Patent Publication Number: US-2015080876-A1

Title: Integrated systems for electrosurgical steam or smoke control

Description:
BACKGROUND 
     The present disclosure relates generally to the field of surgery. In particular, the present disclosure relates to, although not exclusively, medical devices that perform work on target tissue via application of energy. More particularly, the present disclosure relates to, although not exclusively, fluid control systems designed to control steam, smoke, or temperature within a surgical field to protect tissue adjacent to target tissue. 
     Many surgical procedures require application of energy to target tissue. For example, medical devices such as surgical instruments may apply energy to tissue to cut or ligate blood vessels or other internal tissue. In many such procedures, it is desirable to achieve the surgical outcome using a minimally invasive technique that reduces trauma to non-target tissue. For example, electrosurgical medical devices generally include an end effector having an electrical contact to provide energy to target tissue. Advanced energy sealers may apply ultrasonic vibrational or RF energy to raise the temperature of target tissue above 100° C., for example. At this temperature, collagen is denatured and water may boil off to allow vessel walls to approximate tightly. Tissue adjacent to target tissue, however, may be blanched by steam if sufficiently close. Application of energy such as RF energy to target tissue may similarly produce a smoke plume when the target tissue is cooked. The electrosurgical smoke may be hazardous because it impedes visibility and causes delay when a surgeon must wait for the smoke to dissipate before continuing a procedure. Another risk associated with the application of energy is the presence of splay electricity and hot surfaces that may damage adjacent tissue within the surgical field. Accordingly, there is a need to advance this technology to address these and other issues associated with the use of medical devices configured to apply energy such as advanced energy to target tissue. 
     SUMMARY 
     In one embodiment, a medical device comprises an elongate member comprising an end effector positioned along a distal portion thereof; a fluid control system fluidically coupled to the elongate member, the fluid control system configured to control fluid generated when the end effector applies energy to target tissue. The fluid control system comprises a fluid path element comprising one or more fluid paths; a distal fluid port fluidically coupled to at least one of the one or more fluid paths and positioned adjacent to a working portion of the end effector; and a proximal fluid port fluidically coupled to at least one of the one or more fluid paths fluidically coupled to a supply and transport element; wherein the supply and transport element is configured to one of evacuate the fluid adjacent to the working portion of the end effector through at least one of the one or more fluid paths and supply a fluid for transport through at least one of the one or more fluid paths for delivery from the distal fluid port; and wherein the supply and transport element is configured to be operatively coupled to an activation element configured to activate the supply and transport element when end effector applies energy to the target tissue. 
     In another embodiment, a medical device comprises an elongate member having a proximal portion and a distal portion; a fluid control system configured to control a fluid generated when the medical device applies energy to target tissue. The fluid control system comprises a fluid path element comprising a fluid path extending along the elongate member, the fluid path comprising a proximal fluid port configured to couple to a fluid supply and transport element to transport fluid through the fluid path; and a distal fluid port positioned along the distal portion of the elongate member configured to deliver the fluid transported through the fluid path and intake the fluid into the fluid path element. 
     In yet another embodiment, a medical device comprises an elongate member having a proximal portion and a distal portion, wherein the distal portion of the elongate member comprises an end effector coupled to a distal end of a shaft; a fluid control system configured to control a fluid generated when the medical device applies energy to target tissue. The fluid control system comprises a fluid path element comprising a fluid path extending along the end effector, the fluid path comprising a proximal fluid port configured to couple to a fluid supply and transport element to transport fluid through the fluid path; and a distal fluid port positioned along the distal portion of the elongate member configured to deliver the fluid transported through the fluid path and intake the fluid into the fluid path element. 
     In still yet another embodiment, a medical device comprises an elongate member having a proximal portion and a distal portion; a fluid control system configured to control a fluid generated when the medical device applies energy to target tissue, the fluid control system comprising a fluid path element comprising a fluid path extending along the elongate member, the fluid path comprising a proximal fluid port configured to couple to a fluid supply and transport element to transport fluid through the fluid path; a distal fluid port positioned along the distal portion of the elongate member configured to deliver the fluid transported through the fluid path and intake the fluid into the fluid path element; and an activation element configured to activate the supply and transport element to transport fluid or smoke through the fluid path element. 
    
    
     
       FIGURES 
         FIG. 1A  illustrates a perspective view of one embodiment of a medical device including a fluid control system. 
         FIG. 1B  illustrates an enlarged view of the distal portion of the elongate member illustrated in  FIG. 1A . 
         FIG. 2  illustrates one embodiment of a fluid control system shown in block diagram. 
         FIG. 3A  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIG. 3B  illustrates a distal to proximal perspective view from the distal portion of the elongate member illustrated in  FIG. 3A . 
         FIG. 4A  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIG. 4B  illustrates a distal to proximal perspective view from the distal portion of the elongate member illustrated in  FIG. 4A . 
         FIG. 5A  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIG. 5B  illustrates a distal to proximal perspective view from the distal portion of the elongate member illustrated in  FIG. 5A . 
         FIG. 6  illustrates a perspective view of an operation of the fluid control system illustrated in  FIGS. 4A and 4B . 
         FIG. 7  illustrates one embodiment of a fluid path element of a fluid control system comprising one or more fluid paths. 
         FIG. 8  illustrates one embodiment of a fluid path element of a fluid control system comprising one or more fluid paths. 
         FIG. 9  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIG. 10  illustrates a cross-section of one embodiment of a fluid path element of a fluid control system comprising one or more fluid paths integral to a jaw of an end effector. 
         FIG. 11  illustrates one embodiment of a fluid path element of a fluid control system comprising one or more fluid paths. 
         FIG. 12  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIG. 13  illustrates a perspective view of one embodiment of a medical device including a fluid control system. 
         FIG. 14  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIGS. 15A-5D  illustrate cross-sectional views of certain configurations of fluid paths according to various embodiments. 
         FIG. 16  illustrates one embodiment of a medical device including a fluid control system. 
         FIG. 17  illustrates one embodiment of a medical device including a fluid control system. 
         FIG. 18  illustrates a perspective view in cross-section of one embodiment of one or more fluid paths extending along an end effector. 
         FIG. 19  illustrates a perspective view in cross-section of one embodiment of one or more fluid paths and gaskets extending along an end effector. 
         FIG. 20  illustrates a perspective view in cross-section of one embodiment of one or more fluid paths and gaskets extending along an end effector. 
         FIG. 21  illustrates a perspective view in cross-section of one embodiment of one or more fluid paths and gaskets extending along an end effector. 
         FIGS. 22A-22F  illustrate cross-sections of various embodiments of gaskets. 
         FIG. 23  illustrates a perspective view in cross-section of one embodiment of one or more fluid paths and gaskets extending along an end effector wherein tissue is positioned between the first and second jaw of an end effector. 
         FIG. 24  illustrates a perspective view in cross-section of one embodiment of one or more fluid paths and gaskets extending along an end effector. 
         FIG. 25A  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIG. 25B  illustrates a perspective view in cross-section along A-A of  FIG. 25A  wherein tissue is positioned between the first and second jaw of the end effector. 
         FIG. 26A  illustrates a perspective view of one embodiment of a distal portion of an elongate member comprising a fluid control system. 
         FIG. 26B  illustrates a perspective view of the embodiment illustrated in  FIG. 26A  wherein the first and second jaws are in an open position. 
         FIGS. 27A and 27B  illustrate a perspective view in partial cutaway of a medical device comprising one embodiment of a fluid control system. 
         FIG. 28A  illustrates a perspective view a medical device comprising of one embodiment of a fluid control system including a sleeve. 
         FIGS. 28B and 28C  illustrate perspective views in cross-section of various embodiments of sleeves according to the embodiment illustrated in  FIG. 28A . 
     
    
    
     DESCRIPTION 
     Before explaining the various embodiments of ultrasonic and electrical surgical devices in detail, it should be noted that the various embodiments disclosed herein are not limited in their application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. Rather, the disclosed embodiments may be positioned or incorporated in other embodiments, variations and modifications thereof, and may be practiced or carried out in various ways. Accordingly, embodiments of the ultrasonic and electrical surgical devices configured to apply energy, e.g., bipolar energy, to target tissue disclosed herein are illustrative in nature and are not meant to limit the scope or application thereof. Furthermore, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the embodiments for the convenience of the reader and are not to limit the scope thereof. In addition, it should be understood that any one or more of the disclosed embodiments, expressions of embodiments, and/or examples thereof, can be combined with any one or more of the other disclosed embodiments, expressions of embodiments, and/or examples thereof, without limitation. In the following description, like reference characters designate like or corresponding parts throughout the several views. Also, in the following description, it is to be understood that terms such as front, back, inside, outside, top, bottom and the like are words of convenience and are not to be construed as limiting terms. Terminology used herein is not meant to be limiting insofar as devices described herein, or portions thereof, may be attached or utilized in other orientations. The various embodiments will be described in more detail with reference to the drawings. 
     During medical procedures wherein energy including ultrasonic or RF energy, for example, is applied directly or indirectly to target tissue, e.g., an ultrasonic cutting device or a bi-polar RF device configured to seal, weld, cook, appose, transect, dissect, ablate, cauterize, electroporate, etc., tissue adjacent to the target tissue and surrounding the surgical field (generally referred to herein as adjacent tissue) may be susceptible to thermal damage that is directly or indirectly related to the procedure. For example, a medical device may include an end effector having a blade. Ultrasonic energy may be applied to the blade causing the blade to rapidly vibrate as it cuts target tissue to additionally coagulate tissue due to the frictional heat generated by the stress and vibration of the tissue. The heat used to coagulate the target tissue may result in generation of electrosurgical smoke, temperature fluctuations, or thermal pockets of steam that may be expelled or otherwise released into the surgical field causing undesirable damage to non-target tissue. As an additional example, a medical device comprising an end effector having electrodes for application of energy to weld target tissue. In a tissue welding or sealing procedure, for example, energy may be applied to target tissue to raise the temperature of the tissue above 100° C., e.g., above the boiling point of water. At these temperatures, collagen is denatured and water is boiled off to allow vessel walls to approximate tightly. Undesirably, adjacent tissue may be blanched by the steam produced when the water is boiled off. Thus the steam or smoke produced from the operation of such devices may be a byproduct of the direct or indirect application of energy to the target tissue. 
     According to various embodiments, a medical device may comprise or otherwise be integrated with a fluid control system. For clarity, the present disclosure generally describes a medical device as comprising an elongate member having a shaft, a proximal portion of the elongate member comprising a handle and a distal portion comprising an end effector. The shaft being positioned between the proximal and distal portions. However, those having skill in the art will appreciate that other medical devices may similarly comprise or otherwise be integrated with a fluid control system as described herein. Accordingly, the present disclosure is not so limited. In certain embodiments, the end effector comprises a working portion configured to apply energy to target tissue. As previously described, the energy may be ultrasonic vibrational energy or electrical energy and may be applied to the tissue directly or indirectly. As used herein, working portion is used to describe a portion of an end effector that performs work. As such, depending on the configuration, working portions of an end effector may include portions configured to grasp, cut, dissect, transect, tear, apply energy, etc. to target tissue. For example, an end effector comprising a first jaw and a second jaw may comprise a working portion extending along a length of the jaws. The working portion may correspond, for example, to an electrode configuration, e.g., a bipolar electrode configuration, or knife path. In one embodiment, the working portion 
     A variety of medical devices that may comprise or otherwise be integrated with a fluid control system include medical devices having end effectors operable as ultrasonic tissue cutting elements or one or more elements that transmit RF energy to tissue (e.g., to coagulate or seal the tissue). Examples of such devices are the HARMONIC® blade and shears devices and the ENSEAL® Tissue Sealing Device by Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio. 
     In one embodiment, the fluid control system comprises a fluid path element. The fluid path element may comprise one or more fluid paths configured to deliver fluid to or evacuate fluid from a surgical field. In certain embodiments, the fluid may comprise any fluid, including a gas, liquid, combination of the two, as well as fluids that may further include particulates, e.g., electrosurgical smoke. In various embodiments, the fluid path element may be defined in or associated with a medical device comprising an elongate member having a shaft positioned between a proximal portion of the elongate member comprising a handle and a distal portion of the elongate member comprising an end effector. The one or more fluid paths may comprise one or more distal fluid ports positioned to deliver, intake, exhaust, or evacuate fluid, which may include a fluid mixture, adjacent to the distal portion of the elongate member. For example, one or more fluid paths may be in fluid communication with one or more fluid ports, e.g., inlets, outlets, vents, etc., configured to deliver, intake, evacuate, or otherwise provide a point of ingress or egress for fluid with respect to the one or more fluid paths and surrounding environment. The one or more fluid paths may further comprise a proximal fluid port. In various embodiments, the one or more fluid paths may be defined by lumens, lines, channels, cavities, voids, tubing, or ducts defined in the elongate member, e.g., within a shaft, end effector, tube, or sleeve. The one or more fluid paths may provide a flow path for fluid to move or be transported between proximal and distal fluid ports. In one embodiment, a distal fluid port comprises an intake port adjacent to an end effector configured to intake fluid from the surgical field for movement or transport to a proximal fluid port positioned at another location, e.g., end effector, shaft, handle, fluid reservoir or exhaust environment, to evacuate the fluid. In various embodiments, the end effector comprises one or more proximal or distal fluid ports through which fluid, e.g., electrosurgical steam or smoke, may ingress or egress the one or more fluid paths directly through the end effector. In some embodiments, one or more fluid ports comprise vents formed into a side or outer portion or surface of the elongate member. It is to be appreciated that combinations of the one or more fluid paths may be independent or fluidically coupled to a common fluid path element. 
     In various embodiments, a fluid path element or fluid port comprises a filter. The filter may be any filter known in the art and may comprise an obstruction configured to prevent particulates or solids such as tissue and other debris from becoming lodged in and thereby clogging a fluid path element or port. For example, in one embodiment, a distal fluid port includes a membrane or filter to unwanted fluids and or debris from passing into the fluid path element and fouling the medical device, e.g., when a fluid path element may be clogged by debris or expose moisture sensitive components to moisture. In these or other embodiments, the fluid control system may be configured to provide a burst of fluid to ensure that a fluid path element or port is free of foreign obstructions or to dislodge foreign obstructions or fluids that may otherwise damage components of the medical device or its operation. For clarity and brevity, certain portions of the following description refer to a device comprising a fluid path element having a proximal fluid port and a distal fluid port, it is to be appreciated that multiple fluid paths may be used and multiple fluid ports may be associated with one or more of the multiple fluid paths. 
     In one embodiment, the fluid control system comprises or is fluidically coupled to a fluid supply and transport element, e.g., via a proximal fluid port. In various embodiments, the fluid supply and transport element comprises a supply component and a transport component. For example, the proximal fluid port may provide a fluidic coupling with the supply component to receive or exhaust fluid, e.g., into a reservoir or an external environment. Supply components may include fluid sources that provide fluid to the fluid path element as well as reservoirs or an external environment that receives fluid from the fluid path element. Supply components also may comprise or be coupled to fluid transport components. For example, fluid transport components may include any arrangement or manner of transport configured to transport fluid through the one or more fluid paths. For example, fluid, which may include fluid mixtures and particulates, e.g., steam or smoke, may be transported via pressure differentials, diffusion, convection, advection, gravity, etc. In some embodiments, a transport component comprises a positive or negative pressure that is applied within a fluid path to transport fluid. In one embodiment, the transport component includes a physical structure such as a pump that moves fluid through the fluid path element. For example, the pump may fluidically couple to the supply component and one or more fluid path channels of the fluid path element. The pump may be configured to supply positive or negative pressure to, for example, supply, evacuate, or transport fluid via one or more fluid paths. In one embodiment, the supply component is configured with the transport component, e.g., a compressed fluid, such as CO 2 , wherein a pressure differential with respect to the one or more fluid paths drives decompression or evaporation to transport CO 2  through the one or more fluid paths. 
     In various embodiments, the fluid control system comprises or is operatively coupled to an activation element. The activation element may be configured to initiate or control the transport of fluid through the fluid path element. Thus, in certain embodiments, the activation element may be configured to control an operation of the fluid supply and transport element. In one embodiment, for example, the activation element comprises an actuator, switch, or other interface to provide or initiate power to a transport component comprising a pump for pumping fluid through the fluid path element. In another embodiment, the activation element comprises a switch that opens a valve fluidically coupled to the fluid path element and the fluid supply and transport element to allow fluid to be transported through the fluid path element. For example, the activation element may comprise a switch operatively coupled to a valve fluidically coupled between the fluid supply and transport element, e.g., a compressed fluid source, and the fluid path element. Actuation of the switch opens the valve, coupling a pressure differential that exists between a first and second side of the valve, causing fluid to be transported through the fluid path element. 
