Note: Descriptions are shown in the official language in which they were submitted.
CA 02518019 2005-08-30
HANDHELD ELECTROSURGICAL APPARATUS FOR CONTROLLING
OPERATING ROOM EQUIPMENT
BACKGROUND
1. Technical Field
The present disclosure relates generally to electrosurgical instruments and,
more
to particularly, to an electrosurgical handpiece having a plurality of hand-
accessible variable
controls.
2. Background of Related Art
During electrosurgery, a source or active electrode delivers energy, such as
radio
frequency (RF) energy, from an electrosurgical generator to a patient and a
return electrode or a
15 plurality thereof carry current back to the electrosurgical generator. In
monopolar electrosurgery,
the source electrode is typically a hand-held instrument placed by the surgeon
at the surgical site
and the high current density flow at this electrode creates the desired
surgical effect of ablating,
cutting or coagulating tissue. The patient return elechodes are placed at a
remote site from the
source electrode and are typically in the form of pads adhesively adhered to
the patient.
20 Bipolar electrosurgery is conventionally practiced using an electrosurgical
forceps-type
device, where the active and return electrodes are housed within opposing
forceps' jaws. The
return electrode is placed in close proximity to the active electrode (current
supplying) such that
an electrical circuit is formed between the two electrodes (e.g.,
electrosurgical forceps). In this
CA 02518019 2005-08-30
manner, the applied electrical current is limited to the body tissue
positioned between the
electrodes.
Electrosurgical instruments have become widely used by surgeons in recent
years.
Accordingly, a need has developed for equipment and instruments which are easy
to handle, are
reliable and are safe in an operating environment. Generally, most
electrosurgical instruments
are hand-held instruments, e.g., an electrosurgical pencil, which transfer
radio-frequency (RF)
electrical energy to a tissue site.
Electrosurgical procedures are performed in operating rooms including a
variety of
equipment, e.g., an operating table, operating lights, smoke evacuation
systems, insufflation
systems, etc. During surgical procedures, the surgeon and his staffneed to
operate each of these
15 devices. However, controls for these devices are located throughout the
operating room away
from the sterile field instead of a single central location therein. In order
to interact with the
controls, the surgeon must momentarily stop the procedure and focus his
attention away from the
sterile field. For instance, to adjust the light output level the surgeon must
move outside the
sterile field to lighting controls or ask for assistance to do so. These
methods have a few
2o drawbacks, for example, asking another person to adjust the controls does
not provide the same
level of exactitude and feedback that the surgeon would be able to achieve in
adjusting the
desired apparatus himself. Furthermore, the adjustment accomplished by the
surgeon himself
requires that he Ieave the sterile field and cease the procedure temporarily,
resulting in unneeded
interruptions and risks of contamination of the surgical site.
2
CA 02518019 2005-08-30
Therefore, there is a need for a control system having controls for a variety
of operating
room equipment disposed on a single apparatus found within the sterile field.
SUMMARY
The present disclosure provides for an apparatus which includes controls for a
variety of
operating room devices therein. The apparatus is held by a surgeon during
surgical procedures
within the sterile field providing the surgeon immediate control of the
operating room devices,
such as overhead lighting, insufflation unit, operating table, and the like.
The apparatus is
connected to a central controller which in turn is connected to the operating
room devices. The
apparatus may be a stand-alone device or be incorporated in a variety of
surgical devices, such as
irngation apparatuses and electrosurgical pencils.
According to one embodiment of the present disclosure, a system for
controlling
operating room equipment during an electrosurgical procedure is disclosed. The
system includes
an electrosurgical generator, a controller in electrical communication with
and configured to
control the electmsurgical generator and at least one operating room device,
and a handpiece
2o having a housing and a cable extending proximally from the housing
providing electrical
connection to the controller, the handpiece further includes first controls
for controlling the
generator and second controls for controlling at least one operating room
device.
According to another embodiment of the present disclosure, an apparatus for
controlling
operating room equipment during an electrosurgical procedure is disclosed. The
apparatus
includes a housing, a cable extending proximally from the housing providing
electrical
3
CA 02518019 2005-08-30
connection to a controller, the controller in electrical communication with
and configured to
control an electrosurgical generator and at least one operating room device,
first controls for
controlling the generator, and second controls for controlling at least one
operating room device.
