Ultrasonic and plasma combined instrument

Abstract

An ultrasonic and electrosurgical combined surgical instrument is disclosed that includes a housing having an ultrasonic transducer disposed within the housing, and a waveguide configured to support an ultrasonic blade operably coupled to the ultrasonic transducer. The ultrasonic blade is configured to receive ultrasonic energy generated by the ultrasonic transducer. The ultrasonic blade is tapered along both a vertical axis and a horizontal axis defined therealong and defines an elongate edge on an upper surface of the ultrasonic blade that terminates at a spatula-like distal end. Side surfaces of the elongated edge and the spatula-like distal end are coated with an electrically conductive material and both adapted to be connected to a source of electrosurgical energy such that activation of the source of electrosurgical energy and the ultrasound transducer utilizes both electrosurgical energy and ultrasound energy to treat tissue.

Description

Technical Field

[0001] The present disclosure relates to energy-based surgical instruments, and more particularly to surgical instruments and systems that incorporate both ultrasonic and / or electrosurgical functionality to facilitate energy-based tissue treatment. Background Art

[0002] Ultrasonic surgical instruments and systems utilize ultrasonic energy (i.e., ultrasonic vibrations) to treat tissue. More specifically, ultrasonic surgical instruments and systems utilize mechanical vibration energy transmitted at ultrasonic frequencies to treat tissue. An ultrasonic surgical device may include, for example, an ultrasonic blade and a clamping mechanism capable of clamping tissue against the blade. The ultrasonic energy transmitted to the blade causes the blade to vibrate at a very high frequency, which allows heating of the tissue to treat tissue clamped against the blade or otherwise in contact with the blade.

[0003] Electrosurgical instruments and systems conduct radio frequency (RF) energy through tissue to treat tissue. An electrosurgical instrument or system may be configured to conduct bipolar RF energy between oppositely charged electrodes and through tissue (e.g., tissue clamped between or otherwise in contact with the electrodes) to treat tissue. Alternatively or additionally, an electrosurgical instrument or system may be configured to deliver monopolar RF energy from an active electrode to tissue in contact with the electrode, where the energy is returned via a remote return electrode device to complete the circuit. Summary of the invention

[0004] As used herein, the term "distal" refers to the portion of the description that is farther from the operator (whether a surgeon or a surgical robot), while the term "proximal" refers to the portion of the description that is closer to the operator. As used herein, terms including "generally," "about," "substantially," etc. are meant to cover up to and include variations of plus or minus 10% (e.g., manufacturing tolerances, material tolerances, usage tolerances, and environmental tolerances, measurement variations, and / or other variations). In addition, any or all aspects described herein may be used in combination with any or all other aspects described herein where consistent.

[0005] According to various aspects of the present disclosure, there is provided a combined ultrasonic and electrosurgical surgical instrument, the combined ultrasonic and electrosurgical surgical instrument including a housing having an ultrasonic transducer disposed therein and a waveguide configured to support an ultrasonic blade operably coupled to the ultrasonic transducer. The ultrasonic blade is configured to receive ultrasonic energy generated by the ultrasonic transducer. The ultrasonic blade is tapered along both a vertical axis and a horizontal axis defined along it and defines an elongated edge on an upper surface of the ultrasonic blade that terminates at a spatula-shaped distal end. Sides of the elongated edge and the spatula-shaped distal end are coated with a conductive material and both are adapted to be connected to an electrosurgical energy source, such that activation of the electrosurgical energy source and the ultrasonic transducer utilizes both electrosurgical energy and ultrasonic energy to treat tissue.

[0006] In various aspects according to the present disclosure, the ultrasonic transducer can be activated separately from the electrosurgical energy source.

[0007] In various aspects according to the present disclosure, the ultrasonic transducer is energized by an electrosurgical energy source.

[0008] In various aspects according to the present disclosure, the conductive material on the elongated edge and the conductive material on the side of the spatula-shaped distal end are separated by an insulating material and can be independently activated by a switch.

[0009] In aspects according to the present disclosure, an insulating sheath is disposed between conductive material on the elongated edge and conductive material on the sides of the spatula-shaped distal end.

[0010] In various aspects according to the present disclosure, ultrasonic energy and monopolar energy are simultaneously provided to the elongated edge to quickly and finely dissect tissue.

[0011] In various aspects according to the present disclosure, monopolar energy is provided to the elongated edge to dissect tissue.

[0012] In various aspects according to the present disclosure, the side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy and monopolar energy simultaneously to coagulate the tissue.

[0013] In various aspects according to the present disclosure, the side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy to coagulate the tissue.

[0014] In aspects according to the present disclosure, the waveguide is coated with an insulating material selected from the group consisting of glass, ceramic, and polymer.

