by arrows in Figure 1. As explained acoustic vibration of the transducer 12 converts electrical energy to ".~,_I ,c" liu<,l longitudinal vibrating motion 10 along axis A and through pipe tool 24 to its vibratlng distal tip 18. The preferred transducer 12 is an acoustic vibrator having a laminated nickel alloy structure which is excited by a magnetic field creating oscillating currents passin,q through the electrical coil winding 13. Coil winding 13 is excited at 23,000 cycles per second ~23 kilohertz) alternating current. The resulting longitudinal oscillating motion of the 15 preferred laminated nickel alloy structure is amplified by a preferred tapered titanium alloy pipa tool 24 which e%ends from the distal end of the nose cone 15 to the distal end of the vibrating distal tip 18. The pipe tool 24 attaches with threads 27 to the transducer 12 by way of the cu, " ,~u~ d member 14 interposed ~ ltlbtll-.s~.~. The taper and wall of the extending titanium pipe tool 24 is designed to be a ",e~il,~",i..~l 20 structura such that it vibrates at 23,000 cycles per second.
An o l~u-~ .,L of flue 17 shown in Figure 2, is composed of several pieces which may preferably be made of different polymeric materials since the ex~ ,s of the flue 17 should preferably be soft and flexible. There is a central body 28 which is hollow, elongate and semi rigid for extending with and coaxial about the 25 axis A passing longitudinally and centrally therethrough. Central body 28 terminates in a funnel 29 which is proximal and a nozzle 30 which is distal. The flue 17 isprimarily and preferably made of silicone rubber that has a relatively resilient quality whereby the funnel 29 fits tightly over the nose cone 15 of the ultrasonic sur~ical handpiece 10 forming a fluid tight gasket like seal 31 due to the rubbery resilient 30 nature of the silicone rubber used.
In Figures 1 and 2, the flue 17 is shown less than its preferred len~th for l~,u~.. uacuu~, which is about 1 1 112 inches or 29 cc" ~i"~k:~a. The diameter at the funnel 29 is such that the flue 17 tapers generally toward its nozzle 30. The central Wo 951L7855 21 76 75,~ P~"~ ' ' body 28 is hollow throughout. Rt~ ru~u;~-~ ridges 32 extend longitudinally inside the nozzle 30. A recess 34 may circumscribe the exterior of central body 2B and extend proximally from the funnel 30 to the taper of thc nozzle 30. The recess 34 is designed to receive a hollow support surrounding cylinder 35 thereabout for 5 ~ ru~ L thereof in the c."Lo.li ~,.,l shown. It should be understood and .k~t~.~ that the flue 17 can be any length and tha ,~;"ru,. ,L will be u,... y with shorter flues, Similarly the pipe tools can and have been made of various sizes and resonance is the basic criteria for the length and configuration of the pipe tool 24.
The hollow support surrounding cylinder 35 in the composite polymeric .. uaCO,u;~. flue 17 is preferably an extruded polysulfone tubular configuration sized to sit within the recess 34 for ~;,,ru,uc-~llt,llL against bending of central body 28.
Alternately, the central body 28 can be made of a stiffer construction, i. e. thicker wall or of a coextruded material having a greater modulus since the cross sectional 15 ~ ..O.,..e of such a stiffer molded material would not be apparent, that integral construction is not .~-,;r;uc lly shown in the Figures. Skilled artisans would appreciate how that could be dccu"",li..~ r~. The shorter flue 17 can of course be made of one material as a unitary part.
Funnel 29 which is generally enlarged .lic,.".~ 'ly relative to axis A and the 20 rest of the central body 28. The funnel 29 includes a fluid communication port 36 between its inside and ûutside. The port 36 is arranged to pass fluid from tube 20 which seats within a shouldered opening 37 therein and extends distally from a proximal face 38 thereof. Fluid may pass from the tube 20 through the port 36 into flue 17 and more particularly, the annular space 33 between the flue 17 and the pipe 25 tool 24. The reinforcing ridges 32 support the nozzle 30 ~that has a smaller cross sectional area than the funnel 29 or central body 28) ",..:."~:.,;"~ cu,,u~ .iLyrelative to the elongate tapered titanium vibrating pipe tool 24 near vibrating distal tip 18 which passes coaxially therethrough, see Figure 1 and 2. More ;Ill~ulLallLly, ridges 32 are generally very sli3ht in hei3ht so as not to clamp the pipe tool 24 or 30 the vibrating distal tip 18 but still separate the flow of irrigation and coolant so that it passes in laminar fashion along the pipe tool 24 and to the distal tip 18.
Consequently, the coolant is channelled so the flow is between the ridges 32. For a short flue 17 ridges 32 and channels are nût included as the cantilever disposition Wo gs/1785s 2 ~ 7 ~ ~ 5 ~ P~
~o of the flue 17 is not sufficient as to warrant them to prevent droop or provide strength.
