JP7617112B2 - Electrosurgical instrument with electrodes having energy focusing mechanism - Patents.com - Google Patents

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
This non-provisional patent application claims the benefit, pursuant to 35 U.S.C. § 119(e), of U.S. Provisional Patent Application No. 62/955,299, filed December 30, 2019, entitled "DEVICES AND SYSTEMS FOR ELECTROSURGERY," the entire disclosure of which is incorporated herein by reference.

The present invention relates to surgical instruments designed to treat tissue, including, but not limited to, surgical instruments configured to cut and fasten tissue. The surgical instruments may include electrosurgical instruments powered by a generator to effect dissection, cutting, and/or coagulation of tissue during a surgical procedure. The surgical instruments may include instruments configured to cut and staple tissue using surgical staples and/or fasteners. The surgical instruments may be configured for use in open surgical procedures, but also have application in other types of surgery, such as laparoscopic, endoscopic, and robotic-assisted procedures, and may include an end effector that is articulatable relative to a shaft portion of the instrument to facilitate precise positioning within a patient.

In various embodiments, an electrosurgical instrument with an end effector is disclosed. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw includes a tapered body extending from a proximal end to a distal end. The tapered body includes a conductive material. The tapered body includes a first conductive portion extending from a proximal end to a distal end and a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the tapered body. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion in a cross section of the tapered body. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first conductive portion, but not the second conductive portion, from the tissue. The first conductive portion is configured to transmit electrical energy to the tissue only through the second conductive portion.

In various embodiments, an electrosurgical instrument with an end effector is disclosed. The end effector includes a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw includes a conductive body with a tapered oblique profile extending from a proximal end to a distal end. The conductive body includes a first conductive portion extending from the proximal end to the distal end and a second conductive portion protruding from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the conductive body. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion. The second jaw further includes an electrically insulating layer configured to electrically insulate the first conductive portion from tissue, but not the second conductive portion. The first conductive portion is configured to transmit electrical energy to the tissue only through the second conductive portion.

The novel features of the various aspects are set forth with particularity in the appended claims, however the described aspects, both as to organization and method of operation, may best be understood by reference to the following description taken in conjunction with the accompanying drawings, in which:
1 illustrates an example of a generator for use with a surgical instrument in accordance with at least one aspect of the present disclosure. In accordance with at least one aspect of the present disclosure, one form of a surgical system includes a generator and various surgical instruments usable with the generator. 1 shows a schematic diagram of a surgical instrument or tool according to at least one aspect of the present disclosure. FIG. 1 illustrates a partial view of an end effector of an electrosurgical instrument, in accordance with at least one aspect of the present disclosure. FIG. 5 is a cross-sectional view of the end effector of FIG. 4 . 5 illustrates three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue. 5 illustrates three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue. 5 illustrates three different modes of operation of the end effector of FIG. 4 prior to application of energy to tissue. 5 illustrates three different modes of operation of the end effector of FIG. 4 during application of energy to tissue. 5 illustrates three different modes of operation of the end effector of FIG. 4 during application of energy to tissue. 5 illustrates three different modes of operation of the end effector of FIG. 4 during application of energy to tissue. 1 illustrates a method of manufacturing a jaw of an end effector in accordance with at least one aspect of the present disclosure. 1 illustrates a method of manufacturing a jaw of an end effector in accordance with at least one aspect of the present disclosure. FIG. 1 illustrates a partial perspective view of a jaw of an end effector of an electrosurgical instrument, in accordance with at least one aspect of the present disclosure. 15A-15C show steps in a process for manufacturing the jaw of FIG. 15A-15C show steps in a process for manufacturing the jaw of FIG. 15A-15C show steps in a process for manufacturing the jaw of FIG. 15A-15C show steps in a process for manufacturing the jaw of FIG. 15A-15C show steps in a process for manufacturing the jaw of FIG. 20 shows a cross-sectional view of a jaw of an end effector of an electrosurgical instrument taken along line 20-20 of FIG. 22, in accordance with at least one aspect of the present disclosure. 21 is a cross-sectional view of the jaws of the end effector of the electrosurgical instrument taken along line 21-21 of FIG. 22. FIG. 21 shows a perspective view of the jaws of the end effector of the electrosurgical instrument of FIG. 20; FIG. 1 illustrates a cross-sectional view of a jaw of an end effector of an electrosurgical instrument, in accordance with at least one aspect of the present disclosure. FIG. 1 illustrates a partial perspective view of a jaw of an end effector of an electrosurgical instrument, in accordance with at least one aspect of the present disclosure. 1 illustrates a cross-sectional view of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure. FIG. 1 illustrates a partial exploded view of an end effector of an electrosurgical instrument in accordance with at least one aspect of the present disclosure. 1 illustrates an exploded perspective assembly view of a portion of an electrosurgical instrument including an electrical connection assembly according to at least one aspect of the present disclosure. FIG. 28 shows a top view of an electrical pathway defined in a portion of the surgical instrument of FIG. 27, in accordance with at least one aspect of the present disclosure. FIG. 1 illustrates a cross-sectional view of a flex circuit according to at least one aspect of the present disclosure. 1 illustrates a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure. 1 illustrates a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure. 1 illustrates a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure. 1 illustrates a cross-sectional view of a flex circuit extending through a coil tube in accordance with at least one aspect of the present disclosure. 13 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure. 11 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector and several measured parameters of the end effector and tissue in accordance with at least one aspect of the present disclosure. FIG. 1 is a schematic diagram of an electrosurgical system according to at least one aspect of the present disclosure. 13 is a table illustrating a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure. 1 illustrates a tissue treatment cycle applied by an end effector to a tissue treatment area in accordance with at least one aspect of the present disclosure. 1 illustrates a tissue treatment cycle applied by an end effector to a tissue treatment region in accordance with at least one aspect of the present disclosure. 1 illustrates a tissue treatment cycle applied by an end effector to a tissue treatment region in accordance with at least one aspect of the present disclosure. 1 illustrates an end effector applying therapeutic energy generated by a monopolar power source and a bipolar power source to tissue grasped by the end effector, in accordance with at least one aspect of the present disclosure. 1 shows a simplified diagram of an electrosurgical system according to at least one aspect of the present disclosure. 13 is a graph illustrating a power scheme for coagulating and cutting a tissue treatment region in a treatment cycle applied by an end effector and corresponding temperature readings of the tissue treatment region in accordance with at least one aspect of the present disclosure. 1 illustrates an end effector for treating an artery, according to at least one aspect of the present disclosure. 1 illustrates an end effector for treating an artery, according to at least one aspect of the present disclosure. 1 illustrates an end effector applying therapeutic energy generated by a monopolar power source and a bipolar power source to tissue grasped by the end effector, in accordance with at least one aspect of the present disclosure. 1 shows a simplified diagram of an electrosurgical system according to at least one aspect of the present disclosure. 13 is a graph illustrating a power scheme including treatment portions and non-treatment areas for coagulating and cutting tissue treatment areas in a treatment cycle applied by an end effector in accordance with at least one aspect of the present disclosure. 11 is a graph illustrating power schemes, including those for coagulating and cutting tissue treatment areas, applied by an end effector in a treatment cycle, and corresponding monopolar and bipolar impedances and ratios thereof, in accordance with at least one aspect of the present disclosure.

The applicant of this application has owned the following U.S. patent applications, filed on even date herewith, each of which is incorporated herein by reference in its entirety:
- Attorney Docket No. END9234USNP1/190717-1M, Title of Invention: "METHOD FOR AN ELECTROSURGICAL PROCEDURE";
- Attorney Docket No. END9234USNP2/190717-2, Title of invention: "ARTICULATABLE SURGICAL INSTRUMENT";
- Attorney Docket No. END9234USNP3/190717-3, Title of invention: "SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES";
- Attorney Docket No. END9234USNP4/190717-4, Title of invention: "SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR";
- Attorney Docket No. END9234USNP5/190717-5, Title of Invention "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES",
- Attorney Docket No. END9234USNP6/190717-6, Title of Invention: "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT";
- Attorney Docket No. END9234USNP7/190717-7, Title of Invention: "ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLYS";
- Attorney Docket No. END9234USNP8/190717-8, Title of Invention: "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS";
- Attorney Docket No. END9234USNP9/190717-9, Title of Invention: "ELECTROSURGICAL SYSTEMS WITH INTEGRATION AND EXTERNAL POWER SOURCES";
- Attorney Docket No. END9234USNP11/190717-11, Title of Invention: "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY DENSITIES";
- U.S. Patent No. END9234USNP12/190717-12, entitled "ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY CAPABILITIES";
- U.S. Patent No. END9234USNP13/190717-13, entitled "ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVE PORTIONS";
- U.S. Patent No. END9234USNP14/190717-14, entitled "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES";
- U.S. Patent No. END9234USNP15/190717-15, entitled "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE";
- U.S. Patent No. END9234USNP16/190717-16, entitled "CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USER INPUT";
- U.S. Patent No. END9234USNP17/190717-17, entitled "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE", and - Attorney Docket No. END9234USNP18/190717-18, entitled "SURGICAL SYSTEM COMMUNICATION PATHWAYS".

The applicant of this application owns the following U.S. patent applications, filed on December 30, 2019, the disclosures of each of which are incorporated by reference in their entirety herein:
- U.S. Provisional Patent Application No. 62/955,294, entitled "USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITY END-EFFECTOR";
- U.S. Provisional Patent Application No. 62/955,292, entitled "COMBINATION ENERGY MODALITY END-EFFECTOR," and - U.S. Provisional Patent Application No. 62/955,306, entitled "SURGICAL INSTRUMENT SYSTEMS."

The applicant of the present application owns the following U.S. patent applications, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. Patent Application No. 16/209,395, entitled "METHOD OF HUB COMMUNICATION" (now U.S. Patent Application Publication No. 2019/0201136);
U.S. Patent Application No. 16/209,403, entitled "METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB" (now U.S. Patent Application Publication No. 2019/0206569);
U.S. Patent Application No. 16/209,407, entitled "METHOD OF ROBOTIC HUB COMMUNITION, DETECTION, AND CONTROL" (now U.S. Patent Application Publication No. 2019/0201137);
U.S. Patent Application No. 16/209,416, entitled "METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS" (now U.S. Patent Application Publication No. 2019/0206562);
U.S. Patent Application No. 16/209,423, entitled "METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS" (now U.S. Patent Application Publication No. 2019/0200981);
U.S. Patent Application No. 16/209,427, entitled “METHOD OF USING REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMISE PERFORMANCE OF RADIO FREQUENCY DEVICES” (now U.S. Patent Application Publication No. 2019/0208641);
U.S. Patent Application No. 16/209,433, entitled "METHOD OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMP SPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB" (now U.S. Patent Application Publication No. 2019/0201594);
U.S. Patent Application No. 16/209,447 entitled "METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB" (now U.S. Patent Application Publication No. 2019/0201045);
U.S. Patent Application No. 16/209,453, entitled “METHOD FOR CONTROLLING SMART ENERGY DEVICES” (now U.S. Patent Application Publication No. 2019/0201046);
U.S. Patent Application No. 16/209,458, entitled "METHOD FOR SMART ENERGY DEVICE INFRASTRUCTURE" (now U.S. Patent Application Publication No. 2019/0201047);
U.S. Patent Application No. 16/209,465, entitled "METHOD FOR ADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION" (now U.S. Patent Application Publication No. 2019/0206563);
U.S. Patent Application No. 16/209,478, entitled "METHOD FOR SITUSATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUS OR USAGE" (now U.S. Patent Application Publication No. 2019/0104919);
U.S. Patent Application No. 16/209,490, entitled "METHOD FOR FACILITY DATA COLLECTION AND INTERPRETERATION" (now U.S. Patent Application Publication No. 2019/0206564);
U.S. Patent Application No. 16/209,491, entitled "METHOD FOR CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS" (now U.S. Patent Application Publication No. 2019/0200998);
- U.S. Patent Application No. 16/562,123, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES";
- U.S. Patent Application No. 16/562,135, entitled "METHOD FOR CONTROLLING AN ENERGY MODULE OUTPUT";
No. 16/562,144, entitled "METHOD FOR CONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE" and No. 16/562,125, entitled "METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM".

Before describing the various aspects of the electrosurgical system in detail, it should be noted that the exemplary embodiments are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and specification. The exemplary embodiments may be embodied or incorporated in other aspects, variations, and modifications and may be practiced or carried out in various ways. Moreover, unless otherwise indicated, the terms and expressions used herein have been selected for the convenience of the reader for the purpose of describing the exemplary embodiments and not for the purpose of limiting them. Furthermore, it should be understood that one or more of the aspects, aspect expressions, and/or examples described below can be combined with any one or more of the other aspects, aspect expressions, and/or examples described below.

Various aspects relate to an electrosurgical system that includes an electrosurgical instrument powered by a generator to effect dissection, cutting, and/or coagulation of tissue during a surgical procedure. The electrosurgical instrument may be configured for use in open surgical procedures, but also has applications in other types of surgery, such as laparoscopic, endoscopic, and robotic-assisted procedures.

As described in more detail below, electrosurgical instruments generally include a shaft having a distally mounted end effector (e.g., one or more electrodes). The end effector can be positioned relative to tissue such that electrical current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, electrical current is introduced into the tissue by an active electrode of the end effector and returned from the tissue by a return electrode of the end effector, respectively. During monopolar operation, electrical current is introduced into the tissue by an active electrode of the end effector and returned via a return electrode (e.g., a ground pad) separately located on the patient's body. Heat generated by electrical current flowing through the tissue may form a hemostatic seal within and/or between tissues and may thus be particularly useful for sealing blood vessels, for example.

FIG. 1 shows an example of a generator 900 configured to deliver multiple energy modalities to a surgical instrument. The generator 900 provides RF and/or ultrasonic signals for delivering energy to the surgical instrument. The generator 900 includes at least one generator output that can deliver multiple energy modalities (e.g., ultrasonic, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others) through a single port, which signals can be delivered individually or simultaneously to an end effector to treat tissue. The generator 900 includes a processor 902 coupled to a waveform generator 904. The processor 902 and waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory coupled to the processor 902, which is not shown for clarity of disclosure. Digital information related to the waveforms is provided to the waveform generator 904, which includes one or more DAC circuits to convert the digital input to an analog output. The analog output is provided to an amplifier 906 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to a power transformer 908. The signal is coupled across power transformer 908 to a secondary on the patient isolated side. A first signal of a first energy modality is provided to the surgical instrument between terminals labeled ENERGY ₁ and RETURN. A second signal of a second energy modality is coupled across capacitor 910 and provided to the surgical instrument between terminals labeled ENERGY ₂ and RETURN. It will be understood that more than two energy modalities may be output, and thus the subscript "n" may be used to indicate that up to n ENERGY _n terminals may be provided, where n is a positive integer greater than or equal to two. It will also be understood that up to "n" return paths (RETURN _n ) may be provided without departing from the scope of this disclosure.

A first voltage sense circuit 912 is coupled across the terminals labeled ENERGY ₁ and RETURN paths and measures the output voltage therebetween. A second voltage sense circuit 924 is coupled across the terminals labeled ENERGY ₂ and RETURN paths and measures the output voltage therebetween. A current sense circuit 914 is disposed in series with the RETURN section of the secondary side of the power transformer 908 shown to measure the output current of either energy modality. If different return paths are provided for each energy modality, a separate current sense circuit must be provided in each return section. The outputs of the first voltage sense circuit 912 and the second voltage sense circuit 924 are provided to corresponding isolation transformers 928, 922, and the output of the current sense circuit 914 is provided to another isolation transformer 916. The outputs of the isolation transformers 916, 928, 922 on the primary side (non-patient isolated side) of the power transformer 908 are provided to one or more ADC circuits 926. The digitized output of the ADC circuit 926 is provided to the processor 902 for further processing and calculations. Feedback information of the output voltage and output current can be used to calculate parameters such as output impedance to adjust the output voltage and current provided to the surgical instrument. Input/output communication between the processor 902 and the patient isolation circuitry is provided via an interface circuit 920. Sensors may also be in electrical communication with the processor 902 via the interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 by dividing the output of either a first voltage sense circuit 912 coupled across the terminals labeled ENERGY ₁ /RETURN or a second voltage sense circuit 924 coupled across the terminals labeled ENERGY ₂ /RETURN by the output of a current sense circuit 914 placed in series with the RETURN section on the secondary side of the power transformer 908. The outputs of the first voltage sense circuit 912 and the second voltage sense circuit 924 are provided to separate isolation transformers 928, 922, and the output of the current sense circuit 914 is provided to another isolation transformer 916. Digitized voltage and current sense measurements from the ADC circuit 926 are provided to the processor 902 to calculate the impedance. As an example, the first energy modality ENERGY ₁ may be RF monopolar energy and the second energy modality ENERGY ₂ may be RF bipolar energy. Yet, in addition to bipolar and monopolar RF energy modalities, other energy modalities include ultrasound energy, irreversible and/or reversible electroporation, and/or microwave energy, among others. Also, while the example illustrated in FIG. 1 shows that a single return path RETURN may be provided to two or more energy modalities, in other aspects, multiple return paths RETURN _n may be provided to each energy modality ENERGY _n .

As shown in FIG. 1 , a generator 900 with at least one output port can include a power transformer 908 with a single output and multiple taps to provide power to an end effector in the form of one or more energy modalities, such as, for example, ultrasonic, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others, depending on the type of tissue treatment being performed. For example, the generator 900 can deliver high voltage and low current energy to drive an ultrasonic transducer, deliver low voltage and high current energy to drive an RF electrode to seal tissue, or deliver energy having a coagulation waveform for spot coagulation using either monopolar or bipolar RF electrosurgical electrodes. The output waveform from the generator 900 can be steered, switched, or filtered to provide the frequency to the end effector of the surgical instrument. In one embodiment, the connection of an RF bipolar electrode to the output of generator 900 would preferably be located between the outputs labeled ENERGY ₂ and _RETURN . In the case of a monopolar output, the preferred connection would be an active electrode (e.g., a pencil or other probe) to suitable return pads connected to the ENERGY ₂ and RETURN outputs.

Additional details are disclosed in U.S. Patent Application Publication No. 2017/0086914, published March 30, 2017, entitled "TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS," which is incorporated herein by reference in its entirety.

2 illustrates one form of a surgical system 1000 including a generator 1100 and various surgical instruments 1104, 1106, 1108 usable therewith, where the surgical instrument 1104 is an ultrasonic surgical instrument, the surgical instrument 1106 is an RF electrosurgical instrument, and the multi-function surgical instrument 1108 is a combination ultrasonic/RF electrosurgical instrument. The generator 1100 is configurable for use with various surgical instruments. According to various forms, the generator 1100 may be configurable for use with a variety of different types of surgical devices including, for example, an ultrasonic surgical instrument 1104, an RF electrosurgical instrument 1106, and a multi-function surgical instrument 1108 that integrates RF and ultrasonic energy delivered simultaneously from the generator 1100. In the embodiment of FIG. 2, the generator 1100 is shown separate from the surgical instruments 1104, 1106, 1108, but in one embodiment, the generator 1100 may be integrally formed with any of the surgical instruments 1104, 1106, 1108 to form an integrated surgical system. The generator 1100 includes an input device 1110 located on a front panel of the console of the generator 1100. The input device 1110 may include any suitable device for generating signals suitable for programming the operation of the generator 1100. The generator 1100 may be configured for wired or wireless communication.

The generator 1100 is configured to drive a number of surgical instruments 1104, 1106, 1108. The first surgical instrument is an ultrasonic surgical instrument 1104, which includes a handpiece 1105 (HP), an ultrasonic transducer 1120, a shaft 1126, and an end effector 1122. The end effector 1122 includes an ultrasonic blade 1128 acoustically coupled to the ultrasonic transducer 1120 and a clamp arm 1140. The handpiece 1105 includes a trigger 1143 for actuating the clamp arm 1140, and a combination of toggle buttons 1137, 1134b, 1134c for energizing and driving the ultrasonic blade 1128 or other functions. The toggle buttons 1137, 1134b, 1134c may be configured to energize the ultrasonic transducer 1120 using the generator 1100.

The generator 1100 is also configured to drive a second surgical instrument 1106. The second surgical instrument 1106 is an RF electrosurgical instrument and includes a hand piece 1107 (HP), a shaft 1127, and an end effector 1124. The end effector 1124 includes electrodes in the clamp arms 1145, 1142b and back through an electrically conductive portion of the shaft 1127. The electrodes are coupled to and energized by a bipolar energy source in the generator 1100. The hand piece 1107 includes a trigger 1145 for operating the clamp arms 1145, 1142b and an energy button 1135 for actuating an energy switch to energize the electrodes in the end effector 1124. The second surgical instrument 1106 can also be used with a return pad to deliver monopolar energy to tissue.

