Surgical instruments and systems incorporating electrosurgical and ultrasound therapy and sensing functionality

Abstract

A surgical instrument includes an end effector assembly having a first jaw member and a second jaw member, the first jaw member and the second jaw member configured to grasp tissue between the first jaw member and the second jaw member. The first jaw member includes a first conductive tissue contact plate portion and a second conductive tissue contact plate portion, the first and second conductive tissue contact plate portions configured to conduct radio frequency (RF) energy through tissue, and the second jaw member includes a first ultrasonic tissue contact plate portion and a second ultrasonic tissue contact plate portion configured to generate and transmit ultrasonic vibration energy to tissue. A surgical system includes an end effector assembly configured to grasp tissue, and a surgical generator configured to: output RF treatment energy; outputting an ultrasonic driving signal; sensing RF energy feedback; sensing ultrasonic energy feedback; and control the outputs based on the feedback.

Description

Cross Reference to Related Applications

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 63 / 583,063, filed September 15, 2023, the entire contents of each of which are incorporated herein by reference. TECHNICAL FIELD

[0002] The present disclosure relates to energy-based surgical instruments, and more particularly to surgical instruments and systems that incorporate electrosurgical and ultrasonic therapy and sensing functions to facilitate energy-based treatment of tissue. BACKGROUND

[0003] Electrosurgical instruments and systems treat tissue by conducting radiofrequency (RF) energy through tissue. Electrosurgical instruments or systems can be configured to conduct bipolar RF energy between oppositely charged electrodes and through tissue (e.g., tissue grasped between or otherwise in contact with the electrodes) to treat the tissue. Alternatively or additionally, electrosurgical instruments or systems can be configured to deliver monopolar RF energy from an active electrode to tissue in contact with the electrode, with the energy returning via a return electrode to complete the circuit.

[0004] Ultrasonic surgical instruments and systems utilize ultrasonic energy (i.e., ultrasonic vibrations) to treat tissue. More specifically, ultrasonic surgical instruments and systems utilize mechanical vibratory energy transmitted at ultrasonic frequencies to treat tissue. Ultrasonic surgical devices can include, for example, ultrasonic end effectors configured to vibrate at high frequencies, which allows for heating of tissue to treat tissue grasped against or otherwise in contact with the ultrasonic end effector. SUMMARY

[0005] As used herein, the term “distal” refers to the portion of the description that is further from an operator (whether a human user (surgeon, nurse, etc.) or a surgical robot), while the term “proximal” refers to the portion of the description that is closer to the operator. As utilized herein, terms including “approximately,” “about,” “substantially,” and the like are intended to cover variations that are within a reasonable range of the value (e.g., manufacturing tolerances, material tolerances, usage tolerances, and environmental tolerances, measurement variations, design variations, and / or other variations) up to and including 10% positive / negative of the value. Further, any or all aspects detailed herein can be used in conjunction with any or all other aspects detailed herein, within a consistent range.

[0006] According to aspects of the present disclosure, a surgical instrument is provided that includes an end effector assembly having a first jaw member and a second jaw member. The first jaw member and / or the second jaw member are movable relative to one another between a spaced apart position and an approximated position for grasping tissue between the first jaw member and the second jaw member. The first jaw member includes first and second electrically conductive tissue contact plate portions configured to conduct radiofrequency (RF) energy through tissue grasped between the first jaw member and the second jaw member. The second jaw member includes first and second ultrasonic tissue contact plate portions configured to generate and transmit ultrasonic vibrational energy to tissue grasped between the first jaw member and the second jaw member.

[0007] In an aspect of the present disclosure, the first jaw member or the second jaw member further includes first and second walls extending from respective first and second peripheral sides thereof. The first and second walls include respective first and second electrically conductive surfaces. The first and second electrically conductive surfaces are electrically isolated from the first and second electrically conductive tissue contact plate portions and are configured to be energized to different electrical potentials than the first and second electrically conductive tissue contact plate portions to conduct RF energy therebetween and through tissue grasped between the first jaw member and the second jaw member.

[0008] In another aspect of the present disclosure, the second jaw member further includes third and fourth electrically conductive tissue contact plate portions. At least two of the first, second, third, or fourth electrically conductive tissue contact plate portions are electrically isolated and configured to be energized to different electrical potentials to conduct RF energy therebetween and through tissue grasped between the first jaw member and the second jaw member.

[0009] In another aspect of the present disclosure, the third electrically conductive tissue contact plate portion and the first ultrasonic tissue contact plate portion are stacked on the second jaw member relative to one another, and the fourth electrically conductive tissue contact plate portion and the second ultrasonic tissue contact plate portion are stacked on the second jaw member relative to one another.

[0010] In yet another aspect of the disclosure, the first jaw member further includes a third ultrasonic tissue contact plate portion and a fourth ultrasonic tissue contact plate portion configured to generate and transmit ultrasonic vibrational energy to tissue grasped between the first jaw member and the second jaw member.

[0011] In yet another aspect of the disclosure, the first conductive tissue contact plate portion and the third ultrasonic tissue contact plate portion are stacked on the first jaw member relative to one another, and the second conductive tissue contact plate portion and the fourth ultrasonic tissue contact plate portion are stacked on the first jaw member relative to one another.

[0012] In still yet another aspect of the disclosure, the first ultrasonic tissue contact plate portion and the second ultrasonic tissue contact plate portion are configured to sense at least one parameter of tissue in contact therewith.

[0013] In another aspect of the disclosure, the first jaw member or the second jaw member includes an ultrasonic blade disposed between the plate portions thereof, and the ultrasonic blade is configured to generate ultrasonic vibrational energy for transmission to tissue grasped between the first jaw member and the second jaw member. The ultrasonic blade can be formed of a piezoelectric material, or can include a piezoelectric substrate and a transmission body coupled to the piezoelectric substrate.

[0014] In an aspect of the disclosure, the ultrasonic blade is configured to sense at least one parameter of tissue in contact therewith.

[0015] In yet another aspect of the disclosure, the end effector assembly further includes a clevis. In such aspects, the first jaw member and the second jaw member can be operably coupled with the clevis, and movable relative to one another and the clevis between a spaced apart position and an approximated position.

[0016] In yet another aspect of the disclosure, either or both of the first jaw member and the second jaw member further includes a structural jaw frame on which the insulative jaw body is supported. In such aspects, the plate portions of the jaw member can be disposed on the insulative jaw body.

[0017] In another aspect of the disclosure, the first conductive tissue contact plate portion and the second conductive tissue contact plate portion are connected at their ends to define a U-shaped configuration. Alternatively, the first conductive tissue contact plate portion and the second conductive tissue contact plate portion can be electrically isolated from one another.

[0018] In still yet another aspect of the disclosure, the surgical instrument further includes a surgical robot having the end effector assembly releasably connected thereto.

[0019] In another aspect of the present disclosure, the surgical instrument further includes a handle assembly operably coupled with the end effector assembly.

[0020] A surgical system is provided in accordance with the present disclosure includes an end effector assembly including a first jaw member and a second jaw member. The first jaw member and / or the second jaw member are movable relative to each other between a spaced-apart position and an approximated position for grasping tissue between the first jaw member and the second jaw member. The end effector assembly further includes at least one electrically-conductive tissue contact plate portion (e.g., each electrically-conductive tissue contact plate portion is disposed on one of the jaw members) and at least one ultrasonic tissue contact plate portion (e.g., each ultrasonic tissue contact plate portion is disposed on one of the jaw members). The surgical system further includes a surgical generator configured to output radiofrequency (RF) treatment energy to the at least one electrically-conductive tissue contact plate portion, output an ultrasonic drive signal to the at least one ultrasonic tissue contact plate portion, sense feedback from the at least one electrically-conductive tissue contact plate portion, and sense feedback from the at least one ultrasonic tissue contact plate portion. The surgical generator is configured to control the output of the RF treatment energy and the output of the ultrasonic drive signal based on the sensed feedback from the at least one electrically-conductive tissue contact plate portion and the sensed feedback from the at least one ultrasonic tissue contact plate portion to seal tissue grasped between the first jaw member and the second jaw member.

[0021] In an aspect of the present disclosure, the surgical generator is configured to determine a temperature of the tissue grasped between the first jaw member and the second jaw member, a stiffness of the tissue grasped between the first jaw member and the second jaw member, and / or a jaw pressure applied to the tissue grasped between the first jaw member and the second jaw member based on the sensed feedback from the at least one ultrasonic tissue contact plate portion.

