KR101123375B1 - Electorsurgical handpiece for treating tissue - Google Patents

Abstract

An electrosurgical handpiece that can be operated bipolar and unipolar during surgery and configured for application to MIS. This bipolar action limits the electrosurgical current to a small active area between the active ends of the bipolar electrode and thus reduces the possibility of generating excessive heat that may damage the body tissue of the patient. The location of the activated area can also be controlled to avoid body tissue in patients who are more sensitive to excessive heat. In certain embodiments, the handpiece is comprised of flexible ends that can be controlled by the surgeon so that the surgeon can manipulate the ends as desired during surgery. In another embodiment, the handpiece includes both anode and unipolar electrodes and is configured to selectively actuate the electrodes. In another embodiment, the end of the electrode being activated may be replaced with a rake or loop placed with scissors or spaced apart. The flexible ends are secured by regularly spaced slots, spirals or springs.

Electrosurgical, Handpieces, Tissue Therapy, Tubular Components, Electrically Insulated Tubes, Isolators, Electrically Conductive Wiring, Flexible Ends

Description

Electronic surgical handpiece for tissue therapy {ELECTORSURGICAL HANDPIECE FOR TREATING TISSUE}

1 is a perspective view of a form of an electrosurgical handpiece with a handle attached in an open position and connected to a bipolar activation device in accordance with the present invention;

FIG. 2 is a side view of a modified form of the handpiece shown in FIG. 1 by attaching the handle in a closed position. FIG.

FIG. 3 is a cross-sectional view taken along a line across 3-3 in FIG. 2. FIG.

FIG. 4 is a partial perspective view illustrating the operating end of the electrosurgical handpiece of FIG.

Figures 5 and 6 are similar to Figure 4 and show the late stages of the manufacturing process.

7 is a view showing a state assembled at the end of the handpiece of FIG.

8 and 9 are views similar to those of FIG. 7 in which two types of unipolar activation devices are connected according to the invention;

FIG. 10 is a view similar to FIG. 7 with various anode activation devices connected; FIG.

FIG. 11 is a perspective view showing the device shown in FIG. 7 connected to a bipolar adapter and an electrosurgical unit. FIG.

Figure 12 is a view showing a state using the device shown in Figure 11 in laparoscopic surgery for the purpose of treating disc herniation.

Figure 13 is a perspective view of another handpiece comprising both a positive electrode and a monopolar electrode in accordance with the present invention.

FIG. 14 is an enlarged view of the operating end of the handpiece in FIG. 13 with all electrodes contracted; FIG.

15 is a cross sectional view taken along line 15-15 in FIG. 13;

FIG. 16 is a perspective view of the handpiece of FIG. 13 in which the positive electrode is set to the extended position and the single electrode is set to the retracted position; FIG.

FIG. 17 is an enlarged view of the operating end of the handpiece in FIG. 16; FIG.

FIG. 18 is a perspective view of the handpiece of FIG. 13 in which the unipolar electrode is set to the extended position and the positive electrode is set to the retracted position; FIG.

19 is an enlarged view of the operating end of the handpiece in FIG.

20 shows an embodiment using scissors as an enlargement of one type of application for the operating end of the handpiece shown in FIG. 13.

Figure 21 is a perspective view of an operating end (the operating end is presented in an unbent state) in another form of the positive electrode activation device presented according to the present invention.

FIG. 22 is the same as FIG. 21, in which case the end of operation is presented in the state of one of several possible bending positions.

FIG. 23 is a perspective view of an operating end (the operating end is presented in an unbent state) in another form of the positive electrode activation device presented according to the present invention; FIG.

FIG. 24 is the same as FIG. 23, in which case the operating end is shown in the state of one of several possible bending positions. FIG.

Figure 25 shows another proposed form of the handpiece in accordance with the invention, in which the working end is presented in a bent state;

FIG. 26 is a side view of an end portion of an outer handpiece housing in another embodiment of an electrosurgical handpiece in accordance with the present invention. FIG.

FIG. 27 is a view similar to FIG. 26 and showing yet another form of an electrosurgical handpiece in accordance with the invention.

FIG. 28 is a view similar to FIG. 29 showing another form of an electrosurgical handpiece in accordance with the invention; FIG.

FIG. 29 is a view similar to FIG. 28 and showing yet another form of an electrosurgical handpiece in accordance with the invention.

30 is an enlarged cross-sectional view of an end of a loop type electrode according to another modified embodiment of the present invention.

FIG. 31 is a cross-sectional view of the end portion of the electrode observed at a position rotated 90 degrees with respect to FIG. 30. FIG.

32 is an enlarged cross-sectional view of an end of a loop electrode as another modification;

FIG. 33 is a sectional view of the electrode observed at a position rotated 90 degrees with respect to FIG. 32;

34 is an enlarged perspective view of the operating end of the handpiece of FIG.

FIG. 35 is an enlarged perspective view of the operating end of the handpiece of FIG. 32;

FIG. 36 is an enlarged perspective view of the electrode of the operating end of the handpiece of FIG. 35, showing the state in which the operating end is in the bent position; FIG.

** Explanation of symbols on the main parts of the drawing **

12: handle 13: handle

14: Trigger 16: Tubular member

21: electrical insulation wall 20: tubular member

22, 24: electrical insulation zone 26, 28: wire

30, 32: hemispherical electrode 34: slot

35: hole 36: pull wire

The present invention relates to an electrosurgical handpiece and an apparatus for operating the electrosurgical handpiece.

Electrosurgery is already a common treatment for dentists, doctors and veterinarians. Electrosurgical handpieces having electrodes of various shapes and sizes, such as needles, blades, scalpels, balls, wire loops, etc., are commercially available. Also provided are electrodes with various functions. Electrosurgery has been applied to various types of surgery. These surgical methods include minimally invasive surgery (MIS), also known as laparoscopic surgery, which involves inserting small diameter cannula through an incision in the patient's body and with a fiber optic viewer (TV camera and monitor). By extending the nozzle from the electrosurgical handpiece through the cannula to the affected patient's affected area, the surgeon performs the surgery using the electrosurgical electrode while observing the surgical procedure through the viewer. U.S. Patent No. 5,304,763, issued to the applicant, describes one form of MlS, the disclosures of which are incorporated herein by reference.

