`United States Patent
`Eggers
`
`[19]
`
`1|||||IllllllllllllllllllllllllllllllIllllllllllllllllllllllllllllIllllllll
`USOO5330471A
`[11] Patent Number:
`[45] Date of Patent:
`
`5,330,471
`Jul. 19, 1994
`
`[54] BI-POLAR ELECTROSURGICAL
`ENDOSCOPIC INSTRUMENTS AND
`
`5.085.659 2/ 1992 Rydcll -
`5,147,357
`9/1992 Rose et al.
`
`.
`
`METHODS OF USE
`Inventor:
`Philip E. Eggers, Dublin, Ohio
`[75]
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`[21] App1.No.: 877,704
`,
`[22] Filed:
`
`May 1,1992
`
`[63]
`
`Related US. Application Data
`Continuation-in—part of Ser. No. 711,920, Jun. 7, 1991,
`ab3fld0n5d~
`
`Int. Cl.5 .............................................. A613 17/38
`[51]
`[52] US. Cl. ........................................ 606/48; 606/32;
`606/34; 506/39; 505/40; 605/41; 605/45;
`606/49; 606/50
`
`[56]
`
`‘
`
`................. 606/51
`
`................... .. 606/50
`
`Of S8fll'Ch ................ ..
`606/34, 40-41, 48-52, 174, 170, 110-112
`References Cited
`U'S‘ PATENT DOCUMENTS
`659,409 9/1900 Mosher .
`1,586,645
`6/1926 Biemmn .
`1,798,902
`3/1931 Raney .
`3,651,811
`3/1972 Hilderbrant et a1.
`3,685,518
`8/1972 Beurle et a1.
`.
`4,003,380
`1/1977 Wien ..................................... 606/51
`4,128,099 12/1978 Bauer .
`4,232,676 11/1980 Herezog
`,
`’
`,c
`_
`«
`12;
`1/19135 Auth ..................................... 606/40
`4,492,231
`4,643,190 2/1987 Heilnberger '
`4,6552” 4/1987 Tischer _
`.
`4_659_471
`6/1937 Hayashi
`4,671,274 6/1987 Sorochenko .
`4,763,669
`8/1988 Jaeger .
`4,785,807 11/1988 Blanch -
`-
`41319533 4/1989 B"“’°" 5‘ 31-
`4’348’337
`7/1989 Shaw et 3" '
`4’887‘6l2 12/1989 Esser 6' al‘ '
`4,94-4,093
`7/1990 Falk .
`4,977,900 12/1990 Fem-mg at a,_ _
`4,985,030
`1/1991 Melzer et al.
`.
`
`FOREIGN PATENT DOCUMENTS
`0210125
`1/1937 European pat Off.
`_
`034144611/1989 European Pat. Off..
`2355521
`1/1973 France ..................
`2536924 6/1984 France.
`2647683 12/1990 France .
`342619
`7/1971 U.S.S.R..
`575103 1o/1977 U.s.s.R.
`.
`2037167 7/1980 United Kingdom .
`2066104
`8/1981 United Kingdom .
`2161082
`1/1986 Umed Ki“gd°m '
`OTHER PUBLICATIONS
`
`“The Cauitron Bipolar Coagulator”, 1979, Cauitron
`Surgical Systems,
`The Lancet, “New Inventions”, Oct. 24, 1959, J. D. K.
`Burton, pp. 650-651.
`pfovified as [rans]a.
`cf
`Pat. Appln_ 2
`tion of French Pat. Appln. 2 536 924.
`gorspn,
`“Ttfvo new lacparoscopic instmiiiitnts;
`roar s
`1z1n
`oce san uermem 1ua r,
`Mgdical In<.:vtmme§1tat1'0n,I:Io1. 11, Jan.—Feb.a119I7J7.
`0
`.
`.
`Primary Exammer—Randa11 L. Green
`.
`Assistant Examiner——l’. Zuttarelli
`A”0’"€'J’» A89“ 0’ F'""—N1°°1a A- P153110
`TR!