The generator 1100 is also configured to drive a multi-function surgical instrument 1108. The multi-function surgical instrument 1108 includes a hand piece 1109 (HP), a shaft 1129, and an end effector 1125. The end effector 1125 includes an ultrasonic blade 1149 and a clamp arm 1146. The ultrasonic blade 1149 is acoustically coupled to the ultrasonic transducer 1120. The hand piece 1109 includes a trigger 1147 that operates the clamp arm 1146, and a combination of toggle buttons 11310, 1137b, 1137c for energizing and driving the ultrasonic blade 1149 or other functions. The toggle buttons 11310, 1137b, 1137c can be configured to energize the ultrasonic transducer 1120 using the generator 1100, and also to energize the ultrasonic blade 1149 using a bipolar energy source housed within the generator 1100. Monopolar energy can be delivered to tissue in combination with or separate from the bipolar energy.

The generator 1100 is configurable for use with a variety of surgical instruments. According to various configurations, the generator 1100 may be configurable for use with different types of different surgical instruments, including, for example, an ultrasonic surgical instrument 1104, an RF electrosurgical instrument 1106, and a multi-function surgical instrument 1108 that integrates RF and ultrasonic energy delivered simultaneously from the generator 1100. In the configuration of FIG. 2, the generator 1100 is shown separate from the surgical instruments 1104, 1106, 1108, but in another configuration, the generator 1100 may be integrally formed with any one of the surgical instruments 1104, 1106, 1108 to form an integrated surgical system. As discussed above, the generator 1100 includes an input device 1110 located on a front panel of the console of the generator 1100. The input device 1110 may include any suitable device that generates a signal suitable for programming the operation of the generator 1100. The generator 1100 may also include one or more output devices 1112. Further aspects of the generator for digitally generating electrical signal waveforms and surgical instruments are described in U.S. Patent Application Publication No. 2017-0086914 (A1), which is incorporated herein by reference in its entirety.

FIG. 3 shows a schematic diagram of a surgical instrument or tool 600 with multiple motor assemblies that can be actuated to perform various functions. In the illustrated example, a closing motor assembly 610 is operable to transition the end effector between an open configuration and a closed configuration, and an articulation motor assembly 620 is operable to articulate the end effector relative to the shaft assembly. In certain examples, the multiple motor assemblies can be actuated individually to produce a firing motion, a closing motion, and/or an articulation motion in the end effector. The firing motion, the closing motion, and/or the articulation motion can be transmitted to the end effector via the shaft assembly, for example.

In certain examples, the closure motor assembly 610 includes a closure motor. The closure portion 603 may be operably coupled to a closure motor drive assembly 612 that may be configured to transmit a closure motion generated by the motor to the end effector, particularly to displace the closure member closed to transition the end effector to a closed configuration. The closure motion may transition the end effector from an open configuration to a closed configuration to capture tissue, for example. The end effector may be transitioned to an open position by reversing the direction of the motor.

In certain examples, the articulation motor assembly 620 includes an articulation motor operably coupled to an articulation drive assembly 622 that can be configured to transmit articulation generated by the motor to an end effector. In certain examples, the articulation can, for example, cause the end effector to articulate relative to the shaft.

One or more of the motors of the surgical instrument 600 may be equipped with a torque sensor to measure the output torque on the shaft of the motor. The force on the end effector may be sensed in any conventional manner, such as by a force sensor outside the jaws or by a torque sensor on the motor that actuates the jaws.

In various examples, the motor assemblies 610, 620 include one or more motor drivers, which may include one or more H-bridge FETs. The motor drivers may modulate the power transmitted from the power source 630 to the motors, for example, based on input from a microcontroller 640 ("controller") of the control circuit 601. In certain examples, the microcontroller 640 may be used to determine, for example, the current drawn by the motors.

In certain examples, the microcontroller 640 may include a microprocessor 642 ("processor") and one or more non-transitory computer-readable media or memory units 644 ("memory"). In certain examples, the memory 644 may store various program instructions that, when executed, may cause the processor 642 to perform a number of functions and/or calculations described herein. In certain examples, one or more of the memory units 644 may be coupled to the processor 642, for example. In various aspects, the microcontroller 640 may communicate via wired or wireless channels, or a combination thereof.

In certain examples, the power source 630 may be used to provide power to, for example, the microcontroller 640. In certain examples, the power source 630 may include a battery (or "battery pack" or "power pack"), such as, for example, a lithium ion battery. In certain examples, the battery pack may be configured to be releasably attached to the handle to provide power to the surgical instrument 600. Multiple battery cells connected in series may be used as the power source 630. In certain examples, the power source 630 may be, for example, replaceable and/or rechargeable.

In various examples, the processor 642 may control a motor driver to control the position, direction, and/or speed of the motors of the assemblies 610, 620. In various examples, the processor 642 may signal the motor driver to stop and/or disable the motor. The term "processor" as used herein should be understood to include any suitable microprocessor, microcontroller, or other basic computing device that integrates the functionality of a computer's central processing unit (CPU) on one integrated circuit or up to a few integrated circuits. The processor 642 is a general-purpose programmable device that accepts digital data as input, processes the data according to instructions stored in memory, and provides the results as output. Since it has internal memory, it is an example of sequential digital logic. The processor operates on numbers and symbols represented in the binary system.

In one example, the processor 642 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In a particular example, the microcontroller 620 may be, for example, an LM 4F230H5QR available from Texas Instruments. In at least one embodiment, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that includes, among other features readily available on the product data sheet, on-chip memory of 256 KB of single-cycle flash memory or other non-volatile memory up to 40 MHz, a pre-fetch buffer to improve performance beyond 40 MHz, 32 KB of single-cycle SRAM, internal ROM loaded with StellarisWare® software, 2 KB of EEPROM, one or more PWM modules, one or more QEI analog, one or more 12-bit ADCs with 12 analog input channels. Other microcontrollers may be readily substituted for use with the surgical instrument 600. Thus, the present disclosure should not be limited in this context.

In certain examples, the memory 644 may include program instructions for controlling each of the motors of the surgical instrument 600. For example, the memory 644 may include program instructions for controlling a closure motor and an articulation motor. Such program instructions may cause the processor 642 to control the closure and articulation functions according to inputs from an algorithm or control program of the surgical instrument 600.

In certain examples, one or more mechanisms and/or sensors, such as, for example, sensor 645, can be used to alert processor 642 to program instructions to use in a particular setting. For example, sensor 645 can alert processor 642 to use program instructions associated with closing and articulating the end effector. In certain examples, sensor 645 can include a position sensor that can be used to sense, for example, the position of a closure actuator. Thus, processor 642 can initiate the motor of closure drive assembly 620 using program instructions associated with closing the end effector when processor 642 receives a signal from sensor 630 indicating actuation of the closure actuator.

In some examples, the motors may be brushless DC electric motors and each motor drive signal may include a PWM signal provided to one or more stator windings of the motor. Also, in some examples, the motor drive may be omitted and the control circuit 601 may generate the motor drive signals directly.

It is common practice during various laparoscopic surgical procedures to insert a surgical end effector portion of a surgical instrument through a trocar introduced into the patient's abdominal wall to access a surgical site located within the patient's abdomen. In its simplest form, a trocar is a pen-shaped instrument with a sharp triangular point at one end that is typically used inside a hollow tube known as a cannula or sleeve to create an opening in the body through which the surgical end effector can be introduced. Such an arrangement forms an access port in the body cavity through which the surgical end effector can be inserted. The inner diameter of the trocar's cannula necessarily limits the size of the end effector and drive support shaft of the surgical instrument that can be inserted through the trocar.

Regardless of the particular type of surgical procedure being performed, once a surgical end effector is inserted into a patient through a trocar cannula, it is often necessary to move the surgical end effector relative to a shaft assembly positioned within the trocar cannula in order to properly position the surgical end effector relative to the tissue or organ being treated. This movement or positioning of the surgical end effector relative to the portion of the shaft that remains within the trocar cannula is often referred to as "articulation" of the surgical end effector. In an effort to facilitate such articulation of the surgical end effector, various articulation joints have been developed for attaching the surgical end effector to an associated shaft. As anticipated in many surgical procedures, it is desirable to use a surgical end effector that has as large a range of articulation as possible.

Due to size constraints imposed by the size of the trocar cannula, the articulation joint components must be sized to be freely insertable through the trocar cannula. These size constraints also limit the size and composition of the various drive members and components that operably interface with motors and/or other control systems supported within a housing that may be grasped or may comprise a portion of a larger automated system. In many cases, these drive members must operably pass through an articulation joint to be operably coupled to or operably interfaced with a surgical end effector. For example, one such drive member is commonly used to apply an articulation control motion to a surgical end effector. In use, the surgical drive member can be deactivated to position the surgical end effector into a non-articulated position to facilitate insertion of the surgical end effector through the trocar, and then activated to articulate the surgical end effector into a desired position once the surgical end effector has entered the patient.

The aforementioned size constraints therefore create many challenges to developing an articulation system that can achieve the desired range of articulation, yet accommodate the variety of different drive systems required to operate the various features of the surgical end effector. Furthermore, once the surgical end effector is positioned in a desired articulation position, the articulation system and articulation joints must be capable of holding the surgical end effector in that position while the end effector is actuated and until the surgical procedure is completed. Such articulation joint arrangements must also be capable of withstanding the external forces to which the end effector is subjected during use.

Various modes of one or more surgical devices are often used throughout a particular surgical procedure. A communication path extending between the surgical devices and a centralized surgical hub may, for example, improve efficiency and enhance the success of the surgical procedure. In various examples, each surgical device in the surgical system includes a display that communicates the presence and/or operational status of other surgical devices in the surgical system. The surgical hub may use information received through the communication paths to evaluate the compatibility of the surgical devices for use with each other, evaluate the compatibility of the surgical devices for use during a particular surgical procedure, and/or optimize the operating parameters of the surgical devices. As described in more detail herein, the operating parameters of one or more surgical devices may be optimized based on patient demographics, the particular surgical procedure, such as tissue thickness, and/or detected environmental conditions.

4 and 5 show exploded (FIG. 4) and cross-sectional (FIG. 5) views of an end effector 1200 of an electrosurgical instrument (e.g., the surgical instrument described in U.S. Patent Application, Attorney Docket No. END9234USNP2/190717-2). For example, the end effector 1200 may be actuated, articulated, and/or rotated relative to a shaft assembly of the surgical instrument in a manner similar to the end effector described in U.S. Patent Application, Attorney Docket No. END9234USNP2/190717-2. Additionally, the end effector 1200 and other similar end effectors described elsewhere herein may be powered by one or more generators of a surgical system. An exemplary surgical system for use with the surgical instruments is described in U.S. Patent Application No. 16/562,123, filed Sep. 5, 2019, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES," which is incorporated herein by reference.

6-8, the end effector 1200 includes a first jaw 1250 and a second jaw 1270. At least one of the first jaw 1250 and the second jaw 1270 is pivotable toward and away from the other jaw to transition the end effector 1200 between an open configuration and a closed configuration. The jaws 1250, 1270 are configured to grasp tissue therebetween and apply at least one of therapeutic and non-therapeutic energy to the tissue. Energy delivery to tissue grasped by the jaws 1250, 1270 of the end effector 1200 is accomplished by electrodes 1252, 1272, 1274 configured to deliver energy in a monopolar mode, a bipolar mode, and/or a combination mode of alternating or blended bipolar and monopolar energy. The different energy modalities that may be delivered to tissue by the end effector 1200 are described in more detail elsewhere in this disclosure.

In addition to the electrodes 1252, 1272, 1274, a patient return pad is used in conjunction with the application of monopolar energy. Furthermore, bipolar and monopolar energy are delivered using electrically isolated generators. In use, the patient return pad can detect unexpected power crossover by monitoring power transmission to the return pad via one or more suitable sensors on the return pad. Unexpected power crossover can occur when bipolar and monopolar energy modalities are used simultaneously. In at least one example, the bipolar mode uses a higher current (e.g., 2-3 amps) than the monopolar mode (e.g., 1 amp). In at least one example, the return pad includes a control circuit and at least one sensor (e.g., a current sensor) coupled thereto. In use, the control circuit can receive an input indicative of an unexpected power crossover based on measurements of the at least one sensor. In response, the control circuitry can use a feedback system to issue a warning and/or suspend application of bipolar and/or monopolar energy to the tissue.

Further to the above, the jaws 1250, 1270 of the end effector 1200 comprise an oblique profile in which multiple angles are defined between separate portions of each of the jaws 1250, 1270. For example, a first angle is defined by portions 1250a, 1250b (FIG. 4) and a second angle is defined by portions 1250b, 1250c of the first jaw 1250. Similarly, a first angle is defined by portions 1270a, 1270b and a second angle is defined by portions 1270b, 1270c of the second jaw 1270. In various aspects, the separate portions of the jaws 1250, 1270 are linear segments. Successive linear segments intersect at an angle, such as, for example, a first angle or a second angle. The linear segments cooperate to form an overall oblique profile of each of the jaws 1250, 1270. The slanted profile is generally bent away from the central axis.

In one example, the first angle and the second angle are the same or at least substantially the same. In another example, the first angle and the second angle are different. In another example, the first angle and the second angle include values selected from the range of about 120° to about 175°. In yet another example, the first angle and the second angle include values selected from the range of about 130° to about 170°.

Furthermore, portions 1250a, 1270a, which are proximal portions, are larger than portions 1250b, 1270b, which are intermediate portions. Similarly, intermediate portions 1250b, 1270b are larger than portions 1250c, 1270c. In other examples, the distal portions may be larger than the intermediate portions and/or the proximal portions. In other examples, the intermediate portions are larger than the proximal portions and/or the distal portions.

Further to the above, the electrodes 1252, 1272, 1274 of the jaws 1250, 1270 have a diagonal profile similar to the diagonal profile of the jaws 1250, 1270. In the example of Figures 4 and 5, the electrodes 1252, 1272, 1274 include separate segments 1252a, 1252b, 1252c, 1272a, 1272b, 1272c, 1274a, 1274b, 1274c, respectively, that define first and second angles at their respective intersections, as described above.

When in the closed configuration, the jaws 1250, 1270 cooperate to define a tip electrode 1260 formed from electrode portions 1261, 1262 at the distal ends of the jaws 1250, 1270, respectively. The tip electrode 1260 can be energized to deliver monopolar energy to tissue in contact therewith. Both electrode portions 1261, 1262 can be simultaneously activated to deliver monopolar energy, as shown in FIG. 6, or only one of the electrode portions 1261, 1262 can be selectively activated to deliver monopolar energy to one side of the distal tip electrode 1260, for example, as shown in FIG. 10.

The angled profile of the jaws 1250, 1270 positions the tip electrode 1260 on one side of a plane extending laterally between the proximal portions 1252c and 1272c in the closed configuration. The angled profile may also position the intersection of portions 1252b, 1252c, portions 1272b, 1272c, and portions 1274b, 1274c on the same side of the plane as the tip electrode 1260.

In at least one example, the jaws 1250, 1270 include conductive skeletons 1253, 1273 that may be constructed or at least partially constructed of a conductive material, such as titanium. The skeletons 1253, 1273 may be constructed of other conductive materials, such as aluminum. In at least one example, the skeletons 1253, 1273 are prepared by injection molding. In various examples, the skeletons 1253, 1273 may be selectively coated/covered with an insulating material to prevent thermal and electrical conduction in all but the predefined thin energizable zones that form the electrodes 1252, 1272, 1274, 1260. The skeletons 1253, 1273 act as electrodes with electron focusing, and the jaws 1250, 1270 are contained separately from one jaw to the other. The insulating material may be, for example, an insulating polymer such as polytetrafluoroethylene (e.g., Teflon®). The energizable zone defined by the electrodes 1252, 1272 is inside the jaws 1250, 1270 and is independently operable in a bipolar mode to deliver energy to tissue grasped between the jaws 1250, 1270, while the energizable zone defined by the electrode tip 1260 and the electrode 1274 is outside the jaws 1250, 1270 and is operable in a monopolar mode to deliver energy to tissue adjacent the outer surface of the end effector 1200. Both jaws 1250, 1270 may be energized to deliver energy in a monopolar mode.

In various aspects, coating 1264 is a high temperature polytetrafluoroethylene (e.g., Teflon®) coating selectively applied to the conductive skeleton resulting in selectively exposed metal interior portions that define three-dimensional geometric electronic modulation (GEM) for focused dissection and coagulation. In at least one example, coating 1264 includes a thickness of about 0.003 inches, about 0.0035 inches, or about 0.0025 inches. In various examples, the thickness of coating 1264 can be any value selected from the range of about 0.002 inches to about 0.004 inches, the range of about 0.0025 inches to about 0.0035 inches, or the range of about 0.0027 inches to about 0.0033 inches. Other thicknesses of coating 1263 capable of three-dimensional geometric electronic modulation (GEM) are also contemplated by the present disclosure.

The electrodes 1252, 1272 cooperate to transmit bipolar energy through tissue and are offset to prevent short circuits. When energy flows between the offset electrodes 1252, 1272, tissue grasped therebetween is heated, causing a seal to form in the area between the electrodes 1252, 1272. Meanwhile, the areas of the jaws 1250, 1270 surrounding the electrodes 1252, 1272 provide a non-conductive tissue contacting surface by selectively depositing an insulating coating 1264 on the jaws 1250, 1270 over such areas, but not on the electrodes 1252, 1272. Thus, the electrodes 1252, 1272 are defined by the areas of the metal jaws 1250, 1270 that remain exposed after the insulating coating 1264 is applied to the jaws 1250, 1270. The jaws 1250, 1270 are generally formed of an electrically conductive material in this embodiment, but non-conductive areas are defined by an electrically insulating coating 1264.

FIG. 6 illustrates the application of bipolar energy mode to tissue grasped between the jaws 1250, 1270. In bipolar energy mode, RF energy flows through the tissue along a path 1271 that is oblique to a centrally extending curved plane (CL) and longitudinally bisects the jaws 1250, 1270 such that the electrodes 1252, 1272 are on either side of the curved plane (CL). In other words, the only area of tissue that actually receives bipolar RF energy is the tissue that contacts and extends between the electrodes 1252, 1257. Thus, the tissue grasped by the jaws 1250, 1270 does not receive RF energy across the entire lateral width of the jaws 1250, 1270. This configuration can therefore minimize thermal spread of heat caused by the application of bipolar RF energy to the tissue. Such minimization of thermal spread can in turn minimize potential collateral damage to tissue adjacent to the particular tissue area that the surgeon wishes to weld/seal/coagulate and/or cut.

In at least one example, a lateral gap is defined between the offset electrodes 1252, 1272 in a closed configuration with no tissue therebetween. In at least one example, the lateral gap is defined between the offset electrodes 1252, 1272 in a closed configuration by any distance selected from the range of about 0.01 inches to about 0.025 inches, the range of about 0.015 inches to about 0.020 inches, or the range of about 0.016 inches to about 0.019 inches. In at least one example, the lateral gap is defined by a distance of about 0.017 inches.

In the example shown in Figures 4 and 5, the electrodes 1252, 1272, 1274 have widths that gradually narrow as each of the electrodes 1252, 1272, 1274 extends from the proximal end to the distal end. As a result, the proximal segments 1252a, 1272a, 1274a include a larger surface area than the intermediate segments 1252b, 1272b, 1274b, respectively. The intermediate segments 1252b, 1272b, 1274b also include a larger surface area than the distal segments 1252c, 1272c, 1274c.

The angled and narrowing profile of the jaws 1250, 1270 gives the end effector 1200 a curved finger or angled hook shape in the closed configuration. This shape allows for precise delivery of energy to a small portion of tissue using the tip electrode 1260 (FIG. 10) by orienting the end effector 1200 so that the electrode tip 1260 is pointed down toward the tissue. In such an orientation, only the electrode tip 1260 contacts the tissue, thereby focusing the energy delivery to the tissue.

8, the electrode 1274 extends on an outer surface on a peripheral side 1275 of the second jaw 1270, which provides the end effector 1200 with the ability to effectively separate tissue in contact therewith while in a closed configuration. To separate tissue, the end effector 1200 is positioned at least partially on the peripheral side 1275, which includes the electrode 1274. Activation of the monopolar energy mode through the jaw 1270 causes monopolar energy to flow through the electrode 1274 to tissue in contact therewith.

9-11 show end effector 1200' being used to deliver bipolar energy to tissue through electrodes 1252', 1272' (FIG. 9) in a bipolar energy mode of operation, to deliver monopolar energy to tissue through electrode tip 1261 in a first monopolar mode of operation, and/or to deliver monopolar energy to tissue through external electrode 1274 in a second monopolar mode of operation. End effector 1200' is similar in many respects to end effector 1200. Thus, various features of end effector 1200' previously described with respect to end effector 1200 will not be repeated here with the same level of detail for the sake of brevity.

