Patent Publication Number: US-2019175254-A1

Title: Electrosurgically removing tissue with localized return

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation application of U.S. patent application Ser. No. 14/798,104, filed on Jul. 13, 2015, which claims the benefit of and priority to U.S. Provisional Patent Application No. 62/042,523, filed on Aug. 27, 2014, the entire contents of each of which are hereby incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to surgical devices, systems, and methods for performing tonsillectomies present disclosure relates to surgical devices, systems, and methods for performing tonsillectomies and adenoidectomies, and, more particularly, to surgical devices systems, and methods with localized return features utilized for tonsillectomies and adenoidectomies. 
     BACKGROUND 
     The tonsils and adenoids are part of the lymphatic system and are generally located in the back of the throat. These parts of the lymphatic system are generally used for sampling bacteria and viruses entering the body and activating the immune system when warranted to produce antibodies to fight oncoming infections. More particularly, the tonsils and adenoids break down the bacteria or virus and send pieces of the bacteria or virus to the immune system to produce antibodies for fighting off infections. 
     Inflammation of the tonsils and adenoids (e.g., tonsillitis) impedes the ability of the tonsils and adenoids to destroy the bacteria resulting in a bacterial infection. In many instances, the bacteria remain even after treatment and serve as a reservoir for repeated infections (e.g., tonsillitis or ear infections). 
     A tonsillectomy and/or adenoidectomy may be indicated when infections persist and antibiotic treatments fail. Persistent infection typically leads to enlarged tonsil tissue which may need to be removed since in many cases the enlarged tissue causes airway obstruction leading to various sleep disorders such as snoring or, in some cases, sleep apnea. Some individuals are also born with larger tonsils that are more prone to cause obstruction. An adenoidectomy may also be required to remove adenoid tissue when ear pain persists, or when nose breathing or function of the eustachian tube (a.k.a. auditory or pharyngotympanic tube) is impaired. Many surgeons prefer to perform these two procedures at the same time. 
     The type of surgical device and/or method used for tonsillectomies and adenoidectomies usually depends on the type and amount of tissue to be removed and/or a surgeon&#39;s preference. Various methods for performing a tonsillectomy and/or adenoidectomy employ an array of surgical instrumentation and, in most cases, a variety of energy modalities to accomplish the underlying purpose of removing the infected tissue. Technologies include, cold dissection, monopolar and bipolar diathermy dissection, dissection using bipolar scissors, laser tonsillectomy, cryosurgery, ultrasonic removal, microdebrider, Coblation® and so-called thermal welding. A scalpel or other sharp instrument such as a curette or punch device may also be used to remove tissue but using these types of instruments typically results in heavy bleeding which needs to be stemmed with electrocautery. 
     Other electrosurgical devices may also be employed such as suction-tipped devices, blades, or needle tip devices, e.g., various Bovie devices. A Bovie device typically has a hollow center to suction blood, secretions, and smoke from the surgical field, and a rim of metal for cutting and coagulation. A separate aspirator is used when blade and needle tip Bovies are used. Although the use of Bovies reduces blood loss intraoperatively in comparison to various known cold techniques, its use may be associated with an increase in postoperative pain due to thermal spread from the heat created during use (e.g., above 3000° C.). Despite a large thermal injury profile, use of the Bovie surgical instrument remains very popular for tonsil removal. 
     Some commercial attempts have been made to limit or minimize thermal injury. These include: the HARMONIC SYNERGY® Blades (Ethicon Endo-Surgery, Cincinnati, Ohio) (ultrasonic energy), lasers (e.g., KTP, Nd: YAG, or CO2 lasers), and Coblation® devices (Arthrocare, Austin, Tex.) (bipolar radiofrequency ablation). However, the decrease in thermal injury provided by these devices remains questionable and is offset by a reduced control of bleeding and surrounding tissue trauma, longer operative times, introduction of fluids (e.g., saline) and/or less precise cutting. Some of the instruments also obscure the surgical field and are difficult to maneuver due to their large size. 
     SUMMARY 
     Accordingly, new devices for resecting tonsil and adenoid tissue would be useful. In particular, devices that precisely cut tonsil and adenoid tissue while effectively controlling bleeding and surrounding tissue trauma would be desirable. Devices that provide easier access to the tonsils and adenoids and manipulation of those tissues would also be desirable. Moreover, it would also be useful to have devices particularly suited for treating and/or removing the underlying tissue or tissue within the tonsil bed which, in many instances, can lead to serious concerns. As mentioned above, the tonsil bed, if not properly treated or removed, acts as a reservoir for bacteria leading to repeated infections. 
