before explaining the present invention in detail , it should be noted that the invention is not limited in its application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description . the illustrative embodiments of the invention may be implemented or incorporated in other embodiments , variations and modifications , and may be practiced or carried out in various ways . furthermore , unless otherwise indicated , the terms and expressions employed herein have been chosen for the purpose of describing the illustrative embodiments of the present invention for the convenience of the reader and are not for the purpose of limiting the invention . the present invention is particularly directed to an improved ultrasonic surgical clamp coagulator apparatus which is configured for effecting tissue cutting , coagulation , and / or clamping during surgical procedures . the present apparatus can readily be configured for use in both open surgical procedures , as well as laparoscopic or endoscopic procedures . versatile use is facilitated by selective use of ultrasonic energy . when ultrasonic components of the apparatus are inactive , tissue can be readily gripped and manipulated , as desired , without tissue cutting or damage . when the ultrasonic components are activated , the apparatus permits tissue to be gripped for coupling with the ultrasonic energy to effect tissue coagulation , with application of increased pressure efficiently effecting tissue cutting and coagulation . if desired , ultrasonic energy can be applied to tissue without use of the clamping mechanism of the apparatus by appropriate manipulation of the ultrasonic “ blade ” or end - effector of the device . as will become apparent from the following description , the present clamp coagulator apparatus is particularly configured for disposable use by virtue of its straightforward construction . as such , it is contemplated that the apparatus be used in association with an ultrasonic drive unit of a surgical system , whereby ultrasonic energy from the drive unit provides the desired ultrasonic actuation of the present clamp coagulator apparatus . it will be appreciated that a clamp coagulator apparatus embodying the principles of the present invention can be configured for non - disposable use , and non - detachably integrated with an associated ultrasonic drive unit . however , detachable connection of the present clamp coagulator apparatus with an associated ultrasonic drive unit is presently preferred for single - patient use of the apparatus . with reference first to fig1 and 3 , therein is illustrated a presently preferred embodiment of a surgical system , generally designated 10 , which includes an ultrasonic clamp coagulator apparatus embodying the principles of the present invention . preferred details of the ultrasonic generator and associated ultrasonic drive unit of the surgical system 10 will first be described , with subsequent detailed description of the fingertip activation of the end - effector , embodying the principles of the present invention . the surgical system 10 includes an ultrasonic generator 30 and an associated ultrasonic surgical instrument . the surgical instrument includes an ultrasonic drive unit , designated 50 , and an ultrasonic clamp coagulator apparatus 120 embodying the principles of the present invention . as will be further described , an ultrasonic transducer of the drive unit 50 , and an ultrasonic waveguide of the clamp coagulator 120 , together provides an acoustic assembly of the present surgical system , with the acoustic assembly providing ultrasonic energy for surgical procedures when powered by generator 30 . it will be noted that in some applications , the ultrasonic drive unit 50 is referred to as a “ hand piece assembly ” because the surgical instrument of the surgical system is configured such that a surgeon grasps and manipulates the ultrasonic drive unit 50 during various procedures and operations . the clamp coagulator apparatus 120 embodying the principles of the present invention preferably includes a pistol - like grip arrangement that facilitates positioning and manipulation of the instrument apart from manipulation of the ultrasonic drive unit 50 . the generator 30 , for example , a generator 300 available from ethicon endo - surgery , inc ., cincinnati , ohio , of the surgical system sends an electrical signal through a cable 32 at a selected current , frequency , and phase determined by a control system of the generator 30 . as will be further described , the signal causes one or more piezoelectric elements of the acoustic assembly of the surgical instrument to expand and contract , thereby converting the electrical energy into mechanical motion . the mechanical motion results in longitudinal waves of ultrasonic energy that propagate through the acoustic assembly in an acoustic standing wave to vibrate the acoustic assembly