Electrosurgical end effector having thermally insulating and thermally conductive portions - Patents.com

Abstract

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

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This nonprovisional application claims the benefit, pursuant to 35 U.S.C. §119(e), of U.S. Provisional Application No. 62 / 955,299, entitled DEVICES AND SYSTEMS FOR ELECTROSURGERY, filed December 30, 2019, the disclosure of which is incorporated herein by reference in its entirety. [Background technology]

[0002] The present invention relates to surgical instruments designed to treat tissue, including, but not limited to, surgical instruments configured to cut and fasten tissue. The surgical instruments may include electrosurgical instruments powered by a generator to effect dissection, cutting, and / or coagulation of tissue during a surgical procedure. The surgical instruments may include instruments configured to cut and staple tissue using surgical staples and / or fasteners. The surgical instruments may be configured for use in open surgical procedures, but have applications in other types of surgery, such as laparoscopic, endoscopic, and robotic-assisted procedures, and may include an end effector that is articulatable relative to a shaft portion of the instrument to facilitate precise positioning within a patient. Summary of the Invention [Means for solving the problem]

[0003] In various embodiments, an electrosurgical instrument is disclosed that includes a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw includes a first conductive skeleton and a first electrically insulative layer. The first conductive skeleton includes a first thermally insulative core and a first thermally conductive outer layer integral with and extending at least partially around the first thermally insulative core. The first electrode is defined by selective application of the first electrically insulative layer to an outer surface of the first thermally conductive outer layer. The second jaw is configured to define a second electrode. The second jaw includes a second conductive skeleton and a second electrically insulative layer. The second conductive skeleton includes a second thermally insulative core and a second thermally conductive outer layer integral with and extending at least partially around the second thermally insulative core. A second electrode is defined by selective application of a second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

[0004] In various embodiments, an electrosurgical instrument is disclosed that includes a jaw configured to define an electrode. The jaw includes a first conductive portion, a second conductive portion, and an electrically insulating layer. The first conductive portion is configured to resist heat transfer through the first conductive portion. The second conductive portion is integral with and extends at least partially around the first conductive portion. The second conductive portion is configured to define a heat sink. The electrode is defined by selective application of an electrically insulating layer to an outer surface of the second conductive portion.

[0005] In various embodiments, an electrosurgical instrument is disclosed that includes a jaw configured to define an electrode. The jaw includes an electrically conductive skeleton and an electrically insulative layer. The electrically conductive skeleton includes a thermally insulative core and a thermally conductive outer layer integral with and extending at least partially around the thermally insulative core. The electrode is defined by selective application of the electrically insulative layer to an outer surface of the thermally conductive outer layer. [Brief description of the drawings]

[0006] The novel features of the various aspects are set forth with particularity in the appended claims. The described aspects, however, both as to structure and method of operation, can best be understood by reference to the following description taken in conjunction with the accompanying drawings. [Figure 1] FIG. 1 illustrates an example of a generator for use in a surgical system, in accordance with at least one aspect of the present disclosure. [Diagram 2] FIG. 1 illustrates one form of a surgical system including a generator and an electrosurgical instrument usable therewith, in accordance with at least one embodiment of the present disclosure. [Diagram 3] FIG. 1 is a schematic diagram of a surgical instrument or tool, according to at least one embodiment of the present disclosure. [Figure 4] FIG. 1 is an exploded view of an end effector of an electrosurgical instrument, according to at least one embodiment of the present disclosure. [Diagram 5] FIG. 5 is a cross-sectional view of the end effector of FIG. 4. [Figure 6] 5A-5C depict three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue. [Figure 7] 5A-5C depict three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue. [Figure 8] 5A-5C depict three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue. [Figure 9] 5A-5C illustrate three different modes of operation of the end effector of FIG. 4 during application of energy to tissue. [Figure 10] 5A-5C illustrate three different modes of operation of the end effector of FIG. 4 during application of energy to tissue. [Figure 11] 5A-5C illustrate three different modes of operation of the end effector of FIG. 4 during application of energy to tissue. [Figure 12] 1A-1C illustrate a method of manufacturing a jaw of an end effector, according to at least one aspect of the present disclosure. [Figure 13]1A-1C illustrate a method of manufacturing a jaw of an end effector, according to at least one aspect of the present disclosure. [Figure 14] FIG. 1 is a partial perspective view of a jaw of an end effector of an electrosurgical instrument according to at least one embodiment of the present disclosure. [Figure 15] 15A-15C show steps in a process for manufacturing the jaw of FIG. 14. [Figure 16] 15A-15C show steps in a process for manufacturing the jaw of FIG. 14. [Figure 17] 15A-15C show steps in a process for manufacturing the jaw of FIG. 14. [Figure 18] 15A-15C show steps in a process for manufacturing the jaw of FIG. 14. [Figure 19] 15A-15C show steps in a process for manufacturing the jaw of FIG. 14. [Figure 20] FIG. 20 is a cross-sectional view of a jaw of an end effector of an electrosurgical instrument taken through line 20-20 of FIG. 22, in accordance with at least one embodiment of the present disclosure. [Figure 21] 21 is a cross-sectional view of the jaws of the end effector of the electrosurgical instrument taken through line 21-21 of FIG. 22. [Figure 22] FIG. 21 is a perspective view of a jaw of an end effector of the electrosurgical instrument of FIG. [Diagram 23] FIG. 1 is a cross-sectional view of a jaw of an end effector of an electrosurgical instrument according to at least one embodiment of the present disclosure. [Figure 24] FIG. 1 is a partial perspective view of a jaw of an end effector of an electrosurgical instrument according to at least one embodiment of the present disclosure. [Diagram 25] FIG. 1 is a cross-sectional view of an end effector of an electrosurgical instrument according to at least one embodiment of the present disclosure. [Figure 26] FIG. 1 is a partially exploded view of an end effector of an electrosurgical instrument, according to at least one embodiment of the present disclosure. [Figure 27] FIG. 1 is an exploded perspective assembly view of a portion of an electrosurgical instrument including an electrical connection assembly according to at least one embodiment of the present disclosure. [Figure 28]FIG. 28 is a top view of an electrical pathway defined within the surgical instrument portion of FIG. 27, in accordance with at least one embodiment of the present disclosure. [Figure 29] FIG. 2 is a cross-sectional view of a flex circuit according to at least one embodiment of the present disclosure. [Diagram 30] FIG. 2 is a cross-sectional view of a flex circuit extending through a coil tube according to at least one embodiment of the present disclosure. [Diagram 31] FIG. 2 is a cross-sectional view of a flex circuit extending through a coil tube according to at least one embodiment of the present disclosure. [Diagram 32] FIG. 2 is a cross-sectional view of a flex circuit extending through a coil tube according to at least one embodiment of the present disclosure. [Diagram 33] FIG. 2 is a cross-sectional view of a flex circuit extending through a coil tube according to at least one embodiment of the present disclosure. [Diagram 34] 13 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure. [Diagram 35] 11 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector and a number of measured parameters of the end effector and tissue, in accordance with at least one aspect of the present disclosure. [Diagram 36] FIG. 1 is a schematic diagram of an electrosurgical system according to at least one aspect of the present disclosure. [Figure 37] 13 is a table illustrating a power scheme for coagulating and cutting a tissue treatment area in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure. [Figure 38] 13A-13D illustrate a tissue treatment cycle applied by an end effector to a tissue treatment region, in accordance with at least one aspect of the present disclosure. [Figure 39] 13A-13D illustrate a tissue treatment cycle applied by an end effector to a tissue treatment region, in accordance with at least one aspect of the present disclosure. [Diagram 40] 13A-13D illustrate a tissue treatment cycle applied by an end effector to a tissue treatment region, in accordance with at least one aspect of the present disclosure. [Diagram 41] 1A illustrates an end effector for applying therapeutic energy to tissue grasped by the end effector, the therapeutic energy being generated by a monopolar power source and a bipolar power source, in accordance with at least one aspect of the present disclosure. [Diagram 42] FIG. 1 is a simplified schematic diagram of an electrosurgical system according to at least one aspect of the present disclosure. [Diagram 43] 13 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector and corresponding temperature readings of the tissue treatment region in accordance with at least one aspect of the present disclosure. [Diagram 44] FIG. 1 illustrates an end effector for treating an artery, according to at least one aspect of the present disclosure. [Diagram 45] FIG. 1 illustrates an end effector for treating an artery, according to at least one aspect of the present disclosure. [Figure 46] 1A illustrates an end effector for applying therapeutic energy to tissue grasped by the end effector, the therapeutic energy being generated by a monopolar power source and a bipolar power source, in accordance with at least one aspect of the present disclosure. [Figure 47] FIG. 1 is a simplified schematic diagram of an electrosurgical system according to at least one aspect of the present disclosure. [Figure 48] 13 is a graph illustrating a power scheme including treatment portions for coagulating and cutting tissue treatment areas and non-treatment areas in a treatment cycle applied by an end effector in accordance with at least one embodiment of the present disclosure. [Figure 49] 13 is a graph illustrating power schemes including coagulation and cutting of tissue treatment areas in a treatment cycle applied by an end effector, and corresponding monopolar and bipolar impedances and their ratios, in accordance with at least one embodiment of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0007] The applicant of the present application owns the following U.S. patent applications, filed on even date herewith, each of which is incorporated herein by reference in its entirety: · Attorney Docket No. END9234USNP1 / 190717-1M, entitled "METHOD FOR AN ELECTROSURGICAL PROCEDURE"; · Agent Docket No. END9234USNP2 / 190717-2, entitled "ARTICULATABLE SURGICAL INSTRUMENT"; · Entitled "SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES," Agent Docket No. END9234USNP3 / 190717-3; · Attorney Docket No. END9234USNP4 / 190717-4, entitled "SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR"; · Attorney Docket No. END9234USNP5 / 190717-5, entitled "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES"; · Attorney Docket No. END9234USNP6 / 190717-6, entitled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT"; · Attorney Docket No. END9234USNP7 / 190717-7, entitled "ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES"; · Attorney Docket No. END9234USNP8 / 190717-8, entitled "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS"; · Attorney Docket No. END9234USNP9 / 190717-9, entitled "ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWER SOURCES"; · Attorney Docket No. END9234USNP10 / 190717-10, entitled "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES"; · Attorney Docket No. END9234USNP11 / 190717-11, entitled "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY DENSITIES"; · Attorney Docket No. END9234USNP12 / 190717-12, entitled "ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY CAPABILITIES"; · Attorney Docket No. END9234USNP14 / 190717-14, entitled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES"; · Attorney Docket No. END9234USNP15 / 190717-15, entitled "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE"; "CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USER INPUT", Attorney Docket No. END9234USNP16 / 190717-16; "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE", Attorney Docket No. END9234USNP17 / 190717-17; and · Attorney Docket No. END9234USNP18 / 190717-18, entitled "SURGICAL SYSTEM COMMUNICATION PATHWAYS."

[0008] The applicant of this application owns the following U.S. provisional patent applications, filed on December 30, 2019, the disclosures of each of which are incorporated herein by reference in their entirety: · U.S. Provisional Patent Application No. 62 / 955,294, entitled “USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITY END-EFFECTOR”; · U.S. Provisional Patent Application No. 62 / 955,292, entitled “COMBINATION ENERGY MODALITY END-EFFECTOR”; · U.S. Provisional Patent Application No. 62 / 955,306, entitled “SURGICAL INSTRUMENT SYSTEMS.”

[0009] The applicant of the present application owns the following U.S. patent applications, the disclosures of each of which are incorporated herein by reference in their entirety: U.S. Patent Application No. 16 / 209,395, now U.S. Patent Application Publication No. 2019 / 0201136, entitled “METHOD OF HUB COMMUNICATION”; U.S. Patent Application No. 16 / 209,403, now U.S. Patent Application Publication No. 2019 / 0206569, entitled “METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB”; No. 16 / 209,407, now U.S. Patent Application Publication No. 2019 / 0201137, entitled “METHOD OF ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL”; No. 16 / 209,416, now U.S. Patent Application Publication No. 2019 / 0206562, entitled “METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS”; U.S. Patent Application Serial No. 16 / 209,423, now U.S. Patent Application Publication No. 2019 / 0200981, entitled “METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS”; No. 16 / 209,427, now U.S. Patent Application Publication No. 2019 / 0208641, entitled “METHOD OF USING REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZE PERFORMANCE OF RADIO FREQUENCY DEVICES”; No. 16 / 209,433, now U.S. Patent Application Publication No. 2019 / 0201594, entitled “METHOD OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMP SPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB”; U.S. Patent Application No. 16 / 209,447, now U.S. Patent Application Publication No. 2019 / 0201045, entitled “METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB”; U.S. Patent Application No. 16 / 209,453, now U.S. Patent Application Publication No. 2019 / 0201046, entitled “METHOD FOR CONTROLLING SMART ENERGY DEVICES”; U.S. Patent Application No. 16 / 209,458, now U.S. Patent Application Publication No. 2019 / 0201047, entitled “METHOD FOR SMART ENERGY DEVICE INFRASTRUCTURE”; No. 16 / 209,465, now U.S. Patent Application Publication No. 2019 / 0206563, entitled “METHOD FOR ADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION”; No. 16 / 209,478, now U.S. Patent Application Publication No. 2019 / 0104919, entitled “METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION OR USAGE”; U.S. Patent Application No. 16 / 209,490, now U.S. Patent Application Publication No. 2019 / 0206564, entitled “METHOD FOR FACILITY DATA COLLECTION AND INTERPRETATION”; U.S. Patent Application No. 16 / 209,491, now U.S. Patent Application Publication No. 2019 / 0200998, entitled “METHOD FOR CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS”; U.S. Patent Application No. 16 / 562,123, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES"; U.S. patent application Ser. No. 16 / 562,135, entitled “METHOD FOR CONTROLLING AN ENERGY MODULE OUTPUT”; U.S. patent application Ser. No. 16 / 562,144, entitled "METHOD FOR CONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE," and · U.S. Patent Application No. 16 / 562,125, entitled “METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM.”

[0010] Before describing various aspects of the electrosurgical system in detail, it should be noted that the example embodiments are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and specification. The example embodiments may be embodied or incorporated in other aspects, variations, and modifications and may be practiced or carried out in various ways. Moreover, unless otherwise specified, the terms and expressions used herein have been selected for the convenience of the reader for the purpose of describing the example embodiments and not for the purpose of limiting them. Furthermore, it should be understood that one or more of the aspects, aspect expressions, and / or examples described below can be combined with any one or more of the other aspects, aspect expressions, and / or examples described below.

[0011] Various aspects are directed to an electrosurgical system including an electrosurgical instrument powered by a generator to effect tissue incision, cutting, and / or coagulation during a surgical procedure. The electrosurgical instrument may be configured for use in open surgical procedures, but also has applications in other types of surgery, such as laparoscopic, endoscopic, and robotic-assisted procedures.

[0012] As described in more detail below, electrosurgical instruments generally include a shaft having a distally attached end effector (e.g., one or more electrodes). The end effector can be positioned relative to tissue such that electrical current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, electrical current is introduced into tissue by an active electrode of the end effector and returned from the tissue by a return electrode of the end effector, respectively. During monopolar operation, electrical current is introduced into tissue by an active electrode of the end effector and returned through a return electrode (e.g., a ground pad) that is separately located on the patient's body. Heat generated by electrical current flowing through tissue may form a hemostatic seal within and / or between tissues and thus may be particularly useful for sealing blood vessels, for example.

[0013] FIG. 1 illustrates one embodiment of a generator 900 configured to deliver multiple energy modalities to a surgical instrument. The generator 900 provides RF and / or ultrasonic signals for delivering energy to the surgical instrument. The generator 900 includes at least one generator output capable of delivering multiple energy modalities (e.g., ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others) through a single port, which signals can be delivered individually or simultaneously to an end effector to treat tissue. The generator 900 includes a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory coupled to the processor 902, which is not shown for clarity of disclosure. Digital information associated with the waveforms is provided to the waveform generator 904, which includes one or more DAC circuits to convert the digital input to an analog output. The analog output is provided to an amplifier 906 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to a power transformer 908. The signal is coupled across power transformer 908 to a secondary side on the patient isolated side. A first signal of a first energy modality is provided to the surgical instrument between terminals labeled ENERGY1 and RETURN. A second signal of a second energy modality is coupled across capacitor 910 and provided to the surgical instrument between terminals labeled ENERGY2 and RETURN. More than two energy modalities may be output, thus the subscript "n" indicates up to n ENERGY modalities. n It will be understood that n is a positive integer greater than or equal to 2. n It will also be understood that other variations may be provided without departing from the scope of the present disclosure.

[0014] A first voltage sense circuit 912 is coupled across the terminals labeled ENERGY1 and RETURN paths and measures the output voltage between the terminals. A second voltage sense circuit 924 is coupled across the terminals labeled ENERGY2 and RETURN paths and measures the output voltage between the terminals. A current sense circuit 914 is disposed in series with the RETURN leg of the secondary side of the power transformer 908 shown to measure the output current of either energy modality. If different return paths are provided for each energy modality, a separate current sense circuit must be provided for each return leg. The outputs of the first voltage sense circuit 912 and the second voltage sense circuit 924 are provided to respective isolation transformers 928, 922, and the output of the current sense circuit 914 is provided to another isolation transformer 916. The outputs of the isolation transformers 916, 928, 922 on the primary side (non-patient isolated side) of the power transformer 908 are provided to one or more ADC circuits 926. The digitized output of the ADC circuit 926 is provided to the processor 902 for further processing and calculations. Output voltage and output current feedback information can be used to adjust the output voltage and current provided to the surgical instrument and to calculate output impedance, among other parameters. Input / output communication between the processor 902 and the patient isolation circuitry is provided via an interface circuit 920. Sensors may also be in electrical communication with the processor 902 via the interface circuit 920.

[0015] In one aspect, the impedance may be determined by the processor 902 by dividing the output of either the first voltage sense circuit 912 coupled across the terminals labeled ENERGY1 / RETURN or the second voltage sense circuit 924 coupled across the terminals labeled ENERGY2 / RETURN by the output of a current sense circuit 914 placed in series with the RETURN leg of the secondary side of the power transformer 908. The outputs of the first voltage sense circuit 912 and the second voltage sense circuit 924 are provided to separate isolation transformers 928, 922, and the output of the current sense circuit 914 is provided to another isolation transformer 916. Digitized voltage and current sense measurements from the ADC circuit 926 are provided to the processor 902 to calculate the impedance. As an example, the first energy modality ENERGY1 may be RF monopolar energy and the second energy modality ENERGY2 may be RF bipolar energy. Yet, in addition to bipolar and monopolar RF energy modalities, other energy modalities include ultrasound energy, irreversible and / or reversible electroporation, and / or microwave energy, among others. Also, while the embodiment illustrated in FIG. 1 shows that a single return path RETURN may be provided to two or more energy modalities, in other aspects, multiple return paths RETURN n However, each energy modality ENERGY n may be provided to

[0016] As shown in FIG. 1 , the generator 900 with at least one output port can include a power transformer 908 with a single output and multiple taps to provide power to an end effector in the form of one or more energy modalities, such as, for example, ultrasound, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others, depending on the type of tissue treatment to be performed. For example, the generator 900 can deliver high voltage and low current energy to drive an ultrasonic transducer, deliver low voltage and high current energy to drive an RF electrode to seal tissue, or deliver energy with a coagulation waveform for spot coagulation using either monopolar or bipolar RF electrosurgical electrodes. The output waveform from the generator 900 can be steered, switched, or filtered to provide the frequency to the end effector of the surgical instrument. In one example, the connection of the RF bipolar electrode to the generator 900 output will preferably be located between the outputs labeled ENERGY2 and RETURN. In the case of a unipolar output, the preferred connection would be an active electrode (eg, a pencil or other probe) to a suitable return pad connected to the ENERGY2 output and the RETURN output.

[0017] Additional details are disclosed in U.S. Patent Application Publication No. 2017 / 0086914, published March 30, 2017, entitled "TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS," which is incorporated herein by reference in its entirety.

[0018] 2 illustrates one form of a surgical system 1000 that includes a generator 1100 and various surgical instruments 1104, 1106, 1108 that may be used therewith, where the surgical instrument 1104 is an ultrasonic surgical instrument, the surgical instrument 1106 is an RF electrosurgical instrument, and the multifunction surgical instrument 1108 is a combination ultrasonic / RF electrosurgical instrument. The generator 1100 may be configurable for use with a variety of surgical instruments. According to various forms, the generator 1100 may be configurable for use with different surgical instruments of different types, including, for example, an ultrasonic surgical instrument 1104, an RF electrosurgical instrument 1106, and a multifunction surgical instrument 1108 that integrates RF and ultrasonic energy delivered simultaneously from the generator 1100. 2, the generator 1100 is shown separate from the surgical instruments 1104, 1106, 1108, however, in one form the generator 1100 may be integrally formed with any of the surgical instruments 1104, 1106, 1108 to form an integrated surgical system. The generator 1100 includes an input device 1110 located on a front panel of a console for the generator 1100. The input device 1110 may include any suitable device for generating signals suitable for programming the operation of the generator 1100. The generator 1100 may be configured for wired or wireless communication.