MIS in electrosurgery has also been used to alleviate intervertebral disc herniation by introducing a unipolar electrode through the cannula into the herniated intervertebral disc lesion and activating the electrode to shrink the disc. Such a system also provides the ability to bend the monopole to place the activated monopole end at the desired escape intervertebral disc site. In this process, care must be taken to prevent nerve damage. In a conventional system, a thermal sensor is attached to an end of an activated monopolar electrode to detect heat generated by current during electrosurgical operation and to block electrosurgical current when heat is generated to an excessively high level.

It is an object of the present invention to provide an electrosurgical handpiece in which the treatment of tissue is possible when energy is supplied.

It is another object of the present invention to provide an electrosurgical handpiece that can be used in MIS and to reduce the risk of excessive heat that can harm a patient.

According to one embodiment of the present invention, there is provided an electrosurgical handpiece that operates bipolar during surgery and is configured for use in a MIS. Anodic action limits current during electrosurgery to a small active area between the activated ends of the anode electrode and thus reduces the possibility of generating excessive heat that may damage the patient's body tissues. The position of the activated area is also controllable and can be adjusted to avoid the body tissue of a patient who is more sensitive to excessive heat.

According to a more preferred embodiment of this embodiment of the invention, the handpiece is provided with an elongated tube insulated with a double zone, each zone containing one of the two wires of the anode electrode.

According to yet another embodiment of the present invention, the electrode for MIS use consists of a flexible tip that is controllable by the gynecologist so that the gynecologist can manipulate this end as desired during the surgical procedure. In a preferred embodiment, the bent end is realized by weakening the end of the electrode housing, with a pul1 string or wire connected at one end of the weakened housing to one end and at the other end of the conduit. A mechanism is also proposed which allows the bending end of the housing to be moved to the desired position by manipulating this string or wire. This function allows the surgeon to move the activated electrode end to an optimal position in the escape intervertebral disc to apply unnecessary heat to remove unnecessary lesions and to shrink tissue during surgery.

However, another embodiment of the present invention is a multipurpose electrode system in which a monopolar electrode and a bipolar electrode are combined to be applied to MIS use. Preferably, the electrodes are easily replaceable. In a preferred embodiment, the handpiece is provided with an elongated tube insulated into three zones, two of which receive one of the two wires of the positive electrode and the other responsible for receiving the wire of the monopolar electrode. A method is provided for selectively extending a positive electrode or a monopolar electrode to operate the bipolar or monopolar electrode as needed without the removal of the handpiece from the cannula.

In another embodiment of the invention, one of the replaceable elements of the multipurpose electrode system applied for MIS can be an electrically or mechanically operated scissors.

Still other preferred embodiments include changing the housing end flexibly treated to improve performance and changing the electrode tip for a particular procedure.

The configuration of the present invention is expected not only to provide important advantages in MIS of disc herniation, but also to other MIS processes where it is important to control the position of the electrodes and control the generation of heat. This process usually involves drying, shrinking, or degeneration of the tissue, and particularly applicable to collagen tissue for increasing or decreasing the elasticity of the tissue.

Various novelties which characterize the invention are part of this specification and are specifically expressed in the claims appended hereto. In order to facilitate understanding of the present invention, advantages in the application of the invention, specific objects obtainable by the use thereof, and reference materials are provided together with accompanying drawings and explanatory material which provide more preferred embodiments and description of the present invention.

MIS procedures are well known in the art, and further explanation is provided except that the present invention relates to the construction of an electrosurgical electrode that is inserted into the cannula during the procedure for tissue shrinkage, ablation or coagulation of the bleeding site. It is not necessary. Electrosurgical methods for intervertebral disc herniation and other tissue reduction are also well known in the art, and thus detailed descriptions are omitted here. The new handpiece according to the present invention is a bipolar handpiece, in which the device proposed in the invention is an electrosurgical current limited to a minute activation area between two electrode tips, which is undesirable even if heat is generated. Just to mention that distant tissue is similar to a device using a single-pole electrode with a built-in thermal sensor, except that the heat generation is minimal and no complicated temperature sensor and associated control circuitry are required. Will be enough.

In a preferred embodiment of the present invention, the electrode designed for MIS is provided with an outer housing in the form of a tube that is rigid enough to be inserted into the cannula, which flexes when a bending force is applied but before deformation when the force is removed. A straight end, ie a tip, is provided that restores the tubular housing back to form. The tube is made of metal such as plastic or stainless steel. Examples of plastics that keep the tubes straight by exhibiting shape-recovery memory properties when adequate flexibility and force are removed include Delron, vinyl, and nylon. The position when the tube is bent can be determined in various ways and is preferably implemented by weakening one side of the outer tube, for example by placing a slot at the end to be bent. In a preferred embodiment, a handle is provided to support the tubular outer housing, which is attached with a handle that is coupled to a trigger connected to a mechanism that bends the end of the tube when gripped by hand. In a preferred embodiment, it is realized by attaching (attaching to parts other than slots) pull wires or wires on the side of the tube which is weakly treated by slot cutting. A pull string or wire is connected to the trigger in the opposite direction of the tube. Pulling the trigger on the handle causes the end of the tube to bend into the weakly treated portion of the tube. When you release your hand from the trigger, the tube reverts back to its original straight line because of the restoring memory characteristics of the tube.

As can be seen in FIG. 1, one form of the positive electrode handpiece according to the invention is shown at 10. It comprises a handle 13, a handle 12 to which a trigger 14 is attached, through which the first tubular outer member 16 is mounted. This member 16 has a small outer diameter so that it can be inserted into a standard cannula for MIS. Typically, sizes range from 0.018 cm to 0.25 cm (0.07 inches to 0.1 inch) and lengths range from 2.54 cm to 5.08 cm (10 inches to 20 inches). The outer tubular member 16 has a diameter that acts as a stop of the tubular outer member 16 when the tubular outer member 16 is inserted into the handle hole 15 and fixed by, for example, a set screw (not shown). Preferably, an extended end 18 (see FIG. 11) is provided. This simple mounting structure makes it possible to assemble and use disposable tubular members and electrodes as needed.