The electrodes 1252', 1272' differ from the electrodes 1252'', 1272'' in that they define stepped or uneven tissue contacting surfaces 1257, 1277. The electrically conductive skeleton 1253', 1273' of the jaws 1250', 1270' includes an expanded or protruding portion that forms the conductive tissue contacting surface of the electrodes 1252', 1272'. The coating 1264 partially wraps around the expanded or protruding portion that forms the electrodes 1252', 1272', leaving only the conductive tissue contacting surface of the electrodes 1252', 1272' exposed. Thus, in the example shown in FIG. 9, each of the tissue contacting surfaces 1257, 1277 includes a step that includes a conductive tissue contacting surface positioned between two insulating tissue contacting surfaces that gradually descend the step. In other words, each of the tissue contacting surfaces 1257, 1277 includes a first partially conductive tissue contacting surface and a second insulating tissue contacting surface that is stepped downwardly relative to the first partially conductive tissue contacting surface. A method for forming the electrodes 1252', 1272' is described below in connection with FIG. 12.

Furthermore, in a closed configuration without tissue between them, the offset electrodes 1252', 1272' overlap to define a gap between the opposing insulating outer surfaces of the jaws 1250', 1270'. This configuration thus provides electrode surfaces that are vertically offset from one another and laterally offset from one another when the jaws 1250', 1270' are closed. In one example, the gap is about 0.01 inches to about 0.025 inches. Additionally, while overlapping, the electrodes 1252', 1272' are spaced apart by a lateral gap. To prevent short circuits, the lateral gap is equal to or less than a predetermined threshold. In one example, the predetermined threshold is selected from the range of 0.006 inches to 0.008 inches. In one example, the predetermined threshold is about 0.006 inches.

7 and 10, the tip electrode 1260 is defined by an uncoated electrode portion 1261, 1262 immediately preceded by a circumferentially coated proximal coated portion to enable tip coagulation and cutting generation from either or both of the jaws 1250, 1270. In certain examples, the electrode portions 1261, 1262 are covered by a spring-loaded or flexible insulating housing that allows the electrode portions 1261, 1262 to be exposed only when the distal end of the end effector 1200 is pressed against the tissue to be treated.

In addition, the segments 1274a, 1274b, 1274c define an oblique profile extending along the peripheral side 1275 of the jaw 1270. The segments 1274a, 1274b, 1274c are defined by uncoated linear portions protruding from the oblique body of the skeleton 1273 on the peripheral side 1275. The segments 1274a, 1274b, 1274c include outer surfaces that are flush with the outer surface of the coating 1264 defined on the peripheral side 1275. In various examples, a horizontal plane extends through the segments 1274a, 1274b, 1274c. The oblique profile of the electrode 1274 is defined in the horizontal plane such that the electrode 1274 does not extend more than 45 degrees away from the centerline of curvature to prevent unintended lateral thermal damage while using the electrode 1274 to dissect or separate tissue.

14 illustrates a jaw 6270 for use with an end effector (e.g., 1200) of an electrosurgical instrument (e.g., electrosurgical instrument 1106) to treat tissue using RF energy. Additionally, the jaw 6270 can be electrically coupled to a generator (e.g., generator 1100) and energized by the generator to deliver monopolar RF energy to tissue and/or cooperate with another jaw of the end effector to deliver bipolar RF energy to tissue. Additionally, the jaw 6270 is similar in many respects to the jaws 1250, 1270. For example, the jaw 6270 includes a beveled profile similar to that of the jaw 1270. Additionally, the jaw 6270 exhibits thermal mitigation improvements that can be applied to one or both of the jaws 1250, 1270.

During use, the jaws of the end effectors of electrosurgical instruments are subjected to thermal loads that may interfere with the performance of their electrodes. To minimize thermal load interference without adversely affecting the tissue treatment capabilities of the electrodes, the jaws 6270 include an electrically conductive skeleton 6273 having a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain examples, the thermally insulating portion includes an interior gap, void, or pocket that effectively isolates the thermal mass of the outer surface of the jaws 6270 that is in direct contact with tissue without compromising the electrical conductivity of the jaws 6270.

In the illustrated example, the thermally conductive portion defines a conductive outer layer 6269 that surrounds or at least partially surrounds an inner conductive core. In at least one example, the inner conductive core includes gap-setting members that may be in the form of pillars, columns, and/or walls extending between opposite sides of the outer layer 6269 with gaps, voids, or pockets extending between the gap-setting members.

In at least one example, the gap setting members form a honeycomb-like lattice structure 6267 to provide directional force capability when the jaws (i.e., jaw 6270 and another jaw of the end effector) are transitioned to a closed configuration to grasp tissue therebetween (similar to jaws 1250, 1270 of FIG. 6). The directional force can be achieved by aligning the lattice 6267 in a direction transverse to the tissue contacting surface of the jaw 6270 such that their honeycomb walls 6268 are positioned perpendicular to the tissue contacting surface.

Alternatively or additionally, the conductive inner core of the jaw 6270 may include micro-pockets of air that may be more uniformly distributed and shaped without a predefined composition relative to the external shape of the jaw to create a more uniform stress-strain distribution within the jaw. In various aspects, the electrically conductive skeleton 6273 may be prepared by 3D printing and may include 3D printed internal pockets that produce an electrically conductive but proportionately thermally insulated core.

14, the electrically conductive skeleton 6273 is connectable to an energy source (e.g., generator 1100) and includes electrodes 6262, 6272, and 6274 defined in portions of the outer layer 6273 that are selectively not covered by the coating 1264. Thus, the jaws 6270 provide selective thermal and electrical conductivity that reduces thermal spread and thermal mass while controlling/focusing energy interaction with tissue through the electrodes 6272, 6274. The thermally insulating portions of the electrically conductive skeleton 6273 limit the thermal load on the electrodes 6262, 6272, and 6274 during use.

Additionally, the outer layer 6273 defines gripping features 6277 that extend on either side of the electrode 6272 and are at least partially covered by the coating 1264. The gripping features 6277 improve the ability of the jaws 6270 to adhere to tissue and resist slippage of the tissue relative to the jaws 6270.

In the illustrated example, the walls 6268 extend diagonally from a first side of the jaw 6270 to a second side of the jaw 6270. The walls 6268 intersect at a structural node. In the illustrated example, the intersecting walls 6268 define a pocket 6271 that is coated from the top and/or bottom by an outer layer 6269. Various methods for manufacturing the jaw 6270 are described below.

12, 13 show methods 1280, 1281 for manufacturing the jaws 1273", 1273"'. In various examples, one or more of the jaws 1250, 1270, 1250', 1270' are manufactured according to the methods 1280, 1281. The jaws 1273", 1273'" are prepared by applying a coating 1264 (e.g., thickness d) to the entire exterior surface. The electrodes are then defined by selectively removing portions of the coating 1264 from desired zones to expose the exterior surface of the skeletons 1273", 1273'" in such zones. In at least one example, the selective removal of the coating can be performed by etching (FIG. 12) or by partially cutting tapered portions of the skeletons 1273"' together with their respective coated portions (FIG. 13) to form flush conductive and non-conductive surfaces. In the example shown in FIG. 12, electrodes 1272'', 1274'' are formed by etching. In the example shown in FIG. 13, electrode 1274'''' is formed from a raised narrow band or ridge 1274d that runs alongside skeleton 1273''''. A portion of ridge 1274D and coating 1264 directly covering ridge 1274D are cut away to reveal an outer surface of electrode 1274'''' that is flush with the outer surface of coating 1264.

Thus, the jaw 1270''' produced by method 1281 includes a tapered electrode 1274''' comprised of a narrow, raised conductive portion 1274e extending along the skeleton 1273''', which may serve to focus the energy delivered from the skeleton 1273''' to the tissue, with portion 1274e having a conductive outer surface that is flush with the coating 1264.

In another manufacturing process 6200, the jaws 6270 may be prepared as shown in FIG. 15. An electrically conductive skeleton 6273 is formed with narrow raised bands or ridges 6274e, 6274f that define the electrodes 6272 and 6274. In the illustrated example, the skeleton 6273 of the jaws 6270 includes ridges 6274e, 6274f having flat, or at least substantially flat, outer surfaces configured to define the electrodes 6272, 6274. In at least one example, the skeleton 6273 is prepared by 3D printing. Masks 6265, 6266 are applied to the ridges 6274e, 6274f, and a coating 1264 similar to coating 1264 is applied to the skeleton 6273. After coating, masks 6265, 6266 are removed to expose the outer surfaces of electrodes 6272, 6274, which are flush with the outer surface of coating 1264.

14 and 15, in various examples, the outer layer 6269 includes gripping features 6277 extending laterally on one or both sides of each of the electrodes 6272. The gripping features 6277 are coated with a coating 1264. In one example, the coating 1264 defines a compressible feature that changes the gap between the jaws of the end effector in response to a clamp load applied to the end effector 1200. In at least one example, the coating 1264 on the jaws provides an overlap of at least 0.010 inches to 0.020 inches of insulation along the centerline of the jaws. The coating 1264 may be applied directly over the gripping features 6277 and/or the clamp-guided jaw realignment features.

In various aspects, the coating 1264 may include coating materials such as titanium nitride, diamond-like coating (DLC), chromium nitride, Graphit-iC™, and the like. In at least one example, DLC is composed of an amorphous carbon-hydrogen network with graphite and diamond bonds between the carbon atoms. The DLC coating 1264 may form a film having low friction and high hardness properties around the skeleton 1253, 1273 (FIG. 6). The DLC coating 1264 may be doped or undoped, and is generally a form of amorphous carbon (a-C:H) or hydrogenated amorphous carbon containing a majority of sp3 bonds. Various surface coating techniques may be utilized to form the DLC coating 1264, such as the surface coating technique developed by Orikron Balzers. In at least one example, the DLC coating 1264 is produced using plasma-assisted chemical vapor deposition (PACVD).

15, during use, electrical energy flows from the electrically conductive skeleton 6269 through the electrode 6272 to the tissue. The coating 1264 prevents the transfer of electrical energy to the tissue from other areas of the outer layer 6269 that are coated with the coating 1264. As the surface of the electrode 6272 increases in temperature during tissue treatment, the gaps, voids, or pockets defined by the walls 6268 of the inner core slow down or attenuate the transfer of thermal energy from the outer layer 6269 to the inner core of the skeleton 6273.

16 illustrates a skeleton 6290 fabricated for use with the jaws of an end effector of an electrosurgical instrument. One or more of the skeletons 1253, 1273, 1253', 1273', 1273'', 1273''' can include a similar material composition as the skeleton 6290 and/or can be fabricated similarly to the skeleton 6290. In the illustrated example, the skeleton 6290 is constructed from at least two materials: an electrically conductive material, such as titanium, and a thermally insulating material, such as a ceramic material (e.g., ceramic oxide, etc.). The combination of titanium and ceramic oxide results in a jaw component having composite thermal, mechanical, and electrical properties.

In the illustrated example, the composite skeleton 6290 includes a ceramic base 6291 formed, for example, by three-dimensional printing. Additionally, the composite skeleton 6290 includes a titanium crown 6292 prepared separately from the ceramic base 6291, for example, using three-dimensional printing. The base 6291 and the crown 6292 include complementary attachment mechanisms 6294. In the illustrated example, the base 6291 includes a post or overhang that is received in a corresponding opening in the crown 6292. The attachment mechanisms 6294 also control shrinkage. Additionally or alternatively, the interface between the base 6291 and the crown 6292 includes complementary surface irregularities 6296 that are specifically designed for interlocking engagement with one another. The surface irregularities 6296 also resist shrinkage caused by the different material compositions of the base 6291 and the crown 6292. In various examples, the composite skeleton 6290 is selectively coated with an insulative coating 1264, leaving exposed certain portions of the crown 6292 that define electrodes, for example as described above in connection with the jaws 1250, 1270.

17 and 18 show a manufacturing process for making a skeleton 6296 for use with the jaws of an end effector of an electrosurgical instrument. One or more of the skeletons 1253, 1273, 1253', 1273', 1273'', 1273''' can include a similar material composition as the skeleton 6295 and/or can be manufactured similarly to the skeleton 6290. In the illustrated example, the composite skeleton 6295 is produced by injection molding utilizing a ceramic powder 6297 and a titanium powder 6298. The powders are fused together (FIG. 18) to form a titanium ceramic composite 6299 (FIG. 19). In at least one example, a polytetrafluoroethylene (e.g., Teflon®) coating can be selectively applied to metal regions of the composite skeleton 6295 for thermal as well as electrical insulation.

20-22 show a jaw 1290 for use with an end effector (e.g., 1200) of an electrosurgical instrument (e.g., electrosurgical instrument 1106) to treat tissue using RF energy. Additionally, jaw 6270 can be electrically coupled to a generator (e.g., generator 1100) and energized by the generator to deliver monopolar RF energy to tissue and/or cooperate with another jaw of the end effector to deliver bipolar RF energy to tissue. Additionally, jaw 1290 is similar in many respects to jaws 1250, 1270. For example, jaw 1209 includes a beveled profile similar to the beveled or curved profile of jaw 1270.

Additionally, the jaw 1290 is similar to the jaw 6270 in that the jaw 1290 also offers thermal mitigation improvements. Like the jaw 6270, the jaw 1290 includes a conductive skeleton 1293 having a thermally insulating portion and a thermally conductive portion integral with or attached to the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In a particular example, the thermally insulating portion of the conductive skeleton 1293 comprises a conductive inner core 1297 having inner gaps, voids, or pockets that effectively isolate the thermal mass of the outer surface of the jaw 1290 that defines the electrode 1294 in direct contact with tissue without compromising the electrical conductivity of the jaw 1290. The thermally conductive portion defines a conductive outer layer 1303 that surrounds or at least partially surrounds the conductive inner core 1297. In at least one example, the conductive inner core 1297 includes gap setting members 1299 that may be in the form of pillars, columns, and/or walls extending between the opposing sides of the outer layer 1303 of the jaw 1290 with gaps, voids, or pockets extending between the gap setting members.

Alternatively or additionally, the conductive inner core 1297 may include micro-pockets of air that may be uniformly or non-uniformly distributed within the conductive inner core 1297. The pockets may include predefined or random shapes and may be distributed in predetermined or random portions of the conductive inner core 1297. In at least one example, the pockets are distributed to create a more uniform stress-strain distribution within the jaws 1290. In various aspects, the skeleton 1293 may be prepared by three-dimensional printing and may include three-dimensionally printed internal pockets that produce an electrically conductive but proportionately thermally insulated core.

The jaws 1290 thus have selective thermal and electrical conductivity that reduces thermal spread and thermal mass while controlling/focusing energy interaction with tissue. The thermally insulating portions of the conductive skeleton 1293 limit the thermal load on the electrodes of the jaws 1290 during use.

FIG. 22 illustrates an extended portion of the tissue contacting surface 1291 of the jaw 1290. In various aspects, the outer layer 1303 of the skeleton 1293 is selectively coated/covered with a first insulating layer 1264 including a first material, such as DLC. In the illustrated example, the DLC coating electrically insulates the tissue contacting surface 1291 except for an intermediate area extending along the length of the tissue contacting surface 1291, which defines the electrode 1294. In at least one example, the DLC coating extends around the skeleton 1293 to cover the jaw 1290 to the periphery defined on both sides 1294′, 1294″ of the electrode 1294. The conductive zones 1294a, 1294b, 1294c remain exposed and alternate with insulating zones 1298 along the length of the electrode 1294. In various aspects, the insulating zone 1298 comprises high temperature polytetrafluoroethylene (e.g., Teflon®). Because the DLC coating is thermally conductive, only the portion of the tissue contacting surface 1291 that includes the insulating region 1298 is thermally insulated. The portion of the problem contacting surface 1291 that is coated with the DLC coating and the thin conductive energy capable zones 1294a, 1294b, 1294c are thermally conductive. Furthermore, only the thin conductive energy capable zones 1294a, 1294b, 1294c are electrically conductive. The remaining portions of the tissue contacting surface 1291 that are coated with either the DLC coating or polytetrafluoroethylene (e.g., Teflon®) are electrically insulated.

The conductive zones 1294a, 1294b, 1294c define energy concentration locations along the jaw 1290 based on the geometry of the zones 1294a, 1294b, 1294c. Additionally, the size, shape, and arrangement of the conductive zones 1294a, 1294b, 1294c and the insulating zone 1298 direct the coagulation energy transferred through the electrode 1294 into the tissue within a given treatment area, thereby preventing parasitic seepage of both energy and heat from the treatment area. Additionally, the thermally insulating conductive inner core 1297 resists heat transfer to portions of the jaw 1290 that do not form the treatment area, which will prevent inadvertent collateral thermal damage due to accidental contact of tissue with non-treatment areas of the jaw 1290.

The electrode 1294 is selectively interrupted by regions 1298. Selective application of a high temperature polytetrafluoroethylene (e.g., Teflon®) coating to portions of the electrode 1294 results in selectively exposed metal interior portions defining three-dimensional geometric electronic modulations (GEMs) for focused cutting and coagulation at conductive zones 1294a, 1294b, 1294c of the electrode 1294. Regions 1298 are selectively deposited on the electrode 1294 as shown in FIG. 22 to provide a treatment surface with thermally and electrically conductive regions and thermally and electrically insulating regions surrounded by a thermally conductive but electrically insulating outer periphery region defined by the DLC coating.

22, the jaw 1290 comprises a beveled profile with multiple angles defined between the separate portions 1290a, 1290b, 1290c, 1290d of the jaw 1290. For example, a first angle (α1) is defined by the portions 1290a, 1290b, a second angle (α2) is defined by the portions 1290b, 1290c, and a third angle (α3) is defined by the portions 1290c, 1290d of the first jaw 1250. In other examples, at least a portion of the jaw 1290 includes a smooth curved profile with no angles. In various aspects, the separate portions 1290a, 1290b, 1290c, 1290d of the jaw 1290 are linear segments. Successive linear segments intersect at an angle, such as a first angle (α1), or a second angle (α2), and a third angle (α3). The linear segments cooperate to form the generally curved profile of each of the jaws 1290.

In one example, the angles (α1, α2, α3) are the same value or at least substantially the same value. In another example, at least two of the angles (α1, α2, α3) include different values. In another example, at least one of the angles (α1, α2, α3) includes a value selected from the range of about 120° to about 175°. In yet another example, at least one of the angles (α1, α2, α3) includes a value selected from the range of about 130° to about 170°.

Further, due to the gradually narrowing profile of the jaw 1290, the portion 1290a, which is the proximal portion, is larger than the portion 1290b, which is the intermediate portion. Similarly, the intermediate portion 1290b is larger than the portion 1290d, which defines the distal portion of the jaw 1290. In other examples, the distal portion may be larger than the intermediate portion and/or the proximal portion. In other examples, the intermediate portion is larger than the proximal portion and/or the distal portion. Additionally, the electrode 1294 of the jaw 1290 includes a beveled profile similar to the beveled profile of the jaw 1290.

23, in certain aspects, the jaw 1300 includes a solid conductive skeleton 1301 partially surrounded by a DLC coating 1264. Exposed areas of the skeleton 1301 define one or more electrodes 1302. This arrangement results in thermally conductive and electrically conductive portions of the jaw 1300, where thermal energy is delivered indiscriminately, but electrical energy is delivered exclusively through the one or more electrodes 1302.

24-26, the electrosurgical instrument 1500 includes an end effector 1400 configured to deliver monopolar and/or bipolar energy to tissue grasped by the end effector 1400, as described in more detail below. The end effector 1400 is similar in many respects to the end effector 1200. For example, the end effector 1400 includes a first jaw 1450 and a second jaw 1470. At least one of the first jaw 1450 and the second jaw 1470 are movable relative to one another to transition the end effector 1400 from an open configuration to a closed configuration to grasp tissue therebetween. The grasped tissue may then be sealed and/or cut using monopolar and bipolar energy. As described in more detail below, the end effector 1400 utilizes GEM to adjust the energy density at the tissue treatment interface of the jaws 1450, 1470 to provide the desired tissue treatment.

Similar to jaws 1250, 1270, jaws 1450, 1470 include a generally angled profile formed from linear portions angled relative to one another resulting in a bent or finger-like shape as shown in FIG. 26. Additionally, jaws 1450, 1470 include conductive skeletons 1452, 1472 having a narrowing angled body extending distally along the angled profile of jaws 1450, 1470. Conductive skeletons 1452, 1472 may be constructed from a conductive material such as, for example, titanium. In certain aspects, each of conductive skeletons 1453, 1473 includes a thermally insulating portion and a thermally conductive portion integral with the thermally insulating portion. The thermally conductive portion defines a heat sink and the thermally insulating portion resists heat transfer. In certain instances, the thermally insulating portions of the skeleton 1453, 1473 define an inner core with an inner gap, void, or pocket that effectively isolates the thermal mass of the outer surfaces of the jaws 1452, 1472 that are in direct contact with tissue without compromising the electrical conductivity of the jaws 1450, 1470.

