Abstract:
A device is disclosed for simultaneous cutting and cauterizing of tissue. The device comprises a cutting edge of a blade. The blade defines a channel within the blade wherein the outlet end of the channel is near the cutting edge. A catalyst is disposed near the outlet end. The channel carries a gaseous mixture to the catalyst where the mixture reacts in the presence of the catalyst and generated heat. The heat generated cauterizes blood vessels as the blade cuts through tissue.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation-in-part of co-pending U.S. application Ser. No. 10/200,794, filed Jul. 22, 2002, all of which is incorporated by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to surgical cutting instruments. In particular, this invention relates to scalpels that incorporate means for cauterizing blood vessels during usage of the scalpel. 
     BACKGROUND OF THE INVENTION 
     Surgical operations often involve the cutting of a patient&#39;s tissue. Usually, the tissue is cut with a scalpel, a sharp edged cutting instrument. However, the cutting of a patient&#39;s tissue is also usually accompanied by an undesired flow of blood from small blood vessels within the tissue. Reducing, or eliminating this blood flow is advantageous to the patient by reducing blood loss and to the surgeon by removing or reducing an obstruction to the surgeon&#39;s view of the incised tissue. 
     Scalpels making use of lasers for heat sources can be used to heat and irradiate the incised tissue. Light of an appropriate wavelength is absorbed by the tissue, and the optical energy is converted to thermal energy to cauterize the tissue. Cutting instruments of this type are described in U.S. Pat. Nos. 6,383,179; 5,571,098; 5,366,456; and 4,627,435. These devices can use the laser to incise the tissue as well as cauterize, or use an optically transparent material for the cutting instrument coupled with a bundle of optical fibers for directing the laser to the area of interest. 
     Another method of providing cauterizing heat with a scalpel is the use of ultrasonics. U.S. Pat. No. 5,324,299 describes such a device wherein the scalpel blade is vibrated at a rate around 55,000 cycles per second. The vibration generates ultrasound waves for heating the tissue, however, there is only limited cauterizing ability. 
     Control of blood loss can be achieved by cauterizing the small blood vessels in the tissue at the time the tissue is cut. Cauterization of the blood vessels is achieved by applying heat at the vessels. It is advantageous to apply the heat at the time the tissue is cut and at the tissue without exposing the tissue to radiation. 
     SUMMARY OF THE INVENTION 
     The present invention provides a device for cauterizing tissue during the process of cutting the tissue. The apparatus comprises a blade having a cutting edge. The blade has at least one channel formed within the blade, with each channel having an inlet end and an outlet end. The outlet end of each channel is positioned proximate to the cutting edge of the blade. The apparatus further includes a catalyst disposed proximate to the outlet end of each channel. 
     In one embodiment, the invention is a blade having a cutting edge. The blade has a main channel and a plurality of branch channels formed within the blade, with each branch channel having an inlet end and an outlet end and the main channel having an inlet end and at least one outlet end. The outlet end of each branch channel is positioned proximate to the cutting edge of the blade. The inlet end of each branch channel is in fluid communication with an outlet end of the main channel. The apparatus includes a catalyst disposed proximate to the outlet end of each branch channel. 
     In another embodiment, the invention further includes a mixer for mixing reactant gases to form a mixture and delivering the mixture to the inlet end of the channels. The mixer provides for a well-mixed gas composition to provide a substantially complete reaction of the reactant gases. 
     Other objects, advantages and applications of the present invention will become apparent to those skilled in the art from the following detailed description. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The description herein makes reference to the accompanying drawings wherein like reference numerals refer to like parts throughout the several views and wherein: 
     FIG. 1 is an embodiment of the cutting blade of the present invention; 
     FIG. 1 a  is an enlargement of one embodiment of a primary channel; 
     FIG. 2 is an edge view of a blade of the present invention; 
     FIG. 3 is a diagram of the apparatus including an electrolyzer; 
     FIG. 4 is an alternate embodiment of the present invention; 
     FIG. 5 is an embodiment of the present invention with a conduit and blade as separate components; 
     FIG. 6 is an embodiment of the invention with two blades, forming a scissors; 
     FIG. 6 a  is an alternate embodiment of the invention with two blades; 
     FIG. 7 is another embodiment of the invention with two blades; 
     FIG. 8 is an embodiment of the invention for a remote cutting device; 
     FIG. 9 is an embodiment of the invention with a blade shaped for scraping tissue; 
     FIG. 10 is an embodiment of the invention with a blade for cutting over an aperture; 
     FIG. 11 is an embodiment of the invention with a blade for cutting over a notch; and 
     FIG. 12 is an embodiment of a cutting tool having an inner tubular member and an outer tubular member. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Surgical procedures usually require the cutting of a patient&#39;s tissue. However, accompanied with the tissue cutting is the flow of blood from the network of small capillaries in the tissue. The blood obstructs the surgeon&#39;s view, and the open capillaries present sites for possible entry of infection, as well as requiring blood replacement if the bleeding is extensive. Cauterizing the capillaries that have been cut will reduce the amount of blood flowing into the region of the cut, and will reduce the risk of infection by closing the ends of the capillaries. Cauterizing seals by applying heat to the site and by applying heat during the cutting process, the capillaries are closed as they are cut. The present invention is a scalpel blade that provides heat for cauterizing capillaries that have been cut. 