[0022] In another aspect of the present disclosure, the surgical generator is configured to determine an impedance of the tissue grasped between the first jaw member and the second jaw member based on the sensed feedback from the at least one electrically-conductive tissue contact plate portion.

[0023] In yet another aspect of the present disclosure, the end effector assembly further includes an ultrasonic blade engaged with one of the first jaw member or the second jaw member. In such an aspect, the surgical generator can be further configured to output an ultrasonic drive signal to the ultrasonic blade to dissect tissue grasped between the first jaw member and the second jaw member.

[0024] In yet another aspect of the present disclosure, the surgical generator is configured to control the output using temperature-based control.

[0025] In another aspect of this disclosure, the surgical generator is configured to control the output to terminate energy delivery when a sensed feedback indication indicates that the tissue gripped between the first gripper member and the second gripper member is sealed. Attached Figure Description

[0026] The above and other aspects and features of this disclosure will become clearer when considered in conjunction with the following detailed description, in which the same reference numerals denote similar or identical elements.

[0027] Figure 1 The illustration shows a surgical system provided in accordance with this disclosure, which includes surgical instruments, a surgical generator, and in some respects includes a return electrode device;

[0028] Figure 2 This is a schematic diagram of a robotic surgical system provided in accordance with this disclosure;

[0029] Figure 3 This is a side view of an end effector assembly provided in this disclosure, and the end effector assembly is configured to interact with... Figure 1 Surgical system Figure 2 Used in conjunction with a surgical system and / or any other suitable surgical system;

[0030] Figure 4A yes Figure 3 A transverse cross-sectional view of an end effector assembly, wherein the gripper members of the end effector assembly are arranged in spaced-out positions;

[0031] Figure 4B yes Figure 3 A transverse cross-sectional view of the end effector assembly, wherein the gripper member is positioned in the approach position;

[0032] Figure 5 and Figure 6 This is a cross-sectional view of other end effector components provided in this disclosure, and said other end effector components are configured for use with... Figure 1 Surgical system Figure 2 Used in conjunction with a surgical system and / or any other suitable surgical system;

[0033] Figure 7 and Figure 8 This is a cross-sectional view of a gripper member of another end effector assembly provided in this disclosure, and the gripper member of said other end effector assembly is configured for use with... Figure 1 Surgical system Figure 2 Used with the surgical system and / or any other suitable surgical system; and

[0034] Figure 9 is a block diagram of a surgical generator provided in accordance with the present disclosure and configured for use with Figure 1 a surgical system, Figure 2 a surgical system, and / or any other suitable surgical system. DETAILED DESCRIPTION

[0035] Referring to Figure 1 , a surgical system provided in accordance with aspects of the present disclosure is shown, generally identified by reference numeral 10, including a surgical instrument 100, a surgical generator 200, and in aspects including a return electrode arrangement 400, e.g., including a return pad 410. The surgical instrument 100 includes a handle assembly 110, an elongate assembly 150 extending distally from the handle assembly 110, an end effector assembly 160 disposed at a distal end of the elongate assembly 150, and a cable assembly 190 operably coupled with and extending from the handle assembly 110 to connect to the surgical generator 200. As an alternative to the handle assembly 110, the surgical instrument 100 can include a robotic attachment housing for releasable engagement with a robotic arm of a robotic surgical system, such as, for example, the da Vinci® Surgical System 1000 (Intuitive Surgical, Inc., Sunnyvale, CA) as described in detail below. Figure 2

[0036] ​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. The surgical generator 200 is configured to generate an ultrasonic drive signal that is output to the surgical instrument 100 through the ultrasonic plug port 230 and / or to receive an ultrasonic feedback signal from the surgical instrument 100 through the ultrasonic plug port 230 to implement one or more ultrasonic functions of the surgical instrument 100. The surgical generator 200 is further configured to provide electrosurgical energy to the surgical instrument 100 (e.g., RF bipolar energy for output through the bipolar electrosurgical plug port 240 and / or RF monopolar energy for output through the active monopolar electrosurgical port 250) to implement one or more electrosurgical functions of the surgical instrument 100. With respect to bipolar electrosurgical functions, RF energy is returned from the surgical instrument 100 to the surgical generator 200 through the bipolar electrosurgical plug port 240; with respect to monopolar electrosurgical functions, RF energy is returned to the surgical generator 200 via the return electrode device 400, e.g., where the plug 420 of the return electrode device 400 is configured to be connected to the return monopolar electrosurgical plug port 260. It is also contemplated that one or more common ports (not shown) can be configured to function as any two or more of the ports 230-260. The electrosurgical and ultrasonic functions of the surgical generator 200 are described in greater detail below with reference to FIG. 10.

[0037] With continued reference to Figure 1 The handle assembly 110 of the surgical instrument 100 includes a housing 112 defining a body portion and a fixed handle portion. The handle assembly 110 further includes an activation button 120, a movable handle 130, and a drive assembly (not shown). The elongated assembly 150 of the surgical instrument 100 extends distally from the handle assembly 110 and includes an outer shaft 152, an inner driver 154 disposed within the outer shaft 152 Figure 3), a rotation knob 156, and an end effector assembly 160 that includes a first jaw member 162 and a second jaw member 164. In aspects, the elongate assembly 150 further includes an articulation assembly 140 disposed between and interconnecting the outer shaft 152 and the end effector assembly 160 to thereby allow the end effector assembly 160 to articulate about one or more articulation axes relative to the outer shaft 152 (and the handle assembly 110). In aspects, the articulation assembly 140 includes a first articulation joint that enables the end effector assembly 160 to articulate (e.g., pivot) about a first articulation axis relative to the outer shaft 152 (and the handle assembly 110), and a second articulation joint that enables the end effector assembly 160 to articulate (e.g., pivot) about a second articulation axis relative to the outer shaft 152 (and the handle assembly 110). In such aspects, the first and second articulation axes can be substantially perpendicular to one another to, for example, enable roll articulation and pitch articulation of the end effector assembly 160 relative to the outer shaft 152 (and the handle assembly 110). One or more articulation knobs 142 coupled with the articulation joints of the articulation assembly 140 enable operator-controlled articulation of the end effector assembly 160 relative to the handle assembly 110, for example, via one or more articulation cables (not shown) operably coupled between the one or more articulation knobs 142 and the corresponding articulation joints of the articulation assembly 140.

[0038] The rotation knob 156 is rotatable in either direction to rotate the elongate assembly 150 (including the end effector assembly 160) relative to the handle assembly 110 in either direction. Alternatively, the rotation knob 156 can rotate the end effector assembly 160 independent of the outer shaft 152 and the articulation assembly 140 (and thus relative to the outer shaft 152, the articulation assembly 140, and the handle assembly 110). In either configuration, the rotation knob 156 enables roll motion of the end effector assembly 160 relative to the handle assembly 110.

[0039] The drive assembly of the handle assembly 110 operably couples a proximal portion of the inner driver 154 Figure 3 to the movable handle 130. The drive assembly can include any suitable components (e.g., links, gears, sliders, pivots, motors, springs, etc.) configured to convert actuation motions of the movable handle 130 into movement of the inner driver 154 Figure 3 . The inner driver 154 Figure 3 extends from the drive assembly within the handle assembly 110, through the outer shaft 152 and the articulation assembly 140, to the end effector assembly 160, where the inner driver 154 Figure 3The distal portion of the movable handle 130 is operatively coupled to either or both of the gripper members 162, 164. Thus, the movable handle 130 can be actuated relative to the housing 112 (e.g., from an unactuated position spaced further from the housing 112 to an actuated position closer to the fixed handle portion of the housing 112), thereby actuating the drive assembly to drive the internal actuator 154. Figure 3 This causes one or both of the gripper members 162, 164 to move relative to the other from a spaced-out position to an approach position, so as to grasp the tissue between the gripper members 162, 164. Internal actuator 154 ( Figure 3 The end effector assembly 160 may include any suitable actuation drive structure, such as, for example, multiple drive rods, multiple drive cables, multiple drive tubes, multiple drive screws, combinations thereof, etc., and may be configured to perform translational and / or rotational movements to move any or both of the gripper members 162, 164 in response to actuation of the movable handle 130. The end effector assembly 160 is described in more detail below.

