CN101480358A - 电外科设备 - Google Patents

电外科设备 Download PDF

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CN101480358A
CN101480358A CNA2009100051445A CN200910005144A CN101480358A CN 101480358 A CN101480358 A CN 101480358A CN A2009100051445 A CNA2009100051445 A CN A2009100051445A CN 200910005144 A CN200910005144 A CN 200910005144A CN 101480358 A CN101480358 A CN 101480358A
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克劳斯·菲舍尔
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Erbe Elecktromedizin GmbH
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00702—Power or energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00875—Resistance or impedance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/124—Generators therefor switching the output to different electrodes, e.g. sequentially

Abstract

本发明涉及一种电外科设备，包括以铰链方式相互连接的两个分支，所述分支以对应于夹持、扩展或切割工具的方式被致动以便打开或闭合。所述设备进一步包括，在所述分支的远端的电极部分，用于抓住组织并传导凝结电流通过所述组织，所述电极相互绝缘；还有将凝结电流供给到所述电极部分的电流供给装置。所述电外科设备配置成使特别是需要几个过程步骤的手术以最简单的方式且以最佳的步骤顺序完成。为此，在至少一个电极部分上配置设计成切割电极的切割部，使得电极部分包括切割部和凝结部。此外，提供控制单元以便以这样的方式控制HF电流，使得当达到标识被抓组织的特性的阈值时，将不同于凝结电流的切割电流供给到至少切割部。

Description

电外科设备
本发明申请是2005年4月27日提出的发明名称为“电外科设备”、申请号为“200580015089.8”的发明专利申请的分案申请。
技术领域
本发明涉及一种电外科设备。
背景技术
电外科设备多年来一直应用于高频外科，以便凝结(coagulate)和/或切割生物组织。在这一过程中，高频电流传导通过待治疗的组织，使得后者由于蛋白质凝结和脱水而发生改变。组织因此而收缩，使得血管闭合且出血停止。随后的电流密度增加导致组织液的爆炸式蒸发以及细胞膜的撕裂，使得组织被完全横切。与单纯的机械切割方法不同，这类方法的优点是在切割边缘产生止血。
双极设备的应用变得愈加有意义，因为电流强度比单极设备的情况小。特别有利的是，双极设备的电极部分之间的电流路线可以计算，而不会以大的距离通过病人身体。
双极设备基本上包括两个相互铰链连接的夹具部分，在它们的近端提供了用于操作两个夹具部分的抓具。在夹具部分的远端有电极部分，用于抓住组织并用于传导凝结电流通过组织。由HF发生器产生的HF电流通过电流供给装置传导到双极设备的电极部分。
当使用上述双极设备时，在凝结过程之后必须将切割设备用于凝结组织的最后横切。切割由外科剪或HF切割设备完成。然而，不同设备的使用需要中断外科手术，使外科手术不必要地延长。
