Ulllted States Patent
`
`[19]
`
`[11] Patent Number:
`
`6,024,744
`
`Kese et al.
`
`[45] Date of Patent:
`
`Feb. 15, 2000
`
`US006024744A
`
`[54 COMBINED BIPOLAR SCISSOR AND
`GRASPER
`
`[75
`
`Inventors: Kelly Kese, Seattle, Wash.; Donald W.
`R
`1
`B
`M d
`egu a’
`C 6
`ea ’
`.
`.
`.
`[73 Asslgneei Eamon’ Inc" S°memH‘°’> NJ"
`
`[21 Appl. No‘: 08/919,432
`
`[22
`
`[51
`[52
`[58
`
`56
`
`[
`
`Filedi
`
`Aug. 27, 1997
`
`Int. Cl.7 ................................................... .. A61B 17/39
`606/51; 606/45
`
`Field of Search .................................. 606/46, 48-52,
`606/205-207
`
`C-t d
`R f
`1 e
`e erences
`U.S. PATENT DOCUMENTS
`
`.
`5,456,684 10/1995 Schmidt ct a1.
`5,484,436
`1/1996 Eggers et al.
`........................... .. 606/48
`5,540,685
`7/1996 Paiins et al.
`606/51
`1]:’riI}k°rl:°ff
`6.I1l'1S C 6.
`6/1998 Eggers ...................................... 606/48
`8/1998 Y
`.
`11/1998
`........................................ 606/51
`
`,
`,
`5,766,170
`5,797,958
`5,827,281
`
`
`
`Primary Examii1er—Linda M. Dvorak
`Asststarzt Exammer—Roy Gibsoii
`Attorney, Agent, or Firm—Scully Scott Murphy & Presser
`
`[57]
`
`ABSTRACT
`.
`.
`.
`.
`Open Surgery lmd endlmcoplc Verslfmspf a Combmed b1pO'
`lar electrosurgical cutting and grasping instrument Where the
`.
`.
`.
`.
`grasping surfaces are contained within the shape of a stan-
`dard surgical scissor. This unique arrangement results in a
`combined scissor and grasper which has the feel of a
`standard scissor but which allows surgeons to cauterize
`tissue and Vessels While both cutting and grasping thus
`making the instruments Well suited to perform coaptation of
`Vessels. Also disclosed herein, ‘are methods for using the
`YaI‘101lS combined electrosurgical cutting and grasping
`1U5[r11H1emS~
`
`.......................... .. 606/170
`.
`
`.......................... .. 600/564
`
`4’949’717
`5,234,453
`52909287
`53429381
`5,396,900
`5,439,471
`5,445,638
`
`8/1990 Shaw '
`8/1993 Smith etal.
`3/1994 Boebel et al.
`8/1994 1-[demand .
`3/1995 Slater et al.
`8/1995 Kerr.
`8/1995 Rydell et al.
`
`IO
`
`.
`
`53 Claims, 12 Drawing Sheets
`
`ETHICON ENDO-SURGERY, INC.
