Manually articulating devices

The device includes an elongate shaft having a distal end coupled to a proximal end of an articulation joint, and an actuation wire extending through the elongate shaft and the articulation joint. The device includes an end effector having a distal tip coupled to a distal end of the articulation joint and receiving therethrough a distal end of the actuation wire. The end effector includes a hook knife disposed adjacent the distal tip and having a proximal end connected to the distal end of the actuation wire. The actuation wire is translatable along a longitudinal axis of the elongate shaft to extend and retract the distal end of the hook knife relative to the distal tip of the end effector, and the articulation joint is laterally articulatable relative to the longitudinal axis of the elongate shaft to allow the end effector to be angularly oriented relative to the elongate shaft.

BACKGROUND

In laparoscopic surgical procedures, a small incision is made in the body and an elongate shaft of a surgical device is inserted through the incision to position a distal end of the shaft at a surgical site. In endoscopic procedures, the elongate shaft of a surgical device is inserted through a natural orifice, such as the mouth or anus, and is advanced along a pathway to position a distal end of the device at a surgical site. Endoscopic procedures typically require the use of a flexible shaft to accommodate the tortuous pathway of the body lumen, whereas rigid shafts can be used in laparoscopic procedures. These tools can be used to engage and/or treat tissue in a number of ways to achieve a diagnostic or therapeutic effect.

Many current laparoscopic and endoscopic devices utilize articulating effectors to provide the user with more control over the orientation of the working end of the instrument. Integration of the controls for articulating, as well as actuating, a working end of a laparoscopic or endoscopic device tend to be complicated by the size constraints of the relatively small pathway through which it is inserted. The controls for an endoscopic device are further complicated by the flexibility of the shaft. Generally, the control motions are all transferred through the shaft as longitudinal translations, which can interfere with the flexibility of the shaft. There is also a desire to lower the force necessary to articulate and/or actuate the working end to a level that all or a great majority of surgeons can handle. One known solution to lower the force-to-fire is to use electrical motors. However, surgeons typically prefer to experience feedback from the working end to assure proper operation of the end effector. The user-feedback effects are not suitably realizable in present motor-driven devices. What is needed is an improvement over the foregoing.

DESCRIPTION

The present invention generally provides methods and devices for controlling movement of a working end of a surgical device, and in particular for performing various surgical procedures using an instrument having an end effector that can be articulated relative to an elongate shaft of the device. In certain embodiments, the end effector can also optionally rotate relative to the elongate shaft of the device, and/or the shaft can rotate relative to a handle portion of the device. Articulation and rotation of the end effector will allow the end effector to be positioned at various locations during a surgical procedure, thereby providing the user with precise control over the end effector. A person skilled in the art will appreciate that the present invention has application in endoscopic procedures, laparoscopic procedures, and in conventional open surgical procedures, including robotic-assisted surgery.

FIGS. 1A-1Billustrate one exemplary embodiment of an insertion portion10of a manually articulating device. A handle portion50of the device will be discussed in more detail below in connection withFIGS. 3A-3D. It will be appreciated that the terms “proximal” and “distal” are used herein with reference to a clinician gripping the handle portion50of the device. Thus, the insertion portion10is distal with respect to the more proximal handle portion50. The insertion portion10is preferably configured to be inserted into a patient's body, and it can be rigid for laparoscopic applications, flexible for endoscopic applications, or it can have rigid and flexible portions as may be desired. As shown inFIG. 1A, the insertion portion10generally includes a hollow elongate shaft12having a working end or end effector14coupled to a distal end12bthereof by a three-bar linkage16. Operation of the three-bar linkage16is described in commonly-owned U.S. application Ser. No. 11/610,803 to Nobis et al. entitled MANUALLY ARTICULATING DEVICES, the disclosure of which is incorporated herein by reference it its entirety. While the end effector14can have various configurations, in the illustrated embodiment the end effector14is configured for use with a hook knife18. The three-bar linkage16allows the end effector14to be oriented at an angle relative to a longitudinal axis L of the elongate shaft12. The device can also optionally be configured to allow the end effector14to rotate relative to and about the longitudinal axis L of the elongate shaft12. In the illustrated embodiment, the three-bar linkage16is rotatably coupled to the distal end12bof the elongate shaft12, and thus the three-bar linkage16, as well as the end effector14coupled thereto, can be positioned in various axial orientations. The location of the rotation joint R proximal of the articulation joint A is particularly advantageous in that rotation of the end effector14can change the location of the plane within which the end effector14articulates.

