CN101511293A - 能量手术装置 - Google Patents

能量手术装置 Download PDF

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CN101511293A
CN101511293A CNA2007800335427A CN200780033542A CN101511293A CN 101511293 A CN101511293 A CN 101511293A CN A2007800335427 A CNA2007800335427 A CN A2007800335427A CN 200780033542 A CN200780033542 A CN 200780033542A CN 101511293 A CN101511293 A CN 101511293A
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中本孝治
中村俊夫
高桥和彦
吉江方史
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Olympus Corp
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Abstract

一种能量手术装置，该能量手术装置具有：对被检体进行处理的处理部(101)；能量供给部(103)，其向处理部(101)提供能量；状态变化检测部(102)，其检测处理部(101)的状态变化；能量指示输入部(105)，其输入能量供给的指示；以及调整部(104)，其根据能量指示输入部(105)的能量供给指示的输入和状态变化检测部(102)的检测结果来调整能量供给部(103)的能量供给。

Description

能量手术装置
技术领域
本发明涉及能量手术装置。
背景技术
近年来，作为进行治疗处理的方法之一，在外科手术等中广泛使用利用了高频(数百kHz)高压(数百～数千V)的电手术刀等能量手术装置。作为公开了利用高频能量的手术装置的专利文献，例如具有日本特开平7-8503号公报。
另外，作为进行治疗处理的方法之一，在外科手术等中广泛使用超声波处理装置，该超声波处理装置进行如下等处理：吸附或者夹持生物体组织，对进行该吸附或者夹持的部件施加超声波振动，从而切除生物体组织或使生物体组织凝固。作为公开了这样的超声波处理装置的专利文献，例如具有日本特开平10-5236。
在上述以往的能量手术装置中，在处理部相对于生物体组织以过量的力进行动作的状态下，当能量提供部向处理部提供能量时，有时候会将生物体组织过量切开、或者将生物体组织插穿。因此，操作能量手术装置的医生需要非常细心注意地进行处理，以不对电手术装置的前端部施加过量的力。
发明内容
本发明正是鉴于上述课题而完成的，其目的在于提供一种能够防止将生物体组织过量切开、或者将生物体组织插穿的安全性更高的能量手术装置。
为了达到上述目的，本发明的第1方面涉及一种能量手术装置，该能量手术装置具有：对被检体进行处理的处理部；能量供给部，其向所述处理部提供能量；状态变化检测部，其检测所述处理部的状态变化；能量指示输入部，其输入所述能量供给指示；以及调整部，其根据经由所述能量指示输入部的能量供给指示的输入和所述状态变化检测部的检测结果来调整所述能量供给部的能量供给。
并且，本发明的第2方面涉及一种能量手术装置，该能量手术装置具有：对被检体进行处理的处理部；能量供给部，其向所述处理部提供能量；力量变化检测部，其检测所述处理部所受到的力量的变化；能量指示输入部，其输入所述能量供给指示；以及调整部，其根据经由所述能量指示输入部的能量供给指示的输入和所述力量变化检测部的检测结果来调整所述能量供给部的能量供给。
并且，本发明的第3方面涉及一种能量手术装置，该能量手术装置具有：对被检体进行处理的处理部；能量供给部，其向所述处理部提供能量；状态变化检测部，其检测所述处理部的状态变化；能量指示输入部，其输入所述能量供给指示；动力部，其对所述处理部进行有源驱动；动力指示输入部，其指示所述动力部的动作；控制部，其响应于经由所述动力指示输入部的动作指示来控制所述动力部；以及调整部，其根据经由所述能量指示输入部的能量供给指示的输入、经由所述动力指示输入部的动力指示、以及所述状态变化检测部的检测结果来调整所述能量供给部的能量供给和所述动力部的驱动中的一方或双方。
