Ultrasonic device for cutting and coagulating

Abstract

An ultrasonic clamp coagulator assembly that is configured to permit selective cutting, coagulation, and fine dissection required in fine and delicate surgical procedures. The assembly includes a clamping mechanism, including a clamp arm cam-mounted at the distal portion of the instrument, which is specifically configured to create a desired level of tissue clamping forces. The balanced blade provides a functional asymmetry for improved visibility at the blade tip and a multitude of edges and surfaces, designed to provide a multitude of tissue effects: clamped coagulation, clamped cutting, grasping, back-cutting, dissection, spot coagulation, tip penetration and tip scoring. The assembly also features hand activation configured to provide an ergonomical grip and operation for the surgeon. Hand switches are placed in the range of the natural axial motion of the user's index or middle fingers, whether gripping the surgical instrument right-handed or left handed.

1 . An ultrasonic apparatus comprising: 
 an ultrasonic waveguide having a proximal end and a distal end;    an ultrasonically actuated blade attached to the distal end of the waveguide;    a tissue pad having a tissue engaging surface having a first width and a second width less than the first width;    a clamp member defining a distal portion and a proximal portion and moveable with respect to the blade and having an open position in which at least a portion of the clamp member is spaced from the blade and a closed position in which the clamp member is adjacent to the blade for clamping tissue between the tissue pad and the blade.    
     
     
         2 . The ultrasonic apparatus according to  claim 1 , wherein the clamp member defines a first dimension and a second dimension in a first plane and the first dimension is greater than the second dimension.  
     
     
         3 . The ultrasonic apparatus according to  claim 2 , wherein the clamp member defines a first dimension and a second dimension in a second plane and the first dimension is greater than the second dimension.  
     
     
         4 . A method of assembling a sterilized ultrasonic clamp coagulator apparatus comprising the steps of: 
 providing: 
 an ultrasonic waveguide having a proximal end and a distal end;  
 an ultrasonically actuated blade attached to the distal end of the waveguide;  
   a tissue pad having a flange and a tissue engaging surface having a first width and a second width less than the first width;    a clamp member moveable with respect to the blade and having an open position in which at least a portion of the clamp member is spaced from the blade and a closed position in which the clamp member is adjacent to the blade for clamping tissue between the tissue pad and the blade, the clamp member comprising a slot for slidably receiving the flange;    slidably engaging the flange within the slot; and    sterilizing the clamp coagulator apparatus.    
     
     
         5 . A tissue pad for use in an ultrasonic clamp coagulator made from a composition comprising PTFE, the tissue pad portion having first and second ends, each defining a width dimension and a rough tissue engaging surface disposed therebetween, wherein the width of the first end is less than the width of the second end.  
     
     
         6 . The tissue pad according to  claim 5 , wherein the rough tissue engaging surface of the first tissue pad portion comprises a saw tooth configuration.  
     
     
         7 . The tissue pad according to  claim 5 , wherein the tissue pad portion has a substantially T-shaped flange formed on a surface opposite the rough tissue engaging surface.  
     
     
         8 . A method of mounting the tissue pad according to  claim 5  onto an arm of an ultrasonic clamp coagulator, the coagulator comprising a handle portion, the arm having a proximal portion and a distal portion, the distal portion being farther from the handle than the proximal portion and having a T-shaped slot formed therein, the mounting method comprising the step of: inserting the tissue pad portion into the distal portion of the arm by inserting the T-shaped flange formed on the tissue pad portion into the T-shaped slot formed in the distal portion of the arm.  
     
     
         9 . The method according to  claim 8 , further comprising the step of gluing the tissue pad portion to the arm of the ultrasonic clamp coagulator.  
     
     
         10 . The method according to  claim 8 , wherein the T-shaped slot into which the T-shaped flange is inserted is curved in a plane that lies substantially parallel to the tissue engaging surface of the first tissue pad portion.  
     
