Tissue sealing devices with low output cutting

Abstract

A method of operating an electrosurgical device comprising first and second electrodes comprises activating sealing energy for sealing an anatomic structure with the second electrode, sensing a parameter of the sealing energy, determining cutting energy for cutting the anatomic structure with the first electrode based on the sensed parameter, activating heating energy for heating the first electrode, and cutting the anatomic structure with electrical energy from the first electrode. An electrosurgical device comprises a shaft comprising a distal end and an articulating section proximate the distal end and a jaw assembly coupled to the distal end of the shaft comprising first and second jaw members, a first electrode positioned on one of the first jaw member or the second jaw member, a second electrode positioned on the first jaw member, a third electrode positioned on the second jaw member and a heating capability associated with the first electrode.

Description

TISSUE SEALING DEVICES WITH LOW OUTPUT CUTTINGPRIORITY CLAIM

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application Serial No. 63 / 747,716, filed January 21, 2025, the contents of which are hereby incorporated by reference.TECHNICAL FIELD

[0002] The present disclosure is generally directed to, but not by way of limitation, systems, devices and methods for performing tissue sealing and cutting procedures, such as can be used in various endoscopy procedures. More specifically, but not by way of limitation, the present disclosure is directed to electrode configurations and energy delivery modes for tissue sealing and cutting procedures.BACKGROUND

[0003] Various different types of energy, e.g., radio frequency (RF) or other electromagnetic energy, plasma energy, resistive heating, and ultrasound energy, can be used for vessel sealing, tissue cutting or cautery, tissue ablation, and tissue coagulation, among other things, alone or in combination with mechanical energy delivery (e.g., using a sharp cutting instrument) or manipulation (e.g., using a forceps). Many types of monopolar and bipolar energy devices exist for different surgical purposes. In an example of an electrosurgical device, e.g., a device configured to deliver electrical energy, a forceps can be utilized for laparoscopic surgery. The forceps can be deployed inside a patient and can include a tissue gripping assembly and a cutting assembly. Further, the forceps can utilize electrical energy in the gripping assembly. Electrosurgical sealing forceps can further include or use an energy device such as RF, ultrasonic, and microwave vessel sealing devices. The gripping assembly can clamp tissue, and elastin or collagen of the clamped tissue can be melted by the energy device to seal the tissue.

[0004] Electrosurgical medical devices generally fall into one of two categories: monopolar medical devices and bipolar medical devices. A monopolar medical device can include an active electrode electrically connected to an electrosurgical generator. A return electrode is also electrically connected to the electrosurgical generator and can be placed in1Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01contact with a patient. Typical return electrodes in a monopolar medical device can take the form of a patient pad that is located remotely from the electrosurgical medical device. In use, electrical current is passed from the electrosurgical generator to the active electrode, through a site or a region of the anatomy of the patient (e.g., a tissue or a vessel) to the patient pad, and back to the electrosurgical generator. A bipolar medical device can include an active electrode and a return electrode adjacent the active electrode, both of which are electrically connected to an electrosurgical generator. Furthermore, each electrode of a bipolar device can be located on or in the electrosurgical medical device. In use, an anatomic feature such as a vessel is placed between the active and return electrodes, and electrical current passes from the electrosurgical generator to the active electrode, through the anatomic feature to the adjacent return electrode, and then back to the electrosurgical generator.

[0005] Examples of tissue sealing devices are described in Pat. No. US 9,918,774 to Batchelor et al, titled “Resistively Heated Electrosurgical Device”; Pat. No. US 11,020,166 to Batchelor et al., titled “Multifunctional Medical Device”; Pat. No. US 9,474,569 to Manzo et al., titled “Surgical Instrument with End Effector Comprising Jaw Mechanism and Translating Component, and Related Method”; and Pub. No. US 2021 / 0153927 to Ross et al., titled “Electrosurgical Instrument with Compliant Elastomeric Electrode.”OVERVIEW OF THE PRESENT DISCLOSURE

[0006] The present inventor has recognized that there are problems associated with combining bipolar and monopolar energy into a single electrosurgical device.

[0007] Both monopolar and bipolar medical devices are desirable for use in various medical procedures. However, each can have shortcomings in certain applications. For example, monopolar medical devices are known to pass relatively high electrical currents through the patient, which may cause unwanted tissue and / or organ damage. Moreover, in some procedures it is desirable to not use a monopolar medical device altogether because of the high thermal spread and dispersed energy format. While bipolar medical devices minimize these shortcomings, accurately controlling which electrode is the active electrode can be difficult.

[0008] It would therefore be desirable to have a medical device that can address at least one of the aforementioned shortcomings. For example, it would be advantageous to have a single electrosurgical medical device that can be used in both monopolar and bipolar modes,2Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01such as one that can easily and quickly switch between a monopolar mode and a bipolar mode.

[0009] The present inventor has recognized various problems to be solved in electrosurgical devices that utilize an energy source to treat tissue, such as, the potential for arcing of electricity during the procedure. For example, in combined monopolar and bipolar devices, as discussed below, the electrodes can be incorporated into jaws of a forceps. In such configurations, arcing can occur between bipolar electrodes, between the monopolar electrode and a bipolar electrode, and / or between any electrode and tissue.

[0010] One particular form of bipolar sealing energy is Radio Frequency (RF) energy, which can be used for vessel sealing. RF sealing devices are becoming common in surgical procedures, at times even replacing scalpel and sutures. RF vessel sealing devices can apply alternating current (AC) energy at high frequency to allow for more targeted application of the electrical energy. For example, RF energy can more effectively reach collagen and elastin fibers within tissue as compared to direct current (DC) or low frequency AC. For this and other reasons, RF vessel sealing devices can reduce the time that procedures take.Additionally, since the tissue of the patient is used to seal the vessel, the introduction of foreign objects into the wound site, such as sutures, which, in some cases, may cause a reaction in the patient, can be avoided.

[0011] In the past thirty years, RF vessel sealing devices have become more and more refined, being able to seal faster and larger vessels, with increased performance rates of attaining seals. Furthermore, with the advent of robotics, there is even more potential for the application of RF sealing and cutting technology. However, not all surgery is “straight stick” where the working shaft of the device is rigid along its length and not articulated. Sometimes it is useful to have an articulation element behind the jaws of the device, thereby permitting the user to safely reach areas of the patient that might otherwise be difficult or cost time to reach, such as by allowing a shaft of the device to bend or be articulated. Robotic surgical systems can use articulated shafts. However, articulated shafts can also be used in handheld devices.

[0012] An issue with this approach, is that many of the existing devices use a mechanical blade to cut the sealed vessel and this can prevent or limit the amount of articulation that is possible with such devices. Some devices have attempted to use RF energy for both cutting and sealing. These devices can, however, be difficult to use for some surgeons.3Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0013] More recently, companies have incorporated RF sealing in robotic systems or handheld devices that use monopolar energy to cut the tissue. As discussed, monopolar energy has a few disadvantages compared to bipolar energy sources. The present inventor has further recognized that monopolar cutting typically requires high outputs, especially when passing through already dried, e.g., sealed, tissue, which can lead to stray energy affecting local nerves adjacent to the sealing site. Additionally, monopolar energy has the potential for arcing from the active cut electrode to the surrounding bipolar vessel sealing jaws in devices having combined monopolar and bipolar sealing electrodes. The present inventor has recognized that the constraints of incorporating both monopolar and bipolar sealing electrodes in a single device can result in creepage (e.g., the distance between electrodes) and clearance (e.g., the ability to fit within an insertion instrument) requirements that are too strict. For example, many sealing instruments are configured for use in instruments having a 5 mm maximum diameter. This additionally makes it difficult to seal vessels greater than 5 mm in diameter. The diameter of a vessel that can be adequately sealed is directly related to how wide a formed seal extends along the length of the vessel. Larger diameter vessels contain larger pressures, which require wider seal areas. Thus, there is difficulty in providing tissue sealing devices that fit within small space constraints and that are also able to seal large vessels, while also mitigating the potential for arcing.

[0014] Some combined bipolar and monopolar devices include a monopolar electrode positioned between two bipolar electrodes. To overcome the aforementioned size and space limitations, some sealing devices have incorporated thin bipolar sealing electrodes to increase the distance from the monopolar electrode without increasing the width of the sealing device. As such, the outer bipolar sealing electrodes are pushed further away from the center cutting electrode. This increases the creepage distance to reduce the risk of arcing, but reduces the size, e.g., diameter, of vessels that can be sealed.

[0015] In view of these problems and constraints recognized by the present inventor, the presently disclosed subject matter can provide solutions to these and other problems, such as by providing a single device having monopolar and bipolar sealing capabilities. The devices of the present disclosure can provide sealing and cutting devices having lower voltage output for monopolar or bipolar cutting operation, e.g., monopolar RF cutting output, that can achieve the same cutting effects as higher voltage devices. In additional examples, cutting can be performed with resistive heating. Electrosurgical devices of the present disclosure can4Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01include monopolar electrodes that use less power and voltage, and therefore less current, thereby reducing the risk of arcing. Such benefits can be obtained by having one or more of the electrodes of the present disclosure be resistively heated to allow for thermionic disassociation of the electrons, ions, or both so that electrons, ions, or both in a field are accelerated. Thus, less voltage may be required to obtain the same disassociation of the electrons, ions, or both than with only voltage for RF cutting. Furthermore, the resistive heating of the monopolar electrode can additionally be used to provide cutting operations.

[0016] Such configurations of electrodes of the present disclosure can reduce the possibility of monopolar energy arcing to the bipolar electrodes or elsewhere. This thereby allows the jaws to have a closer creepage and clearance distance between the monopolar cut and bipolar sealing electrodes, while still having widths or thicknesses that allow for sealing of larger vessels. Furthermore, the electrical energy applied during bipolar sealing can be used to inform the amount of electrical energy that will be adequate to perform the cutting, further potentially limiting the amount of electrical energy and the potential for arcing. For example, electrical feedback obtained while performing the RF bipolar sealing can be used to identify the type of tissue being sealed, which can then be used to set the amount of energy for RF monopolar or bipolar cutting and resistive heating cutting.

[0017] In an example, a method of operating an electrosurgical device can comprise navigating a medical instrument to an anatomic structure, activating sealing energy for sealing the anatomic structure with a first electrode, sensing a parameter of the sealing energy, determining a type of tissue of the anatomic structure based on the parameter that has been sensed, sealing the anatomic structure with the sealing energy, determining cutting energy for cutting the anatomic structure with a second electrode based on the type of tissue that was determined, activating a heating energy for heating the second electrode, and cutting the anatomic structure with electrical energy from the second electrode.

[0018] In an additional example, an electrosurgical device can comprise a shaft comprising a distal end and an articulating section proximate the distal end, and a jaw assembly coupled to the distal end of the shaft, the jaw assembly comprising a first jaw member, a second jaw member, a first electrode positioned on the first jaw member, a second electrode positioned on the second jaw member, a third electrode positioned on one of the first jaw member or the second jaw member, and a heating capability associated with the third electrode.5Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0019] In another example, a method of controlling an electrosurgical device can comprise providing sealing energy to a first electrode of the electrosurgical device to seal a tissue of an anatomic structure, sensing a parameter of the sealing energy, determining a type of tissue of the anatomic structure based on the parameter that has been sensed, determining cutting energy for cutting the tissue of the anatomic structure with a second electrode based on the type of tissue that was determined, providing cutting energy to the second electrode, and providing a heating energy to the second electrode for heating the second electrode.BRIEF DESCRIPTION OF THE DRAWINGS

[0020] FIG. l is a side view of an example electrosurgical system having an end effector comprising forceps for performing electrosurgical cutting and sealing operations.

[0021] FIG. 2 is a block diagram showing example components of an electrosurgical system having a feedback system capable of performing one or more of the methods, procedures and / or operations discussed herein.

[0022] FIG. 3 A is a perspective view of a jaw assembly of a forceps comprising bipolar and monopolar electrodes, in accordance with some aspects of the present disclosure.

