Surgical devices and methods of use thereof
Contents
1. GE BZ 6 US 2008 0234674 1 EEG 5 Patent Application Publication Sep 25 2008 Sheet 9 of 15 US 2008 0234674 A1 po Patent Application Publication Sep 25 2008 Sheet 10 of 15 US 2008 0234674 A1 EG uec ZOA US 2008 0234674 A1 Sep 25 2008 Sheet 11 of 15 Patent Application Publication O qT O g oj V UN MARAARAANARRRA TARE ESEREREREES i iE P 222 22 A 27 55 SSIS COME ZE NS ZZ SSN KK MANS NEC d E ZAL LLL LLA SOILL 7 SSS AAT E LILI i ZIO L Sep 25 2008 Sheet120f15 US 2008 0234674 A1 Patent Application Publication 9 a 130 eg af do 7 3 RELL LLL he ER SSN e SSSA LAL LN z gZ Sep 25 2008 Sheet130f15 US 2008 0234674 Al Patent Application Publication 1 Q JH 1 Patent Application Publication Sep 25 2008 Sheet 14 of 15 US 2008 0234674 A1 302 2 I r6 17 Hb 220 202 E C zed 222 wr o Re ZIZ Patent Application Publication Sep 25 2008 Sheet 15 of 15 US 2008 0234674 A1 ded 220 be ue FI 20 US 2008 0234674 A1 SURGICAL DEVICES AND METHODS OF USE THEREOF CROSS REFERENCE TO RELATED APPLICATIONS 0001 The present application claims the2. 30 As shown in FIG 2 plug receptacle 38 of electrosurgical unit 14 receives the plug 36 of device 30 therein to electrically connect device 30 to the electrosurgical unit 14 Preferably the fluid delivery tubing 28 US 2008 0234674 A1 is provided as part of cable 34 and produced with the electri cally insulated wires via plastic co extrusion 0042 FIG 2 shows the front panel of the electrosurgical unit 14 A power switch 42 is used to turn the electrosurgical unit 14 on and off After turning the electrosurgical unit 14 on the RF power setting display 44 is used to display the RF power setting numerically in watts Preferably the power setting display comprises a liquid crystal display LCD Additionally this display 44 is used to display errors in which case the display 44 will show Err and blink alter nately with a special error code number s 0043 The RF power selector comprises RF power setting switches 46a 46b which are used to select the RF power setting Pushing the switch 46a increases the RF power set ting while pushing the switch 465 decreases the RF power setting RF power output may be set in 5 watt increments in the range of 20 to 100 watts and 10 watt increments in the range of 100 to 200 watts Additionally electrosurgical unit 14 includes an RF power activation display 74 comprising an indicator light which illuminates when RF power is activated Switches 46a 46b may comprise membrane switches 0044
3. benefit of the filing date of U S Provisional Application Ser No 60 896 768 filed Mar 23 2007 the teachings of which are incorpo rated herein by reference FIELD 0002 This invention relates to surgical devices systems and methods for use upon tissues of a human body during surgery particularly open surgery and minimally invasive surgery such as laparoscopic surgery BACKGROUND 0003 A dry tip electrosurgical device such as a Bovie pencil can cause the temperature of tissue being treated to rise significantly higher than 100 Celsius resulting in tissue desiccation tissue sticking to the electrodes tissue perfora tion char formation and smoke generation 0004 Furthermore certain surgical devices are too large to be used in confined surgical spaces and or are simply ineffective in treating tissue such as to inhibit blood loss 0005 Morerecently fluid assisted electrosurgical devices have been developed which use saline to inhibit undesirable effects such as tissue desiccation electrode sticking smoke production and char formation during the treatment of tissue However too much saline can provide too much electrical dispersion and cooling at the electrode tissue interface This reduces the temperature of the tissue being treated and in turn can result in a longer treatment time to achieve the desired tissue temperature for treatment of the tissue Long treatment times are undesirable for surgeons since it is
4. electrical non conducting mate rial such as a polymer or composite material 0061 Proximal handle 104 comprises mating handle por tions 104a 1045 Handle 104 is preferably made of a steril izable rigid non conductive material such as a polymer Also handle 104 is preferably configured slender along with the rest of the device 30a to facilitate a user of device 30a to hold and manipulate device 30a like a pen type device 0062 Device 30a also comprises a flexible fluid delivery tubing 28 which is connectable to fluid source 22 preferably via a spike located at the end of drip chamber 26 as shown in FIG 1 anda cable 34 which is connectable to electrosurgical unit 14 which respectively provide fluid and RF power to distal portion 106 0063 In this embodiment cable 34 of device 30a com prises three insulated wires 34a 345 34c as shownin FIG 8 connectable to electrosurgical unit 14 via three male plug connectors 37a 370 37c The plug connectors 37a 37b 37c are each assembled with wires 34a 34b 34c and wire con ductors 35a 355 35c within a common plug housing 36 As best shown in FIG 8 which shows the inner components of the handle 104 with the handle 104 removed wire conductor 35a 15 directly connected preferably by welding to wire conductor 158a of insulated wire 160a which is distally connected to electrode 114a as discussed in greater detail below As also shown in FIG 8 wire conductor 355 of wire 34b
5. first connects through hand switch assembly 162 before connecting preferably be welding to wire conductor 1585 of insulated wire 1605 which is distally connected to electrode 114 as discussed in greater detail below Finally wire con US 2008 0234674 A1 ductor 35c of wire 34c is connected to hand switch assembly 162 to alert electrosurgical unit 14 to provide power when the circuit for the switch assembly has been closed through depression of hand switch push button 164 preferably made of a rigid polymer such as polyacetal 0064 In addition to FIG 8 switch assembly 162 is shown in FIGS 9 and 10 As best shown in FIG 10 switch assembly 162 comprises a push button 164 and a dome switch 172 having two electrical contacts The contacts preferably com prise upper and lower contacts disposed on a platform 174 in overlying relationship Preferably the upper contact com prises a dome shaped configuration overlying and spaced from the lower contact which is flat Preferably the contacts are spaced from one another by virtue of the domed configu ration of the upper contact when the button 164 is in an undepressed position thus creating an open control circuit relative to switch 172 However when the top of button 164 is pressed and the upper contact is correspondingly pressed into a depressed position the upper contact comes into contact with the lower contact thus closing the hand switch control circuit The presence of the closed cont
6. herein provide devices systems and methods for treating tissue during a surgical procedure These inventions are particularly useful for pro cedures where it is desirable to shrink coagulate and seal tissue against blood loss for example by shrinking lumens of blood vessels e g veins arteries 0035 The invention will now be discussed with reference to the figures with FIG 1 showing a front view of one embodiment of a system of the present invention having an electrosurgical unit 14 in combination with a fluid source 22 and a handheld electrosurgical device 30 FIG 1 shows a movable cart 2 having a chassis 4 which is provided with four wheels 6 for easy transportation The chassis 4 carries a vertical support member 8 comprising a hollow cylindrical postto which a storage basket 10 may be fastened and used to store the electrosurgical unit s user manual as well as addi tional unused devices Furthermore the support member 8 Sep 25 2008 carries a platform 12 comprising a pedestal table to provide a flat stable surface for location of the electrosurgical unit 14 0036 As shown cart 2 further comprises a fluid source carrying pole 16 having a height which may be adjusted by sliding the carrying pole 16 up and down within the support member 8 and thereafter secured in position with a set screw On the top of the fluid source carrying pole 16 is a cross support 18 provided with loops 20 at the ends thereof to provide a hook
