Patent Publication Number: US-2023149064-A1

Title: Surgical instruments, systems, and methods incorporating ultrasonic, electrosurgical, and fluid delivery functionality

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a 371 National Stage Application of International Application No. PCT/US2022/014466, filed Jan. 30, 2022, which claims the benefit of U.S. Provisional Pat. Application No. 63/154,183, filed Feb. 26, 2021, the entire contents of each of which is incorporated by reference herein. 
    
    
     FIELD 
     The present disclosure relates to energy-based surgical instruments and, more particularly, to surgical instruments, systems, and methods incorporating ultrasonic, electrosurgical, and fluid delivery functionality to facilitate energy-based tissue treatment. 
     BACKGROUND 
     Ultrasonic surgical instruments and systems utilize ultrasonic energy, i.e., ultrasonic vibrations, to treat tissue. More specifically, ultrasonic surgical instruments and systems utilize mechanical vibration energy transmitted at ultrasonic frequencies to treat tissue. An ultrasonic surgical device may include, for example, an ultrasonic blade and a clamp mechanism to enable clamping of tissue against the blade. Ultrasonic energy transmitted to the blade causes the blade to vibrate at very high frequencies, which allows for heating tissue to treat tissue clamped against or otherwise in contact with the blade. 
     Electrosurgical instruments and systems conduct Radio Frequency (RF) energy through tissue to treat tissue. An electrosurgical instrument or system may be configured to conduct bipolar RF energy between oppositely charged electrodes and through tissue, e.g., tissue clamped between the electrodes or otherwise in contact therewith, to treat tissue. Alternatively or additionally, an electrosurgical instrument or system may be configured to deliver monopolar RF energy from an active electrode to tissue in contact with the electrode, with the energy returning via a remote return electrode device to complete the circuit. 
     A fluid, e.g., a conductive fluid such as saline, may be utilized with some electrosurgical instruments and systems, e.g., to couple the RF energy to tissue. The use of fluid may facilitate RF energy-based tissue treatment by controlling temperature, inhibiting sticking, inhibiting smoke production, and/or inhibiting char formation. 
     SUMMARY 
     As used herein, the term “distal” refers to the portion that is described which is further from an operator (whether a human surgeon or a surgical robot), while the term “proximal” refers to the portion that is being described which is closer to the operator. Terms including “generally,” “about,” “substantially,” and the like, as utilized herein, are meant to encompass variations, e.g., manufacturing tolerances, material tolerances, use and environmental tolerances, measurement variations, and/or other variations, up to and including plus or minus 10 percent. Further, any or all of the aspects described herein, to the extent consistent, may be used in conjunction with any or all of the other aspects described herein. 
     Provided in accordance with aspects of the present disclosure is a surgical system including an ultrasonic transducer, an ultrasonic waveguide coupled to and extending distally from the ultrasonic transducer, and an ultrasonic blade disposed at a distal end of the ultrasonic waveguide. The ultrasonic blade is configured to receive ultrasonic energy produced by the ultrasonic transducer and transmitted along the ultrasonic waveguide to vibrate the ultrasonic blade for treating tissue therewith. The ultrasonic blade is configured to connect to a source of electrosurgical energy for conducting electrosurgical energy to tissue to treat tissue. The ultrasonic blade defines a lumen extending at least partially therethrough to at least one opening. The lumen is configured for fluid communication with a fluid source to enable the delivery of fluid from the fluid source through the lumen and out at least one opening into a surgical site to facilitate electrosurgical tissue treatment. 
     In an aspect of the present disclosure, the system further includes a housing. Each of the ultrasonic transducer and the fluid source are disposed on or within the housing. 
     In another aspect of the present disclosure, the fluid is an electrically conductive fluid configured to electrically couple the ultrasonic blade with tissue when the ultrasonic blade is used for electrosurgical tissue treatment. 
     In another aspect of the present disclosure, vibrating the ultrasonic blade heats the ultrasonic blade, and the delivery of fluid from the fluid source through the lumen and out the at least one opening into a surgical site cools the ultrasonic blade. 
     In still another aspect of the present disclosure, the system further includes a jaw member movable relative to the ultrasonic blade from a spaced-apart position to an approximated position for clamping tissue therebetween. 
     In yet another aspect of the present disclosure, the jaw member includes a structural body and a jaw liner disposed within the structural body. The jaw liner defines a tissue contacting surface positioned to oppose the ultrasonic blade in the approximated position. 
