WO1993014708A1 - Laparoscopic surgical apparatus and methods using ultrasonic energy - Google Patents

Laparoscopic surgical apparatus and methods using ultrasonic energy Download PDF

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Publication number
WO1993014708A1
WO1993014708A1 PCT/US1993/000793 US9300793W WO9314708A1 WO 1993014708 A1 WO1993014708 A1 WO 1993014708A1 US 9300793 W US9300793 W US 9300793W WO 9314708 A1 WO9314708 A1 WO 9314708A1
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WO
WIPO (PCT)
Prior art keywords
extension
extension tube
blade
tube
handpiece
Prior art date
Application number
PCT/US1993/000793
Other languages
French (fr)
Inventor
Thomas W. Davison
Paul B. Nelson
Gary R. Whipple
Original Assignee
Ultracision Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ultracision Inc. filed Critical Ultracision Inc.
Publication of WO1993014708A1 publication Critical patent/WO1993014708A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320069—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for ablating tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/32007—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with suction or vacuum means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320082—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for incising tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320084—Irrigation sleeves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320088—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with acoustic insulation, e.g. elements for damping vibrations between horn and surrounding sheath
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320089—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic node location

Definitions

  • the invention relates generally to ultrasonic surgical instruments and methods of use and particularly to apparatus and techniques for dissection of soft, relatively loose and unsupported tissue and coagulation of blood vessels affording exceptional hemostasis using an ultrasonically vibrating surgical instrument at the surgical site under endoscopic observation.
  • the instrument disclosed in that application solved a number of problems in adapting an ultrasonic surgical instrument to laparoscopic surgery, including the introduction and removal of the ultrasonic surgical instrument through a small incision without causing inadvertent cutting or other damage to adjacent body parts, preventing the ultrasonic energy from dissipating or damping out against its supporting structure once inserted and, during the surgical operation, maintaining seals to prevent escape of carbon dioxide gas or other irrigating fluids pumped into the body cavity, while simultaneously maintaining access, visibility and maneuverability of the instrument to effect dissection and coagulation under endoscopic observation and ensuring transmission of the ultrasonic energy at the appropriate frequency to the cutting site.
  • the ultrasonic surgical instrument of the prior application includes a blade coupler for mounting a surgical blade, a power source for generating ultrasonic energy and a blade coupler extension, i.e., a solid shaft, interconnecting the power source and the blade coupler.
  • Ultrasonic energy is transmitted from the power source through the blade coupler extension to the blade coupler and blade.
  • the blade coupler extension has a length corresponding to an integer multiple of the half-wavelength of the frequency of the ultrasonic energy generated by the power source whereby the blade coupler extension is provided in lengths in integer multiples of that haIf-wavelength.
  • the instrument also includes an extension tube to facilitate insertion of the blade, blade coupler and extension through the small incision under endoscopic observation.
  • the extension tube is used in conjunction with a laparoscopic port having an outer tube inserted through the incision for directing the extension tube and extension toward the surgical site.
  • the outer tube of the port serves as a passage for receiving the extension tube and blade coupler extension during insertion, use and removal of the surgical instrument.
  • various isolation mounts are placed along the blade coupler extension at positions of minimal axial ultrasonic activity or nodes, i.e., nodal points at every half-wavelength of the frequency of the blade coupler extension. By locating the mounts at the vibratory nodes, diminution, dissipation or damping out of the transmission of the ultrasonic energy from the power source to the blade is precluded.
  • the outer tube of the laparoscopic port is inserted through the small incision in a conventional manner.
  • a blade coupler, extension and power source are connected to one another and an insertion collar is secured to the blade coupler extension.
  • the insertion collar butts the end of the extension tube, ensuring that the blade lies within the opposite end of the extension tube.
  • the extension tube and blade coupler extension and blade coupler are then jointly inserted through the outer tube of the laparoscopic port into the body cavity.
  • the extension, blade coupler and, hence, the blade are movable axially relative to the extension tube to locate the blade at the surgical site.
  • Ultrasonic energy is then delivered from the power source to the blade to perform the dissection and coagulation functions under endoscopic observation.
  • the blade, blade coupler and blade coupler extension may be withdrawn into the extension tube and those elements simultaneously withdrawn from the outer tube of the laparoscopic port.
  • the extension tube, on the one hand, and the blade coupler and blade coupler extension, coupled to the handpiece of the surgical instrument on the other hand are separate and discrete parts. It is thus necessary to support the blade coupler extension within the extension tube at two or more of the nodal points. While this ultrasonic surgical device has proven effective in performing its intended functions within the body cavity at the surgical site, the present invention affords an endoscopic ultrasonic surgical instrument that is easier to assemble and use, one which is of a much simpler design than the previously described ultrasonic surgical instrument of the prior application, and which has various other advantages in construction, operation and use, as will become evident from this description.
  • the extension tube is attached directly to the handpiece of the ultrasonic instrument in a manner such that the extension tube is isolated from the ultrasonic power element and the transmission of the ultrasonic energy from the power element through the blade extension to the blade.
  • the extension tube directly to the handpiece, only one centering device is required to coaxially center the blade extension and extension tube.
  • two sub-assemblies of the ultrasonic surgical instrument hereof are provided, i.e., a first sub-assembly comprising a handpiece containing the power element, electrical connections and a handpiece adapter and a second sub-assembly comprising the extension tube, the blade coupler, blade, blade coupler extension and a latch.
  • the sub-assemblies are connected to one another by the engagement of the latch and adapter and the threading of the blade extension and power element one to the other thereby enabling (1) the blade coupler extension to transmit ultrasonic energy from the power element in the handpiece to the blade and (2) telescopic movement of the extension tube relative to the blade coupler extension and handpiece during use of the instrument.
  • the first sub-assembly has a tubular adapter extending axially from the handpiece for receiving the end of the blade coupler extension opposite the blade whereby, upon insertion of that blade coupler extension end through the adapter, the blade coupler extension may be screw-threaded to the power element within the handpiece.
  • the second sub-assembly includes a laparoscopic latch which is fixed to the end of the extension tube opposite the blade end of the instrument.
  • the latch includes latching fingers for engaging in recesses at selected axial positions along the adapter to secure the sub-assemblies one to the other.