[0015] According to various aspects of the present disclosure, there is provided a combined ultrasonic and electrosurgical surgical instrument having a housing and a waveguide, the housing including an ultrasonic transducer disposed within the housing, the waveguide being configured to support an ultrasonic blade operably coupled to the ultrasonic transducer. The ultrasonic blade is configured to receive ultrasonic energy generated by the ultrasonic transducer. The ultrasonic blade is tapered along both the vertical axis and the horizontal axis defined along it and defines an elongated edge on the upper surface of the ultrasonic blade that terminates at a spatula-shaped distal end. The sides of the elongated edge and the spatula-shaped distal end are conductive and separated by an insulating material. The elongated edge and the spatula-shaped distal end are adapted to be independently connected to an electrosurgical energy source so that activation of the electrosurgical energy source utilizes both monopolar electrosurgical energy and ultrasonic energy to treat tissue.

[0016] In various aspects according to the present disclosure, the ultrasound transducer is adapted to be connected to a separate source of electrical energy.

[0017] In various aspects according to the present disclosure, the conductive material on the elongated edge and the conductive material on the side of the spatula-shaped distal end can be independently activated by a switch.

[0018] In aspects according to the present disclosure, the conductive material on the elongated edge and the conductive material on the side of the spatula-shaped distal end can be independently activated by switches that are controlled by an algorithm.

[0019] In aspects according to the present disclosure, an insulating sheath is disposed between conductive material on the elongated edge and conductive material on the sides of the spatula-shaped distal end.

[0020] In various aspects according to the present disclosure, both ultrasonic energy and monopolar energy are simultaneously provided to the elongated edge to quickly and finely dissect tissue.

[0021] In various aspects according to the present disclosure, monopolar energy is provided to the elongated edge to dissect tissue.

[0022] In various aspects according to the present disclosure, the side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy and monopolar energy simultaneously to coagulate the tissue.

[0023] In various aspects according to the present disclosure, the side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy to coagulate the tissue.

[0024] In aspects according to the present disclosure, the waveguide is coated with an insulating material selected from the group consisting of glass, ceramic, and polymer. BRIEF DESCRIPTION OF THE DRAWINGS

[0025] The above and other aspects and features of the present disclosure will become more apparent when the following detailed description is considered in conjunction with the accompanying drawings, in which like reference numerals designate similar or identical elements.

[0026] Figure 1 is a side view of a surgical system provided according to the present disclosure, the surgical system including a surgical instrument, a surgical generator, and a return electrode device;

[0027] Figure 2 is a perspective view of another surgical system provided according to the present disclosure, the surgical system including a surgical instrument incorporating an ultrasonic generator, an electrosurgical generator, and a power source;

[0028] Figure 3 is a schematic diagram of a robotic surgery system provided according to the present disclosure;

[0029] Figure 4 yes Figure 1 A longitudinal cross-sectional view of a distal portion of a surgical instrument;

[0030] Figure 5 is with Figure 1 a transverse cross-sectional view of an end effector assembly of a combined ultrasonic and electrosurgical scalpel for use with a system; and

[0031] FIG. 6A to FIG. 6C yes Figure 5 Different magnified views of the blade of a combined ultrasonic and electrosurgical scalpel. DETAILED DESCRIPTION

[0032] refer to Figure 1 , shows a surgical system provided according to various aspects of the present disclosure, which is generally identified by reference numeral 10, and includes a surgical instrument 100, a surgical generator 200, and in some aspects includes a return electrode device 700 (for example, including a return pad 710). The surgical instrument 100 includes a handle assembly 110, an elongated assembly 150 extending distally from the handle assembly 110, an end effector assembly 160 disposed at the distal end of the elongated assembly 150, and a cable assembly 190, which is operably coupled to the handle assembly 110 and extends from the handle assembly to connect to the surgical generator 200.

[0033] The surgical generator 200 includes a display 210, a plurality of user interface features 220 (e.g., buttons, touch screen, switches, etc.), an ultrasonic plug port 230, a bipolar electrosurgical plug port 240, and respectively an active monopolar electrosurgical plug port 250 and a return monopolar electrosurgical plug port 260. As an alternative to a plurality of dedicated ports 230-260, one or more common ports (not shown) may be configured to function as any two or more of the ports 230-260.