     
         11 . An ultrasonic surgical instrument comprising: 
 a housing for accepting a transducer and further defining a longitudinal axis;    a first switch positioned on the housing for actuation by one or more fingers of a user in a direction parallel to the longitudinal axis and further electrically connected to a generator for providing an electrical signal to the generator for controlling a first level of ultrasonic energy delivered by the transducer.    
     
     
         12 . An ultrasonic surgical instrument according to  claim 11  further comprising a second switch positioned on the housing for actuation by one or more fingers of a user in a direction parallel to the longitudinal axis and further electrically connected to a generator for providing an electrical signal to the generator for controlling a second level of ultrasonic energy delivered by the transducer.  
     
     
         13 . An ultrasonic surgical instrument according to  claim 12 , wherein the electrical connection between the first and second switch comprises a spring-biased pin.  
     
     
         14 . An ultrasonic surgical instrument comprising an ultrasonic waveguide defining a longitudinal axis, having a proximal end, a most distal node and a distal end wherein the waveguide comprises: 
 an ultrasonically actuated blade positioned at the distal end of the waveguide and defining a functional asymmetry within a first plane;    a first balance asymmetry distal to the most distal node and proximal to the blade; and    a second balance asymmetry proximal to the most distal node.    
     
     
         15 . The ultrasonic surgical instrument according to  claim 14 , wherein the first balance asymmetry is cut at an angle relative to the longitudinal axis.  
     
     
         16 . The ultrasonic surgical instrument according to  claim 14 , wherein the second balance asymmetry defines an angled balance cut contained in a second plane orthogonal to the first plane.  
     
     
         17 . The ultrasonic surgical instrument according to  claim 14 , wherein the functional asymmetry includes a balance asymmetry.  
     
     
         18 . The ultrasonic surgical instrument according to  claim 14 , wherein the blade defines a taper.  
     
     
         19 . An ultrasonic surgical instrument comprising: 
 a housing;    an outer shroud having a proximal end joined to the housing, the outer tube defining a longitudinal axis;    an ultrasonic waveguide positioned within the outer tube, having a proximal end, a distal end and an ultrasonically actuated blade positioned at the distal end of the waveguide;    an actuating lever for operating a clamp arm located at the distal end of the lever, wherein the actuating lever comprises camming members, which operatively engage the outer tube such that movement of the actuating lever positions the clamp arm between open and clamped positions relative to the blade.    
     
     
         20 . The ultrasonic surgical instrument according to  claim 19 , wherein the outer shroud comprises slots for engaging the camming members.  
     
     
         21 . The ultrasonic surgical instrument according to  claim 19 , wherein the camming members are cylindrical.  
     
     
         22 . The ultrasonic surgical instrument according to  claim 19 , wherein the camming members are spherical.  
     
     
         23 . The ultrasonic surgical instrument according to  claim 20 , wherein the slots comprise an elasto-meric insert.  
     
     
         24 . An ultrasonic surgical instrument comprising: 
 a housing defining a longitudinal axis;    an ultrasonic waveguide positioned within the housing, having a proximal end, a distal end and an ultrasonically actuated blade positioned at the distal end of the waveguide;    a transducer removably connected to the waveguide;    a handle assembly comprising a moveable actuation lever for operating a clamp arm located at the distal end of the lever, and a stationary finger ring defining an opening having a length L; wherein the housing and transducer are sized to position a center of gravity of the surgical instrument at the housing within the dimension of length L.    
     
     
         25 . The ultrasonic surgical instrument according to  claim 24 , wherein the length L is parallel to the longitudinal axis.  
     
     
         26 . The ultrasonic surgical instrument according to  claim 24 , wherein the housing and actuation lever is made from a thermoplastic with a filler selected from the group consisting of aluminum nitride and boron nitride.  
     
     
         27 . A torque wrench for use with an ultrasonic clamp coagulator apparatus, comprising: 
 a hand wrench body having an axis;    a cantilever arm movably attached to said wrench body having proximal and distal ends annularly disposed about said axis;    at least one tooth located at the cantilever arm's distal end; and    an adaptor defining a lumen and rotatably attached to the hand wrench and comprising a cam for operatively engaging the tooth.