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`US005766170A
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`United States Patent
`
`Eggers
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`
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`[191
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`[54]
`
`
`ELECTROSURGICAL ENDOSCOPIC
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`INSTRUMENTS AND METHODS OF USE
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`[75]
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`Inventor: Philip E. Eggers. Dublin. Ohio
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`[73]
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`Assignee: Hemostatic Surgery Corporation.
`Sausalito. Calif.
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`[*1
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`
`Notice:
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`The term of this patent shall not extend
`
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`beyond the expiration date of Pat. No.
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`5.484.436.
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`
`[21]
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`[22]
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`Appl. No.:
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`Filed:
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`778,510
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`Jan. 3, 1997
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`[11]
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`Patent Number:
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`[45] Date of Patent:
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`5,766,170
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`*Jun. 16, 1998
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`4,887,612
`
`4,944,093
`
`4,977,900
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`4,985,030
`
`5,009,656
`
`5,085,659
`
`
`5,147,357
`
`5,423,809
`
`
`12/1989
`
`7/1990
`
`l?Jl990
`
`1/1991
`
`
`4/1991
`
`2/1992
`
`9/1992
`
`6/1995
`
`
`.
`
`
`Esser et al.
`
`Falk .
`
`Fdiling .
`
`Mclz/er et a1.
`
`Reimels .
`
`Rydell .
`
`.
`Rose et a1.
`
`
`Klicek ....................................... 606/45
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`.
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`FOREIGN PATENT DOCUMENTS
`
`
`1/ 1978
`2355521
`
`
`7/1972
`342617
`
`
`575103 10/1977
`
`
`2037167
`7/1980
`
`
`2066104
`7/1981
`
`
`2161082
`1/1986
`
`
`
`France .
`
`U.S.S.R. .
`
`U.S.S.R. .
`
`United Kingdom .
`
`United Kingdom .
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`United Kingdom .
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`[5 1]
`[52]
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`[5 3]
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`[5 6]
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`
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`Related U.S. Application Data
`
`
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`
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`OI‘HER PUBLICATIONS
`
`
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`Continuation of Ser. No. 257,065, Jun. 9, 1994, abandoned,
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`which is a continuation of Ser. No. 877,704, May 1, 1992,
`Pat. No. 5,330,471. which is a continuation-in-part of Ser.
`
`
`
`
`
`
`No. 711,920, Jun. 7, 1991, abandoned.
`
`
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`
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`
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`Int. Cl.° ..................................................... A6113 17/36
`U.S. Cl. .................................. 606/43; 606/42; 606/46
`
`
`
`
`
`Field or Search ........................................... 606/41-52
`
`
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`
`
`
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`J.D.K. Burton. The Lancet. “New Inventions” pp. 650-651.
`
`
`
`
`
`
`
`
`
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`
`
`Oct. 24. 1959.
`
`
`
`S.L. Corson, ‘Two New Laparoscopic Instruments: Bipolar
`
`
`
`
`
`
`
`Sterilizing Forceps and Uterine Manipulator”. Medical
`
`
`
`
`
`
`Instrumentation. Jan.—Feb. 1977.
`
`
`
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`The Cavitron Bipolar Coagulator. Cavilron Surgical Sys-
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`
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`
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`tems. 1979.
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`.
`
`
`References Cited
`
`
`U.S. PATENT DOCUMENTS
`
`
`Mosher .
`9/1900
`
`
`6/1926
`Bierman .
`
`
`3/1931
`Raney .
`
`
`3/1972
`I-lildebrandt et al.
`
`
`8/1972
`Beurle .
`
`Wien .
`1/1977
`12/1978
`Bauer et al.
`
`
`11/1980
`
`
`Herczog .
`Cosman .
`10/1982
`
`
`Lottick .
`2/1983
`
`
`Auth .
`1/1985
`
`
`2/1987
`I-leimberger .
`
`
`4/1987
`Tlscher .
