Material manipulator with conductive coating

Abstract

A device comprising a tissue manipulator, a conductive coating and at least one connector portion. For example, tissue manipulators may be scissors, clip appliers or clips, staplers and staples, or vessel sealing devices. The conductive coating may be applied to the jaws of clips, staples or scissors or closures. Electrical energy can be supplied through contact areas (connector areas), such as between the anvil and pusher of the stapler and the conductive coating on the staple. The conductive coating can be energized with mechanical application of the manipulator to transform and facilitate tissue layer attachment.

Description

Technical Field

[0001] (Related Application) This application claims the priority of U.S. Provisional Patent Application No. 62 / 170,010, filed on June 2, 2015, the entire content of which is incorporated herein by reference.

Background Art

[0002] Surgery and interventional therapies with the least possible invasiveness for patients are generally safer, faster, and less traumatic to the patient. These methods, therefore, generally have a lower risk of inflammation, postoperative pain, and infection, as well as a reduced healing time, compared to more invasive surgeries, including general surgery and open surgery.

[0003] Similarly, in non-medical applications, minimally invasive inspection and / or repair of sewers, hydraulic lines, oil pipelines, gas pipelines, or other non-medical areas that can be inspected and / or repaired with little disruption and intrusion is generally superior to cutting into areas where inspection and repair are more invasive.

[0004] In medical applications, minimally invasive approaches typically involve either direct or remote visualization using devices used for diagnosis as well as treatment and manipulation. Direct visualization applications include surgeries using small incisions (referred to as mini-thoracotomy) and open, direct visualization of common surgical sites. Also, one or more forms of remote visualization may be used, such as inspection of the colon using a flexible colonoscope or visualization of a surgical site using a laparoscope, or imaging of blood vessels or lumens using a contrast agent and fluoroscopy while manipulating the inside of the blood vessels using guide wires and catheters.

[0005] For non-medical applications, direct visualization may be achieved by using small ports. For example, inspecting the above line at a specific location by drilling a hole in the pipeline. Another example is the use of a borescope, which is remotely operated and advanced through the pipeline to visualize the inspection area for possible remote repair.

[0006] Despite the advantages of using these approaches, there is a need to improve the overall visibility and manipulability of tissues and other materials by adding more therapeutic and restorative capabilities for use in both medical and non-medical applications. Material manipulators for open methods (medical and non-medical) can also benefit from further improvements. [Overview of the project]

[0007] Embodiments of the present disclosure overcome the problems of the prior art by providing a device having at least a material manipulator, a conductive coating, and terminals. The conductive material is placed on at least a portion of the manipulator. The manipulator may be, for example, a staple, scalpel, wire, snare, gripper or cutting element, suture, mesh, and other implantable devices (including spinal cages, stents, heart valves, defibrillators and pacemakers, knee and hip replacements, and other implantable devices). Terminals can supply energy (such as electrical energy) to the conductive material. In one embodiment, the conductive material is an optically transparent material. The conductive material can also conduct electrical energy. Advantageously, the device allows for the manipulation of tissue or other material while simultaneously applying energy through the conductive coating.

[0008] These and other features and advantages of the embodiments of the present disclosure will be readily apparent to those skilled in the art, given the following detailed description and accompanying drawings illustrating the embodiments of the present disclosure. [Brief explanation of the drawing]

[0009] [Figure 1] A schematic diagram of an apparatus according to one embodiment of the present invention, including a surgical staple having a conductive coating and a power source, is shown. [Figure 2] A schematic diagram of a series of surgical staples with a conductive coating, such as the continuous staples in Figure 1, is shown. [Figure 3] A schematic diagram of a surgical stapler with a conductive coating and power source is shown. [Figure 4] A schematic diagram of a biporous snare with a conductive coating and power source is shown. [Figure 5] A schematic diagram of a surgical suture and power source having needles, one or both of which may have a conductive coating, is shown. [Figure 6] A schematic diagram of a surgical mesh with a conductive coating, an organic power source, and an external power source is shown. [Figure 7] A schematic diagram of a stent, delivery catheter, and power source with a conductive coating is shown. [Figure 8] A schematic diagram of a heart valve repair ring with a conductive coating, an organic power source, and an external power source is shown. [Figure 9] A schematic diagram of a scalpel with a conductive coating and a power source is shown. [Figure 10] A schematic diagram of articulated and telescopic material manipulators having a gripper with a conductive coating at the distal end is shown. [Figure 11] A schematic diagram of a spine cage with a conductive coating, an organic power source, and an external power source is shown. [Figure 12] A schematic diagram of an apparatus of another embodiment of the present invention is shown on the plate. [Modes for carrying out the invention]

[0010] Embodiments of this disclosure are described in detail below. In fact, these embodiments can be embodied in many different forms and should not be construed as being limited to the embodiments described herein, and these embodiments are provided so as to satisfy the applicable legal requirements of this disclosure. Where used in the specification and in the appended claims, the forms “a,” “an,” and “the” used to indicate singularity include plural references unless explicitly stated otherwise. Where used herein, such “comprising” and its variations are used synonymously with the term “including” and its variations and are unrestrictive, non-limiting terms.

[0011] Despite the many advantages associated with the use of devices for minimally invasive treatment, including remote visualization in medical settings, as well as in open procedures such as general surgical procedures and non-medical applications, or for examining and fixing conditions in non-medical applications, the inventors have noticed significant problems with these technologies that need improvement. Instruments and other elements for providing other therapeutic treatments, including the lack of ability to denature, manipulate, and repair materials, and to effectively supply energy, while performing other beneficial tasks, generally have single or limited capabilities.

[0012] The present invention includes a material manipulator having one or more coatings on the manipulator, including a conductive coating, which allows energy to be applied to a material in contact with or near the manipulator in order to modify or influence the material. Embodiments of the present invention have the advantage of enabling material manipulation and energy supply in the same device. Examples include applying energy to a device used to grasp, cut, capture, manipulate, clean, seal, measure, evaluate, operate, and close tissue and other materials. Furthermore, the conductive coating has the advantage of transferring energy on or across the coating, and, if desired, limiting the effect of the energy on the manipulator, such as limiting unintended incidental effects from the energy, such as self-heating and thermal diffusion.

[0013] Examples of applications for material manipulators with conductive coatings include applying material manipulators as surgical scalpels to seal blood vessels or to reduce device self-heating and vascular adhesion; applying material manipulators to snares to uniformly bipolar apply energy for excising polyps in the gastrointestinal tract; and, in particular, applying material manipulators to surgical grippers and stents to supply energy to tissues and other materials.

