Patent Description:
Surgical resection is a means of removing sections of organs from within the human or animal body. Such organs may be highly vascular. When tissue is cut (divided or transected) small blood vessels called arterioles are damaged or ruptured. Initial bleeding is followed by a coagulation cascade where the blood is turned into a clot in an attempt to plug the bleeding point. During an operation, it is desirable for a patient to lose as little blood as possible, so various devices have been developed in an attempt to provide blood free cutting. For endoscopic procedures, it is also undesirable for a bleed to occur and not to be dealt with as soon as quickly as possible, or in an expedient manner, since the blood flow may obscure the operator's vision, which may lead to the procedure needing to be terminated and another method used instead, e.g. open surgery.

Electrosurgical generators are pervasive throughout hospital operating theatres, for use in open and laparoscopic procedures, and are also increasingly present in endoscopy suites. In endoscopic procedures the electrosurgical accessory is typically inserted through a lumen inside an endoscope. Considered against the equivalent access channel for laparoscopic surgery, such a lumen is comparatively narrow in bore and greater in length. In the case of a bariatric patient the surgical accessory may have a length of <NUM> from handle to RF tip, whereas the equivalent distance in a laparoscopic case can be in excess of <NUM>.

Instead of a sharp blade, it is known to use radiofrequency (RF) energy to cut biological tissue. The method of cutting using RF energy operates using the principle that as an electric current passes through a tissue matrix (aided by the ionic contents of the cells and the intercellular electrolytes), the impedance to the flow of electrons across the tissue generates heat. When an RF voltage is applied to the tissue matrix, enough heat is generated within the cells to vaporise the water content of the tissue. As a result of this increasing desiccation, particularly adjacent to the RF emitting region of the instrument (referred to herein as an RF blade) which has the highest current density of the entire current path through tissue, the tissue adjacent to the cut pole of the RF blade loses direct contact with the blade. The applied voltage is then appears almost entirely across this void which ionises as a result, forming a plasma, which has a very high volume resistivity compared to tissue. This differentiation is important as it focusses the applied energy to the plasma that completed the electrical circuit between the cut pole of the RF blade and the tissue. Any volatile material entering the plasma slowly enough is vaporised and the perception is therefore of a tissue dissecting plasma.

<CIT> describes an electrosurgical instrument for applying to biological tissue RF electromagnetic energy and/or microwave frequency EM energy. The instrument comprises a shaft insertable through an instrument channel of a surgical scoping device. At a distal end of the shaft there is an instrument tip comprising a planar transmission line formed from a sheet of a first dielectric material having first and second conductive layers on opposite surfaces thereof. The planar transmission line is connected to a coaxial cable conveyed by the shaft. The coaxial cable is arranged to deliver either microwave or RF energy to the planar transmission line. The coaxial cable comprises an inner conductor, an outer conductor coaxial with the inner conductor, and a second dielectric material separating the outer and inner conductors, the inner and outer conductors extending beyond the second dielectric at a connection interface to overlap opposite surfaces of the transmission line and electrically contact the first conductive layer and second conductive layer respectively. The instrument further comprises a protective hull with a smoothly contoured convex undersurface facing away from the planar transmission line. The undersurface comprises a longitudinally extending recessed channel formed therein. A retractable needle is mounted within the instrument, and operable to extend through the recessed channel to protrude from a distal end of the instrument. The needle can be used to inject fluid into a treatment zone before the RF or microwave energy is applied.

<CIT> further discloses a hand-held interface joint at a proximal end of the shaft. The interface joint integrates into the shaft all of (i) a fluid feed, (ii) a needle movement mechanism, and (iii) an energy feed (e.g. a coaxial cable). The interface joint includes a slider mechanism for operating the retractable needle.

<CIT> discloses an interface joint for integrating a fluid feed, needle movement mechanism, and an energy deed into a single cable assembly.

At its most general, the present invention provides an interface joint with one or both of an improved needle actuation mechanism or an integrated shaft rotation mechanism. Providing an integrated shaft rotation mechanism may obviate the need for a separate torque transmission unit. The improved needle actuation mechanism may use a pivoting connection to enable longer needle extension distances to be achieved for a given actuation distance.

