Abstract:
An embodiment of a method of the invention provides a method for welding tissue comprising providing a tissue welding device having first and second tissue engaging surfaces with at least one surface including an electrode surface that defines a plurality of surface portions having different resistances to electrical current flow therethrough. A target tissue volume is engaged with the tissue engaging surfaces. Rf energy is delivered to the target volume to create a substantially even temperature distribution across at least a portion of the target tissue volume to substantially uniformly weld at least a portion of the target tissue volume.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS  
       [0001]     This application is a continuation-in-part of co-pending U.S. patent application Ser. Nos. 10/351,449 filed on Jan. 22, 2003, entitled Electrosurgical Instrument and Method of Use (Attorney Docket No. 021447-000540US); Ser. No. 10/032,867 filed on Oct. 22, 2001, entitled Electrosurgical Jaw Structure for Controlled Energy Delivery (Attorney Docket No. 021447-000500US); and Ser. No. 09/982,482 filed on Oct. 18, 2001, entitled Electrosurgical Working End for Controlled Energy Delivery (Attorney Docket No. 021447-000400US), the full disclosures of which are incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION  
       [0002]     1. Field of the Invention  
         [0003]     Embodiments of the invention relates to medical devices and more particularly relates to the working end of an electrosurgical instrument that is adapted for sealing or welding tissue that is engaged between paired jaw members. More specifically, an embodiment of the invention relates to elongate jaw members that carry electrodes with engagement surfaces that provide a resistive gradient for causing controlled heating of engaged tissue.  
         [0004]     2. Description of the Related Art  
         [0005]     In various open and laparoscopic surgeries, it is necessary to weld or seal the margins of transected tissue volumes, for example, in a lung resection. In some procedures, stapling instruments are used to apply a series of mechanically deformable staples to seal the transected edge a tissue volume. Such mechanical devices may create a seal that leaks which can result in later complications.  
         [0006]     Various radio frequency (Rf) surgical instruments have been developed for sealing the edges of transected tissues. For example,  FIG. 1A  shows a sectional view of paired electrode-jaws  2   a  and  2   b  of a typical prior art bi-polar Rf grasper grasping two tissue layers. In a typical bi-polar jaw arrangement, each jaw face comprises an electrode and Rf current engage opposing exterior surfaces of the tissue.  FIG. 1A  shows typical lines of bi-polar current flow between the jaws. Each jaw in  FIG. 1A  has a central slot adapted to receive a reciprocating blade member as is known in the art for transecting the captured vessel after it is sealed.  
         [0007]     While bi-polar graspers as in  FIG. 1A  can adequately seal or weld tissue volumes that have a small cross-section, such bi-polar instruments are often ineffective in sealing or welding many types of anatomic structures, e.g., (i) anatomic structures having walls with irregular or thick fibrous content, such as lung tissue; (ii) bundles of disparate anatomic structures, (iii) substantially thick anatomic and structures, and (iv) large diameter blood vessels having walls with thick fascia layers.  
         [0008]     As depicted in  FIG. 1A , a prior art grasper-type instrument is depicted with jaw-electrodes engaging opposing side of a tissue volume with substantially thick, dense and non-uniform fascia layers underlying its exterior surface, for example, a large diameter blood vessel. As depicted in  FIG. 1A , the fascia layers f prevent a uniform flow of current from the first exterior tissue surface s to the second exterior tissue surface s that are in contact with electrodes  2   a  and  2   b . The lack of uniform bi-polar current across the fascia layers f causes non-uniform thermal effects that typically result in localized tissue desiccation and charring indicated at c. Such tissue charring can elevate impedance levels in the captured tissue so that current flow across the tissue is terminated altogether.  FIG. 1B  depicts an exemplary result of attempting to create a weld across tissue with thick fascia layers f with a prior art bi-polar instrument.  FIGS. 1A-1B  show localized surface charring c and non-uniform weld regions w in the medial layers m of vessel. Further,  FIG. 1B  depicts a common undesirable characteristic of prior art welding wherein thermal effects propagate laterally from the targeted tissue causing unwanted collateral (thermal) damage indicated at d.  
         [0009]     What is needed is an instrument working end that can utilize Rf energy in new delivery modalities: (i) to weld or seal tissue volumes that are not uniform in hydration, density and collagenous content; (ii) to weld a targeted tissue region while substantially preventing collateral thermal damage in regions lateral to the targeted tissue; (iii) to weld a transected margin of a bundle of disparate anatomic structures; and (iv) to weld a transected margin of a substantially thick anatomic structure.  