In particular and as best seen in Figures 1 and 2 the elongate tapered pipe tool24 has the vibrating distal tip 18 at its patient contacting extreme (for r~ uu~ ul 5 and a threaded fittin~q 39 at its proximal extreme (fot ~1.Lal,l 1~ ). Threads 27 8110w removable cu""c~liu" of the elongate tapered pipe tool 24 to the Cu~ a~ ù
member 14 as shown in Figure 1.
In Figure 3 the cross section of the flue 17 and the pipe tool 24 is shown with their preferred coaxial ~ iu" .l,i~,. The flue 17 beinû outside the pipe tool 24. In 10 each of the u.llL~i..lelllla the electrodes are d~ai~lluL~d 42 and the inâulators are shown as 43. The electrodes 42 can be sny conductive material but are preferablymetallic. The insulators 43 may be any electrical resistance material having a high dielectric.
The ultrasonic surgical handpiece 10 has the transducer 12, the electric coil 15 13 and is driven in the ultrasonic surgical instrument circuit, such as disclosed and explained in United States Serial No. 07/982,936, Filed November 30, 1992 and entitled: ULTRASONIC SURGICAL HANDPIECE AND AN ENERGY INITIATOR. That disclosure, which is assigned to the assignee of this application is i, ,cu, ~.u, ~I~a~ herein and made a part hereof ~y reference. The ultrasonic surgical instrument circuit for 20 frequency ",.,:.,lt",a".,e begins and holds a presût vibrational mode and the linear dynamics of the vibrating distal tip 18 to drive the transducer 12 of the ultrasonic surgical handpiece 10 for operation at resonance ~ .a~.lali ~ ,s and under varying loads. An electronic oscillator 46 drives the transducer 12 at a ~ulad~lalll,;"~d frequency, preferably 23 kilohertz. A user set amplitude control 47 is connected to 25 the electronic oscillator 46. The amplitude control 47 permits manua! setting of the level of the ultrasonic vibration. A frequency regulator 48 connects between theamplitude control 47 and the electronic oscillator 46. A frequency control feedback loop may be used with the frequency regulator. The frequency control feedback loop maintains the linear dynamics of the ultrasonic surgical handpiece 10 and vibrating 30 pipe tool 24 about the u,~dala,,,,i,,ed frequency during use.
A preferred bipolar ultrasonic surgical instrurnent of Figures 1 through 4 has the handpiece 10 for manipulation by a surgeon connected to a bipolar source 49 of electrosurgical radio frequency energy. The electronic oscillator 46 drives the W09S/17855 1767Sj p~
ultrasonic instrument at a ~, e.leLél " ,;, led frequency. An ultrasonic driving circuit 50 permits the setting of the level of the u~trasonic vibration. The housing 11 forholding the handpiece 10 is held by the surgeon proximally during use. Leads 51 and 52 connect the bipolar source 49 of electrosurgical radio frequency energy and are 5 carried by the housing 11, The transducer 12 is within the housing 11 for providing ultrasonic energy.
The transducer 12 is positioned along the axis "A" thereof and is selêcted for oscillating along the axis "A" with motion sufficient for ultrasonic surgery at around at least one preferred frequency and ~O~ .IUll,. Pipe tools 24 attach to the 10 transducer 12 so that each pipe tool 24 oscillates around at least the one preferred frequency and ~ vl~,.lulll, each pipe tool 24 has the central bore 22 therethrou~qh connected to a source of aspiration 53. A distal tip 18 on the pipe tool 24 is positioned away from the housing 12 in position for ultrasonic surgery, bipolar electrosurgery or a ~,u,,,L;,,.,tiu,, thereof.
The flue 17 is coaxially disposed about the pipe tool 24 and is supported for cantileYer extension from the housing 11. The annular space 33 between the pipe tool 24 and the flue 17 allows passage of irrigating fluid. In Figure 3 a through j two or more electrodes 42 may be associated with the pipe tool 24, flue 17 or either of them and connected in circuit with the leads 51 or 52 for selected ellel~ liull of 20 the electrodes 42.
The leads 51 and 52 include switching systems 53 added to selectively energ~ze the electrodes 42.
The two or more electrodes 42 are each associated with and eleul,;u~
insulated from the pipe tool 24 as in Figure 3 a, d, e and f and each are connected 25 in circuit with the leads 51 or 52 for selected ellelU;Lclliu" of the electrodes 42 as shown in Figure 3 a through j. The two or more electrodes Ore each movably connected in circuit with the leads 51 or 52 through a compliant ~lectrical coupling 54 between the electrodes 42 and the leads 51 and 52 for elle~_iL~Iiull of the electrodes 42 and for permitting ultrasonic vibration of the pipe tool 24, see Figure 30 2. The two or more electrodes are each alternatively associated with the flue 17 as in Figure 3 b and g and are each connected in circuit with the leads 51 or 52 for selected ellelU;~clLiull of the electrodes 42. At least one of the electrodes 42 is associated with the flue 17 and at least one of the electrodes is ~SSOri~t~l with the W~ 9511'~855 ~ 7 5 4 J