[0014] Embodiments of the device include a material manipulator having a conductive coating that also has hydrophobic and superhydrophobic water contact angles, which prevents the material from adhering or sticking to the material manipulator, including when energy is applied to the material via the conductive coating. This allows energy to be supplied to the material without causing unintended manipulation of the material due to adhesion, carbonization, or other unintended sticking of the material to the manipulator. This also allows energy to be supplied across the coating rather than through the manipulator, thereby reducing the level of self-heating and incidental heat diffusion. This has performance advantages in various applications such as surgical scalpels, surgical staples, clips, clamps, and other fixation devices; application of glue and other adhesives that are activated or cured by energy; grippers that can conduct electricity without heat diffusion; colon snares that can conduct electricity without heat diffusion and without gaps in the application of energy to tissue; and other applications that benefit from conductive coatings to limit the application of energy and material adhesion. While hydrophobic or superhydrophobic water contact angles prevent encapsulation and tissue proliferation, reducing the risk of certain infections and maintaining the option to remove the implant if necessary, such deformities of manipulators may also include long-term implantable devices in which the application of energy via the coating reduces the incidence of bleeding with device implantation and prepares the surrounding material to receive the device.

[0015] Examples of such applications include, among others, pacing leads and pacemakers, implantable cardioverter-defibrillators, removable sutures and staples, certain types of stents (e.g., biliary stents used to open blocked conduits that may be removed later), endografts, breast implants, penile implants, nerve stimulators for treating neurodegenerative diseases (e.g., Parkinson's disease and dysplasia), stimulators for treating arthritis and pain management, knee and lumbar implants, and other implantable devices where the application and limited or restricted tissue transplantation of energy is useful. Furthermore, these devices may be configured such that the conducted energy is from an external source such as an energy generator from an energy source in the device such as a battery, or from an organic source such as a connection to an energy generating element in the implant, such as nerves or other electrical impulse elements in the patient.

[0016] Embodiments of the material manipulator also include variants of conductive coatings having a hydrophilic water contact angle, which facilitate water retention and adhesion or grafting of tissues and other materials to the manipulator, including when energy is applied to the material via the conductive coating. This allows energy to be supplied to the material while promoting adhesion of the material to the coating, in order to create performance advantages through the combination of energy and the application of the hydrophilic coating. Examples of these advantages include, for example, improving the level of tissue grafting in medical applications where the manipulation of material, application of energy, and tissue grafting or adhesion are useful, using bioabsorbable and nonabsorbable sutures, surgical meshes for various repairs (including hernia, pelvic floor, incontinence, breast reconstruction and other reconstructive surgeries), coils for use in lumens (including vascular, lung, uterine and neurovascular systems), certain stents (e.g., stents or similar implants used to close the fallopian tubes), heart valves, heart valve rings, dental implants and gingival grafts.

[0017] A substance manipulator having a conductive coating is useful for non-medical applications, including applications that further benefit from having a conductive coating with various water contact angles, including hydrophobic or superhydrophobic water contact angles, or hydrophilic water contact angles. Examples of applications include, for example, applying energy to remove debris in a pipeline or sewer line, curing glue or an adhesive to repair a defect, welding with a weldable material at a unique joint configured to fit the manipulator to the joint, supplying energy from a user at a distance via a relatively long element using a substance manipulator at the end of a device (or arranged consistently or intermittently across the device), and other forms of extending or manipulating the manipulator to a substance.

[0018] A substance manipulator having a conductive coating may be a hand-held instrument (either a rigid instrument or an articulating instrument or a combination thereof), a remotely operated instrument (e.g., a wire, catheter, scope or other similar device), one or more robotic arms (including part of a robotic system), an implantable device in medical or non-medical applications, part of a production line where the manipulation of substances and the application of energy with various water contact angles are advantageous, part of a manufacturing mold, and any other application where the manipulation of substances and the application of energy with various water contact angles are advantageous or useful.

[0019] The substance manipulator may also be used to supply energy in various forms, including electrical energy supplied as direct current, alternating current, high voltage pulsed current, low intensity direct current, pulsed electromagnetic fields, frequency periodic electrical modulation, and other forms of electrical energy having a therapeutic or useful effect on tissue or other substances. Examples of the medical utility from the application of these various energy forms include improved fracture repair, reduced pain (by percutaneous nerve stimulation and other electrical stimulation approaches), reduced bacterial load, cell modification or cell growth, improved perfusion, accelerated wound healing, and modification of the target tissue or substance.

[0020] In embodiments, the manipulator may be joint mobility, flexibility or rigidity, or a combination of these characteristics.

[0021] In embodiments, the substance manipulator includes feedback elements, such as pressure sensors, thermistors, thermocouples, ultrasound, and other forms of imaging, to enable an operator to supply an accurate amount of energy to the substance, as well as other feedback elements, position elements, and manipulation elements to improve the level of accuracy and precision regarding the energy supply to the substance target, as well as to improve the maneuverability with respect to the substance target.

[0022] Generally, as a further example, the inventors have found that in minimally invasive surgery, instruments need to be advanced, retracted, and exchanged through incisions, ports, working channels, or other points of access. Such approaches mean that the right instrument is not always readily available when needed. When performing laparoscopic surgery, the physician may, for example, sever a blood vessel and cause bleeding while making microincisions in the tissue to access the treatment point. The physician may not have a cauterizing or vascular sealing instrument in one of the ports used to advance and retract instruments in the patient for treatment. If this occurs, the physician will retract one of the instruments and insert a cauterizing or vascular sealing instrument (called device exchange) to try to locate, then locate, and stop the bleeding while it continues. Due to the time required to complete the device exchange, the bleeding area may become filled with blood, obscuring the location of the bleeding. Furthermore, during this time, the scope may become covered with blood, debris, or other fluids, or become cloudy, causing further problems that complicate the discovery and treatment of the bleeding.

[0023] For example, a material manipulator capable of manipulating a substance and rapidly supplying energy is invaluable for addressing bleeding without the need for device replacement. In some cases, a material manipulator can be positioned using a scope equipped with an optical coupler that has (or does not have) a conductive coating. However, in other cases, a physician may attempt to address bleeding by maintaining a range far from the bleeding site and using different instruments at different angles, where a separate material manipulator with a conductive coating would be of special value in overcoming current operational limitations.

