Abstract: An electrosurgical implement for tunneling through tissue for effecting drainage of an organ or to restore patency to a blood vessel is described. The implement comprises a stainless steel, helically wound, wire body similar to a conventional guidewire of the type used in angiography, angioplasty or in implanting cardiac pacing leads. The exterior of the guidewire is coated with an insulating material, save for one or two convolutions at its distal end. A core wire having a Teflon.RTM. shrink tube surrounding it over substantially its entire length is disposed within the lumen of the helical guidewire and only a short segment of the distal end of the core wire is allowed to extend out from the distal end of the guidewire. This short segment is stripped free of insulation.

Abstract: A bioplar sphinctertome for use in endoscopic retrograde sphincterotomy procedures includes an elongated, flexible, plastic tube having either a single or a double lumen and includes a segment near its distal end which is both flexible and conductive. This segment is connected by a wire extending through the lumen to a terminal at the proximal end of the device adapted to be coupled to an electrosurgical generator. A second, longitudinally movable wire passes through the lumen and is connected at the proximal end to a finger-operated slide mechanism while its distal end passes through a small aperture formed in the tube just proximal of the flexible conductive segment. That wire is then anchored distally of the flexible conductive segment so that when a tensioning force is applied to the wire, the distal end portion of the instrument will bow, with the exposed wire comprising the active electrode and the flexible conductive segment functioning as the return electrode.

Abstract: An improved handle for a polypectome snare for use in excising polyps from an internal body cavity. The apparatus generally comprises a radio frequency polypectome snare which includes a hand grip assembly, a flexible tubing assembly capable of fitting within an endoscope, an electrode loop portion and a power supply means. The hand grip assembly is made of molded pieces of inflexible plastic comprising a longitudinal housing portion and a slide member having opposing finger grip members. When the slide member is in its most proximal position, the electrode loop portion is withdrawn into the flexible tubing. As the slide member is advanced toward the distal end of the longitudinal housing, the electrode wires are advanced out of the flexible tubing, forming a loop that can be placed around the stem of a polyp. Once again withdrawing the loop into the end of the flexible tubing while simultaneously applying RF voltage shears the polyp at its base.

Abstract: An bipolar electrosurgical instrument especially designed especially for use in freeing and rerouting of the internal mammary artery during coronary bypass surgery. It comprises a rigid pen-like handle having appropriate cut and coag control switches mounted thereon and a bendable tubular extension projecting from the distal end of the handle member. Mounted on the distal end of the extension is a blade holder designed to contain an ultrasonic transducer as well as the proximal end of the blade itself. The blade comprises a ceramic substrate having a pattern of metallization thereon defining a bipolar cutting gap along the side and end edges of the blade and a bipolar coagulating gap located inwardly from the side and end edges. A cable is used to join the implement to an electrosurgical generator and the individual wires in the cable extend through the pen-like body, the tubular extension and into the blade holder where electrical connections are made to the electrodes on the blade itself.

Abstract: An electrosurgical instrument for use in combination with an endoscope for cutting tissue and cauterizing/coagulating the resulting wound area is described. The instrument comprises an elongated flexible tubular member having a proximal end, a distal end, and plural lumens extending therebetween. Affixed to the distal end of the tube is a bullet-shaped ceramic tip member having a centrally-disposed longitudinal bore passing through the side wall of the tip member. The ceramic exterior surface of the tip member is covered with a conductive layer forming a first inactive electrode. An electrical conductor joined to that electrode surface feeds back through a lumen of the tube to its proximal end where it may be coupled to an electrosurgical generator. Also running through a lumen in the tube is another conductor which can be made to project outwardly through the opening in the tip member.

Abstract: A RF ablation catheter for removing athero-stenotic lesions or modifying the tissue characteristics of the interior walls of selected blood vessels is described. The catheter is characterized in having a tip member which during the initial placement of the catheter within the vascular system so that the distal tip member is disposed in a working relation with the lesion to be removed, means are provided for increasing the cross-sectional profile of the tip members to thereby cause it to move into engagement with the lesion to be excised. The application of an RF voltage across a pair of bipolar electrodes is used to create an electric arc for effecting the cutting action, or alternatively, just sufficient RF energy to sear or otherwise alter the tissue surfaces engaged by the distal tip member.

Abstract: A surgical cutting blade for use in an electrosurgical scalpel includes a thin flat ceramic substrate having a rounded tip where the edge portion of the substrate on the opposed major surfaces thereof are beveled. A pattern of metallization is provided on the opposed major surfaces of the blade substrate with the metallization extending over the tapered portions. The substrate is then back-ground to form a blunt edge extending between the tapered surfaces at the edge of the substrate. The metallization pattern further includes traces extending from the conductors along the blunt working edge of the blade to the handle receiving portion thereof and provide a means whereby RF energy may be conducted to the metallized working edge of the blade.

