Surgical instruments, systems, and methods combining ultrasound and electrosurgical functions

Abstract

A surgical system includes: an electrosurgical system including a first electrode and a second electrode configured to conduct electrosurgical energy therebetween and conduct energy through tissue to treat the tissue; and an ultrasound system configured to ultrasonically vibrate the ultrasound blade to treat tissue in contact therewith. In a first mode of operation, the electrosurgical system is configured to conduct electrosurgical energy according to a first electrosurgical algorithm, and the ultrasound system is configured to ultrasonically vibrate the ultrasound blade according to a first ultrasound algorithm. In a second mode of operation, the electrosurgical system is configured to conduct electrosurgical energy according to a second electrosurgical algorithm, and the ultrasound system is configured to ultrasonically vibrate the ultrasound blade according to a second ultrasound algorithm. The first electrosurgical algorithm and the second electrosurgical algorithm are different from each other, and / or the first ultrasound algorithm and the second ultrasound algorithm are different from each other.

Description

Technical Field

[0001] The present disclosure relates to energy-based surgical instruments, and more particularly to surgical instruments and systems that combine ultrasonic and 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. Ultrasonic surgical devices 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 tissue to be heated to treat tissue clamped against the blade or otherwise in contact with the blade.

[0003] Electrosurgical instruments and systems conduct radiofrequency (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 returns via a local or remote return electrode arrangement 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 away 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, design variations, 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 some aspects of the present disclosure, a surgical system is provided, which includes an electrosurgical system and an ultrasonic system. The electrosurgical system includes a first electrode and a second electrode, the first electrode and the second electrode being configured to conduct electrosurgical energy therebetween and conduct the electrosurgical energy through tissue to treat the tissue. The ultrasonic system includes an ultrasonic blade and is configured to ultrasonically vibrate the ultrasonic blade to treat tissue in contact with the ultrasonic blade. In a first operating mode, the electrosurgical system is configured to conduct electrosurgical energy according to a first electrosurgical algorithm, and the ultrasonic system is configured to ultrasonically vibrate the ultrasonic blade according to the first ultrasonic algorithm. In a second operating mode, the electrosurgical system is configured to conduct electrosurgical energy according to a second electrosurgical algorithm, and the ultrasonic system is configured to ultrasonically vibrate the ultrasonic blade according to the second ultrasonic algorithm. The first electrosurgical algorithm and the second electrosurgical algorithm are different from each other, and / or the first ultrasonic algorithm and the second ultrasonic algorithm are different from each other.

[0006] In one aspect of the present disclosure, the surgical system further includes a jaw member that is movable relative to the ultrasonic blade for clamping tissue between the jaw member and the ultrasonic blade. In such an aspect, the jaw member includes one of the first electrode or the second electrode, and the ultrasonic blade includes the other of the first electrode or the second electrode. Alternatively, the jaw member may include both the first electrode and the second electrode.

[0007] In another aspect of the present disclosure, in at least one of the first operating mode or the second operating mode, electrosurgical energy is conducted while ultrasonically vibrating the ultrasonic blade.

[0008] In yet another aspect of the present disclosure, the first operating mode is a tissue sealing mode of operation and the second operating mode is a tissue transection mode of operation.

[0009] In yet another aspect of the present disclosure, the first electrosurgical algorithm comprises a variable function and the second electrosurgical algorithm comprises a constant function. In some aspects, the variable function comprises a polynomial function.

[0010] In yet another aspect of the present disclosure, a first electrosurgical algorithm includes controlling power based on impedance and a second electrosurgical algorithm includes controlling voltage based on impedance, for example.

[0011] In another aspect of the present disclosure, the first electrosurgical algorithm comprises a plurality of distinct phases and the second electrosurgical algorithm comprises a single phase.

[0012] In yet another aspect of the present disclosure, a first ultrasound algorithm includes a constant function at a first power level and a second ultrasound algorithm includes a constant function at a second, different power level.

[0013] In yet another aspect of the present disclosure, the first ultrasound algorithm comprises a variable function and the second ultrasound algorithm comprises a constant function.

[0014] According to some aspects of the present disclosure, a surgical method is provided, the surgical method comprising: receiving an input to operate in a first operating mode or a second operating mode. In response to receiving the input to operate in the first operating mode, the method comprises conducting electrosurgical energy between a first electrode and a second electrode and through tissue according to a first electrosurgical algorithm, and ultrasonically vibrating an ultrasonic blade in contact with the tissue according to a first ultrasonic algorithm. In response to receiving the input to operate in the second operating mode, the method comprises conducting electrosurgical energy between a first electrode and a second electrode and through tissue according to a second electrosurgical algorithm, and ultrasonically vibrating an ultrasonic blade in contact with the tissue according to a second ultrasonic algorithm. The first electrosurgical algorithm and the second electrosurgical algorithm are different from each other, and / or the first ultrasonic algorithm and the second ultrasonic algorithm are different from each other.

[0015] In one aspect of the present disclosure, in the first operating mode and / or the second operating mode, conducting electrosurgical energy and ultrasonic vibrations are performed simultaneously.

[0016] In another aspect of the present disclosure, the first operating mode is a tissue sealing operating mode and the second operating mode is a tissue transection operating mode.

[0017] In yet another aspect of the present disclosure, conducting electrosurgical energy according to a first electrosurgical algorithm includes implementing a variable function, and conducting electrosurgical energy according to a second electrosurgical algorithm includes implementing a constant function. In such an aspect, the variable function may include a polynomial function.

