# Patent

## Title
Dual purpose surgical instrument for cutting and coagulating tissue

## Abstract

In one general aspect, various embodiments are directed to an ultrasonic surgical instrument that has an ultrasonic blade that protrudes from an ultrasonic transducer assembly. In some embodiments, the ultrasonic blade coaxially extends through a rotatable tissue cutting blade that is rotatably supported by a housing that supports the ultrasonic transducer assembly. In other embodiments, the ultrasonic blade and the tissue cutting blade are both selectively rotatable relative to the housing. In yet other embodiments, the tissue cutting blade and the ultrasonic blade are supported relative to each other in separate sheaths attached to the housing.

## Background
BACKGROUND
The present disclosure generally relates to ultrasonic surgical systems and, more particularly, to ultrasonic systems that allow surgeons to perform cutting and coagulation of tissue.
Over the years, a variety of different types of non-ultrasonically powered cutters and shaving devices for performing surgical procedures have been developed. Some of these devices employ a rotary cutting instrument and other devices employ a reciprocating cutting member. For example, shavers are widely used in arthroscopic surgery. These devices generally consist of a power supply, a handpiece, and a single-use end effector. The end effector commonly has an inner and outer tube. The inner tube rotates relative to the outer tube and will cut tissue with its sharpened edges. The inner tube can rotate continuously or oscillate. In addition, such device may employ a suction channel that travels through the interior of the inner tube. For example, U.S. Pat. No. 4,850,354 to McGurk-Burleson, et al., discloses a non-ultrasonically powered surgical cutting instrument that comprises a rotary cutter for cutting material with a shearing action. It employs an inner cutting member which is rotatable within an outer tube. Those devices lack the ability to coagulate tissue.
U.S. Pat. No. 3,776,238 to Peyman et al. discloses an ophthalmic instrument in which tissue is cut by a chopping action set-up by the sharp end of an inner tube moving against the inner surface of the end of an outer tube. U.S. Pat. No. 5,226,910 to Kajiyama et al. discloses another surgical cutting instrument that has an inner member which moves relative to an outer member to cut tissue entering through an aperture in the outer member. Again each of those devices lack the ability to coagulate tissue.
U.S. Pat. No. 4,922,902 to Wuchinich et al. discloses a method and apparatus for endoscopic removal of tissue utilizing an ultrasonic aspirator. The device uses an ultrasonic probe which disintegrates compliant tissue and aspirates it through a narrow orifice. U.S. Pat. No. 4,634,420 to Spinosa et al. discloses an apparatus and method for removing tissue from an animal and includes an elongated instrument having a needle or probe, which is vibrated at an ultrasonic frequency in the lateral direction. The ultrasonic movement of the needle breaks-up the tissue into fragments. Pieces of tissue can be removed from the area of treatment by aspiration through a conduit in the needle. U.S. Pat. No. 3,805,787 to Banko discloses yet another ultrasonic instrument that has a probe that is shielded to narrow the beam of ultrasonic energy radiated from the tip of the probe. In one embodiment the shield extends past the free-end of the probe to prevent the probe from coming into contact with the tissue. U.S. Pat. No. 5,213,569 to Davis discloses a phaco-emulsification needle which focuses the ultrasonic energy. The focusing surfaces can be beveled, curved or faceted. U.S. Pat. No. 6,984,220 to Wuchinich and U.S. Patent Publication No. US 2005/0177184 to Easley disclose ultrasonic tissue dissection systems that provide combined longitudinal and torsional motion through the use of longitudinal-torsional resonators. U.S Patent Publication no. US 2006/0030797 A1 to Zhou et al. discloses an orthopedic surgical device that has a driving motor for driving an ultrasound transducer and horn. An adapter is provided between the driving motor and transducer for supplying ultrasonic energy signals to the transducer.
While the use of ultrasonically powered surgical instruments provide several advantages over traditional mechanically powered saws, drills, and other instruments, temperature rise in bone and adjacent tissue due to frictional heating at the bone/tissue interface can still be a significant problem. Current arthroscopic surgical tools include punches, reciprocating shavers and radio frequency (RF) devices. Mechanical devices such as punches and shavers create minimal tissue damage, but can sometimes leave behind ragged cut lines, which are undesirable. RF devices can create smoother cut lines and also ablate large volumes of soft tissue; however, they tend to create more tissue damage than mechanical means. Thus, a device which could provide increased cutting precision while forming smooth cutting surfaces without creating excessive tissue damage would be desirable.
It would be desirable to provide an ultrasonic surgical instrument that overcomes some of the deficiencies of current instruments. The ultrasonic surgical instruments described herein overcome many of those deficiencies.
The foregoing discussion is intended only to illustrate some of the shortcomings present in the field of the invention at the time, and should not be taken as a disavowal of claim scope.
SUMMARY
In one general aspect, various embodiments are directed to an ultrasonic surgical instrument that may include a housing that has a motor therein. A cutting blade may be coupled to the motor and be supported for selective rotational travel relative to the housing. At least one ultrasonic transducer may be supported by the housing. An ultrasonic blade may protrude from the at least one ultrasonic transducer such that the ultrasonic blade extends coaxially through a lumen in the cutting blade to protrude through a distal end thereof.
In connection with another general aspect of the present invention, there is provided an ultrasonic surgical instrument that may include a housing that supports at least one ultrasonic transducer therein. A substantially hollow ultrasonic blade may be coupled to the at least one ultrasonic transducer. A cutting blade may extend through the substantially hollow ultrasonic blade. The cutting blade may have a tissue cutting distal end that protrudes outward from a distal end of the substantially hollow ultrasonic blade. A motor may be coupled to the cutting blade for rotating the cutting blade within the substantially hollow ultrasonic blade.
In connection with still another general aspect of the present invention, there is provided an ultrasonic surgical instrument that may include a housing that supports a motor. a cutting blade may be coupled to the motor and be supported for selective rotational travel relative to the housing. A least one ultrasonic transducer may be supported by the housing and have an ultrasonic blade protruding therefrom. The ultrasonic blade may be substantially parallel to the cutting blade.



