Electrosurgical end effector with thermally insulating portion and thermally conductive portion

Abstract

An electrosurgical instrument includes a jaw configured to define an electrode. The jaw includes a first electrically conductive portion, a second electrically conductive portion, and an electrically insulating layer. The first electrically conductive portion is configured to resist heat transfer therethrough. The second electrically conductive portion is integral with the first electrically conductive portion and extends at least partially around the first electrically conductive portion. The second electrically conductive portion is configured to define a heat sink. The electrode is defined by selectively applying the electrically insulating layer to an outer surface of the second electrically conductive portion.

Description

[0001] Cross-references to related applications

[0002] This non-provisional application claims the benefit of U.S. Provisional Patent Application Serial No. 62 / 955,299, filed December 30, 2019, entitled “DEVICES AND SYSTEMS FOR ELECTROSURGERY”, the disclosure of which is incorporated herein by reference in its entirety, pursuant to 35 USC §119(e). Background Technology

[0003] This invention relates to surgical instruments designed for treating tissues, including but not limited to surgical instruments configured to cut and fasten tissues. Surgical instruments may include electrosurgical instruments powered by a generator to perform tissue dissection, cutting, and / or coagulation during surgical procedures. Surgical instruments may include instruments configured to cut and suture tissues using surgical staples and / or fasteners. Surgical instruments may be configured for open surgical procedures, but have applications in other types of surgical procedures (such as laparoscopic, endoscopic, and robot-assisted procedures), and may include end effectors articulate relative to an axial portion of the instrument to facilitate precise positioning within the patient. Summary of the Invention

[0004] In various embodiments, an electrosurgical instrument is disclosed, comprising a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw includes a first conductive frame and a first electrically insulating layer. The first conductive frame includes a first thermally insulating core and a first thermally conductive outer layer integral with and at least partially extending around the first thermally insulating core. The first electrode is defined by selectively applying the first electrically insulating layer to the outer surface of the first thermally conductive outer layer. A second jaw is configured to define a second electrode. The second jaw includes a second conductive frame and a second electrically insulating layer. The second conductive frame includes a second thermally insulating core and a second thermally conductive outer layer integral with and at least partially extending around the second thermally insulating core. The second electrode is defined by selectively applying the second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

[0005] In various embodiments, the present invention discloses an electrosurgical instrument comprising a jaw configured to define an electrode. The jaw includes a first conductive portion, a second conductive portion, and an electrically insulating layer. The first conductive portion is configured to resist heat transfer therethrough. The second conductive portion is integral with the first conductive portion and extends at least partially around the first conductive portion. The second conductive portion is configured to define a heat sink. The electrode is defined by selectively applying the electrically insulating layer to the outer surface of the second conductive portion.

[0006] In various embodiments, the present invention discloses an electrosurgical instrument comprising jaws configured to define an electrode. The jaws include a conductive framework and an electrically insulating layer. The conductive framework includes a thermally insulating core and a thermally conductive outer layer integral with and extending at least partially around the thermally insulating core. The electrode is defined by selectively applying the electrically insulating layer to the outer surface of the thermally conductive outer layer. Attached Figure Description

[0007] The novel features of various aspects are specifically set forth in the appended claims. However, the described aspects relating to both the organization and the method of operation are best understood by referring to the following description in conjunction with the accompanying drawings, wherein:

[0008] Figure 1 An example of a generator for use with a surgical system according to at least one aspect of this disclosure is shown;

[0009] Figure 2 A surgical system according to at least one aspect of the present disclosure is shown, the surgical system comprising a generator and an electrosurgical instrument that can be used therewith;

[0010] Figure 3 A schematic diagram of a surgical instrument or tool according to at least one aspect of this disclosure is shown;

[0011] Figure 4 This is an exploded view of the end effector of an electrosurgical instrument according to at least one aspect of this disclosure;

[0012] Figure 5 yes Figure 4 A cross-sectional view of the end effector;

[0013] Figures 6 to 8 Depicting the process before energy is applied to the tissue Figure 4 Three different operating modes of the end effector;

[0014] Figures 9 to 11 Depicting the process during energy application to tissues Figure 4 Three different operating modes of the end effector;

[0015] Figure 12 A method for manufacturing the jaws of an end effector according to at least one aspect of this disclosure is shown;

[0016] Figure 13 A method for manufacturing the jaws of an end effector according to at least one aspect of this disclosure is shown;

[0017] Figure 14 A partial perspective view of the jaws of the end effector of an electrosurgical instrument according to at least one aspect of the present disclosure is shown;

[0018] Figure 15 Manufacturing process is shown Figure 14 The steps of the jaw-gripping process;

[0019] Figure 16 Manufacturing process is shown Figure 14 The steps of the jaw-gripping process;

[0020] Figures 17 to 19 Manufacturing process is shown Figure 14 The steps of the jaw-gripping process;

[0021] Figure 20 The passage illustrates at least one aspect of this disclosure. Figure 22 A cross-sectional view of the jaws of the end effector of an electrosurgical instrument, taken from line 20-20.

[0022] Figure 21 It shows the way Figure 22 A cross-sectional view of the jaws of the end effector of an electrosurgical instrument, taken along line 21-21.

[0023] Figure 22 It shows Figure 20 A perspective view of the jaws of the end effector of an electrosurgical instrument;

[0024] Figure 23 A cross-sectional view of the jaws of the end effector of an electrosurgical instrument according to at least one aspect of the present disclosure is shown;

[0025] Figure 24 A partial perspective view of the jaws of the end effector of an electrosurgical instrument according to at least one aspect of the present disclosure is shown;

[0026] Figure 25 A cross-sectional view of the end effector of an electrosurgical instrument according to at least one aspect of the present disclosure is shown;

[0027] Figure 26 A partial exploded view of the end effector of an electrosurgical instrument according to at least one aspect of the present disclosure is shown;

[0028] Figure 27An exploded perspective assembly view of a portion of an electrosurgical instrument including an electrical connection assembly according to at least one aspect of the present disclosure is shown.

[0029] Figure 28 At least one aspect of this disclosure is shown. Figure 27 A top view of the electrical pathway defined in the surgical instrument section;

[0030] Figure 29 A cross-sectional view of a flexible circuit according to at least one aspect of the present disclosure is shown;

[0031] Figure 30 A cross-sectional view of a flexible circuit extending through a coil tube according to at least one aspect of this disclosure is shown;

[0032] Figure 31 A cross-sectional view of a flexible circuit extending through a coil tube according to at least one aspect of this disclosure is shown;

[0033] Figure 32 A cross-sectional view of a flexible circuit extending through a coil tube according to at least one aspect of this disclosure is shown;

[0034] Figure 33 A cross-sectional view of a flexible circuit extending through a coil tube according to at least one aspect of this disclosure is shown;

[0035] Figure 34 It is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector, according to at least one aspect of this disclosure;

[0036] Figure 35 It is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector according to at least one aspect of this disclosure, as well as a plurality of measurement parameters of the end effector and the tissue.

[0037] Figure 36 It is a schematic diagram of an electrosurgical system according to at least one aspect of this disclosure;

[0038] Figure 37 This is a table illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector, according to at least one aspect of this disclosure;

[0039] Figures 38 to 40 A tissue treatment cycle, according to at least one aspect of this disclosure, is illustrated, in which an end effector applies the treatment to the tissue treatment area.

[0040] Figure 41An end effector is shown that applies therapeutic energy to tissue gripped by an end effector according to at least one aspect of the present disclosure, the therapeutic energy being generated by a unipolar power source and a bipolar power source;

[0041] Figure 42 A simplified schematic diagram of an electrosurgical system according to at least one aspect of this disclosure is shown;

[0042] Figure 43 It is a graph showing a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector according to at least one aspect of the present disclosure, and the corresponding temperature readings of the tissue treatment area.

[0043] Figure 44 An end effector for treating an artery according to at least one aspect of this disclosure is shown;

[0044] Figure 45 An end effector for treating an artery according to at least one aspect of this disclosure is shown;

[0045] Figure 46 An end effector is shown that applies therapeutic energy to tissue gripped by an end effector according to at least one aspect of the present disclosure, the therapeutic energy being generated by a unipolar power source and a bipolar power source;

[0046] Figure 47 A simplified schematic diagram of an electrosurgical system according to at least one aspect of this disclosure is shown;

[0047] Figure 48 This is a graph illustrating a power scheme according to at least one aspect of this disclosure, including a treatment portion and a non-treatment range for coagulating and cutting tissue treatment areas in a treatment cycle applied by an end effector; and

[0048] Figure 49 This is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector according to at least one aspect of this disclosure, and the corresponding unipolar and bipolar impedances and their ratios. Detailed Implementation

[0049] The applicant of this application owns the following U.S. patent applications filed on the same date as this application, each of which is incorporated herein by reference in its entirety:

[0050] • The agent's case file number, END9234USNP1 / 190717-1M, entitled "METHOD FOR AN ELECTROSURGICAL PROCEDURE";

[0051] • The agent's case file number for the "ARTICULATABLE SURGICAL INSTRUMENT" is END9234USNP2 / 190717-2;

[0052] • The case file number for the agent named “SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES” is END9234USNP3 / 190717-3;

[0053] • The case file number for the agent whose title is “SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLESURGICAL END EFFECTOR” is END9234USNP4 / 190717-4;

[0054] • The agent's case file number for the title "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES" is END9234USNP5 / 190717-5;

[0055] • The agent's case file number END9234USNP6 / 190717-6, titled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT";

[0056] • The agent's case file number for the title "ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES" is END9234USNP7 / 190717-7;

[0057] • The agent's case file number, END9234USNP8 / 190717-8, entitled "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS";

[0058] • The agent's case file number for the title "ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWERSOURCES" is END9234USNP9 / 190717-9;

[0059] • The agent's case file number END9234USNP10 / 190717-10, titled "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGYFOCUSING FEATURES";

[0060] • The agent's case file number END9234USNP11 / 190717-11, titled "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLEENERGY DENSITIES";

[0061] • The agent's case file number for the titled "ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGYCAPABILITIES" is END9234USNP12 / 190717-12;

[0062] • The agent's case file number END9234USNP14 / 190717-14, entitled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE INBIPOLAR AND MONOPOLAR MODES";

[0063] • The agent's case file number for the title "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE" is END9234USNP15 / 190717-15;

[0064] • The agent's case file number END9234USNP16 / 190717-16, entitled "CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USERINPUT";

[0065] • The agent's case file number END9234USNP17 / 190717-17, titled "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE"; and

[0066] • The agent's case file number, END9234USNP18 / 190717-18, is named "SURGICAL SYSTEM COMMUNICATION PATHWAYS".

[0067] The applicant of this patent application owns the following U.S. provisional patent applications filed on December 30, 2019, the entire disclosure of each of which is incorporated herein by reference:

[0068] • U.S. Provisional Patent Application Serial No. 62 / 955,294 entitled “USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATIONENERGY MODALITY END-EFFECTOR”;

[0069] • U.S. Provisional Patent Application Serial No. 62 / 955,292 entitled “COMBINATION ENERGY MODALITY END-EFFECTOR”; and

[0070] • U.S. Provisional Patent Application Serial No. 62 / 955,306 entitled “SURGICAL INSTRUMENT SYSTEMS”.

[0071] The applicant of this patent application owns the following U.S. patent applications, the entire disclosure of each of which is incorporated herein by reference:

[0072] • U.S. Patent Application Serial No. 16 / 209,395, entitled “METHOD OF HUB COMMUNICATION”, now U.S. Patent Application Publication No. 2019 / 0201136;

[0073] • U.S. Patent Application Serial No. 16 / 209,403, entitled “METHOD OF CLOUD BASED DATAANALYTICS FOR USE WITH THE HUB”, now U.S. Patent Application Publication No. 2019 / 0206569;

[0074] • U.S. Patent Application Serial No. 16 / 209,407, entitled “METHOD OF ROBOTIC HUBCOMMUNICATION, DETECTION, AND CONTROL”, now U.S. Patent Application Publication No. 2019 / 0201137;

[0075] • U.S. Patent Application Serial No. 16 / 209,416, entitled “METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS”, now U.S. Patent Application Publication No. 2019 / 0206562;

[0076] • U.S. Patent Application Serial No. 16 / 209,423, entitled “METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THETISSUE WITHIN THE JAWS”, now U.S. Patent Application Publication No. 2019 / 0200981;

[0077] • U.S. Patent Application Serial No. 16 / 209,427, entitled “METHOD OF USING REINFORCEDFLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZE PERFORMANCE OF RADIOFREQUENCY DEVICES”, now U.S. Patent Application Publication No. 2019 / 0208641;

[0078] • U.S. Patent Application Serial No. 16 / 209,433, entitled “METHOD OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMP SPEED BASED ON THESENSED INFORMATION, AND COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB”, now U.S. Patent Application Publication No. 2019 / 0201594;

[0079] • U.S. Patent Application Serial No. 16 / 209,447, entitled “METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB”, now U.S. Patent Application Publication No. 2019 / 0201045;

[0080] • U.S. Patent Application Serial No. 16 / 209,453, entitled “METHOD FOR CONTROLLING SMARTENERGY DEVICES”, now U.S. Patent Application Publication No. 2019 / 0201046;

[0081] • U.S. Patent Application Serial No. 16 / 209,458, entitled “METHOD FOR SMART ENERGYDEVICE INFRASTRUCTURE”, now U.S. Patent Application Publication No. 2019 / 0201047;

[0082] • U.S. Patent Application Serial No. 16 / 209,465, entitled “METHOD FOR ADAPTIVE CONTROLSCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION”, now U.S. Patent Application Publication No. 2019 / 0206563;

[0083] • U.S. Patent Application Serial No. 16 / 209,478, entitled “METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION OR USAGE”, now U.S. Patent Application Publication No. 2019 / 0104919;

[0084] • U.S. Patent Application Serial No. 16 / 209,490, entitled “METHOD FOR FACILITY DATACOLLECTION AND INTERPRETATION”, now U.S. Patent Application Publication No. 2019 / 0206564;

[0085] • U.S. Patent Application Serial No. 16 / 209,491, entitled “METHOD FOR CIRCULAR STAPLERCONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS”, now U.S. Patent Application Publication No. 2019 / 0200998;

[0086] • U.S. Patent Application Serial No. 16 / 562,123, entitled “METHOD FOR CONSTRUCTING ANDUSING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES”;

[0087] • U.S. Patent Application Serial No. 16 / 562,135, entitled “METHOD FOR CONTROLLING ANENERGY MODULE OUTPUT”;

[0088] • U.S. Patent Application Serial No. 16 / 562,144, entitled “METHOD FOR CONTROLLING AMODULAR ENERGY SYSTEM USER INTERFACE”; and

[0089] • U.S. Patent Application Serial No. 16 / 562,125, entitled “METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM”.

[0090] Before detailing the various aspects of the electrosurgical system, it should be noted that the illustrative examples are not limited in application or use to the details of the construction and arrangement of the components shown in the drawings and specifications. The illustrative examples may be implemented or incorporated in other aspects, variations, and modifications, and may be practiced or performed in various ways. Furthermore, unless otherwise specified, the terminology and expressions used herein are chosen for the convenience of the reader in describing the illustrative examples and are not intended to be restrictive. Moreover, it should be understood that one or more of the aspects, expressions, and / or examples described below may be combined with any one or more of the other aspects, expressions, and / or examples described below.

[0091] The various aspects involve an electrosurgical system comprising electrosurgical instruments powered by a generator to perform tissue dissection, cutting, and / or coagulation during surgical procedures. These electrosurgical instruments can be configured for use in open surgical procedures, but can also be applied to other types of surgery, such as laparoscopic, endoscopic, and robot-assisted procedures.

[0092] As described in more detail below, electrosurgical instruments typically include an axis with a distally mounted end effector (e.g., one or more electrodes). This end effector is positioned against tissue so that current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, current is introduced into and returns to the tissue via the active electrode and return electrode of the end effector, respectively. During monopolar operation, current is introduced into the tissue via the active electrode of the end effector and returns via a return electrode (e.g., a grounding pad) separately positioned on the patient's body. The heat generated by the current flowing through the tissue can create a hemostatic seal within and / or between tissues, and is therefore particularly suitable for, for example, sealing blood vessels.

[0093] Figure 1 An example of a generator 900 configured to deliver multiple energy modes to a surgical instrument is shown. The generator 900 provides RF signals and / or ultrasound signals for delivering energy to the surgical instrument. The generator 900 includes at least one generator output that can deliver multiple energy modes (e.g., ultrasound, bipolar or monopolar RF, irreversible and / or reversible electroporation and / or microwave energy, etc.) through a single port, and these signals can be delivered separately or simultaneously to an end effector to process tissue. The generator 900 includes a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate multiple signal waveforms based on information stored in a memory coupled to the processor 902, which is not shown for clarity in this disclosure. Digital information associated with the waveforms is provided to the waveform generator 904, which includes one or more DAC circuits to convert the digital inputs into analog outputs. The analog outputs are fed to an amplifier 906 for signal conditioning and amplification. The regulated and amplified output of amplifier 906 is coupled to power transformer 908. The signal is coupled to the secondary side in the patient isolation area via power transformer 908. A first signal of the first energy mode is provided to a surgical instrument between terminals labeled ENERGY1 and RETURN. A second signal of the second energy mode is coupled across capacitor 910 and provided to a surgical instrument between terminals labeled ENERGY2 and RETURN. It should be understood that more than two energy modes can be output, and therefore the subscript "n" can be used to specify that up to n ENERGY signals can be provided. n Terminals, where n is a positive integer greater than 1. It should also be understood that, without departing from the scope of this disclosure, up to "n" return paths can be provided. n .

[0094] A first voltage sensing circuit 912 is coupled to both ends of a terminal labeled ENERGY1 and RETURN path to measure the output voltage between them. A second voltage sensing circuit 924 is coupled to both ends of a terminal labeled ENERGY2 and RETURN path to measure the output voltage between them. As shown, a current sensing circuit 914 is connected in series with the RETURN branch on the secondary side of the power transformer 908 to measure the output current of any energy mode. If a different return path is provided for each energy mode, a separate current sensing circuit should be provided in each return branch. The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to corresponding isolation transformers 928, 922, and the output of the current sensing circuit 914 is provided to another isolation transformer 916. The outputs of the isolation transformers 916, 928, 922 on the primary side of the power transformer 908 (non-patient isolation side) are provided to one or more ADC circuits 926. The digitized output of the ADC circuit 926 is provided to the processor 902 for further processing and calculation. The output voltage and current supplied to surgical instruments can be adjusted using output voltage and current feedback information, and parameters such as output impedance can be calculated. Input / output communication between the processor 902 and the patient isolation circuit is provided through interface circuit 920. Sensors can also communicate electrically with the processor 902 through interface circuit 920.

[0095] In one aspect, impedance can be determined by processor 902 by dividing the output of a first voltage sensing circuit 912 coupled to the terminals labeled ENERGY1 / RETURN or a second voltage sensing circuit 924 coupled to the terminals labeled ENERGY2 / RETURN by the output of a current sensing circuit 914 connected in series with the RETURN branch on the secondary side of power transformer 908. The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to separate isolation transformers 928, 922, and the output of the current sensing circuit 914 is provided to another isolation transformer 916. Digital voltage and current sensing measurements from ADC circuit 926 are provided to processor 902 for impedance calculation. For example, the first energy mode ENERGY1 can be RF unipolar energy, and the second energy mode ENERGY2 can be RF bipolar energy. However, in addition to bipolar and unipolar RF energy modes, other energy modes include ultrasonic energy, irreversible and / or reversible electroporation and / or microwave energy, etc. Moreover, although Figure 1 The example shown illustrates that a single return path (RETURN) can be provided for two or more energy modes, but in other respects, ENERGY can be provided for each energy mode. n Provide multiple return paths RETURN n .

[0096] like Figure 1 As shown, a generator 900 including at least one output port may include a power transformer 908 having a single output and multiple taps to provide power to the end effector in one or more energy modes (such as ultrasound, bipolar or monopolar RF, irreversible and / or reversible electroporation and / or microwave energy, etc.) depending on the type of tissue treatment being performed. For example, generator 900 may deliver energy with higher voltage and lower current to drive an ultrasound transducer, with lower voltage and higher current to drive an RF electrode for sealing tissue, or with a coagulation waveform for point coagulation using a monopolar or bipolar RF electrosurgical electrode. The output waveform from generator 900 may be manipulated, switched, or filtered to provide a frequency to the end effector of a surgical instrument. In one example, the connection between the RF bipolar electrode and the output of generator 900 would preferably be located between the outputs labeled ENERGY2 and RETURN. In the case of a monopolar output, the preferred connection would be the active electrode (e.g., a pencil or other probe) at the ENERGY2 output and a suitable return pad connected to the RETURN output.