为了消除这一缺点，多功能设备已经投入使用，至少设计用于凝结和切割两个方面。例如，这种设备见于文件DE19915060A1，利用这种设备，用于切割或凝结的不同工作装置，诸如钳子、钩子或甚至超声装置和电极可通过致动器投入到手术中。控制单元使计划的工作步骤得以连续执行。
然而，那里所述的多功能设备的实施例具有以下缺点：尽管所述步骤可由单个设备执行，凝结和切割仍然是在时间上逐次执行的两个不同的处理。因此，第一过程必须有意地结束，其后第二过程再有意地开始。这些过程之间必须完成至少一种操作，即启动多功能设备用于下一个任务。这也不必要地耽误了手术过程。此外，在一个过程的启动期间会发生关于如适合的HF电流的适当工作参数的设置的错误。
上述种类的已知的多功能设备进一步包括相互电绝缘的极，分别提供用于凝结和切割，因此所述设备必须具有相对大的尺度。这明显地限制了外科医生在手术区域的动作的自由度，并因此限制了该已知设备的用途范围。
发明内容
因此本发明的目的是进一步开发在开始时引用的种类的电外科设备，使得手术、特别是需要几个过程部分的手术可以以最简单的方式和优化的步骤顺序进行。
这一目的由一种电外科设备实现，该电外科设备具有：以铰接方式相互连接的两个分支，其能够以对应于夹持、扩展或切割工具的方式被致动以便打开或闭合；在所述分支的远端的电极部分，其相互电绝缘，用于抓住组织及传导凝结电流通过该组织以便将其凝结；电流供给装置，用于将所述凝结电流供给到所述电极部分。至少在一个电极部分上有设计为切割电极的切割部，使得该电极部分包括所述切割部和凝结部。提供控制单元以便以这样的方式控制高频电流，使得当达到表征所抓住的组织的特定特性的阈值时，将不同于凝结电流的切割电流至少供给到切割部。与控制单元关联的开关装置检测作为所述分支之间的特定距离的阈值，以便根据所述距离来供给所述切割电流。
所述目的还可以由一种电外科设备实现，其包括两个以铰接方式连接的分支，根据夹持、扩展或切割工具的适当情况，所述分支可被致动以便打开或闭合。所述设备进一步包括在分支远端的电极部分，其相互电绝缘并用于抓住组织及传导凝结电流通过组织以便将其凝结，还包括将凝结电流递送到电极部分的电流供给装置。在所述设备的至少一个电极部分上，另外形成设计成切割电极的切割部，使得该电极部分包括所述切割部和凝结部。此外，控制HF电流的控制单元被提供，使得当达到表征所监视组织的特性的阈值时，将不同于所述凝结电流的切割电流提供到至少所述切割部。所述切割部构造成能够借助于定位装置相对于所述凝结部移动的部件。所述定位装置包括：可旋转地安装在所述分支之一中的两臂杆，具有第一端和第二端，使得第一端设置为容纳所述切割部，第二端设置为接触相对设置的分支或接触设置于相对设置的分支上的间隔物，以便在接触时，所述切割部能够向相对的电极部分移动；以及再调整装置，以便当所述第二端与相对设置的分支或者与所述间隔物的接触期结束时，所述切割部能够移回到其初始位置。
本发明的基本点在于这一事实，在设计用于凝结的所述电极部分上设置切割部，使得在合适的时间点，即当到达手术的某个阶段时，其用作切割电极。从而，外科医生不再需要在从凝结阶段到后续的切割阶段过渡时作决定。同时，可产生最佳的工作参数，如正确的电流强度，而无需手术者通过HF发生器处的电压来单独设置它们。这样，各个手术阶段之间的事件的时间顺序与短暂需要的HF电流彼此得到最佳的匹配。这样，手术可以在错误源尽可能消除的情况下进行。
在从属权利要求中给出了本发明的优选的进一步展开。
在第一优选实施例中，与控制单元关联的开关装置检测作为分支之间的特定距离的阈值，以便依据这个距离供给切割电流。一旦分支之间的距离，即电极部分之间的距离，降到规定值以下，所述切割电流至少供给到所述切割部。在这一过程中，开关装置在被激励时向控制单元发送一个信号，其使后者通过高频发生器将适合的切割电流供给到所述切割部。所述距离用以识别可以实施切割过程的情况，即电极部分之间处于一距离而使得刚好可以第一次切割的事实。这种情况下，所述电极部分之间的距离可以由经调整的HF电压电平来限定。
开关装置有利地提供在至少一个分支上和/或提供于设置在至少一个分支上的间隔物上。这是有利的，因为所述距离于是由开关装置直接检测，由此可同时启动切割过程。
