Combination surgical scalpel and electrosurgical instrument

A surgical instrument includes a handle and a disposable assembly which can be readily replaced after each operation or as necessary. The disposable assembly includes both an electrically heated scalpel blade and an electrosurgical active electrode which are mounted in a spaced parallel arrangement so that they can be used alternately by rotating the instrument by 180 degrees. The mounted ends of both the blade and the electrode are adapted to be received by separate terminals in the instrument handle so that the appropriate external power sources can be selectively connected thereto.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
This invention pertains to surgical instruments, and more particularly it 
pertains to surgical instruments that apply heat or energy to achieve 
hemostasis or coagulation for the sealing of blood vessels during the 
surgical operation. 
2. Description of the Prior Art 
During a surgical operation, a major portion of the total time required is 
used for controlling bleeding. Such bleeding obscures the surgeon's 
vision, reduces his surgical precision and often makes necessary the 
following of slow and elaborate procedures. Typically, each bleeding 
vessel must be grasped in a surgical clamp to stop the flow of blood. The 
tissue and vessel within each clamp is then tied with pieces of fine 
thread. Such ligated masses of tissue subsequently die and decompose, 
retarding healing and encouraging infection. 
Heating of a cutting instrument to provide simultaneous hemostasis is 
disclosed in U.S. Pat. No. RE. 29,088 which issued on Jan. 11, 1977, U.S. 
Pat. No. RE. 30,190 which issued on Jan. 15, 1980, U.S. Pat. No. 4,089,336 
which issued on May 16, 1978, U.S. Pat. No. 4,091,813 which issued on May 
30, 1978, U.S. Pat. No. 4,185,632 which issued on Jan. 29, 1980, and U.S. 
Pat. No. 4,481,057 which issued on Nov. 6, 1984. While a heated cutting 
instrument of the type disclosed in such patents provides satisfactory 
hemostasis for smaller blood vessels, it does have difficulty sealing 
larger vessels. 
Electrosurgery provides an alternative method of bleeding control, 
coagulation, or hemostasis, as well as providing a cutting capability. An 
electrical current flows through a circuit that begins at a high-frequency 
oscillator within an electrosurgical unit, goes through an active cable 
and an active electrode to the patient, and then returns from the patient 
by way of a dispersive electrode and a cable to the electrosurgical unit. 
The dispersive electrode has a relatively large contact area to prevent 
burns to the patient's body, while the relatively small contact area 
between the tissue and the active electrode tip causes a concentration of 
current (high current density) that heats the tissue at this point. By 
raising the temperature of the tissue or cells to the point of changing 
the protein into coagulum, coagulation or hemostasis is accomplished. 
Electrosurgical instruments that can produce coagulation are disclosed in 
U.S. Pat. No. 4,112,950 which issued Sept. 12, 1978, to Pike; U.S. Pat. 
No. 4,311,145 which issued Jan. 19, 1982, to Esty et al.; and U.S. Pat. 
No. 4,427,006 which issued Jan. 24, 1984, to Nottke. 
Surgical and hemostatic scalpels along with electrosurgical units have been 
available in operating rooms. Hertofore, scalpels and electrosurgical 
active electrodes have been separate instruments mounted in separate 
handles. To use a scalpel and an electrosurgical active electrode 
sequentially during an operation required excessive handling, changing 
back and forth from one instrument to the other. This is both time 
consuming and distracting for the surgeon. Furthermore, after an operation 
the scalpel blade and the electrode are changed individually in their 
respective handles. 
SUMMARY OF THE INVENTION 
Advantages of the invention include simplified handling for sequential use 
of a scalpel that mechanically cuts tissue and an electrosurgical active 
electrode that controls bleeding by coagulation, simplified handling for 
changing both a scalpel blade and an electrode simultaneously, minimized 
interference of the scalpel blade and the electrode with the operation of 
each other, and prevention of electrical short circuits between the 
electrode and a scalpel blade. 
In accordance with the present invention, there is provided a disposable 
assembly for a surgical instrument that cuts tissue mechanically and that 
applies electrical current thereto causing coagulation. The assembly 
includes an electrosurgical active electrode, a scalpel and a body that 
joins the scalpel and the electrode for simultaneous movement and 
simultaneous support. The electrode has a tip at one end, an electrical 
contact at the opposite end, and an intermediate portion with a straight 
section. The scalpel has a shank section and a blade section projecting 
from the shank section. The blade section has a cutting edge and a back 
edge that come together at a point remote from the shank section. A 
straight portion of the blade back edge is positioned adjacent the 
straight section of the electrode with the electrode tip and the blade 
section point facing in the same direction. The blade section point is 
spaced sufficiently from the electrode tip to prevent electrical shorting 
therebetween. The adjacent straight electrode section and back edge 
portion define therebetween an axis of rotation. The body holds the 
scalpel and the electrode in opposed operational positions that are used 
sequentially by rotating the assembly one half revolution about the axis 
of rotation. 
