Patent Description:
Ultrasonic surgical instruments and systems utilize ultrasonic energy, i.e., ultrasonic vibrations, to treat tissue. More specifically, ultrasonic surgical instruments and systems utilize mechanical vibration energy transmitted at ultrasonic frequencies to treat tissue. An ultrasonic surgical device may include, for example, an ultrasonic blade and a clamp mechanism to enable clamping of tissue against the blade. Ultrasonic energy transmitted to the blade causes the blade to vibrate at very high frequencies, which allows for heating tissue to treat tissue clamped against or otherwise in contact with the blade.

Electrosurgical instruments and systems conduct Radio Frequency (RF) energy through tissue to treat tissue. An electrosurgical instrument or system may be configured to conduct bipolar RF energy between oppositely charged electrodes and through tissue, e.g., tissue clamped between the electrodes or otherwise in contact therewith, to treat tissue. Alternatively or additionally, an electrosurgical instrument or system may be configured to deliver monopolar RF energy from an active electrode to tissue in contact with the electrode, with the energy returning via a remote return electrode device to complete the circuit.

A fluid, e.g., a conductive fluid such as saline, may be utilized with some electrosurgical instruments and systems, e.g., to couple the RF energy to tissue. The use of fluid may facilitate RF energy-based tissue treatment by controlling temperature, inhibiting sticking, inhibiting smoke production, and/or inhibiting char formation.

An example of an ultrasonic surgical instrument is disclosed in <CIT>.

As used herein, the term "distal" refers to the portion that is described which is further from an operator (whether a human surgeon or a surgical robot), while the term "proximal" refers to the portion that is being described which is closer to the operator. Terms including "generally," "about," "substantially," and the like, as utilized herein, are meant to encompass variations, e.g., manufacturing tolerances, material tolerances, use and environmental tolerances, measurement variations, and/or other variations, up to and including plus or minus <NUM> percent. Further, any or all of the aspects described herein, to the extent consistent, may be used in conjunction with any or all of the other aspects described herein.

The invention provides a surgical system including an ultrasonic transducer, an ultrasonic waveguide coupled to and extending distally from the ultrasonic transducer, and an ultrasonic blade disposed at a distal end of the ultrasonic waveguide. The ultrasonic blade is configured to receive ultrasonic energy produced by the ultrasonic transducer and transmitted along the ultrasonic waveguide to vibrate the ultrasonic blade for treating tissue therewith. The ultrasonic blade is configured to connect to a source of electrosurgical energy for conducting electrosurgical energy to tissue to treat tissue. The ultrasonic blade defines a lumen extending at least partially therethrough to at least one opening. The lumen is configured for fluid communication with a fluid source to enable the delivery of fluid from the fluid source through the lumen and out at least one opening into a surgical site to facilitate electrosurgical tissue treatment.

In an aspect of the present disclosure, the system further includes a housing. Each of the ultrasonic transducer and the fluid source are disposed on or within the housing.

In another aspect of the present disclosure, the fluid is an electrically conductive fluid configured to electrically couple the ultrasonic blade with tissue when the ultrasonic blade is used for electrosurgical tissue treatment.

In another aspect of the present disclosure, vibrating the ultrasonic blade heats the ultrasonic blade, and the delivery of fluid from the fluid source through the lumen and out the at least one opening into a surgical site cools the ultrasonic blade.

In still another aspect of the present disclosure, the system further includes a jaw member movable relative to the ultrasonic blade from a spaced-apart position to an approximated position for clamping tissue therebetween.

In yet another aspect of the present disclosure, the jaw member includes a structural body and a jaw liner disposed within the structural body. The jaw liner defines a tissue contacting surface positioned to oppose the ultrasonic blade in the approximated position.

In still yet another aspect of the present disclosure, the structural body is configured to connect to the source of electrosurgical energy such that the structural body and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue. Alternatively, the structural body includes at least one electrically conductive surface disposed thereon that is configured to connect to the source of electrosurgical energy such that the at least one electrically conductive surface and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue.

In another aspect of the present disclosure, the ultrasonic blade is configured to conduct monopolar electrosurgical energy to tissue to treat tissue.