     In still yet another aspect of the present disclosure, the structural body is configured to connect to the source of electrosurgical energy such that the structural body and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue. Alternatively, the structural body includes at least one electrically conductive surface disposed thereon that is configured to connect to the source of electrosurgical energy such that the at least one electrically conductive surface and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue. 
     In another aspect of the present disclosure, the ultrasonic blade is configured to conduct monopolar electrosurgical energy to tissue to treat tissue. 
     Another surgical system provided in accordance with aspects of the present disclosure includes an ultrasonic transducer, an ultrasonic waveguide coupled to and extending distally from the ultrasonic transducer, and an ultrasonic blade disposed at a distal end of the ultrasonic waveguide. The ultrasonic blade is configured to receive ultrasonic energy produced by the ultrasonic transducer and transmitted along the ultrasonic waveguide to vibrate the ultrasonic blade for treating tissue therewith. The ultrasonic blade is configured to connect to a source of electrosurgical energy for conducting electrosurgical energy to tissue to treat tissue. A jaw member is movable relative to the ultrasonic blade from a spaced-apart position to an approximated position for clamping tissue therebetween. The jaw member defines a lumen configured for fluid communication with a fluid source to enable the delivery of fluid from the fluid source, through the lumen, out at least one opening defined in the jaw member, and into a surgical site to facilitate electrosurgical tissue treatment. 
     In an aspect of the present disclosure, the system further includes a housing. Each of the ultrasonic transducer and the fluid source are disposed on or within the housing. 
     In another aspect of the present disclosure, the fluid is an electrically conductive fluid configured to electrically couple the ultrasonic blade with tissue when the ultrasonic blade is used for electrosurgical tissue treatment. 
     In another aspect of the present disclosure, vibrating the ultrasonic blade heats the ultrasonic blade, and the delivery of fluid from the fluid source through the lumen and out the at least one opening is directed towards the blade to cool the ultrasonic blade. 
     In yet another aspect of the present disclosure, the jaw member includes a structural body and a jaw liner disposed within the structural body. The jaw liner defines a tissue contacting surface positioned to oppose the ultrasonic blade in the approximated position. 
     In still another aspect of the present disclosure, the structural body is configured to connect to the source of electrosurgical energy such that the structural body and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue. Alternatively, the structural body includes at least one electrically conductive surface disposed thereon that is configured to connect to the source of electrosurgical energy such that the at least one electrically conductive surface and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue. 
     In still yet another aspect of the present disclosure, the ultrasonic blade is configured to conduct monopolar electrosurgical energy to tissue to treat tissue. 
     A method of surgery in accordance with the present disclosure includes transmitting ultrasonic energy to an ultrasonic blade to vibrate the ultrasonic blade for treating tissue therewith, conducting electrosurgical energy from the ultrasonic blade to tissue for treating tissue therewith, and supplying fluid from the ultrasonic blade to tissue. 
     In aspects, the transmitting is performed in conjunction with the supplying such that the supplying of the fluid facilitates electrosurgical tissue treatment. Additionally or alternatively, the supplying is performed after the transmitting such that the supplying of the fluid serves to cool the ultrasonic blade. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above and other aspects and features of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings wherein like reference numerals identify similar or identical elements. 
         FIG.  1    illustrates a surgical system provided in accordance with the present disclosure including a surgical instrument, a surgical generator and, in some aspects, a return electrode device; 
         FIG.  2    is a schematic illustration of a robotic surgical system provided in accordance with the present disclosure; 
         FIG.  3    is an enlarged, longitudinal, cross-sectional view of a distal portion of an end effector assembly configured for use with the surgical instrument of  FIG.  1   , the robotic surgical system of  FIG.  2   , or any other suitable surgical instrument or system; 
         FIG.  4    is an enlarged, longitudinal, cross-sectional view of a distal portion of another end effector assembly configured for use with the surgical instrument of  FIG.  1   , the robotic surgical system of  FIG.  2   , or any other suitable surgical instrument or system; 
         FIG.  5    is an enlarged, transverse, cross-sectional view of the distal portion of the end effector assembly of  FIG.  3   ; and 
         FIG.  6    is an enlarged, transverse, cross-sectional view of a distal portion of another end effector assembly configured for use with the surgical instrument of  FIG.  1   , the robotic surgical system of  FIG.  2   , or any other suitable surgical instrument or system. 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIG.  1   , a surgical system provided in accordance with aspects of the present disclosure is shown generally identified by reference numeral  10  including a surgical instrument  100 , a surgical generator  200 , and, in some aspects, a return electrode device  500 , e.g., including a return pad  510 . Surgical instrument  100  includes a handle assembly  110 , an elongated assembly  150  extending distally from handle assembly  110 , an end effector assembly  160  disposed at a distal end of elongated assembly  150 , and a cable assembly  190  operably coupled with handle assembly  110  and extending therefrom for connection to surgical generator  200 . As an alternative to handle assembly  110 , surgical instrument  100  may include a robotic attachment housing for releasable engagement with a robotic arm of a robotic surgical system such as, for example, robotic surgical system  1000  ( FIG.  2   ) detailed below. 