  • the recesses on the adapter serve as detents and are located at axially spaced positions along the adapter such that the latching fingers and hence extension tube may be axially displaced relative to the handpiece and blade and blade coupler extension.
  • the extension tube is movable between a position wholly encompassing the blade within the end of the extension tube and a position exposing the blade from the end of the extension tube for use.
  • the sub-assemblies are secured to one another and the extension tube is axially extended to cover the blade as described above.
  • the extension tube is inserted through the laparoscopic port tube to locate the end of the extension tube adjacent the surgical site.
  • the extension tube, blade extension and blade are jointly rotated, pivoted and axially advanced and retracted relative to the laparoscopic port to position the blade end of the instrument adjacent the surgical site.
  • the extension tube is then displaced, i.e., retracted, axially toward the handpiece to expose the blade through the end of the extension tube at the surgical site. Ultrasonic energy may then be applied and the surgical procedure commenced.
  • a centering device between the blade extension and the extension tube is located at one of the vibratory nodes adjacent the end of the combined extension tube and blade extension opposite the connection of the blade extension to the handpiece whereby the ultrasonic energy transmitted along the blade extension is not dissipated or damped by the extension tube.
  • the centering device also serves as a seal to prevent any fluids within the body cavity or gases introduced into the body cavity, such as carbon dioxide, from passing through the annular space between the blade extension and extension tube.
  • the present invention provides a number of features and various advantages in construction, mode of operation and use as compared with the prior art. For example, for the efficient transfer of ultrasonic energy from the handpiece to the blade, it has been found that a blade coupler extension formed of aluminum or stress-relieved titanium is most effective. While it was previously believed that aluminum was not sufficiently durable for this use and that stress-relieved titanium would not have sufficient strength for this use, it has been found that these materials, preferably aluminum, may be used to form the blade coupler extension and thus reduce the cost of the instrument. Reductions in cost are, of course, significant because the second sub-assembly comprising the extension tube, the blade coupler, blade, blade coupler extension and latch are designed for one-time disposable use.
  • extension tube An additional, very important feature of the present invention resides in the ability of the extension tube to be extended and retracted relative to the blade. This is very significant in laparoscopic surgery for a number of reasons, including the protection of the blade when the blade is inserted through the laparoscopic port. Without protecting the blade, the blade or the hook on the blade would catch on the valve of the laparoscopic port and/or engage and possibly cut tissue upon displacement of the blade toward the surgical site. Conversely, it is significant that the extension tube can be extended so that the blade lies wholly within the end of the extension tube. This is important during withdrawal of the instrument from the surgical site to avoid cutting or damaging the adjoining tissue along the path of instrument withdrawal.
  • the centering device at the nodal point may be replaced with a non-sealing centering device.
  • the annular space between the extension tube and blade extension may then be used to irrigate or aspirate the surgical site.
  • the annular space is connected to valved ports in the latch assembly.
  • irrigation and aspiration are conducted intermittently through the annular space between the extension tube and blade extension thus providing an instrument having only one passage for both irrigation and suction.
  • the extension tube may be extended to wholly overlie the blade adjacent the surgical site during the course of the surgical procedure in order that suction or irrigating fluid can be supplied.
  • the end of the extension tube is extended over the blade and the extension tube end is located in or adjacent the pool of fluid.
  • suction is applied in the annular space to draw the fluid through the extension tube end past the non-sealing centering device and into the annular space. Consequently, the ability to cover and then uncover the blade relative to the extension tube while the instrument is in the body cavity is particularly significant in the present invention for purposes not only of cutting and dissecting but for intermittent irrigation and suction.
  • an ultrasonic surgical apparatus comprising a handpiece including a power element for generating ultrasonic energy, a surgical instrument, means for transmitting ultrasonic energy from the power element to the instrument including an extension interconnecting the power element and the instrument and an extension tube attached to the handpiece and extending about and radially spaced from the extension.
  • Means are provided for isolating the ultrasonic energy transmitted from the power element to the instrument from the extension tube, including means engageable between the extension and the extension tube at at least one vibratory node along the extension whereby dissipation of ultrasonic energy along the extension by engagement with the extension tube is substantially precluded.
  • an ultrasonic surgical apparatus comprising a handpiece including a power element for generating ultrasonic energy, a surgical instrument, means for transmitting surgical energy from the power element to the instrument including an extension interconnecting the power element and the instrument and an extension tube attached at one end to the handpiece and extending about and radially spaced from the extension. Means are carried by the apparatus mounting the extension tube and the extension for axial movement relative to one another between a position with the surgical instrument exposed through an opposite end of the extension tube and retracted within the opposite end of the extension tube.
  • a method of using an ultrasonic surgical apparatus comprised of a first sub-assembly including a handpiece containing a power element for generating ultrasonic energy, and a second sub-assembly including a surgical blade, a blade extension coupled to the blade, and an extension tube surrounding the blade extension, comprising the steps of connecting the first sub-assembly and the second sub-assembly one to the other such that the extension tube, blade coupler and blade extend from the handpiece, attaching the blade extension and the power element one to the other such that ultrasonic energy generated by the power element may be transmitted through the blade extension to the blade, with the blade within the distal end of the extension tube, disposing the extension tube and the blade extension and blade through a laparoscopic port to locate a distal end of the extension tube adjacent a surgical site, displacing the extension tube and the extension relative to one another to expose the blade for use at the surgical site through the distal end of the extension tube
  • Figures 1-3 are side elevational views of an ultrasonic surgical instrument according to the present invention with parts broken out for ease of illustration, with Figure 1 illustrating the extension tube extended to cover the surgical blade, Figure 2 illustrating the extension tube partially retracted to expose a length of the blade and Figure 3 illustrating the extension tube fully retracted to expose the entirety of the blade;
  • Figure 4 is an enlarged side elevational view thereof with parts broken out and in cross-section, illustrating the connection between the sub-assemblies;
  • Figure 5 is a cross-sectional view thereof taken generally about on lines 5-5 in Figure 4;
  • Figure 6 is a view similar to Figure 4 illustrating a further embodiment of the present invention.
  • Figure 7 is an enlarged view of a non-sealing centering ring located at the nodal point of the blade extension.