The invention also provides another system, including an ultrasonic transducer, an ultrasonic waveguide coupled to and extending distally from the ultrasonic transducer, and an ultrasonic blade disposed at a distal end of the ultrasonic waveguide. The ultrasonic blade is configured to receive ultrasonic energy produced by the ultrasonic transducer and transmitted along the ultrasonic waveguide to vibrate the ultrasonic blade for treating tissue therewith. The ultrasonic blade is configured to connect to a source of electrosurgical energy for conducting electrosurgical energy to tissue to treat tissue. A jaw member is movable relative to the ultrasonic blade from a spaced-apart position to an approximated position for clamping tissue therebetween. The jaw member defines a lumen configured for fluid communication with a fluid source to enable the delivery of fluid from the fluid source, through the lumen, out at least one opening defined in the jaw member, and into a surgical site to facilitate electrosurgical tissue treatment.

In another aspect of the present disclosure, vibrating the ultrasonic blade heats the ultrasonic blade, and the delivery of fluid from the fluid source through the lumen and out the at least one opening is directed towards the blade to cool the ultrasonic blade.

In still another aspect of the present disclosure, the structural body is configured to connect to the source of electrosurgical energy such that the structural body and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue. Alternatively, the structural body includes at least one electrically conductive surface disposed thereon that is configured to connect to the source of electrosurgical energy such that the at least one electrically conductive surface and ultrasonic blade are configured to conduct bipolar electrosurgical energy through tissue disposed therebetween to treat tissue.

In still yet another aspect of the present disclosure, the ultrasonic blade is configured to conduct monopolar electrosurgical energy to tissue to treat tissue.

A method, not forming part of the invention, of surgery in accordance with the present disclosure includes transmitting ultrasonic energy to an ultrasonic blade to vibrate the ultrasonic blade for treating tissue therewith, conducting electrosurgical energy from the ultrasonic blade to tissue for treating tissue therewith, and supplying fluid from the ultrasonic blade to tissue.

In aspects, the transmitting is performed in conjunction with the supplying such that the supplying of the fluid facilitates electrosurgical tissue treatment. Additionally or alternatively, the supplying is performed after the transmitting such that the supplying of the fluid serves to cool the ultrasonic blade.

The above and other aspects and features of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings wherein like reference numerals identify similar or identical elements.

Referring to <FIG>, a surgical system provided in accordance with aspects of the present disclosure is shown generally identified by reference numeral <NUM> including a surgical instrument <NUM>, a surgical generator <NUM>, and, in some aspects, a return electrode device <NUM>, e.g., including a return pad <NUM>. Surgical instrument <NUM> includes a handle assembly <NUM>, an elongated assembly <NUM> extending distally from handle assembly <NUM>, an end effector assembly <NUM> disposed at a distal end of elongated assembly <NUM>, and a cable assembly <NUM> operably coupled with handle assembly <NUM> and extending therefrom for connection to surgical generator <NUM>. As an alternative to handle assembly <NUM>, surgical instrument <NUM> may include a robotic attachment housing for releasable engagement with a robotic arm of a robotic surgical system such as, for example, robotic surgical system <NUM> (<FIG>) detailed below.

Surgical generator <NUM> includes a display <NUM>, a plurality user interface features <NUM>, e.g., buttons, touch screens, switches, etc., an ultrasonic plug port <NUM>, a bipolar electrosurgical plug port <NUM>, and active and return monopolar electrosurgical plug ports <NUM>, <NUM>, respectively. Surgical generator <NUM> is configured to produce ultrasonic drive signals for output through ultrasonic plug port <NUM> to surgical instrument <NUM> to activate surgical instrument <NUM> in an ultrasonic mode and to provide electrosurgical energy, e.g., RF bipolar energy, for output through bipolar electrosurgical plug port <NUM> and/or RF monopolar energy for output through active monopolar electrosurgical port <NUM> to surgical instrument <NUM> to activate surgical instrument <NUM> in one or more electrosurgical modes. It is also contemplated that one or more common ports (not shown) may be configured to act as any two or more of ports <NUM>-<NUM>. In monopolar configurations, plug <NUM> of return electrode device <NUM> is configured to connect to return monopolar electrosurgical plug port <NUM>.