[0019] The generator 1100 is configured to drive a number of surgical instruments 1104, 1106, 1108. The first surgical instrument is an ultrasonic surgical instrument 1104 and includes a handpiece 1105 (HP), an ultrasonic transducer 1120, a shaft 1126, and an end effector 1122. The end effector 1122 includes an ultrasonic blade 1128 acoustically coupled to the ultrasonic transducer 1120, and a clamp arm 1140. The handpiece 1105 includes a trigger 1143 for actuating the clamp arm 1140, and a combination of toggle buttons 1137, 1134b, 1134c for energizing and actuating the ultrasonic blade 1128 or other functions. The toggle buttons 1137, 1134b, 1134c can be configured to energize the ultrasonic transducer 1120 using the generator 1100.

[0020] The generator 1100 is also configured to drive a second surgical instrument 1106. The second surgical instrument 1106 is an RF electrosurgical instrument and includes a hand piece 1107 (HP), a shaft 1127, and an end effector 1124. The end effector 1124 includes electrodes in clamp arms 1145, 1142b and return through an electrical conductor portion of the shaft 1127. The electrodes are coupled to and energized by a bipolar energy source in the generator 1100. The hand piece 1107 includes a trigger 1145 for operating the clamp arms 1145, 1142b, and an energy button 1135 for actuating an energy switch to energize the electrodes in the end effector 1124. The second surgical instrument 1106 may also be used with a return pad to deliver monopolar energy to tissue.

[0021] The generator 1100 is also configured to drive a multifunction surgical instrument 1108. The multifunction surgical instrument 1108 includes a hand piece 1109 (HP), a shaft 1129, and an end effector 1125. The end effector 1125 includes an ultrasonic blade 1149 and a clamp arm 1146. The ultrasonic blade 1149 is acoustically coupled to an ultrasonic transducer 1120. The hand piece 1109 includes a trigger 1147 that operates the clamp arm 1146, and a combination of toggle buttons 11310, 1137b, 1137c for energizing and actuating the ultrasonic blade 1149 or other functions. The toggle buttons 11310, 1137b, 1137c can be configured to energize the ultrasonic transducer 1120 using the generator 1100, and to energize the ultrasonic blade 1149 using a bipolar energy source also housed within the generator 1100. Monopolar energy may be delivered to tissue in combination with bipolar energy or separately from bipolar energy.

[0022] The generator 1100 is configurable for use with a variety of surgical instruments. According to various configurations, the generator 1100 may be configurable for use with different types of different surgical instruments including, for example, an ultrasonic surgical instrument 1104, an RF electrosurgical instrument 1106, and a multi-function surgical instrument 1108 that integrates RF and ultrasonic energy delivered simultaneously from the generator 1100. In the configuration of FIG. 2, the generator 1100 is shown separate from the surgical instruments 1104, 1106, 1108, but in another configuration, the generator 1100 may be integrally formed with any one of the surgical instruments 1104, 1106, 1108 to form an integrated surgical system. As discussed above, the generator 1100 includes an input device 1110 located on a front panel of the console of the generator 1100. The input device 1110 may include any suitable device that generates signals suitable for programming the operation of the generator 1100. The generator 1100 may also include one or more output devices 1112. Further aspects of the generator and the surgical instrument for digitally generating an electrical signal waveform are described in U.S. Patent Application Publication No. 2017-0086914-(A1), which is incorporated by reference herein in its entirety.

[0023] 3 shows a schematic diagram of a surgical instrument or tool 600 with multiple motor assemblies that can be activated to perform various functions. In the illustrated embodiment, a closure motor assembly 610 is operable to transition the end effector between an open configuration and a closed configuration, and an articulation motor assembly 620 is operable to articulate the end effector relative to the shaft assembly. In certain examples, the multiple motor assemblies can be individually activated to produce a firing motion, a closing motion, and / or an articulation motion in the end effector. The firing motion, the closing motion, and / or the articulation motion can be transmitted to the end effector via the shaft assembly, for example.

[0024] In certain examples, the closure motor assembly 610 includes a closure motor. The closure 603 may be operably coupled to a closure motor drive assembly 612, which may be configured to transfer the closure motion generated by the motor to the end effector, and in particular to move the closure member to close to transition the end effector to a closed configuration. The closure motion may, for example, transition the end effector from an open configuration to a closed configuration to capture tissue. The end effector may be transitioned to the open position by reversing the direction of the motor.

[0025] In certain examples, articulation motor assembly 620 includes an articulation motor operably coupled to an articulation drive assembly 622, which can be configured to transfer articulation generated by the motor to an end effector. In certain examples, the articulation can, for example, cause the end effector to articulate relative to the shaft.

[0026] One or more of the motors of the surgical instrument 600 may be equipped with a torque sensor to measure the output torque on the shaft of the motor. The force applied to the end effector may be sensed in any conventional manner, such as by a force sensor outside the jaws or by a torque sensor on the motor that actuates the jaws.

[0027] In various embodiments, the motor assemblies 610, 620 include one or more motor drivers, which may comprise one or more H-bridge FETs. The motor drivers may modulate the power sent to the motors from the power supply 630 based on inputs, for example, from a microcontroller 640 ("controller") of the control circuit 601. In certain examples, the microcontroller 640 may be employed to determine, for example, the current drawn by the motors.

[0028] In particular examples, the microcontroller 640 may include a microprocessor 642 ("processor") and one or more non-transitory computer-readable media or memory units 644 ("memory"). In particular examples, the memory 644 may store various program instructions that, when executed, may cause the processor 642 to perform a number of functions and / or calculations described herein. In particular examples, one or more of the memory units 644 may be coupled to the processor 642, for example. In various aspects, the microcontroller 640 may communicate using wired or wireless channels, or a combination thereof.

[0029] In certain examples, the power source 630 may be used to, for example, power the microcontroller 640. In certain examples, the power source 630 may include a battery (or "battery pack" or "power pack"), such as, for example, a lithium ion battery. In certain examples, the battery pack may be configured to be releasably attached to the handle to power the surgical instrument 600. Multiple battery cells connected in series may be used as the power source 630. In certain examples, the power source 630 may be, for example, replaceable and / or rechargeable.

[0030] In various examples, the processor 642 may control motor drivers to control the position, direction, and / or speed of the motors of the assemblies 610, 620. In certain examples, the processor 642 may send signals to the motor drivers to stop and / or disable the motors. The term "processor" as used herein should be understood to include any suitable microprocessor, microcontroller, or other basic computing device that integrates the functionality of a computer's central processing unit (CPU) on one integrated circuit or up to a few integrated circuits. The processor 642 is a general-purpose programmable device that accepts digital data as input, processes the data according to instructions stored in memory, and provides the results as output. Since it has an internal memory, it is an example of sequential digital logic. The processor operates on numbers and symbols represented in the binary system.

[0031] In one example, the processor 642 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In a particular example, the microcontroller 620 may be, for example, the LM 4F230H5QR available from Texas Instruments. In at least one embodiment, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that includes, among other features readily available in the product data sheet, on-chip memory of 256KB of single-cycle flash memory or other non-volatile memory up to 40MHz, a pre-fetch buffer to improve performance above 40MHz, 32KB of single-cycle SRAM, internal ROM with StellarisWare® software, 2KB of EEPROM, one or more PWM modules, one or more QEI analog, one or more 12-bit ADC with 12 analog input channels. Other microcontrollers may be readily substituted for use in the surgical instrument 600. Thus, the present disclosure should not be limited in this context.

[0032] In particular examples, memory 644 may include program instructions for controlling each of the motors of surgical instrument 600. For example, memory 644 may include program instructions for controlling a closure motor and an articulation motor. Such program instructions may cause processor 642 to control the closure and articulation functions according to inputs from an algorithm or control program of surgical instrument 600.

[0033] In certain examples, one or more mechanisms and / or sensors, such as, for example, sensor 645, can be employed to alert processor 642 to program instructions to be used in a particular setting. For example, sensor 645 can alert processor 642 to use program instructions associated with closing and articulating the end effector. In certain examples, sensor 645 can include a position sensor that can be employed to sense the position of a closure actuator, for example. Thus, processor 642 can activate the motor of closure drive assembly 620 using program instructions associated with closing the end effector when processor 642 receives a signal from sensor 630 indicating actuation of the closure actuator.

[0034] In some embodiments, the motors may be brushless DC electric motors and each motor drive signal may comprise a PWM signal provided to one or more stator windings of the motor, and in some embodiments, the motor driver may be omitted and the control circuit 601 may generate the motor drive signals directly.

[0035] It is common practice during various laparoscopic surgical procedures to insert a surgical end effector portion of a surgical instrument through a trocar placed in the patient's abdominal wall to access a surgical site located within the patient's abdomen. In its simplest form, a trocar is a pen-shaped instrument with a sharp triangular point at one end that is typically used within a hollow tube known as a cannula or sleeve to create an opening in the body through which a surgical end effector may be introduced. Such an arrangement creates an access port within the body cavity through which the surgical end effector may be inserted. The inner diameter of the trocar's cannula necessarily limits the size of the end effector and drive support shaft of a surgical instrument that may be inserted through the trocar.

[0036] Regardless of the particular type of surgical procedure being performed, once a surgical end effector is inserted into a patient through a trocar cannula, it must often be moved relative to a shaft assembly positioned within the trocar cannula in order to properly position the surgical end effector relative to the tissue or organ being treated. This movement or positioning of the surgical end effector relative to the portion of the shaft that remains within the trocar cannula is often referred to as "articulation" of the surgical end effector. To facilitate such articulation of the surgical end effector, a variety of articulation joints have been developed for attaching the surgical end effector to an associated shaft. As may be anticipated in many surgical procedures, it is desirable to employ a surgical end effector that has as large a range of articulation as possible.

[0037] Due to size constraints imposed by the size of the trocar cannula, the components of the articulation joint must be sized to be freely insertable through the trocar cannula. These size constraints may also limit the size and configuration of various drive members and components that operably interface with a motor and / or other control system supported within a housing that may be handheld or comprise a portion of a larger automated system. In many cases, these drive members must operably pass through the articulation joint to operably couple or operably interface with a surgical end effector. For example, one such drive member is commonly employed to apply an articulation control motion to a surgical end effector. In use, the articulation drive member can be deactivated to position the surgical end effector in a non-articulated position to facilitate insertion through the trocar and then actuated to articulate the surgical end effector to a desired position when the surgical end effector enters the patient.

[0038] Thus, the aforementioned size constraints present many challenges to developing an articulation system that can achieve the desired range of articulation, while also accommodating the various different drive systems required to operate the various features of the surgical end effector. Furthermore, once the surgical end effector is positioned in a desired articulation position, the articulation system and articulation joints must be capable of holding the surgical end effector in that position during actuation of the end effector and completion of the surgical procedure. Such articulation joint arrangements must also be capable of withstanding the external forces experienced by the end effector during use.

[0039] Various modes of one or more surgical devices are often used throughout a particular surgical procedure. A communication path extending between the surgical devices and a centralized surgical hub can, for example, promote efficiency and enhance the success of the surgical procedure. In various examples, each surgical device in the surgical system includes a display, which communicates the presence and / or operational status of other surgical devices in the surgical system. The surgical hub can use information received through the communication path to evaluate the compatibility of the surgical devices for use with each other, evaluate the compatibility of the surgical devices for use during a particular surgical procedure, and / or optimize the operating parameters of the surgical devices. As described in more detail herein, the operating parameters of the one or more surgical devices can be optimized based on, for example, patient demographics, the particular surgical procedure, and / or detected environmental conditions such as tissue thickness.

[0040] 4 and 5 show exploded ( FIG. 4 ) and cross-sectional ( FIG. 5 ) views of an end effector 1200 of an electrosurgical instrument (e.g., the surgical instrument described in U.S. Patent Application Attorney Docket No. END9234USNP2 / 190717-2). For example, the end effector 1200 can be actuated, articulated, and / or rotated relative to the shaft assembly of the surgical instrument in a manner similar to the end effector described in U.S. Patent Application Attorney Docket No. END9234USNP2 / 190717-2. Additionally, the end effector 1200 and other similar end effectors described elsewhere herein can be powered by one or more generators of a surgical system. An exemplary surgical system for use with the surgical instruments is described in U.S. patent application Ser. No. 16 / 562,123, filed Sep. 5, 2019, entitled “METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES,” which is incorporated herein in its entirety.

[0041] 6-8, the end effector 1200 includes a first jaw 1250 and a second jaw 1270. At least one of the first jaw 1250 and the second jaw 1270 is pivotable toward and away from the other jaw to transition the end effector 1200 between an open configuration and a closed configuration. The jaws 1250, 1270 are configured to grasp tissue between the jaws 1250 and 1270 and apply at least one of therapeutic and non-therapeutic energy to the tissue. Energy delivery to tissue grasped by the jaws 1250, 1270 of the end effector 1200 is accomplished by electrodes 1252, 1272, 1274 configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combination mode of alternating or mixed bipolar and monopolar energy. The different energy modalities that can be delivered to tissue by the end effector 1200 are described in more detail elsewhere in this disclosure.

[0042] In addition to the electrodes 1252, 1272, 1274, a patient return pad is used in conjunction with the application of monopolar energy. Furthermore, bipolar and monopolar energy are delivered using electrically isolated generators. In use, the patient return pad can detect unexpected power crossover by monitoring power transmission to the return pad via one or more suitable sensors on the return pad. Unexpected power crossover can occur when bipolar and monopolar energy modalities are used simultaneously. In at least one embodiment, the bipolar mode uses a higher current (e.g., 2-3 amps) than the monopolar mode (e.g., 1 amp). In at least one embodiment, the return pad includes a control circuit and at least one sensor (e.g., a current sensor) coupled thereto. In use, the control circuit can receive an input indicative of an unexpected power crossover based on measurements of the at least one sensor. In response, the control circuitry can use a feedback system to issue a warning and / or suspend application of either or both of the bipolar and monopolar energy modalities to tissue.

[0043] Further to the above, the jaws 1250, 1270 of the end effector 1200 comprise an angular profile in which multiple angles are defined between separate portions of each of the jaws 1250, 1270. For example, a first angle is defined by portions 1250a, 1250b (FIG. 4) and a second angle is defined by portions 1250b, 1250c of the first jaw 1250. Similarly, a first angle is defined by portions 1270a, 1270b and a second angle is defined by portions 1270b, 1270c of the second jaw 1270. In various embodiments, the separate portions of the jaws 1250, 1270 are linear segments. Successive linear segments intersect at an angle, such as, for example, a first angle or a second angle. The linear segments cooperate to form an overall angular profile of each of the jaws 1250, 1270. The angular profile is generally curved away from the central axis.

[0044] In one embodiment, the first angle and the second angle are the same or at least substantially the same. In another embodiment, the first angle and the second angle are different. In another embodiment, the first angle and the second angle comprise a value selected from the range of about 120° to about 175°. In yet another embodiment, the first angle and the second angle comprise a value selected from the range of about 130° to about 170°.

[0045] Additionally, portions 1250a, 1270a, which are proximal portions, are larger than portions 1250b, 1270b, which are intermediate portions. Similarly, portions 1250b, 1270b, which are intermediate portions, are larger than portions 1250c, 1270c. In other embodiments, the distal portions may be larger than the intermediate portions and / or the proximal portions. In other embodiments, the intermediate portions are larger than the proximal portions and / or the distal portions.

[0046] Further to the above, the electrodes 1252, 1272, 1274 of the jaws 1250, 1270 include angular profiles similar to the angular profiles of the jaws 1250, 1270. In the embodiment of Figures 4 and 5, the electrodes 1252, 1272, 1274 include separate segments 1252a, 1252b, 1252c, 1272a, 1272b, 1272c, 1274a, 1274b, 1274c, respectively, that define first and second angles at their respective intersections, as described above.

[0047] When in the closed configuration, the jaws 1250, 1270 cooperate to define a tip electrode 1260 formed of electrode portions 1261, 1262 at the distal ends of the jaws 1250, 1270, respectively. The tip electrode 1260 can be energized to deliver monopolar energy to tissue in contact with the tip electrode 1260. Both electrode portions 1261, 1262 can be activated simultaneously to deliver monopolar energy, as shown in FIG 6, or alternatively, only one of the electrode portions 1261, 1262 can be selectively activated to deliver monopolar energy to one side of the distal tip electrode 1260, for example, as shown in FIG 10.

[0048] The angular profile of jaws 1250, 1270 causes tip electrode 1260, in the closed configuration, to lie on one side of a plane extending laterally between proximal portions 1252c, 1272c. The angular profile can also cause the intersection points between portions 1252b, 1252c, portions 1272b, 1272c, and portions 1274b, 1274c to lie on the same side of the plane as tip electrode 1260.

[0049] In at least one embodiment, the jaws 1250, 1270 include a conductive skeleton 1253, 1273 that can be, or be at least partially, made of a conductive material, such as titanium. The skeleton 1253, 1273 can be made of other conductive materials, such as aluminum. In at least one embodiment, the skeleton 1253, 1273 is made by injection molding. In various embodiments, the skeleton 1253, 1273 is selectively coated / covered with an insulating material to prevent thermal and electrical conduction in all but a given thin current-carrying zone that forms the electrodes 1252, 1272, 1274, 1260. The skeleton 1253, 1273 acts as an electrode with electron focusing where the jaws 1250, 1270 have built-in insulation from one jaw to the other. The insulating material can be, for example, an insulating polymer such as polytetrafluoroethylene (e.g., Teflon®). The energizable zone defined by the electrodes 1252, 1272 is inboard of the jaws 1250, 1270 and is independently operable in a bipolar mode to deliver energy to tissue grasped between the jaws 1250, 1270, while the energizable zone defined by the electrode tip 1260 and the electrode 1274 is outboard of the jaws 1250, 1270 and is operable in a monopolar mode to deliver energy to tissue adjacent the outer surface of the end effector 1200. Both jaws 1250, 1270 can be energized to deliver energy in a monopolar mode.

[0050] In various aspects, coating 1264 is a high temperature polytetrafluoroethylene (e.g., Teflon®) coating selectively applied to a conductive scaffold resulting in selectively exposed metallic interior portions that define three-dimensional geometric electron modulation (GEM) for focused dissection and coagulation. In at least one embodiment, coating 1264 comprises a thickness of about 0.003 inches, about 0.0035 inches, or about 0.0025 inches. In various embodiments, the thickness of coating 1264 can be any value selected from the range of about 0.002 inches to about 0.004 inches, the range of about 0.0025 inches to about 0.0035 inches, or the range of about 0.0027 inches to about 0.0033 inches. Other thicknesses of coating 1263 capable of three-dimensional geometric electron modulation (GEM) are contemplated by the present disclosure.

[0051] The electrodes 1252, 1272, which cooperate to transmit bipolar energy through tissue, are offset to prevent short circuits. As energy flows between the offset electrodes 1252, 1272, tissue grasped between the offset electrodes 1252, 1272 heats, creating a seal in the area between the electrodes 1252, 1272. Meanwhile, the areas of the jaws 1250, 1270 surrounding the electrodes 1252, 1272 are provided with a non-conductive tissue contacting surface by virtue of the insulating coating 1264 selectively deposited on such areas on the jaws 1250, 1270, but not on the electrodes 1252, 1272. Thus, the electrodes 1252, 1272 are defined by the areas of the metal jaws 1250, 1270 that remain exposed following application of the insulating coating 1264 to the jaws 1250, 1270. The jaws 1250 , 1270 are formed entirely from an electrically conductive material in this embodiment, but have non-conductive areas defined by an electrically insulating coating 1264 .

[0052] FIG. 6 illustrates the application of bipolar energy mode to tissue grasped between the jaws 1250, 1270. In bipolar energy mode, RF energy flows through the tissue along a path 1271 that extends through the center of the jaws 1250, 1270 and is oblique to the curved surface (CL) that longitudinally bisects the jaws 1250, 1270 such that the electrodes 1252, 1272 are on either side of the curved surface (CL). In other words, the area of ​​tissue that actually receives bipolar RF energy will be only the tissue that contacts and extends between the electrodes 1252, 1257. Thus, tissue grasped by the jaws 1250, 1270 does not receive RF energy across the entire lateral width of the jaws 1250, 1270. This configuration can therefore minimize the thermal spread of heat caused by the application of bipolar RF energy to tissue. Such minimization of thermal spread can in turn minimize potential collateral damage to tissue adjacent to a particular tissue area that the surgeon wishes to join / seal / coagulate and / or cut.

[0053] In at least one embodiment, in the closed configuration, a tissue-free lateral gap is defined between the offset electrodes 1252, 1272. In at least one embodiment, the lateral gap is defined between the offset electrodes 1252, 1272 in the closed configuration by any distance selected from the range of about 0.01 inches to about 0.025 inches, about 0.015 inches to about 0.020 inches, or about 0.016 inches to about 0.019 inches. In at least one embodiment, the lateral gap is defined by a distance of about 0.017 inches.

