Patent Abstract:
An end effector assembly adapted to couple to an electrosurgical instrument, the end effector assembly including a plurality of spaced apart small seal plates on opposing jaw members where each seal plate forms a pair of seal plates with the corresponding seal plate on the opposing jaw member. Each pair of seal plates is individually activatable, and the pair of seal plates are activated in sequence. When the opposing jaw members are in an approximated position, the pairs of seal plates around the periphery of each jaw member define a gap therebetween that is larger than the gap between pairs of seal plates along the center of each jaw member.

Full Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/711,063, filed on Oct. 8, 2012, the entire contents of which are incorporated herein by reference. 
    
    
     BACKGROUND 
     Technical Field 
     The present disclosure relates to electrosurgical instruments used for open and endoscopic surgical procedures. More particularly, the present disclosure relates to an apparatus with multi-circuit seal plates for use in simulating staples with electronic seals. 
     Description of Related Art 
     Staples have traditionally been used to replace suturing when joining or anastomosing various body structures such as, for example, the bowel or bronchus. The surgical stapling devices employed to apply these staples are generally designed to simultaneously cut and seal an extended segment of tissue in a patient, thus vastly reducing the time and risks of such procedures. 
     Linear or annular surgical stapling devices are employed by surgeons to sequentially or simultaneously apply one or more linear rows of surgical fasteners, e.g., staples or two-part fasteners, to body tissue for the purpose of joining segments of body tissue together and/or for the creation of an anastomosis. Linear surgical stapling devices generally include a pair of jaws or finger-like structures that otherwise encompass or engage body tissue. When the surgical stapling device is actuated and/or “fired,” firing bars move longitudinally and contact staple drive members in one of the jaws, and surgical staples are pushed through the body tissue and into/against an anvil in the opposite jaw thereby crimping the staples closed. A knife blade may be provided to cut between the rows/lines of staples. Examples of such surgical stapling devices are described in U.S. Pat. Nos. 4,354,628, 5,014,899 and 5,040,715, the entirety of each of which is incorporated herein by reference. 
     Annular surgical stapling devices generally include an annular staple cartridge assembly including a plurality of annular rows of staples, typically two, an anvil assembly operatively associated with the annular cartridge assembly, and an annular blade disposed internal of the rows of staples. Examples of such annular surgical stapling devices are described in U.S. Pat. Nos. 5,799,857 and 5,915,616 to Robertson et al., the entirety of each of which is incorporated herein by reference. 
     In general, an end-to-end anastomosis stapler typically places an array of staples into the approximated sections of a patient&#39;s bowels or other tubular organs. The resulting anastomosis contains an inverted section of bowel which contains numerous “B” shaped staples to maintain a secure connection between the approximated sections of bowel. 
     SUMMARY 
     As used herein, the term “distal” refers to the portion that is being described which is further from a user, while the term “proximal” refers to the portion that is being described which is closer to a user. 
     As can be appreciated staples leave a foreign body in the patient necessitating a need for a surgical device that creates a similar surgical effect to a staple without leaving a staple within a patient. 
     According to one aspect of the present disclosure, an end effector assembly adapted to couple to an electrosurgical instrument is disclosed and includes a plurality of spaced apart small seal plates on opposing jaw members where each seal plate forms a pair of seal plates with the corresponding seal plate on the opposing jaw member. Each pair of seal plates is individually activatable, and the pair of seal plates are activated in sequence. When the opposing jaw members are in an approximated position, the pairs of seal plates around the periphery of each jaw member define a gap therebetween that is larger than the gap between pairs of seal plates along the center of each jaw member. 
     According to another aspect of the present disclosure, an end effector assembly of a forceps includes first and second jaw members, at least one of the jaw members moveable relative to the other between a spaced-apart position and an approximated position for grasping tissue therebetween. Each jaw member includes a plurality of spaced apart seal plates, and each seal plate corresponds to a seal plate on the opposite jaw member to form a pair of seal plates, each pair of seal plates is individually activatable. The jaw members further include a cutting element. When the first and second jaw members are in an approximated position, the pairs of seal plates closer to the cutting element define a gap therebetween that is smaller than the gap between pairs of seal plates further from the cutting element. 
     According to a further aspect of the present disclosure, the cutting element is located along a central axis on each jaw member. 
     According to another aspect of the present disclosure, each pair of seal plates receives electrical energy in a sequence. 
     According to a further aspect of the present disclosure, the plurality of spaced apart seal plates are each attached to an insulator plate without touching any other seal plates. 
