Methods and systems for advanced harmonic energy

• US 10,376,305 B2
• Filed: 08/05/2016
• Issued: 08/13/2019
• Est. Priority Date: 08/05/2016
• Status: Active Grant

• Current Assignee: Cilag Gmbh International (Johnson & Johnson)
• Original Assignee: Ethicon, LLC (Johnson & Johnson)
• Inventors: Yates, David C., Krumm, Amy M., Davison, Mark A.
• Primary Examiner(s): Giuliani, Thomas A
• Application Number:
  US15/229,562
• Publication Number:
  US 20180036065A1
• Time in Patent Office: 1,103 Days
• Field of Search: 606 33, 606 34, 606 37, 606 38, 606 41, 606 42, 606 45, 606 48, 606 52, 607 98, 607 99, 607101, 607105, 607115, 607116
• 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 18/1206 Generators therefor
• 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 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• 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 2018/00208 actively driven, e.g. by a motor
• CPC Class Codes: A61B 2018/0063 Sealing
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00678 upper
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/00994 combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound

Abstract

Aspects of the present disclosure are presented for a medical instrument configured to adjust the power level for sealing procedures to account for changes in tissue impedance levels over time. In some aspects, a medical instrument may be configured to apply power according to a power algorithm to seal tissue by applying a gradually lower amount of power over time as the tissue impedance level begins to rise out of the “bathtub region,” which is the time period during energy application where the tissue impedance is low enough for electrosurgical energy to be effective for sealing tissue. In some aspects, the power is then cut once the tissue impedance level exceeds the “bathtub region.” By gradually reducing the power, a balance is achieved between still applying an effective level of power for sealing and prolonging the time in which the tissue impedance remains in the “bathtub region.”

Claims

1. A surgical system comprising:

an end effector comprising at least one energy delivery component configured to transmit electrosurgical energy to tissue at a surgical site; and

a control circuit communicatively coupled to the at least one energy delivery component and programmed to;

for a first application period, cause the at least one energy delivery component to transmit the electrosurgical energy at a first power level, the first application period comprising a point in time where impedance of the tissue reaches a minimum impedance value;

for a second application period after the first application period, cause the at least one energy delivery component to transmit the electrosurgical energy, starting from a predetermined proportion of a transition impedance threshold level and decreasing the electrosurgical energy at a steady rate from the first power level until a second power level is reached, wherein the second power level is lower than the first power level and the second application period comprises a point in time where the impedance of the tissue rises above the minimum impedance value; and

for a third application period after the second application period, directly after reaching the second power level, cause the at least one energy delivery component to reduce the second power level to a third power level while maintaining a constant level of the impedance of the tissue to transmit the electrosurgical energy at the third power level upon the impedance of the tissue reaching the transition impedance threshold level, the third power level lower than the second power level and the third application period comprising a point in time where the impedance of the tissue rises above the transition impedance threshold level.

2. The surgical system of claim 1, wherein the first application period and the second application period combined comprise a time period where the electrosurgical energy is delivered at a higher rate and causes sealing of the tissue at the surgical site.

3. The surgical system of claim 1, wherein the third application period further comprises a time period where the impedance of the tissue rises to a level such that the electrosurgical energy is delivered at a lower rate and no longer causes sealing of the tissue at the surgical site.

4. The surgical system of claim 1, further comprising at least one sensor configured to measure an initial level of impedance in the tissue and the minimum impedance value in the tissue.

5. The surgical system of claim 4, wherein the control circuit is further programmed to determine a beginning of the third application period based on the measured initial level of impedance in the tissue.

6. The surgical system of claim 4, wherein the control circuit is further programmed to determine a beginning of the third application period based on the measured minimum impedance value in the tissue.

7. The surgical system of claim 1, wherein the first application period and the second application period combined comprise a continuous time period where the impedance of the tissue remains below an initial level of impedance in the tissue.

8. The surgical system of claim 1, wherein the at least one energy delivery component is configured to transmit RF and ultrasonic energy.