[0018] In yet another aspect of the present disclosure, conducting electrosurgical energy according to a first electrosurgical algorithm includes controlling power based on impedance, and conducting electrosurgical energy according to a second electrosurgical algorithm includes implementing voltage control, for example, based on impedance.

[0019] In yet another aspect of the present disclosure, conducting electrosurgical energy according to the first electrosurgical algorithm includes implementing a plurality of electrosurgical energy delivery phases, and conducting electrosurgical energy according to the second electrosurgical algorithm includes implementing a single electrosurgical energy delivery phase.

[0020] In one aspect of the disclosure, ultrasonically vibrating according to a first ultrasound algorithm includes implementing a constant function at a first power level, and ultrasonically vibrating according to a second ultrasound algorithm includes implementing the constant function at a second, different power level.

[0021] In another aspect of the present disclosure, ultrasonically vibrating according to a first ultrasonic algorithm includes implementing a variable function, and ultrasonically vibrating according to a second ultrasonic algorithm includes implementing a constant function. BRIEF DESCRIPTION OF THE DRAWINGS

[0022] 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.

[0023] 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;

[0024] 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;

[0025] Figure 3 is a schematic diagram of a robotic surgery system provided according to the present disclosure;

[0026] Figure 4 yes Figure 1 A longitudinal cross-sectional view of a distal portion of a surgical instrument;

[0027] Figure 5 yes Figure 1 A transverse cross-sectional view of an end effector assembly of a surgical instrument;

[0028] Figure 6 yes Figure 1 A transverse cross-sectional view of another configuration of an end effector assembly of a surgical instrument;

[0029] Figure 7 is configured with Figures 1 to 3 A simplified block diagram of an ultrasound control system for use with a surgical system of the invention or any other suitable surgical system;

[0030] Figure 8 is configured with Figures 1 to 3 A simplified block diagram of an electrosurgical control system for use with a surgical system of the invention or any other suitable surgical system;

[0031] Fig. 9 is a flow chart of a method of treating a tissue according to some aspects of the present disclosure;

[0032] Fig.10 and Fig.11 is a flow chart of a tissue sealing method provided according to some aspects of the present disclosure; and

[0033] Fig. 12A and Fig. 12B yes Fig.11 Detailed flow chart of some parts of the tissue sealing method. DETAILED DESCRIPTION

[0034] refer to Figure 1 , shows a surgical system provided according to some aspects of the present disclosure, generally identified by reference numeral 10, which includes a surgical instrument 100, a surgical generator 200, and in some aspects a return electrode device 500 (e.g., a return pad 510). 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.

[0035] 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 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.

[0036] 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 to activate the surgical instrument 100 to supply ultrasonic energy, and is configured to provide electrosurgical energy, such as RF bipolar energy for output through the bipolar electrosurgical plug port 240 and RF monopolar energy for output to the surgical instrument 100 through the active monopolar electrosurgical port 250 in some aspects to activate the surgical instrument 100 to supply electrosurgical energy. The plug 520 of the return electrode device 500 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.

[0037] 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.

[0038] The activation button 120 is disposed on the housing 112 and is coupled to the ultrasonic transducer 140 and / or the surgical generator 200 or coupled therebetween, 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 a closed state to different states corresponding to different activation modes, such as a first state corresponding to a first activation mode (such as a tissue sealing mode), a second state corresponding to a second activation mode (such as a tissue transection mode). In other configurations, separate activation buttons may be provided, for example, a first actuation button for activating the first activation mode and a second activation button for activating the second activation mode. It is also conceivable that additional activation buttons, sliders, wheels, etc., can be used to control various activation modes from the housing 112.

[0039] 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 a plurality of inner support sleeves 154 disposed within the outer drive sleeve 152. Figure 4 ), extending through the inner support sleeve 153 ( Figure 4) of the handle assembly 110, a waveguide 154, a drive assembly (not shown), a knob 156, and an end effector assembly 160 including a blade 162 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 ) can pivotally support the jaw member 164 at the 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 162. 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 different from the sleeve can also be envisioned, such as a drive rod, a drive cable, a drive screw, etc.

[0040] 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, such as described in U.S. Patent Application Publication No. 2022 / 0117622 published on April 21, 2022, 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, such 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.

[0041] 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 formed integrally with the waveguide 154, formed separately and subsequently attached (permanently or removably) 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 in a threaded female receiver, so that the 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 the ultrasonic plug port 230 of the surgical generator 200, while the electrosurgical plug 196 is configured to connect to the bipolar electrosurgical plug port 240 of the surgical generator 200 and / or the 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 a bipolar configuration, a separate second electrical lead 199 is electrically coupled to the waveguide 154 and the jaw member 164 (and / or a different portion of the jaw member 164) so ​​that bipolar electrosurgical energy can be conducted between the blade 162 and the jaw member 164 (and / or a different portion of the jaw member 164). In a monopolar configuration, the second electrical lead 199 is 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 154 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 the surgical instrument 20 and the 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 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 plug 520 of the return electrode device 500 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 162 and / or the jaw member 164) and the return electrode device 500.

