Electrosurgical instrument with electrodes having variable energy density

Abstract

An electrosurgical instrument including an end effector is disclosed. 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 transition 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 that cooperates to form a corner profile and a treatment surface including a segment extending along the corner profile. The segment includes different geometries and different electrical conductivities. The segment is configured to produce a variable energy density along the treatment surface.

Description

[0001] Cross Reference to Related Applications

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

[0003] The present disclosure relates to surgical instruments designed for treating tissue, including but not limited to surgical instruments configured to both cut and fasten tissue. The surgical instruments can include electrosurgical instruments powered by a generator to effect tissue dissection, cutting, and / or coagulation during a surgical procedure. The surgical instruments can include instruments configured to cut and staple tissue using surgical staples and / or fasteners. The surgical instruments can be configured for open surgical procedures, but have application in other types of surgical procedures such as laparoscopic, endoscopic, and robotic-assisted procedures, and can include end effectors that can be articulated relative to a shaft portion of the instrument to facilitate precise positioning within a patient. SUMMARY

[0004] In various embodiments, an electrosurgical instrument including an end effector is disclosed. 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 transition 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 that cooperates to form a corner profile and a treatment surface including segments extending along the corner profile. The segments include different geometries and different electrical conductivities. The segments are configured to produce a variable energy density along the treatment surface.

[0005] In various embodiments, an electrosurgical instrument including an end effector is disclosed. 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 transition 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 that cooperates to form a corner profile and a treatment surface including segments extending along the corner profile. The segments include different geometries and different electrical conductivities. The segments are configured to produce a variable energy density along the treatment surface. BRIEF DESCRIPTION OF DRAWINGS

[0006] The novel features of the various aspects are set forth with particularity in the appended claims. These aspects, together with their equivalents, can be best understood from the following description in conjunction with the accompanying drawings, in which:

[0007] Figure 1 An example of a generator for use with a surgical system is shown in accordance with at least one aspect of the present disclosure;

[0008] Figure 2 A surgical system in one form including a generator and an electrosurgical instrument usable therewith is shown in accordance with at least one aspect of the present disclosure;

[0009] Figure 3 A schematic view of a surgical instrument or tool is shown in accordance with at least one aspect of the present disclosure;

[0010] Figure 4 An exploded view of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure;

[0011] Figure 5 A cross-sectional view of the end effector of Figure 4 ;

[0012] Figures 6 to 8 Three different modes of operation of the end effector of Figure 4 are depicted prior to energy application to tissue;

[0013] Figures 9 to 11 Three different modes of operation of the end effector of Figure 4 are depicted during energy application to tissue;

[0014] Figure 12 A method of manufacturing a jaw of an end effector is shown in accordance with at least one aspect of the present disclosure;

[0015] Figure 13 A method of manufacturing a jaw of an end effector is shown in accordance with at least one aspect of the present disclosure;

[0016] Figure 14 A partial perspective view of a jaw of an end effector of an electrosurgical instrument is shown in accordance with at least one aspect of the present disclosure;

[0017] Figure 15 Steps of a process of manufacturing a jaw of Figure 14 ;

[0018] Figure 16 Steps of a process of manufacturing a jaw of Figure 14 ;

[0019] Figures 17 to 19 Manufacturing process is shown Figure 14 The steps of the jaw-gripping process;

[0020] 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.

[0021] 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.

[0022] Figure 22 It shows Figure 20 A perspective view of the jaws of the end effector of an electrosurgical instrument;

[0023] 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;

[0024] 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;

[0025] 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;

[0026] 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;

[0027] Figure 27 An 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.

[0028] 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;

[0029] Figure 29 A cross-sectional view of a flexible circuit according to at least one aspect of the present disclosure is shown;

[0030] 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;

[0031] 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;

[0032] Figure 32 A cross-sectional view of a flexible circuit extending through a coil tube is shown in accordance with at least one aspect of the present disclosure;

[0033] Figure 33 A cross-sectional view of a flexible circuit extending through a coil tube is shown in accordance with at least one aspect of the present disclosure;

[0034] Figure 34 is a graph showing a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure;

[0035] Figure 35 is a graph showing a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector and a plurality of measured parameters of the end effector and tissue in accordance with at least one aspect of the present disclosure;

[0036] Figure 36 is a schematic diagram of an electrosurgical system in accordance with at least one aspect of the present disclosure;

[0037] Figure 37 is a table showing a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure;

[0038] Figures 38 to 40 A tissue treatment cycle applied to a tissue treatment region by an end effector is shown in accordance with at least one aspect of the present disclosure;

[0039] Figure 41 An end effector applying treatment energy to tissue grasped by the end effector, the treatment energy generated by a monopolar power source and a bipolar power source is shown in accordance with at least one aspect of the present disclosure;

[0040] Figure 42 is a simplified schematic diagram of an electrosurgical system in accordance with at least one aspect of the present disclosure;

[0041] Figure 43 is a graph showing a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector and corresponding temperature readings of the tissue treatment region in accordance with at least one aspect of the present disclosure;

[0042] Figure 44 An end effector treating an artery is shown in accordance with at least one aspect of the present disclosure;

[0043] Figure 45 An end effector treating an artery is shown in accordance with at least one aspect of the present disclosure;

[0044] Figure 46An end effector applying therapeutic energy to tissue grasped by the end effector, the therapeutic energy generated by a monopolar power source and a bipolar power source, is shown in accordance with at least one aspect of the present disclosure;

[0045] Figure 47 A simplified schematic of an electrosurgical system is shown in accordance with at least one aspect of the present disclosure;

[0046] Figure 48 is a graph illustrating a power scheme including a therapeutic portion and a non- therapeutic range for coagulating and cutting a tissue treatment zone in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure; and

[0047] Figure 49 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment zone in a treatment cycle applied by an end effector, and corresponding monopolar and bipolar impedances and their ratio in accordance with at least one aspect of the present disclosure. DETAILED DESCRIPTION

[0048] Applicant of the present application owns the following U.S. Patent Applications that were filed on even date herewith and which are each herein incorporated by reference in their respective entireties:

[0049] • Attorney Docket No. END9234USNP1 / 190717-1M, entitled METHOD FOR AN ELECTROSURGICAL PROCEDURE;

[0050] • Attorney Docket No. END9234USNP2 / 190717-2, entitled ARTICULATABLE SURGICAL INSTRUMENT;

[0051] • Attorney Docket No. END9234USNP3 / 190717-3, entitled SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES;

[0052] • Attorney Docket No. END9234USNP4 / 190717-4, entitled SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR;

[0053] • Attorney Docket No. END9234USNP5 / 190717-5, entitled ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES;

[0054] • Attorney Docket No. END9234USNP6 / 190717-6, entitled ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT;

[0055] • Attorney Docket No. END9234USNP7 / 190717-7, entitled ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES;

[0056] • Attorney Docket No. END9234USNP8 / 190717-8, entitled ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS;

[0057] • Attorney Docket No. END9234USNP9 / 190717-9, entitled ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWER SOURCES;

[0058] • Attorney Docket No. END9234USNP10 / 190717-10, entitled ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES;

[0059] • Attorney Docket No. END9234USNP12 / 190717-12, entitled ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY CAPABILITIES;

[0060] • Attorney Docket No. END9234USNP13 / 190717-13, entitled ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVE PORTIONS;

[0061] • Attorney Docket No. END9234USNP14 / 190717-14, entitled ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES;

[0062] • Attorney Docket No. END9234USNP15 / 190717-15, entitled ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE;

[0063] • Attorney Docket No. END9234USNP16 / 190717-16, entitled CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USER INPUT;

[0064] • Attorney Docket No. END9234USNP17 / 190717-17, entitled CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE; and

[0065] • Attorney Docket No. END9234USNP18 / 190717-18, entitled SURGICAL SYSTEM COMMUNICATION PATHWAYS.

[0066] Applicant of the present application owns the following U.S. Provisional Patent Applications that were filed on December 30, 2019, the disclosure of each of which is herein incorporated by reference in its entirety:

[0067] • U.S. Provisional Patent Application Serial No. 62 / 955,294, entitled USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITY END-EFFECTOR;

[0068] • U.S. Provisional Patent Application Serial No. 62 / 955,292, entitled COMBINATION ENERGY MODALITY END-EFFECTOR; and

[0069] • U.S. Provisional Patent Application Serial No. 62 / 955,306, entitled SURGICAL INSTRUMENT SYSTEMS.

[0070] Applicant of the present patent application owns the following U.S. Patent Applications, the disclosure of each of which is herein incorporated by reference in its entirety:

[0071] • U.S. Patent Application Serial No. 16 / 209,395, entitled METHOD OF HUB COMMUNICATION, now U.S. Patent Application Publication No. 2019 / 0201136;

[0072] • U.S. Patent Application Serial No. 16 / 209,403, entitled METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB, now U.S. Patent Application Publication No. 2019 / 0206569;

[0073] • U.S. Patent Application Serial No. 16 / 209,407, entitled METHOD OF ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL, now U.S. Patent Application Publication No. 2019 / 0201137;

[0074] • 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;

[0075] • U.S. Patent Application Serial No. 16 / 209,423, entitled METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS, now U.S. Patent Application Publication No. 2019 / 0200981;

[0076] • U.S. Patent Application Serial No. 16 / 209,427, titled METHOD OF USING REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZE PERFORMANCE OF RADIO FREQUENCY DEVICES, now U.S. Patent Application Publication No. 2019 / 0208641;

[0077] • U.S. Patent Application Serial No. 16 / 209,433, titled METHOD OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMP SPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB, now U.S. Patent Application Publication No. 2019 / 0201594;

[0078] • U.S. Patent Application Serial No. 16 / 209,447, titled METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB, now U.S. Patent Application Publication No. 2019 / 0201045;

[0079] • U.S. Patent Application Serial No. 16 / 209,453, titled METHOD FOR CONTROLLING SMART ENERGY DEVICES, now U.S. Patent Application Publication No. 2019 / 0201046;

[0080] • U.S. Patent Application Serial No. 16 / 209,458, titled METHOD FOR SMART ENERGY DEVICE INFRASTRUCTURE, now U.S. Patent Application Publication No. 2019 / 0201047;

[0081] • U.S. Patent Application Serial No. 16 / 209,465, titled METHOD FOR ADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION, now U.S. Patent Application Publication No. 2019 / 0206563;

[0082] • U.S. Patent Application Serial No. 16 / 209,478, titled 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;

[0083] • U.S. Patent Application Serial No. 16 / 209,490, titled METHOD FOR FACILITY DATA COLLECTION AND INTERPRETATION, now U.S. Patent Application Publication No. 2019 / 0206564;

[0084] • U.S. Patent Application Serial No. 16 / 209,491, titled METHOD FOR CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS, now U.S. Patent Application Publication No. 2019 / 0200998;

[0085] • U.S. Patent Application Serial No. 16 / 562,123, titled METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES;

[0086] • U.S. Patent Application Serial No. 16 / 562,135, titled METHOD FOR CONTROLLING AN ENERGY MODULE OUTPUT;

[0087] • U.S. Patent Application Serial No. 16 / 562,144, titled METHOD FOR CONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE; and

[0088] • U.S. Patent Application Serial No. 16 / 562,125, titled METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM.

[0089] Before the various aspects of the electrosurgical system are described in detail, it should be noted that the illustrative examples are not limited in application or use to the details of construction and arrangement of parts illustrated in the drawings and description. The illustrative examples can be implemented or incorporated in other aspects, variations and modifications and can be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative examples and are not to be taken in a limiting sense. Also, it is to be understood that one or more of the following-described aspects, expressions of aspects, and / or examples can be combined with any one or more of the other following-described aspects, expressions of aspects, and / or examples.

[0090] Various aspects relate to an electrosurgical system that includes an electrosurgical instrument powered by a generator to achieve tissue dissection, cutting, and / or coagulation during a surgical procedure. The electrosurgical instrument can be configured for use in open surgical procedures, but can also be applied in other types of procedures, such as laparoscopic, endoscopic, and robotic-assisted procedures.

[0091] As described in greater detail below, the electrosurgical instrument generally includes a shaft having a distally mounted end effector (e.g., one or more electrodes). The end effector can be positioned against tissue such that electrical current is introduced into the tissue. The electrosurgical instrument can be configured for bipolar or monopolar operation. During bipolar operation, electrical current is introduced into and returned from the tissue by active and return electrodes of the end effector, respectively. During monopolar operation, electrical current is introduced into the tissue by an active electrode of the end effector and returned through a return electrode (e.g., a grounding pad) separately positioned on the patient’s body. The heat generated by the electrical current flowing through the tissue can form a hemostatic seal within and / or between the tissue and can thus be particularly suitable for sealing blood vessels, among other things.

[0092] Figure 1An example of a generator 900 configured to deliver multiple energy modalities to a surgical instrument is shown. The generator 900 provides RF signals and / or ultrasonic signals for energy delivery to a surgical instrument. The generator 900 includes at least one generator output that can deliver multiple energy modalities (e.g., ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others) through a single port and these signals can be delivered to an end effector separately or simultaneously to treat 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 of the present disclosure. Digital information associated with a waveform is provided to the waveform generator 904, which includes one or more DAC circuits to convert the digital input into an analog output. The analog output is fed to an amplifier 906 for signal conditioning and amplification. The conditioned and amplified output of the amplifier 906 is coupled to a power transformer 908. The signal is coupled through the power transformer 908 to the secondary side in the patient isolation side. A first signal of a first energy modality is provided to a surgical instrument between the terminals labeled ENERGY1 and RETURN. A second signal of a second energy modality is coupled across a capacitor 910 and is provided to the surgical instrument between the terminals labeled ENERGY2 and RETURN. It will be appreciated that more than two energy modalities can be output and thus the subscript "n" can be used to designate that up to n ENERGY n terminals, where n is a positive integer greater than 1. It will also be appreciated that up to "n" return paths RETURN n .

[0093] The first voltage sense circuit 912 is coupled across the terminals labeled ENERGY1 and RETURN path to measure the output voltage therebetween. The second voltage sense circuit 924 is coupled across the terminals labeled ENERGY2 and RETURN path to measure the output voltage therebetween. As shown, the current sense circuit 914 is disposed in series with the RETURN leg of the secondary side of the power transformer 908 to measure the output current for either energy modality. If different return paths are provided for each energy modality, a separate current sense circuit should be provided in each return leg. The outputs of the first and second voltage sense circuits 912, 924 are provided to respective isolation transformers 928, 922, and the output of the current sense 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 isolated side) are provided to one or more ADC circuits 926. The digitized outputs of the ADC circuits 926 are provided to the processor 902 for further processing and computation. The output voltage and current feedback information can be employed to regulate the output voltage and current provided to the surgical instrument, and to compute output impedance and other parameters. Input / output communication between the processor 902 and the patient isolated circuitry is provided through the interface circuit 920. Sensors can also be in electrical communication with the processor 902 through the interface circuit 920.

[0094] In one aspect, the impedance can be determined by the processor 902 by dividing the output of the first voltage sense circuit 912 coupled across the terminals labeled ENERGY1 / RETURN or the second voltage sense circuit 924 coupled across the terminals labeled ENERGY2 / RETURN by the output of the current sense circuit 914 disposed in series with the RETURN leg of the secondary side of the power transformer 908. The outputs of the first and second voltage sense circuits 912, 924 are provided to separate isolation transformers 928, 922, and the output of the current sense circuit 914 is provided to another isolation transformer 916. The digitized voltage and current sense measurements from the ADC circuits 926 are provided to the processor 902 for computation of impedance. For example, the first energy modality ENERGY1 can be RF monopolar energy, and the second energy modality ENERGY2 can be RF bipolar energy. However, other energy modalities include ultrasound energy, irreversible and / or reversible electroporation, and / or microwave energy, among others, in addition to bipolar and monopolar RF energy modalities. Also, while the illustrated example shows that a single return path RETURN can be provided for two or more energy modalities, in other aspects, multiple return paths RETURN can be provided for each energy modality ENERGY Figure 1 The illustrated example shows that a single return path RETURN can be provided for two or more energy modalities, but in other aspects, multiple return paths RETURN can be provided for each energy modality ENERGY n The illustrated example shows that a single return path RETURN can be provided for two or more energy modalities, but in other aspects, multiple return paths RETURN can be provided for each energy modality ENERGY n .

[0095] 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.

[0096] 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.

[0097] 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 the form shown, the generator 1100 is shown as being separate from the surgical instruments 1104, 1106, 1108, but in one form, the generator 1100 can be integrally formed with any of the surgical instruments 1104, 1106, 1108 to form an all-in-one surgical system. The generator 1100 includes input devices 1110 on the front panel of the generator 1100 console. The input devices 1110 can include any suitable device for generating signals appropriate for programming operation of the generator 1100. The generator 1100 can be configured for wired or wireless communication.

[0098] The generator 1100 is configured to drive a plurality of surgical instruments 1104, 1106, 1108. The first surgical instrument is an ultrasonic surgical instrument 1104 and includes a handpiece 1105 (HP), an ultrasonic transducer 1120, a shaft 1126, and an end effector 1122. The end effector 1122 includes an ultrasonic blade 1128 and clamp arm 1140 acoustically coupled to the ultrasonic transducer 1120. The handpiece 1105 includes a trigger 1143 for operating the clamp arm 1140 and a combination of switch buttons 1137, 1134b, 1134c for energizing the ultrasonic blade 1128 and driving the ultrasonic blade or other functions. The switch buttons 1137, 1134b, 1134c can be configured to energize the ultrasonic transducer 1120 with the generator 1100.

[0099] 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 handpiece 1107 (HP), a shaft 1127, and an end effector 1124. The end effector 1124 includes electrodes in clamp arms 1145, 1142b and returns through an electrical conductor portion of the shaft 1127. The electrodes are coupled to and energized by a bipolar energy source within the generator 1100. The handpiece 1107 includes a trigger 1145 for operating the clamp arms 1145, 1142b and an energy button 1135 for actuating an energy switch to energize the electrodes in the end effector 1124. The second surgical instrument 1106 can also be used with a return pad for monopolar energy delivery to tissue.

[0100] 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.

[0101] 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.

[0102] 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.

