Electrosurgical apparatus for laparoscopic procedures and method of use

Apparatus and methods of effecting a medical procedure, e.g., laparoscopic, endoscopic, etc. procedures, through a small percutaneous incision or puncture in the body of a patient. One embodiment of the apparatus comprises an elongated outer tube, an elongated inner tube located within the outer tube and moveable relative thereto. An electrosurge electrode is mounted on the distal end of the inner tube so that it can be moved to a retracted position when it is not need or to an extended position when it is to be use. A vacuum system and an irrigation system are provided. The vacuum system is arranged to apply suction through an annular space between the tubes to effect the removal of tissue or other debris from the operative site within the patients body. The irrigation system is arranged to supply an irrigation liquid through the inner tube to the operative site. Each of the tubes is formed of an electrically insulating material so that the apparatus can be safely inserted within the patient's body. Various types of electrodes can be used. In another embodiment the electrode tip is not retractable.

This invention relates generally to medical instruments for and methods of 
performing laparoscopic and endoscopic procedures, and more particularly 
to electrosurgical devices utilizing irrigation and suction for effecting 
laparoscopic or endoscopic procedures. 
BACKGROUND OF THE INVENTION 
Electrosurgical devices have been used to effect various types of medical 
procedures laparoscopically or endoscopically. Such devices commonly 
comprise an elongated stainless steel tube having an electrosurgical 
electrode at the free end thereof. The electrode is coupled to one pole of 
an electrosurgical generator. The other pole of the generator may be 
connected to a large surface area electrode arranged to be placed in 
contact with the skin of the patient being treated (as is the case with a 
unipolar device), or may be connected to an electrode immediately adjacent 
the electrode at the distal end of the tube (as is the case with a bipolar 
device). In either case the outer surface of the tube is typically covered 
by an electrically insulating material, e.g., a shrink wrapped plastic 
film, in order to electrically insulate the steel tube to protect the 
patient and the operator of the instrument and to confine the current to 
the electrode tip. Such shrink wrap, however, is susceptible to tear or 
damage when the stainless steel tube is manipulated into or out of the 
introducing device, e.g., trocar. Such an occurrence can destroy or 
otherwise compromise the electrical insulating properties of the device, 
thereby possibly exposing the patient or operator to shock or other 
injury. 
Some prior art devices for effecting electrocautery make use of suction 
means to withdraw tissue, blood, debris, etc. from adjacent the cautery 
tip. Such devices may become clogged during the surgery. In such an 
occurrence the devices may have to be removed and disassembled to clear 
the suction passageway the operative site. This is obviously undesirable 
since time is frequently of the essence when utilizing such devices. 
Thus, the need exists for a instrument which overcomes the disadvantages of 
the prior art. 
The following constitute examples of various types of prior art 
electrosurgical devices found in the following U.S. Pat. No.: 29,088 
(Shaw); Re. U.S. Pat. No. 30,190 (Shaw); U.S. Pat. No. 2,447,169 (De 
Sousa); U.S. Pat. No. 3,336,916 (Edlich); U.S. Pat. No. 3,648,001 
(Anderson et al); U.S. Pat. No. 3,911,241 (Jarrard); U.S. Pat. No. 
4,034,761 (Prater et al.); U.s. Pat. No. 4,089,336 (Cage et al); U.S. Pat. 
No. 4,091,813 (Shaw et al); U.S. Pat. No. 4,112,950 (Pike); U.S. Pat. No. 
4,185,632 (Shaw); U.S. Pat. No. 4,311,145 (Esty et al); U.S. Pat. No. 
4,362,160 (Hiltebrandt); U.S. Pat. No. 4,638,802 (Okada); U.S. Pat. No. 
4,375,218 (DiGeronimo); U.S. Pat. No. 4,427,006 (Nottke); U.S. Pat. No. 
4,481,057 (Beard); U.S. Pat. No. 4,562,838 (Walker); U.S. Pat. No. 
4,640,279 (Beard); U.S. Pat. No. 4,646,738 (Trott); U.S. Pat. No. 
4,674,498 (Stasz); U.S. Pat. No. 4,793,346 (Mindich); U.S. Pat. No. 