     The present invention, as shown in FIG. 1, is an apparatus for cutting that includes a blade  10  having a cutting edge  12 . The blade  10  is formed with a plurality of primary channels  14  within the blade for the transport of chemical reactants to a catalyst  16 . A mixture of chemical reactants is supplied to the inlet ends  18  of the channels  14 . The mixture is carried to the cutting edge  12  of the blade  10  and flows over the catalyst  16 . The catalyst  16  initiates an exothermic reaction, and the blade  10  heats up, supplying heat to cauterize capillaries as they are cut. The primary channels  14  have an inlet end  18  and an outlet end  20 , with the catalyst  16  deposited near the outlet end  20 . The blade  10  also has a distal edge  24  opposite the cutting edge  12 . At least one of the inlet ends  18  of the primary channels  14  is situated near the distal edge  24  of the blade  10 . The distal edge  24  provides a means to connect the blade  10  to a source of the mixture of chemical reactants. In an alternative, each primary channel  14  is comprised of a pair of secondary channels  14   a , as shown in FIG. 1 a . In this configuration one of the secondary channels  14   a  carries a first reactant and the other of the secondary channels  14   a  carries a second reactant. Each of the secondary channels  14   a  has an outlet that is proximate to the catalyst  16 . 
     The channels  14  are formed as part of the design of the blade  10 . The blade  10  is formed from two plates  26 ,  28  of material which are joined together. Prior to joining the two plates  26 ,  28 , at least one of the plates  26 ,  28  has the groves cut into the plate  26 . Upon joining the plates  26 ,  28 , the channels  14  are formed. The grooves are cut into the plate  26  using any well known method for producing small grooves. Possible methods include for example chemical etching methods and other well-known methods for micro machining. The channels  14  have a diameter of less than about 400 micrometers. The diameter of the channels  14  must be sufficiently small such that the mixture flowing in the channels  14  is stable with respect to combustion and ignition. For medical purposes, a preferred mixture is hydrogen and oxygen. A preferred diameter of the channels  14  for a mixture of hydrogen and oxygen is less than about 100 micrometers. 
     The channels  14  are formed in a pattern to provide a distribution of the outlet ends  20  of the channels along the cutting edge  12  of the blade  10 . One such pattern, as shown in FIG. 1, is a fanned array of channels such that the outlet ends  20  are uniformly distributed along the cutting edge  12 . Although a uniform pattern is presented, any distribution of the channels  14  that position the outlet ends  20  in proximity to the cutting edge  12  is contemplated by this invention. Positioning the outlet ends  20  proximate to the cutting edge  12  enables heating of the blade in the region close to the cut tissue. The channels  14  can be distributed in any pattern deemed necessary to provide the appropriate heating of the blade  10 . The channels  14  are preferably designed such that the pressure drop in each of the channels is substantially the same, providing uniform distribution of the mixture of reactants to the channel outlet ends  20 . The uniform distribution of the mixture to the outlet ends  20 , and in turn to the catalyst  16 , provides for a substantially uniform heating of the cutting edge  12 . 
     Alternately, a non-uniform distribution of the channel outlet ends  20  may be used to provide a greater supply of the mixture of reactants to a particular location on the blade  10 . For example, if heating the region near the tip  22  of the blade  10  is desired, a greater concentration of channel outlet ends  20  would be positioned near the tip  22 . An option to provide for non-uniform distribution of heating of the blade  10  is alternatively provided by non-uniform channel sizing. Channel diameters may be differentially sized to provide different flows of the reactant mixture through the channels  14 . 