[0023] FIG. 3B is a side view of the jaw assembly of FIG. 3 A with an anatomic vessel positioned between jaw members.

[0024] FIG. 4 is a schematic illustration of an articulatable shaft suitable for use with the jaw assembly of FIG. 3 A.

[0025] FIG. 5A is a schematic cross-sectional view of the jaw assembly of FIG. 3 A showing a bipolar electrode and a monopolar electrode configured in accordance with embodiments of the present disclosure.

[0026] FIG. 5B is a close-up schematic view of the bottom jaw of the jaw assembly of FIG. 3 A showing a vessel.

[0027] FIG. 6 is a block diagram illustrating an example method of performing an electrosurgical sealing and cutting operation of the present disclosure.

[0028] FIG. 7 is a schematic diagram of a machine learning model system illustrating inputs for determining cycles of energy application to achieve desired cutting effects for different tissue types using RF and thermal energy.6Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0029] FIG. 8 is a schematic illustration of a robotic surgical system suitable for use with the systems, devices and methods described herein utilizing a heated monopolar electrode that can be tuned to provide customized resistive cutting and RF cutting.

[0030] FIG. 9 is a schematic diagram of a computing system for use with the electrosurgical system of FIG. 1.DETAILED DESCRIPTION

[0031] FIG. 1 is a schematic side view of electrosurgical system 100. Electrosurgical system 100 can comprise medical device 102 and processing unit 104, which can be connected to user interface 105. Medical device 102 can comprise handpiece 106 and end effector assembly 108. As described herein, electrosurgical system 100 can be configured to deliver electrosurgical sealing energy and electrosurgical cutting energy output to end effector assembly 108. Specifically, electrosurgical system 100 can be configured to deliver bipolar sealing energy in RF to a pair of bipolar electrodes, and monopolar cutting energy in RF and resistive forms to a single monopolar electrode positioned between the bipolar electrodes. In additional examples, electrosurgical system 100 can be configured to deliver bipolar cutting in combination with resistive heating, where the central heated electrode creates a bipolar circuit between the upper jaw or the lower jaw or both jaws. Furthermore, in select implementations, the monopolar or resistive heating cutting electrode can be configured to deliver resistive heating cutting. In examples, processing unit 104 can use feedback obtained while performing bipolar sealing to inform energy levels desirable for monopolar or bipolar cutting, thereby reducing the risk of generating stray electrical energy.

[0032] End effector assembly 108 can comprise jaw assembly 110. Alternatively, or additionally, end effector assembly 108 can include or use a “J-shaped Hook” type electrode or other electrode types for surgery. Jaw assembly 110 can comprise first jaw member 112 and second jaw member 114. First jaw member 112 and second jaw member 114 can be pivotably coupled about a pivot axis at pivot point 116 located on or distal of shaft 118. Shaft 118 can couple end effector assembly 108 to handpiece 106. Drives 120 can be included or used in medical device 102, such as housed within handpiece 106 and mechanically coupled to end effector assembly 108. Also, drives 120 can be included at or near the distal end of end effector assembly 108 to directly drive jaw assembly 110 without linkages extending through shaft 118. Drives 120 can be any suitable drive associated or7Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01coupled with the end effector assembly 108 in any arrangement, including, e.g., robotic applications.

[0033] Medical device 102 can comprise lever 122, trigger 123, first button 124, knob 125 and second button 126. Shaft 118 can include articulating section 127. Lever 122 can be used to actuate first jaw member 112 and / or second jaw member 114, such as to cause relative rotation therebetween. Trigger 123 can be used to activate articulating section 127, so as to cause bending of shaft 118. First button 124 can be used to lock first jaw member 112 and second jaw member 114 in place, such as in a relative rotational position. Knob 125 can be used to rotate shaft 118 to change the radial orientation of first jaw member 112 and second jaw member 114. Second button 126 can be used to activate electrosurgical energy of jaw assembly 110, as can be generated at processing unit 104. However, the functionality of lever 122, trigger 123, first button 124, knob 125 and second button 126 can be arranged in other configurations or combinations. Handpiece 106 can include grip 107, e.g., a pistol grip, to facilitate ergonomic grasping of medical device 102 and ergonomic access to lever 122, trigger 123, first button 124, knob 125 and second button 126.

[0034] Electrosurgical system 100 can also include or use one or more of sensor 128 for determining a tissue characteristic or an activation energy characteristic. For example, sensor 128 can comprise sensors for sensing an electrical parameter or imaging sensors for sensing a video parameter. Sensor 128 can include an electrical sensor for measuring one or more electrical properties such as electrical properties of tissue, e.g., resistance, capacitance, or inductance. In examples, sensor 128 can include or comprise a resistance sensor. In examples, sensor 128 can comprise a temperature sensor. More specifically, sensor 128 can also include an electrical sensor or electrode, such as for providing electrical characterization (e.g., resistance) of tissue compressed between first jaw member 112 and second jaw member 114, either during or after or interleaved with application of electrosurgical treatment energy to the tissue. Sensor 128 can be located in the end effector assembly 108, for example, a component of one or more of first jaw member 112 and second jaw member 114 as shown in FIG. 3B. As depicted in FIG. 1, sensor 128 can be integrated at or near the end effector assembly 108. In examples, sensor 128 can be separate from the end effector assembly, such as extending from another shaft of medical device 102, a shaft of another instrument, or such a shaft as extending from another device such as a robotic arm or videoscope. In examples, sensor 128 can comprise one or more imaging sensors, e.g., cameras, located at or near the8Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01distal end of the end effector assembly, on a jaw of the jaw assembly 110, or integrated with an end effector assembly 108, such as a J-hook. However, imaging sensors or cameras can be attached to other portions of medical device 102.

[0035] In the illustrative example, electrosurgical system 100 can provide tailored waveforms to one or more electrodes, such as first electrode 140, second electrode 142 and third electrode 144 of FIG. 2 and FIG. 3A. Such tailored energy output can be used to treat the tissue, such as to seal, cut, ablate, fulgurate, and / or desiccate, among other effects. End effector assembly 108 can include one or more of first electrode 140, second electrode 142 and third electrode 144 integrated into a forceps, as well as a remote return electrode, such as, but not limited to a return electrode pad that can be placed, for example, on the body of the patient, such as pad 148 (FIG. 2). Waveforms delivered by processing unit 104 can be tailored for monopolar and bipolar operation, as well as RF operation and resistive operation. The tailored energy outputs of the present disclosure can be configured to cut or seal different types of tissue and can therefore, in some cases, have lower energy output, reducing energy consumption of the device and increasing safety.

[0036] FIG. 2 is a schematic illustration of circuitry of electrosurgical system 100.Electrosurgical system 100 can comprise medical device 102 and processing unit 104.Medical device 102 can comprise handpiece 106 and end effector assembly 108. Processing unit 104 can comprise heating power supply 130 and therapy power supply 132. Heating power supply 130 can provide heating power to medical device 102, and therapy power supply 132 can provide therapeutic power to medical device 102. In examples, heating power supply 130 can generate power suitable for resistive heating, and therapy power supply 132 can generate power suitable for resistive heating and RF heating. Medical device 102 can include first electrode 140, second electrode 142, and third electrode 144. First electrode 140 can include heater 146. In examples, heater 146 can be configured as first electrode 140 as shown in FIG. 5A. Pad 148 can be in electrical communication with medical device 102 and therapy power supply 132.

[0037] First therapeutic power connection 150, which can include first therapeutic power switch 152, can extend between therapy power supply 132 and first electrode 140. Second therapeutic power connection 154, which can include second therapeutic power switch 156, can extend between therapy power supply 132 and first electrode 140. Third therapeutic power connection 158 can extend between therapy power supply 132 and first electrode 140,9Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01which can provide therapeutic power to first electrode 140. When first therapeutic power switch 152, second therapeutic power switch 156, or both is open, therapeutic power is restricted from communicating to first electrode 140. However, when at least one of first therapeutic power switch 152 and second therapeutic power switch 156 are closed, therapeutic power can be provided from therapy power supply 132 to first electrode 140.

[0038] First heating power connection 160 can extend between heating power supply 130 and heater 146 of first electrode 140. First heating power connection 160 and third therapeutic power connection 158 can be electrically connected at connector 162 or a single, common connection 164 can carry two signals from processing unit 104. That is, common connection 164 can carry therapeutic power to first electrode 140 and heating power to heater 146. Second heating power connection 166, which can include heating power switch 168, can extend between heating power supply 130 and first electrode 140. When heating power switch 168 is closed, heating power can be provided from heating power supply 130 to heater 146 to heat first electrode 140. When heating power switch 168 is open, heating power is restricted from communicating to heater 146 and, as such, first electrode 140 is not heated.

[0039] Fourth therapeutic power connection 170 and fifth therapeutic power connection 172 can extend between therapy power supply 132 and second electrode 142 and third electrode 144, respectively. Sixth therapeutic power connection 174, which can include electrode switch 176, can extend between therapy power supply 132 and third electrode 144. Pad connection 178 can extend between therapy power supply 132 and pad 148.

[0040] When at least one of first therapeutic power switch 152 and second therapeutic power switch 156 are closed, therapeutic power can be communicated from therapy power supply 132 to first electrode 140 and communicated back to therapy power supply 132 via second electrode 142, third electrode 144, or both (i.e., bipolar mode). Alternatively, therapeutic power can be communicated back to therapy power supply 132 via pad 148 (monopolar mode).

[0041] Moreover, by closing electrode switch 176, therapeutic power can be communicated from therapy power supply 132 to third electrode 144 and back to therapy power supply 132 via second electrode 142 (bipolar mode). While therapeutic power is communicated between second electrode 142 and third electrode 144, therapeutic power, heating power, or both can be provided to first electrode 140. Alternatively, heating power switch 168 can be opened to prevent the supply of heating power to heater 146 while10Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01therapeutic power is being communicated between second electrode 142 and third electrode 144. Moreover, one of first therapeutic power switch 152 and second therapeutic power switch 156 can be opened to prevent the supply of therapeutic power to first electrode 140 while therapeutic power is being communicated between second electrode 142 and third electrode 144. In additional examples, therapeutic power, such as bipolar cutting power, can be applied between first electrode 140 and third electrode 144 (or, alternatively, between first electrode 140 and second electrode 142 or between both second electrode 142 and third electrode 144).

[0042] With the present disclosure, heating power supply 130 and therapy power supply 132 can deliver therapy output to first electrode 140, second electrode 142 and third electrode 144. For example, RF sealing energy can be delivered to second electrode 142 and third electrode 144 to seal a vessel. During application of the RF sealing energy, sensor 128 (FIG.1) can obtain feedback from the tissue to which sealing therapy is being delivered from second electrode 142 and third electrode 144. The feedback from sensor 128 can be in the form of resistance measurements that can be correlated to resistance values of different tissue types. However, other types of feedback can be used. Thus, subsequent application of cutting energy at first electrode 140 can be tailored for the specific type of tissue identified, thereby lowering power consumption and reducing the opportunity for arcing to occur between electrodes or to tissue.

[0043] Furthermore, heater 146 can be activated to increase the temperature of first electrode 140 to allow for thermionic disassociation of electrons, ions, or both so that electrons, ions, or both in a field are accelerated, thereby reducing the voltage output needed to get the same disassociation of the electrons, ions, or both than with the application of voltage at a lower temperature. Additionally, first electrode 140 can itself be directly resistively heated without heater 146. Heating of first electrode 140 can be used to perform restive heating cutting of tissue in addition to or alternatively to RF monopolar or bipolar cutting. Feedback from sensor 128 can facilitate a determination of a ratio of resistance heating cutting and RF monopolar or bipolar cutting to apply to the tissue. By constructing the monopolar cut element (e.g., first electrode 140) from a material that is typically considered to be electrically resistive such as nichrome, the voltage required to perform a monopolar cut (once the resistive element is energized to increase its temperature) is decreased, as not only is the voltage of such a material reduced compared to a standard11Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01unheated cut element, the heating itself also assists in the cutting process. These two states of cutting result in an improved incidence of ‘complete cutting’ where the cut achieved is along the entire length of the cut electrode and no ‘whisps’ of tissue are left connected.