7. smoke generation and thus do not suffer from the same drawbacks as prior art dry tip electrosurgical devices The use of the dis closed devices can result in significantly lower blood loss during surgical procedures Such a reduction in blood loss can reduce or eliminate the need for blood transfusions and thus the cost and negative clinical consequences associated with blood transfusions such as prolonged hospitalization 0105 While a preferred embodiment ofthe present inven tion has been described it should be understood that various changes adaptations and modifications can be made therein without departing from the spirit of the invention and the scope of the appended claims The scope of the invention should therefore be determined not with reference to the above description but instead should be determined with reference to the appended claims along with their full scope of equivalents Furthermore it should be understood that the appended claims do not necessarily comprise the broadest scope of the invention which the Applicant is entitled to claim or the only manner s in which the invention may be claimed or that all recited features are necessary 0106 All publications and patent documents cited in this application are incorporated by reference in their entirety for all purposes to the extent they are consistent What is claimed 1 A bipolar electrosurgical device to treat tissue in a pres ence of radio frequency pow
8. the pin completely through device 30a and exiting the pin from the other hole In this manner the matter clogging holes 146a 1465 and bore 144 may be pushed and removed there from by the pin 0078 Also as shown in FIG 11 holes 146a 1465 are located on opposing sides of device 30a Hole 146a 15 pro vided adjacent and closest to electrode 114a at corner 148a thereof and adjacent and closest to electrode 1145 at corner 148b thereof Hole 146b is provided adjacent and closest to electrode 114a at corner 149a thereof and adjacent and clos est to electrode 114 at corner 1497 thereof In this manner fluid may be provided to the locations of electrodes 114a 114b and tissue expected to have the greatest need for the fluid for device 30a to function most properly i e the electrode corners and tissue adjacent thereto Also in this manner fluid from holes 146a 1465 may be provided to the semi circular shaped side perimeter 151a 1515 of electrodes 114a 1145 As shown in FIG 12 the semi circular shaped perimeter 151a 1516 of electrodes 114a 1145 is exposed to tissue and extends circumferentially around a substantial portion of the distal end of device 30a As shown the semi circular shaped Sep 25 2008 perimeter 151a ofelectrode 114a extends from corner 148a to corner 149a of electrode 114a and the semi circular shaped perimeter 1515 of electrode 1145 extends from corner 1485 to corner 1495 of electrode 114b 0079 Inother embodim
9. G 4 is a graph of the RF power output P versus impedance Z for the electrosurgical unit of FIG 1 0017 FIG 5 is graph showing three relationships of fluid flow rate Q of saline at high Q medium Q and low Q in units of cubic centimetres per minute cc min on the Y axis and the RF power setting P in units of watts on the X axis 0018 FIG 6 is a block diagram showing one embodiment of how the electrosurgical unit processes the inputs of RF power setting P and the fluid flow rate setting either 4 Qay or Qy to control the pump speed US 2008 0234674 A1 0019 FIG 7 is an isometric view of an assembly of an exemplary electrosurgical device according to the present invention 0020 FIG 8 is an isometric view of the inner components of the handle with the handle removed 0021 FIG 9isaside view ofa handle portion of the device of FIG 7 assembled with various components 0022 FIG 10 is a close up side view of a button and handle portion of the device of FIG 7 assembled with various components 0023 FIG 11 is an exploded view ofa distal portion of the device of FIG 7 0024 FIG 12 is a close up longitudinal cross sectional view of a distal portion of the device of FIG 7 0025 FIG 13 is a close up longitudinal cross sectional view of a distal portion of an alternative exemplary electro surgical device according to the present invention 0026 FIG 14 is a close up longitudinal cross sectional vi
10. In addition to having a RF power setting display electrosurgical unit 14 further includes a fluid flow rate set ting display Flow rate setting display comprises three indi cator lights 50a 505 and 50c with a first light 50a correspond ing to a fluid flow rate setting of low a second light 505 corresponding to a fluid flow rate setting of medium inter mediate and a third light 50c corresponding to a flow rate setting of high One of these three indicator lights will illu minate when a fluid flow rate setting is selected 0045 A fluid flow selector comprising flow rate setting switches 52a 52b and 52c are used to select or switch the flow rate setting Three push switches are provided with the first switch 52a corresponding to a fluid flow rate setting of low the second switch 525 corresponding to a fluid flow rate setting of medium intermediate and the third switch 52c corresponding to a flow rate setting of high Pushing one of these three switches selects the corresponding flow rate set ting of either low medium intermediate or high The medium or intermediate flow rate setting is automatically selected as the default setting if no setting is manually selected Switches 52a 52b and 52c may comprise mem brane switches 0046 Before starting a surgical procedure it is desirable to prime device 30 with fluid 24 Priming is desirable to inhibit RF power activation without the presence of fluid 24 A priming switch 54 is used
11. US 20080234674A1 a2 Patent Application Publication 10 Pub No US 2008 0234674 Al as United States McClurken et al 43 Pub Date Sep 25 2008 54 SURGICAL DEVICES AND METHODS OF USE THEREOF Michael E McClurken Durham NH US Roger D Greeley Portsmouth NH US Brian M Conley South Berwick ME US 75 Inventors Correspondence Address GROSSMAN TUCKER PFLEGER PLLC 55 SOUTH COMMERICAL STREET MANCHESTER NH 03101 US PERREAUIT amp 73 Assignee SALIENT SURGICAL TECHNOLOGIES INC Dover NH US 21 Appl No 12 053 030 22 Filed Mar 21 2008 Related U S Application Data 60 Provisional application No 60 896 768 filed on Mar 23 2007 provisional application No 60 896 769 filed on Mar 23 2007 Publication Classification 51 Int Cl AGIB 18 14 2006 01 AGIB 18 04 2006 01 52 U S Cl ue cete 606 50 606 41 606 49 57 ABSTRACT The invention provides surgical devices and methods to treat tissue In one device embodiment the invention comprises a bipolar electrosurgical device to treat tissue in a presence of radio frequency power and a fluid provided simultaneously from a distal portion ofthe device with the device comprising a disc shaped distal end In one method embodiment the invention comprises a method of treating tissue having a blood vessel during spine surgery with the method compris ing pressing a portion ofthe blood vessel against a supporti
12. ar to the longitudinal axis of shaft 102 In other embodiments as shown for example in FIG 13 the distal end of device 305 may be convex In still other embodiments as shown for example in FIG 14 the distal end of device 30c may be concave 0073 Returning to FIG 12 housing inner portion 116 also includes a longitudinally oriented linear blind bore 140 and counter bore 142 centrally located within cylindrical portion US 2008 0234674 A1 128 As shown the outside diameter of fluid delivery tubing 150 is configured to extend into counter bore 142 and fit with the diameter of counter bore 142 with the distal end of the tubing in contact with the bottom of the counter bore The outside diameter of fluid delivery tubing 150 may be config ured to fit with the diameter of counter bore 142 to form a press interference fit to provide a secure connection along with use of an adhesive or another bonding agent to provide a fluid tight seal between fluid delivery tubing 150 and housing inner portion 116 0074 In addition to blind bore 140 and counterbore 142 housing inner portion 116 also includes a linear through bore 144 which perpendicularly intersects bore 140 at the distal end of bore 140 and extends through cylindrical portion 128 As shown bore 140 and bore 144 are in fluid communication with lumen 152 of fluid delivery tubing 150 which is ulti mately in fluid communication lumen 29 of fluid delivery tubing 28 In this manner b
13. bility more difficult and prolonging the proce dure A method of the present invention may be used to seal such vertebral blood vessels against blood loss before the vessels are cut rupture or are otherwise severed This method involves pressing a portion of the blood vessel against a supporting spine structure with a surgical device such as the devices of the present invention to provide a compressed portion of the blood vessel and heating the compressed por tion of the blood vessel with the surgical device sufficiently to occlude the blood vessel e g by shrinking the vessel and the lumen by shrinkage of the collagen in the vessel and or weld ing the opposite internal surfaces of the lumen together by collagen welding to inhibit a blood flow through the vessel after the surgical device is removed from the blood vessel 0091 The supporting spine structure against which the blood vessel is compressed comprises one or more vertebra of the spine and may further comprise the vertebral body of the vertebra The vertebra may comprise one of the cervical ver tebrae thoracic vertebrae or lumbar vertebrae In addition to the vertebrae the support structure may also comprise a spi nal ligament such as the anterior longitudinal ligament or the posterior longitudinal ligament or an intervertebral disc 0092 Depending on the type of procedure the supporting spine structure may further comprise an anterior side of the vertebral body of the ver