`
`EX. 1005
`
`1
`
`

`
`U.S. Patent
`
`Feb. 15,2000
`
`Sheet 1 of 12
`
`6,024,744
`
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`U.S. Patent
`
`Feb. 15,2000
`
`Sheet 2 of 12
`
`6,024,744
`
`FlG.|C
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`(PRIOR ART)
`
`
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`FIGID
`
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`
`3
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`

`
` U.S.Patent
`
`Feb. 15,2000
`
`Sheet 3 of 12
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`6,024,744
`
`FIG. 2 A
`
`FIG . 2 B
`
`4
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`4
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`

`
`U.S. Patent
`
`Feb. 15,2000
`
`Sheet 4 of 12
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`6,024,744
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`Feb. 15, 2000Feb. 15, 2000
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`Feb. 15, 2000Feb. 15, 2000
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`Feb. 15, 2000Feb. 15, 2000
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`1111
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`11
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`

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`U.S. Patent
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`Feb. 15,2000
`
`Sheet 11 of 12
`
`6,024,744
`
`Providing Access to
`
`Tissue and/or Vessel(s)
`
`WOVMOO
`
`Locating Tissue and /or
`Vessel(s) Between Grasping Surfaces
`
`l4iO
`
`Grasping the Tissue and/or Vessel(s)
`by Actuating Instrument into Closed
`
`Position
`
`I4|5
`
`Co te 'z‘n
`th Gras ed T'ssue
`on: /or: \'le%seIe(s)
`P
`I
`
`M20
`
`Releasing the Grosped Tissue
`and /or Vessel(s)
`
`i425
`
`Positioning the Couterized Tissue
`and/or vessel (5) Between Cutting
`
`Edges
`
`I430
`
`Dissecting the Couterized Tissue
`and/or Vessel(s) with Cutting Edges
`
`.435
`
`_
`Closing the Access Provided
`
`I440
`
`FIGI4
`
`12
`
`12
`
`

`
`U.S. Patent
`
`Feb. 15, 2000
`
`Sheet 12 of 12
`
`6,024,744
`
`incising Skin for
`
`
`Entry of Trocors and
`Trocor Tubes
`
`I5i0
`
`insertin Trocars and
`Trocor ubes into incisions
`
`I5l5
`
`I520
`
`I505
`
`'500
`
`/
`
`I550
`
`Positioning the Couterized
`Tissue and/or Vessel(s)between
`the Cutting Edges
`
`I555
`
`Dissecting the Couterized
`Tissue and/or Vessei(s) with
`the Cutting Edges
`
`inserting Endoscope
`
`I560
`
`.
`insertinginstrument
`
`'525
`
`Removing the instrument
`and Endoscope from
`the -rrocar Tubes
`
`'53°
`
`I565
`
`Locating Tissue_ond /or Vessei(s)
`between Grasping Surfaces
`
`I535
`
`Grasping Tissue and/or Vesse|(5)
`
`
`
`Removing the T,-ow,
`TubesfronithePunchHes
`and incisions
`
`I540
`
`Closing the incisions
`and Punctures
`
`Couterizing Grosped Tissue and/or
`Vesselis)
`
`1570
`
`Releasing Grosped Tissue and/or
`Vesse|(s
`
`I545
`
`FiG.i5
`
`13
`
`

`
`6,024,744
`
`1
`COMBINED BIPOLAR SCISSOR AND
`GRASPER
`
`BACKGROUND OF THE INVENTION
`1. Field of the Invention
`
`The field of art to which this invention relates is surgical
`instruments, in particular, electrosurgical cutting and grasp-
`ing instruments.
`2. Description of the Related Art
`Surgery requires the use of surgical instruments within a
`restricted and unusually sensitive operating field. During
`surgery, the field becomes crowded if a large number of
`surgical
`instruments must be used simultaneously, with
`concomitant difficulty for the surgical team to maintain a
`clear viewing area. Under such circumstances, surgical
`instruments designed to perform more than one task are of
`particular importance.
`Two techniques used extensively in both open and endo-
`scopic surgery are (a) the controlling of bleeding using
`electrosurgical instrumentation and (b) the incision or sev-
`ering of tissue or vessels. Tl1e control of bleeding during
`surgery accounts for a major portion of the time involved in
`surgery. In particular, bleeding that occurs when tissue is
`incised or severed can obscure the surgeon’s vision, prolong
`the operation, and adversely effect the precision of cutting.
`Blood loss from surgical cutting may require blood infusion,
`thereby increasing the risk of harm to the patient.
`Hemostatic electrosurgical techniques are known in the
`art for reducing bleeding from incised tissue prior to, during,
`and subsequent
`to incision. Electrosurgical cutting and
`coagulating instruments are used to perform such tech-
`niques. These instruments can be of a reusable type (which
`require cleaning and disinfecting or sterilizing before each
`use) or disposable (which are disposed of after a single use).
