Articulating ultrasonic surgical instrument and system

Abstract

A surgical instrument includes a housing having an elongate body extending distally therefrom. The elongate body defines a first articulation section and a second articulation section. The elongate body defines an internal cavity therein. An end effector is supported at a distal end portion of the elongate body. A flexible waveguide extends through the internal cavity of the elongate body. A proximal end portion of the flexible waveguide is connected to an ultrasonic transducer. A distal end portion of the flexible waveguide is connected with the end effector. The flexible waveguide defines a first articulation section and a second articulation section, the first articulation section having a thickness that is narrower than a thickness of other portions of the flexible waveguide, the second articulation section having a thickness that is narrower than a thickness of other portions of the flexible waveguide.

Description

[0001] Cross Reference to Related Applications

[0002] This application claims the benefit of and priority to U.S. Provisional Patent Application Nos. 63 / 026,377 and 63 / 026,323, each of which was filed on May 18, 2020. The entire contents of each of the foregoing applications are incorporated herein by reference. TECHNICAL FIELD

[0003] The present disclosure relates to surgical instruments and systems, and more specifically, to articulating ultrasonic surgical instruments and systems. BACKGROUND

[0004] Ultrasonic surgical instruments and systems utilize ultrasonic energy, i.e., ultrasonic vibrations, to treat tissue. More specifically, a typical ultrasonic surgical instrument or system includes a transducer configured to generate mechanical vibratory energy along a waveguide and transmit it at an ultrasonic frequency along the waveguide to an ultrasonic end effector configured to treat tissue, e.g., coagulate, cauterize, fuse, seal, cut, desiccate, or otherwise treat tissue. Traditionally, the transducer is maintained outside of the surgical site, while the waveguide extends from the transducer into the surgical site to provide ultrasonic energy to the ultrasonic end effector. The ultrasonic end effector is manipulated into position to treat the desired tissue or tissues.

[0005] Some ultrasonic surgical instruments and systems incorporate a rotational feature, enabling the ultrasonic end effector to be rotated to a desired orientation within the surgical site. However, even in such instruments and systems, the ability to navigate within the surgical site via rotation and manipulation alone is limited. SUMMARY

[0006] In one aspect of the present disclosure, a surgical instrument includes a housing having an elongate body extending distally therefrom. The elongate body defines a first articulation portion and a second articulation portion. The elongate body defines an internal lumen therein. An end effector is supported at a distal end portion of the elongate body. A flexible waveguide extends through the internal lumen of the elongate body. A proximal end portion of the flexible waveguide is connected to an ultrasonic transducer. A distal end portion of the flexible waveguide is connected with the end effector. The flexible waveguide defines a first articulation portion and a second articulation portion, the first articulation portion having a thickness that is narrower than a thickness of other portions of the flexible waveguide, the second articulation portion having a thickness that is narrower than a thickness of other portions of the flexible waveguide.

[0007] In some aspects of the present disclosure, the first articulating portion of the flexible waveguide is configured to articulate in a first orientation, and the second articulating portion of the flexible waveguide is configured to articulate in a second orientation. The first articulating portion of the flexible waveguide and the second articulating portion of the flexible waveguide can each articulate in the same orientation as one another or in different orientations from one another. The first or second articulating portion of the flexible waveguide is configured to articulate from about 1 degree to about 45 degrees.

[0008] In some aspects of the present disclosure, the end effector includes an ultrasonic blade and a clamp pad configured to rotate about the ultrasonic blade. The ultrasonic blade and the clamp pad are configured to capture and treat tissue therebetween in a plurality of rotational orientations of the clamp pad relative to the ultrasonic blade.

[0009] In some aspects of the present disclosure, the elongate body is configured to rotate to achieve different directional orientations of the end effector. Independent controls are configured to rotate the elongate body, rotate the clamp pad about the ultrasonic blade, and articulate the first and second articulating portions of the elongate body. Accordingly, the first articulating portion of the flexible waveguide and the second articulating portion of the flexible waveguide are rotated by independent controls.

[0010] In some aspects of the present disclosure, first and second transducers are located on opposite sides of the first articulating portion of the flexible waveguide. At least one of the first or second transducers is configured to amplify ultrasonic waves transmitted through the first articulating portion of the flexible waveguide.

[0011] In some aspects of the present disclosure, the flexible waveguide can define a single articulating portion that is narrower in width than other portions of the flexible waveguide, and the elongate body can be configured to rotate to achieve different directional orientations of the end effector.

[0012] In one aspect of the disclosure, an elongated body of a surgical instrument includes an inner tube including a hinged section and defining an inner lumen therethrough. An outer tube is disposed about the inner tube and includes a proximal portion and a distal portion. The proximal portion of the outer tube defines a hinged section. The hinged section of the outer tube at least partially overlaps the hinged section of the inner tube. The distal portion of the outer tube is slidable relative to the proximal portion of the outer tube. An end effector assembly is disposed at a distal end portion of the inner tube. The end effector assembly includes an ultrasonic blade and a clamp configured to rotate about the ultrasonic blade. The clamp is configured to move relative to the ultrasonic blade between an open position and a clamped position to capture and treat tissue therebetween at a plurality of rotational orientations of the clamp relative to the ultrasonic blade. A flexible waveguide extends through the inner lumen of the inner tube. A distal end portion of the flexible waveguide is connected with the ultrasonic blade of the end effector assembly. Sliding the distal portion of the outer tube relative to the proximal portion of the outer tube actuates the clamp relative to the ultrasonic blade between the open position and the clamped position.

[0013] In some aspects of the disclosure, a cable extends along the proximal portion of the outer tube. The cable is operably coupled to the distal portion of the outer tube. The cable is configured to slide the distal portion of the outer tube in a proximal direction toward the proximal portion of the outer tube to actuate the clamp relative to the ultrasonic blade to the clamped position. A spring is operably coupled to the distal portion of the outer tube. The spring is configured to bias the distal portion of the outer tube in a distal direction away from the proximal portion of the outer tube to bias the clamp relative to the ultrasonic blade to the open position or a closed position.

[0014] In some aspects of the disclosure, a yoke is operably coupled to the cable and the distal portion of the outer tube. Pulling the cable in the proximal direction pulls the distal portion of the outer tube in the proximal direction to actuate the clamp. The yoke is configured to allow the distal portion of the outer tube to rotate relative to the proximal portion of the outer tube.

[0015] In some aspects of the disclosure, the yoke includes a first curved arm and a second curved arm. The first and second curved arms are configured to rotatably slide along a groove formed in the distal portion of the outer tube. The yoke includes a guide block extending along a longitudinal axis of the proximal portion of the outer tube. The guide block is configured to slide along the proximal portion of the outer tube.