[0054] 4 and 5, the electrodes 1252, 1272, 1274 include widths that gradually narrow as each of the electrodes 1252, 1272, 1274 extends from the proximal end to the distal end. As a result, the proximal segments 1252a, 1272a, 1274a include a larger surface area than the intermediate portions 1252b, 1272b, 1274b, respectively. The intermediate segments 1252b, 1272b, 1274b also include a larger surface area than the distal segments 1252c, 1272c, 1274c.

[0055] The angle and narrowing profile of the jaws 1250, 1270 give the end effector 1200 a curved finger or angled hook shape in the closed configuration. This shape allows the tip electrode 1260 (FIG. 10) to be used to precisely deliver energy to small portions of tissue by orienting the end effector 1200 so that the electrode tip 1260 is pointed towards the tissue. In such an orientation, only the electrode tip 1260 is in contact with the tissue, which focuses the energy delivery to the tissue.

[0056] 8, the electrode 1274 extends on an exterior surface on a peripheral side 1275 of the second jaw 1270, which provides the ability to effectively separate contacting tissue while the end effector 1200 is in a closed configuration. To separate tissue, the end effector 1200 is positioned at least partially on the peripheral side 1275, which includes the electrode 1274. Activation of the monopolar energy mode through the jaw 1270 causes monopolar energy to flow through the electrode 1274 and to tissue in contact with the electrode 1274.

[0057] 9-11 show an end effector 1200' that is used to deliver bipolar energy to tissue through electrodes 1252', 1272' (FIG. 9) in a bipolar energy mode of operation, to deliver monopolar energy to tissue through electrode tip 1261 in a first monopolar mode of operation, and / or to deliver monopolar energy through an external electrode 1274 in a second monopolar mode of operation. End effector 1200' is similar in many respects to end effector 1200. Thus, various features of end effector 1200' that were previously described with respect to end effector 1200 will not be repeated in the same level of detail herein for the sake of brevity.

[0058] The electrodes 1252', 1272' differ from the electrodes 1252'', 1272'' in that they define stepped or uneven tissue contacting surfaces 1257, 1277. The conductive skeleton 1253', 1273' of the jaws 1250', 1270' includes expanded or protruding portions that form the conductive tissue contacting surfaces of the electrodes 1252', 1272'. The coating 1264 partially wraps around the expanded or protruding portions that form the electrodes 1252', 1272', leaving only the conductive tissue contacting surfaces of the electrodes 1252', 1272' exposed. Thus, in the embodiment shown in FIG. 9, each of the tissue contacting surfaces 1257, 1277 includes a step that includes a conductive tissue contacting surface positioned between two insulating tissue contacting surfaces that gradually descend the step. In other words, each of the tissue contacting surfaces 1257, 1277 includes a first partially conductive tissue contacting surface and a second insulating tissue contacting surface that is stepped down relative to the first partially conductive tissue contacting surface. A method for forming the electrodes 1252', 1272' is described below in connection with FIG.

[0059] Additionally, in a closed configuration with no tissue between the offset electrodes 1252', 1272', the offset electrodes 1252', 1272' overlap to define a gap between the opposing insulating outer surfaces of the jaws 1250', 1270'. This configuration thus provides electrode surfaces that are vertically offset from one another and laterally offset from one another when the jaws 1250', 1270' are closed. In one embodiment, the gap is between about 0.01 inches and about 0.025 inches. Additionally, while overlapping, the electrodes 1252', 1272' are separated by a lateral gap. To prevent short circuits, the lateral gap is equal to or less than a predetermined threshold. In one embodiment, the predetermined threshold is selected from the range of 0.006 inches to 0.008 inches. In one embodiment, the predetermined threshold is about 0.006 inches.

[0060] 7 and 10, the tip electrode 1260 is defined by an uncoated electrode portion 1261, 1262 immediately preceded by a circumferentially coated proximal coated portion to enable tip coagulation and incision formation from either or both of the jaws 1250, 1270. In certain embodiments, the electrode portions 1261, 1262 are covered by a spring-loaded or flexible insulating housing that allows the electrode portions 1261, 1262 to be exposed only when the distal end of the end effector 1200 is pressed against tissue to be treated.

[0061] Additionally, the segments 1274a, 1274b, 1274c define an angular profile that extends along a peripheral side 1275 of the jaw 1270. The segments 1274a, 1274b, 1274c are defined by uncoated linear portions that protrude from the angled body of the skeleton 1273 at the peripheral side 1275. The segments 1274a, 1274b, 1274c include outer surfaces that are flush with the outer surface of the coating 1264 defined on the peripheral side 1275. In various embodiments, a horizontal plane extends through the segments 1274a, 1274b, 1274c. The angular profile of the electrode 1274 is defined in the horizontal plane such that the electrode 1274 does not extend more than 45 degrees from the centerline of curvature to prevent unintended lateral thermal damage while using the electrode 1274 to cut or separate tissue.

[0062] 14 illustrates a jaw 6270 for use with an end effector (e.g., 1200) of an electrosurgical instrument (e.g., electrosurgical instrument 1106) for treating tissue using RF energy. Additionally, the jaw 6270 can be electrically coupled to a generator (e.g., generator 1100) and energized by the generator to deliver monopolar RF energy to tissue and / or cooperate with another jaw of the end effector to deliver bipolar RF energy to tissue. Additionally, the jaw 6270 is similar in many respects to the jaws 1250, 1270. For example, the jaw 6270 includes an angular profile similar to that of the jaw 1270. Additionally, the jaw 6270 offers improved thermal mitigation that can be applied to one or both of the jaws 1250, 1270.

[0063] During use, the jaws of the end effectors of electrosurgical instruments are subjected to thermal loads that can interfere with the performance of their electrodes. To minimize thermal load interference without adversely affecting the electrodes' ability to treat tissue, the jaws 6270 include an electrically conductive skeleton 6273 having a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink, and the thermally insulating portion resists heat transfer. In certain embodiments, the thermally insulating portion includes internal gaps, voids, or pockets that effectively isolate the thermal mass of the outer surface of the jaws 6270 that is in direct contact with tissue without compromising the electrical conductivity of the jaws 6270.

[0064] In the illustrated embodiment, the thermally conductive portion defines a conductive outer layer 6269 that surrounds or at least partially surrounds an inner conductive core. In at least one embodiment, the inner conductive core includes gap defining members, which may be in the form of posts, rows, and / or walls extending between opposing sides of the outer layer 6269, with gaps, voids, or pockets extending between the gap defining members.

[0065] In at least one embodiment, the gap setting member forms a honeycomb-like lattice structure 6267 to provide directional force capability when the jaws (i.e., jaw 6270 of the end effector and another jaw) are transitioned to a closed configuration to grasp tissue between the jaws (similar to jaws 1250, 1270 of FIG. 6). The directional force can be achieved by aligning the lattice 6267 in a direction transverse to the tissue contacting surface of the jaws 6270 such that the honeycomb walls 6268 of the lattice 6267 are positioned perpendicular to the tissue contacting surface.

[0066] Alternatively, or in addition, the conductive inner core of the jaws 6270 may include micro-pockets of air that may be more homogeneously distributed and shaped in a non-predetermined configuration relative to the jaw geometry to create a more homogeneous stress-strain distribution within the jaws. In various aspects, the conductive skeleton 6273 may be fabricated by three-dimensional printing and may include three-dimensional printed inner pockets that create a conductive but proportionately thermally insulated core.

[0067] 14, the conductive skeleton 6273 is connectable to an energy source (e.g., generator 1100) and includes electrodes 6262, 6272, and 6274 defined in portions of the outer layer 6273 that are selectively not covered by the coating 1264. The jaws 6270 thus have selective thermal and electrical conductivity that reduces heat spread and thermal mass while controlling / focusing energy interaction with tissue through the electrodes 6272, 6274. The thermally insulating portions of the conductive skeleton 6273 limit the thermal load on the electrodes 6262, 6272, and 6274 during use.

[0068] Additionally, the exterior layer 6273 defines gripping features 6277 that extend on either side of the electrode 6272 and are at least partially covered by the coating 1264. The gripping features 6277 improve the ability of the jaws 6270 to adhere to tissue and resist slippage of the tissue relative to the jaws 6270.

[0069] In the illustrated embodiment, the wall 6268 extends diagonally from a first side of the jaw 6270 to a second side of the jaw 6270. The walls 6268 intersect at a structural node. In the illustrated embodiment, the intersecting walls 6268 define a pocket 6271 that is covered from the top and / or bottom by an outer layer 6269. Various methods for manufacturing the jaw 6270 are described below.

[0070] 12, 13 show methods 1280, 1281 for manufacturing the jaws 1273'', 1273''',. In various embodiments, one or more of the jaws 1250, 1270, 1250', 1270' are manufactured according to the methods 1280, 1281. The jaws 1273'', 1273''', are made by applying a coating 1264 (e.g., thickness d) to the entire outer surface. The electrodes are then defined by selectively removing portions of the coating 1264 from desired zones to expose the outer surface of the scaffold 1273'', 1273''', in such zones. In at least one embodiment, selective removal of the coating can be done by etching (FIG. 12) or by partially cutting away tapered portions of the scaffold 1273'', together with the respective coating portions (FIG. 13) to form flat conductive and non-conductive surfaces. In the embodiment shown in FIG. 12, electrodes 1272", 1274" are formed by etching. In the embodiment shown in FIG. 13, electrode 1274"' is formed from a raised narrow strip or ridge 1274d that extends alongside backbone 1273"'. A portion of ridge 1274D, and coating 1264 directly covering ridge 1274D, is cut away, resulting in an outer surface of electrode 1274" that is flush with the outer surface of coating 1264.

[0071] Thus, the jaw 1270'' produced by method 1281 includes a tapered electrode 1274'' consisting of a narrow, raised conductive portion 1274e extending alongside the skeleton 1273'''', which can serve to focus energy delivered from the skeleton 1273'' at the tissue, with portion 1274e having a conductive outer surface that is flush with the coating 1264.

[0072] In another manufacturing process 6200, the jaws 6270 can be fabricated as shown in FIG. 15. A conductive skeleton 6273 is formed with narrow raised bands or ridges 6274e, 6274f that define the electrodes 6272, 6274. In the illustrated embodiment, the skeleton 6273 of the jaws 6270 includes ridges 6274e, 6274f having flat, or at least substantially flat, outer surfaces that are configured to define the electrodes 6272, 6274. In at least one embodiment, the skeleton 6273 is fabricated by 3D printing. Masks 6265, 6266 are applied to the ridges 6274e, 6274f, and a coating 1264 similar to coating 1264 is applied to the skeleton 6273. After coating, the masks 6265, 6266 are removed to expose the outer surfaces of the electrodes 6272, 6274 that are flush with the outer surfaces of the coating 1264.

[0073] 14 and 15, in various embodiments, the outer layer 6269 includes gripping features 6277 extending laterally on one or both sides of each of the electrodes 6272. The gripping features 6277 are covered by a coating 1264. In one embodiment, the coating 1264 defines compressible features that change the gap between the jaws of the end effector in response to a clamp load applied to the end effector 1200. In at least one embodiment, the coating 1264 on the jaws provides an overlap of at least 0.010 inches to 0.020 inches of insulation along the centerline of the jaws. The coating 1264 may be applied directly over the gripping features 6277 and / or the clamp-guided jaw realignment features.

[0074] In various aspects, the coating 1264 may include coating materials such as titanium nitride, diamond-like coating (DLC), chromium nitride, Graphit iC™, and the like. In at least one embodiment, DLC consists of an amorphous carbon-hydrogen network with graphitic and diamond bonds between the carbon atoms. The DLC coating 1264 can form a film having low friction and high hardness properties around the backbone 1253, 1273 (FIG. 6). The DLC coating 1264 may be doped or undoped and is generally in the form of amorphous carbon (aC) or hydrogenated amorphous carbon (aC:H) containing a large percentage of sp3 bonds. Various surface coating techniques, such as those developed by Oerlikon Blazers, can be utilized to form the DLC coating 1264. In at least one embodiment, the DLC coating 1264 is produced using Plasma-assisted Chemical Vapor Deposition (PACVD).

[0075] 15 , during use, electrical energy flows from the conductive scaffold 6269 through the electrode 6272 to the tissue. The coating 1264 prevents electrical energy from being transferred to the tissue from other areas of the outer layer 6269 that are covered by the coating 1264. As the temperature of the surface of the electrode 6272 increases during tissue processing, the gaps, voids, or pockets defined by the walls 6268 of the inner core slow down or attenuate the transfer of thermal energy from the outer layer 6269 to the inner core of the scaffold 6273.

[0076] 16 illustrates a scaffold 6290 fabricated for use with the jaws of an end effector of an electrosurgical instrument. One or more of the scaffolds 1253, 1273, 1253', 1273', 1273'', 1273''' can include a material composition and / or can be fabricated in a manner similar to the scaffold 6290. In the illustrated embodiment, the scaffold 6290 is comprised of at least two materials, an electrically conductive material, such as titanium, and a thermally insulating material, such as a ceramic material (e.g., a ceramic oxide). The combination of titanium and ceramic oxide results in a jaw component with composite thermal, mechanical, and electrical properties.

[0077] In the illustrated embodiment, the composite scaffold 6290 includes a ceramic base 6291 formed, for example, by three-dimensional printing. In addition, the composite scaffold 6290 includes a titanium crown 6292 fabricated separately from the ceramic base 6291, for example, using three-dimensional printing. The base 6291 and the crown 6292 include complementary attachment features 6294. In the illustrated embodiment, the base 6291 includes posts or protrusions that are received in corresponding openings in the crown 6292. The attachment features 6294 also control shrinkage. Additionally or alternatively, the interface between the base 6291 and the crown 6292 includes complementary surface irregularities 6296 that are specifically designed to fit together. The surface irregularities 6296 also resist shrinkage caused by different material compositions of the base 6291 and the crown 6292. In various embodiments, the composite scaffold 6290 is selectively coated with an insulating coating 1264, for example, leaving exposed certain portions of the crown 6292 that define the electrodes, as described above in connection with the jaws 1250, 1270.

[0078] 17 and 18 illustrate a manufacturing process for making a scaffold 6296 for use with the jaws of an end effector of an electrosurgical instrument. One or more of the scaffolds 1253, 1273, 1253', 1273', 1273'', 1273''' may comprise a material composition and / or may be manufactured in a similar manner as the scaffold 6295. In the illustrated embodiment, the composite scaffold 6295 is manufactured by injection molding utilizing a ceramic powder 6297 and a titanium powder 6298. The powders are fused together (FIG. 18) to form a titanium ceramic composite 6299 (FIG. 19). In at least one embodiment, a polytetrafluoroethylene (e.g., Teflon®) coating may be selectively applied to metal regions of the composite scaffold 6295 for thermal as well as electrical insulation.

[0079] 20-22 show a jaw 1290 for use with an end effector (e.g., 1200) of an electrosurgical instrument (e.g., electrosurgical instrument 1106) for treating tissue using RF energy. Additionally, jaw 6270 can be electrically coupled to a generator (e.g., generator 1100) and energized by the generator to deliver monopolar RF energy to tissue and / or cooperate with another jaw of the end effector to deliver bipolar RF energy to tissue. Additionally, jaw 1290 is similar in many respects to jaws 1250, 1270. For example, jaw 1290 includes an angular profile similar to the angle or curvature profile of jaw 1270.

[0080] Additionally, the jaw 1290 is similar to the jaw 6270 in that the jaw 1290 also exhibits improved thermal mitigation. Like the jaw 6270, the jaw 1290 includes an electrically conductive skeleton 1293 having a thermally insulating portion and a thermally conductive portion integral with or attached to the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain embodiments, the thermally insulating portion of the electrically conductive skeleton 1293 comprises an electrically conductive inner core 1297 having internal gaps, voids, or pockets that effectively isolate the thermal mass of the outer surface of the jaw 1290 that defines the electrode 1294 in direct contact with tissue without compromising the electrical conductivity of the jaw 1290. The thermally conductive portion defines an electrically conductive outer layer 1303 that surrounds or at least partially surrounds the electrically conductive inner core 1297. In at least one embodiment, the conductive inner core 1297 includes gap setting members 1299 which may be in the form of posts, rows, and / or walls extending between opposing sides of the outer layer 1303 of the jaw 1290, with gaps, voids, or pockets extending between the gap setting members.

[0081] Alternatively, or in addition, the conductive inner core 1297 may include micro-pockets of air that may be uniformly or non-uniformly distributed within the conductive inner core 1297. The pockets may include predefined or random shapes and may be distributed in predefined or random portions of the conductive inner core 1297. In at least one embodiment, the pockets are distributed to create a more homogenous stress-strain distribution within the jaw 1290. In various aspects, the scaffold 1293 may be fabricated by three-dimensional printing and may include three-dimensional printed internal pockets that produce a conductive but proportionately thermally insulated core.

[0082] Thus, the jaws 1290 have selective thermal and electrical conductivity that controls / focuses energy interaction with tissue while reducing heat spread and thermal mass. The thermally insulating portions of the conductive skeleton 1293 limit the thermal load on the electrodes of the jaws 1290 during use.

[0083] FIG. 22 illustrates an extended portion of the tissue contacting surface 1291 of the jaws 1290. In various embodiments, the outer layer 1303 of the backbone 1293 is selectively coated / covered with a first insulating layer 1264 comprising a first material, such as DLC. In the illustrated embodiment, the DLC coating electrically insulates the tissue contacting surface 1291 except for an intermediate area extending along the length of the tissue contacting surface 1291, which defines the electrode 1294. In at least one embodiment, the DLC coating extends around the backbone 1293 covering the jaws 1290 to the periphery defined on both sides 1294′, 1294″ of the electrode 1294. The conductive zones 1294a, 1294b, 1294c remain exposed and alternate with insulating zones 1298 along the length of the electrode 1294. In various embodiments, the insulating zones 1298 comprise high temperature polytetrafluoroethylene (e.g., Teflon®). Since the DLC coating is thermally conductive, only the portion of the tissue contacting surface 1291 including the insulating region 1298 is thermally insulated. The portions of the tissue contacting surface 1291 that are covered with the DLC coating and the thin conductive energizable zones 1294a, 1294b, 1294c are thermally conductive. Furthermore, only the thin conductive energizable zones 1294a, 1294b, 1294c are electrically conductive. The remaining portions of the tissue contacting surface 1291 that are covered with either the DLC coating or polytetrafluoroethylene (e.g., Teflon®) are electrically insulated.

[0084] The conductive zones 1294a, 1294b, 1294c define where energy is concentrated along the jaws 1290 based on the geometry of the zones 1294a, 1294b, 1294c. Additionally, the size, shape, and arrangement of the conductive zones 1294a, 1294b, 1294c and the insulating zone 1298 direct the coagulation energy transferred through the electrode 1294 into tissue within a predefined treatment area, thereby preventing parasitic seepage of both energy and heat from the treatment area. Additionally, the thermally insulating conductive inner core 1297 resists heat transfer to portions of the jaws 1290 that do not form the treatment area, thereby preventing inadvertent collateral thermal damage due to accidental contact of tissue with non-treatment areas of the jaws 1290.

[0085] The electrode 1294 is selectively interrupted by regions 1298. Selective application of a high temperature polytetrafluoroethylene (e.g., Teflon) coating to portions of the electrode 1294 results in selectively exposed metal interior portions defining three-dimensional geometric electronic modulations (GEMs) for focused cutting and coagulation at conductive zones 1294a, 1294b, 1294c of the electrode 1294. Regions 1298 are selectively disposed on the electrode 1294 as shown in FIG. 22 to provide a treated surface having alternating thermally and electrically conductive and thermally conductive and electrically insulating regions surrounded by a thermally conductive but electrically insulating outer circumferential region defined by the DLC coating.

[0086] 22, the jaw 1290 comprises an angular profile in which multiple angles are defined between the separate portions 1290a, 1290b, 1290c, 1290d of the jaw 1290. For example, a first angle (α1) is defined by the portions 1290a, 1290b of the first jaw 1250, a second angle (α2) is defined by the portions 1290b, 1290c, and a third angle (α3) is defined by the portions 1290c, 1290d. In other embodiments, at least a portion of the jaw 1290 includes a smooth curved profile without angles. In various aspects, the separate portions 1290a, 1290b, 1290c, 1290d of the jaw 1290 are linear segments. Successive linear segments intersect at an angle, such as a first angle (α1), or a second angle (α2), and a third angle (α3), etc. The linear segments cooperate to form the generally curved profile of each of the jaws 1290.

[0087] In one embodiment, the angles (α1, α2, α3) comprise the same or at least substantially the same value. In another embodiment, at least two of the angles (α1, α2, α3) comprise different values. In another embodiment, at least one of the angles (α1, α2, α3) comprises a value selected from the range of about 120° to about 175°. In yet another embodiment, at least one of the angles (α1, α2, α3) comprises a value selected from the range of about 130° to about 170°.