[0097] Additional details are disclosed in U.S. Patent Application Publication 2017 / 0086914, entitled “TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS”, published on March 30, 2017, the entire contents of which are incorporated herein by reference.

[0098] Figure 2 A form of a surgical system 1000 is shown, comprising a generator 1100 and various surgical instruments 1104, 1106, 1108 for use therewith, wherein surgical instrument 1104 is an ultrasonic surgical instrument, surgical instrument 1106 is an RF electrosurgical instrument, and multifunctional surgical instrument 1108 is a combination of ultrasonic / RF electrosurgical instruments. The generator 1100 can be configured for use with a variety of surgical devices. Depending on the form, the generator 1100 can be configured for use with different types of surgical instruments, including, for example, ultrasonic surgical instruments 1104, RF electrosurgical instruments 1106, and multifunctional surgical instruments 1108 integrating RF energy and ultrasonic energy delivered simultaneously from the generator 1100. Although in Figure 2In one embodiment, generator 1100 is shown as independent of surgical instruments 1104, 1106, and 1108; however, in another embodiment, generator 1100 may be integrally formed with any of surgical instruments 1104, 1106, and 1108 to form an integrated surgical system. Generator 1100 includes an input device 1110 located on the front panel of generator 1100's control panel. Input device 1110 may include any suitable means for generating signals suitable for programming the operation of generator 1100. Generator 1100 may be configured for wired or wireless communication.

[0099] Generator 1100 is configured to drive multiple surgical instruments 1104, 1106, and 1108. The first surgical instrument is an ultrasonic surgical instrument 1104 and includes a handheld device 1105 (HP), an ultrasonic transducer 1120, a shaft 1126, and an end effector 1122. End effector 1122 includes an ultrasonic scalpel 1128 acoustically coupled to the ultrasonic transducer 1120 and a clamping arm 1140. Handheld device 1105 includes a trigger 1143 for operating the clamping arm 1140 and a combination of toggle buttons 1137, 1134b, and 1134c for powering the ultrasonic scalpel 1128 and driving the ultrasonic scalpel or other functions. Toggle buttons 1137, 1134b, and 1134c can be configured to power the ultrasonic transducer 1120 using generator 1100.

[0100] The generator 1100 is also configured to drive a second surgical instrument 1106. The second surgical instrument 1106 is an RF electrosurgical instrument and includes a handheld device 1107 (HP), a shaft 1127, and an end effector 1124. The end effector 1124 includes electrodes in gripping arms 1145, 1142b and returns through an electrically conductive portion of the shaft 1127. These electrodes are coupled to and powered by a bipolar energy source within the generator 1100. The handheld device 1107 includes a trigger 1145 for operating the gripping arms 1145, 1142b and an energy button 1135 for actuating an energy switch to power the electrodes in the end effector 1124. The second surgical instrument 1106 can also be used with a return pad to deliver monopolar energy to tissue.

[0101] The generator 1100 is also configured to drive a multi-functional surgical instrument 1108. The multi-functional surgical instrument 1108 includes a handheld component 1109 (HP), a shaft 1129, and an end effector 1125. The end effector 1125 includes an ultrasonic scalpel 1149 and a clamping arm 1146. The ultrasonic scalpel 1149 is acoustically coupled to an ultrasonic transducer 1120. The handheld component 1109 includes a combination of a trigger 1147 for operating the clamping arm 1146 and switching buttons 11310, 1137b, 1137c for powering the ultrasonic scalpel 1149 and driving the ultrasonic scalpel or other functions. The switching buttons 11310, 1137b, 1137c can be configured to power the ultrasonic transducer 1120 using the generator 1100 and to power the ultrasonic scalpel 1149 using a bipolar energy source also included in the generator 1100. Monopolar energy can be delivered to tissues in combination with or separately from bipolar energy.

[0102] Generator 1100 is configurable for use with a variety of surgical devices. Depending on the form, generator 1100 can be configurable for use with different types of surgical instruments, including, for example, ultrasonic surgical instruments 1104, RF electrosurgical instruments 1106, and multifunctional surgical instruments 1108 that integrate RF energy and ultrasonic energy delivered simultaneously from generator 1100. Although in Figure 2 In one embodiment, generator 1100 is shown as independent of surgical instruments 1104, 1106, and 1108; however, in another embodiment, generator 1100 may be integrally formed with any of surgical instruments 1104, 1106, and 1108 to form an integrated surgical system. As discussed above, generator 1100 includes an input device 1110 located on the front panel of generator 1100's control panel. Input device 1110 may include any suitable means for generating signals suitable for programming the operation of generator 1100. Generator 1100 may also include one or more output devices 1112. Further aspects of generators and surgical instruments for digitally generating electrical signal waveforms are described in U.S. Patent Application Publication US-2017-0086914-A1, the entire contents of which are incorporated herein by reference.

[0103] Figure 3 A schematic diagram of a surgical instrument or tool 600 is shown, comprising multiple motor assemblies that can be activated to perform various functions. In the example shown, a closing motor assembly 610 is operable to switch the end effector between an open and closed configuration, and a joint motion motor assembly 620 is operable to articulate the end effector relative to a shaft assembly. In some cases, multiple motor assemblies can be activated individually to result in firing motion, closing motion, and / or joint motion in the end effector. Firing motion, closing motion, and / or joint motion can be transmitted to the end effector, for example, via the shaft assembly.

[0104] In some cases, the closing motor assembly 610 includes a closing motor. The closing member 603 may be operatively coupled to a closing motor drive assembly 612, which may be configured to transmit a closing motion generated by the motor to an end effector, specifically for displacing the closing member to perform closure, thereby changing the end effector to a closed configuration. The closing motion may, for example, change the end effector from an open configuration to a closed configuration to capture tissue. The end effector can be changed to an open position by reversing the direction of the motor.

[0105] In some cases, the articulated motor assembly 620 includes an articulated motor operatively coupled to the articulated drive assembly 622, which can be configured to transmit articulated motion generated by the motor to an end effector. In some cases, the articulated motion can cause the end effector to articulate relative to an axis, for example.

[0106] One or more of the motors in the surgical instrument 600 may include a torque sensor to measure the output torque on the motor shaft. Force on the end effector can be sensed in any conventional manner, such as by a force sensor on the outside of the jaws or by a torque sensor of the motor used to actuate the jaws.

[0107] In various cases, motor assemblies 610, 620 include one or more motor drivers, which may include one or more H-bridge FETs. The motor drivers can regulate the power delivered from the power source 630 to the motor based on inputs from, for example, a microcontroller 640 (“controller”) from control circuitry 601. In some cases, the microcontroller 640 can be used to determine, for example, the current drawn by the motor.

[0108] In some cases, the microcontroller 640 may include a microprocessor 642 (“processor”) and one or more non-transitory computer-readable media or storage units 644 (“memory”). In some cases, the memory 644 may store various program instructions that, when executed, cause the processor 642 to perform the various functions and / or calculations described herein. In some cases, one or more of the memory units 644 may be coupled to the processor 642, for example. In various aspects, the microcontroller 640 may communicate via wired or wireless channels or combinations thereof.

[0109] In some cases, power source 630 may be used, for example, to supply power to microcontroller 640. In some cases, power source 630 may include a battery (or “battery pack” or “power pack”), such as a lithium-ion battery. In some cases, the battery pack may be configured to be releasably mounted to the handle for supplying power to surgical instrument 600. Multiple battery cells connected in series may be used as power source 630. In some cases, power source 630 may be, for example, replaceable and / or rechargeable.

[0110] In various situations, processor 642 can control the motor driver to control the position, direction of rotation, and / or speed of the motors in components 610 and 620. In some cases, processor 642 can send signals to the motor driver to stop and / or deactivate the motor. It should be understood that the term "processor" as used herein includes any suitable microprocessor, microcontroller, or other basic computing device that combines the functionality of a computer's central processing unit (CPU) on one or at most a few integrated circuits. Processor 642 is a versatile programmable device that receives digital data as input, processes the input according to instructions stored in its memory, and then provides the result as output. Because the processor has internal memory, it is an example of sequential digital logic. The processor operates on numbers and symbols represented in a binary number system.

[0111] In one scenario, processor 642 can be any single-core or multi-core processor, such as those known to be manufactured by Texas Instruments under the trade name ARM Cortex. In some cases, microcontroller 620 can be, for example, an LM 4F230H5QR available from Texas Instruments. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor chip that includes: 256KB of single-cycle flash memory or other non-volatile memory (up to 40MHz) on-chip memory, a prefetch buffer for improving performance above 40MHz, 32KB of single-cycle SRAM, and a... The software includes an internal ROM, a 2KB EEPROM, one or more PWM modules, one or more QEI emulations, one or more 12-bit ADCs with 12 analog input channels, and other readily available features. Other microcontrollers can be easily substituted for use with the surgical instrument 600. Therefore, this disclosure should not be limited to this context.

[0112] In some cases, memory 644 may include program instructions for controlling each of the motors in the surgical instrument 600. For example, memory 644 may include program instructions for controlling the closure motor and the joint movement motor. Such program instructions enable processor 642 to control the closure and joint movement functions based on inputs from an algorithm or control program from the surgical instrument 600.

[0113] In some cases, one or more mechanisms and / or sensors, such as sensor 645, can be used to alert processor 642 to program instructions that should be used in a particular setting. For example, sensor 645 can alert processor 642 to use program instructions associated with closing and articulated end effectors. In some cases, sensor 645 may include, for example, a position sensor that can be used to sense the position of the closing actuator. Thus, if processor 642 receives a signal from sensor 630 indicating actuation of the closing actuator, processor 642 can use program instructions associated with the closing end effector to activate the motor of the closing drive assembly 620.

[0114] In some examples, the motor may be a brushless DC electric motor, and the corresponding motor drive signal may include a PWM signal provided to one or more stator windings of the motor. Furthermore, in some examples, the motor driver may be omitted, and the control circuit 601 may directly generate the motor drive signal.

[0115] A common practice during various laparoscopic surgical procedures is to insert the surgical end effector portion of a surgical instrument into the surgical site located within the patient's abdomen via a cannula already embedded in the abdominal wall. In its simplest form, a cannula is a pen-shaped instrument with a sharp triangular dot at one end, typically used within a hollow tube (called a cannula or sleeve) to form an opening into the body through which the surgical end effector can be introduced. This arrangement forms an access port into the body cavity through which the surgical end effector can be inserted. The inner diameter of the cannula of the cannula necessarily limits the size of the end effector and drive support shaft of the surgical instrument that can be inserted through the cannula.

[0116] Regardless of the specific type of surgical procedure being performed, once a surgical end effector has been inserted into the patient through the cannula, it is generally necessary to move the surgical end effector relative to the shaft assembly positioned within the cannula in order to properly position the surgical end effector relative to the tissue or organ to be treated. This movement or positioning of the surgical end effector relative to the portion of the shaft held within the cannula is commonly referred to as the “articular movement” of the surgical end effector. Various articulation joints have been developed to attach the surgical end effector to the associated shaft to facilitate such articulation of the surgical end effector. As may be expected in many surgical procedures, it is desirable to employ a surgical end effector with the largest possible range of articulation.

[0117] Due to the dimensional constraints imposed by the size of the cannula, the dimensions of the articulation joint components must be configured to allow free insertion through the cannula. These dimensional constraints also limit the size and composition of various drive elements and components that operatively intersect with the motor and / or other control systems housed within a housing that may be handheld or part of a larger automated system. In many cases, these drive elements must operatively pass through the articulation joint to operatively couple to or intersect with a surgical end effector. For example, one such drive element is typically used to apply articulated motion control to a surgical end effector. During use, the articulation drive element may be de-actuated to position the surgical end effector in a non-articular position to facilitate insertion of the surgical end effector through the cannula, and then actuated once the surgical end effector has been inserted into the patient to articulate the surgical end effector to the desired position.

[0118] Therefore, the aforementioned dimensional constraints present numerous challenges for developing articulation systems that can achieve the desired range of joint motion but are necessary to accommodate the various actuation systems required for manipulating the diverse features of a surgical end effector. Furthermore, once the surgical end effector is positioned in the desired joint motion location, the articulation system and articulation joint must be able to hold the surgical end effector in that position during actuation and the completion of surgical procedures. Such articulation joint arrangements must also be able to withstand the external forces experienced by the end effector during use.

[0119] Various modalities exist for the use of one or more surgical devices throughout a specific surgical procedure. For example, communication pathways extending between surgical devices and centralized surgical centers can facilitate the efficiency and increase the success of surgical procedures. In various scenarios, each surgical device within a surgical system includes a display that transmits the presence and / or operational status of other surgical devices within the system. Surgical centers can use the information received through the communication pathways to assess the compatibility of surgical devices for use with each other, evaluate the compatibility of surgical devices for use during a specific surgical procedure, and / or optimize the operational parameters of surgical devices. As described in more detail herein, the operational parameters of one or more surgical devices can be optimized based on patient demographics, the specific surgical procedure, and / or environmental conditions being monitored, such as tissue thickness.

[0120] Figure 4 and Figure 5 An exploded view of the end effector 1200 of an electrosurgical instrument (e.g., the surgical instrument described in U.S. Patent Application Attorney General's File No. END9234USNP2 / 190717-2) is shown. Figure 4 ) and sectional view ( Figure 5 For example, end effector 1200 can be actuated, articulated, and / or rotated relative to the shaft assembly of a surgical instrument in a manner similar to that described in U.S. Patent Attorney General's File No. END9234USNP2 / 190717-2. Additionally, end effector 1200 and other similar end effectors described elsewhere herein may be powered by one or more generators of the surgical system. An exemplary surgical system for use with surgical instruments is described in U.S. Application No. 16 / 562,123, filed September 5, 2019, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES," the entire contents of which are incorporated herein by reference.

[0121] refer to Figures 6 to 8The end effector 1200 includes a first jaw 1250 and a second jaw 1270. At least one of the first jaw 1250 and the second jaw 1270 is pivotable toward or away from the other jaw to switch the end effector 1200 between an open configuration and a closed configuration. The jaws 1250 and 1270 are configured to grip tissue between the two jaws to apply at least one of therapeutic energy and non-therapeutic energy to the tissue. Energy delivery to the tissue gripped by the jaws 1250 and 1270 of the end effector 1200 is achieved by electrodes 1252, 1272, and 1274, which are configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combination of alternating or mixed bipolar and monopolar energies. The different energy modes that can be delivered to tissue by the end effector 1200 are described in more detail elsewhere in this disclosure.

[0122] In addition to electrodes 1252, 1272, and 1274, a patient return pad is also used for the application of unipolar energy. Furthermore, an electrically isolated generator is used to deliver both bipolar and unipolar energy. During use, the patient return pad can detect accidental electrical crosstalk by monitoring the power transfer through one or more suitable sensors on the return pad. Accidental electrical crosstalk can occur when both bipolar and unipolar energy modes are used simultaneously. In at least one example, the bipolar mode uses a higher current (e.g., 2-3 amps) than the unipolar mode (e.g., 1 amp). In at least one example, the return pad includes control circuitry and at least one sensor (e.g., a current sensor) coupled thereto. During use, the control circuitry can receive an input indicating an accidental electrical crosstalk based on measurements from at least one sensor. In response, the control circuitry can employ a feedback system to issue an alarm and / or suspend the application of one or both of the bipolar and unipolar energy modes to the tissue.

[0123] In addition to the above, the jaws 1250, 1270 of the end effector 1200 include angular profiles, wherein multiple angles are defined between discrete portions of each of the jaws 1250, 1270. For example, a first angle is defined by portions 1250a, 1250b ( Figure 4 The first jaw 1250 is defined by portions 1250b and 1250c, and the second angle is defined by portions 1270a and 1270b of the second jaw 1270. Similarly, the first angle is defined by portions 1270a and 1270b, and the second angle is defined by portions 1270b and 1270c of the second jaw 1270. In each respect, the discrete portions of jaws 1250 and 1270 are linear segments. Continuous linear segments intersect at angles such as the first angle or the second angle. The linear segments cooperate to form a general angular profile for each of jaws 1250 and 1270. The angular profile is generally curved away from the central axis.

[0124] In one example, the first angle and the second angle are the same or at least substantially the same. In another example, the first angle and the second angle are different. In yet another example, the first angle and the second angle include values ​​selected from a range of about 120° to about 175°. In still another example, the first angle and the second angle include values ​​selected from a range of about 130° to about 170°.

[0125] Furthermore, portions 1250a and 1270a, which are proximal portions, are larger than portions 1250b and 1270b, which are intermediate portions. Similarly, intermediate portions 1250b and 1270b are larger than portions 1250c and 1270c. In other examples, the distal portion may be larger than the intermediate and / or proximal portions. In other examples, the intermediate portion is larger than the proximal and / or distal portions.

[0126] In addition to the above, the electrodes 1252, 1272, and 1274 of the jaws 1250 and 1270 include angular profiles similar to those of the jaws 1250 and 1270. Figure 4 , Figure 5 In the example, electrodes 1252, 1272, and 1274 respectively include discrete segments 1252a, 1252b, 1252c, 1272a, 1272b, 1272c, 1274a, 1274b, and 1274c, which define a first angle and a second angle at their respective intersections, as described above.

[0127] When in the closed configuration, jaws 1250 and 1270 cooperate to define end electrodes 1260 formed by electrode portions 1261 and 1262 at the distal ends of jaws 1250 and 1270, respectively. End electrodes 1260 can be powered to deliver monopolar energy to the tissue in contact with them. For example, both electrode portions 1261 and 1262 can be activated simultaneously to deliver monopolar energy, such as... Figure 6 As shown, or alternatively, only one of electrode portions 1261, 1262 may be selectively activated to deliver unipolar energy on one side of the distal end electrode 1260, such as Figure 10 As shown.

[0128] In the closed configuration, the angular profiles of jaws 1250 and 1270 cause the end electrode 1260 to lie on one side of a plane extending laterally between proximal portions 1252c and 1272c. The angular profiles also cause the intersections of portions 1252b, 1252c, 1272b, 1272c, and 1274b, 1274c to lie on the same side of the plane as the end electrode 1260.

[0129] In at least one example, jaws 1250, 1270 include conductive frameworks 1253, 1273, which may be composed of or at least partially composed of a conductive material (e.g., titanium). Frameworks 1253, 1273 may be composed of other conductive materials (e.g., aluminum). In at least one example, frameworks 1253, 1273 are prepared by injection molding. In various examples, frameworks 1253, 1273 are selectively coated / covered with an insulating material to prevent thermal and electrical conduction in all but predefined thin energy-providing regions forming electrodes 1252, 1272, 1274, 1260. Frameworks 1253, 1273 act as electrodes with electron focusing, wherein jaws 1250, 1270 have built-in isolation from one jaw to another. The insulating material may be an insulating polymer, such as polytetrafluoroethylene (e.g., PTFE). The energy-providing regions defined by electrodes 1252 and 1272 are located inside the jaws 1250 and 1270, and can operate independently in bipolar mode to deliver energy to the tissue gripped between the jaws 1250 and 1270. Simultaneously, the energy-providing regions defined by electrode tips 1260 and 1274 are located outside the jaws 1250 and 1270, and can operate in unipolar mode to deliver energy to the tissue adjacent to the outer surface of the end effector 1200. Both jaws 1250 and 1270 can be powered to deliver energy in unipolar mode.

[0130] In all aspects, coating 1264 is high-temperature polytetrafluoroethylene (e.g., A coating, selectively applied to a conductive skeleton, creates selectively exposed internal metallic portions that define three-dimensional geometric electronic modulation (GEM) for focused dissection and coagulation. In at least one example, coating 1264 comprises a thickness of about 0.003 inches, about 0.0035 inches, or about 0.0025 inches. In various examples, the thickness of coating 1264 can be any value selected from: the range of about 0.002 inches to about 0.004 inches, the range of about 0.0025 inches to about 0.0035 inches, or the range of about 0.0027 inches to about 0.0033 inches. This disclosure covers other thicknesses of coating 1263 capable of three-dimensional geometric electronic modulation (GEM).

[0131] Electrodes 1252 and 1272, which cooperate to transmit bipolar energy through tissue, are biased to prevent short circuits. As energy flows between the biased electrodes 1252 and 1272, the tissue gripped therebetween is heated, thereby creating a seal in the region between the electrodes 1252 and 1272. Simultaneously, the regions of the jaws 1250 and 1270 surrounding the electrodes 1252 and 1272 provide non-conductive tissue contact surfaces due to the selective deposition of the insulating coating 1264 onto these regions of the jaws 1250 and 1270, but not onto the electrodes 1252 and 1272. Therefore, the electrodes 1252 and 1272 are defined by the areas of the metallic jaws 1250 and 1270 that remain exposed after the insulating coating 1264 is applied to the jaws 1250 and 1270. While the jaws 1250 and 1270 are generally formed of a conductive material in this example, the non-conductive regions are defined by the electrically insulating coating 1264.

