Abstract:
A method for ultrasonically treating tissue includes accessing a surgical site with an ultrasonic surgical instrument, dissecting tissue with a first portion of the blade, and sealing tissue with a second portion of the blade. The instrument includes a blade that defines a longitudinal axis. The blade is configured to oscillate along the longitudinal axis to ultrasonically treat tissue.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. Nos. 61/882,035, which was filed on Sep. 25, 2013, and 61/882,033, which was filed on Sep. 25, 2013. This application is related to U.S. patent application Ser. No. 14/464,832, filed on Aug. 21, 2014. The entire contents of each of the above applications are hereby incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to surgical instruments and, more specifically, to ultrasonic surgical instruments having features for dissecting and sealing tissue. 
         [0004]    2. Discussion of Related Art 
         [0005]    Energy-based tissue treatment is well known in the art. Various types of energy (e.g., electrical, ultrasonic, microwave, cryogenic, thermal, laser, etc.) are applied to tissue to achieve a desired result. Ultrasonic energy may be delivered to tissue using a surgical probe that includes a transducer coupled with an end effector configured to deliver the ultrasonic energy to tissue. 
         [0006]    A typical ultrasonic surgical instrument generates a sinusoidal driving signal that causes the mechanical tip of a waveguide to vibrate at a selected frequency, usually from about 20 KHz to about 60 KHz, for cutting and/or coagulating tissue. Improved cutting may result from increased tissue-to-mechanical tip contact caused by the high frequency of vibration of the mechanical tip in relation to tissue. Improved coagulation may result from heat generated by contact between the high frequency vibrations of the mechanical tip and body tissue. 
         [0007]    Ultrasonic surgical instruments may include various waveguides configured to achieve a surgical result. An ultrasonic waveguide may be disposed at a distal end of the ultrasonic instrument. The waveguide may include an end effector having a cutting blade, shears, a hook, a ball, etc., and may also include other features such as jaws for grasping or manipulating tissue. 
       SUMMARY 
       [0008]    In an aspect of the present disclosure, an ultrasonic surgical instrument includes a handle assembly, an elongated body, and a tool assembly. The elongated body extends distally from the handle assembly and defines a longitudinal axis. The elongated body includes a waveguide. The tool assembly includes a blade coupled to a distal end of the waveguide and a jaw member pivotally movable relative to the blade. The blade is configured to oscillate along the longitudinal axis. The blade may be an ultrasonic blade configured to ultrasonically treat tissue. The blade includes a proximal portion and a distal portion. The distal portion extends from the proximal portion and includes a top portion, a bottom portion, and planar side segments. The top portion is configured to seal tissue. The bottom portion includes a notch disposed on a surface thereof. The planar side segments extend between the top and bottom portion. One of the top portion, the bottom portion, or the notch is configured to dissect tissue. 
         [0009]    In aspects of the present disclosure, the distal portion of the blade includes a planar distal tip. 
         [0010]    In aspects of the present disclosure, the distal portion of the blade includes a pointed distal tip. 
         [0011]    In aspects of the present disclosure, the notch is arcuate. The notch may include a vertical surface. The notch may include an arcuate surface. 
         [0012]    In aspects of the present disclosure, the bottom portion of the ultrasonic blade includes converging planar surfaces. 
         [0013]    In other aspects of the present disclosure, a method for ultrasonically treating tissue includes accessing a surgical site with an ultrasonic surgical instrument, dissecting tissue with a first portion of a blade, and sealing tissue with a second portion of the blade different that is different from the first portion of the blade. The instrument includes the blade that defines a longitudinal axis. The first portion may be a bottom portion of the blade. The second portion may be one of a top portion or planar side segments. Sealing the tissue may include clamping tissue between a top portion and a jaw pivotally movable relative to the blade. 
