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WO2025199477A1 - Configuration de mâchoire de forceps de scellement de vaisseau - Google Patents

Configuration de mâchoire de forceps de scellement de vaisseau

Info

Publication number
WO2025199477A1
WO2025199477A1 PCT/US2025/020977 US2025020977W WO2025199477A1 WO 2025199477 A1 WO2025199477 A1 WO 2025199477A1 US 2025020977 W US2025020977 W US 2025020977W WO 2025199477 A1 WO2025199477 A1 WO 2025199477A1
Authority
WO
WIPO (PCT)
Prior art keywords
jaw
target tissue
upper jaw
jaw member
lower jaw
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.)
Pending
Application number
PCT/US2025/020977
Other languages
English (en)
Inventor
Kester Julian Batchelor
Timothy OZELL
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.)
Gyrus ACMI Inc
Original Assignee
Gyrus ACMI Inc
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 Gyrus ACMI Inc filed Critical Gyrus ACMI Inc
Publication of WO2025199477A1 publication Critical patent/WO2025199477A1/fr
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

Links

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
    • 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
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • 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
    • 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
    • A61B2017/2938—Independently actuatable jaw members, e.g. two actuating rods
    • 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
    • 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
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/1253—Generators therefor characterised by the output polarity monopolar
    • 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
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—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

Definitions

  • Electrosurgery involves various techniques that can be used during medical procedures, such as, for example, laparoscopic surgery.
  • the techniques may include, cutting, clamping, coagulating, desiccating, fulgurating, or the like, of biological tissue.
  • These techniques may be used in procedures such as appendectomies, cholecystectomies, colectomies, cystectomies, gastric banding, gastric bypass, hernia repair, nephrectomy, Nissen fundoplication, prostatectomies, sleeve gastrectomy, or other similar procedures.
  • signals can be generated by an electrosurgical generator and provided to the biological tissue through an electrosurgical device.
  • the electrosurgical energy can be provided to tissue via an end effector of the electrosurgical device.
  • other types of tissue effect such as cutting or tearing, may be desired.
  • Robotics can be used to perform medical procedures but there are differences between human surgeons and robotic arms that can benefit from technological improvements.
  • a surgical end effector can include an upper jaw and a lower jaw, opposite the upper jaw.
  • the upper jaw can move vertically toward and away from the lower jaw in a first direction substantially orthogonal to a longitudinal axis.
  • Sub-flush blades may optionally be included.
  • the techniques descried herein relate to a surgical device comprising a shaft extending longitudinally to define a central longitudinal axis, the shaft including a proximal portion and a distal portion, the device comprising: an end effector extending from the distal portion, wherein the end effector comprises: an upper jaw; a lower jaw, opposite the upper jaw; wherein the upper jaw is configured to be actuated to move vertically toward and away from the lower jaw in a first direction that is substantially orthogonal to the longitudinal axis; and wherein at least one of: (1) the upper jaw includes a first upper jaw member and a second upper jaw member, and the first upper jaw member is configured to be actuated to move laterally toward and away from the second upper jaw member in a second direction that is substantially orthogonal to the first direction and to the longitudinal axis; or (2) the lower jaw includes a first lower jaw member and a second lower jaw member, and the first lower jaw member is configured to be actuated to move laterally toward and away from the second
  • the techniques described herein relate to a surgical device comprising: a shaft extending along a central longitudinal axis, the shaft including a proximal portion and a distal portion; and a surgical jaw, extending from the distal portion, wherein the surgical jaw includes a first jaw configuration that is actuatable for delivering radio frequency (RF) electrical energy to target tissue, and includes a different second jaw configuration that is actuatable for severing the target tissue.
  • RF radio frequency
  • the techniques described herein relate to a method comprising: clamping target tissue with a surgical jaw in a first configuration; sealing the target tissue with radio frequency energy from the surgical jaw in the first configuration; and severing the target tissue with the surgical jaw, including by moving the surgical jaw from the first configuration to a second configuration.
  • FIG. 1 A illustrates a schematic diagram of an example of an electrosurgery system including a generator and an electrode.
  • FIGS. 2A-2B depict examples of a vessel sealer jaw configuration and method of using it.
  • FIG. 3 A-3E depict various examples of configurations of a method of using a vessel sealer jaw.
  • FIG. 4A-4F depict examples of various blade configureations of a vessel sealer jaw to seal and cut tissue.
  • FIGS. 5A-5C depict examples of a robotic vessel sealer jaw configuration and method of using.
  • FIG. 6 depicts a method of using a robotic vessel sealer jaw in an example.
  • the present disclosure describes, among other things, a robotic vessel sealer jaw configuration for radio frequency (RF) devices.
  • the RF device discussed herein can have an upper jaw and a lower jaw, such as which can be introduced via a shaft and placed around target tissue to be dissected, sealed, or both.
  • Radio frequency (RF) electromagnetic energy can be delivered to the device for sealing target tissue.
  • vessel sealing can be achieved.
  • the jaws of the device can be re-configured to produce two different pairs of jaws.
  • Each of the reconfigured (“new”) pairs of jaws can include half of the upper jaw together with half of the opposing lower jaw.
