Electrothermal instrument for sealing and joining or cutting tissue

• US 20060142751A1
• Filed: 02/21/2006
• Published: 06/29/2006
• Est. Priority Date: 03/05/1997
• Status: Active Grant

• Current Assignee: Trustees Of Columbia University In The City Of New York (Columbia University)
• Original Assignee: Trustees Of Columbia University In The City Of New York (Columbia University)
• Inventors: Hermann, George D., Mollenauer, Kenneth H., Treat, Michael R., Howell, Thomas A., Kucklick, Theodore R., Monfort, Michelle Y., Co, Fred H.
• Granted Patent: US 7,211,080 B2
• Time in Patent Office: Days
• US Class Current: 606/29
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/085 Forceps, scissors
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/1445 at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/2945 Curved jaws
• CPC Class Codes: A61B 2017/320069 for ablating tissue
• CPC Class Codes: A61B 2017/320071 with articulating means for working tip
• CPC Class Codes: A61B 2018/00083 low, i.e. electrically insulating
• CPC Class Codes: A61B 2018/00095 high, i.e. heat conducting
• CPC Class Codes: A61B 2018/00101 low, i.e. thermally insulating
• CPC Class Codes: A61B 2018/00136 with polymer
• CPC Class Codes: A61B 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/0022 Balloons
• CPC Class Codes: A61B 2018/00345 Vascular system
• CPC Class Codes: A61B 2018/00404 Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/00595 Cauterization
• CPC Class Codes: A61B 2018/00601 : Cutting
• CPC Class Codes: A61B 2018/00619 : Welding
• CPC Class Codes: A61B 2018/0063 : Sealing
• CPC Class Codes: A61B 2018/00666 : using a threshold value
• CPC Class Codes: A61B 2018/00684 : using lookup tables
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00761 : Duration
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00886 : Duration
• CPC Class Codes: A61B 2018/1226 : powered by a battery
• CPC Class Codes: A61B 2018/1266 : with DC current output
• CPC Class Codes: A61B 2018/1412 : Blade
• CPC Class Codes: A61B 2018/1432 : curved
• CPC Class Codes: A61B 2018/1455 : having a moving blade for cutting tissue grasped by the jaws
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61F 2007/0078 : with a battery

Abstract

An instrument and method are provided for sealing and joining or hemostatically dividing tissue, which is particularly suitable for laparoscopic and endoscopic surgery. The instrument makes use of the controlled application of a combination of heat and pressure to seal adjacent tissues, to join adjacent tissues, or to anastomose tissues, whereby tissue is heated for an optimal time and at an optimal temperature under optimal pressure to maximize tissue seal strength while minimizing collateral tissue damage. The instrument of the present invention is lightweight and therefore portable, and is particularly useful in field conditions where a source of external power may not be readily available.

Claims

1. A surgical instrument which comprises two oppositely-positioned working members each having proximal and distal ends and each having an exterior working surface, wherein at least one exterior working surface has a distal end and at least one heating element comprising an electrically resistant wire to seal and cut or cut tissue.

2. The instrument of claim 1, wherein the instrument also comprises a battery pack electrically connected to each heating element.

3. The instrument of claim 1, which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.

5. The instrument of claim 1 wherein a working surface has more than one heating element.

7. The instrument of claim 1, wherein a heating element actuator is operatively connected to each heating element.

8. The instrument of claim 1 which also comprises a working member actuator operatively connected to at least one working member.

9. The instrument of claim 1, wherein the working members are attached to each other at their respective proximal ends.

10. The instrument of claim 1, wherein the opposing working surfaces apply pressure and approximate tissue.

11. The instrument of claim 1, wherein a working surface is textured.

12. The instrument of claim 1, wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.

13. The instrument of claim 1, wherein each heating element has lower ohmic resistance than body tissue.

14. The instrument of claim 1, wherein one or both working surfaces are comprised of non-stick material.

15. The instrument of claim 1, wherein one or both working surfaces are comprised of resilient material.

16. The instrument of claim 1, wherein each heating element is substantially thermally insulated from the working members.