       SUMMARY OF THE INVENTION  
       [0010]     One aspect of the present invention provides an instrument and working end that is capable of transecting tissue and highly compressing tissue to allow for controlled Rf energy delivery to the transected tissue margins. The objective of the invention is to effectively weld tissues that have thick fascia layers or other layers with non-uniform fibrous content. Such tissues are difficult to seal since the fascia layers can prevent uniform current flow and uniform ohmic heating of the tissue.  
         [0011]     As background, the biological mechanisms underlying tissue fusion by means of thermal effects are not fully understood. In general, the delivery of Rf energy to a captured tissue volume elevates the tissue temperature and thereby at least partially denatures proteins in the tissue. One objective is to denature such proteins, including collagen, into a proteinaceous amalgam that intermixes and fuses together as the proteins renature. As the treated region heals over time, the so-called weld is reabsorbed by the body&#39;s wound healing process.  
         [0012]     In order to create an effective weld in a tissue volume dominated by the fascia layers, it has been found that are factors to be considered. It is desirable to create a substantially even temperature distribution across the targeted tissue volume to create a uniform weld or seal. Fibrous tissue layers (i.e., fascia) conduct Rf current differently than adjacent less-fibrous layers, and it is believed that differences in extracellular fluid content in such adjacent tissues also contribute greatly to the differences in ohmic heating. It has been found that by applying very high compressive forces to fascia layers and underlying non-fibrous layers, the extracellular fluids migrate from the site to collateral regions. Thus, the compressive forces can make resistance more uniform regionally within the engaged tissue.  
         [0013]     Another aspect of the invention provides means for creating high compression forces over a very elongate working end that engages the targeted tissue. This is accomplished by providing a slidable extension member that defines channels therein that engage the entire length of elongate guide members that guide the extension member over the tissue. The extension member of the invention thus is adapted to provide multiple novel functionality: (i) to transect the tissue, and (ii) contemporaneously to engage the transected tissue margins under high compression within the components of the working end. Optionally, the extension member can be adapted to carry spaced apart longitudinal electrode surfaces for delivery of Rf current to each transected tissue margin from the just-transected medial tissue layers to surface layers.  
         [0014]     Of particular interest, the invention further provides first and second jaw engagement surfaces with electrodes that define stepped resistive gradients across the electrodes&#39; engagement surfaces for controlling Rf energy delivery to the engaged tissue. It has been found that precise control of ohmic heating in the engaged tissue can be accomplished by having electrode surfaces that define a plurality of portions with differential resistance to electrical current flow therethrough.  
         [0015]     In another embodiment of the invention, the working end includes components of a sensor system which together with a power controller can control Rf energy delivery during a tissue welding procedure. For example, feedback circuitry for measuring temperatures at one or more temperature sensors in the working end may be provided. Another type of feedback circuitry may be provided for measuring the impedance of tissue engaged between various active electrodes carried by the working end. The power controller may continuously modulate and control Rf delivery in order to achieve (or maintain) a particular parameter such as a particular temperature in tissue, an average of temperatures measured among multiple sensors, a temperature profile (change in energy delivery over time), or a particular impedance level or range.  
         [0016]     Other embodiments of the invention provide methods for welding tissue using Rf energy. One embodiment of a method of the invention for welding tissue using Rf energy comprises providing a tissue welding device having first and second tissue engaging surfaces with at least one surface including an electrode surface that defines a plurality of surface portions having different resistances to electrical current flow therethrough. A target tissue volume is engaged with the tissue engaging surfaces. Rf energy is delivered to the target volume to create a substantially even temperature distribution across at least a portion of the target tissue volume to substantially uniformly weld at least a portion of the target tissue volume.  
         [0017]     Another embodiment of a method of the invention for welding tissue comprises providing a tissue welding device having first and second tissue engaging surfaces each surface including an electrode surface having an electrical resistance gradient therethrough. A target tissue volume is engaged with the tissue engaging surfaces. Rf energy is delivered to the target volume to create a substantially even temperature distribution across at least a portion of the target tissue volume to substantially uniformly weld at least a portion of the target tissue volume.  
         [0018]     Still another embodiment of a method for welding tissue comprises providing a tissue welding device having at least one tissue-engaging surface including a section having non-uniform resistance over a substantially continuous portion of the section. A target tissue volume is engaged with the tissue engaging surfaces. Rf energy is delivered to the target volume wherein the non uniform resistance section directs the flow of Rf current in response to resistance changes in the target tissue volume to create a substantially even temperature distribution across at least a portion of the target tissue volume. In a related embodiment, the surface and the engaged tissue can have a combined resistance at every point on the surface such that the points having a relatively low combined resistance will preferentially allow current flow until the resistance is raised at those points, thus causing current to preferentially flow to other points on the surface having an initially higher combined resistance.  