`
`Cr
`ABS
`[57]
`Endoscopic surgical instruments are provided that have
`bipolar electrodes on opposing movable members for
`.
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`passing a high frequency current through tissue for
`Sunu.]a‘a}’:e°"Sl$’a:.':Vef{':;lg ‘:3 manfiulaiunf iheumiue zintd
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`mg material 15 interposed between the movable mem-
`bers so that the electrodes are spaced apart from 0.002
`to 0.050 inches and the current passes between the op-
`posing electrodes through the tissue. Methods of endo-
`scopically achieving hemostasis while simultaneously,
`marupulating and cutting tissue are also provided. Use
`of a constant voltage high frequency power supply to
`deliver current to the tissue to cause hemostasis is de-
`scribed in conjunction with those methods.
`
`27 Claims, 7 Drawing Sheets
`
`ETHICON ENDO-SURGERY, INC.
`
`EX. 1009
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`July 19, 1994
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`BI-POLAR ELECTROSURGICAL ENDOSCOPIC
`INSTRUMENTS AND METHODS OF USE
`
`This application is a continuation-in-part of com-
`monly assigned and copending U.S. patent application
`Ser. No. 07/711,920, filed Jun. 7, 1991 now abandoned.
`This invention relates to hemostatic electrosurgical
`instruments, and particularly to improved bi-polar elec-
`trosurgical instruments for manipulating and causing
`hemostasis of tissue during endoscopic surgical proce-
`dures.
`
`BACKGROUND OF THE INVENTION
`
`the surgeon gains
`In “open” surgical procedures,
`access to work inside the body by cutting large incisions
`through the body wall, then stretching the overlying
`tissue apart to provide visibility and room to manipulate
`his hands and instruments. Vital structures are generally
`held away from the surgical site and shielded from
`instruments by being covered with cloth pads. The
`surgeon can touch and manipulate the tissues. As the
`surgeon manipulates, cuts and dissects tissues, he con-
`trols the resultant bleeding by blotting or suctioning
`away the accumulating blood, enabling him to see the
`bleeding vessels and clamp and tie them off.
`The creation of a large opening in the patient’s body
`tissue greatly increases the risk of surgery to the pa-
`tient’s health, by increasing the probability of complica-
`tions. Those complications can arise not only from
`treatment of the target tissue, i.e., that tissue necessitat-
`ing the surgery, but also from the trauma caused to
`adjacent tissue in creating an opening providing the
`surgeon with access to the target tissue. Once the inter-
`nal tissue is operated upon, the surgeon faces the time-
`consuming task of closing up the surgical site. In addi-
`tion, the patient may require extensive post-operative
`care and an extensive hospital stay.
`Development of the endoscope, a miniaturized televi-
`sion camera that is inserted through a puncture wound
`in the body wall to provide a video image of the inside
`of the body cavity, has enabled surgeons to perform
`surgery using specially designed surgical instruments
`that are inserted through other small puncture wounds.
`Some previously known devices have been constructed
`that enable a surgeon to operate on internal tissue while
`viewing manipulation of the instrument through an
`endoscope. One such device is described in Falk, U.S.
`Pat. No. 4,994,024. Such previously known endoscopic
`instruments have several disadvantages, especially the
`inability to effectively stem blood flow from incised
`tissue.
`Endoscopic surgery no longer requires cutting a
`large gaping incision through the body wall, and per-
`mits patients to undergo some major surgeries practi-
`cally pain-free, with little or no post-operative hospital
`stay. However, in performing endoscopic surgery the
`surgeon forgoes manual access to the tissues being oper-
`ated upon. In doing so, he gives up his traditional means
`of controlling bleeding by clamping and tying off tran-
`sected blood vessels. Consequently, in endoscopic sur-
`gery it is important that tissues that are cut must not
`bleed.