[0034] The surgical instrument 100 is configured to supply electrosurgical energy (e.g., radio frequency (RF) energy) to the tissue to treat the tissue, and / or supply ultrasonic energy to the tissue to treat the tissue, for example, in a monopolar configuration and / or a bipolar configuration. The surgical generator 200 is configured to generate an ultrasonic drive signal for output to the surgical instrument 100 through the ultrasonic plug port 230 (in aspects where the surgical instrument 100 is configured to deliver ultrasonic energy) to activate the surgical instrument 100 to supply ultrasonic energy, and is configured to provide electrosurgical energy, for example, RF bipolar energy for output through the bipolar electrosurgical plug port 240 and / or RF monopolar energy for output to the surgical instrument 100 through the active monopolar electrosurgical port 250 (in aspects where the surgical instrument 100 is configured to deliver electrosurgical energy) to activate the surgical instrument 100 to supply electrosurgical energy. The plug 520 of the return electrode device 700 is configured to be connected to the return monopolar electrosurgical plug port 260 to return monopolar electrosurgical energy from the surgical instrument 100 during monopolar electrosurgery use.

[0035] Surgical instrument 100 is generally described herein as an example of an instrument with which the blade 500 of the present disclosure may be configured to work, as surgical instrument 100 utilizes both ultrasonic energy and monopolar energy and may be configured to be operably coupled to the blade and various electrical components associated therewith. Figures 5 to 6C As shown, the surgical blade 600 can be configured to be coupled to the blade 500 and utilize both ultrasonic energy and high energy monopolar energy to treat tissue for spot coagulation or fine dissection as described herein. In addition, other surgical instruments (not shown) may also be adapted to be coupled to the blade 500 and suitable for the surgical purposes described herein. Thus, the surgical instrument 100 will first be described in sufficient detail so that the mechanical and electrical operating details of the combined ultrasonic and electrosurgical instrument can be understood from an overall perspective, and the details of the blade 500 and features associated therewith are left for reference. Figures 5 to 6C Have a discussion.

[0036] Continue to refer Figure 1, the handle assembly 110 includes a housing 112, an activation button 120, and a clamping lever 130. The housing 112 is configured to support an ultrasonic transducer 140. The ultrasonic transducer 140 may be permanently coupled to the housing 112 or may be removable from the housing. The ultrasonic transducer 140 includes, for example, a piezoelectric stack or other suitable ultrasonic transducer component electrically coupled to the surgical generator 200 via one or more first electrical leads 197, so that an ultrasonic drive signal can be transmitted to the ultrasonic transducer 140, thereby driving the ultrasonic transducer 140 to generate ultrasonic vibration energy, which is transmitted along the waveguide 154 of the elongated assembly 150 to the blade 162 of the end effector assembly 160 of the elongated assembly 150, as described in detail below. Feedback signals and / or control signals can also be transmitted between the ultrasonic transducer 140 and the surgical generator 200. More specifically, the ultrasonic transducer 140 may include a piezoelectric element stack, which is fixed between the proximal block and the distal block, or between the proximal block and the ultrasonic horn under a pre-compression force, wherein the first electrode and the second electrode are electrically coupled between the piezoelectric elements of the piezoelectric element stack so that the piezoelectric element stack can be stimulated to generate ultrasonic energy. However, other suitable ultrasonic transducer configurations are also contemplated, including multiple transducers and / or non-longitudinal (e.g., torsional) transducers.

[0037] The activation button 120 is disposed on the housing 112 and is coupled to or between the ultrasonic transducer 140 and / or the surgical generator 200, for example, via one or more first electrical leads 197, so that the ultrasonic transducer 140 can be activated in response to the activation button 120 being pressed. In some configurations, the activation button 120 may include an on / off switch. In other configurations, the activation button 120 may include a plurality of actuation switches to enable activation from an off state to different states corresponding to different activation settings, such as a first state corresponding to a first activation setting (such as a low power and / or tissue sealing setting), and a second state corresponding to a second activation setting (such as a high power and / or tissue transection setting). In other configurations, separate activation buttons may be provided, for example, a first actuation button for activating the first activation setting and a second activation button for activating the second activation setting. Additional activation buttons, sliders, wheels, etc. are also contemplated to enable control of various different activation settings from the housing 112. Other activation buttons may be provided on the housing 112 for activating other energy modes, such as an activation button 125 ( Figure 5 ).

[0038] The elongated assembly 150 of the surgical instrument 100 includes an outer drive sleeve 152, an inner support sleeve 153 disposed within the outer drive sleeve 152, and an inner support sleeve 153 disposed within the outer drive sleeve 152. Figure 4 ), extending through the inner support sleeve 153 ( Figure 4) of the waveguide 510, a drive assembly (not shown), a knob 156, and an end effector assembly 160 including a blade 500 and a jaw member 164. The knob 156 can be rotated in either direction to rotate the elongated assembly 150 in either direction relative to the handle assembly 110. The drive assembly operably couples the proximal portion of the outer drive sleeve 152 to the clamping lever 130 of the handle assembly 110. The distal portion of the outer drive sleeve 152 is operably coupled to the jaw member 164, and the inner support sleeve 153 ( Figure 4 ) pivotably supports the jaw member 164 at its distal end. In this way, the clamping lever 130 can be selectively actuated, for example, between an unactuated position and a fully actuated position, so as to thereby cause the outer drive sleeve 152 to surround the inner support sleeve 153 ( Figure 4 ) to pivot the jaw member 164 relative to the blade 162 of the end effector assembly 160 from the open position toward the closed position, thereby clamping the tissue between the jaw member 164 and the blade 500. The outer sleeve 152 and the inner sleeve 153 ( Figure 4 ) configuration may be reversed, for example, with the outer sleeve 152 being the support sleeve and the inner sleeve 153 ( Figure 4 ) is a drive sleeve. Other suitable drive structures other than a sleeve are also contemplated, such as a drive rod, a drive cable, a drive screw, etc.

