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WO2024061659A1 - Instruments électro-chirurgicaux - Google Patents

Instruments électro-chirurgicaux Download PDF

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Publication number
WO2024061659A1
WO2024061659A1 PCT/EP2023/074799 EP2023074799W WO2024061659A1 WO 2024061659 A1 WO2024061659 A1 WO 2024061659A1 EP 2023074799 W EP2023074799 W EP 2023074799W WO 2024061659 A1 WO2024061659 A1 WO 2024061659A1
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WO
WIPO (PCT)
Prior art keywords
wire section
cutting
electrode
wire
tissue
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/EP2023/074799
Other languages
English (en)
Inventor
Steven Thomas
George Christian ULLRICH
Aeron JONES
Christopher Paul Hancock
Warren Jones
Louis TURNER
Duncan James Foster FITZSIMONS
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Creo Medical Ltd
Original Assignee
Creo Medical Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Creo Medical Ltd filed Critical Creo Medical Ltd
Publication of WO2024061659A1 publication Critical patent/WO2024061659A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2936—Pins in guiding slots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00779—Power or energy
    • A61B2018/00785—Reflected power
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/128—Generators therefor generating two or more frequencies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/144—Wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1457—Probes having pivoting end effectors, e.g. forceps including means for cutting having opposing blades cutting tissue grasped by the jaws, i.e. combined scissors and pliers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter

Definitions

  • the invention relates to electrosurgical instruments for sealing and cutting tissue .
  • the electrosurgical instruments are configured to grasp biological tissue and are arranged to cut , e . g . separate or divide tissue , e . g . a vessel or surrounding tissue after coagulation or sealing , e . g . using radiofrequency (RF ) energy and/or a mechanical cutting element such as a blade .
  • the electrosurgical instruments are further configured to deliver microwave energy into the grasped tissue to seal the tissue by coagulation or cauterisation .
  • the electrosurgical instruments may be used to apply pressure to close one or more blood vessels before applying electromagnetic radiation (preferably microwave energy) to seal the blood vessel ( s ) .
  • the invention may be applied to a vessel sealer for use in laparoscopic surgery or open surgery as well as to an endoscopic instrument .
  • Electrosurgical instruments for delivering heat energy into grasped biological tissue are known .
  • it is known to deliver microwave energy from a bipolar electrode arrangement in the j aws of a forceps .
  • the microwave energy may be used to seal a vessel by thermal denaturation of extracellular matrix proteins (e . g . collagen) within the vessel wall .
  • the heat energy may also cauterise the grasped tissue and facilitate coagulation .
  • Such devices typically find application on the end of minimally invasive surgical laparoscopic tools but can equally find use in other clinical procedural areas such as gynaecology, endourology, gastrointestinal surgery, ENT procedures , or endoscopic procedures . Depending on the context of use , these devices can have differing physical construction, size , scale and complexity .
  • a gastrointestinal instrument might be nominally of 3 mm diameter mounted on to the end of a very long flexible shaft .
  • a laparoscopic instrument may be used on the end of an industry standard nominal 5mm or 10mm diameter rigid or steerable steel shaft .
  • US 6 , 585 , 735 describes endoscopic bipolar forceps in which the j aws of the forceps are arranged to conduct bipolar energy through the tissue held therebetween .
  • EP 2 233 098 describes microwave forceps for sealing tissue in which the sealing surfaces of the j aws include one or more microwave antennas for radiating microwave energy into tissue grasped between the j aws of the forceps .
  • WO 2015 / 097472 describes electrosurgical forceps in which one or more pairs of non-resonant unbalanced lossy transmission line structures are arranged on the inner surface of a pair of j aws .
  • the present invention provides various types of electrosurgical instruments that can enable fine tissue cutting and dissection to be performed on tissue .
  • the electrosurgical instruments may provide additional functionality, such as sealing biological tissue , such as (blood ) vessels , using a confined microwave field that can yield a well-defined seal location with low thermal margin . With these additional functions , fewer device interchanges may be needed during a procedure .
  • the electrosurgical instruments disclosed herein may be used in any type of surgical procedure , but it is expected to find particular utility for non-invasive or minimally invasive procedures .
  • the electrosurgical instruments may be configured to be introduced to a treatment site through an instrument channel of a surgical scoping device , such as a laparoscope or an endoscope .
  • an electrosurgical instrument for cutting tissue which comprises an instrument shaft , a first j aw, a second j aw, and a cutting device .
  • the instrument shaft comprises a transmission line for conveying microwave and/or radiofrequency electromagnetic energy .
  • the first j aw is attached to the instrument shaft and includes a first surface .
  • the second j aw is attached instrument shaft and includes a second surface .
  • the cutting device includes a cutting portion and at least one wire section ( or elongate section) .
  • the at least one wire section is made from a shape-memory material .
  • the first j aw and the second j aw can be moved between an open position, in which the tissue can be inserted between the first surface and the second surface , and a closed position, in which the first surface and the second surface are brought together to clamp tissue therebetween .
  • the cutting device is configured to be in a relaxed position in which the wire section is a deformed state .
  • the cutting device is configured to been in an active position in which the wire section returns to a pre-deformed state upon heating the wire section .
  • the cutting portion protrudes less from the first j aw or the second j aw in the relaxed position compared to the active position .
  • the cutting portion is configured to contact and cut tissue in the active position .
  • the electrosurgical instrument may thus perform vessel/tissue dividing or cutting .
  • Vessel/tissue dividing is a process of cutting through a continuous biological vessel/tissue to separate it into two pieces . It can be performed after a vessel/tissue is first sealed . Vessel/tissue dividing is performed by the cutting device , which is discussed in more detail below .
  • proximal and distal refer to the ends of the electrosurgical instrument , the shaft , and/or the coaxial transmission line further from and closer to a treatment site respectively .
  • the proximal end is closer to a generator unit for providing the RF and/or microwave energy
  • the distal end is closer to the treatment site , i . e . the patient .
  • conductive is used herein to mean electrically conductive , unless the context dictates otherwise .
  • longitudinal refers to the direction along the instrument channel parallel to the axis of the coaxial transmission line .
  • lateral refers to a direction that is perpendicular to the longitudinal direction .
  • inner means radially closer to the centre ( e . g . axis ) of the instrument channel .
  • outer means radially further from the centre ( axis ) of the instrument channel .
  • radiofrequency electromagnetic energy may mean a stable fixed frequency in a range 10 kHz to 300 MHz, preferably in a range from 100 kHz to 5MHz, and more preferably in a range from 360 to 440 kHz.
  • the microwave electromagnetic energy may mean electromagnetic energy having a stable fixed frequency in the range 300 MHz to 100 GHz.
  • the radiofrequency electromagnetic energy should have a frequency high enough to prevent the energy from causing nerve stimulation.
  • the magnitude of the radiofrequency electromagnetic energy and the duration for which it is applied may be selected to prevent the energy from causing tissue blanching or unnecessary thermal margin or damage to the tissue structure.
  • Preferred spot frequencies for the radiofrequency electromagnetic energy include any one or more of: 100 kHz, 250 kHz, 400 kHz, 500 kHz, 1 MHz, 5 MHz.
  • Preferred spot frequencies for the microwave electromagnetic energy include 915 MHz, 2.45 GHz, 5.8 GHz, 14.5 GHz, 24 GHz. 2.45 GHz and/or 5.8 GHz may be preferred.
  • the microwave electromagnetic energy and the radiofrequency electromagnetic energy may be conveyed along a common signal pathway through the instrument shaft.
  • a coaxial cable may provide the common signal pathway for conveying both the microwave energy and the radiofrequency energy.
  • the transmission line may comprise an inductive filter for blocking the microwave energy from the cutting element, and a capacitive filter for blocking the radiofrequency energy from the first and second electrodes.
  • the radiofrequency energy and microwave energy are conveyed along separate pathways within the instrument shaft (the transmission line includes separate pathways) , wherein the inductive filter and capacitive filter are provided at a proximal end of the instrument shaft, e.g. in a handle.
  • a coaxial cable is provided for conveying the microwave electromagnetic energy while two or more wires are provided for conveying the radiofrequency electromagnetic energy. It also possible that the transmission line includes two or more wires for conveying the radiofrequency electromagnetic energy.
  • the instrument shaft may be dimensioned to fit within an instrument channel of a surgical scoping device.
  • the surgical scoping device may be a laparoscope or an endoscope .
  • Surgical scoping devices are typically provided with an insertion tube that is a rigid or flexible ( e . g . steerable ) conduit that is introduced into a patient' s body during an invasive procedure .
  • the insertion tube may include the instrument channel and an optical channel ( e . g . for transmitting light to illuminate and/or capture images of a treatment site at the distal end of the insertion tube ) .
  • the instrument channel may have a diameter suitable for receiving invasive surgical tools .
  • the diameter of the instrument channel may be equal to or less than 13 mm, preferably equal to or less than 10 mm, and more preferably, especially for flexible insertion tubes , equal to or less than 5 mm.
  • the instrument shaft and the transmission line may be flexible so that they can be inserted into the instrument channel of the scoping device . Further , the transmission line may be arranged within a lumen of the shaft . The instrument shaft may cover and/or shield the transmission line . The transmission line may extend from a distal end to a proximal end of the electrosurgical instrument . In particular, the transmission line electrically connects the first electrode and the second electrode to the generator unit .
  • the energy delivery structure may be used as an alternative to staples .
  • staple guns are used to deliver 50 to 100 small staples that are fired simultaneously between j aws that can have a length of 70 mm or more , or from an annular j awed arrangement with diameters of 20 to 50 mm.
  • multiple antenna structures such as those discussed herein may be used to cover the required length .
  • the antenna structures may be arranged in any number of array forms to be activated simultaneously, sequentially or progressively in a suitable manner .
  • the first j aw and/or the second j aw may be movable relative to their instrument shaft .
  • the first j aw and/or the second j aw may be attached to the instrument shaft via a j oint or hinge .
  • the j oint may include a pivot axis around which the first j aw and/or the second j aw may rotate .
  • the first j aw and/or the second j aw may be activated by one or more actuation rods or control wires respectively connected to the first jaw and/or the second jaw.
  • the one or more actuation rods or control wires may extend within the instrument shaft to a proximal end of the electrosurgical instrument.
  • the one or more actuation rods may be connected to a handle with which the first and/or second jaws can be actuated, e.g. opened and/or closed.
  • the electrosurgical instrument comprises an actuation mechanism which converts a back-and-forth movement of the actuation rod(s) or control wire(s) into a rotational movement of the first jaw and/or the second jaw.
  • both jaws can be movable, e.g. rotatable around a (common) pivot axle.
  • one of the jaws is fixed to the shaft and the other jaw is movable relative to the one jaw.
  • first jaw and the second jaw are (maximally) spaced apart so that there is a free space between the first surface of the first jaw and the second surface of the second jaw.
  • tissue can be inserted between the first surface and the second surface in the open position.
  • first jaw and the second jaw are moved towards the tissue such that the tissue is pushed into the space between the first surface and the second surface in the open position of the first jaw and the second jaw.
  • the tissue between the first surface and the second surface can be grasped and/or clamped between the first surface and the second surface. In this way, the tissue can be fixed between the first surface and the second surface in the closed position.
  • the first surface and the second surface are the faces of the first jaw and the second jaw, respectively, that face each other in the open and/or closed position. In the closed position, the first surface may extend parallel to the second surface.
  • the pair of jaws may be pivotable relative to each other about a hinge axis that lies transverse to a longitudinal axis of the coaxial transmission line.
  • the pair of jaws comprises a static jaw that is fixed relative to the instrument shaft, and a movable jaw that is pivotably mounted relative to the static jaw to open and close the gap between the opposing inner surfaces.
  • the energy delivery structure may be disposed on the inner surface of the static jaw.
  • both jaws are arranged to pivot with respect to the instrument shaft, e.g. in a symmetrical forceps-type or scissors-type arrangement. Relative movement of the pair of jaws may be controlled from a handle at a proximal end of the instrument shaft.
  • a control rod or control wire may pass through the instrument shaft to operably couple an actuation mechanism on the handle to the pair of jaws.
  • the pair of jaws may be arranged to move relative to one another in a manner that maintains the inner surfaces thereof in an aligned, e.g. parallel, orientation. This configuration may be desirable for maintaining a uniform pressure on grasped tissue along the length of the jaws.
  • a closure mechanism is disclosed in WO 2015/097472.
  • the first jaw and/or the second jaw may have a Maryland configuration. This can include that the first jaw and the second jaw are not straight but bent/curved, e.g. forming an arc or an S-shape in a side view.
  • the cutting device refers to that component or group of components of the electrosurgical instrument that provide the cutting functionality of the electrosurgical instrument.
  • the cutting portion is that component or group of components of the cutting device that provides the cutting functionality.
  • the at least one wire section may be used to actuate or move the cutting portion. Alternatively, the at least one wire section may be part of or provide the cutting portion .