  • These reconfigured two pairs of jaws can then be manipulated, such as in opposing directions, such as to tension, tear, sever, or otherwise manipulate tissue to create desired separation of tissue within the reconfigured jaws.
  • Certain RF vessel sealing devices can employ a mechanical cut blade that can be activated through direct mechanical actuation, such as extending the cut blade in a medial region of the jaws, in a direction away from the proximal end of the shaft and in a direction toward the distal end of the shaft.
  • This type of device can use the column strength of a material or an electrical output delivered to an electromechanical actuator to extend, retract, or otherwise actuate the mechanical cut blade.
  • the shaft or column could be undesirably long. This can be challenging in robotic situations in which a robotic arm may be less precise in and may employ a short articulating element of the jaw attached to a long shaft.
  • a sealing device using a longitudinally extendible and retractable mechanically actuated cut blade is not necessarily suited to robotic use and there is a need for cutting elements which need not involve being attached to a long shaft.
  • the use of the robotic vessel sealer jaw configuration that can be enduser actuated to split into two pairs of jaws, when desired, can help allow for cutting elements to be provided by the two pairs of jaws of the device, without requiring or relying on a column transferring force for longitudinal blade extension for cutting, and without requiring a secondary RF output.
  • Configuring the two pairs of jaws to also serve as cutting elements within the device can allow for a more sophisticated articulation type device, such as with a robotic interface.
  • FIG. 1 A illustrates a schematic diagram of an example of portions of an electrosurgery system 100, such as can include an electrosurgery device 110 with an electrosurgical end effector 120 such as for cutting and coagulation.
  • the device 110 can be connected to an electrosurgical energy generator 105 and a controller 160.
  • the electrosurgery device 110 can include an elongated shaft 112 having a proximal portion 114 and a distal portion 116.
  • the distal portion 116 can include an end effector 120, which can include an upper jaw 122 and lower jaw 124 located opposite to the upper jaw 122.
  • the electrosurgery device 110 can also include one or more sensors 130.
  • a proximal portion 114 of the shaft 112 of the electrosurgery device 110 can be connected to a handpiece 140, such as which can include one or more actuators 142, 143, and 144.
  • the device 110 can also include an electrical connector 146 such as can be configured to be physically and electrically connected to the generator 105.
  • the generator 105 can be external to, but coupled to, the electrosurgery device 110.
  • the generator 105 can provide electrical energy to the end effector 120 of the electrosurgery device 110, such as through the electrical connector 146.
  • the electrical generator 105 can produce a current deliverable by the end effector 120.
  • the electrical generator 105 can be in communication with the controller 160, which can direct the application of electrosurgical energy to the end effector 120 in the electrosurgery device 110.
  • the type and amount of electrical energy provided by the generator 105 can vary.
  • the generator 105 can generate and automatically alter (e.g., without requiring user intervention) one or more electrosurgical waveforms that can vary during the procedure, such as according to a tissue characteristic that can indicate correspondence to a tissue type.
  • the electrosurgical waveform produced, the voltage produced, the power of the electrosurgical energy, and the size and surface area of the end effector 120 can affect the energy depth into the target tissue and the rate of producing heat, which can in turn alter the final effect on the target tissue.
  • the electrosurgery device 110 can include one or more electrosurgery electrodes such as for applying high-frequency alternating polarity electrical current to biological tissue, such as to cut, coagulate, desiccate, or fulgurate the tissue, such as may be desired by the surgeon treating the patient.
  • the electrosurgery device 110 can include a wet field device for wet field electrosurgery, such as in a saline solution or in an open wound.
  • a wet field device heating can result from an AC current passing between two electrodes. Heating can be the greatest where the current density is the highest. Thus, smaller surface area electrodes can produce a greater amount of heat for treating tissue.
  • the shaft 112 with the proximal portion 114 and the distal portion 116 can be sized, shaped, or arranged for partial insertion of the electrosurgery device 110 into a patient.
  • the shaft 112 can include or can be made of one or more of a composite, plastic, or metallic material, or other material suitable for surgical applications.
  • the proximal portion 114 can be located near an operator, such as a surgeon, when the electrosurgery device 110 is in use. In some cases, the operator can include or be a robotic arm or other machine.
  • the distal portion 116 can be sized, shaped, or otherwise arranged for insertion into the patient so that distal portion 116 is located further from the operator during use.
  • the shaft 112 can be sized, shaped, arranged, or otherwise configured for laparoscopy, in some cases, the shaft 112 can be shorter such as for open surgery applications. In some cases, the shaft 112 can be longer such as for laparoscopy.
  • Laparoscopy can include, for example, a surgical procedure in which a small incision is made, through which a device is inserted to diagnose or treat conditions. Laparoscopy is considered less invasive than regular open abdominal surgery.
  • an optical visualization or imaging device may also be inserted along with the device 110, such as to permit the optical visualization or imaging device to allow viewing or imaging such as for the operator to observe the tissue.
  • the optical visualization or imaging device can include a laparoscope, or viewing tube, such as with a camera.
  • the optical visualization or imaging device can include an ultrasound type imaging device for the operator to use during treatment.