The thermally conductive portion includes a conductive outer layer 1469, 1469' that surrounds or at least partially surrounds an inner conductive core. In at least one example, the inner conductive core 1297 includes gap-setting members that may be in the form of pillars, columns, and/or walls extending between the opposite sides of the outer layer 1469, 1469' of each of the jaws 1250, 1270 with gaps, voids, or pockets extending between the gap-setting members. In at least one example, the gap-setting members form a honeycomb-like lattice structure 1467, 1467'.

Further to the above, the conductive skeleton 1453, 1473 includes a first conductive portion 1453a, 1473a that extends distally along the oblique profile of the jaws 1450, 1470, and a second conductive portion 1453a, 1473a that projects from the first conductive portion 1453a, 1473a and defines a tapered electrode that extends distally along at least a portion of the narrowing body of the skeleton 1453, 1473. In at least some examples, the first conductive portion 1453a, 1473a is thicker than the second conductive portion 1453b, 1473b in a cross-section (e.g., FIG. 25) of the narrowing body of the skeleton 1453, 1473. In at least one example, the second conductive portion 1453b, 1473b is integral with or permanently attached to the first conductive portion 1453a, 1473a, such that electrical energy flows from the first conductive portion 1453a, 1473a to the tissue only through the second conductive portion 1453b, 1473b. The electrically insulating layer 1464, 1464' is configured such that the first conductive portion 1453a, 1473a is completely electrically insulating, but the second conductive portion 1453b, 1473b is not completely insulating. At least the outer surfaces of the second conductive portion 1453b, 1473b, which define the electrodes 1452, 1472, are not covered by the electrically insulating layer 1464, 1464'. In the illustrated example, the electrodes 1452, 1472 and the electrically insulating layers 1464, 1464' define a flush tissue treatment surface.

As described above, the first conductive portion 1453a, 1473a is generally thicker than the second conductive portion 1453b, 1473b and is wrapped with an electrically insulating layer 1464, 1464', which results in the second conductive portion 1453b, 1473b being a high energy density area. In at least one example, the electrically insulating layer 1464, 1464' comprises a high temperature polytetrafluoroethylene (e.g., Teflon®) coating, a DLC coating, and/or a ceramic coating for insulation and resistance to char adhesion. In various examples, the thicker first conductive portion 1453a conducts more potential power with less resistance to the second conductive portion 1453b in contact with the tissue, resulting in a higher energy density for the electrode 1452.

In various aspects, the outer surfaces of the electrodes 1452, 1472 include continuous linear segments that extend along the oblique tissue treatment surfaces of the jaws 1450, 1470. The linear segments intersect at a predefined angle and include a width that gradually narrows as the linear segments extend distally. In the example shown in FIG. 24, the electrode 1452 includes segments 1452a, 1452b, 1452c, 1452c, 1452d, and the electrode 1472 includes segments 1472a, 1472b, 1472c, 1472c, 1472d. The electrode 1452 of the jaw 1450 is shown by a dashed line on the jaw 1470 in FIG. 24 to indicate the lateral position of the electrode 1452 relative to the electrode 1452 in the closed configuration of the end effector 1400. The electrodes 1452, 1472 are laterally offset from one another in the closed configuration. In bipolar energy mode, electrical energy provided by a generator (e.g., generator 1100) flows from the first conductive portion 1453a to the electrode 1452 of the second conductive portion 1453b and from the electrode 1452 to tissue grasped between the jaws 1450, 1470. The bipolar energy then flows from the tissue to the electrode 1472 of the second conductive portion 1473b and from the electrode 1472 to the first conductive portion 1473a.

24-25, the second jaw 1470 further includes an electrode 1474 spaced apart from the skeleton 1473. In at least one example, the electrode 1474 is a monopolar electrode configured to deliver monopolar energy to tissue grasped between the jaws 1450, 1470 in the closed configuration. For example, a return pad may be positioned under the patient to receive monopolar energy from the patient. Similar to the electrode 1472, the electrode 1474 includes continuous linear segments 1474a, 1474b, 1474c, 1474d that extend distally along an oblique profile defined by the second jaw 1470 from an electrode proximal end to an electrode distal end. Additionally, the electrode 1474 is laterally offset from the electrodes 1472, 1452.

The electrode 1474 includes a base 1474e positioned within the cradle 1480 that extends distally along the oblique profile of the second jaw 1470 from the cradle proximal 1480a to the cradle distal end 1480b. The cradle 1480 is centrally located relative to the lateral edges 1470e, 1470f of the second jaw 1470. The electrode 1474 further includes a tapered edge 1474f that extends from the base 1474e beyond the sidewall of the cradle 1480. In addition, the cradle 1480 is partially recessed in a valley defined in the outer tissue treatment surface of the narrowing curved body. The cradle 1480 is spaced from the gradually narrowing body of the skeleton 1473 by an electrically insulating coating 1464'. As shown in FIG. 24, the base 1480 has a width that gradually narrows as the base extends along a diagonal profile from the base proximal end 1480a to the base distal end 1480b.

In various examples, the cradle 1480 is constructed from a flexible substrate. In an uncompressed state, the sidewalls of the cradle 1480 extend beyond the tissue treatment surfaces of the jaws 1472, as shown in FIG. 25. When tissue is compressed between the jaws 1450, 1470, the compressed tissue exerts a biasing force against the sidewalls of the cradle 1480, further exposing the tapered edge 1474f of the electrode 1474.

One or more of the jaws described by the present disclosure include a stop member or gap setting member, which is a feature that extends outwardly from one or both of the tissue treatment surfaces of the jaws of the end effector. The stop member helps maintain a separation or a predetermined gap between the jaws in a closed configuration with no tissue between the jaws. In at least one example, the sidewall of the cradle 1480 defines such a stop member. In another example, the stop member may be in the form of an insulating pillar or a laterally extending spring-biased mechanism that allows the gap between the opposing jaws and the closed configuration to vary based on the clamp load.

Most electrosurgical generators use a constant power mode. In constant power mode, the power output remains constant even as impedance increases. In constant power mode, the voltage increases as impedance increases. The increased voltage causes thermal damage to the tissue. The GEM focuses the energy output of the jaws 1250, 1270 by controlling the size and shape of the electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474, for example, as described above, and adjusts the power level based on tissue impedance to generate a low voltage plasma.

In some cases, the GEM maintains a constant minimum voltage required for cutting at the surgical site. The generator (e.g., 1100) modulates the power to maintain the voltage as close as possible to the minimum voltage required for cutting at the surgical site. To obtain the arc plasma and cut, current is pushed by the voltage from the narrowing portions of the electrodes 1252, 1272, 1274, 1260, 1294, 1472, 1452, 1474 into the tissue. In certain instances, a minimum voltage of about 200 volts is maintained. Cutting above 200 volts increases thermal damage, while cutting below 200 volts minimizes arcing and drag in the tissue. Thus, the generator (e.g., 1100) modulates the power to ensure that the minimum voltage possible is utilized that still creates the arc plasma and cut.

26, surgical instrument 1500 includes end effector 1400. Surgical instrument 1500 is similar in many respects to other surgical instruments described in U.S. Patent Application, Attorney Docket No. END9234USNP2/190717-2. The various actuation and articulation mechanisms described elsewhere in connection with such surgical instruments may similarly be utilized to articulate and/or actuate surgical instrument 1500. For the sake of brevity, such mechanisms will not be repeated herein.

The end effector 1400 includes an end effector frame assembly 11210 including a distal frame member 11220 rotatably supported within a proximal frame housing 11230. In the illustrated example, the distal frame member 11220 is rotatably attached to the proximal frame housing 11230 by an annular rib on the distal frame member 11220 that is received within an annular groove in the proximal frame housing 11230.

Electrical energy is transmitted to the electrodes 1452, 1472, 1474 of the end effector 1400 by one or more flex circuits that extend distally through or along the distal frame member 11220. In the illustrated example, the flex circuit 1490 is fixedly attached to the first jaw 1450. More specifically, the flex circuit 1490 includes a distal portion 1492 that may be fixedly attached to an exposed portion 1491 of the first jaw 1450 that is not covered by the insulating layer 1464.

The slip ring assembly 1550 in the proximal frame housing 11230 allows free rotation of the end effector 1400 about the shaft of the surgical instrument 1500 without entangling the wires of the circuit that transmits electrical energy to the electrodes 1452, 1472, 1474. In the illustrated example, the flex circuit 1490 includes electrical contacts 1493 that movably engage with the slip ring 1550a of the slip ring assembly 1550. Electrical energy is transmitted through the flex circuit 1490 from the slip ring 1550a to the conductive skeleton 1453 and then to the electrodes 1452. Because the electrical contacts 1493 are not fixedly attached to the slip ring 1550a, rotation of the end effector 1400 about the shaft of the surgical instrument 1500 is permitted without losing electrical connection between the electrical contacts 1493 and the slip ring 1550a. Additionally, similar electrical contacts transmit electrical energy to slip ring 1550a.

In the example shown in FIG. 26, slip ring 1550a is configured to transmit bipolar energy to electrode 1452 of jaw 1450. Slip ring 1550b cooperates with similar electrical contacts and electrode 1472 to define a return path for the bipolar energy. Additionally, slip ring 1550c cooperates with similar electrical contacts and electrode 1474 to provide a path for monopolar electrical energy to tissue. Bipolar and monopolar electrical energy may be delivered to slip rings 1550a, 1550b via one or more electrical generators (e.g., generator 1100). Bipolar and monopolar electrical energy may be delivered simultaneously or separately, as described in more detail elsewhere herein.

In various examples, the slip rings 1550a, 1550b, 1550c are one-piece electrical slip rings having mechanical features 1556a, 1556b, 1556c configured to couple the slip rings 1550a, 1550b, 1550c to an insulating support structure 1557 or to a conductive support structure coated with an insulating material, as shown in FIG. 26. Additionally, the slip rings 1550a, 1550b, 1550c are sufficiently spaced apart to ensure that no short circuit occurs when a conductive fluid fills the space between the slip rings 1550a, 1550b, 1550c. In at least one example, a core flat stamped metal shaft member includes a three-dimensionally printed or overmolded non-conductive portion to support the slip ring assembly 1550.

27 illustrates a portion of an electrosurgical instrument 12000 that includes a surgical end effector 12200 that may be coupled to a proximal shaft segment by an articulation joint in a variety of suitable ways. In a particular example, the surgical end effector 12200 includes an end effector frame assembly 12210 that includes a distal frame member 12220 rotatably supported within a proximal frame housing that is attached to the articulation joint.

The surgical end effector 12200 includes a first jaw 12250 and a second jaw 12270. In the illustrated example, the first jaw 12250 is pivotally pinned to the distal frame member 12220 for selective pivotal movement relative to the first jaw 12250 about a first jaw axis FJA defined by a first jaw pin 12221. The second jaw 12270 is pivotally pinned to the first jaw 12250 for selective pivotal movement relative to the first jaw 12250 about a second jaw axis SJA defined by a second jaw pin 12272. In the illustrated example, the surgical end effector 12200 employs an actuator yoke assembly 12610 pivotally coupled to the second jaw 12270 by a second jaw mounting pin 12273 for pivotal movement about a jaw actuation axis JAA that is proximal and parallel to the first jaw axis FJA and the second jaw axis SJA. The actuator yoke assembly 12610 includes a proximal threaded drive shaft 12614 that is threadably received in a threaded hole 12632 in the distal locking plate 12630. The threaded drive shaft 12614 is attached to the actuator yoke assembly 12610 for relative rotation therebetween. The distal locking plate 12630 is supported for rotational movement within the distal frame member 12220. Thus, rotation of the distal locking plate 12630 results in axial movement of the actuator yoke assembly 12610.

In a particular example, the distal locking plate 12630 comprises a portion of the end effector locking system 12225. The end effector locking system 12225 further comprises a double acting rotation locking head 12640 attached to a rotation drive shaft 12602 of various types disclosed herein. The locking head 12640 comprises a first plurality of radially disposed distal locking features 12642 adapted to lockingly engage a plurality of proximally facing radial grooves or recesses 12634 formed in the distal locking plate 12630. When the distal locking features 12642 lockingly engage with the radial grooves 12634 in the distal locking plate 12630, rotation of the rotation locking head 12640 will cause the distal locking plate 12630 to rotate within the distal frame member 12220. Also, in at least one example, the rotating lock head 12640 further comprises a second series of proximally facing proximal locking features 12644 adapted to lockingly engage a corresponding series of locking grooves provided in the distal frame member 12220. The locking spring 12646 functions to distally bias the rotating lock head into locking engagement with the distal locking plate 12630. In various examples, the rotating lock head 12640 can be pulled proximally by an unlocking cable or other member in the manner described herein. In another configuration, the rotating drive shaft 12602 can also be configured to move axially to move the rotating lock head 12640 axially within the distal frame member 12220. When the proximal locking feature 12644 of the rotational locking head 12640 locks into engagement with a series of locking grooves in the distal frame member 12220, rotation of the rotational drive shaft 12602 results in rotation of the surgical end effector 12200 about the shaft axis SA.

In a particular example, the first and second jaws 12250, 12270 are opened and closed as follows: To open and close the jaws, as discussed in detail above, the rotary lock head 12640 lockingly engages the distal lock plate 12630. Rotation of the rotary drive shaft 12602 in a first direction then rotates the distal lock plate 12630, which in turn drives the actuator yoke assembly 12610 axially in the distal direction DD, moving the first jaw 12250 and the second jaw 12270 toward an open position. Rotation of the rotary drive shaft 12602 in an opposite second direction drives the actuator yoke assembly 12610 axially proximally, pulling the jaws 12250, 12270 toward a closed position. To rotate the surgical end effector 12200 about the shaft axis SA, the locking cable or member is pulled proximally to disengage the rotation lock head 12640 from the distal locking plate 12630 and engage the distal frame member 12220. As the rotational drive shaft 12602 is then rotated in the desired direction, the distal frame member 12220 (and the surgical end effector 12200) rotates about the shaft axis SA.

27 further illustrates an electrical connection assembly 5000 for electrically coupling the jaws 12250, 12270 to one or more power sources, such as, for example, generators 3106, 3107 (FIG. 36). The electrical connection assembly 5000 defines two separate electrical pathways 5001, 5002 extending through the electrosurgical instrument 12000, as shown in FIG. 27. In a first configuration, the electrical pathways 5001, 5002 cooperate to deliver bipolar energy to the end effector 12200, with one of the electrical pathways 5001, 5002 acting as a return path. Additionally, in a second configuration, the electrical pathways 5001, 5002 deliver monopolar energy 12200 separately and/or simultaneously. Thus, in the second configuration, both of the electrical pathways 5001, 5002 may be used as supply paths. Additionally, the electrical connection assembly 5000 can be utilized with other surgical instruments described elsewhere herein (e.g., surgical instrument 1500) to electrically couple such surgical instruments to one or more power sources (e.g., generators 3106, 3107).

In the illustrated example, the electrical pathways 5001, 5002 are implemented using a flex circuit 5004 that extends at least partially through the coil tube 5005. As shown in FIG. 30, the flex circuit 5004 includes two separate conductive trace elements 5006, 5007 embedded in a PCB (printed circuit board) substrate 5009. In a particular example, the flex circuit 5004 may be attached to a core flat stamped metal shaft member with a 3D printed or overmolded plastic casing to provide complete shaft filling/support.

In an alternative example, as shown in FIG. 32, the flex circuit 5004' extending through the coil tube 5005' may include conductive trace elements 5006', 5007' twisted in a helical profile within the PCB substrate 5009', resulting in a reduction in the overall size of the flex circuit 5004', which in turn may result in a reduction in the inner/outer diameter of the coil tube 5005'. FIGS. 31 and 32 show other examples of flex circuits 5004'', 5004''', including conductive trace elements 5006''', 5007'', and 5006'', 5007''', respectively, extending through the coil tubes 5005'', 5005''', with alternative profiles for size reduction. For example, the flex circuit 5004'' has a folded profile, and the flex circuit 5004'' has trace elements 5006'', 5007'' on either side of the PCB 5009''.

Further to the above, the pathways 5001, 5002 are defined by trace portions 5006a-5006g, 5007a-5007g, respectively. Trace portions 5006b, 5006c and trace portions 5007b, 5007c are in the form of rings that define a ring assembly 5010 that maintains electrical connection through the pathways 5001, 5002 while allowing rotation of the end effector 12200 relative to the shaft of the surgical instrument 12000. Additionally, trace portions 5006e, 5007e are disposed on either side of the actuator yoke assembly 12610. In the illustrated example, portions 5006e, 5007e are disposed around a hole configured to receive the second jaw mounting pin 12273, as shown in FIG. The trace portions 5006e, 5007e are configured to make electrical contact with corresponding portions 5006f, 5007f disposed on the second jaw 12270. Additionally, the trace portions 5007f, 5007G are electrically connected when the first jaw 12250 is assembled to the second jaw 12270.

29, the flex circuit 5014 includes spring-biased trace elements 5016, 5017. The trace elements 5016, 5017 are configured to exert a biasing force on the corresponding trace elements to ensure that the corresponding trace portions maintain electrical connection therewith as they move relative to one another. One or more of the trace portions of the paths 5001, 5002 may be modified to include spring-biased trace elements in accordance with the flex circuit 5014.

34, a graph 3000 illustrates a power scheme 3005' of a tissue treatment cycle 3001 applied by the end effector 1400, or any other suitable end effector of the present disclosure, to tissue grasped by the end effector 1400. The tissue treatment cycle 3001 includes a tissue coagulation stage 3006 including a feathering segment 3008, a tissue warming segment 3009, and a sealing segment 3010. The tissue treatment cycle 3001 further includes a tissue transection or cutting stage 3007.

FIG. 36 illustrates an electrosurgical system 3100 including a control circuit 3101 configured to execute a power scheme 3005'. In the illustrated example, the control circuit 3101 includes a controller 3104 with a storage medium in the form of a memory 3103 and a processor 3102. The storage medium stores program instructions for executing the power scheme 3005'. The electrosurgical system 3100 includes a generator 3106 configured to supply monopolar energy to the end effector 1400 in accordance with the power scheme 3005' and a generator 3107 configured to supply bipolar energy to the end effector 1400. In the illustrated example, the control circuit 3101 is shown separate from the surgical instrument 1500 and the generators 3106, 3107. However, in other examples, the control circuit 3101 may be integrated with the surgical instrument 1500, the generator 3106, or the generator 3107. In various aspects, the power scheme 3005' may be stored in the memory 3103 in the form of an algorithm, an equation, and/or a look-up table, or any other suitable format. The control circuitry 3101 may cause the generators 3106, 3107 to supply monopolar and/or bipolar energy to the end effector 1400 according to the power scheme 3005'.

In the illustrated example, the electrosurgical system 3100 further includes a feedback system 3109 in communication with the control circuit 3101. The feedback system 3109 may be a stand-alone system or may be integrated with, for example, the surgical instrument 1500. In various aspects, the feedback system 3109 may be used by the control circuit 3101 to perform a predetermined function, such as, for example, issuing an alert when one or more predetermined conditions are met. In certain cases, the feedback system 3109 may include one or more visual feedback systems, such as, for example, a display screen, a backlight, and/or LEDs. In certain cases, the feedback system 3109 may include one or more audio feedback systems, such as, for example, a speaker and/or a buzzer. In certain cases, the feedback system 3109 may include, for example, one or more tactile feedback systems. In certain cases, the feedback system 3109 may include, for example, a combination of visual, audio, and/or tactile feedback systems. In addition, the electrosurgical system 3100 further includes a feedback system 3110 in communication with the control circuit 3101. The user interface 3110 may be a stand-alone interface or may be integrated with the surgical instrument 1500, for example.

Graph 3000 shows power (W) on the y-axis and time on the x-axis. Bipolar energy curve 3020 spans tissue coagulation stage 3005, while monopolar energy curve 3030 begins at tissue coagulation stage 3006 and ends at the end of tissue traverse stage 3007. Thus, tissue treatment cycle 3001 is configured to apply bipolar energy to tissue through tissue coagulation stage 3006 but not tissue traverse stage 3007, and to apply monopolar energy to tissue during coagulation stage 3006 and portions of traverse stage 3007, as shown in FIG.

In various aspects, a user input may be received by the control circuit 3101 from a user interface 3110. The user input causes the control circuit 3101 to initialize the execution of the power scheme 3005' at time _t1 . Alternatively, the initialization of the execution of the power scheme 3005' may be automatically triggered by a sensor signal from one or more sensors 3111 in communication with the control circuit 3101. For example, the power scheme 3005' may be automatically triggered by the control circuit 3101 in response to a sensor signal indicating a predetermined gap between the jaws 1450, 1470 of the end effector 1400.