[0047] Steering Figure 3 , a robotic surgical system in accordance with aspects and features of the present disclosure is generally indicated 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. The robotic surgery system 1000 may further 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 and 1003 may be driven by an electric drive, 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 tool "ST" respectively perform the desired movement and / or function 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 Figures 4 to 6 , detailing a surgical system 10( Figure 1) of the surgical instrument 100, however, some aspects and features of the end effector assembly 160 may be similarly applicable to the surgical instrument 20 ( Figure 2 ) and / or any other suitable surgical instrument or system. As described above, the end effector assembly 160 includes a blade 162 and a jaw member 164. The blade 162 can define a linear configuration, can define a curved configuration, or can define any other suitable configuration, such as, for example, straight and / or curved surfaces, portions, and / or segments; one or more convex and / or concave surfaces, portions, and / or segments; and the like. With respect to the curved configuration, more specifically, the blade 162 can be bent in any direction relative to the jaw member 164, such as, for example, such that the distal tip of the blade 162 is bent toward the jaw member 164, away from the jaw member 164, or laterally (in either direction) relative to the jaw member 164. Further, the blade 162 can be formed to include multiple bends in similar directions, multiple bends in different directions within a single plane, and / or multiple bends in different directions within different planes. In addition, the blade 162 may additionally or alternatively be formed to include any suitable features, such as a tapered configuration, various cross-sectional configurations along its length, cuts, indentations, edges, protrusions, straight surfaces, curved surfaces, angled surfaces, wide edges, narrow edges, and / or other features.

[0051] The blade 162 may define a polygon, a rounded polygon, or any other suitable cross-sectional configuration. The waveguide 154, or at least the portion of the waveguide 154 proximally adjacent to the blade 162, may define a cylindrical configuration. A plurality of tapered surfaces (not shown) may interconnect the cylindrical waveguide 154 with the polygonal (rounded polygon or other suitable shape) configuration of the blade 162 to define a smooth transition between the body of the waveguide 154 and the blade 162.

[0052] The blade 162 may be entirely or selectively coated with a suitable material, such as a non-stick material, an electrically insulating material, a conductive material, combinations thereof, etc. Suitable coatings and / or methods of applying the coatings include, but are not limited to: Polyphenylene oxide (PPO), deposited liquid ceramic insulating coatings; thermal spray coatings, such as thermal spray ceramics; plasma electrolytic oxidation (PEO) coatings; anodized coatings; sputtered coatings, such as silicon dioxide; coating, available from Surface Solutions Group of Chicago, IL, USA; or other suitable coatings and / or coating application methods.

[0053] Continue to refer Figures 4 to 6As described above, the blade 162 receives the ultrasonic energy from the ultrasonic transducer 140 ( Figure 1 ) is also suitable for connecting to a generator 200 ( Figure 1 ) to enable RF energy to be supplied to the blade 162 for conduction to the tissue in contact therewith. In the bipolar configuration, the RF energy is conducted between the blade 162 and the jaw member 164 (or between the jaw member 164 and / or portions of the blade 162) and through the tissue disposed therebetween to treat the tissue. In the monopolar configuration, the RF energy is conducted from the blade 162, which acts as an active electrode, to the tissue in contact therewith, and ultimately via the return electrode device 500 ( Figure 1 ) returns to generator 200 ( Figure 1 ).

[0054] The jaw member 164 of the end effector assembly 160 includes a more rigid structural body 182 and a more compliant jaw liner 184. The structural body 182 can be formed of a conductive material (e.g., stainless steel) and / or can include conductive portions. The structural body 182 includes a pair of proximal flanges 183a that are pivotally coupled to the inner support sleeve 153 via pivot bosses (not shown) of the proximal flanges 183a received in corresponding openings (not shown) defined in the inner support sleeve 153, and operably coupled to the outer drive sleeve 152 via a drive pin 155 that is fixed relative to the outer drive sleeve 152 and pivotally received in a hole 183b defined in the proximal flanges 183a. In this manner, sliding of outer drive sleeve 152 about inner support sleeve 153 pivots jaw member 164 relative to blade 162 from an open position to a closed position to clamp tissue between jaw liner 184 of jaw member 164 and blade 162 .

[0055] refer to Figure 5 , the structural body 182 can be adapted to be connected to a source of electrosurgical energy (e.g., a generator 200 ( Figure 1 )), and in a bipolar configuration, the structural body is charged to a different potential than the blade 162 to enable bipolar electrosurgical (e.g., RF) energy to be conducted through the tissue sandwiched therebetween to treat the tissue. In a monopolar configuration, the structural body 182 may be unpowered, the structural body may be charged to the same potential as the blade 162 (thus both defining active electrodes), or the structural body may be powered while the blade 162 is unpowered (wherein the structural body 182 defines an active electrode). In either monopolar configuration, energy is delivered to the return electrode device 500 ( Figure 1 ) returns to generator 200 ( Figure 1 ).

[0056] refer to Figure 6 , as a means of connecting the entire structural body 182 of the jaw member 164 to the generator 200 ( Figure 1 ), the structural body can be formed of or at least partially embedded in an insulating material (e.g., an overmolded plastic). In such a configuration, a conductive surface 188 (e.g., in the form of a plate) can be disposed on or captured by the overmolded plastic to define electrodes on either side of the jaw liner 184 on the blade-facing side of the jaw member 164. In such an aspect, the conductive surface 188 is connected to the generator 200 ( Figure 1 ) and can be energized for bipolar and / or monopolar configurations, e.g., to be at the same potential with respect to each other and / or with respect to blade 162, and / or to be at different potentials with respect to each other and / or with respect to blade 162. In some aspects, conductive surface 188 is disposed at other or alternative locations on jaw member 164, e.g., along either or both sides of the jaw member, along a rear surface of the jaw member, etc.