BRIEF DESCRIPTION OF THE DRAWINGS
The above and other aspects, features, and advantages of the present
disclosure will
1o become more apparent in light of the following detailed description when
taken in conjunction
with the accompanying drawings in which:
Fig. 1 is a block diagram illustrating in general an electrosurgical system
including a
handpiece according to the present disclosure;
Fig. 2 is a perspective view of an electrosurgical pencil according to the
present
1s disclosure;
Fig. 3 is a partially broken away perspective view of the electrosurgical
pencil of Fig. 2;
and
Fig. 4 is an exploded perspective view of the electrosurgical pencil of Fig.
2.
2o DETAILED DESCRIPTION
Preferred embodiments of the present disclosure will be described herein below
with
reference to the accompanying drawings. In the following description, well-
known functions or
constructions are not described in detail to avoid obscuring the present
disclosure in unnecessary
detail. As used herein, the term "distal" refers to that portion which is
further from the user
4
CA 02518019 2005-08-30
while the term "proximal" refers to that portion which is closer to the user
or surgeon.
Fig. 1 shows an electrosurgical system including a generator 10 and a
handpiece 12
(e.g., an electrosurgical pencil) having an active electrode 17 at a distal
end thereof which is
brought in contact with a patient P to effect a cut and/or coagulation
procedure depending
upon the operating mode selected. The active electrode 17 is an electrically
conducting
1o element which is usually elongated and may be in the form of a thin flat
blade with a pointed
or rounded distal end. Alternatively, the active electrode 17 may include an
elongated
narrow cylindrical needle which is solid or hollow with a flat, rounded,
pointed or slanted
distal end.
Attached to the patent P is a return electrode 19 which returns the
electrosurgical
~5 current from the patient P to the generator 10. The handpiece 12 is
connected to the
generator 10 via a cable 18 extending from a proximal end of the handpiece 12.
The cable
18 includes electrical wires for supplying the electrosurgical power to the
active electrode 17
as well as electrical power for the controls of the handpiece 12.
The active electrode 17 may be used laparoscopically, e.g., inserted into a
body
2o cavity through a percutaneous incision. To accomplish this, the electrode
17 may be
introduced into a body cavity through a conventional trocar (not shown). The
trocar may
include an elongated tube which penetrates the body cavity with its distal end
and the
electrode 17 is introduced thereto through its proximal end. In addition, the
trocar may
include a hemostatic valve disposed at its proximal end to prevent backflow of
fluids.
CA 02518019 2005-08-30
The handpiece I2 may also include an irrigation tube (not shown) which
irrigates the
surgical site. Other components of the irngation system (e.g., irrigation
fluid supply, valve
mechanisms, etc.) may be disposed within the generator I O or within a
separate stand-alone
device (e.g., a cassette). The irngation and suction lines are connected from
the irngation system
to the handpiece 12 and thereafter to the irngation tube and may be included
within the cable 18.
Other surgical equipment may also be used in conjunction with electrosurgical
equipment, such as an operating table 22, operating room lighting 24, and an
insufflation unit 26.
The operating table 22 may include a plurality of servo actuators which
activate component
pieces of the operating table 22 (e.g., head section, middle section, leg
section, etc.). In
particular, servo actuators may tilt and/or rotate the sections of the
operating table 22 to position
the patient P in a desired posture.
The lighting 24 may be any operating room lighting fixture for illuminating
the surgical
site. The lighting 24 is positioned above the operating table 22 and includes
a support arm 23.
The lighting 24 includes controls for turning the lighting 24 on and off,
adjusting intensity of the
Light. In addition, the lighting 24 may include servo actuators which modify
the position thereof
2o by adjusting the support arm 23.
The insufllation unit 26 inflates body cavities, which is a conventional
procedure used
during laparoscopic surgery. Insufflation is accomplished by pumping gas into
body cavities to
provide more space for the surgeon to maneuver various laproscopic
instruments. The
insufflation unit 26 may include controls for adjusting insufflation pressure,
turning on
6
CA 02518019 2005-08-30
ventilation of insufflation gas to clear smoke generated during laparoscopic
electrosurgical
procedures, etc.
Conventionally, controls for the operating room equipment are disposed on the
equipment
itself. According to the present disclosure, the controls for the operating
table 22, the lighting 24,
and the insufflation unit 26 are located at the handpiece 12. This allows the
surgeon to control a
multitude of operating room devices within the sterile field and alleviates
the problems
associated with conventional control schemes of operating room equipment. The
central controls
may be incorporated in a control device held by the surgeon within the sterile
field. In addition,
the controls may be included on any instruments used by the surgeon during
operating
procedures. Zn particular, the controls may be disposed on the handpiece 12.