[0016] In some aspects of the disclosure, a drive gear is operably coupled to the jaw assembly. An input gear is engaged with the drive gear. Rotation of the input gear drives rotation of the drive gear to rotate the jaw assembly. A torque cable is operably coupled to the input gear. Rotation of the torque cable drives rotation of the input gear.

[0017] In some aspects of the disclosure, the inner tube is rotatably coupled to the proximal portion of the outer tube.

[0018] In some aspects of the disclosure, the inner tube includes a groove and the proximal portion of the outer tube includes a retaining ring positioned in the groove to rotatably couple the inner tube to the proximal portion of the outer tube.

[0019] In some aspects of the disclosure, the distal portion of the outer tube includes at least one slot and the inner tube includes at least one tab slidably positioned in the at least one slot. The at least one slot allows the distal portion of the outer tube to move proximally and distally relative to the inner tube. The inner tube rotates in unison with the outer tube.

[0020] In some aspects of the disclosure, the outer tube includes at least one helical cutout configured to allow articulation in any direction and application of rotational force to the jaws. The inner tube includes a plurality of cutouts spaced apart from one another. The plurality of cutouts are configured to allow the inner tube to articulate substantially along a single plane.

[0021] In some aspects of the disclosure, a direct drive including at least two links extends along the outer tube. The direct drive is configured to drive opening and closing of the jaws.

[0022] Other features of the disclosure will be understood from the following description. BRIEF DESCRIPTION OF DRAWINGS

[0023] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate aspects and features of the disclosure and together with the detailed description

[0024] Figure 1 is a side perspective view of a surgical instrument having an articulating portion configured for use in accordance with aspects and features of the disclosure;

[0025] Figure 2 is a side perspective view of a surgical instrument having first and second articulating portions configured for use in accordance with aspects and features of the disclosure;

[0026] Figure 3is a side view of a single conceptualized articulated portion including a flexible waveguide shown constrained in a test fixture representing supports, pivots, and other features, the flexible waveguide configured for use with a surgical instrument of Figure 1 ;

[0027] Figure 4A is a side view of a first conceptualized articulated portion including a first portion of a flexible waveguide shown constrained in a test fixture representing supports, pivots, and other features, the flexible waveguide configured for use with a surgical instrument of Figure 2 articulated in a first plane;

[0028] Figure 4B is a side view of a second conceptualized articulated portion including a second portion of a flexible waveguide shown constrained in a test fixture representing supports, pivots, and other features, the flexible waveguide configured for use with a surgical instrument of Figure 2 articulated in a second plane;

[0029] Figure 5A is a side view of a flexible waveguide of Figure 4A ;

[0030] Figure 5B is a top plan view of a flexible waveguide of Figure 4A ;

[0031] Figure 6A is a side view of a distal end of an elongated body and an end effector including a rotatable jaw member, the end effector configured for use with a surgical instrument of Figure 1 or 2 in a first rotational position;

[0032] Figure 6B is a side view of a distal end of an elongated body and an end effector of Figure 6A in a second rotational position;

[0033] Figures 7A to 7D is a side perspective view of an elongated body and an end effector including a rotatable jaw member of Figure 6A in various rotational and articulated orientations;

[0034] Figure 8 is a side view of a conceptualized articulated portion including a cable system for articulating the articulated portion and a flexible waveguide shown constrained in a test fixture representing supports, pivots, and other features, the flexible waveguide configured for use with a surgical instrument of Figure 1 or 2;

[0035] Figure 9 is a side view of another articulated portion configured for use with a surgical instrument ofFigure 1 or 2 together with an elongated body of a surgical instrument having multiple curved segments;

[0036] Figure 10 is a side view of a conceptual articulated portion including a flexible waveguide shown constrained in a test fixture representing supports, pivots, and other features, the flexible waveguide configured to be used with Figure 1 or 2 together with an elongated body of a surgical instrument having multiple curved segments;

[0037] Figure 11 is a schematic illustration of a robotic surgical system configured to be used in accordance with the present disclosure;

[0038] Figure 12A is a longitudinal cross-sectional view of a flexible waveguide secured in an internal cavity of an elongated body by a post and hole attachment structure;

[0039] Figure 12B is a perspective view of a flexible waveguide of Figure 12A ;

[0040] Figure 12C is a longitudinal cross-sectional view of a hole formed in an internal surface of an elongated body of Figure 12A ;

[0041] Figure 12D is a longitudinal cross-sectional view of an elongated body and a flexible waveguide of Figure 12A in an articulated configuration;

[0042] Figure 13A is a longitudinal cross-sectional view of a flexible waveguide secured in an internal cavity of an elongated body by an annular collar projecting outwardly from the flexible waveguide;

[0043] Figure 13B is a perspective view of a flexible waveguide of Figure 13A ;

[0044] Figure 13C is a longitudinal cross-sectional view of a notch formed in an internal surface of an elongated body and configured to receive an annular collar of a flexible waveguide of Figure 13A ;

[0045] Figure 14A is a longitudinal cross-sectional view of a flexible waveguide secured in an internal cavity of an elongated body by an annular collar projecting inwardly from an internal surface of the elongated body;

[0046] Figure 14B is a perspective view of a flexible waveguide including a notch configured to receive an annular collar of Figure 14A ;

[0047] Figure 14Cis a longitudinal cross-sectional view of an annular collar protruding from an inner surface of an elongated body of Figure 14A

[0048] Figure 15A is a longitudinal cross-sectional view of a flexible waveguide secured in an inner lumen of an elongated body by a removable annular collar;

[0049] Figure 15B is a perspective view of a flexible waveguide of Figure 15A

[0050] Figure 15C is a longitudinal cross-sectional view of a removable annular collar positioned around a flexible waveguide and secured in an inner lumen by a notch formed in an inner surface of an elongated body of Figure 15A

[0051] Figure 15D is a longitudinal cross-sectional view of a notch of Figure 15C

[0052] Figure 16 is a side perspective view of a cable-driven articulating section and rotatable clamp configured for use in accordance with aspects and features of the present disclosure;

[0053] Figure 17 is another side perspective view of an articulating section of Figure 16

[0054] Figure 18 is an enlarged side perspective view of a yoke of Figure 17

[0055] Figure 19 is a side view showing clamp actuation of Figure 17 by sliding a distal portion of an outer tube proximally toward a proximal portion of the outer tube;

[0056] Figure 20 is another side perspective view of a cable configured for rotating a gear mechanism to rotate a clamp of Figure 17

[0057] Figure 21 is an enlarged side view of a gear mechanism of Figure 20

[0058] Figure 22 is an enlarged side view showing an inner tube in dashed lines, wherein the inner tube is rotatably coupled to a proximal portion of an outer tube;

[0059] Figure 23 ​​​​​​​​is a side view of an articulating portion of an outer tube configured for use in accordance with aspects and features of the present disclosure;

[0060] Figure 24 is a side view of an articulating portion of an inner tube configured for use in accordance with aspects and features of the present disclosure;

[0061] Figure 25 illustrates a cable channel formed in an inner tube of Figure 24 configured to receive a cable for articulating an articulating portion of an inner tube of

[0062] Figure 26 illustrates Figure 23 coupled to a jaw assembly and configured to rotate about an inner tube of Figure 24 to rotate the jaw assembly;

[0063] Figure 27 illustrates Figure 26 opened by a linkage system coupled to the jaws; and

[0064] Figure 28 illustrates Figure 27 actuated by the linkage system. DETAILED DESCRIPTION

[0065] As used herein, the term“distal” refers to the portion being described that is further from the user, while the term“proximal” refers to the portion being described that is closer to the user. Furthermore, to the extent consistent, any of the aspects and features detailed herein can be used in conjunction with any or all of the other aspects and features detailed herein.