     In various embodiments, fluid delivered by the fluid control system interacts with adjacent tissue or steam generated from the application of energy to target tissue. For example, the fluid control system may reduce steam created when using a RF bipolar device to cauterize/seal and transect target tissue, thereby reducing trauma to surrounding tissue. In certain embodiments, the fluid control system is configured to deliver fluid adjacent the distal portion of the elongate member to displace or condense steam or smoke generated from the application of energy or to evacuate the same from the surrounding environment. In one embodiment, a fluid path is configured to inject or deliver a fluid to the surgical site adjacent the end effector or working portion thereof to reduce temperature induced damage to adjacent tissue, such as damage induced by thermal spread. For example, flowing fluid may disperse or absorb heat from steam or provide a protective shield. Additionally, depending on the desired application, fluid may be supplied or delivered at a temperature configured to counteract or otherwise protect adjacent tissue from an undesirable temperature fluctuation. 
     Further to the above, in one embodiment, fluid delivered to the tissue treatment site adjacent a distal portion of the elongate member or end effector via the one or more fluid paths may form a protective barrier between adjacent tissue and damaging temperature fluctuations, e.g., pockets of steam. In various embodiments, the fluid control system may be configured to deliver fluid via the one or more fluid paths to disperse the steam. For example, in one embodiment, fluid is supplied from one or more distal fluid ports. Distal fluid ports may be positioned adjacent to the tissue treatment site, a distal portion of the elongate member, or the end effector to deliver fluid at a volume or rate configured to disperse steam. Dispersing the steam may disperse concentrated thermal pockets of steam that may otherwise damage adjacent tissue. In various embodiments, the fluid is delivered at a rate or temperature configured to reduce the bulk temperature of the environment adjacent to the working end of the end effector while applying energy during surgery. In one embodiment, for example, the fluid delivery system is configured to deliver fluid to cool the surrounding tissue and/or cool and condense steam. In one embodiment, fluid may be delivered at a low temperature or density configured to condense steam or otherwise absorb heat adjacent to the distal portion of the elongate member, end effector, or surrounding tissue. 
     In various embodiments, as introduced above and described in more detail below, the fluid control system may be configured to suction, evacuate, or extract fluid from the surgical field adjacent to elongate member. For example, the fluid control system may comprise or be coupled to a transport component comprising negative pressure or vacuum to provide the same pressure at one or more distal fluid ports and extract or otherwise suction evolved steam away from adjacent tissue. In one embodiment, the fluid control system operates to extract, evacuate, or otherwise suction smoke generated from cooking tissue from the surgical field. 
     As introduced above, steam or mist may be created from the activation and/or application of energy. For example, activation of ultrasonic or RF bipolar energy with shear devices applied to tissues may cause the evolution of mist within the tissue or around the device. In various embodiments, a device may be configured to disperse or reduce the mist by application of the fluid adjacent to the elongate member. In one embodiment, the fluid control system delivers fluid, such as a liquid or gas, to a distal portion of the elongate member through one or more distal fluid ports. The delivery site may be located adjacent to the distal portion of the elongate member or within an internal region of the elongate member, e.g., within a cavity or channel defined within an end effector. In some embodiments, the fluid may be delivered by ejection or injection from a distal fluid port located on an internal or periphery surface and may be delivered by any manner known in the art, such as by diffusion, gravity, or pressure, e.g., a pump, collapsible bladder, injector, etc. In one embodiment, the rate of delivery may be controlled, such as by ejection or release, from one or more fluid ports. Fluid ports may be located on, around, or within the device and may be positioned to disperse or reduce mist by application of fluids to the surgical field. 
     As introduced above, application of energy to target tissue may produce a smoke plume when the target tissue is cauterized or coagulated, for example. Such electrosurgical smoke may be hazardous because it may impede visibility and cause delay when a surgeon must wait for the smoke to dissipate before continuing a procedure. At present, third-party portable smoke evacuators and suction systems generally provide less than optimal relief from electrosurgical smoke because in order to reduce the smoke the surgeon must compromise the available surgical field. That is, the third-party evacuator and suction systems occupy a portion of the surgical field and thereby reduce the space available for instruments or medical devices in the surgical field. In addition to reducing access to target tissue, the reduction in the surgical field also inhibits maneuverability of instruments and devices. According to various embodiments, the fluid control system is configured to manage smoke produced by the operation of a medical device, e.g., evacuate or disperse the smoke produced from the application of energy. For example, for procedures where evacuation of a smoke plume is not required, the smoke may be redirected by using the fluid control system as previously described. In one embodiment, the fluid control system comprises an insufflation pump, source of compressed gas, or other gas source that may be used to provide a flow or stream of gas through the device and out of the one or more distal fluid ports to disperse or divert smoke away from the distal portion of the elongate member and the surgical field. 
     In addition to generation of steam and smoke, operation of a medical device also may present risk to adjacent tissue within the surgical field due to, for example, splay electricity and hot surfaces. When access is limited, it may be difficult to maneuver the medical device while also protecting surrounding tissue from damage due to thermal spread from accidental contact during or after use of the device. In various embodiments, a medical device may comprise or be integrated with a fluid control system comprising a protective sleeve. For example, one or more components or surfaces of the elongate member may be fitted with a cover, e.g., a sleeve positioned over on a shaft or end effector. In one embodiment, a fluid path element comprises a cover or sleeve that at least partially defines one or more fluid path channels. It is to be appreciated that various embodiments may include multiple of the above general configurations of the fluid control system. 
       FIG. 1  illustrates a medical device  2  configurable with a fluid control system  3  according to various embodiments. The medical device  2  comprises an elongate member  4  having a proximal portion  6  comprising a handle  7  coupled to a proximal end  9  of a shaft  10 . A distal portion  12  of the elongate member  4  comprises an end effector  13  coupled to a distal end  14  of the shaft  10 . The proximal portion  6  comprises a handle  17  operatively coupled to the end effector  13  via the shaft  10 . The end effector  13  comprises a first jaw  15   a  and a second jaw  15   b , each having an outer portion or surface  16   a ,  16   b . At least one of the first jaw  15   a  and the second jaw  15   b  is rotatably movable relative to the other along a path shown by arrow J to transition the jaws  15   a ,  15   b  between open and closed positions. In operation, the jaws  15   a ,  15   b  may be transitioned from the open position to a closed position to capture tissue therebetween. Captured tissue may contact one or more working portions of the jaw set, indicated generally as  17   a ,  17   b , configured to apply energy, e.g., bipolar energy, to treat target tissue. Similarly, the working portion  17   a ,  17   b  may comprise a knife extendable along the jaws  15   a ,  15   b  through a slot defined within a central region of the end effector  13  or jaws  15   a ,  15   b.    
     The handle  7  comprises a housing  18  defining a grip  19 . In various embodiments, the handle includes one or more control interfaces  20   a - c , e.g., a button or switch  20   a , rotation knob  20   b  rotatable along arrow R, and a trigger  20   c  movable relative to the grip  19  along arrow T, configured to provide operation instructions to the end effector  13 . The handle  7  is further configured to electrically couple to an energy source  21  to supply the medical device  2  with energy. While the energy source  21  is illustrated as generally coupled to the handle  7 , e.g., with a cord, it is to be understood that in some embodiments the energy source  21  may be positioned within the elongate member  4 . For example, in one embodiment, the energy source  21  comprises one or more direct current batteries positioned in the handle  7 , shaft  10 , or a portion thereof. 
     As introduced above, the medical device  2  includes or is configurable with the fluid control system  3  to control fluid, e.g., smoke, steam, or other fluid.  FIG. 2  shows a schematic of one embodiment of a fluid control system  3 . The fluid control system  3  includes a fluid path element  22  comprising one or more fluid paths  23 . The one or more fluid paths  23  may be fluidically coupled to one or more proximal fluid ports  24  and one or more distal fluid ports  25 . With further reference to  FIG. 1 , the one or more fluid paths  23  may extend along a portion of the shaft  10  and, in various embodiments, may further extend along the handle  7 , end effector  13 , or only along a portion of the end effector  13  or shaft  10 . In certain embodiments, the fluid paths  23  may be defined by lumens, lines, channels, voids, ducts, cavities, or tubing which may be externally or internally positioned relative to the handle  7 , shaft  10 , or end effector  13  or may be integrally formed within such components of the medical device  2 . For example, the fluid paths  23  may be integrated into the housing  18  of the handle  7 , shaft  10 , or end effector  13 , or may comprise fluid paths configured as accessory features such as a cover, mold, attachment, sleeve, coating, or the like, that may be positioned on or associated with the handle  7 , shaft  10 , or end effector  13 . 
     As introduced above, the fluid control system  3  may further comprise or be configured to fluidically couple to a fluid supply and transport element  28  comprising a supply component  30  and a transport component  31 . The supply component  30  is configured to supply or receive fluid from the fluid path element  22  and may comprise a fluid source to supply fluid to a fluid path element  23  or a fluid reservoir, which may comprise an environment external to the fluid path element  23  to receive fluid from the fluid path element  22 . The transport component  31  is configured to move fluid through the one or more fluid paths of the fluid path element  22 . In various embodiments, the transport component  31  is configured to move fluid passively through the fluid path element  23  via gravity or diffusion, for example, and thus may not comprise a physical structure. In various embodiments, the transport component  31  comprises a pump or pressure differential configured to actively move or transport fluid through the fluid path element  22 . For example, the transport component  31  may include a pressurized or compressed fluid supply or a pump to pressurize or compress the fluid supply. In one embodiment, the fluid supply system  3  includes a valve positioned between the supply component  30  and the fluid path element  22 . Fluid path through the valve may be controlled to control transport of fluid through the one or more fluid paths. For example, the transport component  31  may comprise or generate a pressure differential between two outlets of the valve such that fluid is motivated to flow through the valve when the valve is open. 
     As previously described, the one or more fluid paths  23  may be fluidically coupled to one or more proximal fluid ports  24  and one or more distal fluid ports  25 . The proximal fluid ports  24  may be positioned along the elongate member  4 , e.g., within or adjacent to the handle  7 , shaft  10 , or end effector  13 . The distal fluid ports  25  may be configured and positioned to deliver or intake fluid from the surgical field or tissue treatment site adjacent the distal portion  12  of the elongate member  4 , e.g., the distal end  14  of the shaft  10 , the end effector  13 , or working portion thereof  17   a ,  17   b.    
     The present description refers to the proximal fluid ports  24  and the distal fluid ports  25 . The terms proximal and distal are generally used herein to spatially describe embodiments from the perspective of a user of the device  2 . However, in regard to the proximal fluid ports  24  and the distal fluid ports  25  and associated fluid paths  23 , proximal and distal refer to the position of the fluid port  24 ,  25  or fluid paths  23  with respect to a working portion of the end effector. For example, a distal fluid port  24  is most proximate to the position steam or smoke may be evacuated from the surgical field. Thus, while it may generally be the case that the distal fluid ports  25  are distal to the proximal fluid ports  24  in regard to the elongate member  4  taken from the perspective of a user, in various embodiments, a proximal fluid port  24  may be positioned distally of a distal fluid port  25 , e.g., the end effector  13  may comprise a distal fluid port  25  at a proximal position of a jaw  15   a ,  15   b  and a proximal fluid port  24  at a distal portion of the jaw  15   a ,  15   b  to exhaust steam or smoke in a controlled or predictable manner. Thus, proximal and distal in this instance may refer to the extension of a fluid path element  23  relative to a region adjacent to the working portion of an end effector  13 , which may be taken to be the distal most portion of the end effector  13  or fluid path element  23 . For example, a fluid path element  23  may extend between a first end comprising a first fluid port and a second end comprising a second fluid port. The second fluid port may be positioned proximate to the working portion of the end effector to deliver fluid from the fluid path to a region adjacent to the working portion of the end effector  13  or thereby intake steam or smoke generated from the application of energy to the target tissue. The fluid path element  23  thus may extend proximally away from the second fluid port, or distal fluid port  25 , to the first fluid port, or proximal fluid port  24 , in the sense that the working portion is the distal most portion of the end effector  13  or fluid path element  23 . 
     In various embodiments, the fluid control system  3  includes or is configured to associate with an activation element  32 . The activation element  32  may be operatively coupled to the fluid supply and transport element  28  to activate the transport component  31  to, for example, provide power to a pump or to open a valve or port. In one embodiment, the activation element  32  comprises a switch electrically coupled to the energy source  21 . The switch may be associated with the elongate member  4 , e.g., the handle  7 , or may be operatively coupled to the elongate member  4 , such as a foot switch, to selectively activate the fluid control system  3 . In some embodiments, the activation element  32  comprises a movable mechanical component, such as a switch or actuator, configured to open a valve to allow fluid to be transported through the one or more fluid paths  23 . For example, the activation element  32  may include a switch or actuator operatively coupled to a piston or plunger that may be driven within or against a supply component  30  or fluid path element  23 . Pressure resulting from movement of the piston or plunger may induce fluid transport, thus, operating as a transport component  31  to push or pull fluid through the one or more fluid paths  23 . In one embodiment, the handle  7  includes a switch or actuator, which may be associated with the switch  20   a  or trigger  20   c , that is coupled to the energy source  21  or valve to activate transport of fluid through the one or more fluid paths  23 . In various embodiments, the activation element  32  may be configured to open a proximal fluid port  24  or a distal fluid port  25 . The power may be manual or electrical, e.g., activation of the energy source  21  to provide energy to the end effector  13  may further activate the fluid control system  3 . In one embodiment, the transport component  31  may, for example, comprise a bulb that may be squeezed to evacuate fluid from within the bulb or to expel or suction another fluid through one or more fluid paths  23 . In various embodiments, the activation element  32  may be coupled to a valve fluidically coupled to the supply component  30  or the fluid path element  23 . The activation element  32  may be configured to selectively operate the valve via an electrical or manual switch such that the valve may be opened or closed to control movement of fluid between the outlets of the valve. It is to be appreciated that the schematic provided in  FIG. 2  is a general depiction of the scheme of the fluid control system  3  and does not represent an exhaustive representation of all the possible relationships, associations, and couplings of the components and elements of the fluid control system  3 . For example, the transport component  31  or the supply component  30  may be connected or positioned at various locations within or relative to the one or more fluid paths  23  of the fluid path element  22 . For example, the transport component  31  may comprise a pump that is positioned inline with a fluid path element of the one or more fluid paths  23 , e.g., coupled to a proximal fluid port  24  of the one or more fluid paths  23 , or between a first fluid path element and a second fluid path element of the one or more fluid paths  23 . The supply component  30  may be connected or positioned inline with the same or different fluid path element  23  or may be positioned on either side of the first or second fluid path element. In various embodiments, the handle  7  may be configured to house or couple to one or more components or elements of the fluid control system  3 . For example, the handle  7  may comprise a proximal fluid port  24  configured to fluidically couple to a fluid supply component  30  or fluid transport component  31 , as previously described. The handle  7  also may be configured to operatively couple with an activation element  32  when present. 
     According to various embodiments, the activation element  32  may be configured to sequence activation of the fluid control system  3 , e.g., via activation of the fluid transport component  31  to transport fluid through the one or more fluid ports  23 , with an operation of the end effector  13 . The sequence may be before, after, substantially simultaneous or contemporaneous to the activation of energy or another operation of the end effector  13 , such as opening, clamping, or locking of jaws  15   a ,  15   b . In some embodiments, the fluid control system  3  is activated to perform one or more fluid control functions at multiple locations relative to the end effector  13 . These control functions may differ by location to provide customizable steam or smoke control. Activation of the fluid control system  3  to perform control functions may similarly be temporally controlled to occur at multiple time periods with respect to the operation of the end effector  13 . For example, the fluid control system  3  may be activated just prior to activation of energy to deliver or intake a fluid. In one embodiment, the fluid control system  3  may be further activated to deliver or intake the same or different fluid at a later time, such as during or after the activation of energy. As introduced above, the activation element may be configured to couple activation of fluid control system with activation of energy. As an example, in one embodiment, operation of the switch  20   a  or moving the trigger  20   c  along arrow “T” causes activation of the transport component  31 , e.g., activation of a pump or opening of a valve separating a pressure differential. Operation of the switch  20   a  or movement of the trigger  20   c  may provide a signal to a generator associated with the energy source  21  to activate energy and the fluid control system  3 . As previously described, activation of energy and fluid control functions may be sequenced to occur at different times and locations with respect to the operations of the end effector  13 . In certain embodiments, one or more sequences are preprogrammed in a memory module and selectable via user interface controls associated with the handle  7  or a generator. In one embodiment, the user may select or design one or more sequence programs before or during use to suit a desired use of the medical device  2 . 
