Surgical Devices And Methods of Use Thereof
Contents
1. 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 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 1146 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 inhibi2. 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 oftissue 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 in the best interest ofthe patient physician and hospital to perform surgical procedures as quickly as possible 0006 light of the above there is 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 deliverthe fluid a primer to prime the hand device with the
3. 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 1145 to provide a localized fluid coupling 204 between surface 202 of tissue 200 and electrodes 114a 1145 Preferably fluid 24 couples between the electrodes 114a 1145 and the tissue 200 at both the perimeter 151a 1515 of electrodes 114a 1145 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 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 RE energy power and form an alter nating current electrical field in tissue 200 In the presence of alternating current the electrodes 114a 1145 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 t
4. manual Oct 4 2012 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 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 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 cu
5. 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 vesselis compressed comprises one or more vertebra of the spine and may further comprise the vertebral body ofthe 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 vertebra or a lateral anterior side ofthe 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 ofthe vertebral body ofthe 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 ofthe vertebra and stability ofthe vertebrae the blood vessel may be pressed against the verte bra without the vertebra deforming In this manner the blood vessel ma
6. 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 1145 preferably comprise an electrically conductive metal which is 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 perpendicular to the longitudinal axis of shaft 102 In other embodiments as shown for example in US 2012 0253343 Al 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 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 co
7. 0 800 500 1000 Load Ohms gt p FIG 4 Te e UP Tr de ud EN E dy 100 120 140 189 180 200 Power Setting Matts o3 High Qu bn deo Mediam Rep ME FIG 5 US 2012 0253343 1 Oct 4 2012 Sheet 5 of 15 Patent Application Publication 9 Dia venere ain try FRA REEL LSL 0 Patent Application Publication Oct 4 2012 Sheet 6 of 15 US 2012 0253343 A1 120 ere 7 US 2012 0253343 1 Oct 4 2012 Sheet 7 of 15 Patent Application Publication US 2012 0253343 1 Oct 4 2012 Sheet 8 of 15 Patent Application Publication oho 4 Patent Application Publication Oct 4 2012 Sheet 9 of 15 US 2012 0253343 A1 Patent Application Publication Oct 4 2012 Sheet 10 of 15 US 2012 0253343 A1 SO D a 4b ae 1996 Sar NK u BEB WER 50 a rp mmn rt Ptr in pus emn ntn PH 7 Patent Application Publication Oct 4 2012 Sheet 11 0f15 US 2012 0253343 Al ZU EBEN m Q er 4 b e oe 1 SN NE FW U FI i N 4 waren DZD R H A Patent Application Publication Oct 4 2012 Sheet 12 of 15 US 2012 0253343 A1 iie 14 US 2012 0253343 1 Oct
8. 2007 30a device is removed from the blood vessel 180 i 2 g Patent Application Publication Oct 4 2012 Sheet 1 of 15 US 2012 0253343 A1 FIG 1 US 2012 0253343 1 Oct 4 2012 Sheet 2 of 15 Patent Application Publication wi i 1 1 E q TEE ana Ra dee 5222 TEE EEE ELLEELLE Ee ERE md US 2012 0253343 1 Oct 4 2012 Sheet 3 of 15 Patent Application Publication t 4 o EL t o ED AA E j 4 1 mA e A ATA AAA err f Bo B EEE ur RR LEE ri Di Patent Application Publication Oct 4 2012 Sheet 4 of 15 US 2012 0253343 A1 Power Waits Saline Flow Rate e ox s RE 527 1 E pre Power 200 Watt Setting Bipolar Pow er Wat Setting i 5 L M tite AN ER i drm i 790 200 300 400 500 600 70
9. 4 2012 Sheet 13 of 15 Patent Application Publication wh h EO ue to td i we 7 ET X E Sy 422 E Mn 04 Ee Poj A f Dv i 5 EA D 2 A E LL et 4 t o x Ji MU rU treni orte 3 k b C 7v NEN hage ag 5 W Patent Application Publication Oct 4 2012 Sheet 14 of 15 US 2012 0253343 A1 Patent Application Publication Oct 4 2012 Sheet 15 of 15 US 2012 0253343 A1 EEG r9 US 2012 0253343 Al SURGICAL DEVICES AND METHODS OF USE THEREOF CROSS REFERENCE TO RELATED APPLICATIONS 0001 The present application claims the 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
10. 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 466 which are used to select the RF power setting Pushing the switch 46a increases the RE 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 RE power activation display 74 comprising an indicator light which illuminates when RF power is activated Switches 465 may comprise membrane switches 0044 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
11. US 20120253343A1 as United States a2 Patent Application Publication Pub No US 2012 0253343 A1 McClurken et al 43 Pub Date Oct 4 2012 54 SURGICAL DEVICES AND METHODS OF Publication Classification USE THEREOF 51 Int Cl A61B 18 14 2006 01 76 Inventors REUS nu 82 ran 606 41 Roger D Greeley Portsmouth NH US Brian M 57 ABSTRACT Conley South Berwick ME US The invention provides surgical devices and methods to treat tissue In one device embodiment the invention comprises a 21 Appl No 13 494 574 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 22 Filed Jun 12 2012 a disc shaped distal end In one method embodiment the aun invention comprises a method of treating tissue having a Related U S Application Data blood vessel during spine surgery with the method compris 62 Division of application No 12 053 030 filed on Mar IDE Pressing a poruon ofthe blood vessel against a supporting 21 2008 now Pat No 8 216 233 spine structure with a surgical device to provide a compressed portion ofthe blood vessel and heating the compressed tion ofthe blood vessel with the surgical device sufficiently to 60 Provisional application No 60 896 768 filed on Mar inhibit a blood flow through the vessel after the surgical 23
12. al 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 branch as they approach the neural foramina This main dorsal branch continues posteriorly below the transverse process of the vertebrae supplying the bone ofthe 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 Oct 4 2012 0089 During a