[0044] FIG. 3A is a perspective view of jaw assembly 110 comprising first jaw member 112 and second jaw member 114. Jaw assembly 110 can be connected to shaft 118. First jaw member 112 and second jaw member 114 can be connected at pivot point 116.

[0045] First jaw member 112 can comprise elongate body 200 comprising first plate 202A and second plate 202B. First insulator 204 can be positioned between first plate 202A and second plate 202B. Second jaw member 114 can comprise elongate body 210 comprising first plate 212A and second plate 212B. Second insulator 214 can be positioned between first plate 212A and second plate 212B. First electrode 216 can be positioned on second insulator 214. In examples, first electrode 216 can comprise first electrode 140 of FIG. 2, elongate body 210 can comprise second electrode 142 of FIG. 2, and elongate body 200 can comprise third electrode 144 of FIG. 2.

[0046] First insulator 204 and second insulator 214 can be fabricated from an insulating material and can function to restrict or prevent accidental arcing and / or heat transfer between the electrodes. First plate 202A, second plate 202B, first plate 212A and second plate 212B can each include a functional feature. For example, the functional feature can comprise teeth, such as serrations. Furthermore, as shown in FIG. 5A, one or more of first plate 202A, second plate 202B, first plate 212A and second plate 212B can include one or more standoffs or stops, such as standoff 222A and standoff 222B, to prevent direct contact between first jaw member 112 and second jaw member 114.

[0047] One or both of first jaw member 112 and second jaw member 114 can be rotatable relative to shaft 118. One or none of first jaw member 112 and second jaw member 114 can be stationary relative to shaft 118. Thus, one or both of first jaw member 112 and second jaw member 114 can be moveable, independently or cooperatively, such as via operation of lever 122 (FIG. 1). Medical device 102 of FIG. 3 A can perform in one or more of the modes described herein. That is, first electrode 140, second electrode 142 and third electrode 144 can be used in one or more modes to seal, cut, cautery, ablate, and / or coagulate tissue in various modes of application of energy, including RF AC energy and resistive DC energy. For example, therapeutic power, e.g., monopolar cutting power, can be communicated to first electrode 140, to or through tissue, and back to therapy power supply 132 via pad 148 (FIG.12Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W012), via one or both of second electrode 142 and third electrode 144, or a combination thereof. Likewise, first electrode 140 can be optionally heated. That is, by supplying heating power from heating power supply 130 to heater 146, first electrode 140 can be resistively heated. In other arrangements, therapeutic power, such as bipolar sealing power, can be supplied between second electrode 142 and third electrode 144 and back to therapy power supply 132. In additional examples, bipolar cutting power can be applied between first electrode 140 and third electrode 144 (or, alternatively, between first electrode 140 and second electrode 142 or between both second electrode 142 and third electrode 144).

[0048] As explained in detail with reference to FIG. 5 A, second insulator 214 can be configured as or incorporate a heating element, e.g., heater 146 (FIG. 2), to allow first electrode 216 to be elevated in temperature. Alternatively, first electrode 140 can be directly heated by the application of current in a resistive heating mode.

[0049] FIG. 3B is a side view of the jaw assembly 110 of FIG. 3 A with target object 220 positioned between first jaw member 112 and second jaw member 114. First jaw member 112 and second jaw member 114 of jaw assembly 110 can be movable between a first position in which first jaw member 112 and second jaw member 114 are spaced apart from each other, such as to allow for placement of target object 220 therebetween, and a second position in which first jaw member 112 and second jaw member 114 are positioned closer to each other than in the first position, such as to grasp target object 220. As depicted in FIG.3B, end effector assembly 108 can grasp target object 220, which can comprise a blood vessel or other target object of the anatomy of a living organism, an anatomical feature, tissue, veins, arteries, or a combination thereof of a human or animal subject. In an example, end effector assembly 108 can be used in electrosurgical system 100 such as to compress one or more of lymphatics, tissue pedicles, arteries, and veins, such as with diameter DI or similar cross-sectional dimension ranging from about 0.5 mm to about 7 mm, or larger.Herein, a diameter of a vessel can refer to either of a measured diameter or an average diameter along a length of interest of a vessel of interest. With the present disclosure, as explained in greater detail below, end effector assembly 108 can be used in electrosurgical system 100 to form seals along the axis of target object 220 (extending into the plane of FIG.3B) that are sufficiently strong to seal against blood pressure within target object that is present within vessels having diameter DI greater than 7 mm.13Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0050] First jaw member 112 can include sensor 128 and second jaw member 114 can include sensor 128. Each instance of sensor 128 can be positioned on first jaw member 112 and second jaw member 114 to contact target object 220 to obtain readings therebetween. As discussed herein, one or more of sensor 128 can be obtained to identify the type of tissue comprised by target object 220 in order for processing unit 104 to generate tailored sealing and or cutting therapy for the identified tissue.

[0051] FIG. 4 is a schematic illustration of shaft 118 of FIG. 1 including articulating section 127 configured to allow angulation of jaw assembly 110 relative to axis AA (i.e., the central axis of the shaft 118). Jaw assembly 110 can be rotated or bent away from axis AA to form angle a relative to axis AA. Curvature of shaft 118 can be achieved by actuation of a control feature on handpiece 106, such as trigger 123. Further actuation or depression of trigger 123 can result in further bending of shaft 118 and further movement of jaw assembly 110 away from axis AA. Rotation of jaw assembly 110 about axis AA can be achieved by rotation of knob 125 (FIG. 1), which is transmitted through articulating section 127. A clockwise / counterclockwise rotation of knob 125 can result in a corresponding clockwise / counterclockwise rotation of jaw assembly 110. Thus, the plane in which the deflection occurs corresponds to the plane of rotation of articulating section 127. In examples, jaw assembly 110 can be rotated three-hundred-sixty-degrees about axis AA so as to provide bending in any radial direction. The portion of shaft 118 proximal of articulating section 127 can be rigid.

[0052] Articulating section 127 can comprise a flexible portion of shaft 118 that is more bendable than other sections of shaft 118 so as to be deflectable when subject to an articulation force, but that can hold its position when the articulation force is removed.Bending of articulating section 127 can be achieved by actuation of pull wires within shaft 118, as is known in the art. In examples, articulating section 127 can be fabricated from a gooseneck tube, such as those fabricated from a round coil spring interlaced with a wedge-shaped coil.

[0053] In order to accommodate articulating section 127, other components within shaft 118 can also be flexible. Thus, it can be difficult to incorporate non-bendable or rigid members within shaft 118, particularly those that are in close proximity to end effector assembly 108, such as rigid cutting blades used in the prior art. With the present disclosure, because jaw assembly can utilize electrosurgical energy to perform cutting, a rigid cutting14Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01blade can be omitted, and articulating section 127 can be brought close to jaw assembly so that distance D2 is small. When a rigid cutting blade is used, the cutting blade is typically as long as or nearly as long the jaw members of jaw assembly 110, e.g., D3. Thus, in order to use a rigid cutting member distance D2 is typically approximately equal or nearly equal to distance D3. However, with the present disclosure, distance D2 can be shorter than distance D3 because the rigid cutting blade is omitted and replaced by electrosurgical cutting. Thus, articulating section 127 can be brought into close proximity to jaw assembly 110 to allow for tight bending or turning of jaw assembly 110.

[0054] In examples, medical device 102 can be configured to devices described in Pat. No. US 9,271,797 B2 to Adler et al., titled “Robotic Surgery,” the entire contents of which are hereby incorporated herein in their entirety by this reference.

[0055] FIG. 5A is a schematic cross-sectional view of jaw assembly 110 of FIG. 3 A showing first electrode 140, which can comprise a monopolar electrode, and second electrode 142 and third electrode 144, which can comprise a bipolar electrode.

[0056] First electrode 140 can comprise an elongate wire-like body have a circular cross-sectional profile. First electrode 140 can be fabricated from a conductive material. In examples, first electrode 140 can be fabricated from steel, such as stainless steel. In examples, first electrode 140 can be fabricated from a conductive material that is also capable of heating up or releasing thermal energy when subject to electrical current, e.g., is capable of resistive heating. In examples, first electrode 140 can be fabricated from Nichrome (NiCr, ni ckel -chromium) .

[0057] Second insulator 214 can be fabricated of any suitable material capable of preventing or inhibiting electrical flow.

[0058] Second electrode 142 can be comprised of first plate 202A and first plate 212A. Third electrode 144 can be comprised of second plate 202B and second plate 212B.

[0059] Second electrode 142 can include standoff 222 A and third electrode 144 can include standoff 222B. Standoff 222 A and standoff 222B can be used to prevent arcing between first plate 202A and first plate 212A and second plate 202B and second plate 212B, respectively, by preventing contact therebetween. Arcing can divert energy between the plates rather than through tissue positioned therebetween. Standoff 222A and standoff 222B can comprise small pads or stops of insulating material that can be placed at intervals along the length of second plate 202B and second plate 212B. In examples, standoff 222 A and15Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01standoff 222B can be configured similarly to the stops described in in Pub. No. US 2021 / 0307859 Al to Nelson et al., titled “Sealer Divider,” the entire contents of which are hereby incorporated herein in their entirety by this reference.

[0060] First insulator 204 can be fabricated of any suitable material capable of preventing or inhibiting electrical flow. In examples, first insulator 204 can comprise an anvil against which first electrode 140 can press against when first jaw member 112 and second jaw member 114 are pushed toward each other. In examples, first insulator 204 can be deformable or resilient so that first electrode 140 can be pushed into first insulator 204. However, in examples, first insulator 204 can be rigid.

[0061] First electrode 140 can be positioned midway between first plate 212A and second plate 212B. First electrode 140 can extend away from elongate body 210 a greater amount than first plate 212A and second plate 212B.

[0062] As the resistive element, either heater 146 (FIG. 2) or first electrode 140 itself, is heated through current flow in the cutting material, such as nichrome, the ease at which energy passes from the metallic element into the tissue increases with the temperature increase. This makes the hotter electrode more efficient at passing RF energy than a cold electrode alone. This increased efficiency may be due to the electrons being freer to move in the RF circuit at increased temperatures, than at lower temperatures. Free movement of electrons is especially true when the resistive material reaches a light emission (glowing) state.

[0063] As shown in FIG. 5B, the tip of first electrode 140 can be positioned distance D4 from first plate 212A. By symmetry, the tip of first electrode 140 can also be positioned distance D4 away from second plate 212B. Second plate 212B can have thickness Tl. First plate 212A can be configured similarly as second plate 212B so as to also have thickness Tl. Second jaw member 114 can have width Wl. In examples, target object 220 can have diameter D5.

[0064] As discussed above, the effectiveness of sealing target object 220 when target object 220 comprises a blood vessel can depend on diameter D5 of target object 220. As diameter D5 of target object 220 increases, the pressure of blood within a blood vessel increases so that a stronger seal is more beneficial is stopping the blood flow. As such, it can be advantageous to have width Wl of first plate 212A and second plate 212B be wide to allow for the sealing of larger blood vessels. However, it can be advantageous to have the16Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01overall size of jaw assembly 110 be small so that jaw assembly 110 can be inserted into anatomy in a minimally invasive manner. More particularly, it can be desirable to have the overall size of jaw assembly 110 be small to fit within other medical instruments, such as a laparoscope, an endoscope and the like or to be used in a robotic surgical system. As such, it can be desirable to have width W1 be small. Furthermore, it can be desirable to have distance D4 large in order to prevent arcing of current between first electrode 140 and one or both of first plate 212A and second plate 212B.