[0024] Even when used in energy applications, the stability of a specific substrate is desirable to minimize the influence of the substrate on the conductive material and the influence of energy application supply on the substrate. The substrate material may be any material that provides the level of adhesion for the conductive coating and its target and energy application. These materials include, for example, polycarbonate, acrylic, polystyrene, cyclic olefin copolymers, cyclic olefin polymers, polyetherimide, quartz, glass, aluminum, bioabsorbable materials, nitinol, steel, silicone, other elastic materials, other elastomer materials, other metals, ceramic materials, epoxy, graphene, and any other material suitable for the adhesion of conductive coatings in a given application, taking into account factors such as coating adhesion, temperature characteristics, biocompatibility where applicable, durability, ease of manufacture, and other factors.

[0025] For example, polycarbonate materials are highly suitable for certain applications, including those where optically transparent substrates are desirable, due to the refractive index and performance of polycarbonate over a wide temperature range. These materials provide appropriate temperature performance, including insulation and relatively low levels of thermal expansion, when used in applications involving various forms of energy. Furthermore, some of these materials offer an additional combination of relatively low refractive index and high light transmittance for applications where these additional properties are useful.

[0026] The above device may also have one or more other coatings, including another conductive coating, a dielectric coating, and one or more other coatings (including radiopaque coatings or labels) or materials that facilitate the effective supply of energy to the coating or material.

[0027] In other embodiments, devices using multiple materials may join materials by adhesive or other chemical bonding, by molding the multiple materials together, by overmolding one material onto another, by placing mechanical connectors between or on the materials, or by a combination thereof. The connections may also be manufactured by coating one material onto another, screwing one material onto another, inserting a wire, or by other methods of joining one material to another, wherein at least one of the materials is a substrate for a conductive coating.

[0028] Embodiments of material manipulators include at least a somewhat transparent structure for the material manipulator, which, when combined with a transparent conductive material, allows for some improved visibility of the manipulated material. As used herein, the term “transparent” is not always limited to optically transparent. Instead, the term may include the ability or pathway property of energy waves such as infrared and / or ultraviolet light. The term also does not have to be completely transparent, but instead may mean any ability to facilitate or allow the passage of light rays (e.g., semi-transparent).

[0029] Furthermore, the manipulator does not necessarily have to be formed from a transparent material; in some embodiments, it can be manufactured from one or more opaque materials suitable for a particular application of the manipulator. In some embodiments, for a particular application, the manipulator may function as a support and applicator for conductive materials that have a limited ability to improve visualization or that do not have the ability to improve visualization.

[0030] The manipulator may be a single device, a device supplying other devices (such as staples), or may be attached to other devices (including control instruments) by a mounting section. The mounting section may include other structures that facilitate attachment and / or be secured by welding, bonding, screwing, mechanical connectors, interference between one or more materials and other devices (such as optical imaging devices), or other such forms of joining between devices. The mounting section does not need to have a specific shape (such as a cylinder), but can instead be formed to match the shape of the distal end of various optical imaging devices or remote visualization or control devices. Alternatively, the mounting section may be shaped to facilitate other functions of the device, including shaping the sides and distal end to more effectively conform to and manipulate tissues and materials. The shape and material may be selected to make the device less traumatic when in contact with tissues and other materials.

[0031] In some embodiments, the conductive material may be in the form of layers, strips, particles, nanoparticles, or other forms applied in several discontinuous, continuous, or intermittent patterns, and various combinations thereof. Variations in the form or pattern of application of the conductive material are possible within the limits of what can be achieved by bonding or combining the above coating with other materials, thereby adding one material to another.

[0032] Conductive materials include transparent conductive oxides (TCOs), conductive metals such as platinum, polymers, or organic semiconductors or other such materials capable of conducting or transmitting energy across a device. The term “layer” refers to at least some area of ​​conductive material having a relatively uniform thickness and / or method of application of the conductive material. For example, conductive material may be formed or applied by dipping, vapor deposition coating, spray painting, sputtering, ultrasonic coating, brush painting, paint painting, direct ion beam deposition, pulsed laser ablation, filtered cathode arc deposition, ion beam conversion of condensation precursors, magnetron sputtering, high-frequency plasma activated chemical deposition, or other applications of conductive material that can form layers or other patterns on a substrate of interest. In some embodiments, the conductive material may have a uniform material thickness. In other embodiments, the conductive material may have varying thicknesses. No part of the conductive material needs to have a precise thickness, and can vary continuously throughout. Instead, the thickness of the material may vary depending on the function of the electrode of interest, such as a target level of resistance (and its variations) across the coating for a particular application.

[0033] Furthermore, conductive materials may be applied to form specific shapes (other than layers), meaning that energy is applied to the material in different patterns and densities. Alternatively, the conductive material may be applied non-layered, such as by forming it in a mold, and then attached to the material manipulator by bonding, welding, or other means. Alternatively, the shape of the conductive material may correspond to a desired pattern of energy application by the conductive material, including a specific electrode design that includes the conductive material and connectors to the conductive material.

[0034] In embodiments, the conductive material may be applied irregularly to form patterns (stripes, stripes, depressions, gaps, ridges, curves, circles, semicircles) and other such methods to form electrodes for the purpose of applying energy to the device.

[0035] Material manipulator with further exemplary conductive coatings In other embodiments, a conductive coating may be included to conduct energy through a manipulator of a material (e.g., tissue). For example, the device may include a tissue manipulator, a conductive coating placed on the tissue manipulator, and a connector configured to supply energy to the conductive coating. The term “connector,” as used herein, should be broadly interpreted to mean any structure that enables the transfer of electrical or other energy to a conductive coating. The term “connector” can mean a permanent joint (solder, adhesive, stranded wire, conductive path with conductive coating) or a replaceable connector such as a plug and harness assembly, or any other method of transferring energy from a power source to a conductive coating. Not all methods leading to the coating must be physical joints. Joints can be made, for example, by an electromagnetic field, such as by inductance. The term “connector” may also include structures and / or functions that enable, interpose to, enhance, or otherwise facilitate a joint. Certain types of connectors are terminals, for example, areas of conductive material provided for or to be electrically coupled to a power source. The terminal may be, for example, a conductive metal layer positioned on the surface and molded to contact the end of the wire on the energy supply catheter.

[0036] The "connector region" is a region where a connector can be attached, mounted, coated, inserted, contacted, joined, glued, attached, bonded, layered, overlapped, or otherwise used to transfer energy to a conductive coating.