`Each type includes both monopolar and bipolar variations
`having at least one electrode. Radio frequency (RF) energy
`is conducted through this electrode to either a remote
`conductive body—plate (known as a grounding pad) in the
`case of monopolar instruments, or to a second, closely
`spaced conductive electrode in the case of bipolar instru-
`ments. In monopolar instruments electrical current travels
`from the electrode through the patient’s body to the ground-
`ing pad. Bipolar instruments are typically connected to both
`poles of an electrosurgical generator, therefore current flow
`is typically limited to tissue adjacent to the working end of
`the bipolar instrument (where the two electrodes are
`located).
`Prior to the advent of electrosurgical cutting instruments,
`a surgeon would perform any cutting with a scissors and
`coagulate with an entirely different
`instrument. This
`exchange of instrumentation was time consuming.
`In
`response for the need to have a scissors—type instrument for
`cutting but which also incorporated the ability to coagulate
`blood and other body tissue using RF energy, electrosurgical
`cutting devices have been developed which combine
`mechanical cutting with electrosurgical cauterization,
`coagulation, and cutting.
`Standard shape and size scissors have evolved in the
`surgical arts which surgeons have become accustomed to.
`These standards have been incorporated into the electrosur-
`gical cutting instruments, not only because they have been
`tested by time and found to be very functional, but mainly
`because surgeons have become accustomed with their feel
`and use. Examples of some of these standards include the
`Mayo, Metzenbaum, and Tenotomy scissors. Each standard
`scissor is typically available in both curved and straight
`variations.
`
`10
`
`15
`
`20
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`25
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`30
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`35
`
`40
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`45
`
`50
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`55
`
`60
`
`65
`
`2
`Grasper or forcep type instruments are also well known in
`the art. They generally consist of opposing jaws which pivot
`about a pivot point into an open or closed position. In a
`closed position the jaws of the grasper provide a means to
`grasp and hold, or grasp and tear, a piece of body organ, a
`vessel, or tissue.
`Electrosurgical graspers have been developed to cauterize
`a portion of tissue. This is accomplished in one of two ways.
`Cauterization can be accomplished by using an outside
`surface or the tip of bothjaws to cauterize the tissue the jaws
`contact. Cauterization can also be accomplished with a
`grasper by grasping down onto tissue and cauterizing the
`tissue between the jaws. It is in this way that electrosurgical
`graspers are used to coapt a vessel prior to transection with
`a cutting device. Electrosurgical graspers are also used to
`coapt retracted bleeders (severed blood vessels).
`In practice, vessels are coapted in several ways. One such
`way is by using a standard grasper not capable of cauter-
`ization and a monopolar pencil. The vessel is first clamped
`between the jaws of the grasper, and the pencil is used to
`energize the grasper with RF energy. The RF energy passes
`from tl1e monopolar pencil, through the forceps, vessel and
`patients body to the grounding pad. This is a potentially
`dangerous procedure. The patient or surgeon can be easily
`injured in such a procedure.
`Another way to perform coaptation of vessels is by using
`a monopolar or bipolar scissors in which the scissors are
`rotated exposing the vessel
`to the side surfaces of the
`scissor’s blades. In theory,
`the blade sides cauterize the
`vessel and the vessel is then severed with the scissors. In
`practice,
`this procedure is very difficult and can lead to
`complications. It is very easy for a surgeon to nick the vessel
`with the scissor blades before the coaptation of the vessel is
`complete, causing unanticipated bleeding and the need for
`further instrumentation to stop the bleeding.
`Whichever method of coaptation is used, subsequent to
`the coaptation, the vessel is severed by a cutting instrument
`such as an electrosurgical scissor. In light of the above
`discussion, this procedure has been most effectively and
`safely accomplished with at
`least
`two different surgical
`instruments, a grasper to grasp and coapt, and a scissor to
`sever the coapted vessel.
`Tidemand, U.S. Pat. No. 5,342,381, discloses an endo-
`scopic combination bipolar scissors and forceps instrument
`which has blade and forceps portions on each of two jaws.