[0065] Thus, there is a conflict in increasing the thickness of first plate 212A and second plate 212B because if the thickness is increased toward the outside of the device so that W1 increases, jaw assembly 110 will have a larger footprint and if the thickness is increased toward first electrode 140 there is a potential for increased arcing as D4 decreases. The present disclosure can provide a solution to this problem by designing first electrode 140 to provide effective cutting energy at lower voltages, thereby allowing the thickness T1 of first plate 212A and second plate 212B to be increased in the direction of first electrode 140 without increasing the risk of arcing.

[0066] With the present disclosure, one or more of the electrodes can include a heater. In the disclosed embodiment, first electrode 140 can be heated, but second electrode 142 and third electrode 144 can additionally or alternatively be heated. The heater can be any feature, material, or device that can heat the one or more electrodes. The heater can be provided with electrical power, heating power, therapeutic power, one or more signals, or a combination thereof from any source to resistively heat the one or more electrodes. In the disclosed embodiment, heat, or the power to generate the heat, can be provided by heating power supply 130, but can also be supplied by therapy power supply 132. Preferably, the heater can receive heating power from the one or more generators to heat the one or more electrodes with the heater. The heater can receive heating power from the heating power source. The heater can be, for example, a resistor, a wire, a ferromagnetic material, the like, or a combination thereof. The heating power can be constantly supplied to the heater, or the heating power can be selectively supplied to the heater to heat the one or more electrodes. The heating power can be supplied to the heater at any time. In other words, the heating power can be supplied to the heater before therapeutic power is supplied to the electrode, while therapeutic power is being supplied to the electrode, or after therapeutic power has been supplied to the electrode. The heating power can be supplied to the heater to heat the17Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01one or more electrodes before or while performing a device function. The heating power can be supplied to the heater via a constant signal, or the heating power can be pulsed, oscillated, or both. The heating power can be supplied to the heater on an “as-needed” basis to maintain the one or more heaters / electrodes at a predetermined and desired temperature; to elevate the one or more heaters / electrodes to a predetermined temperature; to allow the temperature of the one or more electrodes to drop, or a combination thereof, for example. The heating power can be controlled via the hand piece (e.g., second button 126 of handpiece 106), one or more controls on the hand piece, one or more controls at a remote location (e.g., a foot pedal, a remote computer, processing unit 104, etc.), or a combination thereof. The heater can function to provide thermal cutting, as discussed herein.

[0067] A resistively heated electrode can allow for thermionic disassociation of the electrons, ions, or both. That is, by resistively heating the one or more of the electrodes, electrons, ions, or both in an electrical field can be accelerated. Thermionic disassociation can be advantageous because less voltage may be required to get the same disassociation of the electrons, ions, or both than with only voltage. In other words, a greater total energy is possible with lower voltage. Moreover, in a bipolar mode, a heated electrode is more likely to activate as an intended source of therapeutic current (i.e., the active electrode) providing the surgeon with greater control of the location of the intended tissue effect. The one or more electrodes with a heater can be heated even if the one or more electrodes with a heater are not specifically configured or arranged to perform a device function. For example, if one or more other electrode combinations are used to perform a device function (e.g., second electrode 142 and third electrode 144), the one or more electrodes with a heater (e.g., first electrode 140) can nonetheless still be heated. Alternatively, the one or more electrodes with a heater can be restricted from being heated in an arrangement or configuration where they are not used to perform a device function. Again, this can be controlled via the hand piece, one or more controls on the hand piece, one or more controls at a remote location (e.g., a foot pedal, a remote computer), or a combination thereof.

[0068] The heating of one or more electrodes, e.g., first electrode 140, can also allow for different cycles of energy application to achieve cutting in different tissue types. Some tissue types might cut easier with just resistive heating and very small amounts of RF application, while other tissues cut easier with lower resistive heating and higher amounts of RF application. This tuning can be performed automatically based upon feedback from the18Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01sealing cycle (such as resistance, temperature, total energy applied, energy applied to achieve a specific state (e.g., to create a predetermined delta in the impedance), resistance or impedance rate change against time or delivered energy, current delivered, voltage delivered, total voltage delivered, total current delivered, the energy types previously mentioned delivered in a specific ‘pulse’ of a series of pulses that together create the total seal cycle (e.g., the last pulse, first pulse, the middle pulse, or a specific numbered pulse such as the second or third) or by the user setting the most appropriate setting according to their desired preference. The tuning could also be set to cope with tissue types most commonly encountered in the procedure type that the device is intended to be used in. For example, the device could be tuned for a specific tuned setting for adhesion dissection in Hysterectomy vs tissue dissection in a Nissen fundoplication, where the encountered tissue structures are significantly different. For example, tissues encountered during the Nissen Fundoplication procedure tend to be thicker vascular tissues. Whereas many of the tissues encountered during hysterectomy, tend to be filmy, often sticky support ‘ligaments’ that have lower vascularity, higher hormone levels (especially around the ovaries) and suspend the ovaries and the uterus in the pelvis. Thus, each tissue structure can benefit from different electrosurgical energies. For example, thicker vascular structures can benefit from higher voltages for sealing as compared to hysterectomy tissues. In examples, the tuning of the different cycles of energy application can be determined and applied using a machine learning model or artificial intelligence engine, as described with reference to FIG. 7.

[0069] Electrosurgically sealing or coagulating biological tissue engaged by an electrosurgical instrument is an electrosurgical technique used in various medical procedures. In such techniques, the engaged biological tissue can be electrosurgically sealed by heating the engaged biological tissue in a controlled manner. In some medical procedures, the biological tissue that is being sealed is a vessel. Without wishing to be bound by theory, it is believed that heating of the vessel causes the collagen found in the vessel walls to become denatured. This denatured collagen forms a gel-like substance acting as glue between the vessel walls. When forced together and maintained together while cooling, opposite walls of a vessel will then form a seal.

[0070] Heating of the vessel is carefully controlled so that neither too little nor too much energy is provided to the vessel. If too much energy is provided thereto, then charring and / or burning of the vessel wall can occur. If too little energy is provided thereto, then seal quality19Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01of the vessel can be poor. One measure of seal quality is a pressure difference that the sealed vessel can withstand without bursting. Low quality seals can be compromised when the pressure applied thereto exceeds some value. For example, if the seal width is inadequate along a vessel, blood pressure within the vessel can burst the seal.

[0071] The rate at which the energy is provided to the vessel can also be carefully controlled so as to facilitate rapid performance of the electrosurgical procedure. Rapid performance of electrosurgical procedures reduces the time and difficulty of these procedures. The rate of heating, however, should not be so rapid as to cause uncontrolled boiling of fluid within the biological tissue. Uncontrolled boiling can rupture engaged or nearby biological tissues and / or compromise the quality of the seal.

[0072] Heating of the engaged biological tissue can be controlled by controlling the electrical power of an electrotherapeutic signal provided to and dissipated by the engaged biological tissue. Such electrical power can be controlled according to a sealing schedule. For example, the sealing schedule can be indicative of a product of a voltage difference across an electrical current conducted by the engaged biological tissue. Thus, the sealing schedule can be an electrical-power schedule. In some examples, the electrotherapeutic signal can be reduced or terminated in response to a termination criterion being met. In some examples, the termination criterion is a current characteristic, such as, for example, a decrease in current conducted by the engaged biological tissue. In some examples, the termination criterion is a resistance characteristic, such as, for example, an increase in the electrical resistance of the engaged biological tissue. Such an increase in the electrical resistance in excess of a predetermined delta resistance value can be used as a termination criterion, for example, where the predetermined delta resistance value is the difference between the measured resistance (or impedance) and the lowest value of the resistance (or impedance) measured in the pulse. In some examples, the termination criterion is a temporal condition, such as, for example, a time duration, predetermined or calculated based on some condition.

[0073] The present disclosure includes, among other things, one or more techniques for providing electrotherapy, which can be provided according to a treatment or other plan. The plan can include a recipe, prescription, regimen, methodology, or the like. The plan can include one or more temporal aspects, such as a schedule, such as can include occurrence or recurrence (or inhibition or suppression) timing, frequency, type, relative combination (e.g.,20Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01coagulation relative to cutting), temperature or the like. The plan can include electrotherapy waveform information, such as can include pulse width, duty cycle, on duration, off duration, repetition rate, amplitude, phase, or the like. Different outputs can be used depending on the fluid content of the tissue, the collagen content of the tissue and the thickness of the tissue. Specifically, the greater the fluid amount, collagen amount or thickness, longer or greater amounts of energy can applications be applied. In examples, high fat tissue has high resistance and thus does not need as much energy to coagulate before cutting. The plan need not be static or a priori in nature, but can include one or more dynamic aspects, such as can be modified or governed, such as by diagnostic, operational, or other information obtained during or between electrotherapy delivery instances, including in a closed-loop, or other feedback manner or machine learning input. One or more aspects of the plan can be tailored, such as to the specific type of tissue, such as a vessel, biological tissue, vein, artery, or other anatomical feature or object. Such plans can be determined automatically, by the device, e.g., without requiring user input, or may involve user input, such as can be provided before, during, or after one or more portions of operations of the electrotherapy device according to the plan. The plan can involve communicating with or using another device, such as to receive or provide one or any combination of inputs, outputs, or instructions, operating parameters, or measured data. One or more aspects of the plan can be recorded or encoded onto a medium, such as a computer or other machine-readable medium, such as can be a tangible medium.

[0074] FIG. 6 is a block diagram illustrating method 300 including operation 302 through operation 318 in performing methods of operation of medical device 102 (FIG. 1) with processing unit 104. Though discussed with reference to FIG. 1 through FIG. 5B and a particular medical device, method 300 can encompass the use of any medical device having monopolar and bipolar energy cycles, and the addition of a heated electrode, consistent with the methods and systems described herein. Method 300 can additionally include fewer or greater operations other than operation 302 to operation 318. Additionally, in other examples, operation 302 through operation 318 can be performed in other sequences.

[0075] At operation 302, a medical instrument can be navigated to an anatomic structure, such as target object 220. In examples, operation 302 can comprise an optional step in methods of the present disclosure, as indicated by dashed lines. For example, other operations of method 300 can be performed away from an anatomic structure, such as on a21Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01test sample or the other structure. For example, medical device 102 can be guided to a vessel to perform a sealing and cutting operation. In particular, end effector assembly 108 can be positioned adjacent to target object 220. In examples, shaft 118 of medical device 102 can be inserted into a scope to reach the anatomic structure. The system can utilize imaging guidance to facilitate accurate and efficient locating, ensuring that the instrument is positioned for performing the desired operation. In examples, a robotic surgical system, such as the one described with reference to FIG. 8, can be used to place shaft 118 at the anatomic structure. In examples, shaft 118 can be articulated, such as by causing bending of articulating section 127 to reach the anatomic structure. This operation can facilitate end effector assembly 108 being correctly aligned with the target tissue, facilitating effective sealing and cutting while minimizing potential damage to surrounding tissues.

[0076] At operation 304, energy for sealing the anatomic structure with a bipolar electrode can be activated. In examples, the sealing energy can comprise radio frequency (RF) energy. Although other suitable sealing energy can be used such as resistive and alternating current (AC) energy. In examples, therapy power supply 132 can be used to deliver energy to second electrode 142 and third electrode 144. The activation of the sealing energy can be controlled to ensure that it is applied precisely to the target tissue, facilitating effective sealing without damaging surrounding tissue. The bipolar configuration allows the energy to pass through the tissue between the electrodes, minimizing the risk of unintended tissue damage. For example, RF energy can more effectively reach collagen and elastin fibers within tissue. This operation facilitates achieving a strong and reliable seal and preventing bleeding, thereby ensuring the success of the surgical procedure.

[0077] At operation 306, electrical parameters of the sealing energy activated at operation 304 can be sensed. In examples, processing unit 104 can use one or more of sensor 128 to sense an electrical parameter between second electrode 142 and third electrode 144. In examples, the electrical parameter can comprise resistance, temperature, total energy applied, energy applied, the rate of energy application over time, and the like. By obtaining or capturing these measurements, the system can evaluate the effectiveness of the sealing process (e.g., whether blood flow is likely to have been stopped) and gather data to configure energy delivery for more effective sealing. The sensed parameters can provide feedback, allowing for adjustments tailored to the specific tissue type, ensuring a precise and effective sealing operation. More specifically, the sensed parameters can be used to determine22Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01characteristics for the application of cutting energy cycles after the seal has been formed. This feedback loop can therefore facilitate the generation of cutting energy that can minimize the risk of arcing, enhancing safety, and ensuring the efficacy of the procedure.