In a preferred embodiment of the invention, a surgical instrument is 
provided which includes a disposable assembly as described and a handle to 
support the assembly. The handle has a socket for receiving a portion of 
the disposable assembly body and a receptacle for receiving the electrical 
contact of the electrode.

DESCRIPTION OF THE PREFERRED EMBODIMENT 
Looking now at FIG. 1, a combination surgical, hemostatic and 
electrosurgical instrument system 20 is shown. In this system, a 
disposable assembly 21 is provided which includes an electrosurgical 
active electrode 22 and a hemostatic scalpel blade 23 that are joined 
together by a body 24 of electrically insulative material. A portion of 
this body fits into a handle 26 that supports the disposable assembly. The 
handle is electrically connected to an interface unit 27. A dispersive 
electrode 28, that is arranged to be positioned on the opposite side of a 
patient's body from the active electrode, and a foot switch 29, that 
controls the flow of current to the active electrode, are also 
electrically connected to the interface unit that contains switching and 
control circuitry. Also electrically connected to the interface unit are 
an electrosurgical unit 31 that provides the power for performing 
electrosurgical cauterization or coagulation with the active electrode and 
a controller 32 that provides power for heating the hemostatic scalpel 
blade. 
With reference to FIG. 2, it will be seen that electrode 22 has a tip 34 at 
one end, an electrical contact 35 at the opposite end, and an intermediate 
portion 36 with a straight section 37. A bend section 38 is located 
between the straight section and the electrode tip. This bent section 
diverges away from the scalpel blade 23 and the deflection angle between 
the straight section and the bent section of the electrode is about 30 
degrees so that the tip 34 will be well spaced from the blade 23. A radial 
projection 39, shown in FIGS. 2 and 4, is provided on the electrode for 
locking the electrode against axial rotation within the body 24, and the 
electrode is also locked against axial movement within the body by the 
radial projection. An insulating sleeve 40 is provided about the electrode 
between the electrical contact 35 and the tip 34 to avoid electrical 
shorting between the electrode and the scalpel blade. 
The hemostatic scalpel blade 23 has a shank section 42 and a blade section 
43. The blade section has a cutting edge 44 and a back edge 45 that come 
together at a point 46 remote from the shank section. The back edge of the 
blade section has a straight portion 47 that is positioned adjacent the 
straight section 37 of the electrode 22 with the electrode tip 34 and the 
blade section point 46 facing in the same direction. The blade section 
point is spaced sufficiently from the electrode tip to prevent electrical 
shorting therebetween. The blade section projects beyond the electrode tip 
and shields the electrode when the scalpel is in use. The adjacent 
straight electrode section and the back edge straight portion define 
therebetween an axis of rotation 48 (FIG. 2). 
The hemostatic scalpel blade 23 is of the type disclosed in U.S. Pat No. 
4,481,057 and includes a metallic laminate core 51, shown in FIG. 2, 
formed by a steel substrate, not shown, that is sandwiched between two 
copper composition laminae. A heating assembly 52 (FIG. 3) has a heater 
portion 53, shown in FIG. 2, that is formed of a narrow strip of copper 
foil, an adhesive including thermally conductive filler material advixed 
with resins securing the heater portion to the core 51 in a thermally 
conductive but electrically insulative relationship, and a polyimide 
backing material 54 upon which the heater portion is disposed prior to 
being attached to the metallic laminate core of the scalpel blade section 
43 and which insulates the heater portion from external contacts. After 
assembly of the heating assembly to the core, the outer surfaces of the 
scalpel blade section are coated with a non-stick material that is 
preferably a form of polytetrafluoroethylene and chosen from the group 
consisting of tetrafluoroethane, polyfluorinated alcoxy and fluorinated 
ethylene polymer. 
The heating assembly 52 has a contact portion 55 that is threaded through 
the hollow body 24 and wrapped around the rearwardly projecting end of the 
body, as shown in FIG. 3. An aperture 56 that is provided in the contact 
portion fits about a peg 57 of the body for securing the contact portion 
to the body. Preferably, the body is made of thermoplastic material such 
that peg 57 may be heated so as to expand and heat stake the contact 
portion of the heating assembly to the body. The shank 42 of the scalpel 
blade is secured within a narrow channel in the body (FIG. 3). Thus, the 
body joins the scalpel blade and the electrosurgical active electrode 22 
for simultaneous movement and support. 