     Surgical generator  200  includes a display  210 , a plurality user interface features  220 , e.g., buttons, touch screens, switches, etc., an ultrasonic plug port  230 , a bipolar electrosurgical plug port  240 , and active and return monopolar electrosurgical plug ports  250 ,  260 , respectively. Surgical generator  200  is configured to produce ultrasonic drive signals for output through ultrasonic plug port  230  to surgical instrument  100  to activate surgical instrument  100  in an ultrasonic mode and to provide electrosurgical energy, e.g., RF bipolar energy, for output through bipolar electrosurgical plug port  240  and/or RF monopolar energy for output through active monopolar electrosurgical port  250  to surgical instrument  100  to activate surgical instrument  100  in one or more electrosurgical modes. It is also contemplated that one or more common ports (not shown) may be configured to act as any two or more of ports  230 - 260 . In monopolar configurations, plug  520  of return electrode device  500  is configured to connect to return monopolar electrosurgical plug port  260 . 
     Continuing with reference to  FIG.  1   , handle assembly  110  includes a housing  112  defining a body portion and a fixed handle portion. Handle assembly  110  further includes an activation button  120  and a clamp trigger  130 . The body portion of housing  112  is configured to support an ultrasonic transducer  140 . Ultrasonic transducer  140  may be permanently engaged with the body portion of housing  112  or removable therefrom. Ultrasonic transducer  140  includes a piezoelectric stack or other suitable ultrasonic transducer components electrically coupled to surgical generator  200 , e.g., via one or more of first electrical lead wires  197 , to enable communication of ultrasonic drive signals to ultrasonic transducer  140  to drive ultrasonic transducer  140  to produce ultrasonic vibration energy that is transmitted along a waveguide  154  of elongated assembly  150  to blade  162  of end effector assembly  160  of elongated assembly  150 , as detailed below. An activation button  120  is disposed on housing  112  and coupled to or between ultrasonic transducer  140  and/or surgical generator  200 , e.g., via one or more of first electrical lead wires  197 , to enable activation of ultrasonic transducer  140  in response to depression of activation button  120 . In some configurations, activation button  120  may include an ON/OFF switch. In other configurations, activation button  120  may include multiple actuation switches to enable activation from an OFF position to different actuated positions corresponding to different activation settings, e.g., a first actuated position corresponding to a first activation setting and a second actuated position corresponding to a second activation setting. In still other configurations, separate activation buttons may be provided, e.g., a first actuation button for activating a first activation setting and a second activation button for activating a second activation setting. 
     A fluid source  170  is disposed within housing  112  in fluid communication with a lumen  172  ( FIG.  3   ) extending through at least a portion of waveguide  154  and/or blade  162   (and/or a lumen  176  ( FIG.  4   ) extending through jaw member  164 ). The fluid source  170  may include a fluid reservoir and/or a pump and may be configured to store and/or pump any suitable fluid “F” ( FIG.  3   ) including conductive fluid, e.g., saline, through the lumen  172  ( FIG.  3   ) (and/or lumen  176  ( FIG.  4   )). In configurations, fluid source  170  is external to housing  112  (mounted thereon or separate therefrom and connected via suitable tubing). 