[0078] At operation 308, the anatomic structure can be sealed with the sealing energy activated at operation 304. Operation 308 can comprise an optional step in methods of the present disclosure as, for example, other operations of method 300 can be performed without sealing of the anatomic structure being performed or completed. Applied electrical energy from second electrode 142 and third electrode 144 can cause the anatomic structure to seal. For example, the electrical energy can cause cauterization of the tissue of target object 220. The sealing process can involve the denaturation of proteins within the tissue, leading to the formation of a coagulum that closes the vessel or tissue structure. The precise application of energy ensures that the seal is strong and reliable, preventing bleeding and maintaining the integrity of the surgical site. This operation can help achieve hemostasis and reduce the risk of postoperative complications. The effectiveness of the seal is influenced by the energy parameters sensed in operation 306, allowing for real-time adjustments to optimize the sealing process for different tissue types.

[0079] At operation 310, the type of tissue of the anatomic structure can be determined. Operation 310 can comprise an optional step in methods of the present disclosure as, for example, other operations of method 300 can be performed without determining tissue type, such as those performed at operation 312 through operation 316B. Processing unit 104 can compare the electrical parameter sensed at operation 306 to a database or library of predetermined electrical values, such as resistance, temperature, and energy application rates, that have been previously correlated to different types of tissue and stored in memory of processing unit 104 or stored in servers connected to processing unit 104. By matching the sensed parameters with these stored values, processing unit can accurately identify the tissue type being sealed. This identification can be helpful in tailoring the subsequent application of cutting energy. Understanding the specific tissue characteristics can allow the system to automatically adjust the cutting energy to minimize the risk of arcing, thereby enhancing safety and ensuring the efficacy of the procedure. However, the system can provide an output of tissue type to a user so that a user can make appropriate modifications for particular tissue types. This feedback loop can enable the generation of cutting energy that is precisely calibrated to the tissue type, optimizing the overall surgical process. By doing so, the system23Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01not only improves the precision of the cutting operation but also reduces potential complications, ensuring a smoother and more effective surgical outcome. In examples, operation 310 can be fully or partially performed by a machine learning model or an artificial intelligence engine.

[0080] At operation 312, energy for cutting the anatomic structure with a monopolar electrode can be determined. This can involve analyzing the tissue type identified in operation 310 and using this information to calculate desirable cutting energy parameters or energy cycles. Processing unit 104 can consider factors such as tissue resistance, density, and composition to tailor the energy output specifically for the tissue being cut. This can help ensure that the cutting process is efficient and minimizes the risk of damage to surrounding tissues. The determination of cutting energy can also involve selecting the appropriate balance between resistive heating and radiofrequency (RF) energy. Resistive heating can be applied by the heating of first electrode 140 with electrical current and RF energy can be applied by pulsing of alternating current at high frequency through first electrode 140. By fine-tuning these parameters, the system can achieve precise cutting with reduced power consumption and minimized arcing potential. In examples, heating energy can be applied first followed by RF energy, or heating energy and RF energy can be applied simultaneously. Processing unit 104 can automatically determine the desired cutting energy for the identified tissue type, or the system can provide an output of tissue type to a user so that a user can make appropriate modifications for particular tissue types.

[0081] At operation 314 A, heating energy for the heating of monopolar electrode can be activated. This can involves supplying electrical power, such as direct current or alternating current, to the heater integrated with the first electrode 140, e.g., heater 146, which can raise its temperature to a predetermined level. However, in examples, first electrode 140 can be directly heated by the passage of current therethrough without the use of a separate heating device. The heating process is carefully controlled to ensure that the electrode reaches temperatures suitable for effective cutting. In examples, first electrode 140 can be heated to a glowing state. In examples, heating energy can be supplied by heating power supply 130.

[0082] At operation 314B, radiofrequency (RF) energy for the monopolar electrode can be activated. This can involve delivering alternating current at a high frequency to the first electrode 140, complementing the resistive heating applied in operation 314A. In examples, first electrode 140 can be used alone or with pad 148 to perform monopolar cutting or first24Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01electrode 140 can work in conjunction with another electrode, e.g., second electrode 142 and / or third electrode 144, to perform bipolar cutting. In additional examples, low frequency energy can be used. The RF energy can be calibrated to work in conjunction with the elevated temperature of the electrode, enhancing the cutting efficiency and precision. By elevating the temperature, first electrode 140 can achieve thermionic disassociation, which enhances the efficiency of energy transfer to the tissue, e.g., allows the RF energy to leave first electrode 140 at lower voltage and reducing the potential for arcing. The activation of RF energy allows for targeted energy delivery, focusing on the specific tissue type identified in previous operations. This targeted approach minimizes collateral damage to surrounding tissues and reduces the risk of arcing. By combining RF energy with resistive heating, the system can achieve a synergistic effect, optimizing the cutting process for different tissue types. In examples, heating energy can be supplied by therapy power supply 132.

[0083] The system can continuously monitor the energy application, making real-time adjustments to ensure that the cutting energy remains within an optimal or desirable range. This dynamic control can enhance the safety and efficacy of the procedure, ensuring that the cutting operation is performed smoothly and effectively. The system may also monitor the temperature in real-time, making adjustments as needed to maintain optimal cutting conditions. The integration of RF energy with resistive heating provides a comprehensive solution for precise tissue cutting, tailored to the unique characteristics of the surgical site. In examples, operation 314A and 314B can be performed alternatively, at the same time or in different, alternating sequences, at varying or different pulse widths to achieve desired cutting characteristics for particular tissue types.

[0084] At operation 316A, the anatomic structure can be cut with the thermal energy. This can involve applying the heat generated by the resistively heated monopolar electrode at operation 314A to the tissue. The thermal energy can cause the tissue to undergo a process of disintegration, separating the anatomic structure between the sealed locations of end effector assembly 108.

[0085] At operation 316B, the anatomic structure can be cut with the electrical energy. This can involve applying radiofrequency (RF) energy through the monopolar electrode to achieve precise tissue dissection. The RF energy is calibrated to complement the thermal effects, ensuring efficient and controlled cutting.25Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0086] At operation 318, the medical instrument can be withdrawn or relocated after completing the sealing and cutting operations. Operation 318 can comprise an optional step in methods of the present disclosure as, for example, other operations of method 300 can be performed away from an anatomic structure, such as on a test sample or the other structure. This operation can involve retracting medical device 102 from the surgical site to ensure that no additional trauma is caused to the surrounding tissues or damaging the integrity of the sealed and cut areas, preventing any disruption to the achieved hemostasis. If relocation is desirable, such as to the site of another anatomic structure or vessel to be sealed and cut, the instrument can repositioned to another target site within the anatomy. This can involve navigating through anatomical structures to reach a new area where treatment is to be applied. The system can utilize imaging guidance or robotic assistance to facilitate accurate and efficient relocation, ensuring that the instrument is positioned for subsequent procedures. After all desired surgical procedures or interventions are performed, medical device 102 can be withdrawn and any access portals in the patient can be appropriately closed.

[0087] FIG. 7 is a schematic illustration showing a diagram of an exemplary computer-based clinical decision support system (CDSS), e.g., CDSS 400, that is configured to provide an output indicative of the energy desirable to perform sealing and cutting operations with an electrosurgical device. CDSS 400 can include processing unit 104 (FIG. 1) and machine 600 (FIG. 9). The output can be provided to a user or to an electrosurgical device to perform a actively applied sealing or cutting operation of a cutting or sealing operation to be subsequently performed. The output can be automatically adjusted to perform electrosurgical operations. For example, CDSS 400 can determine the type of tissue upon which an electrosurgical sealing operation is being performed and then determine and adjust to an appropriate level of energy suitable for performing an electrosurgical cutting operation on that tissue type. More specifically, CDSS 400 can determine an appropriate thermal and / or electrical energy cycle to cut the identified tissue, which can vary from tissue type to tissue type. In examples, some tissues can cut easier with lower resistive heating and higher amounts of RF application, while other tissues can cut easier with higher resistive heating and lower amounts of RF application. The adjusted electrosurgical cutting output can be adjusted to minimize arcing potential between electrodes or to tissue. An exemplary system output can comprise generation of thermal and electrical signals to perform a cutting and / or sealing operation, and a graphical or textual output to a user, such as at user interface 105 (FIG. 1) to26Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01inform the user of energy being applied. The graphical or textual output can include an assessment of a tissue type, a level of RF cutting energy, a level of resistive cutting energy, a cutting energy cycle, a user prompt, a user confirmation and the like, as well as warnings perceivable by the user regarding any potential issues detected by the system. In examples, CDSS 400 can automatically apply cutting energy cycles to the identified tissue, or can suggest cutting energy cycles to a user, who can affirm or modify the suggested cutting energy cycle. An exemplary system output can comprise disabling an electrosurgical instrument if a tissue cannot be identified or if a sealing or cutting operation has not been fully performed, until another sealing or cutting operation, e.g., a proper sealing or cutting operation, has been performed. The output can comprise changing the state of any one or more of such as of first therapeutic power switch 152, second therapeutic power switch 156, electrode switch 176 and heating power switch 168 of FIG. 2.

[0088] The output can be based on input from sensor 128, for example. The artificial intelligence model can analyze electrical output of sensor 128 to identify a type of tissue being sealed. Output of sensor 128 can include magnitudes of electrical parameters, changes in electoral parameters and rates of change of electrical parameters. One or more instances of sensor 128. In examples, sensor 128 can comprise temperature sensor such that the input comprises a temperature of an electrode.

[0089] In various embodiments, CDSS 400 can include input interface 402 through which output of sensor 128 which are specific to a patient are provided as input features to an artificial intelligence (Al) model, e.g., Al model 404, processor 406 which performs an inference operation in which the output of sensor 128 are applied to the Al model to generate the feedback signals including operator warnings and system adjustments, and a user interface (UI) through which the feedback signals are communicated to a user, e.g., a clinician, such as display unit 610 (FIG. 9) and user interface 105 (FIG. 1).

[0090] In some embodiments, input interface 402 may be a direct data link between CDSS 400 and one or more medical devices, e.g., medical device 102 (FIG. 1) that generate at least some of the input features. For example, input interface 402 can transmit output of sensor 128 directly to CDSS 400 during a therapeutic and / or diagnostic medical procedure. Additionally, or alternatively, input interface 402 can be a classical user interface that facilitates interaction between a user and CDSS 400. For example, input interface 402 can facilitate a user interface through which the user can manually enter patient information27Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01(heigh, weight, age, etc.), tissue type (blood vessel, artery, carotid artery, renal artery, vein, etc.), procedure type (sealing, cutting, cauterizing, etc., or Hysterectomy vs tissue dissection in a Nissen fundoplication) or output of sensor 128 (e.g., rate of change of resistance, temperature). Additionally, or alternatively, input interface 402 can provide CDSS 400 with access to an electronic patient record 409 from which one or more input features may be extracted. In any of these cases, input interface 402 is configured to collect one or more of the following input features, as well as others, in association with a specific patient on or before a time at which CDSS 400 is used to assess if appropriate levels of sealing and cutting energy are being applied to particular types of tissue:

[0091] Procedure type;

[0092] Tissue type;

[0093] Electrosurgical / medical device type;

[0094] Baseline or threshold rates of change of resistance to achieve a proper seal for various combinations of procedure, tissue and electrosurgical device;

[0095] Selected activation energy;

[0096] Activation energy level;

[0097] Length of time of activation energy;

[0098] Resistance level achieved;

[0099] Change of resistance achieved;

[0100] Rate of change of resistance achieved;

[0101] Total energy applied;

[0102] Temperature of an electrode;

[0103] Temperature of tissue;

[0104] End effector status; and

[0105] Relative position of end effector jaws.