[0039] Still reference Figure 1 , the drive assembly can be adjusted to provide a jaw clamping force or a jaw clamping force within a jaw clamping force range to the tissue clamped between the jaw member 164 and the blade 162, as described in U.S. Patent Application No. 17 / 071,263 filed on October 15, 2020, the entire contents of which are hereby incorporated herein by reference. Alternatively, the drive assembly can include a force limiting feature, such as a spring, whereby the clamping force applied to the tissue clamped between the jaw member 164 and the blade 162 is limited to a specific jaw clamping force or a jaw clamping force within a jaw clamping force range, as described in U.S. Patent No. 10,368,898 issued on August 6, 2019, the entire contents of which are hereby incorporated herein by reference.

[0040] One or more sensors 132 are provided to sense that the clamping lever 130 has been actuated at least to a sufficient degree of actuation and, therefore, to sense whether a clamping force is being applied to tissue clamped between the jaw member 164 and the blade 162 .

[0041] Continue to refer Figure 1 As described above, the waveguide 154 extends from the handle assembly 110 through the inner sleeve 153 ( Figure 4). The waveguide 154 includes a blade 162 disposed at its distal end. The blade 162 may be integrally formed with the waveguide 154, may be formed separately and subsequently attached (permanently or removably attached) to the waveguide 154, or otherwise operably coupled to the waveguide 154. The waveguide 154 and / or the blade 162 may be formed of titanium, a titanium alloy, or other suitable conductive material, although non-conductive materials are also contemplated. The waveguide 154 includes a proximal connector (not shown), such as a threaded male connector, which is configured to engage the ultrasonic transducer 140, such as threadedly engaged within a threaded female receiver, so that ultrasonic motion generated by the ultrasonic transducer 140 is transmitted along the waveguide 154 to the blade 162 to treat tissue clamped between the blade 162 and the jaw member 164 or positioned adjacent to the blade 162.

[0042] The cable assembly 190 of the surgical instrument 100 includes a cable 192, an ultrasonic plug 194, and an electrosurgical plug 196. The ultrasonic plug 194 is configured to connect to an ultrasonic plug port 230 of a surgical generator 200, while the electrosurgical plug 196 is configured to connect to a bipolar electrosurgical plug port 240 of the surgical generator 200 and / or an active monopolar electrosurgical plug port 250 of the surgical generator 200. In configurations where the generator 200 includes a common port, the cable assembly 190 may include a common plug (not shown) configured to function as both the ultrasonic plug 194 and the electrosurgical plug 196.

[0043] A plurality of first electrical leads 197 electrically coupled to the ultrasonic plug 194 extend through the cable 192 and into the handle assembly 110 to electrically connect to the ultrasonic transducer 140 and / or the activation button 120, so that an ultrasonic drive signal from the surgical generator 200 can be selectively supplied to the ultrasonic transducer 140 when the ultrasonic energy is activated. In addition, a plurality of second electrical leads 199 are electrically coupled to the electrosurgical plug 196 and extend through the cable 192 into the handle assembly 110. In the bipolar configuration, the separate second electrical leads 199 are electrically coupled to the waveguide 510 and the jaw member 164 (and / or different portions of the jaw member 164) so ​​that bipolar electrosurgical energy can be conducted between the blade 162 and the jaw member 164 (and / or different portions of the jaw member 164). In the monopolar configuration, the second electrical leads 199 are electrically coupled to the waveguide 154 so that monopolar electrosurgical energy can be supplied from the blade 162 to the tissue. Alternatively or additionally, in a monopolar configuration, second electrical leads 199 may be electrically coupled to jaw member 164 to enable monopolar electrosurgical energy to be supplied to tissue from jaw member 164. In a configuration in which both bipolar and monopolar functions are enabled, one or more second electrical leads 199 may be used for both bipolar and monopolar energy delivery; alternatively, bipolar energy delivery and monopolar energy delivery may be provided by separate second electrical leads 199. One or more other second electrical leads 199 are electrically coupled to activation button 120 to enable electrosurgical energy from surgical generator 200 to be selectively supplied to waveguide 510 and / or jaw member 164 when electrosurgical energy is activated.