[0066] As used herein, the terms parallel and perpendicular are understood to encompass relative configurations that are substantially parallel and substantially perpendicular, which differ from true parallel and true perpendicular by about +10 degrees or -10 degrees.

[0067] Exemplary axes or directions such as an X-axis direction, a Y-axis direction, and a Z-axis direction can be shown in the drawings and / or described herein. As an example, the X-axis direction can be perpendicular to the Y-axis direction, and the Z-axis direction can be orthogonal to the X-axis direction and the Y-axis direction.

[0068] As used herein,“about” or“approximately” or“substantially” can include the stated value and mean within an acceptable range of difference, for a particular value, as determined by one of ordinary skill in the art, taking into account relevant measurements and errors associated with measuring a particular quantity (e.g., limitations of a measurement system). For example,“about” can mean within one or more standard deviations, or within ±30%, 20%, 10%, 5% of a stated value.

[0069] The description of the technical features or aspects of the exemplary embodiments of the present disclosure should generally be considered as available and applicable to other similar features or aspects in another exemplary embodiment of the present disclosure. Accordingly, the technical features described herein according to one exemplary embodiment of the present disclosure can be applicable to other exemplary embodiments of the present disclosure, and thus, a repetitive description can be omitted here.

[0070] Exemplary embodiments of the present disclosure will be described more fully hereinafter (for example, with reference to the accompanying drawings). In the entire specification and drawings, the same reference numerals can refer to the same elements.

[0071] Generally, in the flexible waveguide (for example, flexible waveguides 301, 401, 801, 1001, 1201, 1301, 1401, and 1501) described herein, the ultrasonic waveguide becomes thin enough to be elastic at its articulated portion (for example, articulated portions 310, 410, 430, 810, 1010, 1210, 1310, 1410, 1510, 1747, and 1748) downward, but still has enough material to carry ultrasonic waves to the tip of the instrument (for example, to end effectors 100, 200, 600, 700, and 1700). Although the flexible waveguide has a substantially cylindrical shape, the section that is thinned downward and the section that is elastic can be at least partially flattened to produce an at least partially flattened shape, for example, including opposing planar surfaces. The section that is thinned downward and elastic can also have a circular or elliptical cross-section. The term "flattened" relates to the end configuration, not the method of achieving the flexible section. The above-described configuration achieves an articulated ultrasonic surgical instrument in which the ultrasonic transducer will be "outside" the body and the ultrasonic waves will be carried to the end effector through the bend in the waveguide.

[0072] Unless otherwise indicated, the end effectors 100, 200, 600, 700, and 1700 described herein are substantially identical to one another. Unless otherwise indicated, the flexible waveguides 301, 401, 801, 1001, 1201, 1301, 1401, and 1501 described herein are substantially identical to one another. Unless otherwise indicated, the articulating portions 310, 410, 430, 810, 1010, 1210, 1310, 1410, 1510, 1747, and 1748 described herein are substantially identical to one another. Unless otherwise indicated, the clamp members 101, 201, 601, 701, 1601, 1701, 2001, 2201, 2601, and 2701 described herein are substantially identical to one another. Unless otherwise indicated, the blade members 102, 202, 602, 702, 1602, 1702, 2002, 2502, 2602, and 2702 described herein are substantially identical to one another. Unless otherwise indicated, the housings 12 and 212 described herein are substantially identical to one another. Unless otherwise indicated, the handle assemblies 132 and 232 described herein are substantially identical to one another. Unless otherwise indicated, the stabilizers 351 and 851 described herein are substantially identical to one another. Unless otherwise indicated, the stabilizers 352 and 852 described herein are substantially identical to one another.

[0073] Referring generally to Figure 1 An embodiment of a surgical instrument (e.g., an endoscopic surgical instrument) illustrating aspects and features of the present disclosure is shown generally by reference numeral 10. For purposes of this document, the surgical instrument 10 is generally described. Aspects and features of the surgical instrument 10 that are not directly related to the aspects and features of the present disclosure are omitted in order to not obscure the aspects and features of the present disclosure with unnecessary detail.

[0074] The surgical instrument 10 generally includes a housing 12 (defining a handle assembly 132), an elongate body 14, and an end effector 100. The handle assembly 132 supports a battery assembly 18 as well as a transducer and generator assembly (“TAG”) 120, and includes a first knob 22, a second knob 23, an activation button 24, and a clamp trigger 26.

[0075] The elongate body 14 defines a proximal portion 16 connected with the first knob 22 and a distal portion 18 supporting the end effector 100. The end effector 100 includes an ultrasonic blade 102 and a pivoting clamp 101. In embodiments, the ultrasonic blade 102 is cylindrical or otherwise includes one or more radial symmetry (or complete radial symmetry), and the clamp 101 is configured to rotate about the ultrasonic blade 102 to enable clamping of tissue therebetween in a plurality (or infinite plurality) of orientations. An internal lumen 15 is defined within the elongate body 14.

[0076] The clamp trigger 26 of the surgical instrument 10 is selectively manipulable to actuate a motor, other powered drive mechanism, or a manually driven mechanism (e.g., gears, pulleys, tension cables, etc.) that pivots the clamp jaw 101 relative to the ultrasonic blade 102 to transition the end effector 100 between an open state and a clamped state.

[0077] The first knob 22 is selectively manipulable to rotate the elongated body 14 and, thus, the end effector 100 relative to the housing 12. The second knob 23 is selectively manipulable to actuate a motor, other powered drive mechanism, or a manually driven mechanism (e.g., gears, pulleys, tension cables, etc.) that rotates the clamp jaw member 101 relative to the ultrasonic blade 102. As an alternative to the first and second knobs 22, 23, other suitable actuation mechanisms can be provided, such as toggle switches, joysticks, buttons, etc. The third knob 127 is selectively manipulable to articulate the articulation section 110.