[0106] Based on one or more of the above input features, processor 406 can perform an inference operation using the Al model to generate one or more feedback signals discussed herein for generating instructions for a user or controlling a function of the medical device. For example, input interface 402 can deliver the output of sensor 128 into an input layer of the Al model which propagates these input features through the Al model to an output layer. The Al model can provide a computer system the ability to perform tasks, without explicitly being programmed, by making inferences based on patterns found in the analysis of data. Al28Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01model explores the study and construction of algorithms (e.g., machine-learning algorithms) that may learn from existing data and make predictions about new data. Such algorithms operate by building an Al model from example training data in order to make data-driven predictions or decisions expressed as outputs or assessments.

[0107] There are two common modes for machine learning (ML): supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples that correlate inputs to outputs or outcomes) to learn the relationships between the inputs and the outputs. The goal of supervised ML is to learn a function that, given some training data, best approximates the relationship between the training inputs and outputs so that the ML model can implement the same relationships when given inputs to generate the corresponding outputs.Unsupervised ML is the training of an ML algorithm using information that is neither classified nor labeled, and allowing the algorithm to act on that information without guidance. Unsupervised ML is useful in exploratory analysis because it can automatically identify structure in data.

[0108] Common tasks for supervised ML are classification problems and regression problems. Classification problems, also referred to as categorization problems, aim at classifying items into one of several category values (for example, is this object an apple or an orange?). Regression algorithms aim at quantifying some items (for example, by providing a score to the value of some input). Some examples of commonly used supervised-ML algorithms are Logistic Regression (LR), Naive-Bayes, Random Forest (RF), neural networks (NN), deep neural networks (DNN), matrix factorization, and Support Vector Machines (SVM).

[0109] Some common tasks for unsupervised ML include clustering, representation learning, and density estimation. Some examples of commonly used unsupervised-ML algorithms are K-means clustering, principal component analysis, and autoencoders.

[0110] Another type of ML is federated learning (also known as collaborative learning) that trains an algorithm across multiple decentralized devices holding local data, without exchanging the data. This approach stands in contrast to traditional centralized machinelearning techniques where all the local datasets are uploaded to one server, as well as to more classical decentralized approaches which often assume that local data samples are identically distributed. Federated learning enables multiple actors to build a common, robust machine29Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01learning model without sharing data, thus allowing to address critical issues such as data privacy, data security, data access rights and access to heterogeneous data.

[0111] The machine learning model can be an artificial neural network in some implementations. Artificial neural networks are artificial in the sense that they are computational entities, inspired by biological neural networks but modified for implementation by computing devices. Artificial neural networks are used to model complex relationships between inputs and outputs or to find patterns in data, where the dependency between the inputs and the outputs cannot be easily ascertained. A neural network typically includes an input layer, one or more intermediate (“hidden”) layers, and an output layer, with each layer including a number of nodes. The number of nodes can vary between layers. A neural network is considered “deep” when it includes two or more hidden layers. The nodes in each layer connect to some or all nodes in the subsequent layer and the weights of these connections are typically learnt from data during the training process, for example through backpropagation in which the network parameters are tuned to produce expected outputs given corresponding inputs in labeled training data. Thus, an artificial neural network is an adaptive version of electrosurgical system 100 that is configured to change its structure (e.g., the connection configuration and / or weights) based on information that flows through the network during training, and the weights of the hidden layers can be considered as an encoding of meaningful patterns in the data.

[0112] A fully connected neural network is one in which each node in the input layer is connected to each node in the subsequent layer (the first hidden layer), each node in that first hidden layer is connected in turn to each node in the subsequent hidden layer, and so on until each node in the final hidden layer is connected to each node in the output layer.

[0113] In an example, the machine learning model can include or use a Convolutional Neural Network (CNN). A CNN is a type of artificial neural network, and like the artificial neural network described above, a CNN is made up of nodes and has learnable weights. However, the layers of a CNN can have nodes arranged in three dimensions: width, height, and depth, corresponding to the 2^2 array of pixel values in each video frame (e.g., the width and height) and to the number of video frames in the sequence (e.g., the depth). The nodes of a layer may only be locally connected to a small region of the width and height layer before it, called a receptive field. The hidden layer weights can take the form of a convolutional filter applied to the receptive field. In some examples, the convolutional filters can be two-30Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01dimensional, and thus, convolutions with the same filter can be repeated for each frame (or convolved transformation of an image) in the input volume or for designated subset of the frames. In other examples, the convolutional filters can be three-dimensional and thus extend through the full depth of nodes of the input volume. The nodes in each convolutional layer of a CNN can share weights such that the convolutional filter of a given layer is replicated across the entire width and height of the input volume (e.g., across an entire frame), reducing the overall number of trainable weights and increasing applicability of the CNN to data sets outside of the training data. Values of a layer may be pooled to reduce the number of computations in a subsequent layer (e.g., values representing certain pixels may be passed forward while others are discarded), and further along the depth of the CNN pool masks may reintroduce any discarded values to return the number of data points to the previous size. A number of layers, optionally with some being fully connected, can be stacked to form the CNN architecture. The machine learning model can also be at least one of Support Vector Machine (SVM), K-Nearest Neighbors (KNN), Artificial Neural Network (ANN), or an ensemble model combining the SVM and ANN.

[0114] In some examples, the Al model may be trained continuously or periodically prior to performance of the inference operation by the processor 406. Then, during the inference operation, the patient specific input features provided to the Al model may be propagated from an input layer, through one or more hidden layers, and ultimately to an output layer that corresponds to the adjustments to the electrosurgical device and feedback and warnings produced to the user. For example, a rate of change in the increase of resistance sensed in an end effector during performance of a tissue sealing procedure on a specific patient can be compared to rates of change in the increase of resistance for particular types of tissue. The rate of change in resistance for the specific patient can identify a particular type of tissue upon which a sealing operation is being performed. The Al model can determine the type of tissue by selecting a tissue type having a rate of change in resistance that most closely matches the sensed rate of change of resistance. Thereafter, the Al model can consult lookup tables stored in memory for energy cycles appropriate for sealing the identified tissue while keeping the energy output levels low to avoid arcing. The aforementioned example uses rate of change of resistance to determine a tissue type; however, any of the other parameters listed herein can be used to identify tissue type. The Al model can generate output signals to apply the energy cycles. The Al model can evaluate the effectiveness of the prescribed energy31Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01cycle that has been applied by consulting lookup tables stored in memory having rates of change in resistance for other tissue sealing procedures known to have produced a proper seal. Thus, the Al model can learn new energy cycles to provide effective sealing and cutting operations that minimize energy expenditure.

[0115] During and / or subsequent to the inference operation, the visual, audible or tactile alarm may be communicated to the user via the user interface (UI) and / or automatically cause an apparatus connected to processor 406 to perform a desired action. For example, the output signal can comprise a signal to activate a visual, audible or tactile alarm for a user. The visual, audible or tactile alarm can provide a confidence level for the tissue sealing operation. The visual, audible or tactile alarm can provide information to the user, such as by specifically informing the user that an inadequate seal was likely to have been performed along with directions to re-execute the sealing procedure, e.g., in the same tissue location, or perform a secondary sealing procedure, e.g., on adjacent tissue. The output signal can modify operation of the electrosurgical device, such as by adjusting output of the sealing energy or by locking the electrosurgical device or a portion of the electrosurgical device, such as jaw assembly 110, until the user acknowledges the visual, audible or tactile alarm and / or instructions. The output signal can comprise instructions for activating any one or more of first therapeutic power switch 152, second therapeutic power switch 156, electrode switch 176 and heating power switch 168 of FIG. 2.

[0116] FIG. 8 is a schematic view of robotic surgical system 500 having articulating arm 502 including end effector 512 of the present disclosure comprising a monopolar electrode and a bipolar electrode with a heating element.

[0117] Articulating arm 502 can comprise a multi-joint structure driven by a plurality of wires, and a wire tension sensor provided to the wires that drive a manipulator unit and a gripping unit, the wire tension sensor detecting gripping force, the robot system executing gripping control processing based on an obtained wire tension value (the gripping force).

[0118] Robotic surgical system 500 can comprise controller 504, input unit 506 and treatment instrument drive unit 508. Articulating arm 502 can be a subordinate multi-joint electric treatment instrument that follows an operation of input unit 506, which can comprise an instruction input device. End effector 512 can have a function of a bipolar and monopolar high-frequency treatment instrument with a heating element as described herein.32Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0119] Controller 504 can comprise input unit 506 which is configured to instruct a position, a posture, and gripping of robotic treatment instrument embodied by articulating arm 502, controller 504 that controls articulating arm 502, and tension sensor signal processor 509 which is configured to detect a gripping state.

[0120] Input unit 506 can include operating portion 506a in which a plurality of joint members and rod members are alternately coupled with each other and a controller that converts movement of operating portion 506a into electrical signals and then outputs the converted signal as an operation signal. Moreover, operating portion 506a can include a switch that is configured to instruct operations for effecting an opening / closing operation of end effector 512 to grip tissue and release the tissue.

[0121] Controller 504 can comprise operation setting unit 531 that is configured to set various kinds of settings for articulating arm 502; CPU 532 that executes processing for each later-described sensor signal and various kinds of arithmetic operations, and outputs a control signal to each constituent unit in the system; memory 533 that stores programs for driving, obtained arithmetic operation results, and communication data; motor driver 536 that drives and controls motor 525 in motor drive unit 521 based on the control signal; motor driver communication unit 537 that is configured to communicate with motor drive unit 521; and tension sensor communication unit 538 that is configured to communicate with tension sensor signal processor 509.

[0122] Operation setting unit 531 includes operation switch 535a, operation switch 535b, operation switch 535c, operation switch 535d and operation switch 535e that are configured to set various kinds of settings and a display panel 534 that displays contents of an operation instructed by a user.

[0123] Articulating arm 502 includes end effector 512 having the multi-joint structure driven by the wires. End effector 512 can be provided at an end of manipulator unit 511 to grip tissue (a vessel or anatomic structure described herein), and sheath portion 515 which is inserted into an endoscope channel and can move forward and backward. It is to be noted that articulating arm 502 is not necessarily restricted to a usage pattern that it is inserted into the endoscope to be used, and it can be utilized separately from the endoscope. Also, end effector 512 can be an electrosurgical instrument having a configuration that two gripping members which are formed of a conductor or have opposed electrodes provided thereto, the33Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01treatment instrument opening / closing to grip living tissue and performing high-frequency treatment.

[0124] Manipulator unit 511 can be provided at a distal end of sheath portion 515 and is formed of at least two rod portions 514 and at least one joint portion 513 that couples rod portions 514 with each other, resulting in manipulator unit 511 having at least one degree of freedom. For example, manipulator unit 511 can have one degree of freedom in a vertical direction. In examples, manipulator unit 511 can be configured in such a manner the plurality of rod portions 514 and the plurality of joint portions 513 are alternately coupled to provide different rotation surfaces of joints, so as to have six degrees of freedom in X, Y, and Z directions, a rotating direction, a yawing direction, and a pitch direction, resulting in that manipulator unit 511 can freely bend to lift up and move end effector 512. Each of the two gripping members (jaws) of end effector 512 and the respective joint portions 513 can be connected with wires 517 inserted in manipulator unit 511, sheath portion 515, and external connecting portion 516. When these wires 517 are pulled and paid out from the external connecting portion 516, the gripping members can be opened / closed, and the respective joint portions 513 can be bent and stretched at desired angles. This opening / closing operation and the bending / stretching operation are carried out by treatment instrument drive unit 508.