     Following formation of the channels  14  in the plate  26 , the second plate  28  is placed in contact with the first plate  26  thereby covering the channels  14 . An edge view of the blade  10  is shown in FIG. 2, and depicts a channel within the blade  10 . The plates  26 ,  28  are joined together with any method to form a permanently bonded structure, such as diffusion bonding. The blade  10  is machined with any suitable method to produce the cutting edge  12 . The channels  14  are sealed except for the inlet ends  18  and the outlet ends  20 . FIG. 2 is an edge view of the blade  10  of the present invention, wherein a channel  14  is shown by dashed lines to lie within the blade  10  formed from two plates  26 ,  28 . Machining the cutting edge  12  leaves the channel outlet ends  20  just behind the cutting edge  12 . The distance behind the cutting edge can be adjusted, for example, by modifying the angle of the cutting edge  12 , or by using plates  26 ,  28  of different relative thicknesses. 
     The blade  10  is made of any material having a sufficient hardness and capable of holding a sharp edge and formed with channels within the blade. The material is selected from the group consisting of stainless steels, ceramics such as silicon nitride, glasses, quartz, thermoset plastics, and alloys of metals such as incolloy, inconel, hastalloy, brasses, and bronzes. The choice of material is only limited by the permeability of the reactants, and whether or not the materials react substantially with the reactants. Preferably, the blade is made from a stainless steel. 
     The blade  10  can be treated to harden the surface. Conventional methods for blade hardening include, for example, the application of coatings or heat treatments, and are well known in the art of hardening a blade. Hardening and annealing processes are described in U.S. Pat. Nos. 6,330,750; 5,433,801 and 4,180,420 and are incorporated by reference in their entireties. Optionally, the bonding of the plates  26 ,  28  and the hardening of the blade  10  can be combined into a single process. 
     The blade  10  surface is also treated for the application of a catalyst. Methods for applying coatings are well known in the art, for example, the application of zirconium nitride is described in U.S. Pat. No. 6,330,750. The carbon microstructure can also be adjusted, as described in U.S. Pat. No. 4,180,420. The catalyst may be added to the blade  10  prior to hardening the blade, or may be added to the blade after treatment for hardening the blade. An example of catalyst addition to the blade after hardening, is electroplating the edge of the blade with an appropriate catalyst such as platinum. 
     The choice of catalysts is dependent on the choice of chemicals reacted at the blade. For non-medical applications, reactants for generating heat, include acetylene, methane, and other hydrocarbon gases that react with an oxidizing agent. Examples of oxidizing agents include air and oxygen. In the description which follows, hydrogen and oxygen will be used as examples of reactants, but it is understood that the invention is not limited to those reactants. Suitable catalysts for hydrogen combustion are well known and include the noble metals. Other catalyst materials include scandium, titanium, vanadium, chromium, manganese, iron, cobalt, nickel, copper, zinc, yttrium, zirconium, niobium, molybdenum, technetium, ruthenium, rhodium, palladium, silver, cadmium, hafnium, tantalum, tungsten, rhenium, osmium, iridium, platinum, gold, gallium, germanium, indium, thallium, tin, lead, antimony, bismuth, polonium, and mixtures thereof. Catalyst materials also include oxides of metals, and other oxides. Preferably, the catalyst is selected from platinum, palladium, rhenium, rhodium, nickel, iron, and mixtures thereof. 
     The blade  10  is affixed to a handle is such a manner to align the channel inlet ends  18  with corresponding channels in the handle. The inlet ends  18  of the channels are in fluid communication with a source of hydrogen-oxygen mixture. Preferably, the hydrogen-oxygen mixture is provided in the appropriate stoichiometric ratio for the combustion of hydrogen and oxygen to form water, i.e., a 2:1 molar or volume ratio of hydrogen to oxygen. The hydrogen and oxygen, or other reactants can be supplied by independent sources such as cylinders of gas. Preferably, the hydrogen and oxygen are produced by an electrolyzer. The electrolyzer separates water into the constituents of hydrogen and oxygen in the desired ratio. The hydrogen and oxygen are directed from individual conduits to a mixer. The reactants are well mixed in the mixer and flow to the channel inlet ends  18 . Optionally, the reactants are fed to the channel inlet ends  18  and allowed to mix by diffusion while flowing along the channels  14  to the catalyst  16 . One embodiment of the mixer is described in U.S. patent application Ser. No. 09/850,470, filed on May 7, 2001, which is incorporated by reference in its entirety. 