The three-bar linkage16can have a variety of configurations, but in an exemplary embodiment, as shown in more detail inFIGS. 1B-1D, it includes three links20,22,24that are pivotally coupled to one another. Each link can have a variety of configurations, but in an exemplary embodiment the first and second links20,22each have a generally hollow elongate shape and the third link24is in the form of an elongate rod or bar. The first link20can have a proximal end20athat is coupled to the distal end12bof the elongate shaft12via first and second rotation couplings26,28, which will be discussed in more detail below. The distal end20bof the first link20can be pivotally coupled to a proximal end22aof the second link22, e.g., by a pivot joint. The distal end22bof the second link22can in turn be coupled to the end effector14, which will be discussed in more detail below. The third link24can extend at least partially through the first and second links20,22, and it can have a distal end24bthat is pivotally coupled to the second link22, e.g., by a pivot pin, to form a three-bar linkage mechanism. The particular location at which the third link24mates to the second link22can vary, but it is preferably pivotally mated at a location that will allow the third link24to apply a force to the second link22to cause the second link22to articulate relative to the first link20. A proximal end24aof the third link24can be coupled to an articulation actuator30extending through the elongate shaft12and at least partially through the first link20. The articulation actuator30can have a variety of configurations, but in an exemplary embodiment the articulation actuator30is in the form of a hollow elongate shaft or tube. Such a configuration allows an actuation wire32to extend therethrough for actuating the end effector14, as will be discussed below.FIG. 1Balso illustrates an articulation coupling34for connecting the articulation actuator30to the third link24. The coupling34may be a tubular member that fixedly mates to the articulation actuator30and pivotally mates to the proximal end24aof the third link34. A person skilled in the art will appreciate that the articulation actuator30can alternatively be directly mated to the third link24.

In use, proximal movement of the articulation actuator30relative to and along the longitudinal axis L of the elongate shaft12will apply a proximally-directed force to the third link24. The third link24will thus apply a proximally-directed force to the second link22, causing the second link22to pivot laterally relative to the longitudinal axis L of the elongate shaft12. As a result, the second link22, with the end effector14coupled thereto, will move laterally in a single plane to allow the end effector14to extend at an angle relative the longitudinal axis L of the elongate shaft12, as shown inFIG. 1D. The end effector14can be returned to the original, longitudinally-aligned position, shown inFIGS. 1A and 1C, by moving the articulation actuator30distally relative to the elongate shaft12.

As previously indicated, in addition to articulating movement, the end effector14can also be configured to rotate relative to the elongate shaft12, thus allowing the end effector14to be positioned in multiple angular orientations. The particular location of the rotation joint R can vary, and it can be located proximal to the three-bar linkage16, at a mid-portion of the three-bar linkage16, or distal to the three-bar linkage16. In an exemplary embodiment, the rotation joint R is located proximal to the three-bar linkage16, and more preferably proximal to the articulation joint A formed between the first and second links20,22. As shown inFIGS. 1A-1D, the first link20can be rotatably coupled to the distal end12bof the elongate shaft12by one or more rotation couplings. The illustrated embodiment includes first and second rotation couplings26,28. The first rotation coupling26has a generally elongate hollow shape with a proximal end26athat is fixedly mated to the elongate shaft12and a distal end26bhaving deflectable tabs26cformed therearound. The tabs26ccan be formed by longitudinally-extending cut-outs formed in and spaced radially around the distal end26bof the first rotation coupling26. Each tab26ccan include an annular flange or lip (not shown) formed on an inner surface thereof. The second rotation coupling28can also have a generally elongate hollow shape, and it can include a groove or cut-out28cformed therein. The first and second rotation couplings26,28can be mated by advancing the tabs26cover the proximal end28aof the second rotation coupling28. The tabs26cwill deflect until the annular flange or lip on the tabs26cextends into and engages the groove28cformed in the second rotation coupling28. The two rotation couplings26,28can thus rotate relative to one another, allowing the first link20, which is fixedly mated to the distal end28bof the second rotation coupling28, to rotate relative to the first rotation coupling26and the elongate shaft12. It will be appreciated that the particular construction the rotation joint described above is provided by way of example only, and that the function of the rotation joint may be realized using any of a variety of different components.