13. another way for expediency the tissue should be Oct 4 2012 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 1145 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 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 between electrodes 114a 1145 which rests on surface 202 of tissue 200 and forms a shunt between electrodes 114a 1145 Given this scenario a certain amount of RF energy may be diverted from going into tissue 200 and actually pass between electrodes 114a 1145 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 tre
14. ated 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 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 in
15. 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
16. 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 priming switch 54 is used 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 pullout drawer 76 is located under the electrosurgical unit 14 where the user of electrosurgical unit 14 may find a short form of the user s
17. ctrical 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 corresponding to Qz and Qy respectively Conversely electrosurgical unit 14 has been configured to decrease the fluid flow rate Q linearly with US 2012 0253343 Al decrease RF power setting P each of three fluid flow rate settings of low medium and high corresponding to Q and Q respectively As shown Qz Q and Qy be expressed as a function of the RF power setting by chang ing exemplary proportionality constants as follows Q 0 1xPs 0 1286 01571 0053 FIG 6 shows exemplary block diagram of how electrosurgical unit 14 processes the inputs of RF power setting and the fluid flow rate setting either Q Q or Qy to control the pump spee
18. d 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 and 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 525 52c and the priming switch 54 are 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 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 ofthe computer chip 45 While the functional re
19. e distal portion of device 30a proximal to the distal end of the device In this manner holes 146a 1465 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 1465 are located on the distal portion of device 30a proximal to the distal end ofthe 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 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 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 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 1485 thereof Hole 1465 is provided adjacent and closest to electrode 114a at corner 149a thereof and adjacent and clos est to electrode 1145 at corner 1495 thereof In this manner fluid may be provided to the locatio
20. faces respec tively If the contact angle 0 15 less than 90 degrees the liquid is said to wet the solid If the contact angle is greater than 90 degrees the liquid 15 non wetting 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 either severed US 2012 0253343 Al 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 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 sp
21. fluid a control system to control a flow ofthe fluid delivered by the pump with a functional relationship between the radio frequency power level and the flow ofthe fluid the functional relationship to increase the flow ofthe 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 supporting the distal portion of the device in rigid relation to the handle The distal portion of the device Oct 4 2012 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 ofthe blood vessel against a supporting spine structure with a sur
22. 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 oftreating 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 videa compressed portion ofthe blood vessel and heating the compressed portion of the blood vessel with the surgical 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 havi
23. ises 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 Oct 4 2012 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 further comprises a posterior side of the vertebral
24. issue 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 Iumen 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 the lumen 222 together here by collagen welding 0100 Thetime to shrink tissue containing 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
25. lationships 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 or 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 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 concis text missing or illegible when filed Oct 4 2012 0058 Electrosurgical unit 14 can i
26. mber 8 comprising a hollow cylindrical postto which a storage basket 10 may be fastened and used to Oct 4 2012 store the electrosurgical unit s user manual as well as addi tional unused devices Furthermore the support member 8 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 for carrying fluid source 22 0037 Returning to FIG 1 fluid source 22 comprises 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 k
27. nclude a delay mecha nism such as a text missing or illegible when filed automatically keep the fluid flow on for several seconds after the RF power is deactivated to provide a post treatment cool ing Electrosurgical unit 14 can also include a delay mecha nism 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 desic cation electrode sticking char formation and smoke produc tion 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 ofthe device exemplary bipolar electrosurgical device of the present invention which may be used in conjunction 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 pla
28. nectable 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 375 37c The plug connectors 37a 375 37c are each assembled with wires 34a 345 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 US 2012 0253343 Al 345 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 1145 as discussed in greater detail below Finally wire con 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 ofhand 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 assembl
29. ng at least one aperture formed therein to inhibit the button from adhering with the perimeter wall by the blood 0012 It 15 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 115 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 FIG 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 of saline at high medium 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 615 a block diagram showing one embodiment of how the electrosurgical unit processes the inputs of RF power setting and the fluid flow rate setting either Q or to control the pump speed US 2012 0253343 Al 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 is