Abstract: An electrosurgical angioplasty catheter with ultrasonic enhancement is described. It comprises an elongated, flexible plastic tubular body having located at its distal tip an electrode structure for effecting rf cutting along with a transducer for ultrasonically driving the rf cutting electrodes and the support thereof. The electronics module for driving the cutting electrodes and the ultrasonic transducer also includes means for receiving echo signals picked up by the transducer whereby Doppler flow readings and ultrasound imaging of the blood vessel being worked upon can be obtained.

Abstract: An electro-surgical implement with an improved handle having a cutting mode of operation and a coagulating mode of operation. The implement includes a blade member having an electrically conductive pad area, and a predetermined pattern of electrical conductors. Electrical switch apparatus is contained in the handle member for altering the mode of operation between the cutting mode and coagulating mode when the handle member is in a locked disposition. Apparatus is also contained within the handle member for vibrating the blade member at a predetermined frequency and amplitude sufficient to create cavitation to prevent buildup of tissue and debris, and apparatus for energizing the blade for cutting and coagulating including apparatus for forcing the electrically conductive pad area against the vibration apparatus when the handle member is in a locked disposition. Mechanical switch apparatus is included to allow safe removal of the blade.

Abstract: A polypectome snare whose loop comprises a pair of electrodes mechanically joined but electrically insulated from one another at their distal ends and adapted to be energized by a source of RF voltage for excising polyps on the inside of a body cavity is described. The polypectome snare is designed to be used with an endoscope and includes two concentric flexible plastic tubes each having proximal and distal ends and a lumen running the length thereof. At the proximal end is a hand grip which is secured to the wires leading to the bipolar electrodes with one of the wires passing through the lumen of the outermost tube and the other wire extending through the lumen of the inner tube. In this fashion, the wires remain insulated from one another over the length of the instrument and due to this same arrangement, the conductors comprising the bipolar electrodes cannot become twisted at the distal end of the implement to thereby create a short which would render the snare inoperative.

Abstract: An electrosurgical generator for driving one or more separate electrosurgical implements, e.g., an electrosurgical scalpel and an electrosurgical forceps, over separate output channels. Bipolar electrodes on the scalpel blade are energized by a radio frequency (rf) power source which, by proper manipulation of push-button switches on the scalpel handle, can be made to operate selectively in a CUT and in a COAG (coagulate) mode. In the CUT mode, the rf energy is applied to the tissue, via electrodes which are closely spaced, yielding a high current density. In the COAG mode, the energy is applied to electrodes which are spaced relatively far apart so as to produce heating sufficient to cauterize, but not to the point where the tissue is rent. The generator also provides circuitry for energizing an ultrasonic transducer mechanically coupled to one of the surgical implements whereby vibratory energy is simultaneously applied to the implement along with the rf CUT/COAG energy.

Abstract: A surgical cutting blade for use in an electrosurgical scalpel includes a thin flat ceramic substrate having a rounded tip where the edge portion of the substrate on the opposed major surfaces thereof are beveled. A pattern of metallization is provided on the opposed major surfaces of the blade substrate with the metallization extending over the tapered portions. The substrate is then back-ground to form a blunt edge extending between the tapered surfaces at the edge of the substrate. The metallization pattern further includes traces extending from the conductors along the blunt working edge of the blade to the handle receiving portion thereof and provide a means whereby RF energy may be conducted to the metallized working edge of the blade.

Abstract: An electrosurgical blade having a silicon nitride ceramic substrate having a beveled working edge with first and second conductive metal traces adhered to opposed side surfaces of the substrate along the working edge so as to be closely spaced relative to one another across the thickness dimension of the beveled working edge. Further conductive traces are formed on opposed sides of the substrate along the other edge of the substrate. In use, when a high RF voltage is applied between the traces extending along the working edge and the surgical blade is brought into contact with tissue, the relatively high current density causes relatively high heating to take place, bursting the cells and creating an incision. When a high RF voltage is applied between the traces separated by the width dimension of the substrate, the current density therebetween is significantly lower but sufficient to create enough heat to dehydrate tissue and blood cells whereby coagulation is achieved.

Abstract: Described is a surgical tool having a unique blade comprised of a blank made of electrically conductive material, a first insulative member, a plurality of electrically conductive members laminated to the first and insulative member and a second insulative coating. The blade acts as a capacitive device or as a resistive device depending upon the precise configuration of the second insulative coating.

Abstract: An electro surgical instrument comprising a handle and a replaceable blade. The handle includes a blade receiving slot and means for clamping the proximal portion of the blade within the slot. Also formed internally of the handle and within the slot is a cavity for containing an electrical-to-mechanical transducer and a plurality of conductive terminal pad areas. The blade is provided with a pattern of conductors which are insulated from one another and which lead to contact pad areas on the distal portion of the blade. When the blade is appropriately inserted into the handle and clamped in place, the transducer abuts the blade and electrical contact is established to energize the conductors and the transducer whereby the blade may be vibrated at a frequency and amplitude to limit the build-up of tissue debris on the blade during an electro surgery procedure.