  • open surgery approaches can involve a larger incision, such as can allow more direct visual observation of cutting of skin and tissue, such to permit the surgeon to have a fuller view of the structures and organs involved in the procedure.
  • the shaft 112 can have a length in a range of 5cm to 55cm, inclusive.
  • the shaft 112 can be narrow in a cross-section or a lateral dimension, such as for insertion into a patient via an incision.
  • the shaft 112 can have a cross-sectional or lateral width in a range of less than 6 mm, inclusive.
  • the end effector 120 can be located at or near the distal portion 116 of the shaft 112.
  • the end effector 120 can include a monopolar electrode or bipolar electrodes. Both bipolar and monopolar electrodes can make use of high frequency electrical current such as to cut, coagulate, desiccate, or fulgurate tissue.
  • a monopolar electrode With a monopolar electrode, the current can pass from the probe of the electrode to the target tissue and through the patient to a return pad attached or otherwise located elsewhere on the patient to complete the electrical circuit.
  • a bipolar electrode configuration current passes through the tissue between two more closely-spaced electrodes, such as between individual electrode arms of a forceps-type electrode. For this reason, a bipolar electrode configuration offers a shorter electrical pathway.
  • Monopolar or bipolar can refer to the number of active electrodes used in electrosurgery.
  • an active electrode can carry current to the tissue. The current can then spread through the body and be collected by a dispersive return electrode.
  • the current passes predominantly through the tissue between tips of two active electrodes, such as between electrode tips of a bipolar forceps.
  • the electrical generator 105 can be connected to both active and return electrodes, such as for sending and receiving current.
  • the end effector 120 can include or be one or more monopolar electrodes. In some cases, the end effector 120 can include single pole monopolar outputs, or multi-pole monopolar outputs. For example, the end effector 120 can include or be a monopolar electrode. The end effector 120 can, in some cases, include multiple monopolar electrodes. [0035] The end effector 120 can include or be a bipolar electrode arrangement with upper jaw 122 and lower jaw 124 providing the bipolar electrodes. The first and second jaws 122, 124 can have one or more dissimilar characteristics, such as varying electrode surface area, thermal conductivity, or one or more other characteristics.
  • the upper jaw 122 can be configured as an active electrode (e.g., less surface area) and the lower jaw 124 can be configured as a return electrode (e.g., more surface area) in the electrosurgery device 110.
  • the spacing between the upper jaw 122 and the lower jaw 124, and the voltage supplied to the jaws 122, 124, can be configured such as to permit current to pass through the target tissue between the upper jaw 122 and the lower jaw 124.
  • the end effector 120 can be used for treating target tissue in the patient.
  • the one or more sensors 130 can be used to determine what type of target tissue or surgery environment is present, such as the type of tissue or tissue vascularity.
  • the one or more sensors 130 can be located at or near a distal end of the distal portion 116 of the shaft 112, and can be configured to detect a parameter of the target tissue or a parameter of the environment.
  • the one or more sensors 130 can produce one or more sensor signals, such as can be based on and indicative of one or more such sensed parameters.
  • the one or more sensors 130 can include an electrical sensor, such as for measuring one or more of electrical conductivity, resistivity, impedance, phase angle, reactance, resistance, capacitance, or inductance, or one or more combinations thereof, of the surgery environment.
  • the electrical sensor can include only the end effector 120 itself or the end effector 120 can be used in combination with one or more other electrodes or other internal or external sensor or sensor interface components.
  • the handpiece 140 can include one or more user-actuators, such as actuators 142, 143, and 144. In some cases, these can include one or more of levers, buttons, wheels, switches, triggers, or a combination thereof.
  • One of the actuators 142, 143, 144 can provide a user-interface to control a first switch that selectively connects the end effector 120 to the generator 105 or other circuitry that can provide electrosurgical energy to the end effector 120.
  • Additional actuators, such as buttons, triggers, or other user-actuatable mechanisms can be included on the hand piece 140 of the device 110 or elsewhere for surgeon use, such as for direction and action of the end effector 120, movement of the shaft 112, or one or more other operations of the device 110.
  • the handpiece 140 can include or can be communicatively coupled to one or more alternative or additional buttons, triggers, or controls (e.g., a foot pedal), such as to allow the user to actuate energy delivery to the end effector 120 or other portions or components of the electrosurgical device 110, such as to actuate a forceps or a blade or a corresponding longitudinal extension/retraction translation or rotational mechanism upon which the end effector 120 rides.
  • buttons, triggers, or controls e.g., a foot pedal
  • the handpiece 140 can be augmented or replaced by a surgical robot.
  • the electrosurgical device 110 including the actuators 142, 143, and 144 on the handpiece 140, the end effector 120, and the one or more sensors 130, can be in communication with the controller 160.
  • the generator 105 can also be in communication with the controller 160.
  • the controller 160 can include a processor and a memory such as to permit the controller 160 to communicate with and control the generator 105.
  • the controller 160 can be used to allow for one of or both of predictive and reactive control of the duty cycle of the electrosurgical energy waveform produced by the generator 105.
  • the controller 160 can receive information about the tissue or environment type.