Inside the tubular outer member 16 lies an electrically insulated inner lumen (eg plastic lumen) (second tubular member) 20, which is in the middle two electrically insulated zones 22. , An electrical insulation wall 21 forming 24 (FIG. 3). The inner tubular member 20 can be secured within the outer tube member 16 via a convenient means such as a fastening screw (not shown), which is configured similarly to other anode electrodes or other anode electrodes, as described in more detail below. It is possible to replace the second tubular member 20 with a unipolar electrode. 1 illustrates this property by showing that the electrode 20 is connected to the housing 12 through a hole 15 and extends to the outer tubular member 16. Electrically conductive wires 26, 28 (eg made of stainless steel) extend through one of the insulated zones 22, 24, respectively, with the result that the wall 21 electrically isolates the two conductive wires. (FIG. 4). In addition, the circular wall 30 surrounding the dividing wall 21 is removed by a short distance from the end of the tube (FIG. 5), so that only the dividing wall 21 protrudes forward. This protruding wall 21 becomes an insulator between two hemispherical electrodes 30 and 32 which are fused and connected to the protruding ends of the wires 26 and 28 (FIG. 6).

FIG. 4 shows the distal end of the assembly before the hemispherical electrode is added, and FIG. 6 shows the electrode wires 26 and 28 first pulled forward to make room for attaching the hemispherical electrodes 30 and 32 to the wire ends. It is shown. As can also be seen in FIG. 7, by retracting the wires so that the hemispherical electrodes are placed back in the operating position, the spherical electrodes 30, 32 are sufficiently over the entire length (length of the assembly) by the central wall insulator 21. Spaced apart.

The tubular outer member 16 is treated to weaken at a position spaced a short distance from the distal end of the tubular member 16 by cutting a series of spaced slots 34 through the outer wall 30. The pull wire 36 extends through the outer tubular member 16 along the bottom outside of the inner tubular member 20, ie on the same side as the slot 34, and uses an adhesive or welds when the outer tubular member is plastic. Is fixed to the outer wall 30 by means of welding, or in the case of metal, by means of welding 38. A hole 35 is created in front of the slot 34 to be connected to the pull wire in the assembly. The opposite end of the pull wire 36 is attached to the trigger 14 (FIG. 1). The outer tubular member 16 is held in a fixed position within the handle 23 and the handle 13 is likewise held fixed relative to the handle 12. Thus, by pulling the trigger 14 at which the axis of rotation is fixed to the handle 12, as in FIG. 2, the connected pull wire 36 exerts a tension on the distal end of the outer tubular member, so that the other end as shown at 44. It is bent downward near the weakened portion 34. When the trigger is released, the return characteristic of the outer tubular member 16 returns to its original straight position as in FIG. 1. If necessary, a restoring spring 46 may be added to the trigger 14 to assist in this movement.

The actual anode electrode consists of a combination of the inner tubular member 20 and the insulating hemispherical electrodes 30, 32 located at the ends of this flexible tip. Near the proximal end of each of the wires 26, 28 a standard positive connector 42 is connected (FIG. 1). As described at 48 (FIG. 11), the aforementioned standard connector is connected to a homogeneous connector on the front panel of a typical electrosurgical unit, and when this unit is activated, the bipolar electrosurgical current is spherical through the wires 26 and 28. An electrosurgical discharge is generated which flows through the tips 30 and 32 and is formed between the spherical electrodes 30 and 32 around the ends of the insulating wall insulator 21. Although a spherical electrode is preferred for the reduction of the escape intervertebral disc, in a bipolar device that restricts the discharge to the closest portion of the end of the electrode, various types of electrodes of straight wire, needle, ring, and loop type can be replaced with the spherical electrode. Can be used. Also, as one of the characteristics of the present invention, the double tubular member is drawn by pulling the inner tubular member 20 (see FIG. 1) out of the other tubular member 16 and pushing the other inner tubular member 20 to which another electrode configuration is applied. By applying the member assembly and in this way other electrode ends can be easily applied. This property is applicable before extending the outer tube member 16 through the patient's body or while the cannula is inserted into the patient's body. It is also possible to replace the anode assembly in a dual lumen structure with a monopole electrode in one lumen with a single housing, in which case the monopole electrode end is forward from the end of the inner tube member 20 'with the various electrode shapes mentioned above. It protrudes to eliminate the need for the presence of the central insulation. This property is described in FIG. 9. In the case of electrode replacement, the surgeon pulls out and removes the inner tube member and then replaces it with an inner tube member having another electrode, thereby eliminating the need to replace the handle with the outer tube member that is already securely fixed in the surgical position during surgery. Various electrosurgical current frequencies may be applied but the preferred frequency range is 1.5 MHz to 4 MHz.

8 and 10 are examples of other activated electrode configurations. 10 shows a bipolar ring assembly 50, which can be easily used as a single pole. 8 shows a unipolar loop assembly 52 and FIG. 9 shows a unipolar needle 54, ie a pointed electrode assembly.

One of the advantages of the present invention is to allow the surgeon to gain control and flexibility over these electrodes during the surgical operation where the various electrodes need to be replaced, while at the same time the electrodes are positioned correctly in the cannula to guide the correct surgery. Maintaining at the position allows the control and flexibility of movement of the electrode end within the active surgical area. The degree to which the practitioner actually bends the flexible tip is determined by its position relative to the area of the disc to be cut or reduced. By adopting a flexible tip, the surgeon can more easily find optimized electrode positions before energizing the electrosurgical unit. Since the cannula 50 is generally inserted from the patient side (FIG. 12), a long nozzle 16 is required and the position of the cannula 56 is determined while the physician observes the position of the cannula through the viewer. Once the cannula is correctly positioned, the electrode 16 is inserted through the cannula 56 until the flexible end 44 is positioned outside of the end of the cannula, after which it moves back and forth and the electrode tip 44 Bend to ensure proper positioning within the surgical area of the disc. The connector 42 can be connected directly to the electrosurgical mainframe 48, so the electrosurgical energy supplied to the electrode operating end is determined using the control of the mainframe and a common foot switch. However, most surgeons prefer a method of manually controlling electrosurgical energy using finger switch activation devices that can be mounted on cannula or handles, as in the patent literature cited above.