4,802,476 (Noerenberg et al); U.S. Pat. No. 4,903,696 (Stasz et al); U.S. 
Pat. No. 4,922,903 (Welch et al); U.S. Pat. No. 4,850,353 (Stasz et al); 
and U.S. Pat. No. 5,013,312 (Parins et al). 
OBJECTS OF THE INVENTION 
Accordingly, it is the general object of this invention to provide an 
apparatus and methods of use which overcome the disadvantages of the prior 
art. 
It is a further object of this invention to provide an apparatus for 
effecting a medical procedure entailing electrosurgery through a small 
percutaneous incision or puncture in the body of a patient. 
It is still a further object of this invention to provide an 
electrosurgical apparatus for percutaneous use while protecting the 
patient and user of the apparatus from electrical shock. 
It is yet a further object of this invention to provide an apparatus which 
is easy to use for effecting electrosurgery through a small percutaneous 
incision or puncture in the body of a patient. 
It is another object of this invention to provide an apparatus which is 
easy to use for effecting electrosurgery through a small percutaneous 
incision or puncture in the body of a patient and which apparatus provides 
for irrigation and/or suction. 
It is still another object of this invention to provide a disposable 
apparatus for carrying out a medical procedure involving electrosurgery 
through a small percutaneous incision or puncture in the body of a 
patient. 
SUMMARY OF THE INVENTION 
These and other objects of the instant invention are achieved by providing 
apparatus and methods of use for effecting a medical procedure, e.g., 
laparoscopic, endoscopic, etc. procedures, through a small percutaneous 
incision or puncture in the body of a patient. The apparatus comprises an 
elongated outer tube, an elongated inner tube, an electrode, vacuum means, 
and irrigation means. Each of the tubes is formed of an electrically 
insulating material and having a distal end arranged to be inserted 
through a small opening within the body of the patient to a desired situs 
therein. 
The inner tube has a first lumen therein, with the first lumen having a 
first port communicating with the interior of the body of the being 
adjacent the situs when the distal end of the inner tube is at the situs. 
The inner tube is located within the outer tube to form a second lumen 
therebetween, with the second lumen having a second port communicating 
with the interior of the body of the being adjacent the situs when the 
distal of the outer tube is at the situs. 
One the lumens is coupled to the vacuum means, and the other of the lumens 
being coupled to the irrigation means. The electrode is mounted adjacent 
the free end of the inner tube and has an electrical conductor connected 
thereto and extending through the inner tube for connection to one pole of 
electrosurgical generation means. 
In accordance with one method of this invention the apparatus can be 
operated to apply a high density electric current through the electrode to 
immediately adjacent material within the being's body at the operative 
situs, while applying a vacuum to one of the lumens to withdraw material 
from the operative situs, and applying an irrigation liquid to the other 
of the lumens to irrigate the operative situs with that liquid. 
In accordance with another method of this invention the apparatus can be 
used to apply the high density electric current from the electrode, while 
either applying the vacuum to one of the lumens to withdraw material from 
the operative situs or applying the irrigation liquid to the other of the 
lumens to irrigate the operative situs with that liquid. 
In accordance with another method of this invention the apparatus can be 
used to apply the vacuum to one of the lumens to withdraw material from 
the operative situs and to apply the irrigation liquid to the other of the 
lumens to irrigate the operative situs with that liquid, without applying 
the high density electric current from the electrode.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
Referring now in detail to the drawing wherein like reference characters 
refer to like parts, there is shown at 20 in FIG. 1 and 200 in FIG. 9, 
respective embodiments of an apparatus constructed in accordance with the 
subject invention. Both of the apparatus 20 and 200 arranged for effecting 
some medical procedure through a percutaneous incision or puncture in the 
body of the patient. In particular, the apparatus are arranged to effect 
cauterization (or any other electrosurgical procedure) with or without 
irrigation and/or removal of tissue from within the body of the patient. 
The unique construction of the apparatus 20 and 200 enables all of those 
actions to be accomplished through a small percutaneous incision or 
puncture, e.g., laparoscopically, endoscopically, etc., without any danger 
to the patient. To that end the apparatus 20 and 200 are each elongated 
instruments which are arranged to be introduced through a conventional 
trocar 22 into the patient's body at the desired location for the 
procedure, e.g., cauterization. 