FIGURES
The features of various embodiments are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings as follows.
FIG. 1 is a schematic view of a surgical control system embodiment of the present invention in use with a non-limiting surgical instrument embodiment of the present invention;
FIG. 2 is a partial perspective view of a portion of the outer sheath and blade arrangement of the surgical instrument depicted in FIG. 1;
FIG. 3 is a cross-sectional view of the outer sheath and blade arrangement of FIG. 2 taken along line 3-3 in FIG. 2;
FIG. 4 is a partial side elevational view of the outer sheath and blade arrangement of FIGS. 2 and 3;
FIG. 5 is a partial perspective view of another non-limiting outer sheath and blade arrangement of the present invention;
FIG. 6 is a partial cross-sectional view of the outer sheath and ultrasonic blade of the arrangement depicted in FIG. 5;
FIG. 7 is a cross-sectional view of another non-limiting surgical instrument embodiment of the present invention;
FIG. 8 is a cross-sectional view of another non-limiting surgical instrument embodiment of the present invention;
FIG. 9 is a cross-sectional view of another non-limiting surgical instrument embodiment of the present invention;
FIG. 10 is a cross-sectional view of another non-limiting surgical instrument embodiment of the present invention;
FIG. 11 is a cross-sectional view of another non-limiting surgical instrument embodiment of the present invention;
FIG. 12 is a perspective view of a portion of the outer sheath and blade arrangement employed by the surgical instrument embodiment of FIG. 11;
FIG. 13 is a side elevational view of another non-limiting surgical instrument embodiment of the present invention with portions thereof shown in cross-section;
FIG. 14 is an exploded assembly view of an outer sheath assembly and a shaver blade and an ultrasonic blade of various non-limiting embodiments of the present invention with the outer sheath shown in cross-section;
FIG. 15 is an exploded assembly view of the surgical instrument of FIG. 13;
FIG. 16 is a cross-sectional view of a portion of the surgical instrument of FIGS. 13 and 15 with the ultrasonic blade attached thereto;
FIG. 17 is another view of the surgical instrument of FIG. 16 with the outer sheath assembly being slid over the ultrasonic blade;
FIG. 18 is a cross-sectional view of another non-limiting surgical instrument embodiment of the present invention; and
FIG. 19 is a cross-sectional end view of the surgical instrument of FIG. 18 taken along line 19-19 in FIG. 18.