plp~ tool 24 In an ~ ~ ~r) In FiourrJ 3 c tllnd ~ Thtt ol~ctrodoY 42 ~ro o~cn oonnoctod In cireult wKh tho loads 51 or 52 tor aeleeted ~ _ ~ ot tn3 Isctrodos~2 Th3 one or more electrode~ 42 assoddod with th~ pli~o tool 24, In Fl~ut~ 9 ~, 6 d, e, ~nd f r~re oadl In one 1_ ~ _ mo~bly eonnoct~d In olrcult wth It~ ro~poctivs 10ad S1 or 52 through tho compliant electrlcal couplln~ ~4 ~ In i iguN 2 ~otwttrtn a-ch ot tho Ir~rtrode 42 ~nd tha 13ad 61 or ~2 tor n , ~ o~ ~t~ch ~Ittctrod~ nd tor ~ tnmmln~ ultr sonlc vibrdlon ot ths plpo tool 24 Th~ ono or mor~ ~loctrodos 42 ~r ach u80clatrJd with t,md eloctrlcaliy insulatod tr~m tho plpl~ hol 24 In ~ ~i, Flgut 9 10 , d, ~ tmd t Tho on~ or mora elsctrogtts 42 ~rtJ ach Connsetod In elrouit with ono ot the Ittads ~t or ~2 ond tho pii~o tool 24 ~8 connoctod In dtcult wlth rna o~hor ot the loaos 51 or 52 ~or allowin~ selectad ~ 1~,, , otths t~iar,~trodos 47 Th3 one or mor~
elsctrodss 42 slssocl~ted with th~ plpe tool 24 ~re osch mova~'y connsctod In clrcult wlth tholr r~sp0ctlvo lead 61 or 62 through tho compllsnt el0ctrlcai coupllna ~4 ~ In I S F~gure 2 betwoon tho ~leRrodes And ths l~ad for ~, , ot tho oloctrodes 42 whll~
perrnlttin~i u~rasonlc vlbr~tion ot the plpo twl 24 Th~ two or mor0 elertrodos 42 ~n ~ch assocl~ted with th~l plp- tool Z4 Cy bolng carr~d on tho outslds Ihoroot In i igur~ 3 a tor ~xt~ndln~ 1rom th~ houdno 11 ~nd thsreot to the dlst~l Up 18 Th~ hNo or moN e~octrod0s ~Z ~ro ach In nother20 _ _ ,t assoc~atcd wlth tho plpe tool 24 by beln~ c~nried on th~ Insldo ther ot ~n ~guro 3 tor o~tondlng 1rom tho housln~ nd thoreo~ to th0 dl~tsl tlp 1 e. Tho two or moro oloctrodos 42 ~r each u~soclabd In dffl r~nt ~pproach wlth ths plp~ tool 24 haYin~ at bast ono c~rrled on tho Inslds th-roo~ and at least ono csrrlod on th~
out~ld~ thor~ot ~n F~uro 3 t for extend~n~ trom thr~ housln~ 11 nd thsroof to the distai 25 tlp t~ ~hs two or mor~ aloctrodos 42 ~re e2ch a~socht d wlUl th- nue 1~ In dill l~noth~r w~y by bolng carrled on the outs~de thoroof In Fl~urs 3 b for oxt~ndlno lrom the hou~ upport th~reof dlstally Th~ two or moro d~ctrod-s 42 ~ro ~ch a8sociabd with th0 nue t7 by bolno canlod atomat01y on th~ In~lda ther~r~t In Floura 3 ~ tor Q~t~ndlno trom tho housln~ 11 suppott thor~of d~stally The two or moro 30 21ectrodos 42 r~r~ Gach #~od~t d wl~ tha flue 17 hs~n~ d loast one c~nlr~d on the ~nsldo theroot and at hast ono carr~ed on th~ outs~de thor~of In Flgure 3 h ~nother tor ~tondln~ trom th~ llousln~ upport thereot d~s~ally W095/178s5 767SJ r~
