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United States Patent 
Horner et al.
 DIRECTED ENERGY SURGICAL METHOD AND ASSEMBLY
 Inventors: Glenn A. Horner; Scott A. Miller;
Warren P. Heim; Larry K.
Blankenship; James L. Brassell, all of
 Assignee: The Larren Corporation, Boulder,
 Appl. No.: 437,321
 Filed: May 9, 1995
 Int. CI.6 A61N 1/08
 U.S. CI 607/88; 607/104; 607/105;
 Field of Search 607/104, 105,
607/113, 115, 116, 153, 88; 239/337-339; 128/200.14, 200.21; 606/22, 34, 35, 41
 References Cited
U.S. PATENT DOCUMENTS
4,060,088 11/1977 Morrison, Jr. et al 128/303.17
4,719,914 1/1988 Johnson 128/303.1
4,911,159 3/1990 Johnson et al 606/37
4,929,246 5/1990 Sinofsky 606/8
5,092,864 3/1992 Hayes et al 606/10
5,160,334 11/1992 Billings et al 606/34
5,167,659 12/1992 Ohtomo et al 606/40
5,188,532 2/1993 Levy 433/216
[li] Patent Number: 5,554,172  Date of Patent: Sep. 10, 1996
5,273,524 12/1993 Fox et al 604/21
5,277,696 1/1994 Hagen 606/49
5,300,069 4/1994 Hunsberger et al 606/37
5,304,176 4/1994 Phillips 606/41
5,306,238 4/1994 Fleenor 606/42
5,318,562 6/1994 Levy et al 606/16
5,324,254 6/1994 Phillips 604/21
5,334,193 8/1994 Nardella 606/41
FOREIGN PATENT DOCUMENTS
4138468 6/1983 Germany .
Primary Examiner—Angela D. Sykes
Assistant Examiner—Ryan C. Carter
Attorney, Agent, or Firm—Sheridan Ross & Mcintosh
An improved directed energy surgical method and assembly is disclosed. The method and assembly contemplate the application of a directed energy stream to tissue and the application of a liquid mist stream to the tissue to reduce or eliminate smoke at the surgical site. The invention may be advantageously implemented in an assembly having a surgical pencil for emitting the directed energy stream and liquid mist stream. The liquid mist stream is generated by the surgical pencil, preferably by atomizing a liquid stream supplied thereto (e.g., pressurized via jet atomization). The invention may be utilized in connection with conventional electrosurgical, laser surgery, ultrasound, and other techniques and devices.
51 Claims, 2 Drawing Sheets
DIRECTED ENERGY SURGICAL METHOD
FIELD OF THE INVENTION
The present invention relates to surgical methods and assemblies employing the application of directed energy to tissue to achieve a predetermined surgical effect, and more particularly, to achieve such effect with reduced attendant smoke at the surgical site. io
BACKGROUND OF THE INVENTION
The potential uses and recognized advantages of employing directed energy for surgical purposes are ever-increasing. In particular, for example, electrosurgery and laser surgery techniques are now being widely employed to provide significant localized control advantages in both open and laparoscopic applications relative to prior traditional surgical approaches. 2Q
Despite the advantages associated with directed energy surgical techniques, one drawback has been the heating of tissue and attendant generation of smoke. Such smoke impedes observation of the surgical site during surgical procedures, and there is a growing concern that the smoke 2s may be a medium for the transport of pathogens away from the surgical site, including viruses such as HIV. In turn, such concerns have contributed to the use of face shields and masks by surgical personnel.
To date, proposed approaches to deal with smoke have 30 focused upon the utilization of devices to either evacuate the smoke by sucking the same into a filtering system, or alternatively to merely blow the smoke away from the surgical site by a pressurized gas stream. Typical smoke evacuators require the movement of large amounts of air to 35 be effective. As a result, such evacuators tend to be not only noisy but space consuming in a surgical theater where space efficiency is at a premium. Proposed approaches for blowing the smoke away from the surgical site suffer from the fact that, since the smoke is not actually removed, the above- 40 noted concerns are either only partially addressed or otherwise actually compounded.