  • apparatus 10 includes a first sub-assembly including a handpiece 12 housing an ultrasonic power element 14.
  • Handpiece 12 also includes, as best illustrated in Figure 4, a mount 16 comprising a generally cylindrical, internally threaded element 18 at one end for threaded coupling with the body of the handpiece and a reduced diameter axially projecting adapter 20.
  • Adapter 20 has a bore 22 passing axially therethrough for receiving the extension tube of the second sub-assembly, as described hereinafter.
  • adapter 20 is multi-faceted, i.e., preferably octagonal in shape.
  • the distal end of the adapter 20 includes a radially outwardly projecting lip 24.
  • Adapter 20 is also provided with circumferentially extending axially spaced recesses 26 and 28 which serve as detents in cooperation with the latch, to be described.
  • the power element is internally threaded at one end to receive in threaded engagement therewith the end of the blade coupler extension.
  • the instrument includes a second sub-assembly, generally designated 30.
  • Sub-assembly 30 includes a coupler extension 32, a coupler 34 terminating at one end in a surgical instrument, e.g., a blade 36 having a hook portion, an extension tube 38 and a latch 40.
  • the blade coupler extension 32 comprises a solid shaft which, at the left hand end illustrated in Figure 4, is threaded for threaded connection with threads of the power element whereby ultrasonic energy may be transmitted from power element 14 to the blade extension 32.
  • Blade coupler 34 is connected to the blade extension 32 by a stud 42 and has flats 44 along opposite sides for engagement by a wrench, for example, the wrench described and illustrated in prior U.S. Patent No.
  • the blade coupler extension 32 has a length equal to an integer multiple of the half-wavelength of the frequency generated by the ultrasonic power element 14. Consequently, once the frequency at which the ultrasonic energy will be applied has been determined, for example, a frequency of 55,500 Hz, a blade extension 32 may be formed having a length equal to an integer multiple of the half-wavelength of that frequency.
  • the blade 36 with the hook portion is described and illustrated in a co-pending U.S.
  • Blade extension tube 38 comprises an elongated, hollow tube secured, for example, by a press-fit, in a latch mount 46 which forms part of latch 40.
  • Latch 40 includes a generally annular forward end 48 for receiving the latch mount 46 in a press-fit.
  • a plurality of circumferentially spaced fingers 50 extend axially rearwardly from forward end 48. Fingers 50 terminate at their rearmost ends in inwardly directed flanges 52 for engaging selectively in detents 28 and 26 or behind the radially outwardly projecting lip 24, as described hereinafter.
  • the rearwardly extending end of extension tube 38 passes through the latch mount 46, and has an axial extent terminating adjacent the ends of the latch fingers 50.
  • the ultrasonic apparatus is provided in two major sub-assemblies: a first sub-assembly including the handpiece 12 containing the power element, electrical connections and adapter, and the second sub-assembly comprised of blade extension 32, blade coupler 34, blade 36, extension tube 38 and latch 40.
  • Ancillary equipment, not shown, necessary for the surgery would include a laparoscopic port, for example, as described and illustrated in previously mentioned co-pending application Serial No. 07/670,186.
  • blade extension 32 has a centering device 54 which, in Figure 4, is in the form of an annular seal for sealing between blade extension 32 and extension tube 38.
  • the centering device 54 is located at a nodal point whereby the engagement of the seal with blade extension 32 and extension tube 38 precludes dissipation of ultrasonic energy from the blade extension 32 to the tube 38.
  • the second sub-assembly is provided in a peel pouch, not shown, and is for one-time or disposable use in a particular surgery.
  • the first sub-assembly i.e., the handpiece 10, and ancillary components are, of course, used for multiple surgeries.
  • a wrench not shown, is then applied to blade coupler 34, particularly engaging the flats 44, and the blade coupler and blade extension are jointly rotated to screw-thread the blade extension into the power element 14.
  • the ultrasonic surgical apparatus is now ready for use.
  • the incision is made and the laparoscopic port is applied, as conventional.
  • the extension tube 38 is then advanced axially such that flanges 52 engage behind the radially outwardly directed lip 24, as illustrated in Figure 1.
  • the blade coupler 34 and blade 36 are wholly encompassed within the end of the extension tube 38, as illustrated in Figure 1.
  • the extension tube is then inserted through the laparoscopic port and, under endoscopic observation, its tip is located adjacent the surgical site.
  • the blade 36 with hook portion is retracted within the extension tube end during insertion of the instrument, the blade will not engage any portions of the laparoscopic port or any tissues within the body cavity as the extension tube end is advanced to the surgical site.
  • the latch When located at the surgical site, the latch is retracted rearwardly along the handpiece to retract the extension tube and thus expose blade 36, either partially or fully, as illustrated in Figures 2 and 3, respectively.
  • ultrasonic energy is applied through blade extension 32, blade coupler 34 to the blade 36, whereby cutting, dissection and coagulation are performed.
  • Seal 54 prevents fluids or gases within the body cavity from migrating into the annular space between blade extension 32 and extension tube 38.
  • the latch Upon completion of the surgery, the latch is advanced such that the end of the extension tube 38 advances to once again overlie and wholly encompass blade 36, as illustrated in Figure 1.
  • the instrument can be withdrawn through the laparoscopic port without the blade cutting or damaging any adjacent tissue along the path of its withdrawal.
  • annular centering device 60 is illustrated and has a plurality of ports 62 circumferentially spaced one from the other.
  • the centering device 60 is located similarly as seal 54, i.e., at a nodal point, and the ports 62 permit passage of the fluid or gas in the annular space between extension tube 38 and blade extension 32.
  • latch mount 46a in the embodiment illustrated in Figure 5 is extended to include a pair of passageways 64 and 66 terminating in valved connectors 68 and 70, respectively.
  • the fluid or gases may flow through the annular space between extension tube 38 and blade extension 32.
  • the instrument is located at the surgical site as previously described and the extension tube is retracted to expose the blade.
  • the ultrasonic energy is discontinued and the extension tube is extended by displacing the latch along the adapter into its forward ost position, as illustrated in Figure 1.
  • the ports 68 and 70 are, of course, connected to irrigation and suctioning conduits.
  • the irrigating fluid may be passed within the annular space between the extension 32 and extension tube 38 to irrigate the site.