Continuing with reference to <FIG>, handle assembly <NUM> includes a housing <NUM> defining a body portion and a fixed handle portion. Handle assembly <NUM> further includes an activation button <NUM> and a clamp trigger <NUM>. The body portion of housing <NUM> is configured to support an ultrasonic transducer <NUM>. Ultrasonic transducer <NUM> may be permanently engaged with the body portion of housing <NUM> or removable therefrom. Ultrasonic transducer <NUM> includes a piezoelectric stack or other suitable ultrasonic transducer components electrically coupled to surgical generator <NUM>, e.g., via one or more of first electrical lead wires <NUM>, to enable communication of ultrasonic drive signals to ultrasonic transducer <NUM> to drive ultrasonic transducer <NUM> to produce ultrasonic vibration energy that is transmitted along a waveguide <NUM> of elongated assembly <NUM> to blade <NUM> of end effector assembly <NUM> of elongated assembly <NUM>, as detailed below. An activation button <NUM> is disposed on housing <NUM> and coupled to or between ultrasonic transducer <NUM> and/or surgical generator <NUM>, e.g., via one or more of first electrical lead wires <NUM>, to enable activation of ultrasonic transducer <NUM> in response to depression of activation button <NUM>. In some configurations, activation button <NUM> may include an ON/OFF switch. In other configurations, activation button <NUM> may include multiple actuation switches to enable activation from an OFF position to different actuated positions corresponding to different activation settings, e.g., a first actuated position corresponding to a first activation setting and a second actuated position corresponding to a second activation setting. In still other configurations, separate activation buttons may be provided, e.g., a first actuation button for activating a first activation setting and a second activation button for activating a second activation setting.

A fluid source <NUM> is disposed within housing <NUM> in fluid communication with a lumen <NUM> (<FIG>) extending through at least a portion of waveguide <NUM> and/or blade <NUM> (and/or a lumen <NUM> (<FIG>) extending through jaw member <NUM>). The fluid source <NUM> may include a fluid reservoir and/or a pump and may be configured to store and/or pump any suitable fluid "F" (<FIG>) including conductive fluid, e.g., saline, through the lumen <NUM> (<FIG>) (and/or lumen <NUM> (<FIG>)). In configurations, fluid source <NUM> is external to housing <NUM> (mounted thereon or separate therefrom and connected via suitable tubing).

Elongated assembly <NUM> of surgical instrument <NUM> includes an outer drive sleeve <NUM>, an inner support sleeve <NUM> (<FIG>) disposed within outer drive sleeve <NUM>, a waveguide <NUM> extending through inner support sleeve <NUM> (<FIG>), a drive assembly (not shown), a rotation knob <NUM>, and an end effector assembly <NUM> including a blade <NUM> and a jaw member <NUM>. Rotation knob <NUM> is rotatable in either direction to rotate elongated assembly <NUM> in either direction relative to handle assembly <NUM>. The drive assembly operably couples a proximal portion of outer drive sleeve <NUM> to clamp trigger <NUM> of handle assembly <NUM>. A distal portion of outer drive sleeve <NUM> is operably coupled to jaw member <NUM> and a distal end of inner support sleeve <NUM> (<FIG>) pivotably supports jaw member <NUM>. As such, clamp trigger <NUM> is selectively actuatable to thereby move outer drive sleeve <NUM> about inner support sleeve <NUM> (<FIG>) to pivot jaw member <NUM> relative to blade <NUM> of end effector assembly <NUM> from a spaced apart position to an approximated position for clamping tissue between jaw member <NUM> and blade <NUM>. The configuration of outer and inner sleeves <NUM>, <NUM> (<FIG>) may be reversed, e.g., wherein outer sleeve <NUM> is the support sleeve and inner sleeve <NUM> (<FIG>) is the drive sleeve. Other suitable drive structures as opposed to a sleeve are also contemplated such as, for example, drive rods, drive cables, drive screws, etc..

Referring still to <FIG>, the drive assembly may be tuned to provide a jaw clamping force, or jaw clamping force within a jaw clamping force range, to tissue clamped between jaw member <NUM> and blade <NUM> or may include a force limiting feature whereby the clamping force applied to tissue clamped between jaw member <NUM> and blade <NUM> is limited to a particular jaw clamping force or a jaw clamping force within a jaw clamping force range.