DESCRIPTION
The owner of the present application also owns the following U.S. Patent Applications that were filed on even date herewith and which are herein incorporated by reference in their respective entireties:
U.S. patent application Ser. No. 12/703,860, entitled ULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITH ROTATING CUTTING IMPLEMENT, now U.S. Patent Application Publication No. 2011/0196286;
U.S. patent application Ser. No. 12/703,864, entitled METHODS OF USING ULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITH ROTATABLE CUTTING IMPLEMENTS, now U.S. Patent Application Publication No. 2011/0196287;
U.S. patent application Ser. No. 12/703,866, entitled SEAL ARRANGEMENTS FOR ULTRASONICALLY POWERED SURGICAL INSTRUMENTS, now U.S. Patent Application Publication No. 2011/0196398;
U.S. patent application Ser. No. 12/703,870, entitled ULTRASONIC SURGICAL INSTRUMENTS WITH ROTATABLE BLADE AND HOLLOW SHEATH ARRANGEMENTS, now U.S. Patent Application Publication No. 2011/0196399;
U.S. patent application Ser. No. 12/703,875, entitled ROTATABLE CUTTING IMPLEMENT ARRANGEMENTS FOR ULTRASONIC SURGICAL INSTRUMENTS, now U.S. Patent Application Publication No. 2011/0196400;
U.S. patent application Ser.l No.12/703,877, entitled ULTRASONIC SURGICAL INSTRUMENTS WITH PARTIALLY ROTATING BLADE AND FIXED PAD ARRANGEMENT, now U.S. Patent Application Publication No. 2011/0196401;
U.S. patent application Ser. No. 12/703,885, entitled OUTER SHEATH AND BLADE ARRANGEMENTS FOR ULTRASONIC SURGICAL INSTRUMENTS, now U.S. Patent Application Publication No. 2011/0196401;
U.S. patent application Ser. No. 12/703,893, entitled ULTRASONIC SURGICAL INSTRUMENTS WITH MOVING CUTTING IMPLEMENT, now U.S. Patent Application Publication No. 2011/0196404; and
U.S. patent application Ser. No. 12/703,899, entitled ULTRASONIC SURGICAL INSTRUMENT WITH COMB-LIKE TISSUE TRIMMING DEVICE, now U.S. Patent Application Publication No. 2011/0196405.
Various embodiments are directed to apparatuses, systems, and methods for the treatment of tissue Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, the scope of which is defined solely by the appended claims.
Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation.
Various embodiments are directed to improved ultrasonic surgical systems and instruments configured for effecting tissue dissecting, cutting, and/or coagulation during surgical procedures as well as the cutting implements employed thereby. In one embodiment, an ultrasonic surgical instrument apparatus is configured for use in open surgical procedures, but has applications in other types of surgery, such as arthroscopic, laparoscopic, endoscopic, and robotic-assisted procedures. Versatile use is facilitated by selective use of ultrasonic energy and the selective rotation of the cutting/coagulation implement and/or protective sheaths.
It will be appreciated that the terms “proximal” and “distal” are used herein with reference to a clinician gripping a handpiece assembly. Thus, an end effector is distal with respect to the more proximal handpiece assembly. It will be further appreciated that, for convenience and clarity, spatial terms such as “top” and “bottom” also are used herein with respect to the clinician gripping the handpiece assembly. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.
FIG. 1 illustrates in schematic form one embodiment of a surgical control system 10 of the present invention that may be employed to control various surgical instrument embodiments of the present invention. For example, the surgical control system 10 may include an ultrasonic generator 12 for supplying ultrasonic control signals to an ultrasonic surgical instrument 100. The ultrasonic generator 12 may be connected by a cable 14 to an ultrasonic transducer assembly 114 that is non-rotatably supported within a housing 102 of the ultrasonic surgical instrument 100. In one embodiment, the system 10 may further include a motor control system 20 that includes a conventional power supply 22 that is coupled to a control module 24 by cable 23 to supply, for example, 24 VDC thereto. The motor control module 24 may comprise a control module manufactured by National Instruments of Austin, Tex. under Model No. NI cRIO-9073. However, other conventional motor control modules may be employed. The power supply 22 may be coupled to a motor drive 26 by cable 25 to also supply 24 VDC thereto. The motor drive 26 may comprise a motor drive manufactured by National Instruments. However, other conventional motor drives may be employed. Control module 24 may also be coupled to the motor drive 26 by cable 27 for supplying power thereto. A conventional foot pedal 30 or other control switch arrangement may be attached to the control module 24 by a cable 31. As will be discussed in further detail below, the ultrasonic surgical instrument 100 may include a motor 190 that has an encoder 194 associated therewith. The motor 190 may comprise a motor manufactured by National Instruments under Model No. CTP12ELF10MAA00. The encoder 194 may comprise an encoder manufactured by U.S. Digital of Vancouver, Wash. under Model No. 197-I-D-D-B. However, other conventional motors and conventional encoders may be used. The encoder 194 may be coupled to the motor control module 24 by an encoder cable 32 and the motor 190 may be coupled to the motor drive 26 by cable 33. The surgical system 10 may also include a computer 40 that may communicate by Ethernet cable 42 with the motor control module 24.
As can also be seen in FIG. 1, the motor control system 20 may be housed in an enclosure 21. To facilitate easy portability of the system, various components may be attached to the motor control system 20 by removable cable connectors. For example, foot pedal switch 30 may be attached to a detachable cable connector 37 by cable 35 to facilitate quick attachment of the foot pedal to the control system 20. A/C power may be supplied to the power supply 22 by a conventional plug/cable 50 that is attached to a detachable cable connector 54 that is attached to cable 52. The computer 40 may have a cable 60 that is attached to detachable cable connector 62 that is coupled to cable 42. The encoder 194 may have an encoder cable 70 that is attached to a detachable connector 72. Likewise, the motor 190 may have a cable 74 that is attached to the detachable connector 72. The detachable connector 72 may be attached to the control module 24 by cable 32 and the connector 72 may be attached to the motor drive 26 by cable 33. Thus, cable connector 72 serves to couple the encoder 194 to the control module 24 and the motor 190 to the motor drive 26. The cables 70 and 74 may be housed in a common sheath 76.
In various embodiments, the ultrasonic generator 12 may include an ultrasonic generator module 13 and a signal generator module 15. See FIG. 1. The ultrasonic generator module 13 and/or the signal generator module 15 each may be integrated with the ultrasonic generator 12 or may be provided as a separate circuit module electrically coupled to the ultrasonic generator 12 (shown in phantom to illustrate this option). In one embodiment, the signal generator module 15 may be formed integrally with the ultrasonic generator module 13. The ultrasonic generator 12 may comprise an input device 17 located on a front panel of the generator 12 console. The input device 17 may comprise any suitable device that generates signals suitable for programming the operation of the generator 12 in a known manner. Still with reference to FIG. 1, the cable 14 may comprise multiple electrical conductors for the application of electrical energy to positive (+) and negative (−) electrodes of an ultrasonic transducer assembly 114. In alternative embodiments, the ultrasonic drive module and/or the motor drive module may be supported within the surgical instrument 100.
Various forms of ultrasonic generators, ultrasonic generator modules and signal generator modules are known. For example, such devices are disclosed in commonly owned U.S. patent application Ser. No. 12/503,770, entitled Rotating Transducer Mount For Ultrasonic Surgical Instruments, filed Jul. 15, 2007, now U.S. Patent Application Publication No. 2011-0015660, which is herein incorporated by reference in its entirety. Other such devices are disclosed in one or more of the following U.S. Patents, all of which are incorporated by reference herein: U.S. Pat. No. 6,480,796 (Method for Improving the Start Up of an Ultrasonic System Under Zero Load Conditions); U.S. Pat. No. 6,537,291 (Method for Detecting a Loose Blade in a Handle Connected to an Ultrasonic Surgical System); U.S. Pat. No. 6,626,926 (Method for Driving an Ultrasonic System to Improve Acquisition of Blade Resonance Frequency at Startup); U.S. Pat. No. 6,633,234 (Method for Detecting Blade Breakage Using Rate and/or Impedance Information); U.S. Pat. No. 6,662,127 (Method for Detecting Presence of a Blade in an Ultrasonic System); U.S. Pat. No. 6,678,621 (Output Displacement Control Using Phase Margin in an Ultrasonic Surgical Handle); U.S. Pat. No. 6,679,899 (Method for Detecting Transverse Vibrations in an Ultrasonic Handle); U.S. Pat. No. 6,908,472 (Apparatus and Method for Altering Generator Functions in an Ultrasonic Surgical System); U.S. Pat. No. 6,977,495 (Detection Circuitry for Surgical Handpiece System); U.S. Pat. No. 7,077,853 (Method for Calculating Transducer Capacitance to Determine Transducer Temperature); U.S. Pat. No. 7,179,271 (Method for Driving an Ultrasonic System to Improve Acquisition of Blade Resonance Frequency at Startup); and U.S. Pat. No. 7,273,483 (Apparatus and Method for Alerting Generator Function in an Ultrasonic Surgical System).