     Preferably, the electrolyzer is sized to dissociate water at a rate between about 0.01 milligrams/minute and about 10 grams/minute. The volume of gases to be reacted is easily controlled by the amount of electrical power supplied to the electrolyzer. Details of an electrolyzer are well known in the art, as demonstrated in U.S. Pat. No. 6,036,827, which is incorporated by reference. Optionally, a control system is incorporated in the electrolyzer to provide an upper limit on the amount of electrical power used by the electrolyzer, including, but not limited to, a fuse for shutting off power to the electrolyzer. 
     In one embodiment, as shown in FIG. 3, the mixer (not shown) is disposed within the handle  30 . An electrolyzer  40  generates the hydrogen and oxygen to be reacted. The hydrogen is generated at one electrode and collected in a hydrogen reservoir. The hydrogen flows from the hydrogen reservoir through a hydrogen supply conduit to at least one hydrogen inlet to the mixer. The oxygen is generated at a second electrode and collected in an oxygen reservoir. The oxygen flows from the oxygen reservoir through an oxygen supply conduit to at least one oxygen inlet to the mixer. The hydrogen and oxygen are mixed within the mixer in a mixing chamber and flow out a mixing chamber outlet to the channel inlet ends  18  of the channels within the blade  10 . Although a handle  30  is depicted in this embodiment, any appropriate blade holder is intended to be covered by this invention, including for example a clamp for manipulating the blade. 
     An alternate embodiment of the present invention is shown in FIG.  4 . The invention comprises a blade  10  having a cutting edge  12  with capillary channels  14  formed therein. The channels  14  each have an inlet end  18  and an outlet end  20 . The blade  10  includes a catalyst  16  disposed near the outlet ends  20  of the channels  14 . The blade  10  further includes a main channel  32  formed therein. The main channel  32  has an inlet end  34  disposed at an edge  24  distal to the cutting edge  12 . The main channel  32  is in fluid communication with the inlet ends  18  of the channels  14 . This provides for a larger main channel  32  and facilitates connection to a conduit, or other means, carrying a reactive gas mixture to the blade  10 . Optionally, the main channel  32  decreases in diameter as the main channel  32  intersects with the channels  14  leading to the cutting edge  12 . 
     The invention is intended to cover all variations and permutations involving a blade with a conduit and a catalyst disposed proximate the end of the conduit. To that extent, an alternate embodiment includes the combination of at least one conduit  21  and a blade  10 , providing an inexpensive method of producing the invention. The conduit  21  and blade  10  are held in a common handle  30  to maintain the conduit  21  in a defined relationship with respect to the blade  10 , as shown in FIG.  5 . This provides for an inexpensive disposable conduit  21  and blade  10 , while maintaining a reusable handle  30 . While not limiting the handle configuration, or design, in a preferred embodiment, the handle  30  is sized to hold a mixer (not shown), an electrolyzer (not shown), and a battery (not shown) for power to the electrolyzer. The blade  10  has a cutting edge  12 , a non-cutting edge  23 , and a blade surface  25 . The invention includes a conduit  21  that defines a channel  14  for the transport of a mixture of reactants. The conduit  21  is positioned along the noncutting edge  23 , and has an inlet end  18  and an outlet end  20  with the outlet end  20  positioned proximate to the tip  22  of the blade  10 . The invention further comprises a catalyst  16  disposed proximate to the outlet end  20  of the conduit  21 . In the invention&#39;s simplest form, the invention is a needle positioned next to a scalpel blade with a catalyst disposed proximate to the outlet end of the needle, wherein the needle and scalpel blade are held by a handle and in a defined relationship with respect to each other. The defined relationship can be a single fixed position, or a series of positions wherein the conduit  21 , or needle, is adjustable to a desired position. Alternate embodiments include affixing the conduit  21  to the blade  10 , and further includes the possibility of affixing a plurality of conduits  21  to the blade surface  25  such that the conduits  21  lie on the blade surface  25  and have outlet ends  20  positioned in a desired relationship to the cutting edge  12 . The conduits  21  can be affixed to the blade  10  by any appropriate means, including but not limited to, for example welding, soldering, or use of an adhesive such as an epoxy. 