  • the cutting device may contact and cut tissue in the open position and/or the closed position of the first jaw and the second jaw.
  • the cutting portion may be connected to the transmission line and may be configured to emit radiofrequency energy for cutting tissue.
  • the cutting portion may be considered an active electrode for radiofrequency cutting while other electrically conductive parts of the first jaw and/or the second jaw (e.g. a first to fourth electrode to be discussed below) form a return electrode for the radiofrequency cutting. These electrically conductive parts may also be connected to the transmission line.
  • the shape-memory material provides the shape-memory effect (SME) which includes a temperature-induced phase transformation which reverses a deformation of the shapememory material.
  • the shape-memory material may include at least two phases : the martensitic phase and the austenite phase .
  • the martensitic phase can be considered corresponding to the deformed state while the austenite phase can be considered corresponding to the pre-deformed state .
  • the martensitic phase or the deformed state of the shapememory material can be monoclinic or orthorhombic . Since these crystal structures of the deformed state of the shape-memory material may not have enough slip systems for easy dislocation motion, they deform by twinning — or rather , detwinning .
  • the martensite phase or the deformed state of the shape-memory material can be thermodynamically favoured at lower temperatures , while the austenite phase or the pre-deformed state of the shape-memory material can be thermodynamically favoured at higher temperatures .
  • the shapememory material in the pre-deformed state ( austenite phase ) into deformed state of the shape-memory material (martensite phase ) introduces internal strain energy in the deformed state of the shape-memory material (martensitic phase ) .
  • the shape-memory material in the pre-deformed state (martensitic phase ) can form many twins — this is often called "self-accommodating twinning" and can be the twinning version of geometrically necessary dislocations .
  • the shapememory material can be manufactured in the pre-deformed state ( i . e . at higher temperatures ) .
  • shape-memory material can be engineered so that the shape-memory material is in the pre-deformed state (martensitic phase ) at a normal working temperature ( e . g . room temperature or the temperature of the body) to take advantage of the shape memory effect .
  • a normal working temperature e . g . room temperature or the temperature of the body
  • the shape-memory material "start" highly twinned, i . e . in the pre-deformed state .
  • the shape-memory material in the deformed state (martensite ) is loaded by deformation of the shape-memory material .
  • Applied stresses will detwin shape-memory material in the deformed state ( in the martensite phase ) , but all of the atoms stay in the same position relative to the nearby atoms — no atomic bonds are broken or reformed ( as they would be by dislocation motion ) .
  • the shape memory material may exhibit a two-way shapememory effect in which the material remembers two different shapes: one at low temperatures (corresponding to the deformed state) , and one at the high temperature (corresponding to the pre-deformed state) .
  • a shape-memory material that shows the shape-memory effect during both heating and cooling is said to have two-way shape memory. This can also be obtained without the application of an external force (intrinsic two-way effect) . So, at room or body temperature, the wire section is in the deformed state. Upon heating, the wire section transitions into the pre-deformed state. After cooling to the room or body temperature, the wire section is in the deformed state again. So, the two-way shape memory material (e.g. nitinol) will hold one shape (the deformed state) at a prescribed lower temperature, and, when reaching a prescribed higher temperature, it will reach another shape (the predeformed state) and vice versa.
  • the two-way shape memory material e.g. nitino
  • the shape-memory material may include a shape-memory alloy which can include copper-aluminium-nickel , nickeltitanium (NiTi or Nitinol) , and/or alloys including zinc, copper, gold and iron. Further iron-based and copper-based shape-memory materials are known, such as Fe-Mn-Si, Cu-Zn-Al and Cu-Al-Ni .
  • the cutting portion and/or the at least one wire section are configured either to contact and/or cut tissue or to be received within the electrosurgical instrument (such as the first jaw and/or the second jaw) so that the cutting portion is positioned not to contact and/or cut tissue.
  • This configuration may be present in both the open position and the closed position of the first jaw and the second jaw.
  • the cutting portion and/or the at least one wire section may not be exposed at the first jaw and/or the second jaw to cut and/or to contact the tissue.
  • the cutting portion and/or the at least one wire section are positioned to contact the tissue and/or to cut tissue.
  • the cutting portion and/or at least one wire section protrude from an outer surface of the first jaw and/or the second jaw.
  • the cutting device applies pressure to tissue to be cut in the active position while no or little pressure (e.g. less pressure compared to the active position) is applied in the relaxed position.
  • the cutting device e.g. the cutting portion and/or the at least one wire section
  • the cutting device protrudes from the respective jaw towards the respective other jaw for providing additional pressure on the tissue in the closed position of the first jaw and the second jaw.
  • the at least one wire section may include one or more wires, sheets, and/or (elongate) bodies made from shape-memory materials.
  • the wire may be a flat wire, a round wire, or a wire having a different cross-section.
  • the at least one wire section provides the movement or transition from the relaxed position to the active position by transitioning from the deformed state to the pre-deformed state.
  • the at least one wire section can be considered an actuator which provides the movement of the cutting device from the relaxed position to the active position.
  • the at least one wire section moves the cutting portion from the relaxed position (e.g. in which the cutting portion is received within the first jaw and/or a second jaw) to the active position (e.g. in which the cutting portion protrudes from the first jaw and/or a second jaw) by the transition from the deformed state to the pre-deformed state.
  • the at least one wire section may be compressed, folded, and/or bent in the deformed state and elongated, unfolded, and/or straight in the pre-deformed state.
  • the transition from the deformed state to the pre-deformed state may induce a movement of a portion, section, and/or an endpoint of the wire section resulting in the transition from relaxed position to the active position.
  • the wire section may be compressed, folded, and/or bent when being in the martensite phase for assuming the deformed state . This can be done manually ( e . g . prior to using the electrosurgical instrument ) and/or during manufacturing . Such manual deforming step may not be necessary when using a two-way shape memory material .
  • the heat or thermal energy necessary for effecting the transition from the deformed state to the pre-deformed state of the at least one wire section can be provided in different ways .
  • a heating section is provided with the electrosurgical instrument that is thermally coupled to the at least one wire section so that heat generated by the heating section ( e . g . including a resistive heater ) may raise the temperature of the at least one wire section above the phase transition temperature for the pre-deformed state .
  • the at least one wire section is heated by the heat generated during the emission of the radiofrequency electromagnetic energy .
  • the at least one wire section is positioned in the relaxed position close to a radiofrequency electrode , such as the cutting portion, i . e .
  • the at least one wire section is the radiofrequency electrode itself .
  • the heat generated by the emission of the radiofrequency energy also provides the heat/thermal energy necessary for the transition from the deformed state to the pre-deformed state of the at least one wire section .
  • the cutting device can be thermally activated which eliminates the need for providing a mechanical actuation for the cutting device , such as a control wire or actuation rod . So , it is possible to reduce the diameter of the shaft since the number of control wires or actuation rods can be reduced as no mechanical actuation mechanism is necessary for moving the cutting device between the relaxed position and the active position . Optionally, no further structure/component is necessary for actuating the cutting device since the thermal energy necessary for mechanically and/or spatially moving the cutting device from the relaxed position to the active position is provided by the radiofrequency cutting itself .
  • the additional mechanical pressure intended to be applied during the radiofrequency cutting on the tissue is simultaneously generated during radiofrequency cutting since the radiofrequency cutting itself additionally provides the actuation of the cutting device from the relaxed position to the active position. So, no additional step of mechanically actuating the cutting device from the relaxed position to the active position is necessary.
  • the cutting portion is a free distal end portion of the cutting device and the wire section is configured to move the cutting portion from the relaxed position to the active position.
  • the cutting portion may (solely) be supported by the at least one wire section on the first jaw and/or the second jaw.
  • the cutting portion can be regarded a distal end portion of the cutting device which is not supported by and/or fixed to the first jaw and/or the second jaw other than via the at least one wire section.
  • the cutting device has an elongate shape having a first end attached to the first jaw and/or the second jaw and a second end which can be freely moved, i.e. is not attached to the first jaw and/or the second jaw.
  • the at least one wire section is arranged between the first end and the second end (e.g. the cutting portion) .
  • the at least one wire section is configured to move a distal end portion of the cutting device which functions as the cutting portion.
  • the cutting portion may include a blade and/or sharp edge configured to mechanically cut tissue.
  • the least one wire section is configured to move the blade and/or the sharp edge.
  • the cutting portion is formed by the wire section.
  • a distal end portion of the wire section e.g. one or more wires, a loop of a wire, a sheet
  • the cutting portion which is configured for mechanically cutting tissue and/or emitting radiofrequency energy for radiofrequency cutting at the distal end portion of the wire section .
  • the distal end portion of the cutting device e.g. the blade, the sharp edge, and/or the end portion of the wire section
  • the first jaw and/or the second jaw so that the distal end portion of the cutting device (e.g. the blade, the sharp edge, and/or the end portion of the wire section) are not configured to cut tissue.
  • the distal end portion of the cutting device e.g. the blade, the sharp edge, and/or the end portion of the wire section
  • the at least one wire section (not including the cutting portion) may be permanently received within the first jaw and/or the second jaw. So, in this configuration, only the cutting portion is configured to contact and cut tissue in the active position.
  • the first jaw includes a slot open on an outer surface of the first jaw and/or the second jaw.
  • the cutting portion is received in the slot.
  • the transition of the wire section from the deformed state to the pre-deformed state induces a bending of the wire section so that the cutting portion protrudes from the slot.
  • the slot may include or be a channel and/or an elongate recess in the outer surface of the first jaw.
  • the slot may be completely or partially open at an outer surface of the first jaw.
  • the slot is an optional embodiment in case that the cutting device has an elongate shape. In the relaxed position, the complete cutting device or at least the cutting portion may be received within the slot.
  • the first jaw includes a cavity in which a part of the wire section (not including the cutting portion) is arranged so that this part of the wire section is not exposed both in the relaxed position and the active position.
  • this cavity is open over the extension of another part of the wire section and the cutting portion.
  • This other part of the wire section may bend, bulge, or deform when heated (i.e. when transitioning from the deformed state to the pre-deformed state) . This results in a movement of the cutting portion out of the cavity or slot so that the cutting portion protrudes from the cavity or the slot (especially from an outer surface of the first jaw) .
  • the wire section in the pre-deformed state is bent or curved such that the cutting portion protrudes from the first jaw enabling the cutting functionality of the electrosurgical instrument.
  • the cutting portion Prior to the electrosurgical treatment, the cutting portion can be mechanically pushed into the slot so that the wire section is deformed, for example straightened.
  • the electrosurgical instrument may be inserted into a working channel of the scoping device since no component protrudes from the electrosurgical instrument, e.g. the first jaw.
  • the wire section returns to the pre-deformed state (i.e. curved or bent) so that the cutting portion again protrudes from the first jaw enabling the cutting functionality of the electrosurgical instrument.
  • the first jaw includes a channel having an opening which is open on an outer surface of a distal end portion of the first jaw.
  • the wire section is bent in the deformed state and the wire section in pre-deformed state is straight or less bent. Further optionally, in the relaxed position, the cutting portion is received in the channel and the transition of the wire section from the deformed state to the pre-deformed state moves the cutting portion out of the channel.
  • the channel may be an elongated cavity within the first jaw that is only open at the opening. This means that the channel can only be accessed from the outside of the first jaw through the opening. Thus, if the cutting device is completely within the channel, no part of the cutting device protrudes from the first jaw.
  • the opening may be on the outer surface of the first jaw, for example at a distal end face of the first jaw.
  • the channel extends along a longitudinal direction of the first jaw.
  • the cutting portion in the active position may protrude beyond the first jaw in the longitudinal direction of the first jaw, for example beyond a distal end face of the first jaw.
  • This provides a cutting functionality at a distal end face or a distal end portion of the first jaw.
  • the cutting portion can be used for cutting a whole into tissue so that the electrosurgical instrument can be further advanced into and/or through the tissue.
  • the cutting device may not be used to cut tissue that is grasped or clamped between the first jaw and the second jaw.
  • the location of cutting is offset from the first surface and the second surface.
  • the channel may be inclined to the longitudinal direction of the first j aw and/or may have an opening close to a distal end face .
  • the cutting portion may not be arranged at the distal end face in the active position, but close thereto providing a cutting functionality in a distal end region of the first j aw .
  • the cutting portion In the relaxed position of the cutting device , the cutting portion does not protrude from the opening, i . e . the cutting portion is arranged within the channel .
  • the at least one wire section moves /pushes the cutting portion out of the channel so that the cutting portion protrudes from the opening/ channel .
  • the wire section is bent in the deformed state .
  • This may include one or more curves , spirals , or the like .
  • the wire section In the deformed state of the wire section, the wire section is shorter than a length of the channel so that the cutting portion is arranged within the channel , i . e . does not protrude from the opening .