14. corresponding to the selected radio frequency power level and calculated output for flow of the fluid from the pump 32 to the radio frequency generator 47 and pump controller 48 respectively Thereafter the pump controller 48 controls the speed of the pump drive shaft 55 by controlling the input voltage 59 to the pump motor 61 which rotates the drive shaft 55 More detailed drawings of exemplary electrosurgical unit 14 may be found in U S Publication No 2006 0149225 published Jul 6 2006 and assigned to the assignee of the present invention and hereby incorporated by reference in its entirety to the extent it is consistent 0058 Electrosurgical unit 14 can include a delay mecha nism such as a timer to automatically keep the fluid flow on for several seconds after the RF power is deactivated to pro videa post treatment cooling Electrosurgical unit 14 can also Sep 25 2008 include a delay mechanism such as a timer to automatically turn on the fluid flow up to several seconds before the RF power is activated to inhibit the possibility of undesirable effects as tissue desiccation electrode sticking char forma tion and smoke production 0059 Electrosurgical unit 14 is particularly configured for use with bipolar devices With a bipolar device an alternating current is created between the first and second electrical poles of the device An exemplary bipolar electrosurgical device of the present invention which may be used in con
15. d exit is provided by a housing which secures the first semi circular shaped electrode and the second semi circular shaped electrode to the device 22 The device according to claim 1 wherein the first electrode comprises a first electrode first corner and a first electrode second corner and the at least one fluid exit is closest to the first electrode at one of the first electrode first corner and the first elec trode second corner 23 The device according to claim 1 wherein the first electrode comprises a first electrode first corner and a first electrode second corner and the at least one fluid exit is adjacent to one of the first electrode first corner and the first electrode second cor ner 24 The device according to claim 23 wherein the second electrode comprises a second electrode first corner and a second electrode second corner and the at least one fluid exit is adjacent to at least one of the first electrode first corner the first electrode second cor ner the second electrode first corner and the second electrode second corner 25 The device according to claim 1 wherein the first electrode semi circular shaped perimeter extends from a first electrode first corner to a first electrode second corner and the at least one fluid exit is closest to the first electrode at one of the first electrode first corner and the first elec trode second corner 26 The device according to claim 1 wherein the first electrod
16. ding to claim 41 wherein the electrosurgical device comprises a bipolar electrosur gical device 43 The method according to claim 42 wherein the bipolar electrosurgical device is configured to treat tissue in a presence of radio frequency power and a fluid provided simultaneously from a distal portion of the device 44 The method according to claim 40 further comprising heating the compressed portion of the blood vessel in a range of at least about 65 Celsius to about 85 Celsius 45 The method according to claim 40 further comprising heating the compressed portion of the blood vessel in a range of at least about 70 Celsius to about 75 Celsius 46 The method according to claim 40 further comprising heating the compressed portion of the blood vessel in a range of about 70 Celsius to about 100 Celsius 47 The method according to claim 40 wherein the supporting spine structure comprises a vertebra 48 The method according to claim 47 wherein the supporting spine structure further comprises a vertebral body of the vertebra 49 The method according to claim 48 wherein the supporting spine structure further comprises an anterior side of the vertebral body of the vertebra 50 The method according to claim 48 wherein the supporting spine structure further comprises a lateral anterior side of the vertebral body of the vertebra 51 The method according to claim 48 wherein the supporting spine structure furt
17. e semi circular shaped perimeter extends from a first electrode first corner to a first electrode second corner and the at least one fluid exit is adjacent to one of the first electrode first corner and the first electrode second cor ner 27 The device according to claim 26 wherein the second electrode comprises a second electrode first corner and a second electrode second corner and US 2008 0234674 A1 the at least one fluid exit is adjacent to at least one of the first electrode first corner the first electrode second cor ner the second electrode first corner and the second electrode second corner 28 The device according to claim 1 wherein the at least one fluid exit comprises a plurality of fluid exits 29 The device according to claim 1 wherein the at least one fluid exit comprises at least two fluid exits 30 The device according to claim 29 wherein the at least two fluid exits are located on opposing sides of the device 31 The device according to claim 29 wherein the at least two fluid exits comprise a first fluid exit and a second fluid exit the fluid passage comprises a length from the first fluid exit to the second fluid exit and the fluid passage is linear along its length 32 The device according to claim 1 wherein the fluid passage comprises the lumen of tubing 33 The device according to claim 32 wherein the lumen comprises the lumen of polymer tubing 34 The device according to claim 1
18. e specifically alongitudinal ligament ofthe spine Underlying ligament 230 15 a vertebra 232 and more specifically a vertebral body ofthe vertebra 232 0096 FIG 18 shows device 30a applied to tissue 200 with sufficient force and pressure applied to device 30a by the user thereof to press a portion of the blood vessel 220 against the supporting spine structure here ligament 230 and vertebra 232 to provide a compressed portion of the blood vessel 220 US 2008 0234674 A1 In certain embodiments device 30a may include a feedback mechanism such as a force or pressure gauge which alerts the user of the device when sufficient force pressure is applied to vessel 220 In other embodiments the feedback mechanism may comprise a light which activates As shown electrodes 114a 1145 of device 30a are spaced adjacent tissue surface 202 of tissue 200 by the width of distal spacer portion 126 of housing inner portion 116 0097 FIG 19 shows device 30a in use with fluid 24 expelled from holes 146a 1465 that flows distally to elec trodes 114a 114 to provide a localized fluid coupling 204 between surface 202 of tissue 200 and electrodes 114a 114d Preferably fluid 24 couples between the electrodes 114a 114 and the tissue 200 at both the perimeter 151a 1516 of electrodes 114a 114b and flat semi circular shaped electrode portions 138a 1385 of the electrodes 114a 1145 located at the distal end of device 30a At the same time RF electrical
19. echanical force mecha nism here rollers driven by electric motor does not make contact the fluid 24 thus reducing the likelihood of inadvert ent contamination 0039 In a preferred embodiment the fluid 24 comprises saline and even more preferably normal physiologic saline Although the description herein may make reference to saline as the fluid 24 other electrically conductive fluids can be used in accordance with the invention 0040 While a conductive fluid is preferred as will become more apparent with further reading ofthis specifica tion fluid 24 may also comprise an electrically non conduc tive fluid The use of a non conductive fluid is less preferred than a conductive fluid however the use of a non conductive fluid still provides certain advantages over complete elimina tion of the fluid and the use of a dry electrode including for example reduced occurrence of tissue sticking to the elec trode of device 30 and cooling of the electrode and or tissue Therefore it is also within the scope of the invention to include the use of a non conducting fluid such as for example deionized water 0041 As shown in FIG 1 electrosurgical device 30 is connected to electrosurgical unit 14 via a cable 34 which comprises a plurality ofelectrically insulated wire conductors and at least one plug 36 at the end thereof The electrosurgical unit 14 provides radio frequency RF energy power via cable 34 to electrosurgical device