[0088] Further, because the profile of jaw 1290 narrows, portion 1290a, which is the proximal portion, is larger than portion 1290b, which is the middle portion. Similarly, middle portion 1290b is larger than portion 1290d, which defines the distal portion of jaw 1290. In other embodiments, the distal portion may be larger than the middle portion and / or the proximal portion. In other embodiments, the middle portion is larger than the proximal portion and / or the distal portion. Additionally, electrode 1294 of jaw 1290 comprises an angular profile similar to the angular profile of jaw 1290.

[0089] 23, in certain embodiments, jaw 1300 includes a solid conductive skeleton 1301 that is partially surrounded by a DLC coating 1264. Exposed areas of skeleton 1301 define one or more electrodes 1302. This arrangement results in thermally conductive and electrically conductive portions of jaw 1300 where thermal energy is delivered indiscriminately, but electrical energy is delivered exclusively through the one or more electrodes 1302.

[0090] 24-26, an electrosurgical instrument 1500 includes an end effector 1400 configured to deliver monopolar and / or bipolar energy to tissue grasped by the end effector 1400, as described in more detail below. The end effector 1400 is similar in many respects to the end effector 1200. For example, the end effector 1400 includes a first jaw 1450 and a second jaw 1470. At least one of the first jaw 1450 and the second jaw 1470 is movable relative to the other jaw to transition the end effector 1400 from an open configuration to a closed configuration to grasp tissue therebetween. The grasped tissue may then be sealed and / or cut using monopolar and bipolar energy. As described in more detail below, the end effector 1400 utilizes GEM to modulate the energy density at the tissue treatment interface of the jaws 1450, 1470 to effect the desired tissue treatment.

[0091] Similar to jaws 1250, 1270, jaws 1450, 1470 include a generally angled profile formed from straight sections angled relative to one another resulting in a bent or finger-like shape, as shown in FIG. 26. Additionally, jaws 1450, 1470 include conductive skeletons 1452, 1472 having constricted horns extending distally along the angular profile of jaws 1450, 1470. Conductive skeletons 1452, 1472 may be comprised of a conductive material, such as, for example, titanium. In certain aspects, conductive skeletons 1453, 1473 each include a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain embodiments, the thermally insulating portion of the skeleton 1453, 1473 defines an inner core that includes internal gaps, voids, or pockets that effectively isolate the thermal mass of the outer surfaces of the jaws 1452, 1472 that are in direct contact with tissue without compromising the electrical conductivity of the jaws 1450, 1470.

[0092] The thermally conductive portion comprises a conductive outer layer 1469, 1469' that surrounds or at least partially surrounds an inner conductive core. In at least one embodiment, the inner conductive core comprises gap setting members that may be in the form of posts, rows, and / or walls that extend between opposing sides of the outer layer 1469, 1469' of each of the jaws 1250, 1270, with gaps, voids, or pockets extending between the gap setting members. In at least one embodiment, the gap setting members form a honeycomb-like lattice structure 1467, 1467'.

[0093] Further to the above, the conductive skeleton 1453, 1473 includes a first conductive portion 1453a, 1473a extending distally along the angular profile of the jaws 1450, 1470, and a second conductive portion 1453b, 1473b protruding from the first conductive portion 1453a, 1473a and defining a tapered electrode extending distally along at least a portion of the narrowing body of the skeleton 1453, 1473. In at least one embodiment, the first conductive portion 1453a, 1473a is thicker than the second conductive portion 1453b, 1473b in a cross-section of the narrowing body of the skeleton 1453, 1473 (e.g., FIG. 25). In at least one embodiment, the second conductive portion 1453b, 1473b is integral with or permanently attached to the first conductive portion 1453a, 1473a, so that electrical energy flows from the first conductive portion 1453a, 1473a to the tissue only through the second conductive portion 1453b, 1473b. The electrically insulating layer 1464, 1464' is configured to completely electrically insulate the first conductive portion 1453a, 1473a, but not the second conductive portion 1453b, 1473b. At least the outer surfaces of the second conductive portions 1453b, 1473b that define the electrodes 1452, 1472 are not covered by the electrically insulating layer 1464, 1464'. In the illustrated embodiment, the electrodes 1452, 1472 and the electrically insulating layers 1464, 1464' define a coplanar tissue treatment surface.

[0094] As described above, the first conductive portion 1453a, 1473a is generally thicker than the second conductive portion 1453b, 1473b and is wrapped with an electrically insulating layer 1464, 1464', which makes the second conductive portion 1453b, 1473b an area of ​​high energy density. In at least one embodiment, the electrically insulating layer 1464, 1464' comprises a high temperature polytetrafluoroethylene (e.g., Teflon®) coating, DLC coating, and / or ceramic coating for insulation and resistance to charring. In various embodiments, the thicker first conductive portion 1453a conducts more electrical potential power with less resistance to the second conductive portion 1453b in contact with tissue, resulting in a higher energy density at the electrode 1452.

[0095] In various aspects, the outer surfaces of the electrodes 1452, 1472 include continuous linear segments that extend along the angled tissue treatment surfaces of the jaws 1450, 1470. The linear segments intersect at a predetermined angle and include a width that gradually narrows as the linear segments extend distally. In the example shown in FIG. 24, the electrode 1452 includes segments 1452a, 1452b, 1452c, 1452c, 1452d, and the electrode 1472 includes segments 1472a, 1472b, 1472c, 1472c, 1472d. The electrode 1452 of the jaw 1450 is shown by a dashed line on the jaw 1470 in FIG. 24 to indicate the lateral position of the electrode 1452 relative to the electrode 1452 in the closed configuration of the end effector 1400. The electrodes 1452, 1472 are laterally offset from one another in the closed configuration. In a bipolar energy mode, electrical energy supplied by a generator (e.g., generator 1100) flows from first conductive portion 1453a to electrode 1452 of second conductive portion 1453b, and from electrode 1452 to tissue grasped between the jaws 1450, 1470. The bipolar energy then flows from the tissue to electrode 1472 of second conductive portion 1473b, and from electrode 1472 to first conductive portion 1473a.

[0096] In various embodiments, as shown in FIGS. 24-25, the second jaw 1470 further includes an electrode 1474 spaced apart from the skeleton 1473. In at least one embodiment, the electrode 1474 is a monopolar electrode configured to deliver monopolar energy to tissue grasped between the jaws 1450 and 1470 in the closed configuration. For example, a return pad can be placed under the patient to receive monopolar energy from the patient. Similar to the electrode 1472, the electrode 1474 includes a continuous linear segment 1474a, 1474b, 1474c, 1474d that extends distally along an angular profile defined by the second jaw 1470 from an electrode proximal end to an electrode distal end. Additionally, the electrode 1474 is laterally offset from the electrodes 1472, 1452.

[0097] The electrode 1474 includes a base 1474e positioned within a cradle 1480 that extends distally along the angular profile of the second jaw 1470 from a cradle proximal 1480a to a cradle distal end 1480b. The cradle 1480 is centrally located relative to the lateral edges 1470e, 1470f of the second jaw 1470. The electrode 1474 further includes a tapered edge 1474f that extends from the base 1474e beyond the sidewall of the cradle 1480. Additionally, the cradle 1480 is partially recessed in a valley defined in the outer tissue treatment surface of the constriction curve. The cradle 1480 is spaced from the gradually narrowing body of the skeleton 1473 by an electrically insulating coating 1464'. As shown in FIG. 24, the base 1480 includes a width that gradually narrows as the base extends along the angle profile from the base proximal end 1480a to the base distal end 1480b.

[0098] In various embodiments, the cradle 1480 is made of a compliant substrate. As shown in FIG. 25, in an uncompressed state, the side walls of the cradle 1480 extend beyond the tissue treatment surface of the jaws 1472. When tissue is compressed between the jaws 1450 and 1470, the compressed tissue exerts a biasing force against the side walls of the cradle 1480, further exposing the tapered edge 1474f of the electrode 1474.

[0099] One or more of the jaws described by the present disclosure include a stop or gap setting member, which is a feature that extends outwardly from one or both of the tissue treatment surfaces of the jaws of the end effector. The stop member helps maintain a separation or predetermined gap between the jaws in a closed configuration with no tissue between the jaws. In at least one embodiment, the sidewall of the cradle 1480 defines such a stop member. In another embodiment, the stop member can be in the form of an insulating post or laterally extending spring-loaded feature that allows the gap between the opposing jaws and the closed configuration to change based on the clamp load.

[0100] Most electrosurgical generators use a constant power mode. In constant power mode, the power output remains constant as impedance increases. In constant power mode, the voltage increases as impedance increases. The increase in voltage causes thermal damage to the tissue. The GEM focuses the energy output of the jaws 1250, 1270 by controlling the size and shape of the electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474, for example, as described above, and modulating the power level based on tissue impedance to create a low voltage plasma.

[0101] In some cases, the GEM maintains a constant minimum voltage required for cutting at the surgical site. The generator (e.g., 1100) modulates the power to maintain the voltage as close as possible to the minimum voltage required for cutting at the surgical site. To achieve the arc plasma and cutting, current is pushed into the tissue by the voltage from the narrowing portions of the electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474. In certain embodiments, a minimum voltage of about 200 volts is maintained. Cutting above 200 volts increases thermal damage, and cutting below 200 volts creates minimal arcing and resistance in the tissue. Thus, the generator (e.g., 1100) modulates the power to ensure that a minimum voltage is utilized that can still form an arc plasma and cut.

[0102] 26, the surgical instrument 1500 includes an end effector 1400. The surgical instrument 1500 is similar in many respects to the other surgical instruments described in U.S. Patent Application Attorney Docket No. END9234USNP2 / 190717-2. The various actuation and articulation mechanisms described elsewhere in connection with such surgical instruments may similarly be utilized to articulate and / or actuate the surgical instrument 1500. For the sake of brevity, such mechanisms will not be repeated herein.

[0103] The end effector 1400 includes an end effector frame assembly 11210 including a distal frame member 11220 that is rotatably supported within a proximal frame housing 11230. In the illustrated embodiment, the distal frame member 11220 is rotatably attached to the proximal frame housing 11230 by an annular rib on the distal frame member 11220 that is received in an annular groove in the proximal frame housing 11230.

[0104] Electrical energy is transferred to the electrodes 1452, 1472, 1474 of the end effector 1400 by one or more flex circuits that extend distally through or along the distal frame member 11220. In the illustrated embodiment, the flex circuit 1490 is fixedly attached to the first jaw 1450. More specifically, the flex circuit 1490 includes a distal portion 1492 that can be fixedly attached to an exposed portion 1491 of the first jaw 1450 that is not covered by the insulating layer 1464.

[0105] The slip ring assembly 1550 in the proximal frame housing 11230 allows free rotation of the end effector 1400 about the shaft of the surgical instrument 1500 without entangling the wires of the circuit that transmits electrical energy to the electrodes 1452, 1472, 1474. In the illustrated embodiment, the flex circuit 1490 includes electrical contacts 1493 that movably engage with the slip ring 1550a of the slip ring assembly 1550. Electrical energy is transmitted through the flex circuit 1490 from the slip ring 1550a to the conductive skeleton 1453 and then to the electrodes 1452. Because the electrical contacts 1493 are not fixedly attached to the slip ring 1550a, rotation of the end effector 1400 about the shaft of the surgical instrument 1500 is permitted without losing electrical connection between the electrical contacts 1493 and the slip ring 1550a. Additionally, similar electrical contacts transfer electrical energy to slip ring 1550a.

[0106] In the embodiment shown in FIG. 26, slip ring 1550a is configured to transmit bipolar energy to electrode 1452 of jaw 1450. Slip ring 1550b cooperates with similar electrical contacts and electrode 1472 to define a return path for the bipolar energy. Additionally, slip ring 1550c cooperates with similar electrical contacts and electrode 1474 to provide a path for monopolar electrical energy into tissue. Bipolar and monopolar electrical energy may be delivered to slip rings 1550a, 1550b through one or more electrical generators (e.g., generator 1100). Bipolar and monopolar electrical energy may be delivered simultaneously or separately, as described in more detail elsewhere herein.

[0107] In various embodiments, the slip rings 1550a, 1550b, 1550c are one-piece electrical slip rings with mechanical features 1556a, 1556b, 1556c configured to couple the slip rings 1550a, 1550b, 1550c to an insulating support structure 1557 or to a conductive support structure coated with an insulating material, as shown in FIG. 26. Additionally, the slip rings 1550a, 1550b, 1550c are spaced apart sufficiently to ensure that no short circuit occurs when a conductive fluid fills the space between the slip rings 1550a, 1550b, 1550c. In at least one example, the core flat metal shaft member includes a three-dimensionally printed or overmolded non-conductive portion for supporting the slip ring assembly 1550.

[0108] 27 illustrates a portion of an electrosurgical instrument 12000 including a surgical end effector 12200 that may be coupled to a proximal shaft segment by an articulation joint in a variety of suitable manners. In a particular example, the surgical end effector 12200 includes an end effector frame assembly 12210 including a distal frame member 12220 rotatably supported within a proximal frame housing that is attached to the articulation joint.

[0109] The end effector 12200 includes a first jaw 12250 and a second jaw 12270. In the illustrated embodiment, the first jaw 12250 is pivotally pinned to the distal frame member 12220 for selective pivotal movement relative to the distal frame member 12220 about a first jaw axis FJA defined by a first jaw pin 12221. The second jaw 12270 is pivotally pinned to the first jaw 12250 for selective pivotal movement relative to the first jaw 12250 about a second jaw axis SJA defined by a second jaw pin 12272. In the illustrated embodiment, the surgical end effector 12200 employs an actuator yoke assembly 12610 pivotally coupled to the second jaw 12270 by a second jaw mounting pin 12273 for pivotal movement about a jaw actuation axis JAA that is proximal and parallel to the first jaw axis FJA and the second jaw axis SJA. The actuator yoke assembly 12610 includes a proximal threaded drive shaft 12614 that is threadably received within a threaded hole 12632 in the distal locking plate 12630. The threaded drive shaft 12614 is attached to the actuator yoke assembly 12610 such that relative rotation occurs between the shaft 12614 and the assembly 12610. The distal locking plate 12630 is supported for rotational movement within the distal frame member 12220. Thus, rotation of the distal locking plate 12630 results in axial movement of the actuator yoke assembly 12610.

[0110] In certain examples, the distal locking plate 12630 constitutes part of an end effector locking system 12225. The end effector locking system 12225 further comprises a dual acting rotational locking head 12640 attached to a rotational drive shaft 12602 of various types disclosed herein. The locking head 12640 comprises a first plurality of radially disposed distal locking features 12642 adapted to lockingly engage with a plurality of proximally facing radial grooves or recesses 12634 formed in the distal locking plate 12630. When the distal locking features 12642 lockingly engage with the radial grooves 12634 in the distal locking plate 12630, rotation of the rotational locking head 12640 causes the distal locking plate 12630 to rotate within the distal frame member 12220. Also, in at least one embodiment, the rotating lock head 12640 further comprises a second series of proximally facing proximal locking features 12644 adapted to lockingly engage a corresponding series of locking grooves provided in the distal frame member 12220. The locking spring 12646 functions to distally bias the rotating lock head into locking engagement with the distal locking plate 12630. In various examples, the rotating lock head 12640 can be pulled proximally by an unlocking cable or other member in a manner described herein. In another configuration, the rotating drive shaft 12602 can also be configured to move axially to move the rotating lock head 12640 axially within the distal frame member 12220. When the proximal locking feature 12644 of the rotational locking head 12640 engages with a series of locking grooves in the distal frame member 12220, rotation of the rotational drive shaft 12602 results in rotation of the surgical end effector 12200 about the shaft axis SA.

[0111] In a particular example, the first and second jaws 12250, 12270 are opened and closed as follows: To open or close the jaws, as discussed in detail above, the rotary lock head 12640 lockingly engages the distal lock plate 12630. Rotation of the rotary drive shaft 12602 in a first direction then rotates the distal lock plate 12630, which in turn drives the actuator yoke assembly 12610 axially in a distal direction DD, moving the first jaw 12250 and the second jaw 12270 toward an open position. Rotation of the rotary drive shaft 12602 in an opposite second direction drives the actuator yoke assembly 12610 axially proximally, pulling the jaws 12250, 12270 toward a closed position. To rotate the surgical end effector 12200 about the shaft axis SA, the locking cable or member is pulled proximally causing the rotational lock head 12640 to disengage from the distal locking plate 12630 and engage the distal frame member 12220. As the rotational drive shaft 12602 is then rotated in the desired direction, the distal frame member 12220 (and the surgical end effector 12200) rotates about the shaft axis SA.

[0112] FIG. 27 further illustrates an electrical connection assembly 5000 for electrically coupling the jaws 12250, 12270 to one or more power sources, such as, for example, generators 3106, 3107 (FIG. 36). The electrical connection assembly 5000 defines two separate electrical pathways 5001, 5002 extending through the electrosurgical instrument 12000, as shown in FIG. 27. In a first configuration, the electrical pathways 5001, 5002 cooperate to deliver bipolar energy to the end effector 12200 with one of the electrical pathways 5001, 5002 acting as a return path. Additionally, in a second configuration, the electrical pathways 5001, 5002 deliver monopolar energy 12200 separately and / or simultaneously. Thus, in the second configuration, both electrical pathways 5001, 5002 can be used as supply paths. Additionally, the electrical connection assembly 5000 can be utilized with other surgical instruments described elsewhere herein (e.g., surgical instrument 1500) to electrically couple such surgical instruments to one or more power sources (e.g., generators 3106, 3107).

[0113] In the illustrated embodiment, the electrical pathways 5001, 5002 are implemented using a flex circuit 5004 that extends at least partially through a coil tube 5005. As shown in Figure 30, the flex circuit 5004 includes two separate conductive trace elements 5006, 5007 embedded in a PCB (printed circuit board) substrate 5009. In a particular example, the flex circuit 5004 can be attached to a core flat metal shaft member with a 3D printed or overmolded plastic casing to completely fill / support the shaft.

[0114] In an alternative example, as shown in FIG. 32, the flex circuit 5004' extending through the coil tube 5005' can include conductive trace elements 5006', 5007' twisted in a helical profile into the PCB substrate 5009', resulting in a reduction in the overall size of the flex circuit 5004' and thus a reduction in the inner / outer diameter of the coil tube 5005'. FIGS. 31 and 32 show other embodiments of flex circuits 5004'', 5004''' including conductive trace elements 5006'', 5007'', and 5006'', 5007'', respectively, extending through the coil tubes 5005'', 5005''' and including alternative profiles for size reduction. For example, the flex circuit 5004'' includes a folded profile and the flex circuit 5004'' includes trace elements 5006'', 5007'', on opposite sides of the PCB 5009''.

[0115] Further to the above, the pathways 5001, 5002 are defined by trace portions 5006a-5006g and 5007a-5007g, respectively. The trace portions 5006b, 5006c and the trace portions 5007b, 5007c are in the form of rings that define a ring assembly 5010 that maintains an electrical connection through the pathways 5001, 5002 while allowing rotation of the end effector 12200 relative to the shaft of the surgical instrument 12000. Additionally, the trace portions 5006e, 5007e are disposed on either side of the actuator yoke assembly 12610. In the illustrated embodiment, the portions 5006e, 5007e are disposed about a hole configured to receive the second jaw mounting pin 12273, as shown in FIG. The trace portions 5006e, 5007e are configured to make electrical contact with corresponding portions 5006f, 5007f disposed on the second jaw 12270. Additionally, when the first jaw 12250 is assembled with the second jaw 12270, the trace portions 5007f, 5007g are electrically connected.

[0116] 29, the flex circuit 5014 includes spring-biased trace elements 5016, 5017 that are configured to exert a biasing force on the corresponding trace elements to ensure that the corresponding trace portions maintain electrical connection therewith, particularly as they move relative to one another. One or more of the trace portions of the paths 5001, 5002 can be modified to include spring-biased trace elements in accordance with the flex circuit 5014.

[0117] 34 , a graph 3000 illustrates a power scheme 3005′ of a tissue treatment cycle 3001 applied by the end effector 1400, or any other suitable end effector of the present disclosure, to tissue grasped by the end effector 1400. The tissue treatment cycle 3001 includes a tissue coagulation phase 3006 that includes a feathering segment 3008, a tissue warming segment 3009, and a sealing segment 3010. The tissue treatment cycle 3001 further includes a tissue transection or cutting phase 3007.

