Impedance feedback monitor with query electrode for electrosurgical instrument

• US 5,817,093 A
• Filed: 11/04/1996
• Issued: 10/06/1998
• Est. Priority Date: 07/22/1993
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Williamson, Warren P. IV, Yates, David C.
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US08/743,321
• Time in Patent Office: 701 Days
• Field of Search: 606/27-34, 606/37-42, 606/45-52, 607/100-102, 128/642
• US Class Current: 606/50
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 17/115 Staplers for performing anastomosis in a single operation
• 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 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1447 wherein sliding surfaces cause opening/closing of the end effectors
• CPC Class Codes: A61B 2018/00404 Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00666 using a threshold value
• CPC Class Codes: A61B 2018/00672 lower
• CPC Class Codes: A61B 2018/00678 upper
• CPC Class Codes: A61B 2018/00684 using lookup tables
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00708 switching the power on or off
• CPC Class Codes: A61B 2018/00761 Duration
• CPC Class Codes: A61B 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/00886 Duration
• CPC Class Codes: A61B 2018/1273 including multiple generators in one device
• CPC Class Codes: A61B 2090/032 : pressure limiting, e.g. hydrostatic

Abstract

Query electrodes are provided for monitoring the electrical impedance of tissue as it is treated with electrosurgical energy. In one embodiment, based on a predicted model of tissue impedance and a number of initial impedance readings, the impedance at which tissue treatment is completed is predicted. More particularly, a minimum impedance level is measured and a function of the minimum impedance is used to determine impedance at which coagulation is completed. A control device is provided for bringing the output of the generator within an optimum range based on a system load curve. In one embodiment the impedance monitoring device is used in conjunction with a bipolar electrosurgical instrument. Preferably, the instrument comprises electrically opposite therapeutic electrodes, each located on one or more tissue engaging surfaces for engaging tissue to be treated, and electrically opposite query electrodes, located on one or more tissue engaging surfaces. The therapeutic electrodes provide therapeutic energy to the tissue while the query electrodes provide a lower voltage electrical sensing energy for the purpose of measuring tissue impedance at various stages, e.g. before, during, or after tissue treatment.

Claims

1. An electrosurgical device for treating tissue during a surgical procedure, said device comprising:

a surgical instrument having a tissue treating portion including an end effector adapted to engage tissue to be treated, said end effector comprising first and second opposing interfacing surfaces adapted to engage tissue to be treated therebetween;

electrically isolated first and second therapeutic poles comprised of tissue contacting first and second therapeutic electrodes adapted to receive electrosurgical energy from an energy source and capable of conducting electrical energy therebetween, at least one of said first and second therapeutic electrodes being positioned on at least one of said first and second interfacing surfaces; and

electrically isolated first and second query poles comprised of tissue contacting first and second query electrodes adapted to receive electrosurgical energy from an energy source and capable of conducting electrical energy therebetween, said first query electrode being positioned on one of said first and second interfacing surfaces and said second query electrode being positioned on one of said first and second interfacing surfaces.

2. The electrosurgical device of claim 1 wherein said electrical parameter comprises a phase difference between voltage and current.

3. An electrosurgical device having an end effector, wherein said end effector comprises:

first and second opposing interfacing surfaces, said interfacing surfaces capable of engaging tissue therebetween, and end effector capable of receiving electrosurgical energy therein,

electrically isolated first and second therapeutic poles comprised of first and second electrically opposite therapeutic electrodes capable of conducting electrosurgical energy therethrough;

electrically isolated first and second sensing poles comprised of first and second electrically opposite query electrodes capable of conducting electrosurgical energy therebetween;

wherein said first therapeutic electrode is located on at least one of said first and second interfacing surfaces and said second therapeutic electrode is located on said end effector so that electrosurgical energy may be communicated between said therapeutic poles through the tissue engaged by said interfacing surfaces to electrosurgically treat the tissue; and

wherein said first query electrode is located on at least one of said first and second interfacing surfaces and said second query electrode is located on said end effector so that sensing electrosurgical energy may be communicated between said sensing poles to measure an electrical parameter of said tissue between said sensing poles.

4. The electrosurgical device of claim 3 wherein each of said therapeutic electrodes is located on at least one of said first and second interfacing surfaces.