Waveguide <NUM>, as noted above, extends from handle assembly <NUM> through the inner support sleeve. Waveguide <NUM> includes blade <NUM> disposed at a distal end thereof. Blade <NUM> may be integrally formed with waveguide <NUM>, separately formed and subsequently attached (permanently or removably) to waveguide <NUM>, or otherwise operably coupled with waveguide <NUM>. Waveguide <NUM> and/or blade <NUM> may be formed from titanium, a titanium alloy, or other suitable electrically conductive material(s), although non-conductive materials are also contemplated. Waveguide <NUM> includes a proximal connector (not shown), e.g., a threaded male connector, configured for engagement, e.g., threaded engagement within a threaded female receiver, of ultrasonic transducer <NUM> such that ultrasonic motion produced by ultrasonic transducer <NUM> is transmitted along waveguide <NUM> to blade <NUM> for treating tissue clamped between blade <NUM> and jaw member <NUM> or positioned adjacent to blade <NUM>.

Cable assembly <NUM> of surgical instrument <NUM> includes a cable <NUM>, an ultrasonic plug <NUM>, and an electrosurgical plug <NUM>. Ultrasonic plug <NUM> is configured for connection with ultrasonic plug port <NUM> of surgical generator <NUM> while electrosurgical plug <NUM> is configured for connection with bipolar electrosurgical plug port <NUM> of surgical generator <NUM> and/or active monopolar electrosurgical plug port <NUM> of surgical generator <NUM>. In configurations where generator <NUM> includes a common port, cable assembly <NUM> may include a common plug (not shown) configured to act as both the ultrasonic plug <NUM> and the electrosurgical plug <NUM>. Plural first electrical lead wires <NUM> electrically coupled to ultrasonic plug <NUM> extend through cable <NUM> and into handle assembly <NUM> for electrical connection to ultrasonic transducer <NUM> and/or activation button <NUM> to enable the selective supply of ultrasonic drive signals from surgical generator <NUM> to ultrasonic transducer <NUM> upon activation of activation button <NUM> in an ultrasonic mode. In addition, plural second electrical lead wires <NUM> are electrically coupled to electrosurgical plug <NUM> and extend through cable <NUM> into handle assembly <NUM>. In bipolar configurations, separate second electrical lead wires <NUM> are electrically coupled to waveguide <NUM> and jaw member <NUM> (and/or different portions of jaw member <NUM>) such that, as detailed below, bipolar electrosurgical energy may be conducted between blade <NUM> and jaw member <NUM> (and/or between different portions of jaw member <NUM>). In monopolar configurations, an electrical lead wire <NUM> is electrically coupled to waveguide <NUM> such that, as also detailed below, monopolar electrosurgical energy may be supplied to tissue from blade <NUM>. Alternatively, an electrical lead wire <NUM> may electrically couple to jaw member <NUM> in the monopolar configuration to enable monopolar electrosurgical energy to be supplied to tissue from jaw member <NUM>. One or more second electrical lead wires <NUM> is electrically coupled to activation button <NUM> to enable the selective supply of electrosurgical energy from surgical generator <NUM> to waveguide <NUM> and/or jaw member <NUM> upon activation of activation button <NUM> in an electrosurgical mode.

As an alternative to a remote generator <NUM>, surgical system <NUM> may be at least partially cordless in that it incorporates an ultrasonic generator, an electrosurgical generator, and/or a power source, e.g., a battery, thereon or therein. In this manner, the connections from surgical instrument <NUM> to external devices, e.g., generator(s) and/or power source(s), is reduced or eliminated.

With reference to <FIG>, a robotic surgical system in accordance with the aspects and features of the present disclosure is shown generally identified by reference numeral <NUM>. For the purposes herein, robotic surgical system <NUM> is generally described. Aspects and features of robotic surgical system <NUM> not germane to the understanding of the present disclosure are omitted to avoid obscuring the aspects and features of the present disclosure in unnecessary detail.

Robotic surgical system <NUM> generally includes a plurality of robot arms <NUM>, <NUM>; a control device <NUM>; and an operating console <NUM> coupled with control device <NUM>. Operating console <NUM> may include a display device <NUM>, which may be set up in particular to display three dimensional images; and manual input devices <NUM>, <NUM>, by means of which a person (not shown), for example a surgeon, may be able to telemanipulate robot arms <NUM>, <NUM> in a first operating mode. Robotic surgical system <NUM> may be configured for use on a patient <NUM> lying on a patient table <NUM> to be treated in a minimally invasive manner. Robotic surgical system <NUM> may further include a database <NUM>, in particular coupled to control device <NUM>, in which are stored, for example, pre-operative data from patient <NUM> and/or anatomical atlases.

