U.S. PATENT DOCUMENTS
`1/1937
`3/1983
`4/1987
`7/1990
`4/1995
`8/1995
`8/1995
`10/1995
`1/1996
`2/1996
`
`606/51
`
`606/46
`.......... 606/52
`
`Wappler et al.
`DiGeronimo .
`Tischer ...................................... 606/5]
`Ensslin .
`Yates et al.
`Stem et al.
`.
`Rydell et al.
`Feinberg et al.
`Slater et al.
`
`.......................... 606/52
`...... 606/46
`
`2,063,721
`4,375,213
`4,655,216
`4,938,761
`5,403,312
`5.443.463
`5,445,633
`5,4535%
`5,432,054
`5,439,292
`
`United States Patent
`Fox et al.
`
`[19]
`
`[11]
`
`Patent Number:
`
`[45] Date of Patent:
`
`5,674,220
`
`Oct. 7, 1997
`
`USOO5674220A
`
`BIPOLAR ELECTROSURGICAL CLAMPING
`DEVICE
`
`5,509,922
`5,553,100
`
`4/1996 Aranyietal. ............................. 606/46
`9/1996 Cox ........................................... 606/52
`
`Inventors: William D. Fox. New Richmond;
`David C. Yates. West Chester. both of
`Ohio
`
`FOREIGN PATENT DOCLTMENTS
`2355-521
`6/1976 France.
`WO 95/15124
`6/1995 WIPO.
`
`[54]
`
`[75]
`
`[73]
`
`[21]
`
`[22]
`
`[51]
`[52]
`
`[5 8]
`
`[56]
`
`Assignee: Ethicon Endo-Surgery, Inc..
`Cincinnati. Ohio
`
`Appl. No.: 536,726
`
`Filed:
`
`Sep. 29, 1995
`
`Int. Cl.° ..................................................... A61B 17/39
`U.S. Cl. ............................... .. 606/51; 606/45; 606/41;
`606/205: 606/50
`Field of Search .................................... 606/1. 41. 42.
`606/45-52. 205-208; 128/751
`
`References Cited
`
`Primary Examiner—Lee S. Cohen
`Assistant Examiner—Michael Peffley
`Attomey, Agent, or Firm—Bemard E. Shay
`[57]
`ABSTRACT
`
`An electrosurgical hcmostatic insnument is provided in
`which the coagulation status of tissue engaged by two
`elements delivering an electrosurgical energy to tissue may
`be observed. and in which damage from thermal spread may
`be minimized. A preferred embodiment of the invention
`provides a bipolar endoscopic clamping. coagulation and
`cutting device. In this device. the outer conductive surface of
`the tissue engaging elements includes openings there-
`through. The openings are adapted to allow an observer to
`see the tissue as it is being treated. coagulation may be
`observed by watching the region through the openings. In
`addition.
`the inclusion of openings in the end efiector
`enhances coagulation from speed by reducing the thermal
`mass of the end elfector without substantially reducing the
`structural strength of the end effector jaws. Finally.
`the
`openings may be used to observe the motion of the knife as
`it moves through the end eflector.
`
`2 Claims, 5 Drawing Sheets
`
`ETHICON ENDO-SURGERY, INC.
`
`EX. 1006
`
`1
`
`

`
`U.S. Patent
`
`Oct. 7, 1997
`
`Sheet 1 of 5
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`5,674,220
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`U.S. Patent
`
`Oct. 7, 1997
`
`Sheet 2 of 5
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`5,674,220
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`3
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`

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`5,674,220
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`4
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`

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`Oct. 7, 1997
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`Sheet 4 of 5
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`FIG. 6
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`5
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`

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`U.S. Patent
`
`Oct. 7, 1997
`
`Sheet 5 of 5
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`5,674,220
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`6
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`

`
`5 .674.220
`
`1
`BIPOLAR ELECTROSURGICAL CLAMPING
`DEVICE
`
`FIELD OF THE INVENTION
`
`The present invention relates to an electrosurgical hemo-
`static grasping. clamping or forceps type device. and in
`particular. to a clamping and cutting device including a pair
`of electrically conductive clamping elements with openings
`in the clamping elements.
