Electrothermal instrument for sealing and joining or cutting tissue

• US 6,626,901 B1
• Filed: 08/13/1999
• Issued: 09/30/2003
• Est. Priority Date: 03/05/1997
• Status: Expired due to Term

• 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: Treat, Michael R., Kucklick, Theodore R., Hermann, George D., Mollenauer, Kenneth H., Howell, Thomas A., Monfort, Michelle Y., Co, Fred H.
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/374,563
• Time in Patent Office: 1,509 Days
• Field of Search: 606/27-31, 606/51, 606/52
• 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 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 sleeve circumferentially extends over the distal end of one or both working members.

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

4. The instrument of claim 1, wherein a working surface contains one heating element.

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

6. The instrument of claim 1, wherein both working surfaces have at least 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 the heating element is capable of being heated to a temperature to first seal and then cut tissue.

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

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

15. The instrument of claim 1, wherein each sleeve is comprised of a non-stick polymeric material.

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

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

18. The instrument of claim 1, wherein each working surface comes a thermal conducting material.

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

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

21. The instrument of claim 1, wherein the heating element is curved.

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

23. 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.

24. The instrument of claim 1, wherein the opposing working surfaces are electrically insulated from each other.

25. The instrument of claim 1, wherein the heating element loops around the distal end working member.

26. 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 the heating element.

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

28. The instrument of claim 27, wherein the power source is a portable DC power source.

29. The instrument of claim 27, wherein the power source is an RE power source.

30. The instrument of claim 27, wherein the power source is a low frequency AC power source.

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

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

33. A surgical instrument for sealing or welding tissue which comprises:

two oppositely-positioned working surfaces for compressing tissue, wherein at least one working surface has a heating element and each working surface has a distal end and a proximal end, and

a heating element actuator responsive to a predetermined pressure to activate each heating element to seal or weld tissue,

wherein a sleeve circumferentially extends over the distal end of one or both working surfaces.

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

35. The instrument of claim 33, 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 surface.

36. The instrument of claim 33, wherein a working surface contains one heating element.

37. The instrument of claim 33, wherein the heating element is an electrically resistant wire.

38. The instrument of claim 33, wherein the heating element is a printed circuit, thin film, or electrically conductive coating.

39. The instrument of claim 33, wherein a working surface has more than one heating element.

40. The instrument of claim 33, wherein both working surfaces have at least one heating element.

41. The instrument of claim 33, wherein a heating element actuator is operatively connected to each heating element.

42. The instrument of claim 33 which also comprises a working surface actuator operatively connected to at least one working surface.

43. The instrument of claim 33, wherein the working surfaces are attached to each other at their respective proximal ends.

44. The instrument of claim 33, wherein th opposing working surfaces apply pressure and approximate tissue.

45. The instrument of claim 33, wherein a working surface is textured.

46. The instrument of claim 33, wherein the heating element is capable of being heated to a temperature to first seal and then cut tissue.

47. The instrument of claim 33, wherein the heating element has lower ohmic resistance than body tissue.

48. The instrument of claim 33, wherein one or both working surfaces is comprised of non-stick material.

49. The instrument of claim 33, wherein each sleeve is comprised of a non-stick polymeric material.

50. The instrument of claim 33, wherein in one or both working surfaces are comprised of resilient material.

51. The instrument of claim 33, wherein each heating element is substantially thermally insulated from the working surfaces.

52. The instrument of claim 33, wherein each working surface comprises a thermal conducting material.

53. The instrument of claim 33, wherein each working surface comprises thermally reflective material.

54. The instrument of claim 33, wherein the heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.

55. The instrument of claim 33, wherein the heating element is curved.

56. The instrument of claim 33, wherein the heating element is electrically insulated from the working surface.

57. The instrument of claim 33, wherein one opposing working surface is a resilient working surface that is wider than he heating element in the other working surface.

