ES2350918T3 - ELECTROQUIRURGICAL COAGULATION INSTRUMENT WITH TISSUE DIQUE. - Google Patents

Abstract

An electrosurgical coagulation apparatus (14) comprising: first and second elongated removable jaws (622, 624) comprising a first surface (625) of contact with the tissue that includes a first insulating member (650) located on a first jaw and a second tissue contact surface (626) that includes a second insulation member (652) located on a second jaw, in which the first and second tissue contact surfaces are in face-to-face relationship and said first and second jaws (622, 624) each have opposite elongated edges; wherein the first removable jaw includes a first electrode (642) and said second removable jaw includes a second electrode (646) arranged to lock said tissue when it is turned on, the first and second electrodes being in face-to-face relationship characterized by: first and second dam members (656, 657) projected from at least one of said first and second jaws and located at the elongated edges of said jaws, wherein said surfaces (625, 626) of contact with the fabric are disposed on the first and second tissue dike means, respectively, and the tissue dike means is adapted to contain the tissue (654) within a desired coagulation area by applying a selected compression on the tissue located within the surfaces of contact with the tissue, said selected compression being adapted to constitute zones of higher compression of the tissue and impedance higher tissue than any area in which the electrode surfaces lock the tissue when it is turned on, thereby preventing the transmission of electrical current outside said coagulation area.

Description

Cross Reference to Related Requests

The present application is related to, and claims the benefit of, the provisional patent application with the serial number 60 / 266,055 filed on February 2, 2001, and the provisional patent application with the serial number 60 / 264,644 filed on January 26, 2001.

Field of the Invention

The present invention relates, in general, to the field of electrosurgical instruments and, more specifically, grippers or graspers ("graspers") combined with a tissue dam for surgical applications.

Background of the Invention

The application of heat to treat bleeding wounds dates back to ancient times, applying, in medieval times, in a generalized manner, a hot iron to cauterize the wounds of battles to stop bleeding. In cauterization, the essential mechanism that underlies the treatment is the use of conductive heat transfer from a hot object to raise the temperature of the bleeding tissue to a sufficient point that denatures tissue proteins or warms the blood up to high enough point to cause the formation of a trunk.

Coagulation by electrosurgery is also carried out by heating the tissue, but the main mechanism is the dissipation of electrical energy in the affected tissue, rather than the transfer of heat from an external object. The current flows through the tissue and it is the tissue that offers resistance. This creates a small vapor envelope around the electrodes of the electrosurgical instrument, and the vapor vaporizes the tissue to cause cell dehydration, protein denaturation and tissue contraction causing blood vessel thrombosis. This form of hemostasis is now routinely used in both open and endoscopic surgical interventions for small blood vessels (typically less than 1 mm), and has largely replaced individual vessel ligation.

The bipolar clamping instruments currently available for tissue electrocoagulation, or "tissue welding", generally use only two electrodes of opposite polarity, one of which is located on each of the opposite jaws of the stapler. As illustrated in FIGURE 1, even, the tissue is held between a pair of stapler jaws (shown in cross section incorporating a first and a second electrode (Electrode 1 and Electrode 2) of opposite polarity. bipolar flows between the two electrodes along the current flow lines illustrated, the tissue coagulating first at the edges of the jaws.Then, when the tissue dries and the impedance increases, the current flows through of the wet tissue and coagulation expands both inwardly and outwardly from the center of the jaws and outward from the edges of the jaws.The tissue coagulation and heating outside the jaw continues until the current is cut off.

Thermal damage to adjacent structures may occur due to this diffusion of thermal energy outside the jaws of the instrument. Due to the diffusion of thermal energy outside the jaws of the instrument, it is difficult to coagulate long sections of tissue, for example the intestine, lung, or major blood vessels, without significant lateral thermal diffusion. Overcoagulation often occurs, which causes the tissue to stick to the jaws of the instrument. When the jaws of the instrument open, if the adhesion to the tissue is considerable, the tissue can be fractionated, thus negatively affecting hemostasis. Undercoagulation can occur if an insufficient amount of energy has been applied to the tissue, and the resulting hemostasis will be incomplete.

Therefore, it would be advantageous to have an electrosurgical tissue weld in which the current path is limited to the tissue inside the jaws, to minimize tissue damage caused by thermal effects produced outside the jaws of the jaw. device.

It would be advantageous to have an electrosurgical tissue welding instrument that enables coagulation of a relatively long section of the tissue, while minimizing the lateral diffusion of thermal energy.

It would also be advantageous to have an electrosurgical welding instrument in which the maximum density of the current in the coagulated tissue takes place away from the electrodes, and between two surfaces resistant to adhesion, to minimize the adhesion of the tissue to the electrodes.

Likewise, it would be advantageous to have an electrosurgical tissue welding instrument in which the flow of the current was self-limited to prevent tissue overcoagulation.

Further, it would be advantageous to have an electrosurgical tissue welding instrument that provides a clear view of the clotted tissue to prevent tissue undercoagulation.

Likewise, it would be advantageous to have an electrosurgical tissue welding instrument that would provide an amount of orte combined with the other characteristics and advantages described above.

The present invention provides the advantages described herein and also resolves the deficiencies of the prior art.

US Patent 6,086,586 issued on July 11, 2000, filed on September 14, 1988 by Enable Medical Corporation discloses a bipolar electrosurgical instrument incorporating a pair of removable jaws with each other. The first and second electrodes of one jaw are in opposite relation, respectively, with the first and second electrodes of the other jaw.

World Patent Publication number WO 00/47124 with application number PCT / US00 / 02559, deposited on January 31, 2000 discloses an electrosurgical device for sealing and sealing relatively large structures. The jaws include an electrosurgical cutting element which can be a blade or a wire, and a clamping assembly that holds an area adjacent to a cutting line. The sealing assembly includes sealing electrodes.

World Patent Publication number WO 99/23959 with application number PCT / US98 / 23950, deposited on November 11, 1988 discloses a bipolar electrosurgical instrument that has opposable sealing surfaces on its jaws to ignite, close, seal vessels , and vascular tissue. In one embodiment, the sealing surfaces are partially insulated to prevent a short circuit.

The World Patent Application number WO 99/12488 with the application number PCT / US98 / 18640, filed on November 8, 1988 discloses a bipolar instrument for sealing tissue with bipolar electrosurgery.

The World Patent Application number WO 00/24330 with the application number PCT / US99 / 24869, filed on October 22, 1999 discloses an electrode assembly that can be disassembled for use in combination with tweezers that have terminal effectors Opposites and a handle. The electrodes can be detachably connected to the terminal effectors of the clamps such that the electrodes are housed in opposite relation to each other.

US-A-5 833 690 discloses an electrosurgical device with clamping jaws to constitute a zone of tissue understanding, and with electrodes located on the jaws to apply an electric current along the compression zone.

US Patent No. 5,800,449, issued September 1, 1988, filed on March 11, 1997 by Ethicon Endosurgery discloses a surgical instrument that incorporates a tissue stop that includes a blade guard.

US Patent No. 5,403,312, issued on April 4, 1996, filed on July 2, 1993 by Ethicon, Inc. discloses an electrosurgical instrument for cauterization and / or welding of tissue of various impedances, thicknesses and vascularity especially in performing endoscopic interventions. The instrument compresses the tissue between a pole of a bipolar energy source located on an interconnecting surface, and a second interconnecting surface.

US Patent No. 5,797,938, issued on August 25, 1988, filed on December 18, 1996 by Ethicon Endo-Surgery, Inc. discloses an electrosurgical hemostatic instrument that includes a curved terminal effector. A preferred embodiment of the invention provides a bipolar endoscopic pressure, coagulation and cutting device. A substantially straight, flexible blade in the axial direction is used to treat the tissue caught by the jaws of the end effector.