  • the controller 160 can receive information indicating, for example, whether the target tissue subsequently gets drier than the initial setting suggests, such that the controller 160 can in response establish or change one or more of output time and voltage of the electrosurgical energy being applied. Additionally or alternatively, if the controller 160 receives information indicating bleeding, the coagulation output time can be increased.
  • the controller 160 can operate as a standalone device or may be networked to one or more other machines.
  • the controller 160 can include a hardware processor, such as a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof.
  • the controller 160 can further include a memory, such as which can include a main memory and a static memory.
  • the controller 160 can include an input device, such as a keyboard, a user interface, and a navigation device such as a mouse or touchscreen.
  • the controller 160 can include a memory or other storage device, a signal generation device, a network interface device, and one or more sensors.
  • the storage device can include a machine readable medium on which is stored one or more sets of data structure or instructions embodying or utilized by any one or more of the techniques described herein.
  • the instructions may also reside, completely or at least partially, within the main memory, within static memory, or within the hardware processor during execution thereof by the controller.
  • one or any combination of the hardware processor, the main memory, the static memory, or the storage device may constitute machine readable media, that may include any medium that is capable of storing, encoding, or carrying instructions for execution by the controller 160 and that cause the controller 160 to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions.
  • Non-limiting machine readable medium examples may include solid-state memories, and optical and magnetic media.
  • the instructions on the controller 160 may further be transmitted or received over a communications network using a transmission medium via a network interface device.
  • FIGS. 2 A and 2B depict a perspective view of an example of a forceps end effector 120 that can include a forceps 200 having upper and lower jaws (which can be opened and closed in a first direction 210 that is substantially orthogonal to a longitudinal axis 212 defined by a more proximal shaft from which the jaws extend).
  • Each individual one of the upper and lower jaws can respectively include a pair of right and left jaw members, 122 A, 122B, 124 A, and 124B.
  • the right jaw members 122 A, 124 A can be actuated to move laterally toward and away from the left jaw members 122B, 124B, such as in a lateral second direction 214 that is substantially orthogonal to the first direction 210 and also substantially orthogonal to the longitudinal axis 212 defined by the more proximal shaft.
  • FIG. 2A shows a perspective view showing an example of the upper and lower right jaw members 122A, 124A, and the upper and lower left jaw members 122B, 124B, in a laterally-closed state, in which the upper and lower right jaw members 122 A, 124 A, are laterally adjacent to the upper and lower left jaw members 122B, 124B.
  • FIG. 2B shows a similar perspective view, showing an example of the upper and lower right jaw members 122A, 124A, and the upper and lower left jaw members 122B, 124B, in a laterally-open state, in which the upper and lower right jaw members 122 A, 124 A, are laterally spaced apart from the upper and lower left jaw members 122B, 124B.
  • Upper and lower bias members 204A, 204B can be provided, along with associated separate half-cylinder sheathes or sleeves 202A, 202B.
  • the upper bias member 204A can be located between the upper right jaw member 122A and the upper left jaw member 122B, with an associated half cylinder sleeve 202A extendable distally to cover their respective arm elbows 206 for lateral closing, and retractable distally for lateral opening.
  • the lower bias member 204B can be located between the lower right jaw member 124A and the lower left jaw member 124B, with an associated half cylinder sleeve 202B extendable distally to cover their respective arm elbows for lateral closing, and retractable distally for lateral opening.
  • the forceps can be operated to actuate the upper right jaw member 122 A and upper left jaw member 122B to be initially open in the first direction 210 with respect to the lower right jaw member 124A and the lower left jaw member 124B, such as to accept a blood vessel or other target tissue between (1) the upper right jaw member 122A and the upper left jaw member 122B and (2) the lower right jaw member 124 A and the lower left jaw members 124B.
  • the forceps can be operated to actuate the upper right jaw member 122 A and the upper left jaw member 124B to be closed in the first direction 210 with respect to the lower right jaw member 124 A and the lower left jaw member 124B, such as to grasp the target tissue between (1) the upper right jaw member 122A and the upper left jaw member 122B and (2) the lower right jaw member 124 A and the lower left jaw member 124B.
  • electrosurgical energy can optionally be applied to seal the grasped target tissue.
  • the forceps can be operated to transition from the laterally closed state shown in FIG. 2A to the laterally open state shown in FIG.
  • Springs or other bias members 204A-B can be interposed between (1) the upper right jaw member 122 A and the lower right jaw member 124 A and (2) the upper left jaw member 122B and the lower left jaw member 124B, such as to urge (1) to open with respect to (2), unless a countering force is applied.
  • the bias members 204A-B can be located between elbows 206 on laterally-outward bowed arms extending proximally from the individual ones of the corresponding ones of the upper right jaw member 122 A, the upper left jaw member 122B, the lower right jaw member 124A, and the lower left jaw member 124B.
  • Circumferential sheaths or sleeves 202 A-B can be extended from a more proximal position (such as shown in FIG. 2B) to a more distal position (such as shown in FIG. 2A) such that the sleeves 202A-B circumferentially encompass (“cover”) the elbows 206.
  • the countering force of the sleeves 202A-B against the elbows 206 is applied to transition the jaws to be laterally closed in the second direction 214.