         [0019]     Additional objects of the invention will be apparent from the following description, the accompanying drawings and the appended claims. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0020]      FIG. 1A  is an illustration of Rf current flow between the paired jaws of a prior art bi-polar radiofrequency device in a method of sealing a tissue with fascia layers that are resistant to current flow therethrough.  
         [0021]      FIG. 1B  illustrates representative weld effects of the bi-polar current flow of  FIG. 1A .  
         [0022]      FIG. 2A  is a perspective view of a Type “A” working end of the present invention showing first and second guide members extending from the distal end of an introducer, with a cooperating slidable extension member in a retracted position within the introducer.  
         [0023]      FIG. 2B  is perspective view of the distal end of the slidable extension member of  FIG. 2A  with the lower guide member in phantom view, also showing the distal cutting electrode.  
         [0024]      FIG. 2C  is another view of the working end of  FIG. 2A  with the extension member moved toward an extended position over guide members.  
         [0025]      FIG. 3  is sectional view of a guide member of the invention showing exemplary tissue-gripping elements.  
         [0026]      FIGS. 4A-4C  are illustrations of initial steps of practicing the method of the invention;  FIGS. 4A-4B  depicting the positioning of the guide members over a targeted transection path in an anatomic structure, and  FIG. 4C  depicting the advancement of the extension member over the guide tracks.  
         [0027]      FIG. 5  is an enlarged cross-sectional view of the extension member of  FIG. 2B  showing the electrode arrangement carried by the extension member.  
         [0028]      FIG. 6  is a sectional illustration of the extension member of  FIG. 5  illustrating the manner of delivering bi-polar Rf current flow to seal or weld a transected tissue margin under high compression.  
         [0029]      FIG. 7  is sectional view of a Type “B” working end that open and closes similar to the Type “A” embodiment of  FIG. 5 , with the Type “B” embodiment providing improved electrode engagement surfaces with a resistive gradient for progressive Rf delivery across an engaged tissue volume.  
         [0030]      FIGS. 8A-8D  are sequential sectional views of the Type “B” working end of  FIG. 7  engaging tissue and depicting the induced flow of Rf current progressively through adjacent electrode portions after tissue impedance is altered.  
         [0031]      FIG. 9  is a sectional view of an alternative Type “B” working end with gradient electrodes that has non-parallel electrode engagement surfaces for creating a gradual transition between welded tissue and non-welded tissue.  
         [0032]      FIG. 10  depicts another embodiment of Type “B” working end with gradient electrodes in its engagement surfaces that have continuous tapered layers of resistive material across the engagement surfaces for progressively inducing Rf current flow through adjacent tissue portions.  
         [0033]      FIG. 11  depicts another embodiment of Type “B” working end with gradient electrodes that cooperate in first and second bi-polar jaws. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0034]     1. Type “A” Working End for Transecting Tissue and Sealing the Transected Margins. Referring to  FIG. 2A , the working end  100  of an exemplary Type “A” embodiment is shown that is adapted for transecting and welding at least one transected tissue margin along a targeted track or path p in tissue, such as lung portion, in an open or endoscopic procedure. The working end  100  has first and second elongate guide members or guide-track members indicated at  105 A  
         [0035]     and  105 B that are substantially flexible wire-type elements carried at distal end  108  of an introducer member  110  extending from a proximal handle (not shown). In this Type “A” embodiment, the guide members (or jaws)  105 A and  105 B extend along a central longitudinal axis  115  and provide multiple functionality: (i) to place over or about a target path p in tissue that is to be transected; (ii) to thereafter guide the terminal portion  118  of an extension member  120  carrying an electrode cutting element  122  along the targeted path p in tissue, and (iii) to provide engagement surfaces  127  for the high-compression engagement of the margins of the transected tissue on both left and right sides of the working end in combination with extension member  120 .  
         [0036]     In the exemplary embodiment of  FIG. 2A , the structural component of introducer portion  110  has a cylindrical cross-section and comprises a thin-wall tubular sleeve (with bore  126 ) that extends from the proximal handle, although any cross-section may be suitable. The diameter of introducer sleeve  110  may range from about 3 mm. to 6 mm., although larger diameter sleeves fall within the scope of the invention. The handle may be any type of pistol-grip or other type of handle known in the art that carries actuator levers or slides to translate the extension member  120  within bore  126  and over the guide tracks  105 A and  105 B.  