[0078] The battery assembly 18 and the generator of the TAG 120 cooperate upon activation of the activation button 24 to power the transducer of the TAG 120 to enable the generation of ultrasonic energy that is transmitted to the blade 102 of the end effector 100 to treat tissue therewith, e.g., to coagulate, cauterize, fuse, seal, cut, desiccate, or otherwise treat tissue, as described below. The battery assembly 18 and the TAG 120 are each releasably secured to the handle assembly 132 and can be detached therefrom to facilitate disposal of the handle assembly 132, but the battery assembly 18 and the TAG 120 are excluded. However, it is contemplated that any or all of the components of the surgical instrument 10 are configured as single-use disposable components or multi-use components that are sterilizable, and / or that the surgical instrument 10 can be connected to a remote power source or generator rather than having such onboard components.

[0079] With particular reference to Figure 1 , 3 , 6A, 6B, and 7A-7D, the surgical instrument 10 as described above includes a housing 12 and an elongated body 14 extending therefrom. The elongated body 14 defines an internal lumen 15 therein, a proximal end portion 16, and a distal end portion 18 that supports an end effector 100. The elongated body 14 includes at least one articulation section 110 between the proximal end portion 16 and the distal end portion 18. A flexible waveguide (e.g., the flexible waveguide 301 of Figure 3 , extends through the internal lumen 15 and includes an articulation section 310. The articulation section 110 of the elongated body 14 and the articulation section 310 of the flexible waveguide are positioned at substantially the same location along the elongated body 14 such that the articulation section 110 and the articulation section 310 can be articulated in a similar manner to one another. The elongated body 14 is configured to rotate in unison with the flexible waveguide 310 extending through the internal lumen 15, and the clamp jaw member 101 is configured to rotate about the blade 102 (see also, e.g.,Figure 6A and 6B of the jaw member 601 and the blade 602). Thus, the surgical instrument 10 can achieve any desired directional orientation of the end effector 100 by a combination of rotating the elongated body 14, articulating the articulation portions 110 and 310, and rotating the jaw member 101 about the blade 102 (see also, e.g., Figures 7A to 7D of the elongated body 714, the articulation portion 730, the jaw member 701, and the blade 702). This can be achieved by a single articulation region along the elongated body 14 or by multiple articulation regions.

[0080] Referring to Figure 1 and 3 , a flexible waveguide 301 extends through the lumen 15 of the elongated body 14. A proximal portion 302 of the flexible waveguide 301 is connected with the ultrasonic generator 120. A distal portion 303 of the flexible waveguide 301 is connected with the blade 102 of the end effector 100, e.g., attached, integrally formed, etc. The flexible waveguide 301 defines an articulation portion 310 having a narrower dimension, e.g., width, than other portions of the flexible waveguide 301. In this way, the articulation portion 310 is flexible, while the remainder of the waveguide 301 is substantially non-flexible (e.g., not configured to bend significantly during use). The proximal portion 302 can define a threaded end 380 for connection with the ultrasonic generator 120, and the distal portion 303 can define the blade 102.

[0081] The articulation portion containing the articulation portion 110 of the elongated body 14 and the articulation portion 310 of the waveguide 301 can enable articulation relative to a single plane defined by the thinned portion of the flexible waveguide 301 (the articulation portion 310). As described above, the blade 102 is cylindrical or otherwise defines one or more radial symmetries, and the rotatable jaw 101 can be rotated about the blade 102. The blade 102 can have a curved or partially curved configuration (see, e.g., Figure 3 ) or a substantially straight configuration (see, e.g., Figure 6B ). By making the blade 102 cylindrical or otherwise defining one or more radial symmetries, this allows the jaw 101 to be clamped on the blade 102 at multiple points of the blade or at any point on the outer surface of the blade while achieving the same tissue effect. The flexible waveguide 301 is substantially cylindrical along most of its length and further contains the articulation portion 310 having a partially flattened shape. Due to the cylindrical portion of the waveguide, the jaw 101 can be rotated about the blade 102 while the blade 102 is fixed.

[0082] Referring to Figure 2 , 4A, 4B, 5A and 5B, surgical instrument 20 is substantially identical to surgical instrument 10, except that it has a first articulating portion 210 and a second articulating portion 230. Each articulating portion 210 and 230 can enable some degree of gentle bending (e.g., from about 1 degree to about 45 degrees) about a single plane (e.g., a single or different planes from each other). Surgical instrument 20 generally includes a housing 212 (defining a handle assembly 232), an elongated body 214 defining a proximal end portion 216 and a distal end portion 218 and an internal lumen 215 defined therein, and an end effector 200. End effector 200 includes an ultrasonic blade 202 and a clamp 201 that is pivotable relative to ultrasonic blade 202 and that can be configured to rotate about ultrasonic blade 202. Handle assembly 232 supports a battery assembly 218 and a transducer and generator assembly ("TAG") 220, and includes a first knob 222, a second knob 223, an activation button 224, a clamp trigger 226, a third knob 227, and a fourth knob 228.

[0083] Flexible waveguide 401 includes a first articulating portion 410 and a second articulating portion 430 that extend through internal lumen 215 of elongated body 214. First articulating portion 210 of elongated body 214 and first articulating portion 410 of flexible waveguide 401 are positioned along elongated body 214 at substantially the same location from each other, such that first articulating portion 210 and first articulating portion 410 can be articulated in a similar manner to each other. Second articulating portion 230 of elongated body 214 and second articulating portion 430 of flexible waveguide 401 are positioned along elongated body 214 at substantially the same location from each other, such that second articulating portion 230 and second articulating portion 430 can be articulated in a similar manner to each other, e.g., in a second plane that is different from the articulating plane of first portions 210, 410. Alternatively, the second plane can be substantially the same as the first plane (e.g., the first and second planes can each be along the Y-axis direction of Figure 4A 、 4B , 5A and 5B). For example, the first plane can be along the Y-axis direction of Figure 4A 、 4B , 5A and 5B, and the second plane can be along the Z-axis direction of Figure 4A 、 4B , 5A and 5B. Thus, elongated member 214 and flexible waveguide 401 extending therethrough can be articulated about two different directions to achieve a desired directional orientation of end effector 200 and / or to achieve a desired placement of various segments of elongated member 214.

[0084] With particular reference to Figure 5A and 5BBecause the hinged portions 410, 430 of the flexible waveguide 401 are formed with a flattened shape, the thinning of the hinged portion 430 of the flexible waveguide 401 can be visible only around a single plane (e.g., as in the side view of Figure 5A , while the thinning of the hinged portion 410 of the flexible waveguide 401 can be visible only around a different single plane (e.g., as in the plan view of Figure 5B .