`
`BACKGROUND OF THE INVENTION
`
`Electrosurgical hemostatic devices have been used for
`effecting improved hemostasis by heating tissue and blood
`vessels to cause coagulation or cauterization. Monopolar
`electrosurgical devices utilize one active electrode associ-
`ated with the cutting or cauterizing instrument and a remote
`return or ground electrode which is usually attached exter-
`nally to the patient. Thus in surgery utilizing monopolar
`instruments. electrical current passes from the active
`electrode. through the patient to the return electrode.
`In bipolar electrosurgical instruments both electrodes are
`included on the instrument and. generally. both electrodes
`are active. Thus. a typical bipolar instrument includes two or
`more electrodes which are charged to different electrical
`potentials. In bipolar instruments. the coagulating current
`flows through tissue positioned between the electrodes.
`Bipolar forceps. being one type of bipolar electrosurgical
`instrument. have been used in various procedures for coagu-
`lating tissue. Generally bipolar forceps include two oppos-
`ing jaws each connected to an output electrode of an
`electrical generator such that the opposing jaws are charged
`to difierent electrical potentials. Organic tissue being elec-
`trically conduct.ive. when the jaws are used to grasp tissue
`the two electrodes apply electrical current through the
`grasped tissue. The use of bipolar forceps may. in certain
`circumstances. cause areas of thermal spread. i.e.. regions of
`coagulation caused by the dissipation of heat outside the
`area defined by the grasping or engaging surfaces of the
`forceps.
`U.S. application Ser. No. 08/095.797 filed on Jun. 22.
`1993. illustrates. in a preferred embodiment. a clamping and
`coagtlating device in which most of the tissue being treated
`by the end effector of the device is not visible to the user. The
`electrodes in the preferred embodiment of this device are
`offset from each other with respect to the tissue grasping
`surfaces so that the likelihood of arcing or shorting is
`reduced. However. in this device it is diflicult to visualize
`coagulation as it is occurring to the tissue unless thermal
`spread is occurring.
`U.S. application Ser. No. 08/415,957 filed on Apr. 3.
`1995. illustrates a clamping. cutting and coagulating device
`in which the tissue being treated by the end elfector of the
`device is partially Visible to the user.
`improving visual 55
`feedback. The electrodes of the preferred embodiment of
`this device are also otfset to reduce the likelihood of arcing
`or shorting.
`instruments for
`Electrical energy is used in medical
`hemostasis.
`that
`is to stop or slow bleeding in tissue.
`Application of electrical current in conjunction with pres-
`sure applied by the end eifector results in a significant
`reduction in bleeding. and may be used to reduce bleeding
`along a cut line prior to cutting tissue. The electrical current
`which passes through the tissue acts to heat the tissue. As the
`tissue is heated. it changes in color and texture. The expe-
`rienced surgeon may. by loolcing for changes in the color or
`
`2
`texture of the tissue around the end effector. determine when
`to turn oil’ the current to the end elfector. Although the
`changes in tissue color and texture around the end eflector
`are useful to the surgeon. it is beneficial in many procedures
`to limit the region eifected by the electrical current and
`insulating heat. i.e. to limit the thermal spread. In addition.
`it is beneficial in certain circumstances to speed coagulation
`of tissue damped by the jaws. Therefore.
`it would be
`beneficial to design an end effector wherein the thermal mass
`of the end effector is reduced to speed coagulation. In
`addition. it would be beneficial to design an end etfector
`wherein the movement of the knife blade may be observed
`as the knife moves through the tissue. Further. it would be
`beneficial to design an end eifector wherein tissue grouped
`by the end effector may be observed as it is treated.
`In the device illustrated in FIG. 1.
`the solid bipolar
`electrodes make it difiicult to observe the tissue as it is
`treated As tissue between the electrodes coagulates its
`impedance rises. and the coagulation current seeks a lower
`impedance path through the tissue. Tissue which touches
`uncoated electrodes on the sides of the end effector. olfers a
`low impedance path. increasing thermal spread and decreas-
`ing current density in the region between the electrodes.