[0132] Figure 6 The diagram illustrates the application of a bipolar energy mode to tissue gripped between jaws 1250 and 1270. In the bipolar energy mode, RF energy flows through the tissue along path 1271, which is inclined relative to a bend plane (CL) that extends centrally and longitudinally bisects jaws 1250 and 1270 such that electrodes 1252 and 1272 are on opposite sides of the bend plane (CL). In other words, the tissue area that actually receives bipolar RF energy will only be the tissue that contacts and extends between electrodes 1252 and 1257. Therefore, the tissue gripped by jaws 1250 and 1270 will not receive RF energy across the entire lateral width of jaws 1250 and 1270. Thus, this configuration minimizes thermal diffusion caused by the application of bipolar RF energy to the tissue. This minimization of thermal diffusion, in turn, minimizes potential collateral damage to tissue adjacent to specific tissue areas that the surgeon wishes to engage / seal / coagulate and / or cut.

[0133] In at least one example, in a closed configuration without any organization therebetween, a lateral gap is defined between the bias electrodes 1252, 1272. In at least one example, in the closed configuration, the lateral gap is defined between the bias electrodes 1252, 1272 by any distance selected from: a range of about 0.01 inches to about 0.025 inches, a range of about 0.015 inches to about 0.020 inches, or a range of about 0.016 inches to about 0.019 inches. In at least one example, the lateral gap is defined by a distance of about 0.017 inches.

[0134] exist Figure 4 and Figure 5In the example shown, electrodes 1252, 1272, and 1274 have a gradually narrowing width as each of electrodes 1252, 1272, and 1274 extends from its proximal end to its distal end. Therefore, the proximal segments 1252a, 1272a, and 1274a each have a surface area larger than that of the intermediate segments 1252b, 1272b, and 1274b. Furthermore, the intermediate segments 1252b, 1272b, and 1274b each have a surface area larger than that of the distal segments 1252c, 1272c, and 1274c.

[0135] The angular and narrowed profiles of jaws 1250 and 1270 give the end effector 1200 a curved, finger-like or hook-like shape in a closed configuration. This shape, by oriented the end effector 1200 such that the electrode tip 1260 points downward toward the tissue, allows for the use of the end electrode 1260 (…). Figure 10 This allows for precise delivery of energy to a small portion of the tissue. In this orientation, only the electrode tip 1260 contacts the tissue, which focuses the energy delivery onto the tissue.

[0136] In addition, such as Figure 8 As shown, electrode 1274 extends on the outer surface of the peripheral side 1275 of the second jaw 1270, providing it with the ability to effectively separate tissue in contact with it when the end effector 1200 is in a closed configuration. For tissue separation, the end effector 1200 is at least partially positioned on the peripheral side 1275 including electrode 1274. Activation of the unipolar energy mode of the jaw 1270 causes unipolar energy to flow through electrode 1274 into the tissue in contact with it.

[0137] Figures 9 to 11 An end effector 1200' is shown, which is used in bipolar energy operation mode via electrodes 1252', 1272' ( Figure 9 Bipolar energy is delivered to the tissue, unipolar energy is delivered to the tissue via electrode tip 1261 in a first unipolar operating mode, and / or unipolar energy is delivered to the tissue via external electrode 1274 in a second unipolar operating mode. End effector 1200' is similar to end effector 1200 in many respects. Therefore, for the sake of brevity, the various features of end effector 1200' previously described with respect to end effector 1200 will not be repeated herein at the same level of detail.

[0138] Electrodes 1252' and 1272' differ from electrodes 1252″ and 1272″ in that they define stepped or non-uniform tissue contact surfaces 1257 and 1277. The conductive framework 1253' and 1273' of the jaws 1250' and 1270' include protrusions or projections forming the conductive tissue contact surfaces of electrodes 1252' and 1272'. Coating 1264 partially surrounds the protrusions or projections forming the electrodes 1252' and 1272', exposing only the conductive tissue contact surfaces of the electrodes 1252' and 1272'. Therefore, in Figure 9 In the example shown, each of the tissue contact surfaces 1257 and 1277 includes a step comprising a conductive tissue contact surface positioned between two insulating tissue contact surfaces that cause the step to gradually descend. In other words, each of the tissue contact surfaces 1257 and 1277 includes a first partially conductive tissue contact surface and a second insulating tissue contact surface that descends in a stepped manner relative to the first partially conductive tissue contact surface. Methods for forming electrodes 1252' and 1272' will be discussed later. Figure 12 describe.

[0139] Furthermore, in the unorganized closed configuration, the bias electrodes 1252' and 1272' overlap, thereby defining a gap between the opposing insulating outer surfaces of the jaws 1250' and 1270'. Thus, this configuration provides electrode surfaces that are vertically biased and laterally biased relative to each other when the jaws 1250' and 1270' are closed. In one example, the gap is approximately 0.01 inches to approximately 0.025 inches. Additionally, although overlapping, the electrodes 1252' and 1272' are spaced apart by a lateral gap. To prevent short circuits, the lateral gap is less than or equal to a predetermined threshold. In one example, the predetermined threshold is selected from the range of 0.006 inches to 0.008 inches. In one example, the predetermined threshold is approximately 0.006 inches.

[0140] Refer again Figure 7 , Figure 10 The end electrode 1260 is defined by uncoated electrode portions 1261, 1262 that precede the circumferentially coated proximal coating portions to allow end coagulation and incision creation from either or both of the jaws 1250, 1270. In some examples, electrode portions 1261, 1262 are covered by a spring-biased or compliant insulating shell that allows exposure of electrode portions 1261, 1262 only when the distal end of the end effector 1200 is pressed against the tissue to be treated.

[0141] Additionally, segments 1274a, 1274b, and 1274c define angular profiles extending along the peripheral side 1275 of the jaw 1270. Segments 1274a, 1274b, and 1274c are defined by uncoated linear portions projecting from the angled body of the skeleton 1273 on the peripheral side 1275. Segments 1274a, 1274b, and 1274c include an outer surface flush with the outer surface of the coating 1264 defined on the peripheral side 1275. In various examples, a horizontal plane extends through segments 1274a, 1274b, and 1274c. The angular profile of electrode 1274 is defined in the horizontal plane such that electrode 1274 does not extend more than 45 degrees away from the centerline of curvature to prevent unplanned lateral thermal damage when using electrode 1274 to dissect or separate tissue.

[0142] Figure 14 Jaws 6270 are shown for use with an end effector (e.g., 1200) of an electrosurgical instrument (e.g., electrosurgical instrument 1106) to treat tissue using RF energy. Furthermore, jaws 6270 may be electrically coupled to a generator (e.g., generator 1100) and may be powered by the generator to deliver monopolar RF energy to tissue and / or cooperate with another jaw of the end effector to deliver bipolar RF energy to tissue. Moreover, jaws 6270 are similar to jaws 1250, 1270 in many respects. For example, jaws 6270 include an angular profile similar to that of jaws 1270. Additionally, jaws 6270 exhibit heat-reduction improvements that can be applied to one or both of jaws 1250, 1270.

[0143] During use, the jaws of the end effectors of electrosurgical instruments are subjected to thermal loads that can interfere with the performance of their electrodes. To minimize thermal load interference without negatively impacting the electrode's tissue therapeutic capability, jaw 6270 includes a conductive framework 6273 having a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink, and the thermally insulating portion resists heat transfer. In some examples, the thermally insulating portion includes internal gaps, voids, or pits that effectively isolate the thermal mass of the outer surface of the jaw 6270 in direct contact with tissue without impairing the electrical conductivity of the jaw 6270.

[0144] In the example shown, the thermally conductive portion defines a conductive outer layer 6269 surrounding or at least partially surrounding the inner conductive core. In at least one example, the inner conductive core includes gap-setting members that may extend between opposite sides of the outer layer 6269 in the form of pillars, columns, and / or walls, wherein gaps, voids, or recesses extend between the gap-setting members.

[0145] In at least one example, the gap setting member forms a honeycomb lattice structure 6267 to transition the jaws (i.e., jaw 6270 and the other jaw of the end effector) to a closed configuration to provide orientation force capability (similar to) when gripping tissue between the jaws. Figure 6 The jaws 1250 and 1270. Orientation force can be achieved by aligning the lattice 6267 in the direction intersecting with the tissue contact surface of the jaws 6270, so that its honeycomb walls 6268 are vertically positioned relative to the tissue contact surface.

[0146] Alternatively or additionally, the conductive inner core of jaw 6270 may include micro-air recesses that can be more uniformly distributed and shaped and do not have a predefined structure relative to the outer shape of the jaws to produce a more uniform stress-strain distribution within the jaws. In various aspects, the conductive skeleton 6273 may be fabricated by 3D printing and may include 3D-printed internal recesses that create a conductive but thermally insulated core.

[0147] Still referencing Figure 14 The conductive framework 6273 can be connected to an energy source (e.g., generator 1100) and includes electrodes 6262, 6272, and 6274 defined on portions of the outer layer 6273 that are selectively not covered by the coating 1264. Therefore, selective thermal and electrical conductivity control / focusing of the jaws 6270 via energy interaction with tissue through electrodes 6272, 6274 reduces thermal diffusion and thermal mass. The thermally insulating portions of the conductive framework 6273 limit the thermal load on electrodes 6262, 6272, and 6274 during use.

[0148] Furthermore, the outer layer 6273 defines a gripping feature 6277 extending on the opposite side of the electrode 6272 and at least partially covered by the coating 1264. The gripping feature 6277 improves the ability of the jaws 6270 to adhere to the tissue and resists slippage of the tissue relative to the jaws 6270.

[0149] In the example shown, wall 6268 extends diagonally from a first lateral side of jaw 6270 to a second lateral side of jaw 6270. Walls 6268 intersect at structural nodes. In the example shown, the intersecting walls 6268 define a recess 6271 covered from the top and / or bottom by an outer layer 6269. Various methods for manufacturing jaw 6270 are described below.

[0150] Figure 12 , 13Methods 1280 and 1281 for manufacturing jaws 1273″ and 1273″′ are shown. In various examples, one or more of jaws 1250, 1270, 1250', and 1270' are manufactured according to methods 1280 and 1281. Jaws 1273' and 1273″ are prepared by applying a coating 1264 (e.g., having a thickness d) to their entire outer surface. Electrodes are then defined by selectively removing portions of the coating 1264 from desired areas to expose the outer surfaces of the skeletons 1273″ and 1273″′ at such areas. In at least one example, this can be achieved by etching ( Figure 12 ) or through partial resection ( Figure 13 The tapered portion of the skeleton 1273″′ and its corresponding coating portion are used to selectively remove the coating to form flush conductive and non-conductive surfaces. Figure 12 In the example shown, electrodes 1272″ and 1274″ are formed by etching. Figure 13 In the example shown, electrode 1274″′ is formed by a raised narrow band or ridge 1274d extending next to skeleton 1273″′. Ridge 1274D and a portion of coating 1264 directly covering ridge 1274D are cut off, thereby producing an outer surface of electrode 1274″′ flush with the outer surface of coating 1264.

[0151] Therefore, the jaw 1270″′ manufactured by method 1281 includes a tapered electrode 1274″′ consisting of a narrow, raised conductive portion 1274e extending next to the skeleton 1273″′, which helps to focus the energy delivered from the skeleton 1273″′ to the tissue, wherein the portion 1274e has a conductive outer surface flush with the coating 1264.

[0152] In another manufacturing process 6200, it is possible to... Figure 15 The jaws 6270 are fabricated as depicted. A conductive framework 6273 is formed with narrow raised bands or ridges 6274e, 6274f, which define electrodes 6272 and 6274. In the illustrated example, the framework 6273 of the jaws 6270 includes ridges 6274e, 6274f having flat or at least substantially flat outer surfaces, configured to define electrodes 6272, 6274. In at least one example, the framework 6273 is fabricated by 3D printing. Masks 6265, 6266 are applied to the ridges 6274e, 6274f, and a coating 1264, similar to coating 1264, is applied to the framework 6273. After coating, the masks 6265, 6266 are removed, exposing the outer surfaces of electrodes 6272, 6274 that are flush with the outer surface of coating 1264.

[0153] refer to Figure 14 and Figure 15In various examples, the outer layer 6269 includes gripping features 6277 extending laterally on one or both sides of each of the electrodes 6272. The gripping features 6277 are covered by a coating 1264. In one example, the coating 1264 defines a compressible feature, causing the gap between the jaws of the end effector to vary according to the clamping load applied to the end effector 1200. In at least one example, the coating 1264 on the jaws creates an insulating overlap of at least 0.010"-0.020" along the centerline of the jaws. The coating 1264 can be applied directly to the gripping features 6277 and / or the clamp-induced jaw realignment features.

[0154] In various aspects, coating 1264 may comprise coating materials such as titanium nitride, diamond-like carbon (DLC) coating, chromium nitride, and graphit iC. TM Etc. In at least one example, the DLC consists of an amorphous carbon-hydrogen network with diamond bonds between graphite and carbon atoms. The DLC coating 1264 can form a film with low friction and high hardness properties around the framework 1253, 1273. Figure 6 The DLC coating 1264 can be doped or undoped, and is typically in the form of amorphous carbon (aC) or hydrogenated amorphous carbon (aC:H) containing mostly sp3 bonds. Various surface coating techniques can be used to form the DLC coating 1264, such as those developed by Oerlikon Balzers. In at least one example, plasma-assisted chemical vapor deposition (PACVD) is used to generate the DLC coating 1264.

[0155] Still referencing Figure 15 During use, electrical energy flows from the conductive framework 6269 to the tissue via electrode 6272. Coating 1264 prevents electrical energy from being transferred to the tissue from other areas of the outer layer 6269, which is covered by coating 1264. Because the surface temperature of electrode 6272 increases during tissue treatment, heat transfer from the outer layer 6269 to the inner core of framework 6273 is slowed or weakened due to the gaps, voids, or pits defined by the inner core wall 6268.

[0156] Figure 16 A frame 6290 is shown, manufactured for use with the jaws of an end effector in electrosurgical instruments. One or more of frames 1253, 1273, 1253', 1273', 1273″, and 1273″′ may comprise a material composition and / or may be manufactured in a manner similar to frame 6290. In the example shown, frame 6290 is composed of at least two materials: a conductive material, such as titanium, and a thermally insulating material, such as a ceramic material (e.g., a ceramic oxide). The combination of titanium and ceramic oxide produces a jaw component with combined thermal, mechanical, and electrical properties.

[0157] In the example shown, the composite skeleton 6290 includes, for example, a ceramic base 6291 formed by 3D printing. Additionally, the composite skeleton 6290 includes a titanium crown 6292, separately prepared from the ceramic base 6291 using, for example, 3D printing. The base 6291 and crown 6292 include complementary attachment features 6294. In the example shown, the base 6291 includes a post or protrusion received in a corresponding hole in the crown 6292. The attachment features 6294 also control shrinkage. Additionally or alternatively, the contact surfaces of the base 6291 and crown 6292 include complementary surface irregularities 6296, specifically designed for mating and engaging with each other. The surface irregularities 6296 also resist shrinkage caused by the different material compositions of the base 6291 and crown 6292. In various examples, the composite skeleton 6290 is selectively coated with an insulating coating 1264, thereby creating exposed portions of the crown 6292 that define electrodes, for example, as described above in conjunction with jaws 1250, 1270.

[0158] Figure 17 and Figure 18 The manufacturing process for a skeleton 6296 for use with the jaws of an end effector in electrosurgical instruments is shown. One or more of skeletons 1253, 1273, 1253', 1273', 1273″, and 1273″′ may comprise a material composition and / or may be manufactured in a manner similar to skeleton 6295. In the example shown, the composite skeleton 6295 is produced by injection molding using ceramic powder 6297 and titanium powder 6298. The powders are fused together ( Figure 18 ) to form titanium-ceramic composite material 6299 ( Figure 19 In at least one example, polytetrafluoroethylene (e.g., The coating can be selectively applied to the metallic areas of the composite skeleton 6295 for thermal insulation and electrical insulation.

[0159] Figures 20 to 22 Jaws 1290 are shown for use with an end effector (e.g., 1200) of an electrosurgical instrument (e.g., electrosurgical instrument 1106) to treat tissue using RF energy. Furthermore, jaws 6270 can be electrically coupled to a generator (e.g., generator 1100) and can be powered by the generator to deliver monopolar RF energy to tissue and / or cooperate with another jaw of the end effector to deliver bipolar RF energy to tissue. Moreover, jaws 1290 are similar in many respects to jaws 1250 and 1270. For example, jaws 1290 include an angular profile similar to the angular or curved profile of jaws 1270.

[0160] Additionally, jaw 1290 is similar to jaw 6270 because jaw 1290 also exhibits heat mitigation improvements. Like jaw 6270, jaw 1290 includes a conductive framework 1293 having a thermally insulating portion and a thermally conductive portion integral with or attached to the thermally insulating portion. The thermally conductive portion defines a heat sink, and the thermally insulating portion resists heat transfer. In some examples, the thermally insulating portion of the conductive framework 1293 includes a conductive inner core 1297 having internal gaps, voids, or pits that effectively isolate the thermal mass of the outer surface of the jaw 1290 defining the electrode 1294 in direct contact with tissue without compromising the conductivity of jaw 1290. The thermally conductive portion defines a conductive outer layer 1303 surrounding or at least partially surrounding the conductive inner core 1297. In at least one example, the conductive inner core 1297 includes gap setting members 1299, which may extend between opposite sides of the outer layer 1303 of the jaw 1290 in the form of a strut, post, and / or wall, wherein gaps, voids, or recesses extend between the gap setting members.

[0161] Alternatively or additionally, the conductive core 1297 may include micro-dimples of air distributed uniformly or non-uniformly within the conductive core 1297. The dimples may include predefined or random shapes and may be dispersed at predetermined or random portions of the conductive core 1297. In at least one example, the dimples are dispersed in a manner that creates a more uniform stress-strain distribution within the jaws 1290. In various aspects, the skeleton 1293 may be fabricated by 3D printing and may include 3D-printed internal dimples that create a conductive but thermally insulated core.

[0162] Therefore, the jaw 1290 incorporates selective thermal and electrical conductivity to control / focus energy interaction with the tissue, while minimizing thermal diffusion and thermal mass. The thermally insulating portion of the conductive skeleton 1293 limits the thermal load on the electrodes of the jaw 1290 during use.

[0163] Figure 22An extended portion of the tissue contact surface 1291 of the jaw 1290 is shown. In various aspects, the outer layer 1303 of the skeleton 1293 is selectively coated / covered with a first insulating layer 1264 comprising a first material (e.g., DLC). In the example shown, the DLC coating causes the tissue contact surface 1291 to be electrically insulating, except for a central region extending along the length of the tissue contact surface 1291 that defines the electrode 1294. In at least one example, the DLC coating extends around the skeleton 1293, covering the periphery of the jaw 1290 defined on opposite sides 1294', 1294″ of the electrode 1294. Conductive regions 1294a, 1294b, 1294c remain exposed and alternate with insulating regions 1298 along the length of the electrode 1294. In various aspects, the insulating regions 1298 comprise polytetrafluoroethylene (e.g., high-temperature polytetrafluoroethylene) having a high temperature permeability. Because the DLC coating is thermally conductive, only the portion of the tissue contact surface 1291, including the insulating region 1298, is thermally insulated. The portion of the tissue contact surface 1291 covered with the DLC coating and thin conductive energy-providing regions 1294a, 1294b, 1294c is thermally conductive. Additionally, only the thin conductive energy-providing regions 1294a, 1294b, 1294c are conductive. This is achieved using a DLC coating or polytetrafluoroethylene (e.g., PTFE). The remaining portion of the tissue contact surface 1291 covered by the membrane is electrically insulated.

[0164] Conductive regions 1294a, 1294b, and 1294c define energy accumulation locations along the jaws 1290 based on their geometry. Furthermore, the size, shape, and arrangement of the conductive regions 1294a, 1294b, and 1294c and the insulating region 1298 cause the coagulation energy transmitted through the electrode 1294 to be directed to the tissue within the predefined treatment area, thereby preventing parasitic leaching of both energy and heat from the treatment area. Additionally, the thermally insulating conductive core 1297 resists heat transfer to portions of the jaws 1290 that do not form treatment areas, preventing unintentional collateral thermal damage caused by accidental contact between tissue and non-treatment areas of the jaws 1290.

[0165] Electrode 1294 is selectively interrupted by region 1298. High-temperature polytetrafluoroethylene (e.g., Selective application of the coating to portions of electrode 1294 creates selectively exposed internal metal portions that define three-dimensional geometric electronic modulation (GEM) for focused dissection and solidification at conductive regions 1294a, 1294b, and 1294c of electrode 1294. Figure 22As shown, region 1298 is selectively deposited onto electrode 1294 to create a treatment surface having alternating thermally and electrically conductive regions as well as thermally and electrically insulating regions, which is surrounded by a thermally conductive but electrically insulating outer peripheral region defined by a DLC coating.