  • the circumferential sleeves 202A-B are extended from a more distal position (such as shown in FIG. 2A) to a more proximal position (such as shown in FIG.
  • Cylindrical or half-cylindrical sleeves 202A-B are merely examples of componentry that can be used to provide a countering force to that being provided by bias members 204A-B.
  • a distally extendible and proximally retractable wedge may be located between corresponding right and left portions of either or both of the upper and lower forceps members. The wedge can be actuated to move forward distally or backward proximally to engage with arms or elbows associated with either or both of the upper and lower forceps members, such as to transition between the states shown in FIG. 2 A and FIG. 2B.
  • a hinge can be additionally or alternatively used to permit transition between states such as shown in FIGS.
  • one or more sub-flush blades or other cutting elements can be provided, such as further described herein.
  • the one or more sub-flush blades can be oriented laterally, such as to provide cutting in the second direction, the one or more sub-flush blades can be oriented “vertically”, such as to provide cutting in the first direction, or both types or orientations of sub-flush blades can be included.
  • Actuation of forceps jaw members, blades, or both can be performed using a handinstrument, such as shown in FIG. 1 A, or using a controller circuit to operate control signals to one or more electro-mechanical actuators that can operate such components robotically, such as using a surgical robot including an end effector having the forceps components described herein.
  • FIGS. 3A-3E depict an example of portions of a method 300 of using the forceps end effector 120, such as described above with respect to FIGS. 2A-2B, such as for treatment of tissue, such as sealing and cutting target tissue during a surgical procedure.
  • FIG. 3A depicts an example of a state of the end effector 120 in which the upper jaw members 122A-B open vertically with respect to the lower jaw members 124A-B.
  • the blood vessel or other target tissue 302 is situated between (1) the upper jaw members 122A-B and (2) the lower jaw members 124A-B.
  • the upper jaw members 122A-B and the opposing lower jaw members 124A-B are vertically open with respect to each other, with the upper left jaw member 122 A closed against the upper right jaw member 122B, and with the lower left jaw member 124 A closed against the lower right jaw member 124B.
  • FIG. 3B depicts an example of a subsequent state of the end effector 120, following the state shown in FIG. 3A, in which the upper jaw members 122A-B are vertically closed (in the first direction) with respect to the lower jaw members 124A-B to vertically clamp on a desired portion of the target tissue 302.
  • FIG. 3C depicts an example of a subsequent state of the end effector 120, following the state shown in FIG. 3B, in which RF energy can be delivered (via electrodes) on the upper jaw members 122A-B and the lower jaw members 124A-B to the target tissue 302 to seal the target tissue 302.
  • This RF energy can be delivered from a generator 105 and a controller 160, such discussed with respect to FIG. 1.
  • FIG. 3D depicts an example of a subsequent state of the end effector 120, following the state shown in FIG. 3C, in which, after sealing the target tissue 302, the controller 160 can actuate lateral (in the second direction) separation of the upper right jaw member 122 A from the upper left jaw member 122B, while concurrently actuating lateral separation of the lower right jaw member 124 A from the lower left jaw 124B member.
  • Such vertically-clamped lateral opening can pull respective corresponding portions of the target tissue 302 apart from each other, such as to “cut” or otherwise sever the target tissue by physically tearing the target tissue 302.
  • FIG. 3E depicts an example of a subsequent state of the end effector 120, following the state shown in FIG. 3D, in which, after laterally pulling the target tissue 302 in opposing lateral directions, the target tissue 302 has been severed.
  • one or more sub-flush blades can be included in the forceps 200 provided by the end effector 120. This can allow actual blade-cutting, instead of tearing, of the target tissue 302.
  • FIGS. 4A-4F depict various examples for one or more actuatable sub-flush blades that can be carried by respective individual jaws of the forceps 200 of the end effector 120.
  • a sub-flush blade can be positionable or positioned to be sunken below relative to a sealing surface or a gripping surface of the jaws of the forceps 200 of the end effector 120.
  • a sealing surface of the jaw can include an electrode from which RF energy is delivered and used to seal or otherwise treat target tissue.
  • a gripping surface of the jaw can include a surface that clamps against the target tissue. In an example, the sealing surface may optionally be the same surface as the gripping surface.
  • one or more sub-flush blades can be located so as to be sunken below the sealing surface, the gripping surface, or both, because the target tissue may fluctuate in size during sealing.
  • the sealing process may also result in fluid and vapor being dispelled from the target tissue.
  • FIG. 4A shows a cross-section view of an example of an upper jaw including laterally separable right and left jaw members 122A-B, and a unitary lower jaw 124 of the forceps 200 of the end effector 120.
  • the upper jaw members 122A-B can include a sub-flush anvil 402 and the lower jaw 124 can include a sub-flush blade 404, both of which are recessed within their respective jaws away from the respective gripping or sealing surfaces 406 of the jaws.
  • the lower jaw 124 can include right and left jaw members, similar to the upper jaw.
  • Configuration 408 shows an example in which the upper jaw 122 can be solid, and can include a sub-flush blade 410 instead of a sub-flush anvil 402.