US-A-6 113 598 discloses an RF instrument for welding

of tissue incorporating the characteristics of the first part of claim 1. Summary of the Invention

The present invention is directed to an electrosurgical coagulation apparatus, as claimed.

Brief Description of the Drawings

The novel features of the invention are especially defined in the appended claims and in Figures 44 and 45. The invention itself, however, both with respect to the organization and the operating procedures together with other objects and advantages thereof, It can be better understood with reference to the subsequent description, taken in combination with the rest of the drawings, in which:

FIGURE 1 is a cross-sectional view of the jaws of the bipolar clamps of the prior art, with a non-coagulated fabric disposed between them, showing the flow path of the current between the two jaw members;

FIGURE 2 is a perspective view of an endoscopic bipolar tissue clamp according to the present disclosure shown with an electrosurgical current unit and a connection board;

FIGURE 3 is an enlarged perspective view of the distal end of the endoscopic bipolar tissue clamp of FIGURE 2 showing the jaw members in greater detail;

FIGURES 4a-c are views from above (FIGURE 4a), and lateral views (FIGURES 4b and c) of the distal end of the clamps shown in FIGURE 3, in distal cross-section to show the drive mechanism for displacing the jaws of the clamps between the closed (FIGURE 4b) and open (FIGURE 4c) positions;

FIGURE 5 is a cross-sectional view of the clamps of the clamps taken along line 5-5 of FIGURE 4b; FIGURE 6 is a cross-sectional view of the jaws of the inventive bipolar tissue clamps, with a non-coagulated fabric disposed between

them, which shows the flow path of the current between the two jaw members;

FIGURE 7 is a perspective view of an alternative embodiment of the present disclosure of bipolar clamps in a coagulation mode;

FIGURE 8 is a magnified perspective view of the jaws illustrated in FIGURE 7;

FIGURE 9 illustrates the instrument of FIGURE 7 in the closed position;

FIGURE 10 illustrates the instrument of FIGURE 7 in scissors mode, with the jaws open;

FIGURE 11 is a magnified perspective view of the jaws illustrated in FIGURE 10;

FIGURE 12, is a cross-sectional view of the jaws of a bipolar instrument having opposite electrodes offset in accordance with the present invention;

FIGURE 13 is a side plan view of an alternative embodiment of a clamping / cutting combination instrument in accordance with the present disclosure;

FIGURE 14 is a cross-sectional view of the jaws of the instrument illustrated in FIGURE 13;

FIGURE 15 is a side plan view of an instrument according to the present disclosure incorporating a ratchet handle;

FIGURE 16 is a side plan view of one half of an instrument in accordance with the present disclosure with seals and blade drive improvements;

FIGURE 17 is a sectional view from above taken from the part of FIGURE 16;

FIGURE 18 is an alternative sectional view from above taken from the part of FIGURE 16;

FIGURE 19 is a side sectional view of the blade of the instrument illustrated in FIGURE 16;

FIGURE 20 is a sectional view from above of the jaw from the instrument illustrated in FIGURE 16, showing that the jaw is curved;

FIGURE 21 illustrates an instrument according to the present disclosure, showing the layout of the connector and the wire of a bipolar instrument;

FIGURE 22 is a perspective view of an electrosurgical instrument incorporating a feedback light in accordance with the present disclosure shown with an associated electrosurgical current generating unit, and a connection board;

FIGURE 23 is an enlarged perspective view of the distal end of the electrosurgical instrument incorporating a feedback light of FIGURE 22, showing the jaw members in greater detail;

FIGURES 24 to 26 are views from above (FIGURE 24) and lateral views (FIGURES 25 and 26) of the distal end of the jaws shown in FIGURE 23. In partial cross-section to show the drive mechanism to move the jaws between positions closed (FIGURE 25) and open (FIGURE 26) and the accompanying feedback light;

FIGURE 27 illustrates an electrical scheme of an electrosurgical instrument incorporating a feedback light in accordance with the present disclosure;

FIGURE 28 illustrates an electrical schematic form of an alternative electrosurgical instrument incorporating a feedback light according to the present disclosure;

FIGURE 29 is a cross-sectional view of the jaws (FIGURE 23) of an electrosurgical instrument incorporating an electro-feeding light in accordance with the present disclosure;

FIGURE 30 is a cross-sectional view of the jaws of the electrosurgical instrument incorporating a feedback light, with a non-coagulated tissue disposed between them, showing the flow path of the current between the two jaw members;

FIGURE 31 is a perspective view of an electrosurgical instrument incorporating a feedback light in accordance with the present disclosure shown with an associated electrosurgical current generation unit and with a connector cable and an associated polarized energy source and with a connector cable;

FIGURE 32 is an enlarged perspective view of the distal end of the electrosurgical instrument incorporating a feedback light of FIGURE 22, showing the jaw member in greater detail;

FIGURES 33a -c are views from above (FIGURE 33a) and lateral views (FIGURES 33b and c) of the distal end of the jaws shown in FIGURE 32, in partial cross-section to show the drive mechanism to move the jaws between the closed positions (FIGURE 33b) and open (FIGURE 33c) and the accompanying feedback light;

FIGURE 34 illustrates an electrical electrical scheme of an electrosurgical instrument incorporating a feedback light in accordance with the present disclosure;

FIGURE 35 illustrates an electrical scheme of an alternative embodiment of an electrosurgical instrument incorporating a feedback light in accordance with the disclosure;

FIGURE 36 illustrates an electrical scheme of an alternative embodiment of an electrosurgical instrument having a feedback light in accordance with the present disclosure;

FIGURE 37 is a cross-sectional view of the jaws (FIGURE 32) and an electrosurgical instrument having a feedback light in accordance with the present disclosure;

FIGURE 38 is a cross-sectional view of the jaws of the electrosurgical instrument incorporating a feedback light, with a non-coagulated tissue disposed between them, showing the flow path of the current between the two jaw members;

FIGURE 39 is a perspective view of an electrosurgical instrument in accordance with the present disclosure shown with an associated electrosurgical current generating unit and a connector cable;

FIGURE 40 is a cross-sectional view of the jaws of the electrosurgical instrument incorporating a plurality of protection electrodes in accordance with the present disclosure;

FIGURE 41 is a cross-sectional view of the jaws of an electrosurgical instrument incorporating a plurality of electrodes and a feedback device in accordance with the present disclosure;

FIGURE 42 is a partial view of an electrosurgical instrument according to the disclosure incorporating a knife locking system;

FIGURE 43 is a partial view of an electrosurgical instrument in accordance with the present disclosure incorporating a knife locking system;

FIGURE 44 is a sectional view of an alternative embodiment of a first and a second

FIGURE 45 is a sectional view of an alternative embodiment of first and second removable jaws comprising a tissue contact surface according to the present invention;

FIGURE 45a is a perspective view of an alternative embodiment of first and second removable jaws comprising a tissue contact surface according to the present invention;

FIGURE 46 is a perspective view of an alternative embodiment of first and second removable jaws comprising a tissue contact surface in accordance with the present disclosure;

FIGURE 47 is a perspective view of a jaw in accordance with the present disclosure, in which the tissue dam is located at the distal end of the jaw;

FIGURE 48 is a top view of the jaw shown in FIGURE 47; and FIGURE 49 is a side view of the jaw illustrated in FIGURE 47.

Detailed description of the invention

Directing our attention to FIGURE 2, it shows a perspective view of an electrosurgical instrument system, generically designated with the reference numeral 10. The illustrated system includes an RF power generator 12, endoscopic electrosurgical clamping clamps 14 , of manual clamping, and a cable 16 that connects the clamps 14 with some receptacles 18, 20 holding the plug for the positive and negative bipolar outputs of the generator 12. Although the clamps illustrated 14 are endoscopic pins for use In mini-incisive surgical interventions, the disclosure of the present invention is equally applicable to clamps designed for use in open surgical interventions.