[0118] 36 illustrates an electrosurgical system 3100 including a control circuit 3101 configured to execute a power scheme 3005'. In the illustrated embodiment, the control circuit 3101 includes a controller 3104 having a storage medium in the form of a memory 3103 and a processor 3102. The storage medium stores program instructions for executing the power scheme 3005'. The electrosurgical system 3100 includes a generator 3106 configured to supply monopolar energy to the end effector 1400 in accordance with the power scheme 3005' and a generator 3107 configured to supply bipolar energy to the end effector 1400. In the illustrated embodiment, the control circuit 3101 is depicted separate from the surgical instrument 1500 and the generators 3106, 3107. However, in other embodiments, the control circuit 3101 may be integrated with the surgical instrument 1500, the generator 3106, or the generator 3107. In various aspects, the power scheme 3005' may be stored in the memory 3103 as an algorithm, an equation, and / or a look-up table, or any other suitable format. The control circuit 3101 may cause the generators 3106, 3107 to supply monopolar and / or bipolar energy to the end effector 1400 in accordance with the power scheme 3005'.

[0119] In the illustrated embodiment, the electrosurgical system 3100 further includes a feedback system 3109 in communication with the control circuit 3101. The feedback system 3109 may be a stand-alone system or may be integrated with the surgical instrument 1500, for example. In various aspects, the feedback system 3109 may be employed by the control circuit 3101 to perform a predetermined function, such as, for example, issuing an alert when one or more predetermined conditions are met. In certain examples, the feedback system 3109 may comprise one or more visual feedback systems, such as, for example, a display screen, a backlight, and / or an LED. In certain examples, the feedback system 3109 may comprise one or more audio feedback systems, such as, for example, a speaker and / or a buzzer. In certain examples, the feedback system 3109 may comprise, for example, one or more tactile feedback systems. In certain examples, the feedback system 3109 may comprise a combination of visual, audio, and / or tactile feedback systems, for example. Additionally, the electrosurgical system 3100 further includes a user interface 3110 in communication with the control circuitry 3101. The user interface 3110 may be a stand-alone interface or may be integrated with the surgical instrument 1500, for example.

[0120] The graph 3000 displays power (W) on the y-axis and time on the x-axis. The bipolar energy curve 3020 spans the tissue coagulation phase 3005, while the monopolar energy curve 3030 begins at the tissue coagulation phase 3006 and ends at the end of the tissue transection phase 3007. Thus, the tissue treatment cycle 3001 is configured to apply bipolar energy to tissue throughout the tissue coagulation phase 3006, but not during the tissue transection phase 3007, and to apply monopolar energy to tissue during the coagulation phase 3006 and portions of the transection phase 3007, as shown in FIG.

[0121] In various aspects, a user input may be received by the control circuit 3101 from a user interface 3110. The user input causes the control circuit 3101 to initialize execution of the power scheme 3005' at time t1. Alternatively, the initialization of the execution of the power scheme 3005' may be automatically triggered by a sensor signal from one or more sensors 3111 in communication with the control circuit 3101. For example, the power scheme 3005' may be automatically triggered by the control circuit 3101 in response to a sensor signal indicating a predetermined gap between the jaws 1450 and 1470 of the end effector 1400.

[0122] During the feathering segment 3008, the control circuit 3101 causes the generator 3107 to gradually increase the bipolar energy power delivered to the end effector 1400 to a predetermined power value P1 (e.g., 100 W) and maintain the bipolar energy power at or substantially at the predetermined power value P1 during the remainder of the feathering segment 3008 and tissue warming segment 3009. The predetermined power value P1 may be stored in the memory 3103 and / or provided by a user through the user interface 3110. During the sealing segment 3010, the control circuit 3101 causes the generator 3107 to gradually decrease the bipolar energy power. The application of bipolar energy ends at the end of the sealing segment 3010 of the tissue coagulation phase 3006 and before the start of the cutting / transection phase 3007.

[0123] Further to the above, at t2, the control circuitry 3101, for example, causes the generator 3107 to begin supplying monopolar energy power to the electrode 1474 of the end effector 1400. The application of monopolar energy to tissue begins at the end of the feathering segment 3008 and the beginning of the tissue heating segment 3009. The control circuitry 3101 causes the generator 3107 to gradually increase the monopolar energy power to a predetermined power level P2 (e.g., 75 W) and maintain, or at least substantially maintain, the predetermined power level P2 throughout the remainder of the tissue heating segment 3009 and the first portion of the sealing segment 3010. The predetermined power level P2 can also be stored in the memory 3103 and / or provided by a user through the user interface 3110.

[0124] During the sealing segment 3010 of the tissue coagulation phase 3006, the control circuit 3101 causes the generator 3107 to gradually increase the monopolar energy power delivered to the end effector 1400. The start of the tissue transection phase 3007 is signaled by an inflection point in the monopolar energy curve 3030, where the previous gradual increase in monopolar energy experienced during the sealing segment 3010 is followed by a step-up to a predetermined maximum threshold power level P3 (e.g., 150 W) sufficient to transcribe the coagulated tissue.

[0125] At t4, the control circuitry 3101 causes the generator 3107 to ramp up the monopolar energy power delivered to the end effector 1400 to a predetermined maximum threshold power level P3 and maintain, or at least substantially maintain, the predetermined maximum threshold power level P3 for a predetermined period of time (t4-t5) or until the end of the tissue transection phase 3007. In the illustrated embodiment, the monopolar energy power is terminated by the control circuitry 3101 at t5. Tissue transection continues mechanically as the jaws 1450, 1470 continue to apply pressure to the grasped tissue until the tissue transection phase 3007 ends at t6. Alternatively, in other embodiments, the control circuitry 3101 may cause the generator 3107 to continue to supply monopolar energy power to the end effector 1400 until the end of the tissue transection phase 3007.

[0126] The sensor readings of the sensor 3111 and / or the timer clock of the processor 3102 may be used by the control circuitry 3101 to determine when to cause the generator 3107 and / or the generator 3106 to begin, increase, decrease, and / or end energy supply to the end effector 1400 according to a power scheme, such as, for example, power scheme 3005'. The control circuitry 3101 may implement the power scheme 3005' by, for example, causing one or more timer clocks to count down one or more predetermined time periods (e.g., t1 to t2, t2 to t3, t3 to t4, t5 to t6), which may be stored in the memory 3103. Although the power scheme 3005' is time-based, the control circuit 3101 can adjust the predetermined duration of any of the individual segments 3008, 3009, 3010 and / or stages 3006, 3007 based on sensor readings received from one or more of the sensors 3111, such as, for example, a tissue impedance sensor.

[0127] The end effector 1400 is configured to deliver three different energy modalities to the grasped tissue. A first energy modality applied to the tissue during the feathering segment 3008 includes bipolar energy but not monopolar energy. A second energy modality is a mixed energy modality including a combination of monopolar and bipolar energy and is applied to the tissue during the tissue warming phase 3009 and the tissue sealing phase 3010. Finally, a third energy modality includes monopolar energy but not bipolar energy and is applied to the tissue during the cutting phase 3007. In various aspects, the second energy modality includes a power level that is the sum 3040 of the power levels of the monopolar and bipolar energy. In at least one embodiment, the power level of the second energy modality includes a maximum threshold Ps (e.g., 120 W).

[0128] In various aspects, the control circuitry 3101 delivers monopolar and bipolar energy to the end effector 1400 from two different electrical generators 3106, 3107. In at least one embodiment, energy from one of the generators 3106, 3107 can be detected using the return path of the other generator or utilizing an attached electrode of the other generator to short out unintended tissue interaction. Thus, parasitic loss of energy through unintended return paths can be detected by the generator connected to the return path. Inadvertent conductive paths can be mitigated by affecting voltage, power, waveform, or timing between uses.

[0129] Integrated sensors within the flex circuit of the surgical instrument 1500 can detect energization / shorting of the electrodes / conductive paths when no electrical potential should be present, and the ability to prevent the conductive paths from being open when inadvertent use is sensed. Additionally, directional electronic gating elements can also be utilized to prevent crosstalk from one generator to the source of the other.

[0130] One or more of the electrodes described by this disclosure (e.g., electrodes 1452, 1472, 1474 associated with jaws 1450, 1470) may include a segmented pattern having segments that are linked together when the electrode is energized by a generator (e.g., generator 1100). However, when the electrode is not energized, the segments are separated to prevent shorting beyond the electrode to other areas of the jaw.

[0131] In various embodiments, a thermally resistant electrode material is utilized with the end effector 1400. The material can be configured to inhibit electrical flow through the electrode above a predetermined temperature level, but continue to allow electrical current to flow through other portions of the electrode that are below a temperature threshold.

[0132] 37 shows a table representing an alternative power scheme 3005'' that may be stored in memory 3103 and executed by processor 3102 in a manner similar to power scheme 3005'. In executing power scheme 3005'', control circuit 3101 relies on jaw opening in addition to, or instead of, time in setting the power values ​​of generators 3106, 3107. Thus, power scheme 3005'' is a jaw opening based power scheme.

[0133] In the illustrated embodiment, jaw openings d0, d1, d2, d3, d4 from the power scheme 3005'' correspond to time values ​​t1, t2, t3, t4 from the power scheme 3005'. Thus, the feathering segment corresponds to a jaw opening from about d1 to about d2 (e.g., about 0.700 inches to about 0.500 inches). Additionally, the tissue warming segment corresponds to a jaw opening from about d2 to about d3 (e.g., about 0.500 inches to about 0.300 inches). Further, the sealing segment corresponds to a jaw opening from about d2 to about d3 (e.g., about 0.030 inches to about 0.010 inches). Further, the tissue cutting phase corresponds to a jaw opening from about d3 to about d4 (e.g., about 0.010 inches to about 0.003 inches).

[0134] Thus, the control circuit 3101 is configured to, for example, cause the generator 3106 to begin supplying bipolar energy power to the end effector 1400 when a reading from one or more of the sensors 3111 corresponds to a predetermined jaw opening d1, thereby initializing the feathering segment. Similarly, the control circuit 3101 is configured to, for example, cause the generator 3106 to stop supplying bipolar energy power to the end effector 1400 when a reading from one or more of the sensors 3111 corresponds to a predetermined jaw opening d2, thereby terminating the feathering segment. Similarly, the control circuit 3101 is configured to, for example, cause the generator 3107 to begin supplying monopolar energy power to the end effector 1400 when a reading from one or more of the sensors 3111 corresponds to a predetermined jaw opening d2, thereby initializing the warming segment.

[0135] In the illustrated embodiment, the jaw opening is defined by the distance between two corresponding reference points on the jaws 1450, 1470. The corresponding reference points are in contact with each other when the jaws 1450, 1470 are in a closed configuration with no tissue between the jaws. Alternatively, the jaw opening may be defined by the distance between the jaws 1450, 1470 measured along a line that intersects the jaws 1450, 1470 and perpendicular to a longitudinal axis extending centrally through the end effector 1500. Alternatively, the jaw opening may be defined by the distance between a first parallel line and a second parallel line that intersect the jaws 1450, 1470, respectively. The distance is measured along a line that extends perpendicular to the first and second parallel lines and that extends through the intersection between the first parallel line and the first jaw 1450 and through the intersection between the second parallel line and the second jaw 1470.

[0136] 35, in various embodiments, the electrosurgical system 3100 (FIG. 36) is configured to perform a tissue treatment cycle 4003 using a power scheme 3005. The tissue treatment cycle 4003 includes an initial tissue contact phase 4013, a tissue coagulation phase 4006, and a tissue transection phase 4007. The tissue contact phase 4013 includes an open configuration segment 4011 where no tissue is between the jaws 1450 and 1470, and a proper orientation segment 4012 where the jaws 1450 and 1470 are properly positioned relative to the desired tissue treatment area. The tissue coagulation phase 4006 includes a feathering segment 4008, a tissue warming segment 4009, and a sealing segment 3010. The tissue transection phase 4007 includes a tissue cutting segment. The tissue treatment cycle 4003 includes the application of bipolar and monopolar energy separately and simultaneously to the tissue treatment area in accordance with the power scheme 3005. Tissue treatment cycle 4003 is similar in many respects to tissue treatment cycle 3001, which, for the sake of brevity, will not be repeated in the same level of detail herein.

[0137] FIG. 35 illustrates a graph 4000 depicting a power scheme 3005 similar in many respects to power scheme 3005'. For example, control circuitry 3101 may execute power scheme 3005 in a manner similar to power scheme 3005' to deliver three different energy modalities to a tissue treatment region in three consecutive periods of a tissue treatment cycle 4001. A first energy modality including bipolar energy but no monopolar energy is applied to the tissue treatment region in a feathering segment 4008 from t1 to t2. A second energy modality, a mixed energy modality including a combination of monopolar and bipolar energy, is applied to the tissue treatment region in a tissue warming segment 4009 and a tissue sealing segment from t2 to t4. Finally, a third energy modality including monopolar energy but no bipolar energy 4010 is applied to the tissue in a tissue transection phase 4007 from t4 to t5. Further, the second energy modality includes a power level that is the sum of the power levels of the monopolar energy and the bipolar energy. In at least one embodiment, the power level of the second energy modality includes a maximum threshold (e.g., 120 W). In various aspects, the power scheme 3005 may be delivered to the end effector 1400 from two different electrical generators 3106, 3107. Additional aspects of the power scheme 3005 that are similar to aspects of the power scheme 3005' are not repeated in the same level of detail herein for the sake of brevity.

[0138] In various aspects, the control circuit 3101 causes the generators 3106, 3107 to adjust the bipolar and / or monopolar power levels of the power scheme 3005 applied by the end effector 1400 to the tissue treatment area based on one or more measured parameters including tissue impedance 4002, jaw motor speed 27920d, jaw motor force 27920c, jaw opening 27920b of the end effector 1400, and / or motor current draw resulting in end effector closure. Figure 35 is a graph 4000 illustrating the correlation between such measured parameters and the power scheme 3005 over time.

[0139] In various embodiments, the control circuit 3101 causes the generators 3106, 3107 to adjust the power level of a power scheme (e.g., power schemes 3005, 3005') applied by the end effector 1400 to the tissue treatment area based on one or more parameters (e.g., tissue impedance 4002, jaw / closing motor speed 27920d, jaw / closing motor force 27920c, jaw gap / opening 27920b of the end effector 1400, and / or motor current draw) determined by one or more sensors 3111. For example, the control circuit 3101 can cause the generators 3106, 3107 to adjust the power level based on the pressure in the jaws 1450, 1470.

[0140] In at least one embodiment, the power level is inversely proportional to the pressure in the jaws 1450, 1470. The control circuit 3101 can utilize such an inverse correlation to select a power level based on the pressure value. In at least one embodiment, the current draw of the motor that causes the end effector closure is employed to determine the pressure value. Alternatively, the inverse correlation utilized by the control circuit 3101 can be based directly on the current draw as a proxy for pressure. In various embodiments, the more compression applied by the jaws 1450, 1470 on the tissue treatment area, the lower the power level set by the control circuit 3101, which helps minimize tissue sticking and inadvertent cutting.

[0141] The graph 4000 provides several cues in the measured parameters of tissue impedance 4002, jaw / closure motor speed 27920d, jaw / closure motor force 27920c, jaw gap / opening 27920b of the end effector 1400, and / or motor current draw resulting in end effector closure, which can trigger the initiation, adjustment, and / or termination of the application of bipolar and / or monopolar energy to tissue in a tissue treatment cycle 4003.

[0142] The control circuit 3101 may rely on one or more of such cues in executing and / or adjusting the default power scheme 3005 in the tissue treatment cycle 4003. In certain examples, the control circuit 3101 may rely on sensor readings of one or more sensors 3111 to detect when one or more monitored parameters satisfy one or more predefined conditions, which may be stored, for example, in the memory 3103. The one or more predefined conditions may be reaching a predefined threshold and / or detecting a significant increase and / or decrease in one or more of the monitored parameters. The satisfaction of the predefined conditions, or lack thereof, constitutes a trigger / check point for executing and / or adjusting a portion of the default power scheme 3005 in the tissue treatment cycle 4003. The control circuit 3101 may rely solely on cues in executing and / or adjusting a power scheme, or alternatively, the cues may be used to steer or adjust a timer clock of a time-based power scheme, such as, for example, the power scheme 3005'.

[0143] For example, a sudden decrease (A1) in tissue impedance to a predetermined threshold (Z1), either alone or concomitant with an increase (A2) in jaw motor force to a predetermined threshold (F1) and / or a decrease (A3) in jaw opening to a predetermined threshold (d1) (e.g., 0.5 inches), can trigger the control circuit 3101 to begin the feathering segment 4008 of the tissue coagulation phase 4006 by activating the application of bipolar energy to the tissue treatment region. The control circuit 3101 can signal the generator 3106 to begin supplying bipolar power to the end effector 1400.

[0144] Furthermore, when the jaw motor speed drops (B1) to a predetermined value (v1) following activation of the bipolar energy, it triggers the control circuit 3101 to signal the generator 3106 to stabilize (B2) the power level for the bipolar energy at a constant, or at least a substantially constant value (e.g., 100 W).

[0145] In yet another example, the transition from the feathering segment 4008 to the warming segment 4009 at t2, which triggers the activation (D1) of the application of monopolar energy to the tissue treatment region, coincides with an increase (C2) in the jaw motor force to a predetermined threshold (F2), a decrease (C3) in the jaw opening to a predetermined threshold (e.g., 0.03 inches), and / or a decrease (C1) in the tissue impedance to a predetermined value Z2. When one, or in certain examples two, or in certain examples all of conditions C1, C2, C3 are satisfied, the control circuit 3101 causes the generator 3101 to begin applying monopolar energy to the tissue treatment region. In another example, the application of monopolar energy to the tissue treatment region is triggered when one, or in certain examples two, or in certain examples all of conditions C1, C2, C3 are satisfied at or near time t2.

[0146] When monopolar energy is activated by the generator 3107 in response to an activation signal by the control circuit 3101, a mix of monopolar and bipolar energy (D1) is delivered to the tissue treatment area, causing a shift in the impedance curve characterized by a faster decrease in impedance (E1) from Z2 to Z3 compared to the steady decrease (C1) prior to activation of the monopolar energy. In the illustrated embodiment, tissue impedance Z3 defines the minimum impedance for the tissue treatment cycle 4003.

[0147] In the illustrated example, the control circuit 3101 determines that an acceptable seal has been achieved when (E1) the minimum impedance value Z3 meets or at least substantially meets (E3) a predetermined maximum jaw motor force threshold (F3) and / or (E2) a predetermined jaw opening threshold range (e.g., 0.01 inch to 0.003 inch). When one, or in certain examples two, or in certain examples all of conditions E1, E2, E3 are met, a signal is sent to the control circuit 3101 to shift from the warming segment 4009 to the sealing segment 4010.

[0148] Further to the above, once the minimum impedance value Z3 is exceeded, the impedance level gradually increases at t4 up to a threshold Z4 which corresponds to the end of the seal segment 4010. Once threshold Z4 is met, the control circuit 3101 signals the generator 3107 to step up the monopolar power level to begin the tissue transection phase 4007 and signals the generator 3106 to terminate the application of bipolar energy application to the tissue treatment region.

[0149] In various embodiments, the control circuit 3101 can be configured to verify that (G1) the jaw motor force decreases as the impedance gradually increases from its minimum value Z3, (G2) and / or (G3) the jaw opening has decreased to a predetermined threshold (e.g., between 0.01 inches and 0.003 inches) before increasing the power level of the monopolar energy to cut tissue.

[0150] However, if the jaw motor force continues to increase, the control circuit 3101 can pause the application of monopolar energy to the tissue treatment area for a predetermined amount of time to allow the jaw motor force to begin to decrease. Alternatively, the control circuit can signal the generator 3107 to stop the monopolar energy and complete the seal using only bipolar energy.

[0151] In certain examples, the control circuitry 3101 can employ a feedback system 3109 to warn the user and / or provide instructions or recommendations to pause the application of monopolar energy. In certain examples, the control circuitry 3101 can instruct the user to utilize on a mechanical knife to transect tissue.

[0152] In the illustrated embodiment, the control circuit 3101 maintains the increased monopolar power (H) until a spike (I) is detected in the tissue impedance. Upon detection of a spike (I) in the impedance level to Z5 following the ramp from Z3 to Z4, the control circuit 3101 can cause the generator 3107 to terminate application of monopolar energy to the tissue (J). The spike indicates the completion of the tissue treatment cycle 4003.

[0153] In various embodiments, the control circuit 3101 prevents the electrodes of the jaws 1450, 1470 from being energized before a suitable closure threshold is reached. The closure threshold may be based on a predetermined jaw opening threshold and / or a predetermined jaw motor force threshold, which may be stored in the memory 3103, for example. In such embodiments, the control circuit 3101 may not execute a user input via the user interface 3110 requesting a treatment cycle 4003. In certain examples, the control circuit 3101 may respond by alerting the user through the feedback system 3109 that the suitable closure threshold has not been reached. The control circuit 3101 may also provide an override option to the user.

[0154] Finally, between times t4 and t5, monopolar energy is the only energy delivered to cut the patient tissue. While the patient tissue is being cut, the force clamping the jaws of the end effector may vary. In instances where the force clamping the jaws decreases 27952 from its steady state level maintained between times t3 and t4, efficient and / or effective tissue cutting is recognized by the surgical instrument and / or surgical hub. In instances where the force clamping the jaws increases 27954 from its steady state level maintained between times t3 and t4, inefficient and / or ineffective tissue cutting is recognized by the surgical instrument and / or surgical hub. In such instances, an error may be communicated to the user.