     Elongated assembly  150  of surgical instrument  100  includes an outer drive sleeve  152 , an inner support sleeve  153  ( FIG.  3   ) disposed within outer drive sleeve  152 , a waveguide  154  extending through inner support sleeve  153  ( FIG.  3   ), a drive assembly (not shown), a rotation knob  156 , and an end effector assembly  160  including a blade  162  and a jaw member  164 . Rotation knob  156  is rotatable in either direction to rotate elongated assembly  150  in either direction relative to handle assembly  110 . The drive assembly operably couples a proximal portion of outer drive sleeve  152  to clamp trigger  130  of handle assembly  110 . A distal portion of outer drive sleeve  152  is operably coupled to jaw member  164  and a distal end of inner support sleeve  153  ( FIG.  3   ) pivotably supports jaw member  164 . As such, clamp trigger  130  is selectively actuatable to thereby move outer drive sleeve  152  about inner support sleeve  153  ( FIG.  3   ) to pivot jaw member  164  relative to blade  162  of end effector assembly  160  from a spaced apart position to an approximated position for clamping tissue between jaw member  164  and blade  162 . The configuration of outer and inner sleeves  152 ,  153  ( FIG.  3   ) may be reversed, e.g., wherein outer sleeve  152  is the support sleeve and inner sleeve  153  ( FIG.  3   ) is the drive sleeve. Other suitable drive structures as opposed to a sleeve are also contemplated such as, for example, drive rods, drive cables, drive screws, etc. 
     Referring still to  FIG.  1   , the drive assembly may be tuned to provide a jaw clamping force, or jaw clamping force within a jaw clamping force range, to tissue clamped between jaw member  164  and blade  162  or may include a force limiting feature whereby the clamping force applied to tissue clamped between jaw member  164  and blade  162  is limited to a particular jaw clamping force or a jaw clamping force within a jaw clamping force range. 
     Waveguide  154 , as noted above, extends from handle assembly  110  through the inner support sleeve. Waveguide  154  includes blade  162  disposed at a distal end thereof. Blade  162  may be integrally formed with waveguide  154 , separately formed and subsequently attached (permanently or removably) to waveguide  154 , or otherwise operably coupled with waveguide  154 . Waveguide  154  and/or blade  162  may be formed from titanium, a titanium alloy, or other suitable electrically conductive material(s), although non-conductive materials are also contemplated. Waveguide  154  includes a proximal connector (not shown), e.g., a threaded male connector, configured for engagement, e.g., threaded engagement within a threaded female receiver, of ultrasonic transducer  140  such that ultrasonic motion produced by ultrasonic transducer  140  is transmitted along waveguide  154  to blade  162  for treating tissue clamped between blade  162  and jaw member  164  or positioned adjacent to blade  162 . 
     Cable assembly  190  of surgical instrument  100  includes a cable  192 , an ultrasonic plug  194 , and an electrosurgical plug  196 . Ultrasonic plug  194  is configured for connection with ultrasonic plug port  230  of surgical generator  200  while electrosurgical plug  196  is configured for connection with bipolar electrosurgical plug port  240  of surgical generator  200  and/or active monopolar electrosurgical plug port  250  of surgical generator  200 . In configurations where generator  200  includes a common port, cable assembly  190  may include a common plug (not shown) configured to act as both the ultrasonic plug  194  and the electrosurgical plug  196 . Plural first electrical lead wires  197  electrically coupled to ultrasonic plug  194  extend through cable  192  and into handle assembly  110  for electrical connection to ultrasonic transducer  140  and/or activation button  120  to enable the selective supply of ultrasonic drive signals from surgical generator  200  to ultrasonic transducer  140  upon activation of activation button  120  in an ultrasonic mode. In addition, plural second electrical lead wires  199  are electrically coupled to electrosurgical plug  196  and extend through cable  192  into handle assembly  110 . In bipolar configurations, separate second electrical lead wires  199  are electrically coupled to waveguide  154  and jaw member  164  (and/or different portions of jaw member  164 ) such that, as detailed below, bipolar electrosurgical energy may be conducted between blade  162  and jaw member  164  (and/or between different portions of jaw member  164 ). In monopolar configurations, an electrical lead wire  199  is electrically coupled to waveguide  154  such that, as also detailed below, monopolar electrosurgical energy may be supplied to tissue from blade  162 . Alternatively, an electrical lead wire  199  may electrically couple to jaw member  164  in the monopolar configuration to enable monopolar electrosurgical energy to be supplied to tissue from jaw member  164 . One or more second electrical lead wires  199  is electrically coupled to activation button  120  to enable the selective supply of electrosurgical energy from surgical generator  200  to waveguide  154  and/or jaw member  164  upon activation of activation button  120  in an electrosurgical mode. 