During the feathering segment 3008, the control circuit 3101 causes the generator 3107 to gradually increase the bipolar energy power delivered to the end effector 1400 to a predetermined power value P1 (e.g., 100 W) and maintain the bipolar energy power at or substantially at the predetermined power value P1 throughout the feathering segment 3008 and the remainder of the tissue warming segment 3009. The predetermined power value P1 may be stored in the memory 3103 and/or provided by a user via the user interface 3110. During the sealing segment 3010, the control circuit 3101 causes the generator 3107 to gradually decrease the bipolar energy power. Bipolar energy application is terminated at the end of the sealing segment 3010 of the tissue coagulation stage 3006 and prior to the start of the cutting/tracing stage 3007.

Further to the above, at _t2 , the control circuitry 3101, for example, causes the generator 3107 to begin supplying monopolar energy power to the electrode 1474 of the end effector 1400. Monopolar energy application to the tissue begins at the end of the feathering segment 3008 and the beginning of the tissue heating segment 3009. The control circuitry 3101 causes the generator 3107 to gradually increase the monopolar energy power to a predetermined power level P2 (e.g., 75 W) and to maintain, or at least substantially maintain, the predetermined power level P2 throughout the remainder of the tissue heating segment 3009 and the first portion of the sealing segment 3010. The predetermined power level P2 may also be stored in the memory 3103 and/or provided by a user via the user interface 3110.

During the sealing segment 3010 of the tissue coagulation stage 3006, the control circuit 3101 causes the generator 3107 to gradually increase the monopolar energy power delivered to the end effector 1400. The beginning of the tissue traversing stage 3007 is denoted by an inflection point in the monopolar energy curve 3030, where the previous gradual increase in monopolar energy experienced during the sealing segment 3010 is followed by a step-up to a predetermined maximum threshold power level P3 (e.g., 150 W) sufficient to traverse the coagulated tissue.

At time _t4 , the control circuit 3101 causes the generator 3107 to step up the monopolar energy power supplied to the end effector 1400 to a predetermined maximum threshold power level P3 and maintain, or at least substantially maintain, the predetermined maximum threshold power level P3 for a predetermined period of time ( _t4 - _t5 ) or until the end of the tissue transection stage 3007. In the illustrated example, the monopolar energy power is terminated by the control circuit 3101 at _t5 . Tissue transection continues mechanically as the jaws 1450, 1470 continue to apply pressure to the grasped tissue until the tissue transection stage 3007 at _t6 . Alternatively, in other examples, the control circuit 3101 may cause the generator 3107 to continue supplying monopolar energy power to the end effector 1400 until the end of the tissue transection stage 3007.

Sensor readings of the sensor 3111 and/or a timer clock of the processor 3102 may be used by the control circuitry 3101 to determine when to cause the generator 3107 and/or the generator 3106 to begin, increase, decrease, and/or terminate the supply of energy to the end effector 1400 in accordance with a power scheme, such as, for example, power scheme 3005'. The control circuitry 3101 may execute power scheme 3005' by, for example, causing one or more timer clocks to count down from one or more predetermined time periods (e.g., t ₁ -t ₂ , t ₂ -t ₃ , t ₃ -t ₄ , t ₅ -t ₆ ), which may be stored in memory 3103. While the power scheme 3005' is time-based, the control circuit 3101 may adjust the predetermined time periods for any of the individual segments 3008, 3009, 3010 and/or stages 3006, 3007 based on sensor readings received from one or more of the sensors 3111, such as, for example, a tissue impedance sensor.

The end effector 1400 is configured to deliver three different energy modalities to the grasped tissue. A first energy modality applied to the tissue during the feathering segment 3008 includes bipolar energy but not monopolar energy. A second energy modality is a blended energy modality including a combination of monopolar and bipolar energy and is applied to the tissue during the tissue warming stage 3009 and the tissue sealing stage 3010. Finally, a third energy modality includes monopolar energy but not bipolar energy and is applied to the tissue during the cutting stage 3007. In various aspects, the second energy modality includes a power level that is the sum 3040 of the power level of the monopolar energy and the power level of the bipolar energy. In at least one example, the power level of the second energy modality includes a maximum threshold Ps (e.g., 120 W).

In various aspects, the control circuitry 3101 delivers monopolar and bipolar energy to the end effector 1400 from two different generators 3106, 3107. In at least one example, energy from one of the generators 3106, 3107 can be detected using the return path of the other generator or utilizing an attached electrode of the other generator to abbreviate unintended tissue interaction. Thus, parasitic loss of energy through an unintended return path can be detected by the generator connected to the return path. Inadvertent conductive paths can be mitigated by effecting voltage, power, waveform, or timing between uses.

Integrated sensors within the flex circuit of the surgical instrument 1500 may detect the energy delivery/short circuit of the electrode/conductive pathway when no electrical potential is present, and the ability to prevent the conductive pathway from being shorted when accidental use is sensed. Additionally, directional electronic gating elements may also be utilized to prevent crosstalk from one generator to the source of the other.

One or more of the electrodes described by this disclosure (e.g., electrodes 1452, 1472, 1474 associated with jaws 1450, 1470) may include a segmented pattern having segments that are connected together when the electrode is energized by a generator (e.g., generator 1100). However, when the electrode is not energized, the segments are separated to prevent short circuits across the electrode to other areas of the jaw.

In various aspects, a thermally resistant electrode material is utilized with the end effector 1400. The material can be configured to block current flow through the electrode above a certain temperature level, while still allowing energy delivery to other portions of the electrode that are below the temperature threshold.

FIG. 37 shows a table depicting an alternative power scheme 3005'' that may be stored in memory 3103 and executed by processor 3102 in a manner similar to power scheme 3005'. In executing power scheme 3005'', control circuit 3101 relies on jaw opening in addition to or instead of time in setting the power values of generators 3106, 3107. Thus, power scheme 3005'' is a jaw opening based power scheme.

In the illustrated example, jaw openings d ₀ , d ₁ , d ₂ , d ₃ , d ₄ from the power scheme 3005″ correspond to time values t ₁ , t ₂ , t ₃ , t ₄ from the power scheme 3005′. Thus, the feathering segment corresponds to a jaw opening of about d ₁ to about d ₂ (e.g., about 0.700 inches to about 0.500 inches). Additionally, the tissue warming segment corresponds to a jaw opening of about d ₂ to about d ₃ (e.g., about 0.500 inches to about 0.300 inches). Further, the sealing segment corresponds to a jaw opening of about d ₂ to about d ₃ (e.g., about 0.030 inches to about 0.010 inches). Further, the tissue cutting stage corresponds to a jaw opening of about d ₃ to about d ₄ (e.g., about 0.010 inches to about 0.003 inches).

Thus, the control circuit 3101 is configured to, for example, cause the generator 3106 to begin supplying bipolar energy power to the end effector 1400 when a reading from one or more of the sensors 3111 corresponds to a predetermined jaw opening d1, thereby initializing the feathering segment. Similarly, the control circuit 3101 is configured to, for example, cause the generator 3106 to cease supplying bipolar energy power to the end effector 1400 when a reading from one or more of the sensors 3111 corresponds to a predetermined jaw opening d2, thereby terminating the feathering segment. Similarly, the control circuit 3101 is configured to, for example, cause the generator 3107 to begin supplying monopolar energy power to the end effector 1400 when a reading from one or more of the sensors 3111 corresponds to a predetermined jaw opening d2, thereby initializing the heating segment.

In the illustrated example, the jaw opening is defined by the distance between two corresponding data points on the jaws 1450, 1470. The corresponding data points contact each other when the jaws 1450, 1470 are in a closed configuration with no tissue between them. Alternatively, the jaw opening can be defined by the distance between the jaws 1450, 1470 measured along a line that intersects the jaws 1450, 1470 and perpendicular to a longitudinal axis extending through the center of the end effector 1500. Alternatively, the jaw opening can be defined by the distance between a first parallel line and a second parallel line that intersect the jaws 1450, 1470, respectively. This distance is measured along a line that extends perpendicular to the first and second parallel lines and that extends through the intersection of the first parallel line with the first jaw 1450 and through the intersection of the second parallel line with the second jaw 1470.

35, in various examples, the electrosurgical system 3100 (FIG. 36) is configured to perform a tissue treatment cycle 4003 using the power scheme 3005. The tissue treatment cycle 4003 includes an initial tissue contact stage 4013, a tissue coagulation stage 4006, and a tissue traverse stage 4007. The tissue contact stage 4013 includes an open configuration segment 4011 where no tissue is between the jaws 1450 and 1470, and a proper orientation segment 4012 where the jaws 1450 and 1470 are properly positioned relative to the desired tissue treatment area. The tissue coagulation stage 4006 includes a feathering segment 4008, a tissue warming segment 4009, and a sealing segment 3010. The tissue traverse stage 4007 includes a tissue cutting segment. The tissue treatment cycle 4003 includes applying bipolar and monopolar energy separately and simultaneously to the tissue treatment area in accordance with the power scheme 3005. Tissue treatment cycle 4003 is similar in many respects to tissue treatment cycle 3001, which will not be repeated at the same level of detail for the sake of brevity.

35 illustrates a graph 4000 depicting a power scheme 3005 similar in many respects to power scheme 3005'. For example, control circuit 3101 may execute power scheme 3005 in a manner similar to power scheme 3005' to deliver three different energy modalities to a tissue treatment region in three consecutive periods of a tissue treatment cycle 4001. A first energy modality including bipolar energy but not monopolar energy is applied to the tissue treatment region from _t1 to _t2 in a feathering segment 4008. A second energy modality, a combined energy modality including a combination of monopolar and bipolar energy, is applied to the tissue treatment region from _t2 to _t4 in a tissue warming segment 4009 and a tissue sealing segment. Finally, a third energy modality including monopolar energy but not bipolar energy 4010 is applied to tissue from _t4 to _t5 in a tissue transection stage 4007. Additionally, the second energy modality includes a power level that is the sum of the power level of the monopolar energy and the power level of the bipolar energy. In at least one example, the power level of the second energy modality includes a maximum threshold (e.g., 120 W). In various aspects, the power scheme 3005 may be delivered to the end effector 1400 from two different electrical generators 3106, 3107. Additional aspects of the power scheme 3005 that are similar to aspects of the power scheme 3005' will not be repeated in the same level of detail herein for the sake of brevity.

In various aspects, the control circuit 3101 causes the generators 3106, 3107 to adjust the bipolar and/or monopolar power levels of the power scheme 3005 applied by the end effector 1400 to the tissue treatment area based on one or more measured parameters including tissue impedance 4002, jaw motor speed 27920d, jaw motor force 27920c, jaw opening 27920b of the end effector 1400, and/or motor current draw resulting in end effector closure. FIG. 35 is a graph 4000 illustrating the correlation between such measured parameters and the power scheme 3005 over time.

In various examples, the control circuitry 3101 causes the generators 3106, 3107 to adjust the power level of a power scheme (e.g., power schemes 3005, 3005') applied by the end effector 1400 to the tissue treatment area based on one or more parameters (e.g., tissue impedance 4002, jaw/closing motor speed 27920d, jaw/closing motor force 27920c, jaw gap/opening 27920b of the end effector 1400, and/or motor current draw) determined by one or more sensors 3111. For example, the control circuitry 3101 can cause the generators 3106, 3107 to adjust the power level based on the pressure in the jaws 1450, 1470.

In at least one example, the power level is inversely proportional to the pressure in the jaws 1450, 1470. The control circuitry 3101 can utilize such an inverse correlation to select a power level based on a pressure value. In at least one example, the current draw of the motor that causes the end effector closure is used to determine the pressure value. Alternatively, the inverse correlation utilized by the control circuitry 3101 may be based directly on the current draw as a proxy for pressure. In various examples, the more compression applied by the jaws 1450, 1470 on the tissue treatment area, the lower the power level set by the control circuitry 3101, which helps minimize tissue adhesion and accidental cutting.

Graph 4000 provides some insight into the measured parameters of tissue impedance 4002, jaw/closure motor speed 27920d, jaw/closure motor force 27920c, jaw gap/opening 27920b of the end effector 1400, and/or motor current draw resulting in end effector closure, which may trigger the initiation, adjustment, and/or termination of application of bipolar and/or monopolar energy to tissue during a tissue treatment cycle 4003.

The control circuitry 3101 may rely on one or more of such cues in implementing and/or adjusting the default power scheme 3005 in the tissue treatment cycle 4003. In certain examples, the control circuitry 3101 may rely on sensor readings of one or more sensors 3111 to detect when one or more monitored parameters meet one or more predefined conditions, which may be stored in the memory 3103, for example. The one or more predefined conditions may be reaching a predefined threshold and/or detecting a significant increase and/or decrease in one or more of the monitored parameters. The satisfaction of the predefined conditions, or lack thereof, constitutes a trigger/check point for implementing and/or adjusting portions of the default power scheme 3005 in the tissue treatment cycle 4003. The control circuitry 3101 may rely solely on the cues in implementing and/or adjusting the power scheme, or may instead use the cues to induce or adjust a timer clock of a time-based power scheme, such as, for example, the power scheme 3005'.

For example, a sudden drop in tissue impedance (A ₁ ) to a predetermined threshold (Z ₁ ), alone or concomitant with an increase in jaw motor force (A ₂ ) to a predetermined threshold (F ₁ ) and/or a decrease in jaw opening (A ₃ ) to a predetermined threshold (d1) (e.g., 0.5 inches), can trigger the control circuit 3101 to initiate the application of bipolar energy to the tissue treatment area, thereby initiating the feathering segment 4008 of the tissue coagulation stage 4006. The control circuit 3101 can signal the generator 3106 to begin supplying bipolar power to the end effector 1400.

Furthermore, the reduction in jaw motor speed (B _{1 ) to a predetermined value (v 1} ) after initiation of bipolar energy will trigger the control circuit 3101 to signal the generator 3106 to stabilize (B 2 ) the power level of the bipolar energy at a constant, or at least substantially constant, value (e.g., 100 W).

In yet another example, a shift from the feathering segment 4008 to the heating segment 4009 at _t2 will trigger the initiation (D1) of monopolar energy application to the tissue treatment region, coincident with an increase ( _C2 ) in jaw motor force to a predetermined threshold ( _F2 ), a decrease ( _C3 ) in jaw opening to a predetermined threshold (e.g., 0.03 inches), and/or a decrease (C1) in tissue impedance to a predetermined value Z2. Satisfying one, or in certain instances two, or in certain instances all of conditions C1, C2, C3 will cause the control circuit 3101 to cause the generator 3101 to begin applying monopolar energy to the tissue treatment region. In another example, satisfying one, or in certain instances two, or in certain instances all of conditions C1, C2, C3 at or about time t2 will trigger the application of monopolar energy to the tissue treatment region.

Initiation of monopolar energy by the generator 3107 in response to an initiation signal by the control circuit 3101 results in the delivery of a blend of monopolar and bipolar energy ( _D1 ) to the tissue treatment area, which causes a shift in the impedance curve characterized by a faster decrease in impedance (E1) from _Z2 to _Z3 compared to the steady decrease (C1) prior to initiation of monopolar energy. In the illustrated example, tissue impedance _Z3 defines the minimum impedance for the tissue treatment cycle 4003.

In the illustrated example, the control circuit 3101 determines that an acceptable seal has been achieved when (E ₁ ) the minimum impedance value Z ₃ meets or at least substantially meets (E ₃ ) a predetermined maximum jaw motor force threshold (F3) and/or (E ₂ ) a predetermined jaw opening threshold range (e.g., 0.01 inch to 0.003 inch). Satisfying one, or in certain instances two, or in certain instances all of conditions E 1 , E 2 , E 3 will signal the control circuit 3101 to shift from the warming segment 4009 to the sealing segment 4010.

Further to the above, once the minimum impedance value _Z3 is exceeded, the impedance level gradually increases up to a threshold Z4 which corresponds to the end of the seal segment 4010 at _t4 . Satisfaction of threshold Z4 will cause the control circuit 3101 to signal the generator 3107 to step up the monopolar power level to initiate the tissue traversing stage 4007, and also signal the generator 3106 to terminate the application of bipolar energy application to the tissue treatment region.

In various examples, the control circuit 3101 may be configured to (G ₂ ) decrease the jaw motor force as the impedance gradually increases from (G ₁ ) minimum value Z ₃ , and/or to ensure that (G ₃ ) the jaw opening has decreased to a predetermined threshold (e.g., 0.01 inches to 0.003 inches) before stepping up the power level of the monopolar energy to cut tissue.

However, if the jaw motor force continues to increase, the control circuit 3101 may pause the application of monopolar energy to the tissue treatment area for a predetermined period of time to allow the jaw motor force to begin to decrease. Alternatively, the control circuit may signal the generator 3107 to stop the monopolar energy and complete the seal using only bipolar energy.

In certain examples, the control circuitry 3101 may use the feedback system 3109 to alert the user and/or provide instructions or recommendations to pause application of monopolar energy. In certain examples, the control circuitry 3101 may instruct the user to utilize on a mechanical knife to transcribe tissue.

In the illustrated example, the control circuit 3101 maintains the stepped up monopolar power until a spike (I) is detected in the tissue impedance (H). The control circuit 3101 may cause the generator 3107 to terminate application of monopolar energy to the tissue when a spike (I) in the impedance level to _Z5 is detected after a gradual increase over _Z3 to _Z4 (J). The spike indicates the completion of the tissue treatment cycle 4003.

In various examples, the control circuit 3101 prevents the electrodes of the jaws 1450, 1470 from being energized before the proper closure threshold is reached. The closure threshold may be based on a predetermined jaw opening threshold and/or a predetermined jaw motor force threshold, which may be stored in the memory 3103, for example. In such examples, the control circuit 3101 may not act on a user input via the user interface 3110 requesting a treatment cycle 4003. In certain examples, the control circuit 3101 may respond by alerting the user through the feedback system 3109 that the proper closure threshold has not been reached. The control circuit 3101 may also provide an override option to the user.

Eventually, between times _t4 and _t5 , monopolar energy becomes the only energy delivered to cut the patient tissue. While the patient tissue is being cut, the force clamping the jaws of the end effector may vary. If the force clamping the jaws decreases 27952 from its steady state level maintained between times _t3 and _t4 , an efficient and/or effective tissue cut is recognized by the surgical instrument and/or surgical hub. If the force clamping the jaws increases 27954 from its steady state level maintained between times _t3 and _t4 , an inefficient and/or ineffective tissue cut is recognized by the surgical instrument and/or surgical hub. In such an instance, an error may be communicated to the user.

38-42, the surgical instrument 1601 includes an end effector 1600 similar in many respects to the end effectors 1400, 1500, which will not be repeated in the same level of detail for the sake of brevity. The end effector 1600 includes a first jaw 1650 and a second jaw 1670. At least one of the first jaw 1650 and the second jaw 1670 is movable to transition the end effector 1600 between an open configuration and a closed configuration to grasp tissue between the first jaw 1650 and the second jaw 1670. The electrodes 1652, 1672 are configured to cooperate to deliver bipolar energy from the bipolar energy source 1610 to tissue, as shown in FIG. 39. The electrode 1674 is configured to deliver monopolar energy from the monopolar energy source 1620 to tissue. The return pad 1621 defines a return path for the monopolar energy. In at least one example, monopolar and bipolar energy are delivered to tissue simultaneously (FIG. 36) or alternately, as shown in FIG. 36, for example, to seal and/or cut tissue.

FIG. 42 shows a simplified schematic diagram of an electrosurgical system 1607 including a monopolar generator 1620 and a bipolar generator 1610 connectable to an electrosurgical instrument 1601 including an end effector 1600. The electrosurgical system 1607 further includes a conductive circuit 1602 selectively transitionable between a connected configuration to an electrode 1672 and a disconnected configuration to the electrode 1672. The switching mechanism may be comprised of, for example, any suitable switch capable of opening and closing the conductive circuit 1602. In the connected configuration, the electrode 1672 is configured to cooperate with the electrode 1652 to deliver bipolar energy to tissue, and the conductive circuit 1602 defines a return path for the bipolar energy after passing through the tissue. However, in the disconnected configuration, the electrode 1672 is isolated and thus an inert and internally conductive, externally insulated structure on the jaw 1670. Thus, in the unconnected configuration, electrode 1652 is configured to deliver monopolar energy to tissue in addition to or in addition to the monopolar energy delivered through electrode 1674. Alternatively, instead of electrode 1672, electrode 1652 may be transitionable between a connected configuration and an unconnected configuration relative to conductive circuit 1602, allowing electrode 1672 to deliver monopolar energy to tissue in addition to or in addition to the monopolar energy delivered through electrode 1674.