at a selected frequency and excursion . an end - effector at the distal end of the waveguide of the acoustic assembly is placed in contact with tissue of the patient to transfer the ultrasonic energy to the tissue . as further described below , a surgical tool , such as , a jaw or clamping mechanism , is preferably utilized to press the tissue against the end - effector . as the end - effector couples with the tissue , thermal energy or heat is generated as a result of friction , acoustic absorption , and viscous losses within the tissue . the heat is sufficient to break protein hydrogen bonds , causing the highly structured protein ( i . e ., collagen and muscle protein ) to denature ( i . e ., become less organized ). as the proteins are denatured , a sticky coagulum forms to seal or coagulate small blood vessels . deep coagulation of larger blood vessels results when the effect is prolonged . the transfer of the ultrasonic energy to the tissue causes other effects including mechanical tearing , cutting , cavitation , cell disruption , and emulsification . the amount of cutting as well as the degree of coagulation obtained varies with the excursion of the end - effector , the frequency of vibration , the amount of pressure applied by the user , the sharpness of the end - effector , and the coupling between the end - effector and the tissue . as illustrated in fig1 and 3 , the generator 30 includes a control system integral with the generator 30 and an on - off switch 34 . the power switch 34 controls the electrical power to the generator 30 , and when activated by the triggering mechanism 36 a - b , the generator 30 provides energy to drive the acoustic assembly 40 of the surgical system 10 to drive the end - effector at a predetermined excursion level . the generator 30 drives or excites the acoustic assembly at any suitable resonant frequency of the acoustic assembly . when the generator 30 is activated via the triggering mechanism 36 a - b , the generator 30 continuously applies electrical energy to a transducer stack 90 . a phase - locked loop in the control system of the generator 30 monitors feedback from the acoustic assembly . the phase lock loop adjusts the frequency of the electrical energy sent by the generator 30 to match the resonant frequency of the selected longitudinal mode of vibration of the acoustic assembly including the tissue load . in addition , a second feedback loop in the control system maintains the electrical current supplied to the acoustic assembly at a preselected constant level in order to achieve substantially constant excursion at the end - effector of the acoustic assembly . the electrical signal supplied to the acoustic assembly will cause the distal end of the waveguide , i . e ., the end - effector , ( fig2 ) to vibrate longitudinally in the range of , for example , approximately 20 khz to 250 khz , and preferably in the range of about 54 khz to 56 khz , and most preferably at about 55 . 5 khz . the excursion of the vibrations at the end - effector can be controlled by , for example , controlling the amplitude of the electrical signal applied to the transducer assembly 40 by the generator 30 . switch 36 a provides for one level of amplitude and switch 36 b provides for a second level of amplitude . as noted above , the triggering mechanism 36 a - b of the generator 30 allows a user to activate the generator 30 so that electrical energy may be continuously supplied to the acoustic assembly . the triggering mechanism 36 a - b preferably comprises a rocker switch that is positioned on handle 224 and electrically coupled or attached to the generator 30 by a cable or cord . alternatively , the triggering mechanism 36 a - b could be placed at other convenient locations , for example , on thumb ring 222 or on shroud 130 . referring to fig1 , 3 and 4 , the handpiece 50 includes a multi - piece housing 52 adapted to isolate the operator from the vibrations of the acoustic assembly . the drive unit housing 52 can be shaped to be held by a user in a conventional manner , but it is contemplated that the present clamp coagulator 120 principally be grasped and manipulated by a pistol - like arrangement provided by a housing of the apparatus , as will be described . while the multi - piece housing 52 is illustrated , the housing 52 may comprise a single or unitary component . the housing 52 generally includes a proximal end , a distal end , and a cavity extending longitudinally therein . the distal end of the housing 52 includes an opening 60 configured to allow the acoustic assembly of the surgical system 10 to extend therethrough , and the proximal end of the housing 52 is coupled to the generator 30 by the cable 32 . the housing 52 is preferably constructed from a aluminum , however , it is also contemplated that housing 52 may be made from a variety of plastics , such as ultem rtm . a suitable ultrasonic drive unit 