In various embodiments, the housing 102 may be provided in two or more sections that are attached together by fasteners such as screws, snap features, etc. and may be fabricated from, for example, plastics such as polycarbonate, polyetherimide (GE Ultem®) or metals such as aluminum, titanium or stainless steel. As indicated above, the housing 102 non-rotatably supports a piezoelectric ultrasonic transducer assembly 114 for converting electrical energy to mechanical energy that results in longitudinal vibrational motion of the ends of the transducer assembly 114. The ultrasonic transducer assembly 114 may comprise at least one and preferably a stack of, for example, four to eight ceramic piezoelectric elements 115 with a motion null point located at some point along the stack. The ultrasonic transducer assembly 114 may further include an ultrasonic horn 124 that is attached at the null point on one side and to a coupler 126 on the other side. An ultrasonic blade 200 that may be fabricated from, for example, titanium may be fixed to the coupler 126. In alternative embodiments, the ultrasonic blade 200 is integrally formed with the ultrasonic horn 124. In either case, the ultrasonic blade 200 will vibrate in the longitudinal direction at an ultrasonic frequency rate with the ultrasonic transducer assembly 114. The ends of the ultrasonic transducer assembly 114 achieve maximum motion with a portion of the stack constituting a motionless node, when the ultrasonic transducer assembly 114 is driven at maximum current at the transducer's resonant frequency. However, the current providing the maximum motion will vary with each instrument and is a value stored in the non-volatile memory of the instrument so the system can use it.
The parts of the ultrasonic instrument 100 may be designed such that the combination will oscillate at the same resonant frequency. In particular, the elements may be tuned such that the resulting length of each such element is one-half wavelength or a multiple thereof. Longitudinal back and forth motion is amplified as the diameter closer to the ultrasonic blade 200 of the acoustical mounting horn 124 decreases. This phenomenon is greatest at the node and essentially non-existent when the diameteral change is made at an anti-node. Thus, the ultrasonic horn 124, as well as the blade/coupler, may be shaped and dimensioned so as to amplify blade motion and provide ultrasonic vibration in resonance with the rest of the acoustic system, which produces the maximum back and forth motion of the end of the acoustical mounting horn 124 close to the ultrasonic blade 200. Motions of approximately 10 microns may be achieved at the piezoelectric elements 115. Motions of approximately 20-25 microns may be achieved at the end of the acoustical horn 124 and motions of approximately 40-100 microns may be achieved at the end of the ultrasonic blade 200.
When power is applied to the ultrasonic instrument 100 by operation of the foot pedal 30 or other switch arrangement, the ultrasonic generator 12 may, for example, cause the ultrasonic blade 200 to vibrate longitudinally at approximately 55.5 kHz, and the amount of longitudinal movement will vary proportionately with the amount of driving power (current) applied, as adjustably selected by the user. When relatively high power is applied, the ultrasonic blade 200 may be designed to move longitudinally in the range of about 40 to 100 microns at the ultrasonic vibrational rate. Such ultrasonic vibration of the blade 200 will generate heat as the blade contacts tissue, i.e., the acceleration of the ultrasonic blade 200 through the tissue converts the mechanical energy of the moving ultrasonic blade 200 to thermal energy in a very narrow and localized area. This localized heat creates a narrow zone of coagulation, which will reduce or eliminate bleeding in small vessels, such as those less than one millimeter in diameter. The cutting efficiency of the ultrasonic blade 200, as well as the degree of hemostasis, will vary with the level of driving power applied, the cutting rate or force applied by the surgeon to the blade, the nature of the tissue type and the vascularity of the tissue.
As indicated above, the surgical instrument 100 may further include a motor 190 which is employed to apply rotational motion to a tissue cutting blade 220 that is coaxially aligned with the ultrasonic blade 200. More particularly, the tissue cutting blade 220 has an axial lumen 221 therethrough through which the ultrasonic blade 200 extends. The tissue cutting blade 220 may be fabricated from, for example, stainless steel. In various embodiments, one or more seals 250 of the type described in co-pending U.S. patent application Ser. No. 12/703,866, entitled SEAL ARRANGEMENTS FOR ULTRASONICALLY POWERED SURGICAL INSTRUMENTS, filed Feb. 11, 2010, now U.S. Patent Application Publication No. 2011/0196398, which has been herein incorporated by reference in its entirety may be employed. However, other seal arrangements could also be employed. The motor 190 may comprise, for example, a conventional stepper motor. When used with an encoder 194, the encoder 194 converts the mechanical rotation of the motor shaft 192 into electrical pulses that provide speed and other motor control information to the control module 24.
As can also be seen in FIG. 1, a drive gear 196 may be attached to the motor shaft 195. The drive gear 196 may be supported in meshing engagement with a driven gear 222 that may be attached to the tissue cutting blade 220. Such arrangement serves to facilitate the rotation of the tissue cutting blade 220 about the longitudinal axis A-A when the motor 190 is powered. The tissue cutting blade 220 may also be rotatably supported within an outer sheath 230 by one or more bearings 224. The outer sheath 230 may be fixed to the housing 102 and have a substantially blunt distal end 232. A hole or opening 236 may be provided through the blunt distal end 232 to enable at least a portion of a distal end 202 of the ultrasonic blade 200 to protrude therethrough. See FIGS. 1 and 2. The distal end 202 of the ultrasonic blade 200 may have a ball-like shape as shown in FIGS. 1-3 or, in other embodiments for example, the distal end 202 may have a somewhat flattened portion 206 with an arcuate or rounded distal surface 208 as shown in FIGS. 5 and 6.
The tissue cutting blade 220 may have various configurations. In the embodiment depicted in FIGS. 2-4, the tissue cutting blade 220 has two opposed arcuate portions 221 that serve to form four tissue cutting edges 223. As can be seen in FIG. 2, one portion of the tissue cutting blade 220 is exposed through the distal tissue opening 234. Because in this embodiment, the tissue cutting blade 220 is not ultrasonically active, the blade 220 may be fabricated from a material that will facilitate holding sharp edges. For example, the tissue cutting blade 220 may be fabricated from, for example, stainless steel or other suitable materials. In use, the surgeon could use the portion of the rotating tissue cutting blade 220 that is exposed through the distal tissue cutting opening 234 to cut tissue and then activate the ultrasonic blade 200 when it is needed for coagulation purposes. The surgeon would simply contact the target tissue with the exposed portion of the distal end 202 of the ultrasonic blade 200 while activating the ultrasonic transducer assembly 114.
FIG. 7 illustrates another surgical instrument 300 of the present invention. The surgical instrument 300 includes a housing 302 that may house a transducer assembly 314 that includes an ultrasonic horn 324. The ultrasonic transducer assembly 314 may comprise at least one and preferably a stack of, for example, four to eight ceramic piezoelectric elements 315 with a motion null point located at some point along the stack. In this embodiment, the transducer assembly 314 is non-rotatably supported within the housing 302. Power may be transmitted to the ultrasonic transducer assembly 314 by conductors 360, 362 which are coupled to the ultrasonic generator 12 in the control system 10. The surgical instrument 300 may include a control arrangement of the type described above and be used in the various modes described above. The motor 340 may have an encoder 341 associated therewith that communicates with the control module 24 as was described above. The motor 340 may receive power from the motor drive 26 through conductors 342, 343 that comprise motor cable 74 that extends through the common sheath 76.
An ultrasonic blade 200 of the types and construction described above may be attached to the ultrasonic horn 324 in a manner described above and may extend through a bore 342 in a motor 340 that is mounted within the housing 302. In alternative embodiments, however, the ultrasonic blade 200 may be integrally formed with the ultrasonic horn 324. A tissue cutting blade 220 of the various types and constructions described above may be attached to a rotatable portion/shaft of the motor 340. For example, those motors manufactured by National Instruments may be used. However, other motors may also be successfully employed. The tissue cutting blade 220 may coaxially extend through an outer sheath 230 that is attached to the housing 302. The outer sheath 230 may be fabricated from, for example, aluminum, titanium, aluminum alloys, steels, ceramics, etc. The tissue cutting blade 220 may be rotatably supported by one or more bearings 332 mounted between the housing 302 and/or the outer sheath 230. One or more seals 250 of the type and construction described in one of the aforementioned patent applications or others may be mounted between the ultrasonic blade 200 and the tissue cutting blade 220. The ultrasonic horn 324 may be coupled to the proximal end of the ultrasonic blade 200 in the manner described above. In use, the surgeon may use the portion of the rotating tissue cutting blade 220 that is exposed through the distal tissue cutting opening 234 in the outer sheath 230 to cut tissue and then activate the ultrasonic blade 200 when it is needed for coagulation purposes. The surgeon would simply contact the target tissue with the distal end 202 of the ultrasonic blade 200 while activating the ultrasonic transducer assembly 314. It will be understood that the instrument 300 may be used in a tissue cutting rotation mode, an ultrasonic mode, or tissue cutting and ultrasonic mode (“duel mode”).