In various aspects, the electrosurgical instrument 1601 further includes a control circuit 1604 configured to adjust the level of monopolar and bipolar energy delivered to the tissue to minimize unintended thermal damage to the surrounding tissue. The adjustment may be based on the readings of at least one sensor, such as, for example, a temperature sensor, an impedance sensor, and/or a current sensor. In the example shown in FIGS. 41 and 42, the control circuit 1604 is coupled to temperature sensors 1651, 1671 on the jaws 1650, 1670, respectively. The level of monopolar and bipolar energy delivered to the tissue is adjusted by the control circuit 1604 based on the temperature readings of the sensors 1651, 1671.

In the illustrated example, the control circuitry 1604 includes a controller 3104 having a storage medium in the form of a memory 3103 and a processor 3102. The memory 3103 stores program instructions that, when executed by the processor 3102, cause the processor 3102 to adjust the levels of monopolar and bipolar energy delivered to tissue based on sensor readings received from one or more sensors, such as, for example, temperature sensors 1651, 1671. In various embodiments, as described in more detail below, the control circuitry 1604 can adjust a default power scheme 1701 based on readings from one or more sensors, such as, for example, temperature sensors 1651, 1671. The power scheme 1701 is similar in many respects to the power scheme 3005', which will not be repeated at the same level of detail for the sake of brevity.

FIG. 43 illustrates temperature-based adjustment of a power scheme 1701 for energy delivery to tissue grasped by the end effector 1600. The graph 1700 illustrates time on the x-axis and power and temperature on the y-axis. In the tissue feathering segment (t ₁ -t ₂ ), the control circuit 1604 gradually increases the power level of the bipolar energy to a predetermined threshold (e.g., 120 W), which gradually raises the temperature of the tissue grasped by the end effector 1600 to a temperature within a predetermined range (e.g., 100° C.-120° C.). The power level of the bipolar energy is then maintained at the predetermined threshold as long as the tissue temperature remains within the predetermined range. In the tissue warming segment (t ₁ -t ₃ ), the control circuit 1604 initiates the monopolar energy and gradually decreases the power level of the bipolar energy while gradually increasing the power level of the monopolar energy to maintain the tissue temperature within the predetermined range.

In the illustrated example, during the tissue sealing segment (t ₃ -t ₄ ), the control circuit 1604 detects that the tissue temperature has reached the upper limit of a predetermined range based on the readings of the temperature sensors 1651, 1671. The control circuit 1604 responds by stepping down the power level of the monopolar energy. In other examples, the reduction may be implemented gradually. In certain examples, the reduction value or a method for determining the reduction value, such as, for example, a table or an equation, may be stored in the memory 3103. In certain examples, the reduction value may be a percentage of the current power level of the monopolar energy. In other examples, the reduction value may be based on a previous power level of the monopolar energy that corresponds to a tissue temperature within the predetermined range. In certain examples, the reduction may be implemented in multiple steps spaced apart in time. After each downward step, the control circuit 1604 allows a predetermined period of time to pass before evaluating the tissue temperature.

In the illustrated example, the control circuit 1604 maintains the power level of the bipolar energy according to the default power scheme 1701, but reduces the power level of the monopolar energy to maintain the tissue temperature within a predetermined range while the tissue seal is complete. In other examples, the reduction in the power level of the monopolar energy is combined with or exchanged for a reduction in the power level of the bipolar energy.

In addition to the above, a warning may be issued through the feedback system 3109 to complete the tissue transection in lieu of monopolar energy, e.g., to avoid unintended lateral heat loss to surrounding tissue. In certain examples, the control circuit 1604 may temporarily suspend the monopolar and/or bipolar energy until the tissue temperature returns to a level within the predetermined temperature range. The monopolar energy may then be reactivated to perform the sealed tissue transection.

44, the end effector 1600 applies monopolar energy to a tissue treatment region 1683 of a blood vessel, such as an artery, grasped by the end effector 1600. The monopolar energy flows from the end effector 1600 to the treatment region 1683 and ultimately to a return pad (e.g., return pad 1621). The temperature of the tissue in the treatment region 1683 increases as monopolar energy is applied to the tissue. However, the actual heat spread 1681 is greater than the expected heat spread 1682 due to, for example, a stenosed portion 1684 of the artery that inadvertently draws off the monopolar energy.

In various aspects, the control circuitry 1604 monitors the thermal effect in the treatment region 1683 resulting from the application of monopolar energy to the treatment region 1683. The control circuitry 1604 can further detect a deficiency in the monitored thermal effect to conform to a predetermined correlation between the monopolar energy and the applied thermal effect expected from the application of monopolar energy in the treatment region. In the illustrated example, an accidental energy withdrawal at the stenotic portion of the artery reduces the thermal effect in the treatment region detected by the control circuitry 1604.

In certain examples, the memory 3103 stores a predetermined correlation algorithm between the monopolar energy level applied to the tissue treatment region grasped by the end effector 1600 and the thermal effect expected to result from the application of the monopolar energy to the tissue treatment region. The correlation algorithm may be in the form of, for example, an array, a lookup table, a database, a mathematical equation, or a formula. In at least one example, the stored correlation algorithm defines a correlation between the power level of the monopolar energy and the expected temperature. The control circuit 1604 can monitor the temperature of the tissue in the treatment region 1683 using the temperature sensors 1651, 1671 and can determine whether the monitored temperature reading corresponds to the expected temperature reading at a particular power level.

The control circuitry 1604 may be configured to take certain actions if a failure to comply with the stored correlation is detected. For example, the control circuitry 1604 may alert the user of the failure. Additionally or alternatively, the control circuitry 1604 may reduce or suspend the delivery of monopolar energy to the treatment region. In at least one example, the control circuitry 1604 may adjust or shift from monopolar to bipolar energy application to the tissue treatment region to confirm the presence of parasitic power draw. The control circuitry 1604 may continue to use bipolar energy in the treatment region if parasitic power draw is confirmed. However, if the control circuitry 1604 negates the presence of parasitic power draw, the control circuitry 1604 may restart or re-increase the monopolar power level. The change to the monopolar and/or bipolar power levels may be accomplished by the control circuitry 1604, for example, by signaling the monopolar power supply 1620 and/or the bipolar power supply 1610.

In various aspects, one or more imaging devices, such as a multispectral scope 1690 and/or an infrared imaging device, may be utilized to monitor the spectral tissue changes and/or thermal effects in the tissue treatment region 1691, as shown, for example, in FIG. 45. The imaging data from the one or more imaging devices may be processed to estimate the temperature of the tissue treatment region 1691. For example, a user may aim an infrared imaging device at the treatment region 1691 when monopolar energy is being applied to the treatment region 1691 by the end effector of 1600. As the treatment region 1691 heats up, its infrared thermal signature changes. Thus, the change in thermal signature corresponds to a change in the temperature of the tissue in the treatment region 1691. Thus, the temperature of the tissue in the treatment region 1691 may be determined based on the thermal signature captured by the one or more imaging devices. If the temperature estimated based on the thermal signature in the treatment area 1691 associated with a particular component level is less than or equal to the expected temperature at that power level, the control circuit 1604 detects a discrepancy in the thermal effects in the treatment area 1691.

In other examples, the thermal signature captured by one or more imaging devices is not converted to an estimated temperature. Instead, it is directly compared to the thermal signature stored in memory 3103 to evaluate whether a power level adjustment is required.

In certain examples, the memory 3103 stores a predetermined correlation algorithm between the power level of the monopolar energy applied to the tissue treatment region 1691 grasped by the end effector 1600 and the expected thermal signature resulting from the application of the monopolar energy to the tissue treatment region. The correlation algorithm may be in the form of, for example, an array, a lookup table, a database, a mathematical equation, a formula, or the like. In at least one example, the stored correlation algorithm defines a correlation between the power level of the monopolar energy and the expected thermal signature or a temperature associated with the expected signature.

46 and 47, an electrosurgical system includes an electrosurgical instrument 1801 having an end effector 1800, which is similar in many respects to the end effectors 1400, 1500, 1600 and will not be repeated in the same details for brevity. The end effector 1800 includes a first jaw 1850 and a second jaw 1870. At least one of the first jaw 1850 and the second jaw 1870 is movable to transition the end effector 1800 between an open configuration and a closed configuration to grasp tissue between the first jaw 1850 and the second jaw 1870. The electrodes 1852, 1872 are configured to cooperate to deliver bipolar energy to tissue. The electrode 1874 is configured to deliver monopolar energy to tissue. In at least one example, monopolar and bipolar energy are delivered to tissue simultaneously or alternately, as shown in FIG. 34, for example, to seal and/or cut tissue.

In the illustrated example, bipolar and monopolar energy are generated by separate generators 1880, 1881 and provided to the tissue by separate electrical circuits 1882, 1883 that connect the generator 1880 to the electrodes 1852, 1872 and the generator 1881 to the electrode 1874 and return pad 1803, respectively. For example, the power level associated with the bipolar energy delivered to the tissue by the electrodes 1852, 1872 according to the power scheme 3005' is set by the generator 1880, and the power level associated with the monopolar energy delivered to the tissue by the electrode 1874 is set by the generator 1881.

In use, as shown in FIG. 46, the end effector 1800 applies bipolar and/or monopolar energy to the tissue treatment region 1804 to seal and, in certain instances, transcribe tissue. However, in certain instances, energy is diverted from the intended target of the tissue treatment region 1804, causing off-site thermal damage to the surrounding tissue. To avoid or at least reduce such occurrences, the surgical instrument 1801 includes impedance sensors 1810, 1811, 1812, 1813 positioned between different electrodes and at different locations, as shown in FIG. 46, to detect off-site thermal damage.

In various aspects, the surgical system 1807 further includes a control circuit 1809 coupled to the impedance sensors 1810, 1811, 1812, 1813. The control circuit 1809 can detect off-site, or unintended, thermal damage based on one or more readings of the impedance sensors 1810, 1811, 1812, 1813. In response, the control circuit 1809 can alert the user of the off-site thermal damage and instruct the user to pause or automatically pause energy delivery to the tissue treatment region 1804 while maintaining bipolar energy according to a predetermined power scheme (e.g., power scheme 3005') to complete the tissue seal. In certain examples, the control circuit 1809 can instruct the user to transcribe the tissue using a mechanical knife to avoid further off-site thermal damage.

With further reference to FIG. 46, the impedance sensor 1810 is configured to measure the impedance between the bipolar electrodes 1852, 1872. Additionally, the impedance sensor 1811 is configured to measure the impedance between the electrode 1874 and the return pad 1803. Additionally, the impedance sensor 1812 is configured to measure the impedance between the electrode 1872 and the return pad 1803. Additionally, the impedance sensor 1813 is configured to measure the impedance between the electrode 1852 and the return pad 1803. In another example, an additional impedance sensor is added in series between the monopolar circuit 1882 and the bipolar circuit 1883, which can be utilized to measure impedance at various locations so that off-site thermal anomalies with greater specificity with respect to location and impedance path are detected.

In various aspects, off-site thermal damage occurs in tissue on one side (left/right) of the end effector 1800. The control circuit 1809 may detect which side the off-site thermal damage occurred on by comparing the readings of the impedance sensors 1810, 1811, 1812, 1813. In one example, a non-proportional change in the monopolar and bipolar impedance readings indicates off-site thermal damage. Conversely, if proportionality in the impedance readings is detected, the control circuit 1809 maintains that no off-site thermal damage has occurred. In one example, as described in more detail below, off-site thermal damage may be detected by the control circuit 1809 from the ratio of bipolar impedance to monopolar impedance.

FIG. 48 shows a graph 1900 with time on the x-axis and power on the y-axis. The graph 1900 shows a power scheme 1901 similar in many respects to the power scheme 3005' shown in FIG. 34, which will not be repeated in the same level of detail here for brevity. The control circuit 3101 causes the power scheme 1901 to be applied by the generators 1880 (GEN.2), 1881 (GEN.1) to effect a tissue treatment cycle by the end effector 1800. The power scheme 1901 includes a therapeutic power component 1902 and a non-therapeutic or sensing power component 1903. The therapeutic power component 1902 defines monopolar and bipolar power levels similar to those described in connection with the power scheme 3005'. The sensing power component 1903 includes monopolar 1905 and bipolar 1904 sensing pings that are delivered at various points throughout the tissue treatment cycle performed by the end effector 1800. In at least one example, the sensing power component sensing pings 1903, 1904 are delivered at a predetermined current value (e.g., 10 mA) or range. In at least one example, three different sensing pings are utilized to determine the location/orientation of potential off-site thermal damage.

The control circuit 3101 may determine whether energy is being diverted to non-tissue therapy directed sites during a tissue treatment cycle by delivering sensing pings 1903, 1904 at predetermined time intervals. The control circuit 3101 may then evaluate the return path conductivity based on the delivered sensing pings. If it is determined that energy is being diverted from the target site, the control circuit 3101 may take one or more responsive actions. For example, the control circuit 3101 may adjust the power scheme 1901 applied by the generators 1880 (GEN.2), 1881 (GEN.1). The control circuit 3101 may suspend the application of bipolar and/or monopolar energy to the target site. Additionally, the control circuit 3101 may issue a warning to the user, for example, via the feedback system 3109. However, if it determines that no energy diversion is detected, the control circuit 3101 continues to execute the power scheme 1901.

In various aspects, the control circuitry 3101 evaluates the return path conductivity, for example, by comparing the measured return path conductivity to a predetermined return path conductivity stored in memory 3103. If the comparison indicates that the measured return path conductivity differs from the predetermined return path conductivity by more than a predetermined threshold, the control circuitry 3101 concludes that energy is being diverted to a non-tissue therapy directed site and implements one or more of the response actions described above.

FIG. 49 is a graph 2000 illustrating a power scheme 2001 that was interrupted at t3′ due to detected off-site thermal damage. The power scheme 2001 is in many respects similar to the power schemes shown in FIGS. 34, 48, which will not be repeated at the same level of detail for the sake of brevity. The control circuit 1809 causes the generators 1880 (curve 2010), 1881 (curve 2020) to apply the power scheme 2001 to effect a tissue treatment cycle, for example, by the end effector 1800. In addition to the power scheme 2001, the graph 2000 further illustrates the bipolar impedance 2011 (Z _bipolar ), the monopolar impedance 2021 (Z _monopolar ), and the ratio of monopolar impedance to bipolar impedance 2030 (Z _monopolar /Z _bipolar ) on the y-axis. During normal operation, while monopolar and bipolar energy are simultaneously applied to tissue, the values of bipolar impedance 2011 (Z _bipolar ) and monopolar impedance 2021 (Z _monopolar ) remain proportional or at least substantially proportional. In short, a constant, or at least substantially constant impedance ratio 2030 (Z _monopolar /Z _bipolar ) between monopolar impedance 2021 and bipolar impedance 2011 is maintained within a predetermined range 2031 during normal operation.

In various aspects, the control circuit 1809 monitors the impedance ratio 2030 to assess whether monopolar energy is being diverted to non-tissue therapy directed sites. This diversion changes the proportionality between the detected values of bipolar impedance 2011 (Z _bipolar ) and monopolar impedance 2021 (Z _monopolar ), which changes the impedance ratio 2030. A change in impedance ratio 2030 within a predetermined range 2031 can cause the control circuit 1908 to issue an alert. However, if the change extends to or falls below a lower threshold of the predetermined range 2031, the control circuit 1908 can take additional responsive action.

In the illustrated example, the impedance ratio 2030 (Z _monopolar /Z _bipolar ) remains constant or at least substantially constant throughout the first portion of the treatment cycle involving the combined application of monopolar and bipolar energy to the tissue. However, in B1, a discrepancy occurs where the monopolar impedance (Z _monopolar ) drops unexpectedly or drops disproportionately to the bipolar impedance (Z _bipolar ), indicating potential off-site thermal damage. In at least one example, the control circuit 1809 monitors the change in the ratio of the monopolar impedance to the bipolar impedance (Z _monopolar /Z _bipolar ) and detects off-site thermal damage when the change persists for a predetermined amount of time and/or a change in value below the lower threshold of the predetermined range 2031. In B1, since the detected impedance ratio 2030 is still within the predetermined range 2031, the control circuit 3101 simply issues a warning via the feedback system 3109 that off-site thermal damage has been detected and continues to monitor the impedance ratio 2030.

At t3', the control circuit 3101 further detects that the impedance ratio 2030 has changed to a value below the lower threshold of the predetermined range 2031. In response, the control circuit 3101 may issue another warning and, optionally, may instruct the user to pause energy delivery to the tissue at B2 or automatically pause energy delivery while maintaining or adjusting the power level of the bipolar energy to complete the tissue seal without monopolar energy. In a particular example, the control circuit 1809 further instructs the user to transcribe the tissue using a mechanical knife (t4') to avoid further off-site thermal damage. In the illustrated example, the control circuit 1809 further instructs the generator 1880 to adjust its power level to complete the tissue seal without monopolar energy and to increase the time period allotted to the tissue sealing segment from time t4 to time t4'. In other words, the control circuit 1809 increases the bipolar energy delivery to the tissue to compensate for the loss of monopolar energy by increasing the bipolar power level and its delivery time.

Various aspects of the subject matter described herein are illustrated in the following examples.

Various aspects of the subject matter described herein are illustrated in the following examples.

Example Set 1
Example 1 - A surgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw comprises a constricting body extending from a proximal end to a distal end. The constricting body comprises a conductive material. The constricting body comprises a first conductive portion extending from the proximal end to the distal end and a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the constricting body. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion in a cross section of the constricting body. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first conductive portion but not the second conductive portion from tissue, the first conductive portion being configured to transfer electrical energy to the tissue only through the second conductive portion.

Example 2 - An electrosurgical instrument as described in Example 1, in which the tapered electrode has an outer surface flush with the outer surface of the electrically insulating layer.

Example 3 - An electrosurgical instrument as described in Example 1 or 2, wherein the tapered electrode has a width that gradually narrows as the tapered electrode extends from the proximal end toward the distal end.

Example 4 - An electrosurgical instrument as described in Examples 1, 2, or 3, in which electrical energy is delivered to tissue through the outer surface of the tapered electrode.

Example 5 - The electrosurgical instrument of Examples 1, 2, 3, or 4, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, and the tapered electrode is a second electrode, and the first electrode is laterally offset from the second electrode in the closed configuration.

Example 6 - The electrosurgical instrument of Example 5, wherein the second jaw further comprises a third electrode spaced from the narrowing body.

Example 7 - The electrosurgical instrument of Example 6, wherein the third electrode extends distally from the electrode proximal end to the electrode distal end along an oblique profile defined by the second jaw.

Example 8 - The electrosurgical instrument of Example 7, wherein the third electrode has a base positioned within the cradle that extends distally from the cradle proximal end to the cradle distal end along the oblique profile of the second jaw.

Example 9 - An electrosurgical instrument as described in Example 8, wherein the cradle is centrally located relative to the lateral edge of the second jaw.

Example 10 - The electrosurgical instrument of Examples 8 or 9, wherein the third electrode further comprises a tapered edge extending from the base beyond the side wall of the cradle.

Example 11 - A surgical instrument as described in Example 8, 9, or 10, wherein the cradle is constructed from a flexible substrate.

Example 12 - An electrosurgical instrument as described in Examples 8, 9, 10, or 11, wherein the cradle is partially embedded in a valley defined in the gradually narrowing body.

Example 13 - An electrosurgical instrument as described in Examples 8, 9, 10, 11, or 12, wherein the cradle is spaced from the narrowing body by an electrically insulating coating.

Example 14 - The electrosurgical instrument of Examples 8, 9, 10, 11, 12, or 13, wherein the base comprises a proximal base end, a distal base end, and a width that gradually narrows as the base extends along the oblique profile from the proximal base end to the distal base end.

Example 15 - A surgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw comprises a conductive body comprising a tapered oblique profile extending from a proximal end to a distal end. The conductive body comprises a first conductive portion extending from the proximal end to the distal end and a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the conductive body. The second conductive portion is integral with the first conductive portion. The first conductive portion is thicker than the second conductive portion. The second jaw further comprises an electrically insulating layer configured to electrically insulate the first conductive portion from tissue, but not the second conductive portion. The first conductive portion is configured to transmit electrical energy to the tissue only through the second conductive portion.

Example 16 - The electrosurgical instrument of Example 15, wherein the tapered electrode has a width that gradually narrows as the tapered electrode extends from the proximal end toward the distal end.

Example 17 - The electrosurgical instrument of example 15 or 16, wherein the first jaw comprises a first electrode extending distally along at least a portion of the first jaw, the tapered electrode is the second electrode, and the first electrode is laterally offset from the second electrode in the closed configuration.

Example 18 - The electrosurgical instrument of Examples 15, 16, and 17, wherein the second jaw further comprises a third electrode spaced apart from the conductive body.

Example 19 - The electrosurgical instrument of Example 18, wherein the third electrode extends distally along at least a portion of the tapered oblique profile.

Example 20 - The electrosurgical instrument of Example 19, wherein the third electrode has a base positioned within the cradle that extends distally from the cradle proximal end to the cradle distal end along at least a portion of the tapered oblique profile, and the cradle is constructed from a flexible substrate.