[0125] For example, if each rod portion 514 has a cylindrical shape, a connecting configuration of rod portions 514 and wires 517 in this embodiment is achieved by coupling each rod portion 514 with the joint points 513 at two cylinder opening ends in the horizontal direction to allow the bending operation, disposing an end of each wire 517 to each of two cylinder opening ends in the vertical direction orthogonal to the horizontal direction, and coupling the other end of the same with a manipulator (e.g., a pulley pivotally supported by a motor). When bending rod portion 514 with respect to joint portion 513, one of wires 517 is pulled and the other of wires 517 is paid out, resulting in that rod portion 514 bends upward (or downwards) around a coupling portion between rod portion 514 and joint portion 513. Of course, this embodiment is not restricted to such a multi -joint structure, and a generally known multi -joint structure can be applied to this embodiment.

[0126] Treatment instrument drive unit 508 can include motor drive unit 521 with a plurality of motors which are individually controlled. Motor drive unit 521 can include a plurality of pulleys 524 coupled with wires 517, plurality of motors 525 which axially support the respective pulleys 524, wire tension sensors 523 which measure tensile force of34Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01respective wires 517, and a motor driver communication unit 526 which communicates with controller 504.

[0127] In this embodiment, one pulley 524 is coupled with a set of wires 517 connected with the two movable gripping members of end effector 512 or respective joint portion 513 through a wire coupling portion 522. Furthermore, although the description has been given on the example where a combination of the motor and the pulley is a manipulator that drives wires 517, a combination of a servomotor and a bar-like coupling tool may also be adopted. In this case, two wires are coupled with both ends of the bar-like coupling tool and fixing a central portion of this tool to the servomotor. Moreover, electric hydrodynamic drive based on a combination of a hydraulic piston, an electric pump, and a valve can also be considered. In this case, wires are respectively coupled with the two hydraulic pistons, and the valve is opened / closed to pull / pay out the wires.

[0128] Motor drive unit 521 can further include a motor that rotates articulating arm 502 on a longitudinal axis, a motor that moves articulating arm 502 forward and backward 502 relative to sheath portion 515, and an encoder that measures a rotating angle of each motor. It is to be noted that wire tension sensor 523 can be arranged in wire coupling portion 522. As the wire tension sensor 523, a strain gauge that can detect a slight change in length of each wire 517 in a longitudinal axis direction can be used. A wire tension value measured by wire tension sensor 523 is output to tension sensor signal processor 509 through cable 541 and further supplied to the robotic treatment instrument controller 504 through cable 544.

[0129] As described herein, it can be advantageous for end effector 512 to be small to fit within an endoscope. Additionally, it can be desirable for one of joint portions 513 to be located close to end effector 512 to allow movement inputs entered at input unit 506 to be accurately translated to end effector 512 and to allow end effector 512 to be positioned close to target anatomy that may be located in hard-to-reach places within the anatomy. With the present disclosure, end effector 512 can include bipolar and monopolar sealing and cutting electrodes and a heating element that can allow for sealing and cutting operations to be performed in a small package with reduced risk of arcing and with articulation close to the jaws of end effector 512, as described herein. Thus, end effector 512 need not include a rigid cutting blade that can reduce the articulation capabilities of end effector 512.

[0130] FIG. 9 illustrates generally a block diagram of an example machine 600 upon which any one or more of the techniques (e.g., methodologies or operations) discussed herein35Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01can be performed, such as methods for determining and applying sealing and cutting energy in various cycles. Portions of this description can apply to the computing framework of various portions of the electrosurgical systems and devices and clinical decision support systems (e.g., machine learning video analysis systems) in accordance with examples as discussed in this document.

[0131] Processing unit 104 can comprise an example of machine 600. Likewise, CDSS 400 can be incorporated into machine 600. In examples, processing unit 104 can operate as a standalone device or can be connected (e.g., networked) to other machines. In a networked deployment, processing unit 104 can operate in the capacity of a server machine, a client machine, or both in server-client network environments. In an example, processing unit 104 can act as a peer machine in peer-to-peer (P2P) (or other distributed) network environment. Processing unit 104 can be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations.

[0132] Examples, as described herein, can include, or can operate by, logic or a number of components, or mechanisms. Circuit sets are a collection of circuits implemented in tangible entities that include hardware (e.g., simple circuits, gates, logic, etc.). Circuit set membership can be flexible over time and underlying hardware variability. Circuit sets include members that can, alone or in combination, perform specified operations when operating. In an example, hardware of the circuit set can be immutably designed to carry out a specific operation (e.g., hardwired). In an example, the hardware of the circuit set can include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) including a non-transitory computer readable medium physically modified (e.g., magnetically, electrically, movable placement of invariant massed particles, etc.) to encode instructions of the specific operation. In connecting the physical components, the underlying electrical properties of a hardware constituent are changed, for example, from an insulator to a conductor or vice versa. The instructions enable embedded hardware (e.g., the execution36Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01units or a loading mechanism) to create members of the circuit set in hardware via the variable connections to carry out portions of the specific operation when in operation.Accordingly, the computer readable medium is communicatively coupled to the other components of the circuit set member when the device is operating. In an example, any of the physical components can be used in more than one member of more than one circuit set. For example, under operation, execution units can be used in a first circuit of a first circuit set at one point in time and reused by a second circuit in the first circuit set, or by a third circuit in a second circuit set at a different time.

[0133] Processing unit 104 (e.g., a computer system, machine 600) can include, or be connected to, CPU 602 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), main memory 604 and static memory 606, some or all of which can communicate with each other via interlink 608 (e.g., bus). Processing unit 104 can further include display unit 610 (e.g., a raster display, vector display, holographic display, user interface 105 (FIG. 1), etc.), alphanumeric input device 612 (e.g., a keyboard), and user interface (UI) navigation device 614 (e.g., a mouse). In an example, display unit 610, alphanumeric input device 612 and navigation device 614 can be a touch screen display. Processing unit 104 can additionally include storage device 616 (e.g., a drive unit), signal generation device 618 (e.g., a speaker), network interface device 620, and one or more sensors 621, such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensors. Processing unit 104 can include output controller 628, such as a serial (e.g., universal serial bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.). Processing unit 104 can additionally be connected to sensor 128 of medical device 102 (FIG. 1).

[0134] Storage device 616 can include machine-readable medium 622 on which is stored one or more sets of data structures or instructions 624 (e.g., software) embodying or utilized by any one or more of the techniques or functions described herein, such as the operations described with reference to FIG. 6. Instructions 624 can also reside, completely or at least partially, within main memory 604 and / or within static memory 606 during execution thereof by processing unit 104. In an example, one or any combination of main memory 604, static memory 606, or the storage device 616 can constitute machine readable media.37Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0135] While machine-readable medium 622 is illustrated as a single medium, the term “machine readable medium” can include a single medium or multiple media (e.g., a centralized or distributed database, and / or associated caches and servers) configured to store one or more or instructions 624. As discussed herein, instructions 624 can include baseline or threshold electrical parameter (e.g., resistance, impedance, phase angle, temperature, energy delivered), changes in the electrical parameters that indicate a type of tissue and types of treatment parameters, e.g., cycling of RF and / or thermal energy, to perform sealing and / or cutting of each tissue type. Instructions 624 can include such information for different types and combinations of medical devices, activation or treatment energies, e.g., RF or thermal, tissue types and the like. Instructions 624 can comprise instructions related to comparing obtained signals from sensors 128 to the stored baseline or threshold values to determine a tissue type and appropriate energy levels and cycle patterns. Instructions 624 can comprise instructions for comparing output of sensor 128 along a common timeline. Instructions 624 can comprise instructions for activating first electrode 140, second electrode 142, third electrode 144 and heater 146 and controlling or preventing the operation of medical device 102 (FIG. 1). Instructions 624 can include instructions for operation first therapeutic power switch 152, second therapeutic power switch 156, electrode switch 176 and heating power switch 168 of FIG. 2, as well as other components of medical device 102.

[0136] The term “machine readable medium” can include any medium that is capable of storing, encoding, or carrying instructions for execution by processing unit 104 and that cause processing unit 104 to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. Non-limiting machine-readable medium examples can include solid-state memories, and optical and magnetic media. In an example, a massed machine-readable medium comprises a machine readable medium with a plurality of particles having invariant (e.g., rest) mass. Accordingly, massed machine-readable media are not transitory propagating signals. Specific examples of massed machine-readable media can include: nonvolatile memory, such as semiconductor memory devices (e.g., Electrically Programmable Read-Only Memory (EPROM), Electrically Erasable Programmable Read-Only Memory (EPSOM)) and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.38Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0137] Instructions 624 can further be transmitted or received over communication network 626 using a transmission medium via network interface device 620 utilizing any one of a number of transfer protocols (e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks can include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), mobile telephone networks (e.g., cellular networks), Plain Old Telephone (POTS) networks, and wireless data networks (e.g., Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards known as WiFi®, IEEE 802.16 family of standards known as WiMax®), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, among others. In an example, network interface device 620 can include one or more physical jacks (e.g., Ethernet, coaxial, or phone jacks) or one or more antennas to connect to communication network 626. In an example, network interface device 620 can include a plurality of antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) techniques. The term “transmission medium” shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by processing unit 104, and includes digital or analog communications signals or other intangible medium to facilitate communication of such software.

[0138] The present disclosure provides electrosurgical devices and methods for tissue sealing and cutting with reduced risk of arcing and improved energy efficiency. Combined monopolar and bipolar functionality in a single device can allow for both sealing and cutting operations. Resistively heated monopolar electrodes of the present disclosure can allow for thermionic disassociation of electrons and ions, enabling more efficient energy transfer and reducing the voltage required for cutting. Lower voltage output for monopolar cutting operations, or bipolar cutting operations, can be used while achieving the same cutting effects as higher voltage devices that do not use heating, thereby reducing the risk of arcing and improving safety. Integration of RF and thermal cutting capabilities can provide surgeons with multiple cutting modalities in a single instrument. Live, instantaneous feedback can be obtained from the sealing process to determine energy delivery waveforms for RF and thermal cutting. The cutting energy can be tailored based on tissue type identified during the sealing process, thereby optimizing cutting effectiveness while minimizing energy39Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01consumption and risk of arcing. The devices of the present disclosure can have reduced creepage and clearance distances between monopolar and bipolar electrodes, thereby allowing for more compact designs that can still seal larger vessels. The devices of the present disclosure can be compatible with articulating shafts, enabling use in robotic surgical systems and hard-to-reach anatomical locations.

[0139] These advancements result in more versatile, efficient, and safer electrosurgical devices that can improve surgical outcomes and expand the range of procedures that can be performed using minimally invasive techniques.Examples

[0140] Example l is a method of operating an electrosurgical device comprising a first electrode and a second electrode, the method comprising: activating sealing energy for sealing an anatomic structure with the second electrode of the electrosurgical device; sensing a parameter of the sealing energy; determining cutting energy for cutting the anatomic structure with the first electrode of the electrosurgical device based on the sensed parameter; activating a heating energy for heating the first electrode; and cutting the anatomic structure with electrical energy from the first electrode.

[0141] In Example 2, the subject matter of Example 1 optionally includes wherein cutting the anatomic structure is further accomplished via thermal energy from the heated first electrode.

[0142] In Example 3, the subject matter of Example 2 optionally includes wherein determining the cutting energy comprises selecting energy levels and intervals for the heating energy and the electrical energy to perform the cutting.

[0143] In Example 4, the subject matter of any one or more of Examples 1-3 optionally include wherein activating heating energy for the first electrode comprises resistively heating the first electrode to allow for thermionic disassociation of electrons and ions.

[0144] In Example 5, the subject matter of any one or more of Examples 1-4 optionally include wherein activating the sealing energy comprises activating radio frequency (RF) energy.

[0145] In Example 6, the subject matter of any one or more of Examples 1-5 optionally include wherein sensing the parameter comprises sensing at least one of resistance, temperature, total energy applied, and energy application rate.40Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0146] In Example 7, the subject matter of any one or more of Examples 1-6 optionally include determining a type of tissue of the anatomic structure by comparing the parameter that was sensed to predetermined electrical values correlated to different types of tissue.

