WO1997040759A1

WO1997040759A1 - Wire-form electrosurgical instruments

Info

Publication number: WO1997040759A1
Application number: PCT/US1997/007497
Authority: WO
Inventors: Charles C. Hart
Original assignee: Applied Medical Resources Corporation
Priority date: 1996-05-02
Filing date: 1997-05-01
Publication date: 1997-11-06

Abstract

An electrosurgical instrument includes a movable and deformable electrode (47). The electrode (47) can be moved proximally and distally within a sheath (34), and further can be shaped at the surgical site to meet various cutting and cauterizing requirements. The electrode (47) may include a wire (43) which serves to provide current at specific sites and which is shapeable to meet various surgical requirements. A radio frequency signal is passed through the wire (43) to provide cutting and cauterizing at specific surgical sites. The wire electrode (43) is able to provide a high concentration of energy while maintaining a relatively low power setting.

Description

WIRE-FORM ELECTROSURGICAL INSTRUMENTS

Field of The Invention

The present invention relates generally to surgical instruments and, more particularly, to electrosurgical cutting and cauterizing instruments.

Background of The Invention

Electrosurgical instruments use electricity to cut and cauterize tissue. A variety of electrosurgical instruments have existed in the prior art. Such instruments typically utilize an electrosurgical generator, which produces a radio frequency output. The electrosurgical instrument inputs the radio frequency output from the electrosurgical generator and generates a concentrated current density at a desired location.

A monopolar electrosurgical instrument uses only a single electrode, and the return path back to the generator is provided through the patient. Bipolar electrosurgical instruments implement two electrodes at the surgical site, and the return path is provided through the second electrode.

The electrodes of typical electrosurgical cutting instruments have been formed into various shapes, including blades, hooks, snares, and loops. Each of these shapes may have a particular advantage associated therewith, but a user is faced with keeping each of these various shapes on hand at the surgical site. To change from a blade-shaped to a hood-shaped electrode, for example, the user must remove the blade from the electrosurgical instrument and secure the hook to the electrosurgical instrument. Trauma to the surgical site can occur as a result of removal and reinsertion of the electrosurgical instrument. Precious time is required for each exchange of parts during a surgical procedure, and valuable space is consumed as a result of the various interchangeable parts which must be kept at hand near the surgical site.

Summary of The Invention

The electrosurgical instrument of the present invention includes a movable and deformable electrode. The electrode can be moved proximally and distally within a sheath, and further can be shaped at the surgical site to meet various cutting and cauterizing requirements. The electrode may include a wire, which serves to provide current concentration at specific sites and which is shapable to meet various surgical requirements. A radio frequency electrical signal is passed through the wire or wires to provide cutting and cauterizing effects at specific surgical sites. The wire electrode is able to provide a high concentration of energy while maintaining a relatively low power setting.

According to one aspect of the present invention, an electrosurgical instrument includes a sheath and a conductor disposed within the sheath. The sheath includes a proximal sheath end, a distal sheath end, an inside surface, and a sheath axis extending between the proximal sheath end and the distal sheath end. The conductor includes a proximal conductor end and a distal conductor end. The distal conductor end is movable between a first configuration and a second configuration. In one embodiment, the distal conductor end forms a loop, which is formable between a first configuration and a second configuration. The loop has a first diameter in the first configuration and a second larger diameter in the second configuration.

The conductor can be moved proximally into the distal sheath end to form the first configuration and can be moved distally out of the distal sheath end to form the second configuration.

According to another aspect of the present invention, an electrosurgical instrument includes a sheath and a conductor disposed within the sheath. The conductor comprises a first conductor and a second conductor. The second conductor includes an inner side and an outer side. At least a portion of the inner side or the outer side is covered with a dielectric material. At least one of the first conductor and the second conductor is movable in a direction along a sheath axis within the sheath. A second configuration is obtained by movement of either or both of the conductors in a distal direction, and a first configuration is obtained by movement of either or both of the conductors in a proximal direction. A distal end of the first conductor contacts a distal end of the second conductor in the first configuration, and the two distal ends do not contact one another in the second configuration.

The first conductor includes a proximal first end and a distal first end, and the second conductor includes a proximal second end and a distal second end. The distal second end is coupled to the distal first end. At least a portion of the distal end of the conductor is adapted to press against an inside surface of the sheath when the first conductor is moved relative to the second conductor. Movement of the first conductor relative to the second conductor moves the conductor between the first configuration and the second configuration.

The first conductor and the second conductor are substantially parallel to the sheath axis in the first configuration, and are curved in a substantially non-parallel direction to the sheath axis in the second configuration. The first conductor and the second conductor together can be formed into a double bow shape in the second configuration. Alternatively, the first conductor and the second conductor can be formed into a double U-shape in the second configuration. The proximal second end of the second conductor is coupled to the sheath to thereby prevent movement of the second conductor relative to the sheath. Movement of the first conductor, relative to the sheath, operates to move the conductor between the first configuration and the second configuration.

According to another aspect of the present invention, an electrosurgical instrument includes a frame member and a sheath connected to the frame member. An electrical conductor is disposed within the sheath, and a movable positioner is disposed in close proximity to the frame member and is operatively coupled to the electrical conductor. The movable positioner is adapted to move a distal end of the electrical conductor proximally into the sheath and distally out of the sheath. The electrical conductor has a hook formed at a distal end of the electrical conductor. Alternatively, the electrical conductor includes a first conductor and a second conductor, which is connected to the first conductor at a distal end of the second conductor. Movement of the first conductor relative to the second conductor can deform the electrical conductor into various shapes.

According to yet an other aspect of the present invention, an electrosurgical instrument includes a retaining member having a proximal member end, a distal member end, and a member axis extending between the proximal member end and the distal member end. The electrosurgical instrument further includes a first conductor and a second conductor. A first loop is formed at a distal end of the first conductor, and a second loop is formed at a distal end of a second conductor. The first conductor and the second conductor can be moved in a first direction along the member axis to separate the first loop from the second loop. The two conductors can be moved in a second direction along the member axis to move the first loop into contact with the second loop. The retaining member includes a sheath for housing the first conductor and the second conductor. The sheath includes a divider for insulating the first loop from the second loop. Distal movement of the first and second conductors along the member axis separates the first loop from the second loop, and proximal movement of the first and second conductors along the member axis moves the first loop into contact with the second loop. A portion of the distal end of the first conductor is secured to the retaining member, and a portion of the distal end of the second conductor is secured to the retaining member.