Example Set 2
Example 1 - A surgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw comprises linear portions that cooperate to form an oblique profile and a treatment surface comprising segments extending along the oblique profile. The segments include different geometric shapes and different electrical conductivities. The segments are configured to generate a variable energy density along the treatment surface.

Example 2 - The electrosurgical instrument of Example 1, wherein the segments include a proximal segment and a distal segment. The proximal segment includes a first surface area. The distal segment includes a second surface area. The second surface area is less than the first surface area.

Example 3 - An electrosurgical instrument as described in Example 1 or 2, wherein at least one of the segments includes a conductive treatment region interrupted longitudinally by a non-conductive treatment region.

Example 4 - An electrosurgical instrument as described in Examples 1, 2, or 3, in which the variable energy density is predetermined based on the selection of different geometric shapes and different electrical conductivities of the segments.

Example 5 - The electrosurgical instrument of Examples 1, 2, 3, or 4, wherein at least one of the segments includes a gradually narrowing width along its length.

Example 6 - An electrosurgical instrument as described in Examples 1, 2, 3, 4, or 5, wherein the segment extends along a peripheral side of the second jaw.

Example 7 - An electrosurgical instrument as described in Examples 1, 2, 3, 4, 5, or 6, wherein a segment is defined in the second jaw and not in the first jaw.

Example 8 - The electrosurgical instrument of Example 1, 2, 3, 4, 5, 6, or 7, wherein the second jaw comprises an electrically conductive skeleton partially coated with a first material and a second material, the first material being thermally conductive but electrically insulating, and the second material being both thermally and electrically insulating.

Example 9 - An electrosurgical instrument as described in Example 8, wherein the first material comprises diamond-like carbon.

Example 10 - An electrosurgical instrument as described in Example 8 or 9, wherein the second material comprises polytetrafluoroethylene.

Example 11 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw comprises a tapered body extending from a proximal end to a distal end. The tapered body comprises a tissue contacting surface. The tissue contacting surface comprises an insulating layer comprising a first material. The insulating layer extends on either side of an intermediate area extending along a length of the tapered body. The tissue contacting surface further comprises segments configured to provide a variable energy density along the tissue contacting surface. The segments comprise conductive segments and insulating segments alternating with the conductive segments along the intermediate area. The insulating segments comprise a second material different from the first material.

Example 12 - The electrosurgical instrument of Example 11, wherein the conductive segment includes a proximal segment and a distal segment. The proximal segment includes a first surface area. The distal segment includes a second surface area. The second surface area is less than the first surface area.

Example 13 - An electrosurgical instrument as described in Example 11 or 12, wherein the second jaw includes an electrically conductive skeleton partially coated with the first material.

Example 14 - An electrosurgical instrument as described in Example 13, wherein the electrically conductive skeleton comprises an inner thermally insulative core and an outer thermally conductive layer at least partially surrounding the inner thermally insulative core.

Example 15 - The electrosurgical instrument of Examples 11, 12, 13, or 14, wherein the variable energy density is predetermined based on the selection of different geometric shapes and different electrical conductivities of the conductive segments.

Example 16 - The electrosurgical instrument of Examples 11, 12, 13, 14, or 15, wherein at least one of the segments includes a gradually narrowing width along its length.

Example 17 - An electrosurgical instrument as described in Examples 11, 12, 13, 14, 15, or 16, wherein the segment extends along a peripheral side of the second jaw.

Example 18 - An electrosurgical instrument as described in Examples 11, 12, 13, 14, 15, 16, or 17, wherein the segment is defined in the second jaw and not in the first jaw.

Example 19 - The electrosurgical instrument of Examples 11, 12, 13, 14, 15, 16, 17, or 18, wherein the first material comprises diamond-like carbon.

Example 20 - The electrosurgical instrument of Example 11, 12, 13, 14, 15, 16, 17, 18, or 19, wherein the second material comprises polytetrafluoroethylene.

Example Set 3
Example 1 - An electrosurgical instrument with an end effector. The end effector includes a first jaw, a second jaw, and an electrical circuit. The first jaw includes a first electrically conductive skeleton, a first insulative coating selectively covering portions of the first electrically conductive skeleton, and a first jaw electrode including an exposed portion of the first electrically conductive skeleton. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw includes a second electrically conductive skeleton, a second insulative coating selectively covering portions of the second electrically conductive skeleton, and a second jaw electrode including an exposed portion of the second electrically conductive skeleton. The electrical circuit is configured to transmit bipolar and monopolar RF energy to tissue through the first and second jaw electrodes. The monopolar RF energy shares the first electrical pathway and the second electrical pathway defined by the electrical circuit for transmitting the bipolar RF energy.

Example 2 - An electrosurgical instrument as described in Example 1, in which the electrical circuit defines a third electrical path separate from the first electrical path and the second electrical path.

Example 3 - An electrosurgical instrument as described in Example 1 or 2, wherein the end effector includes a cutting electrode that is electrically isolated from the first electrically conductive skeleton and the second electrically conductive skeleton.

Example 4 - The electrosurgical instrument of Example 3, wherein the cutting electrode is configured to receive cutting monopolar RF energy through a third electrical pathway.

Example 5 - An electrosurgical instrument as described in Example 4, wherein the cutting electrode is configured to cut tissue with cutting monopolar RF energy after coagulation of the tissue has been initiated with bipolar RF energy.

Example 6 - An electrosurgical instrument as described in Examples 3, 4, or 5, wherein the cutting electrode is centrally located in one of the first jaw and the second jaw.

Example 7 - An electrosurgical instrument as described in Example 4 or 5, wherein the end effector is configured to simultaneously deliver cutting monopolar RF energy and bipolar RF energy to tissue.

Example 8 - An electrosurgical instrument as described in Example 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw electrode includes a first distal tip electrode and the second jaw electrode includes a second distal tip electrode.

Example 9 - The electrosurgical instrument of Example 8, wherein the first electrically conductive skeleton and the second electrically conductive skeleton are simultaneously energized to deliver monopolar RF energy to the tissue surface through the first distal tip electrode and the second distal tip electrode.

Example 10 - The electrosurgical instrument of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the second jaw includes a cutting electrode extending along a peripheral surface of the second jaw.

Example 11 - An electrosurgical instrument comprising an end effector and an electrical circuit. The end effector comprises at least two electrode sets, a first jaw, and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The end effector is configured to deliver a combination of bipolar and monopolar RF energy from the at least two electrode sets to the grasped tissue. The electrical circuit is configured to transmit the bipolar and monopolar RF energy. The monopolar RF energy shares an active path and a return path defined by the electrical circuit for transmitting the bipolar RF energy.

Example 12 - An electrosurgical instrument as described in Example 11, wherein at least two electrode sets include three electrical interconnects that are used together in an electrical circuit.

Example 13 - An electrosurgical instrument as described in Example 11 or 12, wherein at least two electrode sets include three electrical interconnects that define at least a portion of an electrical circuit and another separate electrical circuit.

Example 14 - An electrosurgical instrument as described in Example 13, in which separate electrical circuits are connected to the cutting electrodes of at least two electrode sets, the cutting electrodes being isolated and centrally located in one of the first jaw and the second jaw.

Example 15 - The electrosurgical instrument of Example 14, wherein the cutting electrode is configured to cut tissue after coagulation of the tissue has been initiated using the second and third electrodes of the at least two electrode sets.

Example 16 - An electrosurgical instrument as described in Example 14 or 15, wherein at least two electrode sets are configured to simultaneously deliver monopolar RF energy and bipolar RF energy to tissue.

Example 17 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw includes a composite skeleton of at least two different materials configured to selectively produce electrically conductive portions and thermally conductive portions.

Example 18 - An electrosurgical instrument as described in Example 17, wherein the composite skeleton comprises a titanium ceramic composite.

Example 19 - An electrosurgical instrument as described in Example 17 or 18, wherein the composite skeleton includes a ceramic base and a titanium crown that can be attached to the ceramic base.

Example 20 - An electrosurgical instrument as described in Examples 17, 18, or 19, wherein the composite skeleton is at least partially coated with an electrically insulating material.

Example 21 - A method for manufacturing a jaw of an end effector of an electrosurgical instrument. The method includes preparing a composite skeleton of the jaw by fusing titanium powder with a ceramic powder in a metal injection molding process and selectively coating the composite skeleton with an electrically insulating material to produce a plurality of electrodes.

Example Set 4
Example 1 - An electrosurgical instrument comprising a first jaw and a second jaw. The first jaw is configured to define a first electrode. The first jaw comprises a first electrically conductive skeleton and a first electrically insulative layer. The first electrically conductive skeleton comprises a first thermally insulative core and a first thermally conductive outer layer integral with and extending at least partially around the first thermally insulative core. The first electrode is defined by selectively applying a first electrically insulative layer to an outer surface of the first thermally conductive outer layer. The second jaw is configured to define a second electrode. The second jaw comprises a second electrically conductive skeleton and a second electrically insulative layer. The second electrically conductive skeleton comprises a second thermally insulative core and a second thermally conductive outer layer integral with and extending at least partially around the second thermally insulative core, The second electrode is defined by selectively applying a second electrically insulative layer to an outer surface of the second thermally conductive outer layer.

Example 2 - The electrosurgical instrument of Example 1, wherein the first electrode is configured to transmit RF energy to the second electrode through tissue positioned therebetween in a bipolar energy mode of operation.

Example 3 - An electrosurgical instrument as described in Example 1 or 2, wherein the first thermally insulating core includes an air pocket.

Example 4 - An electrosurgical instrument as described in Examples 1, 2, or 3, wherein the first thermally insulating core has a lattice structure.

Example 5 - The electrosurgical instrument of Examples 1, 2, 3, or 4, wherein the second jaw includes a third electrode, the third electrode being defined by selectively applying a second electrically insulating layer to the outer surface of the second thermally conductive outer layer.

Example 6 - The electrosurgical instrument of Example 5, wherein the third electrode is configured to deliver RF energy to tissue in contact with the third electrode in a monopolar energy mode of operation.

Example 7 - An electrosurgical instrument as described in Example 1, 2, 3, 4, 5, or 6, wherein at least one of the first electrically insulating layer and the second electrically insulating layer comprises a diamond-like material.

Example 8 - An electrosurgical instrument as described in Examples 1, 2, 3, 4, 5, 6, or 7, wherein the first jaw has a tissue contacting surface and the first thermally insulating core has a lattice structure including upstanding walls transverse to the tissue contacting surface.

Example 9 - An electrosurgical instrument as described in Example 8, wherein the direction is perpendicular to the tissue contacting surface.

Example 10 - An electrosurgical instrument comprising a jaw configured to define an electrode. The jaw comprises a first electrically conductive portion, a second electrically conductive portion, and an electrically insulative layer. The first electrically conductive portion is configured to resist heat transfer therethrough. The second electrically conductive portion is integral with and extends at least partially around the first electrically conductive portion. The second electrically conductive portion is configured to define a heat sink. The electrode is defined by selectively applying an electrically insulative layer to an outer surface of the second electrically conductive portion.

Example 11 - The electrosurgical instrument of Example 10, wherein the electrode is configured to transmit RF energy to tissue positioned against the electrode.

Example 12 - An electrosurgical instrument as described in Example 10 or 11, wherein the first electrically conductive portion includes an air pocket.

Example 13 - An electrosurgical instrument as described in Examples 10, 11, or 12, wherein the first electrically conductive portion has a lattice structure.

Example 14 - An electrosurgical instrument as described in Example 10, 11, 12, or 13, wherein the electrically insulating layer comprises a diamond-like material.

Example 15 - An electrosurgical instrument as described in Examples 10, 11, 12, 13, or 14, wherein the first jaw has a tissue contacting surface and the first electrically conductive portion has a lattice structure including upstanding walls transverse to the tissue contacting surface.

Example 16 - An electrosurgical instrument as described in Example 15, wherein the direction is perpendicular to the tissue contacting surface.

Example 17 - An electrosurgical instrument comprising a jaw configured to define an electrode. The jaw comprises an electrically conductive skeleton and an electrically insulating layer. The electrically conductive skeleton comprises a thermally insulating core and a thermally conductive outer layer integral with and extending at least partially around the thermally insulating core. The electrode is defined by selectively applying the electrically insulating layer to an outer surface of the thermally conductive outer layer.

Example 18 - An electrosurgical instrument as described in Example 17, wherein the thermally insulating core has a lattice structure.

Example 19 - An electrosurgical instrument as described in Example 18, wherein the jaws have a tissue contacting surface and the lattice structure includes upstanding walls transverse to the tissue contacting surface.

Example 20 - An electrosurgical instrument as described in Example 19, wherein the direction is perpendicular to the tissue contacting surface.

Example Set 5
Example 1 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw comprises a second electrode configured to deliver a first monopolar energy to tissue, a third electrode, and a conductive circuit selectively transitionable between a connected configuration with the third electrode and a disconnected configuration with the third electrode. In the connected configuration, the third electrode is configured to cooperate with the first electrode to deliver bipolar energy to the tissue. The conductive circuit defines a return path for the bipolar energy. In the disconnected configuration, the first electrode is configured to deliver a second monopolar energy to the tissue.

Example 2 - The electrosurgical instrument of Example 1, further comprising a switching mechanism for alternating between a connected configuration and a non-connected configuration.

Example 3 - The electrosurgical instrument of Example 1 or 2, further comprising a switching mechanism for alternating between delivery of bipolar energy and delivery of a second monopolar energy to the tissue through the first electrode.

Example 4 - An electrosurgical instrument as described in Examples 1, 2 or 3, wherein the end effector is configured to simultaneously deliver monopolar energy and first monopolar energy to tissue.

Example 5 - An electrosurgical instrument as described in Examples 1, 2, 3, or 4, wherein the end effector is configured to deliver an energy blend of monopolar energy and a first monopolar energy to tissue.

Example 6 - The electrosurgical instrument of Example 5, wherein the levels of bipolar energy and first monopolar energy in the energy blend are determined based on at least one reading of a temperature sensor indicative of at least one temperature of the tissue.

Example 7 - An electrosurgical instrument as described in Example 5 or 6, wherein the levels of bipolar energy and first monopolar energy in the energy blend are determined based on at least one reading of an impedance sensor indicative of at least one impedance of tissue.

Example 8 - An electrosurgical instrument as described in Examples 5, 6, or 7, wherein the levels of bipolar energy and first monopolar energy in the energy blend are adjusted to reduce lateral thermal damage detected beyond the tissue treatment area between the first and second jaws.

Example 9 - An electrosurgical instrument comprising an end effector and a control circuit. The end effector comprises a first jaw, a second jaw, and at least one sensor. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The second jaw comprises a second electrode configured to deliver monopolar energy to the tissue and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuit is configured to execute a predetermined power scheme to seal and cut tissue in a tissue treatment cycle. The power scheme includes predetermined power levels of the monopolar energy and the bipolar energy. The control circuit is further configured to adjust at least one of the predetermined power levels of the monopolar energy and the bipolar energy based on readings of the at least one sensor in a tissue treatment cycle.

Example 10 - The electrosurgical instrument of Example 9, wherein the predetermined power scheme includes simultaneous and separate application of bipolar and monopolar energy to tissue during a tissue treatment cycle.

Example 11 - An electrosurgical instrument as described in Example 9 or 10, wherein the predetermined power scheme includes applying bipolar energy but not monopolar energy to the tissue during a feathering segment of the tissue treatment cycle, and simultaneously applying bipolar and monopolar energy to the tissue during a tissue warming segment and a tissue sealing segment of the tissue treatment cycle.

Example 12 - The electrosurgical instrument of Example 11, wherein the power scheme further includes applying monopolar energy, but not bipolar energy, to the tissue during the tissue transection segment of the tissue treatment cycle.

Example 13 - An electrosurgical instrument as described in Examples 9, 10, 11, or 12, wherein at least one sensor includes an impedance sensor.

Example 14 - An electrosurgical instrument as described in Example 13, wherein the control circuit is configured to monitor an impedance ratio between monopolar tissue impedance and bipolar tissue impedance based on readings from the impedance sensor.

Example 15 - An electrosurgical instrument as described in Example 14, in which a change in impedance ratio within a predetermined range causes the control circuit to issue an alarm.

Example 16 - The electrosurgical instrument of Example 15, wherein a change in impedance ratio below a lower threshold of a predetermined range causes the control circuit to adjust the predetermined power scheme.

Example 17 - An electrosurgical instrument as described in Example 15 or 16, wherein a change in the impedance ratio below a lower threshold of a predetermined range causes the control circuit to suspend application of monopolar energy to the tissue.

Example 18 - The electrosurgical instrument of Example 17, wherein a change in the impedance ratio below a lower threshold of the predetermined range further causes the control circuit to adjust the application of bipolar energy to the tissue to complete the tissue seal.

Example 19 - An electrosurgical instrument comprising an end effector and a control circuit. The end effector comprises a first jaw and a second jaw. The first jaw comprises a first electrode. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The tissue is at a target site. The second jaw comprises a second electrode configured to deliver monopolar energy to the tissue and a third electrode configured to cooperate with the first electrode to deliver bipolar energy. The control circuit is configured to execute a predetermined power scheme to seal and cut the tissue in a tissue treatment cycle. The power scheme includes predetermined power levels of the monopolar energy and the bipolar energy. The control circuit is further configured to detect energy diversion from the target site and adjust at least one of the predetermined power level of the monopolar energy and the predetermined power level of the bipolar energy to mitigate the energy diversion.

Example 20 - The electrosurgical instrument of Example 19, wherein the predetermined power scheme includes simultaneous and separate application of bipolar and monopolar energy to tissue during a tissue treatment cycle.

Example 21 - An electrosurgical instrument as described in Example 19 or 20, wherein the predetermined power scheme includes applying bipolar energy but not monopolar energy to the tissue during a feathering segment of the tissue treatment cycle, and simultaneously applying bipolar and monopolar energy to the tissue during a tissue heating segment and a tissue sealing segment of the tissue treatment cycle.

Example Set 6
Example 1 - An electrosurgical system comprising an end effector and a control circuit. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The control circuit is configured to simultaneously and separately apply two different energy modalities to tissue during a tissue treatment cycle including a tissue coagulation stage and a tissue transection stage.

Example 2 - An electrosurgical system as described in Example 1, wherein the first energy modality is a monopolar energy modality.

Example 3 - An electrosurgical system as described in Example 2, wherein the second energy modality is a bipolar energy modality.

Example 4 - An electrosurgical system as described in Example 2 or 3, wherein the control circuit is configured to initiate application of a monopolar energy modality to tissue prior to completion of a tissue coagulation stage with a bipolar energy modality.

Example 5 - An electrosurgical system as described in Example 2 or 3, wherein the control circuit is configured to initiate application of a monopolar energy modality to the tissue prior to cessation of the bipolar energy modality to the tissue.

Example 6 - An electrosurgical system as described in Examples 3, 4, or 5, wherein the control circuitry is configured to cause simultaneous application of monopolar and bipolar energy modalities to tissue during a tissue coagulation stage.

Example 7 - An electrosurgical system as described in Examples 1, 2, 3, 4, 5, or 6, wherein the control circuit includes a processor and a storage medium, and the application of the two different energy modalities to the tissue is based on a default power scheme stored in the storage medium.

Example 8 - The electrosurgical system of Example 7, further comprising at least one sensor, and the control circuitry configured to modify the default power scheme based on one or more sensor readings of the at least one sensor.

Example 9 - An electrosurgical instrument comprising an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The end effector is configured to apply three different energy modalities to tissue during a tissue treatment cycle that includes a tissue coagulation stage and a tissue transection stage.

Example 10 - An electrosurgical instrument as described in Example 9, wherein the first energy modality includes bipolar energy.

Example 11 - The electrosurgical instrument of Example 10, wherein the second energy modality includes an energy blend of monopolar and bipolar energy.

Example 12 - An electrosurgical instrument as described in Example 11, wherein the third energy modality includes monopolar energy but does not include bipolar energy.

Example 13 - An electrosurgical instrument as described in Example 11 or 12, wherein initiation of application of monopolar energy to tissue is configured to commence prior to completion of the tissue coagulation stage.

Example 14 - An electrosurgical instrument as described in Example 12 or 13, wherein initiation of application of monopolar energy to tissue is configured to commence before cessation of application of a bipolar energy modality to the tissue.

Example 15 - The electrosurgical instrument of Examples 9, 10, 11, 12, 13, or 14, further comprising a control circuit, the control circuit including a processor and a storage medium, and the application of the two different energy modalities to the tissue is based on a default power scheme stored in the storage medium.

Example 16 - The electrosurgical instrument of Example 15, further comprising at least one sensor, and the control circuitry configured to adjust the default power scheme during a tissue treatment cycle based on one or more sensor readings of the at least one sensor.