附图说明
图1是用于说明第1实施方式的概略的图。
图2A是示出本发明第1实施方式的结构的图。
图2B是示出本发明第1实施方式的结构的图。
图3是挠性镜用电手术刀3的贴附有应变仪8的部分A-A的剖视图。
图4是示出电手术装置1的内部结构的图。
图5是用于说明第1实施方式的结构作用的流程图。
图6是用于说明将第1实施方式应用于ESD时的详细情况的图。
图7A是示出使用了3个应变仪8a、8b、8c的例子的图。
图7B是示出使用了2个应变仪8a、8b的例子的图。
图8是用于说明第2实施方式的概略的图。
图9是示出本发明第2实施方式的结构的图。
图10是示出将挠性镜用电动弯曲电手术刀40插入挠性内窥镜19时的整体图。
图11是示出电手术装置1的内部结构的图。
图12是用于说明第2实施方式的结构作用的流程图。
图13是示出本发明第3实施方式的结构的图。
图14是示出电手术装置1的内部结构的图。
图15是内窥镜下外科手术时的人体腹部53的剖视图。
图16是示出本发明第4实施方式的结构的图。
图17是示出电手术装置1的内部结构的图。
图18是用于说明将第4实施方式应用于内窥镜下外科手术时的详细情况的图。
具体实施方式
以下，参照附图对本发明的实施方式进行详细说明。
(第1实施方式)
以下，使用图1～图7B来说明本发明的第1实施方式。本实施方式的能量手术装置具有：状态变化检测部，其检测作为处理部的电手术刀的状态变化、例如施加给电手术刀的力，以及调整部，其根据该状态变化检测部的检测结果来调整向处理部提供的能量供给量，通过这种结构，本实施方式的能量手术装置能够调整处理部针对被检体的处理量。
图1是用于说明第1实施方式的概略的图。在图1中，能量指示输入部105从操作者接受用于向处理部101提供能量的指示。能量指示输入部105将该指示输入信号传递给调整部104。
另一方面，状态变化检测部102检测处理部101的状态变化。将所检测出的状态变化传递给调整部104。调整部104根据来自能量指示输入部105的信号和来自状态变化检测部102的信号来确定向能量供给部103输出的输出信号并进行输出。能量供给部103根据来自调整部104的信号向处理部101提供能量。处理部101接受来自能量供给部103的能量，对被检体100实施处理。
图2A是示出本发明第1实施方式的结构的图。电源插头(電源コ—ド)2、挠性镜用电手术刀3、用于附在患者脚部或背部等上的配极板4、以及输入高频输出指示的脚踏开关5分别通过电线6a～6d与电手术装置1连接，其中，挠性镜用电手术刀3根据从电手术装置1输出的高频信号来对患者进行处理。电手术装置1具有由阈值显示部34和阈值设定按钮35a～35c构成的阈值输入部33。
挠性镜用电手术刀3的前端部具有电极部7。该电极部7的材料由SUS304形成，可以进行通电。并且，在挠性镜用电手术刀3上贴附有应变仪8，能够检测施加到挠性镜用电手术刀3的前端部的力。
图2B是图2A中的挠性镜用电手术刀3的贴附有应变仪8的部分A-A的剖视图。应变仪8按照多个方向(8a～8d)贴附到挠性镜用电手术刀3上，可以检测从多个方向施加到挠性镜用电手术刀3上的力。并且，应变仪8经由未图示的电缆与电手术装置1内部的传感器信号处理装置(后述)连接。绝缘套9由绝缘体形成，用于防止向电极部7施加电压时的漏电。把手10与电极部7联动地动作，操作者通过操纵该把手10来操作电极部7的伸缩。
上述挠性镜用电手术刀3用于与挠性内窥镜19组合起来进行处理。
图3是将挠性镜用电手术刀3插入挠性内窥镜19时的整体图。上述内窥镜19具有挠性插入部21和近前操作部22，近前操作部22与通用塞绳23连接，该通用塞绳23连接到未图示的光源装置和视频处理器等上。并且，在近前操作部22上形成有用于插入处理器具的通道管路末端开口部30。在挠性内窥镜19的主体中内置有观察光学系统、照明光学系统和通道管路等。
上述插入部21由内窥镜前端部24、与该前端部24邻接的内窥镜弯曲部25、以及与该弯曲部25的近前侧连接的内窥镜挠性管26构成。并且，在上述插入部21的前端部上形成有观察光学系统的观察窗27、照明光学系统的照明窗28以及通道管路前端开口部29。在从前端将挠性镜用电手术刀3插入到通道管路末端开口部30中时，挠性镜用电手术刀3的前端从通道管路前端开口部29伸出。