[0085] With particular reference to Figure 8 A cable system comprising first and second cables 871, 872 can be employed to hinge the hinged portion 810 of the flexible waveguide 801. While two cables can be employed, a single cable on a spool can also be employed, or more than two cables can also be used. The cables 871, 872 can be routed alongside the flexible waveguide 801 within an inner lumen (e.g., the inner lumens 15 or 215 described herein (in Figure 1 and 2 By tensioning one cable 871, 872 and relaxing the other cable 871, 872, the hinged portion 810 is caused to hinge in the direction of the tensioned cable. Alternatively, the hinged portion 810 of the flexible waveguide 801 can be hinged by using a thin wire of nitinol or other material to push and tension the inner tube of the elongated portion for bending actuation. The thin wire can be fixed in a sleeve or channel to allow pushing without needing to flex. The inner lumens described are for accommodating the flexible waveguide 801, while the cable systems and the like described herein employ cables or similar devices accommodated within separate inner lumens or channels to remain separate from the flexible waveguide 801.

[0086] With particular reference to Figure 3 and 8 Stabilizers 351, 851 and 352, 852 can be employed to assist in the controlled hinging of the flexible waveguide 301, 801. The stabilizers 351, 851 are fixed to the flexible waveguide 301, 801 at locations proximal and distal to the hinged portion 310, 810 of the flexible waveguide 301, 801. The stabilizers 351, 851 and 352, 852 can be fixed to the inner surface of the elongated member described herein. Thus, proximal / distal movement of the flexible waveguide 301, 801 is inhibited. Holding / stabilizing the flexible waveguide 301, 801 in these locations allows gradual bending to be formed for hinging without causing heating / friction points in the flexible waveguide 301, 801 or causing unnecessary noise. While Figure 3 and 8 An elongated body containing the stabilizers 351, 851 holding / stabilizing the flexible waveguide 301, 801 is shown conceptually, but one of skill in the art will readily understand how such a stabilizer would be incorporated into the elongated body 14 in practice Figure 1), for holding / stabilizing the flexible waveguide 301, 801 therein. Reference is made below to Figures 12A to 15D Additional stabilizing structures for the flexible waveguide 301, 801 are described.

[0087] With particular reference to Figure 6A , 6B and 9, the articulated portion 630, 910 of the elongated body 614, 914 can include a plurality of bend sections 681, 981 to control the degree of articulation of the articulated portion 630, 910. The bend sections 681, 981 allow for a gradual bend by allowing only a certain amount of bend per section. As an example, each bend section 681, 981 can allow for about 5 degrees of bend, so using 9 bend sections 681, 981 allows for a total of about 45 degrees of bend. The bend sections 681, 981 can be allowed to bend in only one plane by means of a pin joint or hinge or a partial cutout, or can be configured to bend in multiple planes.

[0088] With general reference again to Figure 2 and 4A , 4B, 5A and 5B, the surgical instrument 20 includes a housing 212 having an elongated body 214 extending distally therefrom. The elongated body 214 defines a first articulated portion 210 and a second articulated portion 230 distal to the first articulated portion 210. The elongated body 214 defines an inner lumen 215 therein. An end effector 200 is supported at a distal end portion 218 of the elongated body 214. An ultrasonic transducer and generator assembly 220 is supported on the housing 212. A flexible waveguide 401 extends within the inner lumen 215 of the elongated body 214. A proximal end portion 480 of the flexible waveguide 401 is connected with the ultrasonic generator 220. A distal end portion 490 of the flexible waveguide 401 is connected (attached, integrally formed, etc.) with the blade 202 of the end effector 200. The flexible waveguide 401 defines a first articulated portion 410 having a dimension, e.g., width, that is narrower than other portions of the flexible waveguide 401. The flexible waveguide 401 defines a second articulated portion 430 configured to articulate in a different direction (about the Z-axis direction of Figure 4A ) than the articulation direction (e.g., about the Y-axis direction of Figure 4B ) of the first articulated portion 410. The second articulated portion 430 has a narrower dimension (compared to the first articulated portion 410), e.g., narrowed height, that is different than the height of other portions of the flexible waveguide 401.

[0089] The end effector 200 includes an ultrasonic blade 202, which can be cylindrical or otherwise define one or more radial symmetries, and a clamp 201, which can be configured to rotate about the ultrasonic blade 202. The ultrasonic blade 202 and the clamp 201 are configured to capture and treat tissue therebetween in a clamped position of the clamp 201. Alternatively or additionally, the ultrasonic blade 202 can be used to treat tissue immediately adjacent thereto that is not clamped. The elongated body 214 is configured to rotate (e.g., see Figure 6A and 6B the elongated body 614 of FIGS. 1-3) to achieve different directional orientations of the end effector 200.

[0090] The first knob 222 is configured to rotate the elongated body 214 (e.g., rotate a portion of the elongated body 214 proximate to the first articulating portion 210). In embodiments that provide such rotation, the second knob 223 is configured to rotate the clamp 201 about the ultrasonic blade 202. The third knob 227 is configured to articulate the first articulating portion 210 of the elongated body 214 and, thus, the first articulating portion of the waveguide 410. The fourth knob 228 is configured to articulate the second articulating portion 230 of the elongated body 214 and, thus, the second articulating portion 430 of the flexible waveguide.

[0091] Referring to Figure 10 , the first transducer 1050 and the second transducer 1060 are positioned on opposite sides of the articulating portion 1010 of the flexible waveguide 1001, e.g., on the proximal and distal sides. The first transducer 1050 and the second transducer 1060 amplify ultrasonic waves transmitted through the articulating portion 1010 of the flexible waveguide 1001 (e.g., a portion having a narrower width than other portions of the flexible waveguide 1001). For example, the second transducer 1060 distal of the articulating portion 1010 amplifies ultrasonic energy as the wave continues down the waveguide (i.e., compensating for any energy loss caused by the articulating portion 1010). In embodiments, only a transducer distal of the articulating portion 1010 is provided, e.g., the second transducer 1060. Similar transducers can be located on opposite sides (or only on the distal side) of each articulating portion of a flexible waveguide having multiple articulating portions along its length.

[0092] The various embodiments disclosed herein can also be configured to work with robotic surgical systems and the technology commonly referred to as "tele-surgery." Such systems employ various robotic elements to assist the surgeon and allow remote operation (or partial remote operation) of surgical instruments. For this purpose, various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. can be employed and can be designed to have robotic surgical systems to assist the surgeon during the course of a surgery or treatment. Such robotic systems can include remote steerable systems, automated flexible surgical systems, remote flexible surgical systems, remote articulated surgical systems, wireless surgical systems, modular or selectively configurable remote operation surgical systems, etc.