FIG. 8 illustrates an alternative surgical instrument 300′ that is substantially identical to surgical instrument 300 described above, except for the following differences. As can be seen in FIG. 8, the ultrasonic transducer assembly 314 and the ultrasonic blade 200 are capable of being moved axially by a trigger 370 that is pivotally coupled to the housing 302′. In various embodiments, the trigger 370 may have a yoke 372 that is configured to engage a portion of the transducer assembly 314 such that when the trigger 370 is pivoted (arrow “B”), the ultrasonic transducer assembly 314, and ultrasonic blade 200 move axially along axis A-A (represented by arrow “C”). This “gross” axial motion is distinguishable from ultrasonic axial motion achieved when the ultrasonic transducer assembly 314 is powered.
FIG. 9 illustrates another surgical instrument 400 of the present invention. The surgical instrument 400 includes a housing 402 that may house an ultrasonic transducer assembly 414 that includes an ultrasonic horn 424. The ultrasonic transducer assembly 414 may comprise at least one and preferably a stack of, for example, four to eight PZT-8 (Lead Zirconium Titanate) ceramic piezoelectric elements 415 with a motion null point located at some point along the stack. In this embodiment, the ultrasonic transducer assembly 414 is attached to a transducer housing 430 that is rotatably supported within the housing 402 by a distal bearing 436. The ultrasonic transducer assembly 414 may be substantially ultrasonically insulated from the transducer housing 430 by, for example, epdm elastomeric materials or by a flange placed at a Node and damped by a dampening member such that ultrasonic motion from the ultrasonic transducer assembly 414 is not passed to the transducer housing. A tissue cutting blade 220 of the various types and constructions described above may be attached to the transducer housing 430 for rotatable travel therewith. The tissue cutting blade 220 may coaxially extend through an outer sheath 230 that is attached to the housing 402. The tissue cutting blade 220 may be rotatably supported by one or more bearings 432 mounted between the housing 402 and/or the outer sheath 230. One or more seals 250 may be mounted between the ultrasonic blade 200 and the tissue cutting blade 200. The ultrasonic horn 424 may be coupled to the proximal end of the ultrasonic blade 200 in the manner described above. In alternative embodiments, the ultrasonic blade 200 may be integrally formed with the ultrasonic horn 424.
This embodiment may include a conventional stepper motor 440. The motor 440 may have an encoder associated therewith that communicates with the control module 24 as was described above. The motor 440 may receive power from the motor drive 26 through conductors 441, 442 that comprise motor cable 74 that extends through the common sheath 76. The motor 440 may have a hollow motor shaft 444 attached thereto that extends through a slip ring assembly 450. The hollow motor shaft 444 may be rotatably supported within the housing 402 by a proximal bearing 446.
The slip ring assembly 450 may be fixed (i.e., non-rotatable) within the housing 402 and may include a fixed outer contact 452 that is coupled to conductors 453, 454 that form generator cable 14 as was described above. An inner contact 456 may be mounted on the rotatable hollow drive shaft 444 such that it is in electrical contact or communication with outer contact 452. Conductors 453, 454 are attached to the inner contact 456 and extend through the hollow motor shaft 444 to be coupled to the ultrasonic transducer assembly 414. In various embodiments, to facilitate ease of assembly and also acoustically isolate the motor 440 from the ultrasonic transducer assembly 414, the hollow motor shaft 444 may be detachably coupled to the transducer 430 by one of the various coupling assemblies disclosed in copending U.S. patent application Ser. No. 12/703,860, entitled ULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITH ROTATING CUTTING IMPLEMENT, now U.S. Patent Application Publication No. 2011/0196286, the disclosure of which has been herein incorporated by reference in its entirety.
When power is supplied to the motor 440, the drive shaft 444 rotates about axis A-A which also causes the transducer housing 430 to rotate about axis A-A. Because ultrasonic transducer assembly 414 and the tissue cutting blade 220 are attached to the transducer housing 430, they, too, rotate about axis A-A. When the clinician desires to power the ultrasonic transducer assembly 414, power is supplied from the ultrasonic generator 12 to the fixed contact 452 in the slip ring assembly 450. Power is transmitted to the ultrasonic transducer assembly 414 by virtue of rotational sliding contact or electrical communication between the inner contact 456 and the fixed contact 452. Those signals are transmitted to the ultrasonic transducer assembly 414 by conductors 460, 462. The surgical instrument 400 may include a control arrangement of the type described above and be used in the various modes described above. It will be understood that the instrument 400 may be used in rotation mode, ultrasonic mode, or rotation and ultrasonic mode (“duel mode”).
FIG. 10 illustrates another surgical instrument 500 of the present invention. The surgical instrument 500 includes a housing 502 that may house an ultrasonic transducer assembly 514 that includes an ultrasonic horn 524. The ultrasonic transducer assembly 514 may comprise at least one and preferably a stack of, for example, four to eight PZT-8 (Lead Zirconium Titanate) ceramic piezoelectric elements 515 with a motion null point located at some point along the stack. In this embodiment, the ultrasonic transducer assembly 514 is contained within a sealed transducer chamber 526 that is rotatably supported within the housing 502 by a distal bearing 536. In various embodiments, the sealed transducer chamber 526 may be fabricated from magnetic material such as, for example, iron, rare earth magnetic materials, etc. A tissue cutting blade 220 of the various types and constructions described above may be attached to the transducer chamber 526 for rotatable travel therewith. The tissue cutting blade 220 may coaxially extend through an outer sheath 230 that is attached to the housing 502. The outer sheath 230 may be fabricated from, for example, aluminum, titanium, aluminum alloys, steels, ceramics, etc. The tissue cutting blade 220 may be rotatably supported by one or more bearings 532 mounted between a nosepiece portion 503 of the housing 502 and/or the outer sheath 230. One or more seals 250 may be mounted between the ultrasonic blade 200 and the tissue cutting blade 220. The ultrasonic horn 524 may be coupled to the proximal end of the ultrasonic blade 200 in the manner described above. In alternative embodiments, the ultrasonic blade 200 may be integrally formed with the ultrasonic horn 524.
This embodiment includes a motor 540 that may comprise a stepper motor of the type and construction described above. The motor 540 may have an encoder associated therewith that communicates with the control module 24 as was described above. The motor 540 may receive power from the motor drive 26 through conductors 541, 542 that comprise motor cable 74 that extends through the common sheath 76 (FIG. 1). The motor 540 has a motor shaft 544 attached thereto that is coupled to a magnetic yoke 560 which is magnetically coupled to the transducer chamber 526. The motor shaft 544 may be rotatably supported within the housing 502 by a proximal bearing 546.
A movable contact 550 may be fixed to the sealed transducer chamber 526 and is coupled to the transducer assembly 514 by conductors 552 and 553. A fixed outer contact 554 may be attached to the housing 502 and is coupled to conductors 555, 556 that form generator cable 14 as was described above. When power is supplied to the motor 540, the motor shaft 544 rotates about axis A-A which also causes the transducer chamber 526 to rotate about axis A-A. Because ultrasonic transducer assembly 514 and the tissue cutting blade 220 are attached to the transducer chamber 526, they, too, rotate about axis A-A. When the clinician desires to power the ultrasonic transducer assembly 514, power is supplied from the ultrasonic generator 12 to the fixed contact 554. Power is transmitted to the ultrasonic transducer assembly 514 by virtue of rotational sliding contact or electrical communication between the fixed contact 554 and the movable contact 550. Those signals are transmitted to the ultrasonic transducer assembly 514 by conductors 553, 554. The surgical instrument 500 may include a control arrangement of the type described above and be used in the various modes described above. It will be understood that the instrument 500 may be used in rotation mode, ultrasonic mode, or rotation and ultrasonic mode (“duel mode”).
FIGS. 11 and 12 illustrate another surgical instrument 600 of the present invention. The surgical instrument 600 includes a housing 602 that may support a hollow transducer housing 620. The hollow transducer housing 620 may support a plurality of (e.g., four to eight) piezoceramic elements 622 and may have an ultrasonic horn portion 624 integrally formed therewith. A series of internal threads 625 may be formed on the distal end portion of the horn portion 624 for attachment to a hollow ultrasonic blade 630. Ultrasonic blade 630 may be fabricated from, for example, aluminum, titanium, aluminum alloys, steels, ceramics, etc. and have a threaded proximal end 632 for threaded attachment to the threads 625 on the ultrasonic horn portion 624. As can be further seen in FIG. 11, a proximal end 626 of the transducer housing 620 may have threads 627 formed thereon for threaded attachment to a threaded bushing 640. Threaded bushing 640 may have an axial passage 642 therethrough for receiving a rotatable tissue cutting or “shaver” blade 650 therethrough. In various embodiments, the shaver blade 650 may be fabricated from, for example, aluminum, titanium, aluminum alloys, steels, ceramics, etc. and be rotatably supported within the transducer housing 620 by a bearing 651 that is located at a node “N” in the housing 620. The proximal end 652 of the shaver blade 650 may be attached to a motor 660. The shaver blade 650 may for example, be attached to a drive shaft 662 of the motor 660 by threads (not shown) or other suitable coupling arrangement. The transducers 622 may receive power from the ultrasonic generator 12 in the control system 10 through conductors 628, 629. Motor 660 may communicate with the various components in the control system 10 through conductors 664, 665.