1 shows another example of a handpiece 10 in which the inner member 20 can be replaced, which is connected to the handle and also to the clearance space 58 (FIG. 3) between the inner and outer tube members. A suction (suction) tube 56 is also provided. If suction is provided at the end of the suction tube 56, smoke or vapor is transferred from the surgical site to the distal end of the outer tube member 16 and thus obstructs the field of view of the house as well as cooling the surgical site. To discharge. Modifications 10 'of FIGS. 2 and 11 include a fixed inner tube member 20 and exclude the suction function.

Members of electrosurgical handpieces can be autoclaved if they are made of metal or plastic, such as Delrin, and the device is disposable because it can be easily manufactured at low cost with low cost plastics.

The handpiece proposed in the present invention is generally useful for tissue treatment, and is particularly useful in the following situations: heat-induced radiofrequency therapy for collagen reduction, tissue reduction and degeneration, and clagen contraction. Treatment and production of enlarging encapsulated tissue due to degeneration of collagen fibers. Reduction and remodeling of collagen fibers after exposure to radio frequency waves. Another example is when collagen reduction is needed to promote encapsulated stability, such as in shoulder dislocation and intervertebral disc treatment.

13 to 19 show a variant according to the invention comprising both a positive electrode and a monopolar electrode, with the additional characteristic of allowing the collector to selectively select and activate the positive or single electrode. In addition, the method includes additional electrodes of preconfigured ends, such as pre-bent ends, which are usually placed inside a relatively rigid outer tube but are already moved out of the outer tube. The bent position is taken. One form of this embodiment includes a handle 60, to which a hand grip is attached so that the front portion 62 is attached to the handle 60 and the rear portion 64 fixed to the slidable rigid member 66. The upper portion 68 and the lower portion 70 are included.

The upper portion 68 is connected to a relatively rigid inner tube 72, which is slidably mounted within the handle 60 and connected to a double lumen 74 of the type shown in FIG. 7. When the inner tube is held, the inner tube may be hemispherical as shown in FIG. 7 (78, 80) of wire 78, 80 extending through the double zones 82, 84 of the relatively rigid inner first electrically insulating plastic tube 74. Together with the wire of the electrode 80, it functions to push the double lumen 74 forward.

The plastic tube 74 is slidably mounted in the rigid outer tube 75. Below the tube 74 is a rigid second tube 77 slidably housing the electrically insulated tube 79 containing the wire 81. The end of the wire 81 is connected to the monopolar electrode 88. Connected. In FIG. 15 only two side by side electrically insulating tubes 74, 79 are shown without outer housing 75, 77.

In general, both the anode electrode and the unipolar electrode are in the contracted position as shown in FIGS. 13 and 14. When the handle is grasped, the member 72 is pushed out to the working end so that the double lumen 74 connected to it and the positive wire connected with the positive electrode 80 together exit out of the housing 74 as shown in FIGS. 16 and 17. do.

The surgeon then activates the electrosurgical unit via terminal 91 to supply a bipolar electrosurgical current to the end 80 of the bipolar electrode. When the handle is released, the tube 74 is returned to the position shown in FIGS. 13 and 14 by the spring tension of the handle or, if necessary, with an extra spring (not shown). If it is desirable to use a monopolar electrode, the collector may press the side slide 90 of the tube 70 with the slide connected to the single tube 79 to move it from the retracted position (FIG. 14) to the extended position of FIGS. 18 and 19. You can move forward. In this way, the monopole electrode 88 protrudes forward. Thereafter, the surgeon may activate the electrosurgical unit via wire 92 to supply unipolar electrosurgical current to the unipolar electrode end 88. Since the two operations of the electrodes are distinct from each other, the surgeon may optionally choose which electrode to use during the surgery. When the glyph releases the slide 90 again, a spring (not shown) causes the single tube 79 to retract into the outer tube 77.

Preferably, at least one end (or both, if possible) of the corresponding anode / unipolar tube is constructed of a material that is pre-curved and that can remember the pre-bending shape as it extends outward from the retracted outer tube. It is preferable. Plastic may be used for maintaining the pre-bending shape, or a metal such as stainless steel heat-treated by tempering or the like may be used. Techniques for such materials are very well known and suitable materials will provide clear characteristics for these techniques. If metal is applied to the inner tube, the electrode wires should be insulated appropriately from each other or an insulating layer should be applied to the tube. In this embodiment in which the electrode is bent in advance and manufactured in a constant shape, it is impossible to change the direction such as making the bending direction straight or applying an angle. The only thing that the surgeon can control is that the length of the extension can only be adjusted. One of the characteristics of the present invention is that anode and unipolar electrodes are provided having ends of various orientations, such as electrodes bent in one direction, electrodes bent in another direction, straight electrodes. FIG. 17 shows an electrode with an end bent to the left and a straight electrode in FIG. 19. In general, such an electrode type may include a positive electrode or a monopolar electrode which is not only straight but also bent in all directions in advance, or both may be included at the same time. In the embodiment of FIG. 1, new electrodes 74, 79 can be easily inserted into the handle of a suitable tubular housing during surgery as needed. When using the anode electrode the replacement electrode extends along the tube 68 and the entire tube 72 also moves accordingly when the tube 68 moves relative to the handle 62. As an example, in the case of a monopolar electrode, a slide 90 rack (shown along the side slots in FIG. 13) with the appropriate gear or other means moving on the side to replace the tube 77 along this slide. This applies. These electrodes can be manufactured at a relatively low cost and are therefore disposable. The most expensive handles are also recyclable. Other handle constructions that can extend and contract replaceable electrodes are also apparent to those skilled in the art.