         [0014]    Further, to the extent consistent, any of the aspects described herein may be used in conjunction with any or all of the other aspects described herein. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0015]    Various aspects of the present disclosure are described hereinbelow with reference to the drawings, wherein: 
           [0016]      FIG. 1  is a perspective view of one illustrative embodiment of a surgical instrument provided in accordance with the present disclosure; 
           [0017]      FIG. 2  is an exploded view of components of an elongated body portion of the surgical instrument of  FIG. 1  in accordance with the present disclosure; 
           [0018]      FIG. 3  is an enlarged view of a tool assembly of the surgical instrument of  FIG. 1  with a portion of an outer tube of the elongated body portion of  FIG. 2  cut away in accordance with the present disclosure; 
           [0019]      FIG. 4  is an enlarged view of the distal end of the tool assembly of  FIG. 3  in the closed position in accordance with the present disclosure; 
           [0020]      FIGS. 5A-G  are side views of various embodiments of a blade of the surgical instrument of  FIG. 1  in accordance with the present disclosure; and 
           [0021]      FIGS. 6A-G  are front views of the blades of  FIGS. 5A-G , respectively, in accordance with the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0022]    Embodiments of the present disclosure are now described in detail with reference to the drawings in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “clinician” refers to a doctor, a nurse, or any other care provider and may include support personnel. Throughout this description, the term “proximal” refers to the portion of the device or component thereof that is closer to the clinician and the term “distal” refers to the portion of the device or component thereof that is further from the clinician. 
         [0023]    Referring now to  FIG. 1 , an ultrasonic surgical instrument  10  configured for use in accordance with the present disclosure is shown. Ultrasonic surgical instrument  10  generally includes a handle assembly  12 , an elongated body portion  14 , and a tool assembly  16 . Handle assembly  12  supports a battery assembly  18  and an ultrasonic transducer and generator assembly (hereinafter “TAG”)  20 . Handle assembly  12  includes a rotatable nozzle  22 , an activation button  24 , and a clamp trigger  26 . Battery assembly  18  and TAG  20  are each releasably secured to a central body  28  of handle assembly  12  and are removable from central body  28  to facilitate disposal of the entire device, with the exception of battery assembly  18  and TAG  20 . 
         [0024]    With additional reference to  FIG. 2 , elongated body portion  14  includes a waveguide  30  that extends from handle assembly  12  and couples tool assembly  16  ( FIG. 1 ) thereto. A distal end of waveguide  30  defines a blade  90 , which is described in further detail below. A proximal end of waveguide  30  has a threaded extension  34  for engaging TAG  20 . Waveguide  30  further includes a proximal tapered portion  30   a  and distal tapered portions  30   b  and  30   c.  A series of annular abutments  31   a - d  are disposed along, e.g., machined onto, waveguide  30  at node points along waveguide  30 . 
         [0025]    An inner tube  36  is positioned about waveguide  30  between proximal tapered portion  30   a  and distal tapered portion  30   b  of waveguide  30 . A distal seal member  38  is supported about waveguide  30  distally of a distal end of inner tube  36  and proximally of distal tapered portion  30   c  of waveguide  30  to provide a fluid-tight seal at the distal end of elongated body portion  14  between waveguide  30  and an inner surface of a middle tube  42 . Ultrasonic energy is isolated from transfer to middle tube  42  by inner tube  36 . A series of splines  44  are formed at the proximal end of waveguide  30 . Splines  44  engage corresponding splines (not shown) formed on an inner surface of a torque adapter  46  to rotatably secure torque adapter  46  to waveguide  30 . Torque adapter  46  also includes diametrically opposed wings  48  that are positioned in recesses (not shown) in rotatable nozzle  22  to secure torque adapter  46  to rotatable nozzle  22 . 
         [0026]    With additional reference to  FIGS. 3 and 4 , middle tube  42  is positioned about inner tube  36  ( FIG. 2 ) and includes a distal end having a corset feature  50  and a pair of spaced clamp support arms  52 . Corset feature  50  is positioned to receive distal seal member  38  and to maintain distal seal member  38  in the proper position about the distal end of waveguide  30 . Distal seal member  38  is positioned at a node point along waveguide  30 . An  0 -ring  40  is supported about corset feature  50  to provide a fluid-tight seal between an outer surface of middle tube  42  and an inner surface of an outer tube  66 . 