[0037] As used herein, the term “material manipulator” refers to any device for applying force to a material, preferably through a limited opening, for example, to capture, seize, cut, fasten, or otherwise move or influence a material. In particular, a material manipulator may be one of the tissue manipulators that are operated through small ports in the patient’s tissue and the human body during minimally invasive surgery. It can also be used to manipulate non-tissue material, such as piping systems or material trapped in constricted areas.

[0038] In one example, since staples are applied to tissue, a conductive coating may be applied to the endoscopic stapler to activate the staples. By activating the staples, it is possible to further close two (or more) tissue planes joined together by the staples. Energy may be applied, for example, while the staples are extending through the tissue plane to supply energy into the tissue across the tissue while minimizing heating of the staples. The energy from the conductive coating then affects the tissue plane, cauterizing or crosslinking them, just beyond the mechanical force of the staples themselves, for added safety.

[0039] The above coatings may be used to alter tissue in many ways. Tissue alterations include, for example, excision, cauterization, shaping, sealing, incision, removal, cutting, and coagulation of tissue.

[0040] U.S. Patents No. 5,040,715, 5,413,268, and 5,476,206, titled “APPARATUS AND METHOD FOR PLACING STAPLES IN LAPARASCOPIC OR ENDOSCOPE PROCEDURES,” which are incorporated herein by reference in their entirety, disclose a stapler that may be modified for use having a conductive coating. Figure 13 of U.S. Patent No. 5,476,206 shows, for example, a side view of a stapler cartridge assembly 137. The anvil member 136 includes an anvil plate 136A, a tissue contact surface 136B, and a staple-forming recess 136D. The stapler cartridge assembly also includes a pusher 139 for engaging staples 138 such that the pusher is sequentially engaged by a cam rod 131.

[0041] In the exemplary configuration of U.S. Patent No. 5,476,206, the staples themselves may be partially or completely coated with a conductive material, as described above. The staples may be coated, for example, by immersion before being loaded into the cartridge 137. The anvil member 136 and / or pusher 139 and / or cam rod 131 may also be connected to a power source (power supply can be performed from the proximal end of the stapler assembly by wires through a device to connect the anvil member 136 and cam rod 131).

[0042] As shown in Figure 13 of U.S. Patent No. 5,476,206, a staple 138 is pressed into a recess 136D formed adjacent to it by tissue layers 201 and 202. The recess formed mechanically attaches the two tissue layers together by bending the staple's arm backward over itself. At this time, energy can be supplied to the staple's coating by de-energizing the anvil 136 and the cam rod 131 and the adjacent pusher 139. The electrical energy causes the conductive coating to supply energy to the tissue, facilitating the sealing of the tissue layers together, for example, by sealing, cauterizing, or reconstructing the tissue. Advantageously, the tissue layers are further sealed in a less invasive environment where energy access and supply are more difficult.

[0043] The conductive coating is not limited to the stapler disclosed in U.S. Patent No. 5,476,206, but can be applied to other staplers (or fasteners) such as those disclosed in U.S. Patents No. 5,040,715; 5,137,198; 5,326,013; 5,657,921; 5,662,258; 6,131,789; 6,981,628 and 6,988,650, the contents of which are incorporated herein by reference. U.S. Patent No. 6,981,628 discloses, for example, a lateral articulated stapler. As a further example, a wire powering a coating of conductive material can be bent and articulate with the stapler shown in U.S. Patent No. 6,981,628.

[0044] In another example, a conductive coating may be applied to end-to-end anastomosis staples of blood vessels. U.S. Patent No. 5,104,025, which is incorporated herein by reference in its entirety, discloses a stapler in which the staple is held circumferentially around the head of a trocar and then pressed into shape against a circular anvil. Similar to U.S. Patent No. 5,476,206, the staple of U.S. Patent No. 5,104,025 may be coated with a conductive material, and the stapler is equipped with an energy supply wire connected to the coating on the staple by an anvil and a pusher. The conductive coatings disclosed herein may be applied to other anastomotic surgical staple fasteners, such as U.S. Patent No. 5,205,459, which is incorporated herein by reference in its entirety.

[0045] Other material manipulators for conductive coatings include electrostatic surgical scalpels, vascular sealing devices, clip applicators, or combinations of such devices. U.S. Patent No. 6,988,650, for example, describes a combination of the curved stapler and cutter in which the coating can be used in two locations and has energy supplied by one or more connectors. The coating may be applied to a surgical scalpel to cut tissue and cauterize the tissue when stapling, and the staples may also be coated to allow current to pass through to limit bleeding from the staple and accelerate healing and a low risk of infection along the staple line. The coating may also be applied to vascular sealing devices or clips to facilitate sealing or closing tissue.

[0046] U.S. Patent No. 8,915,931, whose entire contents are incorporated herein by reference, discloses a surgical clip applicator. Figures 1A and 1B of U.S. Patent No. 8,915,931 disclose a clip 10 (using the original reference number as provided in U.S. Patent No. 8,915,931) having a cutting element 38 at one end for clipping and cutting tissue. During use, the clip 10 is advanced over the tissue so that the cutting blade 38 of the clip 10 cuts the tissue after the arms 14, 16 have separated from each other. Once the tissue has been cut to a certain length, the arms 14, 16 can be released and the clip 10 can return to an asymmetric closed position to ligate the cut tissue. As described above, the clip 10, including the cutting blade 38, may be coated with a conductive coating to deform the tissue before, during, or after the application of the clip.

[0047] Figures 4A–4E of U.S. Patent No. 8,915,931 also disclose a clip applicator device 100. The jaws 112 on the distal end of the device may be connected to a power source for holding the clip 10 and energizing the clip. The jaws themselves may also be coated and energized for tissue transformation, such as cauterization, when clamping tissue between the jaws.

[0048] Conductive coatings may also be applied to LigaSure-like instruments for electrosurgical sealing of blood vessels. LigaSure devices use bipolar electrical energy to electrothermally seal blood vessels. Although effective, LigaSure typically requires monitoring the impedance rise of the circuit to suppress excessive energy application. The use of interposed conductive coatings can reduce the incidence of energy overapplication and associated heat diffusion and potential damage to surrounding tissue (or the complexity of controlling them).

[0049] U.S. Patent No. 7,819,872 discloses a flexible endoscopic catheter having a LigaSure device. The jaws of the device may be coated with a conductive coating, and an existing power supply may be modified to provide a connector for the conductive coating. The device also includes a snare, which may be coated with a conductive coating and then energized for tissue transformation.