     In various embodiments, the supply component  30  is configured to supply a gas, e.g., a biologically compatible or inert gas, that is transported through one or more fluid paths  23 . One or more distal fluid ports  25  may deliver the gas adjacent to the distal portion  12  of the elongate member  4 , e.g., distal end  14  of the shaft  10 , end effector  13 , or working portion thereof  17   a ,  17   b . In one embodiment, the fluid control system  3  is configured to produce a gas flow around the end effector  13  to disperse steam and, in some embodiments, absorb heat from the steam. For example, the gas may be delivered at a low temperature to blow cold gas at an increased rate around the end effector  13  to absorb heat from steam or cool surrounding tissue. In one form, the supply component  30  comprises a liquid that may be evaporated to provide a cold gas supply. For example, a gas source may comprise liquid CO 2  that is supplied from an insufflation gas source or external tank. As stated above, the gas flow may also disperse steam or smoke, which may increase visibility as well as avoid damage to adjacent tissue. 
     In various embodiments, the supply component  30  is configured to supply a liquid, e.g., which may be water, saline, or other biologically compatible liquid, that is transported through one or more fluid paths  23 . One or more distal fluid ports  25  may deliver the liquid adjacent to the distal portion  12  of the elongate member  4 , e.g., distal end  14  of the shaft  10 , end effector  13 , or working portion thereof  17   a ,  17   b . In certain embodiments, the liquid irrigates the adjacent tissue by, for example, providing liquid adjacent to the end effector  13 . The liquid may flush surrounding tissue to cool the tissue or condense steam. In some embodiments, irrigation of adjacent tissue may cool and protect the surrounding tissue from thermal damage. For example, the fluid control system  3  may be configured to deliver the liquid at a volume, rate, and location to form a protective liquid shield or thermal barrier between the steam generated from the application of energy and tissue. In these or other embodiments, the liquid may be delivered at a temperature configured to assist in condensing the steam to protect adjacent tissue. For example, a protective barrier provided by the liquid may thus capture steam generated by the cooking of target tissue and also cool surrounding tissues to keep the steam and plume from dispersing through and desiccating the surrounding tissue. 
     In various embodiments the fluid control system  22  is configured to deliver a fluid comprising a gas liquid mixture, e.g., a mist, adjacent to the distal portion  12  of the elongate member  4 , e.g., distal end  14  of the shaft  10 , end effector  13 , or working portion thereof  17   a ,  17   b . For example, the one or more fluid paths  23  may include a proximal fluid port  24  configured to couple to a supply component  30  and transport component  31 . The supply component  30  may comprise a liquid, which in certain embodiments may further include a gas. The transport component  31  may comprise a pump to push or pull the fluid through the one or more fluid paths  23  toward one or more distal fluid ports  25  or a valve operable to allow pressurized or compressed fluid from the supply component  30  to decompress and move through the one or more fluid paths  23 . In one embodiment, the one or more distal fluid ports  25  comprise a nozzle configured to produce a mist formed from a liquid and a gas. The mist may engulf the end effector  13  or portion thereof, e.g., an outer portion or surface  16   a ,  16   b  of the end effector  13 . Interaction of the mist with the steam generated from the heating of the target tissue may actively cool the steam and, therefore, reduce potential damage to adjacent tissue. The mist may also disperse or condense the steam. As previously described, the fluid control system  3  may be configured to spray the mist simultaneously with the activation of the end effector  13 , e.g., to coincide with application of energy, or other times associated with operations of the end effector  13 . 
     In one embodiment, the medical device  2  comprises a laparoscopic bi-polar device comprising an elongate member  4  including handle  7 , shaft  10 , cord to couple to a energy source  21 , and an end effector  13  for apposing tissue. The device  2  comprises or is equipped with a fluid control system  3  comprising one or more fluid paths  23  defined in a lumen of a fluid path element  22  that extends along the elongate member  4 . The one or more fluid paths  23  provide a path for fluid to travel between a proximal fluid port  24  and a distal fluid port  25 . The proximal fluid port  24  is configured to fluidically couple with a fluid supply and transport element  28  configured to supply and transport fluid through the one or more fluid paths  23 . For example, the proximal fluid port  24  may be coupled to a supply component  30  and transport component  31 , such as a fluid retention tank and a pump to affect the pressure of the supply component  30 , to enable fluid to travel distally through the one or more fluid paths  23 . The distal fluid port  25  may comprise a nozzle for creating a mist from the fluid, as previously described. A generator may be used to activate a power source to power the bi-polar device and subsequently simultaneously activate the pump, for example through the cord, to transport fluid through the fluid path element  23  defined by the lumen of the fluid path element  22  such that a misting is created when the fluid exits the distal fluid port  25  during the bi-polar activation. 
     Although generally described with respect to an end effector comprising collapsible jaws configured to apply energy, e.g., bipolar energy, to target tissue, e.g., an ultrasonic or bi-polar device configured to seal, bond, weld, separate, cut, ablate, etc. target tissue, those having skill in the art will recognize that the present disclosure may be broadly applicable to other medical devices and end effector configurations. With this in mind, for clarity and ease of understanding, the following description of the embodiments uses like identifiers for similar features and, thus, specific features may not necessarily be described in detail with respect to every embodiment. Similarly, various embodiments are described in reference to figures illustrating a distal portion of an elongate member of a medical device. It is to be understood that a corresponding proximal portion may be configured as otherwise described for other embodiments, e.g., as generally previously described. Additionally, it is to be understood that, unless stated otherwise, the embodiments depicting fluid paths and fluid ports associated with a portion of an end effector, e.g., a first jaw or side of a first jaw or a second jaw, may also include similar fluid paths and fluid ports associated with another portion of the end effector, e.g., a second jaw or other side of the first jaw or second jaw. 
       FIGS. 3A and 3B  illustrate one embodiment of a distal portion  112  of an elongate member  104  of a medical device comprising a fluid control system  103 . The elongate member  104  comprises a shaft  110  having a distal end  114  coupled to an end effector  113 . The end effector  113  comprises first and second jaws  115   a ,  115   b  configured to apply energy, e.g., bipolar energy, to target tissue positioned along working portions  117   a ,  117   b . Similarly, the working portion  117   a ,  117   b  may comprise a knife extendable along the jaws  115   a ,  115   b  through a slot defined within a central region of the end effector  113  or jaws  115   a ,  115   b . One or more fluid paths  123   a ,  123   b  extend along at least a portion of the shaft  110 . In various embodiments, the fluid paths  123   a ,  123   b  may extend further along a handle (not shown) of the medical device. The fluid paths  123   a ,  123   b  may be defined by lumens, lines, channels, voids, cavities, or tubing, which may include lines or tubing  134   a ,  134   b  positioned along the shaft  110  and/or may be integrally formed within the shaft  110  or other component of the medical device. As such, fluid may be transported through the fluid paths  123   a ,  123   b  via exterior lines or tubing  134   a ,  134   b  in an open environment. The lines or tubing  134   a ,  134   b  may be coupled to components of the elongate member  104  at one or more points.  FIGS. 4A and 4B  illustrate one embodiment of a distal portion  112 ′ of an elongate member  104 ′ of a medical device comprising a fluid control system  103 ′. This embodiment is similar to the embodiment previously described with respect to  FIGS. 3A and 3B  except the one or more fluid paths  123   a ′,  123   b ′ extend along at least a portion of the shaft  110 ′ and are further designed to be flush with an outer circumference of the shaft  110 ′. Thus, the shaft  110 ′ may comprise various cross-sections, which may be uniform along its length or irregular.  FIGS. 5A and 5B  illustrate another embodiment of a distal portion  112 ″ of an elongate member  104 ″ of a medical device comprising a fluid control system  103 ″. This embodiment is similar to the embodiments of  FIGS. 3A-4B  except the one or more fluid paths  123   a ″,  123   b ″ extend internally through the shaft  110 ″ proximally and protrude outward of the shaft  110 ″ distally to form protruding distal fluid ports  125   a ″,  125   b ″ positioned at the distal end  114 ″ of the shaft  110 ′″. The fluid paths  123   a ′,  123   b ′,  123   a ″,  123   b ″ may be defined by channels, lumens, voids, lines, tubing, ducts, or cavities within the shaft  110 ′ or may integrally formed within the various components of the medical device. For example, in one embodiment, components within the shaft  110 ′,  110 ″ are arranged such that a series of voids or cavities between components within the shaft may be used to provide one or more fluid paths  123   a ′,  123   b ′,  123   a ″,  123   b ″. It is to be appreciated that the angle, number, cross-section, arrangement, and position of the distal fluid ports  125   a ,  125   b ,  125   a ′,  125   b ′,  125   a ″,  125   b ″ may be varied to suit particular applications and end effectors. For example, the angle and position may be such that fluid delivered from the fluid control system  103 ,  103 ′,  103 ″ forms a fluid barrier or wall along the outer portion or surface  116   a ,  116   b ,  116   a ′,  116   b ′,  116   a ″,  116   b ″ of the end effector  113 ,  113 ′,  113 ″. The number and cross-section may similarly be increased or decreased to provide greater or more defined fluid path at one or more points. 
     The distal fluid ports  125   a ,  125   b ,  125   a ′,  125   b ′,  125   a ″,  125   b ″ illustrated in  FIGS. 3A-5B  are positioned to deliver or intake fluid from a surgical field adjacent to the distal portion  112 ,  112 ′,  112 ″ of the elongate member  104 ,  104 ′,  104 ″, e.g., the distal end of the shaft  110 ,  110 ′,  110 ″, the end effector  113 ,  113 ′,  113 ″, or working portion thereof  117   a ,  117   b ,  117   a ′,  117   b ′,  117   a ″,  117   b ″. In particular, the distal fluid ports  125   a ,  125   b ,  125   a ′,  125   b ′,  125   a ″,  125   b ″ are arranged on either side of the end effector  113 ,  113 ′,  113 ″, proximal to working portions  117   a ,  117   b ,  117   a ′,  117   b ′,  117   a ″,  117   b ″, and are positioned intermediate the first and second jaws  115   a ,  115   b ,  115   a ′,  115   b ″,  115   a ′,  115   b ″ where fluid, such as steam or smoke, for example, is most likely to be produced or released during application of energy to the target tissue. Thus, the distal fluid ports  125   a ,  125   b ,  125   a ′,  125   b ′,  125   a ″,  125   b ″ may comprise various configurations which may, for example, complement a configuration or operation of the end effector  113 ,  113 ′,  113 ″. As previously described, the one or more fluid paths  123   a ,  123   b ,  123   a ′,  123   b ′,  123   a ″,  123   b ″ may be configured to couple to fluid supply and transport system elements such as a supply component and a transport component, which may be further associated with an activation element. It is to be appreciated that fluid paths  123   a ,  123   b ,  123   a ′,  123   b ′,  123   a ″,  123   b ″ may be separate fluid paths, e.g., comprise at least partially independent paths for fluid or may comprise a primary or common fluid path with one or more branches into secondary or tertiary fluid paths that extend to one or more distal fluid ports  125   a ,  125   b ,  125   a ′,  125   b ′,  125   a ″,  125   b ″, as described in more detail below. 
       FIG. 6  illustrates an operation of the fluid control system  103 ′ illustrated in figure  FIGS. 4A and 4B  according to one embodiment. In various embodiments, a same or similar operation may be applicable to the configurations shown in  FIGS. 3A and 3B  and  FIGS. 5A and 5B . The first jaw  115   a ′ and second jaw  115   b ′ of the end effector  113 ′ are shown in a closed position having target tissue  135  positioned intermediate working portions  117   a ′ and  117   b ′ (not visible). The fluid path  123   a ′ is configured to fluidically couple with a supply component and transport component, which may be further associated with an activation element, as previously described. The distal fluid port  125   a ′ is positioned at the distal end  114 ′ of the shaft  110 ′, adjacent to the end effector  113 ′. When the fluid control system  103 ′ is activated, fluid is transported through the fluid path  123   a  and delivered to the surgical field as generally depicted by arrows  140   a ,  140   b  at the distal fluid port  125   a ′. As previously described, the fluid may be a gas, liquid, or mixture thereof and may be delivered adjacent to the distal portion  112 ′ of the elongate member  104 ′, e.g., the distal end of the shaft  114 ′, the end effector  113 ′, or a working portion thereof  117   a ′,  117   b ′. The fluid may be delivered at a temperature, rate, and pattern configured to disperse the fluid, e.g., steam or smoke, or absorb heat from the fluid. 
     In some embodiments, the fluid path element may be configured to provide a protective shield. For example, fluid may wrap around the end effector  113 ′ or create a fluid wall, e.g., a cylindrical wall, around the outer portion or surface  116   a ′ of the end effector  113 ′, between steam or smoke and adjacent tissue  136 , as previously described. In one embodiment, the fluid control system  103 ′ is configured to activate at times and locations corresponding to operations of the end effector  113 ′. For example, in one embodiment, the fluid control system  103 ′ is configured to deliver fluid upon activation of energy or sequence delivery of fluid with multiple operations of the end effector  113 ′. In this way, a protective barrier may be formed with the fluid to capture the steam produced by the application of energy to target tissue, e.g., cauterization of the target tissue  135  to be apposed. For example, liquid may be delivered or begin to be delivered when the end effector  113 ′ begins to apply energy that is transferred to target tissue  135 , as previously described. In one embodiment, compression of target tissue  135  intermediate the jaws  115   a ′,  115   b ′ occurs before liquid and energy are delivered to the target tissue  135 , therefore, the target tissue  135  may be energized without interference from the liquid. While not visible in  FIG. 6 , in certain embodiments, fluid may similarly be transported through the fluid path  123   b ′ and delivered to the surgical field at the distal fluid port  125   b ′ to control steam or smoke as previously described with respect to the fluid path element  123   a ′ and the distal fluid port  125   a ′. In this or another embodiment, the fluid control system  103 ′ may be configured to suction steam or smoke generated from the application of energy to target tissue  135  away from the adjacent tissue  136 . For example, the transport component may be configured to generate negative pressure or a vacuum within the one or more fluid paths  123   a ′,  123   b ′ to suction steam or smoke through the distal fluid ports  125   a ′,  125   b ′ away from the adjacent or surrounding tissue, e.g., in the direction opposite arrows  140   a ,  140   b . In such embodiments, the distal fluid ports  125   a ,  125   b  may be shaped and positioned to preferentially pull steam or smoke from on or more regions of the surgical field, e.g., adjacent to the working portions  117   a ′,  117   b ′ of the end effector  113 . 
       FIG. 7  illustrates one embodiment of a configuration of a fluid path element  222  comprising one or more fluid paths  223  for use in a fluid control system according to various embodiments. A first fluid path element  223   a  is fluidically coupled to a second fluid path element  223   b  and a third fluid path element  223   c  via an intermediate fluid port  226 . The first fluid path element  223   a  diverges or branches into the second fluid path element  223   b  and third fluid path element  223   c . The second fluid path element  223   b  and the third fluid path element  223   c  similarly converge into the first fluid path element  223   a . In various embodiments, the one or more fluid paths  223  may extend along an elongate member. For example, the configuration of the one or more fluid paths  223  illustrated in  FIG. 7  may be similar to the configuration of the one or more fluid paths in the embodiments depicted in  FIGS. 3A-6 . The one or more fluid paths  223  may be fluidically coupled to a proximal fluid port  224  configured to fluidically couple to a fluid supply and transport element, which may be operatively coupled to an activation element, as previously described. The one or more fluid paths  223  further comprise distal delivery ports  225   a ,  225   b  configured to deliver or intake fluid. 