[0155] 38-42, the surgical instrument 1601 includes an end effector 1600 similar in many respects to the end effectors 1400, 1500, which will not be repeated in the same level of detail herein for the sake of brevity. The end effector 1600 includes a first jaw 1650 and a second jaw 1670. At least one of the first jaw 1650 and the second jaw 1670 is movable to transition the end effector 1600 from an open configuration to a closed configuration to grasp tissue (T) between the first jaw 1650 and the second jaw 1670. The electrodes 1652, 1672 are configured to cooperate to deliver bipolar energy from the bipolar energy source 1610 to the tissue, as shown in FIG. 39. The electrode 1674 is configured to deliver monopolar energy from the monopolar energy source 1620 to the tissue. The return pad 1621 defines a return path for monopolar energy. In at least one embodiment, monopolar and bipolar energy are delivered to tissue simultaneously (FIG. 36) or alternately, as shown in FIG. 36, for example, to seal and / or cut tissue.

[0156] 42 shows a simplified schematic diagram of an electrosurgical system 1607 including a monopolar power source 1620 and a bipolar power source 1610 connectable to an electrosurgical instrument 1601 including an end effector 1600. The electrosurgical system 1607 further includes a conductive circuit 1602 selectively transitionable between a connection configuration with an electrode 1672 and a cutting configuration with the electrode 1672. The switching mechanism may comprise, for example, any suitable switch capable of opening and closing the conductive circuit 1602. In the connection configuration, the electrode 1672 is configured to cooperate with the electrode 1652 to deliver bipolar energy to tissue, and the conductive circuit 1602 defines a return path for the bipolar energy after passing through the tissue. However, in the cutting configuration, the electrode 1672 is insulated, resulting in an inactive internally conductive and externally insulating structure on the jaw 1670. Thus, in the cutting configuration, electrode 1652 is configured to deliver monopolar energy to tissue in addition to, or in addition to, the monopolar energy delivered through electrode 1674. In the alternative, instead of electrode 1672, electrode 1652 may be transitionable between a connected configuration with conductive circuit 1602 and a cutting configuration, allowing electrode 1672 to deliver monopolar energy to tissue in addition to, or in addition to, the monopolar energy delivered through electrode 1674.

[0157] In various aspects, the electrosurgical instrument 1601 further includes a control circuit 1604 configured to adjust the level of monopolar and bipolar energy delivered to the tissue to minimize unintended thermal damage to the surrounding tissue. The adjustment can be based on the readings of at least one sensor, such as, for example, a temperature sensor, an impedance sensor, and / or a current sensor. In the example shown in FIGS. 41 and 42, the control circuit 1604 is coupled to temperature sensors 1651, 1671 on the jaws 1650, 1670, respectively. The level of monopolar and bipolar energy delivered to the tissue is adjusted by the control circuit 1604 based on the temperature readings of the sensors 1651, 1671.

[0158] In the illustrated embodiment, the control circuitry 1604 includes a controller 3104 having a storage medium in the form of a memory 3103 and a processor 3102. The memory 3103 stores program instructions that, when executed by the processor 3102, cause the processor 3102 to adjust the levels of monopolar and bipolar energy delivered to tissue based on sensor readings received from one or more sensors, such as, for example, temperature sensors 1651, 1671. In various embodiments, as described in more detail below, the control circuitry 1604 can adjust a default power scheme 1701 based on readings from one or more sensors, such as, for example, temperature sensors 1651, 1671. The power scheme 1701 is similar in many respects to the power scheme 3005', which will not be repeated in the same level of detail herein for the sake of brevity.

[0159] FIG. 43 illustrates temperature-based adjustment of a power scheme 1701 for energy delivery to tissue grasped by the end effector 1600. The graph 1700 displays time on the x-axis and power and temperature on the y-axis. In the tissue feathering segment (t1-t2), the control circuit 1604 gradually increases the power level of the bipolar energy to a predetermined threshold (e.g., 120 W), which gradually increases the temperature of the tissue grasped by the end effector 1600 to a temperature within a predetermined range (e.g., 100° C.-120° C.). The control circuit 1604 then maintains the power level of the bipolar energy at the predetermined threshold while the tissue temperature is maintained within the predetermined range. In the tissue warming segment (t2-t3), the control circuit 1604 activates the monopolar energy and gradually decreases the power level of the bipolar energy while gradually increasing the power level of the monopolar energy to maintain the tissue temperature within the predetermined range.

[0160] In the illustrated embodiment, during the tissue sealing segment (t3-t4), the control circuit 1604 detects that the tissue temperature has reached the upper limit of a predetermined range based on the readings of the temperature sensors 1651, 1671. The control circuit 1604 responds by stepping down the power level of the monopolar energy. In other embodiments, the reduction can be performed gradually. In certain embodiments, the reduction value, or a method for determining the reduction value, such as a table or equation, can be stored in the memory 3103. In certain embodiments, the reduction value can be a percentage of the current power level of the monopolar energy. In other embodiments, the reduction value can be based on a previous power level of the monopolar energy that corresponds to a tissue temperature within the predetermined range. In certain embodiments, the reduction can be performed in multiple steps spaced apart in time. After each stepping down step, the control circuit 1604 allows a predetermined period of time to pass before evaluating the tissue temperature.

[0161] In the illustrated embodiment, the control circuit 1604 maintains the power level of the bipolar energy according to a default power scheme 1701, but reduces the power level of the monopolar energy to maintain the tissue temperature within a predetermined range while the tissue seal is complete. In other embodiments, the reduction in the power level of the monopolar energy is combined with or replaced by a reduction in the power level of the bipolar energy.

[0162] In addition to the above, to avoid unintended lateral thermal damage to surrounding tissue, an alert can be issued via the feedback system 3109 to complete the tissue transection using, for example, a mechanical knife instead of monopolar energy. In certain examples, the control circuit 1604 can temporarily pause the monopolar and / or bipolar energy until the tissue temperature returns to a level within the predetermined temperature range. The monopolar energy can then be reactivated to effect transection of the sealed tissue.

[0163] 44, the end effector 1600 is applying monopolar energy to a tissue treatment region 1683 in a blood vessel, such as an artery, grasped by the end effector 1600. The monopolar energy flows from the end effector 1600 to the treatment region 1683 and ultimately to a return pad (e.g., return pad 1621). The temperature of the tissue in the treatment region 1683 increases as the monopolar energy is applied to the tissue. However, the actual heat spread 1681 is greater than the expected heat spread 1682 due to, for example, a stenosed portion 1684 of the artery that inadvertently draws the monopolar energy.

[0164] In various aspects, the control circuitry 1604 monitors the thermal effect in the treatment region 1683 resulting from the application of monopolar energy to the treatment region 1683. The control circuitry 1604 can further detect when the monitored thermal effect does not follow a predetermined correlation between the applied monopolar energy and the thermal effect expected from the application of monopolar energy in the treatment region. In the illustrated embodiment, inadvertent energy withdrawal at the arterial stenosis reduces the thermal effect in the treatment region, which is detected by the control circuitry 1604.

[0165] In certain embodiments, the memory 3103 stores a predetermined correlation algorithm between the monopolar energy level applied to the tissue treatment region grasped by the end effector 1600 and the expected thermal effect resulting from the application of the monopolar energy to the tissue treatment region. The correlation algorithm may be in the form of, for example, an array, a look-up table, a database, a mathematical equation, or a formula, etc. In at least one embodiment, the stored correlation algorithm defines a correlation between the power level of the monopolar energy and the expected temperature. The control circuit 1604 can monitor the temperature of the tissue in the treatment region 1683 using the temperature sensors 1651, 1671 and can determine whether the monitored temperature reading corresponds to the expected temperature reading at a particular power level.

[0166] The control circuitry 1604 can be configured to take certain actions if it is detected that the stored correlation has not been followed. For example, the control circuitry 1604 can warn the user of the non-compliance. Additionally or alternatively, the control circuitry 1604 can reduce or suspend the delivery of monopolar energy to the treatment region. In at least one embodiment, the control circuitry 1604 can adjust the application or switch the application from monopolar to bipolar energy to the tissue treatment region to determine the presence of parasitic power draw. The control circuitry 1604 can continue to use bipolar energy in the treatment region if parasitic power draw is determined. However, if the control circuitry 1604 denies the presence of parasitic power draw, the control circuitry 1604 can restart or re-increase the monopolar power level. The change to monopolar and / or bipolar power levels can be accomplished in the control circuitry 1604, for example, by sending a signal to the monopolar power supply 1620 and / or the bipolar power supply 1610.

[0167] In various aspects, as shown in FIG. 45, one or more imaging devices, such as, for example, a multispectral scope 1690 and / or an infrared imaging device, can be utilized to monitor the spectral changes and / or thermal effects of tissue in the tissue treatment region 1691. The imaging data from the one or more imaging devices can be processed to estimate the temperature in the tissue treatment region 1691. For example, a user can point an infrared imaging device at the treatment region 1691 when monopolar energy is being applied to the treatment region 1691 by the end effector of 1600. As the treatment region 1691 heats up, its infrared thermal signature changes. Thus, the change in the thermal signature corresponds to a change in the temperature of the tissue in the treatment region 1691. Thus, the temperature of the tissue in the treatment region 1691 can be determined based on the thermal signature captured by the one or more imaging devices. If the temperature estimated based on the thermal signature in the treatment area 1691 associated with a particular fraction level is less than or equal to the expected temperature at the power level, the control circuit 1604 detects a discrepancy in the thermal effect in the treatment area 1691 .

[0168] In other embodiments, the thermal signature captured by the one or more imaging devices is not converted to an estimated temperature, but instead is directly compared to the thermal signature stored in memory 3103 to assess whether an adjustment to the power level is required.

[0169] In certain embodiments, the memory 3103 stores a predetermined correlation algorithm between the power level of the monopolar energy applied by the end effector 1600 to the tissue treatment region 1691 and an expected thermal signature resulting from the application of monopolar energy to the tissue treatment region. The correlation algorithm may be in the form of, for example, an array, a lookup table, a database, a mathematical equation, a formula, or the like. In at least one embodiment, the stored correlation algorithm defines a correlation between the power level of the monopolar energy and an expected temperature signature or a temperature associated with the expected temperature signature.

[0170] 46 and 47, the electrosurgical system includes an electrosurgical instrument 1801 having an end effector 1800 similar in many respects to the end effectors 1400, 1500, 1600, which will not be repeated in the same level of detail herein for the sake of brevity. The end effector 1800 includes a first jaw 1850 and a second jaw 1870. At least one of the first jaw 1850 and the second jaw 1870 is movable to transition the end effector 1800 from an open configuration to a closed configuration to grasp tissue (T) between the first jaw 1850 and the second jaw 1870. The electrodes 1852, 1872 are configured to cooperate to deliver bipolar energy to the tissue. The electrode 1874 is configured to deliver monopolar energy to the tissue. In at least one embodiment, monopolar and bipolar energy are delivered simultaneously or alternatingly to tissue, as shown in FIG. 34, for example, to seal and / or cut tissue.

[0171] In the illustrated embodiment, bipolar and monopolar energy are generated by separate generators 1880, 1881 and provided to the tissue by separate electrical circuits 1882, 1883 that respectively connect the generator 1880 to the electrodes 1852, 1872 and the generator 1881 to the electrode 1874 and return pad 1803. The power level associated with the bipolar energy delivered to the tissue by the electrodes 1852, 1872 is set by the generator 1880 and the power level associated with the monopolar energy delivered to the tissue by the electrode 1874 is set by the generator 1881, e.g., according to a power scheme 3005'.

[0172] In use, as shown in FIG 46, the end effector 1800 applies bipolar and / or monopolar energy to the tissue treatment region 1804 to seal and, in certain instances, transectomize tissue. However, in certain instances, the energy may be deflected from the intended target in the tissue treatment region 1804, causing off-site thermal damage to the surrounding tissue. To avoid, or at least reduce, such thermal damage from occurring, the surgical instrument 1801 includes impedance sensors 1810, 1811, 1812, 1813 positioned between different electrodes and at different locations, as shown in FIG 46, to detect off-site thermal damage.

[0173] In various aspects, the surgical system 1807 further includes a control circuit 1809 coupled to the impedance sensors 1810, 1811, 1812, 1813. The control circuit 1809 can detect off-site or unintended thermal damage based on one or more readings of the impedance sensors 1810, 1811, 1812, 1813. In response, the control circuit 1809 can alert the user of the off-site thermal damage and instruct the user to pause energy delivery to the tissue treatment region 1804 or automatically pause energy delivery while maintaining bipolar energy according to a predetermined power scheme (e.g., power scheme 3005') to complete the tissue seal. In certain examples, the control circuit 1809 can instruct the user to employ a mechanical knife to transect the tissue and prevent further off-site thermal damage.

[0174] 46, impedance sensor 1810 is configured to measure impedance between bipolar electrodes 1852, 1872. Additionally, impedance sensor 1811 is configured to measure impedance between electrode 1874 and return pad 1803. Additionally, impedance sensor 1812 is configured to measure impedance between electrode 1872 and return pad 1803. Additionally, impedance sensor 1813 is configured to measure impedance between electrode 1852 and return pad 1803. In other embodiments, additional impedance sensors are added in series between monopolar circuit 1882 and bipolar circuit 1883, which can be utilized to measure impedance at various locations to detect off-site thermal anomalies with greater specificity with respect to location and impedance path.

[0175] In various aspects, off-site thermal damage occurs in tissue on one side (left / right) of the end effector 1800. The control circuit 1809 can detect which side the off-site thermal damage occurred on by comparing the readings of the impedance sensors 1810, 1811, 1812, 1813. In one embodiment, a non-proportional change in the monopolar and bipolar impedance readings indicates off-site thermal damage. Conversely, if proportionality in the impedance readings is detected, the control circuit 1809 maintains that no off-site thermal damage has occurred. In one embodiment, the off-site thermal damage can be detected by the control circuit 1809 from the ratio of bipolar impedance to monopolar impedance, as described in more detail below.

[0176] FIG. 48 illustrates a graph 1900 displaying time on the x-axis and power on the y-axis. The graph 1900 illustrates a power scheme 1901 that is in many respects similar to the power scheme 3005′ illustrated in FIG. 34, which is not repeated here at the same level of detail for the sake of brevity. The control circuit 3101 applies the power scheme 1901 through the generators 1880 (GEN.2), 1881 (GEN.1) to effect a tissue treatment cycle through the end effector 1800. The power scheme 1901 includes a therapeutic power component 1902 and a non-therapeutic, or sensing, power component 1903. The therapeutic power component 1902 defines monopolar and bipolar power levels similar to those described in connection with the power scheme 3005′. The sensing power component 1903 includes monopolar 1905 and bipolar 1904 sensing pings delivered at various points throughout the tissue treatment cycle performed by the end effector 1800. In at least one embodiment, the sensing power component sensing pings 1903, 1904 are delivered at a predetermined current value (e.g., 10 mA) or within a predetermined range. In at least one embodiment, three different sensing pings are utilized to determine the location / orientation of potential off-site thermal damage.

[0177] The control circuit 3101 can determine whether energy is diverted to non-tissue therapy directed sites during a tissue treatment cycle by sending sensing pings 1903, 1904 at predetermined time intervals. The control circuit 3101 can then evaluate the return path conductivity based on the delivered sensing pings. If it is determined that energy is diverted from the target site, the control circuit 3101 can take one or more reactive actions. For example, the control circuit 3101 can adjust the power scheme 1901 applied by the generators 1880 (GEN.2), 1881 (GEN.1). The control circuit 3101 can suspend the application of bipolar and / or monopolar energy to the target site. Additionally, the control circuit 3101 can issue a warning to the user, for example, through the feedback system 3109. However, if it is determined that energy is not detected to be diverted, the control circuit 3101 continues to execute the power scheme 1901.

[0178] In various embodiments, the control circuitry 3101 evaluates the return path conductivity, for example, by comparing the measured return path conductivity to a predetermined return path conductivity stored in memory 3103. If the comparison indicates that the measured return path conductivity and the predetermined return path conductivity differ by more than a predetermined threshold, the control circuitry 3101 concludes that energy is being diverted to a non-tissue therapy directed site and performs one or more of the response measurements described above.

[0179] FIG. 49 is a graph 2000 illustrating a power scheme 2001 that is interrupted at t3′ due to detected off-site thermal damage. The power scheme 2001 is in many respects similar to the power schemes shown in FIG. 34, FIG. 48 and, for the sake of brevity, will not be repeated in the same level of detail here. The control circuit 1809, for example, causes generators 1880 (curve 2010), 1881 (curve 2020) to apply the power scheme 2001 to effect a tissue treatment cycle with the end effector 1800. In addition to the power scheme 2001, the graph 2000 further illustrates a bipolar impedance 2011 (Z bipolar), Unipolar Impedance 2021 (Z monopolar ), and the ratio of unipolar to bipolar impedance on the y-axis 2030 (Z monopolar / Z bipolar During normal operation, while monopolar and bipolar energy are simultaneously applied to tissue, the bipolar impedance 2011 (Z bipolar ) and Unipolar Impedance 2021 (Z monopolar ) remain proportional, or at least substantially proportional. As a result, a constant, or at least substantially constant, impedance ratio 2030 (Z monopolar / Z bipolar ) will be maintained within a predetermined range 2031 during normal operation.

[0180] In various embodiments, the control circuit 1809 monitors the impedance ratio 2030 to assess whether monopolar energy is being diverted to non-tissue therapy directed sites. bipolar ) and Unipolar Impedance 2021 (Z monopolar ) changes in the ratio of the detected values, which changes the impedance ratio 2030. A change in impedance ratio 2030 within a predetermined range 2031 may cause the control circuit 1908 to issue an alarm. However, if the change falls below a lower threshold of the predetermined range 2031, the control circuit 1908 may take additional responsive measurements.

[0181] In the illustrated embodiment, the impedance ratio is 2030 (Z monopolar / Z bipolar ) remains constant, or at least substantially constant, for the first portion of the treatment cycle involving the application of mixed monopolar and bipolar energy to the tissue. However, at B1, the monopolar impedance (Z monopolar ) is the bipolar impedance (Z bipolar) may occur, indicating potential off-site thermal damage. In at least one embodiment, the control circuit 1809 may also determine the ratio of unipolar to bipolar impedance (Z monopolar / Z bipolar ) and detects off-site thermal damage if the change persists for a predetermined time and / or the value changes below a lower threshold of a predetermined range 2031. At B1, since the detected impedance ratio 2030 is still within the predetermined range 2031, the control circuit 3101 continues to monitor the impedance ratio 2030, but only issues a warning through the feedback system 3109 that offset thermal damage has been detected.

[0182] At t3', the control circuit 3101 further detects that the impedance ratio 2030 has changed to a value below the lower threshold of the predetermined range 2031. In response, the control circuit 3101 can issue another warning and, optionally, instruct the user to pause energy delivery to the tissue at B2 or automatically pause the energy delivery while maintaining or adjusting the power level of the bipolar energy to complete the tissue seal without monopolar energy. In certain embodiments, the control circuit 1809 can further instruct the user to transecte the tissue using a mechanical knife (t4') to prevent further off-site thermal damage. In the illustrated embodiment, the control circuit 1809 further instructs the generator 1880 to adjust its power level to complete the tissue seal without monopolar energy and increase the time period allocated to the tissue sealing segment from time t4 to time t4'. In other words, the control circuit 1809 increases the bipolar energy delivery to the tissue to compensate for the loss of monopolar energy by increasing the bipolar power level and its delivery time.

[0183] Various aspects of the subject matter described herein are illustrated in the following examples.

[0184] Various aspects of the subject matter described herein are illustrated in the following examples.

[0185] Example Set 1 Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw comprises a constricting body extending from a proximal end to a distal end. The constricting body comprises a conductive material. The constricting body includes a first conductive portion extending from the proximal end to the distal end and a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the constricting body. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion in a cross section of the constricting body. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first conductive portion from tissue but not the second conductive portion, the first conductive portion being configured to transfer electrical energy to tissue only through the second conductive portion.

[0186] Example 2 - The electrosurgical instrument of Example 1, wherein the tapered electrode includes an outer surface that is flush with the outer surface of the electrically insulating layer.

[0187] Example 3 - The electrosurgical instrument of example 1 or 2, wherein the tapered electrode comprises a gradually narrowing width as the tapered electrode extends from the proximal end towards the distal end.

[0188] Example 4 - The electrosurgical instrument of Examples 1, 2, or 3, wherein the electrical energy is delivered to the tissue through an outer surface of the tapered electrode.

[0189] Example 5 - An electrosurgical instrument as described in Examples 1, 2, 3, or 4, wherein the first jaw comprises a first electrode extending distally along at least a portion of the first jaw, the tapered electrode is a second electrode, and the first electrode is laterally offset from the second electrode in the closed configuration.