50 is model no . hp054 , available from ethicon endo - surgery , inc ., cincinnati , ohio . two gold - plated circumferential electrical connectors 111 a and 111 b are located at the distal end of drive unit 50 for communicating electrical control signals from switches 36 a - b to the generator 30 . as shown in fig3 and 5 , the handpiece 50 is preferably acoustically coupled to the second acoustic portion of the ultrasonic clamp coagulator apparatus 120 . the distal end of the drive unit 50 is preferably coupled to the proximal end of the second acoustic portion by an internal threaded connection near an anti - node , but alternative coupling arrangements can be employed . when drive unit 50 is inserted into housing 130 and connected thereto , the distal end of drive unit 50 passes through connector 300 and ring connectors 111 a - b interface with slip ring connectors 310 and 320 , respectively , as is discussed in more detail below . referring also now to fig4 , an exploded view of the ultrasonic clamp coagulator apparatus 120 of the surgical system 10 in accordance with a preferred embodiment is illustrated . the proximal end of the ultrasonic clamp coagulator apparatus 120 preferably receives and is fitted to the distal end of the ultrasonic drive unit 50 by insertion of the drive unit into the housing of the apparatus , as shown in fig3 . the ultrasonic clamp coagulator apparatus 120 is preferably attached to and removed from the ultrasonic drive unit 50 as a unit . the ultrasonic clamp coagulator 120 may be disposed of after a single use . the ultrasonic clamp coagulator apparatus 120 preferably includes a handle assembly or a housing 130 , preferably comprising mating housing portions 131 , 132 , and an elongated or endoscopic portion 150 . when the present apparatus is configured for endoscopic use , the construction can be 5 dimensioned such that portion 150 has an outside diameter of about 5 . 5 mm . the elongated portion 150 of the ultrasonic clamp coagulator apparatus 120 extends orthogonally from the apparatus housing 130 . the elongated portion 150 can be selectively rotated with respect to the housing 130 . the elongated portion 150 preferably includes an outer tubular member or sheath 160 , an inner tubular actuating member 170 , and the second acoustic portion of the acoustic system in the form of a waveguide 180 having an end - effector 180 ′. outer tube 160 , inner tube 170 , end effector 180 ′ and clamp pad 190 are all operatively coupled with rotation knob 216 so that rotation of knob 216 causes corresponding rotation of the end effector 180 ′ and clamp arm 190 . as illustrated in fig4 , the proximal end of the waveguide 180 of the second acoustic portion is preferably detachably coupled to the mounting device 84 of the ultrasonic drive unit 50 near an anti - node as described above . the waveguide 180 preferably has a length substantially equal to an integer number of one - half system wavelengths . the waveguide 180 is preferably fabricated from a solid core shaft constructed out of material that propagates ultrasonic energy efficiently , such as titanium alloy ( i . e ., ti - 6a1 - 4v ) or an aluminum alloy . it is contemplated that the waveguide 180 can alternatively be fabricated from any other suitable material . with particular reference to fig2 , a clamping mechanism of the present clamp coagulator 120 is configured for cooperative action with the end - effector 180 ′ of the waveguide 180 . the clamping mechanism includes a pivotally movable clamp arm 190 , which is pivotally connected at the distal end thereof to the distal end of outer tubular sheath 160 . a clamp pad 192 , preferably formed from teflon or other suitable low - friction material , is mounted on the surface of the clamp arm for cooperation with the end - effector 180 ′, with pivotal movement of the clamp arm positioning the clamp pad in substantially parallel relationship to , and in contact with , the end - effector 180 ′. by this construction , tissue is grasped between the pad 192 and the end effector 180 ′. as illustrated , the pad 192 is preferably provided with a saw tooth - like configuration to enhance the gripping of tissue in cooperation with the end - effector 180 ′. as will be appreciated by those skilled in the art , end - effector 180 ′ and clamp pad 190 may take on any number of shapes , including a curved shaped as disclosed in u . s . pat . no . 