`Thus. the surgeon waits until thermal spread is observed to
`conclude that the tissue between the electrodes is being
`treated In the simplified cross—section of an end effector in
`FIG. 1, first electrode 1 and second electrode 2 hold tissue
`3. In the end eifector in FIG. 1. electrical current travels
`along crnrent paths 4 between first electrode 1 which is
`charged to a first electrical potential and second electrode 2
`which is charged to a second electrical potential. As the
`tissue coagulates. coagulation region 5 forms between elec-
`trode l and electrode 2 increasing the impedance of the
`tissue between the electrodes. In the device illustrated in
`FIG. 1. current paths 4 extend well beyond the edges of the
`end efiector and out into tissue 3. The resulting coagulation
`region therefore extends laterally out into the tissue around
`the end eifector.
`The device illustrated in FIG. 2 utilizes what is known as
`“compression zone” technology wherein one electrode is
`positioned inside one jaw of the device and the second
`electrode is positioned around the outside of at least one jaw.
`As tissue between the inner and outer electrode coagulates.
`the coagulated tissue between the jaws insulates the inner
`electrode. efiectively stopping coagulation and thermal
`spread. In the simplified cross-section of an end efiector
`illustrated in FIG. 2. tissue 13 is positioned between first
`insulator 16 and second insulator 18. In the end effector of
`FIG. 2. electrical current flows between first electrode 11
`and third electrode 17. in addition. if region 12 is an active
`electrode current may flow between second electrode 12 and
`third electrode 17. First electrode 11 and second electrode 12
`are charged to a first electrical potential while third electrode
`17 is charged to a second electrical potential. As current
`flows through tissue 13. coagulation regions 15 are formed
`The arrangement of electrodes in the end effector of FIG. 2
`confines the current paths and thus. coagllation regions 14
`to the space between first insulator 16 and second insulator
`18.
`
`SUMMARY OF THE INVENTION
`
`A surgical device according to the present invention
`includes a bipolar coagulation device which may be used to
`grasp and treat tissue and may further include a cutting
`element to cut the treated tissue. In one embodiment of the
`present invention. an end efiector of an electrosurgical
`device includes first and second clamping elements arranged
`
`7
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`5,674,220
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`3
`such that tissue may be clamped between the first and second
`elements.
`In this embodiment.
`the clamping elements
`include at least one opening in the side of the electrode. In
`a further embodiment of the present invention. multiple
`openings are arranged in the side of the end efiector. In a
`further embodiment of the present invention. the end effector
`includes multiple openings in the side of each jaw of the end
`effector along with a first knife channel in the first clamping
`surface and a second knife channel in the second clamping
`surface. In a further embodiment of the present invention.
`the openings extend into the knife channel.
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`The novel features of the invention are set forth with
`particularity in the appended claims. The invention itself.
`however. both as to organization and methods of operation.
`together with further objects and advantages thereof. may
`best be understood by reference to the following description.
`taken in conjunction with the accompanying drawings in
`which:
`
`FIG. 1 is a simplified cross-section of a bipolar end
`effector without external insulation.
`
`FIG. 2 is a simplified cross-section of a bipolar end
`efiector utilizing compression zone technology.
`FIG. 3 is simplified cross-section of one embodiment of
`a bipolar end effector according to the present invention.
`FIG. 4 is an elevated side view of a bipolar clamping.
`cutting and coagulating device including an end etfector
`according to the present invention;
`FIG. 5 is a perspective exploded view of one embodiment
`of a bipolar end efiector according to the present invention.
`FIG. 6 is a top view of the bipolar end efl"ector illustrated
`in FIG. 5 as it grasps tissue.
`FIG. 7 is a perspective view of a bipolar end effector
`including openings according to the present invention.
`FIG. 8 is a side view of a bipolar end effector including
`openings according to the present invention.
`FIG. 9 is a perspective View of a portion of the topjaw of
`an end efiector according to the present invention.