[0044] As an alternative to the remote generator 200, the surgical system 10 can be at least partially cordless because an ultrasonic generator, an electrosurgical generator, and / or a power source (e.g., a battery) are incorporated therein or therein. In this way, connections from the surgical instrument 100 to external devices (e.g., generator(s) and / or power source(s)) are reduced or eliminated. More specifically, referring to Figure 2 , shows another surgical system according to the present disclosure, which is shown as a surgical instrument 20 having an ultrasonic generator 310, a power source (e.g., a battery assembly 400), and an electrosurgical generator 600 supported thereon or therein. The surgical instrument 20 is similar to the surgical instrument 100 ( Figure 1 ) and may include any features thereof, unless a conflict is identified below. Accordingly, only surgical instrument 20 and surgical instrument 100 ( Figure 1 ) while omitting or describing in general terms the similarities.

[0045] The housing 112 of the surgical instrument 20 includes a body portion 113 and a fixed handle portion 114 depending from the body portion 113. The body portion 113 of the housing 112 is configured to support an ultrasonic transducer and generator assembly (“TAG”) 300 including an ultrasonic generator 310 and an ultrasonic transducer 140. The TAG 300 may be permanently coupled to the body portion 113 of the housing 112 or may be removable therefrom.

[0046] The fixed handle portion 114 of the housing 112 defines a compartment 116 configured to receive the battery assembly 400 and the electrosurgical generator 600, and a door 118 configured to close the compartment 116. An electrical connection assembly (not shown) is disposed within the housing 112 and is used to electrically couple the activation button 120, the ultrasonic generator 310 of the TAG 300, and the battery assembly 400 to one another when the TAG 300 is supported on or in the body portion 113 of the housing 112 and the battery assembly 400 is disposed within the compartment 116 of the fixed handle portion 114 of the housing 112, thereby enabling the surgical instrument 20 to be activated in the ultrasonic mode in response to the activation button 120 being appropriately actuated. In addition, when the electrosurgical generator 600 and the battery assembly 400 are disposed within the compartment 116 of the fixed handle portion 114 of the housing 112, the electrical connection assembly or different electrical connection assemblies disposed within the housing 112 are used to electrically couple the activation button 120, the electrosurgical generator 600, the battery assembly 400, and the end effector assembly 160 (e.g., the blade 162 and the jaw member 164 and / or different portions of the jaw member 164) to each other, thereby enabling the surgical instrument 20 to be activated to supply electrosurgical energy (e.g., bipolar RF energy) in response to the activation button 120 being appropriately actuated. In order to enable the supply of monopolar electrosurgical energy, the return electrode device 700 ( Figure 1 ) can be configured to be connected to the surgical instrument 20 (more specifically, to the electrosurgical generator 600 of the surgical instrument) to complete a monopolar circuit through tissue and between the surgical instrument 20 (e.g., the blade 500 and / or the jaw member 164) and the return electrode device 700.

[0047] Steering Figure 3 , a robotic surgical system in accordance with aspects and features of the present disclosure is shown, generally identified by reference numeral 1000. For purposes herein, the robotic surgical system 1000 is generally described. Aspects and features of the robotic surgical system 1000 that are not germane to an understanding of the present disclosure are omitted to avoid obscuring the aspects and features of the present disclosure with unnecessary detail.

[0048] The robotic surgery system 1000 generally comprises: a plurality of robotic arms 1002, 1003; a control device 1004; and an operation console 1005, which is connected to the control device 1004. The operation console 1005 may include: a display device 1006, which may be configured to display a three-dimensional image in particular; and manual input devices 1007, 1008, by which a person such as a surgeon (not shown) may be able to remotely manipulate the robotic arms 1002, 1003 in a first operation mode. The robotic surgery system 1000 may be configured for a patient 1013 lying on a patient table 1012 to be treated in a minimally invasive manner. The robotic surgery system 1000 may further include a database 1014, in particular connected to the control device 1004, in which, for example, preoperative data and / or anatomical atlases of the patient 1013 are stored.

