Surgery – Instruments – Electrical application
Reexamination Certificate
2000-07-20
2004-02-17
Peffley, Michael (Department: 3739)
Surgery
Instruments
Electrical application
Reexamination Certificate
active
06692489
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates to surgical methods and assemblies employing the application of electrical energy to tissue to achieve a predetermined surgical effect, and, more particularly, to achieve such effect with reduced likelihood of inadvertent tissue damage and with better control of energy application to tissues.
BACKGROUND OF THE INVENTION
The potential uses and recognized advantages of employing electrical energy for surgical purposes are ever-increasing. In particular, for example, electrosurgery techniques are now being widely employed to provide significant localized control advantages in both open and laparoscopic, including arthroscopic, applications relative to prior traditional surgical approaches.
Electrosurgical techniques use an instrument with working surfaces that contact tissue, such as a tissue ablation or cutting device, a source of radio frequency (RF) electrical energy, and a return path device, commonly in the form of a return electrode pad. The working surfaces that contact the patient in the region where the surgical effect is to occur are commonly called the active electrode or electrodes. The return path device contacts the patient either directly on the tissue or indirectly through, for example, a conductive liquid such as blood or normal saline. The return path device provides a return electrical path from the patient's tissues. Both the instrument and the return path device are connected using electrically conductive wires to the source of the radio frequency electrical energy which serves as both the source and the sink for the electrical energy to produce a complete electrical circuit. When the instrument and the return path device are separate devices the technique is termed monopolar. In some cases the instrument contains working surfaces that both supply the electrical energy and provide the return path. In these cases the technique is termed bipolar.
FIG. 3
illustrates a schematic of an electrosurgical system generally of the above-described type which includes an electrosurgical generator
1
with the generator electronics
2
(including the radio frequency (RF) electrical energy source, controls, and power supply being included in the electronics), as well as an electrosurgical accessory or instrument
100
and a return system
110
which is mechanically separated from the accessory
100
. As such, the configuration of
FIG. 3
is of the monopolar type. An output connector plug
3
and a return connector plug
4
of the accessory
100
connect to the output connector
5
and the return connector
6
that are part of the generator
1
. The output connector plug
3
and a return connector plug
4
typically are molded plastic parts with metallic prongs (not shown) or receptacles (not shown). One or more of the metallic prongs in the output connector plug
3
connect to the output line
7
of the accessory
100
, which typically consists of one or more conductive metal wires covered with an insulating coating. The output line
7
passes from the distal end of the output connector plug
3
and has a length suited to have the handle
8
of the accessory
100
a comfortable distance from the generator
1
. The output line
7
passes into the proximal end of the accessory handle
8
. The output line
7
is routed through the accessory handle
8
and may connect to a variety of internal conductors (not shown) that eventually make electrical contact with the active element
9
of the accessory
100
, such as a blade. The accessory active element
9
may be in either direct or indirect contact with the patient
10
. Electrosurgical energy passes from the active element
9
to the patient
10
. The electrical return path is provided by the return system
110
, which again is separate from the accessory
100
in the illustrated monopolar configuration of FIG.
3
. The return system
110
consists of the return line
11
which typically connects with one or more metallic receptacles (not shown) that are molded into the housing of the return connector plug
4
and that, in turn, connect to the return connector
6
that is part of the generator
1
. The return line
11
typically consists of one or more conductive metal wires covered with an insulated coating. The return line
11
exits the distal end of the return connector plug
4
and connects to the return path device
12
of the return system
110
, which is usually a return electrode pad when monopolar procedures are used and as contemplated by the configuration of FIG.
3
.
A variation of the accessory
100
from
FIG. 3
is presented in
FIG. 4
in the form of a schematic of an electrosurgical accessory
100
′. In this case a supplemental return line
13
of the return system
110
′ extends from the return connector plug
4
to the output connector plug
3
where it interfaces with the return line
11
. The supplemental return line
13
will be long enough to span the distance between the output connector
5
and the return connector
6
and allow the user enough slack to conveniently connect the output connector plug
3
and the return connector plug
4
to the generator
1
. This length will typically be between 6 and 18 inches. The length should not be longer than necessary to avoid producing confusing clutter.
The output line
7
and the return line
11
may leave the output plug
3
separately or joined together in a cable in the case of either of the configurations presented in
FIGS. 3-4
. Although this is appropriate for the monopolar configurations presented in
FIGS. 3-4
, joining the lines together is particularly advantageous when they both go to an accessory which is of the bipolar type, and one embodiment of which is schematically presented in FIG.
5
. In this case, the accessory handle
8
of the accessory
150
provides electrical continuity from both the output line
7
and the return line
11
to the active element
9
and the return path device
12
(e.g., return electrode), respectively. In bipolar accessories in general, the active element
9
and the return path device
12
are often joined together mechanically, but not electrically, using an accessory electrode housing
14
. The accessory electrode housing
14
can be of many forms, of which an insulated shaft is an example. The common feature of the various forms of the accessory electrode housing
14
is that it allows both the active element
9
and the return path device
12
to contact simultaneously the patient
10
. Such contact may be either direct or indirect.
One embodiment of a prior art bipolar configuration is more particularly illustrated in
FIG. 15
, which is used in conductive liquid environments. The accessory
200
operatively interfaces with an electrosurgical generator (not shown) via an output connector
5
on the generator and a return connector
6
on the generator. The accessory
200
has a supplemental return line
13
passing from the return connector
4
to the output connector
3
. The accessory
200
illustrated in
FIG. 15
is a bipolar electrosurgical accessory that uses a return electrode and it will be compared to later figures to illustrate distinctive features of the subject invention. The device
200
illustrated in
FIG. 15
includes a probe assembly
27
that has a probe handle
28
and a probe shaft
29
. The output line
7
and the return line
11
are of a length needed to allow the surgeon to conveniently place the electrosurgical generator. The probe shaft
29
is coated with probe shaft insulation
30
that extends almost the complete length of the probe shaft
29
. The probe shaft
29
is typically made of either a polymer, which may be flexible, or, more commonly, of metal. One or more channels (not shown) may pass through the probe shaft
29
to allow irrigation solution, aspirated materials, tools, light sources, or visualization equipment to pass into the patient. At the distal tip of the probe shaft
29
is the active electrode assembly
31
which includes the active electrode
32
. The output line
7
may continue through t
Brassell James L.
Heim Warren P.
Olichney Michael D.
Marsh & Fischmann & Breyfogle LLP
Peffley Michael
Team Medical LLC
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