`DETAILED DESCRIFFION OF THE
`INVENTION
`
`In the simplified cross-section of an end elfector accord-
`ing to the present invention illustrated in FIG. 3. tissue 23 is
`grasped between first elecuode 21 and second electrode 22.
`In end eifector 10. an electrical potential or voltage is
`generated between electrode 21 and second electrode 22.
`Thus when an electrically conductive material such as
`organic tissue is grasped by the end etfector. electrical
`current flows between first electrode 21 and second elec-
`trode 22. In FIG. 3. insulators 26 and 28 cover substantially
`all of the outer surface of first electrode 21 and second
`electrode 22 respectively confining a substantial portion of
`the current path 24 to the region between first electrode 21
`and second electrode 22. A small portion of the electrical
`current flows through tissue 23 in the region outside elec-
`trode 21 and electrode 22. coagulating the tissue and pro-
`viding the surgeon with visible evidence of coagulation.
`Thus.
`the coagulated region around the outside of end
`efiector 10 may be refereed to as the feedback region since
`the thermal spread in this region provides the surgeon with
`visible evidence of coagulation.
`In the embodiment illustrated in FIG. 3. insulation layer
`26 covers substantially all of the outer surface 32 of elec-
`trode 21. leaving only a small region 29 of outer surface 32
`exposed and electrically conductive. Region 29 may be
`
`4
`referred to as an outer electrode. Insulation layer 28 covers
`substantially all of the outer surface 34 of electrode 22.
`leaving only a small region 39 of outer surface 34 exposed
`and electrically conductive. In the embodiment illustrated in
`FIG. 3. outer electrode 29 is located adjacent the interface
`between outer surface 32 and tissue grasping surface 27. The
`region adjacent the interface between outer surface 32 and
`tissue grasping surface 27 may be referred to as the transi-
`tion region. In the embodiment illustrated in FIG. 3. outer
`electrode 39 is located adjacent the interface between outer
`surface 34 and tissue grasping surface 36. The region of
`outer surface 34 adjacent tissue grasping surface 36 may be
`referred to as the transition region. More generally. as used
`herein. the transition region refers to any portion of the jaw
`around the interface between the outer face of an electrode
`and the tissue grasping surface. Tissue 23 conducts current
`between electrodes 21 and 22. generating coagulation region
`25. Since insulators 26 and 28 do not cover the entire outer
`surface 32 and 34 of conductors 21 and 22 respectively.
`leaving outer electrodes 29 and 39. a small por11'on of the
`current will flow outside the region between grasping sur-
`faces 27 and 36. coagulating tissue outside that region and
`providing visual confirmation of coagulation. The size and
`shape of the feedback region may be varied by varying the
`portion of outer stnface 32 and 34 which are not covered by
`insulative coating i.e. by varying the size and location of
`outer electrodes 29 and 39. Where necessary. shorting may
`be prevented by. for example. including an island of insu-
`lation on the grasping surface 27 or 36 of either electrode 21
`or 22 to establish an insulative gap between the conductive
`surfaces. However. the grasped tissue will generally prevent
`shorting of the electrodes during treatment and. once the
`tissue is treated it may not be necessary or desirable to
`prevent the electrodes from shorting.
`FIG. 4 is a perspective view of a bipolar forceps 410
`according to the present invention. In bipolar forceps 410.
`upper jaw 416 and lower jaw 417 of end effector 412 are
`supported by upper wire form 414 and lower wire form 415.
`Wire forms 414 and 415 also act as conductors supplying
`bipolar electrical energy to upper jaw 416 and lowerjaw 417
`respectively. Tissue stop 418 is positioned within closure
`tube 420. Rotation knob 422 is aflixed to closure tube 420
`to cause rotation of closure tube 420 with respect to handle
`426. Handle 426 includes knife button 424. grip 428 and
`trigger 430. Electrical cord 434 is connected to handle 426
`through strain relief 432. Trigger latch 436 is positioned on
`trigger 430. Handle latch shield 438 is positioned on grip
`428.