[0040] In various respects, the drive assembly is configured to provide a gripping force or a range of gripping forces to tissue gripped between the gripper members 162, 164, for example, by adjusting the drive assembly to provide a desired force or a force within a desired range in response to actuation of the movable handle 130; and / or by including force limiting features, thereby limiting the gripping force applied to the tissue gripped between the gripper members 162, 164 to a specific gripping force or a range of gripping forces. Alternatively or additionally, input to, for example, the movable handle 130 can be controlled to thereby adjust the force applied to the tissue gripped between the gripper members 162, 164.

[0041] Still referencing Figure 1The 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 with an ultrasonic plug port 230 of the surgical generator 200, while the electrosurgical plug 196 is configured to connect with 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 can include a common plug (not shown) configured to act as both the ultrasonic plug 194 and the electrosurgical plug 196. One or more first electrical leads 197 electrically coupled with the ultrasonic plug 194 extend through the cable 192 and into the handle assembly 110 for electrical connection with corresponding electrically conductive components of the surgical instrument 100 (e.g., circuit traces, leads, electrically conductive structures, etc. of the surgical instrument 100) that are, in turn, electrically connected with the end effector assembly 160 to enable selective supply of ultrasonic drive signals from the surgical generator 200 to the end effector assembly 160, e.g., to generate ultrasonic vibrational energy for use in treating tissue; and / or to enable return of ultrasonic feedback signals from the end effector assembly 160 to the surgical generator 200, e.g., for use in ultrasonic sensing. In addition, one or more second electrical leads 199 electrically coupled with the electrosurgical plug 196 extend through the cable 192 and into the handle assembly 110 for electrical connection with corresponding electrically conductive components of the surgical instrument 100 (e.g., circuit traces, leads, electrically conductive structures, etc. of the surgical instrument 100) that are, in turn, electrically connected with the end effector assembly 160 to enable selective transmission of electrosurgical energy between the surgical generator 200 and the end effector assembly 160. In bipolar configurations, more particularly, at least two separate second electrical leads 199 are electrically coupled with the end effector assembly 160 such that bipolar electrosurgical energy can be conducted through tissue grasped or otherwise contacted by the end effector assembly 160 to treat the grasped tissue and / or to enable electrosurgical sensing. In monopolar configurations, one or more electrical leads 199 are electrically coupled with the end effector assembly 160 such that monopolar electrosurgical energy can be supplied from either or both of the jaw members 162, 164 to tissue, e.g., for use in treating tissue and / or for sensing, and can be returned to the electrosurgical generator 200 via the return electrode device 400.

[0042] One or more third electrical leads 195 are electrically coupled with the activation button 120 such that, in response to a particular activation of the activation button 120, the surgical generator 200 supplies a corresponding one or more energies to effect one or more electrosurgical functions and / or one or more ultrasonic functions of the end effector assembly 160. The activation button 120 is disposed on the housing 112 and, in aspects, can comprise an ON / OFF switch. In other configurations, the activation button 120 can comprise a plurality of actuation switches to effect activation from an OFF position to different actuation positions corresponding to different activation settings, e.g., a first actuation position corresponding to a first activation setting and a second actuation position corresponding to a second activation setting. In other configurations, separate activation buttons can be provided, e.g., a first actuation button to activate the first activation setting and a second activation button to activate the second activation setting. Although two activation settings are detailed, it will be appreciated that additional activation settings can be provided via additional switch positions associated with the activation button 120 and / or additional activation button(s). Each activation setting can correspond to one or more electrosurgical functions of the end effector assembly 160 and / or one or more ultrasonic functions of the end effector assembly 160. Alternatively or additionally, energy activation and / or mode setting can be accomplished at the surgical generator 200, e.g., via one or more of the user interface features 220.

[0043] Reference Figure 2 A robotic surgical system in accordance with aspects and features of the present disclosure is generally indicated by reference numeral 1000. For purposes of the present discussion, the robotic surgical system 1000 is generally described. Aspects and features of the robotic surgical system 1000 that are not directly related to understanding the present disclosure are omitted in order to avoid obscuring the aspects and features of the present disclosure in unnecessary detail.

[0044] The robotic surgical system 1000 generally includes a plurality of robotic arms 1002, 1003, a control device 1004, and an operating console 1005 coupled with the control device 1004. The operating console 1005 can include a display device 1006, which can be arranged to display, inter alia, three-dimensional images, and manual input devices 1007, 1008 by which an operator (not shown), e.g., a surgeon, can remotely manipulate the robotic arms 1002, 1003. The robotic surgical system 1000 can be configured for a patient 1013 to be treated in a minimally invasive manner to lie on a patient table 1012. The robotic surgical system 1000 can further include a database 1014, which is coupled with the control device 1004, inter alia, preoperative data and / or anatomic atlases from the patient 1013 are stored in the database.

[0045] Each of the robotic arms 1002, 1003 can comprise a plurality of members connected by joints; and an attachment device 1009, 1011 to which a surgical tool "ST", e.g. supporting an end effector 1050, 1060, can be attached. One of the surgical tools "ST" can be a surgical instrument 100 Figure 1 ), wherein manual holding and actuation features, e.g. a housing 112, an actuation button 120, a movable handle 130, a rotary knob 156, etc. (see Figure 1 ), are replaced with robotic inputs. For example and temporarily referring to Figure 1 , the housing 112 can be configured such that mechanical, magnetic and / or electromechanical engagement features replace the fixed handle portion of the housing to enable releasable attachment of the housing 112 to one of the attachment devices 1009, 1011. Likewise, the movable handle 130, the rotary knob 156 and the one or more articulation knobs 142 are replaced with suitable robotic couplings, e.g. rotary input couplings, such that, for example, a motor-driven rotary output from the attachment device 1009, 1011 to the corresponding robotic coupling actuates the drive assembly to actuate, rotate or articulate the end effector assembly 160 accordingly. Similarly, energy activation can be accomplished via one or more physical or virtual buttons associated with the operating console 1005 or other components of the robotic surgical system 1000, rather than having an activation button 120 provided on the housing 112. Further, the robotic surgical system 1000 can comprise or be configured to be connected to a surgical generator 200, e.g. via a cable assembly 190 or in any other suitable manner. In aspects, activation can also be selected (e.g. initiated and / or terminated) from the surgical generator 200 Figure 1 ).

[0046] Continuing to refer to Figure 2 , the other surgical tool(s) "ST" of the robotic surgical system 1000 can comprise any other suitable surgical instrument(s), e.g. an endoscopic camera, a grasper, other surgical tools, etc. The robotic arms 1002, 1003 can be driven by electric drives, e.g. motors, connected to a control device 1004, e.g. a computer. The control device 1004, e.g. a computer, can be configured to activate the motors, in particular by means of 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 movements and / or functions according to the corresponding inputs from the manual input devices 1007, 1008, respectively. The control device 1004 can also be configured in such a way that it regulates the motion of the robotic arms 1002, 1003 and / or the motors.

[0047] Turning toFigure 3 The end effector assembly 160 is shown disposed at a distal end portion of an outer shaft 152 of a surgical instrument 100 (see Figure 1 ) of a surgical system 10 (see FIG. 1), e.g., connected to the outer shaft 152 via the articulation assembly 140, although the end effector assembly 160 can be used with any other suitable surgical instrument and / or surgical system. The end effector assembly 160 includes a horseshoe clip 166a connected to the articulation assembly 140 (or, in aspects in which the articulation assembly 140 is omitted or positioned intermediate between the proximal and distal portions of the outer shaft 152, to the distal portion of the outer shaft 152). As noted above, the end effector assembly 160 further includes a first jaw member 162 and a second jaw member 164, at least one of which is movable relative to the other (and the horseshoe clip 166a) between a spaced-apart position and an approximated position (e.g., pivotable about a pivot 166b) to grasp tissue between the first and second jaw members 162, 164 to effect sealing, severing, and / or sensing of the grasped tissue, as detailed below.