[0050] The material manipulator may include tissue closure or repair devices. For example, the tissue closure or repair device may include devices for closing one or more planes of tissue together. For example, the tissue closure or repair device may include sutures, staples, fasteners, clips, clamps, anastomosis devices, and energy-activated adhesives.

[0051] The material manipulator may include a tissue support such as mesh (or other biocompatible material) for hernia, vaginal repair, spinal and other orthopedic procedures, and uterine or other tissue repair.

[0052] The material manipulator may further include various implants such as spinal cages, stents, clips (e.g., vascular, heart valve, or meniscus clips) or various fixation devices.

[0053] Bioabsorbable materials may be used in material manipulators such as sutures, staples, clips, anchors, meshes, and stents. Synthetic or biological materials may also be used for material manipulators such as synthetic meshes.

[0054] The tissue manipulator may include energy probes, such as bipolar energy probes. These probes and other material coatings on the manipulator may, in addition to being conductive, also be hydrophilic, hydrophobic, or even superhydrophobic. The advantage of controlling hydrophilicity / hydrophobicity is the ability to control the water contact angle. For example, the water contact angle may be 90, 140, or 170 degrees. Controlling hydrophobicity or hydrophilicity allows for the promotion of tissue endografting for the repair device or the avoidance of tissue adhesion or bonding on the manipulator. Conventional devices have employed hydrophobic or hydrophilic coatings, but not as part of or component of the conductive material. For example, the jaws of LigaSure may be conductive, but the hydrophobic coating itself does not need to be conductive.

[0055] The material manipulator may include guidewires or catheters used for maneuvering and operation. These may also be used within or deployed through the lumen. Figures 1 to 11 show examples of devices 600 comprising material manipulators having conductive coatings applied to or near their material contact planes. Figure 1 shows staples 610 connected to a power source 602 by, for example, a wire 604. Figures 2 and 3 show a row of staples 612 connected to a power source 602 via a stapler 614. Figure 4 shows a bipolar snare 616 connected to a power source 602. Figure 5 shows a needle 618 connected to a power source 602 via a surgical suture 620. Figure 6 shows a surgical mesh 622 connected to an organic power source 624 and a power source 602. Figure 7 shows a stent 626 connected to a power source 602 via a power supply catheter 606. Figure 8 shows a heart valve ring 628 connected to a power source 602 and an organic power source 624. Figure 9 shows the female connector 630 connected to the power source 602.

[0056] Figure 10 shows a joint-mobile and stretchable material manipulator 632, which includes a retractable shaft 634 having a flexible end and a pair of grippers 636 at the distal free end. The stretchable material manipulator 632 may be powered, for example, by a wired connection to a power source or by the use of a power delivery catheter 606. Figure 11 shows a spinal cage 638 connected to a power source 602 and an organic power source 624.

[0057] The retractable shaft 634 may include channels for transmitting fluids, air, or other substances. These channels may be used to transmit fluids, including water or saline solution, for washing tissue, rinsing debris from a field of view, washing the outer surface of the manipulator, or transmitting drugs and other chemicals, and other substances, such as air, CO2, argon gas, and other substances that form target tissue or other materials. The openings may extend through conductive material applied to the gripper 636 for drawing in the external environment and applying positive pressure to the instrument receptacle when the instrument is deployed externally.

[0058] These (and other) devices may include one or more connectors to supply energy to the conductive material. In this embodiment, the connector includes a first positive terminal and a second negative terminal. Current flows out from the positive terminal through the conductive material (which conducts current through the conductive material) and through the negative terminal.

[0059] The terminal itself may consist of inert electrodes such as graphite (carbon), platinum, gold, and rhodium. Furthermore, the terminal may include copper, zinc, lead, and silver, or aluminum, or any other material known to those skilled in the art to be suitable for conductive materials or energy transmission. A wire or other power transmitter connects the electrodes to the power source 602. For example, as shown in Figure 7, the power delivery catheter 606 may include a wire 604 embedded in the sheath or extending along the lumen of the delivery catheter.

[0060] The wire may be delivered by another alternative method, including the inductive transmission of current to the device or a battery embedded in the device. Power can also be supplied by a current from a battery, catheter, cable, radio waves or other power transmission device, or by a method that allows for extension of the distance to terminals or connectors.

[0061] As schematically shown in Figure 12, the conductive material 302 (used in the material manipulator) is a resistor and / or capacitor attached to the power source 94 via terminals 300a and 300b, connector 304 and cable 96. The connector 304 may extend (for example) through the endoscope sheath 76 into the cable 96 attached to the proximal end of the endoscope. The connector may be connected to the power source 94, which may be one or more forms of energy for altering tissue or other material, including, for example, monopolar energy, bipolar energy, argon gas energy, microwave, coblation energy, plasma energy, cryogenic energy, thermal energy, ultrasound, focused ultrasound or other forms of energy, including the generation and transmission of multiple energy forms that can be transmitted across or through the conductive coating to alter tissue or material.

[0062] The conductive material 302 in various embodiments of device 11 may be used to supply many types of energy and may be used in many medical and non-medical applications. Examples of such types of energy and applications are provided elsewhere herein for illustrative purposes and should not be construed as being limited thereto.

[0063] There are many ways to supply energy to terminals 300a, 300b and the conductive material 302. Cable 96 can supply power to the conductive material by terminals 300a, 300b. The terminals can be accessed by the cable being wound around the outside of the scope, for example. Alternatively, cable 96 or connector 304 can be attached to an energy delivery catheter that passes through the working channel of the scope and a dock having terminals. At its distal end, the energy delivery catheter may be connected to an electrical terminal in the working channel of the material manipulator. The connector may consist of a flexible circuit, one or more coatings, wires, conductive springs, inductive material for sending and receiving power, cables, or other such methods for transmitting power from a power source to the delivery point.

[0064] Terminal 300 may be any device that supplies several types of energy to the conductive material 302 (including radio waves, induction, or other wireless connections). In the case of extension of the conductive material into a shape for coupling or linking with a wireless excitation or energy generator (or other power source), the conductive material itself may, for example, form or include terminal 300.

[0065] The insulating material may extend from the surface supporting the layer of conductive material and may have the same, less than, or greater thickness as the layer of conductive material 302. The insulating material may advantageously prevent the breakdown of the conductivity of the conductive material 302 by, for example, a metal device that causes a short circuit in the energized conductive material layer. Alternatively, the insulating material may be a more flexible physical guard against damage by material manipulators.