`Although the Tidemand instrument is useful it is subject to
`several disadvantages which effect the performance of the
`device, especially with regard to coaptation of vessels.
`Since the blades of the Tidemand invention are insulated
`
`the blades themselves only offer
`(typically ceramic)
`mechanical cutting. As discussed previously, an instrument
`which offers both mechanical and electrosurgical cutting is
`preferred over one which offers only the former.
`Additionally, certain procedures require that the scissors
`portion of the instrument be distal to the graspers. Likewise,
`some procedures require the grasper portion of the instru-
`ment to be distal to the scissor portion. Tidemand discloses
`only the latter configuration, which is inadequate in many
`surgical procedures.
`Furthermore, the shape and size of the cutting and grasp-
`ing surfaces in the Tidemand instrument are awkward,
`unlike any standard scissor that surgeons have become
`accustomed to.
`
`With regard to surgical procedures in which coaptation of
`vessels is required, the Tidemand combination instrument
`could not be effectively utilized. Effective coaptation
`
`14
`
`14
`
`

`
`6,024,744
`
`3
`requires hemostasis during cutting as well as during grasp-
`ing (or clamping) in order to cauterize the ends of the
`severed vessel.
`
`Like the Tidemand instrument, the single feature electro-
`surgical cutting devices and graspers of the prior art are
`useful and effective, but they too suffer from several defi-
`ciencies associated with their use. The instrument exchange
`associated with cutting, coagulating and coaptation requires
`dexterity on the part of the surgeon. The increased number
`of instruments has the disadvantage of crowding the oper-
`ating field. Additionally, their is a greater burden on assistant
`personnel in the operating room, such as nurses, because of
`the exchange of instrumentation between them and the
`surgeon.
`
`Another disadvantage of the prior art concerns cleaning,
`disinfecting and sterilization (CDS) issues known in the
`surgical instrumentation art. Transmission of sickness and
`disease through contaminated instrumentation is a very real
`problem in the medical field. Typically, surgical instrumen-
`tation is cleaned and disinfected or sterilized after each use
`
`to minimize this possibility. Since effective coaptation of
`vessels has required two instruments, a graspers and a
`scissors, the risk of disease transmission is increased. The
`explanation for this is purely statistical, the probability of
`transmitting disease in two instruments is greater than for a
`single instrument.
`Additionally, the cost of processing (cleaning, disinfect-
`ing or sterilizing) two reusable instruments and purchasing
`two reusable instruments is greater than the costs associated
`with a single combined instrument.
`To combat the CDS problems associated with reusable
`instruments, disposable instruments have been developed
`which are disposed after a single use. While they have their
`advantages, disposable instruments suffer from the disad-
`vantage of contributing to the amount of medical waste
`generated.
`The prior art disposable scissors and graspers suffer the
`disadvantage of contributing twice the medical waste as a
`single disposable instrument combining both features.
`Likewise, the cost of two disposable surgical instruments is
`greater than the cost of a combined disposable instrument.
`Accordingly, there is a need in the art for an improved
`electrosurgical instrument having mechanical grasping and
`cauterization capabilities to coapt vessels combined with
`capabilities to mechanically transect and cauterize the
`vessel, contained within a standard scissors shape and size.
`SUMMARY OF THE INVENTION
`
`invention to
`it is an object of the present
`Therefore,
`provide a single bipolar electrosurgical instrument which is
`capable of performing the functions of both a bipolar forceps
`and a bipolar scissors.
`It is yet a further object of the present invention to provide
`a bipolar surgical
`instrument which combines a bipolar
`scissors and bipolar grasper with the grasping portions
`contained within a standard scissor shape and size.
`It is yet a further object of the present invention to provide
`a bipolar surgical instrument to eliminate the need to ener-
`gize a standard grasper with a monopolar pencil.
`It is yet a further object of the present invention to provide
`a bipolar surgical instrument to eliminate the need to rotate
`a monopolar or bipolar scissors to coapt a vessel.