  • the curves , spirals and or the like In the pre-deformed state of the wire section, the curves , spirals and or the like are straightened or less pronounced, e . g . the bending curvature is increased . Due to the straightening of the wire section during transition from the deformed state to pre-deformed state , the length of the wire section along the channel is increased so that at least the cutting portion protrudes from the opening . In other words , the wire section is used as an actuation means for pushing the cutting portion out of the channel .
  • the electrosurgical instrument further includes a biasing element which is biased to push the wire section from the pre-deformed state to the deformed state .
  • the biasing element may include one or more springs which are arranged on or in the channel for pushing the cutting portion from the active position towards the relaxed position, e . g . the biasing element provides a force which pushes the cutting portion that protrudes from the opening back into the channel .
  • the biasing element may be connected to the wire section and/or the cutting portion .
  • the biasing element provides a force that is smaller than the force generated by the wire section in the pre-deformed state , i . e . the force generated by the shape-memory material when being heated to transition into the pre-deformed state .
  • the force that is generated by the biasing element is however smaller than the force required for deforming the wire section when the temperature of the wire section is in a range that corresponds to deformed state .
  • the biasing element may deform the wire section so that it is bent ( e . g .
  • the deformed state includes curves , spirals , or the like ) in the deformed state . Heating the wire section up to a temperature range in which the wire section is in the pre-deformed state , the force generated by the wire section is greater than the force generated by the biasing element so that the cutting portion is pushed out of the channel and protrudes from the opening .
  • the cutting portion includes a blade , or the cutting portion is a distal end of the wire section .
  • the blade may not be actuated by an actuation rod or control wire that needs to extend within the instrument shaft and is connected to the handle .
  • the blade may have a cutting edge which is sufficiently sharp to mechanically cut tissue which is clamped between first j aw and the second j aw in the closed position or is arranged close to an outer surface of the first j aw and/or the second j aw .
  • the blade may be movable or slidable in the channel between a relaxed position in which it lies within the channel/slot and the active position in which it protrudes from the channel/slot .
  • the channel may be arranged to act as a guide rail for the cutting blade , which may be particularly useful where the pair of j aws curve towards their distal ends ( e . g . having a Maryland configuration) .
  • the blade may comprise a rigid element with a sharp edge adapted to slice biological tissue , e . g . a scalpel-type blade or the like .
  • This type of blade is configured to perform a "cold" cut , which may be preferred because it carries a low ris k of collateral thermal damage that is associated with other cutting techniques .
  • the invention need not be limited to a cold cut blade .
  • the blade and/or the cutting portion may comprise any one of : a bipolar radiofrequency cutting element or radiofrequency electrode , an ultrasound sonotrode , and a heatable wire element .
  • the radiofrequency electrode may be provided by a distal end or distal end portion of the wire section .
  • the cutting device may solely consist of the wire section so that the wire section provides the functionalities as described above ( e . g . actuation of the cutting portion ) and the functionality of the cutting portion by providing a radiofrequency cut .
  • the wire section may include one or more wires whose ends or end portions are configured to emit radiofrequency energy .
  • the wire section also acts as a conductor for conveying the radiofrequency energy wherein the channel is provided in an electrically isolating material such as the first to fourth isolating portions discussed below .
  • the cutting device may be a unitary component or one or wires made from the shape-memory material .
  • One section of the wire ( s ) provides the actuation functionality ( e . g . is bent in the deformed state ) while another section of the wire ( s ) ( e . g . a distal end ) acts as a radiofrequency electrode .
  • the electric energy conveyed by the wire ( s ) can provide the heating of the wire section to a temperature in which to phase transition from the deformed state to the pre-deformed state occurs .
  • This provides a simple implementation of the cutting device as a single piece of one or more wires .
  • the wire section is arranged on the first j aw and the wire section includes a first wire and a second wire .
  • the first wire is arranged further away from the first surface for contacting tissue in the active position and the second wire includes at least one loop .
  • the at least one loop is in a compressed configuration the deformed state and the at least one loop is an expanded configuration in the pre-deformed state .
  • the wire section also acts as a cutting portion, optionally as a radiofrequency electrode .
  • the first wire mainly provides the radiofrequency functionality, for example because the first wire is arranged to contact the tissue whereas the second wire may be arranged further away from the tissue or not in contact with the tissue .
  • the cutting device can be configured to cut tissue in the closed position of the first j aw and the second j aw . This is due to the arrangement of the cutting device on the first surface . In the active position of the cutting device , the first wire is moved further towards the second surface compared to the relaxed position so that the first wire can further apply pressure to the tissue beyond the pressure applied by the first j aw and the second j aw in the closed position . This additional pressure may be useful for effecting radiofrequency cutting and/or this additional pressure may be sufficient for cutting tissue on its own .
  • the first wire and the second wire are arranged above each other , e . g . the first wire and the second wire define a single plane which may be perpendicular to the first surface and in which the first wire and the second wire extend .
  • the first wire is configured to be positioned further away from the first surface in the pre-deformed state compared to the deformed state .
  • the second wire can be arranged between the first wire and the first surface in the deformed state and/or the pre-deformed state .
  • the second wire may be configured to support the first wire in the deformed state and/or in the pre-deformed state .
  • the second wire is used to increase the pressure that can be applied by the first wire on the tissue .
  • the second wire can be used to provide a supporting structure or scaffold against which the first wire abuts in case the pressure applied to the first wire increases above a certain threshold .
  • the first wire in the pre-deformed state , the first wire is spaced apart from the second wire and, if the pressure applied to the first wire by the tissue is above the first threshold, the first wire contacts the second wire .
  • the first wire may include one or more wires which have respective straight sections for contacting and cutting the tissue . These straight sections may be bent upon the application of pressure ( e . g . by the tissue ) .
  • the second wire can be provided for supporting straight sections or acting as a backstop for the straight sections .
  • the rigidity of the second wire is increased by providing one or more loops ( i . e . non-straight sections ) .
  • These loops may include a least two sections of the second wire that are arranged above each other and, thus , increasing the rigidity of the second wire .
  • the one or more loops are compressed such that an area defined by the loop is reduced compared to the pre-deformed state of the second wire in which to loop is an expanded configuration .
  • the loop includes basically two (parallel and/or straight ) sections arranged closed to each other in the deformed state so that the loop is flat .
  • the distance between the sections is increased for increasing the area defined by the loop . In this way, the outer perimeter of the second wire can be moved away from the first surface for supporting the first wire .
  • the above-described embodiments are described as providing the cutting device on the first j aw .
  • the abovedescribed embodiments of the cutting device can be alternatively or additionally provided with the second j aw .
  • the cutting device includes a radiofrequency electrode for emitting radiofrequency energy .
  • the radiofrequency electrode includes the wire section and forms the cutting portion .
  • the cutting device may not include a blade or any other means for mechanically cutting tissue .
  • the above comments regarding the frequency electrode provided by the wire section equally apply to all other embodiments described herein .
  • the wire section is configured to be the deformed state if no radiofrequency energy is emitted .
  • the wire section is configured to return to the pre-deformed state due to the heat generated during the emission of microwave and/or radiofrequency energy .
  • the heat generated by radiofrequency cutting and/or microwave sealing is generated by the shapememory material itself .
  • the radiofrequency electrode or the cutting portion heats itself so that the radiofrequency cut not only provides the cutting of the tissue but also applies an increased pressure on the tissue by the transition from the deformed state to the pre-deformed state which is induced by the heat generated during the radiofrequency cutting .
  • this provides the advantageous functionality that the desired increase in the mechanical pressure on the tissue to be cut is provided at the same time as and caused by the frequency cutting .
  • the heat generated during microwave sealing is sufficient to transform the wire section from the deformed state to the pre-deformed state .
  • the transition temperature may be reached at the end of the microwave sealing so that the increase in pressure on the tissue is provided before the subsequent radiofrequency cutting and at the end or after the microwave sealing .
  • no separate actuation or activation mechanisms are needed for simultaneously increasing the pressure on the tissue and effecting radiofrequency cutting .
  • no separate means is required for heating the wire section for effecting the transition from the deformed state to the pre-deformed state .
  • the electrosurgical instrument further comprises a heating section .
  • the heating section is configured to heat the wire section for transitioning the wire section from deformed state to the predeformed state .
  • the heating section may include an electrical element for heating the wire section .
  • the heating section may include a resistive heating section or other means for locally heating the wire section .
  • the heating section may eliminate the need for providing a mechanical actuation for increasing the pressure on the tissue by the cutting device . Rather, the heating section is connected to one or more wires which usually require less space than the control wire or actuation rod for mechanically actuating the cutting device .
  • the electrical energy required for the heating section may be conveyed by the transmission line .
  • the heating section firstly heats the wire section for transitioning the cutting device from the deformed state to the pre-deformed state so that the cutting device is in the active position . Subsequently, the wire section acts as a radiofrequency electrode for effecting radiofrequency cutting .
  • the heating section may be powered by ( low) frequency alternating current (AC ) or a direct current ( DC ) . Further, pulsed heating ( e . g . by proving pulsed electric energy) can be employed for powering the heating section ( e . g . pulsed DC and/or pulsed AC voltages/currents ) . This may allow a better control over the heating temperature .
  • the generator unit may include a transformer and/or galvanic isolation for providing the electric energy for the heating section .
  • the electrosurgical instrument comprises a first electrical connection point at the wire section and a second electrical connection point at the wire section .
  • the first connection point and the second connection point are connected to the transmission line .
  • the wire section between the first connection point and the second connection point has a sufficiently high resistance for generating heat by current flowing between the first connection point and the second connection point .
  • the first electrical connection point and the second electrical connection point provide electrical contacts between the wire section and the transmission line so that electrical current can flow along the wire section between the first electrical connection point and the second electrical connection point .
  • the wire section between the first electrical connection point and the second electrical connection point may have a smaller diameter and/or is made from a different material compared to other parts of the wire section so that the electrical resistance is higher between the first electrical connection point and the second electrical protection point compared to other sections of the wire section . This results in that heat is generated between the first electrical connection point and the second electrical connection point .
  • the wire section is bent in the deformed state between first electrical connection point and the second electrical connection point so that the heat is generated at the same location at which the transformation from the deformed state to the pre-deformed state takes place .
  • the section of the wire section between the first electrical connection point and the second electrical connection point can act as the heating section as described above .
  • the heating section is a unitary component with the wire section .
  • first electric connection point and the second electrical connection point may be connected to respective wires of the transmission line or other conductors of the transmission line which are configured to convey microwave energy and/or radiofrequency energy .
  • the current that is supplied to the first and/or second connection points may be a ( low) frequency alternating current (AC ) or a direct current ( DC ) .
  • pulsed heating e . g . by proving pulsed electric energy
  • the generator unit may include a transformer and/or galvanic isolation for providing the electric energy between the first and second connection points .
  • the direct heating of the wire section using the first connection point and the second connection point may work well with a two-way shape memory material .
  • the wire section is in the deformed state when no current flows between the first connection point and the second connection point .
  • the wire section may be in the pre-deformed state when current flows between the first connection point and the second connection point .
  • IxIxR heating can be used locally at the site of the wire section to adj ust the position of the cutting portion from being perpendicular to longitudinal to the direction of the first surface or the second surface .
  • an electrosurgical instrument for cutting tissue which comprises an instrument shaft , a first j aw, a second j aw, a cutting device , and an actuation device .
  • the instrument shaft comprises a transmission line for conveying microwave and/or radiofrequency electromagnetic energy .
  • the first j aw is attached to the instrument shaft and includes a first surface .
  • the second j aw is attached to the instrument shaft and includes a second surface .
  • the cutting device includes an wire section, which optionally is elastic .
  • the electric wire section is electrically connected to the transmission line and acts as a radiofrequency electrode configured to emit radiofrequency energy .
  • the actuation device is movable between an advanced position and a retracted position .
  • the first and the second j aw can be moved between an open position, in which tissue can be inserted between the first surface and the second surface , and a closed position in which the first and second surfaces are brought together to clamp tissue therebetween .
  • a proximal end of the wire section is connected or coupled to the actuation device .
  • the wire section is configured to be in a relaxed position when the actuation device is in the retracted position .
  • the cutting device is configured to be in an active position when the actuation device is in the advanced position .
  • the wire section protrudes less from the first j aw and/or the second j aw in a relaxed position compared to the active position .
  • the wire section is configured to cut and contact tissue in the active position .
  • a distal end of the wire section is connected or coupled to a fixation point on a distal end portion of the first j aw and/or the second j aw .
  • the actuation device may include an actuation rod or control wire which can be movable along a channel within the instrument shaft .
  • the actuation rod or control wire protrudes more from the instrument shaft compared to the retracted position .
  • the movement between the retracted position and the advanced position may be a linear movement , for example along the longitudinal direction of the first j aw and/or the second j aw .
  • a distal end of the actuation device that is coupled to the wire section can be laterally moved upon actuation of the actuation device .
  • the actuation device can be directly fixed to the proximal end of the wire section .