[0066] In other embodiments, the material manipulator is attached to the end of a catheter (such as a scope) and has a frustoconical shape with a wider base extending distally. In this embodiment, the conductive material 302 is relatively flat and can be easily applied to a relatively flat tissue surface. Alternatively, the conductive material 302 may extend into a layer surrounding an opening surrounded by an insulating material. This can isolate the conductive material from short circuits or damage by other manipulators passing through the opening, such as biopsy forceps. Also, electrodes 300a and 300b may extend downward along the inclined sides of the frustoconical shape, or may not be partially or completely insulated.

[0067] In another embodiment, the electrical energy generator may include signal generators, such as function generators, RF signal generators, microwave signal generators, pitch generators, arbitrary waveform generators, digital pattern generators, or frequency generators. Existing electrosurgical generators may be used, having the advantage that they meet the standards required for medical applications. These generators may power electronic devices that repeatedly or non-repeatedly generate electronic signals (either in the analog or digital domain). RF signal generators can range from a few kHz to 6 GHz. Microwave signal generators can cover a much wider frequency range, from less than 1 MHz to at least 20 GHz. Some models can reach as high as 70 GHz using direct coaxial output and less than several hundred GHz when used with the largest external waveguide source modules. FM and AM signal generators may also be used.

[0068] The advantage of these different power generators is that one form of power provides a specific form of power for a target application where one form is more advantageous than another. For example, when cutting and coagulating tissue, monopolar electricity can typically cut and coagulate tissue more effectively than bipolar electrical energy. However, monopolar energy requires the use of a grounding pad to avoid arching the monopolar energy into unintended areas. Therefore, a grounding pad can be used in monopolar applications to prevent adverse effects on tissue and to prevent arching the monopolar energy into the patient and subsequent electrical energy and burns. (The grounding pad completes the circuit of the electrical energy passing through the patient.)

[0069] In contrast, bipolar electrical energy has a complete circuit within the device itself, and therefore the energy travels through and across the device, adversely affecting tissue but without an arching effect through the body. Using this approach, bipolar electrical energy is highly effective for causing damage, sealing blood vessels, and other applications including targeted tissue therapy. However, due to the aspects of bipolar electrical energy involved, it tends to be less effective as a substitute for a scalpel for cutting and coagulating tissue. Similarly, microwave energy may be used for certain types of tissue ablation due to its unique tissue effects and bipolar energy, which may also be used for other types of ablation. Other forms of energy, such as FM energy, may be used because the frequency does not excite certain incidental elements such as nerve bundles.

[0070] Coblation generators can be used in non-thermal-driven methods of surgically dissociating soft tissue by using high-frequency energy to excite electrolytes in a conductive medium such as saline to form a surgically focused plasma field. The energized particles or ions in the plasma field can have sufficient energy to break or dissociate organic molecular bonds within the soft tissue at relatively low temperatures, typically between 70°C and 40°C. This allows the coblation device to remove target tissue in terms of volume with minimal damage to surrounding tissue. Coblation can also provide hemostasis and tissue contraction functions. The amount of power supplied can be determined by the intensity of the plasma field and can be adjusted based on local environmental conditions.

[0071] Coblation may be used for temperatures typically below 90°C.

[0072] The ultrasonic generator can generate acoustic waves having a frequency higher than approximately 20 kHz (20,000 Hz). The ultrasound may be conducted to the tissue 200 by the conductive material 302. The ultrasound may be absorbed by body tissues, particularly ligaments, tendons, and fascia, or other materials.

[0073] Ultrasound devices can typically operate at frequencies ranging from 20 kHz to several GHz. The therapeutic ultrasound frequencies used are typically between 0.7 and 3.3 MHz. Ultrasound energy or TENS energy can speed up the healing process by increasing blood flow to the treatment area, reducing swelling and edema, decreasing pain, and gently massaging the muscles, tendons, and / or ligaments in the treatment area.

[0074] Ultrasound can be used to remove tumors or other tissues non-invasively or invasively. This can be achieved using a technique known as high-intensity focused ultrasound (HIFU), also called focused ultrasound surgery (FUS). This method generally uses lower frequencies than medical diagnostic ultrasound (250-2000 kHz). Other common conditions for which ultrasound may be used for treatment include ligament sprains, muscle strains, tendinitis, arthritis, plantar fasciitis, metatarsalgia, facet irritation, impingement syndrome, bursitis, rheumatoid arthritis, osteoarthritis, and scar tissue adhesion.

[0075] Device 600 also allows practitioners to perform, among other things, tissue cauterization, vascular sealing, tissue dissection and resection, tissue shaping, tissue cutting and coagulation, tissue excision, and instrument heating, all in the precise location visible to the practitioner. This at least partially addresses the problem of performing aspects of endoscopic surgery in areas that are not visible. It also eliminates the need to swap one device for another to apply energy to tissue or material, deflect tissue or other material, or engage in other operations while maintaining visibility.

[0076] More specific medical applications include, among others, the application of energy to affect tissue in cases of psychological trauma, arthroscopic surgery, spinal surgery, neurosurgery, shoulder surgery, lung tumor resection, excision and cauterization of cancerous tissue in bladder cancer patients, or excision of uterine tissue for women's health problems (such as endometriosis). In these applications (and other applications described herein), the device can be used to come into contact with tissue and then to cauterize, excise, or reshape the tissue (for example, in the shoulder method, this is done using coblation energy), forming an inherent capability that results from allowing the physician to see the changes occurring in the tissue in real time through optically transparent materials and coatings.

[0077] To further elaborate on its medical applications, the use of the device in diathermy therapy is a useful area, whether achieved using shortwave radio frequencies (range 1–100 MHz) or microwave energy (typically 915 MHz or 2.45 GHz). Diathermy therapy used in surgery may include at least two types. Monopolar energy is in which the current passes from one electrode near the tissue to be treated to the other fixed electrode elsewhere in the body. Typically, this type of electrode is placed at a specific location on the body, such as a contact point with the buttocks or around the legs. Alternatively, bipolar energy can be used when both electrodes are mounted very close together to form a closed electrical circuit on the device (in this case, two separate conductive material parts 302 on the material manipulator) and the current passes through or over the tissue being treated. The advantage of bipolar electrosurgery is that it prevents the current from passing through other tissues in the body and concentrates it only on the tissue in contact with or very close to the electrode. This is useful, for example, in microsurgery, laparoscopic surgery, cardiac procedures, and other procedures involving patients with conditions that make them unsuitable for use with cardiac pacemakers and other devices, as well as other forms of energy.