According to a first non claimed aspect of the disclosure, there is provided an interface joint for interconnecting an electrosurgical generator and an electrosurgical instrument, the interface joint comprising: a housing made of electrically insulating material, the housing having: a first inlet for receiving radiofrequency (RF) electromagnetic (EM) energy and/or microwave frequency EM energy from the electrosurgical generator, a second inlet for receiving fluid, and an outlet; a flexible shaft for connecting the housing to the electrosurgical instrument, the flexible shaft extending through the outlet and having a longitudinal passage therein, which provides a fluid flow path that is in fluid communication with the second inlet, and which conveys a coaxial transmission line that is connected to the first inlet; an actuation mechanism operably connected to the electrosurgical instrument to control deployment of a fluid delivery structure, the actuation mechanism comprising: an actuation rod extending out of the housing through the outlet, an actuator movably mounted on the housing and connected to the actuation rod; and a shaft rotation mechanism for rotating the flexible shaft relative to the housing, the shaft rotation mechanism comprising a rotation actuator rotatably mounted on the housing and operably coupled to the flexible shaft. In this aspect, the interface joint not only combines together the fluid supply and power feed for the electrosurgical instrument, but it also provides both a linear actuation mechanism (e.g. to deploy the fluid delivery structure within the instrument) and a rotation actuation mechanism that can drive rotation of the shaft and therefore the instrument.

The electrosurgical generator may be any device capable of delivery RF EM energy or microwave frequency EM energy for treatment of biological tissue. For example, the generator described in <CIT> may be used.

The electrosurgical instrument may be any device which in use is arranged to use RF EM energy or microwave frequency EM energy for the treatment of biological tissue. The electrosurgical instrument may use the RF EM energy and/or microwave frequency EM energy for any or all of resection, coagulation and ablation. For example, the instrument may be a resection device such as that disclosed in <CIT>, but alternatively may be any of a pair of microwave forceps, a snare that radiates microwave energy and/or couples RF energy, and an argon beam coagulator.

The housing may provide a double isolation barrier for the operator, i.e. the housing may comprise an outer casing (first level of isolation) that encapsulates a branched passageway (second level of isolation) within which the various inputs are integrated into the flexible shaft, which may provide a single cable assembly. The branched passageway may provide a watertight volume which defines a fluid flow path between the second inlet and the outlet, and which has a first port adjacent to the first inlet for admitting the coaxial cable. The actuation rod may extend through the same structure, i.e. the branched conduit may have a second port adjacent the actuation mechanism for admitting the actuation rod. The actuation rod may be conveyed through longitudinal passage of the flexible shaft, e.g. alongside the coaxial transmission line.

In use, the interface joint may be the location at which fluid for treatment at the instrument is introduced. The operator of the interface joint may control the introduction of fluid, e.g. via a syringe or other fluid introducing mechanism attached to the second inlet. The actuation mechanism may comprise a slider element mounted on the housing, the slider element being attached to the actuation rod that extends out of the housing through the outlet. Other types of actuation mechanism may also be used, e.g. the pivoting mechanism discussed below, or a rack type mechanism operating by a rotating wheel. The fluid delivery structure may comprise a retractable needle at the electrosurgical instrument (i.e. at a distal end of the flexible shaft). The retractable needle may be switchable into and out of fluid communication with the fluid flow path in the flexible shaft by sliding the actuation rod back and forth. For example, a distal end of the actuation rod may be connected to a proximal end of a needle ferrule, which has an internal volume in fluid communication with the fluid flow path through the flexible shaft. The needle may be mounted at a distal end of the needle ferrule, and arranged to be in fluid communication with the internal volume.

The rotation actuator may comprise a collar mounted around a distal portion of the housing. The rotation actuator is rotatable relative to the housing around an axis that is aligned with a direction in which the flexible shaft passes through the outlet. The rotation actuator and the housing may have interengaging elements arranged to provide feedback for a user. For example, the rotation actuator may click as it is rotated. The clicks may increase in frequency or volume as the amount of rotation from a centred position is increased.