     According to another aspect of the present disclosure, the end effector assembly further includes at least one orifice within the insulator plate configured to supply a clotting agent or factor and or a surgical adhesive prior to supplying electrical energy to each pair of seal plates. 
     According to a further aspect of the present disclosure, the end effector assembly includes a haptic feedback mechanism disposed within the forceps and configured to supply feedback to the user when each pair of seal plates receives an electrical signal. 
     According to another aspect of the present disclosure, an end effector assembly of a forceps includes first and second jaw members with at least one of the jaw members moveable relative to the other between a spaced-apart position and an approximated position for grasping tissue therebetween. Each jaw member includes a plurality of spaced apart seal plates, and each seal plate corresponds to a seal plate on the opposite jaw member to form a pair of seal plates. Each pair of seal plates is individually activatable. When the first and second jaw members are in the approximated position, the pairs of seal plates around the periphery of each jaw member define a gap therebetween that is larger than the gap between pairs of seal plates along the center of each jaw member 
     According to another aspect of the present disclosure, the end effector assembly further includes a cutting element on at least one jaw member. The cutting element may be an electrical cutting element or a knife blade. 
     According to another aspect of the present disclosure, the first and second jaw members are circular in shape and are moveable relative to one another along an axis aligned through the end effector assembly to allow for end-to-end anastomosis. 
     According to another aspect of the present disclosure, the end effector assembly further includes at least one orifice configured to supply a seal aid to the seal plate. 
     According to another aspect of the present disclosure, a method for generating a plurality of electric staples includes the step of grasping a portion of tissue between a first and second jaw member. Each jaw member includes a plurality of spaced apart seal plates, and each seal plate corresponds to a seal plate on the opposite jaw member to form a pair of seal plates with the pairs of seal plates defined along the periphery of the jaw members defining a gap therebetween that is larger than the gap between the pairs of seal plates along the center of each jaw member. The method further includes the steps of sending an electrical signal to a first pair of seal plates and sending another electrical signal to a second pair of seal plates. 
     The method may further include the step of supplying a seal aid to at least one seal plate prior to supplying an electrical signal thereto. 
     Alternatively or in addition, the method may include the step of supplying an audible sound or haptic feedback when the electrical signals are sent to each pair of seal plates. 
     Alternatively or in addition, the plurality of spaced apart seal plates may be separated by an insulator. 
     Alternatively or in addition, the method may include the step of varying a seal strength by supplying an electrical signal to different pairs of seal plates, wherein the gap between at least two pairs of seal plates is different. The gap defined between the first pair of seal plates may be greater or smaller than the gap between the second pair of seal plates. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various embodiments of the present disclosure are described herein with reference to the drawings wherein: 
         FIG. 1A  is a perspective view of an endoscopic forceps having an end effector including a plurality of seal plates in accordance with an embodiment of the present disclosure; 
         FIG. 1B  is a perspective view of forceps for use in an open surgical procedure having an end effector including a plurality of seal plates in accordance with another embodiment of the present disclosure; 
         FIG. 2  is a perspective view of the end effector for use with the forceps of  FIG. 1A  and  FIG. 1B  in an open condition and including a plurality of seal plates; 
         FIG. 3  is a front, cross-sectional view of the end effector of  FIG. 2  in a closed condition; 
         FIGS. 4A and 4B  are top views of lower jaw member and upper jaw member, respectively in accordance with another embodiment of the present disclosure; 
         FIG. 5  is a schematic block diagram of an electrosurgical system for use with an end effector including a plurality of seal plates according to an embodiment of the present disclosure; 
         FIGS. 6A-6C  are top views of a jaw member in accordance with alternate embodiments of the present disclosure; 
         FIGS. 7A-7C  are top views of a jaw member in accordance with alternate embodiments of the present disclosure; 
         FIG. 7D  is a perspective view of an endoscopic forceps having a jaw member from  FIGS. 7A-7C  in accordance with an embodiment of the present disclosure; 
         FIG. 8  illustrates an end-to-end anastomosis device for use with an alternate embodiment of the electrosurgical stapler device according to the present disclosure; and 
         FIG. 9  is a flow chart for generating a plurality of electrosurgical staples in accordance with the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of the present disclosure are described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. 