According to another aspect of the present invention, an electrosurgical instrument includes a retaining member, a first conductor, and a second conductor. The first conductor is disposed at a distal end of the retaining member and includes a proximal first end a curved distal first end. Similarly, the second conductor is disposed at a distal end of the retaining member, and includes a proximal second end and a curved distal second end. At least one of the first conductor and the second conductor is adapted to be moved in a first direction along an axis of the retaining member to move the curved distal first end into contact with the curved distal second end. Similarly, at least one of the first conductor and the second conductor is adapted to be moved in a second direction along the axis of the retaining member to move the curved distal first end out of contact with the curved distal second end. A first portion of the curved distal first end is transverse to the axis of the retaining member, and a second portion of the curved distal second end is transverse to the axis of the retaining member. The first portion and the second portion contact one another when the curved distal first end is moved into contact with the curved distal second end. The first and second portions do not contact one another when the curved distal first end is moved out of contact with the curved distal second end. The curved distal first end and the curved distal second end comprise L-shapes in one embodiment.

According to still another aspect of the present invention, an electrosurgical instrument includes a retaining member having a proximal member end, a distal member end, and a member axis extending between the proximal member end and the distal member end. The electrosurgical instrument includes a first conductor disposed at the distal member end. The first conductor includes a proximal first end and a distal first end. The electrosurgical instrument further includes a second conductor disposed at the distal member end. The second conductor includes a proximal second end and an angled distal second end. The second conductor is adapted to be moved in a first direction along the member axis to move the angled distal second end out of contact with the distal first end, and is adapted to be moved in a second direction along the member axis to move the angled distal second end into contact with the distal first end. The second conductor includes a cam, which is disposed proximally of the angled distal second end. The retaining member comprises a sheath having a slot, which is parallel to the member axis. The slot is adapted to accommodate the cam therein when the second conductor is moved in the first direction.

According to another aspect of the present invention, an electrosurgical instrument includes a flexible tubular member having a proximal member end, a distal member end, and an intermediate portion between the proximal member end and the distal member end. A member axis extends between the proximal member end and the distal member end. A conductor is coupled to both the distal member end and the intermediate portion. The conductor is movable proximally along the member axis to thereby decrease a distance between the distal member end and the intermediate portion. The conductor is also movable distally along the member axis to thereby increase a distance between the distal member and the intermediate portion. The flexible tubular member includes a weakened portion between the distal member end and the intermediate portion. The flexible tubular member is adapted to bend at the weakened portion when the conductor is moved proximally. The present invention, together with additional features and advantages thereof, may best be understood by reference to the following description taken in connection with the accompanying illustrative drawings.

Brief Description of The Drawings

Figure 1 is a perspective view of an embodiment of the present invention illustrating a positionable conductive element in a first configuration;

Figure 2 is a perspective view of the Figure 1 embodiment illustrating the positionable conductive element in a second configuration;

Figure 3 is a perspective view of an embodiment illustrating the positionable conductive element in a third configuration;

Figure 4 is a perspective view of a positionable conductive element having a dielectric material disposed over a first portion of the positionable conductive element;

Figure 5 is a perspective view of a positionable conductive element having a dielectric material disposed over a second portion of the positionable conductive element;

Figures 6A-6C are perspective views of an embodiment of the present invention illustrating proximal and distal movement of the positional conductive element in a monopolar mode;

Figures 7A and 7B are perspective views of an embodiment of the present invention illustrating various loop configuration applications of a positionable conductive element;

Figures 8A and 8B are perspective views of an embodiment of the present invention illustrating two movable conductive elements;

Figures 9A-9C are perspective views of an embodiment of the present invention illustrating two movable loop-shaped conductive elements;

Figures 10A and 10B are cross-sectional views illustrating a first implementation of the embodiment of Figures 9A-9C;

Figures IIA and IIB are cross-sectional views illustrating a second implementation of the embodiment of Figures 9A-9C;

Figure 12 is a perspective view of an embodiment of the present invention illustrating two bi-polar conductive elements;

Figure 13 is a perspective view of an embodiment of the present invention illustrating two bi-polar conductive elements forming a parallel jaw;

Figure 14 is a perspective view of an embodiment of the present invention illustrating another movable jaw formed by two bi-polar conductive elements;

Figure 15A is a side-elevational view of a positionable conductive element having a dielectric material applied to a first portion thereof; Figure 15B is a side-elevational view of a positionable conductive element having dielectric material applied to a second portion thereof;

Figure 16 is a side-elevational view of an embodiment of the present invention illustrating a conductive element in combination with a positionable sleeve;

Figure 17 is a side-elevational view of the embodiment of Figure 16 in a deployed configuration;

Figure 18 is a cross-sectional view of the apparatus of Figure 16;

Figure 19 is a cross-sectional view of the apparatus of Figure 17;

Figure 20A is a perspective view of an embodiment of the present invention illustrating a passive insulative sleeve in an extended position;

Figure 20B is a perspective view of an embodiment of the present invention illustrating the passive insulative sleeve of Figure 20A in a retracted position;

Figure 21A is a perspective view of an embodiment of the present invention illustrating a passive insulative sleeve in an extended position;

Figure 21B is a perspective view of an embodiment of the present invention illustrating the passive insulative sleeve of Figure 21A in a retracted position; Figure 22A is a perspective view of an embodiment of the present invention illustrating an active insulative sleeve in an extended position;

Figure 22B is a perspective view of an embodiment of the present invention illustrating the active insulative sleeve of Figure 22A in a retracted position;

Figure 23A is a perspective view of an embodiment of the present invention illustrating an insulative sleeve in an extended position; and

Figure 23B is a perspective view of an embodiment of the present invention illustrating the insulative sleeve of Figure 23A in a retracted position.