Rotation of the end effector14relative to the elongate shaft12can be achieved by rotating the articulation actuator30. In particular, rotation of articulation actuator30relative to and about the longitudinal axis L of the elongate shaft12will rotate the third link24, which is coupled to the second link22, which in turn is coupled to the end effector14and the first link20. As a result, the entire three-bar linkage16will rotate with the end effector14relative to and about the longitudinal axis L of the elongate shaft12. Rotation can also be performed while the end effector14is articulated, thereby changing the plane within which the end effector12articulates.

FIGS. 1E-1Hillustrate alternative embodiments of a three-bar linkage. In one embodiment, shown inFIGS. 1E-1F, the third link24ofFIGS. 1B-1Dcan be replaced with a flexible link. While the flexible link can have a variety of configurations, and it can be in the form of a flexible cable or similar member,FIG. 1Eillustrates a flexible wire24′. As shown, the wire24′ has a generally elongate shape with first and second terminal ends24a′,24b′ that are bent to extend at an angle, e.g., 90°, relative to the remainder of the wire24′. The ends24a′,24b′ are configured to replace the pivot pins used to pivotally couple the third link24to the first and second links20,22of the embodiment shown inFIGS. 1A-1D. Thus, the ends24a′,24b′ can extend into and pivotally couple to the first and second links20,22(FIGS. 1B-1D) to allow the first, second, and third links20,22,24′ to pivot relative to one another. In use, proximal movement of the articulation actuator30relative to and along the longitudinal axis L of the elongate shaft12will apply a proximally-directed force to the third link24′. The third link24′ will thus flex or buckle, thereby causing the second link22to pivot laterally relative to the longitudinal axis L of the elongate shaft12. As a result, the second link22, with the end effector14coupled thereto, will move laterally in a single plane to allow the end effector14to extend at an angle relative the longitudinal axis L of the elongate shaft12. The end effector14can be returned to the original, longitudinally-aligned position, shown inFIGS. 1A and 1C, by releasing the articulation actuator30to allow the flexible link24′ to return to its original, non-flexed position shown inFIG. 1E, thereby forcing the articulation actuator30to move distally relative to the elongate shaft12. The flexible link24′ can also be used to transfer rotational forces to effect rotation of the end effector, but in an exemplary embodiment the articulating coupling34(FIGS. 1B-1D) is modified to be non-rotatably coupled to the first link20. As shown inFIG. 1F, which illustrates an alternative embodiment of an articulating coupling34′, this can be achieved by inserting a pin member (not shown) through a bore34a′ formed in the articulating coupling34′, and positioning the pin member such that it is slidably disposed within a longitudinal slot (not shown) formed in the first link20. As a result, when the articulation actuator30is rotated relative to and about the longitudinal axis L of the elongate shaft12, the articulating coupling34′ will rotate therewith, thereby causing the first and second links20,22to rotate, as well as the end effector14. As a result, the entire three-bar linkage16will rotate with the end effector14relative to and about the longitudinal axis L of the elongate shaft12. Rotation can also be done while the end effector14is articulated, thereby changing the plane within which the end effector12articulates.

FIGS. 1G-1Hillustrate another embodiment of a three-bar linkage that is similar to the three-bar linkage shown inFIGS. 1A-1D. However, in this embodiment a cam24″ replaces both the third link24and the articulating coupling34of the previous embodiment. As shown inFIG. 1G, the cam24″ is generally hook-shaped and includes a curved slot24a″ formed therein. A proximal end24p″ of the cam24″ can be fixedly mated to the distal end of the articulation actuator30, and a pin25″ can be slidably disposed through the slot24a″. The pin25″ can be fixedly mated to or formed on an inner wall of the third link22. As with the embodiment shown inFIGS. 1B-1D, the first and second links20″,22″ can be pivotally coupled to one another. InFIG. 1G, the first link20″ is similar to first link20ofFIGS. 1B-1D, however link20″ has opposed bores20a″,20b″ spaced a distance apart from the distal end20d″ of the link20″ for receiving opposed pins (only one pin22b″ is shown) formed on the proximal end22a″ of the second link22″. In use, as shown inFIG. 1H, distal movement of the articulation actuator30will move the cam24″ distally. As the cam24″ is moved relative to the pin25″, the cam slot24a″ will force the pin25″ to follow the path of the slot24a″. As a result, the second link22″ is caused to pivot laterally relative to a longitudinal axis of the elongate shaft (not shown). As a result, the second link22″, with the end effector (not shown) coupled thereto, will move laterally in a single plane to allow the end effector to extend at an angle relative the longitudinal axis of the elongate shaft. The end effector can be returned to the original, longitudinally-aligned position by moving the articulation actuator30proximally and thereby pulling the cam24″ proximally. Again, the cam slot24a″ will cause the pin25″ to slid therein and follow the path of the slot24a″, thus causing the second link22″ to return to its original, longitudinally aligned position.