在一个优选实施例中，开关装置构造成按钮开关。然后优选地将其附着到在一个分支上的间隔物，以便当开关被相对的分支接触从而到达阈值时一在这种情况下为电极部分之间的特定距离，将切割电流供给到切割部。这是一种特别简单的设计，由此当电极部分之间的距离小于规定值时，以一种经济的方式触发切割过程。
在另一优选实施例中，开关装置构造成非接触开关。其优点是无需分支互相接触，因此在精确工作时机械结构不易磨损。
因而将非接触开关设计成例如接近开关或簧片接触是有利的。例如，如果将簧片接触附着到一个分支而将磁体附着到相对的分支，磁体一旦距簧片接触某一距离时簧片接触就切换。接近开关类似地工作，例如电感接近开关。设置在所述相对分支上的金属物体在所述接近开关的交变电磁场中一产生涡流，附着到所述一个分支开关的接近开关就切换。在如这里所述的开关的情况，切换距离优选地可由插入到所述交变场中的金属物体不定期地限定。
控制单元有利地与用于电阻测量的装置关联，其检测组织的欧姆电阻的阈值，以便依据这个欧姆电阻供给切割电流。组织电阻的测量使得能够确定在当时或其后可以开始切割过程的精确的时间点。一旦手术进程使组织内部达到特定电阻，控制单元就使适合的切割电流供给到切割部。这一过程极其可靠，因为组织电阻在被凝结改变时为何时开始切割过程提供了精确的基准值。
在另一优选实施例中，控制单元与电弧监视器和/或电流监视器关联，其检测用于结束凝结的最佳时间形式的阈值，以便根据凝结结束时间点供给切割电流。即，一旦根据对应的监视器所提供的信号终止凝结，切割电流就至少供给到切割部。这样，切割电流的供给有利地发生在对于手术过程理想的时间。电流监视器和电弧监视器工作的方式在例如文件EP0253012B1中详尽描述。
优选地，所述至少一个电极部分上的切割部相对于所述至少一个电极部分的凝结部构造成逐渐缩小的区。在这种情况下，凝结部和切割部能够构成一个整体构造的电极，或者两个区相互独立地设置。所述切割部的逐渐缩小的配置使得来自切割部的电流密度能够按照切割组织所需而增加。凝结部和切割部为一体的电极部分能够在它的整个表面上、即在凝结部的表面和切割部的表面上充当凝结电极，而逐渐缩小的切割部单独可用于后面的切割过程。对于彼此分开的凝结和切割区的情况，它们可以组合使用也可以彼此分开使用。对设计成切割部的较小表面区，对应于以上考虑的充足的切割电流得以通过电流供给装置供给。这样，同一个设备可用于凝结和切割。
在一个优选实施例中，在所述至少一个电极部分上，切割部形成为具有基本上三角形的横截面的刀口结构。三角形横截面使得能够从电极部分的大表面区逐步过渡到它的逐渐缩小的刀口部。逐渐过渡特别适于将整个电极部分作为凝结电极插入(如果组织足够厚)，以及在手术的高级阶段单独将切割部用于切割。
在所述至少一个电极部分上，切割部形成为具有基本上圆形的横截面的刀口结构是有利的。在这个实施例中，相对大的电极表面可用于凝结过程，如果组织足够厚，而切割部的成形刀口并不重要。相反，在手术的高级阶段，如果所述电外科设备的相对电极部分充分闭合，则由于切割部的刀口配置，电流密度可以充分地增加到能够进行切割过程。
另一个解决方案是，所述至少一个电极部分上的切割部基本上成球形。这使得切割表面更大，并且进行相应的宽切割。
根据本发明的解决方案提供具有尖的、针或环型形状的切割部。这对应于切割电极的其它通常的形式，使得能够利用通常用于特定应用的设备来进行切割。
在一个优选实施例中，切割部形成于相对的电极部分的每一个上。因为这里两个部设计用于切割，可以实现特别精确的切割动作，因为电流密度在两个电极部分都能增加。
然而，切割部也能够设置在凝结部之外，即，如上所述分开构造。在这种情况下，将切割部构造成可以借助于定位装置相对于凝结部移动的部件是有利的。切割部然后可以在凝结过程中从凝结区移开，以便这时不发生不希望的切割动作。当达到阈值时，可将一个或多个切割部带到适合的位置，即切割所需的位置。