[0166] refer to Figure 22 The jaws 1290 include angular profiles, wherein multiple angles define discrete portions 1290a, 1290b, 1290c, and 1290d of the jaws 1290. For example, a first angle (α1) is defined by portions 1290a and 1290b, a second angle (α2) is defined by portions 1290b and 1290c, and a third angle (α3) is defined by portions 1290c and 1290d of the first jaws 1290. In other examples, at least a portion of the jaws 1290 includes a smooth, curved profile without angles. In various aspects, the discrete portions 1290a, 1290b, 1290c, and 1290d of the jaws 1290 are linear segments. Continuous linear segments intersect at angles, for example, the first angle (α1) or the second angle (α2) and the third angle (α3). The linear segments cooperate to form a generally curved profile for each of the jaws 1290.

[0167] In one example, angles (α1, α2, α3) include the same or at least substantially the same values. In another example, at least two of the angles (α1, α2, α3) include different values. In yet another example, at least one of the angles (α1, α2, α3) includes a value selected from the range of about 120° to about 175°. In still another example, at least one of the angles (α1, α2, α3) includes a value selected from the range of about 130° to about 170°.

[0168] Furthermore, due to the gradually narrowing profile of the jaws 1290, the portion 1290a, which is the proximal portion, is larger than the portion 1290b, which is the intermediate portion. Similarly, the intermediate portion 1290b is larger than the portion 1290d that defines the distal portion of the jaws 1290. In other examples, the distal portion may be larger than the intermediate and / or proximal portions. In other examples, the intermediate portion is larger than the proximal and / or distal portions. Additionally, the electrodes 1294 of the jaws 1290 include an angular profile similar to the angular profile of the jaws 1290.

[0169] refer to Figure 23 In some respects, the jaws 1300 include a solid conductive skeleton 1301 partially surrounded by a DLC coating 1264. The exposed area of ​​the skeleton 1301 defines one or more electrodes 1302. This arrangement creates thermally conductive and electrically conductive portions of the jaws 1300, wherein thermal energy is delivered indiscriminately, but electrical energy is delivered only through the one or more electrodes 1302.

[0170] Now for reference Figures 24 to 26 The electrosurgical instrument 1500 includes an end effector 1400 configured to deliver monopolar and / or bipolar energy to tissue grasped by the end effector 1400, as described in more detail below. The end effector 1400 is similar in many respects to the end effector 1200. For example, the end effector 1400 includes a first jaw 1450 and a second jaw 1470. At least one of the first jaw 1450 and the second jaw 1470 is movable relative to the other jaw to change the end effector 1400 from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The grasped tissue can then be sealed and / or cut using monopolar and bipolar energy. As described in more detail below, the end effector 1400 utilizes a GEM to adjust the energy density at the tissue-treatment interface of the jaws 1450, 1470 to achieve desired tissue treatment.

[0171] Similar to jaws 1250 and 1270, jaws 1450 and 1470 include a generally angular profile formed by linear portions angled relative to each other, thereby producing a curved or finger-like shape, such as Figure 26 As shown. Furthermore, jaws 1450, 1470 include conductive frameworks 1452, 1472 having narrowed corner bodies extending distally along the angular profile of jaws 1450, 1470. Conductive frameworks 1452, 1472 may be made of a conductive material (e.g., titanium). In some aspects, each of conductive frameworks 1453, 1473 includes a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink, and the thermally insulating portion resists heat transfer. In some examples, the thermally insulating portion of frameworks 1453, 1473 defines an inner core including internal gaps, voids, or recesses that effectively isolate the thermal mass of the outer surfaces of jaws 1452, 1472 in direct contact with tissue without impairing the electrical conductivity of jaws 1450, 1470.

[0172] The heat-conducting portion includes conductive outer layers 1469, 1469' surrounding or at least partially surrounding the inner conductive core. In at least one example, the inner conductive core includes gap-setting members that may extend between opposite sides of the outer layers 1469, 1469' of each of the jaws 1250, 1270 in the form of pillars, columns, and / or walls, wherein gaps, voids, or recesses extend between the gap-setting members. In at least one example, the gap-setting members form a honeycomb mesh structure 1467, 1467'.

[0173] In addition to the above, the conductive frames 1453, 1473 include first conductive portions 1453a, 1473a extending distally along the angular profile of jaws 1450, 1470, and second conductive portions 1453b, 1473b of tapered electrodes protruding from the first conductive portions 1453a, 1473a and extending distally along at least a portion of the gradually narrowing body of the frames 1453, 1473. In at least one example, in the transverse cross-section of the gradually narrowing body of the frames 1453, 1473 (e.g., Figure 25 In the first conductive portions 1453a and 1473a, the first conductive portions 1453b and 1473b are thicker than the second conductive portions 1453b and 1473b. In at least one example, the second conductive portions 1453b and 1473b are integrally or permanently attached to the first conductive portions 1453a and 1473a, such that electrical energy flows from the first conductive portions 1453a and 1473a to the tissue only through the second conductive portions 1453b and 1473b. The electrically insulating layers 1464 and 1464' are configured to completely insulate the first conductive portions 1453a and 1473a from electrical insulation, without insulating the second conductive portions 1453b and 1473b. At least the outer surface of the second conductive portions 1453b and 1473b defining the electrodes 1452 and 1472 is not covered by the electrically insulating layers 1464 and 1464'. In the example shown, electrodes 1452, 1472 and electrical insulating layers 1464, 1464' define a flush tissue treatment surface.

[0174] As described above, the first conductive portions 1453a and 1473a are generally thicker than the second conductive portions 1453b and 1473b, and are encased in electrically insulating layers 1464 and 1464', which causes the second conductive portions 1453b and 1473b to become high-energy-density regions. In at least one example, the electrically insulating layers 1464 and 1464' are made of high-temperature polytetrafluoroethylene (e.g., PTFE). Coatings, DLC coatings, and / or ceramic coatings are used for insulation and resistance to coke adhesion. In various examples, the thicker first conductive portion 1453a conducts more potential power, while the second conductive portion 1453b has lower resistance to tissue contact, thereby generating a higher energy density at electrode 1452.

[0175] In each respect, the outer surfaces of electrodes 1452 and 1472 include continuous linear segments extending along the angled tissue treatment surfaces of jaws 1450 and 1470. The linear segments intersect at predefined angles and have a width that gradually narrows as the linear segments extend distally. Figure 24In the example shown, electrode 1452 includes segments 1452a, 1452b, 1452c, 1452d, and electrode 1472 includes segments 1472a, 1472b, 1472c, 1472d. Electrode 1452 of jaw 1450 is composed of... Figure 24 The dashed lines on jaws 1470 indicate the lateral position of electrode 1452 relative to the closed configuration of end effector 1400. Electrodes 1452 and 1472 are laterally offset from each other in the closed configuration. In bipolar energy mode, electrical energy supplied by a generator (e.g., generator 1100) flows from the first conductive portion 1453a to electrode 1452 of the second conductive portion 1453b, and from electrode 1452 to the tissue gripped between jaws 1450 and 1470. Bipolar energy then flows from the tissue to electrode 1472 of the second conductive portion 1473b, and from electrode 1472 to the first conductive portion 1473a.

[0176] In all aspects, such as Figure 24 , Figure 25 As shown, the second jaw 1470 also includes an electrode 1474 spaced apart from the skeleton 1473. In at least one example, the electrode 1474 is a monopolar electrode configured to deliver monopolar energy in a closed configuration to tissue gripped between the jaws 1450, 1470. A return pad may be placed under the patient, for example, to receive monopolar energy from the patient. Like electrode 1472, electrode 1474 includes continuous linear segments 1474a, 1474b, 1474c, 1474d extending distally from the proximal end of the electrode along an angular profile defined by the second jaw 1470. Furthermore, electrode 1474 is laterally biased relative to electrodes 1472, 1452.

[0177] Electrode 1474 includes a base 1474e located within bracket 1480, extending distally from the proximal end 1480a to the distal end 1480b of bracket along the angular profile of the second jaw 1470. Bracket 1480 is centrally positioned relative to the lateral edges 1470e, 1470f of the second jaw 1470. Electrode 1474 also includes a tapered edge 1474f extending from the base 1474e beyond the sidewall of bracket 1480. Additionally, bracket 1480 is partially embedded in a valley defined on the outer tissue treatment surface of a narrowed, curved body. Bracket 1480 is spaced from the gradually narrowing body of skeleton 1473 by an electrically insulating coating 1464'. Figure 24 As shown, the base 1480 has a width that gradually narrows as it extends along the angular profile from the proximal end 1480a to the distal end 1480b.

[0178] In various examples, the bracket 1480 is constructed from a compliant substrate. In the uncompressed state, such as Figure 25 As shown, the sidewalls of the bracket 1480 extend beyond the tissue treatment surface of the jaws 1472. When tissue is compressed between the jaws 1450 and 1470, the compressed tissue exerts a biasing force on the sidewalls of the bracket 1480, thereby further exposing the tapered edge 1474f of the electrode 1474.

[0179] One or more of the jaws described in this disclosure include a stop or clearance setting member, which is a feature extending outward from one or both of the tissue-treating surfaces of the jaws of the end effector. The stop helps maintain separation or a predetermined clearance between the jaws in a closed configuration, wherein there is no tissue between the jaws. In at least one example, a sidewall of the bracket 1480 defines such a stop. In another example, the stop may be in the form of an insulating post or a laterally extending spring-biased feature, which allows the clearance between the relative jaws and the closed configuration to vary based on the clamping load.

[0180] Most electrosurgical generators use a constant power mode. In constant power mode, the power output remains constant because impedance increases. In constant power mode, the voltage increases with increasing impedance. The increased voltage leads to thermal damage to the tissue. The energy output of the GEM focusing jaws 1250, 1270, for example, is controlled by the size and shape of electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474, as described above, and the power level is modulated based on tissue impedance to generate a low-pressure plasma.

[0181] In some cases, the GEM maintains a constant minimum voltage required for cutting at the surgical site. The generator (e.g., 1100) regulates the power to maintain the voltage at the minimum required for cutting as close as possible to the surgical site. To achieve arc plasma and cutting, current is driven by voltage from the gradually narrowing portions of electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, and 1474 into the tissue. In some examples, a minimum voltage of approximately 200 volts is maintained. Cutting with greater than 200 volts increases thermal damage, while cutting with less than 200 volts results in minimal arc discharge and resistance in the tissue. Therefore, the generator (e.g., 1100) regulates the power to ensure that the minimum voltage that will still be used to form arc plasma and cut is utilized.

[0182] Main Reference Figure 26Surgical instrument 1500 includes an end effector 1400. Surgical instrument 1500 is similar in many respects to other surgical instruments described in U.S. Patent Application Attorney General's File No. END9234USNP2 / 190717-2. Various actuation and joint movement mechanisms described elsewhere in conjunction with such surgical instruments can be similarly used for joint movement and / or actuation of surgical instrument 1500. For the sake of brevity, this mechanism will not be repeated herein.

[0183] End effector 1400 includes end effector frame assembly 11210, which includes a distal frame member 11220 rotatably supported within a proximal frame housing 11230. In the illustrated example, the distal frame member 11220 is rotatably attached to the proximal frame housing 11230 via an annular rib received within an annular recess in the proximal frame housing 11230.

[0184] Electrical energy is transmitted to the electrodes 1452, 1472, 1474 of the end effector 1400 via one or more flexible circuits extending distally through or adjacent to the distal frame member 11220. In the example shown, the flexible circuit 1490 is fixedly attached to the first jaw 1450. More specifically, the flexible circuit 1490 includes a distal portion 1492 that is fixedly attached to an exposed portion 1491 of the first jaw 1450, which is not covered by the insulating layer 1464.

[0185] The slip ring assembly 1550 within the proximal frame housing 11230 allows the end effector 1400 to rotate freely about the axis of the surgical instrument 1500 without tangled wires in the circuitry that transmits electrical energy to the electrodes 1452, 1472, 1474. In the illustrated example, the flexible circuitry 1490 includes electrical contacts 1493 that movably engage with the slip ring 1550a of the slip ring assembly 1550. Electrical energy is transferred from the slip ring 1550a to the conductive frame 1453 and then through the flexible circuitry 1490 to the electrodes 1452. Because the electrical contacts 1493 are not fixedly attached to the slip ring 1550a, rotation of the end effector 1400 about the axis of the surgical instrument 1500 is permissible without losing the electrical connection between the electrical contacts 1493 and the slip ring 1550a. Furthermore, similar electrical contacts transmit electrical energy to the slip ring 1550a.

[0186] exist Figure 26In the example shown, slip ring 1550a is configured to transfer bipolar energy to electrode 1452 of jaw 1450. Slip ring 1550b cooperates with similar electrical contacts and electrode 1472 to define a return path for the bipolar energy. Furthermore, slip ring 1550c cooperates with similar electrical contacts and electrode 1474 to provide a pathway for unipolar electrical energy into the tissue. Bipolar and unipolar electrical energy can be delivered to slip rings 1550a and 1550b via one or more electrical generators (e.g., generator 1100). Bipolar and unipolar electrical energy can be delivered simultaneously or separately, as described in more detail elsewhere herein.

[0187] In various examples, slip rings 1550a, 1550b, and 1550c are integrated electrical slip rings having mechanical features 1556a, 1556b, and 1556c configured to couple slip rings 1550a, 1550b, and 1550c to an insulating support structure 1557, or a conductive support structure coated with insulating material, such as... Figure 26 As shown. Furthermore, slip rings 1550a, 1550b, and 1550c are sufficiently spaced to ensure that no short circuit will occur if conductive fluid fills the space between slip rings 1550a, 1550b, and 1550c. In at least one example, the core-flat stamped metal shaft component includes a 3D-printed or overmolded non-conductive portion for supporting the slip ring assembly 1550.

[0188] Figure 27 A portion of an electrosurgical instrument 12000 is shown, which includes a surgical end effector 12200 that can be coupled to a proximal axial segment via an articulated joint in various suitable manner. In some cases, the surgical end effector 12200 includes an end effector frame assembly 12210 that includes a distal frame member 12220 rotatably supported in a proximal frame housing attached to the articulated joint.

[0189] The surgical end effector 12200 includes a first jaw 12250 and a second jaw 12270. In the illustrated example, the first jaw 12250 is pivotally attached to a distal frame member 12220 to selectively pivot about a first jaw axis FJA defined by a first jaw pin 12221. The second jaw 12270 is pivotally attached to the first jaw 12250 to selectively pivot about a second jaw axis SJA defined by a second jaw pin 12272. In the illustrated example, the surgical end effector 12200 employs an actuator yoke assembly 12610 pivotally coupled to the second jaw 12270 via a second jaw attachment pin 12273 for pivoting about a jaw actuation axis JAA that is close to and parallel to the first jaw axis FJA and the second jaw axis SJA. The actuator yoke assembly 12610 includes a proximal threaded drive shaft 12614, which is threadedly received in a threaded hole 12632 in a distal locking plate 12630. The threaded drive shaft 12614 is mounted to the actuator yoke assembly 12610 for relative rotation therebetween. The distal locking plate 12630 is supported for rotational travel within the distal frame member 12220. Therefore, rotation of the distal locking plate 12630 will cause axial travel of the actuator yoke assembly 12610.

[0190] In some cases, the distal locking plate 12630 includes part of an end effector locking system 12225. The end effector locking system 12225 also includes a double-acting rotary locking head 12640 attached to a rotary drive shaft 12602 of various types disclosed herein. The locking head 12640 includes a first plurality of radially arranged distal locking features 12642 adapted to lockably engage a plurality of proximal-facing radial grooves or recesses 12634 formed in the distal locking plate 12630. When the distal locking features 12642 are locked into engagement with the radial grooves 12634 in the distal locking plate 12630, rotation of the rotary locking head 12640 will cause the distal locking plate 12630 to rotate within the distal frame member 12220. Also in at least one example, the rotary locking head 12640 includes a second series of proximal-facing proximal locking features 12644 adapted to lockably engage a corresponding series of locking grooves provided in the distal frame member 12220. A locking spring 12646 is used to bias the rotary locking head distally to engage it with the distal locking plate 12630. In various cases, the rotary locking head 12640 can be pulled proximally via an unlocking cable or other component as described herein. In another arrangement, the rotary drive shaft 12602 can be configured to also move axially to cause the rotary locking head 12640 to move axially within the distal frame member 12220. Rotation of the rotary drive shaft 12602 will cause the surgical end effector 12200 to rotate about the axis SA when the proximal locking feature 12644 in the rotary locking head 12640 engages with a series of locking grooves in the distal frame member 12220.

[0191] In certain situations, the first jaw 12250 and the second jaw 12270 open and close as follows. To open and close the jaws, as discussed in detail above, the rotary locking head 12640 engages with the distal locking plate 12630. Subsequently, rotation of the rotary drive shaft 12602 in a first direction rotates the distal locking plate 12630, which axially drives the actuator yoke assembly 12610 in the distal direction DD, and moves the first jaw 12250 and the second jaw 12270 toward the open position. Rotation of the rotary drive shaft 12602 in the opposite second direction axially drives the actuator yoke assembly 12610 proximally, and pulls the jaws 12250, 12270 toward the closed position. To rotate the surgical end effector 12200 about the axis SA, the locking cable or component is pulled proximally such that the rotary locking head 12640 disengages from the distal locking plate 12630 and engages the distal frame member 12220. Subsequently, as the rotary drive shaft 12602 rotates in the desired direction, the distal frame member 12220 (and the surgical end effector 12200) will rotate about the axis SA.

[0192] Figure 27 Further illustrations show the use of clamp jaws 12250, 12270 to, for example, generators 3106, 3107 (…). Figure 36 Electrical connection assembly 5000 of one or more power sources. Electrical connection assembly 5000 defines two separate electrical pathways 5001, 5002 extending through electrosurgical instrument 12000, such as... Figure 27 As shown. In a first configuration, electrical pathways 5001 and 5002 cooperate to deliver bipolar energy to the end effector 12200, wherein one of electrical pathways 5001 and 5002 acts as a return pathway. Furthermore, in a second configuration, electrical pathways 5001 and 5002 deliver unipolar energy 12200 individually and / or simultaneously. Therefore, in the second configuration, both electrical pathways 5001 and 5002 can be used as supply pathways. Additionally, the electrical connection assembly 5000 can be used with other surgical instruments (e.g., surgical instrument 1500) described elsewhere herein to electrically couple such surgical instruments to one or more power sources (e.g., generators 3106, 3107).

[0193] In the example shown, a flexible circuit 5004 is used to implement electrical pathways 5001 and 5002, which at least partially extends through the coil tube 5005. Figure 30 As shown, the flexible circuit 5004 includes two separate conductive trace elements 5006 and 5007 embedded in a PCB (printed circuit board) substrate 5009. In some cases, the flexible circuit 5004 may be attached to a core-flat stamped metal shaft member with a 3D-printed or overmolded plastic housing to provide full shaft filling / support.

[0194] In alternative examples, such as Figure 32 As shown, the flexible circuit 5004' extending through the coil tube 5005' may include conductive trace elements 5006' and 5007' twisted in a spiral profile in the PCB substrate 5009', which results in a reduction in the overall size of the flexible circuit 5004' and consequently a reduction in the inner / outer diameter of the coil tube 5005'. Figure 31 and Figure 32 Other examples of flexible circuits 5004″, 5004″′ are shown, which extend through coil tubes 5005', 5005″ and include conductive trace elements 5006″, 5007″ and 5006″′, 5007″′, respectively, including alternative profiles for size reduction. For example, flexible circuit 5004″′ includes a folded profile, while flexible circuit 5004' includes trace elements 5006″, 5007″ on opposite sides of PCB 5009″.

[0195] In addition to the above, passages 5001 and 5002 are defined by trace portions 5006a-5006g and 5007a-5007g, respectively. Trace portions 5006b, 5006c and 5007b, 5007c are in the form of a ring defining a ring assembly 5010, which maintains the electrical connection through passages 5001 and 5002 while allowing the end effector 12200 to rotate relative to the axis of the surgical instrument 12000. Furthermore, trace portions 5006e and 5007e are disposed on opposite sides of the actuator yoke assembly 12610. In the example shown, portions 5006e and 5007e are arranged around a hole configured to receive a second jaw attachment pin 12273, as... Figure 27 As shown. Trace portions 5006e and 5007e are configured to make electrical contact with corresponding portions 5006f and 5007f provided on the second jaw 12270. Furthermore, when the first jaw 12250 is assembled with the second jaw 12270, trace portions 5007f and 5007g become electrically connected.