     In another embodiment of the present invention, the invention includes a second blade  50 . The blade  10  is pivotally attached to the second blade  50  by an attachment means  52  forming a scissors, as shown in FIG.  6 . The second blade  50  includes at least two edges with one of the edges being a cutting edge  54 . The attachment means  52  permits the blades  10 ,  50  to rotate about the attachment means  52  such that the cutting action is performed when one of the blade  10  and second blade  50  slides over the other. The scissors includes handles  30 ,  56  on each blade  10 ,  50  and are for moving the blades relative to each other. The blade  10  includes channels  14  formed within the blade  10 , wherein each channel  14  has an inlet end  18  and an outlet end  20 . The outlet ends  20  of the channels  14  are disposed proximate to the cutting edge  12  of the blade, and a catalyst  16  is disposed proximate to the outlet ends  20  of the channels. The scissors can includes a biasing means (not shown), such as for example a spring, for biasing the cutting edges  12 ,  54  away from each other. The blades  10 ,  50  are manually, or by other means, pressed toward each other such that the blades  10 ,  50  move past each other in a shearing motion. 
     Optionally, the second blade  50  is formed with a plurality of channels  58  therein. The channels  58  each have an inlet end  60  and an outlet end  62 , with the outlet ends  62  disposed proximate to the cutting edge  54  of the second blade  50 . A catalyst  16  is disposed proximate to the channel outlet ends  62 . 
     In another embodiment, the invention includes a second blade  50 . The second blade  50  is pivotally attached to the blade  10  by an attachment means  52  to form a nipper. As described above, the second blade  50  optionally includes channels  58  formed therein. The blades  10 ,  50  of the nipper are manually, or by other means, pressed toward each other wherein the cutting edge  12  of the first blade  10  comes into abutting edge-to-edge contact with a complimentary edge of the second blade  50 , as shown in FIG. 6 a . Optionally, the complimentary edge of the second blade  50  is a cutting edge  54 . 
     In one embodiment, as shown in FIG. 7, the invention comprises at least two blades  10 ,  10 ′, wherein the blades  10 ,  10 ′ are parallel to each other, wherein the blades  10 ,  10 ′ form a double scalpel. Each blade  10 ,  10 ′ is formed as described above for a single blade, with each blade  10 ,  10 ′ having channels  14  formed therein. The blades  10 ,  10 ′ are releasably attached to a handle  30 . The handle  30  is comprised of two members  37  and  37 ′, each member having a corresponding connection end  38 ,  38 ′ for attachment to the corresponding blade  10 ,  10 ′. The handle  30  includes an adjustment means  36  for setting the spacing between the blades  10 ,  10 ′. The adjustment means  36  may be any means for setting and holding the spacing of the two handle members  37 ,  37 ′, such as for example a set screw. The handle  30  includes a conduit having at least one inlet end and at least two outlet ends. The inlet end of the conduit is in fluid communication with a source of reactant mixture, and the outlet conduit ends are in fluid communication with the channel inlet ends  18  of the blades  10 ,  10 ′. 
     The apparatus of the present invention favorably lends itself to surgical procedures involving remote surgery such as laparoscopy. In minimally invasive surgical procedures it is desired to limit the amount of bleeding, and by cauterizing capillaries during the procedure, internal bleeding can be limited. The apparatus, as shown in FIG. 8, comprises a shaft member  90  having a longitudinal axis and first  92  and second  94  ends. The apparatus is a remote cutting tool having a blade  10  is adjustably affixed to the shaft member at the first end  92  of the shaft member  90 . The blade  10  includes a cutting edge  12  and has at least one capillary channel  14  formed within the blade  10 . Each capillary channel  14  has an inlet end  18  and an outlet end  20 , with the outlet end  20  proximate to the cutting edge  12  of the blade  10 . A catalyst  16  is disposed proximate to the outlet end  20 . Affixed to the second end  94  is a handle (not shown) or other means for manipulating the blade  10  affixed to the first end  92 . The apparatus further includes a conduit  96  in fluid communication with the inlet ends  18  of the channels  14 . The conduit  96  provides a means for supplying a chemical mixture to the catalyst  16 , thereby reacting and generating heat at the cutting edge  12 . Optionally, the conduit  96  is disposed within the shaft member  90 . By forming the shaft member  90  with the conduit  96  within the shaft member  90 , fluid communication between the inlet ends  18  of the capillary channels  14  and the source of a chemical reaction mixture is merged into a unitary piece. The blade  10  can be rotated about the longitudinal axis through rotation of the shaft member  90  by rotating the handle. The blade  10  can be pivotally attached to the shaft member  90 . Pivoting the blade  10  can be performed by a spring and cable means, a second shaft member attached to the blade, or other equivalent mechanical or electro-mechanical means. Remote manipulation means are well known in the art, as shown in U.S. Pat. No. 6,051,005, which is incorporated by reference. 