[0103] In certain instances, the closure motor assembly 610 includes a closure motor. The closure 603 can be operably coupled to a closure motor drive assembly 612, which can be configured to transmit closure motions generated by the motor to the end effector, particularly to displace a closure member for closure to transition the end effector to a closed configuration. The closure motions can transition, for example, the end effector from an open configuration to a closed configuration to capture tissue. The end effector can be transitioned to an open position by reversing the direction of the motor.

[0104] In certain instances, the articulation motor assembly 620 includes an articulation motor operably coupled to an articulation drive assembly 622, which can be configured to transmit articulation motions generated by the motor to the end effector. In certain instances, the articulation motions can articulate the end effector relative to the shaft, for example.

[0105] One or more of the motors of the surgical instrument 600 can include a torque sensor to measure the output torque on the shaft of the motor. The 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.

[0106] In various instances, the motor assemblies 610, 620 include one or more motor drivers, which can include one or more H-bridge FETs. The motor drivers can regulate the power transmitted from the power source 630 to the motor based on input from, for example, a microcontroller 640 (“controller”) of the control circuit 601. In certain instances, the microcontroller 640 can be used to determine, for example, the current drawn by the motor.

[0107] In certain instances, the microcontroller 640 can include a microprocessor 642 (“processor”) and one or more non-transitory computer-readable media or memory units 644 (“memory”). In certain instances, the memory 644 can store various program instructions, which when executed, can cause the processor 642 to perform a number of functions and / or calculations described herein. In certain instances, one or more of the memory units 644 can be coupled to the processor 642, for example. In various aspects, the microcontroller 640 can communicate over wired or wireless channels, or a combination thereof.

[0108] In certain instances, power source 630 can be used, for example, to supply power to microcontroller 640. In certain instances, power source 630 can comprise a battery (or "battery pack" or "power pack"), such as a lithium ion battery. In certain instances, the battery pack can be configured to be releasably mounted to a handle for supplying power to surgical instrument 600. A plurality of series-connected battery cells can be used as power source 630. In certain instances, power source 630 can be, for example, replaceable and / or rechargeable.

[0109] In various instances, processor 642 can control the motor drives to control the position, rotation direction, and / or speed of the motors of assemblies 610, 620. In certain instances, processor 642 can send signals to the motor drives to stop and / or disable the motors. It should be understood that the term "processor" as used herein includes any suitable microprocessor, microcontroller, or other base computing device that incorporates the functions of a computer's central processing unit (CPU) onto one integrated circuit or up to several integrated circuits. Processor 642 is a multi-purpose, programmable device that receives digital data as input, processes it according to instructions stored in its memory, and then provides results as output. Because the processor has internal memory, it is an example of sequential digital logic. The objects of the processor's operation are numbers and symbols represented in the binary numeral system.

[0110] In one instance, processor 642 can be any single core or multicore processor, such as those known under the trade name ARM Cortex produced by Texas Instruments. In certain instances, 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 core that includes: 256 KB of single-cycle flash or other non-volatile memory (up to 40 MHz) of on-chip memory, a prefetch buffer for improved performance above 40 MHz, 32 KB of single-cycle SRAM, an internal ROM loaded with software, 2 KB of EEPROM, one or more PWM modules, one or more QEI analog, one or more 12-bit ADCs with 12 analog input channels, and readily available other features. Other microcontrollers can be readily substituted for use with surgical instrument 600. Thus, the present disclosure should not be limited to this context.

[0111] In certain circumstances, the memory 644 can include program instructions for controlling each of the motors of the surgical instrument 600. For example, the memory 644 can include program instructions for controlling the closure motor and the articulation motor. Such program instructions can cause the processor 642 to control the closure and articulation functions in accordance with inputs from the algorithm or control program of the surgical instrument 600.

[0112] In certain circumstances, one or more mechanisms and / or sensors, such as the sensor 645, can be used to alert the processor 642 as to which program instructions the processor 642 should use in a particular setting. For example, the sensor 645 can alert the processor 642 to use program instructions associated with a closed and articulated end effector. In certain circumstances, the sensor 645 can include, for example, a position sensor that can be used to sense the position of the closure actuator. Thus, if the processor 642 receives a signal from the sensor 630 indicating actuation of the closure actuator, the processor 642 can activate the motor of the closure drive assembly 620 using program instructions associated with a closed end effector.

[0113] In some examples, the motor can be a brushless DC electric motor, and the respective motor drive signals can comprise PWM signals provided to one or more stator windings of the motor. Also, in some examples, the motor driver can be omitted, and the control circuit 601 can directly generate the motor drive signals.

[0114] A common practice during various laparoscopic surgical procedures is to insert the surgical end effector portion of a surgical instrument through a trocar needle that has been installed in the abdominal wall of the patient to access a surgical site located within the abdomen of the patient. In its simplest form, a trocar needle is a pen-like instrument having a sharp triangular point at one end, which is typically used inside a hollow tube, called a trocar or sleeve, to form an opening into the body through which the surgical end effector can be introduced. Such an arrangement forms an access port into a body cavity through which a surgical end effector can be inserted. The inner diameter of the trocar needle sleeve necessarily limits the size of the end effector and drive support shaft of a surgical instrument that can be inserted through the trocar needle.

[0115] Regardless of the particular type of surgical procedure being performed, once the surgical end effector has been inserted into the patient through a trocar sleeve, the surgical end effector must typically be moved relative to the shaft assembly positioned within the trocar sleeve 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 trocar sleeve is commonly referred to as "articulation" of the surgical end effector. Various articulation joints have been developed to attach the surgical end effector to the associated shaft in order to facilitate such articulation of the surgical end effector. As can be desirable, in many surgical procedures, it is desirable to employ a surgical end effector having as large an articulation range as possible.

[0116] Due to the size constraints imposed by the trocar sleeve, the size of the articulation joint components must be set to be freely insertable through the trocar sleeve. These size constraints also limit the size and composition of various drive members and components that operably interface with the motor and / or other control systems supported in a housing that can be hand-held or form part of a larger automated system. In many cases, these drive members must be operably threaded through the articulation joint in order to be operably coupled to or interfaceable with the surgical end effector. For example, one such drive member is typically used to apply articulation control motions to the surgical end effector. During use, the articulation drive member can be unactuated to position the surgical end effector in a non-articulated position in order to facilitate insertion of the surgical end effector through the trocar, and then be actuated to articulate the surgical end effector to a desired position once the surgical end effector has entered the patient.

[0117] Accordingly, the aforementioned size constraints present a number of challenges for developing articulation systems for various different drive systems that can achieve the desired articulation range, but accommodate the various features necessary to operate the surgical end effector. Moreover, once the surgical end effector has been positioned in the desired articulated position, the articulation system and articulation joint must be able to hold the surgical end effector in that position during actuation of the end effector and completion of the surgical procedure. Such articulation joint arrangements must also be able to withstand the external forces experienced by the end effector during use.

[0118] Various modes of one or more surgical devices are commonly used throughout a particular surgical procedure. For example, a communication pathway extending between a surgical device and a centralized surgical hub can facilitate efficiency of the surgical procedure and increase the success of the surgical procedure. In various instances, each surgical device within a surgical system includes a display, where the display communicates a presence and / or an operational status of other surgical devices within the surgical system. The surgical hub can use information received through the communication pathway to assess compatibility of surgical devices for use together, assess compatibility of surgical devices for use during a particular surgical procedure, and / or optimize operational parameters of the surgical devices. As described in greater detail herein, operational parameters of one or more surgical devices can be optimized based on patient demographics, a particular surgical procedure, and / or detected environmental conditions, such as tissue thickness.

[0119] Figure 4 and Figure 5 An exploded view ( Figure 4 ) and a cross-sectional view ( Figure 5 ) of an end effector 1200 of an electrosurgical instrument (e.g., the surgical instrument described in U.S. Patent Application Attorney Docket No. END9234USNP2 / 190717-2) are shown. For example, the end effector 1200 can be actuated, articulated, and / or rotated relative to a shaft assembly of the surgical instrument in a manner similar to the end effector described in U.S. Patent Application Attorney Docket No. END9234USNP2 / 190717-2. Additionally, the end effector 1200 and other similar end effectors described elsewhere herein can be powered by one or more generators of a surgical system. An exemplary surgical system for use with the surgical instrument is described in U.S. Application No. 16 / 562,123, filed September 5, 2019, and entitled “METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES,” which is hereby incorporated by reference in its entirety.

[0120] Referring 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.

[0121] 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.

[0122] 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.

[0123] In one example, the first and second angles are the same or at least substantially the same. In another example, the first and second angles are different. In another example, the first and second angles comprise a value selected from a range of about 120° to about 175°. In yet another example, the first and second angles comprise a value selected from a range of about 130° to about 170°.

[0124] Further, the portions 1250a, 1270a that are proximal portions are larger than the portions 1250b, 1270b that are intermediate portions. Similarly, the intermediate portions 1250b, 1270b are larger than the portions 1250c, 1270c. In other examples, a distal portion can be larger than intermediate and / or proximal portions. In other examples, an intermediate portion is larger than proximal and / or distal portions.

[0125] In addition to the above, the electrodes 1252, 1272, 1274 of the jaws 1250, 1270 comprise a corner profile similar to that of the jaws 1250, 1270. In Figure 4 、 Figure 5 In examples where the electrodes 1252, 1272, 1274 comprise discrete segments 1252a, 1252b, 1252c, 1272a, 1272b, 1272c, 1274a, 1274b, 1274c, respectively, the discrete segments define a first angle and a second angle at their respective intersection points, as described above.

[0126] When in the closed configuration, the jaws 1250, 1270 cooperate to define a tip electrode 1260 formed by the electrode portions 1261, 1262 at the distal ends of the jaws 1250, 1270, respectively. The tip electrode 1260 can be energized to deliver monopolar energy to tissue in contact therewith. For example, both electrode portions 1261, 1262 can be activated simultaneously to deliver monopolar energy, as shown in Figure 6 Alternatively, only one of the electrode portions 1261, 1262 can be selectively activated to deliver monopolar energy on one side of the distal tip electrode 1260, as shown in Figure 10 .

[0127] In the closed configuration, the corner profile of the jaws 1250, 1270 causes the tip electrode 1260 to be on one side of a plane that extends laterally between the proximal portions 1252c and 1272c. The corner profile can also cause the intersection points between the portions 1252b, 1252c, the portions 1272b, 1272c, and the portions 1274b, 1274c to be on the same side of the plane as the tip electrode 1260.

[0128] In at least one example, the jaws 1250, 1270 include a conductive skeleton 1253, 1273, which can be composed of or at least partially composed of an electrically conductive material (e.g., titanium). The skeleton 1253, 1273 can be composed of other electrically conductive materials (e.g., aluminum). In at least one example, the skeleton 1253, 1273 is prepared by injection molding. In various examples, the skeleton 1253, 1273 is selectively coated / covered with an insulating material to prevent heat and electrical conduction in all but predefined thin energizable zones forming the electrodes 1252, 1272, 1274, 1260. The skeleton 1253, 1273 acts as an electrode with electronic focusing, where the jaws 1250, 1270 have built-in isolation from one jaw to the other. The insulating material can be an insulating polymer, for example, polytetrafluoroethylene (e.g., ) The energizable zones defined by the electrodes 1252, 1272 are on the interior of the jaws 1250, 1270, and can be independently operated in a bipolar mode to deliver energy to tissue grasped between the jaws 1250, 1270. Meanwhile, the energizable zones defined by the electrode tip 1260 and the electrode 1274 are on the exterior of the jaws 1250, 1270, and can be operated in a monopolar mode to deliver energy to tissue adjacent to the outer surface of the end effector 1200. Both jaws 1250, 1270 can be energized so as to deliver energy in a monopolar mode.

[0129] In various aspects, the coating 1264 is a high temperature polytetrafluoroethylene (e.g., ) coating selectively applied to the conductive skeleton, resulting in a selectively exposed metallic interior portion defining a three-dimensional geometric electronic modulation (GEM) for focused dissection and coagulation. In at least one example, the coating 1264 includes a thickness of about 0.003 inches, about 0.0035 inches, or about 0.0025 inches. In various examples, the thickness of the 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. Other thicknesses of the coating 1263 capable of three-dimensional geometric electronic modulation (GEM) are encompassed by the present disclosure.

[0130] The electrodes 1252, 1272 that cooperate to transmit bipolar energy through the tissue are offset to prevent shorting of the electrical circuit. When energy flows between the offset electrodes 1252, 1272, the tissue grasped therebetween is heated, thereby creating a seal at the region between the electrodes 1252, 1272. At the same time, the region of the jaws 1250, 1270 surrounding the electrodes 1252, 1272 is provided with a non-conductive tissue contact surface due to the selective deposition of the insulative coating 1264 onto the jaws 1250, 1270 at such regions, and not onto the electrodes 1252, 1272. Thus, the electrodes 1252, 1272 are defined by the regions of the metallic jaws 1250, 1270 that remain exposed after the application of the insulative coating 1264 to the jaws 1250, 1270. While the jaws 1250, 1270 are generally formed of an electrically conductive material in this example, the non-conductive regions are defined by the electrically insulative coating 1264.

[0131] Figure 6 The application of a bipolar energy mode to the tissue grasped between the jaws 1250, 1270 is shown. In the bipolar energy mode, RF energy flows through the tissue along a path 1271 that is oblique with respect to a bend plane (CL) that extends centrally and longitudinally bisects the jaws 1250, 1270 such that the electrodes 1252, 1272 are on opposite sides of the bend plane (CL). In other words, the region of tissue that actually receives the bipolar RF energy will be only the tissue that is in contact and extending between the electrodes 1252, 1257. Thus, the tissue grasped by the jaws 1250, 1270 will not receive RF energy across the entire lateral width of the jaws 1250, 1270. Accordingly, this configuration can minimize the thermal diffusion of heat caused by the application of bipolar RF energy to the tissue. This minimization of thermal diffusion can in turn minimize potential collateral damage to tissue adjacent to the specific tissue region that the surgeon wishes to join / seal / coagulate and / or cut.

[0132] In at least one example, a lateral gap is defined between the offset electrodes 1252, 1272 in the closed configuration in which there is no tissue therebetween. In at least one example, the lateral gap is defined between the offset electrodes 1252, 1272 in the closed configuration by any distance selected from the group consisting of: a range of about 0.01 inch to about 0.025 inch, a range of about 0.015 inch to about 0.020 inch, or a range of about 0.016 inch to about 0.019 inch. In at least one example, the lateral gap is defined by a distance of about 0.017 inch.

[0133] In Figure 4 and Figure 5In the illustrated example, the electrodes 1252, 1272, 1274 have a tapering width as each of the electrodes 1252, 1272, 1274 extends from the proximal end to the distal end. Thus, the proximal sections 1252a, 1272a, 1274a include a greater surface area than the intermediate portions 1252b, 1272b, 1274b, respectively. Also, the intermediate sections 1252b, 1272b, 1274b include a greater surface than the distal sections 1252c, 1272c, 1274c.

[0134] The angular and tapering profiles of the jaws 1250, 1270 give the end effector 1200 a curved, finger-like shape or an angular hook shape in the closed configuration. By orienting the end effector 1200 such that the electrode tip 1260 points downward toward tissue, this shape allows for precise delivery of energy to a small portion of the tissue using the tip electrode 1260 Figure 10 ) in such an orientation, only the electrode tip 1260 is in contact with the tissue, which focuses the energy delivery to the tissue.

[0135] Furthermore, as Figure 8 illustrated, the electrode 1274 extends on an outer surface on the peripheral side 1275 of the second jaw 1270, which provides it with the ability to effectively separate tissue in contact therewith when the end effector 1200 is in the closed configuration. To separate tissue, the end effector 1200 is positioned at least partially on the peripheral side 1275 including the electrode 1274. Activation of the monopolar energy mode by the jaw 1270 causes monopolar energy to flow through the electrode 1274 into tissue in contact therewith.

[0136] Figures 9 to 11 The end effector 1200' is shown for delivering bipolar energy to tissue through the electrodes 1252', 1272'( Figure 9 ) in a bipolar energy operating mode, delivering monopolar energy to tissue through the electrode tip 1261 in a first monopolar operating mode, and / or delivering monopolar energy to tissue through the external electrode 1274 in a second monopolar operating mode. The end effector 1200' is similar in many respects to the end effector 1200. Thus, for the sake of brevity, the various features of the end effector 1200' previously described with respect to the end effector 1200 are not repeated herein at the same level of detail.

[0137] Electrodes 1252', 1272' differ from electrodes 1252", 1272" in that they define a stepped or uneven tissue contact surface 1257, 1277. The electrically conductive backbone 1253', 1273' of jaw 1250', 1270' includes a protruding or projecting portion that forms the electrically conductive tissue contact surface of electrodes 1252', 1272'. The coating 1264 partially wraps around the protruding or projecting portion that forms electrodes 1252', 1272', leaving only the electrically conductive tissue contact surface of electrodes 1252', 1272' exposed. Thus, in the illustrated example, the electrically conductive tissue contact surface of electrodes 1252', 1272' is exposed on the distal end of jaw 1250', 1270' and the electrically insulative tissue contact surface of electrodes 1252', 1272' is exposed on the proximal end of jaw 1250', 1270'. Figure 9 In the illustrated example, each of the tissue contact surfaces 1257, 1277 includes a step that includes an electrically conductive tissue contact surface positioned between two insulative tissue contact surfaces that step down. In other words, each of the tissue contact surfaces 1257, 1277 includes a first partially conductive tissue contact surface and a second insulative tissue contact surface that steps down relative to the first partially conductive tissue contact surface. The method for forming electrodes 1252', 1272' is described later in connection with FIG. 6. Figure 12 described.

[0138] Further, in the closed configuration with no tissue therebetween, the bias electrodes 1252', 1272' overlap, defining a gap between the opposing insulative outer surfaces of jaws 1250', 1270'. Thus, this configuration provides electrode surfaces that are vertically offset from one another and laterally offset from one another when jaws 1250', 1270' are closed. In one example, the gap is about 0.01 inches to about 0.025 inches. Further, while overlapping, electrodes 1252', 1272' are spaced apart by a lateral gap. To prevent a short circuit of the electrical circuit, the lateral gap is less than or equal to a predetermined threshold. In one example, the predetermined threshold is selected from a range of 0.006 inches to 0.008 inches. In one example, the predetermined threshold is about 0.006 inches.