`FIG. 5 is an exploded view of one embodiment of a
`bipolar end effector according to the present invention. As
`illust:rated in FIG. 5. jaw members 116 and 117 include
`electrodes 147 and 148 respectively. which include tissue
`grasping surfaces 118 and 119 respectively. Top jaw 116 and
`bottom jaw 117 are arranged to grasp or position tissue
`therebetween. law members 116 and 117 include an outer
`electrically insulative coating 146 and 156 of. for example.
`a ceramic material. Closure tube 115 is adapted to close the
`jaws 116 and 117 together as tube 115 is advanced distally.
`Jaw member 116 includes a U-shaped insulator 134 formed
`on the inside of electrode 147. Jaw member 117 includes a
`U~shaped insulator 164 formed on the inside of electrode
`148. The upper half 120 of groove or knife channel 143 is
`lined by insulator 134. The lower half 121 of groove of lmife
`channel 143 is insulated by insulator 164. Insulators 146 and
`156 are arranged so that when tissue is grasped andjaws 116
`and 117 are closed together. a portion of the external surface
`of electrodes 147 and 148 is exposed. The exposed portion
`of the outer surface of electrode 147 forms outer electrode
`170. The exposed portion of the outer surface of electrode
`148 forms outer electrode 172. Outer electrode 170 is
`formed in the transition region at the interface between the
`
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`5 674,220
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`5
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`outer surface of electrode 147 and tissue grasping surface
`118 while outer electrode 172 is formed in the transition
`region at the interface between the outer surface of electrode
`148 and tissue grasping surface 119. The size and shape of
`outer electrodes 170 and 172 may be adjusted by selectively
`depositing more or less insulation in the transition regions of
`electrodes 147 and 148 respectively. Control of the size and
`shape of the feedback region in treated tissue may be
`achieved. at least in part. by controlling the size and shape
`of the outer electrodes for example. by controlling the size
`and shape of outer electrodes 170 and 172. For the purposes
`of this application. outer electrodes may also be referred to
`as feedback or thermal spread electrodes. The distal end 144
`and 145 of jaw member 116 has an inwardly angled shape.
`The inwardly angled distal ends 144 and 145 form a
`V-shaped space at the distal end jaws 116 and 117. which
`assists in channeling tissue in between jaws 116 and 117.
`In FIG. 5. knife 122 is adapted to cut tissue by moving
`distally in knife channel 143 when jaws 116 and 117 are
`closed to grip tissue. Knife 122 includes upper knife section
`123 and lower knife section 124. Upper knife section 123
`includes sharpened blade 125 at the distal end of upper knife
`section 123. Lower knife section 124 includes sharpened
`blade 126 at the distal end of the lower knife section 124.
`FIG. 6 is a top view of the end effector illustrated in FIG.
`5. In FIG. 6. upper jaw 116 of end effector 610 grasps tissue
`198. As electrical current flows through the tissue. insulator
`146 prevents current from flowing except where the elec-
`trode is exposed (e.g. between the tissue grasping electrodes
`and through the outer electrodes). An area of tissue 197
`surrounding the end effector is illustrated in which desicca-
`tion of and/or thermal effects on the tissue may be visual-
`ized. Region 197 may be referred to as the feedback region.
`FIG. 7 is a perspective view of a straight bipolar end
`efiector 210 without insulation. End etfector 210 comprises
`upper jaw electrode 216 and lower jaw electrode 217.
`Electrodes 216 and 217 include tissue grasping teeth 206
`and 208 respectively. Tissue grasping teeth 206 are disposed
`on at least a portion of upper tissue grasping surface 218.
`Tissue grasping teeth 208 are disposed on at least a portion
`of lower tissue grasping surface 219. In the embodiments of
`FIG. 7. grasping teem 206 and 208 are chamfered such that
`outer faces 22 slant in toward the center of end effector 210.
`In other embodiments of the present invention. outer surface
`faces 222 may have a radius rather than a chamfer. In other
`embodiments of the present invention. outer faces 222 may
`be parallel to or a continuation of outer surfaces 232 and
`234. In FIG. 7. jaws 216 and 217 include openings 280.
