Surgical system for applying ultrasonic energy to tissue

• US 20030055417A1
• Filed: 09/19/2001
• Published: 03/20/2003
• Est. Priority Date: 09/19/2001
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: SurgRx, Inc. (Johnson & Johnson)
• Inventors: Shadduck, John H., Truckai, Csaba, Strul, Bruno
• Granted Patent: US 6,773,409 B2
• Time in Patent Office: Days
• US Class Current: 606/27
• CPC Class Codes: A61B 17/320092 with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/320093 additional movable means performing cutting operation
• CPC Class Codes: A61B 2017/320094 additional movable means performing clamping operation
• CPC Class Codes: A61B 2017/320095 with sealing or cauterizing means
• CPC Class Codes: A61B 2018/1455 having a moving blade for cutting tissue grasped by the jaws
• CPC Class Codes: A61B 2018/1876 with multiple frequencies
• CPC Class Codes: A61B 2018/207 mixing two wavelengths
• CPC Class Codes: A61B 2018/2205 Characteristics of fibres

Abstract

A surgical system for controlled application of ultrasound energy to engaged tissue volumes for creating effective biological welds or seals in tissue. The invention provides an ultrasound transmission assembly including piezoelectric elements coupled to an elongate waveguide that is reciprocatable in an interior of an introducer. The reciprocatable waveguide assembly of the invention is adapted to have multiple functionality: (i) to couple ultrasound energy to both opposing jaws to thereby deliver energy to both sides of engaged tissues to create uniform thermal weld effects; (ii) to apply very high compressive forces to captured tissues over the length of elongate jaws by engaging substantially the entire length of the jaws, and (iii) to transect the captured tissues contemporaneous with the delivery of energy to create the thermal weld. The invention further provides for use of other energy sources to deliver thermal energy to tissue, for example microwave energy, Rf energy and laser energy, either in combination with ultrasound energy or independently.

Claims

1. An ultrasonic surgical instrument for delivering energy to tissue, comprising:

an introducer;

first and second elongate jaw elements carried at a distal working end of said introducer; and

an ultrasonic waveguide reciprocatably coupled to said introducer;

wherein said waveguide defines receiving channels therein with engagement surfaces that engage cooperating exterior engagement surfaces of said jaw elements to thereby move the jaw elements from a spaced apart position to an approximated position as the waveguide moves from a first retracted position and to a second extended position relative to said introducer.

2. The surgical instrument of claim 1 further comprising at least one piezoelectric element coupled to the waveguide thereby providing an ultrasonic energy source.

3. The surgical instrument of claim 2 wherein said at least one piezoelectric element is fixedly coupled to the waveguide and reciprocatable therewith.

4. The surgical instrument of claim 1 wherein said waveguide and said first and second jaw elements comprise portions of a tuned acoustic assembly.

5. The instrument of claim 1 wherein the tolerance between said cooperating engagement surfaces is less than about 0.01 inches to thereby insure acoustic coupling between the waveguide and the jaw elements.

6. A surgical instrument for delivering energy to tissue, comprising:

an introducer member having a working end that defines opposing jaw portions for engaging tissue;

a reciprocatable member carried by said introducer member;

wherein at least one moveable jaw portion and the reciprocatable member define respective first and second engagement surfaces for engaging one another to move said at least on jaw portion toward a closed position;

wherein in the closed position, the second engagement surface of the reciprocatable member engages the first engagement surfaces of said at least one jaw portion substantially from a proximal end to a distal end of said jaw portion; and

at least one energy delivery mechanism coupled to said working end for delivering energy to tissue.

7. The working end of claim 6 wherein the energy delivery mechanism comprises an ultrasound source coupled to at least one of said jaw portions.

8. The working end of claim 6 wherein the energy delivery mechanism comprises an ultrasound source coupled to a cutting element.

9. The working end of claim 8 wherein the waveguide and jaw portions source comprise portions of a tuned acoustic assembly.

10. The working end of claim 6 wherein a tolerance between the first and second engagement surfaces is less than about 0.01 inches to thereby insure coupling of ultrasound energy between the reciprocatable member and said at least one jaw portion.

11. The working end of claim 6 wherein a tolerance between the first and second engagement surfaces is less than about 0.005 inches to thereby insure coupling of ultrasound energy between the reciprocatable member and said at least one jaw portion.

12. The working end of claim 6 further comprising a tissue cutting element carried at a distal termination of the reciprocatable member.