The two or more electrodes are each A~ SO~ d with the pipe tool 24 having at least one carried on the inside thereof and at least one csrried on the outside thereof in Figure 3 f for extending from the housing 11 end thereof to the distsl tip 18 in still snother all~..lù~ ,lll. The two or more electrodes 42 are respectively 5 associated with the flue 17 and the pipe tool 24 by being carried on the outside of each in Figure 3 c for extending from the housing 11 distally to permit yet a further form of bipolar electrosurgery with ultrasonic vibrstion.
The two or more electrodes 42 sre respectively AeeoriAtRd with the flue 17 snd pipe tool 24 by being carried on the inside of each in Figure 3 i for extending 10 from the housing 11 support thereof distally. The two or more electrodes 42 are respectively A- 50~iAtr~d with the flue 17 snd the pipe tool 24 by hsving st least one csrried on the inside of either the flue 17 or the pipe tool 24 snd at least one csrried on the outside of the pipe tool 24 or the flue 17 for extending from the housing 11 support thereof distally snd having at least a bipolar circuit between the outside of 15 one and the inside of the other ss in any of the Figures 3 c, i and j.
A method of using a bipolar ultrasonic surgical instrument includes a handpiece for manipulation by a surgeon. Generating a source of bipolar electrosurgical radio frequency energy is a step. Driving with an electronic oscillator 46 an ultrasonic instrument at a ~ J~ d frequency is a step. Setting a level 20 of ultrasonic vibration with an ultrasonic driving circuit is a step. Holding a housing for the handpiece during use is a step. Connecting leads 51 or 52 the bipolar source 49 of electrosurgical radio frequency energy is a step. Enclosing and pua;Liul.i..ù a transducer 12 within the housing 11 along an axis thereof for oscillating the transducer 12 along the axis with motion sufficient for ultrasonic surgery at around 25 at least one preferred frequency and wavelength is a step. Oscillating a pipe tool 24 attached to the transducer 12 so that each pipe tool 24 oscillates around at least one preferred frequency and v...~ ...ulll is a step. Connectinû the central bore 22 passing through each pipe tool 24 to a source of aspiration is a step. ru iLiu- i- 9 the distal tip 18 on the pipe tool 24 away from the housing 11 for ultrasonic, bipolar 30 electrosurgeryoracu..,bi,,aLiu,,thereofisastep. Disposingaflue17coaxiallyabout the pipe tool 24 the flue 17 supported for cantilever extension from the housing 11 is a step. Passing irrigating fluid through an snnular space between the pipe tool 24 snd the flue 17 is a step. Connecting two or more electrodes 42 sssociated with the Wo 95/17855 21~ 6 ~ ~ 4 r~