         [0037]     As can be seen in  FIG. 2A , one embodiment of the working end  100  has very elongate guide members  105 A and  105 B of a flexible round wire or rod element, for example, having a diameter ranging from about 0.03″ to 0.10″. The cross-section of guide members  105 A and  105 B can provide engagement surfaces  127  (collectively) that are flat as shown in  FIGS. 2A &amp; 3 . Additionally, the surface  127  can carry and type of serrations, sharp projecting elements or any suitable gripping surface better engage tissue as the extension member  120  is advanced over the guides.  105 A and  105 B.  FIG. 3  shows exemplary projecting elements  128  (i.e., spikes) that can be provided in the engagement surfaces  127 .  
         [0038]     The guide members  105 A and  105 B in this embodiment define medial outward bowed portions or curve portions indicated at  128 A and optional distal angled portions  128 B that are adapted to allow guide members  105 A and  105 B to be pushed over a path p in tissue (see  FIG. 4B ). It should be appreciated that the shape of the guide members  105 A and  105 B may be any suitable linear or curved shape to allow ease of placement over a tissue volume targeted for transection.  FIGS. 4A-4C  illustrate the initial steps of the method of advancing the elongate guide members  105 A and  105 B over a targeted path in an anatomic structure.  FIG. 4A  indicates that successive transections along paths p 1  and p 2  can thus accomplish a wedge resection of a targeted tissue volume while at the same time selectively sealing one or both of the transection margins on either side of each path p.  
         [0039]      FIGS. 2A and 2C  illustrate that guide members  105 A and  105 B preferably are fabricated of a spring-type metal rod formed with suitable curves  128 A and  128 B. The guide members  105 A and  105 B do not comprise jaws in the conventional sense since they are substantially flexible and hence lack jaw-type functionality. That is, the guide members  105 A and  105 B cannot be moved to a closed position to capture tissue as they provide no inherent strength to be moved between such open and closed positions. Rather, the rod-type elements that make up guide members  105 A and  1058  are adapted only to guide extension member  120  and to serve as a ramp over the tissue to allow the advancement of extension member  120  over the tissue that otherwise would not be possible.  
         [0040]     Referring to  FIG. 28 , the extension member  120  slides over the rod-type guide elements with its terminal cutting element  122  transecting the tissue, in which process the extension member  120  captures the combination of the transected tissue margins and the guide members  105 A and  105 B in a high compression sandwich-like arrangement. It has been found that this means of engaging tissue margins is ideally suited for tissue welding with Rf current. In the exemplary embodiment, the rod-like elements of guide members  105 A and  105 B comprise paired wire elements, for example, indicated as elements or rods  132   a  and  132   a ′ in guide member  105 A and rods  132   b  and  132   b ′ in guide member  105 B (see  FIG. 2A ). While a metal is a preferred material for guide members  105 A and  105 B, plastic or composite materials also can be used.  
         [0041]     All of the electrosurgical cutting and sealing functionality of the invention is provided in extension member  120  and is described next. As can be seen in FIGS.  2 B,  4 B- 4 C and  FIG. 5 , the extension member  120  has a round exterior cross-section and has a first retracted position within the introducer sleeve  110  (see  FIG. 2A ).  FIGS. 2B &amp; 4C  show views of the extension member  120  being advanced toward a second extended position over the guide members  105 A and  105 B as its distal cutting element  122  in terminal portion  118  transects the captured tissue t.  
         [0042]     Now turning to  FIGS. 2B, 2C  and  FIG. 5 , the sectional views of extension member  120  show how the various functional components cooperate. In the embodiment depicted in  FIGS. 2B and 5 , it can be seen that the extension member  120  has left and right channel portions indicated at  140  (collectively) that are shaped to closely fit around the round rod-type elements of guide members  105 A and  105 B as the member  120  is slidably moved from its first retracted position toward its second extended position.  