FIGS. 2A-2Billustrate exploded and cross-sectional views, respectively, of the end effector14ofFIGS. 1A-1B. Also shown is the distal end22bof the second link22to which the end effector14is attached in an assembled state of the device. The end effector14may comprise, in addition to the hook knife18, a distal tip36, a sleeve37, and a distal end32bof the actuating wire32. The hook knife18may be fabricated from a biocompatible material of suitable hardness and durability, such as, for example, medical grade stainless steel, and comprise a generally hook-shaped distal end18bhaving a sharpened inner edge18cformed thereon for cutting tissue when pulled therethrough. A proximal end18aof the hook knife18may be configured for attachment to the distal end32bof the actuating wire32using, for example, a press fit or other suitable attachment technique. In one embodiment, the hook knife18may be detachable from the distal end32bof the actuating wire32so that it may be replaced. In another embodiment, the hook knife18may be permanently affixed to the distal end32b.

The sleeve37may be generally cylindrical in shape and comprise a longitudinal bore38through which the distal end32bof the actuating wire32coaxially extends. As shown inFIG. 2A, a proximal end37aof the sleeve37may comprise an outer diameter larger than that of more distal portions of the sleeve37for enabling the proximal end37ato be slidably retained within the distal end22bof the second link22, as discussed in more detail below. The longitudinal position of the sleeve37on the actuating wire32may be such that a distal end37bof the sleeve37is adjacent, or in contact with, the proximal end18aof the hook knife18. In one embodiment, the longitudinal position of the sleeve37on the actuating wire32may be fixed using, for example, a crimp38(FIG. 2B) or other fastening device affixed to the actuating wire32adjacent the proximal end37aof the sleeve37. Accordingly, the sleeve37may be retained on the actuating wire32between the proximal end18aof the hook knife18and the crimp38such that the actuating wire32(and thus the hook knife18) are independently rotatable relative to a longitudinal axis of the sleeve37. Alternatively, the longitudinal position of the sleeve37on the actuating wire32may be fixed using, for example, a suitable adhesive material disposed within the bore38. In this embodiment, rotation of the actuation wire32and hook knife18will result in corresponding rotation of the sleeve37. In one embodiment, the sleeve37may be constructed of an electrically non-conductive biocompatible plastic. In other embodiments, the sleeve37may be constructed of an electrically non-conductive and suitably heat-resistant biocompatible material, such as, for example, a ceramic material. A heat-resistant construction of the sleeve37may be used, for example, in electrosurgical configurations of the device, as discussed in more detail below.

With reference toFIG. 2B, the proximal end37aof the sleeve37may be slidably disposed within a recess39defined by the distal end22bof the second link22. As shown, the recess39may form the distal-most portion of a bore40extending longitudinally through the second link22. The distal end37bof the sleeve37may distally protrude from the recess39and pass through a longitudinal bore41defined by the distal tip36. The distal tip36may be longitudinally aligned with and coupled to the distal end22bof the second link22such that a proximally-facing surface42formed by a restriction of the bore41partially encloses the recess39at its distal end. The distal tip36may be coupled to the distal end22busing, for example, a threaded connection or other suitable connection technique. Distal movement of the sleeve37relative to the distal tip36is thus limited by engagement of the outer diameter of the proximal end37aof the sleeve37by the proximally-facing surface42of the distal tip36. Similarly, proximal movement of the sleeve37relative to the distal tip36is limited by engagement of the outer diameter of the proximal end37aof the sleeve37by a surface22cat a proximal end of the recess39. Distal and proximal movement of the actuating wire32(FIGS. 2C-2D, respectively) therefore results in a corresponding extension and retraction of the hook knife18relative to the distal tip36, as well as a corresponding telescopic extension and retraction of a portion of the sleeve37relative to the distal tip36. The amount of the extension and retraction is limited by the degree of longitudinal movement of the proximal end37aof the sleeve37within the recess39(FIG. 2B). Additionally, because the actuation wire32may be rotated independently about its longitudinal axis relative to the longitudinal axis of the distal tip36(e.g., by rotating the actuation wire32within the sleeve37or by rotating the actuation wire32and the sleeve37together within the recess39of the second link22), the hook knife18may be rotationally positionable relative to the longitudinal axis of the distal tip36. As discussed below, distal, proximal and rotational movement of the actuating wire32relative to the distal tip36may be controlled via the handle portion50of the device.