The rotation actuator may be integrated with one or more elements that form the fluid flow path. For example, the housing may include an internal watertight branched conduit that provides a fluid flow path between the second inlet and the outlet. The branched conduit may comprise a main conduit fixed to the housing, and a rotating luer lock fitting rotatably mounted to a distal end of the main conduit. The flexible shaft may be non-rotatably coupled (e.g. adhered or otherwise affixed) to the rotating luer lock fitting, while the rotation actuator is connected to rotate the rotating luer lock fitting relative to the main conduit.

A second aspect of the disclosure and subject of the present invention provides an interface joint for interconnecting an electrosurgical generator and an electrosurgical instrument, the interface joint comprising: a housing made of electrically insulating material, the housing having: a first inlet for receiving radiofrequency (RF) electromagnetic (EM) energy and/or microwave frequency EM energy from the electrosurgical generator, a second inlet for receiving fluid, and an outlet; a flexible shaft for connecting the housing to the electrosurgical instrument, the flexible shaft extending through the outlet and having a longitudinal passage therein, which provides a fluid flow path that is in fluid communication with the second inlet, and which conveys a coaxial transmission line that is connected to the first inlet; an actuation mechanism operably connected to the electrosurgical instrument to control deployment of a fluid delivery structure, the actuation mechanism comprising: an actuation rod extending out of the housing through the outlet, an actuator arm pivotably mounted on the housing, the actuator arm having a first portion that protrudes from the housing, and a second portion operably connected to the actuation rod. Any features of the first aspect may be combined with the second aspect. In other words, the actuation mechanism of the second aspect may be incorporated into an interface joint having a shaft rotation mechanism.

The actuation mechanism may comprise a guide element slidably mounted in a reciprocal manner with respect to the housing. The guide element may be connected to a proximal end of the actuation rod, and the second portion of the actuator arm may be connected to the guide element by a drive arm. The guide element, drive arm and actuator arm may form an articulated structure that converts pivoting motion into longitudinal motion. The housing may comprise a track integrally formed therein for constraining the guide element to be movable only in a longitudinal direction. The longitudinal direction may be aligned with a direction in which the flexible shaft passes through the outlet.

The actuator arm may be connected to the housing at a pivot point, and wherein the second portion is further from the pivot point than the first portion. This may enable the device to drive the actuation rod for a distance that is longer than the distance travelled by the actuation arm. In other words a given movement of a user's finger can be transformed into a longer movement in the fluid delivery structure.

As discussed the housing includes an internal watertight branched conduit that provides a fluid flow path between the second inlet and the outlet. The branched conduit may have a first port adjacent to the first inlet for admitting the coaxial cable, and a second port adjacent the actuation mechanism for admitting the actuation rod. Both the first port and the second port may comprise a plug or sealing bung which defines a watertight passage for the coaxial cable and the actuation rod respectively. Each plug may be formed from a resiliently deformable material, e.g. silicone rubber, whereby the coaxial cable and push rod are encapsulated in the material as they pass through it. Sealing the first and second ports in this way means that the only route for fluid out of the interface joint is through the outlet along the fluid flow path in the flexible shaft.

In either of the aspects discussed above, a connector (e.g. a QMA connector) may be rotatably mounted at the first inlet, wherein the connector is arranged to connect to a coaxial cable from the electrosurgical generator. In one example, the connector may be mounted within a bearing unit that is fixed to the housing. The connector may be secured within an inner race of a ball bearing, with the outer race being fixed to the housing. This may enable the connector to be freely rotatable with respect to the housing.

In order to facilitate manipulation of the instrument at the distal end of the instrument channel of the endoscope, the flexible sheath may be provided with longitudinal braids therein to assist in the transfer of torque, i.e. to transfer a twisting motion at the proximal end of the cable assembly to the distal end of the cable assembly, where it can cause birotational rotation of the instrument because the instrument is attached to the cable assembly. The flexible sheath may comprises a inner tube and an outer tube, which are bonded or otherwise attached together with a tube of metallised braiding in between. The pitch of the braiding may be variable along the length of the cable assembly. For example, it may be useful to have a wider pitch in a region e.g. a distal portion of the cable, where flexibility is important. In order to prevent the metallised braiding from interfering with the RF field or microwave field at the instrument, a distal portion of the flexible sheath may be provided in which the braided is absent. The distal portion may be manufactured separately and attached (e.g. bonded or welded) to the braided portion.

