Electrothermal instrument for sealing and joining or cutting tissue

Abstract

An instrument and method are provided for sealing and joining or hemostatically dividing tissue, which is particularly suitable for laparoscopic and endoscopic surgery. The instrument makes use of the controlled application of a combination of heat and pressure to seal adjacent tissues, to join adjacent tissues, or to anastomose tissues, whereby tissue is heated for an optimal time and at an optimal temperature under optimal pressure to maximize tissue seal strength while minimizing collateral tissue damage. The instrument of the present invention is lightweight and therefore portable, and is particularly useful in field conditions where a source of external power may not be readily available.

1 . A surgical instrument which comprises two oppositely-positioned working members each having proximal and distal ends and each having a working surface, wherein at least one working surface has a heating element comprising an electrically resistant wire to seal and cut or cut tissue and the heating element loops around the distal end of a working surface.  
     
     
         2 . The instrument of  claim 1 , wherein the instrument also comprises a battery pack electrically connected to each heating element.  
     
     
         3 . The instrument of  claim 1 , which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.  
     
     
         4 . The instrument of  claim 1 , wherein a working surface contains one heating element.  
     
     
         5 . The instrument of  claim 1  wherein a working surface has more than one heating element.  
     
     
         6 . The instrument of  claim 1 , wherein both working surfaces have at least one heating element.  
     
     
         7 . The instrument of  claim 1 , wherein a heating element actuator is operatively connected to each heating element.  
     
     
         8 . The instrument of  claim 1  which also comprises a working member actuator operatively connected to at least one working member.  
     
     
         9 . The instrument of  claim 1 , wherein the working members are attached to each other at their respective proximal ends.  
     
     
         10 . The instrument of  claim 1 , wherein the opposing working surfaces apply pressure and approximate tissue.  
     
     
         11 . The instrument of  claim 1 , wherein a working surface is textured.  
     
     
         12 . The instrument of  claim 1 , wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.  
     
     
         13 . The instrument of  claim 1 +wherein each heating element has lower ohmic resistance than body tissue.  
     
     
         14 . The instrument of  claim 1 , wherein one or both working surfaces are comprised of non-stick material.  
     
     
         15 . The instrument of  claim 1 , wherein one or both working surfaces are comprised of resilient material.  
     
     
         16 . The instrument of  claim 1 , wherein each heating element is substantially thermally insulated from the working members.  
     
     
         17 . The instrument of  claim 1 , wherein each working surface comprises a thermal conducting material.  
     
     
         18 . The instrument of  claim 1 , wherein each working surface comprises thermally reflective material.  
     
     
         19 . The instrument of  claim 1 , wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.  
     
     
         20 . The instrument of  claim 1 , wherein each heating element is curved.  
     
     
         21 . The instrument of  claim 1 , wherein each heating element is electrically insulated from a working surface.  
     
     
         22 . The instrument of  claim 1 , wherein one opposing working member has a resilient working surface that is wider than the heating element in the other working surface.  
     
     
         23 . The instrument of  claim 1 , wherein each heating element is electrically insulated from a working member.  
     
     
         24 . The instrument of  claim 1 , wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to each heating element.  
     
     
         25 . The instrument of  claim 1 , wherein each heating element is operatively connected to a power source.  
     
     
         26 . The instrument of  claim 25 , wherein the power source is a portable DC power source.  
     
     
         27 . The instrument of  claim 25 , wherein the power source is an RF power source.  
     
     
         28 . The instrument of  claim 25 , wherein the power source is a low frequency AC power source.  
     
     
         29 . The instrument of  claim 1  which comprises control circuitry operatively connected to each heating element.  
     
     
         30 . The instrument of  claim 1 , which also comprises a heating element actuator responsive to a predetermined pressure to activate each heating element.  
     
     
         31 . A surgical instrument which comprises two oppositely-positioned working members each having proximal and distal ends and each having a working surface, wherein each working surface has a heating element comprising an electrically resistant wire to seal and cut or cut tissue.  
     
     
         32 . The instrument of  claim 31 , wherein each heating element loops around the distal end of a working member.  
     
     
         33 . The instrument of  claim 31 , wherein the instrument also comprises a battery pack electrically connected to each heating element.  
     
     
         34 . The instrument of  claim 31 , which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.  
     
     
         35 . The instrument of  claim 31 , wherein a working surface contains one heating element.  
     
     
         36 . The instrument of  claim 31 , wherein a working surface has more than one heating element.  
     
     
         37 . The instrument of  claim 31 , wherein a heating element actuator is operatively connected to each heating element.  
     