[0147] In Example 8, the subject matter of Example 7 optionally includes wherein: activating sealing energy for sealing the anatomic structure with the second electrode comprises activating bipolar sealing energy; and determining cutting energy for cutting the anatomic structure with the first electrode based on a type of tissue that was determined comprises activating monopolar cutting energy.

[0148] In Example 9, the subject matter of any one or more of Examples 1-8 optionally include automatically adjusting the heating energy and the electrical energy from the first electrode based on feedback obtained from sealing the anatomic structure using an artificial intelligence engine.

[0149] In Example 10, the subject matter of any one or more of Examples 1-9 optionally include manually adjusting the heating energy and the electrical energy from the first electrode based on feedback from sealing the anatomic structure based on information displayed to a user of the electrosurgical device obtained from the parameter of the sealing energy that is sensed.

[0150] In Example 11, the subject matter of any one or more of Examples 1-10 optionally include navigating the electrosurgical device to the anatomic structure, the electrosurgical device comprising forceps comprising jaws having the first electrode and the second electrode; articulating a shaft of the electrosurgical device immediately proximally of the jaws; grasping the anatomic structure with the jaws of the forceps.

[0151] Example 12 is an electrosurgical device comprising: a shaft comprising a distal end and an articulating section proximate the distal end; and a jaw assembly coupled to the distal end of the shaft, the jaw assembly comprising: a first jaw member; a second jaw member; a first electrode positioned on one of the first jaw member or the second jaw member; a second electrode positioned on the first jaw member; a third electrode positioned on the second jaw member; and a heating capability associated with the first electrode.

[0152] In Example 13, the subject matter of Example 12 optionally includes wherein the second electrode and the third electrode are configured to deliver bipolar energy for tissue sealing, and the first electrode is configured to deliver monopolar energy for tissue cutting.41Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0153] In Example 14, the subject matter of any one or more of Examples 12-13 optionally include wherein the second electrode and the third electrode are configured to deliver bipolar energy for tissue sealing, and the first electrode is configured to deliver bipolar energy and resistive heating for tissue cutting.

[0154] In Example 15, the subject matter of Example 14 optionally includes wherein the first electrode is configured to deliver bipolar energy by creating a circuit with at least one of the second electrode and the third electrode.

[0155] In Example 16, the subject matter of any one or more of Examples 12-15 optionally include wherein the articulating section connects the jaw assembly to a rigid portion of the shaft.

[0156] In Example 17, the subject matter of Example 16 optionally includes wherein the first jaw member and the second jaw member have a first length and a distance separating the jaw assembly and the articulating section is less than the first length.

[0157] In Example 18, the subject matter of any one or more of Examples 16-17 optionally include wherein the shaft of the electrosurgical device is connected to a robotic surgical system.

[0158] In Example 19, the subject matter of any one or more of Examples 12-18 optionally include wherein the heating capability is configured to resistively heat the first electrode.

[0159] In Example 20, the subject matter of any one or more of Examples 12-19 optionally include wherein: the first jaw member comprises an elongate body comprising a first plate and a second plate, and a first insulator positioned between the first plate and the second plate; and the second jaw member comprises an elongate body comprising a first plate and a second plate, and a second insulator positioned between the first plate and the second plate; wherein the first electrode is positioned on the second insulator of the second jaw member.

[0160] In Example 21, the subject matter of Example 20 optionally includes wherein the heating capability comprises a resistive heating element embedded in the second insulator.

[0161] In Example 22, the subject matter of any one or more of Examples 20-21 optionally include wherein the first insulator comprises a resiliently deformable anvil against which the first electrode can engage.42Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

[0162] In Example 23, the subject matter of any one or more of Examples 20-22 optionally include at least one sensor positioned on at least one of the first jaw member and the second jaw member, the at least one sensor configured to sense electrical parameters or temperature during tissue sealing.

[0163] In Example 24, the subject matter of any one or more of Examples 12-23 optionally include a power supply connected to the jaw assembly, wherein the first electrode is configured to receive both radiofrequency energy and thermal energy for tissue cutting.

[0164] In Example 25, the subject matter of any one or more of Examples 12-24 optionally include a processing unit configured to: activate sealing energy for the second electrode and the third electrode; sense parameters of the sealing energy; determine a type of tissue based on the sensed parameters; and determine cutting energy for the first electrode based on the determined tissue type.

[0165] Example 26 is a method of controlling an electrosurgical device comprising a first electrode and a second electrode, the method comprising: providing sealing energy to the second electrode of the electrosurgical device to seal a tissue of an anatomic structure; sensing a parameter of the sealing energy; determining a type of tissue of the anatomic structure based on the parameter that has been sensed; determining cutting energy for cutting the tissue of the anatomic structure with the first electrode based on the type of tissue that was determined; providing cutting energy to the first electrode; and providing a heating energy to the first electrode for heating the first electrode.

[0166] In Example 27, the subject matter of Example 26 optionally includes wherein: providing sealing energy to the second electrode of the electrosurgical device to seal a tissue of an anatomic structure comprises providing bipolar sealing energy to the second electrode; and providing cutting energy to the first electrode comprises providing monopolar cutting energy to the first electrode.

[0167] In Example 28, the subject matter of any one or more of Examples 26-27 optionally include wherein activating the heating energy for the first electrode comprises resistively heating the first electrode to allow for thermionic disassociation of electrons and ions.

[0168] In Example 29, the subject matter of any one or more of Examples 26-28 optionally include wherein determining the type of tissue of the anatomic structure comprises43Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01comparing the parameter that was sensed to predetermined electrical values correlated to different types of tissue.

[0169] Each of these non-limiting examples can stand on its own, or can be combined in various permutations or combinations with one or more of the other examples.Various Notes

[0170] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventor also contemplates examples in which only those elements shown or described are provided. Moreover, the present inventor also contemplates examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0171] In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls.

[0172] In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.

[0173] Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable44Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples. An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code can be tangibly stored on one or more volatile, non-transitory, or nonvolatile tangible computer-readable media, such as during execution or at other times.Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), and the like.

[0174] The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.45Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

Claims

THE CLAIMED INVENTION IS:

1. An electrosurgical device comprising:a shaft comprising a distal end and an articulating section proximate the distal end;anda jaw assembly coupled to the distal end of the shaft, the jaw assembly comprising:a first jaw member;a second jaw member;a first electrode positioned on one of the first jaw member or the second jaw member;a second electrode positioned on the first jaw member;a third electrode positioned on the second jaw member; anda heating capability associated with the first electrode.

2. The electrosurgical device of claim 1, wherein the second electrode and the third electrode are configured to deliver bipolar energy for tissue sealing, and the first electrode is configured to deliver monopolar energy for tissue cutting.

3. The electrosurgical device of claim 1, wherein the second electrode and the third electrode are configured to deliver bipolar energy for tissue sealing, and the first electrode is configured to deliver bipolar energy and resistive heating for tissue cutting.

4. The electrosurgical device of claim 3, wherein the first electrode is configured to deliver bipolar energy by creating a circuit with at least one of the second electrode and the third electrode.

5. The electrosurgical device of claim 1, wherein the articulating section connects the jaw assembly to a rigid portion of the shaft.

6. The electrosurgical device of claim 5, wherein the first jaw member and the second jaw member have a first length and a distance separating the jaw assembly and the articulating section is less than the first length.46Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W017. The electrosurgical device of claim 5, wherein the shaft of the electrosurgical device is connected to a robotic surgical system.

8. The electrosurgical device of claim 1, wherein the heating capability is configured to resistively heat the first electrode.

9. The electrosurgical device of claim 1, wherein:the first jaw member comprises an elongate body comprising a first plate and a second plate, and a first insulator positioned between the first plate and the second plate; andthe second jaw member comprises an elongate body comprising a first plate and a second plate, and a second insulator positioned between the first plate and the second plate;wherein the first electrode is positioned on the second insulator of the second jaw member.

10. The electrosurgical device of claim 9, wherein the heating capability comprises a resistive heating element embedded in the second insulator.

11. The electrosurgical device of claim 9, wherein the first insulator comprises a resiliently deformable anvil against which the first electrode can engage.

12. The electrosurgical device of claim 9, further comprising at least one sensor positioned on at least one of the first jaw member and the second jaw member, the at least one sensor configured to sense electrical parameters or temperature during tissue sealing.

13. The electrosurgical device of claim 1, further comprising a power supply connected to the jaw assembly, wherein the first electrode is configured to receive both radiofrequency energy and thermal energy for tissue cutting.

14. The electrosurgical device of claim 1, further comprising a processing unit configured to:47Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01activate sealing energy for the second electrode and the third electrode; sense parameters of the sealing energy;determine a type of tissue based on the sensed parameters; anddetermine cutting energy for the first electrode based on the determined tissue type.

15. A method of operating an electrosurgical device comprising a first electrode and a second electrode, the method comprising:activating sealing energy for sealing an anatomic structure with the second electrode of the electrosurgical device;sensing a parameter of the sealing energy;determining cutting energy for cutting the anatomic structure with the first electrode of the electrosurgical device based on the sensed parameter;activating a heating energy for heating the first electrode; andcutting the anatomic structure with electrical energy from the first electrode.

16. The method of claim 15, wherein cutting the anatomic structure is further accomplished via thermal energy from the heated first electrode.

17. The method of claim 16, wherein determining the cutting energy comprises selecting energy levels and intervals for the heating energy and the electrical energy to perform the cutting.

18. The method of claim 15, wherein activating heating energy for the first electrode comprises resistively heating the first electrode to allow for thermionic disassociation of electrons and ions.

19. The method of claim 15, wherein activating the sealing energy comprises activating radio frequency (RF) energy.

20. The method of claim 15, wherein sensing the parameter comprises sensing at least one of resistance, temperature, total energy applied, and energy application rate.48Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W0121. The method of claim 15, further comprising determining a type of tissue of the anatomic structure by comparing the parameter that was sensed to predetermined electrical values correlated to different types of tissue.

22. The method of claim 21, wherein:activating sealing energy for sealing the anatomic structure with the second electrode comprises activating bipolar sealing energy; anddetermining cutting energy for cutting the anatomic structure with the first electrode based on a type of tissue that was determined comprises activating monopolar cutting energy.

23. The method of claim 15, further comprising automatically adjusting the heating energy and the electrical energy from the first electrode based on feedback obtained from sealing the anatomic structure using an artificial intelligence engine.

24. The method of claim 15, further comprising manually adjusting the heating energy and the electrical energy from the first electrode based on feedback from sealing the anatomic structure based on information displayed to a user of the electrosurgical device obtained from the parameter of the sealing energy that is sensed.

25. The method of claim 15, further comprising:navigating the electrosurgical device to the anatomic structure, the electrosurgical device comprising forceps comprising jaws having the first electrode and the second electrode;articulating a shaft of the electrosurgical device immediately proximally of the jaws;andgrasping the anatomic structure with the jaws of the forceps.

26. A method of controlling an electrosurgical device comprising a first electrode and a second electrode, the method comprising:49Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01providing sealing energy to the second electrode of the electrosurgical device to seal a tissue of an anatomic structure;sensing a parameter of the sealing energy;determining a type of tissue of the anatomic structure based on the parameter that has been sensed;determining cutting energy for cutting the tissue of the anatomic structure with the first electrode based on the type of tissue that was determined;providing cutting energy to the first electrode; andproviding a heating energy to the first electrode for heating the first electrode.

27. The method of claim 26, wherein:providing sealing energy to the second electrode of the electrosurgical device to seal a tissue of an anatomic structure comprises providing bipolar sealing energy to the second electrode; andproviding cutting energy to the first electrode comprises providing monopolar cutting energy to the first electrode.

28. The method of claim 26, wherein activating the heating energy for the first electrode comprises resistively heating the first electrode to allow for thermionic disassociation of electrons and ions.

29. The method of claim 26, wherein determining the type of tissue of the anatomic structure comprises comparing the parameter that was sensed to predetermined electrical values correlated to different types of tissue.50Attorney Docket No. 5409.964WO1Client Reference No. GAP25002-SDMS-W01

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