Another example is shown in FIG. 20 in accordance with the invention of a replacement member for a positive or monopolar housing. In this case, the new structure is the same as FIG. 13 except that the monopole structure can be omitted if necessary. Only the working end is shown in FIG. 20, which in this way is a sheared member 96 of curved stainless steel material, which is connected to the tube 72 at the end of the gun with scissors 94 and the opposite end to the axis of rotation 95. ). As already mentioned, the scissors member 96 is pre-implemented to move to the open position as it extends out of the tube 75. The handles 62 and 64 (FIG. 13) are structured so that springs can be applied to advance the scissors member 96 by releasing the handle. When the handle is released, the scissors member is returned to its original state by the action of the spring, and the restriction of the movement due to the wall of the tube 75 causes the scissors to normally operate on the body tissue around the end of the scissors so that the cutting action occurs. . The double lumen 74 applies a bipolar current to the ends of the scissors if necessary, in which case the rotating shaft 95 must electrically insulate both scissors parts using a member such as a washer, for example. In addition, the scissors 94 may be configured to be able to mount the single-pole tube 77 to apply the unipolar electrode current to the scissors member 96. In addition, it is possible to not apply a current for electrosurgical operation without connecting a terminal (terminal) to the scissors 94. In this case, the scissors 94 may be applied to surgery using only a mechanical action. As mentioned earlier, the scissors 94 have their own tubular housing 74 and are inserted into the gun of FIG. 13 to replace the positive or monopolar electrodes with all tube structures positioned in the cannula during surgery. can do. The shear end is preferably embodied according to the embodiment of FIG. 13 and thereby allows a specific direction to be taken when advancing so that it can be replaced with scissors having a different direction when necessary. Alternatively, if necessary, it may be mounted by adopting a method of bending the opposite end of the structure according to the embodiment of FIG. Those skilled in the art will appreciate the other mechanical or electrical structures available.

21 to 24 illustrate two additional anode electrodes to be used in the handpiece proposed by the present invention. These two new anode electrodes are configured for hemostasis or cauterization treatment of the bleeding site. For this purpose, the ends of the electrodes consist of two electrically insulated members in the form of rakes located close to each other, which are located close together but provide enough space to enclose a particular vessel of the patient. It is placed side by side. The preferred distance between these two members is about 2 mm. The rakes thus arranged protrude at the flexible end of the tubular housing and the guiding member moves the tubular housing and bends its end so that it is wrapped around the side of the blood vessel to be bleeding or positioned laterally. In a first preferred embodiment, the ends of the rake are straight and extend in a plane perpendicular to the bending plane. In a second preferred embodiment, one end of the rake is straight and the other end is positioned extending parallel to the bent plane. Also, in these two embodiments, replaceable electrodes can be used as described above. Thus, for example, a bipolar or monopolar electrode may be first used for incision surgery, and then replaced with one of the electrodes provided in the present invention, thereby bleeding blood vessels cut during the incision operation.

Even at this time, the configuration of the gun remains the same. Only the configuration of the anode electrode end is changed only. Two electrically insulated wires (not shown) pass through the insulated isolation (not shown) of the weakened tubular housing 100 (FIG. 21) by forming spaced slots 112 at the ends. . A third wire (not shown) is connected to the end of the housing such that the end of the housing bends as shown in FIG. 22 when the zip puller pulls. These two wires are not only insulated from each other to apply a bipolar electrosurgical current, but also to the tubular housing 10, which may be made of metal. In particular, the insulation on the tubular housing 10 can be implemented in the form of a flexible plastic tube 14. The two wires are connected to a pair of metal rakes 116 protruding from the ends of the plastic tube 114 side by side. The ends of the rakes are placed next to each other at a distance sufficient to encircle both directions of blood vessels, as indicated at 118. This distance 118 is preferably about 2 mm. The collector can manipulate the position of the electrode by pulling the flexible wire. FIG. 22 shows the possible positions of the rake when the flexible end (tip) 117 is bent. In this embodiment, the curved plane indicated in the vertical direction in FIG. 22 is approximately perpendicular to the plane occupied by the two rakes 116 (shown horizontally in FIG. 21).

In the variant shown in FIGS. 23 and 24, the end of the rake is located in the vertical plane, and when the electrode end 117 is bent, the bent plane shown in the vertical direction in FIG. 24 becomes parallel to the direction of the plane shown in the vertical direction in FIG. . The ends of the rakes are thus positioned in various planes depending on the level of bending. Therefore, direction is not an important factor. In the variant shown in FIG. 23, the protruding rake 122 is short, the other protruding rake 124 is elongated and the end 126 is bent back toward the short protruding rake 122. This type of hook can be useful in certain situations when you need to catch and wrap a blood vessel that requires hemostasis.

After placing the end of the rake around the blood vessel, the gynecologist activates an electrosurgical device that causes bipolar discharge at both ends of the rake in the usual manner. Following the description of the previous application, other useful mechanical or electrical structures may be proposed by one of ordinary skill in the art. As in the previous embodiment, the insulating tube 14 prevents the rake side from inadvertently contacting the patient's tissue such that the discharge of the positive charge is confined between the two rake ends.

In the previous embodiment, the end of the handpiece is bent by applying a slot created along a predetermined space at the end of the handpiece, and the end of the handpiece is bent toward the slot when the pulling line is attached to the end of the handpiece. do. 25-29 provide a more preferred configuration to make it easier to bend the end of the handpiece in the construction of the handpiece end or to bend or position the handpiece end more precisely. In the first preferred embodiment, the open side of the slot has a structure formed wider than the closed side. In a second preferred embodiment, a structure is adopted in which the depth varies as the slot approaches the handpiece. In a third preferred embodiment, the slots have been replaced with the helical end of the handpiece. In a fourth preferred embodiment, the slots have been replaced with springs.