     In one aspect, the present disclosure relates to an electrosurgical system for treating and/or removing tissue. The electrosurgical system includes an electrosurgical device for treating tissue and a grasping device configured to grasp tissue. 
     The electrosurgical device has one or more electrically conductive surfaces adapted to electrically couple to a first electrical potential of an electrosurgical energy source. The electrosurgical energy source may be powered by a battery. The electrosurgical device may be a monopolar pencil. 
     The grasping device includes one or more electrically conductive surfaces adapted to electrically couple to a second electrical potential of the electrosurgical energy source wherein, upon activation of the electrosurgical energy source, electrosurgical energy is transmitted between electrical potentials and through tissue disposed therebetween. In embodiments, the grasping device is adapted to couple to a suction source and a distal end of the grasping device includes the one or more electrically conductive surfaces that engage tissue under suction. In some embodiments, the grasping device includes a pair of jaw members selectively movable between an open condition and a closed condition for grasping tissue therebetween. One or both of the pair of jaw members can include the one or more electrically conductive surfaces. In embodiments, the grasping device is a clamp. In some embodiments, the grasping device has an Allis clamp configuration. 
     According to another aspect, an electrosurgical system for removing tissue includes an electrosurgical energy source, an electrosurgical device, and a grasping device. 
     The electrosurgical device has one or more electrically conductive surfaces electrically coupled to a first potential of the electrosurgical energy source. The one or more electrically conductive surfaces of the electrosurgical device is configured to transmit electrosurgical energy of a first potential therefrom. 
     The grasping device includes first and second opposing jaw members configured to grasp tissue therebetween. The grasping device includes one or more electrically conductive surfaces disposed on one or both of the jaw members. The grasping device is configured to connect to a second potential of the electrosurgical energy source wherein, upon activation of the electrosurgical energy source, electrosurgical energy travels from the one or more electrically conductive surfaces of the electrosurgical device, through tissue grasped by the grasping device, and to the one or more electrically conductive surfaces of the grasping device to complete a circuit. 
     In some embodiments, the electrosurgical energy source is a generator. The generator may be powered by a battery. In certain embodiments, the generator is powered by alternating current. 
     According to yet another aspect, the present disclosure relates to a method for removing tissue. The method involves grasping tissue with a grasping device; conducting electrosurgical energy through the tissue between an electrosurgical device electrically coupled to a first potential of an electrosurgical energy source, and the grasping device electrically coupled to a second potential of the electrosurgical energy source; and manipulating the electrosurgical device to cut the grasped tissue from remaining tissue and removing grasped tissue. The method may involve conducting energy through a return electrode coupled to a patient. The method may include limiting electrical conductance through the return electrode with load resistance coupled to the return electrode. 
     In some embodiments, the electrosurgical device can include an electrosurgical pencil having a first electrically conductive surface and the grasping device can includes a clamp having a second electrically conductive surface, wherein conducting electrosurgical energy can include conducting the electrosurgical energy between the first and second electrically conductive surfaces. 
     In certain embodiments, the electrosurgical device includes a pair of jaw members having a first electrically conductive surface and the grasping device includes a clamp having a second electrically conductive surface, wherein conducting electrosurgical energy can include conducting the electrosurgical energy between the first and second electrically conductive surfaces. 
     Other aspects, features, and advantages will be apparent from the description, the drawings, and the claims that follow. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein: 
         FIG. 1  is a perspective view of an electrosurgical system according to the principles of the present disclosure; 
         FIGS. 2A-2C  are progressive schematic views illustrating removal of tissue with the electrosurgical system of  FIG. 1 ; and 
         FIGS. 3A-3C  are progressive schematic views illustrating removal of tissue with another embodiment of an electrosurgical system. 
     
    
    
     DETAILED DESCRIPTION 
     Particular embodiments of the present disclosure are described hereinbelow with reference to the accompanying drawings in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein the term “distal” refers to that portion of the system, apparatus and/or device, or component thereof, that are farther from the user, while the term “proximal” refers to that portion of the system, apparatus and/or device, or component thereof, that are closer to the user. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail. 
     Turning now to  FIG. 1 , an electrosurgical system, in accordance with the present disclosure, generally referred to as  10 , includes an electrosurgical device such as an electrosurgical pencil  100  and/or an electrosurgical forceps  200  that electrically couple to an electrosurgical energy source  300  (e.g., a generator), and a grasping device  400  that also electrically couples to electrosurgical energy source  300 . 