Detailed Description of the Presently Preferred Embodiment

Referring now more particularly to the drawings, Figure 1 illustrates an electrosurgical instrument 30 having a handle 32 and a dielectric sheath 34. A portion 36 of the dielectric sheath 44 is shown removed for illustrative purposes only. The dielectric sheath 34 preferably extends from a proximal sheath end 38 to a distal sheath end 41 without interruption. Although the dielectric sheath 34 preferably comprises a dielectric material, which is adapted to insulate the conductive electrode or wire 43, other materials may also be implemented. The cutaway portion 36 also illustrates an interior surface 45 of the dielectric sheath 34.

The distal sheath end 41 of the dielectric sheath 34 preferably comprises a strength and rigidity sufficient to support the positionable electrode end 47 when the positionable electrode end 47 is deformed, as discussed below with reference to Figure 2, for example. The positionable electrode end 47 comprises a distal electrode end 50, a first electrode leg 52, and a second electrode leg 54.

The first electrode leg 52 is preferably coupled to the sliding positioner 56, and the second electrode leg 54 is preferably attached to an attachment point 58 on the interior surface 45 of the dielectric sheath 34.

A proximal end 61 of the handle 32 preferably comprises at least one electrical connector for supplying radio frequency current to the electrosurgical instrument 30. The conductive electrode 43 and the positionable electrode end 47 are adapted to provide high-density current to specific surgical sites within a patient, for example. As shown in Figure 2, the positionable electrode end 47 is preferably shapable into different formations, to thereby vary the application of the radio frequency current to the surgical site. The radio frequency current is substantially discharged into adjacent tissue from the positionable electrode end 47.

The electrosurgical instrument 30 of the present invention may be implemented using either monopolar electrodes or bi-polar electrodes. In the case of monopolar electrodes, a radio frequency current is introduced into an active electrode, such as the conductive electrode 43, and is subsequently received by a receiver, such as a grounding pad or return electrode. The electrical signal thus passes through the patient from the active electrode to the receiver or receptive electrode. The receiver is configured to have a large surface area and is securely connected to the patient, according to the present invention, to ensure relatively low current density through the patient at the receiver. Low current density at the receiver serves to minimize cellular damage and cellular modification of tissue near the receiver. In the case of bi-polar electrodes, the receiver is placed adjacent to the active electrode, to thereby receive current therefrom.

The positionable electrode end 47 preferably comprises a flexible conductive element. This flexible conductive element is preferably narrow to thereby maximize the current density and concentration of energy at the surgical site.

Additionally, as illustrated in Figures 4 and 5, for example, a dielectric coating 63 may be applied over portions of the positionable electrode end 47. The dielectric coating 63 atenuates buildup or collection of charred tissue on the positionable electrode end 47. Additionally, the dielectric coating 63 serves to limit the exposed surface area of the positionable electrode end 47, to thereby further increase current density.

The positionable electrode end 47 can be selectively shaped or re-proportioned at the surgical site or during the operative procedure. Figure 2 illustrates a first configuration of the positionable electrode end 47. Movement of the sliding positioner 56 in a distal direction moves the conductive electrode 43 in the distal direction, resulting in a bending or bowing of the positionable electrode end 47. Since the second electrode leg 54 is fixed to the dielectric sheath 34 at the attachment point 58, distal movement of the conductive electrode 43 results in movement of the distal electrode end 50 in a direction from the second electrode leg 54 to the first electrode leg 52, to thereby form a double bow shape.

Figure 3 illustrates another embodiment of the present invention, where the positionable electrode end 65 is movable between a U-shaped configuration, such as shown in Figure 1, and a double hook configuration. The embodiment of Figure 3 is similar to the embodiment of Figure 2 with the movement of the second electrode leg 54 in the direction toward the first electrode leg 52 being enhanced.

The low profile of the electrosurgical instrument 30 is maintained by setting the slide positioner 56 at a neutral position on the handle 32. In the neutral position, the electrosurgical instrument 30 can be inserted and moved to a surgical site through a small diameter trocar or incision. Upon presentation to the surgical site, the electrosurgical instrument 30 can be used to bluntly dissect or maneuver tissue or organs, without any application of electrical energy to the conductive electrode 43 and the positionable electrode end 47. Radio frequency current can be selectively transmitted through the conductive electrode 43. Application of the radio frequency current to the electrosurgical instrument 30 can be used for performing cutting, coagulation, cautery, and fderation procedures.

Movement of the sliding positioner 56 in a distal direction activates the positionable electrode end 47, curving the first electrode leg 52 to a first radius and curving the second electrode leg 54 to a second radius. The shape of the positionable electrode end 47 is thus dynamically adjustable within a range that is suitable for low-profile insertion through a trocar and also deployable to a large profile or shape.

The large profile or shape of the positionable electrode end 47, when activated by distal movement of the sliding positioner 56, provides for a variety of relatively large shapes which would not otherwise be readily insertable through a trocar, for example. The large-diameter hook-shape of the positionable electrode end 65, shown in Figure 3, for example, can be particularly useful for lifting and separating tissue or organs in a non-energized state. Subsequently, the positionable electrode end 47 can be energized to cut or coagulate the tissue or organs . Such cutting and coagulating operations may be performed using the positionable electrode end 47 in any of a variety of shapes, depending upon movement of the sliding positioner 56 by a hand of a user.

Figure 4 illustrates the embodiment of Figure 2 with a dielectric coating 63 applied to the positionable electrode end 47. The dielectric coating 63 preferably comprises a high dielectric strength, but other materials may also be used. The dielectric coating 63 can be used to insulate the positionable electrode end 47 over an entire length of the positionable electrode end 47 and, subsequently, selectively removed or thinned at appropriate locations 67. The selective coating of portions of the positionable electrode end 47 can provide accuracy and can prevent adjacent tissue from inadvertently being damaged. The exposed area 67 can be on an outer curved portion 67, such as shown in Figure 4. Alternatively, an exposed area 70 can be on an inner curved portion, such as illustrated in Figure 5. Placement of the exposed area 70 on the hook-shaped positionable electrode end 65 can provide a function similar to a curved scalpel, for example. The shape of the positionable electrode end 65 can be varied to vary the shape of the exposed area 70, to thereby effectuate various shaped simulated blades or cutting surfaces.