As in the previous embodiment, for the anode handpiece, two electrically insulated wires 210, 212 are passed through the insulated insulators of the tubular housing 218, the ends 219 of which are constantly positioned. It is weakened by the slot 220 and bent well. The third wire 222 is connected to the moving trigger 224 of the gun type housing 226, which has a fixed handle 228. The two wires 210, 212 are not only insulated from each other to apply a bipolar electrosurgical current, but also from a tubular housing 218, which may be made of metal. The two wires 210 and 212 may be connected to various monopolar or bipolar electrode types as described above. In this embodiment, as shown in FIG. 25, the degree of bending is approximately perpendicular to the center of the gun and the center of the slot 220. Two insulated wires 210, 212 are connected to a connector 234 on the left side of the gun. This connector, on the left rake (not shown), can be connected to a common positive cable that connects the gun to the electrosurgical device. Pull string 222 is connected by welding (not shown) to a portion such as the top of the bendable end (when bowed upward as shown in the figure). The welding operation is processed via the access slot 236 at the end of the tube 218 and beyond the bent slot 220 before inserting the insulating tube with the anode electrode wire. When the glyph grasps this gun and pulls the trigger 24, the wire is pulled and the end of the flexible tube is bent as shown in FIG. The position of the pull wire and the position of the slot can be oriented in various planes to control the degree of bending.

These embodiments relate to modifying the structure at the flexible end 219 of the tubular housing 218, which allows for increased flexibility and lifespan, and facilitates positioning control during use. It is usually made of metal. Of the four embodiments described, only the flexible end of the tubular housing is presented and the internal elements are omitted because they are the same as described above. In these four embodiments, the tubular housing may be fabricated from a relatively hard metal that does not bend except when needed in the slot 219 region. For example, suitable metals include stainless steel, and the wall thickness of a suitable tube is about 0.005 cm to 0.025 cm (0.002 inches to 0.01 inches). The outer diameter of the tube is usually approximately 0.10 cm to 0.25 cm (0.04 inch to 0.1 inch). The first two embodiments form slots for flexibility but have a different shape, while the other two embodiments generally employ a spiral structure instead of slots. When shrinking prolapse-producing tissue through the cannula, the tubular housing is generally applied in lengths of 15 inches to 20 inches (38.1 cm to 50.8 cm).

In the first embodiment of FIG. 26, the tubular housing 240 has a single access slot 236 and a slot 242 for securing flexibility (the thinner wall 244 is an open surface 246 of each slot). ) Is wider than the closed face 248). This structure allows the tip 248 to bend more before the slot wall is engaged than in a slot structure in which the slot walls are configured parallel to each other.

In the second embodiment of FIG. 27, curved slots 252 to 256 having different depths are applied as the access slot 236 and the tip 258 approach the single tubular housing 250. In this structure, the tip 258 may be more bent before the slot wall is involved because the slot 256 farthest from the handle 228 is bent more than the closest slot 252.

It is also possible to mix tapered slots (wall tapered slots), parallel walled slots, slots of various depths, etc., as needed to bend the tip of the handpiece. Thus, for example, the flexible end may include one or two parallel wall slots, and then bring six to eight tapered wall slots close to the tip, with or without adding various slot depths. It may be.

In the case of the third embodiment of FIG. 28, a tubular housing 260 is provided which is integrally formed, but without forming a slot in the top wall of the tube, the helical structure 262 is about 11 times (see reference numeral 264) in the tubular member wall. Formed. Spiral 262 is about 1.27 cm to 5.08 cm (0.5 inches to 2 inches) long. This structure provides significant restoring force for returning tip 268 to the original position of the bend gun.

In the fourth embodiment of FIG. 29, the one-piece tubular housing was replaced with a tube housing 270 consisting of a steel tube 272, a spring portion 274, and a short portion 276 of the steel tube. In this structure, one end of the spring 274 is welded to the first steel tube 272 and the other end of the spring 274 is welded to the tip of the next steel tube 276. The advantage of this structure is that more restorative force can be applied to the flexible tip by choosing a material that has more restoring force than that of ordinary stainless steel. It is also possible to make the helical portion 274 more rigid by giving more rotation to it than described in FIG. 28.

If an anode assembly is applied, the electrode wires must be insulated from one another and at the same time insulated from the metal tube. The double electrically insulating housing liner tube plays this role. In practice, however, an insulating housing liner tube may not be needed if the wire for electrical connection has its own good electrical insulating coating, since this coating is responsible for all electrical insulating functions. Similarly, in the case of a monopolar electrode assembly, a liner for electrical insulation with the metal housing may also not be required if a sufficiently good electrical insulation coating is applied to the electrical wire. The slot embodiments of FIGS. 26 and 27 can be used if a rigid material such as an electrically insulated plastic is used for an elongated tubular housing (eg, reference numeral 218 in FIG. 25 or 240 in FIG. 26). No additional insulation liner is needed. However, this requires a plastic material that can withstand repeated bending without breaking the flexible tip. Such materials are well known in the art. 28 and 29 can also be used with an electrically insulated tubular housing such as plastic, provided that the spiral portion 264 of FIG. 28 can be provided to the plastic without breakage. 29 may also be implemented by adhering the metal spring 274 to the plastic material portions 274 and 276. Very strong commercial adhesives can be used for this purpose.

In the following embodiments, a bipolar electrode is applied in the configuration of the new handpiece end and allows more precise control of the electrosurgical current applied to the tissue to be applied.

In a preferred embodiment, the ends of the electrodes are axially projected and loop wires which are doubled at the terminals of the anode source are connected. In a first preferred embodiment, the loop wires are located side by side at approximately the same distance from the insulated ends of the electrodes. In a second preferred embodiment, the loop wire protrudes a different distance from the end of the electrode. It is also possible within the scope of the invention for the loop wire to be located on a plane that is not parallel.