     In various embodiments, referring to  FIG. 8 , a fluid path element  322  comprises one or more fluid paths  323  fluidically coupled to multiple distal fluid ports  325   a - 325   j . For example, a first fluid path  323   a  is shown diverging or branching into a second fluid path element  323   b  and third fluid path element  323   c , which similarly converge into the first fluid path element  323   a , via an intermediate fluid port  326  fluidically coupling the fluid paths  323   a - 323   c . In various embodiments, the one or more fluid paths  323  extend along an elongate member. For example, the second fluid path element  323   b  may extend along a first portion of an end effector, e.g., a first jaw or first side, and the third fluid path element  323   c  may extend along a second portion of the end effector, e.g., a second jaw or second side. As previously described, the fluid paths  223 ,  323  may be defined by lumens, lines, channels, voids, ducts, cavities, or tubing located within the shaft, end effector or associated tubing, lines, molds, sleeves, or covers, for example, or may be or integrally formed therein. A proximal end of the one or more fluid paths  323  may comprise a proximal fluid port  324  configured to fluidically couple to a fluid supply and transport element, which may be operatively coupled to an activation element, as described herein. 
     Referring to  FIG. 9 , in one embodiment, a fluid path element  2222  may comprise one or more fluid paths  2223  that extend along a shaft  2210  and an end effector  2213  of an elongate member  2204 . The one or more fluid paths  2223  define a y-configuration, e.g., similar to that depicted in  FIG. 8 , and comprise a first fluid path or element  2222   a  defining a first fluid path  2223   a  that extends along the shaft  2210 . The first fluid path element  2222   a  diverges distally to branch into a second fluid path element  2222   b  defining a second fluid path  2223   b  and a third fluid path element  2222   c  defining a third fluid path  2223   b , which similarly converge into the first fluid path element  2222   a  and first fluid path  2223   a  proximally, via an intermediate fluid port  2226  fluidically coupling the fluid paths  2223   a - 2223   b . The first fluid path  2223   a  may extend through the shaft  2210  and the first fluid path element  2222   a  may comprise tubing, a channel, or a cavity, for example. The first fluid path element  2222   a  further may comprise a proximal fluid port (not shown) configured to fluidically couple, e.g., via a coupling to an additional fluid path element, to additional components of the fluid control system  2203 , such as a fluid and transport element, which may be operatively coupled to an activation element, as described herein. For example, the shaft  2210  or an additional fluid path may comprise a fitting to couple the first fluid path element  2222   a  with the additional fluid path element. The second fluid path element  2222   b  and the third fluid path element  2222   c  are respectively positioned to extend along the first and second jaws  2215   a ,  2215   b  and each comprises one or more distal fluid ports  2225   a - 2225   j  positioned therealong. Specifically, the distal fluid ports  2225   a - 2225   j  are positioned adjacent the distal portion  2212  of the elongate member  2204 , e.g., along an outer portion or surface  2216   a ,  2216   b  of the end effector  2213  or working portion thereof  2217   a ,  2217   b . The distal fluid ports  2225   a - 2225   j  are positioned to provide delivery of fluid outward or away from the jaws  2215   a ,  2215   b  or to intake fluid, e.g., steam or smoke, inward or toward the jaws into the respective fluid paths  2223   b ,  2223   c . As such, the distal fluid ports  2225   a - 2225   j  may be arranged in various configurations which may, for example, complement a configuration or operation of the end effector  2213 . In this way, a fluid or vacuum may be provided proximate the regions steam or smoke is likely to be generated or escape the jaws  2215   a ,  2215   b . While not shown in  FIG. 9 , the elongate member  2204  may include similarly configured fluid paths defining fluid paths and distal fluid ports on the adjoining sides of the jaws  2215   a ,  2215   b , which may or may not be fluidically coupled to the first, second, and third fluid paths  2223   a - 2223   b.    
       FIG. 10  illustrates a cross-section of one embodiment of a fluid path element  422  of a fluid control system comprising one or more fluid paths integral to a jaw  415  of an end effector. One or more fluid paths  423  are defined, e.g., integrally formed, within a portion  415  of the end effector  413 , such as a jaw  415  of a bi-polar device. A proximal end of the one or more fluid paths  423  comprises a proximal fluid port  424  configured to fluidically couple to fluid supply and transport system elements, which may be operatively coupled to an activation element, as described herein. The one or more fluid paths  423  further include one or more distal fluid ports  425   a - 425   j  positioned therealong to deliver or intake fluid. 
       FIG. 11  illustrates a configuration of a fluid path element  522  comprising a cover  540 , which may be a mold or sleeve, which may comprise a rubber, polymer, or biocompatible material, e.g., thermoset or thermoplastic polymer, silica, silicone, neoprene, etc. The cover  540  is configured to be positioned on the end effector and comprises a proximal fluid port  524  configured to fluidically couple to a fluid supply and transport element, which may be operatively coupled to an activation element, as described herein. The cover  540  may define one or more fluid paths independently, e.g., define a cavity, bladder, or other hollow portion for fluid to travel, or in conjunction with a surface or portion of the end effector, e.g., a fluid path may be defined between the cover  540  and a surface of the end effector. The cover  540  further defines one or more distal fluid ports  525   a - 525   e  configured to deliver or intake fluid. While not visible, a corresponding side of the cover  540  may comprise similar features as those illustrated with respect to the visible side. 
       FIG. 12  illustrates a distal portion  612  of an elongate member  604  of a medical device comprising a fluid control system  603  according to various embodiments. The elongate member  604  comprises a shaft  610  having a distal end  614  coupled to an end effector  613 . The end effector comprises first and second jaws  615   a ,  615   b  configured to apply energy, e.g., bipolar energy, to tissue along working portions  617   a ,  617   b . The fluid control system  603  comprises a fluid path element comprising one or more fluid paths, however, only corresponding distal fluid ports  625   a - 625   j  are visible in the perspective view shown. The one or more fluid paths may be configured internally to the first jaw  615   a  and second jaw  615   b , as illustrated in  FIG. 10 , or may be defined by a cover, e.g., mold or sleeve, as illustrated in  FIG. 11 . Distal fluid ports  625   a - 625   e  may be coupled to the same or different fluid paths, which may be the same or different fluid paths  623   b  coupled to distal fluid ports  625   f - 625   j . In various embodiments, combinations of the one or more fluid paths may be independent or fluidically coupled to a common fluid path element. Distal fluid ports  625   a - 625   j  are positioned adjacent to the distal portion  612  of the elongate member  604 , e.g., along an outer portion or surface  616   a ,  616   b  of the end effector  613  or working portion thereof  617   a ,  617   b . The distal fluid ports  625   a - 625   j  are positioned to deliver of fluid outwardly or away from the jaws  615   a ,  615   b  or to intake fluid, including steam or smoke, inwardly or toward the jaws  615   a ,  615   b  into the one or more fluid paths. As such, the distal fluid ports  625   a - 625   j  may be arranged in various configurations which may, for example, complement the configuration or operation of the end effector  613 . In this way a fluid or vacuum may be provided proximate the regions where steam or smoke is likely to be generated or escape the jaws  615   a ,  615   b . While not shown in  FIG. 12 , the fluid control system  603  may include similarly configured fluid paths and distal fluid ports on the adjoining sides of the jaws  615   a ,  615   b.    
       FIG. 13  illustrates a medical device  702  comprising a fluid control system  703  according to various embodiments. The medical device  702  comprises an elongate member  704  having a proximal portion  706  comprising a handle  707  that is coupled to a proximal end  709  of a shaft  710  and a distal portion  712  comprising an end effector  713  coupled to a distal end  714  of the shaft  710 . The end effector  713  comprises a first jaw  715   a  and a second jaw  715   b , each having an outer portion or surface  716   a ,  716   b . In operation, tissue may be captured intermediate the jaws  715   a ,  715   b  and energy may be applied to the tissue along working portions  717   a ,  717   b  to treat, e.g., cook, target tissue. The handle  707  comprises a housing  718  defining a grip  719  and includes one or more control interfaces  720   a - c , e.g., a switch  720   a , rotation knob  720   b , and a trigger  720   c  movable relative to the grip  719  along arrow “T′”, configured to provide operational instructions to the end effector  713 . The handle  707  is further configured to electrically couple with a power source at fitting  748  to provide energy to the end effector  713 . In other embodiments, however, handle  707  may include a power source in addition to or instead of fitting  748 . 
     Although only the corresponding distal fluid ports  725   a ,  725   b ,  725   c  are visible in the perspective view shown in  FIG. 13 , the fluid control system  703  includes a fluid path element, which may be defined by lumens, lines, channels, voids, ducts, cavities, or tubing which may be externally or internally located within the medical device or integrally formed within the medical device. As previously described, the fluid control system  703  is fluidically coupled to the fluid path element, which is fluidically coupled to a fluid supply and transport element, which may be operatively coupled to an activation element, as described herein. For example, in this and other embodiments, a supply component comprising a fluid source or a reservoir, e.g., an environment to receive or exhaust fluid, may include or be fluidically coupled to a transport component. That is, the supply component may comprise an external environment to exhaust fluid, including steam or smoke, from the one or more fluid paths. The transport component may apply a negative pressure associated with the external environment, representing a pressure differential with the one or more fluid paths to provide a vacuum to pull the fluid. In another embodiment, the supply component may include a fluid supply comprising a transport component such as a pressurized tank containing a compressed fluid representing a pressure differential with a fluid path or external environment. The pressure differential may be exploited to move or transport the fluid, including steam or smoke, through the one or more fluid paths. As previously discussed, an activation element may be operatively coupled to initiate transport of fluid via operation of a valve or activation of the pump. In various embodiments, the pump may be positioned in the handle  707 , shaft  710 , or end effector  713 , to push or pull fluid through the one or more fluid paths. For example, a user may provide a control or operation instruction to the transport component, e.g., via actuation of the trigger  720   c  or other control interface associated with the fluid control system. The control or operation instruction may send mechanical or electrical signals to activate or deactivate the fluid supply and transport element. For example, the control instruction may initiate an activation sequence that may be temporally or spatially varied with respect to the dimensions and operation of the end effector  713 . As noted with other embodiments previously described, in various embodiments, the activation element may be coupled to activation of energy. The activation element may also comprise a mechanical activation mechanism such as a manual pump or a piston or plunger that is driven by the user to mechanically activate fluid path to transport fluid through the one or more fluid paths. 
     In the embodiment illustrated in  FIG. 13 , the handle  707  comprises a fitting  750  configured to fluidically couple to a fluid supply and transport element. For example, an external fluid source to provide fluid to the one or more fluid paths or a fluid reservoir into which steam or smoke may be exhausted. Similarly, the fitting  750  may be configured to couple to a pump to transport the fluid through the one or more fluid paths. The distal fluid ports  725   a ,  725   b  are positioned at a distal end  714  of the shaft  710  to deliver or intake fluid adjacent to the distal portion  712  of the elongate shaft. While the distal fluid ports  725   a ,  725   b  are shown as having outward oriented rectangular cross-sections that are flush with the shaft  710 , in various embodiments the distal fluid ports  725   a ,  725   b  may be arranged and oriented in other configurations. Distal fluid port  725   c  is positioned between the first and second jaws  715   a ,  715   b  to deliver or intake fluid adjacent to the distal portion  712  of the elongate member  704 . 
     The end effector  713  defines a channel fluidically coupled to one or more fluid paths extending along the shaft  710 . In various embodiments, the channel may be a channel used exclusively as a fluid path or distal fluid port  725   a ,  725   b ,  725   c  or may be a channel used as a fluid path and distal fluid port  725   a ,  725   b ,  725   c  as well as having additional functions related to the operation of the end effector  713 . For example, in  FIG. 13 , distal fluid port  725   c  is defined by a slot  749  configured to receive a cutting element, such as a knife or blade, for example, where the cutting element is movable within the slot  749  along the first and second jaws  715   a ,  715   b . In various embodiments, the knife slot  749  may further extend distally along a channel extending through central portions of the end effector  713 , which may comprise a fluid path comprising distal fluid ports positioned adjacent to the working portion  717   a ,  717   b  of the end effector  713 . In one embodiment, the one or more fluid paths may be provided within the medical device or may be formed integrally therewith and are defined by lumens, lines, channels, voids, ducts, cavities, or tubing extending through the shaft  710  comprising a series of voids positioned between components of the shaft  710 . In various embodiments where fluid paths are defined within channels, cavities, or voids of the handle, shaft, or end effector, covers, films, or coatings may be used to protect the components of the elongate member from damage caused by contact with moisture laden steam or smoke, for example, when the fluid control system  703  is configured to eject a liquid or mist or intake smoke or moisture within the one or more fluid paths at the one or more distal fluid ports  725   a ,  725   b ,  725   c.    
     In one embodiment, the one or more fluid paths and corresponding fluid ports  725   a ,  725   b ,  725   c  may comprise multiple independent fluid paths that may be configured to fluidically couple to independent fluid sources. For example, a first fluid path element corresponds to a first fluid port, e.g., distal fluid port  725   a  or  725   b , and a second fluid path element corresponds to a second fluid port, e.g., distal fluid port  725   c . The first and second fluid paths may be independently defined and respectively coupled to first and second supply components, e.g., within handle  707  or through fitting  748 . The first supply component may comprise a fluid source comprising fluid that may be transported through the first fluid path element and delivered to the surgical field adjacent the distal portion  712  of the elongate member  704 . The second supply component may comprise a fluid reservoir configured to receive or exhaust fluid that is pulled from the surgical field, e.g., from between the first and second jaws  715   a ,  715   b  at the distal fluid port  725   c , through the second fluid path element. As previously described, the fluid control system may include an activation element configured to provide selective activation for sequencing of the one or more operations of the fluid control system  703 . 
     In various embodiments, referring to  FIG. 14 , a fluid control system  803  is shown that comprises a fluid path element wherein the shaft  810  comprises a cover  851  comprising a sleeve  852  defining one or more fluid paths, and corresponding distal fluid ports  825 , which are visible in the perspective view shown. The illustrated embodiment shows a distal portion  812  of an elongate member  804  of a medical device. The elongate member  804  comprises a shaft  810  having a distal end  814  coupled to an end effector  813 . The end effector  813  comprises first and second jaws  815   a ,  815   b  configured to apply energy, e.g., bipolar energy, along working portions  817   a ,  817   b . The working portion  817   a ,  817   b  also includes a knife extendable along the jaws  815   a ,  815   b  through a slot  849   a ,  849   b  defined within a central region of the end effector  813  or jaws  815   a ,  815   b  The sleeve  852  defines a lumen  854  configured to receive or be positioned over a surface  856  of the shaft  810 . For example, in one embodiment, the sleeve may be built into the shaft  810 . In another embodiment, the sleeve  852  may be added to or optionally removed from the shaft  810  by sliding or positioning the sleeve  852  over the shaft  810 . In various embodiments, the sleeve  852  may be formed of a biocompatible material. In one embodiment, the sleeve  852  comprises an elastomeric material such as a rubber, polymer, or biocompatible material, e.g., thermoset or thermoplastic polymer, silica, silicone, neoprene, etc. As an example, the sleeve  825  may be extruded or molded with fluid paths  825  defined therein. In various embodiments, the sleeve  852  may be configured to be thermally conductive, e.g., to assist in cooling the surgical field, or may be thermally insulative to prevent heat from the shaft  810  or end effector  813  from conducting to tissue. 
     The one or more fluid paths extend distally along the shaft  810  to one or more distal fluid ports  825  positioned adjacent the distal end  812  of the elongate member. While not shown, the one or more fluid paths may define proximal fluid ports fluidically coupled to a handle. The distal fluid ports  825  are positioned to deliver to or intake fluid from the surgical field. For example,  FIG. 14  illustrates a steam or smoke control operation of the fluid control system  803 . The steam or smoke control operation includes dispersing steam or smoke  45  within the surgical field. In this example, a gas is used as the fluid, however, other fluids may be used. The gas is delivered from the distal fluid ports  825  to produce a gas flow, as generally indicated by arrows G1, G2, and G3, distally toward the end effector  813 . The gas flow may be delivered in a direction or at a rate or temperature configured to disperse, condense, or cool steam or smoke  45 . The gas flow also may protect or cool tissue adjacent the target tissue. Notably, activation of the fluid control system  803  may be sequenced as previously described to occur at various times or locations during the operation of the end effector  813 . Therefore, while the jaws  815   a ,  815   b  are illustrated in the open position, in various embodiments, the fluid control system  803  will be activated when the jaws  815   a ,  815   b  are closed and may not activate when the jaws  815   a ,  815   b  are open. Similarly, in various embodiments, the fluid control system  803  may be configured to intake steam or smoke into the one or more fluid paths  825  to clear the surgical field. 