This allows the
surgeon to control the operating parameters of the generator 10 as well as
other operating
equipment (e.g., the operating table 22, the lighting 24, and the insufflation
unit 26). The
handpiece 12 includes controls which transmit control signals to a central
controller 20 which
then controls each of the operating room devices. The central controller 20
may be a stand-alone
device or be incorporated into the circuitry and/or housing of the generator
10. The controller 20
2o includes inputs for accepting control signals from the handpiece 12 and
outputs for interfacing
with a variety of operating room equipment (e.g., the generator 20, etc.). In
addition, the
controller 20 may include other electronic, electrical, or electromechanical
components (e.g.,
relays) to accept inputs from the handpiece 12 and transmit them to the
operating mom
equipment.
7
CA 02518019 2005-08-30
The handpiece 12 may be in a shape of an electrosurgical pencil. Typically,
the
electrosurgical pencil may be operated by a handswitch or a footswitch. Fig. 2
shows a
perspective view of an electrosurgical pencil constructed in accordance with
one
embodiment of the present disclosure and generally referenced by numeral 13.
While the
following description will be directed towards electrosurgical pencils, it is
envisioned that
to the features and concepts (or portions thereof) of the present disclosure
can be applied to any
electrosurgical type instrument, e.g., forceps, suction coagulator, vessel
sealers, etc.
As shown in Figs. 2-4, electrosurgical pencil 13 includes an elongated housing
2
configured and adapted to support a blade receptacle 4 at a distal end 3
thereof which, in
turn, receives a replaceable electrocautery end effector 6 (e.g., the active
electrode 17) in the
t5 form of a loop and/or blade therein. Electrocautery blade 6 is understood
to include a planar
blade, a loop, a needle and the like. A distal end portion 8 of blade 6
extends distally from
receptacle 4 while a proximal end portion 11 (see FIG. 3) of blade 6 is
retained within distal
end 3 of housing 2. It is contemplated that electrocautery blade 6 is
fabricated from a
conductive type material, such as, for example, stainless steel, or is coated
with an
2o electrically conductive material.
As shown, electrosurgical pencil 13 is coupled to a conventional
electrosurgical generator
via a cable 18, which includes a transmission wire 14 (see Fig. 4) which
electrically
interconnects electrosurgical generator 10 with proximal end portion 11 of
electrocautery blade
6. Cable 18 further includes control wires 16 which electrically interconnect
switches (as will be
25 described in greater detail below), supported on an outer surface 7 of
housing 2, with
CA 02518019 2005-08-30
electrosurgical generator 10. For the purposes herein the terms "switch" or
"switches" includes
electrical actuators, mechanical actuators, electro-mechanical actuators
(rotatable actuators,
pivotable actuators, toggle-like actuators, buttons, etc.) or optical
actuators.
Turning back to Figs. 2-4, as mentioned above, electrosurgical pencil 13
further includes
at least one activation switch, preferably three activation switches 24a-24c,
each of which are
to supported on an outer surface 7 of housing 2. The activation switch 24a
activates the insufflation
unit 26 and initiates the inflation process. The activation switch 24b
activates the siphoning
process of the insufflation unit 26. The activation switch 24c is configured
to turn on or off the
lighting 24. Those skilled in the art will appreciate that the pencil 13 may
include additional
activation switches far adjusting a variety of functions of the operating room
equipment.
t5 Each activation switch 24a-24c is operatively connected to a location on a
tactile element
26a-26c (e.g., a snap-dome is shown) which, in turn, controls various
operating room equipment.
More particularly, tactile elements 26a-26c are operatively connected to a
voltage divider
network 27 (hereinafter "VDN 27") which fornis a switch closure (e.g., here
shown as a film-
type potentiometer). For the purposes herein, the term "voltage divider
network" relates to any
2o known form of resistive, capacitive or inductive switch closure (or the
like) which determines the
output voltage across a voltage source (e.g., one of two impedances) connected
in series. A
"voltage divider" as used herein relates to a number of resistors connected in
series which are
provided with taps at certain points to make available a fixed or variable
fraction of the applied
voltage.