[0049] Each of the robotic arms 1002, 1003 may include an attachment device 1009, 1011 and a plurality of members connected by joints, the attachment device may be attached to a surgical tool "ST" supporting an end effector 1050, 1060, for example. One of the surgical tools "ST" may be a surgical instrument 100 ( Figure 1 )、Surgical instruments 20( Figure 2 ), or any other suitable surgical instrument 20 configured for use in both an ultrasonic mode and one or more electrosurgical (bipolar and / or monopolar) modes, wherein a manual actuation feature (e.g., an actuation button 120 ( Figure 1 )、Clamping lever 130( Figure 1 )) etc. are replaced by robot input. Further, a method for sensing the clamping lever 130 ( Figure 1 ) in a similar manner as described in detail in the manual input device 1007 , 1008 . The robotic surgical system 1000 may include an ultrasonic generator, an electrosurgical generator and / or a power supply or be configured to be connected to an ultrasonic generator, an electrosurgical generator and / or a power supply. Other surgical tools "ST" may include any other suitable surgical instruments, such as endoscopic cameras, other surgical tools, etc. The robotic arms 1002 , 1003 may be driven by an electric drive device, such as a motor, connected to the control device 1004. The control device 1004 (e.g., a computer) may be configured to activate the motor, in particular by a computer program, in such a way that the robotic arms 1002 , 1003 , the attachment devices 1009 , 1011 of the robotic arms and thus the surgical tools "ST" perform the desired movement and / or function, respectively, according to the corresponding inputs from the manual input devices 1007 , 1008. The control device 1004 may also be configured in such a way that it adjusts the movement of the robotic arms 1002 , 1003 and / or the motors.

[0050] refer to Figure 5 , one embodiment of the present disclosure includes a combined ultrasonic and electrosurgical scalpel for treating tissue and is generally identified by the reference numeral 600. The scalpel 600 is shown schematically for simplicity, but is intended to include components similar to the instruments described above. Generally, the scalpel 600 includes a housing 112 that includes a transducer 140 disposed therein, the transducer being operably coupled to a waveguide 510 having a blade 500 disposed at its distal end. The transducer 140 is electrically coupled to the switch 120 so as to transmit ultrasonic energy through the blade 500 when the switch is activated. The blade 500 is also electrically coupled to the switch 125 that provides monopolar energy to the blade 500, which is transmitted through the return path (via opposing jaws 164 or return pads 710, see Figure 1 ) returns. Both energy modalities may be supplied simultaneously or according to a mathematical algorithm using a single switch (eg, switch 120).

[0051] Typically, blades that use highly directed monopolar energy to treat or dissect tissue are often referred to as "plasma blades." In this energy mode, some tissues are better cut than others. Ultrasonic scalpels use kinetic energy to directly heat and remove tissue, but cut tissue in a much slower manner, and the accuracy usually varies depending on tissue type, pressure, and speed. For example, ultrasonic scalpels can be used to deftly peel off vascular tissue in the liver or violently cut through thick avascular tissue (such as tendons and bones). Both ultrasonic scalpels and monopolar scalpels / pens can be used for point coagulation of small vascular systems. Monopolar scalpels / pens use special energy modes to coagulate tissue, but eschar may accumulate along the cutting edge during the process, which may make the instrument less efficient in long-term use, or require repeated cleaning during its use, making the instrument less efficient. Ultrasonic scalpels can also be used for point coagulation by using a blunt surface on the blade or the side of the blade. Although ultrasonic scalpels do not usually cut tissue as fast as monopolar scalpels / pens, there is little or no eschar accumulation on ultrasonic blades, which may be more desirable for surgical purposes.

[0052] Reference again Figure 5 and FIG. 6A to FIG. 6C , shows a blade 500, which includes: a proximal edge portion 500c, a middle edge portion 500b and a distal edge portion 500a, which are respectively configured to perform tissue dissection by using either or both of ultrasonic energy and / or electrosurgical energy; and a proximal side portion 501c, a middle side portion 501b and a distal side portion 501a, which are respectively configured to perform spot coagulation by using either or both of ultrasonic energy and / or electrosurgical energy. Figure 5A surgical knife 600 is shown in use in the field, wherein the surgical knife 600 has a unique shape and is capable of controlling two different types of energy modalities for simultaneous or independent application, thereby allowing a surgeon to more easily dissect a larger blood vessel from surrounding tissue, as explained in more detail below. The blade 500 extends distally from a waveguide 510 disposed at its proximal end, which is disposed within the housing 112 ( Figure 5 ). The shape of the blade 500 is tapered in both vertical and horizontal directions (multi-axis tapered design) to form a long V-shaped tapered cutting edge 505 that extends distally along its top surface to a distal edge portion 500a, and a long tapered thin edge that extends along its side surface to a flat spatula-like surface 507 at the distal side portion 501a. This blade shape enables the surgeon to utilize these two energy modalities simultaneously or independently to enhance tissue treatment, as explained in more detail below.

[0053] Thus, the shaped blade 500 with a multi-axis tapered design (tapered along both the vertical and horizontal axes) combines the processing capabilities of both an ultrasonic scalpel and a plasma monopolar pen with dual energy modalities, thereby enabling rapid dissection of tissue regardless of tissue composition and enabling better spot coagulation without eschar accumulation, allowing the surgeon to treat a variety of tissue types in a precise and rapid manner with little or no eschar accumulation.