The trocar basically comprises an elongated tube 22A for introduction 
through the percutaneous incision or puncture in the patient's body to the 
desired position and a proximally located housing 22B including a 
hemostatic valve. At the proximal end of the housing is an entrance port 
22C into which the apparatus 20 or 200 is introduced for passage through 
the hemostatic valve, and out through the open distal end of the trocar's 
tube 22A. In particular, the apparatus 20 or 200 is inserted into the 
entrance part of the trocar 22 and slid there through until its distal end 
extends out of the open free end of the tube 22A of the trocar. 
The details of the construction and operation of the embodiment 20 will now 
be described with reference to FIGS. 1-8. As can be seen therein the 
apparatus 20 basically comprises an elongated inner member (to be 
described hereinafter) having distal at which a conventional cautery tip 
or electrode 24 is mounted. The inner member is disposed within an 
elongated outer member (also to be described hereinafter) and is slidable 
with respect thereto so that the cautery tip 24 can be moved from a 
retracted position to an extended position and vice versa in order to 
effect a desired procedure. That procedure can include cautery, 
hemostasis, and any other procedure which can be accomplished by use of a 
conventional electrosurgical device. In addition the apparatus 20 is 
arranged to provide additional functions, i.e., irrigation and/or suction, 
which may be accomplished at the time of the electrosurgical action or at 
some other time. The apparatus 200 (which will be described later) 
includes many of the features of the apparatus 20, e.g., the provision of 
means to enable irrigation and/or suction to be performed separately or 
along with the electrosurgical action, but does not permit the retraction 
of the electrode tip. Thus, in the apparatus 200 the electrode tip is 
always located beyond the free distal end of the apparatus. 
As can be seen clearly in FIGS. 1, 3 and 4 the apparatus 20 also includes 
an outer tube 30 and an inner tube assembly 32. The cautery tip 24 is 
located at the distal end of the inner tube assembly. The inner tube 
assembly 32 is disposed concentrically within the outer tube 3 and is 
arranged be slid with respect to the outer tube to move the cautery tip 
from the retracted position, like that shown in FIG. 4, to the extend 
position, like that shown in FIGS. 1, 3 and 5, and vice versa. 
The proximal end of the inner tube 32 and the proximal end of the outer 
tube 30 are connected to a pair of handle sections 36 and 38, 
respectively. These two sections make up a the instrument's handle 26. The 
handle is arranged to be grasped in the hand of the user, e.g., the 
surgeon, enable him/her to manipulate the instrument to a desired 
orientation to effect the procedure desired. The section 36 makes up the 
front section of the handle 26 while the section 38 makes up its rear 
section. 
As mentioned earlier the apparatus 20 is arranged to irrigate an interior 
portion of the patient's body. This action is particularly useful during 
many electrosurgical procedures to clarify the operative situs, e.g., 
clear away debris from the area at which the electrosurgical tip is being 
operated, to provide the surgeon with relatively unobstructed visibility. 
To achieve that end the apparatus 20 includes an irrigation system which 
is arranged to carry any suitable irrigation liquid, e.g., saline, through 
the instrument for emergence adjacent the cautery tip. As will be 
appreciated by those skilled in the art the irrigation liquid can also 
serve a carrier for removing any tissue or other debris produced during 
the operation of the cautery tip 24. To achieve that later function, the 
apparatus 20 includes a suction system which is arranged to produce a 
relative vacuum adjacent the cautery tip 24. As mentioned earlier the 
suction/irrigation systems of the apparatus 20 or 200 can be used either 
in combination with each other or separately. Moreover, such systems can 
be used either in combination with the operation of the cautery tip or 
separately. 
Turning now to FIG. 3 the details of the inner tube 32 will now be 
considered. As can be seen therein the tube 32 is an elongated tubular 
member, having a relatively thin rigid circular sidewall formed of an 
electrical insulating material, e.g. plastic. The tube 32 includes a 
central passageway 32A extending down the entire length thereof. The 
distal end of the tube 30 includes a tip or cap 34. The cap 34 is a 
cylindrical member having a longitudinal central passageway 34A extending 
partially therethrough. The passageway 34A is in communication with the 
central passageway 32A extending through the inner tube 32. The cap 34 
also includes another elongated passageway 34B in communication with the 
passageway 34A and extending through the remainder of the tip 34. The 
passageway 34B is of cruciform shape in cross section (see FIGS. 2 and 5). 