         [0043]     For example,  FIG. 5  shows channel  140  at the right side of the instrument (left in view) that has upper surface portions  142   a  about its top and side that slidably engage one element ( 132   a ) of guide member  105 A about exterior surfaces of that round element. Likewise,  FIG. 5  shows a lower part of the channel  140  with surface portions  142   b  about the bottom and side of another element ( 132   b ) of the lower guide member  105 B that slidably engages an exterior of that element. It thus can be seen how the extension member slides over guide members  105 A and  105 B and flexes the guide members toward one another to allow the entire assembly to compress very tightly about the opposing surfaces of the captured tissue t as the leading edge electrode  122  transects the tissue. The extension member  120  defines a longitudinal slot  144  that extends from each channel  140  to an exterior of the extension member that receives the tissue margin. The slot  144  of extension member  120  thus defines a predetermined gap dimension indicated at g that comprises a selected dimension to which the captured tissue will be compressed (see  FIGS. 4C and 5 ). The distal end of the gap g (see  FIG. 2B ) preferably tapers from a more open dimension to a tighter dimension to initially allow the extension member to slide over engaged tissue. The extension member  120  further defines laterally outward portions  145   a  and  145   b  above and below slot  144  that engage the tissue margin. It has been found that tissue should be compressed under high forces for effective Rf welding and the gap g can be substantially small for many tissues. It can be appreciated that the extension member in combination with guide members  105 A and  105 B can apply very high compressive forces over a long path in tissue for purposes of transection that would not possible with a conventional jaw-type instrument.  
         [0044]     The extension member  120  depicted in  FIG. 5  can be fabricated by in alternative materials (either plastic or metal) by extrusion processes known in the art, or it can be made by various casting methods if made in a conductive metal. One preferred embodiment as depicted in  FIG. 5  provides a body  148  of the extension member that is fabricated of any suitable conductive material such as a metal. The proximal end of the extension member  120  is coupled by an electrical lead (not shown) to an electrical source  150  and controller  155 . Thus, the extension member  120  carries electrical potential to serve as an electrode body. The body  148  of the extension member has cooperating electrode surface portions  160  and  165   a - 165   b  that are exposed to contact the captured tissue: (i) at the transected medial tissue that interfaces the exposed electrode surface indicated at  160 , and (ii) at opposed exterior surfaces of the captured tissue that interface the exposed electrode surfaces  165   a  and  165   b  at upper and lower portions ( 145   a  and  145   b ) of extension member  120  outboard (laterally outward) of channel  140 . For purposes of illustration, these exposed electrode surface portions  160  and  165   a - 165   b  are indicated in  FIG. 5  to have a positive polarity (+) to cooperate with negative polarity (−) electrodes described next. These opposing polarity electrodes are, of course, spaced apart from one another and coupled to the electrical source  150  that defines the positive and negative polarities during operation of the instrument. In  FIG. 5 , it should be appreciated that the left and right sides of the extension member are mirror images of one another with reference to their electrode arrangements. Thus, sealing a tissue margin on either side of the extension member is independent of the other-after the targeted tissue is transected and captured for such Rf welding or sealing as in  FIG. 4C . For simplicity, this disclosure describes in detail the electrosurgical methods of sealing a transected tissue margin on one side of the extension member, with the understanding that mirror image events also (optionally) occur on the other side of the assembly.  
         [0045]     Still referring to  FIG. 5 , thin insulator layers  168   a  and  168   b  of any suitable plastic or ceramic extend in a partial radius around upper and lower portions of channel  140 . Inward of the thin insulator layers  168  are opposing (−) polarity electrodes  170 A and  170 B that constitute radial sections of elongate hypotubes fitted in the channel and therefore comprise inner surface portions of the channel  140 . These longitudinal negative (−) polarity electrodes  170 A and  170 B, for example of stainless steel, provide the additional advantage of being durable for sliding over the rod elements  132   a  and  132   b  that make up portions of guides  105 A arid  105 B. It can be seen that all electrical connections are made to extension member  120  which carries the actual opposing polarity electrodes, thus simplifying fabrication and assembly of the component parts of the working end.  
         [0046]     As described above, the distal terminal portion  118  of extension member  120  carries an electrode cutting element indicated at  122  in  FIGS. 2B, 4B  and  4 C. In  FIG. 2B , it can be seen that electrode cutting element  122  moves with the longitudinal space  172  between the paired rod-type elements that comprise each guide member  105 A and  105 B.  FIG. 5  shows that grooves  174   a  and  174   b  are provided in the extension member  120  to carry electrical leads  175   a  and  175   b  to the cutting electrode  122 . These electrical leads  175   a  and  175   b  are insulated from the body  148  of extension member  120  by insulative coatings indicated at  176   a  and  176   b.    