The illustrated RF generator 12 may be, for example, a moopolar-bipolar unit RF generator such as the PEGASYS generator (Brand of Ethicon Endo-Surgery Inc., Cincinnati, Ohio) and, therefore, also includes the receptacles of fastening to the plug for monopolar active and return terminals. However, for the purposes of this disclosure, only the distinctive feature of bipolar current generation is used.

The clamps 14 have two opposite jaws removable from each other 22, 24, optimally seen in FIGURES 3 and 4a-c. The general structure and mechanism of actuation of the clamps 14 are known in the art and are typified in the clamps disclosed in US Patent Nos. 5,342,359 and 5,403,312. In general, a closure tube 26 coaxially advances through a sheath 28 by a trigger mechanism to lock a cam surface 32 located on the jaws 22, 24 to close the jaws. The retraction of the closure tube moves the jaws to the open position (FIGURE 4c) because the shape and material of the jaws 22, 24 jumps and opens when the closure tube 26 retracts.

The clamping tongs illustrated also include a linear cutting element or blade 34 (optimally appreciated in FIGURES 4c and 5). The blade 34 advances into a groove 36 located in the jaws 22, 24 to cut the tissue held between the jaws 22, 24 after the tissue has been coagulated. The mechanism for advancing the blade is also well known, and may include a drag rod 38 that is advanced after the actuation of a trigger 40. Although the illustrated clamp pliers include a blade, the invention can also be applied to the pliers of Simple clamping that does not include a cutting element. In accordance with the present disclosure, each jaw includes a contact surface with the fabric composed of insulating material with two electrode surfaces disposed adjacent to the position of each jaw in contact with the tissue. The surfaces in contact with the jaw tissue are in a generic face-to-face relationship, the two electrodes associated with each jaw being separated and in face-to-face relationship with the corresponding electrodes located on the opposite jaw, so that the electrodes of each pair of face or face off-center electrodes are of the same polarity. This configuration of the electrodes, being the opposite electrodes of each pair of offset electrodes face to face of the same polarity, opposite to the polarity of the other pair of offset electrodes face to face, is similar to that shown in US Patent No. 2,031,682 from Wappler et al.

Directing attention to FIGURES 3 to 5, jaws 22, 24 include pairs of electrodes 42, 44 and 46, 48, respectively. Electrodes 42, 44 and 46, 48 are transported by jaws 22, 24 adjacent to insulation members 50, 52, respectively. The insulation members 50, 52 constitute a contact surface with the tissue on each jaw 22, 24 that is substantially defined by the surface existing on the insulation members 50, 52, which is located between its associated pairs of electrodes. However, electrodes 42, 44 and 46, 48 also partially contact the tissue caught between the jaws.

As optimally shown in FIGURE 5, the contact surfaces with the tissue of each jaw are in face-to-face relationship, and the electrodes are connected to the terminals of a bipolar RF generator so that the electrodes of each pair Separate face to face are of the same polarity, and a pair of face-to-face off-center electrodes has the opposite polarity to the other side of face-to-face off-center electrode. Therefore, as shown in FIGS. 5 and 6, the offset face electrodes with face 42 and 46 are of positive polarity, while the offset electrodes face with face 44 and 48 are of negative polarity. The term off-center means that no portion of the surface areas of electrodes 42, 44, 46 and 48 is in overlapping relationship.

As shown in FIGURE 6, this configuration of the insulation members and the electrodes provides a current flow (as shown by the double pointed arrows) through the tissue 54 between the electrodes of opposite polarity . There is no flow of the current through the tissue that is not retained between the jaws of the clamps, and the flow of the current is at its highest density between the surfaces of contact with the jaw tissue. Accordingly, the tissue is first coagulated along the center of the jaws and, as the impedance of the tissue increases due to its coagulation the flow of current between the electrodes is cut. Therefore, the flow of current between the electrodes naturally stops when coagulation is complete. This occurs in stark contrast to the prior art bipolar clamp pliers illustrated in FIGURE 1, in which the current tissue continues through the flow retained outside the jaws until the operator deactivates the electrodes

The insulation members 50, 52 comprising the contact surfaces with the fabric are made of a non-conductive, non-adherent material, such as polytetrafluoroethylene, polypropylene-polystyrene, polycarbonate, Acrylonitrile Butariene Styrene (ABS), ULTEM (General Mark) Electricic Plastics), RADEL (BP Amoco Brand) or other appropriate material. A substantially clear adhesion resistant insulation material

or transparent allows the tissue held between the jaws to be observed through the upper or lower surfaces of the jaws, thereby allowing the surgeon to visualize the extent of tissue coagulation.

The electrodes 42, 44, 46, 48 are preferably made of a conductive material, such as aluminum, stainless steel, platinum, silver and gold. For better structural support, the electrodes themselves could be structural elements (as shown in FIGURES 3 and 5).

The clamps of grip or grip are manufactured so that the separation S of the jaws tight is small enough with respect to the width of the electrodes to achieve a considerably higher density of the current within the tissue between the insulated surfaces than the density of the current through the tissue that contacts the surface of the electrodes. This ensures that the density of the current at the electrode level is considerably less than the density of the current that exists in the tissue held between the tissue contact surfaces. Consequently, the tissue in contact with the electrodes will coagulate less than the tissue held between the contact surfaces with the tissue, and the tissue will be less likely to adhere to the electrodes.

Other embodiments of the present disclosure are illustrated in FIGURES 7 to 23. Illustrated FIGURES 7 to 11 refer to tweezers, specifically a hemostatic clip 200, which may be manufactured, for example, with an electrically insulating plastic with padding to provide resistance. The electrodes would be opposite, offset, with the same polarity that minimized lateral thermal damage to the tissue, such as those illustrated in FIGURE 12. This electrode configuration eliminates the shortening of the electrodes when they are in close proximity. and minimizes tissue adhesion. The hemostatic clamp 200 can also incorporate a blade, indicated as sliding blade 220 (see, for example, FIGURE 11), for cutting tissue after coagulation. Likewise, when the instrument is used in scissors mode as illustrated in FIGURES 10 and 11, the sliding blade 220 would extend outward (not energized) and the tissue would be mechanically cut between the upper surface of the blade and the opposite jaw of the instrument.

The configuration of the opposite offset electrodes offers a distinctive current limiting feature. When the tissue is dried, the impedance with respect to the flow of the current increases, which will close the system when the coagulation is complete. Each jaw 240 of the instrument incorporates positive and negative electrodes. Opposite jaws 240A and 240B have a pair of opposite electrodes offset with the same polarity to achieve adequate effects on the tissue and prevent the tissue from adhering because the electrodes cannot physically touch each other when they are completely closed. The tissue is coagulated as a result of the current flowing between the electrodes of opposite polarity located on each jaw 240. In the scissor cutting mode, the upper edge of the sliding blade 220 may be sharp to improve the cutting capacity. The sliding blade 220 may be locked in the extended position until the change to the cutting / coagulation mode is made.

An advantage of the present disclosure consists of coagulation and cutting clamps, which incorporate current limiting electrodes that supply the adequate amount of current to coagulate the tissue (with minimal lateral thermal diffusion) in combination with mechanical scissors without instrument exchanges

The electrodes can be molded as inserts inside the jaws

240. The hemostatic clamp 200 has two opposite jaws 240A and 240B cross-linked by a pivot element, such as a pin 205. Each jaw 240 has an opposite tissue compression zone with two electrodes along the extension of each compression zone as will be described more fully in FIGURES 44 to 49.