     
         38 . The instrument of  claim 31  which also comprises a working member actuator operatively connected to at least one working member.  
     
     
         39 . The instrument of  claim 31 , wherein the working members are attached to each other at their respective proximal ends.  
     
     
         40 . The instrument of  claim 31 , wherein the opposing working surfaces apply pressure and approximate tissue.  
     
     
         41 . The instrument of  claim 31 , wherein a working surface is textured.  
     
     
         42 . The instrument of  claim 31 , wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.  
     
     
         43 . The instrument of  claim 31 , wherein each heating element has lower ohmic resistance than body tissue.  
     
     
         44 . The instrument of  claim 31 , wherein one or both working surfaces are comprised of non-stick material.  
     
     
         45 . The instrument of  claim 31 , wherein one or both working surfaces are comprised of resilient material.  
     
     
         46 . The instrument of  claim 31 , wherein each heating element is substantially thermally insulated from the working members.  
     
     
         47 . The instrument of  claim 31 , wherein each working surface comprises a thermal conducting material.  
     
     
         48 . The instrument of  claim 31 , wherein each working surface comprises thermally reflective material.  
     
     
         49 . The instrument of  claim 31 , wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.  
     
     
         50 . The instrument of  claim 31 , wherein each heating element is curved.  
     
     
         51 . The instrument of  claim 31 , wherein each heating element is electrically insulated from a working surface.  
     
     
         52 . The instrument of  claim 31 , wherein each heating element loops around the distal portion of a working member and the heating element and the working member are electrically insulated from each other.  
     
     
         53 . The instrument of  claim 31 , wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to each heating element.  
     
     
         54 . The instrument of  claim 31 , wherein each heating element is operatively connected to a power source.  
     
     
         55 . The instrument of  claim 54 , wherein the power source is a portable DC power source.  
     
     
         56 . The instrument of  claim 54 , wherein the power source is an RF power source.  
     
     
         57 . The instrument of  claim 54 , wherein the power source is a low frequency AC power source.  
     
     
         58 . The instrument of  claim 31  which comprises control circuitry operatively connected to each heating element.  
     
     
         59 . The instrument of  claim 31 , which also comprises a heating element actuator responsive to a predetermined pressure to activate each heating element.  
     
     
         60 . A surgical instrument which comprises two oppositely-positioned working members each having proximal and distal ends and each having a working surface, wherein at least one working surface has a heating element comprising an electrically resistant wire to seal and cut or cut tissue and wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to each heating element.  
     
     
         61 . The instrument of  claim 60 , wherein each heating element loops around the distal end of a working member.  
     
     
         62 . The instrument of  claim 60 , wherein the instrument also comprises a battery pack electrically connected to each heating element.  
     
     
         63 . The instrument of  claim 60 , which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.  
     
     
         64 . The instrument of  claim 60 , wherein a working surface contains one heating element.  
     
     
         65 . The instrument of  claim 60 , wherein a working surface has more than one heating element.  
     
     
         66 . The instrument of  claim 60 , wherein both working surfaces have at least one heating element.  
     
     
         67 . The instrument of  claim 60 , wherein a heating element actuator is operatively connected to each heating element.  
     
     
         68 . The instrument of  claim 60  which also comprises a working member actuator operatively connected to at least one working member.  
     
     
         69 . The instrument of  claim 60 , wherein the working members are attached to each other at their respective proximal ends.  
     
     
         70 . The instrument of  claim 60 , wherein the opposing working surfaces apply pressure and approximate tissue.  
     
     
         71 . The instrument of  claim 60 , wherein a working surface is textured.  
     
     
         72 . The instrument of  claim 60 , wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.  
     
     
         73 . The instrument of  claim 60 , wherein each heating element has lower ohmic resistance than body tissue.  
     
     
         74 . The instrument of  claim 60 , wherein one or both working surfaces are comprised of non-stick material.  
     
     
         75 . The instrument of  claim 60 , wherein one or both working surfaces are comprised of resilient material.  
     
     
         76 . The instrument of  claim 60 , wherein each heating element is substantially thermally insulated from the working members.  
     
     
         77 . The instrument of  claim 60 , wherein each working surface comprises a thermal conducting material.  
     
     
         78 . The instrument of  claim 60 , wherein each working surface comprises thermally reflective material.  
     
     
         79 . The instrument of  claim 60 , wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.  
     
     
         80 . The instrument of  claim 60 , wherein each heating element is curved.  
     
     
         81 . The instrument of  claim 60 , wherein each heating element is electrically insulated from a working surface.  
     