     As an alternative to a remote generator  200 , surgical system  10  may be at least partially cordless in that it incorporates an ultrasonic generator, an electrosurgical generator, and/or a power source, e.g., a battery, thereon or therein. In this manner, the connections from surgical instrument  100  to external devices, e.g., generator(s) and/or power source(s), is reduced or eliminated. 
     With reference to  FIG.  2   , a robotic surgical system in accordance with the aspects and features of the present disclosure is shown generally identified by reference numeral  1000 . For the purposes herein, robotic surgical system  1000  is generally described. Aspects and features of robotic surgical system  1000  not germane to the understanding of the present disclosure are omitted to avoid obscuring the aspects and features of the present disclosure in unnecessary detail. 
     Robotic surgical system  1000  generally includes a plurality of robot arms  1002 ,  1003 ; a control device  1004 ; and an operating console  1005  coupled with control device  1004 . Operating console  1005  may include a display device  1006 , which may be set up in particular to display three dimensional images; and manual input devices  1007 ,  1008 , by means of which a person (not shown), for example a surgeon, may be able to telemanipulate robot arms  1002 ,  1003  in a first operating mode. Robotic surgical system  1000  may be configured for use on a patient  1013  lying on a patient table  1012  to be treated in a minimally invasive manner. Robotic surgical system  1000  may further include a database  1014 , in particular coupled to control device  1004 , in which are stored, for example, pre-operative data from patient  1013  and/or anatomical atlases. 
     Each of the robot arms  1002 ,  1003  may include a plurality of members, which are connected through joints, and an attaching device  1009 ,  1011 , to which may be attached, for example, a surgical tool “ST” supporting an end effector  1050 ,  1060 . One of the surgical tools “ST” may be ultrasonic surgical instrument  100  ( FIG.  1   ), e.g., configured for use in both an ultrasonic mode and an electrosurgical (bipolar and/or monopolar) mode, wherein manual actuation features, e.g., actuation button  120  ( FIG.  1   ), clamp lever  130  ( FIG.  1   ), etc., are replaced with robotic inputs. In such configurations, robotic surgical system  1000  may include or be configured to connect to an ultrasonic generator, an electrosurgical generator, and/or a power source. The other surgical tool “ST” may include any other suitable surgical instrument, e.g., an endoscopic camera, other surgical tool, etc. Robot arms  1002 ,  1003  may be driven by electric drives, e.g., motors, that are connected to control device  1004 . Control device  1004  (e.g., a computer) may be configured to activate the motors, in particular by means of a computer program, in such a way that robot arms  1002 ,  1003 , their attaching devices  1009 ,  1011 , and, thus, the surgical tools “ST” execute a desired movement and/or function according to a corresponding input from manual input devices  1007 ,  1008 , respectively. Control device  1004  may also be configured in such a way that it regulates the movement of robot arms  1002 ,  1003  and/or of the motors. 
     Referring to  FIG.  3   , end effector assembly  160  of surgical instrument  100  of surgical system  10  ( FIG.  1   ) is detailed, although end effector assembly  160  may be utilized with any other suitable surgical instrument and/or surgical system. End effector assembly  160  includes a blade  162  and a jaw member  164 . Blade  162  may define a linear configuration, may define a curved configuration, or may define any other suitable configuration, e.g., straight and/or curved surfaces, portions, and/or sections; one or more convex and/or concave surfaces, portions, and/or sections; etc. With respect to curved configurations, blade  162 , more specifically, may be curved in any direction relative to jaw member  164 , for example, such that the distal tip of blade  162  is curved towards jaw member  164 , away from jaw member  164 , or laterally (in either direction) relative to jaw member  164 . Further, blade  162  may be formed to include multiple curves in similar directions, multiple curves in different directions within a single plane, and/or multiple curves in different directions in different planes. In addition, blade  162  may additionally or alternatively be formed to include any suitable features, e.g., a tapered configuration, various different cross-sectional configurations along its length, cut outs, indents, edges, protrusions, straight surfaces, curved surfaces, angled surfaces, wide edges, narrow edges, and/or other features. 