  • suction is applied to the other port whereby the debris and blood can be removed from the site.
  • the annular passageway can be used intermittently as an irrigating or suctioning passageway, as long as the blade lies wholly within the extension tube end.
  • the valves are manipulated to close the irrigation or suctioning conduits.
  • the blade is then exposed for use by retracting the latch and extension tube relative to the handpiece as illustrated in Figure 3. Ultrasonic energy is then applied to resume cutting and coagulation.
  • the instrument must transmit ultrasonic energy over a substantial distance from the power element in the handpiece to the surgical blade.
  • the transmission of this ultrasonic energy must be accomplished efficiently if unacceptable power levels are to be avoided. Consequently, the impedance between the power element and the blade must be maintained at a low value.
  • the impedance of the handpiece is, in a preferred embodiment, approximately between 25-75 ohms.
  • the extension By attaching the extension at one end to the power element of the handpiece and supporting the extension adjacent its opposite end at a nodal point and further by forming the extension of materials which will not substantially increase the impedance between the power element of the handpiece and the blade, it is possible to obtain a laparoscopic instrument which efficiently transmits energy over the required distance to enable laparoscopic surgery. This is accomplished in part by forming the extension of either aluminum or stress-relieved titanium. By using these criteria, the impedance between the power element of the handpiece and the blade may be maintained under 200 ohms at power levels which are not considered excessive.

Abstract

The surgical apparatus includes a first sub-assembly including a handpiece (12) and a latch adapter and a second sub-assembly (30) comprised of a latch (40), an extension tube secured to the latch, and a blade extension (32) received within the extension tube (38) for coupling to a power element in the handpiece. The second sub-assembly is latched to the handpiece of the first sub-assembly and the blade extension is screw-threaded to the power element whereby ultrasonic energy may be transmitted through the blade extension to the blade. A centering device (54) centers the distal end of the blade extension in the extension tube and is located at the node point. By axially advancing and retracting the latch, the extension tube may overlie and wholly encompass the blade and expose it for use, respectively.

Description

LAPAROSCOPIC SURGICAL APPARATUS AND METHODS USING ULTRASONIC ENERGY
TECHNICAL FIELD
The invention relates generally to ultrasonic surgical instruments and methods of use and particularly to apparatus and techniques for dissection of soft, relatively loose and unsupported tissue and coagulation of blood vessels affording exceptional hemostasis using an ultrasonically vibrating surgical instrument at the surgical site under endoscopic observation.
BACKGROUND
In our prior U.S. patent application Serial No. 07/670,186, filed March 15, 1991, the disclosure of which is incorporated herein by reference, there is disclosed an ultrasonic surgical instrument specifically adapted for laparoscopic surgery. Particularly, there is disclosed an ultrasonic scalpel for dissection of tissue and coagulation of blood vessels inside a body cavity of a patient using laparoscopic techniques. The instrument disclosed in that application solved a number of problems in adapting an ultrasonic surgical instrument to laparoscopic surgery, including the introduction and removal of the ultrasonic surgical instrument through a small incision without causing inadvertent cutting or other damage to adjacent body parts, preventing the ultrasonic energy from dissipating or damping out against its supporting structure once inserted and, during the surgical operation, maintaining seals to prevent escape of carbon dioxide gas or other irrigating fluids pumped into the body cavity, while simultaneously maintaining access, visibility and maneuverability of the instrument to effect dissection and coagulation under endoscopic observation and ensuring transmission of the ultrasonic energy at the appropriate frequency to the cutting site.
DISCLOSURE OF THE INVENTION
To achieve those ends, the ultrasonic surgical instrument of the prior application includes a blade coupler for mounting a surgical blade, a power source for generating ultrasonic energy and a blade coupler extension, i.e., a solid shaft, interconnecting the power source and the blade coupler. Ultrasonic energy is transmitted from the power source through the blade coupler extension to the blade coupler and blade. The blade coupler extension has a length corresponding to an integer multiple of the half-wavelength of the frequency of the ultrasonic energy generated by the power source whereby the blade coupler extension is provided in lengths in integer multiples of that haIf-wavelength. The instrument also includes an extension tube to facilitate insertion of the blade, blade coupler and extension through the small incision under endoscopic observation. The extension tube is used in conjunction with a laparoscopic port having an outer tube inserted through the incision for directing the extension tube and extension toward the surgical site. Thus, the outer tube of the port serves as a passage for receiving the extension tube and blade coupler extension during insertion, use and removal of the surgical instrument. To prevent dissipation or damping out of the ultrasonic energy transmitted from the power source to the blade, various isolation mounts are placed along the blade coupler extension at positions of minimal axial ultrasonic activity or nodes, i.e., nodal points at every half-wavelength of the frequency of the blade coupler extension. By locating the mounts at the vibratory nodes, diminution, dissipation or damping out of the transmission of the ultrasonic energy from the power source to the blade is precluded.
In using the device of the prior application, the outer tube of the laparoscopic port is inserted through the small incision in a conventional manner. A blade coupler, extension and power source are connected to one another and an insertion collar is secured to the blade coupler extension. Thus, when the blade coupler and blade coupler extension are inserted into the extension tube, the insertion collar butts the end of the extension tube, ensuring that the blade lies within the opposite end of the extension tube. The extension tube and blade coupler extension and blade coupler are then jointly inserted through the outer tube of the laparoscopic port into the body cavity. By removing the insertion collar, the extension, blade coupler and, hence, the blade, are movable axially relative to the extension tube to locate the blade at the surgical site. Ultrasonic energy is then delivered from the power source to the blade to perform the dissection and coagulation functions under endoscopic observation. When the surgical procedure is completed, the blade, blade coupler and blade coupler extension may be withdrawn into the extension tube and those elements simultaneously withdrawn from the outer tube of the laparoscopic port.
From the foregoing description, it will be appreciated that the extension tube, on the one hand, and the blade coupler and blade coupler extension, coupled to the handpiece of the surgical instrument on the other hand are separate and discrete parts. It is thus necessary to support the blade coupler extension within the extension tube at two or more of the nodal points. While this ultrasonic surgical device has proven effective in performing its intended functions within the body cavity at the surgical site, the present invention affords an endoscopic ultrasonic surgical instrument that is easier to assemble and use, one which is of a much simpler design than the previously described ultrasonic surgical instrument of the prior application, and which has various other advantages in construction, operation and use, as will become evident from this description.