9. A method for transmitting electrosurgical energy to tissue at a surgical site by a surgical system, the method comprising:

causing, by an energy delivery component of a surgical system, electrosurgical energy to be applied to the tissue;

measuring, by at least one sensor of the surgical system, a benchmark level of impedance of the tissue; and

determining, among a plurality of power load curve algorithms, a power load curve algorithm to be applied to the energy delivery component, based on the measured benchmark level of impedance of the tissue;

based on the determined power load curve algorithm;

for a first application period, causing the energy delivery component to transmit the electrosurgical energy at a first power level, the first application period comprising a point in time where impedance of the tissue reaches a minimum impedance value;

for a second application period after the first application period, causing the energy delivery component to transmit the electrosurgical energy, starting from a predetermined proportion of a transition impedance threshold level and decreasing the electrosurgical energy at a steady rate from the first power level until a second power level is reached, wherein the second power level is lower than the first power level and the second application period comprises a point in time where the impedance of the tissue rises above the minimum impedance value; and

for a third application period after the second application period, directly after reaching the second power level, causing the energy delivery component to reduce the second power level to a third power level while maintaining a constant level of the impedance of the tissue to transmit the electrosurgical energy at the third power level upon the impedance of the tissue reaching the transition impedance threshold level, the third power level lower than the second power level and the third application period comprising a point in time where the impedance of the tissue rises above the transition impedance threshold level.

10. The method of claim 9, wherein determining the power load curve algorithm comprises determining whether the benchmark level of impedance is less than a first threshold impedance value, whether the benchmark level of impedance is greater than the first threshold impedance value and less than a second threshold impedance value, and whether the benchmark level of impedance is greater than the second threshold impedance value.

11. The method of claim 9, wherein the first application period and the second application period combined comprise a time period where the electrosurgical energy is delivered at a higher rate and causes sealing of the tissue at the surgical site.

12. The method of claim 9, wherein the third application period further comprises a time period where the impedance of the tissue rises to a level such that the electrosurgical energy is delivered at a lower rate and no longer causes sealing of the tissue at the surgical site.

13. The method of claim 9, wherein the benchmark level of impedance is the minimum impedance value or an initial level of impedance of the tissue.

14. The method of claim 9, wherein a beginning of the third application period is based on the measured benchmark level of impedance.

15. The method of claim 9, wherein the first application period and the second application period combined comprise a continuous time period where the impedance of the tissue remains below an initial level of impedance in the tissue.

16. The method of claim 9, wherein the energy delivery component is configured to transmit RF and ultrasonic energy.

17. A surgical instrument comprising:

a handle assembly;

a shaft coupled to a distal end of the handle assembly;

an end effector coupled to a distal end of the shaft and comprising at least one energy delivery component configured to transmit electrosurgical energy to tissue at a surgical site; and

a control circuit communicatively coupled to the at least one energy delivery component and programmed to;

for a first application period, cause the at least one energy delivery component to transmit the electrosurgical energy at a first power level, the first application period comprising a point in time where impedance of the tissue reaches a minimum impedance value;

for a second application period after the first application period, cause the at least one energy delivery component to transmit the electrosurgical energy, starting from a predetermined proportion of a transition impedance threshold level and decreasing the electrosurgical energy at a steady rate from the first power level until a second power level is reached, wherein the second power level is lower than the first power level and the second application period comprises a point in time where the impedance of the tissue rises above the minimum impedance value; and

for a third application period after the second application period, directly after reaching the second power level, cause the at least one energy delivery component to reduce the second power level to a third power level while maintaining a constant level of the impedance of the tissue to transmit the electrosurgical energy at the third power level upon the impedance of the tissue reaching the transition impedance threshold level, the third power level lower than the second power level and the third application period comprising a point in time where the impedance of the tissue rises above the transition impedance threshold level.

18. The surgical instrument of claim 17, wherein the first application period and the second application period combined comprise a time period where the electrosurgical energy is delivered at a higher rate and causes sealing of the tissue at the surgical site.

19. The surgical instrument of claim 17, wherein the third application period further comprises a time period where the impedance of the tissue rises to a level such that the electrosurgical energy is delivered at a lower rate and no longer causes sealing of the tissue at the surgical site.

20. The surgical instrument of claim 17, further comprising at least one sensor configured to measure an initial level of impedance in the tissue and the minimum impedance value in the tissue.