  • the actuation device is configured to move the proximal end of the wire section between the advanced position and the retracted position .
  • the actuation device and the wire section may be a unitary or single component .
  • a distal end region of one or more wires provide the wire section and the other part of the one or more wires provide the actuation device .
  • the fixation point may be implemented by a mechanical fixation of the distal end of the wire section to a distal end portion of the first j aw and/or the second j aw .
  • the fixation point is provided by a hinge , pulley, or other mechanical means for (permanently) fixing the distal end of the wire section to the first j aw and/or the second j aw .
  • the wire section In the relaxed position of the wire section, the wire section may be straight , not bent , or free from stress applied by the actuation device .
  • the lateral movement from the retracted position to the advanced position may induce a stress or bending force to the wire section so that the wire section deforms between the proximal end and the distal end, for example if the distal end of the wire section is connected or coupled to the fixation point and the wire section is elastic .
  • the wire section between the distal end ( i . e . the fixation point ) and a proximal end bends outward from the first surface or the second surface . This is possible due to the elasticity of the wire section between the proximal end and the distal end .
  • the wire section protrudes more from the first surface towards the second surface in the closed position compared to the relaxed position .
  • the wire section protrudes more from the second surface towards the first surface in the closed position compared to the relaxed position .
  • the lateral movement of the actuation device between the advanced position and the retracted position induces a sideways movement of the wire section, i . e . a movement along the longitudinal direction of the first j aw and/or the second j aw is converted in a movement perpendicular to the longitudinal direction of the first j aw and/or the second j aw .
  • this is due to the elasticity of the wire section which transforms the force provided by the actuation device in a deformation or bending of the wire section .
  • the electrosurgical instrument is configured to convert a linear movement of the actuation device in a movement of the cutting device , e . g . the wire section and/or the cutting portion, that includes a component along a direction perpendicular to the first/second surface , e . g . for moving the cutting device from the relaxed position to the active position .
  • the electrosurgical instrument further comprises a first electrode for emitting microwave energy arranged on the first j aw, a second electrode for emitting microwave energy arranged on the first j aw, and a first isolating portion electrically isolating the first electrode from the second electrode .
  • the first electrode and the second electrode are electrically connected to the transmission line .
  • sections of the first and second electrodes are exposed on the first surface to define a first sealing area and a second sealing area on the first surface .
  • the first sealing area is spaced from the second sealing area to form a gap therebetween on the first surface so that the tissue between the first sealing area and the second sealing area is not sealed upon the emission of the microwave electromagnetic energy .
  • the first and second sealing areas are configured to seal the tissue on either side of the gap using the emitted microwave electromagnetic energy .
  • the cutting device is effective along a cutting line on the first surface to cut the tissue in the closed position, the cutting line being positioned on the gap .
  • the cutting line may be defined by the wire section in the active position and/or the relaxed position . This means that the wire section is arranged or is arrangeable between the first sealing area and the second sealing area, i . e . in the gap .
  • the first and second electrodes in the pair of j aws operate to provide two localised seals for a biological vessel/tissue gripped between the first and second j aws , and the cutting device is operable to cut and/or divide the vessel between the two localised seals .
  • the electrosurgical instrument of this embodiment may thus perform vessel/tissue sealing and vessel/tissue dividing .
  • Vessel/tissue sealing is typically the application of pressure to squash the walls of a biological vessel together , followed by the application of some form of thermal energy .
  • the thermal energy is applied by the first and second electrodes to the gripped tissue using the microwave electromagnetic energy .
  • the pressure to the tissue can be applied by the first and/or second electrodes ( e . g . the first and second sealing areas ) and/or other parts of the first and second j aws .
  • the applied microwave energy disrupts /denatures the tissue cells and forms an amalgam of collagen predominant in vessel/tissue walls , which effectively bonds the vessel/tissue walls together .
  • vessel/tissue dividing is a process of cutting through a continuous biological vessel/tissue to separate it into two pieces . It is normally performed after a vessel/tissue is first sealed . Vessel/tissue dividing is performed by the cutting device , e . g . the wire section, which was discussed above and will be discussed in more detail below . As described above , the vessel/tissue dividing is locally offset from the vessel/tissue sealing . In particular , the vessel/tissue dividing occurs between the vessel/tissue seals . Stated differently, the instrument is configured such that vessel/tissue dividing occurs at a different location to vessel/tissue sealing .
  • the first surface includes the exposed sections of the first electrode and the second electrode .
  • the first electrode and/or the second electrode are arranged within and/or on the first j aw .
  • the first electrode and/or the second electrode are made from an electrically conductive material , such as metal , and may be connected to an inner conductor and an outer conductor of the coaxial cable , respectively .
  • the first electrode and the second electrode are electrically isolated from each other by the first isolating portion . Further , the sections of first electrode and the second electrode that are exposed on the first surface are spaced apart from each other , for example by an air gap or an exposed section of the first isolating portion .
  • the exposed sections of the first electrode and/or the second electrode may extend as lines and/or form areas on the first surface .
  • the exposed sections of the first electrode and the second electrode define two sealing areas laterally offset on the first surface , namely the first sealing area and the second sealing area .
  • the first sealing area and the second sealing area may be connected to each other on the first surface by the other parts of the exposed sections of the first electrode and the second electrode . This means that the first sealing area and the second sealing area may or may not be connected to each other on the first surface .
  • the first sealing area and the second sealing area are separated by a gap on the first surface .
  • the first sealing area includes a first set of exposed sections of the first electrode and the second electrode which extend alongside ( and spaced from, in a side-by-side manner ) the second sealing area, wherein the second sealing area includes a second set of exposed sections of the first electrode and the second electrode .
  • the first sealing area and/or the second sealing area define elongated structures ( e . g . rectangles or ellipses ) that are arranged side-by-side and separated by the gap on the first surface .
  • the exposed sections of the first electrode may form ( straight ) lines which are separated by the gap .
  • the exposed sections of the second electrode may form ( straight ) lines between which the exposed sections of the first electrode are positioned .
  • Exposed sections of the first isolating portion may be arranged between the ( straight ) lines of exposed sections of the first electrode and the second electrode .
  • the first sealing area and the second sealing area are each configured to emit microwave energy at the exposed sections of the first electrode and the second electrode .
  • the exposed section of the first electrode may be considered an active electrode and the exposed section of the second electrode may be a dipole antenna for radiating microwave electromagnetic energy .
  • both the first sealing area and the second sealing area include two electrodes of different polarity or electrical potential .
  • the first sealing area and the second sealing area are configured to emit microwave energy to tissue that is close to or in contact with the exposed sections of the first electrode and the second electrode .
  • the exposed sections of the first electrode and the second electrode are arranged such that tissue that is clamped and/or grasped between the first surface and the second surface in the closed position is in contact with the exposed sections of the first electrode and the second electrode or in contact with the first sealing area and the second sealing area .
  • This means that the first sealing area and the second sealing area have a double functionality . They can clamp or grasp tissue (with the second surface being the counterpart ) and emit microwave energy .
  • the greatest intensity of the emitted microwave energy is achieved in a portion of the tissue that is in contact with or directly above the exposed sections of the first electrode and the second electrode in the first sealing area and the second sealing area .
  • the intensity of the emitted microwave energy is highest at respective edges or corners of the exposed sections of the first electrode and the second electrode that face each other .
  • the intensity of the emitted microwave energy is highest above the interface of the first isolating portion and the first electrode ( at the first surface ) and at the interface of the first isolating portion and the second electrode ( at the first surface ) .
  • portions of the exposed sections of the first electrode that are away from the respective exposed sections of the second electrode exhibit a ( significantly) lower intensity of the emitted microwave energy .
  • These portions may be regarded as not corresponding to the first and/or second sealing areas since , due to the reduced intensity, no , or insufficient , microwave sealing can be achieved .
  • tissue that is arranged above or in contact with the area of the first surface that is arranged between the first sealing surface and the second sealing surface , i . e . in the area of the gap .
  • tissue is only sealed above the first sealing area and the second sealing area but tissue in an area between the first sealing area and the second sealing area is not sealed .
  • an intensity of the electromagnetic energy emitted directly at the exposed sections of the first electrode and the second electrode i . e . at the first sealing area and the second sealing area
  • the intensity of the electric energy measured in or above the gap i . e .
  • an area between the first sealing area and the second sealing area is 60% , 50% , 40% , 30% , 25 % , 20% , 10% , 5 % , or less .
  • the intensity of the emitted microwave radiation is only sufficiently high to effect tissue sealing above the first sealing area and the second sealing area whereas the intensity of the emitted microwave energy is below a threshold for effecting tissue sealing in an area between the first sealing area and the second sealing area .
  • the threshold for effecting tissue sealing depends on the tissue .
  • an area between the first sealing area and the second sealing area can be established in which no or little ( e . g . only negligible ) tissue sealing is effected upon the emission of microwave energy .
  • a dimension of the gap is chosen such that effective tissue sealing can be achieved over the first sealing area the second sealing area but not in an area therebetween .
  • the cutting device is configured to cut or divide tissue that is arranged between the first sealing area and the second sealing area .
  • the line of the cut or divide of the tissue may be considered the cutting line .
  • the cutting line is arranged between the first sealing area and the second sealing area, i . e . within the gap .
  • the cutting line is arranged in the middle between the first sealing area and the second sealing area so that a distance from the cutting line to the first sealing area is the same as a distance from the cutting line to the second sealing area .
  • the cutting device is therefore configured to cut tissue that is not sealed .
  • the tissue is first sealed and then cut . Due to the arrangement of the cutting device in the gap, the cutting device cuts into a portion of the tissue that is not sealed although other portions of the tissue have been sealed due to the emission of microwave energy . This means that sealing and cutting of the tissue may be simultaneously conducted because little or no interaction between the sealing and the cutting is expected due to the spatial separation of the sealing at the cutting .
  • the second electrode covers the first electrode on the side of the first electrode facing away from the first surface and/or the first isolating portion is arranged between the first electrode and the second electrode .
  • the second electrode may completely cover the first electrode on one side of the first surface so that the second electrode shields the first electrode .
  • the second electrode may act as and/or form a half-shell or channel in which the first electrode is arranged .
  • the second electrode may be a ground electrode . In the closed position, the second electrode is configured to shield microwave radiation that is emitted from the first electrode away from the first surface .
  • the first electrode may solely be configured to emit microwave energy through or on the first surface .
  • portions of the first electrode and/or the second electrode are plate-shaped and respectively include end faces , wherein optionally the end faces form the exposed sections .
  • the portions of the first electrode and/or the second electrode are U-shaped or V- shaped .
  • the portions of the first electrode and/or the second electrode that extend along sections of the first j aw where the first and second sealing areas are provided may be plate-shaped .
  • Other portions of the first electrode and/or the second electrode may have different configurations .
  • proximal and/or distal end portions of the first electrode and/or the second electrode may have shapes that deviate from a plate shape . This may be provided for forming distal and/or proximal end portions of the j aw . End faces of the plate-shaped portions of the first electrode and/or the second electrode can be in the exposed sections on the first surface .
  • the plate-shaped portions of the first electrode and/or the second electrode may have a shape of the letter U, V, or variations thereof in a cross-sectional view of the first j aw .
  • the first electrode may be arranged within the shape defined by the U-shape or V-shape in a cross-sectional view .
  • the exposed sections of the first electrode and the second electrode at least partially extend parallel to each other, each include two straight portions that extends parallel to each other, and/or each form a loop .
  • the exposed sections of the first electrode and the second electrode completely or partially extend parallel to each other on the first surface .
  • two portions of the exposed sections are straight which are connected by a connecting section - thus forming a loop .
  • Other shapes of the loops are possible .
  • the exposed sections of the first electrode may completely or partially extend parallel to the exposed sections of the second electrode .
  • the straight portions of the exposed sections may form the first sealing area and the second sealing area . So , the distance between straight portions of the exposed sections defines the width of the gap .
  • the first electrode and/or the second electrode each form a single section that is exposed on the first surface .
  • the cutting line and/or the wire section is arranged between the straight portions of the exposed sections of the first electrode in the closed position .
  • the cutting line is arranged within the loop of the exposed sections of the first electrode in the closed position .
  • the cutting line and/or the wire section may extend parallel between the straight portions of the exposed sections of the first electrode and/or the second electrode .
  • the cutting line is straight .
  • the cutting line extends within the loop formed by the exposed section of the first electrode .
  • the exposed section of the first electrode and the exposed section of the second electrode partially surround the cutting line .
  • the electrosurgical instrument further comprises a second isolating portion .
  • the second isolating portion electrically isolates the radiofrequency electrode (the wire section) from the first electrode .
  • the first isolating portion and/or the second isolating portion may be made from an electrically non-conductive material such as a ceramic ( e . g . Zirconia ) or plastic material ( e . g . Polyetheretherketon ( PEEK) ) .
  • the first isolating portion and/or the second isolation portion may be fixed to the first , fourth and/or the second electrode and/or vice versa .