pipe tool 24, flue 17 or either of them in circuit with the leads for ~"~,yi~t~liul, of the electrodes 42 with radio ~requcncy eneryy is a step.
While various a-, a- -u~ - -L~ have been shown in the fiaures and desc~ibed bv way of example, the claims that follow seek to cover all L..-' ~ that permit ultrasonic surqery and bipolar electrosur~qery in any cu..-Li..~iu.. or method.

Claims

What is claimed is:

1. A bipolar ultrasonic surgical instrument including a handpiece for manipulation by a surgeon comprising:
a bipolar source 49 of electrosurgical radio frequency energy;
an electronic oscillator 46 for driving the ultrasonic instrument at a predetermined frequency;
an ultrasonic driving circuit 50 for permitting setting of the level of the ultrasonic vibration;
a housing 11 for holding the handpiece, the housing 11 held proximally by the surgeon during use;
leads 51 or 52 connected to the bipolar source 49 of electrosurgical radio frequency energy and carried by the housing 11;
a transducer 12 enclosed within the housing 11, positioned along an axis thereof and selected for oscillating along the axis with motion sufficient for ultrasonic surgery at around at least one preferred frequency and wavelength;
pipe tools 24 each attachable to the transducer 12 so that each pipe tool 24 oscillates around at least one preferred frequency and wavelength;
a central bore 22 passing through each pipe tool 24 and connected to a source of aspiration 53;
a distal tip 18 on the pipe tool 24 positioned away from the housing 11 in position for ultrasonic, bipolar electrosurgery or a combination thereof;
a flue 17 coaxially disposed about the pipe tool 24 and supported for cantilever extension from the housing 11;
an annular space 33 between the pipe tool 24 and the flue 17 for passage of irrigating fluid, and two or more electrodes 42 associated with the pipe tool 24, flue 17 or either of them and connected in circuit with the leads 51 or 52 for energization of the electrodes 42 with radio frequency energy.

2. The bipolar ultrasonic surgical instrument of Claim 1 wherein the leads 51 or 52 include switching systems added for selected energization by the surgeon of the electrodes 42.

3. The bipolar ultrasonic surgical instrument of Claim 1 wherein the ultrasonic driving circuit 50 has an amplitude control 47 connected to the electronic oscillator 46, a frequency regulator 48 between the amplitude control 47 and theelectronic oscillator 46 and a frequency control feedback loop in the frequency regulator 48 for maintaining the linear dynamics of the ultrasonic surgical instrument about the predetermined frequency.

4. The bipolar ultrasonic surgical instrument of Claim 1 wherein the two or more electrodes 42 are each associated with and electrically insulated from the pipe tool 24 and are connected in circuit with the leads 51 or 52 for selected energization of the electrodes 42.

5. The bipolar ultrasonic surgical instrument of Claim 4 wherein the two or more electrodes 42 are each movably connected and in circuit with the leads 51 or 52 through a sliding electrical coupling 54 between the electrodes 42 and theleads 51 or 52 for energization of the electrodes 42 and for permitting ultrasonic vibration of the pipe tool 24.

6. The bipolar ultrasonic surgical instrument of Claim 1 wherein the two or more electrodes 42 are each associated with the flue 17 and are connected in circuit with the leads 51 or 52 for energization of the electrodes 42 with radiofrequency energy.

7. The bipolar ultrasonic surgical instrument of Claim 1 wherein at least one of the electrodes 42 is associated with the flue 17 and at least one of the electrodes 42 is associated with the pipe tool 24 and the electrodes 42 are connected in circuit with the leads 51 or 52 for energization of the electrodes 42 with radio frequency energy.

8. The bipolar ultrasonic surgical instrument of Claim 7 wherein the one or more electrodes 42 associated with the pipe tool 24 are each movably connected in circuit with its respective lead through a sliding electrical coupling 54 between the electrode and its lead for energization with radio frequency energy of the electrode and for permitting ultrasonic vibration of the pipe tool 24.

9. The bipolar ultrasonic surgical instrument of Claim 1 wherein the one or more electrodes 42 are associated with and electrically insulated from the pipe tool 24, the one or more electrodes 42 are each connected in circuit with one of the leads 51 or 52 and the pipe tool 24 is connected in circuit with the other of the leads 51 or 52 for allowing energization with radio frequency energy of the electrodes 42 by the surgeon.