  • the sub-flush blade 404 of the lower jaw 124 and the sub-flush blade 410 of the upper jaw 122 can each respectively have an angled sub-flush blade tip to cut tissue that has been placed between the sub-flush blades 404, 410.
  • Providing a sub-flush anvil 402 or two opposing sub-flush blades 404, 410 can decrease the distance that the blade has to travel (in the first direction) to cut tissue effectively. By decreasing this distance, the amount of movement of the vessel sealer jaws can be reduced or minimized, which, in turn, can help improve the capabilities of a robotic arm actuating the end effector 120.
  • the sub-flush blades 404 and 410 may be actuated to extend longitudinally distally and proximately along a longitudinal axis defined by the shaft. For example, extending the sub-flush blades 404 and 410 distally into their respective jaws can push respective sharp distal blade edges into the target tissue to perform tissue cutting. Once the blades are in such an extended position, the jaws may be actuated to separate laterally (in the second direction), such as to further separate tissue, or to separate “vertically” (in the first direction) to release the cut target tissue after treatment.
  • FIG. 4B depicts a perspective view of an example configuration 412 of subflush blades 404, 410 located respectively located in a lower jaw 124 and an upper jaw 122 of the forceps 200 of the end effector 120, in which the upper jaw 122 can be unitary such that it need not include laterally separable upper jaw members 122A-B.
  • the lower jaw 124 can be unitary, such that it need not include laterally separable lower jaw members 124A-B.
  • the upper jaw 122 and the lower jaw 124 can respectively each include a sub-flush blade 404, 410.
  • the sub-flush blades 404, 410 can be actuated, individually or together, independently from the vertically opening and closing the corresponding upper jaw 122 and the lower jaw 124.
  • configuration 412 can include a respective connection 414, 416 to each sub-flush blade, 404, 410, such as meeting at a pivot point 418 such that the blades 404, 410 can be actuated like scissors.
  • the sub-flush blades 404, 410 can be actuated to meet each other in a first “cutting state” and to return to a recessed sub-flush position in a second “non-cutting” state, when the connections are closed and separate when the connections are opened.
  • FIG. 4C depicts an example of a configuration 420 of a sub-flush blade 422 such as can be employed in the forceps 200 of the end effector 120.
  • a sub-flush anvil 402 can be situated between the upper right jaw member 122 A and the upper left jaw member 122B
  • a cable 424 can be situated between the lower right jaw member 124 A and the lower left jaw member 124B.
  • the cable 424 can include a first cable end attached to the lower right jaw member 124 A and an opposing second cable end attached to the lower left jaw member 124B.
  • the cable 424 loses tension, and the slack in the cable 424 can fall into the sub-flush space between the lower jaw members 124A- B.
  • the blade 422 can be attached to the center of the cable 424.
  • the cable 424 can become taut.
  • the blade 422 is moved upward toward the upper jaw members 122A-B.
  • the upper jaw members 122A-B and the lower jaw members 124A-B can first be clamped down onto a target vessel or other target tissue and the tissue can then be cut by separating the lower right jaw member 124A from the lower left jaw member 124B, thereby pulling the cable 424 taut, and sending the blade 422 upwards into the tissue and toward the sub-flush anvil 402.
  • FIG. 4D depicts an example of a configuration 428 of a sub-flush blade 422, similar to what is shown in FIG. 4C, but in which the upper jaw 122 can be unitary, such that the upper jaw 122 need not include an upper right jaw member 122A that is laterally separable (in the second direction) from the upper left jaw member 124 A.
  • FIG. 4E depicts an example of a configuration 430 of a sub-flush blade 434 that can be located in the lower jaw 124.
  • the lower jaw 124 can be unitary, in that it need not include a lower right jaw member 124A that is laterally separable from a lower left jaw member 124B.
  • the lower jaw 124 can include a bladder 432, with the sub-flush blade 434 situated on top of the bladder 432, which is shown deflated in the lefthand portion of FIG. 4E, and which is shown as inflated in the right-hand portion of FIG. 4E. Upon inflation of the bladder 432, the blade can be extended upward toward and upper jaw 122 and in so doing can cut the target tissue.
  • the bladder 432 may be connected to a hydraulic or pneumatic tube or other conduit extending toward a fluid reservoir, for example, which can be located at or near the proximal end of the device.
  • the tube may be used to deliver silicon oil or any suitable fluid to the bladder 432 for inflation.
  • the configuration 430 can include an upper jaw 122 that can be unitary, such as which can include an anvil located in a longitudinal channel of the upper jaw 122, such as to decrease the distance over which the blade 434 is to move, such as to help effectively cut tissue.
  • the configuration 430 may also include a second blade, a second bladder, or both, such as which can be located on the upper jaw 122.
  • the upper jaw 122 can include a laterally separable upper right jaw member 122 A and upper left jaw member 122B.
  • FIG. 4F depicts an example of another configuration 436 of a sub-flush blade 438, such as which can be located in a lower jaw 124, with a corresponding opposing upper jaw members 122A-B including an electromagnetically magnetized anvil 440.
  • the lower blade 438 may be magnetically attracted to or repulsed by the magnetized anvil 440, which can be activated by an electrical current control signal.
  • FIGS. 5A-5C depicts an example of portions of a method 500 of sealing and cutting tissue.