  • the first electrode may be sandwiched between the first isolating portion and the second isolating portion .
  • the second isolating portion may cover the side of the first electrode that faces the first surface except for the exposed sections of the first electrode .
  • the second isolating portion is arranged in the space formed by the U- shaped or V-shaped portions of the first electrode .
  • the radiofrequency electrode or wire section may be an active electrode wherein one or more of the first to fourth electrodes may act as a return electrode .
  • the wire section protrudes more from the first surface and towards the second surface in the closed position compared to the relaxed position .
  • the wire section protrudes more from the second surface and towards the first surface in the closed position compared to the relaxed position .
  • the radiofrequency electrode or wire section may be arranged on the second isolating portion (such that it is exposed on the first surface for contacting tissue in the relaxed position ) or within a first groove in the second isolating portion in the relaxed position .
  • the radiofrequency electrode or wire section may be exposed at the first surface , e . g . the second isolating portion .
  • the wire section therefore extends over the second isolation portion .
  • a width of the second isolating portion along the first surface may correspond to the width of the gap .
  • the second isolating portion may delimit the first sealing area and/or the second sealing area .
  • a section of the second isolating portion that is exposed on the first surface is arranged between the first surface area and the second surface area .
  • the section of the second isolating portion that is exposed on the first surface may correspond to the gap .
  • the cutting line may be in the middle of the section of the second isolating portion that is exposed on the first surface .
  • the electrosurgical instrument includes a third electrode for emitting microwave energy which is exposed on the second surface and/or a fourth electrode for emitting microwave energy which it is exposed on the second surface .
  • the first electrode and/or the second electrode may be symmetrical to the third electrode and/or fourth electrode , respectively - both relative to the first and second surface in the closed position . More generally, the characteristics , features and preferred embodiment described in conj unction with the first and/or second electrodes may equally apply for the third and/or fourth electrodes , respectively .
  • the third electrode may be electrically isolated from the fourth electrode by the fourth isolating portion .
  • the third electrode may be covered by the third isolating portion .
  • the second j aw does not include a third electrode and a fourth isolating portion . In this case , only the third electrode as described above is provided .
  • the third isolating portion may be provided for electrically isolating the wire section from the fourth electrode in case the wire section is arranged on the second j aw .
  • the third isolating portion may be provided for electrically isolating the wire section from the fourth electrode in the closed position in case the wire section is arranged on the first j aw .
  • the wire section may be arranged on the third or fourth isolating portion (such that it is exposed on the second surface for contacting tissue in the relaxed position) or within a second groove in the third or fourth isolating portion in the relaxed state .
  • the electrosurgical instrument may further comprise a second isolating portion arranged on the first j aw for electrically isolating the first electrode from the second electrode and a third isolating portion arranged on the second j aw .
  • the second isolating portion includes a first groove , the wire section in the relaxed position of the cutting device being received in the first groove and the wire section in the active position of the cutting device at least partially extending outside the second isolating portion ( e . g . outside the first groove and/or and contacting the third isolating portion in the closed position ) .
  • the third isolating portion includes a second groove , the wire section in the relaxed position of the cutting device being received in the second groove and the wire section in the active position of the cutting device at least partially extending outside from the third isolating portion ( e . g . outside the second groove ) and contacting the second isolating portion in the closed position .
  • the wire section is completely received in the first groove or the second groove in the relaxed position .
  • the wire section in the relaxed position, may not protrude from the first surface or the second surface .
  • the first groove or the second groove have a depth that is larger than a diameter of the wire section in the first groove or second groove .
  • the wire section in the relaxed position, is completely embedded in ( e . g . fully received within ) the first groove or the second groove .
  • the wire section may contact the third isolating portion in the closed position of the first j aw and the second j aw and in the relaxed position of the cutting device .
  • the wire section may contact the second isolating portion in the closed position of the first j aw and the second j aw and the relaxed position of the cutting device .
  • the wire section protrudes from the first groove or the second groove in the relaxed position . So , the wire section in the relaxed position can contact the opposing surface in the closed position . Stated differently, tissue clamped or grasped between the first j aw and the second j aw in the closed position contacts the wire section in the relaxed position .
  • the tissue In the closed position of the j aws and the active position of the wire section, the tissue is further compressed by the wire section due to the movement of the wire section from the relaxed position to the active position .
  • the above-described arrangements of the wire section equally applied to the embodiments in which no actuation device is present and the movement from the relaxed position to the active position is provided by the shapememory material of the wire section, e . g . in embodiments in which the cutting device is not actuated by a mechanical actuation device .
  • the wire section includes at least one hinge .
  • the hinge includes a cut-out in a wire of the wire section .
  • the hinge can be regarded as a means on the wire section in which more bending is provided compared to other sections of the wire where no hinge is provided .
  • the cut-out locally reduces the diameter of the hinge so that the wire requires less bending stress for bending the wire at the position of the hinge .
  • the wire section would relatively uniformly bend along the distance between the distal end and the proximal end of the wire .
  • the wire may have an arc-shape of almost constant curvature .
  • the hinge allows to provide deviations from this arc-shape . So , one or more hinges can be provided for shaping the wire or the wire section in the active position .
  • two hinges are provided close to the distal end and a proximal end of the wire , respectively, resulting in a shape of the wire in the active position that has a substantially straight section along the first or second surface .
  • the one or more hinges can be provided for increasing the area/length of contact between the tissue and the wire section .
  • the first groove or the second groove include at least one ramp and the cutting device includes at least one sloped portion, wherein a movement of the actuation device from retracted position the advanced position pushes the sloped portion along the ramp so that the wire section moves from the relaxed state to the active state .
  • the ramp may be a section of the first groove or the second groove that is inclined with respect to flat sections of the groove and/or to the first and second surface , respectively .
  • the ramp may have a linear or curved slope .
  • the sloped portion may be formed the wire section of the cutting device .
  • the wire section may include in this embodiment a sheet or a loop of wire and/or can be rigid or inelastic .
  • the sloped portion of the wire section may be positioned parallel and adj acent to the ramp in the relaxed position .
  • Other surface sections of the wire section may be parallel and adj acent to the flat sections of the first groove or the second groove .
  • the wire section is moved from the relaxed position to the advanced position .
  • the cutting portion may be within the first/second groove in the relaxed position and the cutting portion protrudes from the first/second surface in the active position .
  • the cutting portion may be a side of the wire section that is opposite of the side where the sloped portion is arranged .
  • the wire section may include two or more sloped portions .
  • the groove includes the same number of ramps so that each sloped portion is associated with a respective ramp .
  • the ramp may not protrude from the first/second surface but is arranged with the first/second groove .
  • the ramp and the sloped portion are used to transform the linear movement of the actuation device in a movement perpendicular thereto , e . g . for moving the wire section out of the first/second groove .
  • the cutting device further includes a cutting position which is reached by moving the cutting device from the relaxed position beyond the active position .
  • the cutting device e . g . the cutting portion
  • the cutting device protrudes beyond a distal end of the first j aw and/or the second j aw .
  • the active position may be as described above and may be reached by the means as described above , e . g . by the provision of the actuation device or making the wire section from a shape-memory material .
  • the cutting position may be reached by further moving the actuation device beyond the advanced position so that the wire section is further bent resulting in a final shape of the wire section as the cutting position .
  • In the cutting position at least a part of the wire section protrudes beyond the distal end face of the first j aw and/or the second j aw .
  • the active position can be used for cutting tissue clamped or grasped between the first j aw and the second j aw in the closed position while the cutting position may be used for cutting tissue at a distal end of the first j aw and/or the second j aw (the first and second j aws may be in the open or the closed position) .
  • the active position may be reached by providing a wire section from a shape-memory material and the cutting position can be reached by using the actuation device .
  • the actuation device may only be provided for the actuation of the wire section from the active position to the cutting position .
  • the active position may correspond to the retracted position of the actuation device and the cutting position may correspond to the advanced position of the actuation device .
  • the fixation point may be a sliding pivot which can be moved between a first position and a second position . In the active position, the sliding pivot is at the first position . In the cutting position, the sliding pivot is at the second position .
  • the provision of the sliding pivot may help the formation of two activated states , the cutting position and the active position, especially with the transition from the active position to the cutting position .
  • the wire section in the open position of the first j aw and the second j aw and the relaxed position of the cutting device , the wire section extends along the first j aw and the second j aw .
  • the wire section in the open position of the first j aw and the second j aw and the active position of the cutting device , the wire section is stretched between the fixation point on the first j aw and the fixation point on the second j aw .
  • the wire section In the relaxed position, the wire section extends along the first surface and the second surface , e . g . is arranged in the first groove and the second groove .
  • the wire section may include a single wire which is connected to the fixation point on the first j aw or the fixation point on the second j aw .
  • the fixation point on the respective other j aw may include a bearing surface or pulley .
  • the wire section can slide along the bearing surface or the pulley .
  • two bearing surfaces and/or pulleys are provided as fixation points , each at the distal end portion of the respective j aw . In this case , both ends of the wire section are attached to the actuation device .
  • the actuation device makes a pull movement for actuating the wire section - compared to the above-described push movement .
  • the length of the wire section inside the first j aw and the second j aw is reduced so that , in the open position of the first j aw and the second j aw, the wire section extends between the distal end portion of the first j aw and distal end portion between the second j aw, i . e . no longer along the first surface and the second surface .
  • the wire section is stretched between the distal end portions of the first j aw and the second j aw and, thus , extends between the respective end portions .
  • the wire section may act as a "cheese wire" for mechanical cutting and/or radiofrequency cutting .
  • the electrosurgical instrument further comprises a retraction device which is configured to mechanically pull the wire section from the active position to the relaxed position .
  • the retraction device may include a pull wire or pull rod which is attached to the wire section at a position between the fixation points in the active position of the wire section .
  • the retraction device is attached in the middle between distal end portions of the first j aw and the second j aw in the active position .
  • the retraction device may be movable along the longitudinal direction of the first j aw and the second j aw and, therefore , may be configured to pull the wire section from the active position back to the relaxed position .
  • the wire section includes a wire made from a superelastic or pseudo elastic material .
  • Pseudoelasticity or superelasticity refers to an elastic ( reversible ) response to an applied stress which is caused by a phase transformation between the austenitic and martensitic phases of a crystal .
  • the wire section may be made from the shape-memory material as described above .
  • the superelasticity provides improved elastic properties for the elastic wire section and, therefore , an improved transition from the relaxed position to the active position .
  • an electrosurgical instrument for cutting tissue which comprises an instrument shaft , a first j aw, a second j aw, a cutting portion, a channel , and an actuator .
  • the instrument shaft comprises a transmission line for conveying microwave and/or radiofrequency electromagnetic energy .
  • the first j aw is attached to the instrument shaft and includes a first surface .
  • the second j aw is attached to the instrument shaft and includes a second surface .
  • the channel has an opening which is open on an outer surface of a distal end portion of the first j aw .
  • the actuator is configured to move the cutting portion between an active position, in which the cutting portion protrudes from the opening and is configured to contact and cut tissue , and a retracted position .
  • the first and the second j aw can be moved between an open position, in which tissue can be inserted between the first surface and the second surface , and a closed position in which the first and second surfaces are brought together to clamp tissue therebetween .
  • the cutting portion includes a blade , or the cutting portion is an electrode connected to the transmission line and configured to emit the radiofrequency electromagnetic energy .
  • the electrode may be a radiofrequency electrode and can be implemented by a distal end portion of the wire section or wire .
  • the actuator includes a solenoid for ( reversibly) moving the cutting portion between the active position and the relaxed position .
  • the solenoid may be arranged in the channel or at an extension of the channel .
  • an electrosurgical apparatus for sealing and cutting tissue which comprises a generator unit for generating radiofrequency and/or microwave electromagnetic energy and the electromagnetic electrosurgical instruments as described above .
  • the transmission line is configured to convey the radiofrequency and/or microwave electromagnetic energy from the generator unit to the first electrode , the second electrode and/or the cutting device .
  • the generator unit may be configured to generate electromagnetic energy of a fixed single frequency or of a plurality of fixed single frequencies .
  • the generator unit may be tuneable to generate electromagnetic energy of various frequencies , for example in a continuous range of frequencies between a minimum frequency and a maximum frequency .
  • the generator unit may be connected to a power supply which provides the energy for generating the radiofrequency electromagnetic energy and/or microwave electromagnetic energy .
  • the generator unit is electrically and/or electronically ( directly or indirectly) connected to the transmission line .
  • the generator unit generates the radiofrequency energy and/or microwave energy which is conveyed by the transmission line to the first to fourth electrodes where the radiofrequency energy and/or microwave energy is radiated into the treatment zone .
  • the generator unit is configured to simultaneously generate microwave electromagnetic energy of the first frequency and microwave electromagnetic energy of a second frequency .
  • the generator unit includes a generator that is configured to simultaneously generate electromagnetic energy of two different ( fixed ) frequencies .