In the present design, the extension tube is attached directly to the handpiece of the ultrasonic instrument in a manner such that the extension tube is isolated from the ultrasonic power element and the transmission of the ultrasonic energy from the power element through the blade extension to the blade. By attaching the extension tube directly to the handpiece, only one centering device is required to coaxially center the blade extension and extension tube. According to the present invention, two sub-assemblies of the ultrasonic surgical instrument hereof are provided, i.e., a first sub-assembly comprising a handpiece containing the power element, electrical connections and a handpiece adapter and a second sub-assembly comprising the extension tube, the blade coupler, blade, blade coupler extension and a latch. The sub-assemblies are connected to one another by the engagement of the latch and adapter and the threading of the blade extension and power element one to the other thereby enabling (1) the blade coupler extension to transmit ultrasonic energy from the power element in the handpiece to the blade and (2) telescopic movement of the extension tube relative to the blade coupler extension and handpiece during use of the instrument. To accomplish the foregoing, the first sub-assembly has a tubular adapter extending axially from the handpiece for receiving the end of the blade coupler extension opposite the blade whereby, upon insertion of that blade coupler extension end through the adapter, the blade coupler extension may be screw-threaded to the power element within the handpiece. The second sub-assembly includes a laparoscopic latch which is fixed to the end of the extension tube opposite the blade end of the instrument. The latch includes latching fingers for engaging in recesses at selected axial positions along the adapter to secure the sub-assemblies one to the other. The recesses on the adapter serve as detents and are located at axially spaced positions along the adapter such that the latching fingers and hence extension tube may be axially displaced relative to the handpiece and blade and blade coupler extension. In this manner, the extension tube is movable between a position wholly encompassing the blade within the end of the extension tube and a position exposing the blade from the end of the extension tube for use.
In use, the sub-assemblies are secured to one another and the extension tube is axially extended to cover the blade as described above. Once the laparoscopic port has been located at the incision site, the extension tube, is inserted through the laparoscopic port tube to locate the end of the extension tube adjacent the surgical site. Thus, the extension tube, blade extension and blade are jointly rotated, pivoted and axially advanced and retracted relative to the laparoscopic port to position the blade end of the instrument adjacent the surgical site. The extension tube is then displaced, i.e., retracted, axially toward the handpiece to expose the blade through the end of the extension tube at the surgical site. Ultrasonic energy may then be applied and the surgical procedure commenced. A centering device between the blade extension and the extension tube is located at one of the vibratory nodes adjacent the end of the combined extension tube and blade extension opposite the connection of the blade extension to the handpiece whereby the ultrasonic energy transmitted along the blade extension is not dissipated or damped by the extension tube. The centering device also serves as a seal to prevent any fluids within the body cavity or gases introduced into the body cavity, such as carbon dioxide, from passing through the annular space between the blade extension and extension tube.
The present invention provides a number of features and various advantages in construction, mode of operation and use as compared with the prior art. For example, for the efficient transfer of ultrasonic energy from the handpiece to the blade, it has been found that a blade coupler extension formed of aluminum or stress-relieved titanium is most effective. While it was previously believed that aluminum was not sufficiently durable for this use and that stress-relieved titanium would not have sufficient strength for this use, it has been found that these materials, preferably aluminum, may be used to form the blade coupler extension and thus reduce the cost of the instrument. Reductions in cost are, of course, significant because the second sub-assembly comprising the extension tube, the blade coupler, blade, blade coupler extension and latch are designed for one-time disposable use.
An additional, very important feature of the present invention resides in the ability of the extension tube to be extended and retracted relative to the blade. This is very significant in laparoscopic surgery for a number of reasons, including the protection of the blade when the blade is inserted through the laparoscopic port. Without protecting the blade, the blade or the hook on the blade would catch on the valve of the laparoscopic port and/or engage and possibly cut tissue upon displacement of the blade toward the surgical site. Conversely, it is significant that the extension tube can be extended so that the blade lies wholly within the end of the extension tube. This is important during withdrawal of the instrument from the surgical site to avoid cutting or damaging the adjoining tissue along the path of instrument withdrawal.
In another form of the present invention, the centering device at the nodal point may be replaced with a non-sealing centering device. The annular space between the extension tube and blade extension may then be used to irrigate or aspirate the surgical site. To accomplish this, the annular space is connected to valved ports in the latch assembly. Thus, the irrigating fluid and aspirant can pass through the annular space and the non-sealing centering device as desired. It is a further feature of the present invention that irrigation and aspiration are conducted intermittently through the annular space between the extension tube and blade extension thus providing an instrument having only one passage for both irrigation and suction. In this connection, it is significant that the extension tube may be extended to wholly overlie the blade adjacent the surgical site during the course of the surgical procedure in order that suction or irrigating fluid can be supplied. For example, where fluid is to be removed, the end of the extension tube is extended over the blade and the extension tube end is located in or adjacent the pool of fluid. At that time, suction is applied in the annular space to draw the fluid through the extension tube end past the non-sealing centering device and into the annular space. Consequently, the ability to cover and then uncover the blade relative to the extension tube while the instrument is in the body cavity is particularly significant in the present invention for purposes not only of cutting and dissecting but for intermittent irrigation and suction.
In a preferred embodiment according to the present invention, there is provided an ultrasonic surgical apparatus comprising a handpiece including a power element for generating ultrasonic energy, a surgical instrument, means for transmitting ultrasonic energy from the power element to the instrument including an extension interconnecting the power element and the instrument and an extension tube attached to the handpiece and extending about and radially spaced from the extension. Means are provided for isolating the ultrasonic energy transmitted from the power element to the instrument from the extension tube, including means engageable between the extension and the extension tube at at least one vibratory node along the extension whereby dissipation of ultrasonic energy along the extension by engagement with the extension tube is substantially precluded.