The user contact surface portion of the hemostatic clamp 200 would contain opposite drive handles 260A and 260B. The user contact surface portion may also include a means of connection with an electrosurgical generator, such as a connector 290 (FIGURE 21). The desired electrode configuration should be a polarity electrode on each compression member. Opposite electrodes of opposite compression members would have the same polarity, as illustrated in FIGURE 12. The offset electrode configuration is convenient because it eliminates shortening on the thin tissue as well as delimits thermal diffusion. The thermal diffusion is limited by the flow of the current. The flow of the current is maintained within the opening of the device. Also, this electrode configuration offers a limiting feature. When the tissue is dried, the impedance on the flow of the current increases. Because the flow of the current is maintained within the jaws, when the impedance of the tissue rises sufficiently, the system will close on its own.

Referring again to FIGURE 11, tweezers according to the present disclosure may also incorporate a sliding blade 220 added to cut tissue after cauterization. The device may include a ratchet mechanism 288 (FIGURE 13) near the annular handles 260A and 260B (such as those shown in FIGURE 7) in order to provide the surgeon with a method of establishing a clamping pressure. Both members of the clamps may include a groove 222, indicated with reference numeral 222A or 222B on the individual members of the clamps located in parallel with the electrodes and centered between the electrodes. One of the clamp members may incorporate an extended groove (towards the annular handle) in order to accommodate the sliding blade 220 and its displacement. The sliding blade 220 may include a notch or groove 221 to enable displacement with respect to the pivot pin 205 of the pliers along the jaw 240 of the pliers. Likewise, the sliding blade 220 may include a distinctive feature characteristic for providing a sliding force 220 (for example, a sliding button 223). As shown in FIGURES 19 and 20, the blade 220 may include grooves 266 to accommodate a curved jaw 240.

The hemostatic clip 200 may include a cutting member 288 of the spring-open scissors and is articulated on the same pivot as the pliers, as illustrated in FIGURE 13. Both clamp members may include grooves that cross the areas of contact with the tissue in parallel and centered between the electrodes. The scissor cutting member may be sharp at the edge of the tissue contact surface and be located within one of the members of the tweezers. The clamp member may include a ratchet mechanism 228 near the annular handles, in order to provide the surgeon with a procedure to maintain the holding pressure.

FIGURES 22 to 30 illustrate an electrosurgical instrument system, generically indicated with reference numeral 310, which constitutes an alternative embodiment of the present invention. The distinctive features of the illustrated system correspond to the same features of the embodiment illustrated in FIGURES 2 through 6, but referenced with the numbers of the serial elements "300" for similar distinctive features. Features that are represented as new are represented with new numbers. FIGURE 22 also illustrates a feedback light 327 which, in one embodiment of the present disclosure is housed within one or both of the first and second removable jaws 322, 324. The feedback light 327 will be described with greater detail below.

The present disclosure illustrates a feedback light 327 used in cooperation with the first removable jaw 322, where the feedback light 327 indicates to the surgeon that operates the electrosurgical instrument system 310 when a significant electrical current ceases to pass through the subject tissue 354 between the first removable jaw 322 and the second removable jaw 324. In a further embodiment of the present disclosure, the feedback light 327 is housed within the first removable jaw 322, when the first removable jaw 322 is manufactured from a substantially transparent material to allow the surgeon to visualize the light housed within the first removable jaw 322. The feedback light 327 can be placed in any portion of the first and / or second removable jaws 322, 324, a plurality of lights can be arranged feedback 327 in the instrument system electrosurgical 310, and / or the feedback light 327 may be located outside the first and / or second removable jaws 322, 324, so that the feedback light 327 is permanently or removably fixed with respect to the first and second removable jaws 322, 324. The feedback light 327 can be manufactured in a variety of shapes, such as oval, square, loop or rectangular and can have any desired color.

FIGURES 24 to 26 illustrate a means of operating the electrosurgical instrument system 310 in accordance with the present disclosure. In general, a closure tube 326 is advanced coaxially through a sheath 328 by a firing mechanism 330 to lock a cam surface 332 located on the first and second removable jaws 322, 324 to close the first and second removable jaws 322 , 324. The retraction of the closing tube 326 moves the first and second removable jaws 322, 324 to the open position because the shape and material of the first and second jaws 322, 324 spring open when the spring tube 326 is retract FIGURES 24 to 26 illustrate an embodiment of the present disclosure comprising a first feedback light 327, a first conductor 329 and a second conductor 331 at the point where the first feedback light 327, the first conductor 329 and the second conductor 331 constitutes a non-twist circuit 335. The first and second conductors 329, 331 run in parallel with the cable 316 (FIGURE 27). The first feedback light 327 can be any electroluminescent device, such as an LED (electroluminescent diode). The first and second cables 329,331 may be manufactured from any conductive material for use in surgical applications, such as, but not limited to, silver or stainless steel.

With reference to FIGURES 27 to 30, the present disclosure may also include variants of the circuit design, for example, of conductors 329,331 that extend along the entire length of the closure tube 326, a plurality of conductors 329, 331 and / or a plurality of feedback lights 327. In one embodiment of the present disclosure, the twist-free circuit 335 is parallel to, but is not coupled in connection with the cable 366. The first light of Feedback 327 is adapted to illuminate when the current passes through circuit 335. The bipolar current supplied between electrodes 342, 344, 346, 348 runs through tissue 354 until tissue 354 is dried. Once dried, the impedance of the fabric 354 increases by reducing the voltage that passes through the non-twisting circuit 335. By passing the conductors 351, 353, 355, 357 of the cable 316 and the first and second conductors 329, 331 along a extension of the closure tube 326 if twisting the first and second conductors 329, 331, a capacitive coupling between the two circuits will be created. When the current is applied to the conductors 351, 353, 355, 357 of the cable 316, they will create a current within the torsion-free circuit 335 that will cause the feedback light 327 to come on. The torsional circuit current 335 will be proportional to the current of the conductors of the cable 316, providing the surgeon with a qualitative indicator of the energy passing through the instrument.

The first and second removable jaws illustrated 322, 324 may also include a linear cutting element or blade 334 (optimally observed in FIGURES 26 and 29). The blade 334 is advanced to the inside of a recess 336 existing in the first and second removable jaws 322, 324 to cut the tissue 354 held between the first and second removable jaws 322, 324 after the tissue 354 has been coagulated. Also here, the mechanism for advancing the blade is well known, and may include the drag rod 338 which is advanced after the trigger 340 is operated. Although the first and second removable jaws illustrated 322, 324 include a blade, the disclosure is likewise Applicable to single jaws that do not include a cutting element.

The distal location of the feedback light 327 in close proximity to the surgical application area, provides the surgeon with a clear indication of when the tissue 354 has been sufficiently dissected to ensure adequate hemostasis while reducing lateral damage due to overexposure of the electric current. Likewise, the present disclosure may also include the use of feedback light 327 in cooperation with all other bipolar electrosurgical devices, such as, for example, instruments incorporating a single pair of electrodes.

FIGURE 27 illustrates an electrical schematic representation of an embodiment of the present disclosure illustrating RF generator 312, in which RF generator 312 is connected to electrodes 342, 344, 346, 348 through conductors. 351, 355, 353, 357, respectively. In one embodiment of the present disclosure, electrodes 342, 344, 346, 348 are adapted, as illustrated, so that electrodes 342, 346 are positive electrodes in an offset but substantially face-to-face arrangement. Electrodes 344, 348 are adapted, as illustrated, to be negative electrodes in an offset but substantially face-to-face arrangement. Additional embodiments of the present disclosure may include the use of a single offset pair of electrodes, a single pair of aligned electrodes, a plurality of electrodes and their corresponding plurality of conductors, a plurality of aligned electrodes, a pair or a plurality of electrodes of the same polarity placed opposite to a face-to-face arrangement, or any other bipolar configuration suitable for use in a surgical application. FIGURE 27 also illustrates the torsion-free circuit 335 comprising the first and second conductors 329, 331, and the feedback light 327. The present disclosure may also include a means of illuminating the feedback light 327 when make a complete circuit between conductors 351, 353, 355, 357 of electrodes 342, 344, 346, 348, tissue 354 and generator 312, by capacitive coupling of the second conductor 331 and / or the first conductor 329 with the minus a conductor 351, 353, 355, 357 which results in the introduction of a current into the non-twist circuit 335. When the tissue 354 is dried, this will increase the impedance of the transmission circuit resulting in a loss of the current transmitted by the coupling. capacitive, causing the 327 feedback light to weaken or go out. The weakening, or inactivity of the feedback light 327 signals the surgeon to stop applying the electrosurgical current on the tissue 354 in order to prevent burns or lateral damage to the tissue. The present disclosure may also include other peculiarities necessary to facilitate capacitive coupling of circuit 335, such as capacitors, resistors, relays, transformers, switches or other appropriate electrical elements.