Figure 6A-6C illustrate an embodiment where a positionable electrode end 72 is movable by a sliding positioner 74. An additional conductive electrode 75 is provided in combination with the conductive electrode 43. Proximal movement of the sliding positioner 74 retracts the positionable electrode end 72 into the dielectric sheath 34, as illustrated in Figure 6A. As the sliding positioner 74 is moved distally, the positionable electrode end 72 is moved distally out of the dielectric sheath 34, as illustrated in Figures 6B and 6C. In the embodiment of Figures 6A-6C the positionable electrode end 72 is not deformable, but other configurations are possible. . In alternative embodiments, for example, the positionable electrode end 72 may be deformable into shapes similar to those shown in Figures 2 and 3. The positionable electrode end 72 can be used for blunt dissection of tissue using only the blunt distal sheath end 41, with the positionable electrode end 47 retracted. The positionable electrode end 47 may be partially extended through the distal sheath end 41, as shown in Figure 6B, to provide partial electrode exposure for a different cutting and manipulative effect. The positionable electrode end 47 preferably comprises a fine gauge wire, which facilitates a high current density at the active discharge site. The proximal and distal movement of the positionable electrode end 47, according to the embodiment of Figures 6A-6C, allows for the use of a fine gauge wire for the positionable electrode end 47 while providing a substantially rugged and operable dielectric sheath 34. The dielectric sheath 34 can be used to protect the fine gauge wire 47 until delicate cutting and cauterization effects are needed.

The illustrated embodiment of Figures 6A-6C comprises a connecting post 77, which is coupled to the handle 32. A return path to an electrosurgical generator (not shown) is preferably provided through a large area dispersive pad or electrode (not shown) which is placed on the skin of the patient. Although Figure 6A-6C illustrate a monopolar mode, the positionable electrode end 72 may also be implemented using a bi-polar mode, according to design preference.

Figures 7A-7B illustrate another embodiment of the present invention, where the conductive electrode 43 and the additional electrode leg 75 terminate in a positionable electrode end 76, which has the shape of a loop. The shape and size of the loop-shaped positionable electrode end 76 can be adjusted by movement of the sliding positioner 74 on the handle 32. As presently embodied, proximal movement of the sliding positioner 74 on the handle 32 moves the conductive electrode 43 and the additional electrode leg 75 proximally, resulting in a smaller loop. Similarly, distal movement of the sliding positioner 74 on the handle 32 results in distal movement of the conductive electrode 43 and the additional electrode leg 75, to thereby form a larger loop. According to one embodiment, the sliding positioner 74 can be fully moved proximally to completely retract the positionable electrode end 76 within the dielectric sheath 34.

The loop formed by the positionable electrode end 76 can be selectively insulated to provide specific discharge paths. Alternatively, the entire positionable electrode end 76 may be left uninsulated and used to cut, cauterize, or fulgurate, depending upon the relative engagement position of the positionable electrode end 76 to the adjacent tissue. For example, if only the edge 78 of the positionable electrode end 76 contacts tissue, a cut will be made at the discharge site 81. If either or both of the faces 83, 85 are used in close proximity or in contact with tissue, coagulation or fulguration will occur along the discharge path 87.

Figures 8A and 8B illustrate an electrosurgical instrument having a first electrode jaw 90 and a second electrode jaw 92. Portions of the first electrode jaw 90 and the second electrode jaw 92 are bent, sized, and configured to splay to an open condition as they are extended from the distal shaft end 41. Figure 8A illustrates a configuration where the sliding positioner 94 is in a somewhat proximally retracted position, corresponding to the first electrode jaw 90 and the second electrode jaw 92 being drawn together. In the configuration of Figure 8A, the distal end of the first electrode jaw 90 and the distal end of the second electrode jaw 92 meet at a conductive junction 96. A high concentration of electrical discharge can be applied at this conductive junction 96. The conductive junction 96 is useful in welding or bonding tissue placed therebetween. In the presently preferred embodiment, only the contacting surfaces of the conductive junction 96 are exposed and the remainder of the first electrode jaw 90 and the second electrode jaw 92 is covered with a dielectric coating. Alternatively, other portions of the first electrode jaw 90 and the second electrode jaw 92 may be exposed.

In a monopolar mode, the conductive electrode 43 and the additional electrode leg 75 are connected together at the proximal end 61 to form a singular electrical path. In this mode, high current density at the conductive junction 96 performs the electrosurgical effect. In a bi-polar mode, the conductive electrode 43 is separated and/or insulated from the additional electrode leg 75 throughout the instrument. Individual electrical paths, such as positive and negative, or, alternatively, active paths and return paths, are maintained. Radio frequency current is then preferably applied through the active electrode and the return electrode.

In the configuration illustrated in Figure 8B, the sliding positioner 94 is moved distally, as are the conductive electrode 43 and the additional electrode leg 75. The first electrode jaw 90 and the second electrode jaw 92 are moved distally to separate the conductive junction 96, and to expose the first uninsulated end 98 and the second uninsulated end 101. The first electrode jaw 90 and the second electrode jaw 92 may be placed in the configuration of Figure 8B and, subsequently, closed together to form the configuration of Figure 8A with tissue or vessel being held between the first uninsulated end 98 and the second uninsulated end 101. Proximal movement of the sliding positioner 94 causes the first electrode jaw 90 and the second electrode jaw 92 to compress the tissue or vessel. The first electrode jaw 90 and the second electrode jaw 92 can be energized to administer an electrosurgical effect to the captured tissue or vessel between the first uninsulated end 98 and the second uninsulated end 101. The tissue or vessel can thus be welded, ligated, or affixed by application of the radio frequency current to the tissue or vessel.

Figures 9A-9C illustrate an embodiment where the conductive electrode 43 and the additional electrode leg 75 extend from the distal sheath end 41 of the dielectric sheath 34 and form a first independent loop 103 and a second independent loop 105. The extensions of the electrodes 43, 75 beyond the dielectric sheath 34 thus form a first compression member 107 and second compression member 110. The first compression member 107 and the second compression member 110 tend to bow outward from each other when urged distally by the sliding positioner 112 upon the handle 32. The first independent loop 103 and the second independent loop 105 become traction members when urged proximally by the sliding positioner 112 on the handle 32. In one preferred embodiment, a first centermost portion 113 and a second centermost portion 114 of the two compression members 107, 110, respectively, form return legs for each of the independent loops 103, 105.