9
CA 02518019 2005-08-30
In use, depending on which activation switch 24a-24c is depressed a respective
switch
26a-26c is pressed into contact with VDN 27 and a characteristic signal is
transmitted to the
controller 24 via control wires 16, which then transmits signals to
corresponding operating room
equipment. Control voltage is supplied to the electrosurgical pencil 13 by a
secondary power
source (not shown) (e.g., a battery). The secondary power source along with
the controls of the
to electrosurgical pencil 13 (e.g., activation switch 24a-24c) and the
controller 20 form a control
loop. Control wires 16 are preferably electrically connected to switches 26a-
26c via a terminal 15
(see Fig. 3 and 4). The controller 20 includes a circuit for interpreting and
responding to the
VDN settings.
In operation and depending on the particular desired operation of one of the
operating
15 room equipment, the surgeon depresses one of activation switches 24a-24c,
in the direction
indicated by arrow "Y" (see FIG. 1) thereby urging a corresponding switch 26a-
26c against VDN
27 and thereby transmitting a respective characteristic signal to
electrosurgical controller 20.
Those skilled in the art will appreciate that the pencil 13 also includes
activation switches
configured and adapted to control the mode and/or "waveform duty cycle" to
achieve a desired
2o surgical intent (not shown). Typically, the "modes" relate to the various
electrical wavefonns,
e.g., a cutting waveform has a tendency to cut tissue, a coagulating wave form
has a tendency to
coagulate tissue and a blend wave form is somewhere between a cut and
coagulate wave from.
The power or energy parameters are typically controlled from outside the
sterile field which
requires an intermediary like a circulating nurse to make such adjustment. A
typical
25 electrosurgical generator has numerous controls for selecting an
electrosurgical output. For
CA 02518019 2005-08-30
example, the surgeon can select various surgical "modes" to treat tissue: cut,
blend (blend levels
1-3), low cut, desiccate, fulgurate, spray, etc. The surgeon also has the
option of selecting a
range of power settings typically ranging from 1-300W. The hemostatic
effect/function can be
defined as having waveforms with a duty cycle from about 1 % to about 12%. The
blending
effect/fimction can be defined as having waveforms with a duty cycle from
about 12% to about
75%. The cutting and/or dissecting effect/function can be defined as having
waveforms with a
duty cycle from about 75% to about 100%. It is important to note that these
percentages are
approximated and may be customized to deliver the desired surgical effect far
various tissue
types and characteristics.
Electrosurgical pencil 13 further includes an intensity controller (not shown)
for adjusting
is the intensity of the electrosurgical current. The intensity controller may
be in the fornn of a
sliding controller as discussed in detail below. The electrosurgical pencil 13
includes a sliding
controller 28 having a pair of nubs 29a, 29b which are slidingly supported,
one each, in
respective guide channels 30a, 30b, formed in outer surface 7 of housing.2 on
either side of
activations switches 24a-24c. The nub 29a is configured to control the tilt of
the operating table
22, sliding the nub 29a along the direction indicated by double-headed arrow
"X" toward the
distal end of the pencil 13 tilts the table 22 forward, while sliding the nub
29a toward the
proximal end tilts the table 22 backward. Tilting of the operating table 22
allows for adjustment
of an angle at which the torso of the patient P is positioned to create
clearances between organs
and abdominal wall for insertion of endoscopic instruments. It is envisioned
that activation
switches may be used instead of sliding nubs to control tilting of the
operating table 22, where
each of the activation switches tilt the table 22 in a corresponding
direction.
11
CA 02518019 2005-08-30
The nub 29b is configured to control the intensity of the lighting 24, whereas
sliding the
nub 29b along the direction indicated by double-headed arrow "X" toward the
proximal end of
the pencil 13 decreases the intensity of the light and sliding the nub 29a
toward the distal end
increases the intensity. Those skilled in the art will understand that the
pencil 13 may include
additional controls for controlling other functions of the lighting 24 such as
lateral, longitudinal,
1o and vertical position of the lighting 24, if corresponding position
adjusters are included (e.g.,
servo actuators, hydraulics, etc.),
Preferably, sliding controller 28 is a slide potentiometer wherein nubs 29a,
29b have a
first position (e.g., proximal-raost position closest to cable 18)
corresponding to a relative low
intensity setting, a second position (e.g., a distal-most position closest to
electrocautery end
1 s effector 6) corresponding to a relative high intensity setting, and a
plurality of intermediate
positions corresponding to intermediate intensity settings. As can be
appreciated, the intensity
settings from proximal end to distal end may be reversed as well, e.g., high
to low. It is
contemplated that nubs 29a, 29b of sliding controller 28 and corresponding
guide channels 30a,
30b may be provided with a series of cooperating discrete or dented positions
defining a series of
20 discrete values, preferably five, to allow easy selection of the output
intensity from the low
intensity setting to the high intensity setting. The series of cooperating
discrete or detented
positions also provide the surgeon with a degree of tactile feedback. As best
seen in FIG. 3,
sliding controller 28 can include a series of indicia 31 provided thereon
which are visible through
guide channels 30a, 30b. Indicia 31 are preferably a series of numbers (e.g.,
numbers 1-5) which
25 reflect the level of intensity that is to be transmitted. Alternatively,
level indicators may be
printed alongside the sides of guide channels 30a, 30b along which nubs 29a,
29b slide.
