Method of treating tissue using end effector with ultrasonic and electrosurgical features

Abstract

An end effector of an instrument is positioned in a patient. An ultrasonic blade of the end effector is positioned against tissue in the patient. The ultrasonic blade is activated to vibrate ultrasonically while the ultrasonic blade is positioned against tissue. At least one electrode of the end effector is positioned against tissue in the patient. The at least one electrode is activated to apply RF electrosurgical energy to tissue against which the at least one electrode is positioned against tissue.

I/we claim: 
     
         1 . A method of using an instrument, the method comprising:
 (a) positioning an instrument end effector within a patient, wherein the end effector comprises:
 (i) an ultrasonic blade, 
 (ii) a clamp pad, and 
 (iii) at least one electrode; 
   (b) positioning the ultrasonic blade against tissue in the patient;   (c) activating the ultrasonic blade to vibrate ultrasonically while the ultrasonic blade is positioned against tissue;   (d) positioning the at least one electrode against tissue in the patient; and   (e) activating the at least one electrode to apply RF electrosurgical energy to tissue against which the at least one electrode is positioned against tissue.   
     
     
         2 . The method of  claim 1 , further comprising compressing tissue between the clamp pad and the ultrasonic blade. 
     
     
         3 . The method of  claim 2 , wherein the act of activating the ultrasonic blade is performed while the tissue is compressed between the clamp pad and the ultrasonic blade. 
     
     
         4 . The method of  claim 2 , wherein the act of activating the at least one electrode is performed while the tissue is compressed between the clamp pad and the ultrasonic blade. 
     
     
         5 . The method of  claim 2 , wherein the end effector further comprises a clamp arm, wherein the clamp arm is pivotable relative to the ultrasonic blade, wherein the at least one electrode is supported by the clamp arm, wherein the act of compressing tissue between the clamp pad and the ultrasonic blade comprises pivoting the at least one electrode toward the tissue. 
     
     
         6 . The method of  claim 1 , wherein the ultrasonic blade provides a return path for the electrode, wherein the act of activating the at least one electrode to apply RF electrosurgical energy to tissue results in the application of bipolar RF electrosurgical energy to the tissue via the at least one electrode and the ultrasonic blade. 
     
     
         7 . The method of  claim 1 , wherein the clamp pad has a pair of lateral sides, wherein the electrode extends along both lateral sides of the clamp pad, wherein the act of activating the at least one electrode to apply RF electrosurgical energy to tissue comprises applying RF electrosurgical energy to tissue at both lateral sides of the clamp pad. 
     
     
         8 . The method of  claim 1 , wherein the ultrasonic blade is positioned against tissue extending along a first plane, wherein the at least one electrode is positioned against tissue extending along a second plane, wherein the second plane is substantially parallel with the first plane. 
     
     
         9 . The method of  claim 1 , wherein the ultrasonic blade is positioned against tissue extending along a first plane, wherein the at least one electrode is positioned against tissue extending along a second plane, wherein the second plane is obliquely oriented relative to the first plane. 
     
     
         10 . The method of  claim 1 , wherein the end effector further comprises a plurality of stand-off features, wherein the stand-off features prevent the at least one electrode from contacting the ultrasonic blade. 
     
     
         11 . The method of  claim 1 , wherein the end effector further comprises a clamp arm body, wherein the at least one electrode is interposed between the clamp pad and the clamp arm body, wherein the clamp pad defines a plurality of openings, wherein the act of positioning the at least one electrode against tissue comprises pressing the tissue through at least some of the openings to contact the at least one electrode. 
     
     
         12 . The method of  claim 1 , wherein the end effector further comprises a blade guard, wherein the blade guard extends along at least a portion of the length of the ultrasonic blade, wherein the blade guard is spaced away from the ultrasonic blade, wherein the at least one electrode is positioned on the blade guard, wherein the act of positioning the at least one electrode against tissue comprises urging the blade guard into contact with the tissue. 
     
     
         13 . The method of  claim 1 , wherein the end effector further comprises a clamp arm assembly, wherein the clamp arm assembly comprises the clamp pad and the at least one electrode, wherein the at least one electrode comprises a first electrode and a second electrode, wherein the act of activating the at least one electrode comprises activating the first and second electrodes to apply bipolar RF electrosurgical energy to tissue. 
     
     
         14 . The method of  claim 1 , wherein the at least one electrode comprises a first electrode and a second electrode, wherein the clamp pad is laterally interposed between the first and second electrodes, wherein the act of positioning the at least one electrode against tissue further comprises positioning the first and second electrodes against the tissue while simultaneously positioning the clamp pad against the tissue. 
     
     
         15 . The method of  claim 14 , wherein the act of positioning the first and second electrodes against the tissue while simultaneously positioning the clamp pad against the tissue further comprises compressing the tissue between the clamp pad and the ultrasonic blade. 
     
     
         16 . The method of  claim 15 , wherein the act of activating the ultrasonic blade to vibrate ultrasonically while the ultrasonic blade is positioned against tissue is performed while the tissue is compressed between the clamp pad and the ultrasonic blade. 
     
     
         17 . The method of  claim 1 , wherein the end effector further comprises a clamp arm body defining a plurality of recesses, wherein at least a portion of the clamp pad flows into at least some of the recesses during one or both of the act of activating the ultrasonic blade to vibrate ultrasonically while the ultrasonic blade is positioned against tissue or the act of activating the at least one electrode to apply RF electrosurgical energy to tissue against which the at least one electrode is positioned. 
     
     
         18 . The method of  claim 1 , wherein the at least one electrode comprises a first electrode and a second electrode, wherein the end effector further comprises a first arm and a second arm, wherein the first electrode is carried by the first arm, wherein the second electrode is carried by the second arm, wherein the act of positioning the at least one electrode against tissue in the patient comprises:
 (i) pivoting the first arm toward the tissue, and   (ii) pivoting the second arm toward the tissue.   
     
     
         19 . A method of using an instrument, the method comprising:
 (a) positioning an instrument end effector within a patient, wherein the end effector comprises:
 (i) an ultrasonic blade, and 
 (ii) a clamp arm assembly, wherein the clamp arm assembly comprises:
 (A) a clamp pad, 
 (B) a first electrode, and 
 (C) a second electrode; 
 
   (b) pivoting the clamp arm assembly toward the ultrasonic blade, thereby compressing tissue between the ultrasonic blade and the clamp pad, and thereby bringing the first and second electrodes into contact with the tissue; and   (c) activating one or both of:
 (i) the ultrasonic blade to vibrate ultrasonically to thereby apply the ultrasonic energy to the tissue, or 
 (ii) the first and second electrodes to thereby apply bipolar RF electrosurgical energy to the tissue. 
   
     
     
         20 . A method of using an instrument, the method comprising:
 (a) positioning an instrument end effector within a patient, wherein the end effector comprises:
 (i) an ultrasonic blade, 
 (ii) a clamp arm assembly, 
 (iii) a first conductive arm, wherein the first conductive arm is spaced apart from the ultrasonic blade and from the clamp arm assembly, and 
 (iv) a second conductive arm, wherein the second conductive arm is spaced apart from the ultrasonic blade and from the clamp arm assembly; 
   (b) pivoting the clamp arm assembly toward the ultrasonic blade, thereby compressing tissue between the ultrasonic blade and the clamp arm assembly; and   (c) activating one or both of:
 (i) the ultrasonic blade to vibrate ultrasonically to thereby apply the ultrasonic energy to the tissue, or 
 (ii) the first and second conductive arms to thereby apply bipolar RF electrosurgical energy to the tissue.