`It is yet another object of the present invention to provide
`a combined bipolar cutting and grasping instrument which
`provides for improved cauterization and coagulation.
`
`10
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`20
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`25
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`30
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`35
`
`40
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`45
`
`50
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`
`60
`
`65
`
`4
`It is yet another object of the present invention to provide
`a combined bipolar cutting and grasping instrument which
`reduces the amount of instrumentation necessary for surgical
`procedures in which both electrosurgical cutting and grasp-
`ing is required.
`It is yet another object of the present invention to provide
`a combined bipolar cutting and grasping instrument which
`reduces the burden on assistant personnel in an operating
`room in which a surgical procedure is being performed that
`requires both electrosurgical cutting and grasping.
`It is yet another object of the present invention to provide
`a combined bipolar cutting and grasping instrument which
`reduces the amount of dexterity needed by a surgeon per-
`forming a surgical procedure in which both electrosurgical
`cutting and grasping is required.
`It is yet another object of the present invention to provide
`a combined bipolar cutting and grasping instrument which
`reduces the costs associated with surgical procedures in
`which both electrosurgical cutting and grasping is required.
`It is yet another object of the present invention to provide
`a combined bipolar cutting and grasping instrument which
`decreases the probability of transmission of disease due to
`contaminated instrumentation in surgical procedures in
`which both electrosurgical cutting and grasping is required.
`It is still yet another object of the present invention to
`provide a combined disposable bipolar cutting and grasping
`instrument which decreases the amount of medical waste
`
`generated in surgical procedures in which both electros1Ir-
`gical cutting and grasping is required.
`Accordingly, a combined bipolar electrosurgical cutting
`and grasping instrument is disclosed. The device has a first
`jaw member. The first jaw member further having a first
`cutting edge, a first cutting surface, a portion of its length as
`a first grasping surface, and a first pivoting surface. Asecond
`jaw member has a second cutting edge, a second cutting
`surface, a second grasping surface, and a second pivoting
`surface. The cutting edges and the grasping surfaces oppose
`each other. Furthermore, the pivoting surfaces oppose each
`other and are in sliding contact with each other. The first and
`second jaw members are pivotally connected by a pivot pin
`where at least one of the jaw members pivots relative to the
`other such that when pivoted from an open position to a
`closed position the grasping surfaces come into substantial
`contact and the cutting edges engage in a shearing motion.
`A means for supplying electrical energy to the first jaw
`member and electrical energy of the opposite polarity to the
`second jaw member is provided. An isolating means for
`electrically isolating the first jaw member from the second
`jaw member is also provided. Lastly, an actuation means is
`provided for opening and closing the jaw members between
`their open and closed positions.
`invention,
`In another embodiment of the present
`cutting edges are distal to the grasping surfaces.
`In yet another embodiment of the present invention, the
`grasping surfaces are distal to the cutting edges.
`In a version of any of the above embodiments the grasping
`surfaces are contained within the shape and size of standard
`scissor blades.
`
`the
`
`In yet another version of any of the above embodiments,
`both jaw members pivot relative to each other.
`In yet another version of any of the above embodiments
`the isolating means comprises electrically insulating coat-
`ings disposed on the first cutting surface, second cutting
`surface, and one of the first or second pivoting surfaces.
`Further provided is a means for preventing electrical con-
`
`15
`
`15
`
`

`
`6,024,744
`
`5
`duction from the first jaw member to the second jaw member
`through the pivot pin.
`In yet another version of any of the above embodiments,
`suitable for open surgical procedures, the present invention
`comprises first and second conductive elongated members as
`the means for actuation of the jaw members. Each elongated
`member having a distal and proximal end. Their distal ends
`respectively connected to the first and seco11djaw members.
`Each elongated member further having a finger loop portion
`at its proximal end for insertion of the user’s fingers. The
`means for supplying electrical energy is provided by a first
`electrical connector disposed at the proximal end of the first
`elongated member and a second electrical connector dis-
`posed at the proximal end of the second elongated member.