[0093] Robotic surgical systems can be employed with one or more control consoles either immediately adjacent to the surgical theater or located at a remote location. In this example, one surgeon or team of nurses can prepare a patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein, while another surgeon (or team of surgeons) controls the instruments remotely via the robotic surgical system. As can be appreciated, a highly skilled surgeon can perform multiple operations at multiple locations without leaving his / her remote control console, which is economically advantageous and beneficial to the patient or series of patients.

[0094] The robotic arms of the surgical system are typically coupled to a pair of master handles through a controller. The surgeon can move the handles to cause a corresponding movement of the working end of any type of surgical instrument (e.g., end effectors, graspers, knives, scissors, etc.), which can complement the use of one or more of the embodiments described herein. The movement of the master handles can be scaled so that the working end has a different, smaller, or larger corresponding movement than the movement performed by the operating hands of the surgeon. The scaling factor or gear ratio can be adjustable so that the operator can control the resolution of the working end of the surgical instrument(s).

[0095] The master handles can incorporate various sensors to provide the surgeon with feedback relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting, or other treatment; instrument pressure against tissue; tissue temperature; tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced haptic feedback that simulates the actual operating conditions. The master handles can also incorporate a variety of different actuators for the manipulation or treatment of delicate tissue, further enhancing the surgeon's ability to simulate the actual operating situation.

[0096] Figure 11A medical workbench is shown, which is generally denoted as workbench 1000 and which can generally comprise a plurality of robot arms 1002, 1003; a control device 1004; and an operating console 1005 coupled with the control device 1004. The operating console 1005 can comprise a display device 1006 which can be specifically set to display three-dimensional images; and manual input devices 1007, 1008 by means of which a person, e.g. a surgeon (not shown), can be able to remotely manipulate the robot arms 1002, 1003 in a first mode of operation.

[0097] According to any one of several embodiments disclosed herein, each of the robot arms 1002, 1003 can comprise a plurality of members connected by joints and attachment devices 1009, 1011 to which surgical tools "ST" such as end effectors 1100 can be attached, as will be described in more detail below. In embodiments, the end effectors 1100 can comprise an elongated body (or a portion thereof) and an end effector of any one of the embodiments described in detail, e.g., in which the robot arms 1003 (together with the relevant parts of the control device 1004, the operating console 1005 and / or the manual input devices 1007, 1008) function as a housing 12, 212 (respectively in Figure 1 and 2 ).

[0098] The robot arms 1002, 1003 can be driven by electric drives (not shown) connected to the control device 1004. The control device 1004, e.g. a computer, can be arranged to activate the drives, in particular by means of a computer program, such that the robot arms 1002, 1003, their attachment devices 1009, 1011 and thus the surgical tools, including the end effectors 1100, perform the required movements according to the movements defined by the manual input devices 1007, 1008. The control device 1004 can also be arranged in such a way that it regulates the movements of the robot arms 1002, 1003 and / or the drives.

[0099] The medical workbench 1000 can be configured for a patient 1013 lying on a patient table 1012 to be treated in a minimally invasive manner by the end effectors 1100. The medical workbench 1000 can also comprise more than two robot arms 1002, 1003, the additional robot arms likewise being connected to the control device 1004 and being remotely manipulatable by the operating console 1005. Medical instruments or surgical tools, including end effectors 1100, can also be attached to the additional robot arms. The medical workbench 1000 can comprise a database 1014, in particular a database coupled with the control device 1004, in which preoperative data, e.g. from the patient / living being 1013 and / or a body structure dataset, are stored.

[0100] With particular reference to Figures 12A to 12D , a support system 1200 for a flexible waveguide 1201 is described. The flexible waveguide 1201 includes a plurality of protruding posts 1251, 1252, 1253, 1254 extending from the flexible waveguide 1201. The protruding posts 1251 and 1252 are shaped and dimensioned to be received in corresponding notches 1261 and 1262, respectively. Similarly, the protruding posts 1253 and 1254 are received in corresponding notches 1263 and 1264, respectively. The notches 1261 and 1262 are formed in an inner surface 1265 of the elongated member 1214 and are configured to receive the protruding posts 1253 and 1254 therein, respectively, to secure the flexible waveguide 1201 within the inner lumen 1215 of the elongated member 1214. Some of the plurality of protruding posts 1251, 1252, 1253, 1254 are positioned proximal to the articulating portion 1210 and others of the plurality of protruding posts 1251, 1252, 1253, 1254 are positioned distal to the articulating portion 1210 to allow articulation of the articulating portion 1210 within the inner lumen 1215 and to prevent contact between the articulating portion 1210 and the inner surface 1265 of the elongated member 1214 (see, e.g., Figure 12D ).

[0101] With particular reference to Figures 13A to 13C , a support system 1300 for a flexible waveguide 1301 is described. The flexible waveguide 1301 includes a first annular collar 1351 and a second annular collar 1352 protruding circumferentially from the flexible waveguide 1301. The first annular collar 1351 and the second annular collar 1352 are shaped and dimensioned to be received in corresponding notches 1361, 1362, respectively. The notches 1361 and 1362 are formed circumferentially in an inner surface 1363 of the elongated member 1314 and are configured to receive the annular collars 1351 and 1352 therein, respectively, to secure the flexible waveguide 1301 within the inner lumen 1315 of the elongated member 1314. The annular collars 1351, 1352 and the notches 1361, 1362 are positioned proximal and distal to the articulating portion 1310, respectively, to allow articulation of the articulating portion 1310 within the inner lumen 1315 and to prevent contact between the articulating portion 1310 and the inner surface 1363 of the elongated member 1314.

[0102] With particular reference to Figures 14A to 14CA support system 1400 for a flexible waveguide 1401 is described. The flexible waveguide 1401 includes a first notch 1461 and a second notch 1462 circumferentially formed in an outer surface 1464 of the flexible waveguide 1401. The first notch 1461 and the second notch 1462 are shaped and sized to receive annular collars 1451 and 1452, respectively. The annular collars 1451 and 1452 protrude circumferentially from an inner surface 1463 of the elongated member 1414 and are configured to be received in the first notch 1461 and the second notch 1462, respectively, to secure the flexible waveguide 1401 within the inner lumen 1415 of the elongated member 1414. The annular collars 1451, 1452 and the notches 1461, 1462 are positioned proximal and distal, respectively, of the articulating portion 1410 to allow the articulating portion 1410 to articulate within the inner lumen 1415 and to prevent contact between the articulating portion 1410 and the inner surface 1463 of the elongated member 1414.

[0103] With particular reference to Figures 15A to 15D A support system 1500 for a flexible waveguide 1501 is described. Removable annular collars 1551 and 1552 are positioned around the flexible waveguide 1501. The removable annular collars 1551 and 1552 can each be formed of or include plastic or silicone. The removable annular collars 1551 and 1552 can allow for some degree of longitudinal movement within the inner lumen 1515 of the elongated member 1514 to prevent the flexible waveguide 1501 from being stressed. The removable annular collars 1551 and 1552 are positioned proximal and distal, respectively, of the articulating portion 1510 to allow the articulating portion 1510 to articulate within the inner lumen 1515 and to prevent contact between the articulating portion 1510 and the inner surface 1563 of the elongated member 1514.