Each of the robot arms <NUM>, <NUM> may include a plurality of members, which are connected through joints, and an attaching device <NUM>, <NUM>, to which may be attached, for example, a surgical tool "ST" supporting an end effector <NUM>, <NUM>. One of the surgical tools "ST" may be ultrasonic surgical instrument <NUM> (<FIG>), e.g., configured for use in both an ultrasonic mode and an electrosurgical (bipolar and/or monopolar) mode, wherein manual actuation features, e.g., actuation button <NUM> (<FIG>), clamp lever <NUM> (<FIG>), etc., are replaced with robotic inputs. In such configurations, robotic surgical system <NUM> may include or be configured to connect to an ultrasonic generator, an electrosurgical generator, and/or a power source. The other surgical tool "ST" may include any other suitable surgical instrument, e.g., an endoscopic camera, other surgical tool, etc. Robot arms <NUM>, <NUM> may be driven by electric drives, e.g., motors, that are connected to control device <NUM>. Control device <NUM> (e.g., a computer) may be configured to activate the motors, in particular by means of a computer program, in such a way that robot arms <NUM>, <NUM>, their attaching devices <NUM>, <NUM>, and, thus, the surgical tools "ST" execute a desired movement and/or function according to a corresponding input from manual input devices <NUM>, <NUM>, respectively. Control device <NUM> may also be configured in such a way that it regulates the movement of robot arms <NUM>, <NUM> and/or of the motors.

Referring to <FIG>, end effector assembly <NUM> of surgical instrument <NUM> of surgical system <NUM> (<FIG>) is detailed, although end effector assembly <NUM> may be utilized with any other suitable surgical instrument and/or surgical system. End effector assembly <NUM> includes a blade <NUM> and a jaw member <NUM>. Blade <NUM> may define a linear configuration, may define a curved configuration, or may define any other suitable configuration, e.g., straight and/or curved surfaces, portions, and/or sections; one or more convex and/or concave surfaces, portions, and/or sections; etc. With respect to curved configurations, blade <NUM>, more specifically, may be curved in any direction relative to jaw member <NUM>, for example, such that the distal tip of blade <NUM> is curved towards jaw member <NUM>, away from jaw member <NUM>, or laterally (in either direction) relative to jaw member <NUM>. Further, blade <NUM> may be formed to include multiple curves in similar directions, multiple curves in different directions within a single plane, and/or multiple curves in different directions in different planes. In addition, blade <NUM> may additionally or alternatively be formed to include any suitable features, e.g., a tapered configuration, various different cross-sectional configurations along its length, cut outs, indents, edges, protrusions, straight surfaces, curved surfaces, angled surfaces, wide edges, narrow edges, and/or other features.

Blade <NUM> may define a polygonal, rounded polygonal, or any other suitable cross-sectional configuration(s) (see <FIG>). Waveguide <NUM> or at least the portion of waveguide <NUM> proximally adjacent blade <NUM>, may define a cylindrical shaped configuration. Plural tapered surfaces (not shown) may interconnect the cylindrically shaped waveguide <NUM> with the polygonal (rounded edge polygonal, or other suitable shape) configuration of blade <NUM> to define smooth transitions between the body of waveguide <NUM> and blade <NUM>.

Blade <NUM> may be wholly or selectively coated with a suitable material, e.g., a non-stick material, an electrically insulative material, an electrically conductive material, combinations thereof, etc. Suitable coatings and/or methods of applying coatings include but are not limited to Teflon®, polyphenylene oxide (PPO), deposited liquid ceramic insulative coatings; thermally sprayed coatings, e.g., thermally sprayed ceramic; Plasma Electrolytic Oxidation (PEO) coatings; anodization coatings; sputtered coatings, e.g., silica; ElectroBond® coating available from Surface Solutions Group of Chicago, IL, USA; or other suitable coatings and/or methods of applying coatings.