In various embodiments, the shaver blade 650 may have a distal end 654 that may be configured to cut tissue when the blade 650 is rotated about axis A-A. In one embodiment, for example, the distal end 654 has a series of teeth 656 formed thereon. See FIG. 12. Also in various embodiments, the shaver blade 650 may have an axial suction lumen 657 therethrough. At least one discharge hole 658 is provided through the shaver blade 650 to enable the suction lumen 657 to discharge cut tissue and fluids therethrough into a suction chamber 670 located within the housing 602. The suction chamber 670 may be sealingly attached to the bushing 640 or be otherwise supported within the housing 602 such that the shaver blade 650 extends therethrough. Because the bushing 640 is part of the acoustic system and attachment of the suction chamber 670 to the bushing 640 would make it part of the acoustic system as well, it is desirable for the connection between the suction chamber 670 and the bushing 640 to be located at a Node of vibration. In the embodiment depicted in FIG. 11, a shaft seal 672 may be provided on the shaver blade 650 to establish a substantially fluid-tight seal between the shaver blade 650 and the suction chamber 670. In various embodiments, the shaft seal 672 may be fabricated from, for example, silicone rubber, epdm rubber, Teflon®, Ultem®, etc. The suction chamber 670 may discharge through a flexible hose 674 that communicates with a collection receptacle 676 and a source of suction 678.
The instrument 600 may further have an acoustically isolated hollow sheath 680 that extends from the housing 602 to cover a substantial portion of the ultrasonic blade 630. That is, in various embodiments, the hollow sheath 680 may cover all of the ultrasonic blade 630 except for a distal end portion 634 that has a blade opening 635 therein. See FIG. 12. The hollow sheath 680 may be fabricated from flouroethylene-propelene (FEP), silicon or similar materials that can acoustically isolate or acoustically insulate the outside of the ultrasonic blade 630. At least one seal 636 may be employed between the outer sheath 680 and the ultrasonic blade 630. Similarly, the ultrasonic blade 630 may be isolated from the shaver blade 650 by at least one seal 651. In various embodiments, the seals 636, 651 may comprise one or more seals of the type described in co-pending U.S. patent application Ser. No. 12/703,866, entitled SEAL ARRANGEMENTS FOR ULTRASONICALLY POWERED SURGICAL INSTRUMENTS, now U.S. Patent Application Publication No. 2011/0196398, which has been herein incorporated by reference in its entirety. As can also be seen in FIGS. 11 and 12, the distal end portion 634 of the ultrasonic blade 630 may be substantially blunt or rounded.
When power is supplied to the motor 660, the drive shaft 662 rotates about axis A-A which also causes the shaver blade 650 to rotate about axis A-A. Activation of the source of suction 678 causes suction to be applied to the suction lumen 657 in the shaver blade 650 to draw tissue into the opening 635 in the hollow sheath 680 and into contact with the rotating shaver blade 650. The source of suction 678 may communicate with and be controlled by the control system 10 such that suction is only applied to the lumen 657 when the shaver blade 650 is being rotated by motor 660.
The surgical instrument 600 may have two primary modes of operation. One mode is the shaver mode, in which the shaver blade 650 rotates in concert with suction to cut tissue that enters the opening 636. The other mode is the ultrasonic coagulation mode. As an ultrasonic instrument, the ultrasonic blade 630 is driven in a linear ultrasonic vibration mode by the transducers 622. The user is able to coagulate bleeders and tissue as needed with the exposed distal end 634 of the ultrasonic blade 630. In use, the instrument 600 can be activated in shaver modes independently or in ultrasonic mode independently. Both modes can also be activated together and suction can be turned on and off at any time. When using the instrument 600 in one of the ultrasonic modes, the distal end 634 of the ultrasonic blade 630 can be used to coagulate tissue while the remainder of the device can safely come in contact with tissue outside of the targeted site because it is not ultrasonically active.
FIGS. 13-17 illustrate another surgical instrument 700 of the present invention. The surgical instrument 700 may include a housing 702 that may be manufactured in multiple pieces from, for example, plastics such as polycarbonate, polyetherimide (GE Ultem®) or metals such as aluminum, titanium or steel that are coupled together by fasteners such as screws, bolts, snap features or may be retained together by adhesive, welding, etc. As can be seen in FIGS. 13 and 15-17, the housing 702 may define a suction chamber 703 that communicates with a suction port 705. A flexible tube or other suitable conduit 707 may be coupled to the suction port 705 as well as to a collection receptacle 709 that may be located within the surgical suite. The collection receptacle 709 may be coupled to a source of suction 711 to apply suction to the suction chamber 703 through the flexible tube 707 and suction port 705. A motor 710 of the type and construction described above may also be supported within the housing 702. The motor 710 has a drive shaft 712 that extends into the suction chamber 703. The drive shaft 712 may be supported by a bearing 714 in a wall of the suction chamber 703. A seal 716 may also be employed to achieve a substantially fluid-tight seal between the drive shaft 712 and the wall of the suction chamber 703. The motor 710 may communicate with the various components of the control system 10 through conductors 717, 718 in the manner discussed above.
An ultrasonic transducer assembly 720 that has an ultrasonic horn portion 722 attached thereto or integrally formed therewith may also be supported within the housing 702. The ultrasonic transducer assembly 720 may comprise at least one and preferably a stack of, for example, four to eight lead zirconate titanate (PZT-8) ceramic piezoelectric elements 725 with a motion null point located at some point along the stack. In various embodiments, for example, a series of internal threads (not shown) may be formed on the distal end portion of the horn portion 722 for attachment to an ultrasonic blade 760. Ultrasonic blade 760 may have a threaded proximal end 762 for threaded attachment to the horn portion 722 as will be discussed in further detail below. The surgical instrument 700 may further include a hollow tissue cutting or “shaver” blade 730 that may be fabricated from, for example, aluminum, titanium, aluminum alloys, titanium alloys, steels, ceramics, etc. A distal end 732 of the shaver blade 730 may have serrations 734 formed thereon or, in other embodiments, the serrations may be omitted. In some embodiments, a proximal end 736 of the shaver blade 730 may be fabricated for removable attachment to the drive shaft 712 of the motor 710. In one embodiment, for example, a “quarter-twist” or bayonet-type coupling 738 may be employed to couple the proximal end 736 of the shaver blade 730 to a corresponding coupling portion 713 that is attached to the drive shaft 712. Such bayonet coupling arrangements are known and may facilitate coupling of the shaver blade 730 to the drive shaft 712 by engaging the coupling portions 738, 713 and rotating the blade 730 while the drive shaft 712 remains stationary. Other forms of coupling arrangements could also be successfully employed without departing from the spirit and scope of the present invention. The shaver blade 730 may further have a suction lumen 740 that extends therethrough. At least one suction hole 742 may provided in the proximal end 736 of the shaver blade 730 to enable the suction lumen 740 extending therethrough to discharge into the suction chamber 703 when the proximal end 736 is coupled to the drive shaft 712 as illustrated in FIG. 13.
In various embodiments, the surgical instrument 700 may further include an outer sheath assembly 770 that may be fixedly attached to the housing 702. In one embodiment, for example, the proximal end 772 of the outer sheath assembly 770 may include a quarter-turn or bayonet-type coupling arrangement that is configured for attachment to the distal end 701 of the housing 702. However, other known coupling arrangements may be employed for removably coupling the outer sheath assembly 770 to the housing 702 without departing from the spirit and scope of the present invention. As can be most particularly seen in FIG. 14, the outer sheath assembly 770 may have a shaver blade lumen 774 that extends therethrough and which is sized to rotatably receive the shaver blade 730 therein. Various embodiments may also employ a bearing 776 in the proximal end 772 of the outer sheath assembly 770 for rotatably supporting the shaver blade 730 therein. Additional bearing and/or seal arrangements may be employed to rotatably support the shaver blade 730 within the outer sheath assembly 770. The distal end 778 of the outer sheath assembly 770 may also have an opening 780 therein to expose the distal end 732 of the shaver blade 730. The distal end 778 of the outer sheath assembly 770 may also form a cutting board surface 782 upon which the distal end 732 of the shaver blade 730 may oscillate. The outer sheath assembly 770 may further have an ultrasonic blade lumen 790 for receiving the ultrasonic blade 760 therein. The ultrasonic blade lumen 790 may be substantially parallel to the shaver blade lumen 774. One or more seal members (not shown) of the type and construction described in the aforementioned pending patent applications that have been incorporated herein by reference or others may be employed to support the ultrasonic blade 760 within the ultrasonic blade lumen 790 while achieving a substantially fluid tight seal between the blade 760 and the lumen 790.
