A therapeutic ultrasound instrument is described for cutting, dissecting, or cauterizing tissue. Ultrasonic vibrations, when transmitted to organic tissue at suitable energy levels and using a suitable end-effector, may be used for the safe and effective treatment of many medical conditions. An ultrasonic surgical instrument is described which incorporates an articulating shearing end-effector. The instrument comprises an ultrasonic transducer, an ultrasonically activatable end-effector, and a substantially solid ultrasonic waveguide that connects the ultrasonic transducer to the end-effector. The waveguide comprises a transmission section extending from the transducer to a fixed node, and an articulation section extending from the fixed node to a pivoting node. The end-effector includes a bifurcated waveguide segment. A handle is adapted to hold the transducer. An outer sheath extends from the handle to the end-effector and surrounds the waveguide. An actuation trigger is rotatably positioned on the handle, and an actuation arm extends from a distal end of the actuation trigger to the pivoting node. Such instruments are particularly suited for use in minimally invasive procedures, such as endoscopic or laparoscopic procedures.
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