[0048] The end effector assembly 160 is shown as a bilateral assembly, e.g., where both the first jaw member 162 and the second jaw member 164 are movable (e.g., about a pivot 166b, which can be a pivot pin or other suitable pivot structure) relative to each other and the horseshoe 166a between a spaced-apart position and an approximated position. However, unilateral assemblies are also contemplated, e.g., where one jaw member 162, 164 is fixed relative to the horseshoe 166a, while the other jaw member 162, 164 is movable relative to the fixed jaw member 162, 164 and the horseshoe 166a between a spaced-apart position and an approximated position. Further, to drive movement of either or both of the jaw members 162, 164, the inner driver 154 of the elongate assembly 150 can be coupled with either or both of the jaw members 162, 164 via a cam pin-cam slot mechanism, a pulley mechanism, a linkage mechanism, a gear mechanism, a lead screw mechanism, or in any other suitable manner, such that movement (e.g., translational movement and / or rotational movement) of the inner driver 154 moves either or both of the jaw members 162, 164 between the spaced-apart position and the approximated position (depending on the direction of movement of the inner driver 154). The jaw members 162, 164 can define a linear configuration along their length, can define a curved configuration along their length, or can define any other suitable configuration, e.g., including one or more linear, angled, and / or curved segments along their length. With at least partially curved or angled configurations, the jaw members 162, 164 can be curved or angled in any suitable direction, e.g., where the jaw members 162, 164 are curved toward each other and away from each other, respectively (or vice versa), or where the jaw members 162, 164 are curved laterally (in either direction). Further, the jaw members 162, 164 can be formed to include multiple angled segments and / or curves in similar directions, multiple angled segments and / or curves in different directions within a single plane, and / or multiple angled segments and / or curves in different directions in different planes. In addition, the jaw members 162, 164 can additionally or alternatively be formed to include other suitable features, such as, e.g., a tapered configuration along their length, a varying cross-sectional configuration along their length, cutouts, notches, edges, protrusions, straight surfaces, curved surfaces, angled surfaces, wide edges, narrow edges, and / or other features.

[0049] Further reference is made to Figure 4A and Figure 4BEach gripper member 162, 164 of the end effector assembly 160 includes a structural gripper frame 163a, 165a and an insulating gripper body 163b, 165b. The structural gripper frames 163a, 165a provide structural support for the gripper members 162, 164 and may be formed of metal or other suitable materials. The insulating gripper bodies 163b, 165b are each formed from one or more components or portions of one or more electrically insulating materials and may include, for example, one or more overmolded parts, spacers, and / or other suitable components. The insulating gripper bodies 163b, 165b are engaged to the structural gripper frames 163a, 165a and may at least partially surround the structural gripper frames.

[0050] The gripper member 162 further includes a first ultrasonic plate portion 167a and a second ultrasonic plate portion 167b disposed on the inner surface of the insulating gripper body 163b, such that the first ultrasonic plate portion 167a and the second ultrasonic plate portion 167b define tissue contact surfaces 170a, 170b oriented toward the gripper member 164. The first ultrasonic plate portion 167a and the second ultrasonic plate portion 167b are spaced apart from each other in a transverse direction across the gripper member 162, such that a transverse gap 168 is defined between the first ultrasonic plate portion 167a and the second ultrasonic plate portion 167b along at least a portion of their length. A portion of the insulating gripper body 163b may be exposed within the transverse gap 168; in other respects, the gripper member 162 includes a separate component (not shown) disposed within the transverse gap 168, such as, for example, a compliant pad formed of PTFE, silicone, rubber or other suitable elastic compressible (elastomer) material.

[0051] In all respects, the first ultrasonic plate portion 167a and the second ultrasonic plate portion 167b are spaced apart along their entire length and are electrically isolated from each other (and from the surgical generator 200). Figure 1 (separate electrical connections) to enable independent activation of the first ultrasonic plate portion 167a and the second ultrasonic plate portion 167b. In other aspects, the first ultrasonic plate portion 167a and the second ultrasonic plate portion 167b may be connected at their distal ends (e.g., defining a U-shaped configuration) to maintain a lateral gap 168 along most of their length rather than along their entire length. In such an aspect, the first ultrasonic plate portion 167a and the second ultrasonic plate portion 167b may share with the surgical generator 200 ( Figure 1 (Although separate electrical connection devices can also be envisioned.)

[0052] The first and second ultrasonic plate portions 167a, 167b can each include one or more layers of material stacked on one another, one or more strips of material positioned side-by-side one another, and / or one or more concentric rings of material. The first and second ultrasonic plate portions 167a, 167b are at least partially formed of or include piezoelectric transducer (PZT) material and / or other suitable ultrasonic transducer material (e.g., magnetostrictive material) such that the ultrasonic plate portions 167a, 167b generate mechanical ultrasonic vibration energy in response to receiving electrical ultrasonic drive signal(s) from the surgical generator 200 Figure 1 ] and / or such that the ultrasonic plate portions 167a, 167b convert their mechanical ultrasonic vibration energy into electrical feedback signal(s) for communication with the surgical generator 200 Figure 1 ] to enable tissue treatment with ultrasonic energy and / or ultrasonic tissue sensing accordingly.

[0053] The first and second ultrasonic plate portions 167a, 167b can be configured to generate similar or different vibration modes. In particular, the first and second ultrasonic plate portions 167a, 167b can be configured to generate lateral vibration energy (e.g., laterally in either or both directions across the jaw member 162), vertical vibration energy toward the jaw member 164, torsional vibration energy, combinations thereof, etc.

[0054] In aspects, the jaw member 162 includes first and second walls 171 that extend along at least a portion of the length of the jaw member 162 on the outer circumferential side of the jaw member 162 (e.g., laterally outwardly of the first and second ultrasonic plate portions 167a, 167b, respectively). The first and second walls 171 extend farther toward the jaw member 164 than the first and second ultrasonic plate portions 167a, 167b. The first and second walls 171 can be at least partially formed of or include electrically conductive material that defines electrically conductive surfaces 172 that can be disposed on laterally inner surfaces of the walls 171, laterally outer surfaces of the walls 171, and / or as shown, on surfaces of the walls 171 that are oriented toward the jaw member 174. The electrically conductive surfaces 172 are electrically isolated from the first and second ultrasonic plate portions 167a, 167b, e.g., via the insulating jaw body 163b, and are adapted (individually or collectively) for connection to the surgical generator 200 Figure 1 ] to enable the conduction of electrosurgical (RF) energy through tissue to treat and / or sense tissue, as detailed below. The walls 171 can further include electrically insulative portions, e.g., on all portions other than the surfaces 172. Alternatively, the entire walls 171 can be electrically conductive (with or without an insulative coating on portions thereof).

[0055] In aspects, the wall 171 is entirely electrically insulative, and the electrically conductive surface 172 is omitted. In yet other aspects, the wall 171 is omitted, and likewise the electrically conductive surface 172 is omitted, or the electrically conductive surface is otherwise positioned on the jaw member 162, e.g., on either or both lateral sides of the insulative jaw body 163b and / or on the outer face of the insulative jaw body 163b. In the aspects provided, the wall 171 and / or the electrically conductive surface 172 can terminate proximal of the distal extent of the first and second ultrasonic plate portions 167a, 167b, as shown in FIGS. 17A and 17B. Figure 3

[0056] With continued reference to Figure 3 and Figure 4A to Figure 4B , the jaw member 164 further includes a first electrically conductive plate portion 173a and a second electrically conductive plate portion 173b disposed on the inner face of the insulative jaw body 165b, such that the first and second electrically conductive plate portions 173a, 173b define tissue contact faces 174a, 174b oriented toward the jaw member 162. As such, in the approximated position of the jaw members 162, 164, tissue is grasped between the tissue contact faces 174a, 174b of the first and second electrically conductive plate portions 173a, 173b of the jaw member 164 and the tissue contact faces 170a, 170b of the first and second ultrasonic plate portions 167a, 167b of the jaw member 162, respectively.

[0057] The first and second electrically conductive plate portions 173a, 173b are spaced apart from one another in the transverse direction across the jaw member 164, such that a transverse gap 175 is defined between the electrically conductive plate portions 173a, 173b along at least a portion of their lengths. As used herein, the term "plate" is not limited to any particular method of formation or resulting thickness; indeed, as used herein, the term "plate" includes "plates" that are pre-formed and subsequently attached, "plates" that are deposited directly onto another component (e.g., via spray deposition techniques, etc.), "plates" that are formed by removing material to expose an underlying layer, and the like.