`The instrument further comprising an insulating means for
`preventing electrical conduction from portions of the instru-
`ment other than those intended.
`
`In yet another version of any of the above embodiments,
`suitable for endoscopic procedures, the present invention
`further having an elongated tube, having a distal end, a
`proximal end, and a lumen extending its entire width. The
`jaw members being pivotally disposed on the distal end of
`the tube. Also provided is an actuating means disposed on
`the proximal end of the tube for remote operation of the jaw
`members. The actuating means being of any type known in
`the art, such as a pistol grip or scissor type handles. The
`instrument further comprising an insulating means for pre-
`venting electrical conduction from portions of the instru-
`ment other than those intended.
`
`Another aspect of the present invention are methods of
`11sing the various embodiments of the present invention for
`both open and endoscopic procedures.
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`These and other features, and advantages of the instru-
`ments and methods of the present invention will become
`better understood with regard to the following description,
`appended claims, and accompanying drawings where:
`FIG. 1A illustrates an isometric view of the operating end
`of an embodiment of the present invention in which the
`scissors portion is distal, the jaw members thereof being
`shown in an opened position;
`FIG. 1B illustrates the top View of the embodiment
`illustrated in FIG. 1A, the jaw members thereof being shown
`in a closed position;
`FIG. 1C illustrates an isometric view of the operating end
`of a typical bipolar surgical scissors of the prior art, the blade
`members thereof being shown in an opened position;
`FIG. 1D illustrates the top View of the embodiment
`illustrated in FIG. 1C,
`the blade members thereof being
`shown in a closed position;
`FIG. 2A illustrates an isometric view of the operating end
`of an embodiment of the present invention in which the
`graspers portion is distal, the jaw members thereof being
`shown in an opened position;
`FIG. 2B illustrates the top View of the embodiment
`illustrated in FIG. 2A, the jaw members thereof being shown
`in a closed position;
`FIG. 3A illustrates a plan View of the second jaw member
`of the present invention as viewed along line 3—3 in FIG.
`1A;
`FIG. 3B illustrates a side View of the second jaw member
`of the present invention as illustrated in FIG. 3A.
`FIG. 3C illustrates a plan view of the second jaw member
`of an alternative version of the present invention as it would
`be viewed along line 3—3 in FIG. 1A;
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`FIG. 3D illustrates a side view of the second jaw member
`of an alternative version of the present invention as illus-
`trated in FIG. 3C.
`
`FIG. 4A illustrates a plan View of the second jaw member
`of the present invention as viewed along line 4—4 in FIG.
`2A;
`FIG. 4B illustrates a side view of the second jaw member
`of the present invention as illustrated in FIG. 4A.
`FIG. 4C illustrates a plan View of the second jaw member
`of an alternative version of the present invention as it would
`be viewed along line 4—4 in FIG. 2A;
`FIG. 4D illustrates a side View of the second jaw member
`of an alternative version of the present invention as illus-
`trated in FIG. 4C.
`
`FIG. 5A illustrates a box—lock version of the present
`invention as shown in FIG. 1A;
`FIG. 5B illustrates a box—lock version of the present
`invention as shown in FIG. 2A;
`FIG. 6 illustrates the instrument of FIG. 1A with the jaw
`members of the instrument being shown in the open posi-
`tion;
`FIGS. 7A and 7B illustrate sectional views taken along
`lines 7A—7A and 7B—7B respectively in FIG. 6;
`FIG. 8 illustrates the instrument of FIG. 1A with the jaw
`members of the instrument being shown in the closed
`position;
`FIG. 9 illustrates the instrument of FIG. 2A with the jaw
`members of the instrument being shown in the open posi-
`tion;
`FIGS. 10A and 10B illustrate sectional views taken along
`lines 10A—10A and 10B—10B respectively in FIG. 9;
`FIG. 11 illustrates the instrument of FIG. 2A with the jaw
`members of the instrument being shown in the closed
`position;
`FIG. 12A illustrates an endoscopic embodiment of the
`present invention having a scissors grip;
`FIG. 12B illustrates a sectional view taken along the line
`12B—12B in FIG. 12A;
`FIG. 13 illustrates an endoscopic embodiment of the
`present invention having a pistol grip;
`FIG. 14 illustrates the steps of a method utilizing an
`instrument of the present invention configured for open
`surgical procedures;
`FIG. 15 illustrates the steps of a method utilizing an
`instrument of the present invention configured for endo-
`scopic surgical procedures.