`
`I-lemostatic surgical techniques are known for reduc-
`ing the bleeding from incised tissue during open surgical
`procedures, i.e., where overlying body tissue is severed
`and displaced to gain access to internal organs. Such
`techniques include electrosurgery,
`that is, passing a
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`high frequency or radio frequency current through the
`patient’s tissue between two electrodes for cutting and
`coagulating the blood vessels contained within the tis-
`sue. The current passing through the tissue causes jou-
`lean (ohmic) heating of the tissue as a function of the
`current density and the resistance of the tissue through
`which the current passes. This heating dehydrates the
`tissues and denatures the tissue proteins to form a coag-
`ulum which seals bleeding sites, so that the body’s own
`collagen is reformed as a glistening white layer on the
`cut surface, sealing the tissues against bleeding.
`Heretofore, endoscopic electrosurgical
`techniques
`have been limited primarily to monopolar devices. Pre-
`viously known monopolar electrosurgical instruments
`employ a small electrode at the end of a handle in the
`surgeon’s hand and a large electrode plate beneath and
`in contact with the patient. Only one of the two elec-
`trodes required to complete the electrical circuit is ma-
`nipulated by the surgeon and placed on or near the
`tissue being operated on. The other electrode is the
`large plate beneath the patient. A power supply im-
`presses high frequency voltage spikes of thousands of
`volts between the two electrodes of the electrosurgical
`instrument, sufficient to cause arcing from the small
`operating electrode the surgeon holds to the most proxi-
`mate tissues, then through the patient to the large elec-
`trode plate beneath the patient. In the patient, the elec-
`trical current becomes converted to heat; hottest in the
`tissues immediately below the small hand-held elec-
`trode where the currents are most concentrated. De-
`vices, such as the forceps Model No. A5261, and elec-
`trode Model No. A5266, available from Olympus Cor-
`poration Medical Instrument Division, Milpitas, Calif.,
`are representative of such monopolar instruments.
`A principal disadvantage of monopolar electrocau-
`tery is that current flows completely through the pa-
`tient. These high voltage electrical currents may arc
`from the small electrode to nearby non-targeted vital
`structures, or may follow erratic paths as they flow
`through the patient’s body, thereby causing damage to
`tissues both near and at some distance from the elec-
`trode.
`
`While monopolar devices have proven useful in open
`surgical procedures, where the surgeon is able to view
`the effects of the current are, the problems encountered
`in open surgical procedures become even more impor-
`tant in endoscopic surgical applications. In particular,
`when using a monopolar device endoscopically, the
`surgeon’s view of the electric are generated by the
`instrument is restricted by the limited field of view
`provided by the endoscope. Consequently, aberrant
`current arcs—the existence of which the surgeon may
`not even be aware—can cause deep tissue necrosis and
`inadvertent damage to adjacent tissue masses.
`The foregoing limitation has proved especially dan-
`gerous for surgeries performed in the abdomen, and in
`the vicinity of the peritonea and bowel wall. Practical
`experience has established that aberrant current arcs
`generated by endoscopic monopolar devices can cause
`perforation of the adjacent bowel wall when used on
`abdominal tissue masses. While such damage typically is
`not apparent to the surgeon during the procedure, it
`may later be manifested as peritonitis, which results in
`death in as many as 25% of all such cases.
`Bipolar electrosurgical devices for open surgical pro-
`cedures are known to enable the surgeon to obtain he-
`mostasis in precise local areas without also heating and
`causing undesirable trauma to adjacent tissue. Bipolar
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`5,330,471
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`devices have two electrodes closely spaced together so
`that current flow is confined to the tissue disposed be-
`tween the electrodes. Heretofore, such instruments
`have had limited use in endoscopic applications because
`of the inherent problem of electrically isolating the high
`voltage electrodes while providing an instrument small
`enough for use with conventional trocar tubes—typi-
`cally 5 to 10 mm in diameter. One such device is de-
`scribed in Tischer U.S. Pat. No. 4,655,216. The compli-
`cated structure of the device described in that patent
`illustrates the difficulty encountered in providing the
`requisite isolation of the electrodes. A second such
`device is the Olympus Model 05127 bipolar endoscopic
`forceps, available from Olympus Corporation Medical
`Instrument Division, Milpitas, Calif.