       FIGS. 15A-15D  illustrate cross-sectional views of fluid paths  822   a - 822   d  that include covers  851   a - 851   d  comprising sleeves  852   a - 852   d  having various configurations of fluid paths  823   a - 823   s  according to various embodiments. The sleeves  852   a - 852   d  may be similar to the sleeve  852  illustrated in  FIG. 14  and  FIGS. 16 and 17 , described below. Each sleeve  852   a - 852   d  defines a lumen  854   a - 854   d  configured to receive or be positioned on a surface of a shaft such that the sleeve  852   a - 852   d  may be positionable along an elongate member. Each sleeve  852   a - 852   d  further defines one or more fluid paths  823   a - 823   s  that extend along a portion of its length. 
     In  FIG. 15A  the sleeve  852   a  defines a plurality of fluid paths  823   a - 823   i  having generally circular cross-sections. The fluid paths  823   a - 823   i  are arranged about a circumference or perimeter of the sleeve  852   a  and are spaced apart at similar intervals. As introduced above, the number, position, arrangement, and cross-sectional size and shape of the one or more fluid paths may vary, e.g. in consideration of the fluid transported or operation or dimensions of an end effector. The sleeve  852   b  illustrated in  FIG. 15B  defines four fluid paths  823   j - 823   m  having generally arcuate cross-sections arranged about the circumference sleeve. The cross-sectional area of each fluid path element  823   j - 823   m  is larger than the cross-sectional area of each of the fluid paths  823   a - 823   d  defined by the sleeve  852   a . For example, the fluid paths  823   j - 823   m  may be configured to transport an increased volume of fluid through each of the fluid paths  823   j - 823   m . It is to be appreciated that one or more of the fluid paths  823   a - 823   s  may similarly merge or branch out to define fewer or additional fluid paths having larger or reduced volumes along a portion of the length of the sleeve  852   a - 852   d . The sleeve  852   c  illustrated in  FIG. 15C  defines two fluid paths  823   n ,  823   o . The fluid paths  823   n ,  823   o  comprise arcuate or crescent cross-sections arranged about the circumference or perimeter of the sleeve  852   c . The cross-sectional area of the fluid paths  823   n ,  823   o  may be larger than the cross-sectional areas of the fluid paths  823   a - 823   m . In various embodiments, sleeves may define one or more first fluid paths defining a first cross-sectional shape and area and one or more second fluid paths defining a second cross-sectional shape and area. For example, the sleeve  852   d  illustrated in  FIG. 15D  defines two generally opposed first fluid paths  823   p ,  823   r  comprising arcuate crescent shaped cross-sections having a first cross-sectional area and two generally opposed second fluid paths  823   q ,  823   s  comprising arcuate circular cross-sections having a second cross-sectional area different than the first. As previously described, one or more fluid paths may be independent, e.g., comprise separate fluid paths extending from a proximal fluid port to a distal fluid port. While not shown, in certain embodiments, multiple fluid ports may be stacked along a radius of the sleeve. It is to be appreciated that sleeves may also comprise regular or irregular cross-sections, which may correspond to an arrangement of fluid paths, a dimension of an end effector, or an operation of an end effector. 
       FIGS. 16 and 17  illustrate two embodiments of medical devices  902 ,  1002  comprising fluid control systems  903 ,  1003 . The medical devices  902 ,  1002  comprise elongate members  904 ,  1004  comprising fluid control systems  903 ,  1003  according to various embodiments. Features of the handle  907 ,  1007  and end effector  913 ,  1013  may be similar in general structure or concept to features previously described with respect to other embodiments and, therefore, have been identified with like numbers and will not be described again. The fluid control systems  903 ,  1003  of the illustrated embodiments comprise fluid path elements  922 ,  1022  including covers  951 ,  1051  comprising sleeves  952 ,  1052 . In particular, the sleeves  952 ,  1052  define one or more fluid paths  923 ,  1023  defining one or more proximal fluid ports  924 ,  1024   a ,  1024   b  and one or more distal fluid ports  925 ,  1025 . The one or more distal fluid ports  925 ,  1025  may be similar to those previously described with respect to  FIGS. 14-15 . The one or more proximal fluid ports  924 ,  1024   a ,  1024   b  may comprise one or more fittings  950 ,  1050   a ,  1050   b  extending from the sleeve  952 ,  1052 . The fittings  950 ,  1050   a ,  1050   b  are configured to fluidically couple to fluid supply and transport elements, which may be associated with an activation element, as described herein. For example, the sleeve  952  illustrated in  FIG. 16  comprises a proximal fluid port  924  configured to fluidically couple to a supply component, e.g., an external fluid source or fluid reservoir configured to evacuate or exhaust fluid. In one such embodiment, the proximal fluid port  924  comprises fitting  950  configured to couple to an insufflation gas source. In operation, activation of the insufflation gas source by the activation element, e.g., via a control signal initiated by the user, provides gas to the one or more fluid paths  923  that is transported distally to the one or more distal fluid ports  925  to mitigate steam or smoke damage to adjacent tissue. The sleeve  1052  illustrated in  FIG. 17  comprises two proximal fluid ports  1024   a ,  1024   b , each configured to fluidically couple to a supply component, e.g., an external fluid source or fluid reservoir configured to evacuate or exhaust fluid. In one such embodiment, the first proximal fluid port  1024   a  comprises fitting  1050   a  configured to couple to an insufflation gas source and the second proximal fluid port  1024   b  comprises a fitting  1050   b  configured to couple to an additional fluid source, e.g., source for liquid saline. As previously described, the one or more fluid paths  923 ,  1023  may be independent or coupled. In operation, fluid such as a gas, liquid, or mist may be supplied to one or more fluid paths  923 ,  1023  and delivered to the surgical field at one or more distal fluid ports  925 ,  1025  positioned adjacent to the distal portion of the elongate member  904 ,  1004 . The end effector  913 ,  1013  may be surrounded by the fluid, e.g., enveloped within a fluid layer. For example, the fluid paths  923 ,  1023  may be provided with a liquid that is ejected from the sleeve  952 ,  1052  at one or more distal fluid ports  925 ,  1025  to provide a liquid wall or tube around the end effector  913 ,  1013 . In one embodiment, negative pressure or vacuum may be provided by a transport component, which may be fluidically coupled to the supply component, such that a vacuum applied around the end effector  913 ,  1013  to intake steam or smoke adjacent to the distal portion of the elongate member  904 ,  1004 . In various embodiments, the shaft  910 ,  1010  may further comprise a seal positioned between surface  956 ,  1056  that underlies the sleeve  952 ,  1052  and a surface of the sleeve  952 ,  1052 , e.g., the inner circumference of a lumen similar to lumens  854 - 854   d , to prevent fluid from leaking from the sleeve  952 ,  1052 . For example, an o-ring or sealant may be positioned between the surface  826  and the inner circumference or beneath a proximal portion of the sleeve  952 ,  1052 . 
     In various embodiments, a fluid control system includes a fluid path element comprising one or more fluid paths internal to or at least partially defined by the end effector, e.g., as illustrated in  FIGS. 10 ,  12 , and  13 .  FIG. 18  illustrates another embodiment of a fluid path element comprising one or more fluid paths integral to or defined within an end effector. Specifically,  FIG. 18  illustrates a perspective view in cross-section of an end effector  1113  defining one or more fluid paths  1123   a - 1123   d  for use as a fluid path element of a fluid control system according to various embodiments. The end effector  1113  comprises a first jaw  1115   a  and a second jaw  1115   b  having outer portions or surfaces of the  1116   a ,  1116   b  and working portions  1117   a ,  1117   b . Working portions  1117   a ,  1117   b  are illustrated as including electrodes  1178   a - 1178   d  and knife slot  1149   a ,  1149   b . Extensions  1155   a - 1155   d  of outer portions or surfaces  1116   a ,  1116   b , which may comprise a cover positioned on the end effector  1113 , extend outward of the end effector  1113  to form a channel or cavity defining one or more fluid paths  1123   a - 1123   d  adjacent to the working portions  1117   a  extending along a perimeter of the jaws  1115   a ,  1115   b . The extensions  1155   a - 1155   d  may be visualized as an umbrella positioned around the working portions  1117   a ,  1117   b  of the end effector  1113 . Notably, in one embodiment, fluid paths  1123   a ,  1123   b  or  1123   c ,  1123   d  extend along the perimeter of the jaw  1115   a  and form a single fluid path element. As shown, the one or more fluid paths  1123   a - 1123   d  are at least partially defined by respective surfaces  1157   a - 1157   d ,  1158   a - 11158   d . In certain embodiments, the extensions  1155   a - 1155   b  may comprise tissue contact surfaces  1159   a - 1159   d  configured to compress and thereby seal the tissue. The contact surfaces  1159   a - 1159   d  may be aligned or offset toward an opposed jaw  1115   a ,  1115   b . For example, the contact surfaces  1159   a - 1159   d  may extend beyond the accompanying surfaces of the jaw  1115   a ,  1115   b  configured to contract tissue. Still in other embodiments, the contact surfaces  1159   a - 1159   b  may be configured to allow fluid external to the jaws  1115   a ,  1115   b  to be suctioned into the fluid paths  1123   a - 1123   d  or fluid delivered through the fluid path  1123   a - 1123   d  to be directed from the fluid paths  1123   a - 1123   d  to the surgical field external to the jaws  1115   a ,  1115   b , e.g., between tissue and contact surfaces  1159   a - 1159   d . In operation, steam or smoke may be produced when energy is applied to target tissue positioned intermediate the first and second jaws  1115   a ,  1115   b . As such, the steam or smoke will enter the one or more fluid paths  1123   a - 1123   d  at distal fluid ports  1125   a - 1125   d . The steam or smoke may be retained or captured within the jaws  1115   a ,  1115   b . In various embodiments, a vacuum may be applied to suction the steam or smoke proximally. In other embodiments, a fluid may be supplied for circulation within the fluid paths  1123   a - 1123   d  to disperse, condense steam, or otherwise suction or cool the steam or smoke. For example, liquid may be circulated through the one or more fluid paths  1123   a - 1123   b  to protect adjacent tissue. Notably, the fluid paths  1123   a - 1123   d  may be configured to fluidically couple to one more fluid paths extending down a shaft of a medical device, e.g., via an intermediate fluid port, as described herein or be directed to exhaust actively or passively from one or more proximal fluid ports, e.g., fluid ports positioned on the outer portion of surface  1116   a ,  1116   b  of the end effector  1113 , cover, or shaft for controlled or predictable release, as described below. In various embodiments, a slot  1149   a ,  1149   b  configured to slidably receive a cutting element, such as a knife or blade, for example, may be configured for use as a fluid path or fluid port. For example, a channel extending along a central portion of the end effector  1113  may be configured for translation of a knife as well as a fluid path adjacent to the working portion  1117   a ,  1117   b  of the end effector  1113 . It is to be appreciated that the respective outer portions or surfaces  1116   a ,  1116   b  of the first and second jaws  1115   a ,  1115   b  may include a cover, such as a sleeve or mold, e.g., overmolding, positioned on the end effector  1113  to form the channel or cavity defining the one or more fluid paths  1123   a - 1123   d.    
       FIG. 19  illustrates a perspective view in cross-section of an end  1213  defining one or more fluid paths  1223   a - 1223   d  for use as a fluid path element of a fluid control system according to various embodiments. The end effector  1213  comprises a first jaw  1215   a  and a second jaw  1215   b . Similar to  FIG. 18 , outer portions or surfaces  1216   a ,  1216   b  of the jaws  1215   a ,  1215   b  comprise extensions  1255   a - 1255   d  extending outwardly from working portions  1217   a ,  1217   b  of the end effector  1213  to form a channel or cavity defining one or more fluid paths  1223   a - 1223   d  that may extend around the end effector  1213 . In operation, steam or smoke may be produced when energy, e.g., bipolar energy at electrodes  1278   a - 1278   d , is applied to target tissue positioned intermediate the first and second jaws  1215   a ,  1215   b . As such, the steam or smoke may enter the one or more fluid paths  1223   a - 1223   d  at distal fluid ports  1225   a - 1225   d  and thereby be retained or captured within the jaws  1215   a ,  1215   b . In certain embodiments, a supply component may supply fluid that is transported by a transport component as described herein. For example, fluid may be circulated through one or more fluid paths  1223   a - 1223   d  to circulate, exhaust, cool, condense, or disperse the steam or smoke or cool adjacent tissue. 
     In one embodiment, the end effector  1213  may differ from the end effector  1113  illustrated in  FIG. 18  in that the extensions  1255   a - 1255   d  comprise gaskets  1260   a - 1260   d  positioned around a perimeter of the jaws  1215   a ,  1215   b . The gaskets  1260   a - 1260   b  have contact surfaces  1259   d - 1259   d  that may be aligned or offset from a jaw  1215   a ,  1215   b . For example, the contact surfaces  1259   a - 1259   d  of the gaskets may be aligned with or offset, e.g., recessed or protruding, from adjacent surfaces of the jaws  1215   a ,  1215   b  configured to contract tissue. In various embodiments, the gaskets  1260   a - 1260   d  are configured to at least partially define the one or more fluid paths  1223   a - 1223   d  in combination with respective surfaces  1257   a - 1258   d . As such, the gaskets  1260   a - 1260   b  may extend along a perimeter of the end effector  1213  and may be positioned at outer portions or surfaces  1216   a ,  1216   b  of the jaws  1215   a ,  1215   b  or may extend outwardly from the working portion  1217   a ,  1217   b , e.g., along electrodes  1278   a - 1278   d  or knife slot  1249   a ,  1249   b , to define a channel or internal region therein configured to function as a fluid path  1223   a - 1223   d  having a distal fluid port  1225   a - 1225   d . As such, gaskets  1260   a - 1260   d  may be aligned or offset toward an opposing jaw  1215   a ,  1215   b  and define an internal region therein in conjunction with extensions  1255   a - 1255   d . In various embodiments, the gaskets  1260   a - 1260   d  are configured to compress tissue therebetween at contract surfaces  1259   a - 1259   d  upon application of a minimum force to form a soft or gentle seal. In the illustrated embodiment, when energy is applied to target tissue between the jaws  1215   a ,  1215   b , the gaskets  1260   a - 1260   d  prevent steam or smoke that may damage adjacent tissue from escaping the jaws  1215   a ,  1215   b . For example, steam or smoke enters the one or more fluid paths  1223   a - 1223   d  at distal fluid ports  1225   a - 1225   d  where it may be transported or circulated, e.g., with an additional fluid, by the fluid control system. As previously described, the extensions  1255   a - 1255   d  or outer portion or surface  1216   a ,  1216   b  of the first and second jaws  1215   a ,  1215   b  may comprise a cover or overmold positioned over the end effector that may include gaskets  1260   a - 1260   d.    
     In certain embodiments, the gaskets  1260   a - 1260   d  may comprise a fitting that includes a dimension for attachment to the end effector  1213 . For example, a fitting may comprise a complementary dimension to snap the gasket  1260   a - 1260   d  into place or a clamping layer configured to be attached, e.g., by an adhesive, screw, rivet, or other fastener, or clamped between components of the end effector. In various embodiments, the gaskets  1260   a - 1260   b  may be pliable or otherwise configured to be fittably positioned on the end effector  1213  or shaft. For example, the gaskets  1260   a - 1260   d  may comprise an elastomeric material such as a rubber, polymer, or biocompatible material, e.g., thermoset or thermoplastic polymer, silica, silicone, neoprene, etc., that may be configured to seal and/or absorb steam. The gasket material may be an impenetrable material that acts as a true barrier. Alternatively, the gasket material may possess absorption properties that prevent steam from passing through the gaskets  1260   a - 1260   d . The gaskets  1260   a - 1260   d  may cool or thermally filter the steam or smoke such that steam or fluid passing from the fluid path  1223   a - 1223   d  of the jaws  1215   a ,  1215   b  will not be passed to the surrounding environment external to the jaws  1215   a ,  1215   b  until the steam is sufficiently cool as to be condensed or otherwise reduce the potential for blanching of adjacent tissue. 