As previously indicated, the device can also include a handle portion coupled to the proximal end of the elongate shaft and having various controls formed thereon for controlling and manipulating the device. A person skilled in the art will appreciate that the particular configuration of the handle portion can vary, and that various techniques known in the art can be used for effecting movement of various portions on the device.FIGS. 3A-3Dillustrate one exemplary embodiment of a handle portion50for use with the insertion portion10of the device shown inFIG. 1A. As shown inFIG. 3A, the handle portion50has a generally elongate cylindrical configuration to facilitate grasping thereof. The handle housing52can have an integral or unitary configuration, or it can be formed from two housing halves52a,52bthat mate to enclose various components therein. The housing halves52a,52bare shown inFIG. 3B. The various component disposed within the handle housing52can also vary, but in an exemplary embodiment the handle portion50includes a first knob54for articulating and rotating the end effector14, and an actuation controller56for actuating the end effector14.

The first knob54is shown in more detail inFIGS. 3B and 3C, and as shown the first knob54has a generally cylindrical configuration. The first knob54can have an integral or unitary configuration, or it can be formed from two halves54a,54bthat mate together, as shown. A proximal end30aof the articulation actuator30can mate to the first knob54such that rotation and translation of the first knob54will cause corresponding rotation and translation of the articulation actuator30, thereby rotating and articulating the end effector14, as previously described. While various techniques can be used to mate the articulation actuator30to the first knob54, in an exemplary embodiment the articulation first knob54includes an axle58fixedly disposed therein and engaged between the knob halves54a,54b. The articulation actuator30extends through an inner lumen of the axel58and is fixedly mated thereto. Various mating techniques can be used to mate the articulation actuator30to the axel58including, for example, an interference or compression fit, an adhesive, or other mechanical or chemical mating techniques known in the art.

In order to translate and rotate the first knob54, the handle housing52can include an elongate cavity52c(FIG. 3B) formed therein that slidably and rotatably receives the first knob54. The handle housing52can also include one or more cut-outs formed therein for allowing a user to access the first knob54.FIGS. 3A-3Billustrate opposed cut-outs52d,52eformed in the handle housing52. The first knob54can also include features to facilitate movement thereof. For example, the first knob54can include one or more surface features formed on an external surface thereof for allowing the user to more easily grasp the first knob54. In the illustrated embodiment, the first knob54includes a series of ridges54rformed therein, as well as a series of longitudinally-oriented teeth54tformed on a portion thereof. In one embodiment, the ridges54rmay be selectively engaged by a thumb screw53accessible from the exterior of the handle housing52such that the articulation and rotational positions may be selectively maintained. In another embodiment, the ridges54rcan provide a detent feature to maintain the position of the articulation. A corresponding detent snap can be located in the cavity52c.

In use, the first knob54can be grasped by a user and rotated about its longitudinal axis (i.e., about the longitudinal axis L of the shaft12and handle portion50). Rotation of the knob will cause corresponding rotation of the axel58and the articulation actuator30. The actuation wire32, which extends through the articulation actuator30, will not rotate with the articulation actuator30since it is not coupled thereto. As previously explained, rotation of the articulation actuator30will cause corresponding rotation of the three-bar linkage16and the end effector14coupled thereto. The first knob54can also be slid or translated longitudinally along its axis L, and within the elongate cavity52cformed in the handle housing52. Proximal movement of the first knob54within the handle housing52will pull the articulation actuator30proximally, thereby articulating the end effector14, as previously explained. Distal movement of the first articulation knob54within the handle housing52will in turn move the articulation actuator30distally, thereby returning the end effector14to its original longitudinally-aligned position.

As indicated above, the handle portion50can also include an actuation controller56for actuating the end effector14(e.g., extending, retracting and/or rotating the hook knife18relative to the distal tip36). The actuation controller56can have a variety of configurations, but in the illustrated embodiment the actuation controller56comprises a second knob70attached to a proximal end71aof a rotation tube71that is slidably disposed through a distal opening52gformed in the handle housing52. The second knob70may generally form the proximal end of the handle portion50. Longitudinal movement of the second knob70along the longitudinal axis of the handle housing52causes corresponding longitudinal movement of the rotation tube71within the handle housing52. Similarly, rotational movement of the second knob70about the longitudinal axis of the handle housing52causes corresponding rotational movement of the rotation tube71within the handle housing52.