[0196] refer to Figure 29 The flexible circuit 5014 includes spring-biased trace elements 5016 and 5017. Trace elements 5016 and 5017 are configured to apply a bias force to a corresponding trace element to ensure maintained electrical connection thereto, particularly when the corresponding trace portions move relative to each other. One or more of the trace portions of the passages 5001 and 5002 can be modified to include the spring-biased trace elements according to the flexible circuit 5014.

[0197] refer to Figure 34 Graph 3000 illustrates a power scheme 3005' of a tissue treatment cycle 3001 applied by end effector 1400 or any other suitable end effector of this disclosure to tissue held by end effector 1400. Tissue treatment cycle 3001 includes a tissue coagulation phase 3006, which includes a feathering section 3008, a tissue heating section 3009, and a sealing section 3010. Tissue treatment cycle 3001 also includes a tissue transverse or cutting phase 3007.

[0198] Figure 36An electrosurgical system 3100 is shown, including a control circuit 3101 configured to execute a power scheme 3005'. In the example shown, the control circuit 3101 includes a storage medium in the form of a memory 3103 and a controller 3104 with a processor 3102. The storage medium stores program instructions for executing the power scheme 3005'. According to the power scheme 3005', the electrosurgical system 3100 includes a generator 3106 configured to supply unipolar energy to an end effector 1400, and a generator 3107 configured to supply bipolar energy to the end effector 1400. In the example shown, the control circuit 3101 is depicted separately from the surgical instrument 1500 and the generators 3106, 3107. However, in other examples, the control circuit 3101 may be integrated with the surgical instrument 1500, the generator 3106, or the generator 3107. In all respects, the power scheme 3005' can be stored in memory 3103 in the form of an algorithm, equation, and / or lookup table, or any other suitable format. The control circuit 3101 can cause the generators 3106, 3107 to supply unipolar and / or bipolar energy to the end effector 1400 according to the power scheme 3005'.

[0199] In the illustrated example, the electrosurgical system 3100 also includes a feedback system 3109 that communicates with the control circuitry 3101. For example, the feedback system 3109 may be a standalone system or may be integrated with the surgical instrument 1500. In various aspects, the control circuitry 3101 may employ the feedback system 3109 to perform a predetermined function, such as issuing an alarm when one or more predetermined conditions are met. In some cases, the feedback system 3109 may include, for example, one or more visual feedback systems, such as a display screen, backlight, and / or LEDs. In some cases, the feedback system 3109 may include, for example, one or more audio feedback systems, such as speakers and / or buzzers. In some cases, the feedback system 3109 may include, for example, one or more tactile feedback systems. In some cases, the feedback system 3109 may include, for example, a combination of visual, audio, and / or tactile feedback systems. Additionally, the electrosurgical system 3100 also includes a user interface 3110 that communicates with the control circuitry 3101. For example, the user interface 3110 may be a standalone interface or may be integrated with the surgical instrument 1500.

[0200] Graph 3000 depicts power (W) on the y-axis and time on the x-axis. The bipolar energy curve 3020 spans the tissue coagulation phase 3005, and the unipolar energy curve 3030 begins in the tissue coagulation phase 3006 and terminates at the end of the tissue transverse phase 3007. Therefore, the tissue treatment cycle 3001 is configured to apply bipolar energy to the tissue throughout the entire tissue coagulation phase 3006 but not in the tissue transverse phase 3007, and to apply unipolar energy to the tissue in a portion of the coagulation phase 3006 and the transverse phase 3007, as... Figure 34 As shown.

[0201] In various aspects, the control circuit 3101 can receive user input from the user interface 3110. The user input causes the control circuit 3101 to initialize the execution of the power scheme 3005' at time t1. Alternatively, the initialization of the execution of the power scheme 3005' can be automatically triggered by sensor signals from one or more sensors 3111 communicating with the control circuit 3101. For example, the power scheme 3005' can be automatically triggered by the control circuit 3101 in response to a sensor signal indicating a predetermined gap between the jaws 1450, 1470 of the end effector 1400.

[0202] During the feathering phase 3008, control circuitry 3101 causes generator 3107 to gradually increase the bipolar energy power supplied to end effector 1400 to reach a predetermined power value P1 (e.g., 100 W), and maintains the bipolar energy power at or substantially at the predetermined power value P1 throughout the remainder of feathering phase 3008 and tissue heating phase 3009. The predetermined power value P1 may be stored in memory 3103 and / or provided by the user through user interface 3110. During sealing phase 3010, control circuitry 3101 causes generator 3107 to gradually decrease the bipolar energy power. Bipolar energy application terminates at the end of sealing phase 3010 (tissue coagulation phase 3006) and before the start of cutting / transverse phase 3007.

[0203] In addition to the above, for example, at t2, control circuit 3101 causes generator 3107 to begin supplying unipolar energy power to electrode 1474 of end effector 1400. Unipolar energy application to the tissue begins at the end of feathering section 3008 and the beginning of tissue heating section 3009. Control circuit 3101 causes generator 3107 to gradually increase the unipolar energy power to reach a predetermined power level P2 (e.g., 75 W), and maintains or at least substantially maintains the predetermined power level P2 in the remainder of tissue heating section 3009 and the first portion of sealing section 3010. The predetermined power level P2 may also be stored in memory 3103 and / or may be provided by the user through user interface 3110.

[0204] During the sealing section 3010 of the tissue coagulation stage 3006, the control circuit 3101 causes the generator 3107 to gradually increase the unipolar energy power supplied to the end effector 1400. The start of the tissue slicing stage 3007 is driven by an inflection point in the unipolar energy curve 3030, where the gradual increase in unipolar energy experienced during the sealing section 3010 is followed by a gradual rise to a predetermined maximum threshold power level P3 (e.g., 150 W) sufficient to slicing the coagulated tissue.

[0205] At t4, control circuit 3101 causes generator 3107 to gradually increase the unipolar energy power supplied to end effector 1400 to a predetermined maximum threshold power level P3, and maintains or at least substantially maintains the predetermined maximum threshold power level P3 for a predetermined time period (t4-t5) or until the end of tissue transection phase 3007. In the example shown, the unipolar energy power is terminated by control circuit 3101 at t5. Tissue transection continues mechanically as jaws 1450, 1470 continue to apply pressure to the gripped tissue until the end of tissue transection phase 3007 at t6. Alternatively, in other examples, control circuit 3101 may cause generator 3107 to continue supplying unipolar energy capability to end effector 1400 until the end of tissue transection phase 3007.

[0206] Control circuitry 3101 may employ sensor readings from sensor 3111 and / or timer clocks from processor 3102 to determine when to cause generators 3107 and / or 3106 to start, increase, decrease, and / or terminate the energy supply to end effector 1400 according to a power scheme (e.g., power scheme 3005'). For example, control circuitry 3101 may execute power scheme 3005' by causing one or more timer clocks to count down from one or more predetermined time periods (e.g., t1-t2, t2-t3, t3-t4, t5-t6), which may be stored in memory 3103. Although power scheme 3005' is time-based, control circuitry 3101 may adjust predetermined time periods of any of individual segments 3008, 3009, 3010 and / or stages 3006, 3007 based on sensor readings received from one or more of sensors 3111 (e.g., tissue impedance sensors).

[0207] The end effector 1400 is configured to deliver three different energy modes to the grasped tissue. A first energy mode applied to the tissue during the feathering phase 3008 includes bipolar energy but excludes monopolar energy. A second energy mode is a mixed energy mode comprising a combination of monopolar and bipolar energy, and is applied to the tissue during the tissue heating phase 3009 and the tissue sealing phase 3010. Finally, a third energy mode includes monopolar energy but excludes bipolar energy, and is applied to the tissue during the cutting phase 3007. In various aspects, the second energy mode includes a power level 3040 as the sum of the power levels of the monopolar and bipolar energy. In at least one example, the power level of the second energy mode includes a maximum threshold Ps (e.g., 120 W).

[0208] In various aspects, control circuitry 3101 causes unipolar and bipolar energy to be delivered from two different generators 3106, 3107 to end effector 1400. In at least one example, the energy from one of the generators 3106, 3107 can be detected using the return path of the other generator, or by utilizing the attachment electrode of the other generator to short-circuit an unexpected tissue interaction. Therefore, parasitic energy losses via unexpected return paths can be detected by the generator connected to the return path. Unintentional conductive paths can be mitigated by implementing voltage, power, waveform, or timing between uses.

[0209] The integrated sensor within the flexible circuitry of the surgical instrument 1500 can detect power supply / short circuits in electrodes / conductive paths when no potential should be present, and prevent unintentional use of the conductive path. Furthermore, directional electronic gating elements can be utilized to prevent crosstalk from one generator down to another.

[0210] One or more electrodes described in this disclosure (e.g., electrodes 1452, 1472, 1474 connected to jaws 1450, 1470) may include a segmented pattern having segments that are connected together when the electrodes are powered by a generator (e.g., generator 1100). However, when the electrodes are not powered, the segments are separated to prevent circuitry from shorting across the electrodes to other areas of the jaws.

[0211] In all respects, the thermal resistance electrode material is used with the end effector 1400. The material can be configured to suppress current through the electrode at or above a predetermined temperature level, but continue to allow power to other parts of the electrode below a temperature threshold.

[0212] Figure 37A table is shown representing alternative power scheme 3005″, which can be stored in memory 3103 and executed by processor 3102 in a manner similar to power scheme 3005″. When executing power scheme 3005″, control circuitry 3101 depends on the jaw hole, except for the timing of setting power values ​​for generators 3106 and 3107, or alternatively, the timing. Therefore, power scheme 3005″ is a jaw hole-based power scheme.

[0213] In the example shown, the jaw holes d0, d1, d2, d3, and d4 from the power scheme 3005″ correspond to the time values ​​t1, t2, t3, and t4 from the power scheme 3005'. Therefore, the feathering section corresponds to the jaw holes from about d1 to about d2 (e.g., about 0.700″ to about 0.500″). Furthermore, the tissue heating section corresponds to the jaw holes from about d2 to about d3 (e.g., about 0.500″ to about 0.300″). Further, the sealing section corresponds to the jaw holes from about d2 to about d3 (e.g., about 0.030″ to about 0.010″). Further, the tissue cutting stage corresponds to the jaw holes from about d3 to about d4 (e.g., about 0.010″ to about 0.003″).

[0214] Therefore, control circuit 3101 is configured to cause generator 3106 to begin supplying bipolar energy power to end effector 1400 when readings from one or more of the sensors 3111 correspond to, for example, a predetermined jaw hole d1, thereby initializing the feathering section. Similarly, control circuit 3101 is configured to cause generator 3106 to stop supplying bipolar energy power to end effector 1400 when readings from one or more of the sensors 3111 correspond to, for example, a predetermined jaw hole d2, thereby terminating the feathering section. Likewise, control circuit 3101 is configured to cause generator 3107 to begin supplying unipolar energy power to end effector 1400 when readings from one or more of the sensors 3111 correspond to, for example, a predetermined jaw hole d2, thereby initializing the heating section.

[0215] In the example shown, the jaw aperture is defined by the distance between two corresponding reference points on jaws 1450 and 1470. When jaws 1450 and 1470 are in an unorganized closed configuration, the corresponding reference points are in contact with each other. Alternatively, the jaw aperture may be defined by the distance between jaws 1450 and 1470 measured along a line intersecting jaws 1450 and 1470 and perpendicular to the longitudinal axis of the end effector 1500 extending centrally. Alternatively, the jaw aperture may be defined by the distance between first and second parallel lines intersecting jaws 1450 and 1470, respectively. The distance is measured along a line perpendicular to the first and second parallel lines and extending through the intersection of the first parallel line and the first jaw 1450, and through the intersection of the second parallel line and the second jaw 1470.

[0216] refer to Figure 35 In various examples, the electrosurgical system 3100 ( Figure 36 The device is configured to perform a tissue treatment cycle 4003 using power scheme 3005. Tissue treatment cycle 4003 includes an initial tissue contact phase 4013, a tissue coagulation phase 4006, and a tissue slicing phase 4007. Tissue contact phase 4013 includes an open configuration section 4011, where the tissue is not located between jaws 1450 and 1470, and a proper orientation section 4012, where jaws 1450 and 1470 are properly positioned relative to the desired tissue treatment area. Tissue coagulation phase 4006 includes a feathering section 4008, a tissue heating section 4009, and a sealing section 3010. Tissue slicing phase 4007 includes a tissue cutting section. Tissue treatment cycle 4003 involves applying bipolar and monopolar energy, individually and simultaneously, to the tissue treatment area according to power scheme 3005. Tissue treatment cycle 4003 is similar in many respects to tissue treatment cycle 3001, which will not be repeated herein for brevity.

[0217] Figure 35A graph 4000 is shown, which represents power scheme 3005, which is similar in many respects to power scheme 3005'. For example, control circuit 3101 can execute power scheme 3005 in a manner similar to power scheme 3005' to deliver three different energy modes to the tissue treatment region in three consecutive time periods of tissue treatment cycle 4001. In the feathering section 4008, a first energy mode, including bipolar energy but excluding monopolar energy, is applied to the tissue treatment region from t1 to t2. In the tissue heating section 4009 and the tissue sealing section, a second energy mode, as a mixed energy mode including a combination of monopolar and bipolar energy, is applied to the tissue treatment region from t2 to t4. Finally, in the tissue transection stage 4007, a third energy mode, including monopolar energy but excluding bipolar energy 4010, is applied to the tissue from t4 to t5. Furthermore, the second energy mode includes a power level that is the sum of the power levels of monopolar and bipolar energy. In at least one example, the power level of the second energy mode includes a maximum threshold (e.g., 120 W). In various aspects, power scheme 3005 can be delivered to end effector 1400 from two different generators 3106, 3107. For the sake of brevity, additional aspects of power scheme 3005 that are similar to those of power scheme 3005' will not be repeated herein at the same level of detail.

[0218] In each respect, the control circuit 3101 causes the generators 3106, 3107 to adjust the bipolar and / or unipolar power levels of the power scheme 3005 applied to the tissue treatment area by the end effector 1400 based on one or more measurement parameters, including tissue impedance 4002, jaw motor speed 27920d, jaw motor force 27920c, jaw hole 27920b of the end effector 1400 and / or current draw of the motor that enables the end effector to close. Figure 35 The graph 4000 shows the correlation between such measurement parameters and power scheme 3005 over time.

[0219] In various examples, control circuitry 3101 causes generators 3106, 3107 to adjust the power level of a power scheme (e.g., power schemes 3005, 3005') applied to the tissue treatment area by end effector 1400 based on one or more parameters determined by one or more sensors 3111 (e.g., tissue impedance 4002, jaw / closing motor speed 27920d, jaw / closing motor force 27920c, jaw gap / hole 27920b of end effector 1400, and / or current draw of the motor). For example, control circuitry 3101 may cause generators 3106, 3107 to adjust the power level based on pressure within jaws 1450, 1470.

[0220] In at least one example, the power level is inversely proportional to the pressure within the jaws 1450, 1470. Control circuitry 3101 can utilize this inverse correlation to select the power level based on the pressure value. In at least one example, the pressure value is determined using the current draw of the motor that achieves end effector closure. Alternatively, the inverse correlation utilized by control circuitry 3101 can be directly based on current draw as a proxy for pressure. In various examples, the greater the compression applied to the tissue treatment area by jaws 1450, 1470, the lower the power level set by control circuitry 3101, which helps minimize tissue adhesion and unintentional cutting.

[0221] The graph 4000 provides several indications of the measured parameters of tissue impedance 4002, jaw / closing motor speed 27920d, jaw / closing motor force 27920c, jaw gap / hole 27920b of end effector 1400, and / or current draw of the motor affecting end effector closure, which may trigger activation, adjustment, and / or termination of the application of bipolar and / or unipolar energy to the tissue during tissue treatment cycle 4003.

[0222] Control circuitry 3101 may rely on one or more of these prompts during the execution and / or adjustment of the default power scheme 3005 in tissue treatment cycle 4003. In some examples, control circuitry 3101 may rely on sensor readings from one or more sensors 3111 to detect when, for example, one or more monitored parameters meet one or more predetermined conditions that can be stored in memory 3103. One or more predetermined conditions may reach predetermined thresholds and / or detect a meaningful increase and / or decrease in one or more of the monitored parameters. The fulfillment or absence of predetermined conditions constitutes a trigger / confirmation point for the execution and / or adjustment of the default power scheme 3005 in tissue treatment cycle 4003. Control circuitry 3101 may rely on prompts only when executing and / or adjusting the power scheme, or alternatively, use prompts to guide or adjust a timer clock for a time-based power scheme (e.g., power scheme 3005').

[0223] For example, a sudden decrease in tissue impedance (A1) to a predetermined threshold (Z1), occurring alone or concurrently with an increase in jaw motor force (A2) to a predetermined threshold (F1) and / or a decrease in jaw orifice (A3) to a predetermined threshold (d1) (e.g., 0.5″), can trigger control circuitry 3101 to initiate the feathering segment 4008 of the tissue coagulation phase 4006 by activating the application of bipolar energy to the tissue treatment area. Control circuitry 3101 can signal generator 3106 to begin supplying bipolar power to end effector 1400.

[0224] Furthermore, after the bipolar energy is activated, the jaw motor speed decreases (B1) to a predetermined value (v1) to trigger the control circuit 3101 to signal the generator 3106, thereby stabilizing the power level (B2) of the bipolar energy at a constant or at least substantially constant value (e.g., 100W).

[0225] In yet another example, the shift from the feathering section 4008 to the heating section 4009 at time t2 (which triggers activation (D1) for the application of monopolar energy to the tissue treatment area) is consistent with the following: the jaw motor force increases (C2) to a predetermined threshold (F2), the jaw aperture decreases (C3) to a predetermined threshold (e.g., 0.03″), and / or the tissue impedance decreases (C1) to a predetermined value Z2. The satisfaction of one or more of conditions C1, C2, and C3, or all of two or more of the conditions, causes the control circuit 3101 to initiate the application of monopolar energy to the tissue treatment area. In another example, the satisfaction of one or more of conditions C1, C2, and C3, or all of two or more of the conditions, at or approximately time t2 triggers the application of monopolar energy to the tissue treatment area.

[0226] Activating monopolar energy by generator 3107 in response to an activation signal from control circuit 3101 causes a mixture of monopolar and bipolar energy (D1) to be delivered to the tissue treatment area. This results in a shift in the impedance curve characterized by a faster decrease (E1) in impedance from Z2 to Z3 (compared to a steady decrease (C1) before activation of the monopolar energy). In the example shown, tissue impedance Z3 defines the minimum impedance of tissue treatment cycle 4003.

[0227] In the example shown, if the minimum impedance value Z3 (E1) matches or is at least substantially matches the predetermined maximum jaw motor force threshold (F3) (E3) and / or the predetermined jaw orifice threshold range (E2) (e.g., 0.01"-0.003"), the control circuit 3101 determines that an acceptable seal has been achieved. The satisfaction of one or more of conditions E1, E2, and E3, or all of two or more of the conditions, signals the control circuit 3101 to shift from the heating section 4009 to the sealing section 4010.

[0228] In addition to the above, beyond the minimum impedance value Z3, at t4, the impedance level gradually increases to a threshold Z4 corresponding to the end of the sealed section 4010. The satisfaction of threshold Z4 causes control circuit 3101 to signal generator 3107 to gradually increase the unipolar power level to begin the tissue slicing phase 4007, and to signal generator 3106 to terminate the application of bipolar energy to the tissue treatment area.

[0229] In various examples, control circuit 3101 can be configured to (G2) verify that as the (G1) impedance gradually increases from its minimum value Z3, the jaw motor force decreases, and / or that the (G3) jaw motor force has decreased to a predetermined threshold (e.g., 0.01"-0.003") before the power level of the unipolar energy is gradually increased to cut the tissue.

[0230] However, if the jaw motor force continues to increase, the control circuit 3101 can pause the application of monopolar energy to the tissue treatment area for a predetermined period of time to allow the jaw motor force to begin to decrease. Alternatively, the control circuit can signal the generator 3107 to deactivate the monopolar energy and complete the seal using only bipolar energy.

[0231] In some cases, the control circuit 3101 may employ a feedback system 3109 to warn the user and / or provide instructions or suggestions to suspend the application of monopolar energy. In some cases, the control circuit 3101 may instruct the user to use a mechanical blade to cut across the tissue.

[0232] In the example shown, control circuit 3101 maintains (H) a gradually increasing monopolar power until a spike (I) is detected in the tissue impedance. After detecting a spike (I) in the impedance level up to Z5 following a gradual increase from Z3 to Z4, control circuit 3101 causes generator 3107 to terminate (J) the application of monopolar energy to the tissue. The spike indicates the completion of tissue treatment cycle 4003.

[0233] In various examples, control circuitry 3101 prevents the electrodes of jaws 1450, 1470 from being powered before a suitable closure threshold is reached. The closure threshold may be based on, for example, a predetermined jaw aperture threshold and / or a predetermined jaw motor force threshold that may be stored in memory 3103. In such examples, control circuitry 3101 may not act on user input via user interface 3110 requesting treatment cycle 4003. In some cases, control circuitry 3101 may respond by warning the user via feedback system 3109 that a suitable closure threshold has not been reached. Control circuitry 3101 may also provide the user with an override option.