定位装置优选地包括两臂杆，其可旋转地安装在所述分支的一个上；该杆包括第一端和第二端，第一端提供用来容纳所述切割部，第二端与相对的分支或置于相对的分支上的间隔物接触。当第二端接触所述相对的分支时，切割部可以沿相对的电极部分的方向移动。定位装置另外包括再调整装置，以便在接触结束时，切割部能够移回到起始位置。这使得在凝结阶段将切割部收回到凝结部特别简单，以避免切割部对凝结过程的损害。在这种情况下，一旦达到阈值并且得以接触，切割部就旋出其静止位置。切割电流可以例如通过开关装置供给到现在暴露的切割部，所述开关装置根据以上描述设置于间隔物上或所述杆的第二端并将适当的信号发送到控制单元。因为简单的机械构造，这样一种多功能电外科设备非常经济且制造简单。切割部的定位还独立于外科医生的手所施加的任何力量，因为控制单元仅在进行接触的基础上得到激励。如以上刚刚描述的，定位装置也可以提供于两个分支上。
一个优选实施例提供一种用作容器的装置，其用于将切割部附着于两臂杆的第一端。在这种情况下，所述切割部能够被暂时移开是有利的。该优点显现于手术阶段后要清洁切割部时，或不再需要切割过程时。这种设置以最简单的方式使切割部去激励。
所述装置的一个可能实施在于将切割部构造成两臂杆的第一端的整体部件。这样就可以以特别简单的方式制造定位装置。
一个优选实施例规定：用于杆臂的再调整装置具有设置于包括所述定位装置的分支上的弹簧元件的形式。弹簧元件是这样一个部件，其安装简单而且经济，并且总是几乎无任何磨损地实现所要求的功能。
根据本发明的一种解决方案规定：切割部由抗粘附涂层和/或抗腐蚀材料制成。当HF电流引入待治疗的组织时所产生的热量不仅仅产生期望的凝结或切割效果。此外，例如，组织残余和血会烧结到夹具的电极部分，从而特别地足以损害电流。抗粘附涂层减小了这种污染，并应该特别地在每一个切割部提供。抗腐蚀材料层能够附加地保护切割部，使其免于由HF电流所引起的磨损。
附图说明
下面参照示例性实施例来描述本发明，所述实施例参照附图得到详述，其中
图1示出第一实施例中的电极设置；
图2示出第二实施例中的电极设置；
图3示出第三实施例中的电极设置；
图4示出第四实施例中的电极设置；
图5示出一个功能框图；
图6示出第五实施例中的电极设置的沿图7的线VI—VI的截面图；
图7示出根据图6的电极设置的侧视图；
图8a示出电流/时间图，其中针对不同的手术模式表示出电流强度的时程(time course)；
图8b示出电压/时间图，其中针对根据图8a的不同手术模式表示出电压的时程。
在下面的描述中，同一标号用于相同的部分或具有相同功能的部分。
具体实施方式
图1到3示出彼此相对设置的电极部分18、19的设置的各种实施例。在每一种情况中，明确的切割部18a仅形成于一个电极部分18上。应该指出这是示意图，其仅仅示出电极部分18、19的前视图。结合有电极部分18、19的电外科设备10未在此示出。
切割部18a的形成可理想地通过使所关联的电极部分18逐渐缩小来实现，以便电极部分18最终包括凝结部18b和切割区，即切割部18a。电极表面的减小使电流密度在切割部18a按照切割组织所需而增加。包括一体的凝结部18b和切割部18a的电极部分18可以在凝结过程中在整个表面区域、即在凝结部18b和切割部18a二者的表面区域上充当凝结电极，而逐渐缩小的切割部18a可单独用于后面的切割过程。对于切割过程，规定将不同于凝结电流的切割电流供给到切割部18a。
如果切割部18a是具有三角形横截面的刀口结构，如图1所示，则从大表面区域到逐渐缩小的刀口区的逐渐过渡尤其可以使整个电极部分18用作凝结电极(假定组织有足够的厚度)，并且在手术的高级阶段只将切割部18a用于切割。
如果切割部18a在所述至少一个电极部分18上形成为具有圆形横截面的刀口结构，如图2所示，则相对大的电极表面可用于凝结过程，而切割部18a的刀口结构并不重要(假定组织有足够厚度)。在随后的手术过程中，如果电外科设备10的相对的电极部分18、19彼此足够靠近，由于切割部18a的刀口结构，电流密度可以增加到足以进行切割过程的程度。
在所述至少一个电极部分18的基本上球形的切割部18a的情况下，如图3所示，切割表面可以做得更大，以便可以进行对应的宽切割。
切割部18a、19a也可以以尖的、针状或环状形状来构造。