The actuation controller56may also include a third knob72accessible from the exterior of the handle housing52and longitudinally slidable relative to the handle housing52via a slot52fformed therein. The third knob72may be coupled to a yolk73(FIGS. 3B-3C) that extends from the third knob72into the interior of the handle housing52. The yolk73may be received through a circumferential slot71cformed on a distal end71bof the rotation tube71. Because the yolk73is received through the circumferential slot71cof the rotation tube71, longitudinal movement of the rotation tube71via the second knob70causes corresponding longitudinal movement of the yolk73, and, therefore, corresponding longitudinal movement of the third knob72, relative to the slot52f. Because the yolk73is not otherwise attached to the rotation tube71, the yolk73does not prevent rotational movement of the rotation tube71via the second knob70.

In one embodiment, the third knob72may be threadingly coupled to the yolk73such that the third knob72is selectively tightenable and untightenable relative to the yolk73. In a tightened, or “locked”, state of the third knob72, a base72a(FIG. 3D) of the third knob72may be pushed into contact with an adjacent outer perimeter of the slot52f, thereby causing an opposing portion of the yolk73to be pulled into contact with an adjacent inner perimeter of the slot52f. In this way, a portion of the handle housing52may be clamped between the third knob72and the yolk73such that the rotation tube71is immovably fixed, or locked, into position relative to the longitudinal axis of the handle housing52. In an untightened, or “unlocked”, state of the third knob72, the base72aof the third knob72may no longer be pushed into contact with the outer perimeter of the slot52f, in which case the handle housing52is no longer clamped between the third knob72and the yolk73. Accordingly, the rotation tube71is freely movable along the longitudinal axis of the handle housing52using the second knob70. As noted above, because the yolk73is received through the slot71cof the rotation tube71and is not otherwise attached thereto, the rotation tube71remains rotatable irrespective of the locked or unlocked state of the third knob72.

In addition to the second and third knobs70,72, the rotation tube71, and the yolk73, the actuation controller56may further comprise a shaft74, at least a portion of which is coaxially disposed within a bore71ddefined by the rotation tube71. According to one embodiment and as shown inFIGS. 3C-3D, the shaft74may define a longitudinal bore74cthrough which the proximal end32aof the actuation wire32may partially extend. The proximal end32aof the actuation wire32may be retained within the bore74cusing, for example, one or more set screws (not shown) transversely extending into the bore74cfrom an exterior surface of the shaft74to engage the distal end32b. A proximal end74aof the shaft74may comprise a reduced outer diameter, with the proximal end74aaligned with and adjacent an opening70aformed through the second knob70. As shown inFIG. 3D, a connector75may extend through the opening70aand into the bore71dof the rotation tube71to engage an inner surface of the opening70aand the distal end74aof the shaft74, thus maintaining the position of the shaft74relative to the rotation tube71. In certain embodiments, the shaft74may be constructed from an electrically conductive material (e.g., stainless steel), and the connector75may comprise an electrical connector (e.g., a male banana plug connector75as shown) that is accessible from the exterior of the handle portion50. An electrical path may thus be established between the connector75and the hook knife18via the shaft74and the actuation wire32, and, as discussed in further detail below, the hook knife18may be used for electrosurgical procedures by connecting to the connector75to a suitable source of electrical energy.

In use, the second knob70can be grasped by a user and, with the third knob72in an unlocked state, slidably manipulated through the opening52gof the handle housing52along the longitudinal axis of the handle housing52. Movement of the second knob70in the distal direction will cause the rotation tube71and the shaft74, and thus the actuation wire32, to be correspondingly moved in the distal direction. As discussed above in connection withFIGS. 2C-2D, this results in an extension of the hook knife18, and a corresponding telescopic extension of a portion of the sleeve37, relative to the distal tip36. In the same way, movement of the second knob70in the proximal direction will result in a retraction of the hook knife18, and a corresponding telescopic retraction of a portion of the sleeve37, relative to the distal tip36. Generally, the second knob70may be used to provide any degree of extension/retraction of the hook knife18and sleeve37between their fully extended and fully retracted positions. Additionally, subsequent to achieving a desired extended/retracted position of the hook knife18and the sleeve37, the position may be maintained by tightening the third knob72relative to the yolk73, as discussed above.