The cruciform passageway 34B extends to the free end of the cap 34 and 
includes portions (to be described later) in which a part of the cautery 
tip 24 is disposed to fixedly mount the tip 24 thereon. The remaining 
portions of the cruciform passageway is open at the free end of the cap 34 
to serve as the port through which the irrigation liquid exits the 
apparatus 20. The manner in which the cautery tip 24 is mounted within the 
cap 34 will be described later. 
As can be seen in FIG. 3 the proximal end of the inner tube 32 is fixedly 
secured, e.g., glued, to the rear handle section 36. The details of the 
rear handle section 36 will be described later. Suffice for now to state 
that the handle section 36 is a cylindrically shaped member having a 
hollow interior in the form of plural bores. The handle section 36 also 
includes a port 40, of conventional construction, to which a conduit 40A 
can be releasably secured. The conduit 40A is arranged to carry any 
suitable irrigation liquid (not shown) from any suitable source (also not 
shown) so that the liquid may pass through the handle section 36, through 
the passageway 32A in the inner tube 32, and out through the open distal 
end of the cruciform passageway 34B in the cap 34 (as will be described 
later). 
The outer tube 30 is also elongated member, constructed similarly to tube 
32. The inner diameter of tube 30 is slightly larger than the outer 
diameter of inner tube 32. The tube 32 is disposed concentrically within 
tube 30, thereby creating an annular passageway 30A therebetween. The 
proximal end of the outer passageway 30A is fixedly secured, e.g., glued, 
to the front handle section 38. The details of the front handle section 38 
will be described later. Suffice for now to state that the handle section 
38, like handle section 36, is a cylindrically shaped member having a 
hollow interior in the form of plural bores. The handle section 38 also 
includes a port 42, of conventional construction, to which a conduit 42A 
can be releasably secured. The conduit 42A is arranged to be connected to 
any suitable source of vacuum or suction (also not shown). Accordingly, 
when the source of vacuum or suction is operated a vacuum is created 
within the hollow interior of handle section 38 and is coupled via the 
communicating passageway 30A to the distal end of the apparatus. Thus, any 
blood, debris and/or irrigation liquid which is located adjacent the distal 
end of the apparatus will flow into the passageway 30A for removal out of 
the instrument via port 42 (as will be described later). 
As mentioned earlier the inner tube 32 and its associated tip 34 mounting 
the electrode tip 24 is slidable with respect to the outer tube 30. In 
order to effect the desired position of the electrode tip 24 the front 
section 36 of the handle is held stationary while the rear section 38 is 
slid forward to carry the tip to the extended position and slid backward 
for carrying the tip to the retracted position. 
The apparatus 20 is arranged so that cautery tip can be locked in the 
extended position. This is accomplished by means of a projecting pin 46A 
(FIG. 4) and a cooperating L-shaped slot 46B. The 46A projects radially 
outward from a front portion 36A of the handle section 36. That portion of 
the handle section 36 is located within a bore (to be described later) 
forming the proximal end of the front handle section 38. The L-shaped slot 
is provided in the sidewall forming the proximal end of the front handle 
section. The L-shaped slot is oriented so that a linear section extends 
parallel to the longitudinal axis of the instrument and is located within 
the "L" shaped slot 46B of in the front handle section 38. When the pin is 
in the longitudinally extending portion of the "L" shaped slot 46B the two 
handle sections are arranged to be slid with respect to each other thereby 
effecting either the extension or retraction (as the case may be) of the 
electrode tip 24. When the tip 24 is in the extended position (such as 
shown in FIG. 1) the pin 46A is at the distal end of the longitudinally 
extending portion of the slot so that the handle section can be rotated 
with respect to the handle section 36 about the central longitudinal and 
axis of the device to cause the pin 46A to enter into the circumferential 
portion of the "L" shaped slot 46B. This action locks the two handle 
sections together, thereby precluding longitudinal movement of the handle 
section 36A with respect to handle section 38, whereupon the electrode 24 
is locked in the extended position. 