     
         82 . The instrument of  claim 60 , wherein one opposing working member has a resilient working surface that is wider than the heating element in the other working surface.  
     
     
         83 . The instrument of  claim 60 , wherein each heating element loops around the distal portion of a working member and the heating element and the working member are electrically insulated from each other.  
     
     
         84 . The instrument of  claim 60 , wherein each heating element is operatively connected to a power source.  
     
     
         85 . The instrument of  claim 84 , wherein the power source is a portable DC power source.  
     
     
         86 . The instrument of  claim 84 , wherein the power source is an RF power source.  
     
     
         87 . The instrument of  claim 84 , wherein the power source is a low frequency AC power source.  
     
     
         88 . The instrument of  claim 60  which comprises control circuitry operatively connected to each heating element.  
     
     
         89 . The instrument of  claim 60 , which also comprises a heating element actuator responsive to a predetermined pressure to activate each heating element.  
     
     
         90 . A surgical instrument which comprises two oppositely-positioned working members each having proximal and distal ends and each having a working surface and a heating element actuator responsive to a predetermined pressure to activate the heating element, wherein at least one working surface has a heating element comprising an electrically resistant wire to seal and cut or cut tissue.  
     
     
         91 . The instrument of  claim 90 , wherein each heating element loops around the distal end of a working member.  
     
     
         92 . The instrument of  claim 90 , wherein the instrument also comprises a battery pack electrically connected to the heating element.  
     
     
         93 . The instrument of  claim 90 , which also comprises an elongated member having distal and proximal ends, the distal end of which is attached to the proximal end of at least one working member.  
     
     
         94 . The instrument of  claim 90 , wherein a working surface contains one heating element.  
     
     
         95 . The instrument of  claim 90  wherein a working surface has more than one heating element.  
     
     
         96 . The instrument of  claim 90 , wherein both working surfaces have at least one heating element.  
     
     
         97 . The instrument of  claim 90 , wherein a heating element actuator is operatively connected to each heating element.  
     
     
         98 . The instrument of  claim 90  which also comprises a working member actuator operatively connected to at least one working member.  
     
     
         99 . The instrument of  claim 90 , wherein the working members are attached to each other at their respective proximal ends.  
     
     
         100 . The instrument of  claim 90 , wherein the opposing working surfaces apply pressure and approximate tissue.  
     
     
         101 . The instrument of  claim 90 , wherein a working surface is textured.  
     
     
         102 . The instrument of  claim 90 , wherein each heating element is capable of being heated to a temperature to first seal and then cut tissue.  
     
     
         103 . The instrument of  claim 90 , wherein each heating element has lower ohmic resistance than body tissue.  
     
     
         104 . The instrument of  claim 90 , wherein one or both working surfaces are comprised of non-stick material.  
     
     
         105 . The instrument of  claim 90 , wherein one or both working surfaces are comprised of resilient material.  
     
     
         106 . The instrument of  claim 90 , wherein each heating element is substantially thermally insulated from the working members.  
     
     
         107 . The instrument of  claim 90 , wherein each working surface comprises a thermal conducting material.  
     
     
         108 . The instrument of  claim 90 , wherein each working surface comprises thermally reflective material.  
     
     
         109 . The instrument of  claim 90 , wherein each heating element is a heater wire selected from a material selected from the group consisting of nichrome, stainless steel, nitinol, and metallic alloys.  
     
     
         110 . The instrument of  claim 90 , wherein each heating element is curved.  
     
     
         111 . The instrument of  claim 90 , wherein each heating element is electrically insulated from a working surface.  
     
     
         112 . The instrument of  claim 90 , wherein one opposing working member has a resilient working surface that is wider than the heating element in the other working surface.  
     
     
         113 . The instrument of  claim 90 , wherein each heating element loops around the distal portion of a working members and the heating element and the working member are electrically insulated from each other.  
     
     
         114 . The instrument of  claim 90 , wherein a primary switch is actuated when the working surfaces are approximated and a secondary switch is manually activated to apply energy to the heating element.  
     
     
         115 . The instrument of  claim 90 , wherein each heating element is operatively connected to a power source.  
     
     
         116 . The instrument of  claim 115 , wherein the power source is a portable DC power source.  
     
     
         117 . The instrument of  claim 115 , wherein the power source is an RF power source.  
     
     
         118 . The instrument of  claim 115 , wherein the power source is a low frequency AC power source.  
     
     
         119 . The instrument of  claim 90  which comprises control circuitry operatively connected to each heating element.