The housing may further comprise a strain relief element mounted in the outlet and surrounding the flexible shaft. The function of the strain relief element is to limit the movement of the sleeve in this location to prevent overflexing that may damage the internal components.

The term "surgical scoping device" may be used herein to mean any surgical device provided with an insertion tube that is a rigid or flexible (e.g. steerable) conduit that is introduced into a patient's body during an invasive procedure. The insertion tube may include the instrument channel and an optical channel (e.g. for transmitting light to illuminate and/or capture images of a treatment site at the distal end of the insertion tube. The instrument channel may have a diameter suitable for receiving invasive surgical tools. The diameter of the instrument channel may be <NUM> or less.

Herein, the term "inner" means radially closer to the centre (e.g. axis) of the instrument channel and/or coaxial cable. The term "outer" means radially further from the centre (axis) of the instrument channel and/or coaxial cable.

The term "conductive" is used herein to mean electrically conductive, unless the context dictates otherwise.

Herein, the terms "proximal" and "distal" refer to the ends of the elongate probe. In use the proximal end is closer to a generator for providing the RF and/or microwave energy, whereas the distal end is further from the generator.

In this specification "microwave" may be used broadly to indicate a frequency range of <NUM> to <NUM>, but preferably the range <NUM> to <NUM>. Specific frequencies that have been considered are: <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM> and <NUM>. In contrast, this specification uses "radiofrequency" or "RF" to indicate a frequency range that is at least three orders of magnitude lower, e.g. up to <NUM>, preferably <NUM> to <NUM>, and most preferably <NUM>.

The electrosurgical instrument discussed herein may be capable of delivering radiofrequency (RF) electromagnetic (EM) energy and/or microwave EM energy into biological tissue. In particular, the electrosurgical instrument may be capable of delivering radiofrequency (RF) energy for cutting tissue and/or microwave frequency energy for haemostasis (i.e. sealing broken blood vessels by promoting blood coagulation). The invention may be particularly suitable in gastrointestinal (GI) procedures associated with the lower and upper GI tract, e.g. to remove polyps on the bowel, i.e. for endoscopic submucosal resection. The invention may also lend itself to precision endoscopic procedures, i.e. precision endoscopic resection, and may be used in ear, nose and throat procedures and liver resection. The device may also be used to address procedures associated with the pancreas, e.g. to resect or remove tumours or abnormalities in close proximity to the portal vein or the pancreatic duct.

Embodiments of the invention are described in detail below with reference to the accompanying drawings, in which:.

Various aspects of the present inventions are presented below in the context of an electrosurgery system that provides an electrosurgical invasive instrument for use in endoscopic procedures for the removal of polyps and malignant growths through the controlled delivery of both microwave and RF energy. However, it is to be understood that the aspects of the invention presented herein need not be limited to this particular application. They may be equally applicable in embodiments where only RF energy is required, or where only RF energy and fluid delivery is required.

<FIG> is a schematic diagram of a complete electrosurgery system <NUM> that is capable of selectively supplying to the distal end of an invasive electrosurgical instrument any or all of RF energy, microwave energy and fluid, e.g. saline or hyaluronic acid. The system <NUM> comprises a generator <NUM> for controllable supplying RF electromagnetic (EM) energy and/or microwave frequency EM energy. A suitable generator for this purpose is described in <CIT>.

The generator <NUM> is connected to an interface joint <NUM> by an interface cable <NUM>. The interface joint <NUM> is also connected to receive a fluid supply <NUM> from a fluid delivery device <NUM>, such as a syringe. The interface joint <NUM> houses a needle movement mechanism that is operable using an actuator <NUM>. The function of the interface joint <NUM> is to combine the inputs from the generator <NUM>, fluid delivery device <NUM> and needle movement mechanism into a single flexible shaft <NUM>, which extends from the distal end of the interface joint <NUM>. Examples of interface joints (which may be referred to herein as a "handle" or "handpiece" or "control device") that are embodiments of the invention are discussed in more detail below.