         [0027]    With reference to  FIGS. 2-4 , spaced clamp support arms  52  each define an opening  54  for pivotally receiving pivot members  56  formed on a clamp member  58  of tool assembly  16 . Clamp member  58  of tool assembly  16  is pivotal between an open position ( FIG. 3 ), wherein clamp member  58  is spaced from blade member  90 , and a closed position ( FIG. 4 ), wherein clamp member  58  is in juxtaposed alignment with blade member  90 . Clamp member  58  is moved between the open position and the closed position in response to actuation of clamp trigger  26  ( FIG. 1 ). 
         [0028]    Referring again to  FIG. 2 , outer tube  66  is slidably repositionable between an advanced position and a retracted position. Upon movement of outer tube  66  from the advanced position to the retracted position, clamp member  58  is moved from the open position ( FIG. 3 ) to the closed position ( FIG. 4 ). A proximal end of outer tube  66  includes an elongated slot  70  ( FIG. 2 ) which receives projections (not shown) of rotatable nozzle  22  ( FIG. 1 ) such that outer tube  66  is rotatably secured to, but slidable about, the projections to facilitate movement of outer tube  66  between the advanced and retracted positions. 
         [0029]    The proximal end of outer tube  66  includes a bifurcated portion that defines an axially extending throughbore  72  that slidably receives wings  48  of torque adapter  46 . A pair of diametrically opposed windows  74  are formed in the proximal end of outer tube  66 . Windows  74  receive bosses (not shown) formed in handle assembly  12  ( FIG. 1 ) to couple outer tube  66  to handle assembly  12  ( FIG. 1 ). 
         [0030]    With reference to  FIGS. 5A and 6A , blade  90  defines a longitudinal axis and includes a proximal portion  91  and a distal portion  92 . Proximal portion  91  is configured to couple to waveguide  30 . In embodiments, proximal portion  91  may be generally conical and may taper down to distal portion  92 . Distal portion  92  includes a planar distal tip  92   a,  planar side segments  93 , an arcuate top portion  94 , an arcuate bottom portion  95 , and a notch  96 . Side segments  93  are substantially flat parallel to the longitudinal axis of blade  90 . Side segments  93  include flat tapered segments  93   a  near distal tip  92   a  such that tapered segments  93   a  form a flat surface at distal tip  92   a.  Side segments  93  and/or tapered segments  93   a  may be configured to score or seal tissue as described in detail below. In embodiments, top portion  94  and bottom portion  95  may be generally arcuate. In some embodiments, top and bottom portions may have a common center of curvature. Notch  96  is disposed on bottom portion  95  and is configured to cut or dissect tissue as described in detail below. Notch  96  has a generally arcuate shape as shown in  FIG. 5A . Top portion  94  contacts clamp member  58  when clamp member  58  is in the closed position. In some embodiments, top portion  94  may be configured to conform to the surface of clamp member  58 . 
         [0031]    In use, blade  90  may be used to dissect and seal tissue. During operation, TAG  20  is activated to ultrasonically translate or oscillate blade  90  along the longitudinal axis. As blade  90  oscillates, the temperature of blade  90  increases. When the temperature of blade  90  reaches a desired temperature, distal portion  92  of blade  90  may be used to dissect and/or seal tissue. The cutting properties of distal portion  92  are improved as the temperature of distal portion  92  increases. It is envisioned that any portion of distal portion  92  may be used to dissect tissue. In embodiments, notch  96  of distal portion  92  may be used to improve cutting properties of distal portion  92 . Notch  92  may increase tissue contact or tissue tension during a cutting or back scoring motion to improve the cutting properties of bottom portion  95 . In some embodiments, clamp member  58  may be used to increase the tension in tissue clamped between clamp member  58  and top portion  94  of blade  90 . 
         [0032]    When the temperature of blade  90  is increased, as described above, planar surfaces, e.g., side segments  93  of distal portion  92  of blade  90  may also be used to score or seal tissue. In embodiments, side segments  93  may seal tissue when the temperature of distal portion  92  is at or above 250° C. However, it is also envisioned that side segments  93  may seal tissue at temperatures below 250° C. by applying additional pressure to the tissue to be sealed against side segments  93 , e.g., it has been shown that tissue may be sealed at a temperature as low as 90° C. Top portion  94  of blade  90  may be used to seal tissue. Clamp member  58  may apply additional pressure to the tissue to be sealed against top portion  94 . 