12
CA 02518019 2005-08-30
It is envisioned that the sliding controller 28 may be replaced by a current
divider network
(e.g., a rheostat) wherein, the rheostat has a first position corresponding to
one setting, a second
position corresponding to another intensity and a plurality of other positions
corresponding to
settings between the minimum and the maximum settings. For instance, in
reference to the
controls for the lighting 24, the minimum setting would dim the lights while
the maximum
to setting adjusts the lights for maximum illumination, with other settings
representing medium
light intensity.
By providing nubs 29a, 29b on either side of activation switches 24a-24c,
controller 28
can be easily manipulated by either hand of the user or the same
electrosurgical pencil can be
operated by a right-handed or a left-handed user. An example of an
electrosurgical pencil for
~5 controlling the modes and intensity is disclosed in a commonly-owned U.S.
Patent Application
Serial No.10/718,113 entitled "Electrosurgical Pencil with Improved Controls"
which is hereby
incorporated by reference in its entirety herein.
It is also contemplated that sliding controller 28 can be configured and
adapted to provide
a degree of tactile feedback. Alternatively, audible feedback can be produced
from sliding
2o controller 28 (e.g., a "click"), from the generator 10 (e.g., a "tone's
and/or from an auxiliary
sound-producing device such as a buzzer (not shown).
Preferably, as seen in Figs. 2 and 4, sliding controller 28 and activation
switches 24a-24c
are supported in a recess 9 formed in outer wall 7 of housing 2. Desirably,
activation switches
24a-24c are positioned at a location where the fingers of the surgeon would
normally rest when
z5 electrosurgical pencil I3 is held in the hand of the surgeon while nubs
29a, 29b of sliding
13
CA 02518019 2005-08-30
controller 28 are placed at locations which would not be confused with
activation switches 24a-
24c. Alternatively, nubs 29a, 29b of sliding controller 28 are positioned at
locations where the
fingers of the surgeon would normally rest when electrosurgical pencil I3 is
held in the hand of
the surgeon while activation switches 24a-24c are placed at locations which
would not be
confused with nubs 29a, 29b of sliding controller 28 . In addition, recess 9
formed in outer wall
7 of housing 2 advantageously minimises inadvertent activation (e.g.,
depressing, sliding and/or
manipulating) of activation switches 24a-24c and sliding controller 28 while
in the surgical field
and/or during the surgical procedure.
As seen in Fig. 4, electrosurgical pencil 13 includes a molded/contoured hand
grip 5
which substantially surrounds the distal and proximal ends of housing 2 as
well as the underside
t 5 of housing 2. Contoured hand grip 5 is shaped and dimensioned to improve
the handling of
electrosurgical pencil 13 by the surgeon. Accordingly, less pressure and
gripping force is
required to use and/or operate electrosurgical pencil Z 3 thereby potentially
reducing the fatigue
experienced by the surgeon.
Those skilled in the art will understand that the above-described embodiments
of controls
disposed on an electrosurgical pencil can incorporate controls for a variety
of operating zoom
equipment not discussed in detail, such as irrigation systems and the like. In
addition, the skilled
in the art will appreciate that the centralized controls of the present
disclosure can be
incorporated into a stand-alone apparatus configured to be held by the surgeon
(e.g., attached to
the electrosurgical pencil) during operating procedures or into existing
surgical devices, such as
irrigation devices and the like.
14
CA 02518019 2005-08-30
The described embodiments of the present disclosure are intended to be
illustrative rather
than restrictive, and are not intended to represent every embodiment of the
present disclosure.
Various modifications and variations can be made without departing from the
spirit or scope of
the disclosure as set forth in the following claims both literally and in
equivalents recognized in
law.