13. The working end of claim 6 wherein the jaw portions each have an opposing axial channel therein for slidably receiving a body portion of the reciprocatable member.

14. An ultrasonic surgical instrument for delivering energy to tissue, comprising:

an introducer portion;

paired jaw elements carried at a distal end of said introducer portion wherein outwardly facing portions of at least one jaw element define a first engagement plane;

a reciprocatable member carried within said introducer portion, wherein at least one channel in said reciprocatable member defines a second engagement plane that slidably engages said first engagement plane to thereby move at least one jaw element toward a closed position as said reciprocatable member moves from a first retracted position and a second extended position; and

an ultrasound source operatively coupled to the reciprocatable member wherein said reciprocatable member comprises a waveguide.

15. The surgical instrument of claim 14 wherein said reciprocatable member and at least one jaw element comprises a portion of a tuned acoustic assembly.

16. The surgical instrument of claim 14 further comprising an ultrasound source coupled to a cutting member carried at a distal end of said reciprocatable member.

17. A method of delivering energy to tissue, comprising:

providing an introducer carrying opposing jaw portions that define a first engagement plane together with a reciprocatable waveguide member with channel portions therein that define a second engagement plane for slidably engaging said first engagement plane to move the jaw portions from a spaced apart position to an approximated position; and

engaging tissue between the opposing jaw portions in the approximated position; and

delivering acoustic energy to said reciprocatable waveguide member wherein said acoustic energy is coupled to at least one jaw portion and thereafter coupled to said tissue engaged by the opposing jaws portions.

18. The method of claim 17 wherein the delivering step delivers acoustic energy to said reciprocatable waveguide member wherein said acoustic energy is coupled to both opposing jaw portions and thereafter to opposing sides of the engaged tissue.

19. The method of claim 17 wherein the delivering step delivers acoustic energy to said reciprocatable waveguide member wherein said acoustic energy is coupled to a cutting member at the a distal end of the reciprocatable waveguide.

20. A surgical instrument for delivering energy to tissue, comprising:

an introducer having a working end that defines opposing jaw portions for engaging tissue;

a reciprocatable member carried by within said introducer;

wherein at least one jaw portion is moveable and defines a first engagement surface and wherein the reciprocatable member defines a second engagement surface that engages said first engagement surface to move said opposing jaw portions toward a closed position;

an energy delivery source coupled to said reciprocatable member for delivering energy to tissue engaged between said opposing jaw portions.

21. The working end of claim 20 further comprising at least one antenna carried by said reciprocatable member and wherein the energy delivery mechanism comprises a microwave source coupled to said at least one antenna.

22. The working end of claim 21 further comprising a tissue-contacting surface layer of the opposing jaws portions made of a microwave responsive material that is elevated in temperature in response to selected parameters of microwave transmission from said at least one antenna.

23. The working end of claim 22 wherein said microwave responsive material comprises a substantially thin layer of a polymer.

24. The working end of claim 20 wherein said first engagement surface is inflexible and engages said second engagement surface along the length of the jaw portions to thereby provide high compression between said jaw portions in said closed position.

25. The working end of claim 20 further comprising at least one electrode carried by said reciprocatable member and wherein the energy delivery mechanism comprises an Rf source.

26. The working end of claim 20 wherein a tissue-contacting portion of said working end is of an electrically resistive material coupled to an electrical source.

27. The working end of claim 20 further comprising at least emitter carried in said working end coupled to a laser source.

28. A method of delivering energy to tissue, comprising:

providing an introducer carrying opposing jaw portions that define a first engagement plane together with a reciprocatable member with channel portions therein that define a second engagement plane for slidably engaging said first engagement plane to move the jaw portions from a spaced apart position to an approximated position; and

engaging tissue between the opposing jaw portions in the approximated position; and

actuating an energy source operatively coupled to said reciprocatable member to deliver energy from said reciprocatable member to the engaged tissue.

29. The method of claim 28 wherein the actuating step delivers energy from an energy source selected from the class of energy sources consisting of ultrasonic energy, electrical energy, microwave energy, laser energy and the conduction of thermal energy from a resistively heated material.

30. The method of claim 28 wherein the actuating step delivers energy from at least two different energy sources selected from the class of energy sources consisting of ultrasonic energy, electrical energy, microwave energy, laser energy and the conduction of thermal energy from a resistively heated material.

31. The method of claim 30 wherein the actuating step delivers energy from at least two different energy sources contemporaneously.

32. The method of claim 30 wherein the actuating step delivers energy from at least two different energy sources sequentially.