Patent Publication Number: US-2019175253-A1

Title: Bipolar electrosurgical cutting and coagulation instrument

Description:
FIELD OF THE INVENTION 
     The present invention relates, in general to a surgical instrument and more particularly, to a bipolar surgical instrument having a front region with at least four coagulation elements entered in the slots at the at least four corners of a rectangle or at least four quarters of a circle of the insulation body for coagulating and one cutting element at the centre of insulating body for cutting the tissue and/or vessel in the body, thereby having at least five electrode arrangement for handling and treating the tissue and or vessel. 
     BACKGROUND OF THE INVENTION 
     Electro surgery involves application of high frequency electrical current to a surgical site to cut, ablate, coagulate, cauterize, desiccate or seal tissue. Bipolar coagulation is a technique for achieving occlusion of blood vessels and tissue bundles by application of high frequency electrical current. 
     Tissue or vessel sealing is a process of liquefying the collagen, elastin and ground substances in the tissue so that they reform into a fused mass with significantly-reduced demarcation between the opposing tissue structures. Generally, the electrical configuration of electrosurgical devices can be categorized in two classifications: 1) monopolar electrosurgical device; and 2) bipolar electrosurgical device. 
     In monopolar electrosurgical forceps the active electrode is placed in the target site and can be used to cut tissue and coagulate bleeding. The patient return electrode is connected to the patient, so the electrical current flows from the generator to the electrode through the target tissue, and passes via patient return electrode and back to the generator. In bipolar electrosurgical devices, the current moves through the tissue that is held between the devices. The path of the electrical current is confined to the tissue between the two electrodes. 
     Advantage of bipolar current is that it flows between only targeted tissue between the electrodes and has minimum effect on adjacent tissue during cutting and coagulation. Hence, surgery becomes safer compared to monopolar cutting and coagulation. 
     During surgical procedures most of the times which is performed at confined spaces, it is difficult to reorient the instrument repetitively to coagulate the tissue and/or vessel after a cut is performed by the surgeon. 
     The present invention discloses a bipolar surgical instrument that is designed in a way that has coagulation elements at the at least four comers of a rectangle or at least four quarters of a circle of the insulating body due to which tissue and/or vessel can be coagulated immediately by placing the sides or front surface of the instrument after cutting of the tissue and/or vessel without the effort of orienting the instrument by the surgeon. 
     The side coagulation disclosed makes it easy and convenient enabling the surgeon to coagulate the tissue and/or vessel at any of the sides or the front after cutting the tissue and/or vessel at any location in the body which saves time and energy and allows ease and swiftness during surgery. 
     Further there is a larger surface area to coagulate the larger bleeding tissue and/or vessel and there is a smaller surface area to coagulate the smaller bleeding tissue and/or vessel. 
     SUMMARY OF THE INVENTION 
     This invention discloses front region of a surgical instrument having at least four coagulation elements  6 ,  7 ,  8 , and  9  entered in respective slots at the at least four corners of a rectangle or at least four quarters of a circle of the insulation body. The circle can be tapered or straight at the tip. The coagulation elements at the at least four corners of a rectangle or at least four quarters of a circle can be utilized by the surgeon for coagulation purpose to coagulate the tissue and/or vessel; the cutting element  10  at the centre acts as a cutting electrode. The cutting element  10  can be at least one blade or a needle and it can be fixed or moved longitudinally in an advanced position or retracted position. Insulation is provided between all four coagulation elements. Cutting element  10  is also separated by insulation surrounding it from all four coagulation elements. Connection wires provide input current to the at least four coagulation element and at least one cutting element. The size of all the at least four coagulation elements can be same, hence producing same intensity current and producing same heat with same effect. The size of the at least one cutting element is thinner than the coagulation elements. This means the coagulation elements  6 ,  7 ,  8 ,  9  have larger surface area and cutting element  10  has a smaller surface area. 
     When the cutting element  10  conducts current due to its size and area being thin, the coagulation elements are electrically short, this creates a thin and fine cutting area, creating an arc at the tip of cutting electrode to cut the tissue and/or vessel leading to the cutting effect. 
     Any of the sides A, B, C, D or front surface E can be utilized to coagulate the tissue and/or vessel to stop the bleeding after a cut is performed by at least one cutting element  10  without reorientation of the device for coagulation purpose. This improves efficiency to coagulate after cut is performed at various locations in the body. 
     When the larger bleeding tissue and/or vessel needs to be coagulated then the coagulating elements  6 ,  7  or  8 ,  9  can be utilized to coagulate the tissue and/or vessel since the surface area of Side A and Side C is greater than Side B and Side D. When the smaller bleeding tissue and/or vessel need to be coagulated then the coagulating elements  7 ,  8  or  9 ,  6  can be utilized. In a way the surgeon can decide on the placement of the sides as per tissue area. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 01  illustrates an isometric view of the surgical instrument for laparoscopic surgery. 