[0139] Referring again to Figure 7 , Figure 10 The tip electrode 1260 is defined by uncoated electrode portions 1261, 1262 that directly precede a circumferentially coated proximal coated portion to allow for tip coagulation and incision creation from either or both of jaws 1250, 1270. In certain examples, electrode portions 1261, 1262 are covered by a spring-biased or compliant insulative outer shell that allows for exposure of electrode portions 1261, 1262 only when the distal end of end effector 1200 is pressed against tissue to be treated.

[0140] Additionally, segments 1274a, 1274b, 1274c define a corner profile that extends along a peripheral side 1275 of jaw 1270. Segments 1274a, 1274b, 1274c are defined by uncoated linear portions on peripheral side 1275 that protrude from the angled body of skeleton 1273. Segments 1274a, 1274b, 1274c include an outer surface that is flush with an outer surface of coating 1264 defined on peripheral side 1275. In various examples, a horizontal plane extends through segments 1274a, 1274b, 1274c. The corner profile of electrode 1274 is defined in the horizontal plane such that electrode 1274 does not extend more than 45 degrees from the centerline of curvature to prevent unintended lateral thermal damage when using electrode 1274 to dissect or separate tissue.

[0141] Figure 14 A jaw 6270 is shown for use with an end effector (e.g., 1200) of an electrosurgical instrument (e.g., 1106) to treat tissue using RF energy. Further, jaw 6270 can be electrically coupled to a generator (e.g., 1100) and can be energized 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. Further, jaw 6270 is similar in many respects to jaws 1250, 1270. For example, jaw 6270 includes a corner profile that is similar to the corner profile of jaw 1270. Additionally, jaw 6270 presents a thermal mitigation improvement that can be applied to one or both of jaws 1250, 1270.

[0142] In use, the jaws of an end effector of an electrosurgical instrument are subjected to thermal loads that can interfere with the performance of their electrodes. To minimize the thermal load interference without negatively impacting the electrode tissue treatment capabilities, jaw 6270 includes an electrically conductive skeleton 6273 having a thermally isolated portion and a thermally conductive portion integral with the thermally isolated portion. The thermally conductive portion defines a heat sink and the thermally isolated portion resists heat transfer. In certain examples, the thermally isolated portion includes an internal gap, void, or dimple that effectively isolates the thermal mass of the outer surface of jaw 6270 in direct contact with tissue without compromising the electrical conductivity of jaw 6270.

[0143] In the illustrated example, the thermally conductive portion defines a conductive outer layer 6269 that surrounds or at least partially surrounds an inner conductive core. In at least one example, the inner conductive core includes gap setting members, which can be in the form of struts, posts, and / or walls extending between opposing sides of outer layer 6269, with a gap, void, or dimple extending between the gap setting members.

[0144] In at least one example, the gap setting member forms a honeycomb lattice structure 6267 to provide directional force capability when the jaw (i.e., the jaw 6270 and the other jaw of the end effector) transitions to a closed configuration to grasp tissue between the jaws (similar to the jaws 1250, 1270 of the end effector 1200 of FIGS. 21A-21C). Directional force can be achieved by aligning the lattice 6267 in a direction that intersects the tissue contacting surface of the jaw 6270 such that its honeycomb walls 6268 are positioned perpendicular relative to the tissue contacting surface. Figure 6

[0145] Alternatively or additionally, the conductive inner core of the jaw 6270 can include micro air pockets that can be more uniformly distributed and shaped and do not have a predefined organization relative to the outer shape of the jaw to create a more uniform stress-strain distribution within the jaw. In various aspects, the electrically conductive scaffold 6273 can be prepared by three-dimensional printing and can include three-dimensionally printed internal pockets that create an electrically conductive but thermally isolating core.

[0146] Still referring to Figure 14 , the electrically conductive scaffold 6273 can be connected to an energy source (e.g., the generator 1100) and includes electrodes 6262, 6272, and 6274 defined on portions of the outer layer 6273 that are selectively uncovered by the coating 1264. Thus, the selective thermal and electrical conductivity of the jaw 6270 controls / focuses the energy interaction with tissue through the electrodes 6272, 6274 while reducing thermal diffusion and thermal mass. The thermally isolated portions of the conductive scaffold 6273 limit the thermal load on the electrodes 6262, 6272, and 6274 during use.

[0147] Further, the outer layer 6273 defines a gripping feature 6277 that extends on opposite sides of the electrode 6272 and is at least partially covered by the coating 1264. The gripping feature 6277 improves the ability of the jaw 6270 to adhere to tissue and resists slippage of the tissue relative to the jaw 6270.

[0148] In the illustrated example, the walls 6268 extend diagonally from a first lateral side of the jaw 6270 to a second lateral side of the jaw 6270. The walls 6268 intersect at structural nodes. In the illustrated example, the intersecting walls 6268 define pockets 6271 that are covered from the top and / or bottom by the outer layer 6269. Various methods for manufacturing the jaw 6270 are described below.

[0149] Figure 12 , 13 ​Methods 1280, 1281 for manufacturing jaws 1273", 1273"' are shown. In various examples, one or more of jaws 1250, 1270, 1250', 1270' are manufactured according to methods 1280, 1281. Jaws 1273', 1273" are prepared by applying a coating 1264 (e.g., having a thickness d) to an entire outer surface thereof. The electrodes are then defined by selectively removing portions of coating 1264 from desired regions to expose the outer surface of skeleton 1273", 1273"' at such regions. In at least one example, the selective removal of the coating to form flush electrically conductive and non-conductive surfaces can be performed by etching Figure 12 ) or by partially cutting away Figure 13 the tapered portion of skeleton 1273"' and its corresponding coating portion. In the example shown, electrodes 1272", 1274" are formed by etching. In the example shown, electrode 1274"' is formed by a raised narrow band or ridge 1274d extending alongside skeleton 1273"'. A portion of ridge 1274D and coating 1264 directly overlying ridge 1274D is cut away, thereby producing an outer surface of electrode 1274"' that is flush with the outer surface of coating 1264. Figure 12 Figure 13 In the example shown, electrode 1274"' is formed by a raised narrow band or ridge 1274d extending alongside skeleton 1273"'. A portion of ridge 1274D and coating 1264 directly overlying ridge 1274D is cut away, thereby producing an outer surface of electrode 1274"' that is flush with the outer surface of coating 1264.

[0150] Thus, jaw 1270"' manufactured by method 1281 includes a tapered electrode 1274"' consisting of a narrow raised electrically conductive portion 1274e extending alongside skeleton 1273"', which can help focus energy delivered from skeleton 1273"' to tissue, wherein portion 1274e has an electrically conductive outer surface that is flush with coating 1264.

[0151] In another manufacturing process 6200, a jaw 6270 can be prepared as depicted in Figure 15 . An electrically conductive skeleton 6273 is formed with narrow raised bands or ridges 6274e, 6274f, which define electrodes 6272 and 6274. In the example shown, skeleton 6273 of jaw 6270 includes ridges 6274e, 6274f having a flat or at least substantially flat outer surface configured to define electrodes 6272, 6274. In at least one example, skeleton 6273 is prepared by 3D printing. Masks 6265, 6266 are applied to ridges 6274e, 6274f, and a coating 1264 similar to coating 1264 is applied to skeleton 6273. After coating, masks 6265, 6266 are removed, exposing an outer surface of electrodes 6272, 6274 that is flush with the outer surface of coating 1264.

[0152] Reference is made to Figure 14 and Figure 15 ​In 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 the coating 1264. In one example, the coating 1264 defines compressible features, causing the gap between the jaws of the end effector to vary as a function of the clamping load applied to the end effector 1200. In at least one example, the coating 1264 on the jaws creates at least a 0.010"-0.020" insulator overlap along the centerline of the jaws. The coating 1264 can be applied directly on the gripping features 6277 and / or the clamp-induced jaw realignment features.

[0153] In various aspects, the coating 1264 can include a coating material such as titanium nitride, diamond-like coating (DLC), chromium nitride, Graphit iC TM In at least one example, the DLC is composed of an amorphous carbon-hydrogen network with a diamond bond between graphite and carbon atoms. The DLC coating 1264 can form a film around the skeleton 1253, 1273 with low friction and high hardness properties Figure 6 ). The DLC coating 1264 can be doped or undoped and is typically in the form of amorphous carbon (a-C) or hydrogenated amorphous carbon (a-C:H) containing a large fraction of sp3 bonds. Various surface coating techniques can be used to form the DLC coating 1264, such as the surface coating technique developed by Oerlikon Balzers. In at least one example, the DLC coating 1264 is generated using plasma- assisted chemical vapor deposition (PACVD).

[0154] Still referring to Figure 15 In use, electrical energy flows from the electrically conductive skeleton 6269 through the electrodes 6272 to the tissue. The coating 1264 prevents the transfer of electrical energy from other areas of the outer layer 6269 covered with the coating 1264 to the tissue. As the temperature of the surface of the electrodes 6272 increases during tissue treatment, the transfer of thermal energy from the outer layer 6269 to the inner core of the skeleton 6273 is slowed or attenuated due to the gap, void, or dimple defined by the wall 6268 of the inner core.

[0155] Figure 16 A skeleton 6290 is shown that is manufactured for use with the jaws of an end effector of an electrosurgical instrument. One or more of the skeletons 1253, 1273, 1253', 1273', 1273", 1273"' can include a material composition and / or can be manufactured in a similar manner as the skeleton 6290. In the illustrated example, the skeleton 6290 is composed of at least two materials: an electrically conductive material such as titanium and a thermal isolation material such as a ceramic material (e.g., a ceramic oxide). The combination of titanium and ceramic oxide results in a jaw component with composite thermal, mechanical, and electrical properties.

[0156] 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.

[0157] 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.

[0158] 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.

[0159] Additionally, jaw 1290 is similar to jaw 6270 in that jaw 1290 also presents a thermal mitigation improvement. As with jaw 6270, jaw 1290 includes a conductive backbone 1293 having a thermally isolated portion and a thermally conductive portion integral with or attached to the thermally isolated portion. The thermally conductive portion defines a heat sink and the thermally isolated portion resists heat transfer. In certain examples, the thermally isolated portion of conductive backbone 1293 includes a conductive inner core 1297 having internal gaps, voids, or dimples that effectively isolate the thermal mass of the outer surface of jaw 1290 defining electrodes 1294 in direct contact with tissue without compromising the electrical conductivity of jaw 1290. The thermally conductive portion defines a conductive outer layer 1303 that surrounds or at least partially surrounds conductive inner core 1297. In at least one example, conductive inner core 1297 includes gap setting members 1299, which can be in the form of struts, posts, and / or walls extending between opposite sides of outer layer 1303 of jaw 1290 with gaps, voids, or dimples extending between the gap setting members.

[0160] Alternatively or additionally, conductive inner core 1297 can include micro-dimples of air that can be uniformly or non-uniformly distributed throughout conductive inner core 1297. The dimples can include predefined or random shapes and can be dispersed at predetermined or random portions of conductive inner core 1297. In at least one example, the dimples are dispersed in a manner that creates a more uniform stress-strain distribution within jaw 1290. In various aspects, backbone 1293 can be fabricated through three-dimensional printing and can include three-dimensionally printed internal dimples that create an electrically conductive but commensurately thermally isolated core.

[0161] Accordingly, jaw 1290 includes selective thermal and electrical conductivity that controls / focuses energy interaction with tissue while reducing thermal diffusion and thermal mass. The thermally isolated portion of conductive backbone 1293 limits the thermal loading on the electrodes of jaw 1290 during use.

[0162] 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 by a first insulating layer 1264 comprising a first material (e.g., DLC). In the illustrated example, the DLC coating renders the tissue contact surface 1291 electrically insulating, except for a middle region extending along the length of the tissue contact surface 1291, which defines an electrode 1294. In at least one example, the DLC coating extends around the skeleton 1293, covering the jaw 1290 up to the periphery defined on the opposite sides 1294', 1294" of the electrode 1294. Conductive zones 1294a, 1294b, 1294c remain exposed and alternate with insulating zones 1298 along the length of the electrode 1294. In various aspects, the insulating zones 1298 comprise high temperature polytetrafluoroethylene (e.g., ). As the DLC coating is thermally conductive, only the portion of the tissue contact surface 1291 including the insulating regions 1298 is thermally isolated. The portion of the tissue contact surface 1291 covered with the DLC coating and the thin conductive energizable zones 1294a, 1294b, 1294c is thermally conductive. Additionally, only the thin conductive energizable zones 1294a, 1294b, 1294c are electrically conductive. The remaining portion of the tissue contact surface 1291 covered with the DLC coating or polytetrafluoroethylene (e.g. ) is electrically insulating.

[0163] The conductive zones 1294a, 1294b, 1294c define energy concentration locations along the jaw 1290 based on the geometry of the zones 1294a, 1294b, 1294c. Moreover, the size, shape, and arrangement of the conductive zones 1294a, 1294b, 1294c and the insulating zones 1298 cause the coagulation energy transmitted through the electrode 1294 to be directed to tissue in a predefined treatment region, thereby preventing parasitic soakage of both energy and heat from the treatment region. Moreover, the thermally isolated conductive inner core 1297 resists heat transfer to portions of the jaw 1290 that do not form the treatment region, which prevents inadvertent collateral thermal damage caused by accidental contact of tissue with the non-treatment region of the jaw 1290.

[0164] The electrode 1294 is selectively interrupted by the zones 1298. Selective application of a high temperature polytetrafluoroethylene (e.g., ) coating to portions of the electrode 1294 yields selectively exposed metallic inner portions that define a three-dimensional geometric electronic modulation (GEM) for focused dissection and coagulation at the conductive zones 1294a, 1294b, 1294c of the electrode 1294. As Figure 22As shown, region 1298 is selectively deposited onto electrodes 1294, thereby creating a treatment surface having alternating thermally conductive and electrically conductive regions and thermally insulating and electrically insulating regions, surrounded by a perimetral region of thermally conductive but electrically insulating defined by the DLC coating.

[0165] Referring to Figure 22 In certain aspects, jaw 1300 includes a solid conductive backbone 1301 partially surrounded by a DLC coating 1264. The exposed regions of backbone 1301 define one or more electrodes 1302. This arrangement creates thermally conductive and electrically conductive portions of jaw 1300, where thermal energy is delivered unselectively, but electrical energy is delivered only through one or more electrodes 1302.

[0166] In one example, the angles (ai, a2, a3) include the same or at least substantially the same value. In another example, at least two of the angles (ai, a2, a3) include different values. In another example, at least one of the angles (ai, a2, a3) includes a value selected from the range of about 120° to about 175°. In yet another example, at least one of the angles (ai, a2, a3) includes a value selected from the range of about 130° to about 170°.

[0167] Further, due to the tapering profile of jaw 1290, portion 1290a, as a proximal portion, is larger than portion 1290b, as an intermediate portion. Similarly, intermediate portion 1290b is larger than portion 1290d, which defines a distal portion of jaw 1290. In other examples, the distal portion can be larger than the intermediate and / or proximal portions. In other examples, the intermediate portion is larger than the proximal and / or distal portions. Further, electrodes 1294 of jaw 1290 include an angular profile similar to the angular profile of jaw 1290.

[0168] Referring to Figure 23 In certain aspects, jaw 1300 includes a solid conductive backbone 1301 partially surrounded by a DLC coating 1264. The exposed regions of backbone 1301 define one or more electrodes 1302. This arrangement creates thermally conductive and electrically conductive portions of jaw 1300, where thermal energy is delivered unselectively, but electrical energy is delivered only through one or more electrodes 1302.

[0169] Referring now to 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 greater 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 transition the end effector 1400 from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. Monopolar and bipolar energy can then be used to seal and / or cut the grasped tissue. As described in greater detail below, the end effector 1400 utilizes GEMs to adjust the energy density at the tissue treatment interface of the jaws 1450, 1470 to achieve a desired tissue treatment.

[0170] Like the jaws 1250, 1270, the jaws 1450, 1470 include a generally angular profile formed by linear portions that are angled relative to one another, resulting in a curved or finger-like shape, as shown in Figure 26 In addition, the jaws 1450, 1470 include a conductive backbone 1452, 1472 having a tapered angular body that extends distally along the angular profile of the jaws 1450, 1470. The conductive backbone 1452, 1472 can be composed of an electrically conductive material (e.g., titanium). In certain aspects, each of the conductive backbones 1453, 1473 includes a thermally isolating portion and a thermally conductive portion integral with the thermally isolating portion. The thermally conductive portion defines a heat sink and the thermally isolating portion resists heat transfer. In certain examples, the thermally isolating portion of the backbone 1453, 1473 defines an inner core that includes an internal gap, void, or dimple that effectively isolates the thermal mass of the outer surface of the jaw 1452, 1472 in direct contact with tissue without compromising the electrical conductivity of the jaw 1450, 1470.

[0171] The thermally conductive portion includes a conductive outer layer 1469, 1469' that surrounds or at least partially surrounds the inner conductive core. In at least one example, the inner conductive core includes gap-setting members, which can be in the form of struts, posts, and / or walls that extend between opposing sides of the outer layer 1469, 1469' of each of the jaws 1250, 1270, with a gap, void, or dimple extending between the gap-setting members. In at least one example, the gap-setting members form a honeycomb-like lattice structure 1467, 1467'.

[0172] In addition to the above, the conductive backbone 1453, 1473 includes a first electrically conductive portion 1453a, 1473a that extends distally along the angular profile of the jaw 1450, 1470, and a second electrically conductive portion 1453b, 1473b of the tapered electrode that protrudes from the first electrically conductive portion 1453a, 1473a and extends distally along at least a portion of the tapered body of the backbone 1453, 1473. In at least one example, in a transverse cross-section of the tapered body of the backbone 1453, 1473 (e.g., Figure 25 ) the first electrically conductive portion 1453a, 1473a is thicker than the second electrically conductive portion 1453b, 1473b. In at least one example, the second electrically conductive portion 1453b, 1473b is integral with or permanently attached to the first electrically conductive portion 1453a, 1473a such that electrical energy flows from the first electrically conductive portion 1453a, 1473a to tissue only through the second electrically conductive portion 1453b, 1473b. The electrically insulating layer 1464, 1464' is configured to completely electrically insulate the first electrically conductive portion 1453a, 1473a without electrically insulating the second electrically conductive portion 1453b, 1473b. At least the outer surface of the second electrically conductive portion 1453b, 1473b that defines the electrode 1452, 1472 is not covered by the electrically insulating layer 1464, 1464'. In the illustrated example, the electrode 1452, 1472 and the electrically insulating layer 1464, 1464' define a flush tissue treatment surface.