[0054] For example, Fig. 6A and Figure 6B As shown, the design of blade 500 enables surgeons to enhance performance by combining two energy modalities. Long V-shaped tapered cutting edge 505 is coated with highly conductive material 502 and extends between its proximal to distal portions 500c-500a and is electrically connected to energy source 200 (providing return via REM). Flat spatula-like spot coagulation surface 507 is provided on distal side portion 501a (actually double-sided (not shown)) and is coated with insulating material 503 (e.g., glass, ceramic, polymer, or other material) extending proximally along side portions 501b and 501a. Waveguide 510 is also coated with the same or similar insulating material 503 (e.g., glass, ceramic, polymer, or other material).

[0055] The blade 500 is coated or covered with an insulating material 503 so that only the desired treatment areas on the blade 500 and the electrical connection locations in the handpiece are exposed and can transfer energy. The insulator 503 can be in the form of an oxide layer, ceramic, glass, or other material that directly coats and is integral with the waveguide 510. Additional insulators can also be in the form of a covering, such as a plastic sheath 900 or some other portion of the handpiece.

[0056] Designing the blade 500 in this manner enables the surgeon to simultaneously activate both modalities and treat a variety of tissue types by simply manipulating the orientation of the scalpel 600. For example, if the surgeon wishes to dissect tissue, the surgeon will orient the blade 500 so that the cutting edge 505 is in contact with the tissue to be dissected and activate the switch 120, in which case both modalities are activated, namely, the monopolar high energy plasma and the ultrasonic energy. In this case, the plasma energy will dominate the effect on the tissue and dissect rapidly along the cutting edge 505. Similarly, in an attempt to use monopolar energy for spot coagulation purposes using the flat spatula surface 507, the addition of ultrasonic energy will be more effective than simply using the monopolar high energy plasma on the tissue along the surface 507.

[0057] Alternatively, the surgeon can activate each modality independently and utilize a specific portion of the blade 500 that is particularly suited to treat a particular tissue type in a more efficient and rapid manner, i.e., utilizing the highly concentrated electrical paths on the cutting edge 505 to create a plasma-like cutting surface that will easily cut through conductive tissue, while utilizing ultrasonic energy on the flat spatula surface 507 to treat thicker non-conductive tissue.

[0058] Figure 6C An example of another embodiment of the present disclosure is shown, in which a blade 500 is coupled to a switch 535 so that different portions of the blade 500 can be activated for different purposes and / or to address safety issues. For example, the blade 500 is similar in all respects to the one described above in Fig. 6A and Figure 6B , except that an insulating sheath 900 is provided on the intermediate portion of the blade 500 (e.g., the intermediate edge portion 500b and the intermediate side portion 501b). The leaf spring or other type of contact 525a is operably coupled to the electrical lead 530a at one end thereof and is operably coupled to the proximal edge portion 500c at an opposite end thereof. Similarly, the leaf spring or other type of contact 525b is operably coupled to the electrical lead 530b at one end thereof and is operably coupled to the proximal side portion 501c at an opposite end thereof. The electrical leads 530a and 530b are provided at opposite ends of a toggle switch 535 that is controlled by a user or an algorithm.

[0059] During use, the toggle switch 535 determines which surface is excited for use, while the insulating sheath 900 electrically insulates the other area from being electrically activated. For example, if the surgeon wants to dissect tissue along the distal edge 500a, the surgeon activates the toggle switch 530a, which in turn activates the leaf spring 525a to excite the edges 500c, 500b, and 500a. As a safety measure, the sheath prevents the current from exciting the surfaces 501a, 501b, and 501c to avoid accidental treatment or collateral damage to the tissue. The insulator 503 (e.g., an oxide layer, ceramic, glass, or other material coated or otherwise deposited on the waveguide 510 (as described above)) prevents the surfaces 500 and 501 from shorting. The disconnected circuit 530b (or 530a) keeps the non-active surface from being excited when it is not selected by the toggle switch 535.

[0060] The generator 200 and / or the algorithm can determine the energy modality to be applied and / or select the parameters of its energy delivery, combination or power level (e.g., high power versus low power when either or both of monopolar energy and / or ultrasonic energy are activated). For example, in various aspects, monopolar energy can be activated in a high power dissection mode, while ultrasonic energy can be activated in a low power spot coagulation mode. In other aspects, monopolar energy can be deactivated, while ultrasonic energy can be activated in a high power mode depending on the specific surgical objectives. In various aspects, the surgeon can manually control the combination of energy modalities according to the surgeon's specific surgical preferences.