5. The electrosurgical device of claim 3 wherein each of said first and second query electrodes is located on at least one of said first and second interfacing surfaces.

6. The electrosurgical device of claim 3 wherein a portion of at least one of said first and second interfacing surfaces comprises a ridge forming a tissue compression zone between said first and second interfacing surfaces, said end effector further comprising a plane bisecting said interfacing surfaces and said ridge;

wherein said query electrodes are located on opposite lateral sides of said compression ridge with respect to said plane.

7. The electrosurgical device of claim 6 wherein therapeutic electrodes are arranged to provide electrosurgical tissue treatment in the compression zone when current flows between said first and second therapeutic poles.

8. The electrosurgical device of claim 3 wherein one of said first and second therapeutic poles is the same electrical potential as one of said first and second sensing poles.

9. The electrosurgical device of claim 3 further comprising a cutting element associated with said end effector, said cutting element adapted to divide tissue engaged by said end effector, through a cutting line.

10. The electrosurgical device of claim 9 wherein said query electrodes are located on opposing sides of said cutting line.

11. the electrosurgical device of claim 3 wherein said first query electrode is arranged on a periphery of said at least one interfacing surface so as to be adapted to measure the impedance of the engaged tissue at the periphery.

12. The electrosurgical device of claim 3 wherein said electrical parameter comprises current delivered to said tissue.

13. The electrosurgical device of claim 3 wherein said electrical parameter comprises voltage delivered to said tissue.

14. The electrosurgical device of claim 3 wherein said electrical parameter comprises tissue impedance.

15. The electrosurgical device of claim 3 wherein said electrical parameter comprises voltage and current delivered to tissue from which impedance of tissue between said query electrodes may be determined.

16. An electrosurgical device having an end effector, wherein said end effector comprises:

first and second opposing interfacing surfaces, said interfacing surfaces capable of engaging tissue therebetween, and end effector capable of receiving electrosurgical energy therein,

electrically isolated first and second therapeutic poles comprised of first and second electrically opposite therapeutic electrodes capable of conducting electrosurgical energy therethrough;

electrically isolated first and second sensing poles comprised of first and second electrically opposite query electrodes capable of conducting electrosurgical energy therebetween;

wherein said first therapeutic electrode is located on at least one of said first and second interfacing surfaces and said second therapeutic electrode is located on said end effector so that electrosurgical energy may be communicated between said therapeutic poles through the tissue engaged by said interfacing surfaces to electrosurgically treat the tissue; and

wherein said first query electrode is located on at least one of said first and second interfacing surfaces and said second query electrode is located on said end effector so that sensing electrosurgical energy may be communicated between said sensing poles to measure an electrical parameter of said sensing electrosurgical energy delivered between said sensing poles.

17. The electrosurgical device of claim 16 wherein each of said therapeutic electrodes is located on at least one of said first and second interfacing surfaces.

18. The electrosurgical device of claim 16 wherein each of said first and second query electrodes is located on at least one of said first and second interfacing surfaces.

19. An electrosurgical method comprising:

providing an electrosurgical device having an end effector, wherein said end effector comprises;

first and second opposing interfacing surfaces, said interfacing surfaces capable of engaging tissue therebetween, and end effector capable of receiving electrosurgical energy therein, electrically isolated first and second therapeutic poles comprised of electrically opposite therapeutic electrodes capable of conducting electrosurgical energy therethrough; and

electrically isolated first and second sensing poles comprised of electrically opposite query electrodes capable of conducting electrosurgical energy therebetween;

wherein each of said therapeutic electrodes and each of said first and second query electrodes is located on a said interfacing surface;

engaging tissue between said surfaces;

delivering therapeutic electrosurgical energy to said tissue between said therapeutic electrodes;

delivering sensing electrosurgical energy to said tissue between said sensing electrodes;

measuring an electrical parameter of said sensing electrosurgical energy;

determining when a desired tissue effect has occurred; and

providing a signal indicating said tissue effect.

20. The method of claim 19 wherein said tissue effect is a coagulation complete condition.

21. The method of claim 19 wherein said electrical parameter is tissue impedance.

22. The electrosurgical method of claim 19 wherein the step of delivering sensing electrosurgical energy occurs at the same time as the step of delivering therapeutic electrosurgical energy.