[0234] Ultimately, between times t4 and t5, the unipolar energy is the energy delivered solely for cutting patient tissue. The force of the jaws holding the end effector can vary during tissue cutting. If the steady-state level of the force 27952 used to hold the jaws decreases between times t3 and t4, efficient and / or effective tissue cutting is identified by the surgical instrument and / or surgical center. If the steady-state level of the force 27954 used to hold the jaws increases between times t3 and t4, inefficient and / or ineffective tissue cutting is identified by the surgical instrument and / or surgical center. In such cases, an error can be communicated to the user.

[0235] refer to Figures 38 to 42 Surgical instrument 1601 includes an end effector 1600 that is similar in many respects to end effectors 1400, 1500; for the sake of brevity, these end effectors will not be repeated in the same level of detail herein. End effector 1600 includes a first jaw 1650 and a second jaw 1670. At least one of the first jaw 1650 and the second jaw 1670 is movable to change the end effector 1600 from an open configuration to a closed configuration, thereby grasping tissue (T) between the first jaw 1650 and the second jaw 1670. Electrodes 1652, 1672 are configured to cooperate to deliver bipolar energy from a bipolar energy source 1610 to the tissue, such as... Figure 39 As shown. Electrode 1674 is configured to deliver monopolar energy from monopolar energy source 1620 to tissue. Return pad 1621 defines a return path for the monopolar energy. In at least one example, monopolar energy and bipolar energy are delivered simultaneously (…). Figure 36 Or delivered to the tissue in an alternating manner, such as Figure 36 As shown, for example, to seal and / or cut tissue.

[0236] Figure 42 A simplified schematic diagram of an electrosurgical system 1607 is shown, which includes a monopolar power source 1620 and a bipolar power source 1610 connectable to an electrosurgical instrument 1601 including an end effector 1600. The electrosurgical system 1607 also includes a conductive circuit 1602 selectively switchable between a connected configuration with electrode 1672 and a disconnected configuration with electrode 1672. The switching mechanism may be constituted by any suitable switch, for example, capable of turning the conductive circuit 1602 on and off. In the connected configuration, electrode 1672 is configured to cooperate with electrode 1652 to deliver bipolar energy to tissue, wherein the conductive circuit 1602 defines a return path for the bipolar energy after passing through the tissue. However, in the disconnected configuration, electrode 1672 is isolated and thus becomes an inert internal conductive and external insulating structure on jaw 1670. Therefore, in the disconnected configuration, electrode 1652 is configured to deliver monopolar energy to tissue in addition to or separately from the monopolar energy delivered via electrode 1674. In an alternative example, electrode 1652, instead of electrode 1672, may switch between a connected configuration and a disconnected configuration with conductive circuit 1602, thereby allowing electrode 1672 to deliver unipolar energy to tissue in addition to or separately from the unipolar energy delivered via electrode 1674.

[0237] In various aspects, the electrosurgical instrument 1601 also includes control circuitry 1604 configured to adjust the levels of monopolar and bipolar energy delivered to the tissue to minimize unintended thermal damage to surrounding tissues. Adjustment may be based on readings from at least one sensor, such as a temperature sensor, an impedance sensor, and / or a current sensor. Figure 41 and Figure 42 In the example shown, control circuit 1604 is coupled to temperature sensors 1651 and 1671 on jaws 1650 and 1670, respectively. Control circuit 1604 adjusts the levels of monopolar and bipolar energy delivered to the tissue based on temperature readings from sensors 1651 and 1671.

[0238] In the example shown, control circuitry 1604 includes a storage medium in the form of memory 3103 and a controller 3104 having a processor 3102. Memory 3103 stores program instructions that, when executed by processor 3102, cause processor 3102 to adjust the levels of unipolar and bipolar energy delivered to the tissue based on sensor readings received from one or more sensors (e.g., temperature sensors 1651, 1671). In various examples, as described in more detail below, control circuitry 1604 may adjust a default power scheme 1701 based on readings from one or more sensors (e.g., temperature sensors 1651, 1671). Power scheme 1701 is similar in many respects to power scheme 3005', which will not be repeated at the same level of detail herein for the sake of brevity.

[0239] Figure 43 Temperature-based adjustments to a power scheme 1701 for energy delivery to tissue gripped by end effector 1600 are illustrated. Graph 1700 plots time on the x-axis and power and temperature on the y-axis. In the tissue feathering phase (t1-t2), control circuitry 1604 causes the power level of the bipolar energy to gradually increase to a predetermined threshold (e.g., 120 W), which causes the temperature of the tissue gripped by end effector 1600 to gradually increase to a temperature within a predetermined range (e.g., 100°C-120°C). The power level of the bipolar energy is then maintained at the predetermined threshold as long as the tissue temperature remains within the predetermined range. In the tissue heating phase (t2-t3), control circuitry 1604 activates monopolar energy and gradually decreases the power level of the bipolar energy while gradually increasing the power level of the monopolar energy to maintain the tissue temperature within the predetermined range.

[0240] In the example shown, during the tissue sealing segment (t3-t4), control circuit 1604 detects that the tissue temperature has reached the upper limit of a predetermined range based on readings from temperature sensors 1651 and 1671. Control circuit 1604 responds by gradually reducing the power level of the monopolar energy. In other examples, the reduction may be performed gradually. In some examples, the reduction value or the method used to determine the reduction value, such as a table or equation, may be stored in memory 3103. In some examples, the reduction value may be a percentage of the current power level of the monopolar energy. In other examples, the reduction value may be based on the previous power level of the monopolar energy corresponding to the tissue temperature within the predetermined range. In some examples, the reduction may be performed in multiple time-spaced steps. After each downward step, control circuit 1604 allows a predetermined time period to pass before assessing the tissue temperature.

[0241] In the example shown, control circuit 1604 maintains the bipolar energy power level according to the default power scheme 1701, but reduces the unipolar energy power level to maintain the tissue temperature within a predetermined range while tissue sealing is completed. In other examples, the reduction in unipolar energy power level is combined with or replaced by reducing the bipolar energy power level.

[0242] In addition to the above, an alarm can be issued via feedback system 3109 to use a mechanical blade to perform a transverse cut of the tissue, for example, instead of monopolar energy to avoid unintended transverse thermal damage to surrounding tissue. In some examples, control circuitry 1604 can temporarily suspend monopolar and / or bipolar energy until the tissue temperature returns to a level within a predetermined temperature range. Monopolar energy can then be reactivated to perform a transverse cut of the sealed tissue.

[0243] refer to Figure 44 The end effector 1600 is applying monopolar energy to a tissue treatment area 1683 at a blood vessel, such as an artery grasped by the end effector 1600. The monopolar energy flows from the end effector 1600 to the treatment area 1683 and eventually to a return pad (e.g., return pad 1621). The temperature of the tissue at the treatment area 1683 increases as monopolar energy is applied to the tissue. However, due to factors such as the constricted portion 1684 of the artery inadvertently absorbing monopolar energy, the actual heat diffusion 1681 is greater than the expected heat diffusion 1682.

[0244] In various aspects, control circuitry 1604 monitors the thermal effect at treatment region 1683, which is caused by the application of monopolar energy to treatment region 1683. Control circuitry 1604 may further detect faults in the monitored thermal effect to follow a predetermined correlation between the applied monopolar energy and the desired thermal effect from applying monopolar energy at the treatment region. In the example shown, unintentional energy consumption at the vasoconstrictive portion of the artery reduces the thermal effect at the treatment region, which is detected by control circuitry 1604.

[0245] In some examples, memory 3103 stores a predetermined correlation algorithm between the level of monopolar energy applied to the tissue treatment area held by end effector 1600 and the expected thermal effect from applying the monopolar energy to the tissue treatment area. The correlation algorithm may be in the form of, for example, an array, lookup table, database, mathematical equation, or formula. In at least one example, the stored correlation algorithm defines the correlation between the power level of the monopolar energy and the expected temperature. Control circuitry 1604 may use temperature sensors 1651, 1671 to monitor the temperature of the tissue at treatment area 1683 and may determine whether the monitored temperature reading corresponds to the expected temperature reading at a specific power level.

[0246] If a stored correlation is not met, the control circuit 1604 can be configured to take certain actions. For example, the control circuit 1604 can warn the user of a malfunction. Alternatively, the control circuit 1604 can reduce or suspend the delivery of monopolar energy to the treatment area. In at least one example, the control circuit 1604 can adjust or shift from monopolar energy to bipolar energy application to the tissue treatment area to confirm the presence of parasitic power extraction. If parasitic power extraction is confirmed, the control circuit 1604 can continue to use bipolar energy at the treatment area. However, if the control circuit 1604 rejects the presence of parasitic power extraction, the control circuit 1604 can reactivate or increase the monopolar power level again. The control circuit 1604 can achieve the change of monopolar and / or bipolar power levels, for example, by signaling the monopolar power source 1620 and / or the bipolar power source 1610.

[0247] In various aspects, one or more imaging devices (e.g., multispectral range 1690 and / or infrared imaging devices) can be used to monitor spectral tissue changes and / or thermal effects at the tissue treatment area 1691, such as Figure 45As shown. Imaging data from one or more imaging devices can be processed to estimate the temperature at the tissue treatment area 1691. For example, when monopolar energy is applied to the treatment area 1691 via the end effector 1600, the user can guide an infrared imaging device to the treatment area 1691. As the treatment area 1691 heats up, its infrared thermal characteristics change. Therefore, the change in thermal characteristics corresponds to a change in the temperature of the tissue at the treatment area 1691. Thus, the temperature of the tissue at the treatment area 1691 can be determined based on the thermal characteristics captured by one or more imaging devices. If the temperature estimated based on the thermal characteristics at the treatment area 1691 associated with a particular portion level is less than or equal to the expected temperature at the power level, the control circuit 1604 detects the difference in thermal effect at the treatment area 1691.

[0248] In other examples, thermal features captured by one or more imaging devices are not converted into estimated temperatures. Instead, they are compared directly with thermal features stored in memory 3103 to assess whether power level adjustments are needed.

[0249] In some examples, memory 3103 stores a predetermined correlation algorithm between the power level of monopolar energy applied to a tissue treatment region 1691 held by end effector 1600 and a predetermined thermal characteristic expected from applying the monopolar energy to the tissue treatment region. The correlation algorithm may be in the form of, for example, an array, lookup table, database, mathematical equation, or formula. In at least one example, the stored correlation algorithm defines the correlation between the power level of the monopolar energy and the expected thermal characteristic or the temperature associated with the expected thermal characteristic.

[0250] refer to Figure 46 and Figure 47 The electrosurgical system includes an electrosurgical instrument 1801 having an end effector 1800 that is similar in many respects to end effectors 1400, 1500, and 1600. For brevity, the end effector will not be repeated in this document at the same level of detail. The end effector 1800 includes a first jaw 1850 and a second jaw 1870. At least one of the first jaw 1850 and the second jaw 1870 is movable to change the end effector 1800 from an open configuration to a closed configuration, thereby grasping tissue (T) between the first jaw 1850 and the second jaw 1870. Electrodes 1852 and 1872 are configured to cooperate to deliver bipolar energy to the tissue. Electrode 1874 is configured to deliver unipolar energy to the tissue. In at least one example, unipolar energy and bipolar energy are delivered to the tissue simultaneously or alternately, such as... Figure 34 As shown, for example, to seal and / or cut tissue.

[0251] In the example shown, bipolar and unipolar energies are generated by separate generators 1880 and 1881, and are supplied to the tissue via separate circuits 1882 and 1883, respectively, connecting generator 1880 to electrodes 1852 and 1872 and connecting generator 1881 to electrode 1874 and return pad 1803. The associated power level is the bipolar energy delivered to the tissue by electrodes 1852 and 1872 and set by generator 1880, and the power level associated with the unipolar energy delivered to the tissue via electrode 1874 is set by generator 1881 according to, for example, power scheme 3005'.

[0252] In use, such as Figure 46 As shown, the end effector 1800 applies bipolar and / or monopolar energy to the tissue treatment area 1804 to seal it, and in some cases, to cut across the tissue. However, in some cases, the energy is deflected from its intended target at the tissue treatment area 1804, resulting in site-specific thermal damage to surrounding tissue. To avoid or at least reduce such occurrences, the surgical instrument 1801 includes impedance sensors 1810, 1811, 1812, and 1813, which are positioned between different electrodes and at different locations, such as... Figure 46 As shown, this is to detect external thermal damage at the site.

[0253] In various aspects, the surgical system 1807 also includes control circuitry 1809 coupled to impedance sensors 1810, 1811, 1812, and 1813. Control circuitry 1809 can detect extra-site or unintended thermal damage based on one or more readings from impedance sensors 1810, 1811, 1812, and 1813. In response, control circuitry 1809 can warn the user of extra-site thermal damage and instruct the user to pause energy delivery to the tissue treatment area 1804, or automatically pause energy delivery while maintaining bipolar energy according to a predetermined power scheme (e.g., power scheme 3005') to complete tissue sealing. In some cases, control circuitry 1809 can instruct the user to use a mechanical scalpel to cut across the tissue to avoid further extra-site thermal damage.

[0254] Still referencing Figure 46Impedance sensor 1810 is configured to measure the impedance between bipolar electrodes 1852 and 1872. Additionally, impedance sensor 1811 is configured to measure the impedance between electrode 1874 and return pad 1803. Furthermore, impedance sensor 1812 is configured to measure the impedance between electrode 1872 and return pad 1803. Furthermore, impedance sensor 1813 is configured to measure the impedance between electrode 1852 and return pad 1803. In other examples, additional impedance sensors are added in-line between unipolar circuit 1882 and bipolar circuit 1883, which can be used to measure impedance at various locations to detect site-specific external thermal anomalies with greater specificity regarding location and impedance path.

[0255] In various aspects, external thermal damage occurs in tissue on one side (left / right) of the end effector 1800. Control circuitry 1809 can detect the side where external thermal damage occurs by comparing readings from impedance sensors 1810, 1811, 1812, and 1813. In one example, a non-proportional change in the unipolar and bipolar impedance readings indicates external thermal damage. Conversely, if a proportional change in the impedance readings is detected, control circuitry 1809 prevents external thermal damage from occurring. In one example, as described in more detail below, external thermal damage can be detected by control circuitry 1809 based on the ratio of bipolar impedance to unipolar impedance.

[0256] Figure 48 Graph 1900 shows curves depicting time on the x-axis and power on the y-axis. Graph 1900 shows similarities in many ways to... Figure 34 Power scheme 1901 of power scheme 3005' is shown, and for simplicity, it will not be repeated at the same level of detail. Control circuitry 3101 causes power scheme 1901 to be applied by generators 1880 (GEN.2), 1881 (GEN.1) to implement a tissue treatment cycle by end effector 1800. Power scheme 1901 includes therapeutic power component 1902 and non-therapeutic or sensing power component 1903. Therapeutic power component 1902 defines monopolar and bipolar power levels similar to those described in conjunction with power scheme 3005'. Sensing power component 1903 includes monopolar 1905 and bipolar 1904 sensing pickups, which are delivered at various points throughout the tissue treatment cycle executed by end effector 1800. In at least one example, the sensing pickups 1903, 1904 of the sensing power component are delivered at a predetermined current value (e.g., 10mA) or within a predetermined range. In at least one example, three different sensing pickups were used to determine the location / orientation of potential external thermal damage.

[0257] Control circuit 3101 can determine whether energy is transferred to a non-tissue therapy-targeted site during a tissue therapy cycle by causing sensing pickups 1903 and 1904 to be delivered at predetermined time intervals. Control circuit 3101 can then assess the return path conductivity based on the delivered sensing pickups. If energy is determined to have deviated from the target site, control circuit 3101 can take one or more reactive measures. For example, control circuit 3101 can adjust the power scheme 1901 applied by generators 1880 (GEN.2) and 1881 (GEN.1). Control circuit 3101 can pause bipolar and / or unipolar energy application to the target site. Additionally, control circuit 3101 can issue a warning to the user, for example, via feedback system 3109. However, if it is determined that no energy deviation is detected, control circuit 3101 continues to execute power scheme 1901.

[0258] In various aspects, for example, control circuit 3101 evaluates return path conductivity by comparing the measured return conductivity with a predetermined return path conductivity stored in memory 3103. If the comparison indicates that the measured and predetermined return path conductivity differ from a predetermined threshold, control circuit 3101 terminates the energy deflection to the non-tissue treatment-targeting site and performs one or more of the previously described reactive measures.

[0259] Figure 49 This is graph 2000 showing the power scheme 2001 interrupted at t3' due to detected external thermal damage. Power scheme 2001 is similar in many respects to... Figure 34 , Figure 48 The power scheme shown is not repeated at the same level of detail in this document for the sake of simplicity. For example, control circuit 1809 causes generators 1880 (curve 2010) and 1881 (curve 2020) to apply power scheme 2001 so that tissue treatment cycle is achieved by end effector 1800. In addition to power scheme 2001, curve 2000 also depicts bipolar impedance 2011 (Z). 双极 ), Unipolar impedance 2021 (Z) 单极 ), and the ratio of unipolar impedance to bipolar impedance on the y-axis 2030 (Z 单极 / Z 双极 During normal operation, when unipolar and bipolar energies are simultaneously applied to the tissue, the bipolar impedance is 2011 (Z). 双极 ) and unipolar impedance 2021 (Z 单极 The value of ) remains proportional, or at least substantially proportional. Therefore, during normal operation, the constant or at least substantially constant impedance ratio 2030 (Z) between the unipolar impedance 2021 and the bipolar impedance 2011 remains proportional. 单极 / Z 双极It remains within the predetermined range of 2031.

[0260] In all aspects, control circuitry 1809 monitors the impedance ratio 2030 to assess whether the monopolar energy is deflected to the non-tissue therapy targeting site. Deflection alters the detected bipolar impedance 2011 (Z). 双极 ) and unipolar impedance 2021 (Z 单极 The value of the impedance ratio 2030 changes proportionally to the value of the impedance ratio 2031. A change in the impedance ratio 2030 within a predetermined range 2031 may cause the control circuit 1908 to issue a warning. However, if the change extends to or falls below the lower threshold 2031 of the predetermined range, the control circuit 1908 may take additional reactive measures.

[0261] In the example shown, for the initial portion of a treatment cycle involving the application of mixed monopolar and bipolar energy to the tissue, the impedance ratio is 2030 (Z). 单极 / Z 双极 The impedance remains constant or at least substantially constant. However, in B1, a difference occurs, where the unipolar impedance (Z) 单极 The unexpected drop, or the bipolar impedance (Z) 双极 A disproportionate decrease in impedance indicates potential external thermal damage. In at least one example, the control circuit 1809 monitors the ratio (Z0) of the unipolar impedance to the bipolar impedance. 单极 / Z 双极 The control circuit 3101 detects external thermal damage to the site by monitoring the change in impedance ratio 2030, and by changing the duration of the predetermined time and / or by changing its value to or below the lower threshold of the predetermined range 2031. In B1, since the detected impedance ratio 2030 is still within the predetermined range 2031, the control circuit 3101 only issues a warning via the feedback system 3109 that external thermal damage to the site has been detected, and continues to monitor the impedance ratio 2030.

[0262] At t3', control circuit 3101 further detects that the impedance ratio 2030 has become at or below the lower threshold value of a predetermined range 2031. In response, control circuit 3101 may issue another warning and, optionally, may instruct the user to suspend energy delivery to the tissue at B2, or automatically suspend energy delivery while maintaining or adjusting the power level of bipolar energy to complete tissue sealing without monopolar energy. In some examples, control circuit 1809 further instructs the user to use a mechanical scalpel (t4') to transversely cut the tissue to avoid further external thermal damage. In the example shown, control circuit 1809 further causes generator 1880 to adjust its power level to complete tissue sealing without monopolar energy and increases the time period allocated for the tissue sealing segment from time t4 to time t4'. In other words, control circuit 1809 increases bipolar energy delivery to the tissue to compensate for the loss of monopolar energy by increasing the bipolar power level and its delivery time.

[0263] Various aspects of the subject matter described herein are illustrated in the following embodiments.

[0264] Various aspects of the subject matter described herein are illustrated in the following embodiments.

[0265] Example Set 1

[0266] Example 1—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a gradually narrowing body extending from a proximal end to a distal end. The gradually narrowing body comprises a conductive material. The gradually narrowing body includes a first conductive portion extending from the proximal end to the distal end, and a second conductive portion defining a tapered electrode protruding from the first conductive portion and extending distally along at least a portion of the gradually narrowing body. The second conductive portion is integral with the first conductive portion. In a transverse cross-section of the gradually narrowing body, the first conductive portion is thicker than the second conductive portion. The second jaw also includes an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue without electrically insulating the second conductive portion. The first conductive portion is configured to transmit electrical energy to the tissue only through the second conductive portion.