     In accordance with the present disclosure, generally an end effector includes an upper seal plate and a lower seal plate described collectively as seal plates. The seal plates according to the present disclosure are manufactured to include a plurality of seal plate segments. The seal plate segments are configured to be selectively energized by a control circuit. Alternatively, two or more seal plate segments may be configured to be simultaneously energized by one or more electrical circuits. In this manner, tissue is selectively treated by one or more of the individual seal plate segments or sequentially treated by one or more of the circuits that connect to the various seal plate segments. As such, the end effectors according to the present disclosure are configured and/or customized such that the tissue, or separate portions of the tissue, grasped between the jaw members, may be selectively treated. 
     Referring now to the figures,  FIG. 1A  depicts an endoscopic forceps  10  for use in connection with endoscopic surgical procedures and  FIG. 1B  depicts an open forceps  10 ′ for use in traditional open surgical procedures. For the purposes herein, either an endoscopic instrument, e.g., forceps  10 , or an open surgery instrument, e.g., forceps  10 ′, may utilize an end effector in accordance with the present disclosure. Obviously, different electrical, optical and mechanical connections and considerations may apply to each particular type of instrument, however, the novel aspects with respect to the end effector assemblies described herein and their operating characteristics remain generally consistent with respect to both the endoscopic or open surgery designs. 
     Turning now to  FIG. 1A , the endoscopic forceps  10  is coupled to an electrosurgical generator  40 , or other suitable surgical energy source. Forceps  10  is adapted to seal tissue using radiofrequency (RF) energy or other suitable electrosurgical energy including microwave, RF, ultrasonic, and light energy. For the purposes herein, the generator  40  will be described using RF energy. Generator  40  is configured to provide electrosurgical energy at any suitable RF frequency. For example, generator  40  may provide an energy signal having a frequency from about 1 MHz to about 300 GHz. 
     Forceps  10  is coupled to generator  40  via a cable  34 . Cable  34  is configured to transmit one or more RF energy signals and/or energy control signals between the generator  40  and the forceps  10 . Forceps  10  may alternatively be configured as a self-contained instrument that includes the functionality of the generator  40  within the forceps  10  (e.g., an energy source, a signal generator, a control circuit, etc.). For example, forceps  10  may include a battery (not explicitly shown) that provides electrical energy, an RF generator ( 40 ) connected to the battery and configured to generate one or more RF energy signals and a microprocessor to perform measurement and control functions and to selectively delivery one or more RF energy signals to the end effector  100 . 
     Forceps  10  includes a housing  20 , a handle assembly  22 , a rotating assembly  28 , a trigger assembly  30  and an end effector  100 . Forceps  10  further includes a shaft  12  having a distal end  16  configured to engage the end effector  100  and a proximal end  14  configured to engage the housing  20  and/or the rotating assembly  28 . Cable  34  connects to wires (not explicitly shown) in the housing  20  that extend through the housing  20 , shaft  12  and terminate in the end effector  100  thereby providing one or more electrical energy signals to the upper and lower sealing plates  112 ,  122 . 
     Handle assembly  22  includes a fixed handle  26  and a moveable handle  24 . Fixed handle  26  is integrally associated with housing  20  and movable handle  24  is movable relative to the fixed handle  26  to actuate the end effector  100  between an open condition and a closed condition to grasp and treat tissue positioned therebetween. Rotating assembly  28  is rotatable in a clockwise and a counter-clockwise rotation to rotate end effector  100  about longitudinal axis “X-X.” Housing  20  houses the internal working components of forceps  10 . 
     End effector  100  includes upper and lower jaw members  110  and  120  each having a proximal end and a distal end, respectively. Jaw members  110  and  120  are pivotable about a pivot  19  and are movable between a first condition wherein jaw members  110  and  120  are closed and mutually cooperate to grasp, seal and/or sense tissue therebetween (See  FIGS. 1A and 1B ) and a second condition wherein the jaw members  110  and  120  are spaced relative to another (See  FIG. 2 ). 
     Each jaw member  110 ,  120  includes a tissue contacting surface  112 ,  122 , respectively, disposed on an inner-facing surface thereof. Tissue contacting surfaces  112  and  122  cooperate to grasp tissue positioned therebetween and are configured to coagulate and/or seal tissue upon application of energy from generator  40 . Tissue contacting surfaces  112  and  122  may be further configured to cut tissue and/or configured to position tissue for cutting after tissue coagulation and/or tissue sealing is complete. One or more of the tissue contacting surfaces  112 ,  122  may form part of the electrical circuit that communicates energy through the tissue held between the upper and lower jaw members  110  and  120 , respectively. 
     Trigger assembly  30  may be configured to actuate a knife (e.g., knife assembly  186 , See  FIG. 4A ) disposed within forceps  10  to selectively cut/sever tissue grasped between jaw members  110  and  120  positioned in the first condition. Switch  32  is configured to selectively provide electrosurgical energy to end effector assembly  100 . 