20. either severed or unsevered during spine surgery such as blood vessels of the vertebral venous and or arterial systems during for example a discectomy 0083 Intervertebral discs are flexible pads of fibrocarti laginous tissue tightly fixed between the vertebrae of the spine The discs comprise a flat circular capsule roughly an inch in diameter and about 0 25 inch thick made of a tough US 2008 0234674 A1 fibrous outer membrane called the annulus fibrosus sur rounding an elastic core called the nucleus pulposus 0084 Under stress it is possible for the nucleus pulposus to swell and herniate pushing through a weak spot in the annulus fibrosus membrane of the disc and into the spinal canal Consequently all or part of the nucleus pulposus mate rial may protrude through the weak spot causing pressure against surrounding nerves which results in pain and immo bility 0085 Where a damaged intervertebral disc must be removed from the patient as part of a discectomy and subse quent fusion of vertebral bodies of the superior and inferior vertebrae the devices of the present invention may be par ticularly useful to shrink and seal blood vessels of the verte bral venous and or arterial systems 0086 The vertebral venous system includes any of four interconnected venous networks surrounding the vertebral column These are known as the anterior external vertebral venous plexus the system around the vertebral bodies the po
21. energy power shown by electrical field lines 206 is provided to tissue 200 at tissue surface 202 and below tissue surface 202 into tissue 200 through fluid 24 0098 Electrodes 114a 1145 are connected to electrosur gical unit 14 to provide RF energy power and form an alter nating current electrical field in tissue 200 In the presence of alternating current the electrodes 114a 114b alternate polar ity between positive and negative charges with current flow from the positive to negative charge Without being bound to a particular theory heating of the tissue is performed by electrical resistance heating That is the temperature of the tissue increases as a result of electric current flow through the tissue with the electrical energy being absorbed from the voltage and transformed into thermal energy i e heat via accelerated movement of ions as a function of the tissue s electrical resistance 0099 Heating the compressed portion of blood vessel 220 with device 30a is sufficient to at least partially occlude blood vessel 220 to inhibit blood flow through the vessel 220 after device 30a is removed from vessel 220 Here this is per formed by heating vessel 220 sufficiently to shrink the col lagen in vessel 220 thereby shrinking the vessel 220 and the lumen 222 of vessel 220 This is also performed by apply sufficient heating and pressure to the compressed portion of vessel 220 to weld the opposing internal surfaces 224 and 226 of t
22. ents as shown in FIGS 15 and 16 the semi circular shaped side perimeter 151a 151 of elec trodes 114a 1145 for device 30d is covered by an electrical insulation preferably provided by outer housing portion 112 to eliminate the semi circular shaped perimeter 151a 151b of electrodes 114a 1145 from being used to treat tissue As shown the semi circular shaped perimeter 151a 151b of electrodes 114a 1147 is covered by a ring shaped portion of outer housing portion 112 0080 During use of device 30a fluid 24 from fluid source 22 is communicated through a fluid passage which provided by various structures Fluid 24 from the fluid source 22 is first communicated through lumen 29 of delivery tubing 28 As shown in FIG 8 fluid 24 then feeds into a lumen 156 size reduction bushing 154 located within handle 104 and then into lumen 152 of tubing 150 which is contained in the lumen 124 of shaft 102 as shown in FIG 12 From lumen 152 of tubing 150 fluid 24 then flows through bore 140 then into bore 144 and is expelled from holes 146a 1465 In the present embodiment which makes use of a peristaltic pump 32 a special pump tubing segment 182 as shown in FIG 7 designed to operate specifically with the peristaltic pump 32 may be spliced in between portions of delivery tubing 28 and connected thereto using barbed fluid line connectors 180 at each end thereof 0081 The relationship between the material for electrodes 114a 1146 and their s
23. er and a fluid provided simulta neously from a distal portion of the device the device com prising a handle a shaft extending distally from the handle the shaft sup porting the distal portion ofthe device in rigid relation to the handle the distal portion ofthe device terminating at a distal end of the device the distal end of the device comprising a disc shaped distal end US 2008 0234674 A1 the disc shaped distal end comprising a first semi circular shaped electrode and a second semi circular shaped electrode a fluid delivery passage being connectable to a fluid source of the fluid and at least one fluid exit in fluid communication with the fluid delivery passage 2 The device according to claim 1 wherein the first semi circular shaped electrode has a shape of about a first half of a circle and the second semi circular shaped electrode has a shape of about a second half of the circle 3 The device according to claim 1 wherein the first semi circular shaped electrode and the second semi circular shaped electrode are mirror images of each other 4 The device according to claim 1 wherein the first semi circular shaped electrode has a first electrode semi circular shaped perimeter and the second semi circular shaped electrode has a second electrode semi circular shaped perimeter 5 The device according to claim 4 wherein the first electrode semi circular shaped perimeter is exposed and the second elect
24. ew of a distal portion of an alternative exemplary electro surgical device according to the present invention 0027 FIG 15 is an isometric view ofa distal portion of an alternative exemplary electrosurgical device according to the present invention 0028 FIG 16 is a close up longitudinal cross sectional view of the distal portion of the device of FIG 15 taken along line 16 16 and 0029 FIG 17 is a close up view of a distal portion of the device of FIG 7 and tissue 0030 FIG 18 is a close up view of a distal portion of the device of FIG 7 pressing against tissue 0031 FIG 19 is a close up view of a distal portion of the device of FIG 7 being used to treat tissue and 0032 FIG 20 is a close up view of a distal portion of the device of FIG 7 removed from treated tissue DETAILED DESCRIPTION 0033 Throughout the description like reference numerals and letters indicate corresponding structure throughout the several views Also any particular feature s of a particular exemplary embodiment may be equally applied to any other exemplary embodiment s of this specification as suitable In other words features between the various exemplary embodi ments described herein are interchangeable as suitable and not exclusive From the specification it should be clear that any use of the terms distal and proximal are made in reference from the user of the device and not the patient 0034 The inventions disclosed
25. for RF power fluid flow rate and priming are then conveyed via corresponding input signals 41 to a main module 43 which preferably com prises a printed circuit board including a computer chip 45 a radio frequency generator 47 and a pump controller 48 As shown display panel module 40 and main module 43 as well as other components receive power from a power supply module 49 which also comprises a printed circuit board 0056 Computer chip 45 preferably comprises a micro processor unit a memory and an input output control unit In this manner the functional relationships between the radio frequency power level and the flow ofthe fluid may be stored in the memory of the computer chip 45 While the functional relationships may be stored in the form of the foregoing equations they may also be stored as numerical data points as part of a database look up table 0057 As shown the input signals 41 are received and processed by computer chip 45 More specifically for example from the input signal received corresponding to the fluid flow rate setting of either Q Qa or Qj the computer chip 45 may first determine which of the above equations to apply After determining which equation to apply computer chip 45 may then apply the relationship to determine the output for flow of the fluid from the pump 32 based on the selected radio frequency power level Having determined this output the computer chip 45 then sends output signals 51 and 53