[0078] Electrocautery is a procedure that uses heat conduction from a metal probe heated by an electric current to repair tissue. This method is used to stop bleeding from small blood vessels (larger vessels can be ligated) or to cut through soft tissue. High-frequency alternating current is used for electrocautery in a unipolar or bipolar manner. This may be a continuous waveform (to cut tissue), an intermittent waveform (to coagulate tissue), or a combination of cutting and coagulation. The exit point of the circuit has a large surface area, such as in the buttocks, to prevent electrical burns, but in the unipolar type, the tissue to be coagulated / cut is in contact with the small electrode. The heat generated depends on the size of the contact area, the power setting or current frequency, the application time, and the waveform. Since the frequency used for cutting tissue is set higher than in the coagulation mode, a constant waveform (generally) generates more heat than the intermittent type. Bipolar electrocautery forms a circuit between two tips and is used like forceps. This has the advantage of not disrupting other electrical rhythms in the body (such as in the heart) and also works to coagulate tissue by pressure.

[0079] Alternatively, the conductive layer 302 and device 600 may be used for cautery in the range of 50–100°C, 50–70°C, or preferably lower temperatures, by applying power within a range suitable for its application. Advantageously, the ability to visualize the energy applied through the device as a form allows for precise energy delivery, including changing the energy level and resulting temperature, using appropriate power settings for a particular application, applying energy over longer periods to broaden the coverage, applying energy across multiple electrodes for multiple effects, and stopping the process with greater confidence that the tissue or other material has been sufficiently converted. (Of course, this advantage also applies to other applications of device 600, where real-time visual monitoring of energy application enables more precise application.)

[0080] This allows for improved visibility and the ability to perform repairs inside pipes, retain tanks, containers, and hydraulic lines, and retain other situations where visualization might otherwise be impaired, including when fluids such as petroleum products, sewage, food, and paints are opaque. The manufacture of biological pharmaceuticals, medicines, and other applications will benefit from this innovation, eliminating the need to widen lines to empty or inspect pipes or containers (e.g., oil tanks).

[0081] The size or degree of flexibility of a material manipulator may be measured for specific applications, such as replacing large volumes of fluid when inspecting a large area. The shape of the material manipulator may generally be flat, convex (with varying levels of curvature), angled, stepped, or other shapes for specific tasks. For example, a material manipulator may be square, or angular for replacing opaque fluid in the corners of a tank to inspect seams. Inspection of joints, seams, welds, corrosion seams, pipes, flexible and inflexible tubular members, or cracks, surface aberrations, and other aspects of inspection and repair can be performed on pipes, lines, tubes, tunnels, and other passages.

[0082] A material manipulator having a working channel allows a device to pass through the material manipulator for repair using screws, adhesive patches, glues, chemicals, welding, soldering, and other repair and modification coatings. In embodiments, the material manipulator may be formed from a material resistant to acids, alkalis, high heat, or the viscosity of the fluid being replaced by the material manipulator. In embodiments, the device may be a single-use disposable device or a reusable device.

[0083] Advantageously, embodiments of device 600 provide the ability to apply energy through the conductive material 302 in these diverse non-medical applications. The energy applied to the object being observed may heat, alter, or otherwise affect the object being manipulated by the material manipulator.

[0084] Conductive material composition The conductive material 302 may have various compositions and may be applied to the material manipulator in various ways. Examples of such compositions and applications are provided below for illustrative purposes and should not be considered as limiting. For medical applications, a preferred conductive material 302 can withstand sterilization by, for example, gamma irradiation, ethylene oxide, vapor, or other forms of sterilization.

[0085] Conductive / electrically responsive coatings can be applied to multiple configurations to form one or more electrodes. Depending on the intended effect using the tissue or other material, these electrodes may be optically transparent and may have varying thicknesses, including thicknesses of less than half a micron and much greater.

[0086] The conductive material may be at least partially transparent and may include any member of the general class of materials known as transparent conductive oxides (TCOs), for example, titanium oxide (TiO2) and aluminum-doped zinc oxide (AZO). It may also include applications of other conductive materials applied in a way that enables visualization, such as silver and gold nanoparticles, as well as other conductive materials applied in a way that enables energy conduction and visualization.

[0087] The transparent conductive oxide may include a transparent material having a band gap with energy corresponding to wavelengths shorter than the visible range of 380–750 nm. The TCO film may have varying conductivity across points on its surface, for example. In one embodiment, the film is free of or substantially free of pores, pinholes, and / or defects. In another embodiment, the number and size of pores, pinholes, and / or defects in the layer do not adversely affect the performance of the layer in the device. The film thickness may range from less than 1 nm to about 3500 nm. In embodiments, different manufacturing methods and intended applications may result in different thicknesses, such as film thicknesses of about 10, 20, 30, 40, 50, 60, 70, 80, 100, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, and 1500 nm.

[0088] The transparent conductive film may be indium tin oxide, Al or Ga-doped zinc oxide, Ta or Nb-doped titanium oxide, F-doped tin oxide, or mixtures thereof. The oxide layer may be formed by directly oxidizing an ultrathin metal layer or by depositing an oxide. The TCO material may have a polycrystalline, crystalline or amorphous microstructure, which affects other properties such as film properties such as transmittance and conductivity.

[0089] Biocompatible TCOs may also be used as transparent conductive materials. These include, for example, aluminum oxide (Al2O3), hydroxyapatite (HA), silicon dioxide (SiO2), titanium carbide (TiC), titanium nitride (TiN), titanium dioxide (TiO2), and zirconium dioxide (ΖrO2). These materials may be n-type doped with other metals such as aluminum (Al), copper (Cu), silver (Ag), gallium (Ga), magnesium (Mg), cadmium (Cd), indium (In), tin (Sn), scandium (Sc), yttrium (Y), cobalt (Co), manganese (Mn), chromium (Cr), and boron (B). P-type doping can be achieved, in particular, with nitrogen (N) and phosphorus (P).

[0090] TiO2 can function as a biocompatible material and can coat substrates at temperatures ranging from room temperature to several hundred degrees Celsius. TiO2 has several different polymorphic phases, which can depend on the initial particle size, initial phase, dopant concentration, reaction atmosphere, and annealing temperature. TiO2 films are generally synthesized by many methods, including sol-gel, thermal spraying, and physical vapor deposition.