     Referring now to  FIG. 1B , an open forceps  10 ′ is depicted and includes end effector  100 ′ attached to a handle assembly  22 ′ that includes a pair of elongated shaft portions  12   a ′ and  12   b ′. Each elongated shaft portion  12   a ′,  12   b ′ includes a respective proximal end  14   a ′,  14   b ′ and a distal end  16   a ′,  16   b ′. The end effector assembly  100 ′ includes upper and lower members  110 ′,  120 ′ formed from, or attached to, each respective distal end  16   b ′ and  16   a ′ of shafts  12   b ′ and  12   a ′. Shafts  12   a ′ and  12   b  are attached via pivot  19 ′ and are configured to pivot relative to one another thereby actuating the jaw members  110 ′,  120 ′ between the first condition and the second condition, as described hereinabove. 
     Shafts  12   a ′ and  12   b ′ include respective handles  17   a ′ and  17   b ′ disposed at the proximal ends  14   a ′ and  14   b ′ thereof. Handles  17   a ′ and  17   b ′ facilitate scissor-like movement of the shafts  12   a ′ and  12   b ′ relative to each other, which, in turn, actuate the jaw members  110 ′ and  120 ′ between a first condition and a second condition. In the first condition, the jaws  110 ′ and  120 ′ are disposed in spaced relation relative to one another and, in a second condition, the jaw members  110 ′ and  120 ′ cooperate to grasp tissue therebetween. 
     In some embodiments, one or more of the shafts, e.g., shaft  12   a ′, includes a switch assembly  32 ′ configured to selectively provide electrical energy to the end effector assembly  100 ′. Forceps  10 ′ is depicted having a cable  34 ′ that connects the forceps  10 ′ to generator  40  (as shown in  FIG. 1 ). Switch assembly  32 ′ is configured to selectively delivery the electrically energy from the generator  40  to the seal plates (not explicitly shown, see seal plates  112 ,  122  in  FIGS. 2 and 3 ). Switch assembly  32 ′ may also be configured to select the electrosurgical energy delivery mode and/or the delivery sequencing as will be discussed hereinbelow. 
     Trigger assembly  30 ′ is configured to actuate a knife assembly  186 , as described with respect to  FIG. 2  hereinbelow, disposed within forceps  10 ′. The proximal end of the knife assembly  186  (See  FIG. 4A ) connects to trigger assembly  30 ′ within the shaft  12   b ′ of the forceps  10 ′. Knife assembly  186  extends through shaft  12   b ′ and forms a distal cutting edge on the distal end thereof (See  FIG. 4A ). Knife assembly  186 , when actuated by trigger assembly  30 ′, extends the distal cutting edge distally through a knife channel  115  (see  FIG. 4A ) to sever tissue positioned between the jaw members  110 ′ and  120 ′. 
     With reference to  FIG. 2 , each seal plate  112 ,  122  forms a planar sealing surface that includes a plurality of seal plate segments  112   a - 112   f  and  122   a - 122   f , respectively, electrically isolated from each other by insulating members  125   a ,  125   b . Each seal plate segment  112   a - 112   f  on the top jaw  110  has an opposing seal plate segment  122   a - 122   f  on the bottom jaw  120  that form each pair of seal plate segments (pair of electrodes). Each seal plate segment  112   a - 112   f  and  122   a - 122   f  forms a substantially equal portion of the planar sealing surface, however the thickness of each seal plate segment may vary (See  FIG. 3 ). The number of seal plates segments  112   a - 112   f ,  122   a - 122   f  on the jaw members may vary as with the number of seal plate segments along axis “X-X” and perpendicular to axis “X-X.” 
     Insulating members  125   a  and  125   b  may be formed from any suitable insulating material or dielectric material that provides electrical isolation between the seal plate segments  112   a - 112   f  and  122   a - 122   f . Insulating members  125   a  and  125   b  may be formed from a polytetrafluorethylene (PTFE), polypropylene, polychlorotrifluoroethylene (IPCTFE), polyethylene, polyethyleneterephthalate (PET), polyvinylchloride (PVC), a ceramic material or even air in a gap formed between adjacent seal segments. The insulating members  125   a  and  125   b  provide areas grasped within the end effector  100  that are not sealed and therefore receive less tissue damage to allow the body to generate the remainder of the seal with healthy tissue. 