FIGURE 28 illustrates an electrical scheme of a further embodiment of the present disclosure comprising RF generator 312, in which RF generator 312 is connected to electrodes 342, 344, 346, 348 by means of conductors 351,355, 353, 357, respectively. In one embodiment of the present disclosure, electrodes 342, 344, 346, 348 are adapted, as illustrated, so that electrodes 342, 346 are positive electrodes within an offset arrangement, but substantially face to face. Electrodes 344, 348 may be adapted to be negative electrodes within an offset but substantially face-to-face arrangement. Other embodiments of the present disclosure may include the use of a single pair of offset electrodes, a single pair of aligned electrodes, a plurality of electrodes and their corresponding plurality of conductors, a plurality of aligned electrodes and / or electrodes of the same polarity placed opposite each other, facing the face-to-face arrangement, or other bipolar configurations appropriate for use in a surgical application. FIGURE 28 also illustrates a non-twisting circuit 371 comprising first and second conductors 329, 331, a toroidal coil 370, and a feedback light 327. The second conductor 331 may be wound around toroidal coil 370 in order to facilitate inductive coupling between at least one conductor 351, 353, 355, 357 and the toroidal coil 370. The electric current passing through at least one conductor 351, 353, 355, 357 will create a magnetic field that can then be converted into an electric current within the twisted circuit 371 by the toroidal coil 370. The twisted circuit 371 and / or the twisted transmission circuit 372 may be twisted in order to reduce the capacitive coupling between the twisted circuit 371 and the transmission circuit twisted 372. The present disclosure may also include a means of illuminating the feedback light 327 when a n full circuit between conductors 351,353,355, 357 of electrodes 342,344,346, 348, tissue 354 and generator 312 by inductive coupling of second conductor 331 and / or first conductor 339 in cooperation with toroidal coil 370 with at least one conductor 351,353,355, 357, determining the introduction of a current into the twisted circuit

371. When tissue 354 is dried, this will increase the impedance of the transmission circuit resulting in a loss of the current transmitted by the inductive coupling, causing the feedback light 327 to weaken or turn off. The weakening or inactivity of the feedback light 327 signals the surgeon to stop applying the electrosurgical current on a tissue in order to prevent burns or lateral damage to the tissue. Likewise, the present invention may include other characteristic elements necessary to facilitate inductive coupling of circuit 371, such as for example capacitors, resistors, relays, transmitters, switches or other appropriate electrical elements.

FIGURES 31 to 38 illustrate a surgical instrument system, generically indicated with reference numeral 410, which constitutes an alternative embodiment of the present disclosure. The characteristic elements of the illustrated element correspond to the same characteristic elements of the embodiments shown in FIGURES 2 to 6, but referenced with the numbers of the series elements "400" for similar characteristic elements. Similarly, new numbers are added when new features are introduced. FIGURE 31 illustrates a perspective view of an embodiment of the present disclosure presenting an electrosurgical instrument system, generically indicated with reference numeral 410, which includes an RF power generator 412, a housing 414, and a cable 416 connecting the housing 414 to the holding receptacle 418 of the positive bipolar output plug and a holding receptacle 420 of the negative bipolar output plug of the generator 412, in which the cable 416 is adapted to transmit an electric current to the electrodes 442 , 444 housed inside the first removable jaw 422 and electrodes 446,448 housed inside the second removable jaw 424, and a battery 413 that includes a cable 415. The battery 413 can be any source of energy suitable for use in a surgical application concrete, such as a 5 volt battery. The battery 413 may be incorporated into the housing 414 and may be located outside the housing 414. Also FIGURE 31 illustrates a feedback light 427 which, in an embodiment of the present disclosure, is housed within one or both of the first and second removable jaws 422, 424. The feedback light 427, the battery 413 and the cable 415 will be described in more detail below.

FIGURES 33a-c and 34 illustrate an embodiment of the present disclosure comprising a first feedback light 427, a first conductor 429, a second conductor 431, and a battery 413, constituting the first feedback light 427, the first conductor 429, the second conductor 431 and the battery 413 a non-twisted circuit 435. The first and second conductors 429, 431 can run in parallel with the cable 416. The first feedback light 427 is connected to the battery 413 by means of the cable 415 which houses the first and second conductors 429, 431. The battery 413 may be located outside the housing 414 or may be housed inside. The first feedback light 427 can be any electroluminescent device, such as an LED (electroluminescent diode). The first and second conductors 429,431 may be manufactured from any conductive material suitable for use in surgical applications such as, but not limited to, silver or stainless steel. The present disclosure may also include certain variants in the circuit design, such as a plurality of first and second conductors 429, 431 and / or a plurality of feedback lights 427. In the illustrated embodiment, the first and second conductors 429, 431 are parallel to, but are not coupled in connection with conductors 451, 453, 455, 457 housed within cable 416. Battery 413 is a polarized energy source that supplies a direct current at a lower voltage. to that necessary to illuminate the feedback light 427. The use of the battery 413 in cooperation with the feedback light 427 provides a tuning capability that enables the surgeon to control the amount of energy required for the feedback light 427 to be turn on For example, by adjusting the voltage supply the battery 413 just below the threshold required to turn on the feedback light 427, the surgeon will smoothly cross the threshold even when the impedance continues to increase. If a lower voltage supply is chosen from battery 413, in cooperation with the same first feedback light 427, the non-twist circuit voltage 435 can fall below the threshold required to keep the feedback light 427 on with only a quantity Minimum impedance The use of a plurality of voltage supplies from a battery 413 in cooperation with the choice of a plurality of different feedback lights with different lighting thresholds, allows the surgeon to choose the optimal regulation of a specific surgical application. The first feedback light 427 is adapted to illuminate when a current of the circuit without torsion 435 passes. The bipolar current fed between the circuits 442, 444, 446, 448 runs through the fabric 454 until the tissue 454 is dried. Once dried, the fabric 454 no longer conducts any current, which will increase the impedance in the torsion-free transmission circuit 459 between electrodes 442,444, 446, 448. By passing the conductors 451, 453, 455, 457 of cable 416, and the first and second conductors 429, 441 a section below the closure tube 426 without twisting of the first and second conductors 429, 441, a capacitive coupling will be created between the two circuits. When the conductors 451, 453, 455, 457 of the cable 416 are energized, this will increase the voltage of the non-twisted circuit 435 causing the feedback light 427 to come on. The current flowing through the torsion-free circuit 435 will be proportional to the current flowing through the cable conductors, providing the surgeon with a qualitative indicator of the energy passing through the instrument.

FIGURE 37 also illustrates the feedback light 427 housed within the first removable jaw 422, however another embodiment of the present disclosure may include a feedback cable 427 housed within the second removable jaw 424, the feedback light 427 housed within the first and second removable jaws 422, 424 and the feedback light 427 fixed outside one or both of the first and second removable jaws 422, 424. The distal location of the feedback light 427 in close proximity to the Surgical application area, provides the surgeon with a clear indicator of when tissue 454 has been sufficiently dried to ensure adequate hemostasis while reducing lateral damage due to overexposure of electric current.