The flexible shaft <NUM> is insertable through the entire length of an instrument (working) channel of a surgical scoping device <NUM>. The surgical scoping device <NUM> may be an endoscope, gastroscope, bronchoscope, or the like. The instrument channel may extend though an instrument cord of the surgical scoping device, which is steerable in a conventional manner. The surgical scoping device <NUM> may include an optical channel for providing images of a treatment zone at a distal end of the instrument cord.

A torque transfer unit <NUM> may be mounted on a proximal length of the shaft <NUM> between the interface joint <NUM> and endoscope <NUM>. The torque transfer unit <NUM> engages the shaft to permit it to be rotated within the instrument channel of the endoscope <NUM>. As discussed below, in one embodiment of the invention, the torque transfer unit is incorporated into the interface joint <NUM>.

The flexible shaft <NUM> has a distal assembly <NUM> that is shaped to pass through the instrument channel of the endoscope <NUM> and protrude (e.g. inside the patient) at the distal end of the instrument cord. The distal end assembly includes an active tip for delivering RF EM energy and/or microwave EM energy into biological tissue and a retractable hypodermic needle for delivering fluid. These combined technologies provide a unique solution for cutting and destroying unwanted tissue and the ability to seal blood vessels around the targeted area. Through use of the retractable hypodermic needle, the surgeon is able to inject saline and/or hyaluronic acid with added marker dye between tissues layers in order to distend and mark the position of a lesion to be treated. The injection of fluid in this manner lifts and separates the tissue layers making it both easier to resect around the lesion and plane through the submucosal layer, reducing the risk of bowel wall perforation and unnecessary thermal damage to the muscle layer.

At the proximal end of the instrument channel, which is typically held <NUM> to <NUM> from the patient, the flexible shaft <NUM> emerges from a port and extends a further <NUM> to <NUM> to the interface joint <NUM>. In use, the interface joint <NUM> is typically held by a gloved assistant throughout the procedure. The interface joint <NUM> may be designed and manufactured from polymer materials in such a way as to provide primary and secondary electrical insulation with extended creepage and clearance distances.

<FIG> and <FIG> show various views of an interface joint <NUM> that is a first embodiment of the invention. The interface joint <NUM> may be used with the apparatus <NUM> discussed above, in place of the interface joint <NUM>.

The interface joint <NUM> comprises a housing <NUM>, e.g. formed from a rigid polymer. The housing <NUM> encasing the components of the interface joint <NUM> discussed below.

The housing <NUM> has a plurality of apertures in its outer surface which provide various ports for the joint.

On a top surface there is a first port for receiving a fluid supply, e.g. a syringe for injecting a liquid such as saline or hyaluronic acid. The first port has a moulded receiving element <NUM> mounted therein. The moulded receiving element <NUM> may be shaped to cooperate with a connection interface of the fluid supply to provide a secure interconnection.

At the rear (proximal end) of the housing there is a second port for receiving power from the electrosurgical generator. The second port may include a QMA connector <NUM> or the like (see <FIG>) that can couple a coaxial cable from the electrosurgical generator to a coaxial transmission line <NUM> within the housing <NUM>. The second port has a moulded connection element <NUM> mounted therein. The moulded connection element <NUM> may be shaped to cooperate with the QMA connector and/or the coaxial cable from the electrosurgical generator to provide a secure interconnection.

At the front (distal end) of the housing <NUM> there is a third port <NUM> from which a flexible shaft <NUM> extends. The flexible shaft <NUM> comprise a sheath defining a longitudinal passageway for conveying the fluid from the first port, the coaxial cable <NUM> from the second port, and a needle actuation rod <NUM> (see <FIG>) to an electrosurgical instrument at a distal end thereof.

On the bottom of the housing <NUM> there is a fourth port <NUM> through which an actuator for a needle actuation mechanism protrudes. The needle actuation mechanism is discussed in more detail below.