[0058] In aspects, the first and second electrically conductive plate portions 173a, 173b are spaced apart along their entire lengths, and are electrically isolated from one another (and from the surgical generator 200 Figure 1 ​) to enable independent activation of the first and second conductive plate portions 173a, 173b. In other aspects, the first and second conductive plate portions 173a, 173b can be joined at their distal ends (e.g., defining a U-shaped configuration) to maintain the lateral gap 175 along a majority of their lengths, but not along their entire lengths. In such aspects, the first and second conductive plate portions 173a, 173b can share a common electrical connection to the surgical generator 200 (although separate electrical connections are also contemplated). Figure 1

[0059] The conductive plate portions 173a, 173b are adapted to be connected to the surgical generator 200 ( Figure 1 ) to enable energization of the conductive plate portions 173a, 173b with RF energy. In aspects, the conductive plate portions 173a, 173b are electrically isolated and are energizable with RF energy at different potentials to conduct electrosurgical energy between the conductive plate portions 173a, 173b and conduct electrical energy through tissue grasped between the jaw members 162, 164 to treat (e.g., seal) the grasped tissue. In such configurations, the RF energy flows generally laterally (e.g., laterally) through the jaw members 164 and through the grasped tissue to treat the tissue. Alternatively or additionally, the conductive plate portions 173a, 173b are energizable with RF energy at different potentials than either or both of the conductive surfaces 172 of the walls 171 of the jaw members 162 (in aspects where the conductive surfaces 172 are provided) such that electrosurgical energy is conducted between the jaw members 162, 164 and electrical energy is conducted through tissue grasped therebetween to treat (e.g., seal) the grasped tissue. The above electrical pathways, although described with respect to tissue treatment, are equally applicable to electrosurgical tissue sensing.

[0060] Still referring to Figure 3 and Figure 4A to Figure 4B , the blade 176 engaged within the insulative jaw body 165b of the jaw member 164 is disposed within the lateral gap 175 and protrudes beyond the conductive plate portions 173a, 173b of the jaw member 164, further toward the jaw member 162, such that in the approximated position of the jaw members 162, 164, the blade 176 is disposed very close to or extends into the lateral gap 168 of the jaw member 162. In other aspects, this configuration is reversed, e.g., where the blade 176 is disposed on the jaw member 162 and in the approximated position of the jaw members 162, 164, the blade 176 is disposed very close to or extends into the lateral gap 175 of the jaw member 164. Figure 4B Figure 4B ​​) extends into or into a transverse gap 175 of the jaw member 164. The blade 176 can define a blunt tissue contact face, one or more tissue contact edges, and / or any other suitable features (e.g., a tapered configuration, various different cross-sectional configurations along its length, notches, indentations, edges, protrusions, straight surfaces, curved surfaces, angled surfaces, wide edges, narrow edges, and / or other features).

[0061] The blade 176 is at least partially formed of or includes piezoelectric transducer (PZT) material and / or other suitable ultrasonic transducer material (e.g., magnetostrictive material) and is electrically connected to the surgical generator 200 ( Figure 1 ) such that the blade 176 generates mechanical ultrasonic vibrational energy in response to receiving electrical ultrasonic drive signal(s) from the surgical generator 200 ( Figure 1 ) and / or such that the blade 176 converts its mechanical ultrasonic vibrational energy into electrical feedback signal(s) for communication with the surgical generator 200 ( Figure 1 ), thus enabling tissue treatment (e.g., tissue dissection) and / or ultrasonic tissue sensing, respectively, with ultrasonic energy. The blade 176 can be configured to generate any suitable vibrational mode(s), such as, for example, transverse vibrational energy (e.g., laterally in either or both directions across the jaw member 164), vertical vibrational energy toward the jaw member 162, torsional vibrational energy, combinations thereof, or the like.

[0062] The blade 176 and / or the ultrasonic plate portions 167a, 167b can be coated, in whole or selectively, with a suitable material, such as, for example, a non-stick material, an electrically insulative material, an electrically conductive material, combinations thereof, or the like. Suitable coatings and / or methods of applying the coatings include, but are not limited to, Teflon®, polyphenylene oxide (PPO), deposited liquid ceramic insulative coatings; thermal spray coatings, such as thermal spray ceramic; plasma electrolytic oxidation (PEO) coatings; anodized coatings; sputtered coatings, such as silicon dioxide; Electro Bond® coatings, available from Surface Solutions Group of Chicago, IL, USA; or other suitable coatings and / or methods of applying the coatings.

[0063] With continued reference to Figure 3 and Figure 4A to Figure 4B , in use, the jaw members 162, 164 are moved from a spaced-apart position ( Figure 4A ) to an approximated position ( Figure 4B) to grasp tissue between the jaw members, and more particularly, between the tissue-contacting surfaces 170a, 170b of the first and second ultrasonic plate portions 167a, 167b of the respective jaw member 162 and the tissue-contacting surfaces 174a, 174b of the first and second electrically-conductive plate portions 173a, 173b of the jaw member 164. In aspects, in the approximated position (FIG. 10A) Figure 4B ) the wall 171 at least partially overlaps the jaw member 164 on the outer lateral side thereof. Alternatively, the wall 171 can extend to the tissue-contacting surfaces 174a, 174b, or can be vertically spaced apart therefrom.

[0064] With tissue grasped between the jaw members 162, 164, the first and second electrically-conductive plate portions 173a, 173b and / or the electrically-conductive surface 172 are energized with RF energy at two or more different potentials to create at least one potential gradient for conducting RF energy between the jaw members and through the grasped tissue. As described above, the RF energy (e.g., current) can flow laterally through and / or between the jaw members 162, 164 and through the tissue grasped therebetween. The RF energy (laterally and / or vertically between the jaw members 162, 164) conducts through the tissue (via Joule heating) to heat the grasped tissue, for example, to seal or otherwise treat the grasped tissue. In aspects, the surgical generator 200 (FIG. 1) is configured to implement current-based control, voltage-based control, tissue impedance-based control, time duration-based control, combinations thereof, and / or other suitable control of the RF energy to achieve a desired tissue treatment, e.g., tissue sealing. Figure 1 ) is configured to implement current-based control, voltage-based control, tissue impedance-based control, time duration-based control, combinations thereof, and / or other suitable control of the RF energy to achieve a desired tissue treatment, e.g., tissue sealing.

[0065] Concurrent with, overlapping, alternating, or in any other suitable manner with the supply of RF energy is the supply of an ultrasonic drive signal to the ultrasonic plate portions 167a, 167b to cause the ultrasonic plate portions 167a, 167b to ultrasonically vibrate against the grasped tissue. The transmission of such ultrasonic vibratory energy to the grasped tissue (via conductive heating) heats the grasped tissue, thereby facilitating tissue sealing (or other tissue treatment). The surgical generator 200 (FIG. 1) is configured to implement current-based control, voltage-based control, tissue impedance-based control, time duration-based control, combinations thereof, and / or other suitable control of the ultrasonic drive signal to achieve a desired tissue treatment, e.g., tissue sealing. Figure 1The ultrasonic drive signal can be controlled to achieve a desired ultrasonic vibration output of the ultrasonic pad portions 167a, 167b, and can be varied to achieve different ultrasonic vibration outputs, e.g., a first output corresponding to a first vibration amplitude (e.g., LOW power) and a second output corresponding to a second, greater vibration amplitude (e.g., HIGH power). Thus, both RF energy and ultrasonic energy can be controlled to facilitate tissue sealing or other tissue treatment.

[0066] With respect to tissue sensing, the surgical generator 200 (e.g., via the processor 202) can monitor the impedance of the grasped tissue by monitoring the RF signals transmitted to and from the jaw members 162, 164. The surgical generator 200 (e.g., via the processor 202) can also receive feedback from the ultrasonic pad portions 167a, 167b via the electrical connections to the ultrasonic pad portions, to enable the ultrasonic pad portions 167a, 167b to function as ultrasonic sensors that can sense tissue temperature, tissue stiffness, and / or jaw pressure on the tissue. With these RF and / or ultrasonic sensing parameters, the surgical generator 200 (e.g., via the processor 202) can control either energy modality or both energy modalities to achieve and maintain a desired tissue temperature and / or tissue temperature profile. Additionally or alternatively, the surgical generator 200 (e.g., via the processor 202) can use these sensed parameters to assess the status of tissue sealing and / or can determine when tissue sealing is complete, e.g., based on whether the sensed parameters meet predetermined criteria. Figure 1 Figure 1 Figure 1 Figure 1

[0067] Once the grasped tissue is sealed, or in other instances where it is desired to separate the grasped tissue, the blade 176 can be activated by the ultrasonic drive signal to heat and ultimately separate the sealed tissue on the tissue sealing device by ultrasonically exciting the blade 176. The geometry of the blade 176 facilitates tissue separation, while the geometry of the ultrasonic pad portions 167a, 167b facilitates tissue sealing. During tissue separation, the conductive pad portions 173a, 173b and / or the ultrasonic pad portions 167a, 167b can be turned off (e.g., not excited); alternatively, the conductive pad portions 173a, 173b and / or the ultrasonic pad portions 167a, 167b can be excited during excitation of the blade 176 to achieve tissue treatment and / or tissue sensing, to thereby facilitate tissue separation. Further, in aspects, the blade 176 can be used for ultrasonic sensing during tissue sealing and / or tissue separation (similar to that detailed above).