26. for carrying fluid source 22 0037 Returning to FIG 1 fluid source 22 comprises a bag of fluid from which the fluid 24 flows through a drip chamber 26 after the bag is penetrated with a spike located at the end of the drip chamber 26 Thereafter fluid 24 flows through flex ible delivery tubing 28 to handheld electrosurgical device 30 Preferably the fluid delivery tubing 28 is made from a poly mer material 0038 As shown in FIG 1 the fluid delivery tubing 28 passes through pump 32 As shown pump 32 comprises a peristaltic pump and more specifically a rotary peristaltic pump With a rotary peristaltic pump a portion ofthe delivery tubing 28 is loaded into the pump head by raising and lower ing the pump head in a known manner As best shown in FIG 6 fluid 24 is conveyed within the delivery tubing 28 by waves of contraction placed externally on the tubing 28 which are produced mechanically typically by rotating pinch rollers 57 which rotate on a drive shaft 55 and intermittently compress the tubing 28 against an anvil support 58 Alternatively pump 32 may comprise a linear peristaltic pump With a linear peristaltic pump fluid 24 is conveyed within the delivery tubing 28 by waves of contraction placed externally on the tubing 28 which are produced mechanically typically by a series of compression fingers or pads which sequentially squeeze the tubing 28 against a support Peristaltic pumps are generally preferred as the electro m
27. g agent will be employed between cylindrical portion 128 and housing outer portion 112 to provide a secure con nection or a press interference fit which would not require the use of a separate bonding agent 0070 In addition to the above as best shown in FIG 11 proximal cylindrical portion 128 of housing inner portion 116 is provided with two opposing flat surfaces 132a 132b formed thereon to create two localized gaps 134a 1345 as shown in FIG 12 between housing outer portion 112 and housing inner portion 116 through which legs 136a 1365 of electrodes 114a 1145 may extend to be connected with wire conductors 158a 1585 of insulated wires 160a 1605 0071 Returning to FIG 11 legs 136a 1365 of electrodes 114a 1145 extend proximally from two semi circular shaped electrode portions 138a 1385 located at the distal end of device 30a and having the same size and shape In this man ner the current density exhibited by the electrodes relative to one another will be substantially uniform Also as shown the semi circular electrode portions are mirror images of each other and each comprises the shape of about half of a circle Electrodes 114a 114b preferably comprise an electrically conductive metal which 15 also preferably non corrosive A preferred material is stainless steel Other suitable metals include titanium gold silver and platinum 0072 As shown in FIG 12 the distal end of device 30a is planar flat and perpendicul
28. he lumen 222 together here by collagen welding 0100 The time to shrink tissue containing Type I collagen such as blood vessels is generally dependent on temperature For example Type I collagen shrinks at an exposure time of about 0 01 seconds when exposed to a temperature of about 85 C at an exposure time of about 1 second when exposed to a temperature of about 75 C at an exposure time of about 10 second when exposed to a temperature of about 70 C and at an exposure time of about 15 minutes when exposed to a temperature of about 65 C An exemplary target tempera ture time for tissue heating is about 75 C with second Stated another way for expediency the tissue should be heated sufficiently to shrink the collagen in the range between and including about 1 second to 10 seconds after RF activa tion 0101 Fluid 24 in addition to providing an electrical cou pling between the device 30a and tissue 200 cools and lubri cates surface 202 of tissue 200 to inhibit electrodes 114a 1142 from sticking to tissue 200 Depending on the amount of fluid at the distal end of device 30a and the tissue treatment site the fluid coupling 204 may comprise a single coupling which encompasses the distal end of the device 30a or a Sep 25 2008 plurality of discrete couplings which are located on each side of the device closest to holes 146a 1465 0102 The fluid coupling for device 30a may also comprise a conductive fluid bridge betwee
29. her comprises a posterior side of the vertebral body of the vertebra 52 The method according to claim 48 wherein the supporting spine structure further comprises a lateral posterior side of the vertebral body of the vertebra 53 The method according to claim 40 wherein the supporting spine structure comprises a spinal ligament and a vertebra 54 The method according to claim 40 wherein the spine surgery further comprises a discectomy 55 The method according to claim 40 wherein the spine surgery further comprises a spinal fusion
30. in the best interest of the patient physician and hospital to perform surgical procedures as quickly as possible 0006 In light of the above there is a need for devices and methods which address the foregoing concerns SUMMARY OF THE INVENTION 0007 The invention in one embodiment provides an electrosurgical apparatus to provide controlled delivery of radio frequency power and a fluid to an electrosurgical hand held device to treat tissue The apparatus comprises a radio frequency generator to deliver the radio frequency power with the radio frequency power from the radio frequency generator selectable at a radio frequency power level a pump to deliver the fluid a primer to prime the hand device with the fluid a control system to control a flow of the fluid delivered by the pump with a functional relationship between the radio frequency power level and the flow of the fluid the functional relationship to increase the flow of the fluid in response to an increase in the radio frequency power level and to decrease the flow of the fluid in response to a decrease in the radio frequency power level and a fluid flow selector which changes the functional relationship between the radio fre quency power level and the flow of the fluid 0008 In another embodiment the invention provides a bipolar electrosurgical device to treat tissue The device com prises a handle and a shaft extending distally from the handle with the shaft supporti
31. junction with electrosurgical unit 14 of the present invention is shown at reference character 30a in FIG 7 While various electrosur gical devices of the present invention are described herein with reference to use with electrosurgical unit 14 it should be understood that the description of the combination is for purposes of illustrating the system of the invention Conse quently it should be understood that while the electrosurgical devices disclosed herein may be preferred for use with elec trosurgical unit 14 it may be plausible to use other electro surgical devices with electrosurgical unit 14 such as monopo lar devices or it may be plausible to use the electrosurgical devices disclosed herein with another electrosurgical unit other than electrosurgical unit 14 0060 As shown in FIG 7 exemplary bipolar electrosur gical device 30a comprises a single stationary arm 100 which comprises a rigid self supporting hollow shaft 102 As shown shaft 102 is preferably angled to provide better view ing of the distal tip portion 106 of device 30a during use thereof Shaft 102 preferably comprises metal tubing and more preferably thick walled hypodermic stainless steel tub ing In this manner shaft 102 has sufficient rigidity to main tain its form during use of device 30a without kinking or significant bending and support the distal portion 106 in rigid relation to a proximal handle 104 In other embodiments shaft 102 may be made of an
32. n electrically insulative material 12 The device according to claim 11 wherein the electrically insulative material comprises a polymer material 13 The device according to claim 12 wherein the polymer material comprises a fluorinated polymer 14 The device according to claim 13 wherein the fluorinated polymer comprises polytetrafluoroethyl ene Sep 25 2008 15 The device according to claim 10 wherein the housing is connected to the shaft 16 The device according to claim 15 wherein the housing comprises a proximal cylindrical portion and the housing is connected to the shaft by fitting the proximal cylindrical portion of the housing within a lumen of the shaft 17 The device according to claim 1 wherein the first semi circular shaped electrode and second semi circular shaped electrode are spaced apart by an electri cal insulator 18 The device according to claim 1 wherein the disc shaped distal end of the device further comprises an electrical insulator located between the first semi circular shaped electrode and second semi circular shaped electrode 19 The device according to claim 1 wherein the at least one fluid exit is located on the distal portion of the device proximal to the distal end of the device 20 The device according to claim 1 wherein the at least one fluid exit is formed in an electrically insu lative material 21 The device according to claim 1 wherein the at least one flui