`in all previously
`A further disadvantage inherent
`known monopolar and bipolar electrosurgical devices is
`that of coagulum buildup on the working surfaces of the
`device. Previously known power supplies used in elec-
`trosurgical applications have generally provided high
`voltage-low current power outputs, which poorly
`match the impedance of the tissue over the range of
`conditions typically encountered in electrosurgery.
`This mismatch, in combination with the arcing charac-
`teristic of previously known instruments, leads to char-
`ring of the tissue and excessive coagulum buildup on the
`instrument surfaces.
`
`Yet another difficulty encountered in endoscopic
`surgery is the limited range of motion available to the
`surgeon at the surgical site. In particular, because of the
`relatively small incision through which the instruments
`are inserted for endoscopic procedures, the surgeon’s
`range of movement of the instrument
`is greatly re-
`stricted.
`It would therefore be desirable to provide bipolar
`electrosurgical instruments for hemostatically severing
`or manipulating tissue in endoscopic surgical proce-
`dures that overcome these disadvantages of such previ-
`ously known instruments. Such instruments would en-
`able a large number of operations to be carried out
`endoscopically, thereby reducing the need and risk of
`open surgical procedures.
`SUMMARY OF THE INVENTION
`
`In view of the foregoing, it is an object of the present
`invention to provide improved endoscopic surgical
`instruments, the existence of which will expand the field
`of endoscopic surgery. In particular, the existence of
`instruments providing heretofore unavailable functions,
`ease of use, and enhanced safety will encourage the
`conversion of a number of surgeries—now carried out
`as open procedures—to endoscopic procedures. Such
`conversion from open to endoscopic surgeries will re-
`duce the risk of surgery to the patient, reduce the
`trauma to adjacent tissue from the surgery, and enable
`faster post-operative recovery.
`It is, therefore, an object of this invention to provide
`bipolar electrosurgical instruments for endoscopic sur-
`gical procedures that have a simple structure, yet pro-
`vide the necessary electrical isolation of the bipolar
`electrodes. The bipolar devices constructed in accor-
`dance with the present invention confine current flow
`to the tissue immediately adjacent to the electrodes of
`the instrument. Thus, these devices significantly reduce
`the likelihood of creating aberrant current arcs that can
`perforate the peritonea or other adjacent tissue. The
`overall safety of endoscopic procedures is thereby en-
`
`4
`hanced, permitting a larger number of surgeries to be
`performed endoscopically.
`It is another object of the present invention to pro-
`vide bipolar endoscopic instruments which experience
`little sticking or coagulum buildup during extended use.
`In accordance with the present invention, endoscopic
`bipolar instruments are employed in conjunction with
`power supplies providing load-independent substan-
`tially constant voltage output. Voltage and current
`ranges are provided that significantly reduce coagulum
`buildup and charting of tissue.
`It is another object of this invention to provide bipo-
`lar electrosurgical instruments that provide the surgeon
`with a high degree of maneuverability of the instrument
`once it is located at the surgical site. The instrument
`constructed in accordance with the principles of this
`invention therefore includes means for rotating the
`working end of the instrument while it is positioned at
`the surgical site.
`These and other objects are accomplished in accor-
`dance with the principles of the present invention by
`providing bipolar electrosurgical instruments having an
`elongated barrel for insertion through a trocar tube at
`the patient’s skin, a working end disposed on the distal
`end of the elongated barrel, and handle members for
`actuating the instrument. Means are provided near the
`proximal end of the barrel for rotating the working end
`of the instrument. The instrument includes means for
`connecting the instrument to a power supply to ener-
`gize the electrodes at the working end.
`Bipolar instruments constructed in accordance with
`the present invention have a working end that com-
`prises bipolar electrodes and movable members capable
`of performing any of a number of functions. A layer of
`insulation is provided on one or both of the mating
`surfaces of the movable members to maintain electrical
`isolation of those components. A working end con-
`structed in accordance with the present invention may
`comprise a scissors-like cutting instrument which simul-
`taneously causes hemostasis of tissue and mechanically
`severs that tissue in a continuous manner, a dissector-
`like instrument for grasping and achieving hemostasis of
`tissue, or a dissector for blunt dissection, which hemo-
`statically separates tissue.