     The remote cutting tool may optionally include a tube  98 , often referred to as a cannula, through which the blade  10  and shaft member  90  are fed. The tube  98  is sized to permit access of remote operational instruments such as a laparoscope for observation of the procedure in addition to the remote cutting tool. A nominal diameter of the tube is about 1 cm. 
     In another embodiment of the remote cutting tool, the apparatus includes a second blade (not shown). The second blade is pivotally attached to the blade  10  and rotates about the attachment means relative to the blade  10  forming a scissors. The second blade has a cutting edge such that when the second blade pivots relative to the blade  10 , the second blade slides across the cutting edge  12  of the blade  10  in a scissor-like motion. Alternately, the second blade is pivotally attached to the blade  10 , and forms a nipper as described above. 
     The shape and design of the cutting tools is not confined to a shape for performing a straight cut, or to a blade having a substantially planar formation. In some surgical procedures, as in for example transurethral resection of the prostate, an electrocautery probe is used. The electrocautery probe is a cutting loop and the procedure is accomplished by applying a highly damped radio frequency current to the tissue through the probe. To achieve adequate performance the probe must be moved very slowly which increases operative time. Since operative time is limited by the safe time that a patient can withstand anesthesia, trauma, etc., the slow performance limits the amount of area of tissue that can be treated. The use of a shaped cutting blade that is heated through chemical reactions can provide a faster response and allow for a greater amount of tissue to be treated. 
     The shaped cutting tool as shown in FIG. 9 comprises a blade  10  having a first end  11  and a second end  13  opposite the first end  11 . The blade  10  has at least one cutting edge  12  located between the first  11  and second  13  ends, with a leading edge  15  and a trailing edge  17 . The blade  10  is affixed to a handle  30  having a pair of arms  31 ,  33 , wherein the first end  11  is attached to one of the pair of arms  31 ,  33  and the second end  13  is attached to the other of the pair of arms  31 ,  33 . The blade  10  is formed with a plurality of channels  14  defined therein. The channels  14  each have an inlet end  18  and an outlet end  20 . The outlet end  20  of each channel  14  is located proximate to the cutting edge  12  of the blade  10 . The blade  10  includes a catalyst  16  located proximate to the outlet ends  20  of the channels. The blade  10  may be formed using the methods described above, such as using two thin plates, wherein the channels  14  are formed in one plate, and bonding the second plate over the channels  14 . The blade  10  may be sharpened, and then formed into a desired configuration. One such configuration, as shown in FIG. 9, has a general U-shape. As an alternative, the plates are formed into the desired shape, the channels  14  are formed in one plate, and then the second plate is bonded with the first plate. 
     The channel inlet ends  18  are located at either the first end  11  or second end  13  of the blade. Depending on the number and distribution of channels  14  within the blade  10 , the inlet ends may be distributed between the first end  11  and the second end  13 . A conduit  96  is in fluid communication with the inlet ends  18  of the channels  14  for supplying a chemical mixture to the channels  14 . The conduit  96  may optionally be a channel formed within the handle  30  that runs through the handle arms  31 ,  33  to connect with the channel inlet ends  18 . 
     While the blade  10  in FIG. 9 is depicted as substantially perpendicular to the handle  30 , the orientation of the blade  10  is not limited to this configuration. On the contrary, the orientation of the blade  10  relative to the handle  30  can be any angle from substantially parallel to substantially perpendicular to the handle  30 . The cutting edge  12  maybe located on a leading edge  15  of the blade  10 , a trailing edge  17  of the blade  10 , or both the leading  15  and trailing  17  edges of the blade  10 . 