  • target tissue 302 can be positioned between the upper jaw 122, when it is open to be away from the lower jaw 124.
  • An upper sub-flush blade 410 can be located on the upper jaw 122, and a lower sub-flush blade 404 can be located on the lower jaw 124.
  • a sealing surface 406 can be located on portions of the upper jaw 122 and the lower jaw 124 that grip the target tissue 302.
  • the tissue 302 is shown as being treated by RF electrical energy via the sealing surfaces 406.
  • the sealing surfaces 406 can comprise electrodes that permit current to pass through to the target tissue, as described elsewhere herein.
  • portions of the target tissue 302 may go through various stages of contraction and/or expansion.
  • FIG. 5B shows an example in which the tissue is expanding within the upper jaw 122 and the lower jaw 124.
  • fluid within the target tissue 302 can be heated and dispersed as steam.
  • the steam being dispersed may have enough force to push the upper jaw 122 upwards and the lower jaw 124 downwards. As the steam dissipates, its force is weakened and the upper jaw 122 can return toward the lower jaw 124.
  • the upper and lower jaws are separated into right and left jaw members.
  • An upper right jaw memberl22A and a lower right jaw member 124A may be concurrently vertically (in the first direction) moved away from the upper left jaw member 122B and the lower left jaw member 124B, such as to stretch or separate the target tissue 302. This can sever the target tissue 302 by tearing, otherwise, sub-flush blades can be employed (e.g., such as described above) to blade-cut through the target tissue 302.
  • FIG. 6 depicts an example method 600 of using a robotic vessel sealer in an example.
  • the method 600 can include steps 610 to 630.
  • clamping target tissue with a surgical jaw in a first configuration can occur.
  • sealing the target tissue with radio frequency energy from the surgical jaw in the first configuration can occur.
  • tearing the target tissue with the surgical jaw in a second configuration can occur.
  • the method 600 can be executed by a robotic controller or computer, such that the process is partially or fully automated.
  • the techniques described herein relate to a surgical device comprising a shaft extending longitudinally to define a central longitudinal axis, the shaft including a proximal portion and a distal portion, the device comprising: an end effector extending from the distal portion, wherein the end effector comprises: an upper jaw; a lower jaw, opposite the upper jaw; wherein the upper jaw is configured to be actuated to move vertically toward and away from the lower jaw in a first direction that is substantially orthogonal to the longitudinal axis; and wherein at least one of: (1) the upper jaw includes a first upper jaw member and a second upper jaw member, and the first upper jaw member is configured to be actuated to move laterally toward and away from the second upper jaw member in a second direction that is substantially orthogonal to the first direction and to the longitudinal axis; or (2) the lower jaw includes a first lower jaw member and a second lower jaw member, and the first lower jaw member is configured to be actuated to move laterally toward and away from the second lower
  • the techniques described herein relate to a surgical device, in which at least one of the upper jaw or the lower jaw includes a blade located in a channel of at least one of the upper jaw or the lower jaw, wherein the blade is positionable to be subflush to a gripping or sealing surface of at least one of the upper jaw or the lower jaw.
  • the techniques described herein relate to a surgical device, in which at least one of: (1) at least one of the first upper jaw member or the second upper jaw member includes an elbowed arm actuatable by at least one of a sheath or a wedge for actuation in the second direction laterally toward and away from the other of the first upper jaw member or the second upper jaw member; or (2) at least one of the first lower jaw member or the second lower jaw member includes an elbowed arm actuatable by at least one of a sheath or a wedge for actuation in the second direction laterally toward and away from the other of the first lower jaw member or the second lower jaw member.
  • the techniques described herein relate to a surgical device, wherein at least one of the sheath or the wedge includes at least one of a cylindrical or a semi-cylindrical sheath.
  • the techniques described herein relate to a surgical device, wherein the upper jaw and the lower jaw include one or more sealing surfaces for treating tissue.
  • the techniques described herein relate to a surgical device, wherein the upper jaw and the lower jaw are independently actuatable.
  • the techniques described herein relate to a surgical device, including both (1) and (2).
  • the techniques described herein relate to a surgical device, comprising one or more blades that are configured to cut tissue when at least one of: (1) the first upper jaw member and the second upper jaw member are laterally separated to be spaced apart from each other; or (2) the first lower jaw member and the second lower jaw member are laterally separated to be spaced apart from each other.
  • the techniques described herein relate to a surgical device, comprising at least one blade positioned sunken relative to one or more sealing or gripping surfaces of the device.
  • the techniques described herein relate to a surgical device, wherein the one or more sealing or gripping surfaces comprise one or more electrodes configured to deliver RF energy to target tissue positioned between the upper and lower jaws.
  • the techniques described herein relate to a surgical device comprising: a shaft extending along a central longitudinal axis, the shaft including a proximal portion and a distal portion; and a surgical jaw, extending from the distal portion, wherein the surgical jaw includes a first jaw configuration that is actuatable for delivering radio frequency (RF) electrical energy to target tissue, and includes a different second jaw configuration that is actuatable for severing the target tissue.