`In a first embodiment, the movable members of the
`working end comprise scissor members having oppos-
`ing mating surfaces. Electrodes associated with the
`scissor members conduct high frequency current to
`tissue to coagulate the blood vessels extending through
`the tissue while cutting edges of the scissor members
`mechanically sever the tissue. A layer of insulating
`material is disposed on at least one of the mating sur-
`faces of the scissor members so that the electrically
`active portions of the scissor members do not contact
`each other at any point during operation of the instru-
`ment. Thus, current flows through tissue between the
`scissor members, but short circuits, which would termi-
`nate hemostasis, do not occur. With this arrangement,
`hemostasis and cutting occurs in a continuous manner
`along tissue disposed between the scissor members,
`thereby providing a smooth and precise surgical cut.
`Another embodiment of the invention comprises an
`endoscopic hemostatic dissector, wherein the movable
`members comprise opposing jaws for simultaneously
`grasping and causing hemostasis of the tissue. Like the
`first embodiment, the jaw members include shank por-
`tions forming opposing mating surfaces. A layer of
`insulating material is disposed on at least one of these
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`5,330,471
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`mating surfaces so that electrically active portions of
`the members do not contact each other during opera-
`tion of the instrument.
`The movable members of either embodiment may be
`curved so that the tips of the members lie in a plane
`parallel to, and separate from, the longitudinal axis of
`the elongated barrel. This feature enhances the sur-
`geon’s view of the working end of the instrument,
`thereby providing greater precision in manipulating the
`tissue at the operative site.
`The present invention also includes methods of endo-
`scopically using bipolar electrosurgical instruments to
`simultaneously grasp or mechanically sever tissue while
`thermally reforming the collagen of the tissue to seal the
`tissue against bleeding. For endoscopically performing
`surgery on a patient’s internal tissue using a bipolar
`electrosurgical instrument in combination with a power
`supply having a selectable substantially constant volt-
`age load-independent output, the instrument having an
`elongated barrel, a working end comprising electrodes,
`and means for actuating the working end, the methods
`include the steps of:
`(a) connecting the electrodes of the bipolar electro-
`surgical instrument to the power supply;
`(b) incising the patient’s tissue with a trocar or similar
`device to create a small opening;
`(c) inserting the working end and elongated barrel of
`the bipolar electrosurgical instrument through a trocar
`tube so that the working end is disposed proximal to the
`internal tissue; and
`((1) operating the actuating means to simultaneously
`manipulate and cause hemostasis of the tissue.
`Further steps of the methods include the step of set-
`ting the power supply to provide a voltage across the
`electrodes in the range of 10 to 120 volts (RMS) and a
`frequency in the range of 100 kHz to 2 MHz. The meth-
`ods further include the use of altemating-current volt-
`age waveforms having a crest factor—ratio of peak
`voltage to root-mean-square (RMS) voltage—near
`unity.
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`The above and other objects and advantages of the
`invention will be apparent upon consideration of the
`following detailed description,
`taken in conjunction
`with the accompanying drawings, in which like refer-
`ence numerals refer to like parts throughout, and in
`which:
`
`FIG. 1 is an elevated perspective view of an illustra-
`tive embodiment of the instrument of the present inven-
`tion;
`FIG. 2 is an elevation cross-sectional side view of the
`instrument taken along the line 2-2 of FIG. 1, in which
`an intermediate portion of the elongated barrel has been
`omitted for clarity;
`FIG. 3 is an exploded perspective view of the work-
`g end of the instrument taken along line 3-3 of FIG.
