JPH10146344A - Electric operating device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To precisely select a function at necessary time, and improve safety and efficiency of an operation by monitoring output of a high frequency, controlling a start and a stoppage of the output by automatically detecting contact of an electrode and a living body tissue, and controlling permission or nonpermission of the function by detection of an output switch. SOLUTION: An operation condition of a switch detecting circuit 6 is monitored by a CPU 5, and whether or not a CUT or COAG output switch is pushed is detected. When the CUT output switch is pushed, a high frequency output current of a feeble output level uninfluencing on a living body 12 is flowed, and when contact of a scalpel electrode of a hand piece 8 to the living body 12 is detected from a change in an electric current detected by a monitor circuit 7, high frequency output is started. When the switch is inputted again, the whole high frequency output is prohibited. The hand piece 8 having an output switch or a foot switch is selectively operated to select a delay of this output start and stopping time, to automatically output a high frequency and to select a stopping function or the like.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electrosurgical apparatus, such as a high-frequency ablation power supply, for applying high-frequency current to a human body to perform ablation or hemostasis.

[0002]

2. Description of the Related Art Conventionally, most electrosurgical devices control the start and end of output of a high-frequency current by an operator's operation of a hand switch or a foot switch. Further, in DE2540968, which is a German patent, a separate current source is provided in order to detect that an electrode has come into contact with tissue separately from a high-frequency current.
A technique related to bipolar coagulation tweezers that automatically outputs a high frequency after a predetermined delay time has elapsed has been proposed.

FIG. 8 shows the above-mentioned prior art DE.
The configuration of the bipolar coagulating tweezers disclosed in U.S. Pat. As shown in FIG. 8A, a bipolar electrode 101 for sandwiching a living body 102 is connected to a detection power supply and a relay 104 via a coil. Further, one of the bipolar electrodes 101 is connected to one end of the coil, and the other is connected to the other end of the coil via a capacitor. Both ends of the coil facing the coil are connected to the high-frequency power supply 103.

In such a configuration, a current for detection from the detection power supply 104 is applied to the living body 10 through the bipolar electrode 101.
Flow to 2. When the bipolar electrode 101 is not in contact with the living body, no current flows.
The current I shown in the time chart of FIG. 8B starts to flow from t0. Then, after a certain delay time, a signal is sent from the relay 104 to the high-frequency power supply 105 from t1, and output is started. When the electrode 101 leaves the living body again,
Since the detection current I stops flowing again at t2, the detection is detected, the relay 104 is operated, and the operation of the high-frequency power supply 105 is stopped.

Therefore, according to this technique, the high-frequency output can be automatically started and stopped without operating the foot switch or the output switch formed in the handpiece (not shown) by the above operation.

On the other hand, Japanese Utility Model Application Laid-Open Publication No. Sho 61-185405 discloses a technique in which, in order to prevent microshock, when the scalpel is not touching the human body, output cannot be started even if an output switch is pressed. I have. This is to avoid the problem that the leakage current increases when the scalpel is output without touching the living body when the human body touches the operating table.

[0007] Here, FIG.
The configuration of the device disclosed in Japanese Patent Publication No. 405 is shown and described. As shown in FIG.
An operating table 106 for placing the patient is placed, and the output of the electrode 119 attached to the patient 107 is a patient code 1
08 and connected to the input of the detection circuit 116. The output of the output switch 111 is connected to the input of the relay 113 via the output switch cable 110, and the detection circuit 116
Is connected to the handpiece 112 via an output cable. The patient cord 108 and the output cable are both connected to a high-frequency power supply 115.
5 is connected to the relay 113. This relay 1
An electrosurgical apparatus 114 having a power supply 13, a high-frequency power supply 115, and a detection circuit 116 is connected to a commercial power supply and a ground via a commercial power supply cable 117 and an earth cable 118, respectively.

In such a configuration, the detection of the output control switch 111 is released by the relay 113 provided in the electrosurgical device 114. Detection circuit 11
6, the detection current detects that the electrode has contacted the living body by starting to flow through the output cable 109, the patient 107, the patient electrode 119, the patient code 108, and the detection circuit 116 when the handpiece 112 comes into contact with the living body. Only after driving the relay 113, the output switch can be detected and the output is permitted.