58. The instrument of claim 33, wherein the opposing working surfaces are electrically insulated from each other.

59. The instrument of claim 33, wherein the heating element loops around the distal end of a working surface.

60. The instrument of claim 33, 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.

61. The instrument of claim 33, wherein each heating element is operatively connected to a power source.

62. The instrument of claim 33, wherein the power source is a portable DC power source.

63. The instrument of claim 33, wherein the power source is an RF power source.

64. The instrument of claim 61, wherein the power source is a low frequency AC power source.

65. The instrument of claim 33 which comprises control circuitry operatively connected to each beating element.

66. A surgical instrument for sealing or welding tissue which comprises:

two oppositely-positioned working surfaces having proximal and distal ends, and for compressing tissue, wherein at least one working surface has a heating element, and

a heating element actuator responsive to a predetermined pressure to activate the heating element to seal or weld tissue,

wherein the heating element loops around a distal end of a working surface.

67. The instrument of claim 66, wherein the instrument also comprises a battery pack electrically connected to the heating element.

68. The instrument of claim 66, 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 surface.

69. The instrument of claim 66, wherein a working surface contains one heating element.

70. The instrument of claim 66, wherein the beating element is an electrically resistant wire.

71. The instrument of claim 66, wherein the heating element is a printed circuit, thin film, or electrically conductive coating.

72. The instrument of claim 66, wherein a working surface has more than one heating element.

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

74. The instrument of claim 66, wherein a heating element actuator is operatively connected to a heating element.

75. The indent of claim 66, also comprises a working surface actuator operatively connected to at least one working surface.

76. The instrument of claim 66, wherein the working surfaces are attached to each other at their respective proximal ends.

77. The instrument of claim 66, wherein the opposing working surfaces apply pressure and approximate tissue.

78. The instrument of claim 66, wherein a working surface is textured.

79. The instrument of claim 66, wherein the heating element is capable of being heated to a temperature to first seal and then cut tissue.

80. The instrument of claim 66, wherein the heating element has lower ohmic resistance man body tissue.

81. The instrument of claim 66, wherein one or both working surfaces is comprised of non-stick material.

82. The instrument of claim 66, wherein one or both working surfaces are comprised of resilient material.

83. The instrument of claim 66, wherein each heating element is substantially thermally insulated from the working surfaces.

84. The instrument of claim 66, wherein each working surface comprises a thermal conducting material.

85. The instrument of claim 66, wherein each working surface comprises thermally reflective material.

86. The instrument of claim 66, wherein the heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.

87. The instrument of claim 66, wherein the heating element is curved.

88. The instrument of claim 66, wherein the heating element is electrically insulated from the working surfaces.

89. The instrument of claim 66, wherein one opposing working surface is a resilient working surface that is wider than the heating element in the other working surface.

90. The instrument of claim 66, wherein the opposing working surfaces are electrically insulated from each other.

91. The instrument of claim 66, 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.

92. The instrument of claim 66, wherein each heating element is operatively connected to a power source.

93. The instrument of claim 66, wherein the power source is a portable DC power source.

94. The instrument of claim 66, wherein the power source is an RF power source.

95. The instrument of claim 66, wherein the power source is a low frequency AC power source.

96. The instrument of claim 66 which comprises control circuitry operatively connected to each heating element.

97. An instrument for sealing and/or cutting corporeal vessels or organ tissue, comprising:

a fist grasping member having a proximal end and a distal end, said distal end comprising a heating element comprising an electrically resistant wire,

a second grasping member having a proximal end and a distal end, wherein the proximal ends of the first and second grasping members are positioned adjacent to and rotatively connected to each other,

an elongated member having proximal and distal ends, and

a handle attached to the proximal end of the elongated member, the handle comprising a actuator, and

a power source,

wherein the first ad second grasping members are operatively connected through the elongated member to the actuator in the handle, wherein the heating element is operatively connected to the power source, and wherein the distal ends of the first and second grasping members each have a circumferentially aged sleeve comprised of a non-stick polymeric material.

98. The instrument of claim 97, wherein the heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless, steel, nitinol, and metallic alloys.

99. The instrument of claim 97, wherein the handle comprises a finger operated switch for controlling current to the heating element.

100. The instrument of claim 97, wherein the distal ends of the first and second grasping members are aligned to meet one another.

101. The instrument of claim 97, wherein the power source is a portable DC power source.

102. The instrument of claim 97, wherein the power source is an RF power source.

103. The instrument of claim 97, wherein the power source is a low frequency AC power source.

104. The instrument of claim 97, wherein the handle comprises control circuitry operatively connected to each heating element.