  • the generator unit includes a first generator for generating electromagnetic energy of the first frequency and a second generator for generating electromagnetic energy of the second frequency .
  • the output of the first generator and output of the second generator can be combined using a multiplexer .
  • the multiplexer may be a diplexer and can combine the input from various sources into one output .
  • a multiplexer ( or diplexer ) is used to combine the output of first and second generators to a single output which is connected or coupled to the transmission line .
  • a first coaxial cable of the transmission line is connected to the generator unit to receive the first frequency and a second coaxial cable of the transmission line is connected to the generated unit to receive the second frequency .
  • the generator unit may include a first generator for generating electromagnetic energy of the first frequency and a second generator for generating electromagnetic energy of the second frequency .
  • the first coaxial cable is connected to the first generator and the second coaxial cable is connected to the second generator .
  • the generator unit is configured to simultaneously or alternatingly generate microwave electromagnetic energy of the first frequency and radiofrequency electromagnetic energy of a third frequency .
  • the generator unit may include a first generator for generating electromagnetic energy of the first frequency, a second generator for generating electromagnetic energy of the second frequency, and/or a third generator for generating electromagnetic energy of the third frequency .
  • the output of the first generator and the output of the second generator may be combined as described above using a multiplexer .
  • the output of the third generator may be combined with the output of the multiplexer using a combiner which can include a switch for alternatingly switching between outputting the output of the multiplexer and outputting the output of the third generator .
  • the combiner may include an additional multiplexer for combining the output of the multiplexer and the output of the third generator to simultaneously emit electromagnetic energy of the first frequency, the second frequency, and the third frequency . In this case , microwave sealing and radiofrequency cutting can be simultaneously effected .
  • Fig. 1 shows a schematic view of an embodiment of an electrosurgical apparatus
  • Fig. 2 shows a perspective view of an embodiment of an electrosurgical instrument (in an open position of jaws and a relaxed position of a cutting device) of the electrosurgical apparatus shown in Fig. 1;
  • Fig. 3 shows a further perspective view of the electrosurgical instrument shown in Fig. 2 (in the open position of jaws and an active position of a cutting device) ;
  • Fig. 4 shows a further perspective view of the electrosurgical instrument shown in Fig. 2 (in the open position of jaws and the active position of a cutting device) ;
  • Fig. 5 shows a side view of the electrosurgical instrument shown in Fig. 2 (in a closed position of jaws and the relaxed position of the cutting device (top image) and the active position of the cutting device (bottom image) ) ;
  • Fig. 6 shows a cross-sectional view of the electrosurgical instrument in the positions shown in Fig. 5 (i.e. in a closed position of jaws and the relaxed position (top image) and the active position of a cutting device (bottom image) ) ;
  • Fig. 7 shows a cross-sectional schematic view of a further embodiment of a jaw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig. 1, wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device;
  • Fig. 8 shows a cross-sectional schematic view of a further embodiment of a jaw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig. 1, wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device;
  • Fig. 9 shows a cross-sectional schematic view of a further embodiment of a jaw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig. 1, wherein the solid lines refer to an active position of a cutting device, the dashed-line refer to a relaxed position of the cutting device, and the dash-dot line refers to a cutting position of the cutting device;
  • Fig . 10 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 , wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device ;
  • Fig . 11 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 , wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device ;
  • Fig . 12 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 , wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device ;
  • Fig . 13 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 , wherein the solid lines refer to an active position of a cutting device (bottom image ) and the dashed-line refer to a relaxed position of the cutting device ( top image ) ;
  • Fig . 14 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 in an active position of a cutting device ;
  • Fig . 15 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 in an active position of a cutting device ;
  • Fig . 16 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 , wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device ;
  • Fig . 17 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 , wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device ; and
  • Fig . 18 shows a cross-sectional schematic view of a further embodiment of a j aw of the electrosurgical instrument of the electrosurgical apparatus shown in Fig . 1 , wherein the solid lines refer to an active position of a cutting device and the dashed-line refer to a relaxed position of the cutting device .
  • the present invention relates to an electrosurgical instrument and apparatus capable of delivering microwave energy to seal tissue (e . g . blood vessels ) and of cutting the tissue .
  • the electrosurgical instrument and apparatus may be used in open surgery but may find particular use in procedures where there is restricted access to the treatment site .
  • the electrosurgical instrument of the invention may be adapted to fit within the instrument channel of a surgical scoping device i . e . laparoscope , endoscope , or the like .
  • Fig . 1 shows a schematic view of an electrosurgical apparatus 10 in which the electrosurgical instrument of the invention may be used .
  • Fig . 1 is a schematic diagram of a complete electrosurgical apparatus 10 that is an embodiment of the invention .
  • the electrosurgical apparatus 10 is arranged to treat biological tissue using radiofrequency (RF) and/or microwave electromagnetic (EM) energy delivered from an electrosurgical instrument 12 .
  • RF radiofrequency
  • EM microwave electromagnetic
  • the electromagnetic energy emitted by the electrosurgical instrument 12 into a treatment zone can be used to coagulate , cut , and/or ablate tissue in the treatment zone .
  • the electrosurgical apparatus 10 further comprises a generator unit 14 which can controllably supply radiofrequency and/or microwave electromagnetic energy to the electrosurgical instrument 12 .
  • the generator unit 14 may include a first generator 16 and a second generator 17 . Suitable generators for this purpose are described in WO 2012 /076844 , which is incorporated herein by reference .
  • the generator unit 14 may be arranged to monitor reflected signals received back from the electrosurgical instrument 12 in order to determine an appropriate power level for delivery . For example , the generator unit 14 may be arranged to calculate an impedance seen at the electrosurgical instrument 12 in order to determine an optimal delivery power level .
  • the electrosurgical apparatus 10 further comprises a surgical scoping device 18 , such as a bronchoscope , endoscope , gastroscope , laparoscope or the like .
  • the scoping device 18 may include a handpiece 20 and a flexible shaft 22 .
  • the handpiece 20 may include means for guiding the flexible shaft 22 through a cavity of a body .
  • the handpiece 20 can include means for moving a distal end of the flexible shaft 22 to change direction of the distal end of the flexible shaft 22 . This helps manoeuvring the flexible shaft 22 through the cavity of the body .
  • the flexible shaft 22 may include a working channel through which elongated structures can be moved and, thus , positioned at the treatment zone within the cavity of the body .
  • the first generator 16 and the second generator 17 are each configured to generate electromagnetic energy of a fixed frequency .
  • the generator unit 14 is not limited thereto ; the first generator 16 and/or the second generator 17 can be configured to generate AC electromagnetic energy in a continuous range between a minimum frequency and a maximum frequency .
  • the frequency of the electromagnetic energy to be generated by the first generator 16 and/or the second generator 17 may be selected using an interface (not shown in the figures ) .
  • the generator unit 14 can include a combiner 26 which is configured to temporally switch between outputting the output of the first generator 16 or the output of the second generator 17 .
  • the combiner 26 may also be configured to combine the outputs of the first generator 16 and of the second generator 17 . In this case , the combiner 26 acts as a multiplexer or diplexer .
  • the generator unit 14 is thus capable of generating and controlling power to be delivered to the electrosurgical instrument 12 , e . g . via a transmission line 28 , which extends from the generator unit 14 through the surgical scoping device 18 and instrument channel to the distal tip of the instrument channel.
  • the generator unit 14 may have a user interface for selecting and/or controlling the power delivered to the electrosurgical instrument 12, e.g. controlling the first and/or the second generators 16, 17 and/or the combiner 26.
  • the generator unit 14 may have a display for showing the selected energy delivery mode. In some examples, the generator unit 14 may allow for an energy delivery mode to be selected based on the size of the vessel to be sealed.
  • the electrosurgical instrument 12 can include the transmission line 28, an instrument shaft 30, a joint 32, a first jaw 34, and/or a second jaw 36 which will be discussed in further detail below.
  • the transmission line 28 may include a single coaxial cable that connects the generator unit 14 to the first jaw 34 and/or second jaw 34 for conveying the radiofrequency and/or microwave energy (see Fig. 6) .
  • Figs. 2 to 5 show schematic perspective views of a distal end of an embodiment of the electrosurgical instrument 12.
  • Fig. 6 shows a cross-sectional view of Fig. 5.
  • the first jaw 34 and the second jaw 36 are rotatably or pivotally connected or coupled to the instrument shaft 30 which is dimensioned to fit within the instrument channel of the surgical scoping device 18.
  • the instrument shaft 30 comprises a tubular sheath that covers the transmission line 28 for carrying microwave and/or radiofrequency energy to the jaws 34, 36 together with various control wires or (actuation) rods that are arranged to control and/or physically manipulate the first and second jaws 34, 36, as discussed below.
  • the first jaw 34 and the second jaw 36 are operably coupled to the joint 32 that is mounted on a distal end of the instrument shaft 30. Both the first and second jaws 34, 36 may be arranged to pivot relative to the joint 32.
  • the joint 32 may be arranged to ensure that the jaws remain laterally aligned as they are moved together.
  • the pair of jaws 34, 36 comprise a static jaw that is fixed relative to the instrument shaft 30 or the joint 32.
  • the other jaw is pivotable or rotatable .
  • the joint 32 includes a pivot axle 44 which defines a pivot axis.
  • the first jaw 34 and the second jaw 36 can pivot around the pivot axis or pivot axle 44.
  • the pivot axle 44 is fixed to the joint 32 and the first jaw 34 and the second jaw 36 can rotate around the pivot axle 44.
  • the joint 32 may have a clevis structure and slots 46 on the arms of the clevis structure.
  • the slot 46 may have an elongate shape and can be a through-hole or a recess in an inner surface of the clevis structure.
  • the first jaw 34 and/or the second jaw 36 also include elongated slots (see Fig. 4) .
  • a control wire or actuation rod includes a cam 48 which is inserted in the slots 46 of the clevis structure and in the slots of the first jaw 34 and the second jaws 36. The engagement of the cam 48 with the slots provides an actuation mechanism which translates a back-and-forth movement of the control wire (and thus of the cam 48) into a rotational movement of the first jaw 34 and the second jaw 36 around the pivot axle 44.
  • first jaw 34 and the second jaw 36 are intended to grip biological tissue (in particular a blood vessel) therebetween.
  • the first jaw 34 and the second jaw 36 are arranged to apply pressure to the biological tissue between the opposed surfaces of the jaws 34, 36 and deliver energy (preferably microwave and/or radiofrequency electromagnetic energy) into the tissue from the transmission line 28.
  • the first jaw 34 includes a first surface 50 which opposes a second surface 52 of the second jaw 36.
  • the first surface 50 and/or the second surface 52 may form an outer surface of the first jaw 34 and the second jaw 36 respectively, which can be brought into contact with each other when the jaws 34, 36 are in the closed position.
  • the first surface 50 and the second surface 52 may be considered pressure pads or pressure areas with which pressure can be applied to the tissue grasped between the first jaw 34 and the second jaw 36.
  • the first jaw 34 includes a first electrode 54, a second electrode 56, a first isolating portion 58, and/or a second isolating portion 60.
  • the first electrode 54 and the second electrode 56 are made from an electrically conductive material, such as metal or a metal alloy.
  • the second electrode 56 may form the outer surface of the first jaw 34 and/or may provide the connection to the pivot axle 44 .
  • the slot of the first j aw 34 may be provided in the second electrode 56 .
  • the second electrode 56 may have a function of providing the stability of the first j aw 34 .
  • the second electrode 56 may have a form of a half-shell in a portion along the first surface 50 .
  • the second electrode 56 may surround the first electrode 54 , the first isolating portion 58 and/or the second isolating portion 60 . This means that the first electrode 54 , the first isolating portion 58 , and/or the second isolating portion 60 may be embedded in the half-shell of the second electrode 56 .
  • the shape of the second electrode 56 may also be considered as providing a recess or channel in which the first electrode 54 , the first isolating portion 58 and/or the second isolating portion 60 are arranged .
  • the first isolating portion 58 electrically isolates the first electrode 54 from the second electrode 56 .
  • the first isolating portion 58 may be made from an electrically non- conductive material such as a ceramic material ( e . g . including Zirconia ) , PEEK, silicone , and/or other plastic materials .
  • the first isolating portion 58 may be sandwiched between the first electrode 54 and the second electrode 56 .
  • the first electrode 54 and the second electrode 56 may have a U-shape or V-shape (not shown in the figures ) in a cross-sectional view along a section of the first j aw 34 . Further, the first electrode 54 and the second electrode 56 may have a plate-shape ( see Fig . 6 ) along this section of the first j aw 34 . At a distal end of the first j aw 34 , the first electrode 54 and/or the second electrode 56 may have a different configuration so that the first electrode 54 and/or the second electrode 56 do not have an open end but a closed end . This means that the second electrode 56 can shield the first electrode 54 in all directions away from the first surface 50 .