         FIG. 02  illustrates the front view of the surgical instrument showing a handle with a long tube. 
         FIG. 03  illustrates the front view of the surgical instrument displaying a handle having a short tube with two buttons. 
         FIG. 04  illustrates the front view of the surgical instrument for open surgery displaying a handle with a short tube and showing front region. 
         FIG. 05  illustrates the front view of the front region of the tube displaying the coagulation elements at the corner of the insulator body. 
         FIG. 06  illustrates the top view of the front region of the tube displaying the coagulation elements at the corner. 
         FIG. 07  illustrates a side view of the front region. 
         FIG. 08  illustrates the backside view of the front region. 
         FIG. 09  illustrates the exploded view of the front region. 
         FIG. 10  illustrates an embodiment where the front region is in curved form at the front of the tube. 
         FIG. 11  illustrates the top view of the curved front region. 
         FIG. 12  illustrates the front view of the curved front region. 
         FIG. 13  illustrates the side view of the curved front region. 
         FIG. 14  illustrates the exploded view of the curved front region. 
         FIG. 15  illustrates the generator showing the switching circuit. 
         FIG. 16  illustrates circular arrangement of coagulation elements and cutting element which is in needle form. 
         FIG. 17  illustrates the exploded view of coagulation elements arranged in circular manner.  FIG. 19  illustrates the tip details B in  FIG. 18  which is in tapered or straight form. 
         FIG. 20  illustrates cutting button, coagulation button and needle rotation movement knob. 
         FIG. 22  illustrates the sectional view of the instrument of  FIG. 21 . 
         FIG. 23  illustrates that the tips (Both rectangle and circular cross section) can be articulated at required angle using hand control, motorised control, console or they can be integrated with robotic systems/arms for achieving difficult angles during surgery. 
     
    
    
     DESCRIPTION OF THE INVENTION 
     The invention discloses a surgical instrument with a front region of a tube having at least four coagulation elements entered in respective slots at the at least four corners of a rectangle or at least four quarters of a circle of insulating body at the front region  3  for coagulation of the tissue and/or vessel and one cutting element at the centre of the insulator body for cutting of the tissue and/or vessel in a laparoscopic or open surgery, or any other surgical procedure. Together the front region  3  of the instrument is having an at least Five electrode arrangement for handling and treating the tissue and/or vessel. 
       FIG. 01  illustrates an isometric view of the surgical instrument for laparoscopic surgery. The instrument comprises of a handle  1  with long tube  2  showing front region  3 . 
       FIG. 02  illustrates the front view of the surgical instrument displayed in  FIG. 01  showing a handle  1  with a long tube  2 . The handle  1  comprises of two buttons  4  and  5 . One button  4  is utilized by the surgeon for coagulation and another button  5  is utilized for cutting the tissue and or vessel (or vice versa). The instrument can sometimes be operated with foot pedal. This instrument can be used for laparoscopic surgery. There can be more than two buttons as per requirement. There is a front region  3 . 
       FIG. 03  illustrates the front view of the surgical instrument displaying a handle  1  having a short tube  2  with two buttons  4  and  5 . One button  4  is utilized by the surgeon for coagulation and another button  5  is utilized for cutting the tissue and/or vessel. There can be more than two buttons as per requirement. There is a front region  3 . This instrument can be used for open surgery with confined spaces. 
       FIG. 04  illustrates the front view of the surgical instrument for open surgery displaying a handle  1  with a short tube  2  (shorter than shown in  FIG. 02 ) and showing front region  3 . The handle  1  comprises of two buttons  4  and  5 . One button  4  is utilized by the surgeon for coagulation and another button  5  is utilized for cutting the tissue and/or vessel (or vice versa). There can be more than two buttons as per requirement. This instrument can be used for open surgery. 
       FIG. 05  illustrates the front view of the front region  3  of the tube  2  displaying the coagulation elements  6  and  7  entered in the slot at the first and second corner of rectangle of the insulation body  22 . The coagulation elements  6  and  7  at the first and second corner can be utilized by the surgeon for coagulation purpose to coagulate the tissue and/or vessel; the front region  3  further includes cutting element  10  at the centre which acts as a cutting electrode. 
     Insulator body  22  is of construction such that insulation is provided in between the coagulation elements  6  and  7 . 
       FIG. 05  further illustrates that the first coagulation element  6  is provided input current through terminal  30  (shown in  FIG. 08 ) that is utilized for coagulation of the tissue and/or vessel; second coagulation element  7  is provided input current through terminal  31  (shown in  FIG. 08 ) that is utilized for coagulation of the tissue and/or vessel. 