`
`1;
`
`FIG. 4 is an exploded perspective view, similar to
`FIG. 3, of an alternate embodiment of the working end
`of the instrument;
`FIGS. 5A and 5B show, respectively, open and
`closed enlarged cross-sectional views of the working
`end of the instrument shown in FIG. 2;
`FIG. 6 is a cross-sectional view of an alternate em-
`bodiment of the scissors-like working end of the present
`invention;
`
`6
`FIGS. 7A and 7B, respectively, are cross-sectional
`views, similar to FIGS. SA and SB, showing a dissector
`embodiment of the working end of the present inven-
`tion; and
`FIG. 8 is a plan view of an alternate embodiment of
`the dissector embodiment of the present invention.
`DETAILED DESCRIPTION OF THE
`INVENTION
`
`Referring to FIGS. 1 and 2, a bipolar electrosurgical
`instrument 10 for performing endoscopic surgical pro-
`cedures is described. While an instrument constructed
`in accordance with the principles of the present inven-
`tion may include any of a variety of severing or grasp-
`ing members at its working end 11, the illustrative em-
`bodiment of FIGS. 1 and 2 includes scissor-like shearing
`members for simultaneously severing and causing he-
`mostasis of a patient’s tissue.
`Instrument 10 includes actuating means comprising
`handle members 12 and 13 joined for relative movement
`at pivot 14, tubular elongated barrel 15, and working
`end 11. Drive rod 16 disposed in elongated barrel 15 has
`electrical terminals 17 that are connected to movable
`members 18 and 19 of working end 11 to provide an
`electrical potential therebetween.
`Handle member 12 has a pistol-like configuration,
`including a body portion 20 having a longitudinal bore
`21 and a portion defuiing a hole for one or more fingers.
`Handle member 12 may be made of a light-weight rigid
`material, for example cast aluminum. Elongated barrel
`15 comprises a tube having a proximal end mounted in
`body portion 20 and a distal portion forming part of
`working end 11. The proximal end of elongated barrel
`15 is mounted in bore 21 of body portion 20 so that
`elongated barrel 15 can be rotated about its longitudinal
`axis. Elongated barrel may consist of a rigid structural
`material, for example a stainless steel alloy, e.g., SS 304,
`and may include a coating of abherent material, such as
`Teflon, on its exterior surface.
`Knurled rotation knob 22 is mounted on a portion of
`elongated barrel 15 disposed in body portion 21, so that
`it projects through slots 23 intersecting bore 21 of body
`portion 20. Rotation of knurled knob 22 causes elon-
`gated barrel 15 to rotate about its longitudinal axis,
`thereby also rotating working end 11.
`Body member 20 has bore 24 communicating with
`bore 21 so that set screw 25 disposed in bore 24 engages
`elongated barrel 15 substantially perpendicularly to the
`longitudinal axis of the barrel. Set screw 25 has locking
`knob 26 at one end and teat 27 at the other end to en-
`gage elongated barrel 15. Rotation of locking knob 26
`may i.mpose a load on elongated barrel 15 to establish a
`threshold torque for rotating knurled rotation knob 22.
`Alternatively, locking knob 26 may be rotated so that
`teat 27 of set screw 25 effectively locks elongated barrel
`15 in a given angular orientation, and against further
`rotation.
`.
`
`Handle member 13 has a lower portion defining a
`finger or thumb hole and an upper portion 28 having
`longitudinal bore 29. Longitudinal bore 29 aligns with
`longitudinal bore 21 in body portion 20 of handle mem-
`ber 12 when handle members 12 and 13 are joined for
`relative movement at pivot 14. Handle member 13 com-
`prises a similar material as handle member 12, e.g., a cast
`aluminum alloy.
`Drive rod 16 has a proximal end 30 disposed within
`elongated barrel 15 and a distal end 31 engaged with
`working end 11. Proximal end 30 of drive rod 16 has
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`electrical terminals 17 projecting from its endface 32,
`and a portion adjacent to endface 31 that defines a semi-
`circular groove 33. Because drive rod 16 has a high
`electrical potential relative to handle members 12 and
`13 when electrical terminals 17 are connected to a 5
`power supply, drive rod 16 is electrically insulated from
`handle member 13 and elongated barrel 15 by a coating
`of electrically insulating material disposed on the exte-
`rior surface of drive rod 16.