Waveguide <NUM> and/or blade <NUM> defines lumen <NUM> extending at least partially therethrough. Lumen <NUM>, as noted above, is disposed in fluid communication with fluid source <NUM> (<FIG>) to enable the delivery, e.g., pumping, of fluid "F" through lumen <NUM> and into a surgical site via one or more openings <NUM> in fluid communication with lumen <NUM>. Although one opening <NUM> is shown on a distal face of blade <NUM>, any other suitable number and/or positioning of openings <NUM> may be provided to facilitate introduction of fluid "F" into the surgical site such as, for example, openings <NUM> along at least a portion of a length of either or both sides of blade <NUM>, openings <NUM> along at least a portion of a length of a top (jaw member facing side) of blade <NUM>, and/or openings <NUM> along at least a portion of a length of a bottom (opposite the jaw member facing side) of blade <NUM>. Further, the one or more openings <NUM> may be configured to deliver fluid "F" in any suitable manner, e.g., spray, jet, drip, etc., and/or direction(s).

With additional reference to <FIG>, blade <NUM>, as noted above, in addition to receiving ultrasonic energy transmitted along waveguide <NUM> from ultrasonic transducer <NUM> (<FIG>), is adapted to connect to generator <NUM> (<FIG>) to enable the supply of RF energy to blade <NUM> for conduction to tissue in contact therewith or coupled thereto (e.g., via conductive fluid "F," for example). In bipolar configurations, RF energy is conducted between blade <NUM> and jaw member <NUM> (or between portions of jaw member <NUM> and/or blade <NUM>) and through tissue (and/or fluid "F") disposed therebetween to treat tissue. In monopolar configurations, RF energy is conducted from blade <NUM>, serving as the active electrode, to tissue in contact therewith or coupled thereto (e.g., via fluid "F") and is ultimately returned to generator <NUM> (<FIG>) via return device <NUM> (<FIG>), serving as the passive or return electrode.

Continuing with reference to <FIG>, jaw member <NUM> of end effector assembly <NUM> includes a more rigid structural body <NUM> and a more compliant jaw liner <NUM>. Structural body <NUM> may be formed from an electrically conductive material, e.g., stainless steel, and/or may include electrically conductive portions. Structural body <NUM> includes a pair of proximal flanges 183a that are pivotably coupled to the inner support sleeve <NUM> via receipt of pivot bosses (not shown) of proximal flanges 183a within corresponding openings (not shown) defined within the inner support sleeve <NUM> and operably coupled with outer drive sleeve <NUM> via a drive pin <NUM> secured relative to outer drive sleeve <NUM> and pivotably received within apertures 183b defined within proximal flanges 183a. As such, sliding of outer drive sleeve <NUM> about inner support sleeve <NUM> pivots jaw member <NUM> relative to blade <NUM> from a spaced apart position to an approximated position to clamp tissue between jaw liner <NUM> of jaw member <NUM> and blade <NUM>.

Referring also to <FIG>, structural body <NUM> may be adapted to connect to a source of electrosurgical energy, e.g., generator <NUM> (<FIG>), and, in a bipolar electrosurgical mode, is charged to a different potential as compared to blade <NUM> to enable the conduction of bipolar electrosurgical (e.g., RF) energy through tissue clamped therebetween (and/or through fluid "F"), to treat the tissue. In a monopolar electrosurgical mode, structural body <NUM> may be un-energized, may be charged to the same potential as compared to blade <NUM> (thus both defining the active electrode), or may be energized while blade <NUM> is not energized (wherein structural body <NUM> defines the active electrode). In either monopolar configuration, energy is returned to generator <NUM> (<FIG>) via return device <NUM> (<FIG>), which serves as the passive or return electrode.

With momentary reference to <FIG>, as an alternative to the entirety of structural body <NUM> of jaw member <NUM> being connected to generator <NUM> (<FIG>), the structural body may be formed from or embedded at least partially in an insulative material, e.g., an overmolded plastic. In such configurations, electrically conductive surfaces <NUM>, e.g., in the form of plates, may be disposed on or captured by the overmolded plastic to define electrodes on either side of jaw liner <NUM> on the blade facing side of jaw member <NUM>. The electrically conductive surfaces <NUM>, in such aspects, are connected to generator <NUM> (<FIG>) and may be energized for use in bipolar and/or monopolar configurations, e.g., energized to the same potential as one another and/or blade <NUM> and/or different potentials as one another and/or blade <NUM>. In aspects, electrically conductive surfaces <NUM> are disposed at additional or alternative locations on jaw member <NUM>, e.g., along either or both sides thereof, along a back surface thereof, etc..