As can be seen from Figures 10A and 10B, the first compression member 107 and the second compression member 110 are secured to the dielectric sheath 34 at a first fixation point 116 and a second fixation point 118, respectively. The first compression member 107 and the second compression member 110 can be fixed at other points within the surgical instrument, besides the first fixation point 116 and the second fixation point 118, so long as these two compression members 107, 110 are prevented from movement at their fixed ends. The conductive electrode 43 and the additional electrode leg 75, and the first compression member 107 and the second compression member 110, may be constructed to be monopolar or bi-polar in operation. The dielectric sheath 34 comprises a dividing wall 121, which operates as an insulative barrier and fixing member for the centermost portions 112, 114 in the bi-polar configuration.

As the sliding positioner 112 is moved proximally upon the handle 32, the first and second compression members 107, 110 are urged apart to form a space 123 therebetween. Tissue may be engaged between the first and second compression members 107, 110, as the sliding positioner 112 is moved distally upon the handle 32. Distal movement of the sliding positioner 112 on the handle 32 moves the first and second compression members 107, 110 together, to thereby engage the tissue therebetween. Electrosurgical energy can be applied to the tissue between the two compression members 107, 110. Further distal movement of the sliding positioner 112 on the handle 32 adds additional compression to the tissue between the first compression member 107 and the second compression member 110. In the embodiment of Figures 11A-11B, the first centermost portion 113 and the second centermost portion 114 are secured to the dividing wall 121 at a first fixation point 125 and a second fixation point 127, respectively.

Figure 12 illustrates an embodiment of the present invention where the conductive electrode 43 and the additional electrode leg 75 extend beyond the distal sheath end 41 to form somewhat parallel electrode extensions. The parallel electrode extensions can be alternately extended or retracted, as needed, by movement of the sliding positioner 130 on the handle 32. The embodiment of Figure 12 comprises a bi-polar mode, having an active electrical connector 132 and a passive electrical connector 134. A monopolar configuration can also be constructed, according to preference.

Figures 13 and 14 illustrate other embodiments of the present invention, which preferably operates in a bi-polar mode having an active electrical connector 132 and a passive electrical connector 134. In the embodiment of Figure 13, a sliding positioner 136 controls the first conductive electrode 43 and the additional electrode leg 75. The additional electrode leg 75 transitions into a first extended electrode portion 138 having an L-shaped end 141.

The conductive electrode 43 transitions into a second extended electrode portion 143 having an L-shaped end 145. As presently embodied, the first extended electrode portion 138 and the second extended electrode portion 143 are entirely covered with a dielectric coating, except for the proximally facing surface 147 of the L-shaped end 141 and the distally facing surface 152 of the L-shaped end 145.

The conductive electrode 43 and the second extended electrode portion 143, as well as the L- shaped end 145, are positionable within the dielectric sheath 34 in response to movement of the sliding positioner 136 on the handle 32. Movement of the sliding positioner 136 proximally creates a gap between the proximally facing surface 147 and the distally facing surface 152. Distal movement of the sliding positioner 136 closes the gap. A vessel or other tissue can be compressed or held within the gap and supported by one of the extended electrode portions 138, 143. At any point during the holding, grasping, clamping, or compressing of a vessel or tissue, radio frequency energy may be transmitted and discharged between the proximally facing surface 147 and the distally facing surface 152 to accomplish an electrosurgical effect.

Figure 14 illustrates another embodiment of the present invention, where a sliding positioner 154 controls a movable jaw 156 via a cam 158 and a slot 161 within the dielectric sheath 34. The conductive electrode 43 transitions into the movable jaw 156, and the additional electrode leg 75 transitions into a fixed jaw 163. The fixed jaw 163 comprises a first electrically conductive region 165, and the movable jaw 156 comprises a second electrically conductive region 167. Proximal and distal movement of the sliding positioner 154 affects closing and opening of the movable jaw 156, respectively. Tissue may be held between the movable jaw 156 and the fixed jaw 163 and radio frequency current applied therethrough. The embodiments of Figures 13 and 14 illustrate two examples of electrode extensions which are movable together.

Figures 15A and 15B illustrate dielectric sheaths 34 having positionable electrode ends 72 extending from the distal sheath end 41. A dielectric coating 63 is applied to the positionable electrode end 72, and portions of the dielectric coating 63 can be subsequently removed from the positionable electrode end. An exposed area 170, as shown in Figure 15A, or an exposed area 172, as shown in Figure 15B, for example, may be formed to transmit radio frequency current to the tissue. The active regions 170, 172, for example, may be specifically dedicated to certain surgical procedures or to mimic certain surgical instruments. Figures 16-19 illustrate an electrosurgical instrument 174 having a handle 176 and a sliding positioner 178 positioned thereon. A dielectric sheath 181 extends from a distal end of the handle 176. A flexible tubular member 183 extends through the dielectric sheath 181 and through a distal end 185 of the dielectric sheath 181. The flexible tubular member 183 comprises a weakened portion 187, which is adapted to facilitate bending of the flexible tubular member 183, as illustrated in Figure 17. A conductor 190, which is operatively coupled to the sliding positioner 178, extends from a proximal aperture 193 to a distal aperture 194 of the flexible tubular member 183. A slot 196 extends between the proximal aperture 193 and the distal aperture 194 and, as presently embodied, comprises part of the weakened portion 187. Additionally, as presently embodied, the weakened portion 187 comprises a number of creases 198. Although a proximal aperture 193 and a distal aperture 194 are presently preferred, the conductor 190 may be secured by other means to the flexible tubular member 183. For example, a band, such as the band 201 can encircle the flexible tubular member 183 at a distal end 203, to thereby secure the conductor 190 to the flexible tubular member 183. A similar band (not shown) may be used to secure the conductor 190 to a portion where the proximal aperture 193 would otherwise be used.

Distal movement of the sliding positioner 178 relaxes the conductor 190, to thereby form an elongate, low-diameter flexible tubular member 183, as illustrated in Figure 16. Proximal movement of the sliding positioner 178 decreases a distance between the proximal aperture 193 and the distal aperture 194, resulting in the flexible tubular member 183 forming a hook shape. Radio frequency current may be applied to the conductor 190 at any time during a surgical procedure.