FIGURE 35 illustrates a further embodiment of the present disclosure. The first conductor 429 includes a Zener diode 461 that functions to transfer the current through the torsion-free circuit 453 only after a certain voltage threshold has been exceeded. This feature allows, for example, that the surgeon regulate the voltage threshold of the Zener diode 461 just above the battery voltage 413 making it possible for the feedback light 427 to come on only when there is a capacitive coupling voltage from the circuit of torsion-free transmission 459. The surgeon will be able to carefully tune the electrosurgical instrument system 410 adjusting it to their precise needs to select the appropriate battery voltage 413, the feedback light voltage 427 and the threshold voltage of the Zener diode 461, providing a qualitative indicator controlled with great precision of the energy that passes through the instrument. When the tissue 454 is dried, this will increase the impedance of the torsion-free transmission circuit 459 resulting in a loss of the capacitive instrument current, causing the feedback light 427 to weaken or turn off. The weakening, or inactivity of the feedback light 427 signals the surgeon to stop applying the electrosurgical current on the tissue 454 in order to prevent burns or lateral damage to the tissue.

FIGURE 36 illustrates an electrical scheme of a further embodiment of the present disclosure. FIGURE 36 also discloses a second feedback light 477, a relay 478, conductors 485, 479, 480, 481, 483, 484, a transformer 482 and a switch 486, collectively known herein as the medium. feedback 490. Feedback means 490 functions to detect when a first tissue impedance level 454 has been exceeded. The oppression of switch 486 also couples conductor 485 to conductor 479. Conductor 479 is coupled to relay 478. The relay 478 is normally closed when electrical current is not flowing through conductors 483, 484. When switch 476 is pressed and electrical current passes through coupled transmission circuit 484, energy is transmitted through conductors 483, 484 due to inductive coupling by means of transformer 482. The current passing through conductors 483, 484 causes relay 478 to break open and e The circuit that connects conductor 479 to conductor 480, to the second feedback light 477 and to conductor 481. When it is reduced, the electric current does not pass through the coupled transmission circuit 476, as happens when the switch 486 has not been pressed. or when the impedance has significantly reduced the voltage of the coupled transmission circuit 476, the relay 478 will close due to the lack of appreciable inductive coupling in the transformer 482. When the relay 478 is closed, the direct current caused by the battery 413 passes through conductors 485, 479, relay 478 of conductor 480, the second feedback light 477, and conductors 481, 431 where this current operates to turn on the second feedback light 477.

The illumination of the second feedback light 477 alerts the surgeon that an appreciable electrical current is not passing through the coupled transmission circuit 476 and that either the instrument is not active or that the tissue 454 has been properly dried. The appreciable current passing through the transmission circuit 476 is inductively coupled by means of the transformer 482 to the relay 478, where the current pressure then turns on the first feedback light 427. The opening of the relay 478 extinguishes the second feedback light. 477, alerting the surgeon that an appreciable electrical current is passing through the coupled transmission circuit 476. This embodiment of the present disclosure works to turn on the feedback light 427 when the coupled transmission circuit 476 conducts a considerable voltage and extinguishes the feedback light 427 when the coupled transmission circuit 427 stops conducting an appreciable electric current. At the same time, a noticeable lack of current in the coupled transmission circuit 476 will cause the second feedback light 477 to come on.

The use of a second light provides the surgeon with a supplementary safety measure to determine when an appreciable level of voltage stops passing through the coupled transmission circuit 476 due to the impedance caused by the drying of the tissue 454. An appreciable level of current Electrical refers to the voltage conditioning or the outputs of the feedback lights, Zener diodes, batteries or other electrical components intended to provide the surgeon with the qualitative feedback level of a given application. The weakening or inactivity of the feedback light 427 and the illumination of the second feedback light 477 signals the surgeon to stop applying the electrosurgical current on the tissue 454 in order to prevent burns or tissue damage. Likewise, the present disclosure also includes the use of a plurality of feedback lights, a plurality of relays, a plurality of transformers, twisted or non-twisted conductors, a plurality of switches, and / or the use of a capacitive coupling and / or inductive. It should be apparent to the person skilled in the art that a plurality of electrical configurations is possible to achieve the desired qualitative feedback result.

FIGURE 39 illustrates a perspective view of an electrosurgical instrument system, generically indicated with reference numeral 510, which incorporates the present disclosure. The illustrated system includes an RF power generator 512, a housing 514 and a cable 516 that connects the housing 514 with the positive bipolar holding receptacle 518 of the output plug, and the negative bipolar holding receptacle 520 of the output outlet of the generator 512, in which the housing is adapted to transmit an electric current to the electrode 542 housed within the first removable jaw 522 and to the electrode 546 housed within the second removable jaw 524. The first removable jaw 522 also houses about protection electrodes 550, 560, and the second removable jaw 524 also houses protection electrodes 570, 580, the protection electrodes 550, 560, 570, 580 being able to be connected to a grounding adapter (not shown) . Although the first and second removable jaws illustrated 522, 524 are endoscopic jaws for use in mini-incisive surgical procedures, the disclosure of the present application is also extensible to jaws designed for use in open surgical interventions.

The illustrated RF generator 512 may be, for example, a monopolar-bipolar unitary RF generator, such as the PEGASYS RF generator and, therefore, also includes the plug holding receptacles for the monopolar active and return terminals , however, for the purposes of this disclosure only the bipolar current generation version is used.

FIGURE 40 illustrates a cross section of an embodiment of the present disclosure comprising a first removable jaw 522 incorporating electrode 542 and protective electrodes 550, 560 and a second removable jaw 524 incorporating an electrode 546 and electrodes of protection 570, 580. When the first and second removable jaws are holding the tissue 554 and the electrodes 542, 546 are electrically activated by means of the generator 512, the electric current passes through the tissue 554 so that the electric current desiccates the tissue 554. When tissue 554 is dried, the impedance of tissue 554 is raised. When the impedance of the tissue 554 rises between electrode 542 and electrode 546 the electric current can choose a path of least resistance from electrode 542 to protection electrodes 550, 560, 570, 580

or from electrode 546 to protection electrodes 550, 560, 570, 580. The attraction of electric current to protection electrodes 550, 560, 570, 580 when the tissue impedance is high between electrode 542 and electrode 546 will prevent lateral electric current which would cause serious lateral damage to the tissue. In order for the protection electrodes 550, 560, 570, 580 to be a favorable transmission surface, they can be maintained at an active desirable charging power, such as by incorporating resistors that connect the protection electrodes 550 , 560, 570, 580 with generator 512; a grounding adapter connected to the ground electrodes 550, 560, 570, 580; or by using detection electrodes in cooperation with protection electrodes that transmit the presence of lateral current flow to the generator, so that it works to reduce generator output 512 and / or warn the surgeon of the presence of the flow of lateral electric current. The protection electrodes can also act in a passive system, for example a system in which the protection electrodes 550, 560, 570, 580 constitute an autonomous unit. The present disclosure may also include the use of other configurations of protection electrodes 550, 560, 570, 580 and / or detection electrodes (not shown) that substantially perform the function of reducing thermal damage to tissue outside the desired cutting / coagulation zone. The present invention may also include a plurality of protection electrodes 550, 560, 570, 580 and / or detection electrodes, a combination of characteristic elements of the disclosed embodiments, such as resistors used in cooperation with the detection electrodes, and the use of other undisclosed electrical characteristic elements that should be apparent to those skilled in the art to obtain the desired function.