[0173] As noted above, the first electrically conductive portion 1453a, 1473a is generally thicker than the second electrically conductive portion 1453b, 1473b and is wrapped with the electrically insulating layer 1464, 1464' which causes the second electrically conductive portion 1453b, 1473b to become a high energy density region. In at least one example, the electrically insulating layer 1464, 1464' is composed of a high temperature polytetrafluoroethylene (e.g., ) coating, a DLC coating, and / or a ceramic coating for insulation and resistance to coke adhesion. In various examples, the thicker first electrically conductive portion 1453a conducts more potential power with less resistance to the second electrically conductive portion 1453b of tissue contact resulting in a higher energy density at the electrode 1452.

[0174] In various aspects, the outer surface of the electrode 1452, 1472 includes a continuous linear segment that extends along the angled tissue treatment surface of the jaw 1450, 1470. The linear segment intersects at a predefined angle and has a width that tapers as the linear segment extends distally. In Figure 24In the illustrated example, the electrodes 1452 include segments 1452a, 1452b, 1452c, 1452c, 1452d, and the electrodes 1472 include segments 1472a, 1472b, 1472c, 1472c, 1472d. The electrodes 1452 of the jaw 1450 are spaced apart from the electrodes 1472 of the jaw 1470 by a gap 1454. The electrodes 1452, 1472 are laterally offset from each other in the closed configuration of the end effector 1400. In bipolar energy mode, electrical energy supplied by a generator (e.g., the generator 1100) flows from the first conductive portion 1453a to the second conductive portion 1453b of the electrode 1452, and from the electrode 1452 to tissue grasped between the jaws 1450, 1470. Bipolar energy then flows from the tissue to the second conductive portion 1473b of the electrode 1472, and from the electrode 1472 to the first conductive portion 1473a. Figure 24 The electrodes 1452, 1472 are laterally offset from each other in the closed configuration of the end effector 1400. In bipolar energy mode, electrical energy supplied by a generator (e.g., the generator 1100) flows from the first conductive portion 1453a to the second conductive portion 1453b of the electrode 1452, and from the electrode 1452 to tissue grasped between the jaws 1450, 1470. Bipolar energy then flows from the tissue to the second conductive portion 1473b of the electrode 1472, and from the electrode 1472 to the first conductive portion 1473a.

[0175] In various aspects, as Figure 24 , Figure 25 illustrated in FIGS. 1 1 A and 1 1 B, the second jaw 1470 further includes electrodes 1474 spaced apart from the backbone 1473. In at least one example, the electrodes 1474 are monopolar electrodes configured to deliver monopolar energy to tissue grasped between the jaws 1450, 1470 in the closed configuration. A return pad can be placed beneath a patient, for example, to receive monopolar energy from the patient. Like the electrodes 1472, the electrodes 1474 include contiguous linear segments 1474a, 1474b, 1474c, 1474d that extend distally from an electrode proximal end to an electrode distal end along the angular profile defined by the second jaw 1470. Further, the electrodes 1474 are laterally offset from the electrodes 1472, 1452.

[0176] The electrodes 1474 include a base 1474e located in a cradle 1480 that extends distally from a cradle proximal end 1480a to a cradle distal end 1480b along the angular profile of the second jaw 1470. The cradle 1480 is centrally positioned relative to the lateral edges 1470e, 1470f of the second jaw 1470. The electrodes 1474 further include a tapered edge 1474f that extends from the base 1474e beyond the sidewalls of the cradle 1480. Additionally, the cradle 1480 is partially embedded in a valley defined on the outer tissue treatment surface of the tapered body. The cradle 1480 is spaced apart from the tapered body of the backbone 1473 by an electrically insulative coating 1464'. As illustrated in FIG. 1 1 A, the base 1480 has a width that tapers as the base extends along the angular profile from the base proximal end 1480a to the base distal end 1480b. Figure 24

[0177] ​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.

[0178] 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.

[0179] 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.

[0180] 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.

[0181] Main reference Figure 26The surgical instrument 1500 includes the end effector 1400. The surgical instrument 1500 is similar in many respects to other surgical instruments described in U.S. Patent Application Attorney Docket No. END9234USNP2 / 190717-2. The various actuation and articulation mechanisms described elsewhere in connection with such surgical instruments can be similarly used to articulate and / or actuate the surgical instrument 1500. Such mechanisms are not repeated herein for the sake of brevity.

[0182] The end effector 1400 includes an end effector frame assembly 11210 that includes a distal frame member 11220 rotatably supported in a proximal frame housing 11230. In the illustrated example, the distal frame member 11220 is rotatably attached to the proximal frame housing 11230 by an annular rib on the distal frame member 11220 that is received within an annular groove in the proximal frame housing 11230.

[0183] Electrical energy is transmitted to the electrodes 1452, 1472, 1474 of the end effector 1400 by one or more flexible circuits that extend distally through or alongside the distal frame member 11220. In the illustrated example, a 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 attachable to an exposed portion 1491 of the first jaw 1450 that is not covered by the insulating layer 1464.

[0184] A slip ring assembly 1550 within the proximal frame housing 11230 allows the end effector 1400 to freely rotate about the shaft of the surgical instrument 1500 without entanglement of the electrical wires of the circuits that transmit electrical energy to the electrodes 1452, 1472, 1474. In the illustrated example, the flexible circuit 1490 includes electrical contacts 1493 that are moveably engaged with a slip ring 1550a of the slip ring assembly 1550. Electrical energy is transmitted from the slip ring 1550a to the conductive backbone 1453 and then through the flexible circuit 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 shaft of the surgical instrument 1500 is permissible without loss of electrical connection between the electrical contacts 1493 and the slip ring 1550a. Moreover, similar electrical contacts transmit electrical energy to the slip ring 1550a.

[0185] In Figure 26In the illustrated example, slip ring 1550a is configured to transmit bipolar energy to electrode 1452 of jaw 1450. Slip ring 1550b cooperates with a similar electrical contact and electrode 1472 to define a return path for the bipolar energy. In addition, slip ring 1550c cooperates with a similar electrical contact and electrode 1474 to provide a pathway for monopolar electrical energy into the tissue. Bipolar and monopolar electrical energy can be delivered to slip rings 1550a, 1550b by one or more electrical generators (e.g., generator 1100). Bipolar and monopolar electrical energy can be delivered simultaneously or separately, as described in greater detail elsewhere herein.

[0186] In various examples, slip rings 1550a, 1550b, 1550c are integrated electrical slip rings having mechanical features 1556a, 1556b, 1556c configured to couple the slip rings 1550a, 1550b, 1550c to an insulative support structure 1557, or a conductive support structure coated with an insulative material, as Figure 26 illustrated. In addition, slip rings 1550a, 1550b, 1550c are spaced apart sufficiently to ensure that if a conductive fluid fills the space between slip rings 1550a, 1550b, 1550c, an electrical short will not occur. In at least one example, the core flat stamped metal shaft member includes a three- dimensionally printed or over-molded non-conductive portion for supporting the slip ring assembly 1550.

[0187] Figure 27 A portion of an electrosurgical instrument 12000 is shown, including a surgical end effector 12200 that can be coupled to a proximal shaft segment by an articulation joint in various suitable ways. In certain instances, the surgical end effector 12200 includes an end effector frame assembly 12210 that includes a distal frame member 12220 that is rotatably supported in a proximal frame housing that is attached to the articulation joint.

[0188] The surgical end effector 12200 includes a first jaw 12250 and a second jaw 12270. In the example shown, the first jaw 12250 is pivotally fixed to the distal frame member 12220 for selective pivotal travel relative thereto about a first jaw axis FJA defined by a first jaw pin 12221. The second jaw 12270 is pivotally fixed to the first jaw 12250 for selective pivotal travel relative to the first jaw 12250 about a second jaw axis SJA defined by a second jaw pin 12272. In the example shown, the surgical end effector 12200 employs an actuator yoke assembly 12610 that is pivotally coupled to the second jaw 12270 by a second jaw attachment pin 12273 for pivotal travel about a jaw actuation axis JAA that is proximal 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 that is threadably received in a threaded aperture 12632 in a distal lock plate 12630. The threaded drive shaft 12614 is mounted to the actuator yoke assembly 12610 for relative rotation therebetween. The distal lock plate 12630 is supported for rotational travel within the distal frame member 12220. Thus, rotation of the distal lock plate 12630 will result in axial travel of the actuator yoke assembly 12610.

[0189] In certain instances, the distal lock plate 12630 comprises a portion of the end effector lock system 12225. The end effector lock system 12225 further comprises a double-acting rotary lock head 12640 that is attached to various types of rotary drive shafts 12602 disclosed herein. The lock head 12640 comprises a first plurality of radially arranged distal lock features 12642 that are adapted to lockingly engage a plurality of proximally facing radial grooves or recesses 12634 formed in the distal lock plate 12630. When the distal lock features 12642 are lockingly engaged with the radial grooves 12634 in the distal lock plate 12630, rotation of the rotary lock head 12640 will cause the distal lock plate 12630 to rotate within the distal frame member 12220. Also in at least one example, the rotary lock head 12640 further comprises a second series of proximally facing proximal lock features 12644 that are adapted to lockingly engage a corresponding series of lock grooves provided in the distal frame member 12220. A lock spring 12646 is used to bias the rotary lock head distally into lockingly engaged with the distal lock plate 12630. In various instances, the rotary lock head 12640 can be pulled proximally by an unlock cable or other member in the manner described herein. In another arrangement, the rotary drive shaft 12602 can be configured to also move axially to move the rotary lock head 12640 axially within the distal frame member 12220. When the proximal lock features 12644 in the rotary lock head 12640 are lockingly engaged with the series of lock grooves in the distal frame member 12220, rotation of the rotary drive shaft 12602 will cause the surgical end effector 12200 to rotate about the shaft axis SA.

[0190] In certain instances, the first jaw 12250 and the second jaw 12270 are opened and closed as follows. To open and close the jaws, the rotary lock head 12640 is lockingly engaged with the distal lock plate 12630 as discussed in detail above. Thereafter, rotation of the rotary drive shaft 12602 in a first direction will rotate the distal lock plate 12630 which will axially drive the actuator yoke assembly 12610 in the distal direction DD and move the first jaw 12250 and the second jaw 12270 toward the open position. Rotation of the rotary drive shaft 12602 in an opposite second direction will axially drive the actuator yoke assembly 12610 proximally and draw the jaws 12250, 12270 toward the closed position. To rotate the surgical end effector 12200 about the shaft axis SA, the lock cable or member is pulled proximally to cause the rotary lock head 12640 to disengage the distal lock plate 12630 and engage the distal frame member 12220. Thereafter, when the rotary drive shaft 12602 is rotated in the desired direction, the distal frame member 12220 (and the surgical end effector 12200) will rotate about the shaft axis SA.

[0191] Figure 27 Further shown is an electrical connection assembly 5000 for electrically coupling the jaws 12250, 12270 to one or more power sources, such as generators 3106, 3107 Figure 36 ) of a bipolar electrosurgical instrument 12000. The electrical connection assembly 5000 defines two separate electrical pathways 5001, 5002 that extend through the electrosurgical instrument 12000, as Figure 27 shown. In a first configuration, the electrical pathways 5001, 5002 cooperate to deliver bipolar energy to the end effector 12200, with one of the electrical pathways 5001, 5002 acting as a return pathway. Further, in a second configuration, the electrical pathways 5001, 5002 deliver monopolar energy 12200 separately and / or simultaneously. Thus, in the second configuration, both of the electrical pathways 5001, 5002 can be used as supply pathways. Further, the electrical connection assembly 5000 can be used with other surgical instruments described elsewhere herein (e.g., the surgical instrument 1500) to electrically couple such surgical instruments with one or more power sources (e.g., the generators 3106, 3107).

[0192] In the illustrated example, the electrical pathways 5001, 5002 are implemented using a flexible circuit 5004 that extends at least partially through a coil tube 5005. As Figure 30 shown, the flexible circuit 5004 includes two separate conductive trace elements 5006, 5007 that are embedded in a PCB (printed circuit board) substrate 5009. In certain instances, the flexible circuit 5004 can be attached to a core flat stamped metal shaft member with a 3D printed or overmolded plastic housing to provide full shaft fill / support.

[0193] In an alternative example, as Figure 32 shown, a flexible circuit 5004' that extends through a coil tube 5005' can include conductive trace elements 5006', 5007' that are twisted in a helical profile in a PCB substrate 5009', which results in a reduction in the overall size of the flexible circuit 5004' and, in turn, the inner / outer diameter of the coil tube 5005'. Figure 31 and Figure 32 Other examples of flexible circuits 5004", 5004"' are shown that extend through coil tubes 5005', 5005" and include conductive trace elements 5006", 5007" and 5006"', 5007"', respectively, that include alternative profiles for size reduction. For example, the flexible circuit 5004"' includes a folded profile, while the flexible circuit 5004' includes trace elements 5006", 5007" on opposite sides of a PCB 5009".

[0194] In addition to the above, the vias 5001, 5002 are defined by trace portions 5006a-5006g, 5007a-5007g, respectively. Trace portions 5006b, 5006c and trace portions 5007b, 5007c are in the form of a loop that defines a loop assembly 5010 that maintains electrical connectivity through the vias 5001, 5002 while allowing end effector 12200 to rotate relative to the shaft of the surgical instrument 12000. In addition, trace portions 5006e, 5007e are disposed on opposite sides of the actuator yoke assembly 12610. In the example shown, portions 5006e, 5007e are disposed about a hole configured to receive a second jaw attachment pin 12273, as shown. Trace portions 5006e, 5007e are configured to make electrical contact with corresponding portions 5006f, 5007f disposed on the second jaw 12270. In addition, when the first jaw 12250 is assembled with the second jaw 12270, trace portions 5007f, 5007g become electrically connected. Figure 27

[0195] Referring to FIGS. 27-29, the flexible circuit 5014 includes spring biased trace elements 5016, 5017. The trace elements 5016, 5017 are configured to exert a biasing force against the corresponding trace element to ensure that electrical connectivity is maintained therewith, particularly when the corresponding trace portions are moved relative to one another. One or more of the trace portions of the vias 5001, 5002 can be modified to include spring biased trace elements in accordance with the flexible circuit 5014. Figure 29

[0196] Referring to FIG. 30, the graph 3000 illustrates a power scheme 3005’ of a tissue treatment cycle 3001 applied by an end effector 1400 or any other suitable end effector of the present disclosure to tissue grasped by the end effector 1400. The tissue treatment cycle 3001 includes a tissue coagulation phase 3006 that includes a feathering section 3008, a tissue warming section 3009, and a sealing section 3010. The tissue treatment cycle 3001 also includes a tissue transection or cutting phase 3007. Figure 34

[0197] Figure 36 ​​​An electrosurgical system 3100 including a control circuit 3101 configured to execute a power scheme 3005' is shown. In the illustrated example, the control circuit 3101 includes a controller 3104 having a processor 3102 and a storage medium in the form of a memory 3103. The storage medium stores program instructions for executing the power scheme 3005'. In accordance with the power scheme 3005', the electrosurgical system 3100 includes a generator 3106 configured to supply monopolar energy to the end effector 1400, and a generator 3107 configured to supply bipolar energy to the end effector 1400. In the illustrated example, 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 can be integrated with the surgical instrument 1500, the generator 3106, or the generator 3107. In various aspects, the power scheme 3005' can be stored in the memory 3103 in the form of an algorithm, an equation, and / or a lookup table, or any suitable other suitable format. The control circuit 3101 can cause the generators 3106, 3107 to supply monopolar and / or bipolar energy to the end effector 1400 in accordance with the power scheme 3005'.

[0198] In the illustrated example, the electrosurgical system 3100 also includes a feedback system 3109 in communication with the control circuit 3101. For example, the feedback system 3109 can be a standalone system, or can be integrated with the surgical instrument 1500. In various aspects, the control circuit 3101 can employ the feedback system 3109 to perform predetermined functions, such as sounding an alarm when one or more predetermined conditions are met. In certain instances, the feedback system 3109 can include, for example, one or more visual feedback systems, such as a display screen, a backlight, and / or an LED. In certain instances, the feedback system 3109 can include, for example, one or more audio feedback systems, such as a speaker and / or a buzzer. In certain instances, the feedback system 3109 can include, for example, one or more haptic feedback systems. In certain instances, the feedback system 3109 can include, for example, a combination of visual, audio, and / or haptic feedback systems. Additionally, the electrosurgical system 3100 also includes a user interface 3110 in communication with the control circuit 3101. For example, the user interface 3110 can be a standalone interface, or can be integrated with the surgical instrument 1500.

[0199] The 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 monopolar energy curve 3030 begins at the start of the tissue coagulation phase 3006 and terminates at the end of the tissue transection phase 3007. Thus, the tissue treatment cycle 3001 is configured to apply bipolar energy to the tissue throughout the tissue coagulation phase 3006 but not in the tissue transection phase 3007, and to apply monopolar energy to the tissue in a portion of the coagulation phase 3006 and the transection phase 3007, as Figure 34 shown.

[0200] In various aspects, the control circuit 3101 can receive a user input from the user interface 3110. The user input causes the control circuit 3101 to initialize execution of the power profile 3005' at time ti. Alternatively, initialization of execution of the power profile 3005' can be triggered automatically by a sensor signal from one or more sensors 3111 in communication with the control circuit 3101. For example, the power profile 3005' can be triggered automatically by the control circuit 3101 in response to a sensor signal indicative of a predetermined gap between the jaws 1450, 1470 of the end effector 1400.

[0201] During the feathering segment 3008, the control circuit 3101 causes the generator 3107 to gradually increase the bipolar energy power supplied to the end effector 1400 to reach a predetermined power value Pi (e.g., 100 W) and to maintain the bipolar energy power at or substantially at the predetermined power value Pi throughout the remainder of the feathering segment 3008 and the tissue warming segment 3009. The predetermined power value Pi can be stored in the memory 3103 and / or can be provided by a user through the user interface 3110. During the sealing segment 3010, the control circuit 3101 causes the generator 3107 to gradually decrease the bipolar energy power. Bipolar energy application terminates at the end of the sealing segment 3010 of the tissue coagulation phase 3006 and before the cutting / transection phase 3007 begins.