30. nown 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 mechanical 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 cond
31. ns of electrodes 114a 1145 andtissue expected to have the greatest need forthe fluid for device 30a to function most properly i e the electrode corners and tissue adjacent thereto Also in this manner fluid Oct 4 2012 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 1515 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 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 1145 0079 Inother embodiments as shown in FIGS 15 and 16 the semi circular shaped side perimeter 151a 1515 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 1515 of electrodes 114a 1145 from being used to treat tissue As shown the semi circular shaped perimeter 151a 151 of electrodes 114a 1145 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 so
32. ntact 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 ofan 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 bore 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 th
33. ometric view of the inner components of the handle with the handle removed 0021 FIG 9isaside view ofa handle portion ofthe device of FIG 7 assembled with various components 0022 FIG 10 is a close up side view of a button and handle portion ofthe device ofFIG 7 assembled with various components 0023 FIG 11 is exploded view ofa distal portion ofthe 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 view 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 ofthe distal portion ofthe 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 di
34. ot 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 posterior 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 ofthe exterior vertebral venous plexus communicate with the veins ofthe interior vertebral venous plexus through interver tebral veins and anterior and posterior segmental medullary radicular veins of each vertebr
35. posterior discectomy the devices of the present invention may be more particularly used by a surgeon to seal veins ofthe 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 anterior external vertebral venous plexus and segmental arter les 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 visibility 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 ofthe blood vessel with the surgical device sufficiently to occlude the blood vessel e g by shrinking the vessel and the by shrinkage ofthe collagen in the vessel and
36. r 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 1145 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 bonding 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 1325 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
37. rve of electrosurgical unit 14 is shown in FIG 4 Impedance Z shown in units of ohms on the X axis and output power P 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 P of 200 watts the output power 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 Po will decrease as shown by the low impedance ramp Above an impedance Z of 250 ohms the output power will also decrease as shown by the high impedance ramp 0051 Electrosurgical 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 Q in units of cubic centimetres per minute cc min 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 which is not so great as to provide too much fluid and associated ele
38. stal 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 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 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 me
39. ts fluids present during surgery from settling thereon provides good are resistance and provides a low coefficient of friction for reduced tissue sticking Oct 4 2012 0068 As shown in FIG 12 housing outer portion 112 electrically insulates electrodes 114a 1145 from metal shaft 102 As shown in FIGS 11 and 12 housing outer portion 112 comprises a proximal cylindrical portion 118 and a distal 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 into 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 space
40. uctive 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 15 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 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 US 2012 0253343 Al electrosurgical unit 14 Preferably the fluid delivery tubing 28 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 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
41. urce 22 is first communicated through lumen 29 of delivery tubing 28 As shown in FIG 8 fluid 24 then feeds into a lumen 156 ofa size reduction bushing 154 located within handle 104 and then into lumen 152 oftubing 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 Therelationship between the material for electrodes 114a 1145 and their surfaces 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 cos where Ysy and refer to the interfacial energies of the liquid vapor solid vapor and solid liquid inter
42. usible 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 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 15 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 con
43. vention 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 publications and patent documents cited in this application are incorporated by reference in their entirety for all purposes to the extent they are consistent US 2012 0253343 Al 1 39 canceled 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 heating the compressed portion ofthe 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 according to claim 41 wherein the electrosurgical device compr
44. y 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 control circuit is then sensed by electrosurgical unit 14 which then provides power to the electrodes 114a 114 0065 When 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 1145 More detailed drawings and an explanation of the operation of switch assembly 162 may be found in U S Publication No 2005 0090816 published
45. y be compressed at which time the compressed portion ofthe 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 more specifically US 2012 0253343 Al a longitudinal ligament ofthe spine Underlying ligament 230 is 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 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
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