23. The electrosurgical method of claim 19 wherein the step of delivering sensing electrosurgical energy occurs prior to the step of delivering therapeutic electrosurgical energy.

24. The electrosurgical method of claim 19 wherein the step of delivering sensing electrosurgical energy occurs after the step of delivering therapeutic electrosurgical energy.

25. An electrosurgical device for treating tissue during a surgical procedure, said device comprising;

a surgical instrument having a tissue treating portion including an end effector adapted to engage tissue to be treated;

electrically isolated first and second therapeutic poles comprised of tissue contacting first and second therapeutic electrodes adapted to receive electrosurgical energy from an energy source and capable of conducting electrical energy therebetween, fat least said first therapeutic electrode being positioned on said tissue treating portion of said instrument and said second therapeutic electrode being positioned on said end effector;

electrically isolated first and second query poles comprised of tissue contacting first and second query electrodes adapted to receive electrosurgical energy from an energy source and capable of conducting electrical energy therebetween, of said first query electrodes being positioned on said tissue treating portion of said instrument and said second query electrode being positioned on said end effector;

a tissue treatment status determining device including electrical parameter measuring circuitry coupled to said query electrodes for measuring an electrical parameter of tissue engaged by said end effector, said tissue treatment status determining device adapted to provide an energy control signal for controlling electrosurgical energy supplied to said therapeutic electrodes.

26. The electrosurgical device of claim 25 further comprising:

an energy source arranged to supply electrosurgical energy to said therapeutic electrodes, wherein said energy source is responsive to said control signal to supply said energy to said therapeutic electrodes.

27. The electrosurgical device of claim 25 wherein said electrical parameter measuring circuitry includes:

a first device for determining the minimum impedance value;

a target determining device coupled to said first device, for determining the target impedance value as a function of said minimum impedance value; and

a first comparison device for comparing measured impedance values to said target impedance value and generating a signal indicating whether said measured impedance value exceeds said target impedance value.

28. The electrosurgical device of claim 25 wherein said end effector includes first and second elements movable relative to each other for engaging tissue therebetween, wherein said first therapeutic electrode is located on at least one of said first and second elements.

29. The electrosurgical device of claim 28 wherein said second therapeutic electrode is located on at least one of said first and second elements.

30. The electrosurgical device of claim 29 wherein said first and second query electrodes are each located on either one or both of said first and second elements;

and wherein said electrical parameter measuring circuitry is adapted to measure an electrical parameter of the tissue between said first and second query electrodes and engaged by said first and second elements.

31. The electrosurgical device of claim 30, wherein each of said first therapeutic electrodes is offset from each of said second therapeutic electrodes with respect to said interfacing surfaces.

32. The electrosurgical device of claim 28, wherein:

said first and second elements comprise first and second interfacing surfaces for engaging tissue to be electrosurgically treated;

wherein said first therapeutic pole is comprised of one or more first therapeutic electrodes located on at least one of said first and second interfacing surfaces; and

wherein said second therapeutic pole is comprised of one or more second therapeutic electrodes located on at least one of said first and second interfacing surfaces.

33. The electrosurgical device of claim 32,

wherein each of said one or more first therapeutic electrodes is offset from each of said one or more second therapeutic electrodes with respect to said interfacing surfaces.

34. The electrosurgical device of claim 25 wherein said electrical parameter determining circuitry comprises impedance measuring circuitry for measuring impedance of tissue engaged by said end effector.

35. The electrosurgical device of claim 34 wherein said impedance measuring circuitry is adapted to:

determine a minimum impedance value of tissue between the query electrodes as said tissue between the therapeutic electrodes is treated with therapeutic energy by the treatment electrodes;

determine a target impedance value at which a desired tissue status is attained, said target value being a function of said minimum impedance value; and

compare measured impedance values of tissue between the query electrodes to the target impedance value and adjust said control signal when said measured impedance value exceeds said target impedance value.

36. The electrosurgical device of claim 25 wherein said tissue status determining device comprises a tissue coagulation status determining device for determining a degree of coagulation of tissue being treated by said therapeutic electrodes.