33. n electrodes 114a 1145 which rests on surface 202 of tissue 200 and forms a shunt between electrodes 114a 114b Given this scenario a certain amount of RF energy may be diverted from going into tissue 200 and actually pass between electrodes 114a 1147 via the conductive fluid bridge This loss of RF energy may slow down the process of treating the tissue However for device 30a having this coupling located between the opposing cor ners 148a and 1485 and or opposing corners 149a and 1495 of electrodes 114a 1145 respectively may be desirable as the tissue adjacent to these corners may heat faster or get hotter than other tissue being treated due to the electrode configuration In such a case having the fluid coupling 204 at these locations may provide for more balanced heating and treating of tissue 200 Consequently it may be desirable to provide fluid 24 from device 30a in such a quantity that a small portion ofthe fluid boils to dissipate heat from the tissue while at the same time the fluid diverts a certain amount of RF energy from going into tissue 200 at locations which may heat faster or get hotter than other tissue being treated 0103 FIG 20 shows device 30a removed from tissue 200 with the blood vessel 220 sealed against blood loss and blood flow there through 0104 As established above the bipolar devices of the present invention inhibit such undesirable effects of tissue desiccation electrode sticking char formation and
34. ng spine structure with a surgical device to provide a compressed portion of the blood vessel and heating the compressed por tion ofthe blood vessel with the surgical device sufficiently to inhibit a blood flow through the vessel after the surgical device is removed from the blood vessel US 2008 0234674 A1 Sep 25 2008 Sheet 1 of 15 Patent Application Publication FIG 1 US 2008 0234674 A1 Sep 25 2008 Sheet 2 of 15 Patent Application Publication 209 9 S 3 6 Old Patent Application Publication Sep 25 2008 Sheet 3 of 15 US 2008 0234674 A1 14 FIG 5 Patent Application Publication Sep 25 2008 Sheet 4 of 15 US 2008 0234674 A1 250 200 150 2 Power Watts HO o a e O 100 200 300 400 500 600 700 800 900 1000 Load Ohms Z FIG 4 Saline Flow Rate cc min 20 40 60 80 100 120 140 160 180 200 Power Setting Watts i High QD Medium Om ow Qe FIG 5 Patent Application Publication Sep 25 2008 Sheet 5 of 15 US 2008 0234674 A1 Patent Application Publication Sep 25 2008 Sheet 6 of 15 US 2008 0234674 A1 Ere 4 06 Patent Application Publication Sep 25 2008 Sheet 7 of 15 US 2008 0234674 A1 FIG 8 Patent Application Publication Sep 25 2008 Sheet 8 of 15 2X 34 fa eS by 4 EIL a eS li kA 8
35. ng the distal portion of the device in rigid relation to the handle The distal portion of the device Sep 25 2008 terminates at a distal end comprising a disc shaped distal end The disc shaped distal end comprises a first semi circular shaped electrode and a second semi circular shaped elec trode The device may further comprise a fluid delivery pas sage being connectable to a fluid source of fluid and at least one fluid exit in fluid communication with the fluid delivery passage 0009 In another embodiment the invention provides a method of treating tissue having a blood vessel during spine surgery with the method comprising pressing a portion of the blood vessel against a supporting spine structure with a sur gical device to provide a compressed portion of the blood vessel and heating the compressed portion of the blood ves sel with the surgical device sufficiently to occlude the blood vessel after the surgical device is removed from the blood vessel In certain embodiments the supporting spine struc ture comprises a vertebra and more particularly a vertebral body of the vertebra 0010 In another embodiment the invention provides a method of treating tissue having a blood vessel during surgery with the method comprising pressing a portion of the blood vessel against a bone structure with a surgical device to pro vide a compressed portion of the blood vessel and heating the compressed portion of the blood vessel with the su
36. nto lumen 124 of shaft 102 and fit with the inside diameter of shaft 102 with rim 122 in contact with the distal end 110 of shaft 102 The outside diameter of proximal cylindrical portion 118 may be config ured to fit with the inside diameter of shaft 102 to form a slip fit in which case adhesive or another bonding agent will be employed between cylindrical portion 118 and shaft 102 to provide a secure connection or a press interference fit which would not require the use of a separate bonding agent 0069 As shown in FIGS 11 and 12 housing inner portion 116 electrically insulates electrodes 114a 1145 from one another by providing a spacer there between In particular housing inner portion 116 comprises a distal spacer portion 126 disposed between electrodes 114a and 1145 For assem bly housing inner portion 116 further comprises a proximal cylindrical portion 128 for connecting housing inner portion 116 to housing outer portion 112 As shown in FIG 12 the outside diameter of proximal cylindrical portion 128 is con figured to extend into inner bore 130 of housing outer portion 112 and fit with the diameter of bore 130 with the distal cylindrical portion 120 of housing outer portion 112 provid ing a collar around housing inner portion 116 and electrodes 114a 114b The outside diameter of proximal cylindrical portion 128 may be configured to fit with the diameter of bore 130 to form a slip fit in which case adhesive or another bondin
37. ore 140 and bore 144 provide a T shaped fluid flow passage for fluid 24 provided from fluid delivery tubing 28 and 150 0075 As shown in FIG 11 in order to have fluid from the fluid passage provided by bore 144 exit device 30a cylindri cal portion 120 of housing outer portion 112 is provided with two through holes 146a 1465 which align with bore 144 and provide fluid exits for fluid As shown bore 144 extends through housing inner portion 116 parallel to distal spacer portion 126 0076 As best shown in FIG 11 holes 146a 1465 are provided in the electrically insulative material used for hous ing outer portion 112 and are located on the distal portion of device 30a proximal to the distal end of the device In this manner holes 146a 146 are configured to inhibit clogging during use of the device 30a In other words since housing outer portion 112 is not electrically conductive and does not function as an electrode tissue and blood coagulum are less apt to stick to housing outer portion 112 Also since holes 146a 146b are located on the distal portion of device 30a proximal to the distal end of the device holes 146a 1465 are less apt to be exposed directly to the bloody field generally located at the distal end of device 30a 0077 Inthe event holes 146a 1465 and bore 144 become clogged holes 146a 1465 and bore 144 may be unclogged and cleaned by inserting a pin type structure into one of the holes and bore 144 and extending
38. ranch as they approach the neural foramina This main dorsal branch continues posteriorly below the transverse process of the vertebrae supplying the bone of the posterior elements of the vertebrae and the paraspinal muscles Shortly after its origin the dorsal branch gives off a spinal branch which supplies the anterior radicular artery and anterior segmental medullary artery which ultimately sup plies the anterior spinal artery The spinal branch also sup plies a branch to the vertebral body and dura mater and the posterior radicular artery which ultimately supplies the pos terior spinal arteries 0089 During a posterior discectomy the devices of the present invention may be more particularly used by a surgeon to seal veins of the posterior external vertebral venous plexus posterior internal vertebral epidural venous plexus and ante rior internal vertebral epidural venous plexus prior to enter ing the intervertebral disc space Alternatively during an anterior discectomy the devices of the present invention may be more particularly used by a surgeon to seal veins of the Sep 25 2008 anterior external vertebral venous plexus and segmental arter ies particularly the anterior and lateral anterior portions adjacent the vertebral bodies 0090 During a discectomy blood vessels are often cut ruptured or otherwise severed These blood vessels bleed and the resulting blood can flow into the tissue treatment site making visi