Therefore, according to this technique, even if the output switch is pressed in a state where the electrode is not in contact with the living body, no high-frequency output is output. Burns and the like are less likely to occur.

[0010]

However, when the operator always starts and ends the output with a hand switch or a foot switch as in the above-mentioned conventional electrosurgical apparatus, there is a danger that an erroneous waveform output will occur. In other words, in order to prevent the place where the coagulation waveform should be output in order to stop the bleeding, the surgeon always checks the output switch before performing the output in order to prevent the operator from operating the switch of the ablation waveform by mistake, so the operation efficiency Was not good.

In order to solve this problem, in DE 25 40 968, a coagulation waveform for hemostasis is produced by flowing a detection current when a bipolar (bipolar) type electrode is used as described above. Automatically starts output after a predetermined delay time from contact with the tissue. However, in this method, a dedicated circuit such as a separate power supply for contact detection is required, and the cost increases. Further, since the high-frequency output is automatically output by always detecting the contact, the application site and the procedure are limited.

For example, in the case of brain surgery, only coagulation and hemostasis are often used. However, always starting automatic output, that is, continuing to supply a detection current, may damage brain cell tissues. There is. In addition, in a surgical operation using a rigid endoscope, which has been increasing in the number of surgical cases in recent years, a high-frequency output is output only when it is desired to stop the hemostasis mechanically without energizing the electrodes. This is to minimize damage due to high frequency as much as possible. However, if automatic output is always performed as in the above-mentioned DE2540968, high frequency is output erroneously during mechanical peeling, and unnecessary Solidification may occur.

Further, the above-mentioned Japanese Utility Model Application Publication No. 61-185405.
In the technology disclosed in the publication, a separate power supply for contact detection is required, and a dedicated circuit for flowing a current must be formed. Further, since it is necessary to switch the high-frequency output circuit by a switching means such as a relay only after detecting the contact, it has been difficult to control the delay of the automatic switching widely.

SUMMARY OF THE INVENTION The present invention has been made in view of the above problems, and has as its object to automatically start and stop output by automatically detecting contact between an electrode and living tissue by monitoring and detecting high frequency output. In addition, the automatic control of the function and the control of permission or non-permission of the function by detection of the output switch improve the safety and the efficiency of the operation by selectively using the function when necessary.

[0015]

In order to achieve the above object, an electrosurgical apparatus according to the present invention is an electrosurgical apparatus for incising or coagulating a living tissue using a high-frequency current. Power supply means for providing a current to be supplied, a waveform generation means for generating a waveform of a high-frequency output current based on the output of the power supply means, a high-frequency current amplification means for amplifying the high-frequency output current, Detecting means for detecting at least one of a current and a voltage returned from the living tissue when energized, monitoring means for monitoring at least one of a current and a voltage detected by the circuit, and detecting by the monitoring means A change in the living tissue is detected based on at least one of the detected current and the voltage, and the output of the current is opened in accordance with the change. And the permission / non-permission of the termination is automatically controlled, and when the output of the current is permitted, a weak level of high frequency that does not affect the living body is output before outputting the preset high frequency. And a control means for outputting the output and detecting the contact of the electrode with the living body.

That is, in the electrosurgical apparatus according to the present invention, in an electrosurgical apparatus for incising or coagulating a living tissue using a high-frequency current, a power supply means provides a current to be applied to the living tissue, and a waveform generating means. Generated a high-frequency output current waveform based on the output of the power supply means, the high-frequency current amplifying means amplifies the high-frequency output current, and the detecting means was fed back from the living tissue while supplying the high-frequency current to the living tissue. Detecting at least one of the current or the voltage, monitoring means for monitoring at least one of the current or the voltage detected by the circuit,
Detecting a change in the living tissue based on at least one of the current or the voltage detected by the monitoring means, and automatically controlling permission / non-permission of the start and end of the current output in accordance with the change; If the output of the current is permitted, a weak level of high frequency that does not affect the living body is output before outputting a preset high frequency, and control is performed to detect contact of the electrode with the living body. .