`Groove 33 of drive rod 16 is captured in insulating 10
`disk 34 between insulating pins 35. Insulating disk 34
`seats in circular aperture 36 in upper portion 28 of han-
`dle member 13. Insulating disk 34 may comprise a high
`strength plastic, such as, Ultem (a proprietary plastic of
`the General Electric Company, Fort Wayne, Ind., fabri- 15
`cated from polyethermide), or a ceramic material. Lon-
`gitudinal bore 37 extends through insulating disk 34 in
`alignment with longitudinal bore 29 of upper portion
`28, for accepting proximal portion 30 of drive rod 16.
`Insulating disk 34 includes a pair of bores that perpen-
`dicularly intersect bore 37, the pair of bores accepting
`insulating pins 35. Insulating disk 34 is capable of angu-
`lar movement
`in circular aperture 36, when handle
`member 13 rotates relative to handle member 12 about
`pivot 14.
`Insulating pins 35, which may comprise a sturdy
`electrically insulating material such as ceramic or anod-
`ized aluminum, engage groove 33 in drive rod 16 so that
`the drive rod 16 is capable of rotating about its longitu-
`dinal axis, but cannot move transversely with respect to
`insulating pins 35. Accordingly, drive rod 16 is mounted
`to handle member 13 for rotation about its longitudinal
`axis in insulating pins 35 and for transverse motion with
`respect to handle member 12 by virtue of angular move-
`ment of insulating disk 34 in aperture 36.
`Referring now to FIG. 3, a scissors-like embodiment
`of working end 11 is described. The distal end of elon-
`gated barrel 15 has diametrically opposed U-shaped
`slots 38 extending proximally from distal endface 39.
`Apertures 40 in the distal end of elongated barrel 15 are 40
`aligned across the diameter of the barrel to accept insu-
`lating pivot pin 41.
`Proximal end 31 of drive rod 16 comprises semi-cir-
`cular halves 16' each half 16' having an indentation 42
`extending inward from its distal endface 43. Indenta-
`tions 42 of halves 16’ oppose each other to create a slot
`in the distal end of drive rod 16 within which the shanks
`of the movable members of working end 11 are dis-
`posed. Halves 16' have layer 45 of insulating material
`disposed on contacting surfaces 44, so that no current
`passes through those contacting surfaces. Layer 45 of
`insulating material also covers the outer surfaces of
`drive rod halves 16' to provide electrical
`insulation
`between drive rod 16 and elongated barrel 15. No insu-
`lation is provided on the interior surfaces of indenta- 55
`tions 42, so that the interior surfaces of indentations 42
`are in electrical contact with the shanks of the movable
`members. Insulating drive pin 46 extends through aper-
`tures 47 near the endfaces 43 of halves 16’.
`An alternative embodiment of the drive rod is illus-
`trated in FIG. 4, wherein drive rod 16 comprises drive
`member 70 carrying electrode assembly 71. Electrode
`assembly 71 in turn comprises semi-circular electrode
`halves 72 separated by insulating strip 73. Insulating
`strip 73 extends from the distal end of drive member 70
`to a position near the shanks of the movable members to
`form a slot in the end of drive rod 16 for accepting the
`shanks of the movable members of working end 11. The
`
`45
`
`50
`
`60
`
`5,330,471
`
`25
`
`30
`
`8
`inner surfaces of electrode halves 72 need not include a
`layer of insulating material, because insulating strip 71
`serves to electrically isolate the electrode halves from
`each other.
`The outer surfaces of electrode halves 72 are coated
`with an abrasion-resistant electrically insulating mate-
`rial 45' that electrically isolates the electrode halves
`from elongated barrel 15. Insulating material 45’ may
`comprise, for example, Teflon or polyimide. Insulating
`drive pin 46 extends through apertures 47’ located near
`the distal endfaces 43' of the electrode halves, as in the
`previously described embodiment.
`Still referring to FIG. 4, electrode halves 72 are af-
`fixed to either side of insulating strip 73 by insulating
`pins 74. Insulating pins 74 extend through apertures 75
`in electrode halves 72 and apertures 76 in insulating
`strip 73, respectively. Insulating pins may comprise a
`sturdy electrically insulating material, for example, ce-
`ramic or anodized aluminum.
`The proximal end of insulating strip 73 is inserted into
`slot 77 in the distal end of drive member 70. In this
`embodiment, drive member 70, which comprises the
`major portion of drive rod 16, may comprise a sturdy
`electrically insulating material, such as Teflon or nylon.
`Drive member may then be formed, for example by
`extrusion, having two bores 78 to accept electrical con-
`nectors 79 projecting from the proximal faces of elec-
`trode halves 72. Bores 78 may then contain electrical
`leads that connect electrode halves 72 to electrical ter-
`minals 17 projecting from the proximal end of drive rod
`16.
`
`The proximal end of insulating strip 73 is affixed to
`the distal end of drive member 70 by pins 80. Pins 80
`extend through apertures 81, provided for that purpose
`adjacent the slot 77 in drive member 70, and apertures
`82 in insulating strip 73, respectively. Pins 80 comprise
`a sturdy electrically conducting or insulating material,
`inasmuch as pins 80 do not form a part of the electrical
`circuit of instrument 10. Thus, pins 80 may comprise,
`for example, either stainless steel or alumina.
`For the illustrative embodiment shown in FIGS. 1-5,
`working end 1] of instrument 10 includes first and sec-
`ond members 18 and 19. First and second members 18
`and 19 comprise scissor halves pivotally connected by
`insulating pivot pin 41. Tube insulator halves 48 are
`disposed adjacent to the exterior surfaces of members 18
`and 19 to electrically insulate those members from elon-
`gated barrel 15. Insulating pivot pin 41 has its ends flush
`with the outer surface of elongated barrel 15 and ex-
`tends, from side to side, through a first tube insulator
`half 48, members 18 and 19, and a second tube insulator
`half 48.
`Insulating pivot pin may comprise an electrically
`insulating metallic pin, e.g., anodized aluminum, having
`its ends deformed by peening. Alternatively, insulating
`pivot pin 41 may comprise a rod-like member having a
`threaded recess at either end to accept a screw. The
`screws engage the threaded recesses and permit an
`adjustable compressive load to be applied to elongated
`barrel 15, and hence members 18 and 19.
`Members 18 and 19 include, respectively, shearing
`surfaces 50 and 60, cutting edges 51 and 61, exterior
`surfaces 52 and 62, apertures 53 and 63, and shank por-
`tions 54 and 64. A thin layer 49 of insulating coating is
`provided on one or both of the opposing mating sur-
`faces of members 18 and 19, including one or both of the
`shearing surfaces 50 and 60, and one or both of the
`mating surfaces of the shank portions 54 and 64.
`
`12
`
`
`
`5,330,471
`
`10
`ohm. The interior surfaces of indentations 42 and the
`exterior surfaces of shank portions 54 and 64 may be
`gold plated to reduce the sliding electrical contact resis-
`tance.
`
`Accordingly, the electrical circuit energizing each
`bipolar electrode extends from electrical terminals 17
`on the proximal portion 30 of drive rod 16, through
`halve 16’ of drive rod 16 to proximal portion 31 of halve
`16'. The outwardly disposed shank portion of the re-
`spective members 18 and 19 are in sliding electrical
`contact with the interior surfaces of indentations 42 of
`each of drive rod halves 16', thereby providing a volt-
`age potential across the tissue contacting portions of
`working end 11. Insulating layer 45 (or insulating strip
`73 of the embodiment of FIG. 4) electrically isolates
`halves 16’ (or electrode halves 72), while layer 49 of
`insulating material on one or both of members 18 and 19
`electrically isolates those members, as described hereto-
`fore.
`
`9
`Members 18 and 19 are configured to constitute the
`individual electrodes of a bipolar electrode instrument,
`as described in copending and commonly assigned U.S.
`patent application Ser. No. 07/877,703 filed May 1,
`1992 the disclosure of which is incorpo
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