`
`
`6/1987
`Hayashi .
`
`
`6/1987
`Sorochenko .
`
`8/1988
`laeger .
`
`
`
`11/1988
`Blanch .
`
`
`4/1989
`Bauer et al.
`
`
`7/1989
`Shaw et al.
`
`
`
`.
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`
`
`
`
`.
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`
`.
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`
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`
`
`
`
`Primary Examiner—David M. Shay
`Attorney, Agent, or Firm—Fish & Neave; Nicola A. Pisano
`
`
`
`
`
`
`
`
`[57]
`
`
`
`ABSTRACT
`
`
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`instruments are provided that have
`Endoscopic surgical
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`bipolar electrodes on opposing movable members for pass-
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`ing a high frequency current through tissue for simu1ata—
`neously severing or manipulating the tissue and causing
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`hemostasis of the tissue. An electrically insulating material
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`is interposed between the movable members so that the
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`eleclrodes are spaced apart from 0.002 to 0.050 inches and
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`the current passes between the opposing electrodes through
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`the tissue. Methods of endoscopically achieving hemostasis
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`while simultaneously. manipulating and cutting tissue are
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`also provided. Use of a constant voltage high frequency
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`power supply to deliver current
`to the tissue to cause
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`hemostasis is described in conjunction with those methods.
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`13 Claims, 7 Drawing Sheets
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`659,409
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`1,586,645
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`1 ,798,902
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`3,65 1 ,8 1 1
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`3,685,518
`4,003,380
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`4,128,099
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`4,232,676
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`4,353,371
`4,370,980
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`4,492,231
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`4,643,190
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`4,655,216
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`4,669,471
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`4,671,274
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`4,763,669
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`4,785,807
`4,819,633
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`4,848,337
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` 1Qt'l‘J 'CCl—_'
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`':\......T 5.5
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`73-1 TCCII
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`I9
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`ETHICON ENDO-SURGERY, INC.
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`EX. 1018
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`1
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`

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`U.S. Patent
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`Jun. 16, 1993
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`Sheet 1 of 7
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`5,766,170
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`2
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`U.S. Patent
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`Jun. 16, 1998
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`Sheet 2 of 7
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`5,766,170
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`3
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`U.S. Patent
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`Jun. 16, 1998
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`Sheet 3 of 7
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`5,766,170
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`4
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`U.S. Patent
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`Jun. 16, 1998
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`Sheet 4 of 7
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`5,766,170
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`5
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`

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`U.S. Patent
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`Jun. 16, 1998
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`Sheet 5 of 7
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`5,766,170
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`U.S. Patent
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`Jun. 16, 1993
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`Sheet 6 of 7
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`5,766,170
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`7
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`

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`U.S. Patent
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`Jun. 16, 1993
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`Sheet 7 of 7
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`5,766,170
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`

`
`
`1
`ELECTROSURGICAL ENDOSCOPIC
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`INSTRUMENTS AND METHODS OF USE
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`5,766,170
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`10
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`2
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`include electrosurgery. that is. passing a high frequency or
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`radio frequency current through the patient’s tissue between
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`two electrodes for cutting and coagulating the blood vessels
`contained within the tissue. The current passing through the
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`tissue causes joulean (ohmic) heating of the tissue as a
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`function of the current density and the resistance of the
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`tissue through which the current passes. This heating dehy-
`drates the tissues and denatures the tissue proteins to form a
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`coagulum which seals bleeding sites. so that the body’s own
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`collagen is reformed as a glistening white layer on the cut
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`surface. sealing the tissues against bleeding.