39. responding to Qz Qay and Q respectively Conversely electrosurgical unit 14 has been configured to decrease the fluid flow rate Q linearly with adecrease RF power setting P for each of three fluid flow rate settings of low medium and high corresponding to Qz Qay and Qy respectively As shown Qz Q and Qy can be US 2008 0234674 A1 expressed as a function of the RF power setting P by chang ing exemplary proportionality constants as follows Q 0 1xP Qy 0 1286xPs Qg 0 1571xPs 0053 FIG 6 shows an exemplary block diagram of how electrosurgical unit 14 processes the inputs of RF power setting P and the fluid flow rate setting either Q Qar or Qy to control the pump speed and therefore the throughput of fluid expelled by the pump 32 As shown user selected input values for the RF power setting P and the fluid flow rate setting of either low medium and high corresponding to Q Q and Q as well as activating the priming function are entered into electrosurgical unit 14 by pushing corresponding switches for these parameters positioned on the front panel of the electrosurgical unit 14 0054 As shown in FIG 6 the RF power setting switches 46a 46b the flow rate setting switches 52a 520 52c and the priming switch 54 are all preferably part of a display panel module 40 preferably comprising a printed circuit board which receives the inputs into electrosurgical unit 14 0055 The user selected input values
40. rgical device sufficiently to occlude the blood vessel after the sur gical device is removed from the blood vessel 0011 In another embodiment the invention provides an electrically powered surgical device to be used during a sur gical procedure with the device comprising an aperture formed in the device the aperture having a button therein to activate the device the aperture defined by a perimeter wall surrounding the button a narrow gap between the button and the perimeter wall the narrow gap open to a flow of fluid therein from the surgical procedure the fluid comprising blood and the button having at least one side closely adjacent the perimeter wall surrounding the button the at least one side of the button having at least one aperture formed therein to inhibit the button from adhering with the perimeter wall by the blood 0012 It is understood that the specific features described in these embodiments can be rearranged among the various embodiments to provide devices apparatus systems and methods that fall within the scope of this disclosure BRIEF DESCRIPTION OF THE DRAWINGS 0013 FIG 1 isa front view of one embodiment ofa system of the present invention having an electrosurgical unit in combination with a fluid source and handheld electrosurgical device 0014 FIG 2 is a front perspective view of the electrosur gical unit of FIG 1 0015 FIG 3 is a rear view of the electrosurgical unit of FIG 1 0016 FI
41. rgical unit 14 has also been configured such that the pump speed and therefore the throughput of fluid expelled by the pump is predetermined based on two input variables the RF power setting and the fluid flow rate setting In FIG 5 there is shown a relationship of fluid flow rate Qinunits of cubic centimetres per minute cc min on the Y axis and the RF power setting P in units of watts on the X axis The relationship has been engineered to inhibit unde sirable effects such as tissue desiccation electrode sticking smoke production and char formation while at the same time providing a fluid flow rate Q at a corresponding RF power setting P which is not so great as to provide too much fluid and associated electrical dispersion and cooling at the elec trode tissue interface While not being bound to a particular theory a more detailed discussion on how the fluid flow rate interacts with the radio frequency power modes ofheat trans fer from the tissue fractional boiling of the fluid and various control strategies may be found in U S Publication No 2001 0032002 published Oct 18 2001 and assigned to the assignee ofthe present invention and hereby incorporated by reference in its entirety to the extent it is consistent 0052 As shown electrosurgical unit 14 has been config ured to increase the fluid flow rate Q linearly with an increas ing RF power setting P for each of three fluid flow rate settings of low medium and high cor
42. rode semi circular shaped perimeter is exposed 6 The device according to claim 4 wherein the distal end of the device has a circumference and the first electrode semi circular shaped perimeter and the second electrode semi circular shaped perimeter each extend around a portion of the circumference 7 The device according to claim 4 wherein the first electrode semi circular shaped perimeter is cov ered by an electrical insulation and the second electrode semi circular shaped perimeter is covered by an electrical insulation 8 The device according to claim 4 wherein a housing secures the first semi circular shaped electrode and the second semi circular shaped electrode to the device and a portion of the housing covers the first electrode semi circular shaped perimeter and the second electrode semi circular shaped perimeter 9 The device according to claim 8 wherein the portion ofthe housing covering the first electrode semi circular shaped perimeter and the second electrode semi circular shaped perimeter comprises a ring shaped portion of the housing 10 The device according to claim 1 wherein the distal portion of the device comprises the first semi circular shaped electrode the second semi circular shaped electrode and a housing which secures the first semi circular shaped electrode and the second semi circular shaped electrode to the device 11 The device according to claim 10 wherein the housing comprises a
43. rol circuit is then sensed by electrosurgical unit 14 which then provides power to the electrodes 114a 114 0065 When a depression force is removed from the upper contact the contact returns to its undepressed domed position as a result of its resiliency or elastic memory thus returning button 164 to its undepressed position and reopening the hand control circuit The presence ofthe open control circuit is then sensed by electrosurgical unit 14 which then stops providing power to electrodes 114a 114b More detailed drawings and an explanation of the operation of switch assembly 162 may be found in U S Publication No 2005 0090816 published Apr 28 2005 and assigned to the assignee of the present invention and hereby incorporated by reference in its entirety to the extent it is consistent 0066 During use of device 30a blood and coagulum may deposit in a narrow gap 170 between button 164 and handle 104 As best shown in FIG 10 button 164 is located in aperture 166 of handle 104 which is defined by a perimeter wall 168 As shown button 164 includes a plurality of aper tures 163 in the sides thereof Apertures 163 reduce the sur face area of the side walls 165 of button 164 adjacent to the perimeter wall 168 of handle portions 104a 1045 Conse quently due to the reduced surface area of the side walls 165 of button 164 button 164 is less apt to adhere and stick to handle portions 104a 1045 by virtue ofthe blood and coagu Ium
44. sterior external vertebral venous plexus the system around the vertebral processes the anterior internal vertebral epi dural venous plexus the system running the length of the vertebral canal anterior to the dura and the posterior internal vertebral epidural venous plexus the system running the length of the vertebral canal posterior to the dura with the latter two constituting the epidural venous plexus The veins of the exterior vertebral venous plexus communicate with the veins of the interior vertebral venous plexus through interver tebral veins and anterior and posterior segmental medullary radicular veins of each vertebral level 0087 The vertebral arterial system includes the segmental arteries of the vertebral column which supply anterior and posterior radicular arteries of the various vertebral levels In thoracic and lumbar regions segmental arteries include the posterior intercostal subcostal and lumbar arteries which arise from posterior aspect of the aorta The blood supply to the spinal column is derived from the segmental arteries which supply two networks one feeds the bony elements of the vertebrae the paraspinal muscles and the extradural space and the other an inner network nourishes the spinal cord itself 0088 Extending from the aorta the segmental arteries hug the perimeter of the vertebral bodies of the vertebrae giving off paravertebral anastomoses prevertebral anastomoses and a main dorsal b