     Blade  162  may define a polygonal, rounded polygonal, or any other suitable cross-sectional configuration(s) (see  FIG.  5   ). Waveguide  154  or at least the portion of waveguide  154  proximally adjacent blade  162 , may define a cylindrical shaped configuration. Plural tapered surfaces (not shown) may interconnect the cylindrically shaped waveguide  154  with the polygonal (rounded edge polygonal, or other suitable shape) configuration of blade  162  to define smooth transitions between the body of waveguide  154  and blade  162 . 
     Blade  162  may be wholly or selectively coated with a suitable material, e.g., a non-stick material, an electrically insulative material, an electrically conductive material, combinations thereof, etc. Suitable coatings and/or methods of applying coatings include but are not limited to Teflon®, polyphenylene oxide (PPO), deposited liquid ceramic insulative coatings; thermally sprayed coatings, e.g., thermally sprayed ceramic; Plasma Electrolytic Oxidation (PEO) coatings; anodization coatings; sputtered coatings, e.g., silica; ElectroBond® coating available from Surface Solutions Group of Chicago, IL, USA; or other suitable coatings and/or methods of applying coatings. 
     Waveguide  154  and/or blade  162  defines lumen  172  extending at least partially therethrough. Lumen  172 , as noted above, is disposed in fluid communication with fluid source  170  ( FIG.  1   ) to enable the delivery, e.g., pumping, of fluid “F” through lumen  172  and into a surgical site via one or more openings  173  in fluid communication with lumen  172 . Although one opening  173  is shown on a distal face of blade  162 , any other suitable number and/or positioning of openings  173  may be provided to facilitate introduction of fluid “F” into the surgical site such as, for example, openings  173  along at least a portion of a length of either or both sides of blade  162 , openings  173  along at least a portion of a length of a top (jaw member facing side) of blade  162 , and/or openings  173  along at least a portion of a length of a bottom (opposite the jaw member facing side) of blade  162 , Further, the one or more openings  173  may be configured to deliver fluid “F” in any suitable manner, e.g., spray, jet, drip, etc., and/or direction(s). 
     With additional reference to  FIG.  5   , blade  162 , as noted above, in addition to receiving ultrasonic energy transmitted along waveguide  154  from ultrasonic transducer  140  ( FIG.  1   ), is adapted to connect to generator  200  ( FIG.  1   ) to enable the supply of RF energy to blade  162  for conduction to tissue in contact therewith or coupled thereto (e.g., via conductive fluid “F,” for example). In bipolar configurations, RF energy is conducted between blade  162  and jaw member  164  (or between portions of jaw member  164  and/or blade  162 ) and through tissue (and/or fluid “F”) disposed therebetween to treat tissue. In monopolar configurations, RF energy is conducted from blade  162 , serving as the active electrode, to tissue in contact therewith or coupled thereto (e.g., via fluid “F”) and is ultimately returned to generator  200  ( FIG.  1   ) via return device  500  ( FIG.  1   ), serving as the passive or return electrode. 
     Continuing with reference to  FIG.  3   , jaw member  164  of end effector assembly  160  includes a more rigid structural body  182  and a more compliant jaw liner  184 . Structural body  182  may be formed from an electrically conductive material, e.g., stainless steel, and/or may include electrically conductive portions. Structural body  182  includes a pair of proximal flanges  183   a  that are pivotably coupled to the inner support sleeve  153  via receipt of pivot bosses (not shown) of proximal flanges  183   a  within corresponding openings (not shown) defined within the inner support sleeve  153  and operably coupled with outer drive sleeve  152  via a drive pin  155  secured relative to outer drive sleeve  152  and pivotably received within apertures  183   b  defined within proximal flanges  183   a . As such, sliding of outer drive sleeve  152  about inner support sleeve  153  pivots jaw member  164  relative to blade  162  from a spaced apart position to an approximated position to clamp tissue between jaw liner  184  of jaw member  164  and blade  162 . 
     Referring also to  FIG.  5   , structural body  182  may be adapted to connect to a source of electrosurgical energy, e.g., generator  200  ( FIG.  1   ), and, in a bipolar electrosurgical mode, is charged to a different potential as compared to blade  162  to enable the conduction of bipolar electrosurgical (e.g., RF) energy through tissue clamped therebetween (and/or through fluid “F”), to treat the tissue. In a monopolar electrosurgical mode, structural body  182  may be un-energized, may be charged to the same potential as compared to blade  162  (thus both defining the active electrode), or may be energized while blade  162  is not energized (wherein structural body  182  defines the active electrode). In either monopolar configuration, energy is returned to generator  200  ( FIG.  1   ) via return device  500  ( FIG.  1   ), which serves as the passive or return electrode. 