In a further preferred embodiment according to the present invention, there is provided an ultrasonic surgical apparatus comprising a handpiece including a power element for generating ultrasonic energy, a surgical instrument, means for transmitting surgical energy from the power element to the instrument including an extension interconnecting the power element and the instrument and an extension tube attached at one end to the handpiece and extending about and radially spaced from the extension. Means are carried by the apparatus mounting the extension tube and the extension for axial movement relative to one another between a position with the surgical instrument exposed through an opposite end of the extension tube and retracted within the opposite end of the extension tube.
In a further preferred embodiment according to the present invention, there is provided a method of using an ultrasonic surgical apparatus comprised of a first sub-assembly including a handpiece containing a power element for generating ultrasonic energy, and a second sub-assembly including a surgical blade, a blade extension coupled to the blade, and an extension tube surrounding the blade extension, comprising the steps of connecting the first sub-assembly and the second sub-assembly one to the other such that the extension tube, blade coupler and blade extend from the handpiece, attaching the blade extension and the power element one to the other such that ultrasonic energy generated by the power element may be transmitted through the blade extension to the blade, with the blade within the distal end of the extension tube, disposing the extension tube and the blade extension and blade through a laparoscopic port to locate a distal end of the extension tube adjacent a surgical site, displacing the extension tube and the extension relative to one another to expose the blade for use at the surgical site through the distal end of the extension tube, actuating the power element to generate ultrasonic energy and transmit the ultrasonic energy through the blade extension to the blade, isolating the blade extension and the extension tube one from the other to prevent transmission of ultrasonic energy from the blade extension to the extension tube and withdrawing the extension tube and blade jointly from the surgical site through the laparoscopic port.
Accordingly, it is a primary object of the present invention to provide a novel and improved ultrasonic surgical instrument and methods of use for laparoscopic surgery wherein the instrument and its operation are greatly simplified in comparison with the ultrasonic surgical instrument and methods of use described in our prior application Serial No. 07/670,186.
These and further objects and advantages of the present invention will become more apparent upon reference to the following specification, appended claims and drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
Figures 1-3 are side elevational views of an ultrasonic surgical instrument according to the present invention with parts broken out for ease of illustration, with Figure 1 illustrating the extension tube extended to cover the surgical blade, Figure 2 illustrating the extension tube partially retracted to expose a length of the blade and Figure 3 illustrating the extension tube fully retracted to expose the entirety of the blade;
Figure 4 is an enlarged side elevational view thereof with parts broken out and in cross-section, illustrating the connection between the sub-assemblies;
Figure 5 is a cross-sectional view thereof taken generally about on lines 5-5 in Figure 4; Figure 6 is a view similar to Figure 4 illustrating a further embodiment of the present invention; and
Figure 7 is an enlarged view of a non-sealing centering ring located at the nodal point of the blade extension.
BEST MODE FOR CARRYING OUT THE INVENTION
Reference will now be made in detail to a present preferred embodiment of the invention, an example of which is illustrated in the accompanying drawings.
Referring now to the drawings, particularly to Figures 1-3, there is illustrated an ultrasonic surgical apparatus, generally designated 10, and constructed in accordance with the present invention. In the illustrated form of the invention, apparatus 10 includes a first sub-assembly including a handpiece 12 housing an ultrasonic power element 14. Handpiece 12 also includes, as best illustrated in Figure 4, a mount 16 comprising a generally cylindrical, internally threaded element 18 at one end for threaded coupling with the body of the handpiece and a reduced diameter axially projecting adapter 20. Adapter 20 has a bore 22 passing axially therethrough for receiving the extension tube of the second sub-assembly, as described hereinafter. In cross-section, adapter 20 is multi-faceted, i.e., preferably octagonal in shape. The distal end of the adapter 20 includes a radially outwardly projecting lip 24. Adapter 20 is also provided with circumferentially extending axially spaced recesses 26 and 28 which serve as detents in cooperation with the latch, to be described. While not shown in the drawings, the power element is internally threaded at one end to receive in threaded engagement therewith the end of the blade coupler extension.
Still referring to Figure 4, the instrument includes a second sub-assembly, generally designated 30. Sub-assembly 30 includes a coupler extension 32, a coupler 34 terminating at one end in a surgical instrument, e.g., a blade 36 having a hook portion, an extension tube 38 and a latch 40. The blade coupler extension 32 comprises a solid shaft which, at the left hand end illustrated in Figure 4, is threaded for threaded connection with threads of the power element whereby ultrasonic energy may be transmitted from power element 14 to the blade extension 32. Blade coupler 34 is connected to the blade extension 32 by a stud 42 and has flats 44 along opposite sides for engagement by a wrench, for example, the wrench described and illustrated in prior U.S. Patent No. 5,057,119 of common assignee herewith. The blade coupler extension 32 has a length equal to an integer multiple of the half-wavelength of the frequency generated by the ultrasonic power element 14. Consequently, once the frequency at which the ultrasonic energy will be applied has been determined, for example, a frequency of 55,500 Hz, a blade extension 32 may be formed having a length equal to an integer multiple of the half-wavelength of that frequency. The blade 36 with the hook portion is described and illustrated in a co-pending U.S. patent application
Serial No. (Attorney Dkt. 688-14), of common assignee herewith, filed , the disclosure of which is incorporated herein by reference.
Blade extension tube 38 comprises an elongated, hollow tube secured, for example, by a press-fit, in a latch mount 46 which forms part of latch 40. Latch 40 includes a generally annular forward end 48 for receiving the latch mount 46 in a press-fit. A plurality of circumferentially spaced fingers 50, extend axially rearwardly from forward end 48. Fingers 50 terminate at their rearmost ends in inwardly directed flanges 52 for engaging selectively in detents 28 and 26 or behind the radially outwardly projecting lip 24, as described hereinafter. As illustrated, the rearwardly extending end of extension tube 38 passes through the latch mount 46, and has an axial extent terminating adjacent the ends of the latch fingers 50.
It will be appreciated from the foregoing description that the ultrasonic apparatus is provided in two major sub-assemblies: a first sub-assembly including the handpiece 12 containing the power element, electrical connections and adapter, and the second sub-assembly comprised of blade extension 32, blade coupler 34, blade 36, extension tube 38 and latch 40. Ancillary equipment, not shown, necessary for the surgery would include a laparoscopic port, for example, as described and illustrated in previously mentioned co-pending application Serial No. 07/670,186.