Figures 20A-20B illustrate an electrical surgical probe 300 having a proximal end 301, a distal end 302, a handle 305, and an electrically insulative shaft 303. The electrically insulative shaft 303 comprises a proximal section 306, a distal reduced-diameter second 307, and a distal slidable sleeve 312. The proximal section 306 of the electrically insulative shaft 303 preferably comprises a majority of the length of the electrically insulative shaft 303. The slidable sleeve 312 is adapted to slide over the distal reduced-diameter section 307 in both proximal and distal directions. The slidable sleeve 312 can be moved to a distal position, as illustrated in Figure 20A where the distal end 321 covers the electrosurgical electrode 310. Additionally, the slidable sleeve 312 can be moved proximally, to thereby expose the electrosurgical electrode 310. Frictional engagement of the electrosurgical probe 300, as the electrosurgical probe 300 is inserted through a trocar seal, for example, moves the slidable sleeve 312 proximally to thereby expose the electrosurgical electrode 310. Withdrawal of the electrically insulative shaft 303 from a trocar, for example, moves the slidable sleeve 312 distally, to thereby cover the electrosurgical electrode 310.

The electrically insulative shaft 303 serves to insulate and protect the electrosurgical electrode

310, as well as to protect delicate seals and valves from being torn or ripped during withdrawal of the hook-shaped electrosurgical electrode 310, for example. Each time the electrosurgical probe 300 is inserted into a trocar, for example, the slidable sleeve 312 is retracted, and each time the electrosurgical probe 300 is withdrawn from the trocar, the slidable sleeve 312 is extended to cover the electrosurgical electrode 310, due to frictional engagement with the trocar seal. The distance between the proximal end 320 of the slidable sleeve 312 and the distal end 321 of the slidable sleeve 312 assures that the slidable sleeve 312 is positioned as required to expose or cover the electrosurgical electrode 310, but only in response to complete insertion or complete withdrawal of the electrosurgical probe 300 from the trocar.

Figures 21A and 21B illustrate another embodiment of the present invention, where an elongate slidable sleeve 312 responds to each distal and proximal movement of the electrosurgical probe 300, relative to the trocar, through a much narrower range of motion. In the embodiment of Figure 21A and 21B, the proximal end 320 of the elongate slidable sleeve 312 is extended in shape proximally to cover a longer portion of the electrically insulative shaft 303.

Figures 22A and 22B illustrate a manually slidable sleeve 312 controlled by a slidable positioner 313. Proximal movement of the sliding positioner 313 moves the manually slidable sleeve 312 proximally, and distal movement of the sliding positioner 313 moves the manually slidable sleeve 312 distally.

Figures 23A and 23B illustrate a semi-automatic version of the electrosurgical probe 300. Proximal movement of the sliding positioner 320 urges the dielectric sheath 312 distally to thereby cover the electrosurgical electrode 310. Distal movement of the sliding positioner 320 urges the dielectric sleeve 312 proximally to thereby expose the electrosurgical electrode 310. The electrosurgical electrode 310 is automatically covered by the dielectric sheath 312 whenever the electrosurgical probe 300 is withdrawn through a trocar as a result of frictional engagement with the trocar seal.

Figures 20A-23B illustrate several embodiments using a slidable sleeve. The slidable sleeve and/or the electrosurgical electrode 310 may be controlled by one or more slidable positioners. Additionally, the slidable sleeve may be controlled independently by frictional forces. Combinations of manual and frictional control of the slidable sleeve are also possible.

Although exemplary embodiments of the invention have been shown and described, many other changes, modifications and substitutions, in addition to those set forth in the above paragraphs, may be made by one having ordinary skill in the art without necessarily departing from the spirit and scope of this invention.

Claims

1. An electrosurgical instrument, comprising: a sheath having a proximal sheath end, a distal sheath end, an inside surface, and a sheath axis extending between the proximal sheath end and the distal sheath end; a conductor disposed within the sheath, the conductor having a proximal conductor end and a distal conductor end, the distal conductor end being movable between a first configuration and a second configuration.

2. The electrosurgical instrument as recited in Claim 1, the conductor comprising: a first conductor; and a second conductor having an inner side and an outer side, at least a portion of one of the inner side and the outer side comprising a dielectric material.

3. The electrosurgical instrument as recited in Claim 2, at least one of the first conductor and the second conductor being movable in a direction along the sheath axis within the sheath, whereby the second configuration is obtained by movement of the at least one of the first conductor and the second conductor along the sheath axis in a distal direction, and whereby the first configuration is obtained by movement of the at least one of the first conductor and the second conductor along the sheath axis in a proximal direction.

4. The electrosurgical instrument as recited in Claim 1, the conductor comprising: a first conductor having a proximal first end and a distal first end; and a second conductor having a proximal second end and a distal second end, the distal second end being adapted to contact the distal first end in the first configuration and being adapted to not contact the distal first end in the second configuration.

5. The electrosurgical instrument as recited in Claim 4, at least one of the first conductor and the second conductor being movable in a direction along the sheath axis within the sheath, whereby the second configuration is obtained by movement of the at least one of the first conductor and the second conductor along the sheath axis in a distal direction, and whereby the first configuration is obtained by movement of the at least one of the first conductor and the second conductor along the sheath axis in a proximal direction.

6. The electrosurgical instrument as recited in Claim 1, the conductor comprising: a first conductor having a proximal first end and a distal first end; and a second conductor having a proximal second end and a distal second end, the distal second end being coupled to the distal first end to thereby form the distal conductor end, and the first conductor being movable relative to the second conductor to thereby move the conductor between the first configuration and the second configuration.

7. The electrosurgical instrument as recited in Claim 6, the sheath comprising an inside surface, the distal conductor end being adapted to extend through the distal sheath end, and at least a portion of the distal conductor end being adapted to press against the inside surface of the sheath when the first conductor is moved relative to the second conductor, to thereby move the conductor between the first configuration and the second configuration.

8. The electrosurgical instrument as recited in Claim 7, the first conductor and the second conductor being substantially parallel to the sheath axis in the first configuration, and the first conductor and the second conductor being curved in a substantially nonparallel direction to the sheath axis in the second configuration.

9. The electrosurgical instrument as recited in Claim 8, the first conductor having an inner side and an outer side, at least a portion of one of the inner side and the outer side comprising an dielectric material disposed thereon.