[0202] In addition to the above, for example, at t2, the control circuit 3101 causes the generator 3107 to begin supplying monopolar energy power to the electrode 1474 of the end effector 1400. Monopolar energy application to the tissue begins at the end of the feathering segment 3008 and the beginning of the tissue warming segment 3009. The control circuit 3101 causes the generator 3107 to gradually increase the monopolar energy power to reach a predetermined power level P2 (e.g., 75 W) and to maintain or at least substantially maintain the predetermined power level P2 throughout the remainder of the tissue warming segment 3009 and the first portion of the sealing segment 3010. The predetermined power level P2 can also be stored in the memory 3103 and / or can be provided by a user through the user interface 3110.

[0203] During the sealing segment 3010 of the tissue coagulation phase 3006, the control circuit 3101 causes the generator 3107 to gradually increase the monopolar energy power supplied to the end effector 1400. The start of the tissue transection phase 3007 is driven by an inflection point in the monopolar energy curve 3030, where the previous gradual increase in monopolar energy experienced during the sealing segment 3010 is followed by a step-up to a predetermined maximum threshold power level P3 (e.g., 150 W) sufficient to transect the coagulated tissue.

[0204] At t4, the control circuit 3101 causes the generator 3107 to step-up the monopolar energy power supplied to the end effector 1400 to the predetermined maximum threshold power level P3 and maintain or at least substantially maintain the predetermined maximum threshold power level P3 for a predetermined period of time (t4-t5) or until the end of the tissue transection phase 3007. In the example shown, the monopolar energy power is terminated by the control circuit 3101 at t5. The tissue transection mechanically continues as the jaws 1450, 1470 continue to apply pressure to the grasped tissue until the end of the tissue transection phase 3007 at t6. Alternatively, in other examples, the control circuit 3101 can cause the generator 3107 to continue to supply monopolar energy to the end effector 1400 until the end of the tissue transection phase 3007.

[0205] The control circuit 3101 can employ sensor readings of the sensors 3111 and / or timer clocks of the processor 3102 to determine when to cause the generator 3107 and / or the generator 3106 to begin, increase, decrease, and / or terminate energy supply to the end effector 1400 according to a power scheme, such as the power scheme 3005'. For example, the control circuit 3101 can execute the power scheme 3005' by causing one or more timer clocks to count down from one or more predetermined time periods (e.g., ti-t2, t2-t3, t3-t4, t5-t6), which can be stored in the memory 3103. Although the power scheme 3005' is time-based, the control circuit 3101 can adjust the predetermined time periods of any of the individual segments 3008, 3009, 3010 and / or phases 3006, 3007 based on sensor readings received from one or more of the sensors 3111, such as tissue impedance sensors.

[0206] The end effector 1400 is configured to deliver three different energy modalities to the grasped tissue. The first energy modality applied to the tissue during the feathering section 3008 includes bipolar energy but not monopolar energy. The second energy modality is a hybrid energy modality that includes a combination of monopolar and bipolar energy and is applied to the tissue during the tissue warming phase 3009 and the tissue sealing phase 3010. Finally, the third energy modality includes monopolar energy but not bipolar energy and is applied to the tissue during the cutting phase 3007. In various aspects, the second energy modality includes a power level that is the sum 3040 of the power levels of the monopolar and bipolar energy. In at least one example, the power level of the second energy modality includes a maximum threshold Ps (e.g., 120 W).

[0207] In various aspects, the control circuit 3101 causes monopolar and bipolar energy to be delivered to the end effector 1400 from two different generators 3106, 3107. In at least one example, energy from one of the generators 3106, 3107 can be detected using the return path of the other generator or with the attached electrode of the other generator shorted to unintended tissue interaction. Thus, parasitic loss of energy through unintended return paths can be detected by the generator connected to the return path. Unintended conductive paths can be mitigated by implementing voltage, power, waveform, or timing between uses.

[0208] The integrated sensors within the flexible circuit of the surgical instrument 1500 can detect energization / shorting of the electrodes / conductive paths when no potential should be present and the ability to prevent conductive paths once unintended use is sensed. In addition, directional electronic gating elements can also be utilized to prevent cross-talk from one generator down to the source of the other generator.

[0209] One or more of the electrodes described by the present disclosure (e.g., electrodes 1452, 1472, 1474 connected with the jaws 1450, 1470) can include a segmented pattern with segments that are connected together when the electrodes are energized by a generator (e.g., generator 1100). However, when the electrodes are not energized, the segments are separated to prevent the circuit from shorting to other areas of the jaw across the electrodes.

[0210] In various aspects, a thermally resistive electrode material is used with the end effector 1400. The material can be configured to inhibit current flow through the electrode at or above a predetermined temperature level, but continue to allow energization of other portions of the electrode below the temperature threshold.

[0211] Figure 37A table representing an alternative power scheme 3005" is shown, which can be stored in the memory 3103 and can be executed by the processor 3102 in a similar manner as the power scheme 3005'. In executing the power scheme 3005", the control circuit 3101 relies on the jaw gap, in addition to or instead of the time at which the generator 3106, 3107 is set to a power value. Thus, the power scheme 3005" is a jaw gap-based power scheme.

[0212] In the example shown, the jaw gap d0, dl, d2, d3, d4 from the power scheme 3005" corresponds to the time values tl, t2, t3, t4 from the power scheme 3005'. Thus, the feathering segment corresponds to a jaw gap from about dl to about d2 (e.g., about 0.700" to about 0.500"). Further, the tissue warming segment corresponds to a jaw gap from about d2 to about d3 (e.g., about 0.500" to about 0.300"). Further, the sealing segment corresponds to a jaw gap from about d2 to about d3 (e.g., about 0.030" to about 0.010"). Further, the tissue cutting phase corresponds to a jaw gap from about d3 to about d4 (e.g., about 0.010" to about 0.003").

[0213] Thus, the control circuit 3101 is configured to cause the generator 3106 to begin supplying bipolar energy power to the end effector 1400, thereby initializing the feathering segment, when the reading from one or more of the sensors 3111 corresponds to, for example, the predetermined jaw gap dl. Likewise, the control circuit 3101 is configured to cause the generator 3106 to stop supplying bipolar energy power to the end effector 1400, thereby terminating the feathering segment, when the reading from one or more of the sensors 3111 corresponds to, for example, the predetermined jaw gap d2. Likewise, the control circuit 3101 is configured to cause the generator 3107 to begin supplying monopolar energy power to the end effector 1400, thereby initializing the warming segment, when the reading from one or more of the sensors 3111 corresponds to, for example, the predetermined jaw gap d2.

[0214] In the illustrated example, the jaw aperture is defined by the distance between two corresponding fiducial points on the jaws 1450, 1470. The corresponding fiducial points contact one another when the jaws 1450, 1470 are in their closed configuration with no tissue therebetween. Alternatively, the jaw aperture can be defined by the distance between the jaws 1450, 1470 measured along a line that intersects the jaws 1450, 1470 and that intersects perpendicularly with a longitudinal axis that extends through the end effector 1500. Alternatively, the jaw aperture can be defined by the distance between first and second parallel lines that intersect the jaws 1450, 1470, respectively. The distance is measured along a line that extends perpendicular to the first and second parallel lines and that extends through the intersection between the first parallel line and the first jaw 1450 and through the intersection between the second parallel line and the second jaw 1470.

[0215] Referring to Figure 35 In various examples, the electrosurgical system 3100( Figure 36 ) is configured to perform a tissue treatment cycle 4003 using the power scheme 3005. The tissue treatment cycle 4003 includes an initial tissue contact phase 4013, a tissue coagulation phase 4006, and a tissue transection phase 4007. The tissue contact phase 4013 includes an open configuration segment 4011 in which tissue is not located between the jaws 1450 and 1470 and a proper orientation segment 4012 in which the jaws 1450 and 1470 are properly positioned relative to a desired tissue treatment region. The tissue coagulation phase 4006 includes a feathering segment 4008, a tissue warming segment 4009, and a sealing segment 3010. The tissue transection phase 4007 includes a tissue cutting segment. The tissue treatment cycle 4003 involves the application of bipolar energy and monopolar energy to a tissue treatment region separately and simultaneously in accordance with the power scheme 3005. The tissue treatment cycle 4003 is similar in many respects to the tissue treatment cycle 3001, which is not repeated herein for the sake of brevity.

[0216] Figure 35A graph 4000 is shown that represents a power scheme 3005 that is similar in many respects to the power scheme 3005'. For example, the control circuit 3101 can execute the power scheme 3005 in a similar manner as the power scheme 3005' to deliver three different energy modalities to a tissue treatment region over three consecutive time periods of a tissue treatment cycle 4001. In a feathering segment 4008, a first energy modality that includes bipolar energy but not monopolar energy is applied to the tissue treatment region from ti to t2. In a tissue warming segment 4009 and a tissue sealing segment, a second energy modality that is a hybrid energy modality including a combination of monopolar energy and bipolar energy is applied to the tissue treatment region from t2 to t4. Finally, in a tissue transection phase 4007, a third energy modality that includes monopolar energy but not bipolar energy 4010 is applied to the tissue from t4 to t5. Further, the second energy modality includes a power level that is a sum of the power levels of the monopolar energy and the bipolar energy. In at least one example, the power level of the second energy modality includes a maximum threshold (e.g., 120 W). In various aspects, the power scheme 3005 can be delivered from two different generators 3106, 3107 to the end effector 1400. For the sake of brevity, additional aspects of the power scheme 3005 that are similar to aspects of the power scheme 3005' are not repeated herein at the same level of detail.

[0217] In various aspects, the control circuit 3101 causes the generators 3106, 3107 to adjust the bipolar and / or monopolar power levels of the power scheme 3005 applied by the end effector 1400 to a tissue treatment region based on one or more measured parameters including the tissue impedance 4002, the jaw motor speed 27920d, the jaw motor force 27920c, the jaw gap 27920b of the end effector 1400, and / or the current draw of the motor implementing end effector closure. Figure 35 A graph 4000 is shown that represents a power scheme 3005 that is similar in many respects to the power scheme 3005'. For example, the control circuit 3101 can execute the power scheme 3005 in a similar manner as the power scheme 3005' to deliver three different energy modalities to a tissue treatment region over three consecutive time periods of a tissue treatment cycle 4001. In a feathering segment 4008, a first energy modality that includes bipolar energy but not monopolar energy is applied to the tissue treatment region from ti to t2. In a tissue warming segment 4009 and a tissue sealing segment, a second energy modality that is a hybrid energy modality including a combination of monopolar energy and bipolar energy is applied to the tissue treatment region from t2 to t4. Finally, in a tissue transection phase 4007, a third energy modality that includes monopolar energy but not bipolar energy 4010 is applied to the tissue from t4 to t5. Further, the second energy modality includes a power level that is a sum of the power levels of the monopolar energy and the bipolar energy. In at least one example, the power level of the second energy modality includes a maximum threshold (e.g., 120 W). In various aspects, the power scheme 3005 can be delivered from two different generators 3106, 3107 to the end effector 1400. For the sake of brevity, additional aspects of the power scheme 3005 that are similar to aspects of the power scheme 3005' are not repeated herein at the same level of detail.

[0218] In various examples, the control circuit 3101 causes the generators 3106, 3107 to adjust the power levels of a power scheme (e.g., the power scheme 3005, 3005') applied by the end effector 1400 to a tissue treatment region based on one or more parameters determined by one or more sensors 3111 (e.g., the tissue impedance 4002, the jaw / closure motor speed 27920d, the jaw / closure motor force 27920c, the jaw gap / bore 27920b of the end effector 1400, and / or the current draw of the motor). For example, the control circuit 3101 can cause the generators 3106, 3107 to adjust the power levels based on the pressure within the jaws 1450, 1470.

[0219] In at least one example, the power level is inversely related to the pressure within the jaws 1450, 1470. The control circuit 3101 can utilize such an inverse correlation to select a power level based on a pressure value. In at least one example, the current draw of the motor that effects end effector closure is employed to determine the pressure value. Alternatively, the inverse correlation utilized by the control circuit 3101 can be based directly on the current draw as a proxy for pressure. In various examples, the greater the compression of the jaws 1450, 1470 applied to the tissue treatment region, the lower the power level set by the control circuit 3101, which helps to minimize sticking and inadvertent cutting of the tissue.

[0220] The graph 4000 provides several cues of the measured parameters of tissue impedance 4002, jaw / closure motor speed 27920d, jaw / closure motor force 27920c, jaw gap / bore of the end effector 1400 27920b, and / or current draw of the motor affecting end effector closure, which can trigger activation, adjustment, and / or termination of the application of bipolar energy and / or monopolar energy to the tissue during a tissue treatment cycle 4003.

[0221] The control circuit 3101 can rely on one or more of such cues to execute and / or adjust the default power scheme 3005 in the tissue treatment cycle 4003. In certain examples, the control circuit 3101 can rely on sensor readings of 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 the memory 3103. The one or more predetermined conditions can reach a predetermined threshold and / or detect a meaningful increase and / or decrease in one or more of the monitored parameters. The satisfaction of the predetermined condition or lack thereof constitutes a trigger / confirmation point for executing and / or adjusting the portion of the default power scheme 3005 in the tissue treatment cycle 4003. The control circuit 3101 can rely on the cues only when executing and / or adjusting the power scheme or, alternatively, use the cues to guide or adjust the timer clock of a time-based power scheme, such as the power scheme 3005'.

[0222] For example, a sudden decrease (Al) in tissue impedance to a predetermined threshold (Zl) occurring alone or in conjunction with an increase (A2) in jaw motor force to a predetermined threshold (Fl) and / or a decrease (A3) in jaw bore to a predetermined threshold (dl) (e.g., 0.5”) can trigger the control circuit 3101 to begin a feathering segment 4008 of a tissue coagulation phase 4006 by activating the application of bipolar energy to the tissue treatment region. The control circuit 3101 can signal the generator 3106 to begin supplying bipolar power to the end effector 1400.

[0223] Furthermore, the reduction (B1) of the jaw motor speed to a predetermined value (vl) after activation of the bipolar energy triggers the control circuit 3101 to signal the generator 3106 to stabilize the power level (B2) of the bipolar energy at a constant or at least substantially constant value (e.g., 100 W).

[0224] In yet another example, the shift of the tissue treatment region from the defrosting segment 4008 to the warming segment 4009 at t2, which triggers activation (D1) of monopolar energy application to the tissue treatment region, coincides with one or some cases of two or all of the following conditions: an increase (C2) of the jaw motor force to a predetermined threshold (F2), a reduction (C3) of the jaw aperture to a predetermined threshold (e.g., 0.03”), and / or a reduction (Cl) of the tissue impedance to a predetermined value Z2. Satisfaction of one or some cases of two or all of the conditions Cl, C2, C3 causes the control circuit 3101 to cause the generator 3101 to begin applying monopolar energy to the tissue treatment region. In another example, satisfaction of one or some cases of two or all of the conditions Cl, C2, C3 at or around time t2 triggers application of monopolar energy to the tissue treatment region.

[0225] Activation of the monopolar energy by the generator 3107 in response to the activation signal of the control circuit 3101 can cause a mixture (D1) of monopolar and bipolar energy to be delivered to the tissue treatment region, which results in a shift in the impedance curve characterized by a faster reduction (El) in impedance from Z2 to Z3 (compared to the steady reduction (Cl) prior to activation of the monopolar energy). In the illustrated example, the tissue impedance Z3 defines a minimum impedance of the tissue treatment cycle 4003.

[0226] In the illustrated example, if (El) the minimum impedance value Z3 coincides or at least substantially coincides with (E3) a predetermined maximum jaw motor force threshold (F3) and / or (E2) a predetermined jaw aperture threshold range (e.g., 0.01”-0.003”), the control circuit 3101 determines that an acceptable seal is achieved. Satisfaction of one or some cases of two or all of the conditions El, E2, E3 signals the control circuit 3101 to shift from the warming segment 4009 to the sealing segment 4010.

[0227] 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 sealing segment 4010. Satisfaction of the threshold Z4 causes the control circuit 3101 to signal the generator 3107 to gradually increase the monopolar power level to begin the tissue transection phase 4007 and to signal the generator 3106 to terminate application of the bipolar energy to the tissue treatment region.

[0228] In various examples, the control circuit 3101 can be configured to verify (G2) that the jaw motor force decreases as (G1) the impedance gradually increases from its minimum value Z3, and / or that (G3) the jaw motor force has decreased to a predetermined threshold (e.g., 0.01"-0.003") before progressively increasing the power level of monopolar energy to cut tissue.

[0229] However, if the jaw motor force continues to increase, the control circuit 3101 can pause the application of monopolar energy to the tissue treatment region for a predetermined period of time to allow the jaw motor force to begin decreasing. Alternatively, the control circuit can signal the generator 3107 to deactivate the monopolar energy and complete the seal using only bipolar energy.

[0230] In certain instances, the control circuit 3101 can employ the feedback system 3109 to alert the user and / or provide instructions or recommendations to pause the application of monopolar energy. In certain instances, the control circuit 3101 can instruct the user to utilize a mechanical knife to transect the tissue.

[0231] In the illustrated example, the control circuit 3101 maintains (H) the progressively increasing monopolar power until a spike (I) is detected in the tissue impedance. The control circuit 3101 can cause the generator 3107 to terminate (J) the application of monopolar energy to the tissue after detecting the spike (I) in the impedance level to Z5 after the gradual increase from Z3 to Z4. The spike indicates completion of the tissue treatment cycle 4003.

[0232] In various examples, the control circuit 3101 prevents the electrodes of the jaws 1450, 1470 from being energized until a suitable closure threshold is reached. The closure threshold can be based on, for example, a predetermined jaw aperture threshold and / or a predetermined jaw motor force threshold that can be stored in the memory 3103. In such examples, the control circuit 3101 can not actuate the user input through the user interface 3110 of the treatment cycle 4003. In certain instances, the control circuit 3101 can respond by alerting the user through the feedback system 3109 that the suitable closure threshold has not been reached. The control circuit 3101 can also provide the user with an override option.

[0233] Finally, between times t4 and t5, monopolar energy is the only energy delivered in order to cut the patient tissue. The force to clamp the jaws of the end effector can vary when cutting the patient tissue. In the case where the force to clamp the jaws 27952 decreases from its steady state level maintained between times t3 and t4, an efficient and / or effective tissue cut is identified by the surgical instrument and / or the surgical hub. In the case where the force to clamp the jaws 27954 increases from its steady state level maintained between times t3 and t4, an inefficient and / or ineffective tissue cut is identified by the surgical instrument and / or the surgical hub. In such cases, an error can be communicated to the user.