     An embodiment of the shaped cutting tool includes a tube  98  sized to permit movement of the blade  10  is shown in FIG.  10 . The tube  98  has a leading end  74  to be positioned near tissue to be cut. The tube  98  includes an aperture  70  within a wall of the tube proximate to the leading edge. The leading end  74  of the tube  98  can be open, or closed with a rounded end to permit smooth insertion of the tube  98 . The aperture  70  permits access of tissue to be cut by the blade  10 . The blade  10  is shaped to conform with the shape of the interior surface of the tube  98 . The blade  10  slides in a longitudinal direction over the aperture  70  to cut tissue projecting into the tube  98  through the aperture  70 . The blade  10  can also have a straight configuration, wherein the blade  10  slides over the aperture through rotation of the handle  30  within the tube  98 . 
     An alternate design includes at least one notch  72  in an open leading end  74  of the tube  98 , as shown in FIG.  11 . The blade  10  slides over the notch  72  cutting tissue positioned within the notch  72 . The blade  10  is of a design having a straight cutting edge  12 , and slides over the notch  72  through rotation of the cutting tool within the tube  98 . Alternately, the blade  10  is designed to conform to the shape of the interior wall of the tube  98  and slides over the notch in a longitudinal direction. 
     The cutting tool is not confined to a blade, but may be any cutting tool used in surgical procedures. A cutting tool can take the form of an arthroscopic cutting tool, as shown in FIG.  12 . The cutting tool comprises an outer tubular member  80  and an inner member  82 . The outer tubular member  80  has a longitudinal axis, a first end  84  and a second end opposite the first end, wherein the first end  84  is inserted into a patient for cutting tissue. The first end  84  includes at least one notch  86 , wherein tissue to be cut is positioned. The inner tubular member  82  has a longitudinal axis, a first end  88  and a second end opposite the first end  88 . The first end  88  of the inner tubular member  82  includes a sharpened edge  90  for cutting proximate to the first end  88 . The inner tubular member  82  is sized such that the outer surface of the inner tubular member  82  is in contact with the inner surface of the outer tubular member  80 . The inner tubular member  82  can move along the longitudinal axis within the outer tubular member  80 , or can rotate around the longitudinal axis within the outer tubular member  80 . The sharpened edge  90  of the inner tubular member  82  slides over the inner surface of the outer tubular member  80  when the inner tubular member  82  is rotated around the longitudinal axis relative to the outer tubular member  80 . 
     The inner tubular member  82  has in interior surface and includes capillaries  92  affixed to the interior surface. The capillaries  92  have inlet ends and outlet ends  94 , wherein the outlet ends  94  are positioned proximate to the sharpened edge  90 . A catalyst  16  is disposed on the inner tubular member  82  proximate to the sharpened edge  90 . In one embodiment, capillaries  92  are formed of a flexible material that is impermeable to hydrogen and oxygen. The capillaries  92  are positioned on the interior surface of the inner tubular member  82  with the outlet ends  94  positioned near the sharpened edge  90 . The capillaries  92  are bonded to the inner surface of the inner tubular member  82  with an appropriate bonding agent, for example an epoxy resin. The inlet ends of the capillaries  92  extend to at least the second end of the inner tubular member  82  where the inlet ends  94  of the capillaries  92  are in fluid communication with a source of a gaseous mixture of hydrogen and oxygen. Preferably, the source of hydrogen and oxygen are generated from an electrolyzer as described above. The hydrogen and oxygen from the electrolyzer are directed to inlet ports of a mixing chamber and mixed in the chamber producing a mixture. The mixture is directed to an outlet port of the mixing chamber in fluid communication with the inlet ends of the capillaries. 
     In an alternate embodiment, the inner tubular member  82  moves in a longitudinal direction relative to the outer tubular member  80  and the sharpened edge  90  slides over the notch  86  cutting through tissue positioned within the notch  86 . There are many other obvious variations on the cutting tool, including for example an embodiment (not shown) with an aperture in the side of the outer tubular member and proximate to the first end, all of which are contemplated by the present invention. 
     Additional cutting tools include the leading edge of a dissector which can be adapted to be covered by the present invention for surgery where bleeding is expected and cauterization of capillaries is desired. Although the dissector is relatively blunt when compared with a scalpel blade, the dissector is sometimes used to separate tissue and in the separation process bleeding can occur. The cutting edge of a resector is also contemplated to be covered by this invention. 
     While the invention has been described with what are presently considered the preferred embodiments, it is to be understood that the invention is not limited to the disclosed embodiments, but it is intended to cover various modifications and equivalent arrangements included within the scope of the appended claims.