     During activation of the device, a vacuum or negative pressure may be applied to one or more fluid paths  1223   a - 1223   d  as previously described. In the illustrated embodiment, the end effector  1213  comprises fluid paths  1223   a - 1223   d  extending along respective channels formed by a slot configured to slidably receive a blade or cutting element, for example. When a vacuum or negative pressure is applied to the one or more fluid paths  1223   a - 1223   d  internal to the jaws  1215   a ,  1215   b  steam or smoke created from the application of energy may be evacuated via the fluid control system. For example, a vacuum may be applied to suction the steam or smoke proximally. In other embodiments, a fluid may be supplied for circulation within the fluid path to disperse or condense steam. For example, liquid may be circulated through the one or more fluid paths  1223   a - 1223   d  to protect adjacent tissue. In an alternate embodiment, a pressure differential is not applied to the fluid path and the steam or smoke is allowed to passively exhaust from a proximal fluid port in a controlled or predictable manner. 
       FIG. 20  illustrates an alternate embodiment of  FIG. 19  wherein gaskets  1360   a - 1360   d  define one or more second fluid paths  1323   e - 1323   h  within a lumen extending within the gasket  1360   a - 1360   d . For example, the one or more first fluid paths  1323   a - 1323   d  are fluidically coupled to the one or more second fluid paths  1323   e - 1323   h  via intermediate fluid ports  1326   a - 1326   k  when the gaskets  1360   a - 1360   d  compress tissue between contact surfaces  1359   a - 1359   d . As such, the intermediate fluid ports  1327   a - 1327   i  may defined on a surface defining the first fluid path and be positioned to open to the internal region between the jaws  1315   a ,  1315   b  or into the first fluid path to deliver, intake, or circulate fluid with the one or more fluid paths  1323   a - 1323   d  to protect adjacent tissue. In one embodiment, the fluid path element depicted in the embodiment illustrated in  FIG. 9  may include a gasket. Thus, in various embodiments, fluid ports may be positioned inward or outward of the end effector. 
       FIG. 21  illustrates a cross-section of an end effector  1413  defining one or more fluid paths  1423   a ,  1423   b  for use as a fluid path element of a fluid control system according to various embodiments. Similar to the embodiments illustrated in  FIGS. 19 and 20 , gaskets  1460   a - 1460   d  are positioned at outer portions or surfaces  1416   a ,  1416   b  along perimeters of the first and second jaw  1415   a ,  1415   b . The end effector  1413 , however, does not include the one or more channels or cavities positioned around the outer surface or perimeter portion of the jaws  1415   a ,  1415   b  to define one or more fluid paths, rather a channel or cavity is defined within a central portion of the end effector  1413 . For example, first and second jaws  1415   a ,  1415   b  define channels or cavities within knife slot  1149   a ,  1449   b  defining one or more fluid paths  1423   a ,  1423   b . The gaskets  1460   a - 11460   d  are aligned or offset toward an opposing jaw  1415   a ,  1415   b  from the components of the first and second jaw  1415   a ,  1415   b  such that the gaskets  1460   a - 1460   d  may contact and thereby provide a seal with tissue at contact surfaces  1459   a - 1459   d  adjacent to the working portions  1417   a ,  1417   b  when the first and second jaws  1415   a ,  1415   b  are in a closed position. Consequently, steam or smoke within the jaws  1415   a ,  1415   b  will be captured or retained within the one or more fluid paths  1423   a ,  1423   b  through distal fluid ports  1425   a ,  1425   b . As previously described, the one or more fluid paths  1423   a ,  1423   b  may be fluidically coupled to fluid supply and transport elements to exhaust or circulate fluid within the one or more fluid paths  1423   a ,  1423   b.    
     According to various embodiments, referring to  FIGS. 22A-22F , gaskets  1560   a - 1560   l  may comprise one or more dimension configured to compress or form a seal with tissue positioned between contact surfaces  1559   a - 1559   l . The gaskets  1560   a - 1560   l , for example, may be dimensioned to increase surface interaction with tissue compressed therebetween or present a tortuous path for fluid, steam, or smoke to ingress or egress between the regions internal and external to the jaws.  FIGS. 22A-22C  illustrate gaskets  1560   a - 1560   h  comprising contact surfaces  1559   a - 1559   h  that comprise complementary dimensions. When tissue is compressed between the contact surfaces  1559   a - 1159   h , a tortuous path is created between tissue and the contact surface  1559   a - 1559   h  thereby improving the sealing interaction between the gaskets  1560   a - 1560   h  and the tissue with minimal compression force.  FIG. 22D  illustrates gaskets  1560   i ,  1560   j  with contact surfaces  1559   i ,  1559   j  presenting dimensions that increase compression at one or more points of contact. For example, greater contact or compression with tissue may be applied closer to the target tissue which may be cauterized while less contact may be applied to tissue positioned a greater distance from the target tissue which may retain fluid content.  FIG. 22F  illustrates gaskets  1560   k ,  1560   l  comprising contact surfaces  1559   k ,  1559   l  that increase contact area with increasing proximity. For example, gaskets  1560   k ,  1560   l  may be similar to duckbill gaskets configured to apply a soft seal with tissue. 
       FIG. 23  illustrates a cross-section of an end effector  1613  defining one or more fluid paths  1623   a - 1623   f  for use as a fluid path element of a fluid control system according to various embodiments. The embodiment may be similar to the embodiment illustrated in  FIG. 12  that is fitted with extensions or a cover comprising gaskets  1660   a - 1660   d  having contact surfaces  1659   a - 1659   d  configured to form a seal with tissue  1636 . The gaskets  1660   a - 1660   d  may be positioned around a perimeter or periphery of the jaws  1615   a ,  1615   b  to form a retention seal or barrier to prevent steam or smoke from damaging adjacent tissue. In particular, the gaskets  1660   a - 1660   d  may form a duckbill interaction with tissue  1636  and form a channel in combination with another surface. For example, first fluid paths  1623   a - 1623   d  are at least partially defined by respective surfaces  1657   a - 1657   d  of the jaws  1615   a - 1615   d  and surfaces  1658   a - 1658   d  of the gaskets  1660   a - 1660   d  to define one or more fluid paths  1623   a - 1623   d  configured to capture or retain steam or smoke through distal fluid ports  1625   a - 1625   d  produced from the action of the working portions  1617   a ,  1617   b , e.g., application of energy at electrodes  1678   a - 1678   d . The first jaw  1615   a  defines one or more second fluid paths  1623   e ,  1623   f  having one or more intermediate fluid ports  1626   a ,  1626   b  positioned to deliver fluid or intake smoke, steam, or other fluid. It is to be appreciated that in various embodiments, the second jaw  1615   b  may similarly define one or more second fluid paths and intermediate fluid ports similar to the first jaw  1615   b . In certain embodiments, one or more of the fluid paths  1623   a - 1623   e  may be independent or may fluidically couple to additional fluid paths or one or more fluid supply or transport components as previously described. 
       FIG. 24  illustrates a cross-section of an end effector  1713  defining one or more fluid paths  1723   a - 1723   f  for use as a fluid path element of a fluid control system according to various embodiments. The embodiment may be similar to the embodiment illustrated in  FIG. 23  and includes extensions or covers comprising gaskets  1760   a - 1760   d  having contact surfaces  1759   a - 1759   d  configured to form a seal with tissue. End effector  1713  however also includes proximal fluid ports  1724   a ,  1724   b  positioned at an outer portion or surface  1716   a  of the first jaw to exhaust steam or smoke from the one or more fluid paths  1723   e ,  1723   f  in a controlled or predictable manner. In some embodiments, the fluid control system operates passively as previously described. In other embodiments, a pump or fan may be provided that is fluidically coupled to one or more fluid paths  1723   a - 1723   f  to assist in the exhaust of steam or smoke from the proximal fluid ports  1724   a ,  1724   b . In one embodiment, the second jaw  1715   b  comprises one or more second fluid paths and proximal fluid ports similar to those described with respect to the first jaw  1715   a . It is to be appreciated that the angle, position, and number of fluid ports may vary depending on desired operation and configuration of the end effector. As above, the outer portion or surface  1716   a ,  1716   b  of the end effector  1713  may comprise a cover. 
       FIGS. 25A and 25B  illustrate a distal portion  1812  of an elongate member  1804  of a medical device  1802  according to various embodiments. The medical device  1802  comprises a fluid control system  1803  including a fluid path element defining one or more fluid paths  1823   a - 1823   d  similar to the embodiment illustrated in  FIG. 18 .  FIG. 25A  illustrates the distal portion  1812  of the elongate member  1804  in perspective.  FIG. 25B  illustrates a cross-section along B-B and further depicts the jaws  1815   a ,  1815   b  in a closed position having target tissue  1835  positioned between working portions  1817   a ,  1817   b  of the jaws  1815   a ,  1815   b , e.g., along electrodes  1878   a - 1878   d  or knife slot  1849   a ,  1849   b . Outer portions or surfaces  1816   a ,  1816   b  of the jaws  1815   a ,  1815   b  include extensions  1855   a - 1855   d , which may comprises a cover or gasket as previously described, extend away from working portions  1817   a ,  1817   b  of the end effector  1813  to form a channel or cavity defining one or more fluid paths  1823   a - 1823   d  that may extend around a perimeter or periphery of the end effector  1813 . As shown, the one or more fluid paths  1823   a - 1823   d  are defined by respective surfaces  1857   a - 1857   d  and  1858   a - 1858   d . In certain embodiments, contact surfaces  1859   a - 1859   d  of the jaws  1815   a ,  1815   b  may be configured to compress tissue to form a seal thereon. In operation, steam or smoke may be produced when energy is applied to the target tissue  1835 . As such, the steam or smoke may enter the one or more fluid paths  1823   a - 1823   d  at the distal fluid ports  1825   a - 1825   d  and may thereby be captured or retained within the one or more fluid paths  1823   a - 1823   d . In various embodiments, covers, gaskets, extensions  1855   a - 1855   d , or outer portions or surfaces  1816   a ,  1816   b  of one or both jaws  1815   a ,  1815   b  may define one or more proximal fluid ports to fluidically communicate steam or smoke between an internal environment, e.g., a fluid path element, and an external environment, e.g., surgical field surrounding the end effector. As shown, one or more proximal fluid ports  1824   a ,  1824   b  are positioned on the extensions  1855   a - 1855   d  to exhaust the captured or retained steam or smoke in a controlled or predictable manner. In some embodiments, the fluid control system  1803  operates passively as previously described. In other embodiments, a pump or fan may be provided to assist the exhaustion of steam or smoke from the proximal fluid ports  1824   a ,  1824   b . In one embodiment, the second jaw  1815   b  comprises a cover or gasket having proximal fluid ports similar to those described with respect to the first jaw  1815   a . As with all of the non-limiting embodiments described herein, it is to be appreciated that angle, position, and number of fluid paths and ports may vary, e.g., in consideration of operation, dimension, or configuration of the end effector. Similarly, multiple fluid applications may be used. For example, slot  1849 , generally configured to slidably receive a cutting element or blade therein, may be used as a fluid path coupled to a supply or transport component, e.g., comprising a positive or negative pressure. In this embodiment, the supply component may comprise the external environment into which steam or smoke is exhausted from the fluid path element and the transport component may comprise gravity or a form of diffusion, convection, advection, for example. 
     As previously described, in certain embodiments, the outer portion or surface  1816   a ,  1816   b  of the first and second jaws  1815   a ,  1815   b  may comprise or be formed on a cover, e.g., an overmolded cover, housing, or sleeve, comprising a biologically compatible materials such as a rubber, polymer, or biocompatible material, e.g., thermoset or thermoplastic polymer, silica, silicone, neoprene, etc., positioned over the end effector  1813 . For example, in one embodiment, the cover may be similar to an umbrella, e.g., a rubber umbrella, positioned over the end effector  1813  that forms a soft or gentle seal with tissue to retain and redirect steam or smoke to a proximal fluid port  1824   a ,  1824   b . In various embodiments, the cover may define a complementary dimension with that of the end effector  1813 . In one embodiment, the cover snaps onto the end effector  1813  or is attached to the end effector  1813  using an adhesive. In one embodiment, a cover is applied to the surface  1816   a ,  1816   b  of the end effector  1813  and includes a chemical pre-bond treatment to enhance the chemical bond, e.g., in an overmold process. 
     As previously described, various embodiments of fluid control systems are configured to selectively activate the fluid control system, which may include an activation sequence of one or more steam control operation, e.g., fluid delivery, suction, or temporal or spatial sequencing of steam control operations with an operation of the end effector. For example, an activation element may be provided to manually or electronically activate the fluid control system via a switch or actuator that opens a valve or activates a pump as herein described. Notably, when a medical device comprising a two jaw system having an RF function, for example, is used for dissection, the needs of the user may change compared to those when the RF device is used for transaction and sealing. For example, opening and closing the jaws and application of suction to clear the visible surgical field in an effort to see the tissue being dissected are some of the most repetitive operations. Current methods to provide suction to clear the visible surgical field however require separate suction devices. Furthermore, current methods to provide suction also do not couple the motions of the jaws with that of the suction. According to various embodiments, a medical device, such as an RF device comprising a energy delivery function, comprises a multi-functional device comprising a suction function and a dissection function. In various embodiments, the medical device comprises intuitive one handed operation. For example the medical device may be equipped with seamless suction use while dissecting tissue and allow improved dissection techniques. 
     Referring to  FIGS. 26A and 26B , one embodiment of a distal portion  1912  of an elongate member  1904  of a medical device  1902  comprising a fluid control system is illustrated. A proximal portion of the elongate member  1904  may be similar to that previously described with respect to other embodiments. In this embodiment, the fluid control system  1903  may be configured to intake fluid, such as blood or irrigation fluid, present in the surgical field. Of course, in various embodiments, the fluid control system  1903  may be configured to intake or otherwise control fluid such as steam or smoke. The distal portion  1912  of the elongate member  1904  comprises a multi-functional end effector  1913  comprising a first jaw  1915   a  and a second jaw  1915   b  configured to open and close to dissect tissue. The first jaw  1915   a  and second jaw  1915   b  are operatively coupled to a handle through a shaft  1910 . One or more fluid paths  1923   a - 1923   d  extend along the shaft  1910  and comprises one or more distal fluid ports  1925   a ,  1925   b  positioned adjacent to or between the two jaws  1915   a ,  1915   b  or working portions  1917   a ,  1917   b  thereof. The fluid paths  1923   a - 1923   d  comprise a proximal end configured to couple to a supply and transport element as herein described. In one embodiment, at least one of the fluid paths  1923   a - 1923   d  is configured to couple to a negative pressure or vacuum. In one such embodiment, an activation element is configured to couple activation of the vacuum to one of opening or closing the jaws  1915   a ,  1915   b . For example, suction may be activated when the jaws  1915   a ,  1915   b  are opened. In some embodiments, the vacuum may be activated when the jaws  1915   a ,  1915   b  are in an open and closed position. For example, the jaws  1915   a ,  1915   b  may create a seal when closed such that the vacuum may be on when the jaws  1915   a ,  1915   b  are closed without significant suction of fluid taking place. For example, in one embodiment, each jaw  1915   a ,  1915   b  may comprise a channel defining one or more fluid paths  1923   a ,  1923   b  along a central portion of its length. In operation, the one or more fluid paths  1923   a ,  1923   b  may “wick up” fluid when the first and second jaws  1915   a ,  1915   b  are in the closed position. When the first and second jaws  1915   a ,  1915   b  are in the open position, fluid is suctioned proximally through one or more fluid paths  1923   a - 1923   d . In various embodiments, both of the fluid paths  1923   a ,  1923   b  are configured to fluidically couple to both of the fluid paths  1923   c ,  1923   d . For example, fluid path  1923   c  may comprise a proximal fluid port configured to couple to a vacuum and fluid path  1923   d  may comprise a proximal fluid port configured to couple to a fluid source configured to supply a fluid such as an irrigation fluid along the fluid paths  1923   a  and  1923   b . In one embodiment, a valve is positioned between the fluid paths  1923   c ,  1923   d  to control one or more of the fluid connections between fluid paths  1923   c ,  1923   d  and fluid paths  1923   a ,  1923   b . Depending on the desired configuration, the valve may be selectively operable by the user or may comprise multiple valves to allow unidirectional fluid flow through the valve, which may allow fluid paths  1923   c ,  1923   d  to transport fluid in the same or different directions. 
