Surgical instruments with integrated electrocautery

Abstract

The present invention provides a series of devices for performing surgical procedures utilizing electrodes for performing electrocautery on a tissue of the body of a patient. The invention includes, in one aspect, a series of devices comprising surgical instruments providing at least one electrode for performing electrocautery, and, in another aspect, provides a method for cutting and cauterizing tissue with a surgical instrument. In yet another aspect, the invention involves a method for detecting the location of a bleeding vessel in a liquid-filled, visually monitored surgical field of a patient and for electrocauterizing the vessel to stop the bleeding before visualization of the surgical field is compromised. Preferred surgical instruments according to the invention also include operable components for forming a liquid cutting jet for cutting or ablating tissue of a patient and/or for providing a rotating, tissue contacting component for cutting, grinding, ablating, etc. tissue during a surgical procedure. Some surgical instruments, according to the invention, include one or more liquid conducting lumen therein for transporting and/or removing a liquid from a surgical operating field, which lumen, in some cases, are selectively coated with a layer of an electrically insulating material so that certain, selected, uncoated regions of an external surface of the lumen can act as an electrocautery electrode of the instrument.

1 - 22 . (canceled)  
   
   
       23 . A device comprising: 
 a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator, the instrument including:    a first lumen constructed of an electrically conducting material providing a first liquid passageway between the distal end and the proximal end of the instrument; and    a second lumen constructed of an electrically conducting material providing a second liquid passageway between the distal end and the proximal end of the instrument,    the first lumen being connectable in electrical communication with a first electrical potential, and having an external surface, at at least the distal end of the instrument, which is inserted into a surgical field of a patient when the instrument is utilized for a surgical procedure, that is coated with an essentially continuous layer of electrical insulation and includes an uninsulated region at a distal end of the first lumen, which region at a distal end of the first lumen forms a first electrocautery electrode, and    the second lumen being connectable in electrical communication with a second electrical potential different from the first electrical potential, and having an external surface, at at least the distal end of the instrument, which is inserted into a surgical field of a patient when the instrument is utilized for a surgical procedure, that is electrically conductive, forming a second electrocautery electrode, except in a region at a distal end of the second lumen, which region at a distal end of the second lumen is coated with an essentially continuous layer of electrical insulation    
   
   
       24 . The device as in  claim 23 , wherein the first electrical potential is provided by a positive terminal of an external power supply and the second electrical potential is provided by a source of ground potential, so that the first electrocautery electrode acts as a positive electrocautery electrode and the second electrocautery electrode acts as a ground electrocautery electrode, when the instrument is in operation.  
   
   
       25 . The device as in  claim 23 , wherein at least one layer of electrical insulation is formed from poly(vinylidene fluoride) shrink-wrap tubing.  
   
   
       26 . The device as in  claim 25 , wherein the thickness of the layers of electrical insulation is between about 0.004 inch and between about 0.006 inch.  
   
   
       27 . The device as in  claim 23 , wherein the distal end of the second lumen is insulated from a distal-most end of the lumen to a distance, measured proximally from the distal-most end, of about 0.2 inch.  
   
   
       28 . The device as in  claim 24 , wherein the total surface area of the distal end of the instrument which is inserted into a surgical field and which is maintained at ground potential exceeds the total surface area of the positive electrocautery electrode formed on the first lumen by at least a factor of about 2.  
   
   
       29 . The device as in  claim 28 , wherein the total surface area of the distal end of the instrument which is inserted into a surgical field and which is maintained at ground potential exceeds the total surface area of the positive electrocautery electrode formed on the first lumen by at least a factor of about 5.  
   
   
       30 . The device as in  claim 29 , wherein the total surface area of the distal end of the instrument which is inserted into a surgical field and which is maintained at ground potential exceeds the total surface area of the positive electrocautery electrode formed on the first lumen by at least a factor of about 10.  
   
   
       31 . The device as in  claim 24 , wherein the positive electrocautery electrode formed on the first lumen has a total surface area of about 0.2 cm 2 .  
   
   
       32 . The device as in  claim 24 , wherein the total surface area of the ground electrocautery electrode formed on the second lumen is sufficient to prevent boiling of any liquid contained in the surgical field of the patient, when the instrument is in operation.  
   
   
       33 . The device as in  claim 32 , wherein the ground electrocautery electrode formed on the second lumen has a total surface area of at least about 2 cm 2 .  
   
   
       34 . A method comprising: 
 inserting a surgical instrument into a surgical field of a patient;    creating a liquid cutting jet with the surgical instrument;    cutting or ablating a selected tissue of the patient with the liquid cutting jet;    applying an electrical signal to at least one electrode of the surgical instrument; and    cauterizing a tissue of the patient.    
   
   
       35 . The method as in  claim 34 , further comprising after the creating step, the step of: 
 directing the liquid cutting jet towards a jet-receiving opening in an evacuation lumen of the surgical instrument.    
   
   
       36 . The method as in  claim 35 , wherein at least one electrode comprises a distal surface of at least one of a pressure lumen and the evacuation lumen of the surgical instrument.  
   
   
       37 . The method as in  claim 36 , wherein in the applying step, a bipolar electrical signal is applied to two electrodes of the surgical instrument.  
   
   
       38 . The method as in  claim 34 , further comprising the steps of: 
 rotating a rotatable component of the surgical instrument;    contacting a rotating surface of the rotatable component with a second selected tissue; and    grinding, cutting, or abrading the second selected tissue with the rotating surface.    
   
   
       39 . The method as in  claim 34 , wherein the creating step is performed independently of the cauterizing step.  
   
   
       40 . The method as in  claim 34 , wherein the creating step and the cauterizing step are performed concurrently.  
   
   
       41 - 45 . (canceled)