  • RF radio frequency
  • the techniques described herein relate to a surgical device, wherein in the first configuration, the surgical jaw comprises an upper jaw and a lower jaw configured to grasp and deliver the RF electrical energy to the target tissue via one or more electrodes.
  • the techniques described herein relate to a surgical device, wherein in the second configuration, at least one of an upper jaw or a lower jaw of the surgical jaw comprises a left jaw member and a right jaw member, and at least one of the left jaw member or the right jaw member is configured to physically tear the target tissue.
  • the techniques described herein relate to a surgical device, wherein the surgical jaw further comprises one or more blades for physically cutting the target tissue, the one or more blades respectively located in one or more channels of at least one of the upper jaw or the lower jaw.
  • the techniques described herein relate to a method, the method comprising: clamping target tissue with a surgical jaw in a first configuration; sealing the target tissue with radio frequency energy from the surgical jaw in the first configuration; and severing the target tissue with the surgical jaw, including by moving the surgical jaw from the first configuration to a second configuration.
  • the techniques described herein relate to a method, wherein the severing the target tissue comprises blade-cutting through the target tissue.
  • the techniques described herein relate to a method, wherein the severing the target tissue comprises tearing the target tissue by laterally separating left and right portions of the surgical jaw from each other.
  • the techniques described herein relate to a method, wherein the upper jaw is opposite the lower jaw, and the method further comprises: opening the upper jaw and the lower jaw with respect to each other to accept target tissue therebetween; and closing the upper jaw and the lower jaw with respect to each other; and at least one of (1) moving a left upper jaw portion laterally away from a right upper jaw portion to stretch or sever tissue; or (2) moving a left lower jaw portion laterally away from a right lower jaw portion to stretch or sever tissue.
  • the techniques described herein relate to a method, further comprising sealing the target tissue when the upper jaw and the lower jaw are closed.
  • Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine- readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples.
  • An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code can be tangibly stored on one or more volatile, non-transitory, or nonvolatile tangible computer-readable media, such as during execution or at other times.
  • Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), and the like.

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Abstract

Un effecteur terminal chirurgical peut comprendre une mâchoire supérieure et une mâchoire inférieure, opposée à la mâchoire supérieure. La mâchoire supérieure peut se déplacer verticalement vers la mâchoire inférieure et à l'opposé de celle-ci dans une première direction sensiblement orthogonale à un axe longitudinal. Au moins l'un des éléments suivants : (1) la mâchoire supérieure comprend un premier élément de mâchoire supérieur et un second élément de mâchoire supérieur, configurés pour être actionnés pour se déplacer latéralement l'un vers l'autre et à l'opposé l'un de l'autre dans une seconde direction qui est sensiblement orthogonale à la première direction et à l'axe longitudinal ; ou (2) la mâchoire inférieure comprend un premier élément de mâchoire inférieur et un second élément de mâchoire inférieure, configurés pour être actionnés pour se déplacer latéralement l'un vers l'autre et à l'opposé l'un de l'autre dans la seconde direction qui est sensiblement orthogonale à la première direction et à l'axe longitudinal. Des lames sub-affleurantes peuvent éventuellement être incluses.
PCT/US2025/020977 2024-03-22 2025-03-21 Configuration de mâchoire de forceps de scellement de vaisseau Pending WO2025199477A1 (fr)

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US63/568,567 2024-03-22

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20130085494A1 (en) * 2011-09-30 2013-04-04 Ethicon Endo-Surgery, Inc. Laparoscopic device with three jaws
US20140336698A1 (en) * 2013-05-10 2014-11-13 Ethicon Endo-Surgery, Inc. Surgical instrument with split jaw
US20150150581A1 (en) * 2013-12-02 2015-06-04 Covidien Lp Surgical instrument with end-effector assembly including three jaw members
US20160038221A1 (en) * 2014-08-11 2016-02-11 Covidien Lp Surgical instruments and methods for performing tonsillectomy and adenoidectomy procedures
US20160296274A1 (en) * 2015-04-10 2016-10-13 GYRUS ACMI, INC., d/b/a Olympus Surgical Technologies America Medical forceps with offset teeth
US20190216491A1 (en) * 2018-01-17 2019-07-18 Covidien Lp Surgical instruments incorporating ultrasonic and electrosurgical functionality

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20130085494A1 (en) * 2011-09-30 2013-04-04 Ethicon Endo-Surgery, Inc. Laparoscopic device with three jaws
US20140336698A1 (en) * 2013-05-10 2014-11-13 Ethicon Endo-Surgery, Inc. Surgical instrument with split jaw
US20150150581A1 (en) * 2013-12-02 2015-06-04 Covidien Lp Surgical instrument with end-effector assembly including three jaw members
US20160038221A1 (en) * 2014-08-11 2016-02-11 Covidien Lp Surgical instruments and methods for performing tonsillectomy and adenoidectomy procedures
US20160296274A1 (en) * 2015-04-10 2016-10-13 GYRUS ACMI, INC., d/b/a Olympus Surgical Technologies America Medical forceps with offset teeth
US20190216491A1 (en) * 2018-01-17 2019-07-18 Covidien Lp Surgical instruments incorporating ultrasonic and electrosurgical functionality

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