[0057] Back to Figures 4 to 6 The shape of the jaw liner 184 is complementary to the cavity 185 defined in the structural body 182 (e.g., defining a T-shaped configuration) so that the jaw liner is received and retained in the cavity, although other configurations are also contemplated. The jaw liner 184 is made of an electrically insulating, compliant material, such as polytetrafluoroethylene (PTFE). The compliance of the jaw liner 184 allows the blade 162 to vibrate when in contact with the jaw liner 184 without damaging the ultrasonic surgical instrument 100 ( Figure 1 ) and does not affect the retention of tissue clamped between the jaw member 164 and the blade 162. The jaw liner 184 extends from the structural body 182 toward the blade 162 to prevent contact between the structural body 182 and the blade 162 when the jaw member 164 is in the closed position. The insulation of the jaw liner 184 maintains electrical insulation between the blade 162 and the structural body 182 of the jaw member 164, thereby preventing short circuits.

[0058] Go to Figure 7 , detailing surgical system 10 (see Figure 1 ) of the surgical instrument 100, however, some aspects and features of the ultrasonic control system 700 can be similarly applied to the surgical instrument 20 ( Figure 2 ) and / or any other suitable surgical instrument or system. The ultrasonic control system 700 includes a controller 710 (e.g., a generator 200 ( Figure 1 )、Ultrasonic generator 310( Figure 2 ) or any other suitable generator controller) and a power source 720 (e.g., generator 200 ( Figure 1 )、Battery 400( Figure 2 ) or any other suitable power source), the controller and power source are configured to control the electrical input of and power the ultrasonic transducer 140. More specifically, the controller 710 includes a microprocessor 712 and a memory 714, for example, the memory storing instructions to be executed by the microprocessor 712 to control the ultrasonic drive signal provided to the ultrasonic transducer 140.

[0059] The ultrasonic control system 700 further includes a motion bridge 730 configured to sense mechanical motion of the ultrasonic transducer 140, for example, the amplitude and frequency of the mechanical motion. The mechanical motion feedback provided by the motion bridge 730 to the controller 710 enables the controller 710 to control the frequency and / or amplitude of the drive signal (e.g., a high voltage AC drive signal) provided to the ultrasonic transducer 140 to achieve a target amount of mechanical motion of the ultrasonic transducer 140 at its resonant frequency, thereby achieving a target blade speed ( Figures 4 to 6 ). The controller 710 is also configured to monitor the resonant frequency of the ultrasonic transducer 140, which may be due to the application of ultrasonic force to the blade 162 ( Figure 4 ) load, blade 162( Figure 4 ) changes with changes in temperature and / or other factors.

[0060] refer to Figure 8 , detailing surgical system 10 (see Figure 1 ) of the surgical instrument 100, however, some aspects and features of the electrosurgical control system 800 may be similarly applied to the surgical instrument 20 ( Figure 2 ) and / or any other suitable surgical instrument or system. The electrosurgical control system 800 includes a controller 810 (e.g., a generator 200 ( Figure 1 )、Electrosurgical generator 600( Figure 2 ) or any other suitable generator controller), power supply 820 (e.g., generator 200 ( Figure 1 )、Battery 400( Figure 2 ) or any other suitable power source), an RF output stage 830, and a sensor circuit system 840. The controller 810 includes a microprocessor 812 and a memory 814, for example, which stores instructions to be executed by the microprocessor 812 to control the electrosurgical energy output by the RF output stage 830. The controller 810 (and / or the microprocessor 812 and / or the memory 814) may be an ultrasonic control system 700 ( Figure 7) or may be a separate controller 810 (and / or microprocessor 812 and / or memory 814). Similarly, power supply 820 may be the same controller 710 (and / or microprocessor 712 and / or memory 714) used in ultrasound control system 700 ( Figure 7 ) or may be a separate power supply 820.

[0061] Additional references Figure 4 In the bipolar configuration, the RF output stage 830 is configured to supply electrosurgical energy to the jaw member 164, a portion of the jaw member 164, and / or the blade 162 of the end effector assembly 160 via one of the electrical leads 199, and return energy from the jaw member 164, a portion of the jaw member 164, and / or the blade 162 of the end effector assembly 160 via the other electrical lead 199 to complete the circuit back to the electrosurgical control system 800. In the monopolar configuration, the RF output stage 830 supplies electrosurgical energy to the jaw member 164, a portion of the jaw member 164, and / or the blade 162 of the end effector assembly 160 via one of the electrical leads 199 to treat tissue, while returning energy to the end effector assembly 160 via the return device 500 ( Figure 1 ) returns energy to complete the loop back to the electrosurgical control system 800.

[0062] Sensor circuit system 840 is operably connected to 199 (or a line 199 and return device 500 ( Figure 1 )) to sense electrical parameters of the energy delivered to the end effector assembly 160, such as its voltage, current, resistance, etc., and determine one or more parameters of the tissue based on these electrical parameters, such as the impedance of the tissue, which one or more parameters can be used to determine whether the tissue is adequately sealed (or the tissue stage in the tissue sealing process), transected, or otherwise treated. The sensor circuit system 840, for example, provides electrical surgical control system 800 and / or ultrasonic control system 700 (based on the sensed electrical parameters) Figure 7 )'s controller 810 and / or controller 710 provides feedback, and the controller then implements the energy delivery algorithm, selects the energy delivery algorithm, modifies the energy delivery algorithm and / or adjusts the energy delivery parameters based on the feedback.