[0017]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a diagram showing a configuration of the electrosurgical apparatus according to the first embodiment. As shown in FIG. 1, a commercial power supply 11 is connected to a power supply circuit 1, and an output of the power supply circuit 1 is supplied via a waveform generation circuit 10, a high-frequency generation circuit 2, a high-frequency amplification circuit 3, and an output transformer 4. The handpiece 8 is connected to the patient electrode 9. The connection end of the output transformer 4 with the handpiece 8 and the patient electrode 9 is connected to the CPU 5 via the monitor circuit 7. The CPU 5 is also connected to the power supply circuit 1, the high-frequency generation circuit 2, the high-frequency amplification circuit 3, and the switch detection circuit 6.

In such a configuration, the power supply circuit 1
Thereby, the commercial power supply 11 is distributed to the digital control system and the high-frequency transmission circuit system. The high-frequency waveform generated by the waveform generating circuit 10 is supplied to the high-frequency generating circuit 2. Then, the power is amplified by the high frequency amplifier circuit 3, separated by the output transformer 4, and then returned through the living body 12 and the patient electrode 9 via the handpiece 8. At this time, parameters such as voltage and current are detected by the monitor circuit 7, and it is detected that the handpiece 8 has come into contact with the living body 12,
Alternatively, the end of the high-frequency ablation is detected by a change in these parameters, and information is sent to the CPU 5. CPU5
Receives the information and controls high-frequency transmission. Further, the CPU 5 monitors a switch operation state of the switch detection circuit 6 and performs output control based on the monitoring.

Hereinafter, the operation of the present apparatus will be described in detail with reference to the flowchart of FIG. As shown in FIG.
While the CPU 5 monitors the operation status of the switch detection circuit 6, the CUT or CO (not shown) of the switch detection circuit 6
It is detected whether the AG output switch has been pressed (steps S1 to S3). When the CUT output switch is pressed, a high-frequency output current with a weak output level that does not affect the living body 12 flows (steps S4 and S5).
Thereby, the contact with the living body is detected (steps S6, S
7) The high-frequency output preset by the user is started only after the contact of the knife tip electrode with the living body 12 is detected (step S8). If the switch is re-input (step S9), all high-frequency outputs are prohibited (step S10), and the process proceeds to step S1 to repeat the above operation. If the COAG switch is pressed in step S3, the process proceeds to step S11, and the process proceeds to step S11.
The same operations as in steps S5 to S10 are repeated.

In the above operation, any one of the output start and stop time delay selection, the high frequency automatic output and the stop function, and the normal high frequency treatment are performed by a selection switch (not shown) provided on the control panel of the electrosurgical apparatus. In order to perform the above, it is possible to select whether to use the output switch of the handpiece 8 or a foot switch (not shown) only for the output control of the treatment high frequency.

Further, it is possible to stop the high frequency output upon detecting that the knife tip has left the living body and automatically switch to a weak high frequency for detection. Also, CUT or C
It is also possible to detect that the OAG switch has been pressed again and prohibit the application of this detection current. Also,
Even during the high frequency ablation, the CPU 5 can determine the end of the ablation due to a change in the biological parameter detected by the monitor circuit 7 and automatically end the ablation.

As described above, according to the first embodiment, it is detected that the scalpel is in contact with the living body, and automatically starts outputting the high-frequency ablation current. It is possible to automatically stop the output of the high frequency upon detecting the occurrence of the high frequency. Further, it is possible to detect a change in a biological parameter and automatically determine the end of cauterization.

In addition, the control by the CPU allows the user to select permission or non-permission of this function. Also, from the start of output or the contact of the female end, or when the female end The delay time of the stop time of the high-frequency current after leaving from the distance can be freely selected. Thereby, it can be said that the user's function selectivity has a higher degree of freedom in accordance with the treatment site and the procedure.

Next, an electrosurgical apparatus according to a second embodiment of the present invention will be described. The second embodiment measures the high-frequency output time, and issues a warning or warning display by sound.
Further, the output is automatically stopped when a predetermined time is exceeded. Note that the basic configuration is the same as that of the above-described first embodiment, and a description thereof will be omitted.