         [0047]     Now turning to  FIGS. 4C and 6 , the operation and use of the working end  100  of  FIG. 2A  in performing a method of the invention can be briefly described as follows.  FIG. 4C  depicts the extension  120  being advanced from a proximal position toward an extended distal position as it ramps over the tissue by advancing over the guide-track members that compress the tissue just ahead of the advancing extension member. The laterally-outward portions  145   a  and  145   b  of the extension member thereby slide over and engage the just-transected tissue margins contemporaneous with the cutting element  122  transecting the tissue. By this means, the transected tissue margins are captured under high compression by working end components on either side of the margins.  FIG. 5  thus depicts the targeted tissue margins t captured between upper and lower portions of the extension member outward of channels  140 . The targeted tissue t may be any soft tissue or anatomic structure of a patient&#39;s body. The targeted tissue is shown with a surface or fascia layer indicated at f and medial tissue layers m. While  FIGS. 4B-4C  depict the tissue being transected by a high voltage Rf cutting element  122 , it should be appreciated that the cutting element also can be a blade member.  
         [0048]      FIG. 6  provides an illustration of one preferred manner of Rf current flow that causes a sealing or welding effect by the medial-to-surface bi-polar current flow (or vice versa) indicated by arrows A. It has been found that a substantially uniform weld can be created across the captured tissue margin by causing current flow from exposed electrode surfaces  165 A and  165 B to the electrodes  170 A and  170 B that further conducts current flow through conductive guide rod elements  132   a  and  132   b . In other words, the sectional illustration of  FIG. 6  shows that a weld can be created in the captured tissue margin where proteins (including collagen) are denatured, intermixed under high compressive forces, and fused upon cooling to seal or weld the transected tissue margin. Further, it is believed that the desired weld effects can be accomplished substantially without collateral thermal damage to adjacent tissues indicated at  182  in  FIG. 6 .  
         [0049]     Another embodiment of the invention (not shown) includes a sensor array of individual sensors (or a single sensor) carried in any part of the extension member  120  or guide member  105 A- 105 B that contacts engaged tissue. Such sensors preferably are located either under an electrode  170 A- 170 B or adjacent to an electrode for the purpose of measuring temperatures of the electrode or tissue adjacent to an electrode during a welding procedure. The sensor array typically will consist of thermocouples or thermistors (temperature sensors that have resistances that vary with the temperature level). Thermocouples typically consist of paired dissimilar metals such as copper and constantan which form a T-type thermocouple as is known in the art. Such a sensor system can be linked to feedback circuitry that together with a power controller can control Rf energy delivery during a tissue welding procedure. The feedback circuitry can measure temperatures at one or more sensor locations, or sensors can measure the impedance of tissue, or voltage across the tissue, that is engaged between the electrodes carried by the working end. The power controller then can modulate Rf delivery in order to achieve (or maintain) a particular parameter such as a particular temperature in tissue, an average of temperatures measured among multiple sensors, a temperature profile (change in energy delivery over time), a particular impedance level or range, or a voltage level as is known in the art.  
         [0050]     2. Type “B” Working End for Welding Tissue.  FIG. 7  depicts another embodiment of working end  200  in which the guide members or jaws  205 A and  205 B comprise electrodes of common polarity that cooperate with the opposing polarity central electrode  215  to deliver a bi-polar type of Rf current flow to engaged tissue. In this embodiment, the body of extension member  220  can be of a non-conductive plastic or any metal of composite with an insulative coating.  FIG. 7  shows an exemplary embodiment in which extension member  220  does not carry electrical potential to serve as an electrode body, in contrast to the Type “A” embodiment. Still, the extension member  220  carries a central electrode  215  having an exposed surface in each channel  240  that contacts the transected edge the medial tissue layers of the transected tissue that interfaces these electrode surfaces. In use, the Rf current thus will flow between the common-polarity electrode engagement surfaces  245 A and  245 B of jaws  205 A and  205 B, respectively, and the opposing polarity central electrode  215 .  
         [0051]     As described in the Type “A” embodiment, the system again uses extension member  220  that cooperates with guide members  205 A and  205 B and is thus capable of applying very high compressive forces to tissue t engaged between the engagement surfaces  245 A and  245 B of the guide members or jaws. The compression forces applied to tissue can be strong enough to greatly reduce the engaged tissue&#39;s cross-section. For example, the tissue can be reduced to a selected dimension ranging down to a few thousandths of an inch. It has been found that such high compression is conducive to welding tissue when combined with the manner of Rf current flow through the tissue as previously described.  