In this embodiment the configuration of the gun is essentially the same as when the anode is applied. The ends of the anode electrodes are formed by spaced loops 330 and 332. The two wire ends that make up each loop can be located about 0.05 cm to 0.13 cm (0.02 inch to 0.05 inch) away from the plane and 0.0953 cm (0.0375 inch) is appropriate. The radius of each loop is about 1/2 of the aforementioned distance. The two loops can be positioned approximately 0.033 cm to 0.063 cm (0.013 inches to 0.025 inches) in a direction perpendicular to each plane, with an optimum distance of about 0.0475 cm (0.0187 inches). Insulation between the two wires 330, 332 may be handled by an internal adhesive material 334, a plastic tube 336, a heat dissipation tube 338, or the like. It can also be replaced with other electrically insulating materials. When shrinking prolapse-producing tissue through the cannula, the tubular housing is generally applied in lengths of 15 inches to 20 inches (38.1 cm to 50.8 cm).

In the first embodiment of FIGS. 30 and 31, two wires 330, 332 extend the same distance at the free ends of the insulating tubes 336, 338. This distance, indicated at 340 in FIG. 30, is measured along the transverse axis of the tube 328 and is set to about 0.13 cm to 0.23 cm (0.05 inch to 0.09 inch). The preferred distance is about 0.191 cm (0.075 inches).

In the second embodiment of FIGS. 32, 33, 35 and 36 the two wires 342 and 344 are axially separated from each other in two parallel planes and thus at the free ends of the insulating tubes 336 and 338. Extends to a different distance. For example, wire 344 extends about 0.13 cm to 0.23 cm (0.05 inch to 0.09 inch), approximately the same length 340 as that of the wire in the first embodiment, with a preferred length of about 0.191 cm (0.075 inch). )to be. The other wire 342 extends about half the distance from the free ends of the insulation tubes 336, 338, that is, about 0.051 cm to 0.114 cm (0.02 inch to 0.045 inch), corresponding to the distance 346. Preferred values for are about 0.0953 cm (0.0375 inches). 35 shows the second embodiment in an unbent position. 36 shows one of the possible positions of the anode electrodes 342 and 344 when the flexible tip 349 is bent. In this embodiment, the degree of bending as shown in FIG. 36 is approximately perpendicular across the center of the gun and the center of the slot 320.

As described above, the slot 320 can be configured as a tapered wall or side-by-side wall, slots of varying depths or spiral or spring portions. Fine loop wires can be about 0.018 cm to 0.089 cm (0.007 inches to 0.035 inch) in diameter, with a preferred value of 0.038 cm (0.015 inch).

When operating the handpiece according to this embodiment, the electrosurgical current is concentrated between the sides of the ends 330, 332 of the wire from which an activated voltage is generated. When an offset is applied to the wires 342 and 344 as in the second embodiment, most of the discharge occurs obliquely between the curved distal ends. The surgeon may select the electrode for optimal results during such procedures as tissue resection or vascular hemostasis.

Although the present invention has been described in connection with the preferred embodiment, it is within the scope of the principles outlined above in the position of experts in the relevant field, but there may be inevitable modifications, and thus the present invention is not limited to the preferred embodiment, and until such modification is made. We shall cover.

It provides an electrosurgical handpiece that is operable with bipolar and unipolar during surgery and is configured to be applied to a MIS, wherein the bipolar action limits the electrosurgical current to a small active area between the active ends of the bipolar electrode and thus the patient's body Reduces the possibility of excessive heat that can damage tissue. The location of the activated area can also be controlled to avoid body tissue in patients who are more sensitive to excessive heat. In certain embodiments, the handpiece consists of flexible ends that can be controlled by the surgeon so that the surgeon can manipulate the ends as desired during surgery.

Claims (33)