First, an operation of measuring the elapsed time by a clock circuit (not shown) in the present embodiment will be described with reference to the flowchart of FIG. In the figure, when the high-frequency output is continued for a predetermined time, the time for performing a sound warning or a warning display is Tk, the maximum time for which the high-frequency output can be continued is Tmax, and both times are stored in the main body in advance. A value or a value set before use (steps S21 and S22). Next, ON / OF of the output switch
After reading the F state and turning on the output switch (steps S23 and S24), the respective values are stored as T1 when the high-frequency output is started and T2 as the current time during which the high-frequency output is continued (step S23). Step S25, S
26).

Subsequently, the output elapsed time T2-T1, which is the time during which the high-frequency output is continuously performed, is compared with the above Tk,
If the output elapsed time T2-T1 exceeds the above Tk (step S27), a sound warning or a warning display is performed (step S28), and if the output elapsed time T2-T1 exceeds the above Tmax, it is compulsory. The high-frequency output is stopped, T1 and T2 are set to "0", and the operation ends (steps S29 to S33).

On the other hand, if the output elapsed time T2-T1 does not exceed Tk in step 27,
If the output elapsed time T2−T1 does not exceed Tmax at 29, the ON / OFF state of the output switch is read.
32, and if not turned off, the process proceeds to step S26 to perform the above operation (step S3
0, S31).

Next, the operation of measuring the elapsed time by a timer circuit such as a clock circuit will be described with reference to the flowchart of FIG. The description of the same contents as those in FIG. 3 is omitted, and only the characteristic portions will be described here. As shown in the figure, in this operation, the elapsed time by the timer is set to Timer, and when Timer exceeds Tk, a sound warning or a warning display is performed as in FIG.
If x is exceeded, the high-frequency output is forcibly stopped (steps S51 to S64).

FIG. 5 is a schematic block diagram of an apparatus in which a timer such as a clock circuit is used for measuring the elapsed time. As shown in FIG.
2 and the handpiece 14 are connected via a switch 13, which is connected to a switch detection circuit 26. The high frequency generation circuit 22 and the switch detection circuit 26 are connected to a CPU 25,
A clock 32 and a counter 33 are connected to U25. The clock 32 and the counter 33 are connected to each other.

In such a configuration, the output switch 1
The CPU 25 generates a high frequency from the high frequency generation circuit 22 by the switch detection circuit 26 which detects that the button 3 has been pressed, and simultaneously measures the elapsed time by using the counter 33 by the clock 32. Using the elapsed time, a warning by sound, a warning display, and a stop of high-frequency output are performed as shown in FIG.

FIG. 6 is a schematic block diagram of an apparatus capable of measuring elapsed time without using another circuit such as a clock circuit as shown in FIG. As shown in the figure, in this configuration, the high-frequency generation circuit 22 and the handpiece 14 are connected via the switch 13, and this switch 1
3 is connected to a switch detection circuit 26 for detecting a high-frequency output. The high-frequency generation circuit 22 and the switch detection circuit 26 are connected to a CPU 25, and a counter 33 is connected to the CPU 25. This counter 33 is also connected to the output of the high frequency generation circuit 22.

In such a configuration, the counter circuit 33 counts a high-frequency waveform example as shown in FIG. 7, for example. In this case, it is conceivable to convert one waveform, one period, or the like into an elapsed time t by counting, and use this elapsed time to perform a warning or warning display by sound shown in FIG. .

The counter circuit 33 has a high frequency output O
At the time of FF, it is reset by the CPU 25. The switch detection circuit 26 performs impedance change, current change, voltage change, capacitance change, switch depression detection, and the like. For the counter circuit 33, it is conceivable to selectively use a means for measuring by a counter element such as a microcontroller or a binary counter constituted by a logic IC.

When the elapsed time of the high-frequency output reaches the time Tk at which the warning starts, a warning or a warning is displayed by sound, and the elapsed time of the high-frequency output is Tma.
When it becomes x, the high frequency output can be automatically stopped.

As described above, according to the second embodiment, the elapsed time is calculated without increasing the number of parts such as a clock circuit or a timer circuit such as a clock circuit, and the sound is generated with respect to the duration of the high-frequency output. By performing the warning or the warning display and the stop of the high-frequency output, the application of the high-frequency current to the patient for a long time can be prevented. Further, it is possible to prevent wasteful heat generation, deterioration or destruction of durability of the electrosurgical device, and further improve safety.