     The individual seal plate segments  112   a - 112   f  and  122   a - 122   f  may be pre-selected, or dynamically selected, as part of one or more electrical circuits that deliver electrosurgical energy to tissue positioned between the jaw members  110  and  120 . For example, in one configuration the end effector  100  may include a first bipolar circuit that includes the inner seal plate segments  112   a  and  122   a , a second bipolar circuit that includes the middle seal plate segments  112   b  and  122   b  and a third bipolar circuit that includes the outer seal plate segments  112   c  and  122   c  wherein the first, second and third bipolar circuits are independently enabled and/or controlled to deliver electrosurgical energy to tissue. 
     The seal plate segments on each jaw (e.g., lower seal plate segments  122   a - 122   f  on lower jaw  120 ) are arranged such that the seal plate segments are positioned in rows and columns. The number of rows and columns can be varied to control the number of individual seals caused by a single grasp of tissue by the end effector  100 . The seal plate segments  112   a - 112   f  on the upper seal plate  112  may have corresponding seal plate segments  122   a - 122   f  on the lower seal plate  122  positioned oppose and one another, as illustrated in  FIGS. 2 and 3 . 
     With reference to  FIG. 3 , the seal segments  112   a - 112   f  and  122   a - 122   f  are arranged such that the seal segments  112   c - 112   d  and  122   c - 122   d  closest to the central axis “A-A” have a greater thickness t 3 . Also, when jaws  110  and  120  are in the closed position, the gap g 3  between segments  112   d  and  122   d , and similarly between segments  112   c  and  122   c  is the smallest. This creates the tightest seal in the center or closest to the cut if there is a knife blade  184  (see  FIG. 4A ) (or electrical cutter  610 ) along the central axis “A-A.” The smallest gap g 3  creates the highest compression seal which limits the acute bleeding. More specifically, the seal in the center may be about 3.5 to about 4.5 times systolic pressure, although the desired pressure range may vary depending on tissue type or other factors. As you move left or right along Axis B-B from the central axis “A-A” the thickness of the seal segments  112   e - 112   f ,  112   b - 112   a ,  122   e - 122   f , and  122   b - 122   a  is smaller. In other words the thickness t 2  of  112   e  is greater than the thickness t 1  of  112   f . Therefore, when the jaws  110 ,  120  are in a closed position, the gap increases as you move left or right away from the central axis “A-A” along axis “B-B.” In other words the gap g 2  between  112   b  and  122   b  is smaller than the gap g 1  between  112   a  and  122   a , and therefore the seal in the middle may be about 2.5 to 3.5 times systolic pressure at each seal. The medium gap g 2  allows for medium compression of tissue. The larger gap g 1  allows for a lower compression which reduces tissue damage. The largest gap seal allows for about 1.5 to about 2.5 times systolic pressure at each seal although, similarly as noted above, the desired pressure range may vary depending on tissue type or other factors. 
     With reference to  FIGS. 4A and 4B , knife channel  115  is defined by a channel formed within one or both jaw members  110  and  120  to permit reciprocation of knife assembly  186  therethrough, e.g., via activation of the trigger assembly  30 ,  30 ′ (See  FIGS. 1A and 1B ). The upper jaw member  110  and the lower jaw member  120 , while in a closed position form a knife channel  115  therebetween. Knife channel  115  includes an upper knife channel  115   b , formed in the upper jaw member  110 , mated with a lower knife channel  115   a , formed in the lower jaw member  120 . 
     Alternatively, instead of a knife blade assembly  186 , the end effector  100  may include an electrical cutting electrode  610  (See  FIG. 6B ) on the lower  110  and/or upper jaw member  120 . 
     The seal segments  122   a - 122   f  and  112   a - 112   f  decrease in thickness as the distance increases from the knife channel  115  or electrical cutter  610  (see  FIG. 6B ). This allows for greatest compression closest to the knife blade  184  or the electrical cutter  610 , which creates the tightest seal to prevent acute bleeding. The lowest compression is formed with the seal segments  122   a ,  112   a ,  122   f , and  112   f  furthest from the knife channel  115  or electrical cutter  610 , which allows for more blood profusion between the seal plates  122   a ,  112   a ,  122   f , and  112   f  to allow the patient&#39;s body to slowly generate a long term seal. The number of seal segments  112   a - 112   f  and  122   a - 122   f  may vary and therefore the gradient of compression applied between each seal segment can vary. 