Within the housing <NUM>, a pair of Y conduit connectors <NUM>, <NUM> are provided to define respective pathways for (i) the fluid from the first port, (ii) the coaxial transmission line <NUM> from the second port, and (iii) the needle actuation rod <NUM> associated with the needle actuation mechanism to the flexible shaft <NUM>. The Y conduit connectors <NUM>, <NUM> are retained in the housing <NUM>, e.g. by being clipped within ribs or other projections that are integrally formed in the housing.

A first Y conduit connector <NUM> has a first input tube connected to the moulded receiving element <NUM> in a fluid tight manner, and a second input tube arranged to receive the coaxial transmission line <NUM> from the second port. A plug <NUM> is mounted at the proximal end of the second input tube. The coaxial transmission line <NUM> passes through the plug <NUM>. The plug <NUM> is formed from resilient material so that it defines a fluid tight seal around the coaxial transmission line <NUM>. The first Y conduit connector <NUM> has an output tube connected to a first input tube of a second Y conduit connector <NUM>. The fluid and coaxial transmission line <NUM> are thus conveyed together to the second Y conduit connector <NUM>.

The second Y conduit connector <NUM> comprises a second input tube connected to receive the needle actuation rod <NUM>. The needle actuation rod <NUM> is slidable under operation of the needle actuation mechanism into and out of the second Y conduit connector. A plug <NUM> is secured at the proximal end of the second input tube of the second Y conduit connector to prevent fluid from leaking. The plug <NUM> is formed from resilient material so that it defines a fluid tight seal around the needle actuation rod <NUM> whilst still permitting slidable movement thereof.

The second Y conduit connector <NUM> comprises an output tube that is secured to a proximal end of the flexible shaft <NUM> in a fluid tight manner, whereby all of (i) the fluid from the first port, (ii) the coaxial transmission line <NUM> from the second port, and (iii) the needle actuation rod <NUM> are transferred into a longitudinal passageway defined within the flexible shaft <NUM>.

As shown in <FIG>, in this example the first Y conduit connector has the first and second input tubes at an acute angle to each other, whereas the second Y conduit connector has its first and second input tubes in parallel. However, the invention is not limited to this arrangement. In other embodiment different junctions may be used. For example, a single junction with three input tubes leading to a single output tube may be used.

The needle actuation mechanism will now be discussed in more detail. <FIG> shows the interface joint when the needle is extended. <FIG> shows the interface joint when the needle is retracted. The needle itself is located in the electrosurgical instrument at a distal end of the flexible shaft <NUM>. It is connected to a distal end of the needle actuation mechanism by the needle actuation rod <NUM>, which is slidable with the shaft <NUM>. A proximal end of the needle actuation rod <NUM> is connected to a guide element <NUM>, which is slidably mounted in a track <NUM> defined by projecting ribs within the housing <NUM>. The track <NUM> extends in a longitudinal direction, i.e. a direction in line with a direction in which the flexible shaft <NUM> extends away from the housing <NUM>. Movement of the guide element <NUM> along the track <NUM> therefore controls movement of the needle actuation rod <NUM> into and out of the flexible shaft <NUM>.

In <FIG>, the guide element <NUM> is at a distal end of the track <NUM>, whereby the needle actuation rod <NUM> is fully extended into the flexible shaft <NUM>. In <FIG>, the guide element <NUM> is at a proximal end of the track <NUM>, whereby the needle actuation rod <NUM> is at a retracted position relative to the flexible shaft <NUM>.

Movement of the guide element <NUM> is controlled by a pivoting trigger mechanism. The trigger mechanism comprises a trigger arm <NUM> which is pivotably connected to the housing <NUM> via a pin <NUM>, which defines a first pivot axis. The trigger arm <NUM> extends out of the fourth port <NUM> and terminates at a first end in a finger grip <NUM>. The finger grip <NUM> is arranged to facilitate operation (i.e. forwards and backwards motion) of the trigger arm <NUM> by a user holding the housing <NUM>. In this example, the finger grip <NUM> is a ring for receiving a user's finger.