  • the first electrode 54 and/or the second electrode 56 are exposed at the first surface 50 to allow for contact with the tissue clamped between the first j aw 34 and the second j aw 36 .
  • two sections of the first electrode 54 and the second electrode 56 are exposed on the first surface 50 which are spaced from each other by a gap .
  • the two exposed sections are straight and extend in a direction of extension of the first j aw 34 .
  • Each exposed section includes an exposed section of the first electrode 54 , the second electrode 56 , and the first isolating portion 58 .
  • the two exposed sections provide a first sealing area 62 and a second sealing area 64 which are separated from each other by the gap in a direction perpendicular to the extension of the first aw 34 .
  • the first sealing area 62 and the second sealing area 64 are each provided for the emission of microwave energy so that tissue is sealed at the first sealing area 62 and the second sealing area 64 .
  • the intensity of the microwave energy that is emitted from the first electrode 54 and the second electrode 56 is highest at the sealing areas 62 and 64 .
  • the intensity of the emitted microwave energy is considerably lower in the area of the gap ( i . e . between the first sealing area 62 and the second sealing area 64 ) compared to the first sealing area 62 and the second sealing area 64 , for example 10% to 80% less than over the first sealing area 62 and the second sealing area 64 . This means that tissue is effectively sealed at the first sealing area 62 and at the second sealing area 64 but not in the gap therebetween .
  • the first sealing area 62 and the second sealing area 64 may be provided by the end faces of the plate-shaped first electrode 54 , the second electrode 56 , and the first isolating portion 58 .
  • the exposed sections of the first electrode 54 , the second electrode 56 , and the first isolating portion 58 outside the first and second sealing areas 62 and 64 may form a loop at the first surface 50 which connects the first sealing area 62 with the second sealing area 64 on the first surface 50 . This loop may not be considered belonging to the first sealing area 62 or the second sealing area 64 since there is no separation by a gap .
  • the exposed sections of the first electrode 54 and the second electrode 56 over the first sealing area 62 and the second sealing area 64 may form two parallel straight lines which are respectively separated by the gap .
  • the separation of the first sealing area 62 and the second sealing area 64 by the gap is provided by the second isolating portion 60 .
  • the second isolating portion 60 separates the exposed sections of the first electrode 54 on the first surface 50 .
  • the second isolating portion 60 separates the first sealing area 62 from the second sealing area 64 .
  • the second isolating portion 60 may be received in a cavity formed by the U-shaped first electrode 54 .
  • the first electrode 54 forms a channel similar to the second electrode 56 .
  • the second isolating portion 60 may be embedded or arranged in this channel .
  • the second isolating portion 60 may have a flat or straight outer surface at the first surface 50 .
  • the exposed section of the second isolating portion 60 on the first surface 50 may be parallel to a lower surface of the second electrode 56 defining a lower surface of the first j aw 34 ( see Fig . 6 ) .
  • the first sealing area 62 and the second sealing area 64 may be inclined relative to each other and relative to the exposed section of the second isolating portion 60 .
  • the angle between a plane defined by the exposed section of the second isolating portion 60 and a plane defined by the first and/or second sealing surface 62 , 64 may be between 5 ° to 45 ° .
  • the first sealing area 62 and the second sealing area 64 define the same angle with the exposed section of the second isolating portion 60 at the first surface 50 .
  • the inclined arrangement of the first sealing area 62 and the second sealing area 64 increases the respective surface areas without widening the first j aw 34 . Further, after cutting the tissue clamped between the first j aw 34 and the second j aw 36 , the cut tissue can be more easily released from the first j aw 34 compared to a flat ( i . e . non-inclined) first surface 50 .
  • the second isolating portion 60 may comprise a silicone- based material or silicone .
  • Other examples include polyimide , PTFE or FEP type materials . These types of materials are more flexible or softer compared to a ceramic material which helps to reduce the pressure on the tissue over the area of the gap ( i . e . between the first sealing area 62 and the second sealing area 64 ) . So the pressure on the tissue can be reduced in an area where the tissue is not sealed .
  • the first j aw 34 and the second j aw 36 press and seal the tissue at the first sealing area 62 and the second sealing area 64 .
  • the first j aw 34 and the second j aw 36 press and seal the tissue only at the first sealing area 62 and the second sealing area 64 .
  • the second j aw 36 includes a fourth electrode 66 , a third isolating portion 68 , and/or a cutting device 70 .
  • the fourth electrode 66 is made from an electrically conductive material , such as metal .
  • the fourth electrode 66 may form the outer surface of the second j aw 36 and/or may provide the connection to the pivot axle 44 . Further, the slot of the second j aw 36 may be arranged on the fourth electrode 66 .
  • the fourth electrode 66 may have a function of providing the stability of the second j aw 36 .
  • the fourth electrode 66 may have a form of a half-shell in a portion of the second surface 52 .
  • the fourth electrode 66 may surround the third isolating portion 68 .
  • the third isolating portion 68 may be embedded in the half-shell of the fourth electrode 66 .
  • the shape of the fourth electrode 66 may also be considered as providing a recess or channel in which the third isolating portion 68 is arranged .
  • the fourth electrode 66 may be mirror-symmetric to the second electrode 56 .
  • the fourth electrode 66 may have a U- shape ( see Fig . 4 ) in a cross-sectional view along a section of the second j aw 36 . Further, the fourth electrode 66 may have a plate-shape ( see Fig . 6 ) along this section of the second j aw 36 .
  • the fourth electrode 66 may include an opening in an outer surface thereof which can be filled by the third isolating portion 68 .
  • the fourth electrode 66 may have a different configuration so that the fourth electrode 66 does not have an open end but a closed end . This means that fourth electrode 66 can shield the first electrode 54 in directions away from the second surface 52 .
  • the second electrode 56 and the fourth electrode 66 may be electrically connected to each other , either directly or by being connected to the same conductor of the transmission line 28 .
  • the first electrode 54 may be connected to an inner conductor of the coaxial cable and the second electrode 56 is connected to an outer conductor of the coaxial cable ( see Fig . 6 ) .
  • the third isolating portion 68 is made from an electrically non-conductive material , optionally a ceramic material .
  • Other examples include polyimide , PTFE or FEP type materials .
  • the sections of the fourth electrode 66 and of the third isolating portion 68 that are exposed to contact tissue in the closed position may define or form the second surface 52 .
  • tissue can be grasped between the first electrode 54 and the second electrode 56 on the first j aw 34 and the fourth electrode 66 on the second j aw 36 .
  • the cutting device 70 includes a cutting portion 72 and a wire section 74 .
  • the cutting portion 72 is provided by the wire section 74 .
  • the wire section 74 may be a radiofrequency electrode for emitting radiofrequency energy .
  • a proximal end of the wire section 74 is connected to a control wire 76 which is movable with respect to the second j aw 36 and is configured to convey radiofrequency energy .
  • the control wire 76 ( see Fig . 6 ) is configured to apply pressure to the wire section 74 .
  • the control wire 76 and the wire section 74 may be a unitary component , e . g . a single wire .
  • a distal end of the wire section 74 is fixed to a distal end portion of the second j aw 36 at a fixation point 78 .
  • the wire section 74 is press-fit within a cavity of the third isolation portion 68 .
  • the cavity in the third isolation portion 68 provides an isolation of the wire section 74 from the fourth electrode 66 and a mechanical connection to the second j aw 36 .
  • the wire section 74 is not fixed to the second j aw 36 between the control wire 76 and the fixation point 78 .
  • the wire section 74 and/or the cutting portion 72 of the cutting device 70 is received within a groove 80 of the third isolating portion 68 .
  • the groove 80 is an example of a first groove or a second groove .
  • the cutting portion 72 of the cutting device 70 or the wire section 74 is completely embedded within the groove 80 . So , the cutting portion 72 of the cutting device 70 or the wire section 74 does not protrude from the second surface 52 or the groove 80 ( see Fig . 2 ) .
  • the cutting portion 72 of the cutting device 70 and/or the wire section 74 protrude from the groove 80 .
  • the control wire 76 is retracted to a retracted position (as indicated by the arrow in the top image of Fig. 6) , the cutting device 70 returns from the active position to the relaxed position.
  • the wire section 74 may include a hinge 82 which can be formed by a cut-out in the wire section 74.
  • a hinge 82 which can be formed by a cut-out in the wire section 74.
  • the mechanical stability of the wire section 74 is reduced at the position of the hinge 82 in comparison with the rest of the wire section. Bending stress applied to the wire section 74 results in a greater bending of the wire section at the hinge 82 compared to other parts of the wire section 74.
  • the hinge 82 can be used to shape the wire section 74 in the active position.
  • the cutting portion 72 of the cutting device 70 extends substantially parallel to the first jaw 74 in the closed position (see Fig. 5) .
  • the wire section 74 may be made from an elastic material such as metal (copper, steel, etc. ) . Further, the wire section 74 may be made from a super elastic material or alloy such as copper-aluminium-nickel and nickel-titanium (NiTi) . In this embodiment, the wire section 74 may be in the martensite phase or deformed state during the relaxed position and the active position .
  • the electrosurgical instrument 12 may be used as follows: the first jaw 34 and the second jaw 36 are moved to the open position so that there is a gap between the first jaw 34 and second jaw 36. At the same time, the cutting device 70 is in the relaxed position (see Fig. 2) . Subsequently, the first jaw 34 and the second jaw 36 are brought into the closed position for grasping tissue between the first jaw 34 and the second jaw 36 (see Fig. 5, top image - no tissue is shown) . Then, the tissue is sealed using microwave energy which is emitted at the first sealing area 62 and the second sealing area 64. Thereafter, the cutting device 70 is moved from the relaxed position to the active position by pushing the control wire 76 towards the second jaw 36.
  • the cutting portion 72 advances towards the first jaw 34 and potentially contacts the second isolating portion 60 (see Fig. 6) .
  • focused pressure at the point of radiofrequency cutting can be applied to the tissue when radiofrequency electromagnetic energy is emitted by the cutting portion 72 , i . e . a section of the control wire 74 .
  • the first j aw 34 and the second j aw 36 may be moved away from the closed position ( lower image of Fig . 5 ) to un-clamp the tissue allowing the cut tissue to be released .
  • the inclination of the first sealing area 62 and the second sealing area 64 improves the release of the cut tissue .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 7 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs . 2 and 6 except for the following differences .
  • the wire section 74 includes two hinges 82 for providing a cutting portion 72 that is substantially parallel to the first surface 50 in the active position .
  • Other shapes of the wire section in the active position are possible , for example mirroring the shape of the first and/or second surfaces 50 , 52 .
  • the cutting device 70 can be arranged on either the second j aw 36 as described above or at the first j aw 34 .
  • the groove 80 can be arranged in the second isolating portion 60 . This also applies to the embodiments shown in Figs . 8 to 15 .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 8 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs . 2 and 7 except for the following differences .
  • the wire section 74 does not include a hinge 82 so that the cutting portion 72 has an approximately constant curvature . So in this embodiment , the wire section 74 flexes , bends , or bulges due to the bending stress applied by the control wire 76 . So the embodiment of Fig . 8 shows a "naturally" bent wire section 74 .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 9 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs . 2 and 7 except for the following differences .
  • the wire section 74 can be brought to the active position in which the cutting portion 72 is approximately parallel to the first surface 50 or the second surface 52 .
  • there cutting device 70 can be moved into a cutting position in which a part or portion of the cutting device 70 , optionally of the wire section 74 , protrudes beyond a distal end of the first j aw 34 and/or the second j aw 36 .
  • the cutting device 70 in the active position, can be used for cutting tissue that is clamped or grasped between the first j aw for the second j aw 36 in the closed position as described above .
  • the cutting device 70 can be used to cut tissue arranged at the distal end of the first or second j aws 34 , 36 .
  • the first j aw 34 and the second j aw 36 may be in the open position .
  • the fixation point 78 may include a slidable pivot which facilitates the movement from the active position to the cutting position . This transition can be effected by moving the control wire 36 beyond the advanced position as seen from the retracted position .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 10 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs . 2 and 9 except for the following differences .
  • the wire section 74 is made from a shape-memory alloy such as nickel-titanium (NiTi ) .
  • the actuation wire 76 for bending the wire section 74 is not necessary in this embodiment . Rather, in the relaxed position of the cutting device 70 , the wire section 74 is in a deformed state which corresponds to the martensitic phase . In the active position of the cutting device 70 , the wire section 74 is a predeformed state which corresponds to the austenite phase . Upon heating the wire section 74 above the transition temperature between the martensitic phase and the austenite phase , the wire section 74 moves the cutting device 70 from the relaxed position to the active position .
  • NiTi nickel-titanium
  • the heat or thermal energy that is necessary for this phase transition and, thus , the activation of the cutting device 70 may be generated by the radiofrequency cutting .