     Turning now to  FIG. 5 , a system schematic block diagram for driving an end effector  100  according to the present disclosure is indicated as system  1000 . System  1000  includes a generator  40 , a forceps  10  with a multi-seal circuit end effector  100  connected by a cable  34 . The generator  40  includes a controller  42 , a power supply  44 , an RF output stage  46 , a sensor module  48  and a multiplexer  60 . The power supply  44  provides DC power to the RF output stage  46  that converts the DC power into one or more RF energy signals. The one or more RF energy signals are individually provided to the multiplexer  60 . 
     The controller  42  includes a microprocessor  50  having a memory  52  which may be volatile type memory (e.g., RAM) and/or non-volatile type memory (e.g., flash media, disk media, etc.). The microprocessor  50  includes a connection to the power supply  44  and/or RF output stage  46  that allows the microprocessor  50  to control the output of the generator  40  according to an open-loop and/or closed-loop control scheme. The power supply  44 , RF output stage  46 , multiplexer  60  and sensor module  48  are connected to, and controlled by, the controller  42  and configured to operate in concert to perform a selected surgical procedure. 
     For example, controller  42  may instruct the multiplexer  60  to connect an RF energy signal generated by the RF output stage  46  between any two or more segments of the end effector  100 . For example, multiplexer  60  may be instructed by the controller  42  to form an electrosurgical energy delivery circuit between with seal plate  112   a  on the upper jaw member  110  and the seal plate  122   a  on the lower jaw member  120  (See  FIG. 2 ). Additionally, controller  42  may instruct the multiplexer  60  to connect the sensor module  48  between any two or more segments of the end effector  100  and controller  42  may instruct the sensor module  48  to perform a measurement between the selected segments of the end effector  100 . For example, multiplexer  60  may be instructed by the controller  42  to form a measurement circuit between the seal plate segment  112   b  on the upper jaw member  110  and the seal plate segment  122   b  on the lower jaw member  120  (See  FIG. 2 ). Controller  42  may issue instructions to the various components in the generator  40  to performed energy delivery and measurements sequentially or simultaneously. 
     Controller  42 , in executing a closed-loop control scheme, may instruct the multiplexer  60  to simultaneously connect two segments on the end effector  100  to the RF output stage  46  for delivery of electrosurgical energy and may further instruct the multiplexer to connect the sensor module  48  to two segments on the end effector  100  wherein the sensor module  48  provides feedback to the controller  42  for an energy delivery control loop (e.g., the sensor module  48  includes one or more sensing mechanisms/circuits for sensing various tissue parameters such as tissue impedance, tissue temperature, output current and/or voltage, etc.). The controller  42 , using the energy delivery control loop, signals the power supply  44  and/or RF output stage  46  to adjust the electrosurgical energy signal. 
     The controller  42  also receives input signals from the input controls of the generator  40  and/or forceps  10 ,  10 ′. The controller  42  utilizes the input signals to generate instructions for the various components in the generator  40 , to adjust the power output of the generator  40  and/or to perform other control functions. The controller  42  may include analog and/or logic circuitry for processing input signals and/or control signals sent to the generator  40 , rather than, or in combination with, the microprocessor  50 . 
     The microprocessor  50  is capable of executing software instructions for processing data received by the sensor module  48 , and for outputting control signals to the generator  40 , accordingly. The software instructions, which are executable by the controller  42 , are stored in the memory  52  of the controller  42 . 
     The sensor module  48  may also include a plurality of sensors (not explicitly shown) strategically located for sensing various properties or conditions, e.g., tissue impedance, voltage (e.g., voltage at the generator  40  and/or voltage at the tissue site) current (e.g., current at the generator  40  and/or current delivered at the tissue site, etc.) The sensors are provided with leads (or wireless) for transmitting information or signals to the controller  42 . The sensor module  48  may include control circuitry that receives information and/or signals from multiple sensors and provides the information and/or signals, and/or the source of the information (e.g., the particular sensor providing the information), to the controller  42 . 
     The sensor module  48  may include a real-time voltage sensing system and a real-time current sensing system for sensing real-time values related to applied voltage and current at the surgical site. Additionally, an RMS voltage sensing system and an RMS current sensing system may be included for sensing and deriving RMS values for applied voltage and current at the surgical site. 