As can be seen in FIGS. 2, 3, and 4 four longitudinally extending, 
centering fins or ribs 58 are provided at equidistantly spaced peripheral 
positions on the cap 34. These fins form a sliding interface with the free 
or open end of outer tube 30 to maintain the centering of the inner tube 32 
within the outer tube 30 when they are slid relative to each other. The 
fins being spaced from each other about the peripheral of the tip 34 
provide openings therebetween which serve as inlet ports to the passageway 
30A. 
The construction of the rear handle section 36 will now be described with 
reference to FIGS. 3 and 4. As can be seen therein the handle section 36 
is a hollow cylindrical member having the heretofore identified front 
portion 36A, and a larger diameter rear portion 36B. The handle section 36 
includes four bores 50A, 50B, 50C, and 50D therein. In particular bore 50A 
is located at the distal end of handle section 36 and is of the same or 
slightly larger internal diameter as the external diameter of the proximal 
end of the inner tube 32 to receive that portion of the inner tube therein. 
Any suitable adhesive (not shown) is located at the interface to secure the 
tube 32 within bore 50A. The bore 50B is of slightly smaller diameter than 
bore 50A and is in communication therewith to form a shoulder against 
which the proximal free end of the inner tube 32 abuts. The bore 50C is of 
larger internal diameter than the bore 50 and forms a large diameter 
chamber into which the irrigation liquid is introduced via port 40. The 
bore 50D is located at the proximal end of the handle section 36 and is 
arranged to be closed by a resilient material cap (to be described later). 
The construction of the front handle section 38 will now be described, also 
with reference to FIGS. 3 and 4. As can be seen therein the handle section 
38 is a hollow cylindrical member having three bores 52A, 52B, and 52C 
therein. The bore 52A is located at the distal end of handle section 38 
and is of the same or slightly larger internal diameter as the external 
diameter of the proximal end of the outer tube 30 to receive that portion 
of the outer tube therein. Any suitable adhesive (not shown) is located at 
the interface to secure the tube 30 within bore 52A. The bore 52B is of 
slightly smaller diameter than bore 52A and is in communication therewith 
to form a shoulder against which the proximal free end of the outer tube 
30 abuts. The bore 52C is of larger internal diameter than the bore 52B 
and is the bore which was mentioned heretofore as receiving the portion 
36A of the rear handle section 36 therein. 
In order to provide a fluid tight seal between the interior of the bore 52B 
and the exterior of the inner tube 32 extending therethrough a sealing 
gasket 54 is provided. That gasket is a resilient ring-like member located 
within a bore section 52D at the interface of bores 52B and 52C. The 
ring-like gasket is held in place by mounting ring 56 so that when the two 
tubes 30 and 32 are slid with respect to each other the inner surface of 
the gasket 54 will slide over the outer periphery of the inner tube 32, 
thereby precluding the egress of material out of that interface. 
Electric power is provided to the electrode tip 24 via an elongated 
electrical conductor 62. The conductor 62 extends through the instrument 
from the proximal end thereof to the electrode tip 24. In particular the 
conductor extends centrally through the interior of the rear handle 
section 36, through the inner tube 32 to the interior passageway 34A in 
the cap 34. It is at this point that the distal end of the conductor 62 is 
electrically connected, e.g., crimped, to the electrode tip 24. The 
electrode tip 24 is also used in the apparatus 200 and basically comprises 
a generally planar distal end portion 24A of arcuate profile and a 
generally planar intermediate portion 24B of flared profile. Both of those 
portions of the electrode extend beyond the free end of the cap 34 when the 
tip 24 is used in the apparatus 20. The tip 24 also includes a planar 
generally rectangular portion or tang 24C which extends through the 
horizontally oriented portions of the cruciform passageway 34B. The tang 
is secured in place within that portion of the passageway by any suitable 
means, e.g., barbs (not shown). The proximal free end of the tang 24C 
includes a hole 24D. The free end of the conductor 62 extends through this 
hole and is crimped in place to electrically interconnect the electrode tip 
24 to the conductor 62. The proximal end of the conductor is connected to a 
conventionally electrical connector, e.g., a banana plug, 64. The banana 
plug is arranged to be connected to one pole of any conventional 
electrosurgical generator (not shown). The banana plug 64 is arranged to 
extend through a central opening in the resilient sealing cap 66 located 
within proximally located bore 50D. The other electrode of the 
electrosurge generator may be connected to a rather large plate electrode 
(which may or may not be grounded) for engagement with the skin of the 
patient (in the case of a unipolar system) or may be connected to any 
suitable bipolar electrode (in the case of a bipolar system). 