     Referring to  FIGS. 27A and 27B , in various embodiments, a medical device  2002  comprises a fluid control system  2003  configured to employ a steam control operation comprising a staged pressure and vacuum configured to mitigate potential blanching of adjacent tissue. For example, positive pressure may be introduced through one or more fluid paths  2023   a ,  2023   b  to clear one or more fluid ports  2025   a ,  2025   b , e.g., vents, outlets, inlets, holes, perforations, etc., that may further be used to evacuate steam when a vacuum is applied to the one or more fluid paths  2023   a ,  2023   b . The embodiment may be understood according to the general medical device  2002  layout previously described with respect to other embodiments. Briefly, the medical device  2002  comprises an elongate member  2004  having a proximal portion  2006  comprising a handle  2007  and a distal portion  2012  comprising an end effector  2013 . A shaft  2010  is operatively coupled to the handle  2007  at a proximal end  2009  and the end effector  2013  at a distal end  2014 . The handle comprises housing  2018  defining a grip  2019  and having one or more user interface controls including a trigger  2020   c  movable as indicated by arrow Q and a switch or button  2020   d . The trigger  2020   c  is configured to activate ultrasonic or RF energy to seal target tissue positioned between first and second jaws  2015   a ,  2015   b  of the end effector  2013 . 
     The fluid control system  2003  comprises a fluid path element including one or more fluid paths  2023   a ,  2023   b  that extend proximally along the handle  2007  and distally along the end effector  2013 . The fluid paths  2023   a ,  2023   b  comprise distal fluid ports  2025   a ,  2025   b  positioned at outer portions or surfaces  2016   a ,  2016   b  of the first and second jaws  2015   a ,  2015   b . The distal fluid ports  2025   a ,  2025   b  are positioned as previously described with respect to  FIG. 12 , however, other configurations could be used. A proximal end of the one or more fluid paths  2023   a ,  2023   b  comprises one or more proximal fluid ports  2024   a ,  2024   b  configured to fluidically couple to supply and transport elements. The fluid supply and transport elements include a fluid source and reservoir comprising a compressible bulb  2070 . The compressible bulb contains a fluid that may be supplied to the one or more fluid paths  2023   a ,  2023   b . The bulb  2070  also comprises a fluid reservoir configured to receive fluid from the one or more fluid paths  2023   a ,  2023   b . The fluid supply and transport elements are operatively coupled to an activation element comprising a trigger mechanism. For example, actuation of the trigger  2020   c  along arrow Q rotates a cam arm  2076  in direction R, which may further activate energy when the trigger  2020   c  obtains a predetermined position during rotation. 
     The actuation of the trigger  2020   a  compresses the cam arm  2076  against a piston  2078 , moving the piston  2078  in direction R to compress the bulb  2070 .  FIG. 27A  illustrates partial actuation of the trigger  2020   c  to cause the bulb to be squeezed or compressed between the piston  2078  and the housing  2018 . In the illustrated embodiment, the piston moves about a pivot  2079 , however, in other embodiments the piston may be movable using other methods such as tracks of fixation to the trigger  2020   c  or cam arm  2076 . When the bulb  2070  is compressed, fluid is evacuated from the bulb  2070  into the one or more fluid paths  2023   a ,  2023   b  and delivered distally at distal fluid ports  2025   a ,  2025   b  outward of the end effector  2013 , as indicated by arrow P. In one embodiment, simultaneous with or just prior to activation of the energy, a positive pressure is applied to the one or more fluid paths  2023   a ,  2023   b  as previously described and a volume of fluid is ejected from the distal fluid ports  2025   a ,  2025   b . The volume of fluid may clear the distal fluid ports  2025   a ,  2025   b . Subsequent to the ejection of fluid, a negative pressure may be applied to the one or more fluid paths  2023   a ,  2023   b  to evacuate fluid, e.g., steam or smoke, via distal fluid ports  2025   a ,  2025   b  and through the one or more fluid paths  2023   a ,  2023   b  to the bulb  2070 , which may include an exhaust. When the trigger  2020   c  is actuated in the direction of Q to activate the device, the actuation causes cam arm  2076  to drive piston  2078  against the bulb in direction S to rapidly squeeze the bulb  2078  and expel the fluid, e.g., air/CO 2 , and clear the distal fluid ports  2025   a ,  2025   b.    
     As the trigger  2020   c  is actuated further, as illustrated in  FIG. 27B , the piston  2078  is allowed to move in the direction indicated by arrow U to allow the bulb  2070  to create a vacuum and draw fluid inward toward the end effector  2013  and one or more fluid paths  2023   a ,  2023   b  at the distal fluid ports  2025   a ,  2025   b , as indicated by arrow G. The negative pressure causes fluid to be suctioned inward toward the one or more fluid paths  2023   a ,  2023   b  at the distal fluid ports  2025   a ,  2025   b  as indicated by arrow G and transported proximally to the bulb  2070 . Operation of the transport component further includes a valve system comprising valves  2072 ,  2074  operatively coupled to the operation of the trigger  2020   c  and button  2020   d  associated with the activation element as described below. Notably, as also described below, in various embodiments, button or switch  2020   a  may similarly be operatively coupled to the transport component. 
     In one embodiment, activation of energy is coupled to activate the fluid control system. Similarly, in other embodiments, fluid delivery may be synchronized to energy pulses delivered to target tissue or position of the jaws. In various embodiments, the trigger  2020   c  may be coupled to the activation element to initiate the positive and negative pressure sequence as previously described. The activation element may be automated or may include one or more manual aspects. In the embodiment shown in  FIGS. 27A and 27B , the bulb  2070  is positioned within the handle  2007 , although in other embodiments supply components may be positioned external to the handle  2007 . In the embodiment illustrated in  FIGS. 27A and 27B  one or more valves  2072 ,  2074  are connected between the bulb  2070  and the one or more fluid paths  2023   a ,  2023   b . The valves  2072 ,  2074  may be wide open for application of positive pressure and then nearly closed during application of negative pressure, e.g., a metering valve, to evacuate steam over the duration of the application of energy to the target tissue. For example, valve  2074  may be a leaky duck bill valve that is wide open under pressure but steam may be evacuated through the leaky or tortuous path when the duck bill is closed. Notably, in various embodiments only one valve  2072 ,  2074  is provided. Additional mechanisms to stage or extend fluid control operations also are contemplated. For example, in one embodiment, the movement of the piston  2078  in direction U is dampened by a dampener (not shown) to extend the application of negative pressure to the fluid path  2023   a ,  2023   b  over the course of the application of energy to the target tissue. 
     Also illustrated in  FIGS. 27A and 27B  is an activation button  2020   d , which may be coupled to a valve  2072 . The valve  2072  may be a trumpet valve to allow the user to begin application of negative pressure within a desired sequence or may be a pump or coupled thereto to a pump to initiate negative pressure or positive pressure. The activation button  2020   d  may be provided instead of or in addition to the mechanical operation previously described to provide an additional control option. 
     In one embodiment, switch  2020   a  is configured to activate ultrasonic or RF energy. In one such embodiment, switch  2020   a  is operatively coupled to open a valve, initiate a pump, or release the cam  2076  from engagement with the piston  2078  to allow negative pressure from the bulb to be applied to the one or more fluid paths  2023   a ,  2023   b  to evacuate steam or smoke from the surgical field. Thus, in one such embodiment, rotating the trigger  2020   c  may cause the jaws  2015   a ,  2015   b  to rotate toward a closed position. Rotation of the trigger  2020   c  may further coincide with compression of the bulb  2070 , which my clear the fluid paths  2023   a ,  2023   b  and the distal fluid ports  2025   a ,  2025   b . Operation of switch  2020   a  may provide ultrasonic or RF energy to target tissue and further cause a valve to open or the cam  2076  to release from engagement with the piston  2078  to allow negative pressure from the bulb to be applied to the one or more fluid paths  2023   a ,  2023   b  to evacuate steam or smoke from the surgical field. 
     In various embodiments, when steam is evacuated, the evacuated steam may be converted to water, captured in the bulb  2070 , and condensed to water. In some embodiments, a trumpet valve is provided to remove the condensed water from the bulb  2070 . In one embodiment, the combined operation of positive and negative pressure is implemented with two trumpet valves staged appropriately with the activation of the trigger  2020   c . For example, suction and irrigation lines may be connected to the device (not shown). In such an embodiment, the bulb  2070  may be eliminated and thereby the accumulation of water in the bulb  2070  also may be eliminated. 
     As previously described, during operation of a medical device, fluid such as steam, body fluids, irrigation fluid, or smoke, which for present purposes may be considered a fluid, may occupy the surgical field. The presence of such fluids may interfere with field of view or contaminate or damage surrounding tissues. Operation of medical devices also may present risk to tissue adjacent to the target tissue and surrounding the surgical field due to, for example, splay electricity and hot surfaces of the medical device. For example, when access is limited, it may be difficult to maneuver the medical device to protect surrounding tissue from damage due to thermal spread from accidental contact during or after operation of the device. 
     In one embodiment, referring to  FIGS. 28A-28C  a medical device  2102  may include or be integrated with a fluid control system  2103  comprising a fluid path element  2122  that includes a cover  2151  comprising a sleeve  2152 . The layout of the medical device  2102  may be similar to those previously described with respect to other embodiments and the details are unnecessary for understanding the embodiment. Briefly, the medical device  2102  comprises an elongate member  2104  having a proximal portion  2106  comprising a handle  2107  and a distal portion  2112  comprising an end effector  2113 . A shaft  2110  extends between the handle  2107  and the end effector  2113  and operatively couples the handle  2107  at a proximal end  2109  and the end effector  2113  at a distal end  2114 . The handle comprises housing  2118  defining a grip  2119  and having one or more user interface controls  2120   a - 2120   d  as previously described. For example, a trigger  2120   c  and switch or button  2120   a  may be configured to operate the end effector  2113 , e.g., rotate jaws or activate ultrasonic or RF energy, e.g., bipolar energy, to seal target tissue positioned between first and second jaws  2115   a ,  2115   b  of the end effector  2113 . 
     The shaft  2110  may comprise the sleeve  2152  or the sleeve  2152  may be fitted on or around a surface  2156  of the shaft  2110 . The sleeve  2152  preferably comprises an insulator material to prevent transfer of excessive heat or electrical current to tissue adjacent the target tissue or surrounding the surgical field. In one embodiment, the sleeve  2152  comprises a molded material that may snap into place of the end effector  2113  or shaft  2110  or components thereof. For example, a portion of the sleeve  2152  may snap onto a dimension of a component of the shaft  2110  or end effector  2113 , e.g., using a slot or other feature associated with the end effector  2113  that is configured to slidably receive therein a cutting element or blade. In one embodiment, the sleeve  2152  comprises a proximal portion  2180  and a distal portion  2182 . The proximal portion  2180  may comprise a proximal fluid port  2124  comprising a fitting configured to couple with a fluid supply and transport element. In the illustrated embodiment, the proximal fluid port  2124  comprises a luer fitting. The proximal portion  2180  may also comprise a seal positioned along surface  2154  to seal with the surface  2156  of the shaft  2110 . The distal portion  2182  comprises an end effector portion  2186 , also referred to as an end effector guard  2186 , configured to be positioned over the end effector  2113 . In various embodiments, the end effector guard  2186  may be configured to deliver fluid to a surgical field or intake steam or smoke from the surgical field. In one embodiment, the end effector guard  2186  also provides a thermal barrier between the end effector  2113  and the surgical field. 
       FIGS. 28B and 28C  illustrate cross-sections of exemplary configurations of a portion of the guard  2184  positioned along the distal portion  2182  of the sleeve  2152 , as indicated with broken lines in  FIG. 28A . The end effector  2113  is not shown for clarity but may be positioned along surface  2190   a - 2190   d . In one embodiment, the end effector guard  2186  comprises a pliable material. At least a portion of the sleeve  2152  at least partially defines one or more fluid paths  2123   a - 2123   p  extending from distal fluid ports  2125   a - 2125   p  to the proximal fluid port  2124 . The one or more fluid paths  2123   a - 2123   p  may comprise one or more first fluid paths extending along the end effector  2113  fluidically coupled to one or more second fluid paths extending along the shaft  2110 . In one embodiment, the one or more fluid paths  2123   a - 2123   p  are defined between one or more surfaces of the sleeve  2152  and one or more surfaces  2116   a ,  2116   b ,  2156  of the end effector  2113  or shaft  2110 . For example, a portion of the sleeve  2152  may loosely fit over the shaft  2110  or end effector  2113  or may comprise a ridge or channel defined thereon for fluid to transport therethrough. In one embodiment, the proximal fluid port  2124  may be flush with the sleeve  2152  or may extend outward or branch off of the sleeve  2152 . In various embodiments, the proximal fluid port  2124  may be fluidically coupled to a vacuum to pull steam generated via the cooking of tissue within the one or more fluid paths  2123   a - 2123   p  at the distal fluid ports  2125   a - 2125   p  adjacent to the end effector  2113 , e.g., drawn under the end effector guard  2186 , where it can be removed with a vacuum luer port  2184 . In certain embodiments, the sleeve  2152  comprises a proximal seal positional along surface  2154  configured to fluidically seal with a surface  2156  of shaft. For example, when the sleeve  2152  defines one or more fluid paths  2123   a - 2123   p  in conjunction with the shaft  2110  or end effector  2113 , e.g., comprises a loose fit or defines channels, the proximal seal allows a vacuum to be applied through the one or more fluid paths  2123   a - 2123   p . In the embodiment illustrated in  FIG. 28B , the end effector guard  2186   a  includes a surface  2190   a ,  2190   b  configured to be positioned over the surfaces  2116   a ,  2116   b  of the end effector  2113  and defines distal fluid ports  2125   a - 2125   h . When the guard  2186   a  is positioned on the end effector  2113 , the distal fluid ports  2125   a - 2125   h  are positioned adjacent to the first and second jaws  2115   a ,  2115   b , e.g., along a working portion  2117   a ,  2117   b  thereof, to communicate fluid between the one or more fluid paths  2123   a - 2123   p  and the surgical field. The end effector guard  2186   a  further defines fluid paths  2123   a - 2123   h  that fluidically couple with the proximal fluid port  2124 . As previously described, fluid paths  2123   a - 2123   h  may be further coupled to second fluid paths proximally, which may be defined within the proximal portion  2180  of the sleeve  2152   a  or in conjunction with the shaft  2110  or surface  2156  thereof. In the embodiment illustrated in  FIG. 28C , the end effector guard  2186   b  defines distal fluid ports  2125   i - 2125   p  configured to be positioned adjacent to the first and second jaws  2115   a ,  2115   b , e.g., along a working portion  2117   a ,  2117   b  thereof, to allow fluid to flow between the surgical field and the one or more fluid paths  2123   i - 2123   p . The one or more fluid paths  2123   i - 2123   p  are defined between an adjacent surface  2116   a ,  2116   b  of the end effector  2113  and a surface  2190   c ,  2190   d  of the guard  2186   b  which may be loosely fit over the end effector  2113  or defined by channels formed in the surface  2190   c ,  2190   d  thereby forming fluid paths  2123   i - 2123   p . As previously described, fluid paths  2123   i - 2123   p  may be further fluidically coupled to second fluid paths extending along a proximal portion  2180  of the sleeve  2152   b  or in conjunction with the shaft  2110  or surface  2156  thereof. 
     It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material. 
     The disclosed embodiments have application in conventional endoscopic and open surgical instrumentation as well as application in robotic-assisted surgery. 
     Embodiments of the devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. Embodiments may, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning may include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, embodiments of the device may be disassembled, and any number of the particular pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, embodiments of the device may be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application. 
     By way of example only, embodiments described herein may be processed before surgery. First, a new or used instrument may be obtained and if necessary cleaned. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation may kill bacteria on the instrument and in the container. The sterilized instrument may then be stored in the sterile container. The sealed container may keep the instrument sterile until it is opened in a medical facility. A device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam. 
     It is worthy to note that any reference to “one aspect,” “an aspect,” “one embodiment,” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one aspect. Thus, appearances of the phrases “in one aspect,” “in an aspect,” “in one embodiment,” or “in an embodiment” in various places throughout the specification are not necessarily all referring to the same aspect. 
     One skilled in the art will recognize that the herein described components (e.g., operations), devices, objects, and the discussion accompanying them are used as examples for the sake of conceptual clarity and that various configuration modifications are contemplated. Consequently, as used herein, the specific exemplars set forth and the accompanying discussion are intended to be representative of their more general classes. In general, use of any specific exemplar is intended to be representative of its class, and the non-inclusion of specific components (e.g., operations), devices, and objects should not be taken limiting. 
     With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. The various singular/plural permutations are not expressly set forth herein for sake of clarity. 