[0190] Example 6 - The electrosurgical instrument of Example 5, wherein the second jaw further comprises a third electrode spaced apart from the narrowing body.

[0191] Example 7 - The electrosurgical instrument of Example 6, wherein the third electrode extends distally from the electrode proximal end to the electrode distal end along an angular profile defined by the second jaw.

[0192] Example 8 - The electrosurgical instrument of Example 7, wherein the third electrode comprises a base positioned within the cradle that extends distally from the cradle proximal and to the cradle distal end along the angular profile of the second jaw.

[0193] Example 9 - The electrosurgical instrument of Example 8, wherein the cradle is centrally located relative to the lateral edge of the second jaw.

[0194] Example 10 - The electrosurgical instrument of example 8 or 9, wherein the third electrode further comprises a tapered edge extending from the base beyond the side wall of the cradle.

[0195] Example 11 - The electrosurgical instrument of Example 8, 9, or 10, wherein the cradle is made of a compliant substrate.

[0196] Example 12 - An electrosurgical instrument as described in Examples 8, 9, 10, or 11, wherein the cradle is partially embedded in a valley defined within the gradually narrowing body.

[0197] Example 13 - An electrosurgical instrument as described in Examples 8, 9, 10, 11, or 12, wherein the cradle is spaced from the narrowing body by an electrically insulating coating.

[0198] Example 14 - An electrosurgical instrument as described in Example 8, 9, 10, 11, 12, or 13, wherein the base includes a base proximal end, a base distal end, and a width that gradually narrows as the base extends along the angular profile from the base proximal end to the base distal end.

[0199] Example 15 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw comprises a conductor including a tapered angular profile extending from a proximal end to a distal end. The conductor includes a first conductive portion extending from the proximal end to the distal end and a second conductive portion protruding from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the conductor. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first conductive portion, but not the second conductive portion, from tissue. The first conductive portion is configured to transmit electrical energy to tissue only through the second conductive portion.

[0200] Example 16 - The electrosurgical instrument of Example 15, wherein the tapered electrode comprises a gradually narrowing width as the tapered electrode extends from the proximal end towards the distal end.

[0201] Example 17 - An electrosurgical instrument as described in Example 15 or 16, wherein the first jaw has a first electrode extending distally along at least a portion of the first jaw, the tapered electrode is a second electrode, and the first electrode is laterally offset from the second electrode in the closed configuration.

[0202] Example 18 - The electrosurgical instrument of Examples 15, 16, or 17, wherein the second jaw further comprises a third electrode spaced apart from the electrical conductor.

[0203] Example 19 - The electrosurgical instrument of Example 18, wherein the third electrode extends distally along at least a portion of the tapered angular profile.

[0204] Example 20 - An electrosurgical instrument as described in Example 19, wherein the third electrode has a base positioned within the cradle extending distally from the cradle proximal end and to the cradle distal end along at least a portion of the tapered angular profile, and the cradle is made of a compliant substrate.

[0205] Example Set 2 Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw comprises a linear portion that cooperates to form an angular profile and a treatment surface including segments that extend along the angular profile. The segments include different geometric shapes and different electrical conductivities. The segments are configured to generate a variable energy density along the treatment surface.

[0206] Example 2 - The electrosurgical instrument of example 1, wherein the segments comprise a proximal segment and a distal segment. The proximal segment comprises a first surface area. The distal segment comprises a second surface area. The second surface area is less than the first surface area.

[0207] Example 3 - An electrosurgical instrument as described in Example 1 or 2, wherein at least one of the segments includes a conductive treatment region longitudinally interrupted by a non-conductive treatment region.

[0208] Example 4 - An electrosurgical instrument as described in Examples 1, 2, or 3, wherein the variable energy density is predetermined based on the selection of different geometric shapes and different electrical conductivities of the segments.

[0209] Example 5 - An electrosurgical instrument as described in Example 1, 2, 3, or 4, wherein at least one of the segments includes a gradually narrowing width along its length.

[0210] Example 6 - An electrosurgical instrument as described in Examples 1, 2, 3, 4, or 5, wherein the segment extends along a peripheral side of the second jaw.

[0211] Example 7 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, or 6, wherein the segment is defined in the second jaw but not in the first jaw.

[0212] Example 8 - An electrosurgical instrument as described in Example 1, 2, 3, 4, 5, 6, or 7, wherein the second jaw comprises a conductive skeleton partially coated with a first material and a second material, the first material being thermally conductive but not electrically insulating, and the second material being thermally and electrically insulating.

[0213] Example 9 - The electrosurgical instrument of Example 8, wherein the first material comprises diamond-like carbon.

[0214] Example 10 - The electrosurgical instrument of Example 8 or 9, wherein the second material comprises polytetrafluoroethylene.

[0215] Example 11 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw comprises a converging body extending from a proximal end to a distal end. The converging body comprises a tissue contacting surface. The tissue contacting surface comprises an insulating layer comprising a first material. The insulating layer extends on either side of an intermediate area extending along a length of the converging body. The tissue contacting surface further comprises segments configured to provide a variable energy density along the tissue contacting surface. The segments include conductive segments and insulating segments alternating with the conductive segments along the intermediate area. The insulating segments comprise a second material different from the first material.

[0216] Example 12 - The electrosurgical instrument of example 11, wherein the conductive segment comprises a proximal segment and a distal segment. The proximal segment includes a first surface area. The distal segment includes a second surface area. The second surface area is less than the first surface area.

[0217] Example 13 - The electrosurgical instrument of Example 11 or 12, wherein the second jaw comprises a conductive skeleton partially coated with the first material.

[0218] Example 14 - An electrosurgical instrument as described in Example 13, wherein the conductive skeleton comprises an inner thermally insulative core and an outer thermally conductive layer at least partially surrounding the inner thermally insulative core.

[0219] Example 15 - An electrosurgical instrument as described in Examples 11, 12, 13, or 14, wherein the variable energy density is predetermined based on the selection of different geometric shapes and different electrical conductivities of the conductive segments.

[0220] Example 16 - An electrosurgical instrument as described in Examples 11, 12, 13, 14, or 15, wherein at least one of the segments includes a width that gradually narrows along its length.

[0221] Example 17 - An electrosurgical instrument as described in Examples 11, 12, 13, 14, 15, or 16, wherein the segment extends along a peripheral side of the second jaw.

[0222] Example 18 - An electrosurgical instrument as described in Examples 11, 12, 13, 14, 15, 16, or 17, wherein the segment is defined in the second jaw but not in the first jaw.

[0223] Example 19 - The electrosurgical instrument of Examples 11, 12, 13, 14, 15, 16, 17, or 18, wherein the first material comprises diamond-like carbon.

[0224] Example 20 - The electrosurgical instrument of Examples 11, 12, 13, 14, 15, 16, 17, 18, or 19, wherein the second material comprises polytetrafluoroethylene.

[0225] Example Set 3 Example 1 - An electrosurgical instrument comprising an end effector. The end effector includes a first jaw, a second jaw, and an electrical circuit. The first jaw includes a first jaw electrode including a first conductive skeleton, a first insulating coating selectively covering a portion of the first conductive skeleton, and an exposed portion of the first conductive skeleton. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw includes a second jaw electrode including a second conductive skeleton, a second insulating coating selectively covering a portion of the second conductive skeleton, and an exposed portion of the second conductive skeleton. The electrical circuit is configured to deliver bipolar RF energy and monopolar RF energy to tissue through the first jaw electrode and the second jaw electrode. The monopolar RF energy shares a first electrical path and a second electrical path defined by the electrical circuit to deliver the bipolar RF energy.

[0226] Example 2 - The electrosurgical instrument of example 1, wherein the electrical circuit defines a third electrical pathway separate from the first electrical pathway and the second electrical pathway.

[0227] Example 3 - An electrosurgical instrument as described in Example 1 or 2, wherein the end effector comprises a cutting electrode electrically insulated from the first conductive skeleton and the second conductive skeleton.

[0228] Example 4 - The electrosurgical instrument of Example 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through a third electrical pathway.

[0229] Example 5 - An electrosurgical instrument as described in Example 4, wherein the cutting electrode is configured to cut tissue using cutting monopolar RF energy after coagulation of the tissue has been initiated using bipolar RF energy.

[0230] Example 6 - An electrosurgical instrument as described in Examples 3, 4, or 5, wherein the cutting electrode is centrally located in one of the first jaw and the second jaw.

[0231] Example 7 - An electrosurgical instrument as described in Example 4 or 5, wherein the end effector is configured to simultaneously deliver cutting monopolar RF energy and bipolar RF energy to tissue.

[0232] Example 8 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw electrode comprises a first distal tip electrode and the second jaw electrode comprises a second distal tip electrode.

[0233] Example 9 - An electrosurgical instrument as described in Example 8, wherein the first conductive scaffold and the second conductive scaffold are simultaneously energized to deliver monopolar RF energy to the tissue surface through the first distal tip electrode and the second distal tip electrode.

[0234] Example 10 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the second jaw comprises a cutting electrode extending along a peripheral surface of the second jaw.

[0235] Example 11 - An electrosurgical instrument comprising an end effector and an electrical circuit. The end effector comprises at least two electrode sets, a first jaw, and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The end effector is configured to deliver a combination of bipolar and monopolar RF energy from the at least two electrode sets to the grasped tissue. The electrical circuit is configured to transmit the bipolar and monopolar RF energy. The monopolar RF energy shares an active path and a return path defined by the electrical circuit to transmit the bipolar RF energy.

[0236] Example 12 - An electrosurgical instrument as described in Example 11, wherein at least two electrode sets include three electrical interconnects that are used together in an electrical circuit.

[0237] Example 13 - An electrosurgical instrument as described in Example 11 or 12, wherein at least two electrode sets have three electrical interconnects that define at least a portion of an electrical circuit and another separate electrical circuit.

[0238] Example 14 - An electrosurgical instrument as described in Example 13, wherein a separate electrical circuit is connected to the cutting electrodes of at least two electrode sets that are insulated and centrally located in one of the first jaw and the second jaw.

[0239] Example 15 - An electrosurgical instrument as described in Example 14, wherein the cutting electrode is configured to cut tissue after initiating coagulation of the tissue using the second electrode and the third electrode of the at least two electrode sets.

[0240] Example 16 - An electrosurgical instrument as described in Example 14 or 15, wherein at least two electrode sets are configured to simultaneously deliver monopolar RF energy and bipolar RF energy to tissue.

[0241] Example 17 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw comprises a composite scaffold of at least two different materials configured to selectively provide an electrically conductive portion and a thermally insulating portion.

[0242] Example 18 - The electrosurgical instrument of Example 17, wherein the composite scaffold comprises a titanium ceramic composite.

[0243] Example 19 - An electrosurgical instrument as described in Example 17 or 18, wherein the composite scaffold comprises a ceramic base and a titanium crown attachable to the ceramic base.

[0244] Example 20 - The electrosurgical instrument of Examples 17, 18, or 19, wherein the composite scaffold is at least partially coated with an electrically insulating material.

[0245] Example 21 - A method for manufacturing the jaws of an end effector of an electrosurgical instrument, the method including creating a composite skeleton of the jaws by fusing titanium powder with ceramic powder in a metal injection molding process, and selectively coating the composite skeleton with an electrically insulating material to provide a plurality of electrodes.

[0246] Example Set 4 Example 1 - An electrosurgical instrument comprising a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw comprises a first conductive skeleton and a first electrically insulative layer. The first conductive skeleton comprises a first thermally insulative core and a first thermally conductive outer layer integral with and extending at least partially around the first thermally insulative core. The first electrode is defined by selective application of the first electrically insulative layer to an outer surface of the first thermally conductive outer layer. The second jaw is configured to define a second electrode. The second jaw comprises a second conductive skeleton and a second electrically insulative layer. The second conductive skeleton comprises a second thermally insulative core and a second thermally conductive outer layer integral with and extending at least partially around the second thermally insulative core. A second electrode is defined by selective application of a second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

[0247] Example 2 - The electrosurgical instrument of Example 1, wherein the first electrode is configured to transmit RF energy to the second electrode through tissue positioned between the first electrode and the second electrode in a bipolar energy operating mode.

[0248] Example 3 - The electrosurgical instrument of example 1 or 2, wherein the first thermally insulating core comprises air pockets.

[0249] Example 4 - The electrosurgical instrument of Examples 1, 2, or 3, wherein the first thermally insulative core comprises a lattice structure.

[0250] Example 5 - An electrosurgical instrument as described in Examples 1, 2, 3, or 4, wherein the second jaw comprises a third electrode, the third electrode being defined by selective application of a second electrically insulative layer to an outer surface of the second thermally conductive outer layer.

[0251] Example 6 - The electrosurgical instrument of Example 5, wherein the third electrode is configured to deliver RF energy to tissue in contact with the third electrode in a monopolar energy operating mode.

[0252] Example 7 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, or 6, wherein at least one of the first electrically insulative layer and the second electrically insulative layer comprises a diamond-like material.

[0253] Example 8 - An electrosurgical instrument as described in Example 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw has a tissue contact surface and the first thermally insulating core has a lattice structure including upright walls in a direction transverse to the tissue contact surface.

[0254] Example 9 - The electrosurgical instrument of Example 8, wherein the direction is perpendicular to the tissue contacting surface.

[0255] Example 10 - An electrosurgical instrument comprising a jaw configured to define an electrode. The jaw comprises a first conductive portion, a second conductive portion, and an electrically insulating layer. The first conductive portion is configured to resist heat transfer through the first conductive portion. The second conductive portion is integral with and extends at least partially around the first conductive portion. The second conductive portion is configured to define a heat sink. The electrode is defined by selectively applying an electrically insulating layer to an outer surface of the second conductive portion.

[0256] Example 11 - The electrosurgical instrument of Example 10, wherein the electrode is configured to deliver RF energy to tissue positioned adjacent the electrode.

[0257] Example 12 - An electrosurgical instrument as described in Example 10 or 11, comprising a first conductive portion, an air pocket.

[0258] Example 13 - The electrosurgical instrument of Examples 10, 11 or 12, wherein the first conductive portion has a lattice structure.

[0259] Example 14 - The electrosurgical instrument of Examples 10, 11, 12, or 13, wherein the electrically insulating layer comprises a diamond-like material.

[0260] Example 15 - An electrosurgical instrument as described in Example 10, 11, 12, 13, or 14, wherein the jaw has a tissue contact surface and the first conductive portion has a lattice structure including upright walls in a direction transverse to the tissue contact surface.

[0261] Example 16 - The electrosurgical instrument of Example 15, wherein the direction is perpendicular to the tissue contacting surface.

[0262] Example 17 - An electrosurgical instrument comprising jaws configured to define electrodes. The jaws comprise an electrically conductive skeleton and an electrically insulative layer. The electrically conductive skeleton comprises a thermally insulative core and a thermally conductive outer layer integral with and extending at least partially around the thermally insulative core. The electrodes are defined by selective application of the electrically insulative layer to an outer surface of the thermally conductive outer layer.

[0263] Example 18 - The electrosurgical instrument of Example 17, wherein the thermally insulating core comprises a lattice structure.

[0264] Example 19 - An electrosurgical instrument as described in Example 18, wherein the jaws have a tissue contacting surface and the lattice structure includes upstanding walls in a direction transverse to the tissue contacting surface.

[0265] Example 20 - The electrosurgical instrument of Example 19, wherein the direction is perpendicular to the tissue contact surface.

[0266] Example Set 5 Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw comprises a second electrode configured to deliver a first monopolar energy to the tissue, a third electrode, and a conductive circuit selectively transitionable between a connection configuration with the third electrode and a cutting configuration with the third electrode. In the connection configuration, the third electrode is configured to cooperate with the first electrode to deliver a bipolar energy to the tissue. The conductive circuit defines a return path for the bipolar energy. In the cutting configuration, the first electrode is configured to deliver a second monopolar energy to the tissue.

[0267] Example 2 - The electrosurgical instrument of Example 1, further comprising a switching mechanism for alternating between a connecting configuration and a disconnecting configuration.

[0268] Example 3 - An electrosurgical instrument as described in Example 1 or 2, further comprising a switching mechanism for alternating between delivery of bipolar energy and a second monopolar energy to the tissue via the first electrode.

[0269] Example 4 - An electrosurgical instrument as described in Examples 1, 2, or 3, wherein the end effector is configured to simultaneously deliver bipolar energy and a first monopolar energy to tissue.

[0270] Example 5 - An electrosurgical instrument as described in Examples 1, 2, 3, or 4, wherein the end effector is configured to deliver a combination of bipolar energy and a first monopolar energy to tissue.

[0271] Example 6 - An electrosurgical instrument as described in Example 5, wherein the levels of bipolar energy and first monopolar energy in the energy combination are determined based on at least one reading of a temperature sensor indicating at least one temperature of the tissue.

[0272] Example 7 - An electrosurgical instrument as described in Example 5 or 6, wherein the levels of bipolar energy and first monopolar energy in the energy combination are determined based on at least one reading of an impedance sensor indicating at least one impedance of tissue.

[0273] Example 8 - An electrosurgical instrument as described in Examples 5, 6, or 7, wherein the levels of bipolar energy and first monopolar energy within the energy combination are adjusted to reduce lateral thermal damage detected beyond the tissue treatment area between the first jaw and the second jaw.

[0274] Example 9 - An electrosurgical instrument comprising an end effector and a control circuit. The end effector comprises a first jaw, a second jaw, and at least one sensor. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The second jaw comprises a second electrode configured to deliver monopolar energy to the tissue and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuit is configured to execute a predetermined power scheme to seal and cut tissue in a tissue treatment cycle. The power scheme includes predetermined power levels of monopolar energy and bipolar energy. The control circuit is further configured to adjust at least one of the predetermined power levels of monopolar energy and bipolar energy based on readings of the at least one sensor in a tissue treatment cycle.

[0275] Example 10 - An electrosurgical instrument as described in Example 9, wherein the predetermined power scheme includes simultaneous and separate application of bipolar and monopolar energy to tissue during a tissue treatment cycle.

[0276] Example 11 - An electrosurgical instrument as described in Example 9 or 10, wherein the predetermined power scheme includes application of bipolar energy but not monopolar energy during the feathering segment of the tissue treatment cycle, and simultaneous application of bipolar energy and monopolar energy during the tissue heating segment and tissue sealing segment of the tissue treatment cycle.

[0277] Example 12 - An electrosurgical instrument as described in Example 11, wherein the power scheme further includes application of monopolar energy rather than bipolar energy to tissue within the tissue transection segment of the tissue treatment cycle.

[0278] Example 13 - An electrosurgical instrument as described in Examples 9, 10, 11, or 12, wherein at least one sensor comprises an impedance sensor.

[0279] Example 14 - An electrosurgical instrument as described in Example 13, wherein the control circuit is configured to monitor the impedance ratio of monopolar tissue impedance to bipolar tissue impedance based on readings from the impedance sensor.

[0280] Example 15 - An electrosurgical instrument as described in Example 14, wherein a change in impedance ratio within a predetermined range causes the control circuit to issue an alarm.

[0281] Example 16 - An electrosurgical instrument as described in Example 15, wherein a change in impedance ratio below a lower threshold of a predetermined range causes the control circuit to adjust the predetermined power scheme.

[0282] Example 17 - An electrosurgical instrument as described in Example 15 or 16, wherein a change in impedance ratio below a lower threshold of a predetermined range causes the control circuit to suspend application of monopolar energy to tissue.

[0283] Example 18 - An electrosurgical instrument as described in Example 17, wherein a change in impedance ratio below a lower threshold of a predetermined range further causes the control circuit to adjust the application of bipolar energy to the tissue to completely seal the tissue.

[0284] Example 19 - An electrosurgical instrument comprising an end effector and a control circuit. The end effector comprises a first jaw and a second jaw. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. Tissue at a target site. The second jaw comprises a second electrode configured to deliver monopolar energy to the tissue and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuit is configured to execute a predetermined power scheme to seal and cut tissue in a tissue treatment cycle. The power scheme includes predetermined power levels of monopolar energy and bipolar energy. The control circuit is further configured to detect energy divergence from the target site and adjust at least one of the predetermined power levels of monopolar energy and bipolar energy to mitigate the energy divergence.

[0285] Example 20 - An electrosurgical instrument as described in Example 19, wherein the predetermined power scheme includes simultaneous and separate application of bipolar and monopolar energy to tissue during a tissue treatment cycle.

[0286] Example 21 - An electrosurgical instrument as described in Example 19 or 20, wherein the predetermined power scheme includes application of bipolar energy rather than monopolar energy during the feathering segment of the tissue treatment cycle, and simultaneous application of bipolar energy and monopolar energy during the tissue heating segment and tissue sealing segment of the tissue treatment cycle.

[0287] Example Set 6 Example 1 - An electrosurgical system comprising an end effector and a control circuit. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw. The control circuit is configured to cause the simultaneous and separate application of two distinct energy modalities to tissue during a tissue treatment cycle including a tissue coagulation phase and a tissue transection phase.