     With momentary reference to  FIG.  6   , as an alternative to the entirety of structural body  182  of jaw member  164  being connected to generator  200  ( FIG.  1   ), the structural body may be formed from or embedded at least partially in an insulative material, e.g., an overmolded plastic. In such configurations, electrically conductive surfaces  188 , e.g., in the form of plates, may be disposed on or captured by the overmolded plastic to define electrodes on either side of jaw liner  184  on the blade facing side of jaw member  164 . The electrically conductive surfaces  188 , in such aspects, are connected to generator  200  ( FIG.  1   ) and may be energized for use in bipolar and/or monopolar configurations, e.g., energized to the same potential as one another and/or blade  162  and/or different potentials as one another and/or blade  162 . In aspects, electrically conductive surfaces  188  are disposed at additional or alternative locations on jaw member  164 , e.g., along either or both sides thereof, along a back surface thereof, etc. 
     Returning to  FIGS.  3  and  5   , jaw liner  184  is shaped complementary to a cavity  185  ( FIG.  5   ) defined within structural body  182 , e.g., defining a T-shaped configuration, to facilitate receipt and retention therein, although other configurations are also contemplated. Jaw liner  184  is fabricated from an electrically insulative, compliant material such as, for example, polytetrafluoroethylene (PTFE). The compliance of jaw liner  184  enables blade  162  to vibrate while in contact with jaw liner  184  without damaging components of ultrasonic surgical instrument  100  ( FIG.  1   ) and without compromising the hold on tissue clamped between jaw member  164  and blade  162 . The insulation of jaw liner  184  maintains electrical isolation between blade  162  and structural body  182  of jaw member  164 , thereby inhibiting shorting. 
     Turning to  FIG.  4   , in some aspects, rather than or in addition to blade  162  defining a lumen  172  ( FIG.  3   ) for delivery of fluid “F” to the surgical site, a lumen  176  disposed in fluid communication with fluid source  170  ( FIG.  1   ) may extend through elongated assembly  150  and at least partially through jaw member  164  to enable the delivery, e.g., pumping, of fluid “F” through lumen  176  and into a surgical site via one or more openings  177  in fluid communication with lumen  176 . A plurality of openings  177  are shown defined through jaw liner  184  and spaced apart along the length thereof such that fluid “F” is directed towards blade  162 ; however, any other suitable number and/or positioning of openings  177  may be provided to facilitate introduction of fluid “F” from jaw member  164  into the surgical site. Further, the one or more openings  177  may be configured to deliver fluid “F” in any suitable manner(s), e.g., spray, jet, drip, etc., and/or direction(s). 
     With general reference to  FIGS.  1 ,  3 , and  5   , as noted above, end effector assembly  160  is configured for use in an ultrasonic mode and/or one or more electrosurgical modes; the modes may operate consecutively, overlapping, alternatingly, simultaneous, and/or in any other suitable manner. Further, end effector assembly  160  may be configured to supply fluid “F” to tissue, before, after, and/or together with energy delivery (in either or both modes). Various nonlimiting use modes of end effector assembly  160  are detailed below. 
     With respect to the ultrasonic mode, upon activation, an ultrasonic drive signal is provided from surgical generator  200  to ultrasonic transducer  140  to generate ultrasonic energy that is transmitted from ultrasonic transducer  140  along waveguide  154  to blade  162  to thereby vibrate blade  162  for treating tissue in contact with or adjacent to blade  162 . More specifically, in the ultrasonic mode: ultrasonic energy may be supplied to blade  162  to treat, e.g., seal and/or transect, tissue clamped between blade  162  and jaw liner  184  of jaw member  164 ; ultrasonic energy may be supplied to blade  162  to treat, e.g., transect, perform an otomy, backscore, etc., tissue in contact with or adjacent to blade  162  (with jaw member  164  disposed in the spaced apart or approximated position), statically or dynamically; and/or ultrasonic energy may be supplied to blade  162  to treat, e.g., plunge, spot coagulate, etc., tissue utilizing the distal end of blade  162 . The ultrasonic mode may include one or more energy level settings such as, for example, a first, e.g., LOW, setting and a second, e.g., HIGH, setting. The first and second energy level settings may correspond to different vibration velocities of blade  162 . 