`
`DETAILED DESCRIPTION OF THE
`PREFERRED EMBODIMENTS
`
`Referring now in detail to FIGS. 1A and 1B there is
`illustrated the operating (or distal) end of the inventive
`combined bipolar scissors and grasper instrument 10 which
`includes first and second jaw members 12,14. Each jaw
`member having a cutting edge 16,18, a cutting surface
`17,19, and a grasping surface 20,22. The cutting edges 16,18
`and grasping surfaces 20,22 generally being constructed of
`a conductive material, preferably stainless steel. The first
`cutting edge 16 opposes the second cutting edge 18 and the
`first grasping surface 20 opposes the second grasping sur-
`face 22.
`
`The first jaw member 12 further having a first pivoting
`surface 30. The second jaw member 14 further having a
`second pivoting surface 32. The pivoting surfaces 30,32
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`6,024,744
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`7
`slidably contact each other at a point where the jaw members
`12,14 intersect.
`The jaw members 12,14 are pivotally connected by way
`of a rivet, screw, or pin 24 at their point of intersection such
`that they are capable of pivoting between an open and closed
`position. The point of intersection is configured with a
`conventional surgical scissors pivot.
`As shown in FIGS. 1C and ID, a conventional bipolar
`surgical scissor is shown and referred to generally as refer-
`ence numeral 1, wherein a first blade member 12a pivots
`about a second blade member 14a whereby they are retained
`into a pivoting relationship by a rivet, pin or screw 24a. Each
`blade member has a cutting edge 16cz,18cz and a cutting
`surface 17a,19a. Afirst electrically insulating coating 26a is
`applied to the first cutting surface 17a and a second insu-
`lating coating 36a is applied to the pin 24a for electrically
`isolating the first blade member 12a from the second blade
`member 14a. Therefore, electrical conduction is prevented
`from the first jaw member 12a to the second jaw member
`14a through the rivet, pin or screw 24a.
`Referring back to FIGS. 1A and 1B, when in the closed
`position, the first cutting edge 16 engages the second cutting
`edge 18 in a shearing motion. Similarly, the first grasping
`surface 20 substantially meets the second grasping surface
`22 to form a clamp for grasping and clamping tissue or
`vessels therewithin.
`
`Electrically insulating material is provided to electrically
`isolate the first jaw member 12 from the second jaw member
`14. A first electrically insulating coating 26 is secured to the
`first cutting surface 17 thereby insulating the first cutting
`surface 17 from the second cutting surface 19 when the jaw
`members 12,14 are in their closed position but which allows
`electrical conduction between the first and second cutting
`edges 16,18 when tissue is present between the cutting edges
`16,18.
`Furthermore, a second insulating coating 28 is secured to
`the second grasping surface 22 thereby insulating the first
`grasping surface 20 from the second grasping surface 22. A
`third insulating coating 34 is supplied at the first pivoting
`surface 30. Lastly, a fourth insulating coating 36 is provided
`on the rivet, pin, or screw 24, to prevent electrical conduc-
`tion from the first jaw member 12 to the second jaw member
`14 through the pivot rivet, screw, or pin 24.
`The insulating coatings 26, 28, and 34 are preferably
`aluminum oxide, plasma deposited on the instrument sur-
`faces. The thickness of the aluminum oxide coatings can be
`between 0.003 and 0.010 inches thick, preferably between
`0.005 and 0.007 inches thick to withstand a voltage of
`approximately 1,500 volts.