SUMMARY OF THE INVENTION
Accordingly, the primary objective of the present invention is to provide a surgical method and assembly which employs directed energy to achieve a desired surgical effect while reducing smoke otherwise attendant thereto. Relatedly, it is a further objective to reduce smoke in a manner 5Q which does not entail significant space requirements, significant cost, or adverse impact upon the effectiveness of the particular directed energy surgical technique employed.
To achieve the noted objectives, the surgical method of the present invention comprises the step(s) of simulta- 55 neously or alternately applying a directed energy stream to a tissue region to achieve a predetermined surgical effect and contacting the predetermined tissue region with a liquid mist stream. As employed herein, the term "liquid mist stream" means a two phase stream of liquid droplets at least partially go suspended in a gas.
More particularly, the liquid mist stream employed in the present invention comprises liquid droplets preferably having a diameter of between about 0.1 to 1000 micrometers, and even more preferably between about 0.6 to 60 microme- 65 ters. The liquid mist stream is preferably further characterized by providing a mass flow rate at the surgical site of less
than about 1511 milligrams/square centimeter per second. Even more preferably, the mass flow rate is less than about 21.5 milligrams/square centimeter per second and greater than about 0.58 milligrams/square centimeter per second.
The liquid mist contacting step preferably includes the step of atomizing a liquid stream to generate the liquid mist stream. Such atomization most preferably is achieved by directing a liquid stream across a pressurized gas stream (i.e., jet atomization). Alternative atomization techniques include emitting a high pressure liquid stream from a nozzle (i.e., pressure atomization), passing a substantially saturated fluid phase stream through a nozzle such that the substantially saturated fluid phase stream undergoes a phase change to a mixed gas and liquid phase stream (i.e., condensation atomization), deflecting a pressurized liquid stream against an angled impact plate (i.e., impact atomization), passing a liquid stream in at least partial contact with a vibrating surface (i.e., vibrating surface atomization), passing a liquid stream through a spinning disk (i.e., spinning disk atomization), passing a high pressure air stream through a thin film water surface (i.e., surface tension atomization), or impacting a plurality of liquid streams (i.e., impact atomization).
The application of a liquid mist stream to tissue heated by the directed energy stream serves to quench tissue pyrolysis, thereby reducing or even eliminating the generation of smoke. Further, it is believed that the liquid droplets in the liquid mist stream serve to reduce any smoke by contacting smoke particles, coalescing therewith, and delivering the same back to the surgical site. Additionally, it is anticipated that another potential benefit of the present invention will be the tissue "washing" achieved by the liquid mist stream, thereby allowing for the identification of bleeders, etc.
While the above-noted benefits are due to the liquid mist stream, it should be appreciated that for a given tissue, the optimal droplet size, droplet velocity, and mass flow rate established should avoid accumulation of excess liquid at the surgical site which may interfere with achieving the desired surgical effect.
The surgical assembly of the present invention preferably comprises a surgical pencil for emitting a directed energy stream and a liquid mist stream, a liquid supply for supplying a liquid (e.g., a sterile irrigation solution commonly used in surgery such as 0.9% NaCl) stream to the surgical pencil, a directed energy source, and control means for selectively controlling the emission of the directed energy stream and/or liquid mist stream. Preferably, the liquid has a density between about 0.7 to 1.8 grams/cubic centimeter. To remove undesired liquid from the surgical site (e.g., body fluid and/or liquid accumulating as a result of the liquid mist stream), the assembly may further include suction means and suction control means either separately provided or supportably interconnected to with the surgical pencil.
The surgical pencil includes a support structure preferably sized for handheld use, a directed energy means for emitting the directed energy stream and a liquid mist generation means for generating the liquid mist stream. The directed energy means and the liquid mist generation means are supportably interconnected to the support structure. By way of primary example, the directed energy source may comprise an electrosurgical generator, a plasma generator, ultrasonic generator, or a surgical laser. If an electrosurgical generator is employed, the directed energy means of the pencil will include a surgical electrode that is electrically interconnected with the generator. In arrangements utilizing a surgical laser, the directed energy means of the surgical pencil may include a laser energy transport means (e.g.,