10. The bipolar ultrasonic surgical instrument of Claim 9 wherein the one or more electrodes 42 associated with the pipe tool 24 are each movably connected in circuit with their respective lead through a sliding electrical coupling 54 between the electrodes 42 and its lead for energization with radio frequency energy of the electrodes 42 and for permitting ultrasonic vibration of the pipe tool 24.

11. The bipolar ultrasonic surgical instrument of Claim 4 wherein the two or more electrodes 42 are each associated with the pipe tool 24 by being carried on the outside thereof for extending from the housing 11 end thereof to the distal tip.

12. The bipolar ultrasonic surgical instrument of Claim 4 wherein the two or more electrodes 42 are each associated with the pipe tool 24 by being carried on the inside thereof for extending from the housing 11 end thereof to the distal tip 18.

13. The bipolar ultrasonic surgical instrument of Claim 4 wherein the two or more electrodes 42 are each associated with the pipe tool 24 having at least one carried on the inside thereof and at least one carried on the outside thereof for extending from the housing 11 end thereof to the distal tip 18.

14. The bipolar ultrasonic surgical instrument of Claim 6 wherein the two or more electrodes 42 are each associated with the flue 17 by being carried on the outside thereof for extending from the housing 11 support thereof distally.

15. The bipolar ultrasonic surgical instrument of Claim 6 wherein the two or more electrodes 42 are each associated with the flue 17 by being carried on the inside thereof for extending from the housing 11 support thereof distally.

16. The bipolar ultrasonic surgical instrument of Claim 6 wherein the two or more electrodes 42 are each associated with the flue 17 having at least one carried on the inside thereof and at least one carried on the outside thereof for extending from the housing 11 support thereof distally.

17. The bipolar ultrasonic surgical instrument of Claim 6 wherein the two or more electrodes 42 are each associated with the pipe tool 24 having at least one carried on the inside thereof and at least one carried on the outside thereof for extending from the housing 11 end thereof to the distal tip 18.

18. The bipolar ultrasonic surgical instrument of Claim 7 wherein the two or more electrodes 42 are respectively associated with the flue 17 and the pipe tool 24 by being carried on the outside of each for extending from the housing 11 distally.

19. The bipolar ultrasonic surgical instrument of Claim 7 wherein the two or more electrodes 42 are respectively associated with the flue 17 by being carried on the inside of each for extending from the housing 11 support thereof distally.

20. The bipolar ultrasonic surgical instrument of Claim 7 wherein the two or more electrodes 42 are respectively associated with the flue 17 having at least one carried on the inside of either the flue 17 or the pipe tool 24 and oppositethereto at least one carried on the outside of the pipe tool 24 or the flue 17 for extending from the housing 11 support thereof distally and having at least a bipolar circuit between the outside of one and the inside of the other.

21. A method of using a bipolar ultrasonic surgical instrument including a handpiece for manipulation by a surgeon having the steps of:
generating a source of bipolar electrosurgical radio frequency energy;
driving with an electronic oscillator 46 an ultrasonic instrument at a predetermined frequency;
setting a level of ultrasonic vibration with an ultrasonic driving circuit 50;
holding a housing 11 for the handpiece during use;
connecting leads 51 or 52 the bipolar source 49 of electrosurgical radio frequency energy;
enclosing and positioning a transducer 12 within the housing 11 along an axis thereof for oscillating the transducer 12 along the axis with motion sufficient for ultrasonic surgery at around at least one preferred frequency and wavelength;
oscillating a pipe tool 24 attached to the transducer 12 so that each pipe tool 24 oscillates around at least one preferred frequency and wavelength;
connecting a central bore 22 passing through each pipe tool 24 to a source of aspiration 53;
positioning a distal tip 18 on the pipe tool 24 away from the housing 11 for ultrasonic, bipolar electrosurgery or a combination thereof;
disposing a flue 17 coaxially about the pipe tool 24 and supported for cantilever extension from the housing 11;

passing irrigating fluid through an annular space 33 between the pipe tool 24 and the flue 17, and connecting two or more electrodes 42 associated with the pipe tool 24,flue 17 or either of them in circuit with the leads 51 or 52 for energization of the electrodes 42 with radio frequency energy.