The present invention provides methods and devices for treating endovascular disease. Vibrational energy is delivered to change compliance and increase permeability at the treatment area. To improve clinical outcomes, one or more therapeutic drugs may be delivered to the treatment area.

A surgical instrument includes an end effector that has an ultrasonic blade and a clamp arm that is movable relative to the ultrasonic blade from an opened position toward a closed position. The ultrasonic blade and the clamp arm are able to receive tissue in the opened position, and the clamp arm is able to clamp tissue against the ultrasonic blade in the closed position. There is a first electrode connected with the clamp arm, and a second electrode associated with the ultrasonic blade. The electrodes are able to apply bipolar radiofrequency (RF) energy to tissue captured in the end effector. The instrument further has a first button for activating the ultrasonic blade to provide a cutting and sealing mode at the end effector. There is also a second button for activating the electrodes to provide a spot coagulation mode at the end effector.

A surgical instrument includes an ultrasonic transducer, a shaft defining a longitudinal axis, and an end effector at a distal end of the shaft. The end effector includes an ultrasonic blade driven by the ultrasonic transducer to treat tissue with ultrasonic energy. A tissue treatment portion of the ultrasonic blade includes a linear blade region extending parallel to the longitudinal axis, a curved blade region extending distally from the linear blade region along a curved path that deflects laterally from the longitudinal axis, an upper treatment side, a lower treatment side, a first lateral side having a first sweeping side surface, and a second lateral side having a second sweeping side surface. The sweeping side surfaces define respective first and second side edges of a transverse cross-section of the tissue treatment portion, and are configured such that the first and second side edges are parallel to one another.

A surgical instrument includes a body, a shaft assembly, and an end effector. The end effector includes an ultrasonic blade and a clamp arm movably coupled with the shaft assembly. The shaft assembly extends between the body and the end effector and includes an acoustic waveguide, a rotational driver, and a driver wrench. The rotational driver is configured to be received within the rotational drive channel and rotate the shaft assembly relative to the body. The acoustic waveguide includes a notch and the driver wrench includes a key, wherein the first notch of the acoustic waveguide is configured to receive the key.

In one general aspect, various embodiments are directed to an ultrasonic surgical instrument that comprises a transducer configured to produce vibrations along a longitudinal axis at a predetermined frequency. In various embodiments, an ultrasonic blade extends along the longitudinal axis and is coupled to the transducer. In various embodiments, the ultrasonic blade includes a body having a proximal end and a distal end, wherein the distal end is movable relative to the longitudinal axis by the vibrations produced by the transducer.

Various example embodiments described herein are directed to articulating surgical instruments for treating tissue comprising an end effector and a shaft extending proximally from the end effector along a longitudinal axis. In certain embodiments, the shaft comprises a plurality of transverse spacer members as well as first and second rotatable members extending through at least a portion of the plurality of transverse spacer members. The first and second rotatable members may both be biased away from the longitudinal axis such that their respective directions of bias vary with rotation of the first rotatable member. When the respective directions of bias of the first and second rotatable members oppose one another, the shaft may be substantially straight. When the respective directions of bias of the first and second rotatable members are aligned with one another, the shaft may articulate away from the longitudinal axis in the direction of the alignment.

Various example embodiments described herein are directed to articulating surgical instruments for treating tissue comprising an end effector and a shaft extending proximally from the end effector along a longitudinal axis. In certain embodiments, the shaft comprises a plurality of transverse spacer members as well as first and second rotatable members extending through at least a portion of the plurality of transverse spacer members. The first and second rotatable members may both be biased away from the longitudinal axis such that their respective directions of bias vary with rotation of the first rotatable member. When the respective directions of bias of the first and second rotatable members oppose one another, the shaft may be substantially straight. When the respective directions of bias of the first and second rotatable members are aligned with one another, the shaft may articulate away from the longitudinal axis in the direction of the alignment.

Ultrasonic surgical instruments having angularly and/or linearly off-set blades are described. The angularly and/or linearly off-set blades may facilitate increased surgical site access, visibility, and manipulability.

A surgical instrument, has an end effector that includes an ultrasonic blade, and a clamp arm that moves relative to the ultrasonic blade from an opened position toward an intermediate position and a closed position. The clamp arm is offset from the ultrasonic blade to define a predetermined gap in the intermediate position between the opened position and the closed position. A clamp arm actuator connects to the clamp arm and moves from an opened configuration to a closed configuration to direct the clamp arm from the opened position toward the intermediate position and the closed position. A spacer connects with the clamp arm to inhibit movement of the clamp arm from the intermediate position toward the closed position for maintaining the predetermined gap between the clamp arm and the ultrasonic blade.

A device for the fragmentation of a calculus includes a probe, and a drive unit for deflecting the probe along the longitudinal extension thereof. The drive unit includes a first drive element for periodically deflecting the probe and a second drive element for the pulsed deflection of the probe. The drive unit is configured such that periodic deflection and pulsed deflection can be superimposed.