[0104] The inner lumen 1515 can include a first notch 1561 and a second notch 1562 circumferentially formed in an inner surface 1563 of the inner lumen 1515. The first notch 1561 and the second notch 1562 are shaped and sized to receive the removable annular collars 1551 and 1552, respectively.

[0105] With particular reference to Figure 16 Another surgical instrument 1610 (except where contradicted below) similar to the previous surgical instrument includes a cable-driven articulation system for articulating an outer tube 1641. The outer tube 1641 is disposed around an inner tube 1640. The inner tube 1640 defines an inner lumen 1615 therethrough.

[0106] As an example, a first cable 1651 extending within a first channel 1653 and a second cable 1652 extending within a second channel 1654 can be employed. However, a single cable or more than two cables can also be employed. Each of the cables 1651 and 1652 can be a tension cable. The cables (e.g., 1651 or 1652) are routed alongside (e.g., on opposite sides of) a waveguide (not shown) through the respective channels (e.g., 1653 or 1654). The channels can be formed along an inner surface of the outer tube 1641 or can be formed along an outer surface of the outer tube 1641. By tensioning one cable and relaxing the other, the articulation of the outer tube 1641 (e.g., articulation 1655) is engaged in its curved configuration. The articulation 1655 allows for a gentle bend by only allowing a certain amount of bend per segment. For example, each articulation 1655 can allow for a 5 degree bend, and thus using 9 articulation segments allows for a total bend of 45 degrees. As an example, by using a pin joint in each articulation 1655, the articulation 1655 only allows bending in one plane, although multiple bending planes can also be considered.

[0107] With particular reference to Figures 17 to 19 , another surgical instrument 1710 is described that is similar to the previous surgical instrument (except where contradicted below), which includes an outer tube 1741. The outer tube 1741 includes a proximal portion 1742 and a distal portion 1743. The outer tube 1741 is positioned around an inner tube 1740. The proximal portion 1742 of the outer tube 1741 defines an articulation segment 1747. The articulation segment 1747 of the outer tube 1741 at least partially overlaps the articulation segment 1748 of the inner tube 1740. The distal portion 1743 of the outer tube 1741 is slidable and rotatable relative to the proximal portion 1742 of the outer tube 1741. An end effector assembly 1700 is supported at a distal end portion of the inner tube 1740.

[0108] The end effector assembly 1700 includes an ultrasonic blade 1702 and a clamp 1701 configured to rotate about the ultrasonic blade 1702. The clamp 1701 is configured to move relative to the ultrasonic blade 1702 between an open position (see, e.g., Figure 17 ) and a clamped position (see, e.g., Figure 19 ), and to radially rotate about the ultrasonic blade 1702 to enable capture and treatment of tissue therebetween at multiple rotational orientations of the clamp 1701 relative to the ultrasonic blade 1702.

[0109] By moving the distal portion 1743 of the outer tube 1741 toward the proximal portion 1742 of the outer tube 1741 (see, e.g., Figure 19) and proximally slide relative to the clamp assembly 1744 supported by the inner tube 1740 to actuate the clamp 1701 relative to the ultrasonic blade 1702. The distal portion 1743 of the outer tube 1741 engages a foot (e.g., 1745) of the clamp assembly 1744 to actuate the clamp 1701 relative to the ultrasonic blade 1702.

[0110] To cause the distal portion 1743 of the outer tube 1741 to slide back and forth, cable tension via cable 1761 is used to pull the distal portion 1743 of the outer tube 1741 proximally, and a spring (not shown) is used to bias the distal portion 1743 of the outer tube 1741 and return it to its original position in the absence of tension on the cable 1761. The cable 1761 can be a tension cable.

[0111] To allow the clamp 1701 to rotate without rotating the cable 1761, a yoke 1762 is utilized that is coupled with the cable 1761. The yoke 1762 is located in a groove 1763 on the distal portion 1743 of the outer tube 1741, allowing the distal portion 1743 of the outer tube 1741 to rotate, but when tension is applied to pull the cable 1761, the yoke 1762 is pulled and the distal portion 1743 of the outer tube 1741 moves proximally with the yoke 1762.

[0112] The yoke 1762 includes a first curved arm 1764 and a second curved arm (not shown, but substantially a mirror image of the first curved arm 1764). The curved arms (e.g., arm 1764) rotatably slide along the groove 1763 formed in the distal portion 1743 of the outer tube 1741. The yoke 1762 includes a guide block 1765 that extends along the longitudinal axis of the proximal portion 1742 of the outer tube 1741. As the distal portion 1743 of the outer tube 1741 moves proximally with the yoke 1762, the guide block 1765 slides along the proximal portion 1742 of the outer tube 1741.

[0113] With particular reference to Figures 20 to 21 The clamp assembly 2044, which includes the clamp 2001, is rotated by a gear transmission 2071 that includes a drive gear 2072 operably coupled to the clamp assembly 2044 and an input gear 2073 engaged with the drive gear 2072, such that rotation of the input gear 2073 rotates the drive gear 2072 to rotate the clamp assembly 2044 and the clamp 2001.

[0114] As an example, a torque cable 2074 coupled to a robotic drive motor (not shown) extends along the length of the surgical instrument to actuate the input gear 2073. The gear transmission 2071 can be positioned in a distal portion 2043 of an outer tube (e.g., see outer tube 2041).

[0115] With particular reference toFigure 22 The inner tube 2240 is rotatably coupled to a proximal portion 2242 of the outer tube 2241. The inner tube 2240 does not slide proximally / distally with the distal portion 2243 of the outer tube 2241, but both the inner tube 2240 and the distal portion 2243 of the outer tube 2241 rotate with each other. The inner tube 2240 can include a groove 2249 and a retaining ring 2299 to rotatably couple the inner tube 2240 to the proximal portion 2242 of the outer tube 2241.

[0116] The inner tube 2240 can include a tab 2250 that is positioned in a slot 2260 of the distal portion 2243 of the outer tube 2241. The slot 2260 engages the tab 2250 to drive rotation of the inner tube 2240 and rotation of the distal portion 2243 of the outer tube 2241. The tab 2250 and the slot 2260 allow the distal portion 2243 of the outer tube 2241 to slide proximally / distally relative to the inner tube 2240 to actuate the clamp 2201.