         [0033]    The ultrasonic motion of blade  90  results in decreasing internal stress from the proximal portion  91  to distal tip  92   a.  Thus, location of notch  96  is based on reducing physical strain and/or stress on the blade  90 . In embodiments, if notch  96  is disposed too proximally, the reduction in the cross-sectional area as well as the stress concentration of notch  96  may result in excessive stress causing fracture of blade  90 . 
         [0034]    Referring to  FIGS. 5B and 6B , another exemplary embodiment of a distal portion  192  in accordance with the present disclosure is shown. Distal portion  192  includes a planar distal tip  192   a,  planar side segments  193 , a planar top portion  194 , a planar bottom portion  195 , and a triangular notch  196  disposed on bottom portion  195 . Distal portion  192  is similar to distal portion  92  described above, as such only the differences are described in detail below for reasons of brevity. Bottom portion  195  has a stepped configuration as shown in  FIG. 6B  such that the bottom planar surface of bottom portion  195  is smaller than the planar surface of top portion  194 , e.g., in a plane parallel to the longitudinal axis. In embodiments, tip  192   a,  side segments  193 , top portion  194 , and bottom portion  195  are configured to seal tissue as described above. In addition, tip  192   a,  side segments  193 , top portion  194 , bottom portion  195 , and notch  196  are configured to dissect tissue as described above. 
         [0035]    Referring to  FIGS. 5C and 6C , yet another exemplary embodiment of a distal portion  292  in accordance with the present disclosure is shown. Distal portion  292  includes a planar distal tip  292   a,  planar side segments  293 , an arcuate top portion  294 , a pointed bottom portion  295 , and a notch  296 . Distal portion  292  is similar to distal portion  92  described above, as such only the differences will be described in detail below for reasons of brevity. Bottom portion  295  includes planar surfaces  295   a  that converge to form a pointed edge. In some embodiments, the pointed edge at the convergence of planar surfaces  295   a  is sharpened to improve the cutting properties of bottom portion  295   a.  Notch  296  includes a vertical distal surface  296   a  and an angled planar surface  296   b.  Vertical distal surface  296   a  of notch  296  may also be sharpened to improve the cutting properties of notch  296 . In this embodiment, tip  292   a,  side segments  293 , top portion  294 , and planar surfaces  295   a  of bottom portion  295  are configured to seal tissue as described above. In addition, tip  292   a,  side segments  293 , top portion  294 , bottom portion  295 , and notch  296  are configured to dissect tissue as described above. 
         [0036]    Referring to  FIGS. 5D and 6D , still another exemplary embodiment of a distal portion  392  in accordance with the present disclosure is shown. Distal portion  392  includes a planar distal tip  392   a,  planar side segments  393 , a planar top portion  394 , a concave bottom portion  395 , and a notch  396 . Distal portion  392  is similar to distal portion  92  described above, as such only the differences will be described in detail below for reasons of brevity. Concave bottom portion  395  may be generally arcuate, which improves the cutting properties of distal portion  392  along bottom portion  395  between side segments  393 . Notch  396  includes a vertical distal surface  396   a  and an arcuate surface  396   b  extending proximally therefrom. Vertical distal surface  396   a  may be sharpened to improve the cutting properties of notch  396 . In this embodiment, tip  392   a,  side segments  393 , and top portion  394  are configured to seal tissue as described above. In addition, tip  392   a,  side segments  393 , top portion  394 , bottom portion  395 , and notch  396  are configured to dissect tissue as described above. 