[0234] Referring to Figures 38 to 42 , the surgical instrument 1601 includes an end effector 1600 that is similar in many respects to the end effectors 1400, 1500, which are not repeated herein at the same level of detail for the sake of brevity. The 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 transition the end effector 1600 from an open configuration to a closed configuration to grasp 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, as shown in Figure 39 . An electrode 1674 is configured to deliver monopolar energy from a monopolar energy source 1620 to the tissue. A return pad 1621 defines a return path for the monopolar energy. In at least one example, the monopolar energy and the bipolar energy are delivered to the tissue simultaneously Figure 36 ) or in an alternating manner, as shown in Figure 36 , to, for example, seal and / or cut the tissue.

[0235] Figure 42 A simplified schematic of an electrosurgical system 1607 is shown that includes a monopolar power source 1620 and a bipolar power source 1610 that are connectable to an electrosurgical instrument 1601 that includes an end effector 1600. The electrosurgical system 1607 also includes a conductive circuit 1602 that is selectively transitionable between a connected configuration with the electrode 1672 and a disconnected configuration from the electrode 1672. The switching mechanism can be comprised of, for example, any suitable switch that can open and close the conductive circuit 1602. In the connected configuration, the electrode 1672 is configured to cooperate with the electrode 1652 to deliver bipolar energy to the tissue, with the conductive circuit 1602 defining a return path for the bipolar energy after passing through the tissue. However, in the disconnected configuration, the electrode 1672 is isolated and thus becomes an inert inner conductive and outer insulating structure on the jaw 1670. Thus, in the disconnected configuration, the electrode 1652 is configured to deliver monopolar energy to the tissue in addition to or separate from the monopolar energy delivered through the electrode 1674. In an alternative example, the electrode 1652 instead of the electrode 1672 can be transitionable between a connected configuration and a disconnected configuration with the conductive circuit 1602 to allow the electrode 1672 to deliver monopolar energy to the tissue in addition to or separate from the monopolar energy delivered through the electrode 1674.

[0236] In various aspects, the electrosurgical instrument 1601 further includes a control circuit 1604 configured to adjust the levels of monopolar and bipolar energy delivered to tissue to minimize unintended thermal damage to surrounding tissue. The adjustment can be based on readings of at least one sensor, such as a temperature sensor, an impedance sensor, and / or a current sensor. In Figure 41 and Figure 42 In the example shown, the control circuit 1604 is coupled to temperature sensors 1651, 1671 on the jaws 1650, 1670, respectively. The control circuit 1604 adjusts the levels of monopolar and bipolar energy delivered to tissue based on temperature readings of the sensors 1651, 1671.

[0237] In the example shown, the control circuit 1604 includes a controller 3104 having a storage medium in the form of a memory 3103 and a processor 3102. The memory 3103 stores program instructions that, when executed by the processor 3102, cause the processor 3102 to adjust the levels of monopolar and bipolar energy delivered to tissue based on sensor readings received from one or more sensors, such as the temperature sensors 1651, 1671. In various examples, as described in greater detail below, the control circuit 1604 can adjust a default power scheme 1701 based on readings from one or more sensors, such as the temperature sensors 1651, 1671. The power scheme 1701 is similar in many respects to the power scheme 3005', which is not repeated herein at the same level of detail for the sake of brevity.

[0238] Figure 43 Temperature-based adjustment of a power scheme 1701 for energy delivery to tissue grasped by the end effector 1600 is shown. The graph 1700 depicts time on the x-axis and power and temperature on the y-axis. In a tissue feathering segment (t1-t2), the control circuit 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 grasped by the end effector 1600 to gradually increase to a temperature within a predetermined range (e.g., 100°C-120°C). Then, as long as the tissue temperature remains within the predetermined range, the power level of the bipolar energy is maintained at the predetermined threshold. In a tissue warming segment (t2-t3), the control circuit 1604 activates the 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.

[0239] 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.

[0240] 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.

[0241] 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.

[0242] 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.

[0243] In various aspects, the control circuit 1604 monitors the thermal effects at the treatment region 1683 resulting from the application of monopolar energy to the treatment region 1683. The control circuit 1604 can further detect a failure of the monitored thermal effects to follow a predetermined correlation between the applied monopolar energy and the thermal effects expected from the application of monopolar energy at the treatment region. In the illustrated example, the unintentional energy consumption at the constricted portion of the artery reduces the thermal effects at the treatment region, which is detected by the control circuit 1604.

[0244] In certain examples, the memory 3103 stores a predetermined correlation algorithm between the level of monopolar energy applied to a tissue treatment region grasped by the end effector 1600 and the thermal effects expected from the application of monopolar energy to the tissue treatment region. The correlation algorithm can be in the form of, for example, an array, a lookup table, a database, a mathematical equation or formula, or the like. In at least one example, the stored correlation algorithm defines a correlation between the power level of monopolar energy and an expected temperature. The control circuit 1604 can monitor the temperature of the tissue at the treatment region 1683 using the temperature sensors 1651, 1671 and can determine whether the monitored temperature reading corresponds to the expected temperature reading at a particular power level.

[0245] If a failure to comply with the stored correlation is detected, the control circuit 1604 can be configured to take certain actions. For example, the control circuit 1604 can alert a user of the failure. Additionally or alternatively, the control circuit 1604 can reduce or suspend the delivery of monopolar energy to the treatment region. In at least one example, the control circuit 1604 can adjust or shift from monopolar energy to bipolar energy application to the tissue treatment region to confirm the presence of parasitic power drain. If the parasitic power drain is confirmed, the control circuit 1604 can continue to use bipolar energy at the treatment region. However, if the control circuit 1604 denies the presence of parasitic power drain, the control circuit 1604 can reactivate or increase the monopolar power level. The control circuit 1604 can effectuate the changes to the monopolar and / or bipolar power levels, for example, by signaling the monopolar power source 1620 and / or the bipolar power source 1610.

[0246] In various aspects, one or more imaging devices, such as the multi-spectral range 1690 and / or infrared imaging device, can be used to monitor the spectral tissue changes and / or thermal effects at the tissue treatment region 1691, as Figure 45The imaging data from one or more imaging devices can be processed to estimate the temperature at the tissue treatment region 1691. For example, when monopolar energy is applied to the treatment region 1691 by the end effector 1600, the user can direct an infrared imaging device at the treatment region 1691. As the treatment region 1691 heats, its infrared thermal signature changes. Thus, the change in the thermal signature corresponds to a change in the temperature of the tissue at the treatment region 1691. Accordingly, the temperature of the tissue at the treatment region 1691 can be determined based on the thermal signature captured by the one or more imaging devices. If the temperature estimated based on the thermal signature at the treatment region 1691 associated with a particular power level is less than or equal to the expected temperature at the power level, the control circuit 1604 detects a disparity in the thermal effect at the treatment region 1691.

[0247] In other examples, the thermal signature captured by the one or more imaging devices is not converted to an estimated temperature. Rather, it is directly compared to the thermal signatures stored in the memory 3103 to assess whether a power level adjustment is needed.

[0248] In certain examples, the memory 3103 stores a predetermined correlation algorithm between the power level of monopolar energy applied to a tissue treatment region 1691 grasped by the end effector 1600 and the expected thermal signature resulting from the application of monopolar energy to the tissue treatment region. The correlation algorithm can be in the form of, for example, an array, a lookup table, a database, a mathematical equation or formula, or the like. In at least one example, the stored correlation algorithm defines a correlation between the power level of monopolar energy and the expected thermal signature or a temperature associated with the expected thermal signature.

[0249] Referring to Figure 46 and Figure 47 , an electrosurgical system includes an electrosurgical instrument 1801 having an end effector 1800 that is similar in many respects to the end effectors 1400, 1500, 1600, which are not repeated herein in the same level of detail for the sake of brevity. 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 transition the end effector 1800 from an open configuration to a closed configuration to grasp tissue (T) between the first jaw 1850 and the second jaw 1870. Electrodes 1852, 1872 are configured to cooperate to deliver bipolar energy to the tissue. An electrode 1874 is configured to deliver monopolar energy to the tissue. In at least one example, the monopolar energy and the bipolar energy are delivered to the tissue simultaneously or in an alternating manner, as shown in Figure 34 , to, for example, seal and / or cut the tissue.

[0250] In the illustrated example, bipolar energy and monopolar energy are generated by separate generators 1880, 1881 and provided to the tissue by separate circuits 1882, 1883 connecting generator 1880 to electrodes 1852, 1872 and generator 1881 to electrode 1874 and return pad 1803, respectively. The associated power level is the bipolar energy delivered to the tissue by electrodes 1852, 1872 and set by generator 1880, and the power level associated with the monopolar energy delivered to the tissue by electrode 1874 is set by generator 1881 according to, for example, power scheme 3005'.

[0251] In use, as Figure 46 illustrated, end effector 1800 applies bipolar energy and / or monopolar energy to tissue treatment region 1804 to seal, and in some cases, transect, the tissue. In some cases, however, the energy is diverted from the intended target at tissue treatment region 1804, resulting in extraneous thermal injury to surrounding tissue. To avoid or at least reduce such occurrences, surgical instrument 1801 includes impedance sensors 1810, 1811, 1812, 1813 positioned between different electrodes and at different locations, as Figure 46 illustrated, to detect extraneous thermal injury.

[0252] In various aspects, surgical system 1807 further includes control circuit 1809 coupled to impedance sensors 1810, 1811, 1812, 1813. Control circuit 1809 can detect extraneous or unintended thermal injury based on one or more readings of impedance sensors 1810, 1811, 1812, 1813. In response, control circuit 1809 can alert a user of the extraneous thermal injury and instruct the user to pause energy delivery to tissue treatment region 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 circuit 1809 can instruct the user to employ a mechanical knife to transect the tissue to avoid further extraneous thermal injury.

[0253] Still referring to Figure 46Impedance sensor 1810 is configured to measure impedance between bipolar electrodes 1852, 1872. Additionally, impedance sensor 1811 is configured to measure impedance between electrode 1874 and return pad 1803. Further, impedance sensor 1812 is configured to measure impedance between electrode 1872 and return pad 1803. Moreover, impedance sensor 1813 is configured to measure impedance between electrode 1852 and return pad 1803. In other examples, additional impedance sensors are added in-line between monopolar circuit 1882 and bipolar circuit 1883, which can be used to measure impedance at various locations to detect extra-site thermal abnormalities with greater specificity as to location and impedance path.

[0254] In various aspects, an extra-site thermal injury occurs in tissue on one side (left / right) of end effector 1800. Control circuit 1809 can detect the side on which an extra-site thermal injury occurs by comparing the readings of impedance sensors 1810, 1811, 1812, 1813. In one example, a disproportionate change in monopolar and bipolar impedance readings indicates an extra-site thermal injury. Conversely, if a proportionality in impedance readings is detected, control circuit 1809 remains that no extra-site thermal injury has occurred. In one example, as described in greater detail below, an extra-site thermal injury can be detected by control circuit 1809 from the ratio of bipolar impedance to monopolar impedance.

[0255] Figure 48 A plot 1900 is shown that depicts time on the x-axis and power on the y-axis. Plot 1900 shows a power scheme 1901 that is similar in many respects to power scheme 3005' shown Figure 34 The power scheme 1901 shown is a power scheme 3005' for brevity that is not repeated in the same level of detail. Control circuit 3101 causes power scheme 1901 to be applied by generators 1880 (GEN.2), 1881 (GEN.1) in order to implement a tissue treatment cycle by end effector 1800. Power scheme 1901 includes a treatment power component 1902 and a non-treatment or sensing power component 1903. Treatment power component 1902 defines monopolar and bipolar power levels similar to those described in connection with power scheme 3005'. Sensing power component 1903 includes monopolar 1905 and bipolar 1904 sensing pickups that are delivered at various points throughout the tissue treatment cycle performed 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., 10 mA) or a predetermined range. In at least one example, three different sensing pickups are utilized to determine the location / orientation of a potential extra-site thermal injury.

[0256] The control circuit 3101 can determine whether energy is being diverted from the tissue therapy directed site during a tissue therapy cycle by causing the sensing pickups 1903, 1904 to deliver at predetermined time intervals. The control circuit 3101 can then assess the return path conductivity based on the delivered sensing pickups. If it is determined that energy is being diverted from the target site, the control circuit 3101 can take one or more reactive measures. For example, the control circuit 3101 can adjust the power regime 1901 applied by the generators 1880 (GEN.2), 1881 (GEN.1). The control circuit 3101 can suspend the bipolar and / or monopolar energy application to the target site. Additionally, the control circuit 3101 can alert the user, for example, through the feedback system 3109. If, however, it is determined that no energy diversion is detected, the control circuit 3101 continues to execute the power regime 1901.

[0257] In various aspects, for example, the control circuit 3101 assesses the return path conductivity by comparing the measured return conductivity to a predetermined return path conductivity stored in the memory 3103. If the comparison indicates that the measured and predetermined return path conductivities differ by more than a predetermined threshold, the control circuit 3101 concludes that energy is being diverted to a non-tissue therapy directed site and executes one or more of the previously described reactive measures.

[0258] Figure 49 is a graph 2000 illustrating a power regime 2001 that is interrupted at t3' due to a detected extraneous thermal lesion. The power regime 2001 is similar in many respects to the power regime illustrated by Figure 34 , Figure 48 which is not repeated herein at the same level of detail for the sake of brevity. For example, the control circuit 1809 causes the generators 1880 (curve 2010), 1881 (curve 2020) to apply the power regime 2001 so as to effect a tissue therapy cycle by the end effector 1800. In addition to the power regime 2001, the graph 2000 depicts the bipolar impedance 2011 (Z 双极 ), the monopolar impedance 2021 (Z 单极 ), and the ratio 2030 (Z 单极 / Z 双极 ) of the monopolar impedance to the bipolar impedance on the y-axis. During normal operation, when monopolar energy and bipolar energy are simultaneously applied to the tissue, the values of the bipolar impedance 2011 (Z 双极 ) and the monopolar impedance 2021 (Z 单极 ) remain proportional, or at least substantially proportional. Thus, during normal operation, the constant or at least substantially constant impedance ratio 2030 (Z 单极 / Z 双极) is maintained within a predetermined range 2031.

[0259] In various aspects, the control circuit 1809 monitors the impedance ratio 2030 to assess whether monopolar energy is being deflected to a non-tissue therapy directed site. Deflection changes the proportion of values of the detected bipolar impedance 2011 (Z 双极 ) and monopolar impedance 2021 (Z 单极 ), which changes the impedance ratio 2030. Changes in the impedance ratio 2030 within the predetermined range 2031 can cause the control circuit 1908 to issue a warning. However, if the changes extend to or below a lower threshold of the predetermined range 2031, the control circuit 1908 can take additional reactive measures.

[0260] In the illustrated example, for an initial portion of a therapy cycle involving mixed monopolar and bipolar energy application to tissue, the impedance ratio 2030 (Z 单极 / Z 双极 ) remains constant or at least substantially constant. However, at Bl, a divergence occurs in which the monopolar impedance (Z 单极 ) unexpectedly drops, or drops disproportionately to the bipolar impedance (Z 双极 ), indicating a potential off-site thermal injury. In at least one example, the control circuit 1809 monitors changes in the ratio of monopolar impedance to bipolar impedance (Z 单极 / Z 双极 ) and detects an off-site thermal injury if the changes persist for a predetermined amount of time, and / or if the value changes to or below a lower threshold of the predetermined range 2031. At Bl, since the detected impedance ratio 2030 is still within the predetermined range 2031, the control circuit 3101 only issues a warning through the feedback system 3109 that an off-site thermal injury has been detected and continues to monitor the impedance ratio 2030.

[0261] At t3', the control circuit 3101 further detects that the impedance ratio 2030 has become a value at or below the lower threshold of the predetermined range 2031. In response, the control circuit 3101 can issue another warning and, optionally, can instruct the user to pause energy delivery to the tissue at B2, or automatically pause energy delivery while maintaining or adjusting the power level of the bipolar energy to complete tissue sealing without monopolar energy. In certain examples, the control circuit 1809 further instructs the user to employ a mechanical knife (t4') to transect the tissue to avoid further extraneous thermal injury. In the illustrated example, the control circuit 1809 further causes the generator 1880 to adjust its power level to complete tissue sealing without monopolar energy and increase the time period allocated to the tissue sealing segment from time t4 to time t4'. In other words, the control circuit 1809 will increase the bipolar energy delivery to the tissue to compensate for the loss of monopolar energy by increasing the bipolar power level and its delivery time.

[0262] Various aspects of the subject matter described herein are set out in the following embodiments.

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

[0264] Set of Examples 1

[0265] Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition 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 comprises a tapered body extending from a proximal end to a distal end. The tapered body comprises an electrically conductive material. The tapered body comprises a first electrically conductive portion extending from the proximal end to the distal end, and a second electrically conductive portion defining a tapered electrode that protrudes from the first electrically conductive portion and extends distally along at least a portion of the tapered body. The second electrically conductive portion is integral with the first electrically conductive portion. In a transverse cross-section of the tapered body, the first electrically conductive portion is thicker than the second electrically conductive portion. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first electrically conductive portion from the tissue without electrically insulating the second electrically conductive portion. The first electrically conductive portion is configured to transmit electrical energy to the tissue only through the second electrically conductive portion.

[0266] Example 2 - The electrosurgical instrument of Example 1, wherein the tapered electrode comprises an outer surface that is flush with an outer surface of the electrically insulating layer.

[0267] Example 3 - The electrosurgical instrument of Example 1 or 2, wherein the tapered electrode has a width that tapers as the tapered electrode extends from the proximal end toward the distal end.

[0268] Example 4 - The electrosurgical instrument of Examples 1, 2, or 3, wherein the electrical energy is delivered to the tissue through an outer surface of the tapered electrode.

[0269] Example 5 - The electrosurgical instrument of Examples 1, 2, 3, or 4, wherein the first jaw comprises 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 the closed configuration.

[0270] Example 6 - The electrosurgical instrument of Example 5, wherein the second jaw further comprises a third electrode spaced apart from the tapered body.