A second end of the trigger arm <NUM> is connected to a drive arm <NUM> via a hinge <NUM>. The drive arm <NUM> in turn is pivotably connected to the guide element <NUM> so that its angle relative to the guide element <NUM> can change as the guide element <NUM> slides along the track <NUM>. The hinge <NUM> defines a second pivot axis that moves within the housing <NUM> when the trigger arm <NUM> is operated.

By providing an articulated needle actuation mechanism it may be possible to provide an increased distance of travel for the needle actuation rod <NUM> for a given movement of the finger grip <NUM> through suitable positioning of the pivot points. This can be advantageous compared with actuation mechanisms in which the rod is moved by a liner slider without any gearing.

The location of the first port and second port on the interface joint <NUM> are arranged such that a user can grip and hold the device with their hand between the fluid supply and the power supply. The spacing between these ports may be desirable to assist in assembly and to avoid any interference.

<FIG> is a perspective view of a second exemplary interface joint <NUM> The interface joint <NUM> comprise a housing <NUM>. The interface joint <NUM> may be used with the apparatus <NUM> discussed above, in place of the interface joint <NUM> and torque transfer unit <NUM>.

The housing <NUM> may be a rigid hollow casing that encloses the junctions and components discussed below. The casing may be made from moulded plastic, e.g. in two halves that are securable together, e.g. by welding or the like.

The housing <NUM> has a pair of ring elements <NUM> integrally formed on opposing sides thereof. The ring elements <NUM> provide finger grips for a user operating the device.

The housing <NUM> has a outlet port at a distal end thereof. A flexible shaft <NUM> extends out of the output port, whereupon it may be fed into an instrument channel of a surgical scoping device. The distal end of the housing may comprise a conical tip section <NUM>. The tip section may be rigid. Alternatively it may be deformable e.g. to provide strain relief for the flexible shaft <NUM>.

A collar <NUM> is rotatable mounted on a distal portion of the housing <NUM>. The collar <NUM> is operably coupled to the flexible shaft <NUM> whereby rotation of the collar <NUM> relative to the housing <NUM> causes the flexible shaft to rotate. This rotation may be transferred through the instrument channel to cause rotation of an electrosurgical instrument at a distal end of the flexible shaft <NUM> relative to the instrument channel. The collar <NUM> may be arranged to rotate about an axis that is aligned with the flexible shaft as it leaves the housing <NUM>. This ensures that the rotation of the collar <NUM> is intuitively linked to the resulting rotation of the instrument tip. The collar <NUM> may have a plurality of upstanding ridges to facilitate grip.

The housing <NUM> may include a feedback mechanism for a user to sense the degree of rotation being applied. The feedback mechanism may be haptic or audio. For example, the housing <NUM> and collar <NUM> may have interengaging elements that produce a sound (e.g. a click) or a impulse that can be perceived by the user to give feedback on the incremental degrees of rotation being applied.

The housing <NUM> has three ports at a proximal end thereof.

A first proximal port is in line with (i.e. is coaxial with) the output port. The first port receives a slider element <NUM> which is movable relative to the housing in a longitudinal direction. The slider element is connected to a needle actuation rod (not shown) that passes through the flexible shaft to control deployment and retraction of a needle in the electrosurgical instrument in a similar manner to that discussed above with respect to <FIG>. The housing <NUM> may comprise a guide track (not shown) that defines the longitudinal path of motion for the slider element <NUM>. The slider element may have a proximal finger grip <NUM>, e.g. a ring for receiving a user's thumb in this example, for ease of deployment.

One or more biasing elements (e.g. springs or other resilient structures) may be provided between the housing <NUM> and the slider element <NUM> to urge the needle actuation mechanism into a certain configuration, e.g. a retracted configuration.

Markings <NUM> may be formed on the housing to indicate the direction of movement of the collar <NUM> and the slider element <NUM>.

A second proximal port <NUM> is for receiving a fluid supply. In <FIG>, the second proximal port <NUM> is connected to a syringe body <NUM>, e.g. for injecting a liquid such as saline or hyaluronic acid.