17. The instrument of claim 1, wherein each working surface comprises a thermal conducting material.

18. The instrument of claim 1, wherein each working surface comprises thermally reflective material.

19. The instrument of claim 1, wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.

20. The instrument of claim 1, wherein each heating element is curved.

21. The instrument of claim 1, wherein each heating element is electrically insulated from a working surface.

22. The instrument of claim 1, wherein one opposing working member has a resilient working surface that is wider than the heating element in the other working surface.

23. The instrument of claim 1, wherein each heating element is electrically insulated from a working member.

24. The instrument of claim 1, wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to each heating element.

25. The instrument of claim 1, wherein each heating element is operatively connected to a power source.

26. The instrument of claim 25, wherein the power source is a portable DC power source.

27. The instrument of claim 25, wherein the power source is an RF power source.

28. The instrument of claim 25, wherein the power source is a low frequency AC power source.

29. The instrument of claim 1 which comprises control circuitry operatively connected to each heating element.

30. The instrument of claim 1, which also comprises a heating element actuator responsive to a predetermined pressure to activate each heating element.

4. (canceled)

6. (canceled)

31. A surgical instrument which comprises two oppositely-positioned working members each having proximal and distal ends and each having a working surface, wherein each working surface has an outwardly extending heating element comprising an electrically resistant wire to seal and cut or cut tissue.

32. The instrument of claim 31, wherein each heating element loops around the distal end of a working member.

33. The instrument of claim 31, wherein the instrument also comprises a battery pack electrically connected to each heating element.

34. The instrument of claim 31, which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.

35. The instrument of claim 31, wherein a working surface contains one heating element.

36. The instrument of claim 31, wherein a working surface has more than one heating element.

37. The instrument of claim 31, wherein a heating element actuator is operatively connected to each heating element.

38. The instrument of claim 31 which also comprises a working member actuator operatively connected to at least one working member.

39. The instrument of claim 31, wherein the working members are attached to each other at their respective proximal ends.

40. The instrument of claim 31, wherein the opposing working surfaces apply pressure and approximate tissue.

41. The instrument of claim 31, wherein a working surface is textured.

42. The instrument of claim 31, wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.

43. The instrument of claim 31, wherein each heating element has lower ohmic resistance than body tissue.

44. The instrument of claim 31, wherein one or both working surfaces are comprised of non-stick material.

45. The instrument of claim 31, wherein one or both working surfaces are comprised of resilient material.

46. The instrument of claim 31, wherein each heating element is substantially thermally insulated from the working members.

47. The instrument of claim 31, wherein each working surface comprises a thermal conducting material.

48. The instrument of claim 31, wherein each working surface comprises thermally reflective material.

49. The instrument of claim 31, wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.

50. The instrument of claim 31, wherein each heating element is curved.

51. The instrument of claim 31, wherein each heating element is electrically insulated from a working surface.

52. The instrument of claim 31, wherein each heating element loops around the distal portion of a working member and the heating element and the working member are electrically insulated from each other.

53. The instrument of claim 31, wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to each heating element.

54. The instrument of claim 31, wherein each heating element is operatively connected to a power source.

55. The instrument of claim 54, wherein the power source is a portable DC power source.

56. The instrument of claim 54, wherein the power source is an RF power source.

57. The instrument of claim 54, wherein the power source is a low frequency AC power source.

58. The instrument of claim 31 which comprises control circuitry operatively connected to each heating element.

59. The instrument of claim 31, which also comprises a heating element actuator responsive to a predetermined pressure to activate each heating element.

60. A surgical instrument which comprises two oppositely-positioned working members each having proximal and distal ends and each having a working surface, wherein at least one working surface has a heating element comprising an electrically resistant wire to seal and cut or cut tissue and wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to each heating element.

61. The instrument of claim 60, wherein each heating element loops around the distal end of a working member.

62. The instrument of claim 60, wherein the instrument also comprises a battery pack electrically connected to each heating element.

63. The instrument of claim 60, which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.

64. The instrument of claim 60, wherein a working surface contains one heating element.

65. The instrument of claim 60, wherein a working surface has more than one heating element.

66. The instrument of claim 60, wherein both working surfaces have at least one heating element.

67. The instrument of claim 60, wherein a heating element actuator is operatively connected to each heating element.

68. The instrument of claim 60 which also comprises a working member actuator operatively connected to at least one working member.

69. The instrument of claim 60, wherein the working members are attached to each other at their respective proximal ends.