10. The electrosurgical instrument as recited in Claim 8, the second conductor having an inner side and an outer side, at least a portion of one of the inner side and the outer side comprising an dielectric material disposed thereon.

11. The electrosurgical instrument as recited in Claim 8, the first conductor and the second conductor together forming a double bow shape in the second configuration.

12. The electrosurgical instrument as recited in Claim 8, the first conductor and the second conductor together forming a double U-shape in the second configuration.

13. The electrosurgical instrument as recited in Claim 6, the proximal second end being coupled to the sheath.

14. The electrosurgical instrument as recited in Claim 13, the coupling of the proximal second end to the sheath preventing movement of the proximal second end in a direction along the sheath axis, and the first conductor and the second conductor being adapted to be deformed in response to movement of the first conductor along the sheath axis.

15. The electrosurgical instrument as recited in Claim 14, the sheath comprising an inside surface, and the proximal second end being coupled to the inside surface.

16. An electrosurgical instrument, comprising: a sheath having a proximal sheath end, a distal sheath end, an inside surface, and a sheath axis extending between the proximal sheath end and the distal sheath end; a conductor disposed within the sheath, the conductor having a proximal conductor end and a distal conductor end, the distal conductor end forming a loop and being formable between a first configuration and a second configuration.

17. The electrosurgical instrument as recited in Claim 16, the loop having a first diameter in the first configuration and having a second diameter in the second configuration, the second diameter being greater than the first diameter.

18. The electrosurgical instrument as recited in Claim 17, the conductor comprising a distal conductor end, and the conductor being adapted to be moved proximally into the distal sheath end to form the first configuration and being adapted to be moved distally out of the distal sheath end to form the second configuration.

19. An electrosurgical instrument, comprising: a frame member; a sheath adapted to be connected to the frame member, the sheath having a proximal sheath end, a distal sheath end, and a sheath axis extending between the proximal sheath end and the distal sheath end; an electrical conductor disposed within the sheath; and a movable positioner disposed in close proximity to the frame member, the movable positioner being operatively coupled to the electrical conductor and being movable by a user to move the electrical conductor along the sheath axis.

20. The electrosurgical instrument as recited in Claim 19, the electrical conductor comprising a distal conductor end, and the movable positioner being adapted to move the distal conductor end proximally into the sheath and distally out of the sheath.

21. The electrosurgical instrument as recited in Claim 19, the electrical conductor comprising a distal conductor end and a hook formed on the distal conductor end.

22. The electrosurgical instrument as recited in Claim 19, the electrical conductor comprising: a first conductor having a proximal first end and a distal first end; and a second conductor having a proximal second end and a distal second end, the distal first end being coupled to the distal second end.

23. The electrosurgical instrument as recited in Claim 22, the first conductor extending from the proximal sheath end to the distal sheath end, and the second conductor extending only a partial distance from the distal sheath end to the proximal sheath end.

24. The electrosurgical instrument as recited in Claim 23, the sheath further comprising an inside surface, and the proximal second end being coupled to the inside surface, the first conductor and the second conductor being adapted to be deformed in response to movement of the movable positioner by a user.

25. The electrosurgical instrument as recited in Claim 19, the frame comprising a handle, the handle comprising a proximal handle end, a distal handle end, and a handle axis extending between the proximal handle end and the distal handle end, and the proximal sheath end being connected to the distal handle end.

26. An electrosurgical instrument, comprising: a housing having a proximal housing end, a distal housing end, and a housing axis extending between the proximal housing end and the distal housing end; a first conductor disposed within the housing, the first conductor having a proximal first end and a distal first end; and a second conductor disposed within the housing, the second conductor having a proximal second end and a distal second end, the distal first end and the distal second end being coupled together and extending through the distal housing end, and the proximal second end being coupled to the housing.

27. The electrosurgical instrument as recited in Claim 26, the housing further comprising an inside surface, and the proximal second end being coupled to the inside surface of the housing.

28. The electrosurgical instrument as recited in Claim 27, the first conductor and the second conductor being adapted to be deformed in response to movement of the first conductor, relative to the housing, in a direction along the housing axis.

29. The electrosurgical instrument as recited in Claim 28, further comprising a movable positioner coupled to the first conductor, the movable positioner being movable by a user to move the first conductor in a direction along the sheath axis.

30. An electrosurgical instrument, comprising: a retaining member having a proximal member end, a distal member end, and a member axis extending between the proximal member end and the distal member end; a first conductor disposed at the distal member end, the first conductor having a proximal first end and a distal first end, the distal first end forming a first loop; and a second conductor disposed at the distal member end, the second conductor having a proximal second end and a distal second end, the distal second end forming a second loop, the first conductor and the second conductor being adapted to be moved in a first direction along the member axis to separate the first loop form the second loop and being adapted to be moved in a second direction along the member axis to move the first loop into contact with the second loop.

31. The electrosurgical instrument as recited in Claim 30, further comprising an dielectric material disposed on at least one of the first conductor and the second conductor.

32. The electrosurgical instrument as recited in Claim 30, the first conductor extending through the retaining member and out of the distal member end, the second conductor extending through the retaining member and out of the distal member end, and the retaining member comprising a sheath.

33. The electrosurgical instrument as recited in Claim 30, the retaining member comprising a divider for insulating the first loop from the second loop.

34. The electrosurgical instrument as recited in Claim 30, the first conductor and the second conductor being adapted to be moved distally in a first direction along the member axis to separate the first loop form the second loop and being adapted to be moved proximally in a second direction along the member axis to move the first loop into contact with the second loop.

35. The electrosurgical instrument as recited in Claim 30, a portion of the distal first end of the first conductor being secured to the retaining member, and and a portion of the distal second end of the second conductor being secured to the retaining member.

36. An electrosurgical instrument, comprising: a retaining member having a proximal member end, a distal member end, and a member axis extending between the proximal member end and the distal member end; a first conductor disposed at the distal member end, the first conductor having a proximal first end and a curved distal first end; and a second conductor disposed at the distal member end, the second conductor having a proximal second end and a curved distal second end, at least one of the first conductor and the second conductor being adapted to be moved in a first direction along the member axis to move the curved distal first end into contact with the curved distal second end, and the at least one of the first conductor and the second conductor being adapted to be moved in a second direction along the member axis to move the curved distal first end out of contact with the curved distal second end.