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`Heretofore. endoscopic electrosurgical techniques have
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`been limited primarily to monopolar devices. Previously
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`known monopolar electrosurgical
`instruments employ a
`small electrode at the end of a handle in the surgeon’s hand
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`and a large electrode plate beneath and in contact with the
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`patient. Only one of the two electrodes required to complete
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`the electrical circuit is manipulated by the surgeon and
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`placed on or near the tissue being operated on. The other
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`electrode is the large plate beneath the patient. A power
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`supply impresses high frequency voltage spikes of thou-
`sands of volts between the two electrodes of the electrosur-
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`gical instrument. sufiicient to cause arcing from the small
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`operating electrode the surgeon holds to the most proximate
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`tissues. then through the patient to the large electrode plate
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`beneath the patient. In the patient.
`the electrical current
`becomes converted to heat; hottest in the tissues immedi-
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`ately below the small hand-held electrode where the currents
`are most concentrated. Devices. such as the forceps Model
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`No. A5261. and electrode Model No. A5266. available from
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`Olympus Corporation Medical Instrument Division.
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`Milpitas. Calif.. are representative of such monopolar instru-
`ments.
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`A principal disadvantage of monopolar electrocautery is
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`that current flows completely through the patient. These high
`voltage electrical currents may are from the small electrode
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`to nearby non-targeted vital structures. or may follow erratic
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`paths as they flow through the patient’s body.
`thereby
`causing damage to tissues both near and at some distance
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`from the electrode.
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`While monopolar devices have proven useful in open
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`surgical procedures. where the surgeon is able to view the
`effects of the current arc. the problems encountered in open
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`surgical procedures become even more important in endo-
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`scopic surgical applications. In particular. when using a
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`monopolar device endoscopically. the surgeon’s view of the
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`electric are generated by the instrument is restricted by the
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`limited field of view provided by the endoscope.
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`Consequently. aberrant current arcs—the existence of which
`the surgeon may not even be aware—can cause deep tissue
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`necrosis and inadvertent damage to adjacent tissue masses.
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`The foregoing limitation has proved especially dangerous
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`for surgeries performed in the abdomen. and in the vicinity
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`of the peritonea and bowel wall. Practical experience has
`established that aberrant current arcs generated by endo-
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`scopic monopolar devices can cause perforation of the
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`adjacent bowel wall when used on abdominal tissue masses.
`While such damage typically is not apparent to the surgeon
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`during the procedure.
`it may later be manifested as
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`peritonitis. which results in death in as many as 25% of all
`such cases.
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`Bipolar electrosurgical devices for open surgical proce-
`dures are known to enable the surgeon to obtain hemostasis
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`in precise local areas without also heating and causing
`undesirable trauma to adjacent tissue. Bipolar devices have
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`two electrodes closely spaced together so that current flow
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`This is a continuation of application Ser. No. 08/257065.
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`filed Jun. 9. 1994. entitled BI-POLAR ELECTROSURGL
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`CAL ENDOSCOPIC INSTRU'MENTS AND METHODS
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`OF USE. now abandoned. which is a continuation of Ser.
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`No. O7/877.704 filed May 1. 1992 now U.S. Pat. No.
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`5.330.471. which is a continuation-in-part of commonly
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`assigned and U.S. patent application Ser. No. 07/711920.
`filed Jun. 7. 1991. now abandoned.
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`This invention relates to hemostatic electrosurgical
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`instruments. and particularly to improved bi-polar electro-
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`surgical instruments for manipulating and causing hemosta-
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`sis of tissue during endoscopic surgical procedures.
`BACKGROUND OF THE INVENTION
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`In “open” surgical procedures. the surgeon gains access to
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`work inside the body by cutting large incisions through the
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`body wall. then stretching the overlying tissue apart to
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`provide visibility and room to manipulate his hands and
`instruments. Vital structures are generally held away from
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`the surgical site and shielded from instruments by being
`covered with cloth pads. The surgeon can touch and manipu-
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`late the tissues. As the surgeon manipulates. cuts and dis-
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`sects tissues. he controls the resultant bleeding by blotting or
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`suctioning away the accumulating blood. enabling him to
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`see the bleeding vessels and clamp and tie them off.