It will also be appreciated that blade extension 32 has a centering device 54 which, in Figure 4, is in the form of an annular seal for sealing between blade extension 32 and extension tube 38. The centering device 54 is located at a nodal point whereby the engagement of the seal with blade extension 32 and extension tube 38 precludes dissipation of ultrasonic energy from the blade extension 32 to the tube 38.
In use, the second sub-assembly is provided in a peel pouch, not shown, and is for one-time or disposable use in a particular surgery. The first sub-assembly, i.e., the handpiece 10, and ancillary components are, of course, used for multiple surgeries. Upon removal of the first sub-assembly from the peel pouch, it is applied to handpiece 12 by inserting the adapter 20 between the latch fingers 50 and engaging the flanges 52 in the detent 38. A wrench, not shown, is then applied to blade coupler 34, particularly engaging the flats 44, and the blade coupler and blade extension are jointly rotated to screw-thread the blade extension into the power element 14. The ultrasonic surgical apparatus is now ready for use. The incision is made and the laparoscopic port is applied, as conventional. The extension tube 38 is then advanced axially such that flanges 52 engage behind the radially outwardly directed lip 24, as illustrated in Figure 1. By advancing the latch and extension tube 38, the blade coupler 34 and blade 36 are wholly encompassed within the end of the extension tube 38, as illustrated in Figure 1. The extension tube is then inserted through the laparoscopic port and, under endoscopic observation, its tip is located adjacent the surgical site. Importantly, because the blade 36 with hook portion is retracted within the extension tube end during insertion of the instrument, the blade will not engage any portions of the laparoscopic port or any tissues within the body cavity as the extension tube end is advanced to the surgical site. When located at the surgical site, the latch is retracted rearwardly along the handpiece to retract the extension tube and thus expose blade 36, either partially or fully, as illustrated in Figures 2 and 3, respectively. Once the latch is detented in the appropriate position, ultrasonic energy is applied through blade extension 32, blade coupler 34 to the blade 36, whereby cutting, dissection and coagulation are performed. Seal 54 prevents fluids or gases within the body cavity from migrating into the annular space between blade extension 32 and extension tube 38. Upon completion of the surgery, the latch is advanced such that the end of the extension tube 38 advances to once again overlie and wholly encompass blade 36, as illustrated in Figure 1. Thus, the instrument can be withdrawn through the laparoscopic port without the blade cutting or damaging any adjacent tissue along the path of its withdrawal.
In certain procedures, it is desirable to irrigate or suction the surgical site. This can be accomplished with the present apparatus by substituting for the centering seal 54 a centering device which permits fluid or gas to pass through the device. For example, in Figure 6, an annular centering device 60 is illustrated and has a plurality of ports 62 circumferentially spaced one from the other. The centering device 60 is located similarly as seal 54, i.e., at a nodal point, and the ports 62 permit passage of the fluid or gas in the annular space between extension tube 38 and blade extension 32. To permit this irrigation or aspiration, latch mount 46a in the embodiment illustrated in Figure 5 is extended to include a pair of passageways 64 and 66 terminating in valved connectors 68 and 70, respectively. Thus, the fluid or gases may flow through the annular space between extension tube 38 and blade extension 32. In use, the instrument is located at the surgical site as previously described and the extension tube is retracted to expose the blade. When it is desired to irrigate or suction the site, the ultrasonic energy is discontinued and the extension tube is extended by displacing the latch along the adapter into its forward ost position, as illustrated in Figure 1. The ports 68 and 70 are, of course, connected to irrigation and suctioning conduits. By manipulation of valves, not shown, the irrigating fluid may be passed within the annular space between the extension 32 and extension tube 38 to irrigate the site. Alternatively, if suction is required, the suction is applied to the other port whereby the debris and blood can be removed from the site. Thus, the annular passageway can be used intermittently as an irrigating or suctioning passageway, as long as the blade lies wholly within the extension tube end. To resume the surgical procedure, the valves are manipulated to close the irrigation or suctioning conduits. The blade is then exposed for use by retracting the latch and extension tube relative to the handpiece as illustrated in Figure 3. Ultrasonic energy is then applied to resume cutting and coagulation.
It will be appreciated that for laparoscopic surgery, the instrument must transmit ultrasonic energy over a substantial distance from the power element in the handpiece to the surgical blade. The transmission of this ultrasonic energy must be accomplished efficiently if unacceptable power levels are to be avoided. Consequently, the impedance between the power element and the blade must be maintained at a low value. The impedance of the handpiece is, in a preferred embodiment, approximately between 25-75 ohms. By attaching the extension at one end to the power element of the handpiece and supporting the extension adjacent its opposite end at a nodal point and further by forming the extension of materials which will not substantially increase the impedance between the power element of the handpiece and the blade, it is possible to obtain a laparoscopic instrument which efficiently transmits energy over the required distance to enable laparoscopic surgery. This is accomplished in part by forming the extension of either aluminum or stress-relieved titanium. By using these criteria, the impedance between the power element of the handpiece and the blade may be maintained under 200 ohms at power levels which are not considered excessive.
While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiment, it is to be understood that the invention is not to be limited to the disclosed embodiment, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.

Claims

WHAT IS CLAIMED IS:
1. Ultrasonic surgical apparatus comprising:
a handpiece including a power element for generating ultrasonic energy;
a surgical instrument;
means for transmitting ultrasonic energy from said power element to said instrument including an extension interconnecting said power element and said instrument;
an extension tube attached to said handpiece and extending about and radially spaced from said extension; and
means for isolating the ultrasonic energy transmitted from said power element to said instrument from said extension tube, including means engageable between said extension and said extension tube at at least one vibratory node along said extension whereby dissipation of ultrasonic energy along said extension by engagement with said extension tube is substantially precluded.
2. Apparatus according to Claim 1 wherein said extension has a length corresponding to an integer multiple of the half-wavelength of the frequency of the ultrasonic energy generated by said power element and transmitted therefrom along said extension to said instrument.
3. Apparatus according to Claim 2 wherein said engageable means includes a seal between said extension and said extension tube to prevent the passage of fluid between said extension and said extension tube.
4. Apparatus according to Claim 3 wherein said extension and said extension tube are slidable relative to one another, said seal maintaining said extension and said extension tube in sealed relation to prevent passage of fluid between said extension and said extension tube throughout the range of relative axial movement of said extension and said extension tube.