         [0052]     Of particular interest, the present invention provides further means for allowing precise control of the Rf current paths in the engaged tissue to create more controlled thermal effects—thereby allowing for the creation of a more controlled weld. One means for accomplishing such control includes the use of tissue engaging surface or members that have non-uniform resistances in at least a portion thereof. One embodiment of a tissue engaging surface/member having non uniform resistance is shown in  FIG. 7 . The figure shows that the electrode engagement surfaces  245 A and  245 B (on at least one side of working end  200 ) define a resistive gradient comprising varied thicknesses of a thin resistive material  250  in adjacent axial-extending portions  255   a - 255   d  of the electrode surfaces. It should be appreciated that the jaw surfaces can be serrated for gripping tissue, but for clarity of explanation are shown as smooth in the Figures. More in particular,  FIG. 7  shows that 5 differential resistances are provided in the electrode surfaces.  FIG. 7  depicts elongate electrode portion  250   a  in the outer region of each jaw member that is farthest from the opposing polarity central electrode  215 . This electrode portion  250   a  is without a resistive layer or coating.  FIG. 7  further shows electrode portion  255   b  in each jaw member carries a resistive coating having thickness and resistance indicated at R 1  wherein the thickness is directly proportional to the level of electrical resistance. In the embodiment of  FIG. 7 , the next adjacent electrode portion  255   c  in each jaw has a double-thickness resistive coating having a total thickness (and total resistance) indicated at R 2 . Similarly, elongate electrode portion  255   d  in each jaw has a triple-thickness resistive coating having a total thickness and resistance indicated at R 3 . The resistive coating can be any suitable thin film material (e.g., a resistive metal, ceramic or composite) that is applied in layers by masks of other similar manners known in the art. One manner of creating the gradient electrode surface is to use an electroplating process, combined with masks or the selected removal of layer portions, that provides for deposition of black chrome on the jaw surfaces—a process that has been developed by Seaboard Metal Finishing Co., Inc., 50 Fresh Meadow Rd., West Haven, Conn. 06518. Another suitable manner of creating the resistive gradient electrode surfaces is to use varied thickness layers of a TCX™ coating developed by ThermoCeramix, LLC, 17 Leominster Rd., Shirley, Massachusetts 01464. Turning now to  FIGS. 8A-8D , the method of the invention in directing Rf current to flow in selected paths of the engaged tissue is shown schematically, following transection of the tissue by the cutting electrode  122  (see  FIGS. 2B and 4C ).  FIG. 8A  depicts the initial actuation of controller  155  and electrical source  150  that are coupled to the bi-polar electrode arrangement of the working end  200 . In other words, Rf current flow is created between the central electrode  215  (for convenience indicated with (+) polarity) and the common polarity electrode engagement surfaces  245 A and  245 B (indicated with (−) polarity) of the jaws. In  FIG. 8A , it can be understood that the engaged and compressed tissue t has a substantially uniform resistance (indicated at a particular resistance level Ω) to electrical current flow, which resistance Ω increases substantially as tissue hydration is reduced and the engaged tissue is welded. During the initial activation of energy delivery as depicted in  FIG. 8A , Rf current will naturally flow along the lines of least resistance between the bi-polar electrode arrangement. Since, the more inward surface portions ( 255   b - 255   d ) of the electrode engagement surfaces have higher resistivities and thickness (R 1  to R 3 ), the resistive gradient electrodes will induce or direct the Rf current to flow generally between central electrode  215  and the outermost electrode portions  255   a  of each jaw as indicated by arrows A in  FIG. 8A . The Rf current will flow in this selected manner until the impedance of the tissue volume compressed between electrode portions  255   a  of each jaw  205 A and  205 B increases to match or exceed the resistivity R 1  of the electrode coating in surface portion  255   b .  FIG. 8B  next illustrates the region of increase tissue resistivity at Ω′ between electrode portions  255   a , which then induces or directs Rf flow between the adjacent tissue volume engaged between electrode portions  255   b  of the opposing jaws as indicated by arrows A′ ( FIG. 8B ).  FIG. 8C  then illustrates that more outward tissue has its resistance increased, for example to Q″, with Rf current then induced to flow along a line of lesser resistance through tissue engaged between electrode portions  255   c  (having resistivity R1) and indicated by arrows A″. Finally,  FIG. 8D  depicts outward tissue with an arbitrary increased resistance Ω′″, with Rf current induced to the tissue engaged between electrode portions  255   d  (indicated by arrows Am) that is closest to the central electrode  215 .  
         [0053]     It has been found that the above-described manner of selectively delivering Rf current to tissue can create a uniform thermal effect and biological weld in captured tissue, particularly when the engaged tissue is substantially thin and under high compression. The method of the invention can create a thermally-induced biological weld with little collateral thermal damage in the collateral tissue region indicated at ct.  