FIGURE 41 illustrates a further embodiment of the present disclosure, comprising protection electrodes 550, 560, 570, 580, connected to feedback lights 551, 552, by means of conductors 553,554, 555,556 in which the feedback lights 551, 552 will come on if the side current is collected by protection electrodes 550, 560, 570, 580. The presence of feedback light 551, 552 will indicate to a surgeon when the impedance of tissue 554 has increased substantially to favor the transmission of electric current of the protection electrodes 550, 560, 570, 580, at which time the feedback light will indicate to the surgeon that an undesirable lateral current flow is occurring. The present disclosure may also include the use of a single feedback light 551, or a plurality of feedback lights. The feedback light is preferably located in the distal portion of the end effector in order to provide direct feedback to the surgeon in the area of action, however the feedback light 551 may be located anywhere on the instrument. or outside the instrument that may be convenient in a surgical intervention. The feedback light 551 can be any feedback device, such as an electroluminescent diode (LED), an audible alarm, or a generator shut-off system, or other appropriate feedback device. The feedback device may be directly coupled, inductively coupled or capacitively coupled to one.

or to a plurality of feedback electrodes, grounding electrodes and / or detection electrodes.

FIGURE 42 illustrates a further embodiment of the present disclosure comprising a blade closure system 650 of the hemostatic clamp 200, in which the closure system 650 may also include a blade actuator 651, such as a switch Sliding The blade actuator 651 is connected to a blade rod and a ratchet 653. The distal end of the blade rod 652 is fixed to the sliding blade 220 and the proximal end of the blade rod 652 is fixed to the blade actuator. When the hemostatic clamp 200 is in a closed position, the blade actuator 651 can be actuated by extending the sliding blade 220.

When the sliding blade 220 extends distally, the blade actuator 651 fits with the closed ratchet 653 effectively locking the hemostatic clamp 200 in the closed position. The hemostatic clip 200 can only be opened after the blade actuator 651 retracts free of its engagement with the ratchet 653. The digital blade actuator 651 can retain the ratchet 653 when it engages with the ratchet 653 by engaging the protrusions male of the ratchet 653 with corresponding female grooves of the blade actuator 651, however other means of engagement between the ratchet 653 and the blade actuator 651 are in accordance with the present invention. The engagement of the blade actuator 651 with the ratchet 653 while the sliding blade 220 is extended prevents the surgeon from opening the blade and continuing the application with the blade exposed. This prevention prevents the surgeon from opening the hemostatic forceps until the sliding blade 220 retracts.

FIGURE 43 illustrates a further embodiment of the present disclosure comprising an alternative blade locking system 654 incorporating a blade locking latch 657. Male projections of the blade lock latch 657 correspond to female grooves of the blade actuator 655, however other suitable means of engagement between the blade lock latch 657 and the actuator 655 with the blade fingers are in line with the present invention.

FIGURE 44, in accordance with the present invention, illustrates the first and second removable jaws 622, 624 comprising a first tissue contact surface 625 and a second tissue contact surface 626 including a first insulation member 650 and a second insulation member 652, respectively, the first and second insulation members 650, 652 being made from an insulating material, such as plastic, rubber, nylon, polytetrafluoroethylene (PTFE), or other suitable insulating material. The first removable jaw 622 includes a first electrode 642. The second removable jaw 624 includes a second electrode 646. The first and second surfaces 625, 626 of contact with the tissue of the first and second removable jaws 622, 624 are in a generic relationship face to face with the first electrode 642 associated with the first removable jaw 622 in relation face to face with the corresponding first electrode 646 of the second removable jaw 624. The first removable jaw 622 may also also include a first member of dam 656 and a second dam member 657. The second removable jaw 624 may also include a first dam member 658 and a second dam member 659, the first dam member 656 and the first dam member 658 being able to be opposite, and also opposite the second dam member 657 and the second dam member 659. When the first electrode 642 and the first electrode 646 are electric When activated, the tissue 654 held between the first dam members 656, 658 and the tissue 654 held between the second dam members 657, 659 will have a high impedance due to the pressure applied by the first dam members 656, 658 and by the second members of dike 657, 659. An increase in tissue impedance in the areas adjacent to the first members of dike 656, 658 and in the second members of dike 657, 659 will constitute a brake on the transmission of electric current to through the high impedance zone of the fabric, preventing the transmission of the current outside the first removable jaw 622 and the second removable jaw 624, thereby reducing the risk of unwanted lateral damage to the tissue. The first dam members 656, 658 and the second dam members 657, 659 can extend from the first removable jaw 622 and from the second removable jaw 624 from 0.12 mm -0.38 mm respectively, however, other appropriate measurements which may be suitable for a given application are in line with the present invention.

The present invention may also include the use of a first dam member 656 and a second dam member 657 of the first removable jaw 622 for use in the absence of the first dam member 658 and the second dam member 659 of the second removable jaw 624. The present invention may also include the use of the first dam member 658 and the second dam member 659 in the absence of the first dam member 656 and the second dam member 657 of the first removable jaw 622. The first dike members 656, 658 and the second dike members 657, 659 may have any form suitable for use in a surgical application, for example in an interlocking form in which, for example, a portion male of the first dam member 656 and the second dam member 657 are coupled within the corresponding female portions of the first dam member 658 and the second dam member 659, respectively , an embodiment of flat surfaces in which the faces of the first dike members 656, 658 and the second dike members 657,659 are substantially at the same level with each other or other forms suitable for use in a surgical intervention. The first and second electrodes 642, 646 may be electrically activated by a connection with a generator 312 by means of a cable 316 or by another appropriate electrical activation means. The first dam members 656, 658 and the second dam members 657, 659 can be permanently fixed, or they can be separated and removed from the first removable jaw 622 and the second removable jaw 624, respectively. For the purposes of the present specification, the first dike members 656, 658 and the second dike members 657, 659 may collectively be referred to as tissue dike.

FIGURES 45 and 45a illustrate first and second removable jaws 722, 724, the distinctive features of the illustrated embodiment corresponding to the same distinctive features and attributes of the embodiment shown in FIGURE 44, but referenced with the numbers of reference of the “700” series for similar distinctive features. The jaws 722 and 724 comprise a first tissue contact surface 725 and a second tissue contact surface 726 that include a first insulation member 750 and a second insulation member 752, respectively, the first and second members of insulation 750, 752 made from an insulating material, such as plastic, rubber, nylon, polytetrafluoroethylene (PTFE), or other suitable insulating material. The first removable jaw 722 includes a first electrode 742 and a second electrode 743. The second removable jaw 724 includes a first electrode 746 and a second electrode 747. The first and second surfaces 725, 726 of contact with the tissue of the first and second removable jaws 722, 724 are in a generic face-to-face relationship, the first electrode 742 and the second electrode 743 being associated with the first removable jaw 622 in a face-to-face relationship with the corresponding first electrode 746 and the second electrode 747 of the second removable jaw 724. The first removable jaw 722 may also include a first dam member 756 and a second dam member 757. The second removable jaw 724 may also include a first dam member 758 and a second dock member 759, with the first dock member 756 and the first dock member 758 being opposite, as well as the second dock member 757 and the second dam member 759. When the first electrode 742 and the second electrode 743 of the first removable jaw 722 and the first electrode 746 and the second electrode 747 of the second removable jaw 724 are electrically activated, the tissue 754 held between the first members of dam 756, 758 and tissue 754 held between the second members of dam 757, 759 will have a high impedance due to the pressure applied by the first members of dam 756, 758 and by the second members of dam 757, 759. An increase in the impedance of the tissue in areas favorable to the first members of dike 756, 758 and the second members of dike 757, 759 will curb the transmission of electric current through the area of high impedance of tissue, preventing transmission of electric current outside the first removable jaw 722 and the second removable jaw 724, thereby reducing the risk of unwanted side damage to the fabric.