`Preferably, the pivot pin, screw, or rivet 24 is similarly
`coated, but also can be fabricated from a high strength
`polymer, a glass-filled polymer, a ceramic-filled polymer, or
`fabricated entirely from a ceramic. If fabricated from a
`ceramic, it can be further impregnated with a polymer, such
`as PTFE,
`to improve its lubricity. Additionally,
`the pin,
`screw or rivet is typically epoxied in place with any suitable
`medical grade epoxy.
`As shown in FIGS. 3A through 3D, the second insulating
`coating 28 preferably covers only a portion of the second
`grasping surface 22. When tissue is grasped between the first
`grasping surface 20 and second grasping surface 22, RF
`energy from one jaw member will be conducted to the other
`in the portions of the second grasping surface 22 which are
`uncoated, thereby cauterizing the tissue between the grasp-
`ing surfaces 20,22 in the region of the uncoated portions.
`Since the second insulating coating 28 covers only a
`portion of the second grasping surface 22 it can therefore
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`take on a variety of shapes and sizes. FIG. 3A shows the
`second insulating coating 28a applied as a semi-circle across
`the width of the second grasping surface 22. The second
`insulating coating 28a is preferably raised above the second
`grasping surface 22, as shown in FIG. 3B, such that an
`insulating gap is maintained between the first grasping
`surface 20 and the second grasping surface 22 when the jaw
`members 12,14 are in their closed position. The insulating
`gap prevents electricity from being conducted from the first
`grasping surface 20 to the second grasping surface 22 when
`the jaw members 12,14 are in their closed position and tissue
`is not present between them.
`It should be noted that the second insulating coating 28 is
`used to maintain an insulating gap between the first grasping
`surface 20 and the second grasping surface 22 equal to the
`thickness of the coating 28. The second insulating coating 28
`can be eliminated and an insulating air gap used to isolate
`the first grasping surface 20 from the second grasping
`surface 22.
`
`It should also be noted that the second insulating coating
`28, as well as the first insulating coating 26, are not essential
`to the functioning of the instrument. They are provided for
`safety reasons to eliminate the possibility of electrical short-
`ing between the jaw members 12,14 in the situation where
`the instrument is accidentally energized with RF energy
`while the jaw members 12,14 are in their closed position and
`tissue is not present between them. Such a situation where
`electrical shorting occurs between the jaw members 12,14
`can be potentially dangerous to both the surgeon and patient.
`Similarly, FIG. 3C shows an alternatively shaped second
`insulating coating 28b applied as a strip across the length of
`the first grasping surface 20. FIG. 3D shows that the second
`insulating coating 28b is likewise raised above the second
`grasping surface 22 such that an insulating gap is maintained
`between the first grasping surface 20 and the second grasp-
`ing surface 22 when the jaw members 12, 14 are in their
`closed position.
`Referring back to FIGS. 1A and 1C, as shown clearly in
`a comparison of FIGS. 1B and 1D, the shape of the instru-
`ment’s distal end does not vary from the shape of a standard
`scissor’s blades 12a,14a even though grasping surfaces
`20,22 have been incorporated therein. Since the grasping
`surfaces 20,22 follow the contours of a standard scissor
`shape, the feel and use of the standard scissor is maintained
`for the combined instrument.
`
`FIGS. 1A and 1B illustrate an embodiment of the present
`invention 10 configured to have the cutting edges 16,18
`distal to the grasping surfaces 20,22. FIGS. 2A and 2B
`illustrate a similar embodiment of the present invention 40
`in which all components similar to or identical with those in
`FIGS. 1A and 1B are designated by the same reference
`numerals, and is merely modified with regard to the previous
`embodiment, in that the jaw members 12,14 are configured
`to have the grasping surfaces 20,22 distal to the cutting
`edges 16,18. Similarly, FIGS. 4A through 4D illustrate two
`variations of the second insulating surface 28a,28b similar
`to those previou