     The front region  3  comprises of an insulating material support  20  at the back end of the front region  3  that fits with the tube  2  and an insulator body  22 . Insulating material support  20  and insulator body  22  can be same part or may be different parts of same material or different material. 
       FIG. 06  illustrates the top view of the front region  3  of the tube  2  displaying the coagulation elements  7  and  8  at the third and fourth corner of a rectangle of the insulation body  22  that can be utilized by the surgeon for coagulation purpose to coagulate the tissue and/or vessel. Insulator body  22  is provided in between the coagulation elements  7  and  8 . 
       FIG. 06  further illustrates the cutting element  10  that is utilized by the surgeon to cut the tissue and/or vessel. The third coagulation element  8  is provided input current through terminal  30  (shown in  FIG. 08 ) that is utilized for coagulation of the tissue and/or vessel. Fourth coagulation element  9  is provided input current through terminal  31  (shown in  FIG. 08 ).The cutting element  10  is provided input current (shown in  FIG. 08 ) through terminal  31  that is utilized for cutting of the tissue and/or vessel. 
     In an embodiment, there can be more than five electrodes that will enable numerous applications and effects. 
     The cutting element  10  slightly protrudes out of the surface and is slightly in elevated form and fixed compared to the coagulation elements  6 , 7 , 8 , 9  or the cutting element can move to and fro. 
       FIG. 07  illustrates aside view of the front region  3  which clearly displays the at least four coagulation elements  6 , 7 , 8 , 9  at the at least four corners of the rectangle of the insulator body  22  and one cutting element  10  at the centre of the insulator body  22  which is a cutting electrode. 
     It can be clearly illustrated here that the coagulation elements  6 , 7 , 8 , 9  are electrodes that coagulate the tissue and/or vessel. Cutting element  10  is an electrode that cuts the tissue and/or vessel. The size of all the at least four coagulation elements is the same, hence produces the same intensity current and produces same heat with same effect. The size of the cutting element is thinner than the coagulation elements. This means the coagulation elements  6 , 7 , 8 , 9  have larger surface area and cutting element  10  has a smaller surface area. 
     When the cutting element  10  conducts current, due to its size and area being thin, the coagulation elements are electrically short which creates a thin and fine cutting area creating an arc at the tip of cutting electrode to cut the tissue and/or vessel leading to the cutting effect. The cutting element  10  can be a blade, needle, cutter, sharp element or any other material or there can be more than one cutting element without limitation that conducts electricity. Coagulation elements can also be of any material without limitation that conducts electricity. The coagulation elements can be more than four without limitation as per requirement increasing the usage and the number of effect. There can also be three coagulation elements as per requirement. 
     As can be seen from the  FIG. 7 , the front view shows four sides A, B, C, D and E. Any of the sides A, B, C, D or front surface E can be utilized to coagulate the tissue and/or vessel to stop the bleeding after a cut is performed by cutting element  10  without reorientation of the device for coagulation purpose. This improves efficiency to coagulate after cut is performed at various locations in the body. 
     In such a way, coagulating elements  6 ,  7  can be utilized to coagulate the tissue and/or vessel where side A has a larger surface area. When tissue and/or vessel is cut at side B by the cutter, coagulating elements  7 ,  8  can be utilized to coagulate. Similarly, coagulating elements  8 ,  9  can be utilized to coagulate the tissue and/or vessel where side C has a larger surface area. When tissue and/or vessel is cut at side D by the cutter, coagulating elements  9 ,  6  can be utilized to coagulate. Front surface E is utilized in any other cases to coagulate. 
     Insulation is provided between all the coagulation elements that separates all the elements from each other. Cutting element  10  is also insulated from all sides from all at least four coagulation elements  6 , 7 , 8 , 9 . Thus all the elements are separate and insulated from one another. 
     The shape of the whole arrangement is plane region on all the four sides. The front view shows a rectangular shape of the arrangement. The shape without limitation can be curved or circular or square in front or any other desired shape. 
     When the larger bleeding tissue and/or vessel need to be coagulated then the coagulating elements  6 ,  7  or  8 ,  9  can be utilized to coagulate the tissue and/or vessel since the surface area of Side A and Side C is greater than Side B and Side D. When the smaller bleeding tissue and/or vessel need to be coagulated then the coagulating elements  7 ,  8  or  9 ,  6  can be utilized. In a way the surgeon can decide on the placement of the sides as per tissue area. 
     Only the cutting element  10  can sometimes be directly utilized for cutting purpose of the tissue and/or vessel. Alternatively, only the coagulation elements  6 ,  7 ,  8 ,  9  can sometimes be directly utilized by the surgeon for coagulating the tissue and/or vessel by placing only the sides or front surface on the tissue and/or vessel. 