In the second embodiment, the warning or warning display by sound and the automatic stop of the ultrasonic output are automatically stopped. However, the warning sound by sound or the output sound or output at a predetermined output time before the warning display is performed. If the display is generated at regular intervals, it is possible for the operator to recognize whether or not the output has been performed reliably, or how much the output has been performed, and it is possible to further improve safety.

As described above, according to the present invention, the start and stop of the output are automatically controlled by automatically detecting the contact between the electrode and the living tissue by monitoring and detecting the high frequency output. Also, by enabling or disabling this function by detecting the output switch, the safety and efficiency of the operation are improved by selectively using this function when necessary.

The above embodiment of the present invention includes the following inventions. (1) In an electrosurgical apparatus for dissecting or coagulating a living tissue using a high-frequency current, a power supply for providing a current to be applied to the living tissue, and a high-frequency output current based on an output of the power supply. A waveform generating means for generating a waveform, a high-frequency current amplifying means for amplifying the high-frequency output current, and a detection for detecting at least one of a current and a voltage returned from the living tissue while supplying the high-frequency current to the living tissue. Means, monitoring means for monitoring at least one of the current or voltage detected by the circuit, and at least one of the current or voltage detected by the monitoring means, to detect a change in the living tissue, According to the change, the permission / non-permission of the start and end of the current output is automatically controlled, and the output of the current is permitted. In this case, before outputting a preset high frequency, a weak level of high frequency that does not affect the living body is output, and control means for controlling to detect contact of the electrode with the living body is provided. Characterized electrosurgical device.

According to this, the output of the high frequency is monitored,
By detecting the contact of the electrode with the living body, the biological information and changes in the living body are detected, the output is automatically controlled, and the control is performed for the purpose of increasing the efficiency of the treatment. This function is enabled or disabled by detecting the output switch. By doing so, selection can be made in accordance with the treatment. (2) The above-mentioned (1), wherein the detecting means is a monopolar electrode comprising a patient electrode and an active electrode.
An electrosurgical device according to claim 1.

According to this, the output mode of the electrosurgical apparatus includes a monopolar mode requiring a patient electrode and a bipolar mode not requiring a patient electrode, and the object (1) can be achieved for each output. . (3) The electrosurgical apparatus according to (1), wherein the detecting means is a bipolar electrode having no patient electrode.

According to this, the output mode of the electrosurgical apparatus includes a monopolar mode requiring a patient electrode and a bipolar mode not requiring a patient electrode, and the above-mentioned object (1) can be achieved for each output. . (4) The electrosurgical apparatus according to (1), wherein the monitoring means is means for measuring the impedance of a human body.

According to this, in each of the monopolar mode and the bipolar mode, the change in impedance as a parameter of the human body can be detected to achieve the above object (1). (5) The electrosurgical apparatus according to the above (1), wherein the monitoring means is means for measuring a capacitance of a human body.

According to this, in each of the monopolar mode and the bipolar mode, the change in the living body is detected by detecting the change in the capacitance between the electrodes, thereby achieving the object (1). it can. (6) The electrosurgical apparatus according to (1), wherein the monitoring means is means for measuring an output voltage.

According to this, in each of the monopolar mode and the bipolar mode, the change in the living body can be detected by detecting or monitoring the change in the voltage, thereby achieving the object (1). (7) The electrosurgical apparatus according to (1), wherein the monitoring means is a means for measuring an output current.

According to this, in each of the monopolar mode and the bipolar mode, the change in the living body can be detected by detecting or monitoring the change in the current, thereby achieving the object (1). (8) The electrosurgical apparatus according to (1), wherein the control unit further includes a notification unit that performs a visual display by a display element.

According to this, it is possible to reliably notify the user by performing visual display at the time of abnormality. (9) The electrosurgical apparatus according to (1), wherein the control unit further includes a notifying unit that performs auditory phonetic sound using a phonetic element.

According to this, it is possible to surely notify the user by giving a phonetic indication by hearing at the time of abnormality. (10) The control means according to (1), wherein at least one of an automatic output start function and an automatic end function is enabled / disabled when the foot switch or the output switch of the hand device is pressed. An electrosurgical device according to claim 1.