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`The creation of a large opening in the patient’s body tissue
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`greatly increases the risk of surgery to the patient’s health.
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`by increasing the probability of complications. T'hose com-
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`plications can arise not only from treatment of the target
`tissue. i.e.. that tissue necessitating the surgery. but also from
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`the trauma caused to adjacent tissue in creating an opening
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`providing the surgeon with access to the target tissue. Once
`the internal tissue is operated upon. the surgeon faces the
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`time-consuming task of closing up the surgical site. In
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`addition. the patient may require extensive post-operative
`care and an extensive hospital stay.
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`Development of the endoscope. a miniaturized television
`camera that is inserted through a puncture wound in the body
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`wall to provide a video image of the inside of the body
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`cavity. has enabled surgeons to perform surgery using spe-
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`cially designed surgical inst1'urnents that are inserted through
`other small puncture wounds. Some previously known
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`devices have been constructed that enable a surgeon to
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`operate on internal tissue while viewing manipulation of the
`instrument
`through an endoscope. One such device is
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`described in Falk. US. Pat. No. 4.994.024. Such previously
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`known endoscopic instruments have several disadvantages.
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`especially the inability to effectively stem blood flow from
`incised tissue.
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`Endoscopic surgery no longer requires cutting a large
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`gaping incision through the body wall. and permits patients
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`to undergo some major surgeries practically pain-free. with
`little or no post-operative hospital stay. However. in per-
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`forming endoscopic surgery the surgeon forgoes manual
`access to the tissues being operated upon. In doing so. he
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`gives up his traditional means of controlling bleeding by
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`clamping and tying olf transected blood vessels.
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`Consequently. in endoscopic surgery it is important that
`tissues that are cut must not bleed.
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`Hemostatic surgical techniques are known for reducing
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`the bleeding from incised tissue during open surgical
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`procedures. i.e.. where overlying body tissue is severed and
`displaced to gain access to internal organs. Such techniques
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`55
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`9
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`5,766,170
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`is confined to the tissue disposed between the electrodes.
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`Heretofore. such instruments have had limited use in endo-
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`scopic applications because of the inherent problem of
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`electrically isolating the high voltage electrodes while pro-
`viding an instrument small enough for use with conventional
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`trocar tubes—typically 5 to 10 mm in diameter. One such
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`device is described in Tischer U.S. Pat. No. 4.655.216. The
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`complicated structure of the device described in that patent
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`illustrates the difliculty encountered in providing the requi-
`site isolation of the electrodes. A second such device is the
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`Olympus Model 05127 bipolar endoscopic forceps. avail-
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`able from Olympus Corporation Medical Instrument
`Division. Milpitas. Calif.
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`A further disadvantage inherent in all previously known
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`monopolar and bipolar electrosurgical devices is that of
`coagulum buildup on the working surfaces of the device.
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`Previously known power supplies used in electrosurgical
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`applications have generally provided high voltage-low cur-
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`rent power outputs. which poorly match the impedance of
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`the tissue over the range of conditions typically encountered
`in electrosurgery. This mismatch. in combination with the
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`arcing characteristic of previously known instruments. leads
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`to charring of the tissue and excessive coagulum buildup on
`the instrument surfaces.
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`Yet another difliculty encountered in endoscopic surgery
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`is the limited range of motion available to the surgeon at the
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`surgical site. In particular. because of the relatively small
`incision through which the instruments are inserted for
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`endoscopic procedures. the surgeon’s range of movement of
`the instrument is greatly restricted.
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`It would thmefore be desirable to provide bipolar elec-
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`trosurgical
`instruments for hemostatically severing or
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`manipulating tissue in endoscopic surgical procedures that
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`overcome these disadvantages of such previously known
`instruments. Such instruments would enable a large number
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`of operations to be carried out endoscopically.
`thereby
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`reducing the need and risk of open surgical procedures.
`SUMMARY OF THE INVENTION
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`In view of the foregoing. it is an object of the present
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`invention to provide improved endoscopic surgical
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`instruments. the existence of which will expand the field of
`endoscopic surgery. In particular. the existence of instru-
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`ments providing heretofore unavailable functions. ease of
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`use. and enhanced safety will encourage the conversion of a
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`number of surgen'es—now carried out as open procedures-
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`to endoscopic procedures. Such conversion from open to
`endoscopic surgeries will reduce the risk of surgery to the
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`patient. reduce the trauma to adjacent
`tissue from the
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`surgery. and enable faster post-operative recovery.
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`It is. therefore. an object of this invention to provide
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`bipolar electrosurgical instruments for endoscopic surgical
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`procedures that have a simple structure. yet provide the
`necessary electrical isolation of the bipolar electrodes. The
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`bipolar devices constructed in accordance with the present
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`invention confine current flow to the tissue immediately
`adjacent to the electrodes of the instrument Thus. these
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`devices significantly reduce the likelihood of creating aber-
`rant current arcs that can perforate the peritonea or other
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`adjacent tissue. The overall safety of endoscopic procedures
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`is thereby enhanced. permitting a larger number of surgeries
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`to be performed endoscopically.
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`It is another object of the present invention to provide
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`bipolar endoscopic instruments which experience little
`sticking or coagulum buildup during extended use. In accor-
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`dance with the present invention. endoscopic bipolar instru-
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`4
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`ments are employed in conjunction with power supplies
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`providing load-independent substantially constant voltage
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`output. Voltage and current ranges are provided that signifi-
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`cantly reduce coagulum buildup and chairing of tissue.
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`It is another object of this invention to provide bipolar
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`electrosurgical instruments that provide the surgeon with a
`high degree of maneuverability of the instrument once it is
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`located at the surgical site. The instrument constructed in
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`accordance with the principles of this invention therefore
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`includes means for rotating the working end of the instru-
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`ment while it is positioned at the surgical site.
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`These and other objects are accomplished in accordance
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`with the principles of the present invention by providing
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`bipolar electrosurgical instruments having an elongated bar-
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`rel for insertion through a trocar tube at the patient’s skin. a
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`working end disposed on the distal end of the elongated
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`barrel. and handle members for actuating the instrument.
`Means are provided near the proximal end of the barrel for
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`rotating the working end of the instrument. The instrument
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`includes means for connecting the instrument to a power
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`supply to energize the electrodes at the working end.
`Bipolar instruments constructed in accordance with the
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`present invention have a working end that comprises bipolar
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`electrodes and movable members capable of performing any
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`of a number of functions. A layer of insulation is provided
`on one or both of the mating surfaces of the movable
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`members to maintain electrical isolation of those compo-
`nents. A working end constructed in accordance with the
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`present
`invention may comprise a scissors-like cutting
`instrument which simultaneously causes hemostasis of tis-
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`sue and mechanically severs that tissue in a continuous
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`manner. a dissector-like instrument for grasping and achiev-
`ing hemostasis of tissue. or a dissector for blunt dissection.
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`which hemostatically separates tissue.
`In a first embodiment.
`the movable members of the
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`working end comprise scissor members having opposing
`mating sinfaces. Electrodes associated with the scissor
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`members conduct high frequency current to tissue to coagu-
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`late the blood vessels extending through the tissue while
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`cutting edges of the scissor members mechanically sever the
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`tissue. A layer of insulating material is disposed on at least
`one of the mating surfaces of the scissor members so that the
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`electrically active portions of the scissor members do not
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`contact each other at any point during operation of the
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`instrument. Thus. crnrent flows through tissue between the
`scissor members. but short circuits. which would terminate
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`hemostasis. do not occur. With this arrangement. hemostasis
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`and cutting occurs in a continuous manner along tissue
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`disposed between the scissor members. thereby providing a
`smooth and precise surgical cut.
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`Another embodiment of the invention comprises an endo-
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`scopic hemostatic dissector. wherein the movable members
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`comprise opposing jaws for simultaneously grasping and
`causing hemostasis of the tissue. Like the first embodiment.
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`the jaw members include shank portions forming opposing
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`mating surfaces. A layer of insulating material is disposed on
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`at least one of these mating surfaces so that electrically
`active portions of the members do not contact each other
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`during operation of the instrument.
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`The movable members of either embodiment may be
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`curved so that the tips of the members lie in a plane parallel
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`to. and separate from. the longitudinal axis of the elongated
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`barrel. This feature enhances the surgeon’s View of the
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`working end of the instrument. thereby providing greater
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`precision in manipulating the tissue at the operative site.
`The present invention also includes methods of endo-
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`scopically using bipolar electrosurgical
`instruments to
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`50
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`simultaneously grasp or mechanically sever tissue while
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`thermally refonning the collagen of the tissue to seal the
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`tissue against bleeding. For endoscopically performing sur-
`gery on a patient’s internal tissue using a bipolar electro-
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`surgical instrument in combination with a power supply
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`having a selectable substantially constant voltage load-
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`independent output.
`the instrument having an elongated
`barrel. a working end comprising electrodes. and means for
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`actuating the worldng end. the methods include the steps of:
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`(a) connecting the electrodes of the bipolar electrosurgical
`instrument to the power supply;
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`(b) incising the patient’s tissue with a trocar or similar
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`device to create a small opening;
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`(c) inserting the working end and elongated barrel of the
`bipolar electrosurgical instrument through a trocar tube so
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`that the working end is disposed proximal to the internal
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`tissue; and
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`(d) operating the actuating means to simultaneously
`manipulate and cause hemostasis of the tissue.
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`Further steps of the methods include the step of setting the
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`power supply to provide a voltage across the electrodes in
`the range of 10 to 120 volts (RMS) and a frequency in the
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`range of 100 kHz to 2 MHz. The methods further include the
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`use of alternating-current voltage waveforms having a crest
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`factor—ratio of peak voltage to root-mean-square (RMS)
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`voltage—near unity.
`BRIEF DESCRIPTION OF THE DRAWINGS
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`The above and other objects and advantages of the
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`invention will be apparent upon consideration of the fol-
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`lowing detailed description. taken in conjunction with the
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`accompanying drawings. in which like reference numerals
`refer to like parts throughout. and in which:
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`FIG. 1 is an elevated perspective view of an illustrative
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`embodiment of the instrument of the present invention;
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`FIG. 2 is an elevation cross-sectional side View of the
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`instrument taken along the line 2-—2 of FIG. 1. in which an
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`intermediate portion of the elongated barrel has been omit-
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`ted for clarity;
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`FIG. 3 is an exploded perspective view of the working end
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`of the instrument taken along line 3-3 of FIG. 1;
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`FIG. 4 is an exploded perspective view. similar to FIG. 3.
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`of an alternate embodiment of the working end of the
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`instrument;
`
`FIGS. 5A and 5B show. respectively. open and closed
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`enlarged cross-sectional views of the working end of the
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`instrument shown in FIG. 2;
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`FIG. 6 is a cross-sectional view of an alternate embodi-
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`ment of the scissors-like worldng end of the present inven-
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`tion;
`
`FIGS. 7A and 713. respectively. are cross-sectional views.
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`similar to FIGS. 5A and SB. showing a dissector embodi-
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`ment of the working end of the present invention; and
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`FIG. 8 is a plan view of an alternate embodiment of the
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`dissector embodiment of the present invention.
`
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`
`DETAILED DESCRIPTION OF THE
`
`
`
`INVENTION
`
`
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`
`
`Referring to FIGS. 1 and 2. a bipolar electrosurgical
`
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`instrument 10 for performing endoscopic surgical proce-
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`dures is described. While an instrument constructed in
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`accordance with the principles of the present invention may
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`include any of a variety of severing or grasping members at
`
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`its working end 11. the illustrative embodiment of FIGS. 1
`
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`5
`
`5,766,170
`
`
`
`
`6
`and 2 includes scissor-like shearing members for sirnulta-
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`neously severing and causing hemostasis of a patient’s
`tissue.
`
`Instrument 10 includes actuating means comprising
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`handle members 12 and 13 joined for relative movement at
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`pivot 14. tubular elongated barrel 15. and working end 11.
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`Drive rod 16 disposed in elongated barrel 15 has electrical
`terminals 17 that are connected to movable members 18 and
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`19 of working end 11 to provide an electrical potential
`therebetween.
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`Handle member 12 has a pistol-like configuration. includ-
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`ing a body portion 20 having a longitudinal bore 21 and a
`portion defining a hole for one or more fingers. Handle
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`member 12 may be made of a light-weight rigid material. for
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`example cast aluminum. Elongated barrel 15 comprises a
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`tube having a proximal end mounted in body portion 20 and
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`a distal portion forming part of working end 11. The
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`proximal end of elongated barrel 15 is mounted in bore 21
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`of body portion 20 so that elongated barrel 15 can be rotated
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`about its longitudinal axis. Elongated barrel may consist of
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`a rigid structural material. for example a stainless steel alloy.
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`e.g.. SS 304. and may include a coating of abherent material.
`such as Teflon. on its exterior surface.
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`Knurled rotation knob 22 is mounted on a portion of
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`elongated barrel 15 disposed in body portion 21. so that it
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`projects through slots 23 intersecting bore 21 of body
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`portion 20. Rotation of knurled knob 22 causes elongated
`barrel 15 to rotate about its longitudinal axis. thereby also
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`rotating working end 11.
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`Body member 20 has bore 24 communicating with bore
`21 so that set screw 25 disposed in bore 24 engages
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`elongated barrel 15 substantially perpendicularly to the
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`longitudinal axis of the barrel. Set screw 25 has locking
`knob 26 at one end and teat 27 at the other end to engage
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`elongated barrel 15. Rotation of locking knob 26 may
`impose a load on elongated barrel 15 to establish a threshold
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`torque for rotating knurled rotation knob 22. Alternatively.
`locking knob 26 may be rotated so that teat 27 of set screw
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`25 eifectively locks elongated barrel 15 in a given angular
`orientation. and against further rotation.
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`Handle member 13 has a lower portion defining a finger
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`or thumb hole and an upper portion 28 having longitudinal
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`bore 29. Longitudinal bore 29 aligns with longitudinal bore
`21 in body portion 20 of handle member 12 when handle
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`members 12 and 13 are joined for relative movement at pivot
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`14. Handle member 13 comprises a similar material as
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`handle member 12. e.g.. a cast aluminum alloy.
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`Drive rod 16 has a proximal end 30 disposed within
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`elongated barrel 15 and a distal end 31 engaged with
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`working end 11. Proximal end 30 of drive rod 16 has
`electrical terminals 17 projecting from its endface 32. and a
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`portion adjacent to endface 31 that defines a semi—circular
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`groove 33. Because drive rod 16 has a high electrical
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`potential relative to handle members 12 and 13 when
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`electrical terminals 17 are connected to a power supply.
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`drive rod 16 is electrically insulated from handle member 13
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`and elongated barrel 15 by a coating of electrically insulat-
`ing material disposed on the exterior surface of drive rod 16.
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`Groove 33 of drive rod 16 is captured in insulating disk
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`34 between insulating pins 35. Insulating disk 34 seats in
`circular aperture 36 in upper portion 28 of handle member
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`13. Insulating disk 34 may comprise a high strength plastic.
`such as. Ultem (a proprietary plastic of the General Electric
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`Company. Fort Wayne. Ind.. fabricated from
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`polyethermide). or a ceramic material. Longitudinal bore 37
`extends through insulating disk 34 in alignment with lon-
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`I0
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`20
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