70. The instrument of claim 60, wherein the opposing working surfaces apply pressure and approximate tissue.

71. The instrument of claim 60, wherein a working surface is textured.

72. The instrument of claim 60, wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.

73. The instrument of claim 60, wherein each heating element has lower ohmic resistance than body tissue.

74. The instrument of claim 60, wherein one or both working surfaces are comprised of non-stick material.

75. The instrument of claim 60, wherein one or both working surfaces are comprised of resilient material.

76. The instrument of claim 60, wherein each heating element is substantially thermally insulated from the working members.

77. The instrument of claim 60, wherein each working surface comprises a thermal conducting material.

78. The instrument of claim 60, wherein each working surface comprises thermally reflective material.

79. The instrument of claim 60, wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.

80. The instrument of claim 60, wherein each heating element is curved.

81. The instrument of claim 60, wherein each heating element is electrically insulated from a working surface.

82. The instrument of claim 60, wherein one opposing working member has a resilient working surface that is wider than the heating element in the other working surface.

83. The instrument of claim 60, wherein each heating element loops around the distal portion of a working member and the heating element and the working member are electrically insulated from each other.

84. The instrument of claim 60, wherein each heating element is operatively connected to a power source.

85. The instrument of claim 84, wherein the power source is a portable DC power source.

86. The instrument of claim 84, wherein the power source is an RF power source.

87. The instrument of claim 84, wherein the power source is a low frequency AC power source.

88. The instrument of claim 60 which comprises control circuitry operatively connected to each heating element.

89. The instrument of claim 60, which also comprises a heating element actuator responsive to a predetermined pressure to activate each heating element.

90. (canceled)

120. A surgical instrument to seal and cut or cut tissue, comprising:

two oppositely-positioned working members each having proximal and distal ends and each having an exterior working surface, at least one exterior working surface having a heating element comprising an electrically resistant wire to seal and cut or cut tissue, and

a heating element actuator,

wherein the heating element actuator is responsive to a predetermined pressure to activate the heating element to seal and cut or cut tissue.

91. The instrument of claim 120, wherein each heating element loops around the distal end of a working member.

92. The instrument of claim 120, wherein the instrument also comprises a battery pack electrically connected to the heating element.

93. The instrument of claim 120, which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.

94. The instrument of claim 120, wherein a working surface contains one heating element.

95. The instrument of claim 120, wherein a working surface has more than one heating element.

96. The instrument of claim 120, wherein both working surfaces have at least one heating element.

97. The instrument of claim 120, wherein a heating element actuator is operatively connected to each heating element.

98. The instrument of claim 120, which also comprises a working member actuator operatively connected to at least one working member.

99. The instrument of claim 120, wherein the working members are attached to each other at their respective proximal ends.

100. The instrument of claim 120, wherein the opposing working surfaces apply pressure and approximate tissue.

101. The instrument of claim 120, wherein a working surface is textured.

102. The instrument of claim 120, wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.

103. The instrument of claim 120, wherein each heating element has lower ohmic resistance than body tissue.

104. The instrument of claim 120, wherein one or both working surfaces are comprised of non-stick material.

105. The instrument of claim 120, wherein one or both working surfaces are comprised of resilient material.

106. The instrument of claim 120, wherein each heating element is substantially thermally insulated from the working members.

107. The instrument of claim 120, wherein each working surface comprises a thermal conducting material.

108. The instrument of claim 120, wherein each working surface comprises thermally reflective material.

109. The instrument of claim 120, wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.

110. The instrument of claim 120, wherein each heating element is curved.

111. The instrument of claim 120, wherein each heating element is electrically insulated from a working surface.

112. The instrument of claim 120, wherein one opposing working member has a resilient working surface that is wider than the heating element in the other working surface.

113. The instrument of claim 120, wherein each heating element loops around the distal portion of a working member and the heating element and the working member are electrically insulated from each other.

114. The instrument of claim 120, wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to the heating element.

115. The instrument of claim 120, wherein each heating element is operatively connected to a power source.

116. The instrument of claim 115, wherein the power source is a portable DC power source.

117. The instrument of claim 115, wherein the power source is an RF power source.

118. The instrument of claim 115, wherein the power source is a low frequency AC power source.

119. The instrument of claim 120, which comprises control circuitry operatively connected to each heating element.