[0063] In addition to or as an alternative to having the electrosurgical control system 800 control the supply of electrosurgical energy to treat tissue, the electrosurgical control system 800 can also be configured to supply energy to the tissue to interrogate the tissue, for example, where the sensor circuit system 840 senses one or more electrical parameters to provide feedback to the controller 810, for example, to enable determination of the impedance of the tissue. That is, the system 10( Figure 1 ), System 20( Figure 2) or any other suitable apparatus or system according to the present disclosure may be configured to treat tissue with ultrasonic energy while interrogating the tissue with electrosurgical energy (during, before, after, intermittently, or without supplying tissue treatment electrosurgical energy). Tissue interrogation may be initiated in a bipolar electrosurgical interrogation mode and / or a monopolar electrosurgical interrogation mode. In some aspects, electrosurgical interrogation may be performed without any treatment energy (e.g., with ultrasonic energy turned off), for example, to assess tissue prior to treatment (e.g., to determine treatment type, appropriate energy delivery algorithm, and / or appropriate energy delivery parameters), to assess tissue after treatment (e.g., to determine tissue treatment completion and / or status of treated or surrounding tissue), or to assess tissue in other circumstances. Tissue interrogation may also be performed in conjunction with the supply of tissue treatment electrosurgical energy (e.g., simultaneously with or otherwise in conjunction with the supply of tissue treatment electrosurgical energy).

[0064] With respect to tissue interrogation, the electrosurgical control system 800 is configured to transmit an interrogation signal according to any of the electrosurgical pathways detailed above so that the signal is returned to the electrosurgical control system 800 so that it can be evaluated. The interrogation signal may be a continuous signal, a pulsed signal, or a plurality of pulses. More specifically, the electrosurgical control system 800 is configured to evaluate the returned signal, e.g., its voltage, current, resistance, etc., and based thereon determine one or more parameters of the tissue (e.g., the impedance of the tissue) that indicate whether the tissue is adequately sealed. The electrosurgical control system 800 and / or the ultrasonic control system 700 ( Figure 7 ) and then based on this, implement the energy delivery algorithm, select the energy delivery algorithm, modify the energy delivery algorithm and / or adjust the energy delivery parameters.

[0065] Go to Fig. 9 , electrosurgical energy and ultrasonic energy can be supplied simultaneously, continuously, intermittently, a combination thereof, or in any other suitable manner according to one or more tissue treatment modes. For example, the instruments and systems of the present disclosure can be configured to operate in a first activation mode (e.g., a tissue sealing mode) and a second activation mode (e.g., a tissue transection mode), and to apply electrosurgical and / or ultrasonic energy differently based on the selected operating mode. As described above, mode selection can be performed by activating button 120 ( Figure 1 ) or any other suitable user input. Alternatively or additionally, the mode selection may be determined automatically based on sensed feedback about the tissue, instrument, or system or in any other suitable manner.

[0066] Continue to refer Fig. 9 , according to the organization of the present disclosure (e.g., clamped between the jaw member 164 and the blade 162 ( Figure 1 and Figure 4) between tissues) The treatment method 900 begins at 910, where for example based on the activation button 120 ( Figure 1 ) received signal, sensed feedback and / or in any other suitable manner to determine the activation mode. In the case of determining the first activation mode, as indicated at 920, for example, based on the activation button 120 ( Figure 1 ) is actuated to a first activation state, and a first electrosurgery (RF) algorithm and an ultrasound algorithm are respectively implemented according to the first activation mode to treat the tissue, as indicated at 930 and 940. In the case of determining a second activation mode, as indicated at 950, for example, based on pressing the activation button 120 ( Figure 1 ) is actuated to a second activation state to implement a second electrosurgical (RF) algorithm and an ultrasonic algorithm, respectively, to treat the tissue, as indicated at 960 and 970. The electrosurgical (RF) and ultrasonic energies may be delivered simultaneously in one or both of the first activation mode and the second activation mode, however other configurations are also contemplated for one or both modes, such as alternative energy delivery, sequential energy delivery, offset and overlapping energy delivery, delivery of only one energy modality, etc.

[0067] The first electrosurgical (RF) algorithm and the second electrosurgical (RF) algorithm may be different from each other, and / or the first ultrasound algorithm and the second ultrasound algorithm may be different from each other. That is, the first activation mode and the second activation mode are different from each other at least in terms of the application of electrosurgical energy and / or in terms of the application of ultrasound energy.

[0068] The electrosurgical (RF) algorithms may be different from each other, for example, in terms of controlled parameters, profiles, combinations thereof, etc. With respect to controlled parameters, the first electrosurgical (RF) algorithm and the second electrosurgical (RF) algorithm (or portions of these algorithms) may correspond to applying electrosurgical (RF) energy using different parameter-based controls, such as voltage control, current control, impedance control, power control, combinations thereof, etc.