[0068] ​​​​Alternatively or alternatively, the blade 176 can be used for open gripper separation, for example by moving the end effector assembly 160 relative to the tissue so that the blade 176 can dynamically cut the tissue as the end effector assembly 160 moves relative to the tissue.

[0069] Turn Figure 5 This illustrates another end effector component 560 provided according to this disclosure. End effector component 560 is similar to end effector component 160 ( Figure 3 to Figure 4B Any feature of the end effector assembly 560 and the end effector assembly 160 ( ) may be included. Accordingly, for the sake of brevity, only the end effector assembly 560 and the end effector assembly 160 ( ) are described in detail below. Figure 3 to Figure 4B The differences between them are briefly described or the similarities are omitted entirely.

[0070] The end effector assembly 560 includes: ultrasonic plate portions 567a and 567b disposed on one of the gripper members 562 and 564 (e.g., gripper member 564); and conductive plate portions 573a and 573b disposed on both gripper members 562 and 564. Regarding the gripper member 564 comprising both conductive plate portions 573a and 573b and ultrasonic plate portions 567a and 567b, the conductive plate portions 573a and 573b may be correspondingly stacked on the ultrasonic plate portions 567a and 567b, although the opposite configuration is also conceivable. The conductive plate portions 573a and 573b of the gripper members 562 and 564 can be charged to different potentials in any suitable manner, and in various respects, they can be generated by the surgical generator 200 ( Figure 1 The configuration is as follows: For example, in some aspects, the conductive plate portions 573a and 573b of the gripper member 562 can be charged to a first potential, and the conductive plate portions 573a and 573b of the gripper member 564 can be charged to different second potentials for vertically conducting energy between the gripper members 562 and 564. In other aspects, the conductive plate portion 573a of the gripper members 562 and 564 can be charged to a first potential, and the conductive plate portion 573b of the gripper members 562 and 564 can be charged to different second potentials for laterally conducting energy on the gripper members 562 and 564.

[0071] Continue to refer to Figure 5 The blade 576 is shown engaging with the gripper member 564, although alternatively the blade 576 may engage with the gripper member 562. Similar to what has been detailed above, the end effector assembly 560 may (in various respects, with the aid of electrosurgery and / or additionally with the aid of ultrasound) be used for electrosurgery and / or ultrasound tissue treatment and / or sensing, and also for ultrasound tissue dissection.

[0072] refer to Figure 6The end effector assembly 660 is similar to the end effector assembly 560 ( Figure 5 The end effector assembly 660 may include any of its features, except that both gripper members 662, 664 include conductive plate portions 673a, 673b respectively stacked on the ultrasonic plate portions 667a, 667b, although the opposite configuration is also conceivable. The end effector assembly 660 may define the above-described end effector assembly 560 ( Figure 5 Any electrical pathway detailed above, and / or similar pathways that can (in all respects, with the aid of electrosurgery and / or additionally with the aid of ultrasound) be used for electrosurgery and / or ultrasound tissue treatment and / or sensing, and can also be used for ultrasound tissue separation.

[0073] refer to Figure 7 and Figure 8 The diagram illustrates blades 776 and 876 with correspondingly different configurations provided in accordance with this disclosure. Blades 776 and 876 are shown engaging correspondingly with gripper members 764 and 864, although blades 776 and 876 can be used with any gripper member detailed herein or any other suitable gripper member. Figure 7 The blade 776 shown is formed of a PZT crystal 778, which, when excited by an ultrasonic driving signal, is driven to generate mechanical ultrasonic vibration energy. The PZT crystal 778 is further configured to transmit this mechanical ultrasonic vibration energy to the tissue in contact with it. On the other hand, as... Figure 8 The blade 876 shown includes a PZT crystal substrate 878 and a blade body 879 attached to the PZT crystal substrate 878 (e.g., stacked thereon, received therein, surrounding, or otherwise attached to the PZT crystal substrate 878). The PZT crystal substrate 878 is configured to be excited by an ultrasonic drive signal to generate mechanosonic vibration energy, which is transmitted to the blade body 879. The blade body 879 is further configured to transmit the mechanosonic vibration energy to tissue in contact with it. In various respects, the blade body 879 is formed of ceramic, titanium (or other suitable metal), or other suitable materials.

[0074] Figure 9The surgical generator 200 is illustrated, and more specifically, internal operable features associated with the electrosurgical and ultrasonic functions of the surgical generator are schematically illustrated. The surgical generator 200 includes a controller 282, one or more power supplies 283a, 283b, an RF output stage 284, RF sensor circuitry 288a, an ultrasonic drive signal output 287, an amplifier / filter 289, and ultrasonic sensor circuitry 288b. The controller 282 includes one or more processors 285 and associated memory(ies) 286 that, for example, store instructions to be executed by the processor(s) 285 to control the electrosurgical energy output by the RF output stage 284, control the ultrasonic drive signal output by the ultrasonic drive signal output 287, receive electrosurgical feedback from the RF sensor circuitry 288a, and receive ultrasonic feedback from the ultrasonic sensor circuitry 288b.

[0075] The power supply 283a can be a high-voltage DC power supply configured to provide high-voltage DC power to the RF output stage 284, which converts the high-voltage DC power to RF electrosurgical energy for delivery to the end effector assembly 160 Figure 3 to Figure 4B ), for example, to one or more of the electrosurgical components of the end effector assembly 160: the conductive plate portions 173a, 173b, and / or the conductive surface 172 (see Figure 3 to Figure 4B ); and to receive return energy from one or more of the electrosurgical components of the end effector assembly 160 Figure 3 to Figure 4B ) to complete a return loop back to the surgical generator 200. The RF sensor circuitry 288a is operably coupled with input and output electrical lines to and from the RF output stage 284 to sense electrical parameters of the energy delivered to and returned from the end effector assembly 160 Figure 3 to Figure 4B ), for example, the voltage, current, resistance, etc. of the energy, and determine one or more parameters of the tissue (e.g., the impedance of the tissue) based on the electrical parameters. The RF sensor circuitry 288a provides feedback to the controller 282 based on the sensed parameter(s) of the tissue, which in turn selects an energy delivery algorithm, modifies an energy delivery algorithm, and / or adjusts energy delivery parameters of the electrosurgical energy and / or ultrasonic energy based at least in part on the sensed parameter(s) of the tissue.

[0076] In addition to the controller 282 controlling the supply of electrosurgical energy and / or ultrasonic energy to treat tissue or as an alternative thereto, the controller 282 can be configured to interrogate (e.g., sense) tissue, such as, for example, where the RF sensor circuitry 288a senses one or more electrical parameters to provide feedback to the controller 282, such as, for example, to enable determination of the impedance of the tissue. That is, in lieu of or in conjunction with electrosurgical tissue treatment, the surgical generator 200 enables interrogation of tissue with electrosurgical energy (without supplying tissue treatment electrosurgical energy as detailed above). The tissue interrogation can be initiated in a bipolar electrosurgical interrogation mode and / or a monopolar electrosurgical interrogation mode. In aspects, the electrosurgical interrogation can be performed without any treatment energy (e.g., with the electrosurgical treatment energy and ultrasonic treatment energy turned off), for example, to evaluate tissue prior to treatment (e.g., to determine a treatment type, appropriate energy delivery algorithm, and / or appropriate energy delivery parameters), to evaluate tissue after treatment (e.g., to determine that tissue treatment is complete and / or the status of treated tissue or surrounding tissue), or to evaluate tissue in other circumstances.