A third proximal port is for receiving power from the electrosurgical generator. The third proximal port may have a connector <NUM>, e.g. a QMA connector or the like, arranged to connect to a coaxial cable from the electrosurgical generator.

The second and third proximal ports may be on opposite sides of the first proximal port, and may be angled away from it, e.g. to facilitate attachment of the corresponding components.

The housing <NUM> operates in a similar manner to housing <NUM> discussed above. Inputs from the fluid supply, needle actuation mechanism and power supply are combined together and conveyed through a passageway formed in the flexible shaft <NUM>.

<FIG> is a side view of the internal components of the interface joint <NUM>. The backbone of the interface joint <NUM> comprises a branched conduit connector <NUM> and a main conduit <NUM>. The branched conduit connector <NUM> may resemble a tri-connector conduit junction, having a three angled inlet ports <NUM>, <NUM>, <NUM> in fluid communication with an outlet port that is connected to the main conduit <NUM> by a suitable fluid tight coupling <NUM>. The main conduit <NUM> may define a longitudinal passageway that is in fluid communication with the passage within the flexible shaft <NUM>. The main conduit <NUM> may be aligned along the axis of the flexible shaft <NUM> as it leave the housing.

The flexible shaft <NUM> is secured to an output portion <NUM> of a rotatable luer lock fitting <NUM>, which is mounted on the distal end of the main conduit <NUM>. The flexible shaft <NUM> may be secured or potted within the output portion in a fluid tight manner, e.g. using a suitable adhesive.

The rotatable luer lock fitting <NUM> may be operably connected to the collar <NUM> such that rotation of the collar causes the rotatable luer lock fitting <NUM> to rotate about the main conduit <NUM>, which in turn causes the flexible shaft <NUM> to rotate relative to the housing <NUM>. Rotation of the main conduit <NUM> is prevent by ensuring that is fixed to the housing <NUM> in a non-rotatable manner. For example, a retaining element <NUM> may be mounted on the main conduit to secure it within the housing <NUM>.

The inlet ports <NUM>, <NUM>, <NUM> of the branched conduit connector <NUM> provide the first, second and third ports discussed above. Thus, a first inlet port <NUM> is connected to the fluid supply (e.g. a syringe housing <NUM>). A second inlet port <NUM> receives the needle actuation rod (not shown). A third inlet port <NUM> receives the coaxial cable from the electrosurgical generator. The second port <NUM> and third ports <NUM> may include plugs (not shown) for prevent leakage of fluid received through the first inlet port <NUM> in a similar manner to that shown in <FIG> above.

Fluid from the first inlet port <NUM>, a needle actuation rod (not shown) from the second inlet port <NUM>, and a coaxial transmission line (not shown) from the third inlet port are combined within and conveyed by the main conduit <NUM> to the passage within the flexible shaft <NUM>.

An advantage of this arrangement is that both the shaft rotation mechanism (which controls turning of the instrument) and the needle actuation instrument are provided on the same unit.

Claim 1:
An interface joint (<NUM>) for interconnecting an electrosurgical generator (<NUM>) and an electrosurgical instrument, the interface joint comprising:
a housing (<NUM>) made of electrically insulating material, the housing having:
a first inlet (<NUM>) for receiving radiofrequency (RF) electromagnetic (EM) energy and/or microwave frequency EM energy from the electrosurgical generator,
a second inlet for receiving fluid (<NUM>), and
an outlet (<NUM>);
a flexible shaft (<NUM>) for connecting the housing to the electrosurgical instrument, the flexible shaft extending through the outlet and having a longitudinal passage therein, which provides a fluid flow path that is in fluid communication with the second inlet, and which conveys a coaxial transmission line (<NUM>) that is connected to the first inlet;
an actuation mechanism operably connected to the electrosurgical instrument to control deployment of a fluid delivery structure, the actuation mechanism comprising:
an actuation rod (<NUM>) extending out of the housing through the outlet,
an actuator arm pivotably mounted on the housing, the actuator arm having a first portion (<NUM>) that protrudes from the housing, and a second portion (<NUM>) operably connected to the actuation rod.