[0069] With respect to distribution, the first electrosurgical (RF) algorithm and the second electrosurgical (RF) algorithm (or portions of these algorithms) may correspond to applying electrosurgical (RF) energy using different energy profiles by implementing different functions, combinations of functions, and / or durations of functions, such as constant functions, step functions, ramp functions, polynomial functions, etc., where these functions may be based on the same or different parameters (e.g., voltage, current, power, impedance, etc.). Additionally or alternatively, the energy profile function may differ, for example, with continuous energy application (constant or variable) versus pulsed energy application (and / or different pulse patterns, durations, etc.).

[0070] The ultrasound algorithms may be different from each other, for example, in terms of power level, distribution, combination thereof, etc. With regard to the power level, the power supplied to the ultrasound transducer 140 ( Figure 7 ) current to control the amplitude of the drive signal to achieve the target speed of the blade movement, and the motion current feedback signal is an analog of the blade speed. Alternatively, the power level can correspond to the input to the ultrasonic transducer 140 ( Figure 7 ) current or voltage, or may be determined in any other suitable manner. In some aspects, for example, the first ultrasonic algorithm (or a portion thereof) may correspond to a first power level where the blade 162 ( Figure 1 and Figure 4 ) is driven to vibrate at one or more first speeds, and a second ultrasonic algorithm (or a portion thereof) corresponds to a different second power level, wherein blade 162 ( Figure 1 and Figure 4 ) is driven to vibrate at one or more different second speeds. In such a configuration, the first speed and the second speed may be constant, for example, in the first ultrasonic algorithm (or a portion thereof), the blade 162 ( Figure 1 and Figure 4 ) is driven to vibrate at a constant first speed and to vibrate at a constant second speed (different from the constant first speed) during a second ultrasonic algorithm (or a portion thereof). In other configurations, the first power level and the second power level (e.g., blade speed) may vary over time, and different set points, ramps, durations, etc. may be defined such that the power levels are different for at least a portion of the first ultrasonic algorithm and the second ultrasonic algorithm.

[0071] Regarding the distribution, the first ultrasonic algorithm and the second ultrasonic algorithm (or parts of these algorithms) can correspond to applying different ultrasonic energy distributions by implementing different functions, combinations of functions and / or function durations, such as: constant functions, step functions, ramp functions, polynomial functions, etc., where these functions can be output functions (e.g., blade speed) or input functions (e.g., voltage or current of a drive signal).

[0072] In some aspects, as described above, the first activation mode can correspond to a tissue sealing mode, while the second activation mode corresponds to a tissue transection mode. Figure 10 to Figure 14 describes various configurations of tissue sealing modes and aspects and features thereof. With respect to tissue transection mode, RF energy and ultrasonic energy can be supplied simultaneously. RF energy can be supplied at a constant voltage (e.g., according to a constant voltage algorithm). Ultrasonic energy can be supplied according to a constant power level function (e.g., according to a constant blade speed algorithm), whereby the blade speed remains constant. The power level or blade speed can correspond to a relatively high blade speed of about 8 m / s to about 12 m / s in some aspects, about 9 m / s to about 11 m / s in other aspects, and about 10.0 m / s to about 10.5 m / s in still other aspects.

[0073] Go to Fig.10 , describes a tissue sealing mode 1000. Initially, for example, when activated in the tissue sealing mode, RF energy is applied in a cook phase 1010, and ultrasonic energy is applied at a constant low power ultrasonic energy level 1020 simultaneously. During the cook phase of the RF energy application 1010, the RF energy application can be controlled according to a polynomial curve (such as a polynomial curve of current, voltage, or power). In some aspects, the RF power can be in a power range of about 1 W to about 25 W, and the RF voltage can be in a range of about 25 Vrms to about 50 Vrms. The constant low power ultrasonic energy level can correspond to a blade speed of about 3 m / s to about 8 m / s in some aspects, about 5 m / s to about 7 m / s in other aspects, and about 6.0 m / s to about 6.5 m / s in other aspects.

[0074] Once the thermal change phase 1010 is completed, RF energy is used to identify the treated tissue in the tissue ID phase 1030 while the constant low power ultrasonic energy 1020 is continuously applied. In the tissue ID phase 1030, the tissue can be identified as, for example, small / medium tissue or large tissue, and can be identified based on end impedance or in any other suitable manner after the thermal change phase 1010 is completed. In the case of small or medium tissue being identified, RF energy is applied in the tissue reaction phase 1040 while the constant low power ultrasonic energy 1020 is continuously applied. In the tissue reaction phase 1040, the RF energy can be controlled, for example by controlling the power, to achieve a target tissue impedance trajectory based on the measured tissue impedance and a predetermined rise in tissue impedance (tissue impedance ramp). In the case of large tissue being identified, the process can return to repeat the thermal change phase before entering the tissue reaction phase 1040.

[0075] Upon completion of the tissue reaction phase 1040, a determination is made at 1050 as to whether the tissue seal final condition is met. The determination at 1050 as to whether the tissue seal final condition is met may be based, for example, on whether a target impedance threshold is reached. Additionally or alternatively, sensor feedback may be used to determine whether the final condition is met, for example, a sensor configured to sense tissue temperature (compared to a final temperature condition), tissue color or opacity (compared to a tissue color or opacity final condition), tissue moisture (compared to a final tissue moisture condition), jaw caliber or jaw angle (compared to a jaw caliber or jaw angle final condition), etc. If the tissue seal final condition is not met at 1050, the process returns to repeat the tissue seal mode 1000 or a portion thereof. Alternatively, in the event that the seal final condition is not met at 1050, an error may be returned, wherein an indication (e.g., a visual indication, an audible tone, a combination thereof, etc.) is output from the generator, instrument, and / or system and / or all energy delivery is terminated.