  • radiofrequency cutting is associated with a significant increase in the temperature surrounding the radiofrequency electrode ( the cutting device 70 ) . So , the cutting portion 72 or the wire section 74 generates its own heat for the activation of the cutting device 70 . As a consequence , the activation of the cutting device 70 from the relaxed position to the active position occurs during radiofrequency cutting . A separate (mechanical ) activation of the cutting device 70 is not necessary .
  • a heating section 84 is provided for heating the wire section 74 .
  • the heating section 84 may include a resistive heater which can be arranged in the first j aw 34 or the second j aw 36 .
  • the heating section is electrically connected to the generator unit 14 . This may be achieved by separate wires or using the conductors of the coaxial cable .
  • the cutting device 70 can be activated prior to the radiofrequency cutting . Since the cutting device 70 is electrically activated, no further control wires or control rods are necessary within the shaft 30 resulting in a reduction of the diameter of the shaft 30 .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 11 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Fig . 10 except for the following differences .
  • the wire section 74 includes a first wire 86 , a second wire 88 , and/or one or more loops 90 . So in this embodiment , the wire section 74 includes two wires which is different to the above-described embodiments which show only one wire for the wire section 74 .
  • the first wire 86 and the second wire 88 define a plane which may be perpendicular to the first surface 50 or the second surface 52 .
  • the first wire 86 protrudes more from the first surface 50 or the second surface 52 compared to the second wire 88 .
  • the first wire 86 may provide the cutting portion 72 while the second wire 88 is provided for supporting and/or strengthening the first wire 86 .
  • the second wire 88 includes several loops 90 which are compressed in the deformed state of the wire section 74 ( the relaxed position ) and are expanded in the pre-deformed state of the wire section 74 (the active position) .
  • the loops 90 strengthen the second wire 88 which in turn supports or strengthens the first wire 86.
  • the first wire 86 and the second wire 88 may be both arranged below the first surface or second surface 50, 52, i.e. in the first groove 80 (not depicted in Fig. 11) .
  • the embodiment of the electrosurgical instrument 12 shown in Fig. 12 includes the same features, characteristics, and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs. 10 or 11 except for the following differences .
  • the first jaw 34 and/or the second jaw 36 includes a slot which is open on a surface other than the first surface 50 and the second surface 52.
  • the cutting device 70 includes the wire section 74 and the cutting portion 72 which is a distal free end of the cutting device 70.
  • the cutting portion 72 e.g. the distal end of the cutting device 70
  • the cutting portion 72 protrudes from an outer surface of the first jaw 34 and the second jaw 36 whereas, in the relaxed position, the cutting portion 72 (the distal end of the cutting device 70) is received within the slot; i.e.
  • the activation of the cutting device 70 from the relaxed position to the active position is achieved by the phase transition from the deformed state (martensitic phase) to the pre-deformed state (austenite phase ) .
  • the cutting portion 72 may be an active electrode and the second electrode 56 or the fourth electrode 66 form a return electrode.
  • radiofrequency cutting can be effected on an outer surface of the first jaw 34 or the second jaw 36.
  • the embodiment of the electrosurgical instrument 12 shown in Fig. 13 includes the same features, characteristics, and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs. 10 to 12 except for the following differences .
  • the first j aw 34 and/or the second j aw 36 include a channel 92 which has an opening 94 at an outer surface of the first j aw 34 and/or a second j aw 36 , respectively .
  • the cutting device 70 extends within the channel 92 . In the relaxed position as indicated in the top image of Fig . 13 , the cutting device 70 , in particular the cutting portion 72 , does not protrude from the opening 94 but is received within the channel 92 .
  • the cutting device 70 protrudes from the opening 94 for contacting tissue .
  • the cutting portion 72 may be a distal end portion of the wire section 74 .
  • the wire section 74 may be made from a single piece of wire .
  • the cutting portion 72 is a separate wire or blade that is attached to the wire section 74 .
  • the wire of the cutting portion 72 is not made from a shape-memory alloy but from one or more other types of metal .
  • the wire section 74 can include a spiral shape which is compressed in the deformed state and extended in the predeformed state .
  • the extension of the spiral of wire section 74 during the phase transition from the deformed state (martensitic phase ) to the pre-deformed state ( austenite phase ) moves the cutting portion 72 out of the channel 92 .
  • Other forms of the wire section 74 are possible as long as the phase transition from the deformed state (martensitic phase ) to the pre-deformed state ( austenite phase ) results in a movement of the cutting portion out of the channel 92 .
  • the heat necessary for the phase transition may be generated by providing a first connection point 96 and a second connection point 98 at opposing sides of the wire section 74 .
  • the first connection point 96 and the second connection point 98 are configured to convey electric energy through the wire section 74 for heating up the wire section 74 .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 14 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Fig . 13 except for the following differences .
  • the electrosurgical instrument 12 further includes a biasing element 100 which is arranged to provide a biasing force for moving the cutting device 70 from the active position to the relaxed position .
  • a biasing element 100 which is arranged to provide a biasing force for moving the cutting device 70 from the active position to the relaxed position .
  • the biasing force is smaller than the force provided by the activation of the wire section 74 so that the activation of the wire section 74 moves the cutting device 70 from the relaxed position to the active position .
  • the biasing force is sufficiently large to deform the wire section 74 so that the cutting device 70 , in particular the cutting portion 72 , is moved back into the channel 92 .
  • the biasing element 100 therefore provides a means for returning the cutting device 70 from the active position to the relaxed position .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 15 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs . 13 or 14 except for the following differences .
  • the cutting device 70 does not include a wire section 74 made from a shape-memory alloy .
  • an actuator 102 is provided which moves the cutting device 70 from the relaxed position to the active position and/or vice versa .
  • the actuator 102 may include a solenoid which is configured to move a wire which includes the cutting portion 72 at its distal end
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 16 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs . 2 or 9 except for the following differences .
  • the first j aw 34 and the second j aw 36 each include a fixation point 78 which may include a roller, pivot , and/or sliding surface along which the wire section 74 can slide or move .
  • a fixation point 78 which may include a roller, pivot , and/or sliding surface along which the wire section 74 can slide or move .
  • the wire section 74 or the cutting device 70 in general is not fixed to the respective fixation points 78 . Rather, the fixation points 78 guide the wire section 74 .
  • the wire section 74 provides the cutting portion 72 .
  • the wire section 74 In the relaxed position of the cutting device 70 , the wire section 74 extends along the first surface 50 and the second surface 52 , for example in respective grooves of the first j aw 34 and the second j aw 36 ( as indicated by the dashed lines in Fig . 16 ) .
  • the wire section 74 By pulling the control wire 76 , the wire section 74 is stretched between the respective fixation points 78 in the open position of the first j aw 34 and the second j aw 36 .
  • the cutting portion 72 is thus the section of the wire section 74 which extends between the fixation point 78 on the first j aw 34 and the fixation point 78 on the second j aw 36 .
  • the cutting portion 72 may be configured for emitting radiofrequency energy and/or mechanically cutting tissue similar to a cheese wire .
  • the electrosurgical apparatus 12 further includes a retraction device 104 which is connected to the cutting portion 72 .
  • the retraction device 104 allows pulling back the cutting portion from the active position to the relaxed position .
  • the retraction device 104 may include one or more control wires or an actuation rod .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 17 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Figs . 2 or 9 except for the following differences .
  • the cutting device 70 is not attached to the fixation point 78 but includes a free distal end .
  • the wire section 74 ( or a proximal end thereof or of the cutting device ) is attached to the actuation device ( not shown in Fig . 16 ) .
  • the wire section 74 includes a sheet of metal material , such as ( stainless ) steel .
  • One side of the wire section 74 forms the cutting portion 72 . This side protrudes from the first/second surface 50 /52 in the active position .
  • the other side of the wire section 74 includes on sloped portion 110 .
  • the groove 80 includes a corresponding ramp 112 . In the relaxed position, the sloped portion 110 extends parallel to the ramp 112 .
  • the embodiment of the electrosurgical instrument 12 shown in Fig . 18 includes the same features , characteristics , and/or optional embodiments as the embodiment of the electrosurgical instrument 12 shown in Fig . 17 except for the following differences .
  • the wire section 74 includes two sloped portions 110 and the groove 80 includes two ramps 112 .
  • Each sloped portion 110 is associated with a respective ramp 112 .
  • the slope of the sloped portion 110 and the ramp 112 may be steeper compared to the embodiment of Fig . 17 including only one sloped portion 110 /ramp 112 . So , less movement in the longitudinal direction along the first/second j aw 34 /36 of the cutting device 70 is necessary to achieve the same movement of the cutting portion 72 in a direction perpendicular to the longitudinal direction .

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  • Surgical Instruments (AREA)

Abstract

Divers modes de réalisation concernent un instrument électrochirurgical pour découper un tissu. L'instrument comprend une tige d'instrument comprenant une ligne de transmission pour transporter une énergie électromagnétique hyperfréquence et/ou radiofréquence. L'instrument comprend une première mâchoire fixée à la tige d'instrument et comprenant une première surface, et une seconde mâchoire fixée à la tige d'instrument et comprenant une seconde surface. L'instrument comprend un dispositif de coupe comprenant une partie de coupe et au moins une section de fil, la ou les sections de fil étant constituées d'un matériau à mémoire de forme. La première mâchoire et la seconde mâchoire peuvent être déplacées entre une position ouverte, dans laquelle le tissu peut être inséré entre la première surface et la seconde surface, et une position fermée, dans laquelle les première et seconde surfaces sont amenées ensemble pour serrer un tissu entre elles. Le dispositif de coupe est configuré pour être dans une position relâchée dans laquelle la section de fil est dans un état déformé. Le dispositif de coupe est configuré pour être dans une position active dans laquelle la section de fil revient à un état pré-déformé lors du chauffage de la section de fil. La partie de coupe fait saillie moins de la première mâchoire ou de la seconde mâchoire dans la position relâchée par rapport à la position active. La partie de coupe est configurée pour entrer en contact et découper un tissu dans la position active.
PCT/EP2023/074799 2022-09-23 2023-09-08 Instruments électro-chirurgicaux Ceased WO2024061659A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GBGB2213950.5A GB202213950D0 (en) 2022-09-23 2022-09-23 Electrosurgical instruments
GB2213950.5 2022-09-23

Publications (1)

Publication Number Publication Date
WO2024061659A1 true WO2024061659A1 (fr) 2024-03-28

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WO (1) WO2024061659A1 (fr)

Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6585735B1 (en) 1998-10-23 2003-07-01 Sherwood Services Ag Endoscopic bipolar electrosurgical forceps
EP2233098A1 (fr) 2009-03-24 2010-09-29 Tyco Healthcare Group, LP Appareil pour l'étanchéité de tissus
US20120041438A1 (en) * 2010-08-10 2012-02-16 Tyco Healthcare Group Lp Surgical Forceps Including Shape Memory Cutter
WO2012076844A1 (fr) 2010-12-10 2012-06-14 Creo Medical Limited Appareil électrochirurgical pour application de rf et de micro-ondes
US20140214030A1 (en) * 2011-07-20 2014-07-31 Olympus Winter & Ibe Gmbh Electrosurgical gripping instrument
WO2015097472A1 (fr) 2013-12-23 2015-07-02 Creo Medical Limited Pince électrochirurgicale pour la distribution d'énergie radiofréquence (rf) et/ou micro-onde dans un tissu biologique
US20170333114A1 (en) * 2016-05-23 2017-11-23 Gyrus Medical Limited Electrode assembly
US20180280084A1 (en) * 2017-03-30 2018-10-04 Creo Medical Limited Electrosurgical instrument
US20200337762A1 (en) * 2002-06-25 2020-10-29 Covidien Ag Vessel sealer and divider

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6585735B1 (en) 1998-10-23 2003-07-01 Sherwood Services Ag Endoscopic bipolar electrosurgical forceps
US20200337762A1 (en) * 2002-06-25 2020-10-29 Covidien Ag Vessel sealer and divider
EP2233098A1 (fr) 2009-03-24 2010-09-29 Tyco Healthcare Group, LP Appareil pour l'étanchéité de tissus
US20120041438A1 (en) * 2010-08-10 2012-02-16 Tyco Healthcare Group Lp Surgical Forceps Including Shape Memory Cutter
WO2012076844A1 (fr) 2010-12-10 2012-06-14 Creo Medical Limited Appareil électrochirurgical pour application de rf et de micro-ondes
US20140214030A1 (en) * 2011-07-20 2014-07-31 Olympus Winter & Ibe Gmbh Electrosurgical gripping instrument
WO2015097472A1 (fr) 2013-12-23 2015-07-02 Creo Medical Limited Pince électrochirurgicale pour la distribution d'énergie radiofréquence (rf) et/ou micro-onde dans un tissu biologique
US20170333114A1 (en) * 2016-05-23 2017-11-23 Gyrus Medical Limited Electrode assembly
US20180280084A1 (en) * 2017-03-30 2018-10-04 Creo Medical Limited Electrosurgical instrument

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