[0267] Example 2—An electrosurgical instrument according to Example 1, wherein the conical electrode includes an outer surface flush with the outer surface of the electrical insulating layer.

[0268] Example 3—An electrosurgical instrument according to Example 1 or 2, wherein the conical electrode has a width that gradually narrows as the conical electrode extends from the proximal end toward the distal end.

[0269] Example 4—An electrosurgical instrument according to Example 1, 2 or 3, wherein electrical energy is delivered to the tissue through the outer surface of a conical electrode.

[0270] Example 5—An electrosurgical instrument according to Example 1, 2, 3 or 4, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, wherein the tapered electrode is a second electrode, and wherein the first electrode is laterally offset from the second electrode in a closed configuration.

[0271] Example 6—An electrosurgical instrument according to Example 5, wherein the second jaw further includes a third electrode spaced apart from the gradually narrowing body.

[0272] Example 7—An electrosurgical instrument according to Example 6, wherein a third electrode extends from the proximal end of the electrode to the distal end along an angular profile defined by a second jaw.

[0273] Example 8—An electrosurgical instrument according to Example 7, wherein the third electrode includes a base positioned in a bracket extending from the proximal end of the bracket to the distal end of the bracket along the angular profile of the second jaw.

[0274] Example 9—An electrosurgical instrument according to Example 8, wherein the bracket is centered relative to the lateral edge of the second jaw.

[0275] Example 10—An electrosurgical instrument according to Example 8 or 9, wherein the third electrode further includes a tapered edge extending from the base beyond the sidewall of the bracket.

[0276] Example 11—An electrosurgical instrument according to Example 8, 9 or 10, wherein the support is made of a compliant substrate.

[0277] Example 12—An electrosurgical instrument according to Examples 8, 9, 10 or 11, wherein the bracket is partially embedded in a valley defined in a gradually narrowing body.

[0278] Example 13—An electrosurgical instrument according to Examples 8, 9, 10, 11 or 12, wherein the bracket is spaced apart from the gradually narrowing body by an electrically insulating coating.

[0279] Example 14—An electrosurgical instrument according to Examples 8, 9, 10, 11, 12 or 13, wherein the base includes a proximal end of the base, a distal end of the base, and a width that gradually narrows as the base extends along the angular profile from the proximal end of the base to the distal end of the base.

[0280] Example 15—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a conductive body comprising a tapered angular profile extending from a proximal end to a distal end. The conductive body includes a first conductive portion extending from the proximal end to the distal end, and a second conductive portion defining a tapered electrode projecting from the first conductive portion and extending distally along at least a portion of the conductive body. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion. The second jaw also includes an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue without electrically insulating the second conductive portion. The first conductive portion is configured to transmit electrical energy to the tissue only through the second conductive portion.

[0281] Example 16—An electrosurgical instrument according to Example 15, wherein the conical electrode has a width that gradually narrows as the conical electrode extends from the proximal end toward the distal end.

[0282] Example 17—An electrosurgical instrument according to Example 15 or 16, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, wherein the tapered electrode is a second electrode, and wherein the first electrode is laterally offset from the second electrode in a closed configuration.

[0283] Example 18—An electrosurgical instrument according to Examples 15, 16 or 17, wherein the second jaw further includes a third electrode spaced apart from the conductive body.

[0284] Example 19—An electrosurgical instrument according to Example 18, wherein the third electrode extends distally along at least a portion of the conical angle profile.

[0285] Example 20—An electrosurgical device according to Example 19, wherein the third electrode includes a base positioned in a bracket extending from a proximal end of the bracket to a distal end along at least a portion of a tapered angular profile, and wherein the bracket is formed of a compliant substrate.

[0286] Example Set 2

[0287] Example 1—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a linear portion cooperating to form an angular profile and a treatment surface including segments extending along the angular profile. The segments include different geometries and different electrical conductivities. The segments are configured to generate variable energy density along the treatment surface.

[0288] Example 2—The electrosurgical device according to Example 1, wherein the segment includes a proximal segment and a distal segment. The proximal segment includes a first surface area. The distal segment includes a second surface area. The second surface area is smaller than the first surface area.

[0289] Example 3—An electrosurgical device according to Example 1 or 2, wherein at least one of the segments includes a conductive treatment region longitudinally interrupted by a non-conductive treatment region.

[0290] Example 4—An electrosurgical device according to Example 1, 2 or 3, wherein the variable energy density is predetermined based on the selection of different geometries and different conductivities of the segments.

[0291] Example 5—An electrosurgical instrument according to Example 1, 2, 3 or 4, wherein at least one of the segments has a width that gradually narrows along its length.

[0292] Example 6—An electrosurgical instrument according to Examples 1, 2, 3, 4 or 5, wherein the segment extends along the periphery of the second jaw.

[0293] Example 7—An electrosurgical instrument according to Examples 1, 2, 3, 4, 5 or 6, wherein the segment is defined in the second jaw instead of the first jaw.

[0294] Example 8—An electrosurgical instrument according to Examples 1, 2, 3, 4, 5, 6 or 7, wherein the second jaw includes a conductive skeleton partially coated with a first material and a second material, wherein the first material is thermally conductive but electrically insulating, and wherein the second material is thermally insulating and electrically insulating.

[0295] Example 9—An electrosurgical device according to Example 8, wherein the first material comprises diamond-like carbon.

[0296] Example 10—An electrosurgical device according to Example 8 or 9, wherein the second material comprises polytetrafluoroethylene.

[0297] Example 11—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a gradually narrowing body extending from a proximal end to a distal end. The gradually narrowing body includes a tissue contact surface. The tissue contact surface includes an insulating layer comprising a first material. The insulating layer extends on opposite sides of an intermediate region extending along the length of the gradually narrowing body. The tissue contact surface also includes segments configured to generate variable energy density along the tissue contact surface. The segments include conductive segments and insulating segments, the insulating segments alternating with the conductive segments along the intermediate region. The insulating segments comprise a second material different from the first material.

[0298] Example 12—The electrosurgical device according to Example 11, wherein the conductive section includes a proximal section and a distal section. The proximal section includes a first surface area. The distal section includes a second surface area. The second surface area is smaller than the first surface area.

[0299] Example 13—An electrosurgical instrument according to Example 11 or 12, wherein the second jaw includes a conductive skeleton partially coated with a first material.

[0300] Example 14—An electrosurgical device according to Example 13, wherein the conductive skeleton includes an inner thermally insulating core and an outer thermally conductive layer, the outer thermally conductive layer at least partially surrounding the inner thermally insulating core.

[0301] Example 15—An electrosurgical device according to Examples 11, 12, 13 or 14, wherein the variable energy density is predetermined based on the selection of different geometries and different conductivities of the conductive sections.

[0302] Example 16—An electrosurgical device according to Examples 11, 12, 13, 14 or 15, wherein at least one of the segments has a width that gradually narrows along its length.

[0303] Example 17 - An electrosurgical instrument according to Examples 11, 12, 13, 14, 15 or 16, wherein the segment extends along the periphery of the second jaw.

[0304] Example 18—An electrosurgical instrument according to Examples 11, 12, 13, 14, 15, 16 or 17, wherein the segment is defined in the second jaw instead of the first jaw.

[0305] Example 19—An electrosurgical device according to Examples 11, 12, 13, 14, 15, 16, 17 or 18, wherein the first material comprises diamond-like carbon.

[0306] Example 20—An electrosurgical device according to Examples 11, 12, 13, 14, 15, 16, 17, 18 or 19, wherein the second material comprises polytetrafluoroethylene.

[0307] Example Set 3

[0308] Example 1—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw, a second jaw, and circuitry. The first jaw includes a first conductive skeleton, a first insulating coating selectively covering portions of the first conductive skeleton, and a first jaw electrode including an exposed portion of the first conductive skeleton. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a second conductive skeleton, a second insulating coating selectively covering portions of the second conductive skeleton, and a second jaw electrode including an exposed portion of the second conductive skeleton. The circuitry is configured to deliver bipolar RF energy and monopolar RF energy to tissue via the first jaw electrode and the second jaw electrode. The monopolar RF energy shares a first electrical path and a second electrical path defined by the circuitry for delivering the bipolar RF energy.

[0309] Example 2—An electrosurgical device according to Example 1, wherein the circuit defines a third electrical path separate from the first and second electrical paths.

[0310] Example 3—An electrosurgical instrument according to Example 1 or 2, wherein the end effector includes a cutting electrode electrically insulated from a first conductive frame and a second conductive frame.

[0311] Example 4—An electrosurgical device according to Example 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through a third electrical path.

[0312] Example 5—An electrosurgical instrument according to Example 4, wherein the cutting electrode is configured to cut tissue with cutting monopolar RF energy after tissue coagulation has been initiated by bipolar RF energy.

[0313] Example 6—An electrosurgical instrument according to Example 3, 4 or 5, wherein the cutting electrode is centrally located in one of the first jaws and the second jaws.

[0314] Example 7—An electrosurgical device according to Example 4 or 5, wherein the end effector is configured to simultaneously deliver cutting monopolar RF energy and bipolar RF energy to the tissue.

[0315] Example 8—An electrosurgical instrument according to Examples 1, 2, 3, 4, 5, 6 or 7, wherein the first jaw electrode includes a first distal end electrode, and wherein the second jaw electrode includes a second distal end electrode.

[0316] Example 9—An electrosurgical device according to Example 8, wherein a first conductive framework and a second conductive framework are simultaneously powered to deliver monopolar RF energy to the tissue surface via a first distal end electrode and a second distal end electrode.

[0317] Example 10—An electrosurgical instrument according to Examples 1, 2, 3, 4, 5, 6, 7, 8 or 9, wherein the second jaw includes an anatomical electrode extending along the peripheral surface of the second jaw.

[0318] Example 11—An electrosurgical instrument comprising an end effector and circuitry. The end effector includes at least two electrode sets, a first jaw, and a second jaw. At least one of the first and second jaws is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The end effector is configured to deliver a combination of bipolar RF energy and monopolar RF energy from the at least two electrode sets to the grasped tissue. The circuitry is configured to transmit both bipolar RF energy and monopolar RF energy. The monopolar RF energy shares an active path and a return path defined by the circuitry for transmitting the bipolar RF energy.

[0319] Example 12—An electrosurgical device according to Example 11, wherein at least two electrode groups include three electrical interconnects used together in a circuit.

[0320] Example 13—An electrosurgical device according to Example 11 or 12, wherein at least two electrode groups include three electrical interconnects that define at least a portion of a circuit and another separate circuit.

[0321] Example 14—An electrosurgical instrument according to Example 13, wherein a separate circuit leads to a cutting electrode of at least two electrode groups, the cutting electrode being isolated and centrally located in one of a first jaw and a second jaw.

[0322] Example 15—An electrosurgical instrument according to Example 14, wherein the cutting electrode is configured to cut tissue after coagulation has begun using the second and third electrodes, which have already used at least two electrode sets.

[0323] Example 16—An electrosurgical device according to Example 14 or 15, wherein at least two electrode groups are configured to simultaneously deliver monopolar RF energy and bipolar RF energy to tissue.

[0324] Example 17—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a composite skeleton of at least two different materials configured to selectively generate conductive and thermally insulating portions.

[0325] Example 18—An electrosurgical device according to Example 17, wherein the composite skeleton comprises a titanium-ceramic composite material.

[0326] Example 19—An electrosurgical device according to Example 17 or 18, wherein the composite skeleton includes a ceramic base and a titanium crown that can be attached to the ceramic base.

[0327] Example 20—An electrosurgical device according to Example 17, 18 or 19, wherein the composite skeleton is at least partially coated with an electrically insulating material.

[0328] Example 21—A method for manufacturing the jaws of an end effector for electrosurgical instruments. The method includes preparing a composite framework of the jaws by fusing titanium powder and ceramic powder during a metal injection molding process, and selectively coating the composite framework with an electrically insulating material to create multiple electrodes.

[0329] Example Set 4

[0330] Example 1—An electrosurgical instrument includes a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw includes a first conductive frame and a first electrically insulating layer. The first conductive frame includes: a first thermally insulating core; and a first thermally conductive outer layer integral with and at least partially extending around the first thermally insulating core. The first electrode is defined by selectively applying the first electrically insulating layer to the outer surface of the first thermally conductive outer layer. A second jaw is configured to define a second electrode. The second jaw includes a second conductive frame and a second electrically insulating layer. The second conductive frame includes: a second thermally insulating core; and a second thermally conductive outer layer integral with and at least partially extending around the second thermally insulating core. The second electrode is defined by selectively applying the second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

[0331] Example 2—An electrosurgical device according to Example 1, wherein the first electrode is configured to transmit RF energy to the second electrode through tissue positioned between the first and second electrodes in a bipolar energy operation mode.

[0332] Example 3—An electrosurgical device according to Example 1 or 2, wherein the first thermal isolation core includes an air cavity.

[0333] Example 4—An electrosurgical device according to Example 1, 2 or 3, wherein the first thermally insulating core comprises a lattice structure.

[0334] Example 5—An electrosurgical instrument according to Example 1, 2, 3 or 4, wherein the second jaw includes a third electrode, and wherein the third electrode is defined by selectively applying a second electrically insulating layer to the outer surface of a second thermally conductive outer layer.

[0335] Example 6—An electrosurgical device according to Example 5, wherein the third electrode is configured to deliver RF energy to tissue in contact with the third electrode in a monopolar energy operating mode.

[0336] Example 7—An electrosurgical device according to Examples 1, 2, 3, 4, 5 or 6, wherein at least one of the first electrical insulating layer and the second electrical insulating layer comprises a diamond-like material.

[0337] Example 8—An electrosurgical instrument according to Examples 1, 2, 3, 4, 5, 6 or 7, wherein the first jaw includes a tissue contact surface, and wherein the first thermally insulating core includes a lattice structure including walls erected in a direction transverse to the tissue contact surface.

[0338] Example 9—An electrosurgical instrument according to Example 8, wherein the direction is perpendicular to the tissue contact surface.

[0339] Example 10—An electrosurgical instrument comprising a jaw configured to define an electrode. The jaw includes a first conductive portion, a second conductive portion, and an electrically insulating layer. The first conductive portion is configured to resist heat transfer therethrough. The second conductive portion is integral with the first conductive portion and extends at least partially around the first conductive portion. The second conductive portion is configured to define a heat sink. The electrode is defined by selectively applying the electrically insulating layer to the outer surface of the second conductive portion.

[0340] Example 11—An electrosurgical device according to Example 10, wherein the electrodes are configured to transmit RF energy to tissue positioned against the electrodes.

[0341] Example 12—An electrosurgical instrument according to Example 10 or 11, wherein the first conductive portion includes an air cavity.

[0342] Example 13—An electrosurgical device according to Example 10, 11 or 12, wherein the first conductive portion comprises a lattice structure.

[0343] Example 14—An electrosurgical instrument according to Example 10, 11, 12 or 13, wherein the electrically insulating layer comprises a diamond-like material.

[0344] Example 15—An electrosurgical instrument according to Examples 10, 11, 12, 13 or 14, wherein the jaws include a tissue contact surface, and wherein a first conductive portion includes a lattice structure comprising walls erected in a direction transverse to the tissue contact surface.

[0345] Example 16—An electrosurgical instrument according to Example 15, wherein the direction is perpendicular to the tissue contact surface.

[0346] Example 17—An electrosurgical instrument comprising jaws configured to define an electrode. The jaws include a conductive framework and an electrically insulating layer. The conductive framework includes a thermally insulating core and a thermally conductive outer layer integral with and extending at least partially around the thermally insulating core. The electrode is defined by selectively applying the electrically insulating layer to the outer surface of the thermally conductive outer layer.

[0347] Example 18—An electrosurgical device according to Example 17, wherein the thermal isolation core comprises a lattice structure.

[0348] Example 19—An electrosurgical instrument according to Example 18, wherein the jaws include a tissue contact surface, and wherein the lattice structure includes walls erected in a direction transverse to the tissue contact surface.

[0349] Example 20—An electrosurgical instrument according to Example 19, wherein the direction is perpendicular to the tissue contact surface.

[0350] Example Set 5

[0351] Example 1—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. The first jaw includes a first electrode. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a second electrode configured to deliver a first monopolar energy to tissue, a third electrode, and conductive circuitry, the conductive circuitry being selectively switchable between a connected configuration with the third electrode and a disconnected configuration with the third electrode. In the connected configuration, the third electrode is configured to cooperate with the first electrode to deliver bipolar energy to tissue. The conductive circuitry defines a return path for the bipolar energy. In the disconnected configuration, the first electrode is configured to deliver a second monopolar energy to tissue.

[0352] Example 2—The electrosurgical device according to Example 1 further includes a switching mechanism for alternating between a connected configuration and a disconnected configuration.

[0353] Example 3—The electrosurgical device according to Example 1 or 2 further includes a switching mechanism for alternating between delivering bipolar energy and second monopolar energy to tissue via a first electrode.

[0354] Example 4—An electrosurgical device according to Example 1, 2 or 3, wherein the end effector is configured to deliver bipolar energy and a first monopolar energy to the tissue simultaneously.

[0355] Example 5—An electrosurgical device according to Example 1, 2, 3 or 4, wherein the end effector is configured to deliver a mixture of bipolar energy and a first monopolar energy to the tissue.

[0356] Example 6—An electrosurgical instrument according to Example 5, wherein the levels of bipolar energy and first unipolar energy in the energy mixture are determined based on at least one reading from a temperature sensor indicating at least one temperature of the tissue.

[0357] Example 7—An electrosurgical instrument according to Example 5 or 6, wherein the levels of bipolar energy and first unipolar energy in the energy mixture are determined based on at least one reading of an impedance sensor indicating at least one impedance of the tissue.

[0358] Example 8—An electrosurgical device according to Example 5, 6 or 7, wherein the levels of bipolar energy and first monopolar energy in the energy mixture are adjusted to reduce detected transverse thermal damage beyond the tissue treatment area between the first jaw and the second jaw.

[0359] Example 9—An electrosurgical instrument comprising an end effector and control circuitry. The end effector includes a first jaw, a second jaw, and at least one sensor. The first jaw includes a first electrode. At least one of the first and second jaws is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The second jaw includes a second electrode configured to deliver monopolar energy to tissue; and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuitry is configured to execute a predetermined power scheme to seal and cut tissue during a tissue treatment cycle. The power scheme includes predetermined power levels of monopolar and bipolar energy. The control circuitry is further configured to adjust at least one of the predetermined power levels of monopolar and bipolar energy based on readings from at least one sensor during a tissue treatment cycle.

[0360] Example 10—An electrosurgical device according to Example 9, wherein the predetermined power scheme includes simultaneously and individually applying bipolar and monopolar energy to the tissue during a tissue treatment cycle.

[0361] Example 11—An electrosurgical device according to Example 9 or 10, wherein the predetermined power scheme includes applying bipolar energy instead of monopolar energy to the tissue in the feathering section of the tissue treatment cycle, and applying bipolar energy and monopolar energy to the tissue simultaneously in the tissue heating section and the tissue sealing section of the tissue treatment cycle.

[0362] Example 12—An electrosurgical device according to Example 11, wherein the power scheme further includes applying monopolar energy, rather than bipolar energy, to the tissue in a transverse tissue section of the tissue treatment cycle.

[0363] Example 13—An electrosurgical instrument according to Example 9, 10, 11 or 12, wherein at least one sensor includes an impedance sensor.

[0364] Example 14—An electrosurgical instrument according to Example 13, wherein the control circuit is configured to monitor the impedance ratio of unipolar tissue impedance to bipolar tissue impedance based on readings from an impedance sensor.

[0365] Example 15—An electrosurgical instrument according to Example 14, wherein a change in the impedance ratio within a predetermined range causes the control circuit to issue a warning.

[0366] Example 16—An electrosurgical device according to Example 15, wherein a change in the impedance ratio at or below a predetermined lower threshold causes the control circuit to adjust a predetermined power scheme.

[0367] Example 17—An electrosurgical device according to Example 15 or 16, wherein a change in the impedance ratio at or below a predetermined lower threshold causes the control circuit to suspend the application of monopolar energy to the tissue.

[0368] Example 18—An electrosurgical device according to Example 17, wherein a change in the impedance ratio at or below a predetermined lower threshold also causes the control circuit to adjust the application of bipolar energy to the tissue to complete the sealing of the tissue.

[0369] Example 19—An electrosurgical instrument comprising an end effector and control circuitry. The end effector includes a first jaw and a second jaw. The first jaw includes a first electrode. At least one of the first and second jaws is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The tissue is located at a target site. The second jaw includes a second electrode configured to deliver monopolar energy to the tissue; and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuitry is configured to execute a predetermined power scheme to seal and cut tissue during a tissue treatment cycle. The power scheme includes predetermined power levels of monopolar and bipolar energy. The control circuitry is further configured to detect energy deviation from the target site and adjust at least one of the predetermined power levels of monopolar and bipolar energy to mitigate the energy deviation.