         [0054]      FIG. 9  shows another embodiment of an electrosurgical working end  260  with gradient electrode surfaces  245 A and  245 B that are adapted for creating a selected dimension coagulation zone or transition zone tz in the engaged tissue between the welded tissue and the more laterally outward tissue that is not elevated in temperature. The previously described embodiment of  FIG. 7  is well suited for welding blood vessels and many other tissues wherein collateral thermal damage is undesirable. However, it has been found that certain thin friable tissues, when welded under high compression as described above, can be susceptible to tearing or perforation along the line between the welded tissue and the non-welded tissue. For example, lung tissue can comprise the type of tissue that can be difficult to seal along a transected margin and where any leakage around the seal in is highly undesirable. In such cases, referring to  FIG. 9 , it can be desirable to selectively deliver Rf energy to the tissue to create a transition zone tz in which tissue is coagulated, but not necessarily welded, to add strength to the tissue across the tissue margin.  
         [0055]     The working end  260  of  FIG. 9  depicts guide members or jaws  205 A and  205 B that carry gradient electrode engagement surfaces  245 A and  245 B that cooperate with central electrode  215  to deliver bi-polar Rf current flow as described above. In this embodiment, the extension member  220  again is a non-conductive member that is used to create continuous high compression over the length of guide members  205 A and  205 B. The working end provides two features that are adapted to deliver Rf energy to collateral tissues ct that can create a thermal transition zone tz of a selected dimension. First, the working end  260  provides electrode engagement surfaces  245 A and  245 B in the paired guide members that are non-parallel transverse to axis  265  of the openable-closable guide members  205 A and  205 B. Second, the working end provides gradient-type electrodes to induce current to flow progressively through selected adjacent portions of the engaged tissue. More in particular, still referring to  FIG. 9 , the electrode engagement surfaces  245 A and  245 B of the elongate guide members define first interior portions  266   a - 266   b  that are parallel (in transverse direction to axis  265 ) and are thus adapted for creating very high compressive forces on the captured tissue. The engagement surfaces  245 A and  245 B define second laterally-outward portions  270   a - 270  that are not parallel (transverse to axis  265 ) but provide an increasing dimension of gap g between the tissue engaging surfaces. The laterally increasing gap g between the electrode surfaces provides for Rf current flow that progressively creates a more effective weld in the direction of the center of the jaw structure. Further, the working end  260  and electrode engagement surfaces  245 A and  245 B provide the resistive gradients of resistant material  250  in adjacent portions  255   a - 255   d  of engagement surfaces as described in detail above. As depicted in  FIG. 9 , this combination of components is capable of first delivering Rf energy to the less compressed tissue volume in the transition zone tz, and then progressively inducing Rf current to flow between the bi-polar electrode arrangement by means of the resistive electrode portions  255   a - 255   d  similar to the manner shown in  FIGS. 8A-8D .  
         [0056]      FIG. 10  depicts the guide members or jaws  205 A and  2058  of another embodiment of working end  280  that carry gradient electrode engagement surfaces  245 A and  2458 . In this embodiment, the electrode surfaces have a tapered layer of resistive material  250  that provides a continuous and progressive resistive gradient across the engagement surfaces from thin portion  282   a  to thick portion  282   b . One manner of making such an electrode engagement surface comprises the deposition of multiple thin layers  283  of resistive material on the surface of a member. Following such a build up of resistive material, a precision grinding process (along line  285 ) can be used to material at an angle to the build up to create the engagement surface as indicated in  FIG. 10 .  
         [0057]      FIG. 11  depicts another embodiment of an electrosurgical working end  290  wherein the guide members or jaws  205 A and  205 B again carry gradient electrode surfaces  245 A and  245 B. In this embodiment, the gradient electrode engagement surfaces  245 A and  245 B themselves cooperate in a bi-polar electrode arrangement with surface  245 A indicated with negative (−) polarity and surface  245 B indicated with positive (+) polarity. Such opposing jaw surfaces can advantageously use gradient electrodes to progressively deliver Rf energy across the engagement surfaces, similar to the manner illustrated in  FIG. 8A-8D , but without the cooperation of a central electrode in contact with transected medial tissues. Such gradient electrodes in opposing jaw members also can be multiplexed in cooperation with a central electrode as described in U.S. Patent Applications listed above in the Section titled Cross-References to Related Applications, all of which are incorporated herein by reference.  
         [0058]     Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration. Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention. Further variations will be apparent to one skilled in the art in light of this disclosure and are intended to fall within the scope of the appended claims.