     The herein described subject matter sometimes illustrates different components contained within, or connected with, different other components. It is to be understood that such depicted architectures are merely examples and that in fact many other architectures may be implemented which achieve the same functionality. In a conceptual sense, any arrangement of components to achieve the same functionality is effectively “associated” such that the desired functionality is achieved. Hence, any two components herein combined to achieve a particular functionality can be seen as “associated with” each other such that the desired functionality is achieved, irrespective of architectures or intermedial components. Likewise, any two components so associated can also be viewed as being “operably connected,” or “operably coupled,” to each other to achieve the desired functionality, and any two components capable of being so associated can also be viewed as being “operably couplable,” to each other to achieve the desired functionality. Specific examples of operably couplable include but are not limited to physically mateable and/or physically interacting components, and/or wirelessly interactable, and/or wirelessly interacting components, and/or logically interacting, and/or logically interactable components. 
     Some aspects may be described using the expression “coupled” and “connected” along with their derivatives. It should be understood that these terms are not intended as synonyms for each other. For example, some aspects may be described using the term “connected” to indicate that two or more elements are in direct physical or electrical contact with each other. In another example, some aspects may be described using the term “coupled” to indicate that two or more elements are in direct physical or electrical contact. The term “coupled,” however, also may mean that two or more elements are not in direct contact with each other, but yet still co-operate or interact with each other. 
     In some instances, one or more components may be referred to herein as “configured to,” “configurable to,” “operable/operative to,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc. Those skilled in the art will recognize that “configured to” can generally encompass active-state components and/or inactive-state components and/or standby-state components, unless context requires otherwise. 
     While particular aspects of the present subject matter described herein have been shown and described, it will be apparent to those skilled in the art that, based upon the teachings herein, changes and modifications may be made without departing from the subject matter described herein and its broader aspects and, therefore, the appended claims are to encompass within their scope all such changes and modifications as are within the true spirit and scope of the subject matter described herein. It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to claims containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should typically be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations. 
     In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, typically means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that typically a disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms unless context dictates otherwise. For example, the phrase “A or B” will be typically understood to include the possibilities of “A” or “B” or “A and B.” 
     With respect to the appended claims, those skilled in the art will appreciate that recited operations therein may generally be performed in any order. Also, although various operational flows are presented in a sequence(s), it should be understood that the various operations may be performed in other orders than those which are illustrated, or may be performed concurrently. Examples of such alternate orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reverse, or other variant orderings, unless context dictates otherwise. Furthermore, terms like “responsive to,” “related to,” or other past-tense adjectives are generally not intended to exclude such variants, unless context dictates otherwise. 
     In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more embodiments has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more embodiments were chosen and described in order to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize the various embodiments and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope. 
     Various aspects of the subject matter described herein are set out in the following numbered clauses: 
     1. A medical device comprising: a fluid control system to control the flow of a fluid produced when the medical device applies energy to heat a target tissue, the fluid control system comprising: a fluid path element defining a fluid path to transport a fluid therethrough; a distal fluid port fluidically coupled to the fluid path element, the distal fluid port configured to intake the fluid for transport through the fluid path and to transport the fluid through the fluid path; and a proximal fluid port fluidically coupled to the fluid path element, the proximal fluid port configured to intake the fluid transported through the fluid path and to exhaust the fluid transported through the fluid path; and an effector fluidically coupled to the fluid control system, the end effector comprising a working portion configured to apply energy to the target tissue, wherein the distal fluid port is positioned adjacent to the working portion of the end effector. 
     2. The medical device of clause 1, wherein the proximal fluid port is fluidically coupled to a transport component to actively transport fluid through the one or more fluid paths. 
     3. The medical device of clause 2, wherein the transport component comprises a pressure differential. 
     4. The medical device of clause 3, wherein the transport component is fluidically coupled to a pump that provides the pressure differential. 
     5. The medical device of clause 2, wherein the proximal fluid port is fluidically coupled to a supply component, wherein the supply component comprises one of a fluid source to supply fluid for transport through the fluid path and an environment to exhaust fluid transported through the fluid path element. 
     6. A medical device comprising: a fluid control system to control the flow of a fluid produced when the medical device applies energy to heat a target tissue, the fluid control system comprising: a fluid path element defining a fluid path to transport a fluid therethrough, wherein the fluid path comprises a first fluid path at least partially defined by a first surface; a distal fluid port fluidically coupled to the fluid path element, the distal fluid port configured to intake the fluid for transport through the fluid path and to transport the fluid through the fluid path; and a proximal fluid port fluidically coupled to the fluid path element, the proximal fluid port configured to intake the fluid transported through the fluid path and to exhaust the fluid transported through the fluid path; and an effector fluidically coupled to the fluid control system, the end effector comprising a working portion configured to apply energy to the target tissue, wherein the distal fluid port is positioned adjacent to the working portion of the end effector. 
     7. The medical device of clause 6, wherein the first surface defines a channel extending along a central portion of the end effector. 
     8. The medical device of clause 7, wherein the end effector comprises a first jaw and a second jaw, wherein the first jaw and the second jaw are operatively coupled and movable between an open position and a closed position, and wherein the proximal fluid port is fluidically coupled to the first fluid path and to a transport component comprising a vacuum to intake the fluid from the first fluid path when the first and second jaws are in the open position. 
     9. The medical device of clause 7, wherein the end effector comprises a first jaw, a second jaw, and a cutting element positioned between the first and second jaw, wherein the cutting element is slidably movable through the channel. 
     10. The medical device of clause 9, further comprising a gasket positioned along a perimeter of the first jaw, wherein the gasket comprises a tissue contact surface configured to form a seal with tissue when compressed against the tissue. 
     11. A medical device comprising: a fluid control system to control the flow of a fluid produced when the medical device applies energy to heat a target tissue, the fluid control system comprising: a fluid path element defining a fluid path to transport a fluid therethrough, wherein the fluid path comprises a first fluid path at least partially defined by a first surface, wherein the first surface extends along a perimeter of the end effector; a distal fluid port fluidically coupled to the fluid path element, the distal fluid port configured to intake the fluid for transport through the fluid path and to transport the fluid through the fluid path; and a proximal fluid port fluidically coupled to the fluid path element, the proximal fluid port configured to intake the fluid transported through the fluid path and to exhaust the fluid transported through the fluid path; and an effector fluidically coupled to the fluid control system, the end effector comprising a working portion configured to apply energy to the target tissue, wherein the distal fluid port is positioned adjacent to the working portion of the end effector. 
     12. The medical device of clause 11, wherein the fluid path element comprises one of an extension and a cover comprising a second surface extendable around the perimeter of the end effector, adjacent to the first surface, to at least partially define the first fluid path together with the first surface. 
     13. The medical device of clause 12, wherein the fluid path element comprises the cover, wherein the cover comprises a gasket positionable along the perimeter of the end effector and comprising the second surface, and wherein the gasket further comprises a tissue contract surface configured to form a seal with tissue when compressed against the tissue. 
     14. The medical device of clause 12, further comprising a gasket positioned on the one of the extension and the cover, wherein the gasket is configured to form a seal with tissue. 
     15. The medical device of clause 14, wherein the gasket defines at least a portion of the second surface, wherein the gasket further defines a second fluid path fluidically coupled to the first fluid path via an intermediate fluid port formed on the second surface of the gasket. 
     16. The medical device of clause 12, wherein the fluid path element comprises the cover, wherein the cover comprises a mold positionable on the end effector and comprising the second surface. 
     17. The medical device of clause 12, wherein the proximal fluid port is positioned along the one of the extension and the cover to allow one of steam and smoke to passively exhaust from the first fluid path element. 
     18. The medical device of clause 12, wherein the fluid path element comprises the cover, wherein the cover comprises a sleeve configured to extend along a shaft coupled to the end effector, and wherein the proximal fluid port is positioned along the sleeve. 
     19. The medical device of clause 12, wherein the end effector defines a second fluid path fluidically coupled to the first fluid path via an intermediate fluid port formed on the first surface. 
     20. The medical device of clause 19, wherein the proximal fluid port is positioned at an outer surface of the end effector to allow one of steam and smoke to passively exhaust from the second fluid path element. 
     21. A medical device comprising: a fluid control system to control the flow of a fluid produced when the medical device applies energy to heat a target tissue, the fluid control system comprising: a fluid path element defining a fluid path to transport a fluid therethrough; a distal fluid port fluidically coupled to the fluid path element, the distal fluid port configured to intake the fluid for transport through the fluid path and to transport the fluid through the fluid path; and a proximal fluid port fluidically coupled to the fluid path element, the proximal fluid port configured to intake the fluid transported through the fluid path and to exhaust the fluid transported through the fluid path; an effector fluidically coupled to the fluid control system, the end effector comprising a working portion extending along a first jaw and a second jaw, the working portion configured to apply bipolar energy to the target tissue, wherein the distal fluid port is positioned adjacent to the working portion of the end effector; and an activation element configured to activate a supply and transport element to transport one the fluid through the fluid path. 
     22. The medical device of clause 21, wherein the activation element is configured to activate the supply and transport element to transport fluid or smoke through the fluid path to correspond with an operation of the end effector. 
     23. The medical device of clause 21, wherein the activation element is coupled to a valve fluidically coupled to the fluid path element, wherein the valve is positioned between a pressure differential, and wherein the activation element is configured to open the valve to allow fluid to be transported through the fluid path element. 
     24. The medical device of clause 22, wherein the activation element is coupled to an actuator, wherein actuation of the actuator communicates engagement of a piston with a fluid element, wherein the piston is configured to drive fluid from the fluid element to cause the fluid to be transported through the fluid path and exhausted from the distal fluid port. 
     25. The medical device of clause 24, wherein at least one of the supply and transport element comprises a compressible bulb. 
     26. The medical device of clause 25, wherein the piston is configured to disengage the compressible bulb after the bulb has been compressed to allow negative pressure within the compressible bulb to transport one of fluid or smoke through the fluid path toward the compressible bulb. 
     27. The medical device of clause 26, further comprising a valve fluidically coupled to the fluid path element, wherein the valve allows fluid to be transported through the fluid path toward the distal fluid port at a greater rate than fluid is transported through the fluid path toward the proximal fluid port. 
     28. The medical device of clause 26, wherein the activation element comprises a switch to activate the supply and transport element, wherein the supply and transport element comprises a pump fluidically coupled to the fluid path element. 
     29. A medical device comprising: an elongate member having a proximal portion comprising a handle coupled to a proximal end of a shaft and a distal portion comprising an end effector coupled to a distal end of a shaft, the end effector comprising a first jaw, a second jaw, and a working portion, wherein the end effector is configured to apply energy to heat target tissue; a fluid control system configured to control one of steam and smoke generated when the end effector applies energy to heat target tissue, the fluid control system comprising a fluid path element comprising a fluid path; a distal fluid port positioned adjacent to the working portion of the end effector and fluidically coupled to the fluid path element; and a proximal fluid port fluidically coupled to the supply and transport element; wherein the fluid path is defined along a perimeter of the end effector between a first surface and a second surface, wherein the second surface comprises a gasket configured to form a seal with tissue. 
     30. A medical device comprising: an elongate member comprising an end effector positioned along a distal portion thereof; a fluid control system fluidically coupled to the elongate member, the fluid control system configured to control fluid generated when the end effector applies energy to target tissue, the fluid control system comprising: a fluid path element comprising one or more fluid paths; a distal fluid port fluidically coupled to at least one of the one or more fluid paths and positioned adjacent to a working portion of the end effector; and a proximal fluid port fluidically coupled to at least one of the one or more fluid paths fluidically coupled to a supply and transport element; wherein the supply and transport element is configured to one of evacuate the fluid adjacent to the working portion of the end effector through at least one of the one or more fluid paths and supply a fluid for transport through at least one of the one or more fluid paths for delivery from the distal fluid port; and wherein the supply and transport element is configured to be operatively coupled to an activation element configured to activate the supply and transport element when end effector applies energy to the target tissue. 
     31. A medical device comprising: an elongate member having a proximal portion and a distal portion; a fluid control system configured to control a fluid generated when the medical device applies energy to target tissue, the fluid control system comprising: a fluid path element comprising a fluid path extending along the elongate member, the fluid path comprising: a proximal fluid port configured to couple to a fluid supply and transport element to transport fluid through the fluid path; and a distal fluid port positioned along the distal portion of the elongate member configured to deliver the fluid transported through the fluid path and intake the fluid into the fluid path element. 
     32. The medical device of clause 31, wherein the elongate member comprises a shaft having a proximal end and a distal end, wherein the proximal end is configured to couple to a handle along the proximal portion of the elongate member, wherein the distal end is configured to couple to an end effector along the distal portion of the elongate member, and wherein the end effector comprises a working portion configured to apply energy to the target tissue. 
     33. The medical device of clause 32, wherein the fluid path element comprises one or more channels defined within the shaft. 
     34. The medical device of clause 32, wherein the fluid path element comprises a sleeve extending along the shaft, wherein the sleeve defines at least a portion of the fluid path element. 
     35. The medical device of clause 34, wherein the sleeve comprises one or more proximal fluid ports positioned there along. 
     36. The medical device of clause 32, wherein the fluid path comprises one or more fluid paths defined by one or more tubes extending along the shaft. 
     37. The medical device of clause 32, wherein the distal fluid port comprises one or more distal fluid ports positioned at the distal end of the shaft, proximal to the working portion of the end effector. 
     38. The medical device of clause 32, wherein the distal fluid port comprises one or more first distal fluid ports positioned along the shaft and one or more second distal fluid ports positioned along the end effector. 
     39. The medical device of clause 32, wherein the supply and transport element is configured to supply a fluid comprising a liquid adjacent to the end effector to flush tissue adjacent to the target tissue with the liquid, and wherein the liquid is supplied at a temperature configured to cool the adjacent tissue and condense steam produced when the end effector applies energy to heat the target tissue. 
     40. The medical device of clause 32, wherein the fluid control system is configured to deliver fluid adjacent to the end effector to form a protective barrier of fluid between the end effector and tissue adjacent to the end effector. 
     41. The medical device of clause 32, wherein the supply and transport element is configured to transport a fluid comprising a gas through the fluid path to disperse one of steam and smoke adjacent to the distal portion of the elongate member. 
     42. The medical device of clause 32, wherein the supply and transport element is configured to transport a fluid comprising a liquid through the fluid path to the distal fluid port, wherein the distal fluid port comprises a nozzle configured to produce a mist. 
     43. The medical device of clause 32, wherein the supply and transport element is configured to provide a fluid at a temperature configured to condense steam adjacent to the distal portion of the elongate member. 
     44. A medical device comprising: an elongate member having a proximal portion and a distal portion, wherein the distal portion of the elongate member comprises an end effector coupled to a distal end of a shaft; a fluid control system configured to control a fluid generated when the medical device applies energy to target tissue, the fluid control system comprising: a fluid path element comprising a fluid path extending along the end effector, the fluid path comprising: a proximal fluid port configured to couple to a fluid supply and transport element to transport fluid through the fluid path; and a distal fluid port positioned along the distal portion of the elongate member configured to deliver the fluid transported through the fluid path and intake the fluid into the fluid path element. 
     45. The medical device of clause 44, wherein the distal fluid port comprises one or more distal fluid ports positioned along the end effector. 
     46. The medical device of clause 44, wherein the one or more distal fluid ports are positioned adjacent to a working portion of the end effector. 
     47. The medical device of clause 46, wherein the end effector defines at least a portion of the fluid path element. 
     48. The medical device of clause 47, wherein the fluid path element comprises a cover positionable on the end effector. 
     49. The medical device of clause 47, wherein the fluid path element comprises one or more tubes extending along a perimeter of the end effector and defining a plurality of the one or more distal fluid ports, wherein the plurality of distal fluid ports are positioned adjacent to the working portion and are configured to deliver fluid outward of the end effector 
     50. A medical device comprising: an elongate member having a proximal portion and a distal portion; a fluid control system configured to control a fluid generated when the medical device applies energy to target tissue, the fluid control system comprising: a fluid path element comprising a fluid path extending along the elongate member, the fluid path comprising: a proximal fluid port configured to couple to a fluid supply and transport element to transport fluid through the fluid path; a distal fluid port positioned along the distal portion of the elongate member configured to deliver the fluid transported through the fluid path and intake the fluid into the fluid path element; and an activation element configured to activate the supply and transport element to transport fluid or smoke through the fluid path element. 
     51. The medical device of clause 50, wherein the activation element is configured to sequence activation of the supply and transport element to transport fluid or smoke through the fluid path with an operation of the end effector.