5. Apparatus according to Claim 1 including an adapter carried by said handpiece and a latch cooperable between said extension tube and said adapter for releasably coupling said extension tube and said handpiece one to the other.
6. Apparatus according to Claim 1 wherein said extension tube and said extension are axially movable relative to one another between a first position with the end of said extension tube spaced back from and exposing said surgical instrument and a second position with the surgical instrument retracted within the end of said extension tube.
7. Apparatus according to Claim 5 wherein said extension tube and said extension are axially movable relative to one another and said extension tube is movable relative to said handpiece between positions exposing said surgical instrument through the end of said extension tube and retracting said surgical instrument within said extension tube and means for releasably locking said extension tube and said handpiece one to the other in a selected one of said positions.
8. Apparatus according to Claim 5 wherein said adapter includes an axial projection on said handpiece for receiving a portion of said extension for connection with said power element, said latch including a plurality of generally axially extending, circumferentially spaced fingers engageable with said adapter.
9. Apparatus according to Claim 8 including means for releasably detenting said latch and said adapter in selected axial positions relative to one another whereby the surgical instrument and the end of said extension tube can be releasably secured in selected axial positions relative to one another.
10. Apparatus according to Claim 9 wherein said adapter includes a plurality of axially spaced recesses and said latch fingers include radially inwardly directed flanges for engaging in said recesses to selectively detent said latch and said adapter one to the other.
11. Apparatus according to Claim 1 wherein said engageable means includes a centering element enabling passage of fluid in the annular space between said extension and said extension tube past said engageable means and at least one port carried by said apparatus in communication with the annular space between said extension and said extension tube enabling transmission of fluid through said space and said port.
12. Apparatus according to Claim 11 including a second port carried by said apparatus in communication with said annular space wherein an irrigant and an aspirant may communicate between the respective ports and the annular space.
13. Ultrasonic surgical apparatus comprising:
a handpiece including a power element for generating ultrasonic energy;
a surgical instrument;
means for transmitting surgical energy from said power element to said instrument including an extension interconnecting said power element and said instrument;
an extension tube attached at one end to said handpiece and extending about and radially spaced from said extension; and
means carried by said apparatus mounting said extension tube and said extension for axial movement relative to one another between a position with said surgical instrument exposed through an opposite end of said extension tube and retracted within said opposite end of said extension tube.
14. Apparatus according to Claim 13 wherein said extension has a length corresponding to an integer multiple of the half-wavelength of the frequency of the ultrasonic energy generated by said power element and transmitted therefrom along said extension to said instrument, and means engageable between said extension and said extension tube at at least one vibratory node along said extension and including a seal between said extension and said extension tube to prevent the passage of fluid between said extension and said extension tube.
15. Apparatus according to Claim 13 including an adapter carried by said handpiece and a latch cooperable between said extension tube and said adapter for releasably coupling said extension tube and said handpiece one to the other in said positions.
16. Apparatus according to Claim 13 including means engageable between said extension tube and said extension tube and said extension at at least one vibratory node along said extension to preclude dissipation of ultrasonic energy along said extension by engagement with said extension tube, said engageable means including a centering element enabling passage of fluid in the annular space between said extension and said extension tube past said engageable means and at least one port carried by said apparatus in communication with the annular space between said extension and said extension tube enabling transmission of fluid through said space and said port.
17. Apparatus according to Claim 15 including a second port carried by said apparatus in communication with said annular space wherein an irrigant and an aspirant may communicate between the respective ports and the annular space.
18. A method of using an ultrasonic surgical apparatus comprised of a first sub-assembly including a handpiece containing a power element for generating ultrasonic energy, and a second sub-assembly including a surgical blade, a blade extension coupled to said blade, and an extension tube surrounding said blade extension, comprising the steps of:
connecting said first sub-assembly and said second sub-assembly one to the other such that said extension tube, blade coupler and blade extend from said handpiece; attaching said blade extension and said power element one to the other such that ultrasonic energy generated by said power element may be transmitted through said blade extension to said blade;
with said blade within the distal end of said extension tube, disposing said extension tube and the blade extension and blade through a laparoscopic port to locate a distal end of the extension tube adjacent a surgical site;
displacing said extension tube and said extension relative to one another to expose said blade for use at the surgical site through the distal end of said extension tube;
actuating the power element to generate ultrasonic energy and transmit the ultrasonic energy through said blade extension to said blade;
isolating said blade extension and said extension tube one from the other to prevent transmission of ultrasonic energy from said blade extension to said extension tube; and
withdrawing said extension tube and blade jointly from the surgical site through the laparoscopic port.
19. A method according to Claim 18 including, prior to disposing the extension tube and the blade extension through the laparoscopic port, the step of displacing said extension tube and said extension relative to one another to locate said blade within a distal end of said extension tube, and, prior to withdrawing said extension tube and blade jointly from the surgical site through the laparoscopic port, displacing said extension tube and said extension relative to one another to locate said blade within the distal end of said extension tube.
20. A method according to Claim 18 including the step of supplying through the annular space between said extension and said extension tube an irrigant or an aspirant for either irrigating the surgical site or suctioning the surgical site.
21. A method according to Claim 20 including, prior to the step of supplying and while the blade is located adjacent the surgical site, displacing said extension tube and said extension relative to one aother to locate said blade wholly within the distal end of said extension tube.
PCT/US1993/000793 1992-02-03 1993-01-29 Laparoscopic surgical apparatus and methods using ultrasonic energy WO1993014708A1 (en)

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US11696776B2 (en) 2019-12-30 2023-07-11 Cilag Gmbh International Articulatable surgical instrument
US11937866B2 (en) 2019-12-30 2024-03-26 Cilag Gmbh International Method for an electrosurgical procedure
US11937863B2 (en) 2019-12-30 2024-03-26 Cilag Gmbh International Deflectable electrode with variable compression bias along the length of the deflectable electrode
US11944366B2 (en) 2019-12-30 2024-04-02 Cilag Gmbh International Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode
US11950797B2 (en) 2020-05-29 2024-04-09 Cilag Gmbh International Deflectable electrode with higher distal bias relative to proximal bias

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