图4示出一个电极设置，其中切割部18a、19a各形成于相对的电极部分18、19上。这里，明确的凝结部18b、19b还是被提供于所述两个电极部分18、19处。该图仍要理解为示意图。由于两个部18a、19a被设计用于切割，可以实现特别精确的切割动作，因为可以增加两个电极部分18、19的电流密度。
图5示出一个功能框图，其中电外科设备10连接到高频外科设备60。这里所示的HF外科设备60的部件专门地而且因此示意性地是那些说明本发明所需的。
HF外科设备60包括输出连接器63，例如，诸如手指和/或脚开关(未示出)的激励装置可通过它来连接，以便激励和/或去激励HF电流。这里所述的激励装置可以优选地以计算机装置实施，并且在实际应用时通过控制单元(未示出)连接到HF发生器61。为简单起见，该图中的输入连接器63直接连接到HF发生器61，如虚线所示。在HF外科设备60的输出侧上提供了第一输出连接器64和第二输出连接器65，电外科设备10可通过它们来连接。
HF外科设备60的中心部件是用于产生HF电流的可控HF发生器61，更确切地说是用来产生电压UHF。通过调整电压UHF，各种手术模式如凝结或切割所需的电流强度IHF可以根据需要来设置。HF发生器61连接到控制单元62。控制单元62设计用来接受来自设置于电外科设备10上的开关装置50的信号。
开关装置50设置于电外科设备的分支11、12之间，并检测例如作为分支11、12之间即电极部分18、19之间的特定距离的阈值。电极部分18、19之间的距离在这里用来表征可以执行切割过程的事实，并因此匹配于HF电压所设置的电平。一旦分支11、12达到规定距离，开关装置50激励并将信号传导到控制单元62。这然后开始将适当的切割电流从HF发生器61通过电外科设备的关联近端15、16发送到切割部18a、19a。这里应该再一次指出，切割部可形成于电极部分18、19的仅一个上或全部两个上。
作为检测所述距离和激励控制切割电流的控制单元62的方法，可以用按钮开关，也可以用非接触开关，如簧片接触或接近开关。利用接触型开关，所述电外科设备可具有特别经济的构造，而非接触开关工作极其精确且基本上没有磨损。
关于所述开关装置的确切设置参考图6和7的描述。
例如，也可以通过与控制单元62关联的用于电阻测量的装置(未示出)来检测所述阈值。一旦手术进行到已经达到组织内的特定电阻时，控制单元62就使适当的切割电流供给到有关的切割部18a、19a。因此，所述阈值根据欧姆电阻来规定。
控制单元62也可以配备电弧监视器和/或电流监视器(未示出)，以便可以检测作为终止凝结的最佳时间的阈值。然后一旦由于对应的监视器所提供的信号使凝结停止，切割电流被供给到至少所述有关切割部18a、19a。因此切割电流的传递有利地发生在实验过程的最佳时间。电流监视器和电弧监视器的工作方式在例如文件EP0253012B1中详述。
图6以沿图7中的VI-VI线的截面图示出第五实施例中的电极设置。图7示出根据图6的电外科设备10的侧视图。电外科设备10在这里设计为镊子形的设备。
在这些图中说明了电外科设备10的分支11、12的远端13、14，以及相关的电极部分18、19。特别是在图7中可以看到，在一个分支12内，具有第一端31和第二端32的两臂杆30设置为可以绕轴34旋转；第一端31提供为用于切割部19a的支持器(holder)，第二端32提供为接触相对的分支11或设置于相对分支11上的间隔物20。这里杆30帮助切割部19a的定位，以便后者能够相对于为凝结而提供的部19a移动。即，在这一实施例中，电极部分19包括两个独立的部，凝结部19b和切割部19a。
因此，杆30可以设置于分支12中，后者包括凹陷21，杆30的第一端31可以嵌入其中，优选地以便于完全封闭。所述凹陷形成于分支12的凝结部19b和分支12自身两者之中。因为这种设置使得切割部19a能够嵌入凹陷中，避免了在凝结过程中切割部19a干扰凝结电极19b的可能性。