[0117] With particular reference to Figures 23 to 26 The surgical instrument 2610 includes an outer tube 2381 configured to rotate about an inner tube 2482. A clamp 2601 is pivotably supported by the outer tube 2381. Rotation of the outer tube 2381 about the inner tube 2482 correspondingly rotates the clamp 2601 about an ultrasonic blade 2602 that extends from the inner tube 2482. The inner tube 2482 and the outer tube 2381 can each be a semi-rigid shaft (e.g., including both rigid and flexible portions). The outer tube 2381 drives rotation of the clamp 2601.

[0118] As an example, the outer tube 2381 can be directly welded to a clamp assembly 2644 that includes the clamp member 2601. Thus, rotation of the clamp 2601 is driven by rotation of the entire outer tube 2381 (see, e.g., Figure 26 ).

[0119] The outer tube 2381 is configured to articulate in any direction (see, e.g., Figure 23 ). The inner tube 2482 is configured to articulate substantially along a single plane (see, e.g., Figure 24), although multiple hinged plates can also be considered. The outer tube 2381 includes a helical cutout 2383 configured to allow hinging in any direction and to impart rotation, which is carried to the jaw assembly (e.g., jaw assembly 2644). The configuration of the helical cutout 2383 can be modified to increase or decrease the amount of torque imparted to the jaw assembly (e.g., jaw assembly 2644). The inner tube 2482 includes pairs of opposing cutouts 2384 that are spaced apart from one another. The pairs of cutouts 2384 allow the inner tube 2482 to hinge substantially along a single plane (in a direction substantially perpendicular to the cutouts 2384). The size and spacing of the cutouts 2384 allow for a predetermined degree of bending along the single plane.

[0120] As described herein, a flexible waveguide is rotatably fixed within the inner tube 2482. The flexible waveguide is coupled to the ultrasonic blade 2502.

[0121] With particular reference to Figure 25 and 26 , the hinging of the surgical instrument 2610 can be cable driven. Similar to the cable system described with reference to Figure 16 , the cable 2585 can extend within a channel 2586 formed along the inner tube 2482.

[0122] A barrier layer (not shown), such as a Teflon sleeve, can be positioned between the outer tube 2381 and the inner tube 2482.

[0123] With reference to Figures 27 to 28 , actuation of the jaws 2701 relative to the ultrasonic blade 2702 is described.

[0124] A direct drive, including links 2791 and 2794 that extend along the outer tube 2381, is operably connected with the jaws 2701. A distal link 2792 is connected to a pin 2793 that drives opening and closing of the jaws 2701. As an example, pulling on the links 2791 and 2794 drives the jaws 2701 open (e.g., see Figure 27 ), and pushing on the links 2791 and 2794 drives the jaws 2701 to a clamped position (e.g., see Figure 28 ); however, this arrangement can be reversed such that pulling on the links 2791 and 2794 drives the jaws 2701 closed. As an example, a superelastic nitinol wire 2795 (e.g., see Figure 28 ) can extend along the hinged portion of the outer tube 2381 to connect the links 2791 and 2794 to one another.

[0125] From the foregoing and in reference to various drawing Figures, those skilled in the art will appreciate that certain modifications can also be made to the described embodiments without departing from the scope of the disclosure. Although several embodiments of the disclosure have been illustrated, the disclosure is not to be limited to the embodiments. It is therefore contemplated that the disclosure shall also cover any and all modifications, variations, combinations or equivalents that fall within the scope of the present disclosure as defined by the appended claims.

Claims

1. A surgical instrument (10) comprising an elongated body (14), said elongated body further comprising: Inner tube (2240), which includes a hinged section and defines an inner cavity passing through it; An outer tube (2241) is disposed around the inner tube and includes a proximal portion and a distal portion, the proximal portion of the outer tube defining a hinge section, wherein the hinge section of the outer tube at least partially overlaps with the hinge section of the inner tube, and the distal portion of the outer tube is slidable relative to the proximal portion of the outer tube. An end effector assembly (100) disposed at the distal portion of the inner tube includes an ultrasonic blade (102) and a clamp (101) configured to rotate about the ultrasonic blade, the clamp being configured to move relative to the ultrasonic blade between an open position and a clamping position to capture and treat tissue located between the clamps in multiple rotational orientations of the clamp relative to the ultrasonic blade. as well as A flexible waveguide (301, 401) extends through the inner cavity of the inner tube, and the distal portion of the flexible waveguide is connected to the ultrasonic blade of the end effector assembly. Sliding the distal portion of the outer tube relative to the proximal portion of the outer tube actuates the clamp relative to the ultrasonic blade between the open position and the clamping position; The surgical instrument further includes: A cable (871) extending along the proximal portion of the outer tube, the cable being operatively connected to the distal portion of the outer tube, the cable being configured to slide the distal portion of the outer tube toward the proximal portion of the outer tube in a proximal direction to actuate the clamp to the clamping position relative to the ultrasonic blade. as well as A spring, operably coupled to the distal portion of the outer tube, is configured to bias the distal portion of the outer tube away from the proximal portion in a distal direction, and is configured to bias the clamp relative to the ultrasonic blade to the open or closed position; and The surgical instrument further includes a yoke (1762) operably coupled to the cable and the distal portion of the outer tube, wherein pulling the cable in the proximal direction pulls the distal portion of the outer tube in the proximal direction to actuate the clamps, and the yoke is configured to allow the distal portion of the outer tube to rotate relative to the proximal portion of the outer tube.

2. The surgical instrument according to claim 1, wherein the yoke comprises a first curved arm (1764) and a second curved arm (1743) configured to rotatably slide along a groove (1763) formed in a distal portion of the outer tube, the yoke further comprising a guide block extending along a longitudinal axis of a proximal portion of the outer tube, the guide block being configured to slide along the proximal portion of the outer tube.

3. The surgical instrument according to claim 1, further comprising: A drive gear (2072) operably coupled to the clamp assembly; and An input gear (2073) engages with the drive gear, wherein rotation of the input gear causes rotation of the drive gear to rotate the clamp assembly.

4. The surgical instrument according to claim 3, further comprising a torque cable (2074) operably coupled to the input gear, wherein rotation of the torque cable causes rotation of the input gear.

5. The surgical instrument according to claim 1, wherein the inner tube is rotatably connected to the proximal portion of the outer tube.

6. The surgical instrument of claim 5, wherein the inner tube includes a groove (2249) and the proximal portion of the outer tube includes a retaining ring (2299) positioned in the groove to rotatably connect the inner tube to the proximal portion of the outer tube.

7. The surgical instrument of claim 5, wherein the distal portion of the outer tube includes at least one slot (2260), and the inner tube includes at least one boss (2250) slidably positioned in the at least one slot, wherein the at least one slot allows the distal portion of the outer tube to move proximally and distally relative to the inner tube, and wherein the inner tube rotates in unison with the outer tube.

8. The surgical instrument according to any one of claims 1-7, comprising: The housing (12) has an elongated body extending distally from the housing.

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