45. tebra or a lateral anterior side of the vertebral body of the vertebra which would be encountered during an anterior approach For a posterior approach the supporting spine structure may further comprise a posterior side of the vertebral body of the vertebra or a lateral posterior side of the vertebral body of the vertebrae The anterior or posterior approach may be part of an endoscopic spine sur gery laparoscopic spine surgery or open spine surgery 0093 Due to the rigidity of the vertebra and stability of the vertebrae the blood vessel may be pressed against the verte bra without the vertebra deforming In this manner the blood vessel may be compressed at which time the compressed portion of the vessel may be heated sufficiently to occlude the blood vessel after the surgical device is removed from the blood vessel 0094 FIG 17 shows how the distal portion 106 of device 30a and similarly for devices 305 304 may be oriented for use with the longitudinal axis of shaft 102 vertically oriented and the distal end of device 30a facing a tissue treatment site In other embodiments device 30a may be used with the longitudinal axis of shaft 102 horizontally oriented or at any orientation between vertical and horizontal 0095 FIG 17 shows device 30a and tissue 200 prior to treatment thereof As shown tissue 200 comprises a blood vessel 220 and more specifically an epidural vein Underly ing blood vessel 220 is a ligament 230 and mor
46. the electrosurgical unit 14 to earth ground using a suitable cable The rear panel also includes a removable cap 68 for the installation of a bipolar footswitch socket connectable to an internal footswitch cir cuit of electrosurgical unit 14 so that the RF power may be activated by a footswitch in addition to a handswitch of device 30 Additionally the rear panel also includes a fuse drawer 70 which includes which contains two extra fuses consistent with the line voltage Finally the rear panel includes a name plate 72 which may provide information such as the model number serial number nominal line voltages frequency cur rent and fuse rating information ofthe electrosurgical unit 14 0050 The RF power output curve of electrosurgical unit 14 is shown in FIG 4 Impedance Z shown in units of ohms on the X axis and output power Po is shown in units of watts on the Y axis In the illustrated embodiment the bipolar elec trosurgical power RF is set to 200 watts As shown in the figure for an RF power setting Ps of 200 watts the output power Po will remain constant with the set RF power P as long as the impedance Z stays between the low impedance cut off of 30 ohms and the high impedance cut off of 125 ohms Below an impedance Z of 30 ohms the output power P will decrease as shown by the low impedance ramp Above an impedance Z of 250 ohms the output power Po will also decrease as shown by the high impedance ramp 0051 Electrosu
47. to initiate priming of device 30 with fluid 24 Pushing switch 54 once initiates operation of pump 32 for a predetermined time period to prime device 30 After the time period is complete the pump 32 shuts off automatically When priming of device 30 is initiated a prim ing display 56 comprising an indicator light illuminates dur ing the priming cycle 0047 On the front panel the bipolar activation display 74 illuminates when RF power is activated from the electrosur gical unit 14 either via a hand switch 162 on device 30 as shown in FIG 1 or a footswitch not shown A pullout drawer 76 is located under the electrosurgical unit 14 where the user of electrosurgical unit 14 may find a short form ofthe user s manual 0048 FIG 3 shows the rear panel of electrosurgical unit 14 The rear panel of the electrosurgical unit 14 includes a speaker 60 and a volume control knob 62 to adjust the volume ofthe tone that will sound when the RF power is activated RF Sep 25 2008 power activation tone The volume of the RF power activa tion tone is increased by turning the knob clockwise and decreased by turning the knob counterclockwise However the electrosurgical unit 14 prevents this tone from being com pletely silenced 0049 Rear panel of electrosurgical unit 14 also includes a power cord receptacle 64 used to connect the main power cord to the electrosurgical unit 14 and an equipotential grounding lug connector 66 used to connect
48. urfaces and fluid 24 throughout the various embodiments should be such that the fluid 24 wets the surface of the electrodes 114a 1145 Contact angle 0 is a quantitative measure of the wetting of a solid by a liquid It is defined geometrically as the angle formed by a liquid at the three phase boundary where a liquid gas and solid intersect In terms of the thermodynamics of the materials involved contact angle 0 involves the interfacial free energies between the three phases given by the equation Yur COS O Ysr YsL where Ysy and y refer to the interfacial energies of the liquid vapor solid vapor and solid liquid interfaces respec tively If the contact angle 0 is less than 90 degrees the liquid is said to wet the solid If the contact angle is greater than 90 degrees the liquid 1s non wetting A zero contact angle 0 represents complete wetting Thus preferably the contact angle is less than 90 degrees 0082 The bipolar devices disclosed herein are particularly useful as non coaptive tissue sealers in providing hemostasis during surgery In other words grasping of the tissue 1s not necessary to shrink coagulate and seal tissue against blood loss for example by shrinking collagen and associated lumens of blood vessels e g arteries veins thereby inhib iting blood flow therethrough and therefrom to provided the desired hemostasis of the tissue More particularly the devices may be useful to shrink blood vessels
49. when the depression force is removed from button 164 0067 As best shown in FIG 11 device 30a has a disc shaped distal end comprising two bipolar electrodes 114a 114b An insulator housing assembly comprising housing outer portion 112 and housing inner portion 116 secures the electrodes 114a 1145 to device 30a Housing outer portion 112 and housing inner portion 116 comprise an electrically insulative material preferably a polymer and more preferably a fluorinated polymer such as polytetrafluoroethylene PTFE In addition to functioning as an electrical insulator polytetrafluoroethylene is preferred because it is hydrophobic and thus inhibits fluids present during surgery from settling thereon provides good arc resistance and provides a low coefficient of friction for reduced tissue sticking 0068 As shown in FIG 12 housing outer portion 112 electrically insulates electrodes 114a 114 from metal shaft 102 As shown in FIGS 11 and 12 housing outer portion 112 comprises a proximal cylindrical portion 118 and a distal Sep 25 2008 cylindrical portion 120 Proximal cylindrical portion 118 has a slightly small outer diameter than distal cylindrical portion 120 which creates a rim 122 there between For assembly proximal cylindrical portion 118 provides a connector por tion for connecting housing outer portion 112 to shaft 102 As shown in FIG 12 the outside diameter of proximal cylindri cal portion 118 is configured to extend i
50. wherein the fluid passage comprises at least one bore in a housing which secures the first semi circular shaped electrode and the second semi circular shaped electrode to the device 35 The device according to claim 34 wherein the at least one bore in the housing comprises a first bore in the housing and a second bore in the housing and the first bore and the second bore intersect and are perpen dicular to each other 36 The device according to claim 34 wherein the fluid passage comprises a T shaped bore in the housing 37 The device according to claim 1 wherein the shaft comprises a metal shaft 38 The device according to claim 37 wherein the metal shaft comprises stainless steel 39 The device according to claim 1 wherein the shaft is angled 40 A method of treating tissue having a blood vessel dur ing spine surgery the method comprising providing an electrically powered surgical device having a planar distal end pressing a portion of the blood vessel against a supporting spine structure with the planar distal end of the device to provide a compressed portion of the blood vessel and 10 Sep 25 2008 heating the compressed portion of the blood vessel with the surgical device sufficiently to occlude the blood vessel after the surgical device is removed from the blood ves sel 41 The method according to claim 43 wherein the surgical device comprises an electrosurgical device 42 The method accor
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