Assembly of the instrument 700 will now be explained with reference to FIGS. 16 and 17. As can be seen in FIG. 16, for example, the proximal end 762 of the ultrasonic blade 760 is attached to the ultrasonic horn 722. In one embodiment, the proximal end 762 of the ultrasonic blade 760 is threaded onto the ultrasonic horn 722. In still other embodiments, however, the ultrasonic blade 760 may be integrally formed with the ultrasonic horn 722. After the ultrasonic blade 760 is coupled to the ultrasonic horn 722, the outer sheath assembly 770 with the shaver blade 730 supported therein is oriented such that the distal end 764 of the ultrasonic blade 760 is introduced into the lumen 790. The outer sheath assembly 770 is then slid over the ultrasonic blade 760 to bring the proximal end 772 of the outer sheath assembly 770 into engagement with the distal end 701 of the housing 702. The outer sheath assembly 770 may then be manipulated in a known manner to couple the bayonet-type coupling arrangement together. In other embodiments, the outer sheath assembly 770 may be permanently fixed to the housing 702 with adhesive, welding, etc. In still other arrangements, the outer sheath assembly 770 may be attached to the housing 702 with removable fasteners such as screws, bolts, etc.
In use, the control system 10 components may be employed to control motor 710 such that the drive shaft 712 is caused to oscillate back and forth about axis A-A which also causes the shaver blade 730 to rotate about axis A-A. Activation of the source of suction 711 may cause suction to be applied to the suction lumen 740 in the shaver blade 730 to draw tissue into contact with the oscillating distal end 732 of the shaver blade 730. Pieces of severed tissue may be drawn in through the suction lumen 740 and ultimately be collected in the collection receptacle 709. If hemostasis is desired, the surgeon can activate the ultrasonic transducer assembly 720 to ultrasonically power the ultrasonic blade 760. The distal end 764 of the ultrasonic blade 760 that protrudes out of the outer sheath assembly 770 (FIG. 13) may then be pressed against the bleeding tissue to utilize the ultrasonic energy to stop the bleeding.
FIGS. 18 and 19 illustrate another surgical instrument 800 of the present invention. The surgical instrument 800 may include a housing 802 that may be manufactured in multiple pieces from, for example, plastics such as polycarbonate, polyetherimide (GE Ultem®) or metals such as aluminum, titanium or steel that are coupled together by fasteners such as screws, bolts, snap features or may be retained together by adhesive, welding, etc. As can be seen in FIG. 18, the housing 802 may define a suction chamber 803 that communicates with a suction port 805. A flexible tube or other suitable conduit 807 may be coupled to the suction port 805 as well as to a collection receptacle 809. The collection receptacle 809 may be coupled to a source of suction 811 for applying suction to the suction chamber 803 through the flexible tube 807 and suction port 805. A motor 810 of the type and construction described above may also be supported within the housing 802. The motor 810 has a motor drive shaft 812 that extends into the suction chamber 803. The motor drive shaft 812 may be supported by a bearing 814 in a wall of the suction chamber 803. A seal 816 may also be employed to achieve a substantially fluid-tight seal between the drive shaft 812 and the wall of the suction chamber 803. The motor 810 may communicate with the various components of the control system 10 through conductors 817, 818 in the various manners described above.
Also supported in the housing 802 is an ultrasonic transducer assembly 820 that has an ultrasonic horn portion 822 attached thereto or integrally formed therewith. The ultrasonic transducer assembly 820 may comprise at least one and preferably a stack of, for example, four to eight lead zirconate titanate (PZT-8) ceramic piezoelectric elements 821 with a motion null point located at some point along the stack. In various embodiments, the ultrasonic blade 860 may be attached to the distal end of the horn portion 822 by, for example, a screw fitting. The surgical instrument 800 may further include a hollow shaver blade 830 that may be fabricated from, for example, aluminum, titanium, aluminum alloys, titanium alloys, steels, ceramics, etc. A distal end 832 of the shaver blade 830 may have an opening 834 therein that forms two sharp tissue cutting edges 835, 837 as shown in FIG. 19. A proximal end 836 of the shaver blade 830 may have a driven gear 838 that is retained in meshing engagement with a drive gear 818 attached to the drive shaft 812 of the motor 810. The shaver blade 830 may further have a suction lumen 840 that extends therethrough. At least one suction hole 882 may be provided in the proximal end 836 of the shaver blade 830 to discharge into the suction chamber 803 when the proximal end 836 is coupled to the drive shaft 812 as illustrated in FIG. 18.
In various embodiments, the surgical instrument 800 may further include a shaver blade sheath 870 that may be fixedly attached to the housing 802. In one embodiment the proximal end 872 of the shaver blade sheath 870 may be fabricated from, for example, a metal material such as aluminum, titanium, steels, titanium alloys or aluminum alloys and include a quarter-turn or bayonet-type coupling arrangement that is configured for attachment to the distal end 801 of the housing 802. However, other known coupling arrangements may be employed for removably coupling the shaver blade sheath 870 to the housing 802 without departing from the spirit and scope of the present invention. As can be most particularly seen in FIG. 18, the shaver blade sheath 870 may have a shaver blade lumen 874 extending therethrough that is sized to rotatably receive the shaver blade 830 therein. Various embodiments may also employ a bearing (not shown) in the proximal end of the shaver blade sheath 870 for rotatably supporting the shaver blade 830 within the shaver blade sheath 870. Additional bearing and/or seal arrangements may be employed to rotatably support the shaver blade 830 within the shaver blade sheath 870. The distal end 878 of the shaver blade sheath 870 may for a substantially blunt closed end that has an opening 880 therein to expose the distal end 832 of the shaver blade 830.
Also in this embodiment, an ultrasonic blade sheath 890 may be attached to the housing 802. In various embodiments, for example, the ultrasonic blade sheath 890 may be fabricated from a polymer material such as polyetherimide, liquid crystal polymers, polycarbonate, nylon or ceramic material and be attached to the housing 802 by screw threads, bonding, press fitting, crimping, etc. The ultrasonic blade sheath 890 may further have an ultrasonic blade lumen 892 extending therethrough for receiving the ultrasonic blade 860 therein. One or more seal members (not shown) of the type and construction described in the aforementioned pending patent applications that have been incorporated by reference or others may be employed to support the ultrasonic blade 860 within the lumen 892 while achieving a substantially fluid-tight seal between the blade 860 and the lumen 892. The ultrasonic blade sheath 890 may further have an opening 896 in a distal end 894 to expose a distal end 864 of the ultrasonic blade 860.
In use, the control system 10 components may be used to control motor 810 such that the drive shaft 812 is rotated about axis A-A which also causes the shaver blade 830 to rotate about axis A-A. Activation of the source of suction 811 will cause suction to be applied to the suction lumen 840 in the shaver blade 830 to draw tissue in through the opening 880 in the distal end 878 of the shaver blade sheath 870 and into the opening 834 in the shaver blade 830. Pieces of severed tissue may be drawn in through the suction lumen 840 and ultimately be collected in the collection receptacle 809. If hemostasis is desired, the surgeon can activate the ultrasonic transducer assembly 820 to ultrasonically power the ultrasonic blade 860. The distal end 864 that protrudes out of the ultrasonic sheath assembly 890 (FIG. 19) may then be pressed against the bleeding tissue to utilize the ultrasonic energy to stop the bleeding.
The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
Preferably, the various embodiments described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility. Sterilization can also be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, and/or steam.
In various embodiments, an ultrasonic surgical instrument can be supplied to a surgeon with a waveguide and/or end effector already operably coupled with a transducer of the surgical instrument. In at least one such embodiment, the surgeon, or other clinician, can remove the ultrasonic surgical instrument from a sterilized package, plug the ultrasonic instrument into a generator, as outlined above, and use the ultrasonic instrument during a surgical procedure. Such a system can obviate the need for a surgeon, or other clinician, to assemble a waveguide and/or end effector to the ultrasonic surgical instrument. After the ultrasonic surgical instrument has been used, the surgeon, or other clinician, can place the ultrasonic instrument into a sealable package, wherein the package can be transported to a sterilization facility. At the sterilization facility, the ultrasonic instrument can be disinfected, wherein any expended parts can be discarded and replaced while any reusable parts can be sterilized and used once again. Thereafter, the ultrasonic instrument can be reassembled, tested, placed into a sterile package, and/or sterilized after being placed into a package. Once sterilized, the reprocessed ultrasonic surgical instrument can be used once again.
Although various embodiments have been described herein, many modifications and variations to those embodiments may be implemented. For example, different types of end effectors may be employed. Also, where materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modification and variations.
All of the above U.S. Patents and U.S. Patent applications, and published U.S. Patent Applications referred to in this specification are incorporated herein by reference in their entirety, but only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