[0271] Example 7 - The electrosurgical instrument of Example 6, wherein the third electrode extends distally along the angular profile defined by the second jaw from a proximal electrode end to a distal electrode end.

[0272] Example 8 - The electrosurgical instrument of Example 7, wherein the third electrode comprises a base positioned in a cradle extending distally along the angular profile of the second jaw from a proximal cradle end to a distal cradle end.

[0273] Example 9 - The electrosurgical instrument of Example 8, wherein the cradle is positioned centrally relative to a lateral edge of the second jaw.

[0274] Example 10 - The electrosurgical instrument of Examples 8 or 9, wherein the third electrode further comprises a tapered edge extending from the base beyond a sidewall of the cradle.

[0275] Example 11 - The electrosurgical instrument of Examples 8, 9, or 10, wherein the cradle is composed of a compliant substrate.

[0276] Example 12 - The electrosurgical instrument of Examples 8, 9, 10, or 11, wherein the cradle is partially embedded in a valley defined in the tapered body.

[0277] Example 13 - The electrosurgical instrument of Examples 8, 9, 10, 11, or 12, wherein the cradle is spaced apart from the tapered body by an electrically insulative coating.

[0278] Example 14 - The electrosurgical instrument of Examples 8, 9, 10, 11, 12, or 13, wherein the base comprises a base proximal end, a base distal end, and a width tapering as the base extends along the angular profile from the base proximal end to the base distal end.

[0279] Example 15 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition 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 comprises a conductive body comprising a tapered corner profile extending from a proximal end to a distal end. The conductive body comprises a first conductive portion extending from the proximal end to the distal end, and a second conductive portion defining a tapered electrode that protrudes from the first conductive portion and extends 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 further comprises 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.

[0280] Example 16 - The electrosurgical instrument of Example 15, wherein the tapered electrode has a width that tapers narrower as the tapered electrode extends from the proximal end toward the distal end.

[0281] Example 17 - The electrosurgical instrument of Example 15 or 16, wherein the first jaw comprises 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 the closed configuration.

[0282] Example 18 - The electrosurgical instrument of Example 15, 16, or 17, wherein the second jaw further comprises a third electrode spaced apart from the conductive body.

[0283] Example 19 - The electrosurgical instrument of Example 18, wherein the third electrode extends distally along at least a portion of the tapered corner profile.

[0284] Example 20 - The electrosurgical instrument of Example 19, wherein the third electrode comprises a base positioned in a cradle extending distally from a proximal end of the cradle to a distal end of the cradle along at least a portion of the tapered corner profile, and wherein the cradle is composed of a compliant substrate.

[0285] Set of Examples 2

[0286] Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition 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 comprises a linear portion that cooperates to form a corner profile and a treatment surface comprising segments that extend along the corner profile. The segments comprise different geometries and different electrical conductivities. The segments are configured to produce a variable energy density along the treatment surface.

[0287] Example 2 - The electrosurgical instrument of Example 1, wherein the segments comprise a proximal segment and a distal segment. The proximal segment comprises a first surface area. The distal segment comprises a second surface area. The second surface area is less than the first surface area.

[0288] Example 3 - The electrosurgical instrument of Example 1 or 2, wherein at least one of the segments comprises an electrically conductive treatment region that is longitudinally interrupted by a non-conductive treatment region.

[0289] Example 4 - The electrosurgical instrument of Example 1, 2, or 3, wherein the variable energy density is predetermined based on the selection of the different geometries and different electrical conductivities of the segments.

[0290] Example 5 - The electrosurgical instrument of Example 1, 2, 3, or 4, wherein at least one of the segments has a tapered width along its length.

[0291] Example 6 - The electrosurgical instrument of Example 1, 2, 3, 4, or 5, wherein the segments extend along a peripheral side of the second jaw.

[0292] Example 7 - The electrosurgical instrument of Example 1, 2, 3, 4, 5, or 6, wherein the segments are defined in the second jaw and not the first jaw.

[0293] Example 8 - The electrosurgical instrument of Example 1, 2, 3, 4, 5, 6, or 7, wherein the second jaw comprises an electrically conductive scaffold 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 isolating and electrically insulating.

[0294] Example 9 - The electrosurgical instrument of Example 8, wherein the first material comprises diamond-like carbon.

[0295] Example 10 - The electrosurgical instrument of Example 8 or 9, wherein the second material comprises polytetrafluoroethylene.

[0296] Example 11 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition 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 comprises a tapered body extending from a proximal end to a distal end. The tapered body comprises a tissue contact surface. The tissue contact surface comprises an insulating layer comprising a first material. The insulating layer extends on opposite sides of a middle region extending along a length of the tapered body. The tissue contact surface further comprises a segment configured to produce a variable energy density along the tissue contact surface. The segment comprises an electrically conductive segment and an insulating segment alternating with the electrically conductive segment along the middle region. The insulating segment comprises a second material different from the first material.

[0297] Example 12 - The electrosurgical instrument of Example 11, wherein the electrically conductive segment comprises a proximal segment and a distal segment. The proximal segment comprises a first surface area. The distal segment comprises a second surface area. The second surface area is less than the first surface area.

[0298] Example 13 - The electrosurgical instrument of Example 11 or 12, wherein the second jaw comprises an electrically conductive scaffold partially coated with the first material.

[0299] Example 14 - The electrosurgical instrument of Example 13, wherein the electrically conductive scaffold comprises an inner thermal isolation core and an outer thermally conductive layer at least partially surrounding the inner thermal isolation core.

[0300] Example 15 - The electrosurgical instrument of Example 11, 12, 13, or 14, wherein the variable energy density is predetermined based on a selection of different geometries and different electrical conductivities of the electrically conductive segment.

[0301] Example 16 - The electrosurgical instrument of Example 11, 12, 13, 14, or 15, wherein at least one of the segments has a tapered width along its length.

[0302] Example 17 - The electrosurgical instrument of Example 11, 12, 13, 14, 15, or 16, wherein the segments extend along a peripheral side of the second jaw.

[0303] Example 18 - The electrosurgical instrument of Example 11, 12, 13, 14, 15, 16, or 17, wherein the segments are defined in the second jaw but not the first jaw.

[0304] Example 19 - The electrosurgical instrument of Example 11, 12, 13, 14, 15, 16, 17, or 18, wherein the first material comprises diamond-like carbon.

[0305] Example 20 - The electrosurgical instrument of Examples 11, 12, 13, 14, 15, 16, 17, 18, or 19, wherein the second material comprises polytetrafluoroethylene.

[0306] Set of Examples 3

[0307] Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw, a second jaw, and an electrical circuit. The first jaw comprises a first electrically conductive framework, a first insulative coating selectively covering portions of the first electrically conductive framework, and a first jaw electrode comprising exposed portions of the first electrically conductive framework. At least one of the first jaw and the second jaw is movable to transition 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 comprises a second electrically conductive framework, a second insulative coating selectively covering portions of the second electrically conductive framework, and a second jaw electrode comprising exposed portions of the second electrically conductive framework. The electrical circuit is configured to transmit bipolar RF energy and monopolar RF energy to the tissue through the first jaw electrode and the second jaw electrode. The monopolar RF energy shares a first electrical pathway and a second electrical pathway defined by the electrical circuit for transmitting the bipolar RF energy.

[0308] Example 2 - The electrosurgical instrument of Example 1, wherein the electrical circuit defines a third electrical pathway separate from the first electrical pathway and the second electrical pathway.

[0309] Example 3 - The electrosurgical instrument of Examples 1 or 2, wherein the end effector comprises a cutting electrode electrically insulated from the first electrically conductive framework and the second electrically conductive framework.

[0310] Example 4 - The electrosurgical instrument of Example 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through the third electrical pathway.

[0311] Example 5 - The electrosurgical instrument of Example 4, wherein the cutting electrode is configured to cut tissue with the cutting monopolar RF energy after coagulation of the tissue has been initiated by the bipolar RF energy.

[0312] Example 6 - The electrosurgical instrument of Examples 3, 4, or 5, wherein the cutting electrode is centrally located in one of the first jaw and the second jaw.

[0313] Example 7 - The electrosurgical instrument of Examples 4 or 5, wherein the end effector is configured to simultaneously deliver the cutting monopolar RF energy and the bipolar RF energy to the tissue.

[0314] Example 8 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw electrode comprises a first distal tip electrode, and wherein the second jaw electrode comprises a second distal tip electrode.

[0315] Example 9 - The electrosurgical instrument of Example 8, wherein the first electrically conductive framework and the second electrically conductive framework are simultaneously energized to deliver monopolar RF energy to the tissue surface through the first distal tip electrode and the second distal tip electrode.

[0316] Example 10 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the second jaw comprises a dissecting electrode extending along a peripheral surface of the second jaw.

[0317] Example 11 - An electrosurgical instrument comprising an end effector and an electrical circuit. The end effector comprises at least two electrode sets, a first jaw, and a second jaw. At least one of the first jaw and the second jaw is movable to transition 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 deliver a combination of bipolar RF energy and monopolar RF energy from the at least two electrode sets to the grasped tissue. The electrical circuit is configured to transmit the bipolar RF energy and the monopolar RF energy. The monopolar RF energy shares an active and return path defined by the electrical circuit for transmitting the bipolar RF energy.

[0318] Example 12 - The electrosurgical instrument of Example 11, wherein the at least two electrode sets comprise three electrical interconnections used together in the electrical circuit.

[0319] Example 13 - The electrosurgical instrument of Examples 11 or 12, wherein the at least two electrode sets comprise three electrical interconnections that define at least a portion of the electrical circuit and another separate electrical circuit.

[0320] Example 14 - The electrosurgical instrument of Example 13, wherein the separate electrical circuit leads to a cutting electrode of the at least two electrode sets that is isolated and centrally located in one of the first jaw and the second jaw.

[0321] Example 15 - The electrosurgical instrument of Example 14, wherein the cutting electrode is configured to cut tissue after coagulation of the tissue has begun using a second electrode and a third electrode of the at least two electrode sets.

[0322] Example 16 - The electrosurgical instrument of Examples 14 or 15, wherein the at least two electrode sets are configured to simultaneously deliver monopolar RF energy and bipolar RF energy to the tissue.

[0323] Example 17 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition 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 comprises a composite scaffold of at least two different materials configured to selectively produce an electrically conductive portion and a thermally isolated portion.

[0324] Example 18 - The electrosurgical instrument of Example 17, wherein the composite scaffold comprises a titanium ceramic composite material.

[0325] Example 19 - The electrosurgical instrument of Example 17 or 18, wherein the composite scaffold comprises a ceramic base and a titanium crown attachable to the ceramic base.

[0326] Example 20 - The electrosurgical instrument of Example 17, 18, or 19, wherein the composite scaffold is at least partially coated with an electrically insulating material.

[0327] Example 21 - A method for manufacturing a jaw of an end effector of an electrosurgical instrument. The method comprises preparing a composite scaffold of the jaw by fusing titanium powder with ceramic powder in a metal injection molding process and selectively coating the composite scaffold with an electrically insulating material to produce a plurality of electrodes.

[0328] Set of Examples 4

[0329] Example 1 - An electrosurgical instrument comprising a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw comprises a first electrically conductive scaffold and a first electrically insulating layer. The first electrically conductive scaffold comprises: a first thermally isolated core; and a first thermally conductive outer layer integral with the first thermally isolated core and extending at least partially around the first thermally isolated core. The first electrode is defined by selectively applying the first electrically insulating layer to an outer surface of the first thermally conductive outer layer. The second jaw is configured to define a second electrode. The second jaw comprises a second electrically conductive scaffold and a second electrically insulating layer. The second electrically conductive scaffold comprises: a second thermally isolated core; and a second thermally conductive outer layer integral with the second thermally isolated core and extending at least partially around the second thermally isolated core. The second electrode is defined by selectively applying the second electrically insulating layer to an outer surface of the second thermally conductive outer layer.

[0330] Example 2 - The electrosurgical instrument of Example 1, wherein the first electrode is configured to transmit RF energy to the second electrode through tissue positioned between the first electrode and the second electrode in a bipolar energy operating mode.

[0331] Example 3 - The electrosurgical instrument of Examples 1 or 2, wherein the first thermally isolating core comprises an air pocket.

[0332] Example 4 - The electrosurgical instrument of Examples 1, 2, or 3, wherein the first thermally isolating core comprises a lattice structure.

[0333] Example 5 - The electrosurgical instrument of Examples 1, 2, 3, or 4, wherein the second jaw comprises a third electrode, and wherein the third electrode is defined by selectively applying a second electrically insulating layer to an outer surface of the second thermally conductive outer layer.

[0334] Example 6 - The electrosurgical instrument of 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.

[0335] Example 7 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, or 6, wherein at least one of the first electrically insulating layer and the second electrically insulating layer comprises a diamond-like material.

[0336] Example 8 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw comprises a tissue contact surface, and wherein the first thermally isolating core comprises a lattice structure comprising walls that stand in a direction transverse to the tissue contact surface.

[0337] Example 9 - The electrosurgical instrument of Example 8, wherein the direction is perpendicular to the tissue contact surface.

[0338] Example 10 - An electrosurgical instrument comprising a jaw configured to define an electrode. The jaw comprises 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.

[0339] Example 11 - The electrosurgical instrument of Example 10, wherein the electrode is configured to transmit RF energy to tissue positioned against the electrode.

[0340] Example 12 - The electrosurgical instrument of Examples 10 or 11, wherein the first electrically conductive portion comprises an air pocket.

[0341] Example 13 - The electrosurgical instrument of Examples 10, 11, or 12, wherein the first electrically conductive portion comprises a lattice structure.

[0342] Example 14 - The electrosurgical instrument of Examples 10, 11, 12, or 13, wherein the electrically insulative layer comprises a diamond-like material.

[0343] Example 15 - The electrosurgical instrument of Examples 10, 11, 12, 13, or 14, wherein the jaw comprises a tissue-contacting surface, and wherein the first electrically conductive portion comprises a lattice structure comprising walls that stand in a direction transverse to the tissue-contacting surface.

[0344] Example 16 - The electrosurgical instrument of Example 15, wherein the direction is perpendicular to the tissue-contacting surface.

[0345] Example 17 - An electrosurgical instrument comprising a jaw configured to define an electrode. The jaw comprises an electrically conductive framework and an electrically insulative layer. The electrically conductive framework comprises a thermally isolating core and a thermally conductive outer layer that is integral with the thermally isolating core and extends at least partially around the thermally isolating core. The electrode is defined by selectively applying the electrically insulative layer to an outer surface of the thermally conductive outer layer.

[0346] Example 18 - The electrosurgical instrument of Example 17, wherein the thermally isolating core comprises a lattice structure.

[0347] Example 19 - The electrosurgical instrument of Example 18, wherein the jaw comprises a tissue-contacting surface, and wherein the lattice structure comprises walls that stand in a direction transverse to the tissue-contacting surface.

[0348] Example 20 - The electrosurgical instrument of Example 19, wherein the direction is perpendicular to the tissue-contacting surface.

[0349] Set of Examples 5

[0350] Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable to transition 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 comprises a second electrode configured to deliver first monopolar energy to the tissue, a third electrode, and an electrically conductive circuit that is selectively transitionable between a connected configuration with the third electrode and a disconnected configuration from the third electrode. In the connected configuration, the third electrode is configured to cooperate with the first electrode to deliver bipolar energy to the tissue. The electrically conductive circuit defines a return path for the bipolar energy. In the disconnected configuration, the first electrode is configured to deliver second monopolar energy to the tissue.

[0351] Example 2 - The electrosurgical instrument of Example 1, further comprising a switching mechanism for alternating between the connected configuration and the disconnected configuration.

[0352] Example 3 - The electrosurgical instrument of Example 1 or 2, further comprising a switching mechanism for alternating between delivery of bipolar energy and second monopolar energy to tissue by the first electrode.

[0353] Example 4 - The electrosurgical instrument of Example 1, 2, or 3, wherein the end effector is configured to simultaneously deliver bipolar energy and first monopolar energy to tissue.

[0354] Example 5 - The electrosurgical instrument of Example 1, 2, 3, or 4, wherein the end effector is configured to deliver an energy mix of bipolar energy and first monopolar energy to tissue.

[0355] Example 6 - The electrosurgical instrument of Example 5, wherein the levels of bipolar energy and first monopolar energy in the energy mix are determined based on at least one reading of a temperature sensor indicative of at least one temperature of the tissue.

[0356] Example 7 - The electrosurgical instrument of Example 5 or 6, wherein the levels of bipolar energy and first monopolar energy in the energy mix are determined based on at least one reading of an impedance sensor indicative of at least one impedance of the tissue.

[0357] Example 8 - The electrosurgical instrument of Example 5, 6, or 7, wherein the levels of bipolar energy and first monopolar energy in the energy mix are adjusted to reduce detected lateral thermal damage beyond a treatment zone of the tissue between the first jaw and the second jaw.

[0358] Example 9 - An electrosurgical instrument comprising an end effector and a control circuit. The end effector comprises a first jaw, a second jaw, and at least one sensor. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable to transition 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 comprises 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 circuit is configured to execute a predetermined power scheme to seal and cut the tissue in a tissue treatment cycle. The power scheme comprises predetermined power levels of monopolar energy and bipolar energy. The control circuit is further configured to adjust at least one of the predetermined power levels of monopolar energy and bipolar energy based on readings of the at least one sensor during the tissue treatment cycle.

[0359] Example 10 - The electrosurgical instrument of Example 9, wherein the predetermined power scheme includes simultaneous and separate application of bipolar energy and monopolar energy to the tissue in the tissue treatment cycle.

[0360] Example 11 - The electrosurgical instrument of Example 9 or 10, wherein the predetermined power scheme includes application of bipolar energy, but not monopolar energy, to the tissue in a feathering segment of the tissue treatment cycle, and simultaneous application of bipolar energy and monopolar energy to the tissue in a tissue warming segment and a tissue sealing segment of the tissue treatment cycle.

[0361] Example 12 - The electrosurgical instrument of Example 11, wherein the power scheme further includes application of monopolar energy, but not bipolar energy, to the tissue in a tissue transection segment of the tissue treatment cycle.

[0362] Example 13 - The electrosurgical instrument of Example 9, 10, 11, or 12, wherein the at least one sensor includes an impedance sensor.

[0363] Example 14 - The electrosurgical instrument of Example 13, wherein the control circuit is configured to monitor an impedance ratio of monopolar tissue impedance to bipolar tissue impedance based on readings from the impedance sensor.