     Electrosurgical devices such as electrosurgical pencil  100  generally include a body  110  having a supply line  112  extending from a proximal end thereof and one or more active electrodes and/or electrically conductive surface(s)  114  (e.g., electrosurgical cutting probe, ablation electrode(s), etc.) extending from a distal end thereof that are configured to electrical communicate with supply line  112 . The supply line  112  connects to an active terminal of electrosurgical energy source  300  at a proximal end of the supply line  112 . One or more actuators  116  (e.g., buttons, switches, knobs, slides, etc.) are coupled to body  110  to control electrical communication between supply line  112  and electrically conductive surface(s)  114  for selectively activating electrically conductive surface(s)  114  to treat tissue (e.g., cut, coagulate, ablate, etc.) 
     Electrosurgical devices such as electrosurgical forceps  200  generally include a handle  210  having a distally extending shaft  220  that supports an end effector  230  on a distal end of shaft  220 . End effector  230  includes a pair of jaw members having an upper jaw member  232  and a lower jaw member  234  that are movable/pivotable between open and closed conditions upon an actuation of a jaw trigger  210   a  for grasping tissue therebetween. One or both of the pair of jaw members  232 ,  234  include a sealing surface  236  that electrically communicates with a supply line  240  extending proximally from a proximal end of handle  210 . An activation trigger  210   b  is actuatable to provide electrical communication between sealing surface  236  and supply line  240  for selectively activating electrically conductive surface  236  to treat tissue (e.g., cut, coagulate, ablate, etc.). 
     As can be appreciated, any of these electrosurgical devices can be monopolar and/or bipolar. 
     Electrosurgical energy sources such as electrosurgical energy source  300  can perform monopolar and/or bipolar electrosurgical procedures, including, for example, cutting, coagulation, ablation, and vessel sealing procedures. The electrosurgical energy source  300  may include a plurality of outputs for interfacing with various electrosurgical instruments such as electrosurgical pencil  100 , electrosurgical forceps  200 , grasping device  400  and/or any other suitable energy modality. Electrosurgical energy source  300  may be configured to interface with any suitable electrosurgical instrument (e.g., a monopolar instrument, return electrode, bipolar electrosurgical forceps, footswitch, etc.). Further, the electrosurgical energy source  300  can include any suitable electronic circuitry. For example, electrosurgical energy source  300  can include electronic circuitry configured to generate radio frequency energy specifically suited for various electrosurgical modes (e.g., cut, blend, coagulate, division with hemostasis, fulgurate, spray, etc.) and procedures (e.g., monopolar, bipolar, vessel sealing). In embodiments, electrosurgical energy source  300  may be embedded, integrated or otherwise coupled to the electrosurgical and/or grasping devices providing for an all-in-one electrosurgical apparatus/system. In embodiments, electrosurgical energy source  300  may be powered by a battery or powered by alternating current. Electrosurgical energy source  300  may include one or more converting devices for converting from DC to AC or vice a versa. 
     Grasping device  400  includes a body  410  including a first arm  410   a  and a second arm  410   b  that are pivotally coupled together to form a handle portion  412  at a proximal end thereof and a pair of jaw members  414   a,    414   b  at a distal end thereof. Handle portion  412  is operable to selectively move/pivot the pair of jaw members  414   a,    414   b  between open and closed conditions for grasping tissue, such as throat tissue, therebetween. At least a portion of body  410  can include electrically conductive material (e.g., metallic material or the like) which can be an electrically conductive surface. In some embodiments, only portions of body  410  include electrically conductive materials and/or surfaces, such as, for example, one or both of the pair of jaw members  414   a,    414   b.  In certain embodiments, the entire body  410  is electrically conductive. Body  410 , or portions thereof, can include insulative material which may be provided as a layer or coating. For example, handle portion  412  can include a dielectric cover  412   a  positioned on electrically conductive surfaces of handle portion  412 . 
     A return line  416  extends proximally from body  410  and is disposed in electrical communication with the electrically conductive material/surface(s) of body  410 . Return line  416  is configured to couple the electrically conductive material/surfaces of body  410  to electrosurgical energy source  300  (e.g., via a return terminal of electrosurgical energy source  300 ) for electrically communicating with electrosurgical energy source  300 . In this manner, grasping device  400  can function as an electrical return for electrosurgical energy (e.g., electric current) conducted through/transmitted from one or more of the electrosurgical devices  100 ,  200  of the present disclosure as will be described in greater detail below. Embodiments of grasping device  400  can include configurations of Allis clamps, Babcock clamps, hemostats, tweezers, forceps, and other suitable graspers. 