In the embodiment of the apparatus 20 shown herein the irrigation liquid 
flows through various components of the apparatus in the direction and 
path as shown by the arrows bearing the reference numeral 70, while the 
blood, debris and or other material removed through the apparatus flows 
through various components of that apparatus in the direction and path as 
shown by the arrows bearing the reference numeral 80. 
In FIGS. 6-8 there are shown three other electrosurgical tips which can be 
used in the apparatus 20 or 200 of this invention. These tips are merely 
exemplary of many others which can be used. Thus, as shown in FIG. 6 the 
electrosurgical (cautery) electrode is in the form of an elongated 
extension 100 of the conductor 62. The extension 100 includes a sharpened 
point 102. In order to hold the extension 100 in place with respect to the 
cap 34 of the apparatus 20, a mounting strip 90 is provided. The mounting 
strip 90 is constructed in a similar manner to the tang 24C of the 
electrode tip 24 and thus includes an opening 92 through which the 
conductor 62 extends. The mounting strip 90 is located within the 
horizontally located portions of the cruciform passageway 34B of the 
apparatus 20. 
In FIG. 7 the electrode tip is designated by the reference numeral 200, and 
is similar in construction and mounting to electrode 100, except that its 
free end is bent into a generally U-shaped configuration 202. In FIG. 8 
the electrode tip is designated by the reference numeral 300, and is 
similar in construction and mounting to electrode 200, except that its 
free end is bent into a generally L-shaped configuration 302. 
Referring now to FIGS. 9-13 the details of the apparatus 200 will now be 
considered. That apparatus basically comprises a simpler version of the 
apparatus 20 in that it eliminates the extendibility/retractability of the 
electrode tip 24 and thus eliminates the need for the slidable tube, the 
associated handle sections, and the locking mechanism. Thus, as can be 
seen in FIG. 9 the apparatus 200 basically comprises an elongated tube 202 
having a distal end 204 at which the electrode tip 24 is mounted (as will 
be described later) and a proximal end 206 terminating in a handle 208. 
The tube 202 is formed of an electrically insulating material, like that 
used to form the tube assemblies 30 and 32 described earlier, and includes 
a generally planar separator wall 210 extending longitudinally down the 
passageway through the tube 202 to divide the tube into a pair of lumens 
212 and 214. As can be seen in FIG. 10 the lumen 212 is slightly larger in 
cross sectional area than the lumen 214. 
The electrode tip 24 is located within the lumen 214 at the distal end 
thereof. The width of the tang portion 24C of the electrode tip is 
sufficiently wide to frictionally engage portions of the inner surface of 
the lumen 214 to secure the electrode tip 24 in place therein. Additional 
means, e.g., an adhesive (not shown) may be used to enhance the securement 
of the tip in place. 
The proximal end 206 of the tube 202 extends through a hole 216 in the 
distal end of the handle 208 and is secured in place by an adhesive (not 
shown). The handle 208 is a generally hollow member formed of an 
electrically insulating material, e.g., plastic, having a pair of isolated 
chambers 218 and 220 located therein. The chamber 218 is located in the 
distal portion of the handle and is in fluid communication with the 
proximal end of the lumen 212. The chamber 220 is located in the proximal 
portion of the handle and is isolated from the chamber 218 by a circular 
wall member 222. The wall member 222 is formed of an electrically 
insulating material includes a tubular extension 22 which extends through 
the chamber 218 and terminates within the proximal end of the lumen 214. 