Returning to <FIG> and <FIG>, jaw liner <NUM> is shaped complementary to a cavity <NUM> (<FIG>) defined within structural body <NUM>, e.g., defining a T-shaped configuration, to facilitate receipt and retention therein, although other configurations are also contemplated. Jaw liner <NUM> is fabricated from an electrically insulative, compliant material such as, for example, polytetrafluoroethylene (PTFE). The compliance of jaw liner <NUM> enables blade <NUM> to vibrate while in contact with jaw liner <NUM> without damaging components of ultrasonic surgical instrument <NUM> (<FIG>) and without compromising the hold on tissue clamped between jaw member <NUM> and blade <NUM>. The insulation of jaw liner <NUM> maintains electrical isolation between blade <NUM> and structural body <NUM> of jaw member <NUM>, thereby inhibiting shorting.

Turning to <FIG>, in some aspects, rather than or in addition to blade <NUM> defining a lumen <NUM> (<FIG>) for delivery of fluid "F" to the surgical site, a lumen <NUM> disposed in fluid communication with fluid source <NUM> (<FIG>) may extend through elongated assembly <NUM> and at least partially through jaw member <NUM> to enable the delivery, e.g., pumping, of fluid "F" through lumen <NUM> and into a surgical site via one or more openings <NUM> in fluid communication with lumen <NUM>. A plurality of openings <NUM> are shown defined through jaw liner <NUM> and spaced apart along the length thereof such that fluid "F" is directed towards blade <NUM>; however, any other suitable number and/or positioning of openings <NUM> may be provided to facilitate introduction of fluid "F" from jaw member <NUM> into the surgical site. Further, the one or more openings <NUM> may be configured to deliver fluid "F" in any suitable manner(s), e.g., spray, jet, drip, etc., and/or direction(s).

With general reference to <FIG>, <FIG>, and <FIG>, as noted above, end effector assembly <NUM> is configured for use in an ultrasonic mode and/or one or more electrosurgical modes; the modes may operate consecutively, overlapping, alternatingly, simultaneous, and/or in any other suitable manner. Further, end effector assembly <NUM> may be configured to supply fluid "F" to tissue, before, after, and/or together with energy delivery (in either or both modes). Various non-limiting use modes of end effector assembly <NUM> are detailed below.

With respect to the ultrasonic mode, upon activation, an ultrasonic drive signal is provided from surgical generator <NUM> to ultrasonic transducer <NUM> to generate ultrasonic energy that is transmitted from ultrasonic transducer <NUM> along waveguide <NUM> to blade <NUM> to thereby vibrate blade <NUM> for treating tissue in contact with or adjacent to blade <NUM>. More specifically, in the ultrasonic mode: ultrasonic energy may be supplied to blade <NUM> to treat, e.g., seal and/or transect, tissue clamped between blade <NUM> and jaw liner <NUM> of jaw member <NUM>; ultrasonic energy may be supplied to blade <NUM> to treat, e.g., transect, perform an otomy, backscore, etc., tissue in contact with or adjacent to blade <NUM> (with jaw member <NUM> disposed in the spaced apart or approximated position), statically or dynamically; and/or ultrasonic energy may be supplied to blade <NUM> to treat, e.g., plunge, spot coagulate, etc., tissue utilizing the distal end of blade <NUM>. The ultrasonic mode may include one or more energy level settings such as, for example, a first, e.g., LOW, setting and a second, e.g., HIGH, setting. The first and second energy level settings may correspond to different vibration velocities of blade <NUM>.

The one or more electrosurgical energy modes may include bipolar electrosurgical modes and/or monopolar electrosurgical modes. With respect to bipolar electrosurgical tissue treatment, bipolar electrosurgical energy is conducted between blade <NUM> and structural body <NUM> of jaw member <NUM> (or surfaces <NUM> of jaw member (<FIG>)) to treat, e.g., seal, tissue clamped between blade <NUM> and jaw liner <NUM>. Bipolar electrosurgical tissue treatment may be utilized simultaneously or otherwise in cooperation with the ultrasonic mode, e.g., in the first energy level setting, to facilitate treating, e.g., sealing, tissue. Other suitable configurations for bipolar electrosurgical tissue treatment are also contemplated.