(a) an elongated tubular first member having a first end and a flexible remaining opposite second end, (b) an elongated tubular second member located within the first member, the electrical insulating tube having a first end and a flexible second end adjacent to the second end of the first member, the second tube being connected to the first zone; An elongated tubular second member comprising electrically insulating means for dividing into a second zone, (c) a first electrically conductive wire and a second electrically conductive wire, respectively located in the first and second zones and electrically insulated from each other; (d) first means connected to the first member through a first end of the first member for flowing an electrosurgical anode current to the first wire and the second wire, (e) second means connected to the first member for selectively bending the opposite flexible end of the first member with the opposite flexible end of the second member relative to the first end of the first member, and (f) an electrosurgical electrode that is extendable, electrically insulated and activated at opposite flexible ends connected to the first and second wires, the opposite flexible end being actuated when the second means is operated with electrical insulation maintained; An electrosurgical electrode that bends together, The electrosurgical electrode is an electrosurgical bipolar handpiece, characterized in that it comprises a first rake and a second rake exposed side by side at the same interval as the blood vessel size of the surviving patient. The method of claim 1, And wherein the first member comprises a weakened portion at the flexible end. The method of claim 1, The separating device includes an electrically insulating wall portion projecting outwardly from an opposite end of the second member, wherein the electrodes are located on either side of the projecting wall portion. The method of claim 1, The second means comprises a pull string or string located inside the first member and connected one end to an opposite end of the first member, And a means for pulling the other side of the pull string or string. The method of claim 1, The first member has a length of 25.4 cm to 50.8 cm (10 inches to 20 inches) and a diameter of 0.18 cm to 0.25 cm (0.07 inches to 0.1 inches) and can be inserted into the MIS cannula. Anode handpiece. delete delete delete delete delete The method of claim 1, The first and second wires have exposed ends forming a loop that protrudes from the second end of the first member, and the exposed end loops of the first and second wires are spaced parallel or not parallel. Extend over planes, Electrosurgical bipolar handpiece, characterized in that when an electrosurgical voltage is applied to the first and second wires, an electrosurgical current is produced between the spaced exposed end loops. delete delete delete (a) a handle having a handle portion and a member rotatable relative to the handle portion, the handle having means for mounting a tubular member, (b) an elongated tubular first member having a second flexible end opposite the first end, (c) a second tubular second member positioned within the first member and electrically insulated, the second member comprising an electrical insulation tube having a first end and an opposite flexible second end adjacent to the second end of the first member; , (d) an electrically conductive wire located within the second member, (e) first means connected to the first end of the first member to apply an electrosurgical current to the electrically conductive wire, (f) second means connected to the rotatable member for selectively bending the opposite flexible end of the first member with the opposite flexible end of the second member relative to the first end of the first member, (g) an electrosurgical electrode connected to the electrically conductive wire and extending from the opposite flexible end, the electrode comprising an electrosurgical electrode that bends with the opposite flexible end when the rotatable member is actuated, Opposite flexible end is flexible by having a weakened portion of the electrosurgical handpiece. delete The method of claim 15, And wherein the weakened portion includes one or more spaced slots on the side of the first member at positions spaced proximately from opposite ends of the first member. delete delete The method of claim 15, An electrosurgical handpiece, characterized in that the weakly treated portion comprises a spiral portion. The method of claim 15, The weakly treated portion includes an electrosurgical handpiece comprising a spring portion to obtain the same flexibility. The method of claim 15, And the second member is detachably mounted in the first member. The method of claim 15, And on the handle, a means connected to the handle and also connected between the first member and the second member to provide a suction function at the opposite second end through the space between the first and second members. Electrosurgical handpiece, characterized in that. The method of claim 15, An end of the electrode is composed of a scissors member, And means for selectively performing extension and contraction of the scissors member, wherein the scissors member is configured to open when extended and close when contracted. A handle, generally a tubular first member, generally a tubular second member, and first to third means, (a) the handle having a handle portion and a first member movable relative to the handle portion, the handle comprising means for mounting a support member, (b) the tubular first member comprises a positive or monopolar electrode having a second end opposite the first end and having a second end adjacent to the first end and the second end of the first member, and electrically The anode electrode to be insulated is connected to the first member and is movable in the tubular first member, (c) the tubular second member is mounted to the handle along the tubular first member and includes other anode and unipolar electrodes moveable within the tubular second member, (d) the first and second means are respectively connected to the anode and the unipolar electrode to apply the current for the anode and the unipolar electrosurgery, respectively (e) the third means selectively makes the anode and unipolar electrodes accessible at opposite second ends, selectively energizes the selected electrodes by applying an electrosurgical current, At least one of the anode and unipolar electrodes includes a bent opposite end, and one of the anode and unipolar electrodes is selectively removable in each tubular member, and thus the other electrode having the opposite end bent in the other direction. An electrosurgical handpiece, wherein one of the anode and unipolar electrodes can be replaced. The method of claim 25, An electrosurgical handpiece, further comprising: fourth and fifth means for selectively advancing and retracting each of the anode and unipolar electrodes such that the ends of each electrode protrude outwardly from the respective tubular first and second members. delete (I) (a) an elongated tubular first member having a first end and a flexible remaining opposite second end,     (b) an elongated tubular second member located within the first member, the electrical insulating tube having a first end and a flexible second end adjacent to the second end of the first member, the second tube being connected to the first zone; An elongated tubular second member comprising electrically insulating means for dividing into a second zone,     (c) a first electrically conductive wire and a second electrically conductive wire, respectively located in the first and second zones and electrically insulated from each other;     (d) first means connected to the first member through an end of the first member for flowing an electrosurgical bipolar current to the first wire and the second wire,     (e) second means connected to the first end of the first member for selectively bending the opposite flexible end of the first member with the opposite flexible end of the second member relative to the first end of the first member, and     (f) Electrosurgical, electrically insulated, activated electrosurgical electrodes connected to the first and second wires and extending from respective zones at opposite flexible ends, the opposite side when the second means is operated while the electrical insulation is maintained. Flexing electrosurgical electrodes with flexible ends Providing an electrosurgical bipolar handpiece comprising: (II) inserting the tubular first member into the body of a non-human animal near the tissue to be treated, (III) bending the opposite flexible end to bend the electrosurgical electrode to the location of the tissue to be treated, and (IV) supplying an electrosurgical current to the first end to provide bipolar discharge to generate and treat heat in the tissue. Surgical surgical tissue treatment method comprising. The method of claim 28, wherein the cannula is first inserted into the body of a non-human animal, and then the first member is inserted into the cannula so that the flexible end of the first member reaches near the tissue, After step (IV), the tubular second member is removed from the tubular first member, and the tubular second member is replaced with another tubular second member composed of other electrodes without removing the tubular first member from the cannula and then Surgical surgical tissue contraction method, characterized in that for supplying energy to the electrode in the tubular second member. 29. The electrosurgical handpiece of claim 28, wherein the electrosurgical handpiece is provided with a monopolar electrode and also with means for selectively accessing the opposite end of the positive electrode or monopolar electrode and selectively providing energy to the positive electrode or monopolar electrode, First treating the tissue with one of the anode and monopole electrodes and then treating the tissue with the other of the anode and monopole electrodes while the tubular first member is held in the cannula. Surgical surgical tissue contraction method. (a) a handle having a handle portion and a member rotatable relative to the handle portion, the handle having means for mounting a tubular member, (b) an elongated tubular first member having a second flexible end opposite the first end, (c) a second tubular second member positioned within the first member and electrically insulated, the second member comprising an electrical insulation tube having a first end and an opposite flexible second end adjacent to the second end of the first member; , (d) an electrically conductive wire located within the second member, (e) first means connected to the first end of the first member to apply an electrosurgical current to the electrically conductive wire, (f) second means connected to the rotatable member for selectively bending the opposite flexible end of the first member with the opposite flexible end of the second member relative to the first end of the first member, (g) an electrosurgical electrode connected to the electrically conductive wire and extending from the opposite flexible end, the electrode comprising an electrosurgical electrode that bends with the opposite flexible end when the rotatable member is actuated, And the opposite flexible end of the first member comprises a material having restoring memory properties. The method of claim 31, wherein And the second member is detachably mounted in the first member. The method of claim 31, wherein And on the handle, a means connected to the handle and also connected between the first member and the second member to provide a suction function at the opposite second end through the space between the first and second members. Electrosurgical handpiece, characterized in that.

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