Example 17 - An electrosurgical system comprising a first generator configured to output bipolar energy, a second generator configured to output monopolar energy, a surgical instrument electrically coupled to the first and second generators, and a control circuit. The surgical instrument comprises an end effector. The end effector comprises a first jaw and a second jaw. At least one of the first and second jaws is movable relative to one another to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The control circuit comprises a processor and a storage medium including program instructions that, when executed by the processor, cause the processor to cause the first and second generators to apply a predetermined power scheme to the end effector. The power scheme includes simultaneous and separate application of monopolar and bipolar energy to tissue in a tissue treatment cycle.

Example 18 - The electrosurgical system of Example 17, further comprising at least one sensor, and the control circuitry configured to adjust the power scheme during a treatment cycle based on one or more sensor readings of the at least one sensor.

Example 19 - An electrosurgical system as described in Examples 17 or 18, wherein the power scheme includes applying bipolar energy but not monopolar energy to the tissue during the feathering segment of the tissue treatment cycle, and simultaneously applying bipolar and monopolar energy to the tissue during the tissue warming and tissue sealing segments of the tissue treatment cycle.

Example 20 - The electrosurgical system of Examples 17, 18, and 19, wherein the power scheme further includes applying monopolar energy, but not bipolar energy, to the tissue during the tissue transection segment of the tissue treatment cycle.

While several embodiments have been shown and described, it is not the intention of the applicant to restrict or limit the scope of the appended claims to such details. Numerous modifications, variations, changes, substitutions, combinations, and equivalents of these embodiments can be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Furthermore, the structure of each element associated with the described embodiments can alternatively be described as a means for providing the function performed by that element. Also, although materials are disclosed with respect to specific components, other materials may be used. It is therefore to be understood that the above description and the appended claims are intended to cover all such modifications, combinations, and variations as falling within the scope of the disclosed embodiments. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

The above detailed description has described various aspects of the apparatus and/or processes using block diagrams, flow diagrams and/or examples. To the extent that such block diagrams, flow diagrams and/or examples include one or more functions and/or operations, it should be understood by one of ordinary skill in the art that each function and/or operation included in such block diagrams, flow diagrams and/or examples can be implemented individually and/or collectively by a variety of hardware, software, firmware, or virtually any combination thereof. It will be understood by one of ordinary skill in the art that some aspects of the embodiments disclosed herein, in whole or in part, can be equivalently implemented on an integrated circuit as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing circuitry and/or writing software and/or firmware code is within the skill of one of ordinary skill in the art in view of the present disclosure. In addition, those skilled in the art will appreciate that the subject matter described herein may be distributed as one or more program products in a variety of forms, and that the specific form of the subject matter described herein applies regardless of the particular type of signal-bearing medium used to actually effect the distribution.

The instructions used to program the logic to implement the various disclosed aspects may be stored in a system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Additionally, the instructions may be distributed over a network or by other computer-readable media. Thus, a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to floppy diskettes, optical disks, compact disks, read-only memories (CD-ROMs), as well as magneto-optical disks, read-only memories (ROMs), random access memories (RAMs), erasable programmable read-only memories (EPROMs), electrically erasable programmable read-only memories (EEPROMs), magnetic or optical cards, flash memories, or tangible machine-readable storage used to transmit information over the Internet via electrical, optical, acoustic, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Thus, non-transitory computer-readable media includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).

As used in any aspect of this specification, the term "control circuitry" may refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor including one or more individual instruction processing cores, a processing unit, a processor, a microcontroller, a microcontroller unit, a controller, a digital signal processor (DSP), a programmable logic device (PLD), a programmable logic array (PLA), or a field programmable gate array (FPGA)), a state machine circuit, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuitry may be embodied, collectively or individually, as a circuit that forms part of a larger system, such as, for example, an integrated circuit (IC), an application specific integrated circuit (ASIC), a system on a chip (SoC), a desktop computer, a laptop computer, a tablet computer, a server, a smartphone, etc. Thus, as used herein, "control circuitry" includes, but is not limited to, electrical circuits having at least one discrete electrical circuit, electrical circuits having at least one integrated circuit, electrical circuits having at least one application specific integrated circuit, electrical circuits forming a general purpose computing device configured by a computer program (e.g., a general purpose computer configured by a computer program to at least partially execute the processes and/or devices described herein, or a microprocessor configured by a computer program to at least partially execute the processes and/or devices described herein), electrical circuits forming a memory device (e.g., a form of random access memory) and/or electrical circuits forming a communication device (e.g., a modem, a communication switch, or an optical-electrical facility). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital form, or some combination thereof.

As used in any aspect of this specification, the term "logic" may refer to an application, software, firmware, and/or circuitry configured to perform any of the operations described above. Software may be embodied as a software package, code, instructions, instruction sets, and/or data recorded on a non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions, or instruction sets in a memory device, and/or hard-coded (e.g., non-volatile) data.

When used in any aspect of this specification, the terms "component," "system," "module," etc. may refer to a computer-related entity that is either hardware, a combination of hardware and software, software, or software in execution.

As used in any aspect of this specification, an "algorithm" refers to a self-consistent sequence of steps leading to a desired result, and the "steps" refer to manipulations of physical quantities and/or logical states, which may, but need not, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common practice to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities or are merely convenient labels applied to these quantities and/or states.

The network may include a packet-switched network. The communication devices may communicate with each other using a selected packet-switched network communication protocol. One exemplary communication protocol may include an Ethernet communication protocol that may enable communication using Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard entitled "IEEE 802.3 Standard" issued December 2008 by the Institute of Electrical and Electronics Engineers (IEEE), and/or later versions of this standard. Alternatively or additionally, the communication devices may communicate with each other using the X.25 communication protocol. The T.25 communication protocol may conform to or be compatible with standards promulgated by the International Telecommunications Union-Telecommunications Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may communicate with each other using a frame relay communication protocol. The frame relay communication protocol may conform to or be compatible with standards promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an asynchronous transfer mode (ATM) communication protocol. The ATM communications protocol may conform to or be compatible with the ATM standard published by the ATM Forum in August 2001, entitled "ATM-MPLS Network Interworking 2.0," and/or any later version of this standard. Of course, different and/or later developed connection-oriented network communications protocols are equally contemplated herein.

Unless expressly specified otherwise, as will be apparent from the foregoing disclosure, discussions throughout the foregoing disclosure using terms such as "processing," "computing," "calculating," "determining," "displaying," and the like will be understood to refer to the actions and processing of a computer system or similar electronic computing device that manipulates and transforms data represented as physical (electronic) quantities in the registers and memory of the computer system into other data similarly represented as physical quantities in the memory or registers of the computer system or other such information storage, transmission, or display devices.

One or more components may be referred to herein as being "configured to," "configurable to," "operable/operative to," "adapted/adaptable," "able to," "conformable/conformed to," and the like. Those skilled in the art will understand that "configured to" may generally encompass active and/or inactive and/or standby components, unless the context requires otherwise.

The terms "proximal" and "distal" are used herein with reference to a clinician manipulating a handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion located away from the clinician. It will be further understood that for convenience and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Those skilled in the art will understand that the terms used herein in general, and in the appended claims in particular (e.g., the body of the appended claims) are generally intended as "open" terms (e.g., the term "including" should be interpreted as "including but not limited to", the term "having" should be interpreted as "having at least", the term "includes" should be interpreted as "includes but is not limited to", etc.). Furthermore, those skilled in the art will understand that where a specific number is intended in an introduced claim recitation, such intent is clearly set forth in the claim, and in the absence of such a recitation, no such intent exists. For example, as an aid to understanding, the appended claims may include the introductory phrases "at least one" and "one or more" to introduce the claim recitation. However, the use of such phrases should not be construed as implying that when a claim recitation is introduced by the indefinite article "a" or "an," any particular claim containing such an introduced claim recitation is limited to claims containing only one such recitation, even if the same claim contains an introductory phrase such as "one or more" or "at least one" and the indefinite article "a" or "an" (e.g., "a" and/or "an" should generally be construed to mean "at least one" or "one or more"). The same applies when a definite article is used to introduce a claim recitation.

In addition, those skilled in the art will recognize that even when a specific number is specified in an introduced claim description, such a description should typically be interpreted to mean at least the number recited (e.g., a description of just "two items" without other qualifiers generally means at least two items, or two or more items). Furthermore, when a notation similar to "at least one of A, B, and C, etc." is used, such syntax is generally intended in the sense that a person skilled in the art would understand the notation (e.g., "a system having at least one of A, B, and C" includes, but is not limited to, systems having only A, only B, only C, both A and B, both A and C, both B and C, and/or all of A, B, and C, etc.). When a notation similar to "at least one of A, B, or C, etc." is used, such syntax is generally intended in the sense that one of ordinary skill in the art would understand the notation (e.g., "a system having at least one of A, B, or C" includes, but is not limited to, systems having only A, only B, only C, both A and B, both A and C, both B and C, and/or all of A, B, and C, etc.). Furthermore, one of ordinary skill in the art will understand that any disjunctive word and/or phrase expressing two or more alternative terms should typically be understood to contemplate the possibility of including one of those terms, either of those terms, or both of those terms, unless the context requires otherwise, whether in the specification, claims, or drawings. For example, the phrase "A or B" will typically be understood to include the possibility of "A" or "B" or "A and B."

With respect to the appended claims, one of ordinary skill in the art will appreciate that the recited operations herein may generally be performed in any order. Also, while flow diagrams of various operations are shown in a sequence, it should be understood that the various operations may be performed in orders other than those shown, or may be performed simultaneously. Examples of such alternative orderings may include overlapping, interleaving, interrupting, reordering, incremental, preliminary, additional, simultaneous, reverse, or other different orderings, unless the context requires otherwise. Moreover, terms such as "responsive to," "related to," or other past tense adjectives are generally not intended to exclude such variations, unless the context requires otherwise.

It is worth noting that any reference to "one embodiment," "an embodiment," "an example," "an example," or the like means that a particular feature, structure, or characteristic described in connection with that embodiment is included in at least one embodiment. Thus, the appearances of the phrases "in one embodiment," "in an embodiment," "in an example," and "in one example" in various places throughout this specification do not necessarily all refer to the same embodiment. Furthermore, particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.

As used herein, unless otherwise indicated, the term "about" or "approximately" as used in this disclosure refers to an acceptable error for a particular value as determined by one of ordinary skill in the art, which depends in part on how the value is measured or determined. In certain embodiments, the term "about" or "approximately" means within 1, 2, 3, or 4 standard deviations. In certain embodiments, the term "about" or "approximately" means within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.05% of a given value or range.

In this specification, unless otherwise indicated, all numerical parameters should be understood in all instances to be preceded and modified by the word "about," and such numerical parameters have the inherent variability characteristic of the underlying measurement method used to determine the numerical value of the parameter. At the very least, no attempt should be made to limit the application of the doctrine of equivalents to the scope of the claims, and each numerical parameter set forth herein should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques.

Any numerical range described herein includes all subranges subsumed within the described range. For example, the range "1 to 10" includes all subranges between (and including) the stated minimum of 1 and the stated maximum of 10, i.e., all subranges having a minimum of 1 or more and a maximum of 10 or less. Also, all ranges recited herein include the recited range endpoints. For example, the range "1 to 10" includes the endpoints 1 and 10. Every maximum numerical limit recited herein is intended to include all lower numerical limits subsumed therein, and every minimum numerical limit recited herein is intended to include all higher numerical limits subsumed therein. Accordingly, applicants reserve the right to amend this specification, including the claims, to include any expressly recited subranges subsumed within the expressly recited ranges. All such ranges are inherently recited herein.

Any patent application, patent, non-patent publication, or other disclosure material referenced herein and/or listed in any Application Data Sheet is incorporated herein by reference to the extent that the incorporated material is not inconsistent with this specification. As such, and to the extent necessary, the disclosure material explicitly set forth in this specification shall take precedence over any conflicting statements incorporated herein by reference. Any material, or portions thereof, that is referred to as being incorporated herein by reference but that conflicts with current definitions, views, or other disclosure material set forth herein shall be incorporated only to the extent that no conflict arises between the incorporated material and the current disclosure material.

In summary, many benefits have been described that result from using the concepts described herein. The foregoing description of one or more embodiments has been presented for purposes of illustration and description. It is not intended to be exhaustive or to be limited to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more embodiments have been selected and described to illustrate the principles and practical applications, thereby enabling those skilled in the art to utilize the various embodiments, with various modifications, as suitable for the particular use contemplated. It is intended that the claims presented herewith define the overall scope.

[Embodiment]
(1) An electrosurgical instrument comprising:
An end effector,
The first Joe,
a second jaw, at least one of the first jaw and the second jaw being movable to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween, the second jaw comprising:
a narrowing body extending from a proximal end to a distal end, the narrowing body comprising an electrically conductive material;
a first conductive portion extending from the proximal end to the distal end;
a converging body comprising: a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the converging body, the second conductive portion being integral with the first conductive portion, the first conductive portion being thicker in a transverse cross-section of the converging body than the second conductive portion;
an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue but not the second conductive portion, the first conductive portion being configured to transmit electrical energy to the tissue only through the second conductive portion; and a second jaw comprising an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue but not the second conductive portion, the first conductive portion being configured to transmit electrical energy to the tissue only through the second conductive portion.
2. The electrosurgical instrument of claim 1, wherein the tapered electrode includes an outer surface flush with an outer surface of the electrically insulating layer.
3. The electrosurgical instrument of claim 1, wherein the tapered electrode comprises a width that gradually narrows as the tapered electrode extends from the proximal end toward the distal end.
4. The electrosurgical instrument of claim 1, wherein the electrical energy is delivered to the tissue through an outer surface of the tapered electrode.
5. The electrosurgical instrument of claim 1, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, the tapered electrode being a second electrode, the first electrode being laterally offset from the second electrode in the closed configuration.

6. The electrosurgical instrument of claim 5, wherein the second jaw further comprises a third electrode spaced from the converging body.
7. The electrosurgical instrument of claim 6, wherein the third electrode extends distally from an electrode proximal end to an electrode distal end along an oblique profile defined by the second jaw.
8. The electrosurgical instrument of claim 7, wherein the third electrode includes a base positioned within a cradle that extends distally along the oblique profile of the second jaw from a cradle proximal end to a cradle distal end.
9. The electrosurgical instrument of claim 8, wherein the cradle is centrally located relative to a lateral edge of the second jaw.
10. The electrosurgical instrument of claim 9, wherein the third electrode further comprises a tapered edge extending from the base beyond a side wall of the cradle.

11. The electrosurgical instrument of claim 10, wherein the cradle is constructed from a flexible substrate.
12. The electrosurgical instrument of claim 10, wherein the cradle is partially recessed in a valley defined in the narrowing body.
13. The electrosurgical instrument of claim 12, wherein the cradle is spaced from the narrowing body by an electrically insulative coating.
(14) The base portion is
a base proximal end;
a proximal distal end;
11. The electrosurgical instrument of claim 10, wherein the base comprises a width that gradually narrows as it extends along the oblique profile from the base proximal end to the base distal end.
(15) An electrosurgical instrument comprising:
An end effector,
The first Joe,
a second jaw, at least one of the first jaw and the second jaw being movable to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween, the second jaw comprising:
a conductive body having a tapered diagonal profile extending from a proximal end to a distal end,
a first conductive portion extending from the proximal end to the distal end;
a conductive body comprising: a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the conductive body, the second conductive portion being integral with the first conductive portion, the first conductive portion being thicker than the second conductive portion;
an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue but not the second conductive portion, the first conductive portion being configured to transmit electrical energy to the tissue only through the second conductive portion; and a second jaw comprising an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue but not the second conductive portion, the first conductive portion being configured to transmit electrical energy to the tissue only through the second conductive portion.

16. The electrosurgical instrument of claim 15, wherein the tapered electrode comprises a width that gradually narrows as the tapered electrode extends from the proximal end toward the distal end.
17. The electrosurgical instrument of claim 16, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, the tapered electrode being a second electrode, the first electrode being laterally offset from the second electrode in the closed configuration.
18. The electrosurgical instrument of claim 17, wherein the second jaw further comprises a third electrode spaced from the conductive body.
19. The electrosurgical instrument of claim 18, wherein the third electrode extends distally along at least a portion of the tapered oblique profile.
20. The electrosurgical instrument of claim 19, wherein the third electrode comprises a base positioned within a cradle that extends distally along at least the portion of the tapered diagonal profile from a cradle proximal end to a cradle distal end, the cradle being constructed from a flexible substrate.

Claims (18)

1. An electrosurgical instrument comprising:
An end effector,
The first Joe,
a second jaw, at least one of the first jaw and the second jaw being movable to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween, the second jaw comprising:
a body extending from a proximal end to a distal end, the body including an electrically conductive material;
a first conductive portion extending from the proximal end to the distal end;
a body comprising: a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the body, the second conductive portion being unitary with the first conductive portion , the thickness of the first conductive portion being greater than the thickness of the second conductive portion in a closing orientation of the end effector ;
an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue but not the second conductive portion, the first conductive portion configured to transmit electrical energy to the tissue only through the second conductive portion ; and
the tapered electrode has a width in a lateral direction that gradually narrows as it extends from the proximal end to the distal end of the tapered electrode, the lateral direction being perpendicular to a longitudinal direction extending through the proximal and distal ends of the tapered electrode and perpendicular to the closing direction of the end effector;
an end effector closure direction extending from the proximal end to the distal end of the body; and a thickness in the closure direction of the end effector that is gradually reduced from a central portion to both ends of the body in the lateral direction . The electrosurgical instrument of claim 1, wherein the tapered electrode has an outer surface that is flush with the outer surface of the electrically insulating layer. The electrosurgical instrument of claim 1, wherein the electrical energy is delivered to the tissue through an outer surface of the tapered electrode. 2. The electrosurgical instrument according to claim 1, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw, the tapered electrode being a second electrode, the first electrode being laterally offset from the second electrode in the closed configuration. The electrosurgical instrument according to claim 4 , wherein the second jaw further includes a third electrode spaced from the body . The electrosurgical instrument according to claim 5 , wherein the third electrode extends distally from an electrode proximal end to an electrode distal end along an oblique profile defined by the second jaw. The electrosurgical instrument according to claim 6 , wherein the third electrode includes a base positioned within a cradle that extends distally along the oblique profile of the second jaw from a cradle proximal end to a cradle distal end. The electrosurgical instrument according to claim 7 , wherein the cradle is centrally located relative to a lateral edge of the second jaw. The electrosurgical instrument according to claim 8 , wherein the third electrode further includes a tapered edge extending from the base beyond a side wall of the cradle. The electrosurgical instrument of claim 9 , wherein the cradle is constructed from a flexible substrate. The electrosurgical instrument according to claim 9 , wherein the cradle is partially recessed in a valley defined in the body . The electrosurgical instrument of claim 11 , wherein the cradle is spaced from the body by an electrically insulative coating. The base portion is
a base proximal end;
a proximal distal end;
The electrosurgical instrument according to claim 9 , wherein the base comprises a gradually narrowing width as it extends along the angled profile from the base proximal end to the base distal end. 1. An electrosurgical instrument comprising:
An end effector,
The first Joe,
a second jaw, at least one of the first jaw and the second jaw being movable to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween, the second jaw comprising:
a conductive body extending from a proximal end to a distal end,
a first conductive portion extending from the proximal end to the distal end;
a conductive body comprising: a second conductive portion projecting from the first conductive portion and defining a tapered electrode extending distally along at least a portion of the conductive body, the second conductive portion being unitary with the first conductive portion, the thickness of the first conductive portion being greater than the thickness of the second conductive portion in a closing orientation of the end effector ;
an electrically insulating layer configured to electrically insulate the first conductive portion from the tissue but not the second conductive portion, the first conductive portion configured to transmit electrical energy to the tissue only through the second conductive portion ; and
the tapered electrode has a width in a lateral direction that gradually narrows as it extends from the proximal end to the distal end of the tapered electrode, the lateral direction being perpendicular to a longitudinal direction extending through the proximal and distal ends of the tapered electrode and perpendicular to the closing direction of the end effector;
the conductive body has a width in the lateral direction that narrows gradually as it extends from the proximal end toward the distal end of the conductive body, and the conductive body has a thickness in the closure direction of the end effector that narrows gradually from a central portion toward both ends in the lateral direction . 15. The electrosurgical instrument according to claim 14, wherein the first jaw includes a first electrode extending distally along at least a portion of the first jaw , the tapered electrode being a second electrode, the first electrode being laterally offset from the second electrode in the closed configuration. The electrosurgical instrument according to claim 15 , wherein the second jaw further includes a third electrode spaced from the conductive body. The electrosurgical instrument according to claim 16 , wherein the third electrode extends distally . 18. The electrosurgical instrument of claim 17, wherein the third electrode includes a base positioned within a cradle extending distally from a cradle proximal end to a cradle distal end , the cradle constructed from a flexible substrate.

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