     The generator  40  includes suitable input controls (e.g., buttons, activators, switches, touch screen, etc.) for controlling the generator  40 , as well as one or more display screens for providing the surgeon with information (e.g., intensity settings, treatment complete indicators, etc.). The controls allow the surgeon to adjust power of the RF energy, waveform, and other parameters to achieve the desired waveform suitable for a particular task (e.g., surgical procedure such as tissue ablation, coagulation, cauterization, resection or any combination thereof). Further, the forceps  10 ,  10 ′ may include one or more input controls, some of which may be redundant, with certain input controls included in the generator  40 . Placing select input controls at the instrument  10 ,  10 ′ allows for easier and faster modification of RF energy parameters during the surgical procedure without requiring interaction with the generator  40 . 
     Returning to  FIG. 2 , the control circuit (e.g., controller  42 ) may be configured to dynamically select one or more of the seal plate segments  112   a - 112   c  and  122   a - 122   c  before and/or during the surgical procedure and may be configured to dynamically switch the selected seal plate segments that form one or more of the electrosurgical energy delivery circuits. More specifically, the control circuit (e.g., controller  42 ) may be configured to provide electrosurgical energy to the first bipolar circuit during a simulated stapling action, configured to provide electrosurgical energy to the second bipolar circuit during a second simulated stapling action and configured to provide electrosurgical energy to the third bipolar circuit during a third simulated stapling action. In operation, the controller  42  instructs the multiplexer  60  to direct an RF energy signal, generated by the RF output stage  46 , to each of the first, second, etc. bipolar circuits during the simulated stapling actions. The simulated stapling actions may be executed consecutively, simultaneously, sequentially, or any portion of a simulated stapling action may overlap any other treatment simulated stapling action. 
     As each simulated stapling action is performed by the generator  40  sending an electrical signal to a pair of seal plates, for example  122   a  and  112   a , the generator  40  may provide a ratcheting sound through a speaker (not shown) in the generator  40  or the hand held device  10  or  10 ′. Alternatively, the generator  40  may provide haptic feedback through a haptic mechanism (not shown) in the hand held device  10  or  10 ′ when a signal is sent to the pair of seal plates, for example  122   a  and  112   a , similar to feedback felt when using a traditional stapling end effector. 
     Referring now to  FIGS. 6A-6C , which show different embodiments of seal plate segments that may be generated along each jaw member  110  and/or  120 .  FIG. 6A  shows a jaw member  620  with staggered seal plate segments  622   a - 622   f . Between each seal segment is an insulative material  125 . The insulative material provides an area of unsealed tissue between each seal similar to how traditional staples form seals.  FIG. 6B  shows a jaw member  630  with diagonal seal segments  722   a - 722   f .  FIG. 6C  shows a jaw member  640  with diagonal seal segments  822   a  and  822   f , and staggered seal plate segments  822   b - 822   e . Only one jaw member is shown in  FIGS. 6A-6C , however, the opposite jaw member would have a similar look to the jaw member shown so that each seal plate segment forms a seal plate segment pair with the opposite seal plate segment on the opposing jaw member. The different possible arrangements of seal plate segments  622   a - 622   f ,  722   a - 722   f , and  822   a - 822   f  allow for different seal strengths. Additionally, the thickness of the seal plate segments  612   a - 612   f  varies similar to seal plate segments  112   a - 112   f  and  122   a - 122   f  shown in  FIG. 3 . 
     Referring to  FIGS. 7A-7D , the end effector  100  may provide seal aid as the seal is generated. The seal aid may include a clotting factor, such as Fibrin, and or adhesive.  FIG. 7A  shows one embodiment that includes orifice rings  750  around each seal segment  122   a - 122   d . Such that as each seal segment is activated, the seal aid is delivered through the jaw member  710  to reduce bleeding or “oozing.” Alternatively, as shown in  FIG. 7B , the jaw member  720  may include orifices  760  between each seal segment  122   a - 122   d . Both jaw member  710  and  720  allow for the use of an electrical cutter  610  because the orifices  750  or  760  are around or near the seal segments  122   a - 122   d .  FIG. 7C  shows another alternative for supplying seal aid near the seal that allows the seal aid to ooze from the knife channel  115  or through specific orifices  770  in the knife channel  115 . Another alternative, is to have the seal aid applied directly to each seal plate segment and as each seal plate segment heats up when receiving the electrical energy the seal aid is applied to the seal. 
       FIG. 7D  shows a surgical device  10  that includes a container  780  for storing pressurized seal aid that is supplied when trigger  785  is selected by the user. The pressurized seal aid is supplied to one or more jaw members  110  and or  120  through lumen  790 . The seal aid then applies to the seal through orifices  750 ,  760 , or  770  from lumen  790 . 