The handle 208 also includes a port 226, of conventional construction, to 
which a conduit (not shown) can be releasably secured. The conduit is 
arranged to be connected to any suitable source of vacuum or suction (also 
not shown). The port 226 is in fluid communication with the interior of 
chamber 218. Accordingly, when the source of vacuum or suction is operated 
a vacuum is created within the hollow interior chamber 218 of the handle 
208 and is coupled via the communicating lumen 212 to the distal end of 
the apparatus. Thus, any blood, debris and/or irrigation liquid which is 
located adjacent the distal end of the apparatus will flow into the distal 
open end of the lumen 212 for removal out of the instrument via port 226. 
The handle 208 also includes a port 228, of conventional construction, to 
which a conduit (not shown) can be releasably secured. The conduit is 
arranged to be connected to any suitable source of an irrigation liquid 
(also not shown). The port 228 is in fluid communication with the interior 
of chamber 220 and through the tubular extension 224 to the interior of the 
proximal end of the lumen 214. Accordingly, when the source of irrigation 
liquid is operated liquid can flow through the port 228 into the hollow 
interior chamber 220 of the handle 208, through tubular extension 224 into 
the lumen 214 to the distal end of the apparatus to irrigate the operative 
situs. 
Electric power is provided to the electrode tip 24 via a elongated 
electrical conductor 230. The conductor 230 extends through the instrument 
from the proximal end thereof to the electrode tip 24. In particular the 
conductor extends centrally through the chamber 220 of the handle 208, 
through the tubular extension 224 and through the interior of the lumen 
214 to the electrode tip 24. It is at this point that the distal end of 
the conductor 230 is electrically connected, e.g., crimped, to the 
electrode tip 24 in the same manner as described with respect to apparatus 
20. In order to accommodate the offset free end portion of the conductor 
230 as it exits the hole 24D in the electrode tip a slot 232 (FIG. 12) is 
provided in the distal end of the wall 210. The proximal end of the 
conductor 230 is connected to a conventionally electrical connector, e.g., 
a banana plug, 232. The banana plug is arranged to be connected to one pole 
of any conventional electrosurgical generator (not shown). The banana plug 
extends through a central opening 234 in a resilient sealing cap 236 
located within a bore 238 at the proximal end of the handle 208. The other 
electrode of the electrosurge generator (not shown) may be connected to a 
rather large plate electrode (which may or may not be grounded) for 
engagement with the skin of the patient (in the case of a unipolar system) 
or may be connected to any suitable bipolar electrode (in the case of a 
bipolar system). 
As should be appreciated by those skilled in the art from the foregoing, 
the apparatus 20 and 200 each overcome the shock hazard disadvantage of 
the prior art devices using stainless steel or other electrically 
conductive material tubes for introduction into the patient's body by 
containing all electrical means within the electrically insulating, e.g., 
plastic tube. The only electrical portion of the apparatus of this 
invention that is exposed to the patient or surgeon is the electrode tip 
24 itself. With the inner tube 32 retracted, as is possible with the 
apparatus 20, even the electrode tip 24 is eliminated as a source of 
electrical shock. Moreover, the danger of accidental burning is contained 
to the electrode tip. 
Unlike the prior art where the stainless steel tube is exposed to the user 
and patient, the tubing of apparatus 20 and 200 is plastic eliminating any 
heated metal tubes coming into contact with surgeon or patient. 
In addition to the foregoing the apparatus 20 overcomes the clogging 
disadvantage of some prior art devices by permitting the apparatus to 
remain in the patient while the surgeon slides the inner tube 3 back and 
forth within the outer tube 30 to clear any obstruction in the suction 
passageway. Moreover, for maximum suction capability the surgeon can fully 
retract the inner tube 32. Once the obstruction is cleared or the desired 
tissue reflected, the cautery tip, irrigation and suction functions are 
immediately and simultaneously available with little disruption to the 
overall operation. 
Further still, the apparatus 20 and 200 also have the following advantages 
over the prior art. Since each apparatus is made of mostly plastic, it is 
relative inexpensive, so that it can be disposable, thereby eliminating 
the need for sterilization. Such a feature is of considerable importance 
today to minimize the spread of AIDS or other blood-related diseases. 
Moreover, since the electrical means is contained with the apparatus of 
this invention a variety of cautery tips can be accommodated to the 
apparatus with little or no modification to its overall construction. 
Without further elaboration, the foregoing will so fully illustrate our 
invention that others may, be applying current or future knowledge, adopt 
the same for use under various conditions of service.