[0076] If the final tissue sealing condition is met at 1050, the delivery of both RF and ultrasonic energy is terminated, as indicated at 1060, the tissue seal is determined to be complete, and a corresponding indication (e.g., a visual indication, an audible tone, a combination thereof, etc.) is provided from the generator, instrument and / or system to indicate that the tissue seal is complete.

[0077] Continue to refer Fig.10 In some aspects, once the tissue seal is complete, as indicated at 1060, the sealed tissue can be transected. In particular, upon application of a user input (from a button, switch, or other suitable input) to transect the tissue, for example, by switching to the second operating mode after tissue sealing or automatically switching to the second operating mode based on the first operating mode being a tissue sealing and transecting mode, the process proceeds to 1070, where ultrasonic energy is applied at a constant high power ultrasonic energy level 1020 (while the RF energy remains off). As described above, the power level or blade speed at high power can correspond to a relatively high blade speed of about 8 m / s to about 12 m / s in some aspects, about 9 m / s to about 11 m / s in other aspects, and about 10.0 m / s to about 10.5 m / s in still other aspects. After applying the constant high power ultrasonic energy for a predetermined duration, tissue transection is completed at 1080 based on sensed feedback or in any other suitable manner.

[0078] refer to Fig.11 , another tissue sealing pattern 1100 is described. For the sake of brevity, the tissue sealing pattern 1000 ( Fig.10) features of a tissue sealing mode 1100 similar to the features of the tissue sealing mode 1100. Initially, for example, when activated in the tissue sealing mode, RF energy is applied in the thermal change stage 1110. In some aspects, ultrasonic energy is applied at a constant low-power ultrasonic energy level or according to a variable ultrasonic energy power distribution, as indicated by 1120. With respect to the variable ultrasonic energy power distribution, ultrasonic energy can be delivered to initially reach a first blade speed for a first time, and then reach a second blade speed for a second time. The transition between the first blade speed and the second blade speed can be a step or a ramp (e.g., the speed changes over time at a defined one or more rates). In some aspects, the first blade speed corresponds to a high power level and the second blade speed corresponds to a low power level. Further, in some aspects, the first time is a relatively short time, for example, less than 3 seconds, less than 2 seconds, or less than 1 second, and the second time is a relatively long time, for example, greater than 3 seconds, greater than 4 seconds, or greater than 5 seconds. In other aspects, ultrasonic energy is not applied simultaneously during the RF thermal change stage 1110.

[0079] Once the thermal modification phase 1110 is completed, the RF energy is used to identify the treated tissue in the tissue ID phase 1130. In the tissue ID phase 1130, the tissue can be identified as, for example, small / medium tissue or large tissue, and can be identified based on end impedance or in any other suitable manner after the thermal modification phase 1110 is completed. In the event that large tissue is identified, a large tissue algorithm 1140 is implemented. On the other hand, in the event that small / medium tissue is identified, a small / medium tissue algorithm 1150 is implemented. The large tissue algorithm 1140 and the small / medium tissue algorithm 1150 are respectively referred to below. Fig. 12A and Fig. 12B describe.

[0080] After the large tissue algorithm 1140 or the small / medium tissue algorithm 1150 is completed, a determination is made at 1160 whether a tissue seal final condition is met. If so, the tissue seal is complete, as indicated at 1170, and if tissue transection is required, high power ultrasonic energy is provided at 1180 to transect the tissue to complete tissue transection, as indicated at 1190. If the tissue seal final condition is not met, the process returns to the thermal modification stage 1110 or an error is returned.

[0081] refer to Fig. 12A, with respect to the large tissue algorithm 1140, RF energy is applied during the thermal change phase 1210 while ultrasonic energy is applied at a constant low power ultrasonic energy level 1220. At the end of the thermal change phase 1210, a determination is made as to whether the thermal change phase final condition is met, as indicated at 1230. If the condition is not met, the large tissue algorithm 1140 is restarted or an error is returned. If the condition is met, RF energy is applied during the tissue response phase 1240 while the constant low power ultrasonic energy 1220 is continuously applied. Upon completion of the tissue response phase 1240, the process proceeds to 1160 where a determination is made as to whether the tissue sealing final condition is met. The process continues from 1160 as described in detail above (see Fig.11 ).

[0082] refer to Fig. 12B , with respect to the small / medium tissue algorithm 1150, RF energy is applied during a tissue response phase 1250 while simultaneously applying ultrasonic energy at a constant medium power ultrasonic energy level 1260. The power level or blade speed at medium power can correspond to a medium blade speed of about 6 m / s to about 10 m / s in some aspects, about 7 m / s to about 9 m / s in other aspects, and about 7.5 m / s to about 8.5 m / s in yet other aspects.

[0083] At the completion of the tissue response phase 1250, the process proceeds to 1160 where it is determined whether the tissue sealing final condition is met. If, after the small / medium tissue algorithm 1150, it is determined at 1160 that the tissue sealing final condition is not met, the large tissue algorithm 1140 may be implemented, as described in detail above, or an error indication may be provided. If the tissue sealing final condition is met, the process continues from 1160, as described in detail above (see Fig.11 ).

[0084] In alternative or additional aspects, the electrosurgical energy delivery algorithm in the tissue sealing mode can be any tissue sealing algorithm detailed in the following U.S. Patent Nos.: 8,147,485; 8,685,016; 8,920,421; 9,186,200; and / or 10,617,463, the entire contents of each of which are hereby incorporated by reference herein.