[0077] With respect to tissue interrogation, the controller 282 is configured to transmit an interrogation signal according to any of the electrosurgical pathways detailed above, such that the signal returns to the controller 282 to enable evaluation thereof. The interrogation signal can be a continuous signal, a pulsed signal, or a plurality of pulses. More particularly, the controller 282 is configured to evaluate the returned signal (e.g., the voltage, current, resistance, etc. of the returned signal) and determine one or more parameters of the tissue (e.g., the impedance of the tissue) based on the returned signal that indicate whether the tissue is sufficiently sealed. The controller 282 can then, for example, select an energy delivery algorithm, modify an energy delivery algorithm, and / or adjust energy delivery parameters based on the energy delivery algorithm, including stopping energy delivery.

[0078] With continued reference to Figure 9 The power source 283b (which can be the same as or separate from the power source 283a), the ultrasonic drive signal output 287, and the amplifier / filter 289 are configured to generate an ultrasonic drive signal that is output to one or more of the ultrasonic components of the end effector assembly 160: the ultrasonic blade portion 167a, 167b, and / or the blade 176 (see Figure 3 to Figure 4B) for therapy, e.g., to seal and / or separate tissue. Further, the ultrasonic sensor circuitry 288b is configured to monitor electrical inputs (e.g., voltage, current, resistance, etc.) from one or more of the ultrasonic components of the end effector assembly 160 to provide ultrasonic sensing, e.g., to determine one or more parameters of tissue (such as, for example, tissue temperature, tissue stiffness, and / or clamp jaw pressure on tissue). These sensed tissue parameter(s) are communicated to the controller 282, which in turn selects an energy delivery algorithm, modifies an energy delivery algorithm, and / or adjusts energy delivery parameters of the electrosurgical energy and / or ultrasonic energy (including stopping energy delivery) based at least in part on the sensed tissue parameter(s).

[0079] As shown above, the end effector assembly and surgical generator of the present disclosure enable RF energy tissue treatment for sealing tissue and / or to facilitate tissue separation; ultrasonic energy tissue treatment to facilitate sealing tissue and / or for separating tissue; RF tissue sensing (e.g., for sensing tissue impedance); and ultrasonic tissue sensing (e.g., for sensing tissue temperature, tissue stiffness, and / or clamp jaw pressure on tissue). Some or all of this sensing feedback can be used to adjust the application of electrosurgical energy and / or ultrasonic energy to efficiently and effectively treat (e.g., seal and / or separate) tissue.

[0080] Aspects of the present disclosure can be further described by reference to the following examples:

[0081] Example 1. A surgical instrument comprising: an end effector assembly comprising: first and second jaw members, at least one of the first or second jaw members movable relative to the other between a spaced-apart position and an approximated position for grasping tissue between the first and second jaw members, the first jaw member comprising first and second electrically conductive tissue contact plate portions configured to conduct radiofrequency (RF) energy through tissue grasped between the first and second jaw members, the second jaw member comprising first and second ultrasonic tissue contact plate portions configured to generate and transmit ultrasonic vibrational energy to tissue grasped between the first and second jaw members.

[0082] Example 2. The surgical instrument of Example 1, wherein one of the first jaw member or the second jaw member further comprises first and second walls extending from respective first and second peripheral sides thereof, the first and second walls comprising first and second electrically conductive surfaces, respectively, the first and second electrically conductive surfaces being electrically isolated from the first and second electrically conductive tissue contact plate portions and configured to be energized to different electrical potentials than the first and second electrically conductive tissue contact plate portions to conduct RF energy therebetween and through tissue grasped between the first and second jaw members.

[0083] Example 3. The surgical instrument of Example 1, wherein the second jaw member further comprises third and fourth electrically conductive tissue contact plate portions, at least two of the first, second, third, or fourth electrically conductive tissue contact plate portions being electrically isolated and configured to be energized to different electrical potentials to conduct RF energy therebetween and through tissue grasped between the first and second jaw members.

[0084] Example 4. The surgical instrument of Example 3, wherein the third electrically conductive tissue contact plate portion and the first ultrasonic tissue contact plate portion are stacked on the second jaw member relative to one another, and wherein the fourth electrically conductive tissue contact plate portion and the second ultrasonic tissue contact plate portion are stacked on the second jaw member relative to one another.

[0085] Example 5. The surgical instrument of Example 1, wherein the first jaw member further comprises third and fourth ultrasonic tissue contact plate portions configured to generate and transmit ultrasonic vibrational energy to tissue grasped between the first and second jaw members.

[0086] Example 6. The surgical instrument of Example 5, wherein the first electrically conductive tissue contact plate portion and the third ultrasonic tissue contact plate portion are stacked on the first jaw member relative to one another, and wherein the second electrically conductive tissue contact plate portion and the fourth ultrasonic tissue contact plate portion are stacked on the first jaw member relative to one another.

[0087] Example 7. The surgical instrument of Example 1, wherein the first and second ultrasonic tissue contact plate portions are configured to sense at least one parameter of tissue in contact therewith.

[0088] Example 8. The surgical instrument of Example 1, wherein one of the first jaw member or the second jaw member includes an ultrasonic blade disposed between its plate portions, the ultrasonic blade configured to generate and transmit ultrasonic vibrational energy to tissue grasped between the first jaw member and the second jaw member.

[0090] Example 9. The surgical instrument of Example 8, wherein the ultrasonic blade is formed of a piezoelectric material.

[0091] Example 10. The surgical instrument of Example 8, wherein the ultrasonic blade includes a piezoelectric substrate and a transmission body coupled to the piezoelectric substrate.

[0092] Example 11. The surgical instrument of Example 8, wherein the ultrasonic blade is configured to sense at least one parameter of tissue in contact therewith.

[0093] Example 12. The surgical instrument of Example 1, wherein the first and second electrically conductive tissue-contacting plate portions are connected at their ends to define a U-shaped configuration.

[0094] Example 13. The surgical instrument of Example 1, wherein the first and second electrically conductive tissue-contacting plate portions are electrically isolated from one another.

[0095] Example 14. The surgical instrument of Example 1, wherein the end effector assembly further includes a horseshoe clamp, the first and second jaw members are operably coupled with the horseshoe clamp, and the first and second jaw members are movable relative to one another and the horseshoe clamp between the spaced-apart position and the approximated position.

[0096] Example 15. The surgical instrument of Example 1, wherein the second jaw member further includes a structural jaw frame that supports an insulative jaw body thereon, and wherein the first and second ultrasonic tissue-contacting plate portions are disposed in spaced-apart relation to one another on the insulative jaw body.

[0097] Example 16. The surgical instrument of Example 1, further comprising a surgical robot, wherein the end effector assembly is configured to be releasably connected to the surgical robot.

[0098] Example 17. The surgical instrument of Example 1, further comprising a handle assembly, wherein the end effector assembly is operably coupled to the handle assembly.

[0099] Example 18. A surgical system comprising: an end effector assembly including a first gripper member and a second gripper member, at least one of the first gripper member or the second gripper member being movable relative to the other between a spaced-out position and a proximal position for gripping tissue between the first gripper member and the second gripper member, the end effector assembly further including at least one conductive tissue contact plate portion and at least one ultrasonic tissue contact plate portion; and A surgical generator configured to: output radio frequency (RF) therapeutic energy to at least one conductive tissue contact plate portion; output an ultrasonic drive signal to at least one ultrasonic tissue contact plate portion; sense feedback from at least one conductive tissue contact plate portion; and sense feedback from at least one ultrasonic tissue contact plate portion, the surgical generator being configured to control the output of RF therapeutic energy and the output of the ultrasonic drive signal based on the sensed feedback from at least one conductive tissue contact plate portion and the sensed feedback from at least one ultrasonic tissue contact plate portion, to seal tissue gripped between the first gripper member and the second gripper member.

[0100] Example 19. A surgical system according to Example 18, wherein the surgical generator is configured to determine at least one of the following based on sensed feedback from the at least one ultrasonic tissue contact plate portion: the temperature of the tissue grasped between the first gripper member and the second gripper member, the stiffness of the tissue grasped between the first gripper member and the second gripper member, or the gripper pressure applied to the tissue grasped between the first gripper member and the second gripper member.

[0101] Example 20. A surgical system according to Example 19, wherein the surgical generator is configured to determine the impedance of the tissue being gripped between the first gripper member and the second gripper member based on feedback sensed from the at least one conductive tissue contact plate portion.