[0364] Example 15 - The electrosurgical instrument of Example 14, wherein a change in the impedance ratio within a predetermined range causes the control circuit to issue a warning.

[0365] Example 16 - The electrosurgical instrument of Example 15, wherein a change in the impedance ratio at or below a lower threshold of the predetermined range causes the control circuit to adjust the predetermined power scheme.

[0366] Example 17 - The electrosurgical instrument of Example 15 or 16, wherein a change in the impedance ratio at or below a lower threshold of the predetermined range causes the control circuit to suspend application of monopolar energy to the tissue.

[0367] Example 18 - The electrosurgical instrument of Example 17, wherein a change in the impedance ratio at or below a lower threshold of the predetermined range further causes the control circuit to adjust application of bipolar energy to the tissue to complete sealing of the tissue.

[0368] Example 19 - An electrosurgical instrument comprising an end effector and a control circuit. The end effector comprises a first jaw and a second jaw. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The tissue is at a target site. The second jaw comprises 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 circuit is configured to execute a predetermined power scheme to seal and cut the tissue in a tissue treatment cycle. The power scheme comprises predetermined power levels of the monopolar energy and the bipolar energy. The control circuit is further configured to detect an energy excursion from the target site and adjust at least one of the predetermined power levels of the monopolar energy and the bipolar energy to mitigate the energy excursion.

[0369] Example 20 - The electrosurgical instrument of Example 19, wherein the predetermined power scheme comprises simultaneous application and separate application of the bipolar energy and the monopolar energy to the tissue in the tissue treatment cycle.

[0370] Example 21 - The electrosurgical instrument of Example 19 or 20, wherein the predetermined power scheme comprises application of the bipolar energy and not the monopolar energy to the tissue in a feathering segment of the tissue treatment cycle, and simultaneous application of the bipolar energy and the monopolar energy to the tissue in a tissue sealing segment and a tissue warming segment of the tissue treatment cycle.

[0371] Set of Examples 6

[0372] Example 1 - An electrosurgical system comprising an end effector and a control circuit. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The control circuit is configured to simultaneously and separately apply two different energy modalities to the tissue during a tissue treatment cycle comprising a tissue coagulation phase and a tissue transection phase.

[0373] Example 2 - The electrosurgical system of Example 1, wherein the first energy modality is a monopolar energy modality.

[0374] Example 3 - The electrosurgical system of Example 2, wherein the second energy modality is a bipolar energy modality.

[0375] Example 4 - The electrosurgical system of Example 2 or 3, wherein the control circuit is configured to activate application of the monopolar energy modality to the tissue prior to completion of the tissue coagulation phase by the bipolar energy modality.

[0376] Example 5 - The electrosurgical system of Examples 2 or 3, wherein the control circuit is configured to activate application of the monopolar energy modality to the tissue prior to deactivation of the bipolar energy modality application to the tissue.

[0377] Example 6 - The electrosurgical system of Examples 3, 4, or 5, wherein the control circuit is configured to simultaneously apply the monopolar energy modality and the bipolar energy modality to the tissue during the tissue coagulation phase.

[0378] Example 7 - The electrosurgical system of Examples 1, 2, 3, 4, 5, or 6, wherein the control circuit comprises a processor and a storage medium, and wherein the application of the two different energy modalities to the tissue is based on a default power scheme stored in the storage medium.

[0379] Example 8 - The electrosurgical system of Example 7, further comprising at least one sensor, and wherein the control circuit is configured to modify the default power scheme based on one or more sensor readings of the at least one sensor.

[0380] Example 9 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition 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 modalities to the tissue during a tissue treatment cycle comprising a tissue coagulation phase and a tissue transection phase.

[0381] Example 10 - The electrosurgical instrument of Example 9, wherein the first energy modality comprises bipolar energy.

[0382] Example 11 - The electrosurgical instrument of Example 10, wherein the second energy modality comprises an energy mix of monopolar energy and bipolar energy.

[0383] Example 12 - The electrosurgical instrument of Example 11, wherein the third energy modality comprises monopolar energy but no bipolar energy.

[0384] Example 13 - The electrosurgical instrument of Examples 11 or 12, wherein activation of the monopolar energy application to the tissue is configured to begin prior to completion of the tissue coagulation phase.

[0385] Example 14 - The electrosurgical instrument of Examples 12 or 13, wherein activation of the monopolar energy application to the tissue is configured to begin prior to deactivation of the bipolar energy modality application to the tissue.

[0386] Example 15 - The electrosurgical instrument of Examples 9, 10, 11, 12, 13, or 14, further comprising a control circuit, wherein the control circuit comprises a processor and a storage medium, and wherein the application of the two different energy modalities to the tissue is based on a default power scheme stored in the storage medium.

[0387] Example 16 - The electrosurgical instrument of Example 15, further comprising at least one sensor, wherein the control circuit is configured to adjust the default power scheme during the tissue treatment cycle based on one or more sensor readings of the at least one sensor.

[0388] Example 17 - An electrosurgical system comprising a first generator configured to output bipolar energy, a second generator configured to output monopolar energy, a surgical instrument electrically coupled to the first generator and the second generator, and a control circuit. The surgical instrument comprises an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The control circuit comprises a processor and a storage medium comprising program instructions that, when executed by the processor, cause the processor to cause the first generator and the second generator to apply a predetermined power scheme to the end effector. The power scheme comprises simultaneous and separate application of the bipolar energy and the monopolar energy to the tissue in a tissue treatment cycle.

[0389] Example 18 - The electrosurgical system of Example 17, further comprising at least one sensor, wherein the control circuit is configured to adjust the power scheme during the tissue treatment cycle based on one or more sensor readings of the at least one sensor.

[0390] Example 19 - The electrosurgical system of Examples 17 or 18, wherein the power scheme comprises application of the bipolar energy, but not the monopolar energy, to the tissue in a feathering segment of the tissue treatment cycle, and simultaneous application of the bipolar energy and the monopolar energy to the tissue in a tissue warming segment and a tissue sealing segment of the tissue treatment cycle.

[0391] Example 20 - The electrosurgical system of Examples 17, 18, or 19, wherein the power scheme further comprises application of the monopolar energy, but not the bipolar energy, to the tissue in a tissue transection segment of the tissue treatment cycle.

[0392] Although a number of forms have been exemplified and described, the scope of the appended claims is not intended to be limited to the particular forms disclosed. Many modifications, variations, changes, substitutions, combinations, and equivalents will occur to those skilled in the art upon reading this disclosure and may be made without departing from the scope of the disclosure. Additionally, alternative forms will occur to practitioners of the art. For instance, the structural description of each element associated with the forms described can alternatively be described as a means for providing the function performed by the element. Furthermore, where materials are disclosed for certain components, other materials may

[0393] The detailed description set forth above exemplifies and describes various forms of apparatus and / or methods. As such, the terms "exemplary" and "in one form" used throughout this disclosure are used merely for purposes of explanation and / or illustration. They are not intended to limit the scope of the appended claims in any way. Although a number of forms have been exemplified and described, the scope of the appended claims is not intended to be limited to the particular forms disclosed. Many modifications, variations, changes, substitutions, combinations, and equivalents will occur to those skilled in the art upon reading this disclosure and may be made without departing from the scope of the disclosure. Additionally, alternative forms will occur to practitioners of the art. For instance, the structural description of each element associated with the forms described can alternatively be described as a means for providing the function performed by the element. Furthermore, where materials are disclosed for certain components, other materials may

[0394] Instructions for programming logic to perform various disclosed aspects can be stored within memory in the system, such as dynamic random access memory (DRAM), cache, flash memory, or other memory. Furthermore, instructions can be received via a network or by way of other computer-readable media. Thus, a machine-readable medium can include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, soft disks, optical disks, magnetic 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 now known or later developed that is appropriate for the job at hand, using electrical, optical, acoustical or other form of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.) in the Internet. Accordingly, non-transitory computer-readable media include all tangible, machine-readable media appropriate for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).

[0395] As used herein in any aspect, the term "control circuitry" can refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor including one or more individual instruction processing cores, processing units, processors, microcontrollers, microcontroller units, controllers, digital signal processors (DSPs), programmable logic devices (PLD), programmable logic arrays (PLA), field programmable gate arrays (FPGA)), state machine circuitry, firmware that stores instructions executed by programmable circuitry, and any combination thereof. The control circuitry can be implemented, in whole or in part, as circuitry that forms a part of a larger system, such as an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system-on-chip (SoC), a desktop computer, a laptop computer, a tablet computer, a server, a smart phone, etc. As used herein, "control circuitry" includes, but is not limited to, electronic circuitry with one or more discrete components, electronic circuitry with one or more integrated circuits, electronic circuitry with one or more application-specific integrated circuits, electronic circuitry forming a general-purpose computing device configured by a computer program (e.g., a general-purpose computer configured by computer program instructions to implement, at least in part, the methods described herein and / or a microprocessor configured by computer program instructions to implement, at least in part, the methods described herein), electronic circuitry forming a memory device (e.g., forming a random access memory), and / or electronic circuitry forming a communications device (e.g., a modem, a communications switch, or an opto-electronic device). Those skilled in the art will recognize that the subject matter described herein can be implemented in analog or digital form, or some combination thereof.

[0396] As used in any aspect herein, the term “logic” can refer to an application program, software, firmware, and / or circuitry configured to perform any of the aforementioned operations. Software can be embodied as a software package, code, instructions, instruction sets, and / or data recorded on non-transitory computer readable storage medium. Firmware can be embodied as code, instructions, or instruction sets and / or data hard-coded (e.g., non-volatile) in memory devices.

[0397] As used in any aspect herein, the terms “component,” “system,” “module” and the like can refer to a computer-related entity, either hardware, a combination of hardware and software, software, or software in execution.

[0398] As used in any aspect herein, “algorithm” refers to a self-consistent sequence of steps leading to a desired result, where a “step” refers to a manipulation of physical quantities and / or logic states, which may, but need not, take the form of electrical or magnetic signals, that may, but need not, be stored, transferred, combined, compared, and otherwise manipulated in a manner that is consistent with the nature of the physical quantities and / or logic states. Commonly used in referring to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms can be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and / or states.

[0399] The network can include a packet-switched network. The communication devices can be capable of communicating with each other using a selected packet-switched network communication protocol. One example communication protocol can include an Ethernet communication protocol that can be capable of allowing communication using the Transmission Control Protocol / Internet Protocol (TCP / IP). The Ethernet protocol can 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 later versions of this standard. Alternatively or additionally, the communication devices can be capable of communicating with each other using an X.25 communication protocol. The X.25 communication protocol can conform to or be compatible with standards published by the International Telecommunication Union Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices can be capable of communicating with each other using a Frame Relay communication protocol. The Frame Relay communication protocol can conform to or be compatible with standards published by the Consultative Committee International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers can be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol can conform to or be compatible with the ATM standard entitled “ATM-MPLS Network Interworking 2.0” published by the ATM Forum in August 2001 and / or later versions of this standard. Of course, different and / or later-developed connection-oriented network communication protocols are likewise contemplated herein.

[0400] Unless specifically stated otherwise as apparent from the above disclosure, it is appreciated that, throughout the foregoing disclosure, the use of terms such as "processing," "computing," "calculating," "determining," "displaying," or the like, can refer to the action and processes of a computer system, or similar electronic

[0401] One or more components can be referred to herein as "configured to," "configurable to," "operable / operative to," "adapted to / adaptable to," "capable of," "adapted to adaptably," etc. Those skilled in the art will recognize that "configured to" can generally include active- state components and / or inactive-state components and / or pending-state components unless context clearly dictates otherwise.

[0402] The terms "proximal" and "distal" are used herein with respect to a clinician manipulating a handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician, and the term "distal" refers to the portion positioned away from the clinician. It will also be appreciated that, for conciseness and clarity, spatial terms such as "vertical," "horizontal," "up," and "down," can be used herein with respect to the accompanying drawings. However, surgical instruments are employed in many orientations and positions, and the terms are not intended to be limiting and / or absolute.

[0403] Those skilled in the art will recognize that, in general, the terms used herein, and particularly in the appended claims (e.g., in the body of the appended claims), are intended to be "open" terms (e.g., the term "including" is to be interpreted as "including but not limited to," the term "having" is to be interpreted as "having at least," the term "includes" is to be interpreted as "includes, but is not limited to," etc.). Those skilled in the art will also recognize that, unless otherwise specified, a stated number of a particular item refers to one or more of the items. The mere fact that terms are used in the description, including the claims, does not indicate that the terms are being redefined, to the extent the term is used as an adjective. The reader will realize that the terms used in this application, including the appended claims, are to be interpreted as "open" and "partitive" rather than "closed" or "unitary" terms. For example, the term "comprising" and variations thereof, such as "comprise" and "comprises," are to be construed in an open, inclusive sense (i.e., "including, but not limited to"), rather than an open, exclusive sense (i.e., "comprising, but not limited to"). Similarly, the terms "including," "comprising," and "having" are to be construed in an open, inclusive sense (i.e., "including, but not limited to"), rather than an open, exclusive sense (i.e., "comprising, but not limited to"). Further, the terms "a," "an," and "at least one" are to be construed to cause the reader to understand that there is at least one, but it is also possible that there are more than one.

[0404] 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".

[0405] 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.

[0406] 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.

[0407] In this specification, unless otherwise indicated, the term "about" or "approximately," as used in the disclosure, means an acceptable error for a particular value as determined by one of ordinary skill in the art, which depends in part on how the value is measured or determined. In certain embodiments, the term "about" or "approximately" means within 1, 2, 3, or 4 standard deviations. In certain embodiments, the term "about" or "approximately" means 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.

[0408] In this specification, unless otherwise indicated, all numerical values are to be understood as being modified in all instances by the term "about" or are to be interpreted in a manner consistent with the description surrounding use of the term "about". To the extent that there is any conflict between a definition and the disclosure provided herein, the definition is intended to control. To the extent that a numerical value is reported as an approximation by use of the adjective "about" or words of similar import, it is intended that the approximation also be understood as including the stated value and any smaller range that would still be considered to be within the scope of the stated value.

[0409] Any numerical range recited herein is intended to include all sub-ranges of the same entire range. For example, a range of "1 to 10" is intended to include any sub-range of the same entire range, for example, such as 1 to 6, 5.5 to 9, and 3.5 to 7.7, etc. In other embodiments, a range includes the singleton, for example, the range of 7 includes 7 alone. In addition, all ranges recited herein are intended to include the endpoints of the range in addition to any additional smaller ranges that fall within the recited range. For example, a range of "1 to 10" includes the endpoints 1 and 10, and also any smaller range that falls within the recited range, for example, such as 2 to 8 or 3 to 7. Any list of values recited herein is intended to include all sub-ranges of the same entire range. For example, a list of values of "1, 2, 3, 4, and 5" is intended to include any sub-range of the same entire range, for example, such as 1 to 5, 3 to 4, and 2 to 6, etc. In other embodiments, a list of values includes the singletons, for example, the list of values of 1 includes 1 alone. Applicant reserves the right to amend this specification to expressly recite any sub-ranges of the ranges explicitly recited in this specification. All such ranges are inherently described in this specification.

[0410] Any patent application, patent, non-patent publication, or other disclosure material referred to in this specification is hereby incorporated by reference to the extent that the incorporated material is not inconsistent with this specification, and in which the incorporated material is otherwise made specifically accessible herewith. Thus, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference in this specification, but which contradicts directly or indirectly the present disclosure provided herein, is only incorporated to the extent that it is consistent with the present disclosure.

[0411] In general, numerous benefits have been described which result from the techniques described herein. The foregoing specific embodiments have been presented for purposes of illustration and description. They are not intended to be exhaustive of or to limit the application to the precise forms disclosed. Modifications and variations are possible in light of the above teachings or can be acquired from practice of the application. One or more forms have been chosen and described expressed in one or more specific forms chosen for the convenience of the reader. The one or more forms are not intended to limit the scope of the application which is defined by the claims submitted herewith.

Claims

1. An electrosurgical device, comprising: End effector, the end effector comprising: First jaws; and A second jaw, wherein 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, wherein the second jaw includes a gradually narrowing body extending from a proximal end to a distal end, and wherein the gradually narrowing body includes a tissue contact surface, the tissue contact surface comprising: An insulating layer comprising a first material, wherein the insulating layer extends on opposite sides of an intermediate region extending along the length of the gradually narrowing body; and The intermediate region defines an electrode, the electrode including segments configured to generate variable energy density along the tissue contact surface, wherein the segments include: Conductive section; and An insulating section, which alternates with the conductive section along the intermediate region, wherein the insulating section comprises a second material different from the first material, the first material being thermally conductive but electrically insulating, and the second material being thermally insulating and electrically insulating.

2. The electrosurgical device according to claim 1, wherein, The segment includes: Including the proximal segment of the first surface area; and The distal segment includes a second surface area, wherein the second surface area is smaller than the first surface area.

3. The electrosurgical device according to claim 1, wherein, The conductive section includes: Including the proximal segment of the first surface area; and The distal segment includes a second surface area, wherein the second surface area is smaller than the first surface area.

4. The electrosurgical device according to claim 1 or 2, wherein, The second jaw includes an electrically conductive skeleton partially coated with the first material.

5. The electrosurgical device according to claim 4, wherein, The electrically conductive framework includes an inner thermally insulating core and an outer thermally conductive layer, wherein the outer thermally conductive layer at least partially surrounds the inner thermally insulating core.

6. The electrosurgical device according to claim 1 or 2, wherein, The variable energy density is predetermined based on the selection of different geometries and different conductivities of the segment.

7. The electrosurgical device according to claim 1 or 2, wherein, The variable energy density is predetermined based on the selection of different geometries and different conductivities of the conductive sections.

8. The electrosurgical device according to claim 1 or 2, wherein, At least one of the segments has a width that gradually narrows along its length.

9. The electrosurgical device according to claim 1 or 2, wherein, The section extends along the outer periphery of the second jaw.

10. The electrosurgical device according to claim 1 or 2, wherein, The segment is defined in the second jaw rather than in the first jaw.

11. The electrosurgical device according to claim 1 or 2, wherein, The first material contains diamond-like carbon.

12. The electrosurgical device according to claim 1 or 2, wherein, The second material contains polytetrafluoroethylene.

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