Monopolar electrosurgical tissue treatment involves the supply of electrosurgical energy from blade <NUM> (with jaw member <NUM> un-energized), from jaw member <NUM> (with blade <NUM> un-energized), or from both blade <NUM> and jaw member <NUM> (with both energized to the same potential) to tissue to treat, e.g., transect and/or spot coagulate, tissue. Monopolar electrosurgical tissue treatment utilizes a remote return electrode device, e.g., return pad <NUM> of device <NUM> (see <FIG>) attached to the patient's skin, to safely return energy to generator <NUM>.

Delivery of fluid "F," e.g., conductive fluid such as saline, together with the supply of electrosurgical energy may be used to facilitate tissue treatment, in the bipolar and/or monopolar modes. For example, the use of both electrosurgical energy (bipolar or monopolar), and conductive fluid "F" enables the delivery of energy to tissue while regulating the tissue temperature, e.g., at or below about <NUM>. Unlike conventional electrosurgical devices which typically operate at high temperatures, the use of conductive fluid "F" may be utilized to decrease temperature and/or to reduce or eliminate sticking, smoke production, and/or char formation. Additionally or alternatively, the use of a conductive fluid "F" may facilitate coupling the electrode(s) to tissue, enabling tissue treatment without direct contact between the electrode(s) and tissue, thereby expanding the potential treatment area. In aspects, fluid "F" may also be delivered during an ultrasonic mode of operation.

Fluid delivery in conjunction with electrosurgical energy supply may be performed, for example, as detailed in <CIT>. Other fluid enhanced electrosurgical (and/or ultrasonic) energy implementations are also contemplated.

In configurations where the fluid "F" is delivered through lumen <NUM> of waveguide <NUM> and blade <NUM>, this flow of fluid "F" through blade <NUM> also serves to cool blade <NUM>. As such, after activation in an ultrasonic mode, for example, fluid "F" may be delivered to a surgical site in preparation for or together with the supply of electrosurgical energy to facilitate electrosurgical tissue treatment, while providing the additional benefit of cooling blade <NUM>. Likewise, where the fluid "F" is delivered from jaw member <NUM>, the supply of fluid onto blade <NUM> may also facilitate cooling of blade <NUM> after an ultrasonic activation.

The use of non-conductive fluid "F," while not providing the electrical coupling features of conductive fluid "F," may still provide certain advantages over dry bipolar and/or monopolar electrosurgical modes including, for example, reduced occurrence of tissue sticking, charring, and/or smoke production. Further, a non-conductive fluid "F" may also serve to cool blade <NUM> after an ultrasonic activation, similarly as detailed above. Other suitable fluids are also contemplated such as irrigating fluids for irrigating the surgical site, fluids for cleaning tissue, medicaments to treat tissue, contrast agents, adhesives, etc. These fluids may be utilized for a surgical purpose while, in aspects, also facilitating cooling of blade <NUM>. Further, as an alternative to pumping fluid, fluid source <NUM> (<FIG>) may be configured to suction tissue through lumen <NUM>, e.g., for aspiration, removing fluid form the surgical site, etc. Such suction of fluid may likewise facilitate cooling of blade <NUM> as the fluid is drawn into and through blade <NUM>.

Claim 1:
A surgical system (<NUM>), comprising:
an ultrasonic transducer (<NUM>);
an ultrasonic waveguide (<NUM>) coupled to and extending distally from the ultrasonic transducer; and
an ultrasonic blade (<NUM>) disposed at a distal end of the ultrasonic waveguide and configured to receive ultrasonic energy produced by the ultrasonic transducer and transmitted along the ultrasonic waveguide to vibrate the ultrasonic blade for treating tissue therewith, the ultrasonic blade configured to connect to a source of electrosurgical energy (<NUM>) for conducting electrosurgical energy to tissue to treat tissue, characterized in that the ultrasonic blade defines a lumen (<NUM>) extending at least partially therethrough to at least one opening (<NUM>), the lumen configured for fluid communication with a fluid source (<NUM>) to enable the delivery of fluid from the fluid source through the lumen and out the at least one opening into a surgical site to facilitate electrosurgical tissue treatment.