`Openings 282 are interspersed along the length of jaws 216
`and 217. I-Ioles such as holes 280 perform at least three
`functions in an end effector such as the end etfector illus-
`trated in FIG. 7. Openings 280 may be used to observe the
`tissue clamped between jaws 216 and 217. Alternatively.
`openings 280 may be used to observe the position of a
`cutting element. such as the knife illustrated in FIG. 5. as it
`moves along channel 282 whenjaws 216 and 217 are closed.
`Openings 280 reduce the physical and thermal mass ofjaws
`216 and 217. Reducing the thermal mass of the jaws reduces
`the jaws ability to absorb heat generated in the treated tissue.
`thus increasing coagulation speed which may. in certain
`circumstances. improve the performance of the end effector.
`In the embodiment of FIG. 7. U-shaped electrodes 216 and
`217 have a substantially rectangular cross section. The use
`of a substantially rectangular cross section improves the
`structural strength of the jaws and. as a result. the clamping
`force which may be applied to the jaws. The rectangular
`cross section of the jaw improves shielding of a knife blade
`as it moves along channel 282.
`
`5
`
`6
`FIG. 8 is a side view of a bipolar end etfector 810
`including openings 880. In FIG. 8. upper jaw 816 and lower
`jaw 817 include material covering the knife channel such
`that the knife motion is only observed through openings 880.
`FIG. 9 is a perspective view of a portion of a further
`embodiment of an end etfector 910 including openings 980
`according to the present invention. In FIGS. 8 and 9. the
`openings perform multiple functions. including. providing
`visual access to the knife as it moves through the knife
`channel 882 and 982 respectively. providing visual access to
`tissue gripped by the end etfector and. by removing material.
`thus reducing physical and thermal mass of the end effector
`without compromising the structural integrity of the end
`etfector. The openings in the end effectors illustrated in
`FIGS. 7-9 are substantially evenly spaced to provide
`improved visual access and to improve observability at the
`knife as it travels down the knife channel. Since there may
`be no need to include openings in certain portions of the end
`effector. it may not be desirable to have all of the openings
`evenly spaced.
`While preferred embodiments of the present invention
`have been shown and described herein. it will be obvious to
`those skilled in the art that such embodiments are provided
`by way of example only. Numerous variations. changes. and
`substitutions will now occur to those skilled in the art
`without departing from the invention. For example. while all
`of the embodiments illustrated and described herein include
`round openings. one skilled in the art would recognize that
`openings of any shape including square. rectangular. oblong
`or any other shape would fall within the scope of applicants
`invention. Accordingly. it is intended that the invention be
`limited only by the spirit and scope of the appended claims.
`What is claimed is:
`1. A bipolar electrosurgical instrument comprising.
`an end effector located at a distal end of the instrument.
`said end elfector comprising:
`first tissue grasping element including an exterior surface.
`a channel therethrough and a plurality of openings
`through said exterior surface to said channel; and
`second tissue element including an exterior surface. a
`channel
`therethrough and a plurality of openings
`through said exterior surface to said channel; and
`a cutting element operalively coupled to said electrosur-
`gical
`instrument and adapted to move through said
`channels and arranged to cut tissue positioned between
`said first and second tissue grasping surfaces.
`2. A bipolar electrosurgical instrument comprising:
`an end effector located at the distal end of the instrument
`said end effector comprising:
`including a plurality of
`first
`tissue grasping element
`openings in an exterior surface of said time element
`wherein said plurality of openings are arranged to
`connect said first exterior surface to a channel in said
`end elfector;
`
`second tissue grasping element including a plurality of
`openings in an exterior surface of said second element
`wherein said plurality of openings are arranged to
`connect said second exterior surfaces to a channel in
`said end efiector; and
`a knife operatively coupled to said electrosurgical instru-
`ment and adapted to move within said channel and
`arranged to cut tissue positioned between said first and
`second tissue grasping elements.
`*
`*
`=0‘
`*
`ll<
`
`9