     Electrosurgical devices  100 ,  200  can be configured to conduct/transmit any suitable electric current (e.g., AC and/or DC) at any suitable frequency. In embodiments, one or more of the presently described devices  100 ,  200  can be configured to provide radio frequency (RF) energy. For a detailed discussion of the construction and operation of example electrosurgical devices, electrosurgical energy sources, and/or grasping devices, reference may be made to U.S. Patent Application Publication No. 2013/0267947, U.S. Patent Application Publication No. 2013/0255063, U.S. Pat. No. 7,156,844, U.S. Pat. No. 5,766,167, and/or U.S. Pat. No. 5,026,370, each of which is incorporated herein by reference. 
     In operation, as seen in  FIGS. 2A-2C , grasping device  400  is operable to grasp tissue “T” disposed on a wall “W” so that electrosurgical energy “E” (e.g., current) can be conducted through tissue “T” while electrosurgical device (e.g., electrosurgical pencil  100 ) is disposed adjacent to the tissue “T.” In the illustrated embodiment, tissue “T” is throat tissue such as tonsil or adenoid tissue; however, the presently described devices, systems, and methods can be applied to any suitable tissue. 
     To remove the tissue “T” from the wall “W,” activation of electrosurgical pencil  100  draws the electrosurgical energy “E” from electrosurgical energy source  300  through supply line  112  and directs the electrosurgical energy “E” into the tissue “T.” Grasping device  400  functions as a return electrode for the electrosurgical energy “E,” returning the electrosurgical energy “E” to electrosurgical energy source  300  through return line  416 . In this regard, the electrosurgical energy “E” applied via electrosurgical pencil  100  across the tissue “T” severs the tissue “T” from the wall “W.” Thus, with severed tissue “ST” grasped by the grasping device  400 , the severed tissue “ST” can be removed and the process can be repeated as necessary to remove any undesirable tissue “T” using, for example, intracapsular (e.g., subtotal tonsillectomy) and/or extracapsular (e.g., total tonsillectomy) techniques. 
     After tissue “T” is removed, a clinician may need to coagulate and/or cauterize uncontrolled bleeding (“bleeders”). As such, a separate return electrode (e.g., a return pad, not shown) may be positioned on the patient to act as a return pathway for electrosurgical energy. The return electrode may include a load resistor, e.g., 50 ohm load resistor (not shown), that prevents the return electrode from serving as the return pathway until after tissue “T” is removed. In this regard, thermal damage to underlying tissue is minimized while enabling a clinician to coagulate and/or cauterize bleeders after removal of tissue “T.” 
     Turning now to  FIGS. 3A-3C , one embodiment of a grasping device, generally referred to as  500 , includes a grasping member  502  in fluid communication with a vacuum/suction source  502  and electrically coupled to a return line  506  in electrical communication with electrosurgical energy source  300 . Suction source  502  is configured to apply suction “S” through a lumen  508  defined by inner surfaces  502   a  of grasping member  502 . Grasping member  502  can be wholly, or partially, formed of electrically conductive material. 
     In operation, grasping device  500  is operable to grasp tissue “T” (e.g., via suction “S” from suction source  504 ) disposed on a wall “W” so that electrosurgical energy “E” can be conducted through tissue “T” while electrosurgical device (e.g., electrosurgical pencil  100 ) is disposed adjacent to the tissue “T” similar to that described above. In particular, to remove the tissue “T” from the wall “W,” activation of electrosurgical pencil  100  draws the electrosurgical energy “E” from electrosurgical energy source  300  through supply line  112  and directs the electrosurgical energy “E” into the tissue “T.” Grasping device  500  functions as a return electrode for the electrosurgical energy “E,” returning the electrosurgical energy “E” to electrosurgical energy source  300  through return line  506 . In this regard, the electrosurgical energy “E” applied via electrosurgical pencil  100  across the tissue “T” severs the tissue “T” from the wall “W” so that suction “S” draws severed tissue “ST” through lumen  508  of grasping member  502  for removal. This process can be repeated as necessary to remove any undesirable tissue “T” using, for example, intracapsular and/or extracapsular techniques. 
     The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery”. Such systems employ various robotic elements to assist the surgeon in the operating theatre and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include, remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc. 
     The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients. 
     The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s). 
     The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon&#39;s ability to mimic actual operating conditions. 
     Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, the elements and features shown or described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the present disclosure, and that such modifications and variations are also included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not limited by what has been particularly shown and described.