     End effector  100  may also include a lumen (not shown) that receives a cooling liquid from the surgical device  10 . The cooling liquid assists in reducing tissue damage near each activated seal plate segment  122   a - 122   f  or  112   a - 112   f  by reducing the temperature of end effector  100 , and therefore reducing tissue damage near each seal plate segment because the insulative material  125  remains at lower temperature. 
     Surgical device  10  may be adapted for use as an end-to-end anastomosis (EEA) apparatus  2000  ( FIG. 8 ), such as that disclosed in U.S. Pat. No. 7,455,676, the contents of which are hereby incorporated by reference herein in its entirety. The EEA apparatus  2000  includes a handle assembly  2002  having at least one pivotable actuating handle member  2004 , and advancing means  2006 . Extending from handle assembly  2002 , there is provided a tubular body portion  2008  that terminates in a fastener ejection (tool) assembly  2010  having a first circular electrical stapler member  2012  that includes a plurality of seal segments  2122   a - 2122   c  in a circular pattern. The seal plate segments  2122   a - 2122   c  are located on both the first circular electrical stapler member  2012  and a second circular electrical stapler member  2016 . The first and second circular electrical stapler members  2012 ,  2016  are connected together through shaft  2014 . 
     When the first and second circular electrical stapler members  2012 ,  2016  are in a closed position, the seal plate segments  2122   a - 2122   c  are each paired with an opposing seal segment on the opposite circular electrical stapler member. The smallest gap is formed between the pair of seal segments  2122   c  on the inner most ring of the first and second circular electrical stapler members  2012 ,  2016 . The smallest gap allows for the most compression and therefore the “tightest” or highest quality or acute seal. The middle row of seal segments  2122   b  provides a slightly larger gap and a medium amount of compression. The gap is the largest between seal segments  2122   a  in the outer most ring, which provides the lowest compression and allows for the least “tightest” seal. In alternative embodiments the number of rings of segments may vary and therefore the varying gap/compression will vary too. 
       FIG. 9  discloses a flow chart for using an electronic stapler device  10 ,  10 ′,  2000  to simulate staples during a surgical procedure. The process  900  starts at step  905  and at step  910 , the surgeon grasps tissue with end effector  100 . Next at step  920 , the surgeon cuts the tissue if necessary using a knife blade  184  or electrical cutter  610 . Alternatively, the tissue may be cut between two seals. Then at step  930 , the generator  40  sends an electrical signal to a first electrode pair after the surgeon hits a trigger button on the electronic stapler device  10 . Whenever the signal is sent from the generator  40 , the generator  40  may provide a ratcheting sound or haptic feedback to inform the surgeon that a signal was sent and that a electric staple seal was formed. The first electrode pair may create the “tightest” or highest quality, or acute seal, i.e. between  122   c  and  112   c  (see  FIG. 3 ), to create an acute seal first. Then at step  940 , an electrical signal is sent to the a second electrode pair, i.e. between  112   b  and  122   b , to create a medium “tight” seal. Then at  950 , an electrical signal is sent to a third electrode pair, i.e. between  112   a  and  122   a , to create the least “tightest” seal. 
     Alternatively, the first electrode pair may create the least “tightest” seal, i.e. between  122   a  and  112   a  (see  FIG. 3 ), which pushes inward any blood or other fluids directionally during sealing and controls profusion of fluids at the time of sealing. The second electrode, i.e. between  112   b  and  122   b , receives the second electrical signal to create a medium “tight” seal. Then, the third electrode pair, i.e. between  112   c  and  122   c , receives the electrical signal to create the “tightest” seal (higher quality or acute seal). 
     In another alternative embodiment, the sequence may sequentially send an individual signal to each seal plate pair that generates an acute seal. Then, the sequence may sequentially send an individual signal to each seal plate pair that generates a medium “tight” seal. Finally, the sequence may sequentially send an individual signal to each seal plate pair that generates the least “tightest” seal. 
     The process  900  ends at step  965 , when each electrode pair has been individually fired on the end effector  100  or the seal is complete at step  960 . Additionally, as each pair of seal plate segments receives an electrical signal, the surgeon may select to supply a seal aid to the seal. Also, the end effector  100  may also include a cooling liquid supplied through lumens to cool the end effector  100  and reduce damage to tissue near a seal from the end effector  100  being too hot. 
     In alternative embodiments, more than one seal plate segment  112   a - 112   f  and  122   a - 122   f  may receive an electrical signal at the same time, however the goal is to reduce tissue damage to tissue near an energized seal plate segment by reducing the heat dissipated to the non-sealed tissue. 
     While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Technology Classification (CPC): 0