     The one or more electrosurgical energy modes may include bipolar electrosurgical modes and/or monopolar electrosurgical modes. With respect to bipolar electrosurgical tissue treatment, bipolar electrosurgical energy is conducted between blade  162  and structural body  182  of jaw member  164  (or surfaces  188  of jaw member ( FIG.  6   )) to treat, e.g., seal, tissue clamped between blade  162  and jaw liner  184 . Bipolar electrosurgical tissue treatment may be utilized simultaneously or otherwise in cooperation with the ultrasonic mode, e.g., in the first energy level setting, to facilitate treating, e.g., sealing, tissue. Other suitable configurations for bipolar electrosurgical tissue treatment are also contemplated. 
     Monopolar electrosurgical tissue treatment involves the supply of electrosurgical energy from blade  162  (with jaw member  164  un-energized), from jaw member  164  (with blade  162  un-energized), or from both blade  162  and jaw member  164  (with both energized to the same potential) to tissue to treat, e.g., transect and/or spot coagulate, tissue. Monopolar electrosurgical tissue treatment utilizes a remote return electrode device, e.g., return pad  510  of device  500  (see  FIG.  1   ) attached to the patient’s skin, to safely return energy to generator  200 . 
     Delivery of fluid “F,” e.g., conductive fluid such as saline, together with the supply of electrosurgical energy may be used to facilitate tissue treatment, in the bipolar and/or monopolar modes. For example, the use of both electrosurgical energy (bipolar or monopolar), and conductive fluid “F” enables the delivery of energy to tissue while regulating the tissue temperature, e.g., at or below about 100° C. Unlike conventional electrosurgical devices which typically operate at high temperatures, the use of conductive fluid “F” may be utilized to decrease temperature and/or to reduce or eliminate sticking, smoke production, and/or char formation. Additionally or alternatively, the use of a conductive fluid “F” may facilitate coupling the electrode(s) to tissue, enabling tissue treatment without direct contact between the electrode(s) and tissue, thereby expanding the potential treatment area. In aspects, fluid “F” may also be delivered during an ultrasonic mode of operation. 
     Fluid delivery in conjunction with electrosurgical energy supply may be performed, for example, as detailed in U.S. Pat. Application Publication No. 2001/0032002, titled “FLUID DELIVERY SYSTEM AND CONTROLLER FOR ELECTROSURGICAL DEVICES” and filed on Mar. 1, 2001, the entire contents of which are hereby incorporated herein by reference. Other fluid enhanced electrosurgical (and/or ultrasonic) energy implementations are also contemplated. 
     In configurations where the fluid “F” is delivered through lumen  172  of waveguide  154  and blade  162 , this flow of fluid “F” through blade  162  also serves to cool blade  162 . As such, after activation in an ultrasonic mode, for example, fluid “F” may be delivered to a surgical site in preparation for or together with the supply of electrosurgical energy to facilitate electrosurgical tissue treatment, while providing the additional benefit of cooling blade  162 . Likewise, where the fluid “F” is delivered from jaw member  164 , the supply of fluid onto blade  162  may also facilitate cooling of blade  162  after an ultrasonic activation. 
     The use of non-conductive fluid “F,” while not providing the electrical coupling features of conductive fluid “F,” may still provide certain advantages over dry bipolar and/or monopolar electrosurgical modes including, for example, reduced occurrence of tissue sticking, charring, and/or smoke production. Further, a non-conductive fluid “F” may also serve to cool blade  162  after an ultrasonic activation, similarly as detailed above. Other suitable fluids are also contemplated such as irrigating fluids for irrigating the surgical site, fluids for cleaning tissue, medicaments to treat tissue, contrast agents, adhesives, etc. These fluids may be utilized for a surgical purpose while, in aspects, also facilitating cooling of blade  162 . Further, as an alternative to pumping fluid, fluid source  170  ( FIG.  1   ) may be configured to suction tissue through lumen  172 , e.g., for aspiration, removing fluid form the surgical site, etc. Such suction of fluid may likewise facilitate cooling of blade  162  as the fluid is drawn into and through blade  162 . 
     While several aspects of the disclosure have been detailed above and are shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description and accompanying drawings should not be construed as limiting, but merely as exemplifications of particular aspects. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.