当分支11、12由手术者互相移近时，间隔物20持续地接近杆30的第二端32。第二端32在这一实施例中包括支承表面33。一旦相对的分支11上的间隔物20与支承表面33接触，杆30的第一端31被提升出静止位置，从分支12中露出来，以便切割部19a从凝结部19b伸出来。切割部19a和相对的电极部分18现在可以在切割阶段彼此合作。为此，间隔物20或支承表面33包括以上所详述的开关装置50。当间隔物20或支承表面33与开关装置50接触时，后者的激励使对应的切割电流通过电流供给装置17供给到切割部19a，同样如以上所述。
在包括杆30的分支12中设有弹簧元件40。其在第一端41连接到分支12，在第二端42连接到第二杆端32。因为第二杆端32的支承表面33与相对的分支11上的间隔物20，和/或与设置于间隔物20或支承表面33上的开关装置50接触，附着到第二杆端32的弹簧40例如螺旋形弹簧被压缩。一旦接触被破坏，弹簧40将杆30移回到其静止位置，使得承载切割部19a的杆端31降回到分支12中。因此凝结电极19b再次可用于凝结组织。弹簧元件40是一种经济的部件，其安装简单，并总是无任何磨损地执行所需的功能。
此外，开关装置50也可设置于分支11、12的其它位置。在这种情况下，非接触开关特别值得考虑，因为即使没有任何直接接触，当达到电极部分18、19之间的规定距离时，它们也将信号传到控制单元。
两臂杆31的第一端可以包括用于切割部19a的容器，以便例如为了清洁的目的，后者能够从电外科设备方便地移去。可替选地，可以将第一杆端31与切割部19a做成一体，这使装置得以极其经济地制造。
由于用于切割部19a的刚刚描述的定位装置30的机械构造简单，多功能电外科设备10能够以简单和经济的方式制造。
切割部18a、19a可优选地以抗粘附涂层和/或抗腐蚀材料层构造。这避免组织烧结到切割部上或材料磨损的可能性。
图8a是HF电流强度随不同的手术模式的典型变化的图。纵坐标表示电流强度IHF，横坐标表示时间t。图8b是对应于图8a的电压/时间图。这里纵坐标表示电压UHF，横坐标仍表示时间t。因为两个图都是示意图，所以未示出单位。
根据图8a，在时间t1，凝结模式接通，电流开始流经待凝结的组织。随着组织变得较热，电流强度IHF增加，直到时间t2。从时间t2起，组织开始凝结，因此汽化阶段开始。由于与HF电流相关的热生成，组织的指定区域通过蛋白质的凝结和脱水而改变或毁坏。在这一过程中，已经处于溶解状态的组织的胶质成分首先进入凝胶状态，然后作为凝胶成分，它们失去液体并因此变得更加致密；该组织被“弄熟”。组织的电阻相应地升高，因此由于组织的电导率的下降，电流强度IHF下降，直到时间t3。当组织的干燥已经达到某个阶段，凝结停止。在时间t3和t4之间，切割模式被激励。在这期间，曲线图示出相对恒定的电流强度IHF水平，因为在整个切割过程，组织电阻基本上相同。
如图8b所示，HF发生器在时间间隔t1到t3被设置为特定电压UHF。凝结模式之后的切割模式需要电压UHF在时间t3和t4之间增加。电流强度IHF最终取决于电压UHF所设置的电平以及已经凝结的组织的电阻。在时间t4电流模式可例如通过自动关断装置终止。
就此而言，应指出上述部分的全部作为本发明的实质而要求保护，单独地或组合地，特别是附图中提供的细节。其修改为本领域的技术人员所熟知。
标号列表
10  电外科设备
11  夹具部分，分支
12  夹具部分，分支
13  远端
14  远端
15  近端
16  近端
17  电流供给装置
18  电极部分
18a 切割部，切割电极
18b 凝结部，凝结电极
19  电极部分
19a 切割部，切割电极
19b 凝结部，凝结电极
20  间隔物
21  凹陷
30  两臂杆，定位装置
31  杆的第一端
32  杆的第二端
33  支承表面
34  旋转轴
40  弹簧元件
41  弹簧元件的第一端
42  弹簧元件的第二端
50  开关装置
60  HF外科设备
61 HF发生器
62 控制单元
63 输入连接器
64 第一输出连接器
65 第二输出连接器。

Claims (18)

1.一种电外科设备，具有：
以铰接方式相互连接的两个分支(11，12)，其能够以对应于夹持、扩展或切割工具的方式被致动以便打开或闭合，
在所述分支(11，12)的远端(13，14)的电极部分(18，19)，其相互电绝缘，用于抓住组织及传导凝结电流通过该组织以便将其凝结，