## Claims

1. An ultrasonic surgical instrument, comprising:
a housing;
a motor;
a cutting blade coupled to said motor and supported for selective rotational travel relative to said housing;
at least one ultrasonic transducer supported by said housing; and
an ultrasonic blade protruding from said at least one ultrasonic transducer and coaxially extending through a lumen in said cutting blade to protrude through a distal end thereof.

2. The ultrasonic surgical instrument of claim 1 further comprising an outer sheath coupled to said housing and rotatably supporting said cutting blade therein, said outer sheath having a distal end with an opening therein to expose a distal tissue cutting portion of said cutting blade and wherein said distal end of said ultrasonic blade protrudes through another opening in said distal end of said outer sheath.

3. The ultrasonic surgical instrument of claim 2 wherein at least a portion of said distal end of said ultrasonic blade that protrudes through said another opening in said outer sheath is rounded.

4. The ultrasonic surgical instrument of claim 1 wherein said ultrasonic blade extends through a hollow passage in said motor.

5. The ultrasonic surgical instrument of claim 1 wherein said at least one ultrasonic transducer is movably supported within said housing.

6. The ultrasonic surgical instrument of claim 5 further comprising an actuator member coupled to said housing and interacting with said at least one ultrasonic transducer to facilitate the selective gross axial movement of said at least one ultrasonic transducer relative to said housing.

7. The ultrasonic surgical instrument of claim 1 wherein said at least one ultrasonic transducer is housed within a transducer housing coupled to said motor.

8. The ultrasonic surgical instrument of claim 7 wherein said ultrasonic transducer housing is attached to said motor by a magnetic coupling arrangement.

9. The ultrasonic surgical instrument of claim 1 wherein said cutting blade has a plurality of cutting edges formed thereon.

10. An ultrasonic surgical instrument, comprising:
a housing;
at least one ultrasonic transducer supported within said housing;
a substantially hollow ultrasonic blade coupled to said at least one ultrasonic transducer;
a cutting blade extending through said substantially hollow ultrasonic blade and having a tissue cutting distal end protruding outward from a distal end of said substantially hollow ultrasonic blade; and
a motor coupled to said cutting blade for rotating said cutting blade within said substantially hollow ultrasonic blade.

11. The ultrasonic instrument of claim 10 wherein said cutting blade has a suction lumen therein that communicates with a source of suction.

12. The ultrasonic instrument of claim 10 further comprising a suction chamber within said housing, said suction chamber communicating with said source of suction and said suction lumen in said cutting blade.

13. The ultrasonic surgical instrument of claim 11 further comprising an outer sheath coupled to said housing such that said ultrasonic blade extends therethrough and at least a portion of said distal end of said ultrasonic blade extends distally out of said outer sheath.

14. The ultrasonic surgical instrument of claim 13 wherein the outer sheath is connected to said ultrasonic blade by an acoustically isolating material.

15. The ultrasonic surgical instrument of claim 13 wherein said outer sheath is in direct contact with said ultrasonic blade.

16. An ultrasonic surgical instrument, comprising:
a housing;
a motor supported by said housing;
a cutting blade coupled to said motor and supported for selective rotational travel relative to said housing;
at least one ultrasonic transducer supported by said housing; and
an ultrasonic blade protruding from said at least one ultrasonic transducer, said ultrasonic blade being substantially parallel to said cutting blade.

17. The ultrasonic surgical instrument of claim 16 wherein said cutting blade has a suction lumen extending therethrough that communicates with a source of suction.

18. The ultrasonic surgical instrument of claim 16 wherein said cutting blade is rotatably supported within a cutting blade lumen in an outer sheath assembly attached to said housing and wherein said ultrasonic blade extends through an ultrasonic blade lumen in said outer sheath.

19. The ultrasonic surgical instrument of claim 16 wherein said cutting blade is rotatably supported within a cutting blade lumen in a cutting blade outer sheath attached to said housing and wherein said ultrasonic blade extends through an ultrasonic blade lumen in an ultrasonic outer sheath attached to said housing.

20. The ultrasonic surgical instrument of claim 19 wherein said cutting blade outer sheath is made from a first material and wherein said ultrasonic outer sheath is made from a second material that differs from said first material.