37. The electrosurgical instrument as recited in Claim 36, the first conductor extending through the retaining member and out of the distal member end, the second conductor extending through the retaining member and out of the distal member end, and the retaining member comprising a sheath.

38. The electrosurgical instrument as recited in Claim 37, the curved distal first end and the curved distal second end being adapted to be moved along the member axis into and out of the sheath.

39. The electrosurgical instrument as recited in Claim 37, the curved distal first end comprising a first portion which is transverse to the sheath axis, the curved distal second end comprising a second portion which is transverse to the sheath axis, the first portion and the second portion contacting one another when the curved distal first end is moved into contact with the curved distal second end, and the first portion and the second portion not contacting one another when the curved distal first end is moved out of contact with the curved distal second end.

40. The electrosurgical instrument as recited in Claim 39, further comprising an dielectric material disposed on at least one of the first conductor and the second conductor.

41. The electrosurgical instrument as recited in Claim 39, the curved distal first end comprising an L-shape, and the curved distal second end comprising an L- shape.

42. An electrosurgical instrument, comprising: a retaining member having a proximal member end, a distal member end, and a member axis extending between the proximal member end and the distal member end; a first conductor disposed at the distal member end, the first conductor having a proximal first end and a distal first end; and a second conductor disposed at the distal member end, the second conductor having a proximal second end and an angled distal second end, the second conductor being adapted to be moved in a first direction along the member axis to move the angled distal second end out of contact with the distal first end, and the second conductor being adapted to be moved in a second direction along the member axis to move the angled distal second end into contact with the distal first end.

43. The electrosurgical instrument as recited in Claim 42, further comprising an dielectric material disposed on at least one of the first conductor and the second conductor.

44. The electrosurgical instrument as recited in Claim 42, the first conductor extending through the retaining member and out of the distal member end, the second conductor extending through the retaining member and out of the distal member end, and the retaining member comprising a sheath.

45. The electrosurgical instrument as recited in Claim 44, the first conductor and the second conductor being adapted to be moved along the member axis into and out of the sheath.

46. The electrosurgical instrument as recited in Claim 44, the second conductor comprising a cam disposed proximally of the angled distal second end, the sheath having a slot which is parallel to the member axis, the slot being adapted to accommodate the cam therein when the second conductor is moved in the first direction.

47. An electrosurgical instrument, comprising: a flexible tubular member having a proximal member end, a distal member end, an intermediate portion between the proximal member end and the distal member end, and a member axis extending between the proximal member end and the distal member end; and a conductor coupled to both the distal member end and the intermediate portion, the conductor being movable proximally along the member axis to thereby decrease a distance between the distal member end and the intermediate portion, and the conductor being movable distally along the member axis to thereby increase a distance between the distal member end and the intermediate portion.

48. The electrosurgical instrument as recited in Claim 47, the flexible tubular member having a weakened portion between the distal member end and the intermediate portion, whereby the flexible tubular member is adapted to bend at the weakened portion when the conductor is moved proximally.

49. An electrosurgical instrument having an electrical conductor that is responsive to an electrical signal to direct current to and perform a surgical function upon body tissue of a patient, comprising: a dielectric sheath surrounding said conductor along the longitudinal axis and forming a support member for said conductor; a wire conductor sized and configured to carry said current; a handle sized and configured to be useful in positioning said wire; and a coating upon said wire to prevent adhesion of charred tissue to said wire.

50. An electrosurgical instrument wherein a current carrying wire is positionable within a dielectric tubular member, comprising: a dielectric substantially tubular or hollow support member; at least a pair of conductive elements within said support member; a handle for use in holding said instrument; a movable or positionable means, upon said handle, communicating with said conductive elements for applying a tensile or compressive load upon said conductors; and a distal portion of said conductive elements forming an active portion shapeable through said movable means to form a cutting or coagulating electrode or electrodes.

51. An electrosurgical instrument for delivering radio frequency electrical energy to a surgical site for the purpose of welding cellular tissue, comprising: at least a pair of conductive electrodes sized and configured to oppose each other at the distal end of said instrument; a hollow support structure; a handle connected to said support structure; a positioning means upon said handle and in communication with said electrodes so that said electrodes may be urged apart or together by the action of said positioning means.

52. The electrosurgical instrument of Claim 51 wherein: the active electrode may be constructed of a superelastic or memory alloy; the active electrode may have a preset first shape or condition and a second condition or shape and where the shape of said electrode may be adjusted to mimic various surgical instruments.

53. An electrosurgical instrument for delivering radio frequency electrical energy to a surgical site comprising: an electrode mounted within a dielectric sheath which forms a shaft; a section of said sheath sized and configured to be reciprocally movable over said electrode in response to frictional engagement of said sheath section to a seal or septum; and a handle for holding said instrument.

54. The instrument of Claim 53 wherein the movable or slidable sheath section is disposed to expose or cover a hook in response to frictional engagement of said sheath section to a seal of a trocar.

55. The instrument of Claim 53 wherein the movable or slidable sheath section is disposed to cover a hook or electrode in response to frictional engagement to a trocar seal; where said sheath section is configured to be retractable at the urging of a positioning means upon a handle of said instrument; where said sheath is sized and configured to cover said hook or electrode each and every time said instrument is withdrawn from a seal; and where said sheath may be retracted at will by means of a positioning means.

56. A sheath for a surgical instrument comprising: a first proximal or main section extending from the handle of said instrument for a distance toward the distal end of said instrument; a second section extending from the distal end of said first section to a distal point which exposes a hook or electrode; a slidable connection means for connecting said second section to said first section so that said second section may slide rearward and forward in response to frictional engagement with a seal, septum or other restriction whenever said second section makes an initial contact with said seal; and where said slidable second section is disposed to remain in one or the other, either retracted or extended condition until urged by frictional engagement to assume the alternate condition.

57. A reciprocally disposed safety sheath for a surgical instrument that extends or retracts in response to frictional engagement with a seal.

58. The sheath of Claim 12 wherein said sheath is automatically extended to cover a hook or electrode or the like and manually retractable to expose said hook or electrode or the like.

59. The sheath of Claim 12 wherein said sheath is manually extendable and manually retractable and automatically extendable in response to frictional engagement with a seal.