FIGURE 46 illustrates a further embodiment of the present disclosure comprising first and second removable jaws 822, 824 comprising a first tissue contact surface 825 and a second tissue contact surface 826 including a first member insulation 850 and a second insulation member 852, respectively, the first and second insulation members 850, 852 being made from an insulating material, such as plastic, rubber, polytetrafluoroethylene (PTFE), or other suitable insulating material. The first removable jaw 822 includes a first electrode 842 and a second electrode 843. The second removable jaw 824 includes a first electrode 846 and a second electrode 847. The first and second surfaces 825, 826 of contact with the tissue of the first and second removable jaws 822, 824 are in a generic face-to-face relationship, the first electrode 842 and the second electrode 843 being associated with the first removable jaw 822 in face-to-face relationship with the corresponding first electrode 846 and the second electrode 847 of the second removable jaw 824. An embodiment of the present invention may also include a first dam member 856 and a second dam member 857, a first dam member 858 and a second dam member 859, and may the first dock member 856 and the first dock member 858 be opposite, as does the second dock member 857 and the second dock member 859. At the end s herein, the first members of dike 856, 858 and the second members of dike 857, 858 can collectively be called independent dike 865 of the tissue. When the first electrode 842 and the second electrode 843 of the first removable jaw 822 and the first electrode 846 and the second electrode 847 of the second removable jaw 824 are electrically activated, the tissue 854 held between the first dike members 856, 858 and tissue 854 held between the second members of dike 857, 859 will have a high impedance due to the pressure applied by the first members of dike 856, 858 and by the second members of dike 857, 859.

The illustrated embodiment allows the surgeon to apply pressure on the first dam members 856,858 and the second dam members 857, 859 irrespective of the pressure applied by the first removable jaw 822 and the second removable jaw 824. The capacity Applying a controlled pressure with both the independent tissue dam 865 and the first and second removable jaws 822, 824 allows greater manipulation and control of an area that is to be cut and / or coagulated during an intervention. An increase in tissue impedance in the areas adjacent to the first dike members 856, 858 and in the second dike members 857, 859 will curb the transmission of electric current through the high impedance zone of tissue, preventing the transmission of the electric current outside the first removable jaw 822 and the second removable jaw 824, thereby reducing the risk of unwanted lateral damage to the tissue.

The present disclosure may also include the use of the first dam member 856 and the second dam member 857 in the absence of the first dam member 858 and the second dam member 859. The independent tissue dam 865 can be operated by a firing mechanism, a scissor mechanism, or by another drive means known in the art. The first removable jaw 822 and the second removable jaw 824 can be operated independently of the independent tissue dam 865 by means of a cam system, a scissor system or by another drive means generally known in the art. The first dike members 856, 858 and the second dike members 857, 859 may have any form suitable for use in a surgical application, such as an interlocking form in which, for example, a male portion of the first member of dock 856 and of the second dock member 857 are coupled within the corresponding female members of the first dock member 858 and the second dock member 859, respectively, a flat surface embodiment in which the faces of the first members of dike 856, 858 and of the second members of dike 857 and 859 are substantially at the same level with each other, or other forms suitable for use in surgical intervention. The first electrodes 842, 846 and the second electrodes 843, 847 can be electrically activated by a connection with a generator 312 by means of a cable 316 or by another electrically appropriate means of activation. An embodiment of the present invention can also include the disabling, after a single use, of the tissue dike and / or the entire instrument (not shown). A further embodiment of the present invention may also include the use of a sliding blade 220 that can be operated through slots (not shown) of the blade. The present invention may also include a feedback system, such as an electroluminescent diode, in accordance with the above described herein, to indicate, for example, lateral thermal diffusion, impedance levels, or other variables, a single pair of electrodes, a plurality of electrodes, first and second removable jaws 822, 824 from an independent dike 865 of the tissue, in which the independent dike 865 of the tissue would function as a hemostatic clamp, a plurality of first dock members 856, 858 and / or a few second dock members 857, 859, tissue cutting elements that did not incorporate opposing jaws, tissue cutting elements that used energy sources other than RF electrosurgical energy , such as ultrasound or laser.

FIGURES 47 to 49 illustrate an embodiment of the present disclosure, in which the first removable jaw 822 may also include a first tissue contact surface 825 that includes a first insulation member 850, the member being Insulation 850 manufactured from an insulating material, such as plastic, rubber, nylon, polytetrafluoroethylene (PTFE), or other suitable insulating material. The first removable jaw 822 includes a first electrode 842 and a second electrode 843. In this embodiment, the first insulation member 850 acts as a tissue dike at the distal end of the first removable jaw 822. The first insulation member 850 it is raised above the first electrode 842 only at the distal end of the first removable jaw 822. The insulation members, such as for example the first insulation member 822 may, alternatively, consist of coatings that can be sprayed on the first removable jaw 822, or by using alternative coating procedures, such as immersion, plasma coating, coating or the like.

Although preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are offered by way of example only. Those skilled in the art will notice the existence of numerous variants, changes and substitutions without departing from the invention. For example, as would be apparent to those skilled in the art, the disclosures of the present specification of the electrode configuration including the cutting blade used, either as a coagulation medium or also as a means of clamping and cutting, as well as the tissue dike and indication light have the same application in robot-assisted surgery. Likewise, it should be understood that all the structures described above have a function and said structures can be designated as means to carry out that function. Accordingly, it is intended that the invention be limited only by the scope of the appended claims.

Claims (7)

1. An electrosurgical coagulation apparatus (14) comprising: first and second elongated removable jaws (622, 624) comprising a first contact surface (625) with the fabric including a first insulating member (650) located on a first jaw and a second contact surface (626) with the fabric that includes a second insulation member (652) located on a second jaw, in which the first and second surfaces of contact with the tissue are in face-to-face relationship and said first and second jaws (622, 624) have each an opposite elongated edges; wherein the first removable jaw includes a first electrode (642) and said second removable jaw includes a second electrode (646) arranged to lock said tissue when it is turned on, the first and second electrodes being in face-to-face relationship  characterized by: first and second dam members (656, 657) projected from at least one of said first and second jaws and located at the elongated edges of said jaws, wherein said surfaces (625, 626) of contact with the fabric are arranged on the first and second tissue dike means, respectively, and the tissue dike means is adapted to contain the tissue (654) within a desired coagulation area by applying a selected compression on the tissue located within the tissue contact surfaces, said selected compression being adapted to constitute areas of higher tissue compression and higher tissue impedance than any area where electrode surfaces lock the tissue when it is turned on, thereby preventing the transmission of electric current outside said coagulation area.

2.

The apparatus of claim 1, wherein each jaw (722, 724) includes a first and a second electrode (742 743, 746 747) adjacent to the surfaces (725, 726) of contact with the tissue and wherein the two separate electrodes of each jaw have an opposite polarity.

3.

The apparatus of claim 2 also comprising a cutting blade (220) removably disposed between the two separate electrode surfaces.

Four.

The apparatus of claim 1 wherein the tissue dike means comprises a first dike member (656), said first dike member projecting from the first jaw (622); wherein the apparatus comprises a first insulation material and a second insulation material, wherein said first insulation material comprises said surface (625) of contact with the fabric of said first jaw (622) and said second insulation material comprises said surface (626) of contact with the tissue of said second jaw;

wherein at least one electrode (642) adjacent to the surface (625) of contact with the tissue of the first jaw (622) is housed within said first jaw and at least one electrode (646) adjacent to the surface (626 ) of contact with the tissue of the second jaw (624) is housed within said second jaw; Y wherein the apparatus also comprises a means (316) for connecting said first electrode and said second electrode with a power source (312) to provide an electric current between said first electrode and said second electrode.

5.

The apparatus of claim 5, which also comprises a second dike member (657), wherein said second dike member protrudes from said first jaw (622), wherein said second dike member is positioned adjacent to said first dike member (656).

6.

The apparatus of claim 6, further comprising a third dam member (658), wherein said third dam member protrudes from said second jaw (624).

7.

The apparatus of claim 7, which also comprises a fourth dike member (659), wherein said fourth dike member protrudes from said second jaw (624), wherein said fourth dike member is positioned adjacent to said third dike member (658).