The scalpel handle 26 has a forward section 60, shown in FIG. 5, with 
internal configurations as illustrated in FIGS. 6-10. This forward section 
of the handle defines a socket 61 (FIG. 6) having a rectangular 
cross-sectional configuration for receiving the rearwardly projecting 
portion of the assembly body 24, as shown in FIG. 15, to support the 
assembly 21. Penetration of the assembly body into the socket and the 
minimal clearances therebetween provide a tight fit sufficient for 
resisting rotational forces on the body due to forces applied to the 
scalpel blade or the electrode during their use. At the upper side of 
socket 61 is a coextensive groove 62, shown in FIGS. 9 and 10, for 
enabling passage of the electrode contact 35 when the assembly body 24 is 
inserted into the socket 61. At the innermost end of the groove 62 is a 
bore 63 that is followed by a rectangular slot 64, shown in FIGS. 8 and 
10. Fitting within the rectangular slot is a clip receptacle 66, shown in 
FIGS. 11, 12 and 15, for receiving the electrode contact 35 and making 
good electrical contact therewith. It will be seen that the clip 
receptacle is attached to an electrical lead which is connected to the 
appropriate circuitry for providing a sufficient voltage to the electrode 
22. 
In the handle forward section 60, spaced inwardly from the socket 61, are a 
plurality of spaced flanges 67, 68 and 69 projecting laterally inwardly 
from one side wall and a plurality of spaced flanges 71, 72 and 73 
projecting laterally inwardly from the opposite side wall, as shown in 
FIGS. 6 and 8-10, all of such flanges being formed integrally with the 
remainder of the handle. A printed circuit board 74, shown in FIGS. 13, 14 
and 15, is provided at one end thereof with a plurality of spaced metallic 
contacts 76, 77, 78 and 79 that are arranged to interfit with the plastic 
flanges of the handle, as shown in FIGS. 15, so that the flanges insulate 
the contacts from each other. As can be seen from FIGS. 13 and 14, the 
contacts 76-79 are opposed prongs that are adapted to yield outwardly when 
they grip the heater assembly 52. The forwardly directed portion of the 
contacts define a receptacle 81 (FIG. 13) for receiving the contact 
portion 55 of the heating assembly 52. A partition 82 in the handle body 
separates and insulates the electrosurgical clip receptacle 66 from the 
heating assembly contact receptacle 81. The clip receptacle grips the 
electrode contact 35, and contacts 76, 77, 78 and 79 grip the contact 
portion of the heating assembly with sufficient friction to overcome the 
gravitational forces on the disposable assembly 21 when the handle 26 is 
inverted. 
Before a surgical operation, the combination surgical, hemostatic and 
electrosurgical instrument system 20 is made ready. A new disposable 
assembly 21 is inserted into the handle 26 until the clip receptacle 66 
grips the electrode contact 35 and the electrical contacts 76, 77, 78 and 
79 grip the contact portion 55 of the heating assembly 52. After an 
operation, the disposable assembly is withdrawn by hand applying 
sufficient force to overcome the frictional grip of the clip receptacle 
and the printed circuit board contacts. The disposable assembly is changed 
after each operation or during an operation as required. Since the 
assembly body 24 joins the scalpel blade 23 and the electrode 22 for 
simultaneous movement and for simultaneous support, the scalpel blade and 
the electrode are changed simultaneously, thus simplifiying the required 
handling. 
During a surgical operation, the body 24 holds the hemostatic scalpel blade 
23 and the electrosurgical active electrode 22 in opposed operational 
positions. A surgeon with the surgical instrument in hand can use the 
scalpel blade and the electrode sequentially without putting down the 
instrument. By rotating the handle 26, the disposable assembly 21 can be 
turned one-half revolution about the axis of rotation 48, changing from 
one operational position to the other. Since the operational positions of 
the scalpel blade and the electrode are one-half revolution apart, when 
one is in use, the other is thereabove and out of the way, minimizing the 
interference of one with the other. The scalpel blade section 43 projects 
beyond the electrode tip 34 and shields the electrode 22 when the scalpel 
blade is in use. Electrical short circuits between the electrode and the 
scalpel blade are prevented by the insulating sleeve 40 on the electrode, 
the spacing between the electrode tip and the blade section point 46, and 
the internal handle partition 82 that insulates the electrode clip 
receptacle 66 from the heater contact receptacle 81. 
From the foregoing description, it will be seen that the present design of 
a combination surgical, hemostatic and electrosurgical instrument system 
20 has the advantages of simplified handling for sequential use of a 
scalpel blade 23 that mechanically cuts tissue and an electrosurgical 
active electrode 22 that controls bleeding by coagulation, simplified 
handling provided by changing both the scalpel blade and the electrode 
simultaneously, minimized interference of the scalpel blade and the 
electrode with each other, and the prevention of electrical short circuits 
between the electrode and the scalpel blade. 
Although the best mode contemplated for carrying out the present invention 
has been herein shown and described, it will be apparent that modification 
and variation may be made without departing from what is regarded to be 
the subject matter of the invention.