[0102] Example 21. The surgical system according to Example 18, wherein the end effector assembly further includes an ultrasonic blade engaged with one of the first gripper member or the second gripper member, and wherein the surgical generator is further configured to output an ultrasonic drive signal to the ultrasonic blade to separate tissue gripped between the first gripper member and the second gripper member.

[0103] Example 22. A surgical system according to Example 18, wherein the surgical generator is configured to control the output using temperature-based control.

[0104] Example 23. The surgical system of Example 18, wherein the surgical generator is configured to control the output to terminate energy delivery when the sensed feedback indicates that the tissue grasped between the first jaw member and the second jaw member is sealed.

[0105] While several aspects of the present disclosure have been described in connection with the preferred embodiments of the various aspects and implementations of the present disclosure, it will be understood that the scope of the disclosure encompasses other aspects and implementations not specifically shown. For example, although the disclosure has been described with respect to a single surgical instrument, the disclosure can be used in connection with multiple surgical instruments. Furthermore, the scope of the disclosure encompasses various modifications and alterations of the described implementations and implementations thereof. It is intended, therefore, to embrace all such alterations and modifications as fall within the scope of the present disclosure. Thus, the above description should not be construed as limiting, but merely as illustrative of particular aspects of the present disclosure. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims

1. A surgical instrument (100), comprising: End effector assemblies (160, 560, 660), the end effector assemblies comprising: A first gripper member and a second gripper member (162, 164; 562, 564; 662, 664), at least one of the first gripper member or the second gripper member being movable relative to the other between a spaced-out position and a proximal position, for gripping tissue between the first gripper member and the second gripper member. The first gripper member includes a first conductive tissue contact plate portion and a second conductive tissue contact plate portion (173a, 173b; 573a, 573b; 673a, 673b), the first conductive tissue contact plate portion and the second conductive tissue contact plate portion being configured to conduct radio frequency (RF) energy through the tissue gripped between the first gripper member and the second gripper member. The second gripper component includes a first ultrasonic tissue contact plate portion and a second ultrasonic tissue contact plate portion (167a, 167b; 567a, 567b; 667a, 667b), the first ultrasonic tissue contact plate portion and the second ultrasonic tissue contact plate portion being configured to generate ultrasonic vibration energy and transmit the ultrasonic vibration energy to the tissue being gripped between the first gripper component and the second gripper component.

2. The surgical instrument (100) according to claim 1, wherein, One of the first gripper member or the second gripper member further includes a first wall and a second wall (171) extending from their respective first and second peripheral sides, the first wall and the second wall (171) respectively including a first conductive surface and a second conductive surface (172), the first conductive surface and the second conductive surface (172) contacting the first conductive tissue contact plate portion and the second conductive tissue contact plate portion (173a, 173b). 573a, 573b; 673a, 673b) Electrically isolated and configured to be excited to a different potential than the first conductive tissue contact plate portion and the second conductive tissue contact plate portion, so as to conduct RF energy therebetween and conduct it through the tissue gripped between the first gripper member and the second gripper member.

3. The surgical instrument (100) according to claim 1 or 2, wherein, The second gripper component further includes a third conductive tissue contact plate portion and a fourth conductive tissue contact plate portion (573a, 573b); (673a, 673b) At least two of the first conductive tissue contact plate portion, the second conductive tissue contact plate portion, the third conductive tissue contact plate portion, or the fourth conductive tissue contact plate portion are electrically isolated and configured to be excited to different potentials to conduct RF energy between them and through the tissue gripped between the first gripper member and the second gripper member.

4. The surgical instrument (100) according to claim 3, wherein, The third conductive tissue contact plate portion and the first ultrasonic tissue contact plate portion are stacked on the second gripper member relative to each other, and wherein the fourth conductive tissue contact plate portion and the second ultrasonic tissue contact plate portion are stacked on the second gripper member relative to each other.

5. The surgical instrument (100) according to any of the preceding claims, wherein, The first gripper component further includes a third ultrasonic tissue contact plate portion and a fourth ultrasonic tissue contact plate portion (667a, 667b), the third ultrasonic tissue contact plate portion and the fourth ultrasonic tissue contact plate portion being configured to generate ultrasonic vibration energy and transmit the ultrasonic vibration energy to the tissue being gripped between the first gripper component and the second gripper component.

6. The surgical instrument (100) according to claim 5, wherein, The first conductive tissue contact plate portion and the third ultrasonic tissue contact plate portion are stacked on the first gripper member relative to each other, and wherein the second conductive tissue contact plate portion and the fourth ultrasonic tissue contact plate portion are stacked on the first gripper member relative to each other.

7. The surgical instrument (100) according to any of the preceding claims, wherein, The first ultrasonic tissue contact plate portion and the second ultrasonic tissue contact plate portion are configured to sense at least one parameter of the tissue in contact with them.

8. The surgical instrument (100) according to any of the preceding claims, wherein, One of the first gripper member or the second gripper member includes an ultrasonic blade (176, 576, 676, 776, 876) disposed between its plate portions, the ultrasonic blade being configured to generate ultrasonic vibration energy and transmit the ultrasonic vibration energy to tissue gripped between the first gripper member and the second gripper member.

9. The surgical instrument (100) according to claim 8, wherein, The ultrasonic blade is formed of a piezoelectric material (778), or the ultrasonic blade includes a piezoelectric substrate (878) and a transmission body (879) connected to the piezoelectric substrate.

10. The surgical instrument (100) according to claim 8 or 9, wherein, The ultrasonic blade is configured to sense at least one parameter of the tissue in contact with it.

11. The surgical instrument (100) according to any of the preceding claims, wherein, The first conductive tissue contact plate portion and the second conductive tissue contact plate portion are connected at their ends to define a U-shaped configuration, or wherein the first conductive tissue contact plate portion and the second conductive tissue contact plate portion are electrically isolated from each other.

12. The surgical instrument (100) according to any of the preceding claims further includes a surgical robot (1002, 1003), wherein, The end effector assembly (160) is configured to be releasably connected to the surgical robot; or further includes a handle assembly (110), wherein the end effector assembly (160) is operatively coupled to the handle assembly.

13. A surgical system comprising: An end effector assembly (160, 560, 660), the end effector assembly including a first gripper member and a second gripper member (162, 164; 562, 564); (662, 664), at least one of the first gripper member or the second gripper member is movable relative to the other between a spaced-out position and a close position for gripping tissue between the first gripper member and the second gripper member, and the end effector assembly further includes at least one conductive tissue contact plate portion (173a, 173b). 573a, 573b; 673a, 673b) and at least one ultrasound tissue contact plate portion (167a, 167b; 567a, 567b; 667a, 667b); and A surgical generator (200) configured to: output radio frequency (RF) therapeutic energy to the at least one conductive tissue contact plate portion; output an ultrasonic drive signal to the at least one ultrasonic tissue contact plate portion; and sense feedback from the at least one conductive tissue contact plate portion; The surgical generator is configured to control the output of the RF treatment energy and the output of the ultrasound drive signal based on the sensed feedback from the at least one ultrasonic tissue contact plate portion and the sensed feedback from the at least one ultrasonic tissue contact plate portion, in order to seal the tissue gripped between the first gripper member and the second gripper member.

14. The surgical system according to claim 13, wherein, The surgical generator is configured to determine, based on the sensed feedback from the at least one ultrasonic tissue contact plate portion, at least one of the following: the temperature of the tissue gripped between the first and second gripper members, the stiffness of the tissue gripped between the first and second gripper members, or the gripper pressure applied to the tissue gripped between the first and second gripper members.

15. The surgical system according to claim 13 or 14, wherein, The surgical generator is configured to determine the impedance of the tissue being gripped between the first gripper member and the second gripper member based on the sensed feedback from the at least one conductive tissue contact plate portion.

16. The surgical system according to any one of claims 13 to 15, wherein, The end effector assembly further includes an ultrasonic blade (176, 576, 676, 776, 876) engaged with one of the first gripper member or the second gripper member, and wherein the surgical generator is further configured to output an ultrasonic drive signal to the ultrasonic blade to separate tissue gripped between the first gripper member and the second gripper member.

17. The surgical system according to any one of claims 13 to 16, wherein, The surgical generator is configured to control the output using temperature-based control, and / or wherein the surgical generator is configured to control the output to terminate energy delivery when the sensed feedback indicates that the tissue gripped between the first gripper member and the second gripper member is sealed.

Images