[0288] Example 2 - The electrosurgical system of Example 1, wherein the first energy modality is a monopolar energy modality.

[0289] Example 3 - The electrosurgical system of Example 2, wherein the second energy modality is a bipolar energy modality.

[0290] Example 4 - An electrosurgical system as described in Example 2 or 3, wherein the control circuit is configured to activate application of a monopolar energy modality to tissue prior to completion of the tissue coagulation phase with a bipolar energy modality.

[0291] Example 5 - An electrosurgical system as described in Example 2 or 3, wherein the control circuit is configured to initiate application of a monopolar energy modality to tissue prior to cessation of application of a bipolar energy modality to tissue.

[0292] Example 6 - An electrosurgical system as described in Examples 3, 4, or 5, wherein the control circuit is configured to cause simultaneous application of monopolar and bipolar energy modalities to tissue during the tissue coagulation phase.

[0293] Example 7 - An electrosurgical system as described in Example 1, 2, 3, 4, 5, or 6, wherein the control circuit comprises a processor and a storage medium, and the application of two different energy modalities to tissue is based on a default power scheme stored in the storage medium.

[0294] Example 8 - An electrosurgical system as described in Example 7, further comprising at least one sensor, and wherein the control circuit is configured to modify the default power scheme based on one or more sensor readings of the at least one sensor.

[0295] Example 9 - An electrosurgical instrument comprising an end effector, the end effector comprising a first jaw and a second jaw, at least one of the first jaw and the second jaw being movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first jaw and the second jaw, the end effector being configured to cause application of three different energy modalities to tissue during a tissue treatment cycle including a tissue coagulation phase and a tissue transection phase.

[0296] Example 10 - The electrosurgical instrument of Example 9, wherein the first energy modality comprises bipolar energy.

[0297] Example 11 - The electrosurgical instrument of Example 10, wherein the second energy modality includes an energy mixture of monopolar and bipolar energy.

[0298] Example 12 - The electrosurgical instrument of Example 11, wherein the third energy modality includes monopolar energy but does not include bipolar energy.

[0299] Example 13 - An electrosurgical instrument as described in Example 11 or 12, wherein activation of monopolar energy application to tissue is configured to begin prior to completion of the tissue coagulation phase.

[0300] Example 14 - An electrosurgical instrument as described in Example 12 or 13, wherein activation of monopolar energy application to tissue is configured to begin before cessation of application of bipolar energy modality to tissue.

[0301] Example 15 - An electrosurgical instrument as described in Examples 9, 10, 11, 12, 13, or 14, further comprising a control circuit, the control circuit comprising a processor and a storage medium, and the application of the two different energy modalities to the tissue is based on a default power scheme stored in the storage medium.

[0302] Example 16 - An electrosurgical instrument as described in Example 15, further comprising at least one sensor, and wherein the control circuit is configured to adjust the default power scheme during a tissue treatment cycle based on one or more sensor readings of the at least one sensor.

[0303] Example 17 - An electrosurgical system comprising a first generator configured to output bipolar energy, a second generator configured to output monopolar energy, a surgical instrument electrically coupled to the first and second generators, and a control circuit. The surgical instrument comprises an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first and second jaws is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue between the first and second jaws. The control circuit comprises a processor and a storage medium including program instructions that, when executed by the processor, cause the processor to cause the first and second generators to apply a predetermined power scheme to the end effector. The power scheme includes simultaneous and separate application of bipolar and monopolar energy to tissue in a tissue treatment cycle.

[0304] Example 18 - An electrosurgical system as described in Example 17, further comprising at least one sensor, and wherein the control circuit is configured to adjust the power scheme during a tissue treatment cycle based on one or more sensor readings of the at least one sensor.

[0305] Example 19 - An electrosurgical system as described in Example 17 or 18, wherein the power scheme includes applying bipolar energy but not monopolar energy to tissue during the feathering segment of the tissue treatment cycle, and simultaneously applying bipolar energy and monopolar energy to tissue during the tissue heating segment and tissue sealing segment of the tissue treatment cycle.

[0306] Example 20 - An electrosurgical system as described in Examples 17, 18, or 19, wherein the power scheme further includes applying monopolar energy but not bipolar energy to the tissue during the tissue transection segment of the tissue treatment cycle.

[0307] While several embodiments have been shown and described, it is not the intention of the applicant to restrict or limit the scope of the appended claims to such details. Numerous modifications, variations, changes, substitutions, combinations, and equivalents of these embodiments can be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Moreover, the structure of each element associated with the described embodiments can alternatively be described as a means for providing the function performed by that element. Also, although materials are disclosed with respect to specific components, other materials may be used. It is therefore to be understood that the above specification and the appended claims are intended to cover all such modifications, combinations, and variations as falling within the scope of the disclosed embodiments. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

[0308] The above detailed description has set forth various aspects of the devices and / or processes via block diagrams, flow diagrams and / or examples. To the extent that such block diagrams, flow diagrams and / or examples include one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation included in such block diagrams, flow diagrams and / or examples can be individually and / or collectively implemented by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will understand that some aspects of the embodiments disclosed herein may be equivalently implemented in whole or in part on an integrated circuit as one or more computer programs running on one or more computers (e.g., one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., one or more programs running on one or more microprocessors), as firmware, or as substantially any combination thereof, and that designing circuitry and / or writing software and / or firmware code is within the skill of one of ordinary skill in the art in view of this disclosure. In addition, those skilled in the art will understand that the subject mechanisms described herein may be distributed as one or more program products in a variety of forms, and that the specific forms of the subject matter described herein apply regardless of the particular type of signal-bearing medium used to actually effect the distribution.

[0309] The instructions used to program the logic to implement the various disclosed aspects may be stored in a system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Additionally, the instructions may be distributed over a network or by other computer-readable media. Thus, machine-readable media may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), including, but not limited to, floppy diskettes, optical disks, compact disks, read-only memory (CD-ROM), as well as magneto-optical disks, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory, or tangible machine-readable storage used for transmitting information over the Internet via electrical, optical, acoustic, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Thus, non-transitory computer-readable media includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).

[0310] The term "control circuitry" as used in any aspect of the present specification may refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor including one or more individual instruction processing cores, a processing unit, a processor, a microcontroller, a microcontroller unit, a controller, a digital signal processor (DSP), a programmable logic device (PLD), a programmable logic array (PLA), or a field programmable gate array (FPGA)), a state machine circuit, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuitry may be embodied, collectively or individually, as circuits that form part of a larger system, such as, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system on-chip (SoC), a desktop computer, a laptop computer, a tablet computer, a server, a smartphone, etc. Thus, as used herein, "control circuitry" includes, but is not limited to, electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application specific integrated circuit, electrical circuitry forming a general purpose computing device configured by a computer program (e.g., a general purpose computer configured by a computer program that at least partially executes the processes and / or devices described herein, or a microprocessor configured by a computer program that at least partially executes the processes and / or devices described herein), electrical circuitry forming a memory device (e.g., a form of random access memory) and / or electrical circuitry forming a communications device (e.g., a modem, a communications switch, or an optical-electrical facility).Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital form, or some combination thereof.

[0311] As used in any aspect of this specification, the term "logic" may refer to an application, software, firmware, and / or circuitry configured to perform any of the operations described above. Software may be embodied as a software package, code, instructions, instruction sets, and / or data recorded on a non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions, or instruction sets, and / or hard-coded (e.g., non-volatile) data in a memory device.

[0312] As used in any aspect of this specification, the terms "component," "system," "module," etc. may refer to a computer-related entity that is either hardware, a combination of hardware and software, software, or software in execution.

[0313] As used in any aspect of this specification, an "algorithm" refers to a self-consistent sequence of steps leading to a desired result, and the "steps" refer to manipulations of physical quantities and / or logical states, which may, but need not, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common practice to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities or are merely convenient labels applied to these quantities and / or states.

[0314] The network may include a packet-switched network. The communication devices may communicate with each other using a selected packet-switched network communication protocol. One exemplary communication protocol may include an Ethernet communication protocol that may enable communication using the Transmission Control Protocol / Internet Protocol (TCP / Internet Protocol, IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard entitled "IEEE 802.3 Standard" published in December 2008 by the Institute of Electrical and Electronics Engineers (IEEE), and / or later versions of this standard. Alternatively or additionally, the communication devices may communicate with each other using an X.25 communication protocol. The X.25 communication protocol may conform to or be compatible with standards promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may communicate with each other using a Frame Relay communication protocol. The frame relay communication protocol may conform to or be compatible with standards promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard published in August 2001 by the ATM Forum entitled "ATM-MPLS Network Interworking 2.0" and / or later versions of this standard.Of course, different and / or later developed connection-oriented network communication protocols are equally contemplated herein.

[0315] Unless expressly specified otherwise, and as will be apparent from the foregoing disclosure, discussions throughout the foregoing disclosure using terms such as "processing," "computing," "calculating," "determining," "displaying," and the like will be understood to refer to the actions and processing of a computer system or similar electronic computing device that manipulates and transforms data represented as physical (electronic) quantities in the computer system's registers and memory into other data that is similarly represented as physical quantities in the computer system's memory or registers or other such information storage, transmission, or display device.

[0316] One or more components may be referred to herein as being "configured to," "configurable to," "operable / operative to," "adapted / adaptable," "able to," "conformable / conformed to," etc. Those skilled in the art will understand that "configured to" may generally encompass active and / or inactive and / or standby components, unless the context requires otherwise.

[0317] The terms "proximal" and "distal" are used herein with reference to a clinician manipulating a handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion located away from the clinician. It will be further understood that for convenience and clarity, spatial terms such as "vertical," "horizontal," "up," and "down" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

[0318] Those skilled in the art will understand that the terms used herein in general, and in the appended claims in particular (e.g., the body of the appended claims) are generally intended as "open" terms (e.g., the term "including" should be interpreted as "including but not limited to," the term "having" should be interpreted as "having at least," the term "includes" should be interpreted as "includes but is not limited to," etc.). Moreover, those skilled in the art will understand that where a specific number is intended in an introduced claim recitation, such intention will be clearly recited in the claim, and in the absence of such recitation, no such intention exists. For example, as an aid to understanding, the appended claims which follow may include the introductory phrases "at least one" and "one or more" to introduce the claim recitation. However, the use of such phrases should not be construed as implying that when a claim is introduced by the indefinite article "a" or "an," any particular claim containing such an introduced claim statement is limited to claims containing only one such statement, even if the same claim contains an introductory phrase such as "one or more" or "at least one" and the indefinite article "a" or "an" (e.g., "a" and / or "an" should normally be construed to mean "at least one" or "one or more"). The same applies when a definite article is used to introduce a claim statement.

[0319] In addition, those of skill in the art will recognize that even when a particular number is specified in an introduced claim, such a statement should typically be interpreted to mean at least the recited number (e.g., a statement simply stating "two items" without other qualifiers generally means at least two items, or two or more items). Furthermore, when a notation similar to "at least one of A, B, and C, etc." is used, such syntax is generally intended in the sense that a person of skill in the art would understand the notation (e.g., "a system having at least one of A, B, and C" includes, but is not limited to, systems having only A, only B, only C, both A and B, both A and C, both B and C, and / or all of A, B, and C, etc.). When a notation similar to "at least one of A, B, or C, etc." is used, such syntax is generally intended in the sense that one of ordinary skill in the art would understand the notation (e.g., "a system having at least one of A, B, or C" includes, but is not limited to, systems having only A, only B, only C, both A and B, both A and C, both B and C, and / or all of A, B, and C, etc.). Furthermore, one of ordinary skill in the art will understand that any disjunctive word and / or phrase expressing two or more alternative terms should typically be understood to contemplate the possibility of including one of those terms, either of those terms, or both of those terms, unless the context requires otherwise, whether in the specification, claims, or drawings. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B."

[0320] With respect to the appended claims, those skilled in the art will appreciate that the recited operations herein may generally be performed in any order. Also, while flow diagrams of various operations are shown in a sequence, it should be understood that the various operations may be performed in orders other than those shown, or may be performed simultaneously. Examples of such alternative orderings may include overlapping, interleaving, interrupting, reordering, incremental, preliminary, additional, simultaneous, reverse, or other different orderings, unless the context requires otherwise. Moreover, terms such as "responsive to," "related to," or other past tense adjectives are generally not intended to exclude such variations, unless the context requires otherwise.

[0321] It is worth noting that any reference to "one embodiment," "an embodiment," "an example," "an example," etc. means that a particular feature, structure, or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the appearances of the phrases "in one embodiment," "in an embodiment," "in an example," and "in an example" in various places throughout this specification do not necessarily all refer to the same embodiment. Furthermore, particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.

[0322] As used herein, unless otherwise indicated, the term "about" or "approximately" as used in this disclosure refers to an acceptable error for a particular value as determined by one of ordinary skill in the art, which depends in part on how the value is measured or determined. In certain embodiments, the term "about" or "approximately" refers to 1, 2, 3, or 4 standard deviations. In certain embodiments, the term "about" or "approximately" refers to within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.05% of a given value or range.

[0323] In this specification, unless otherwise indicated, all numerical parameters should be understood in all instances to be preceded and modified by the term "about" and such numerical parameters have the inherent variability of the underlying measuring methods used to determine the numerical value of the parameter. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter set forth in this specification should at least be construed in light of the reported significant digits and by applying ordinary rounding techniques.

[0324] Also, any numerical range described herein includes all subranges subsumed within the described range. For example, the range "1 to 10" includes all subranges between (and including) the recited minimum of 1 and the recited maximum of 10, i.e., all subranges having a minimum of 1 or more and a maximum of 10 or less. Also, all ranges described herein include the endpoints of the described range. For example, the range "1 to 10" includes the endpoints 1 and 10. Every maximum numerical limit described herein is intended to include all lower numerical limits subsumed therein, and every minimum numerical limit described herein is intended to include all higher numerical limits subsumed therein. Accordingly, applicants reserve the right to amend this specification, including the claims, to include every expressly recited subrange that is subsumed within the expressly recited range. All such ranges are inherently described herein.

[0325] Any patent application, patent, non-patent publication, or other disclosure material referenced herein and / or listed in any Application Data Sheet is incorporated herein by reference to the extent that the incorporated material is not inconsistent with this specification. As such, and to the extent necessary, the disclosure explicitly set forth in this specification shall prevail over any conflicting material incorporated herein by reference. Any material, or portions thereof, that is referred to as being incorporated herein by reference but that conflicts with current definitions, opinions, or other disclosure material set forth herein shall be incorporated only to the extent that no conflict arises between the incorporated material and the current disclosure material.

[0326] In summary, many benefits are described that result from using the concepts described herein. The above description of one or more embodiments has been presented for purposes of illustration and description. It is not intended to be exhaustive or to be limited to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more embodiments have been selected and described to illustrate the principles and practical applications, thereby enabling those skilled in the art to utilize the various embodiments, with various modifications, as appropriate for the particular use contemplated. It is intended that the claims presented herewith define the overall scope.

[0327] [Embodiment] (1) An electrosurgical instrument comprising: A first jaw configured to define a first electrode, the first jaw comprising: A first conductive skeleton, A first thermally insulating core; and a first electrically conductive skeleton comprising a first thermally conductive outer layer integral with and extending at least partially around the first thermally insulative core; and a first jaw comprising a first electrically insulating layer, the first electrode being defined by selective application of the first electrically insulating layer to an outer surface of the first thermally conductive outer layer; a second jaw configured to define a second electrode, the second jaw comprising: A second conductive skeleton, A second thermally insulating core; and a second electrically conductive skeleton comprising a second thermally conductive outer layer integral with and extending at least partially around the second thermally insulating core; and a second jaw comprising a second electrically insulating layer, the second electrode being defined by selective application of the second electrically insulating layer to an outer surface of the second thermally conductive outer layer. (2) The electrosurgical instrument of embodiment 1, wherein the first electrode is configured to transmit RF energy to the second electrode through tissue positioned between the first electrode and the second electrode in a bipolar energy operating mode. (3) An electrosurgical instrument as described in embodiment 1, wherein the first thermally insulating core includes an air pocket. (4) An electrosurgical instrument as described in embodiment 1, wherein the first thermally insulating core has a lattice structure. (5) The electrosurgical instrument of embodiment 1, wherein the second jaw includes a third electrode, the third electrode being defined by selective application of the second electrically insulative layer to the outer surface of the second thermally conductive outer layer.

[0328] (6) The electrosurgical instrument of embodiment 5, wherein the third electrode is configured to deliver RF energy to tissue in contact with the third electrode in a monopolar energy operating mode. (7) The electrosurgical instrument of embodiment 1, wherein at least one of the first electrically insulating layer and the second electrically insulating layer comprises a diamond-like material. (8) The electrosurgical instrument of embodiment 1, wherein the first jaw has a tissue contacting surface, and the first thermally insulative core has a lattice structure including upstanding walls transverse to the tissue contacting surface. (9) The electrosurgical instrument of embodiment 8, wherein the direction is perpendicular to the tissue contact surface. (10) An electrosurgical instrument comprising a jaw configured to define an electrode, the jaw comprising: a first conductive portion configured to resist heat transfer through the first conductive portion; a second conductive portion integral with and extending at least partially around the first conductive portion, the second conductive portion configured to define a heat sink; and an electrically insulating layer, the electrodes being defined by selective application of the electrically insulating layer to an exterior surface of the second conductive portion.

[0329] (11) The electrosurgical instrument of embodiment 10, wherein the electrode is configured to deliver RF energy to tissue positioned adjacent the electrode. (12) The electrosurgical instrument of embodiment 10, wherein the first conductive portion includes an air pocket. (13) The electrosurgical instrument of embodiment 10, wherein the first conductive portion comprises a lattice structure. (14) The electrosurgical instrument of claim 10, wherein the electrically insulating layer comprises a diamond-like material. (15) The electrosurgical instrument of claim 10, wherein the jaw has a tissue contacting surface, and the first conductive portion has a lattice structure including upstanding walls transverse to the tissue contacting surface.

[0330] (16) The electrosurgical instrument of claim 15, wherein the direction is perpendicular to the tissue contact surface. (17) An electrosurgical instrument comprising: A jaw configured to define an electrode, the jaw comprising: A conductive skeleton, A thermally insulating core; and a thermally insulating core having a thermally conductive outer layer integral with and extending at least partially around the thermally insulating core; 1. An electrosurgical instrument comprising: a jaw comprising an electrically insulating layer, the electrodes being defined by selective application of the electrically insulating layer to an outer surface of the thermally conductive outer layer. (18) The electrosurgical instrument of claim 17, wherein the thermally insulating core comprises a lattice structure. (19) The electrosurgical instrument of claim 18, wherein the jaws include a tissue contacting surface, and the lattice structure includes upstanding walls transverse to the tissue contacting surface. (20) The electrosurgical instrument of claim 19, wherein the direction is perpendicular to the tissue contact surface.

Claims

1. 1. An electrosurgical instrument comprising: A first jaw configured to define a first electrode, the first jaw comprising: A first conductive skeleton, A first thermally insulating core; and a first electrically conductive skeleton comprising a first thermally conductive outer layer integral with and extending at least partially around the first thermally insulative core; and a first jaw comprising a first electrically insulating layer, the first electrode being defined by partially surrounding an outer surface of the first thermally conductive outer layer with the first electrically insulating layer such that the first electrode is formed on the first thermally conductive outer layer; a second jaw configured to define a second electrode, the second jaw comprising: A second conductive skeleton, A second thermally insulating core; and a second thermally insulating core; and a second thermally conductive outer layer integral with and extending at least partially around the second thermally insulating core; a second jaw comprising a second electrically insulative layer, the second electrode being defined by partially surrounding an outer surface of the second thermally conductive outer layer with the second electrically insulative layer such that the second electrode is formed on the second thermally conductive outer layer.

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

3. The electrosurgical instrument according to claim 1 , wherein the first thermally insulative core includes a gap setting member that defines a pocket.

4. The electrosurgical instrument according to claim 1 , wherein the first thermally insulative core includes gap setting members forming a lattice structure.

5. 2. The electrosurgical instrument of claim 1, wherein the second jaw includes a third electrode defined by partially surrounding the outer surface of the second thermally conductive outer layer with the second electrically insulative layer such that the third electrode is formed on the second thermally conductive outer layer.

6. The electrosurgical instrument according to claim 5, wherein the third electrode is configured to deliver RF energy to tissue in contact with the third electrode in a monopolar energy mode of operation.

7. 2. The electrosurgical instrument of claim 1, wherein at least one of the first and second electrically insulative layers comprises a material consisting of an amorphous carbon-hydrogen network having graphite and diamond bonds between carbon atoms.

8. The electrosurgical instrument according to claim 1 , wherein the first jaw includes a tissue contacting surface, and the first thermally insulative core includes gap setting members forming a lattice structure including upstanding walls relative to the tissue contacting surface.

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