According to this, the control means of the above (1) detects that the output switch has been pressed, disallows the automatic start or stop function of the output, and allows selection of this function in various procedures. And (11) The electrosurgical apparatus according to (1), wherein the start of the high-frequency output is detected and the output time is measured by the means of (4) to (7) and (10).

According to this, it is possible to detect the start of the high-frequency output by detecting a change in impedance, a change in current, a change in voltage, a change in capacitance, detection of depression of a switch, and the like. (12) The control means measures the output time, detects that a preset time or a preset time has elapsed before use, and stops a warning or output with at least one of a sound and a display means. The electrosurgical apparatus according to the above (11), wherein

According to this, when a continuous output time elapses with respect to at least one or more fixed values determined in advance or at least any value that can be set by the user, it is visually displayed to the user. Alternatively, a sound notification may be provided, or the output may be stopped. (13) The electrosurgical apparatus according to (1), wherein the control means is a microcontroller.

According to this, the process (12) can be performed in real time by the microcontroller. (14) The electrosurgical apparatus according to (1), wherein the control unit further includes a counter element for measuring an output time.

According to this, the processing of the above (12) can be performed by the counter element and the timer element. (15) The electrosurgical apparatus according to (15), wherein the control means stops the output when a change in the living tissue exceeds a preset or variable value.

According to this, the quality of the excision or coagulation is automatically determined by detecting a change in the living body, and the high-frequency output can be stopped when the quality exceeds a preset or settable value. (16) The electrosurgical apparatus according to (15), wherein the control means changes the characteristic of the high-frequency output when the change in the living tissue exceeds a preset or variable value.

According to this, it is possible to change the output characteristics using a preset or variable value as a threshold value in order to stabilize the excision performance or coagulation performance by detecting a change in the living body.

[0055]

As described in detail above, according to the present invention,
By automatically detecting the contact between the electrode and the living tissue by monitoring and detecting the high-frequency output, the start and stop of the output are automatically controlled, and the permission or non-permission of the function is controlled by detecting the output switch. An electrosurgical apparatus that improves safety and efficiency of surgery by selectively using the function when needed can be provided.

[Brief description of the drawings]

FIG. 1 is a diagram showing a configuration of an electrosurgical apparatus according to a first embodiment of the present invention.

FIG. 2 is a flowchart for explaining the operation of the first embodiment.

FIG. 3 is a flowchart illustrating an operation of measuring an elapsed time by a clock circuit (not shown) according to the second embodiment.

FIG. 4 is a flowchart illustrating an operation of measuring an elapsed time by a timer circuit such as a clock circuit according to the second embodiment.

FIG. 5 is a schematic configuration diagram of an apparatus when a timer such as a clock circuit is used for measuring elapsed time.

FIG. 6 is a schematic configuration diagram of an apparatus capable of measuring elapsed time without using another circuit such as a clock circuit as shown in FIG. 5;

FIG. 7 is a diagram showing an example of a high-frequency waveform.

FIG. 8 is a diagram showing a configuration of an electrosurgical apparatus according to a conventional technique.

FIG. 9 is a diagram showing a configuration of an electrosurgical apparatus according to a conventional technique.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Power supply circuit 2 High frequency generation circuit 3 High frequency amplification circuit 4 Output transformer 5 CPU 6 Switch detection circuit 7 Monitor circuit 8 Handpiece 9 Patient electrode 10 Waveform generation circuit 11 Commercial power supply 12 Living body

Claims (1)

[Claims] An electrosurgical apparatus for incising or coagulating a living tissue using a high-frequency current, comprising: a power supply for providing a current to be applied to the living tissue; and a high-frequency output based on an output of the power supply. Waveform generating means for generating a current waveform; high-frequency current amplifying means for amplifying the high-frequency output current; applying the high-frequency current to living tissue and detecting at least one of a current and a voltage returned from the living tissue Detecting means for monitoring, at least one of the current or the voltage detected by the circuit, and detecting a change in the living tissue based on at least one of the current or the voltage detected by the monitoring means. Automatically controls the permission / non-permission of the start and end of the current output according to the change, and permits the output of the current. Control means for outputting a weak level of high frequency that does not affect the living body before outputting a preset high frequency, and controlling to detect contact of the electrode with the living body. An electrosurgical device characterized in that: