# US 9,433,461 B2 · Instruments, systems, and methods for sealing tissue structures

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- Number: US 9,433,461 B2
- Document ID: US9433461B2
- Status: Granted
- Kind: B2
- Application number: 14/017,572
- Filed: 2013-09-04
- Published: 2014-03-13
- Granted: 2016-09-06
- Earliest claimed: 2012-09-07
- Assignees: Covidien LP
- Applicants: Covidien LP
- Inventors: Shobhit Arya; Lei Su; Ara W. Darzi; George B. Hanna
- Web page: https://patentgrep.com/patent/US9433461B2

## CPC

- A61B 18/1445: {at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod}
- A61B 2017/00057: {Light}
- A61B 2018/00494: {Stomach, intestines or bowel}
- A61B 2018/0063: {Sealing}
- A61B 2018/00654: {with individual control of each of a plurality of energy emitting elements}
- A61B 2018/00672: {lower}
- A61B 2018/00678: {upper}
- A61B 2018/00702: {Power or energy}
- A61B 2018/00714: {Temperature}
- A61B 2018/00755: {Resistance or impedance}
- A61B 2018/00791: {Temperature}
- A61B 2018/00875: {Resistance or impedance}
- A61B 2018/1253: {monopolar}
- A61B 2018/126: {bipolar}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

A method of sealing bowel tissue includes grasping bowel tissue between first and second electrically-conductive surfaces, applying a clamping pressure to the grasped bowel tissue in a range of about 1 kg/cm2 to about 2.5 kg/cm2, supplying energy to at least one of the first and second electrically-conductive surfaces such that the energy is conducted between the first and second electrically-conductive surfaces and through the grasped bowel tissue to seal the grasped bowel tissue, and monitoring one or more parameters during the supplying of energy to the electrically-conductive surface(s). Instruments, end effector assemblies, generators, and systems suitable for this purpose are also provided.

## Claims

### Claim 1

A method of sealing bowel tissue, comprising:
grasping bowel tissue between first and second electrically-conductive surfaces;
applying a clamping pressure to the grasped bowel tissue in a range of about 1 kg/cm2 to about 2.5 kg/cm2;
supplying energy to at least one of the first and second electrically-conductive surfaces such that the energy is conducted between the first and second electrically-conductive surfaces and through the grasped bowel tissue;
monitoring an impedance of the grasped bowel tissue as a function of time during the supplying of energy to the at least one of the first and second electrically-conductive surfaces; and
controlling the supply of energy to the at least one of the first and second electrically-conductive surfaces to maintain a target impedance ramp of the grasped bowel tissue such that the grasped bowel tissue is sealed with minimal bowel tissue denaturation, bowel tissue damage, and breakdown of bowel tissue layer architecture.

### Claim 2 (depends on 1)

The method according to claim 1, wherein the target impedance ramp is about 0.010 Ω/ms.

### Claim 3 (depends on 1)

The method according to claim 1, wherein supplying energy to the at least one of the first and second electrically-conductive surfaces includes supplying energy until bowel tissue impedance reaches a target end impedance.

### Claim 4 (depends on 3)

The method according to claim 3, wherein the target end impedance is about 200Ω.

### Claim 5

A method of sealing bowel tissue, comprising:
grasping bowel tissue between first and second electrically-conductive surfaces;
applying a clamping pressure to the grasped bowel tissue in a in a range of about 1 kg/cm2 to about 2.5 kg/cm2;
supplying energy to at least one of the first and second electrically-conductive surfaces such that the energy is conducted between the first and second electrically-conductive surfaces and through the grasped bowel tissue;
monitoring a temperature of the grasped bowel tissue during the supplying of energy to the at least one of the first and second electrically-conductive surfaces; and
controlling the supply of energy to the at least one of the first and second electrically-conductive surfaces to maintain the temperature of the grasped bowel tissue between a lower temperature limit, corresponding to a minimum temperature for sealing bowel tissue, and an upper temperature limit, corresponding to a maximum temperature prior to occurrence of bowel tissue denaturation, bowel tissue damage, and breakdown of bowel tissue layer architecture, such that the grasped bowel tissue is sealed with minimal bowel tissue denaturation, bowel tissue damage, and breakdown of bowel tissue layer architecture.

### Claim 6

A method of sealing bowel tissue, comprising:
grasping bowel tissue between first and second electrically-conductive surfaces;
applying a clamping pressure to the grasped bowel tissue in a range of about 1 kg/cm2 to about 2.5 kg/cm2;
supplying energy to at least one of the first and second electrically-conductive surfaces such that the energy is conducted between the first and second electrically-conductive surfaces and through the grasped bowel tissue;
monitoring an optical property of the grasped bowel tissue during the supplying of energy to at least one of the first and second electrically-conductive surfaces; and
stopping the supplying of energy to the at least one of the first and second electrically-conductive surfaces when the optical property of the grasped bowel tissue indicates at least one of bowel tissue denaturation, bowel tissue damage, and breakdown of bowel tissue layer architecture, such that the grasped bowel tissue is sealed with minimal bowel tissue denaturation, bowel tissue damage, and breakdown of bowel tissue layer architecture.