37. A method of electrosurgically treating tissue, said method comprising the steps of:

providing an electrosurgical instrument including electrically different query electrodes;

electrically different therapeutic electrodes; and

an end effector comprising one or more of said tissue treating electrodes and one or more of said query electrodes;

applying sensing electrosurgical energy through said one or more query electrodes to tissue to be electrosurgically treated;

measuring an electrical parameter of the tissue between said query electrodes;

generating a signal representative of the measured electrical parameter of tissue between said query electrodes;

determining a therapeutic target electrical parameter value from said measured electrical parameter;

comparing subsequent measured electrical parameters to said target value;

generating a control signal to control the electrosurgical energy to said electrosurgical instrument in response to said measured electrical parameter reaching said target value; and

controlling the energy applied to the tissue through said one or more therapeutic electrodes in response to said control signal.

38. A method of electrosurgically treating tissue, said method comprising the steps of:

providing an electrosurgical instrument including electrically different query electrodes;

electrically different therapeutic electrodes; and

an end effector comprising one or more of said tissue treating electrodes and one or more of said query electrodes;

applying sensing electrosurgical energy through said one or more query electrodes to tissue to be electrosurgically treated;

measuring the impedance of the tissue between said query electrodes;

generating an impedance signal representative of the measured impedance value of tissue between said query electrodes;

determining a representative minimum impedance value from said impedance signal;

determining a representative target impedance value as a function of said minimum impedance value;

comparing subsequent impedance signals to said target impedance value;

generating a control signal to control the electrosurgical energy to said electrosurgical instrument in response to said measured impedance value reaching said target impedance value; and

controlling the energy applied to the tissue through said one or more therapeutic electrodes in response to said control signal.

39. The method of claim 38 further comprising;

providing tissue contacting opposing surfaces included with said end effector wherein said surfaces engaging tissue to be treated between said surfaces are moveable to engage tissue to be treated therebetween; and

wherein said query electrodes and said one or more therapeutic electrodes are each positioned on either one or both of said surfaces.

40. A method of electrosurgically treating tissue comprising the steps of:

providing an electrosurgical instrument having an end effector comprising first and second tissue engaging surfaces, one of said first and second tissue engaging surfaces including thereon a first tissue contacting therapeutic electrode electrically connected to a first pole of an electrosurgical therapeutic system, and one of said first and second tissue engaging surfaces containing thereon a second tissue contacting therapeutic electrode electrically connected to a second pole of the therapeutic system;

one of said first and second tissue engaging surfaces including thereon a first query electrode electrically connected to a first pole of an impedance sensing system and one of said first and second tissue engaging surfaces including thereon a second query electrode electrically connected to a second pole of said impedance sensing system;

engaging tissue to be treated between the first and second tissue engaging surfaces;

selectively controlling electrosurgical energy supplied to the first and second tissue contacting therapeutic electrodes for treating tissue positioned therebetween;

measuring the impedance of the treated tissue between the first and second query electrodes with said first and second query electrodes;

setting a threshold impedance value at which tissue treatment is complete;

comparing measured impedance values to the threshold impedance value; and

controlling or switching off the electrosurgical energy coupled to the first and second therapeutic electrodes upon the condition of the measured impedance value reaching or exceeding the threshold impedance value.

41. An electrosurgical impedance feedback control device, said device comprising:

an energy control signal generating device for generating a control signal to control electrosurgical energy supplied from an energy source to one or more therapeutic electrodes positioned on a tissue treating portion of a surgical instrument;

impedance measurement circuitry adapted to be coupled to at least one tissue contacting query electrode positioned on the tissue treating portion of the surgical instrument and to an energy source arranged to supply therapeutic electrosurgical energy to the one or more therapeutic electrodes positioned on the tissue treating portion of the surgical instrument,

wherein said impedance measurement circuitry is adapted to measure the impedance of tissue engaged by the tissue treating portion of the surgical instrument;

wherein said impedance measuring circuitry comprises;

a first device for determining a minimum impedance value;

a target determining device coupled to said first device, for determining the target impedance value as a function of said minimum impedance value; and

a first comparison device for comparing measured impedance values to said target impedance value and generating a signal indicating whether said measured impedance value exceeds said target impedance value.