[0091] Transparent conductive, aluminum-doped zinc oxide thin film (Al x Zn y O z ZnO:Al contains a small amount of aluminum (typically less than 5% by weight). The underlying substrate can affect the structure and photoelectronic properties of the film made of the above material. Even with the same substrate, the thickness of the layer (deposition time, position on the substrate) itself affects the physical properties of the deposited thin film.

[0092] Changes in physical quantities from the grown thin film can also be achieved by changing process parameters such as temperature or pressure, or by adding a process gas such as oxygen or hydrogen. Generally, zinc oxide is n-type doped with aluminum. n-type doping may also be carried out using metals such as copper (Cu), silver (Ag), gallium (Ga), magnesium (Mg), cadmium (Cd), indium (In), tin (Sn), scandium (Sc), yttrium (Y), cobalt (Co), manganese (Mn), chromium (Cr), and boron (B). p-type doping can be achieved using nitrogen (N) and phosphorus (P).

[0093] Furthermore, the incorporation of subwavelength metal nanostructures into TCO can result in a change in the wavelength at which the TCO becomes transparent. Articles with embedded particles can also be used to control absorption and scattering at desired wavelengths. Other optical effects of the material, including absorption, scattering, light trapping or detrapping, filtering, and photo-induced heating, can be similarly affected. The morphology of the particles (including particle size, shape, density, uniformity, fit, separation, arrangement, and random or periodic distribution) may be used to design these effects.

[0094] For optically transparent applications, the substrate of the electrode of the present invention may be any suitable material on which the transparent electrode structure of the present invention is applied. This may include other conductive or dielectric materials. In one example for illustrative purposes, the material contact portion of a material manipulator functions as the substrate. Other substrates include, among others, glass, semiconductors, inorganic crystals, and rigid or flexible plastic materials. Examples for illustrative purposes include, among others, silica (SiO2), borosilicate (BK7), silicon (Si), lithium niobate (LiNbO3), polyethylene naphthalate (PEN), and polyethylene terephthalate (PET).

[0095] Organic materials can also function as conductive materials. These include carbon nanotube networks and graphene, which can be manufactured to be highly transparent to infrared light along a network of polymers such as poly(3,4-ethylenedioxythiophene) and its derivatives.

[0096] Polymers can also function as conductive materials. Examples of conductive polymers include polyacetylene, polyaniline, polypyrrole or polythiophene, and derivatives of poly(3,4-ethylenedioxythiophene) (PEDOT) and poly(styrenesulfonic acid) PSS. Iodine-doped poly(4,4-dioctylcyclopentadithiophene) or 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ) can also be used. Other polymers using n-type or p-type dopants can also be used.

[0097] Conductive material films may be deposited onto substrates by a variety of deposition methods, including metal-organic chemical vapor deposition (MOCVD), metal-organic molecular beam deposition (MOMBD), spray pyrolysis, pulsed laser deposition, immersion coating, paint coating, bonding, or other applications suitable for bonding conductive materials to a given substrate for a specific application. Manufacturing techniques for TCOs include magnetron sputtering, sol-gel methods, electrodeposition, vapor deposition, magnetron DC sputtering, magnetron RF sputtering, or a combination of both ultrasonic feeding and welding sputtering deposition methods. Furthermore, high-quality deposition methods using thermal plasma, (low-pressure (LP), organometallic (MO), plasma-enhanced (PE)) chemical vapor deposition (CVD), electron beam deposition, pulsed laser deposition, and atomic layer deposition (ALD) can be used, among others.

[0098] Thin films such as ALD, with a thickness of only a few nanometers, are flexible and therefore less prone to cracking, resulting in less formation and diffusion of harmful particles within the human body or designated non-medical examination sites. Low-protein and high-protein-binding affinity coatings may also be deposited using ALD. These, like surface coatings resistant to bacterial growth, are particularly useful in the fields of diagnostics and preparative techniques.

[0099] For example, pre- and post-deposition treatments such as oxygen plasma and heat treatment can be combined to obtain improved conductive material properties. Oxygen plasma may be preferable when the substrate or conductive material is affected by high temperatures. Conductive material films can have a wide range of material properties depending on variations in process parameters. For example, changing process parameters can result in a wide range of film conductivity and morphology.

[0100] Many aspects of the system, device, and method are described. Nevertheless, it is understood that various modifications are possible without departing from the spirit and scope of this disclosure. Accordingly, other aspects are within the scope of the following claims. [Explanation of symbols]

[0101] 11,600… devices 94, 602 … Power source 96… Cable 604… Wire 610, 612… staples 614… Stapler 616... Bipolar snare drum 618 … needle 620… Surgical sutures 622… Surgical mesh 624 … Organic power source 626… Stent 628… Heart valve ring 630… Female 634... Extendable shaft 636…Gripper 638... Vertebral cage 302 ... Conductive materials 304… Connector 636…Gripper 638... Vertebral cage

Claims

1. A tissue manipulator comprising a conductive substrate having an outer surface and consisting of staples, wherein the tissue manipulator comprises a conductive coating disposed on at least a portion of the outer surface of the conductive substrate and configured for energy conduction, and an insulating material disposed between the conductive coating and the outer surface of the conductive substrate, A power source bonded to the conductive coating and configured to transmit sufficient energy through the conductive coating to alter the structure, A device characterized by including at least one connector portion capable of supplying energy from the power source to the conductive coating.

2. The device according to claim 1, wherein the connector portion is configured for connection to the power source, which consists of an electrical energy generating device.

3. The device according to claim 1 or 2, wherein the region of the conductive coating and the region of the tissue manipulator are at least partially optically transparent, and these optically transparent regions overlap.

4. The device according to claim 3, wherein the conductive coating comprises a conductive oxide, and the conductive oxide is selected from the group consisting of conductive titanium oxide and conductive aluminum oxide.

5. The device according to any one of claims 1 to 4, wherein the conductive coating is configured to convert electrical energy into thermal energy.

6. The device according to any one of claims 1 to 5, wherein the tissue manipulator is configured to transmit force onto tissue and is composed at least partially of a biocompatible material, the biocompatible material having adhesive properties for bonding to the insulating material.

7. The device according to any one of claims 1 to 6, wherein the coating is configured to be further hydrophilic.

8. The device according to any one of claims 1 to 6, wherein the coating is configured to be further hydrophobic or superhydrophobic.

Images