[0085] 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 surgical system, comprising: an electrosurgical system comprising a first electrode and a second electrode configured to conduct electrosurgical energy therebetween and through tissue to treat the tissue; as well as an ultrasonic system including an ultrasonic blade, the ultrasonic system being configured to ultrasonically vibrate the ultrasonic blade to treat tissue in contact with the ultrasonic blade, wherein, in a first operating mode, the electrosurgical system is configured to conduct the electrosurgical energy according to a first electrosurgical algorithm, and the ultrasonic system is configured to ultrasonically vibrate the ultrasonic blade according to the first ultrasonic algorithm, wherein, in a second operating mode, the electrosurgical system is configured to conduct the electrosurgical energy according to a second electrosurgical algorithm, and the ultrasonic system is configured to ultrasonically vibrate the ultrasonic blade according to a second ultrasonic algorithm, and Among them, at least one of the following situations is included: the first electrosurgical algorithm and the second electrosurgical algorithm are different from each other, or the first ultrasound algorithm and the second ultrasound algorithm are different from each other.

2. The surgical system of claim 1 , further comprising a jaw member movable relative to the ultrasonic blade for clamping tissue between the jaw member and the ultrasonic blade, wherein The jaw member includes one of the first electrode or the second electrode, and wherein the ultrasonic blade includes the other of the first electrode or the second electrode.

3. The surgical system according to claim 1, wherein: In at least one of the first operating mode or the second operating mode, the electrosurgical energy is conducted while ultrasonically vibrating the ultrasonic blade.

4. The surgical system according to claim 1, wherein: The first mode of operation is a tissue sealing mode of operation and the second mode of operation is a tissue transection mode of operation.

5. The surgical system according to claim 1, wherein: The first electrosurgical algorithm comprises a variable function and the second electrosurgical algorithm comprises a constant function.

6. The surgical system according to claim 5, wherein: The variable function includes a polynomial function.

7. The surgical system according to claim 1, wherein: The first electrosurgical algorithm comprises impedance-based power control, and wherein the second electrosurgical algorithm comprises voltage control.

8. The surgical system according to claim 1, wherein: The first electrosurgical algorithm comprises a plurality of distinct phases, and wherein the second electrosurgical algorithm comprises a single phase.

9. The surgical system according to claim 1, wherein: The first ultrasound algorithm comprises a constant function at a first power level, and wherein the second ultrasound algorithm comprises a constant function at a second, different power level.

10. The surgical system according to claim 1, wherein: The first ultrasound algorithm comprises a variable function, and wherein the second ultrasound algorithm comprises a constant function.

11. A surgical method comprising: receiving an input to operate in a first operating mode or a second operating mode; In response to receiving the input to operate in the first operating mode: conducting electrosurgical energy between the first electrode and the second electrode and through tissue according to a first electrosurgical algorithm; and ultrasonically vibrating an ultrasonic blade in contact with the tissue according to a first ultrasonic algorithm; as well as In response to receiving the input to operate in the second operating mode: conducting electrosurgical energy between the first electrode and the second electrode and through the tissue according to a second electrosurgical algorithm; and ultrasonically vibrating the ultrasonic blade in contact with the tissue according to a second ultrasonic algorithm; Among them, at least one of the following situations is included: the first electrosurgical algorithm and the second electrosurgical algorithm are different from each other, or the first ultrasound algorithm and the second ultrasound algorithm are different from each other.

12. The surgical method according to claim 11, wherein: In at least one of the first operating mode or the second operating mode, conducting electrosurgical energy and ultrasonic vibrations are performed simultaneously.

13. The surgical method according to claim 11, wherein: In each of the first mode of operation and the second mode of operation, conducting electrosurgical energy and ultrasonic vibrations are performed simultaneously.

14. The surgical method according to claim 11, wherein: The first mode of operation is a tissue sealing mode of operation, and wherein the second mode of operation is a tissue transection mode of operation.

15. The surgical method according to claim 11, wherein: Conducting electrosurgical energy according to the first electrosurgical algorithm includes implementing a variable function, and wherein conducting electrosurgical energy according to the second electrosurgical algorithm includes implementing a constant function.

16. The surgical method according to claim 15, wherein: The variable function includes a polynomial function.

17. The surgical method according to claim 11, wherein: Conducting electrosurgical energy according to the first electrosurgical algorithm includes controlling power based on impedance, and wherein conducting electrosurgical energy according to the second electrosurgical algorithm includes implementing voltage control.

18. The surgical method according to claim 11, wherein: Conducting electrosurgical energy according to the first electrosurgical algorithm includes implementing a plurality of electrosurgical energy delivery phases, and wherein conducting electrosurgical energy according to the second electrosurgical algorithm includes implementing a single electrosurgical energy delivery phase.

19. The surgical method according to claim 11, wherein: Vibrating ultrasonically according to the first ultrasound algorithm comprises implementing a constant function at a first power level, and wherein vibrating ultrasonically according to the second ultrasound algorithm comprises implementing the constant function at a second, different power level.

20. The surgical method according to claim 11, wherein: Ultrasonic vibrating according to the first ultrasound algorithm includes implementing a variable function, and wherein ultrasonic vibrating according to the second ultrasound algorithm includes implementing a constant function.

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