6 , 325 , 811 . as is described in the u . s . patents previously incorporated by reference , the surgeon &# 39 ; s thumb squeezes trigger 222 to cause the clamping mechanism to pivot the movable clamp arm 190 . one or more of the surgeon &# 39 ; s other fingers may rest comfortably within handle 224 . in accordance with the current invention , the surgeon &# 39 ; s index finger controls the operation of the generator 30 by selectively depressing switches 36 a - b . switches 36 a - b are conveniently located such that the surgeon may energize end effector 180 ′ and also cause rotation of the end effector 180 ′ and clamp pad 190 via knob 216 using the same hand ( fingers ) for operation . referring now to fig5 - 8 and 10 , switches 36 a - b are mechanically connected via a rocker arm 40 comprising an aperture 140 a for accepting pivot post 42 . in this configuration , switches 36 a - b cannot be simultaneously depressed , which , if were the case , would provide an error message from generator 30 . a flex circuit 330 provides for the electro - mechanical interface between switches 36 a - b and the generator 30 via the drive unit 50 . also referring to fig8 a , flex circuit 330 includes , at the distal end , two dome switches 332 and 334 that are mechanically actuated by depressing pins 142 a - b of corresponding switches 36 a - b , respectively . dome switches 332 and 334 are electrical contact switches , that when depressed provide an electrical signal to generator 30 as shown by the electrical wiring schematic of fig8 b . flex circuit 330 also comprises two diodes within a diode package 336 , also illustrated in fig8 b . flex circuit 330 provides conductors , as is known to those in the art , that connect to slip ring conductors 310 and 320 via connector 300 , which in turn provide electrical contact to ring conductors 111 a - b , which in turn are connected to conductors in cable 32 that connect to generator 30 . ring conductors 111 a - b are situated within the distal end of handpiece 50 as is generally described in u . s . pat . no . 6 , 623 , 500 b1 , the contents of which are incorporated by reference herein . with particular reference now to fig6 a - b and 7 , slip ring conductors 310 and 320 are generally open - ended o - shaped springs that slip onto mounting surfaces 302 and 304 of connector 300 , respectively . each spring slip - ring comprises two pressure point contacts ( 312 a - b and 322 a - b ) that contact the respective ring conductor 111 a - b of handpiece 50 . the spring tension of the slip rings 310 and 320 cause positive contact between contacts 312 a - b , 322 a - b and conductors 111 a - b . it is evident that the slip - ring construction allows electrical contact to be made even as hand piece 50 may be rotated by the surgeon during use of the instrument . posts 314 and 324 of the respective slip rings electrically connect to the respective conductor within flex circuit 330 to complete the electrical circuit as shown in fig8 b . referring now to fig9 , switches 36 a - b are preferably configured in such a way to provide an ergonomically pleasing grip and operation for the surgeon . in particular , the angle of depression / activation of switches 36 a - b is not parallel , but the direction of activation for each switch define an angle of actuation θ with respect to a common point p within area of thumb placement of the thumb grip of trigger 222 , when the trigger 222 is in its normal state . the range of angle θ is from about 10 ° to about 30 ° , and more preferably from about 15 ° to about 20 ° . switches 36 a - b are also separated by a distance l 1 , which is sufficient to minimize inadvertent activation by the surgeon &# 39 ; s finger resting on handle 224 between switches 36 a - b , but at the same time provides for a high degree of grip stability during tissue grasping and manipulation functions . distance l 1 is from about 1 inch to about 0 . 5 inches , and more preferably , from about 0 . 8 inches to about 0 . 6 inches . while the present invention has been illustrated by description of several embodiments , it is not the intention of the applicant to restrict or limit the spirit and scope of the appended claims to such detail . numerous variations , changes , and substitutions will occur to those skilled in the art without departing from the scope of the invention . moreover , the structure of each element associated with the present invention can be alternatively described as a means for providing the function performed by the element . accordingly , it is intended that the invention be limited only by the spirit and scope of the appended claims .
an ultrasonic surgical clamp coagulator apparatus is configured to effect cutting , coagulation , and clamping of tissue by cooperation of a clamping mechanism of the apparatus with an associated ultrasonic end - effector . the handle of the apparatus is configured to permit hand activation for cutting , coagulation , and clamping of tissue during surgical procedures . in order to promote convenient and efficient use of the apparatus , the fingertip controls are provided directly into the disposal shears handle in a position that allows surgeons to activate the device without repositioning their hand . the two buttons provide independent control of the two power levels available from the generator , matching the two foot pedal configuration of the prior art .