[0061] Although several aspects of the present disclosure are described in detail above and illustrated in the accompanying drawings, it is not intended to limit the present disclosure thereto, as it is intended that the scope of the present disclosure be as broad as the art will allow, and this specification should be read in the same manner. Therefore, the above description and drawings should not be construed as limiting, but rather as merely illustrative of particular aspects. Those skilled in the art will envision other modifications within the scope and spirit of the appended claims.

Claims

1. A combined ultrasonic and electrosurgical surgical instrument, comprising: case; an ultrasonic transducer, wherein the ultrasonic transducer is disposed in the housing; as well as A waveguide configured to support an ultrasonic blade operably coupled to the ultrasonic transducer, the ultrasonic blade configured to receive ultrasonic energy generated by the ultrasonic transducer, the ultrasonic blade being tapered along both a vertical axis and a horizontal axis defined along the ultrasonic blade and defining an elongated edge on an upper surface of the ultrasonic blade terminating in a spatula-like distal end, wherein sides of the elongated edge and the spatula-like distal end are coated with a conductive material and both are adapted to be connected to an electrosurgical energy source such that activation of the electrosurgical energy source and the ultrasonic transducer treats tissue using both electrosurgical energy and ultrasonic energy.

2. The ultrasonic and electrosurgical combined surgical instrument according to claim 1, wherein: The ultrasonic transducer is capable of being activated independently of the electrosurgical energy source.

3. The ultrasonic and electrosurgical combined surgical instrument according to claim 1, wherein: The ultrasonic transducer is energized by the electrosurgical energy source.

4. The ultrasonic and electrosurgical combined surgical instrument according to claim 1, wherein: The conductive material on the elongated edge and the conductive material on the side of the spatula-shaped distal end are separated by an insulating material and can be independently activated by a switch.

5. The ultrasonic and electrosurgical combined surgical instrument according to claim 4, wherein: An insulating sheath is disposed between the conductive material on the elongated edge and the conductive material on the sides of the spatula-shaped distal end.

6. The ultrasonic and electrosurgical combined surgical instrument according to claim 1, wherein: Both ultrasonic energy and monopolar energy are simultaneously provided to the elongated edge to quickly and finely dissect tissue.

7. The combined ultrasonic and electrosurgical surgical instrument according to claim 1, wherein: Monopolar energy is provided to the elongated edge to dissect tissue.

8. The combined ultrasonic and electrosurgical surgical instrument according to claim 1, wherein: The side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy and monopolar energy simultaneously to coagulate the tissue.

9. The combined ultrasonic and electrosurgical surgical instrument according to claim 1, wherein: The side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy to coagulate the tissue.

10. The combined ultrasonic and electrosurgical surgical instrument according to claim 1, wherein: The waveguide is coated with an insulating material selected from the group consisting of glass, ceramic and polymer.

11. An ultrasonic and electrosurgical combined surgical instrument, comprising: case; an ultrasonic transducer, wherein the ultrasonic transducer is disposed in the housing; as well as A waveguide configured to support an ultrasonic blade operably coupled to the ultrasonic transducer, the ultrasonic blade configured to receive ultrasonic energy generated by the ultrasonic transducer, the ultrasonic blade being tapered along both a vertical axis and a horizontal axis defined along the ultrasonic blade and defining an elongated edge on an upper surface of the ultrasonic blade terminating in a spatula-shaped distal end, wherein sides of the elongated edge and the spatula-shaped distal end are electrically conductive and separated by an insulating material, the elongated edge and the spatula-shaped distal end being adapted to be independently connected to an electrosurgical energy source such that activation of the electrosurgical energy source treats tissue using both monopolar electrosurgical energy and ultrasonic energy.

12. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: The ultrasonic transducer is adapted to be connected to a separate source of electrical energy.

13. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: The conductive material on the elongated edge and the conductive material on the side of the spatula-shaped distal end can be independently activated by a switch.

14. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: The conductive material on the elongated edge and the conductive material on the sides of the spatula-shaped distal end can be independently activated by switches, which are controlled by an algorithm.

15. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: An insulating sheath is disposed between the conductive material on the elongated edge and the conductive material on the sides of the spatula-shaped distal end.

16. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: Both ultrasonic energy and monopolar energy are simultaneously provided to the elongated edge to quickly and finely dissect tissue.

17. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: Monopolar energy is provided to the elongated edge to dissect tissue.

18. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: The side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy and monopolar energy simultaneously to coagulate the tissue.

19. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: The side surface of the spatula-shaped distal end is used to treat tissue using ultrasonic energy to coagulate the tissue.

20. The combined ultrasonic and electrosurgical surgical instrument according to claim 11, wherein: The waveguide is coated with an insulating material selected from the group consisting of glass, ceramic and polymer.

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