Additionally, the rotational position of the rotation tube71and the shaft74relative to the handle portion52, and thus the rotational position of the actuation wire32about the longitudinal axis of the distal tip36, may be controlled by rotating the second knob70about the longitudinal axis of the handle portion50. In this way, the rotational position of the hook knife18relative to the distal tip18may be controlled via the second knob70.

In certain embodiments and as previously mentioned, the end effector14may be suitable for use in electrosurgical procedures by virtue of a conductive path formed between the hook knife18and the connector75of the handle portion50.FIG. 4illustrates a system80for performing electrosurgical procedures according to one embodiment. The system may comprise a manually articulating surgical device81comprising an insertion portion10and a handle portion50as described above wherein the hook knife18is electrically coupled to the connector75(e.g., a male banana connector) via the shaft74and the actuation wire32. To ensure that the articulation wire32is suitably insulated from other components within the device81, electrical insulation (e.g., plastic tubing or an insulative coating) may cover at least a portion of the actuation wire32. The system80may further comprise an energy source82comprising a first output82aelectrically coupled to the connector75via a first wire82b, and a second output82celectrically coupled to a patient to be treated (not shown) via a second wire82dand a grounding pad82e. It will be appreciated that this configuration of the system80corresponds to a monopolar mode of operation. In one embodiment and as shown, the energy source82may comprise a radio frequency (RF) generator to produce RF waveforms at predetermined frequencies, amplitudes, polarities, and pulse widths. The RF generator may be a conventional bipolar/monopolar electrosurgical generator such as one of many models commercially available, including Model Number ICC 350, available from Erbe, GmbH. In use, the insertion portion10of the device81may be introduced into the patient (e.g., via a flexible endoscope) such that the hook knife18of the end effector14is adjacent a surgical site comprising an area of tissue. RF energy may be introduced to the tissue by suitably contacting the tissue with the hook knife18. It will appreciated that RF energy may operate to enhance the cutting ability of the hook knife14and/or to perform other electrosurgical procedures, such as, for example, fulguration and desiccation. As discussed above, the sleeve37may be fabricated from a heat-resistant material (e.g., a ceramic material) in order to insulate and protect the distal tip36from potentially damaging heat dissipated by the hook knife18during an electrosurgical procedure.

As indicated above, the various devices disclosed herein for controlling movement of a working end of a surgical device can be used in a variety of surgical procedures, including endoscopic procedures, laparoscopic procedures, and in conventional open surgical procedures, including robotic-assisted surgery. In one exemplary endoscopic procedure, an elongate shaft of a surgical device, such as one previously disclosed herein, can be inserted through a natural orifice and a body lumen to position an end effector located at a distal end of the elongate shaft adjacent to tissue to be treated. An articulation actuator can be translated along a longitudinal axis of the elongate shaft to cause a three-bar linkage to laterally articulate the end effector in a direction substantially perpendicular to a longitudinal axis of the elongate shaft to allow the end effector to be angularly oriented relative to the elongate shaft. This can be achieved by actuating one or more articulation mechanisms formed on a handle of the device. The method can also include rotating the end effector relative to the elongate shaft. In one embodiment, the three-bar linkage can rotate with the end effector relative to the elongate shaft. For example, the articulation actuator can be rotated relative to the elongate shaft to rotate both the three-bar linkage and the end effector. In another embodiment, the end effector can rotate relative to the three-bar linkage. For example, an actuation wire coupled to the end effector and extending through the elongate shaft and the three-bar linkage can be rotated. Once the end effector is suitably positioned, the end effector may be actuated using one or more actuation mechanisms formed on the handle of the device.

It is preferred that device is sterilized. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam.

It is to be understood that the figures and descriptions of the present application have been simplified to illustrate elements that are relevant for a clear understanding of the disclosed subject matter. Those of ordinary skill in the art will recognize that these and other elements may be desirable. However, because such elements are well known in the art and because they do not facilitate a better understanding of the present application, a discussion of such elements is not provided herein.

While several embodiments have been described, it should be apparent that various modifications, alterations and adaptations to those embodiments may occur to persons skilled in the art with the attainment of some or all of the advantages disclosed in the present application. It is therefore intended to cover all such modifications, alterations and adaptations without departing from the scope and spirit of the present application as defined by the appended claims.