         [0037]    Referring to  FIGS. 5E and 6E , still yet another exemplary embodiment of a distal portion  492  in accordance with the present disclosure is shown. Distal portion  492  includes a planar distal tip  492   a,  planar side segments  493 , a planar top portion  494 , a recessed bottom portion  495 , and a notch  496 . Distal portion  492  is similar to distal portion  92  described above, as such only the differences will be described in detail below for reasons of brevity. Recessed bottom portion  495  includes inwardly converging angled planar surfaces. The recess of bottom portion  495  may improve the cutting properties of distal portion  492  along bottom portion  495  between side segments  493 . Notch  496  includes an arcuate surface  496   a  and a vertical proximal surface  496   b.  Vertical proximal surface  496   b  may be sharpened to improve the cutting properties of notch  496 . In this embodiment, tip  492   a,  side segments  493 , and top portion  494  are configured to seal tissue as described above. In addition, tip  492   a,  side segments  493 , top portion  494 , bottom portion  495 , and notch  496  are configured to dissect tissue as described above. 
         [0038]    Referring to  FIGS. 5F and 6F , another exemplary embodiment of a distal portion  592  in accordance with the present disclosure is shown. Distal portion  592  includes a pointed distal tip  592   a,  planar side segments  593 , a concave top portion  594 , a planar bottom portion  595 , and a notch  596 . Distal portion  592  is similar to distal portion  92  described above, as such only the differences will be described in detail below for reasons of brevity. Pointed distal tip  592   a  may be sharpened to improve the cutting properties of distal tip  592   a.  Concave top portion  594  is generally arcuate, which improves the cutting properties of distal portion  592  along top portion  594  between side segments  593 . Notch  596  includes an angled surface  596   a  and a vertical proximal surface  596   b.  Vertical proximal surface  596   b  may be sharpened to improve the cutting properties of notch  596 . In this embodiment, side segments  593 , tapered segments  593   a,  and bottom portion  595  are configured to seal tissue as described above. In addition, tip  592   a,  side segments  593 , tapered segments,  593   a,  top portion  594 , bottom portion  595 , and notch  596  are configured to dissect tissue as described above. 
         [0039]    Referring to  FIGS. 5G and 6G , yet another exemplary embodiment of a distal portion  692  in accordance with the present disclosure is shown. Distal portion  692  includes a pointed distal tip  692   a,  planar side segments  693 , a planar top portion  694 , a bottom portion  695 , a proximal notch  696   c,  and a distal notch  696   d.  Distal portion  692  is similar to distal portion  92  described above, as such only the differences will be described in detail below for reasons of brevity. Pointed distal tip  692   a  may be sharpened to improve the cutting properties thereof. 
         [0040]    As shown in  FIG. 6G , bottom portion  695  includes planar surfaces  695   a  and an arcuate surface  695   b.  Planar surfaces  695   a  converge to form a pointed tip. In some embodiments, the pointed tip at the convergence of planar surfaces  695   a  may be sharpened to improve the cutting properties of a portion of bottom portion  695 . Arcuate surface  695   b  is positioned proximal to planar surfaces  695   a.  In embodiments, arcuate surface  695   b  may be positioned proximal to planar surfaces  695   a.  Proximal notch  696   c  is generally arcuate and distal notch  696   d  includes a vertical distal surface  696   a  and an angled planar surface  696   b.  Vertical distal surface  696   a  may be sharpened to improve the cutting properties of distal notch  696   d.  It is envisioned that any of the notches described above may be used in place of either of notches  696   c,    696   d.  In this embodiment, side segments  693 , tapered segments  693   a,  top portion  694 , and planar surfaces  695   a  of bottom portion  695  are configured to seal tissue as described above. In addition, tip  692   a,  side segments  693 , tapered segments,  693   a,  top portion  694 , bottom portion  695 , and notches  696   c,    696   d  are configured to dissect tissue as described above. 
         [0041]    Distal portions  192 ,  292 ,  392 ,  492 ,  592 , and  692  are used in a manner substantially similar to distal portion  92  described above, as such the use of these distal portions will not be discussed in detail. 
         [0042]    Although various embodiments of distal portions have been described in detail above, it is envisioned that a distal portion may include any combination of features as described above. It is also envisioned that a distal portion may include more than two notches. Moreover, while particular elements of distal portions have been described as configured to seal and/or dissecting tissue, this is not meant to be limiting to the capabilities of these or other elements described above. 
         [0043]    While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.