       FIG. 08  illustrates backside view of the front region  3 ; where the coagulation elements  7 ,  9  (shown in  FIG. 7 ) are electrically same unit having a common terminal  31 . While coagulation elements  6 ,  8  (shown in  FIG. 7 ) are electrically same unit having a common terminal  30 . Cutting element  10  (shown in  FIG. 7 ) has terminal  31  connected to it for conduction of current. Thus the coagulation elements have same electrical potential at  6 ,  8  and same electrical potential at  7 ,  9  when coagulation takes place. When coagulation electrodes  6 , 7 , 8 , 9  are electrically short the cutting element  10  conducts current. 
       FIG. 09  illustrates the exploded view of the front region  3  wherein the cutting element  10  which is in the slot  11  of the insulator body  22 . 
     The at least four coagulation elements  6 , 7 , 8 , 9  are arranged at the at least four corners  15 , 14 , 12 , 13  of the insulator body  22  which then together with the cutting element  10  which is in slot  11  forms the front region  3  of the instrument. 
     In an embodiment as illustrated in  FIG. 10 , the front region  3  is in curved form  16  at the front of the tube. 
       FIG. 11  illustrates the top view of the curved front region  3  with coagulation elements  17 ,  19  at the corners of the insulator body  23  and cutting element  21  is in the centre which is a cutting electrode. 
       FIG. 12  illustrates the front view of the curved front region  3  with coagulation elements  17 ,  18  which are coagulating electrodes and cutting element  21  is in the centre which is a cutting electrode. There is an insulating material support  22  for attachment with the tube. Insulating material support  20  and insulator body  22  can be same part or may be different parts of same material or different material. 
       FIG. 13  illustrates the side view of the curved front region  3  with coagulation elements  17 , 18 , 19 , 20  which are coagulating electrodes and cutting element  21  in the centre which is a cutting electrode on the insulator body  23 . 
       FIG. 14  illustrates the exploded view of the curved front region  3  with coagulation elements  17 , 18 , 19 , 20  which Fits in the slots at the at least four comers  24 , 25 , 26 , 27  on the insulator body  23  and cutting element  21  that fits in the slot  28  in the centre of the insulator body  23  and there is an insulating material support  22  at the back side of the insulator body  23  which Fits on the tube. 
       FIG. 15  illustrates the generator showing the switching circuit. The circuit shows the isolated output current terminals  36  that provide the bipolar current  37 . There is a relay  33 . The current switches in mode from S I (Switch 1,  34 ) to S2 (Switch 2,  35 ) and follows a conductive pathway to PI towards wire ( 30 ) and to P2 towards wire ( 31 ) and towards wire ( 32 ) at cutting element C. 
       FIG. 16  illustrates cutting element which is in needle form  38 . The needle can be moved longitudinally in an advanced position or retracted position. At least four coagulation elements  39 ,  40 ,  41 ,  42  that are arranged at least four quarter wise are used to coagulate the tissue/vessel which enters in the slot of the at least four quarter of a circle. 
       FIG. 17  illustrates the exploded view of (tip embodiment)  38 ,  39 ,  40 ,  41 . 
       FIG. 19  illustrates the tip details B in  FIG. 18  which is in tapered form.  FIG. 20  illustrates cutting button  43 , coagulation button  44  and needle to and fro motion knob  45 , all of which can be handled with single hand by the surgeon.  FIG. 22  illustrates the sectional view of the instrument of  FIG. 21 . 
     As illustrated in  FIG. 23  the tips (square, rectangle and circular cross section) can be articulated at- required angle using hand control, motorised control, console or they can be integrated with robotic systems/arms for achieving difficult angles during surgery. 
     Single hand control can be achieved for all activities like cut, coagulation, and needle adjustment while the surgeon can use other hand for holding other devices/tools. 
     The instrument can be used without limitation for all other surgical procedures. 
     All the electrodes/elements can have non sticky/superconductive coatings or can be made of superconductive materials or have special chemical coatings for improved results. 
     Electrodes/elements can have rectangular, square or circular or curved cross section area. 
     Electrodes/elements can be made up of nonconductive material with conductive coating surface. 
     The present disclosure relates to a surgical instrument comprising at least four coagulation elements ( 6 ,  7 ,  8 ,  9 ) placed in respective slots that are positioned in at least four corners of a rectangle or in at least four quarters of a circle of an insulator body; and at least one cutting element near the center of the insulator body and separated from the at least four coagulation elements through insulation, wherein the at least four coagulation elements are utilized to coagulate a tissue and/or vessel and said at least one cutting element is utilized to cut the tissue and/or vessel. 
     In an aspect, the coagulation elements  7 ,  9  are electrically configured as part of a first unit having a common terminal  31 , while coagulation elements  6 ,  8  are electrically configured as part of a second unit having a common terminal  30 , wherein the at least one cutting element is connected to the common terminal  31  for conduction of current.