[0370] Example 20—An electrosurgical device according to Example 19, wherein the predetermined power scheme includes simultaneously and individually applying bipolar and monopolar energy to the tissue during a tissue treatment cycle.

[0371] Example 21—An electrosurgical device according to Example 19 or 20, wherein the predetermined power scheme includes applying bipolar energy instead of monopolar energy to the tissue in the feathering section of the tissue treatment cycle, and applying bipolar energy and monopolar energy to the tissue simultaneously in the tissue heating section and tissue sealing section of the tissue treatment cycle.

[0372] Example Set 6

[0373] Example 1—An electrosurgical system comprising an end effector and control circuitry. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The control circuitry is configured to simultaneously and independently apply two different energy modes to the tissue during a tissue treatment cycle, including a tissue coagulation phase and a tissue transection phase.

[0374] Example 2—The electrosurgical system according to Example 1, wherein the first energy mode is a unipolar energy mode.

[0375] Example 3—An electrosurgical system according to Example 2, wherein the second energy mode is a bipolar energy mode.

[0376] Example 4—An electrosurgical system according to Example 2 or 3, wherein the control circuit is configured to activate the application of a unipolar energy mode to the tissue prior to the completion of the tissue coagulation phase via the bipolar energy mode.

[0377] Example 5—An electrosurgical system according to Example 2 or 3, wherein the control circuit is configured to activate the application of a unipolar energy mode to the tissue prior to deactivation of the bipolar energy mode applied to the tissue.

[0378] Example 6—An electrosurgical system according to Example 3, 4 or 5, wherein the control circuit is configured to simultaneously apply a unipolar energy mode and a bipolar energy mode to the tissue during the tissue coagulation phase.

[0379] Example 7—An electrosurgical system according to Examples 1, 2, 3, 4, 5 or 6, wherein the control circuitry includes a processor and a storage medium, and wherein the application of two different energy modes to the tissue is based on a default power scheme stored in the storage medium.

[0380] Example 8—The electrosurgical system according to Example 7 further includes at least one sensor, and wherein the control circuitry is configured to modify the default power scheme based on one or more sensor readings from the at least one sensor.

[0381] Example 9—An electrosurgical instrument comprising an end effector. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The end effector is configured to apply three different energy modes to the tissue during a tissue treatment cycle, including a tissue coagulation phase and a tissue transection phase.

[0382] Example 10—An electrosurgical device according to Example 9, wherein the first energy mode includes bipolar energy.

[0383] Example 11—An electrosurgical device according to Example 10, wherein the second energy mode comprises a mixture of unipolar and bipolar energy.

[0384] Example 12—An electrosurgical device according to Example 11, wherein the third energy mode includes unipolar energy but excludes bipolar energy.

[0385] Example 13—An electrosurgical device according to Example 11 or 12, wherein activation of the monopolar energy applied to the tissue is configured to begin before the completion of the tissue coagulation phase.

[0386] Example 14—An electrosurgical device according to Example 12 or 13, wherein activation applied to the tissue by a unipolar energy is configured to begin prior to deactivation applied to the tissue by a bipolar energy mode.

[0387] Example 15—The electrosurgical device according to Examples 9, 10, 11, 12, 13 or 14 further includes a control circuit, wherein the control circuit includes a processor and a storage medium, and wherein the application of two different energy modes to the tissue is based on a default power scheme stored in the storage medium.

[0388] Example 16—The electrosurgical device according to Example 15 further includes at least one sensor, wherein the control circuitry is configured to adjust a default power scheme during a tissue treatment cycle based on one or more sensor readings from at least one sensor.

[0389] Example 17—An electrosurgical system includes a first generator configured to output bipolar energy, a second generator configured to output unipolar energy, surgical instruments electrically coupled to the first and second generators, and control circuitry. The surgical instruments include an end effector. The end effector includes a first jaw and a second jaw. At least one of the first and second jaws is movable to change the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The control circuitry includes a processor and a storage medium including program instructions that, when executed by the processor, cause the processor to cause the first and second generators to apply a predetermined power scheme to the end effector. The power scheme includes simultaneously applying bipolar energy and unipolar energy to tissue and applying them separately during a tissue treatment cycle.

[0390] Example 18—The electrosurgical system according to Example 17 further includes at least one sensor, wherein the control circuitry is configured to adjust the power scheme during tissue treatment cycles based on one or more sensor readings from the at least one sensor.

[0391] Example 19—An electrosurgical system according to Example 17 or 18, wherein the power scheme includes applying bipolar energy instead of monopolar energy to the tissue in the feathering section of the tissue treatment cycle, and applying bipolar energy and monopolar energy to the tissue simultaneously in the tissue heating section and tissue sealing section of the tissue treatment cycle.

[0392] Example 20—An electrosurgical system according to Examples 17, 18 or 19, wherein the power scheme further includes applying monopolar energy, rather than bipolar energy, to the tissue in a transverse tissue section of the tissue treatment cycle.

[0393] Although several forms have been illustrated and described, the applicant does not intend to limit or restrict the scope of the appended claims to such details. Many modifications, variations, alterations, substitutions, combinations, and equivalents of these forms can be made without departing from the scope of this disclosure, and those skilled in the art will recognize such modifications, variations, alterations, substitutions, combinations, and equivalents. Furthermore, alternatively, the structure of each element associated with a described form can be described as a device for providing the function performed by said element. Additionally, where materials for certain components are disclosed, other materials may also be used. Therefore, it should be understood that the foregoing detailed descriptions and the appended claims are intended to cover all such modifications, combinations, and variations falling within the scope of the forms disclosed in this invention. The appended claims are intended to cover all such modifications, variations, alterations, substitutions, modifications, and equivalents.

[0394] The specific embodiments described above have illustrated various forms of apparatus and / or methods using block diagrams, flowcharts, and / or examples. Wherever such block diagrams, flowcharts, and / or examples contain one or more functions and / or operations, those skilled in the art will understand that each function and / or operation in such block diagrams, flowcharts, and / or examples can be implemented individually and / or collectively by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein can be equivalently implemented in an integrated circuit, wholly or partially, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as any combination thereof, and that designing circuit systems and / or writing software and / or hardware code according to this disclosure will be within the skill of those skilled in the art. Furthermore, those skilled in the art will recognize that the mechanisms of the subject matter described herein can be distributed as one or more program products in various forms, and that the exemplary forms of the subject matter described herein apply regardless of the specific type of signal-bearing medium used for actual distribution.

[0395] Instructions used for programming logic to execute various disclosed aspects may be stored in the system's memory, such as dynamic random access memory (DRAM), cache, flash memory, or other memory. Furthermore, the instructions may be distributed via a network or through other computer-readable media. Therefore, machine-readable media may include any means for storing or transmitting information in a machine-readable (e.g., computer-readable) form, but are not limited to floppy disks, optical disks, optical disc read-only memory (CD-ROM), and magneto-optical disks, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic cards or optical cards, flash memory, or tangible machine-readable storage devices used for transmitting information over the Internet via electrical signals, optical signals, acoustic signals, or other forms of propagation signals (e.g., carrier waves, infrared signals, digital signals, etc.). Therefore, non-transitory computer-readable media include any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a machine-readable (e.g., computer-readable) form.

[0396] As used in any aspect of this document, the term "control circuitry" may refer to, for example, hardwired circuitry systems, programmable circuitry systems (e.g., computer processors including one or more individual instruction processing cores, processing units, processors, microcontrollers, microcontroller units, controllers, digital signal processors (DSPs), programmable logic devices (PLDs), programmable logic arrays (PLAs), field-programmable gate arrays (FPGAs)), state machine circuitry systems, firmware storing instructions executed by the programmable circuitry system, and any combination thereof. Control circuitry can be implemented collectively or individually as part of a larger system, such as integrated circuits (ICs), application-specific integrated circuits (ASICs), system-on-a-chip (SoCs), desktop computers, laptop computers, tablet computers, servers, smartphones, etc. Therefore, as used herein, "control circuit" includes, but is not limited to, electronic circuits having at least one discrete circuit, electronic circuits having at least one integrated circuit, electronic circuits having at least one application-specific integrated circuit, electronic circuits forming a general-purpose computing device configured by a computer program (e.g., a general-purpose computer configured by a computer program that at least partially implements the methods and / or devices described herein, or a microprocessor configured by a computer program that at least partially implements the methods and / or devices described herein), electronic circuits forming a memory device (e.g., forming a random access memory), and / or electronic circuits forming a communication device (e.g., a modem, a communication switch, or an optoelectronic device). Those skilled in the art will recognize that the subject matter described herein can be implemented in analog or digital modes, or some combination thereof.

[0397] As used in any aspect of this document, the term "logic" can refer to an application, software, firmware, and / or circuit system configured to perform any of the foregoing operations. Software can be embodied as a software package, code, instructions, instruction sets, and / or data recorded on a non-transitory computer-readable storage medium. Firmware can be embodied as hard-coded (e.g., non-volatile) code, instructions, or instruction sets and / or data in a memory device.

[0398] As used in any part of this document, the terms “component,” “system,” “module,” etc., can refer to computer-related entities, hardware, combinations of hardware and software, software, or software in execution.

[0399] As used in any aspect of this document, "algorithm" refers to a systematic sequence of steps that leads to a desired result, where "step" refers to the manipulation of physical quantities and / or logical states, which may (but not necessarily) take the form of electrical or magnetic signals that can be stored, transferred, combined, compared, and otherwise manipulated. These signals are commonly referred to as bits, values, elements, symbols, characters, terms, numbers, etc. These and similar terms may be associated with appropriate physical quantities and are merely convenient labels applied to these quantities and / or states.

[0400] The network may include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet-switched network communication protocol. An exemplary communication protocol may include an Ethernet communication protocol that may allow communication using Transmission Control Protocol / Internet Protocol (TCP / IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard entitled "IEEE 802.3 Standard" published by the Institute of Electrical and Electronics Engineers (IEEE) in December 2008 and / or a higher version of this standard. Alternatively or additionally, communication devices may be able to communicate with each other using the X.25 communication protocol. The X.25 communication protocol may conform to or be compatible with standards published by the International Telecommunication Union Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, communication devices may be able to communicate with each other using the Frame Relay communication protocol. The Frame Relay communication protocol may conform to or be compatible with standards published by the International Telegraph and Telephone Consultative Committee (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, transceivers may be able to communicate with each other using the Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard entitled "ATM-MPLS Network Interworking 2.0" and / or a higher version of that standard, published by the ATM Forum in August 2001. Of course, this document also envisions different and / or subsequently developed connectivity-oriented network communication protocols.

[0401] Unless otherwise expressly stated in the foregoing disclosure, it is understood that in the foregoing disclosure, discussions using terms such as “processing,” “estimating,” “calculating,” “determining,” and “displaying” refer to the actions and processes of a computer system or similar electronic computing device that manipulate data represented as physical (electronic) quantities in the registers and memories of the computer system and convert them into other data similarly represented as physical quantities in the memory or registers of the computer system or other such information storage, transmission, or display devices.

[0402] One or more components may be referred to herein as “configured to be,” “configurable to be,” “operable / operationally,” “suitable / adaptable,” “capable,” “adaptable / fittable,” etc. Those skilled in the art will recognize that, unless the context otherwise requires, “configured to be” generally encompasses components in an active state and / or in an inactive state and / or in a standby state.

[0403] The terms "proximal" and "distal" are used herein in relation to the clinician manipulating the handle portion of the surgical instrument. "Proximal" refers to the portion closest to the clinician, and "distal" refers to the portion furthest from the clinician's position. It should also be understood that, for brevity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used in conjunction with accompanying drawings. However, surgical instruments are used in many orientations and locations, and these terms are not restrictive and / or absolute.

[0404] Those skilled in the art will recognize that, in general, the terminology used herein, and particularly in the appended claims (e.g., the text of the appended claims), is typically intended to be “open” terms (e.g., the term “comprising” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “at least having,” the term “including” should be interpreted as “comprising but not limited to,” etc.). Those skilled in the art will also understand that if a specific number of statements in the introduced claims is intended, such an intention will be explicitly stated in the claims, and if no such statement is present, such an intention does not exist. For example, to aid understanding, the appended claims below may contain the use of the introductory phrases “at least one” and “one or more” to introduce the claims. However, the use of such phrases should not be construed as implying that introducing a claim statement with the indefinite article "a" or "an" limits any particular claim containing such an introductory claim statement to a claim containing only one such statement, even when the same claim includes the introductory phrase "one or more" or "at least one" and indefinite articles such as "a" or "an" (e.g., "a" and / or "an" should generally be interpreted as meaning "at least one" or "one or more"); this also applies to the use of definite articles used to introduce a claim statement.

[0405] Furthermore, even when a specific number of claims is explicitly stated, those skilled in the art should recognize that such a statement should generally be interpreted as referring to at least the number stated (e.g., in the absence of other modifiers, a bare statement of "two statements" generally means at least two statements, or two or more statements). Moreover, in cases where conventions such as "at least one of A, B, and C" are used, such constructions are generally intended to have a meaning that those skilled in the art will understand (e.g., "a system having at least one of A, B, and C" will include, but is not limited to, systems having only A, only B, only C, A and B together, A and C together, B and C together, and / or A, B, and C together, etc.). In cases where conventions such as "at least one of A, B, or C" are used, such constructions are generally intended to have a meaning that those skilled in the art will understand (e.g., "a system having at least one of A, B, or C" should include, but is not limited to, systems having only A, only B, only C, A and B together, A and C together, B and C together, and / or A, B, and C together, etc.). Those skilled in the art should also understand that, generally, unless the context otherwise indicates, any transitional words and / or phrases presenting two or more alternative terms in the detailed description, claims, or drawings should be understood to cover the possibility of including one of the terms, any one of the terms, or both of the terms. For example, the phrase "A or B" will generally be understood to include the possibility of "A" or "B" or "A and B".

[0406] With respect to the appended claims, those skilled in the art will understand that the operations described herein can generally be performed in any order. Furthermore, although various operation flowcharts are shown in one or more sequences, it should be understood that the various operations may be performed in other orders than those shown, or may be performed simultaneously. Unless the context otherwise requires, examples of such alternative orderings may include overlapping, interleaving, interruption, reordering, incremental, preparatory, supplementary, simultaneous, reverse, or other altered orderings. Moreover, unless the context otherwise requires, terms such as “in response to,” “related,” or other past tense adjectives are generally not intended to exclude such variations.

[0407] It is worth noting that any reference to "one aspect," "one aspect," "one example," or "one example" means that the specific feature, structure, or characteristic described in connection with said aspect is included in at least one aspect. Therefore, the phrases "in one aspect," "in one aspect," "in one example," and "in one example" appearing in various places throughout the specification do not necessarily refer to the same aspect. Furthermore, specific features, structures, or characteristics may be combined in one or more aspects in any suitable manner.

[0408] In this specification, unless otherwise stated, the terms "about" or "approximately" as used herein refer to an acceptable error in a particular value as determined by one of ordinary skill in the art, depending in part on how the value is measured or determined. In some embodiments, the terms "about" or "approximately" mean within 1, 2, 3, or 4 standard deviations. In some embodiments, the terms "about" or "approximately" mean within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.05% of a given value or range.

[0409] In this specification, unless otherwise specified, all numerical parameters should in all cases be understood to be referred to by or modified by the term "about," whereby the numerical parameters have inherent differences in the underlying measurement techniques used to determine the parameter values. To a minimum, and without attempting to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter described herein should be interpreted at least according to the significant digits of the reported value and by applying customary rounding methods.

[0410] Any numerical ranges listed herein include all subranges covered by the listed range. For example, the range “1 to 10” includes all subranges between the listed minimum value 1 and the listed maximum value 10 (inclusive), that is, a minimum value equal to or greater than 1 and a maximum value equal to or less than 10. Furthermore, all ranges listed herein include the endpoints of the listed range. For example, the range “1 to 10” includes the endpoints 1 and 10. Any upper limit value listed in this specification is intended to include all smaller limits covered therein, and any lower limit value listed in this specification is intended to include all larger limits covered therein. Therefore, the applicant reserves the right to amend this specification (including the claims) to expressly list any subranges covered by the expressly listed ranges. All such ranges are inherently described in this specification.

[0411] Any patent application, patent, non-patent publication, or other public material mentioned in this specification and / or listed in any application data sheet is incorporated herein by reference, provided that the incorporated material is inconsistent with this specification. Therefore, and to the extent necessary, the disclosures expressly listed herein replace any conflicting material incorporated herein by reference. Any material or portion thereof allegedly incorporated herein by reference that conflicts with existing definitions, statements, or other public materials listed herein will be incorporated only to the extent that the incorporated material does not conflict with existing public materials.

[0412] In summary, many beneficial effects resulting from employing the concepts described herein have been described. For illustrative and descriptive purposes, one or more of the specific embodiments described above have been provided. These embodiments are not intended to be exhaustive or limited to the precise forms disclosed in the invention. Modifications or variations may be made to the invention in accordance with the teachings above. The one or more forms chosen and described are intended to illustrate the principles and practical applications, thereby enabling those skilled in the art to utilize various forms and modifications suitable for the intended particular use. The claims filed herein are intended to define the full scope.

Claims

1. An electrosurgical device, comprising: A first jaw, configured to define a first electrode, wherein the first jaw includes: A first conductive framework, the first conductive framework comprising: First thermal insulation core; and A first thermally conductive outer layer, the first thermally conductive outer layer being integral with the first thermally insulating core and extending at least partially around the first thermally insulating core; and A first electrical insulating layer, wherein the first electrode is defined by an area of ​​the first jaws that remains exposed after the first electrical insulating layer is selectively applied to the outer surface of the first thermally conductive outer layer; and A second jaw, configured to define a second electrode, wherein the second jaw includes: The second conductive framework includes: Second thermal insulation core; and A second thermally conductive outer layer, which is integral with and at least partially extends around the second thermally insulating core; and A second electrical insulating layer, wherein the second electrode is defined by an area of ​​the second jaw that remains exposed after the second electrical insulating layer is selectively applied to the outer surface of the second thermally conductive outer layer. Wherein, the first jaw includes a tissue contact surface, and wherein the first thermal insulation core includes a lattice structure, the lattice structure including walls erected in a direction transverse to the tissue contact surface. The direction is perpendicular to the tissue contact surface.

2. The electrosurgical device according to claim 1, wherein, The first electrode is configured to transmit RF energy to the second electrode via tissue positioned between the first and second electrodes in a bipolar energy operation mode.

3. The electrosurgical device according to claim 1, wherein, The first thermal insulation core includes an air cavity.

4. The electrosurgical device according to claim 1, wherein, The second jaw includes a third electrode, wherein the third electrode is defined by selectively applying the second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

5. The electrosurgical device according to claim 4, wherein, The third electrode is configured to deliver RF energy to tissue in contact with the third electrode in a unipolar energy operation mode.

6. The electrosurgical device according to claim 1, wherein, At least one of the first electrical insulating layer and the second electrical insulating layer comprises a diamond-like material.

7. An electrosurgical instrument comprising jaws configured to define electrodes, wherein the jaws include: A first conductive portion, the first conductive portion being configured to resist heat transfer passing through it; A second conductive portion, which is integral with and extends at least partially around the first conductive portion, wherein the second conductive portion is configured to define a heat sink; as well as An electrically insulating layer, wherein the electrode is defined by an area of ​​the jaws that remains exposed after the electrically insulating layer has been selectively applied to the outer surface of the second conductive portion. The clamp jaws include a tissue contact surface, and the first conductive portion includes a lattice structure comprising walls erected in a direction bisecting the tissue contact surface. The direction is perpendicular to the tissue contact surface.

8. The electrosurgical device according to claim 7, wherein, The electrode is configured to transmit RF energy to tissue located against the electrode.

9. The electrosurgical device according to claim 7, wherein, The first conductive portion includes an air cavity.

10. The electrosurgical device according to claim 7, wherein, The electrical insulating layer contains a diamond-like material.

11. An electrosurgical device, comprising: Jaws, the jaws being configured to define electrodes, wherein the jaws include: The conductive framework includes: Thermal isolation core, the thermal isolation core comprising a lattice structure; and A thermally conductive outer layer, said thermally conductive outer layer being integral with the thermally insulating core and extending at least partially around the thermally insulating core; and An electrically insulating layer, wherein the electrode is defined by an area of ​​the jaws that remains exposed after the electrically insulating layer is selectively applied to the outer surface of the thermally conductive outer layer. The jaws include a tissue contact surface, and the lattice structure includes walls erected in a direction bisecting the tissue contact surface. The direction is perpendicular to the tissue contact surface.

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