电流供给装置(17)，用于将所述凝结电流供给到所述电极部分(18，19)，
其中至少在一个电极部分(18，19)上有设计为切割电极的切割部(18a，19a)，使得该电极部分(18，19)包括所述切割部(18a，19a)和凝结部(18b，19b)，以及
其中提供控制单元(62)以便以这样的方式控制高频电流，使得当达到表征所抓住的组织的特定特性的阈值时，将不同于凝结电流的切割电流至少供给到切割部(18a，19a)，
其中所述切割部(18a，19a)构造成能够借助于定位装置(30)相对于所述凝结部(18b，19b)移动的部件，
其中所述定位装置(30)包括：
可旋转地安装在所述分支之一(12)中的两臂杆(30)，具有第一端(31)和第二端(32)，使得第一端(31)设置为容纳所述切割部(19a)，第二端(32)设置为接触相对设置的分支(11)或接触设置于相对设置的分支(11)上的间隔物(20)，以便在接触时，所述切割部(19a)能够向相对的电极部分(18a)移动；以及
再调整装置(40)，以便当所述第二端与相对设置的分支或者与所述间隔物的接触期结束时，所述切割部(19a)能够移回到其初始位置。
2.根据权利要求1的电外科设备，其特征在于，还包括与控制单元(62)关联的开关装置(50)，其检测作为所述分支(11，12)之间的特定距离的阈值，以便根据所述距离来供给所述切割电流。
3.根据权利要求2的电外科设备，其特征在于，所述开关装置(50)提供于所述分支(11，12)的至少一个上，或提供于设置在所述分支(11，12)的至少一个上的间隔物(20)上。
4.根据权利要求2的电外科设备，其特征在于，所述开关装置(50)构造成按钮开关。
5.根据权利要求2的电外科设备，其特征在于所述开关装置(50)构造成非接触开关。
6.根据权利要求5的电外科设备，其特征在于，所述非接触开关构造成接近开关或簧片接触。
7.根据权利要求1的电外科设备，其特征在于，所述控制单元(62)设有用于电阻测量的装置，其检测作为所述组织的欧姆电阻的阈值，以便根据所述欧姆电阻来供给所述切割电流。
8.根据权利要求1的电外科设备，其特征在于，所述控制单元(62)设有电弧监视器和/或电流监视器，其检测作为终止凝结的最佳时间的阈值，以便根据凝结终止时间来供给所述切割电流。
9.根据权利要求1的电外科设备，其特征在于，与所述至少一个电极部分(18，19)的凝结部(18b，19b)相比，所述至少一个电极部分(18，19)上的切割部(18a，19a)是逐渐缩小的区。
10.根据权利要求1的电外科设备，其特征在于，所述切割部(18a，19a)构造成刀口结构，其在所述至少一个电极部分(18，19)上具有基本上三角形的横截面。
11.根据权利要求1的电外科设备，其特征在于，所述切割部(18a，19a)构造成刀口结构，其在所述至少一个电极部分(18，19)上具有基本上圆形的横截面。
12.根据权利要求1的电外科设备，其特征在于，在所述至少一个电极部分(18，19)上，所述切割部(18a，19a)以基本上球形形状来构造。
13.根据权利要求1的电外科设备，其特征在于，所述切割部(18a，19a)以尖的、针状或环状形状来构造。
14.根据权利要求1的电外科设备，其特征在于，所述切割部(18a，19a)构造于两个相对设置的电极部分(18，19)的每一个上。
15.根据权利要求1的电外科设备，其特征在于，在所述杆(30)的第一端(31)，附着有用于所述切割部(19a)的容器。
16.根据权利要求1的电外科设备，其特征在于，所述切割部(19a)构造成所述杆(30)的第一端(31)的整体部件。
17.根据权利要求1的电外科设备，其特征在于，所述再调整装置(40)设置为弹簧元件，该弹簧元件设置在包括所述定位装置(30)的分支(12)中。
18.根据权利要求1的电外科设备，其特征在于，所述切割部(18a，19a)由抗粘附涂层和/或抗腐蚀材料制成。
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