图4是示出电手术装置1的内部结构的图。AC/DC变换装置12根据由电源插头2提供的商用电源而生成DC电压，并将该DC电压提供给电手术装置1内的结构设备。输出变压器装置13向电极部7和配极板4施加电压。通过将配极板4安装到患者背部或脚部等上，并使电极部7触及患者的病变部位，来进行通电。在配极板4和电极部7附近都会发热，但是由于配极板4的面积较大，因此温度上升较小。另一方面，由于电极部7的面积较小，因此在电极部7附近温度急剧上升并由此来灼烧生物体组织。
对各部分进行控制的控制装置14包括波形产生装置15、传感器信号处理装置17以及计算装置18。波形产生装置15产生用于进行高频处理的波形。功率放大装置16对波形产生装置15所产生的波形进行能量放大。传感器信号处理装置17通过处理应变仪8的感应信号来检测施加到挠性镜用电手术刀3的前端部的力。
下面，使用图5的流程图来说明上述第1实施方式的结构作用。处理从步骤S1-1开始。在步骤S1-2中，当作为通电指示而从踏板开关(高频开关)5输入了信号时，进入步骤S1-3。
应变仪8检测施加到挠性镜用电手术刀3的前端部的力，将其感应信息发送给控制装置14。在控制装置14中预先设定了阈值，该阈值用于根据感应信息来识别施加到挠性镜用电手术刀3的前端部的力是否过量。另外，此时的阈值可以通过另外的阈值输入装置33内的阈值设定按钮35a～35c而设定为任意值，并显示在阈值显示装置34上。由于可以将阈值设定为任意值，因此能够设定操作者所希望的阈值，或者设定与患者组织的状况相应的阈值。
控制装置14的传感器信号处理装置17通过处理应变仪8的感应信号来获得感应信息。控制装置14判断传感器信号处理装置17所获得的感应信息是否不高于阈值(步骤S1-3)。在不高于阈值的情况下进入步骤S1-4。
在步骤S1-4中，控制装置14向功率放大装置16输出波形产生装置15所生成的波形。功率放大装置16对控制装置14所接收到的波形进行能量放大，并将其输出到输出变压器装置13中。输出变压器装置13根据从功率放大装置16得到的电压向电极部7和配极板4进行高频输出。由于配极板4安装在患者的脚部等上，并且电极部7触及到病变部位附近，因此通过患者(被检体100)的身体进行通电。发生通电时，作为其结果，病变部位被进行灼烧。在通电后进入步骤S1-5。
在步骤S1-5中，在操作者没有切断电手术装置1的电源的情况下，返回步骤S1-2。通过重复上述步骤S1-2～S1-5(循环控制)而对病变部位附近进行灼烧。
另一方面，在步骤S1-2中，在没有从踏板开关5输入作为通电指示的信号的情况下，转移到步骤S1-5，这里如果为“否”，则返回步骤S2。在重复上述步骤S1-2、1-5(循环控制)的同时，进行待机，直到操作者切断电源，或者踩下脚踏开关5为止。
另一方面，在步骤S1-3中，在传感器信号处理装置17所获得的感应信息高于阈值的情况下，执行步骤S1-2、S1-3、S1-5，当在步骤S1-5中为“否”时，返回步骤S2。在重复上述步骤S1-2、S1-3、S1-5(循环控制)的同时，进行待机，直到操作者切断电源，或者踩下脚踏开关5为止。在该情况下，即使操作者踩下脚踏开关5，也不进行通电。
然后，在步骤S1-5中，在操作者切断了电手术装置1的电源的情况下，进入步骤S1-6，结束处理。
下面，使用图6来说明将上述第1实施方式应用于内窥镜粘膜下层剥离术(以下称为ESD(endoscopic submucosal dissection))时的详细情况。所谓ESD是指使用内窥镜来统一切除位于胃或大肠内的病变的技术。图6是胃内部的病变示意图，在进行ESD时，预先在包含病变部位36的粘膜组织20与固有肌层31之间局部注入生理盐水32。挠性镜用电手术刀3通过从挠性内窥镜19的通道管路末端开口部30插入来进行使用。操作者操作挠性内窥镜19，使电极部7与粘膜组织20接触。在该状态下，通过对电极部7施加高频电压来灼烧并切开病变部36周边的粘膜组织20。
这里如图中所示，从电极部7对粘膜组织20施加F力，相反，从粘膜组织20向电极部7施加F’反作用力。对于力F与反作用力F’而言，F＝F’的关系式成立。在力F过大的状态下施加高频电压时，有可能会将粘膜组织20过量切开、或者将固有肌层31插穿。
因此在第1实施方式中，在应变仪8所检测到的反作用力F’高于阈值的情况下，控制向电极部7施加高频电压。由此，在对电极部7施加了过量的力时，能够防止将粘膜组织20过量切开、或者将固有肌层31插穿的情况，能够提高安全性。
另外，在本实施方式中列举了胃内ESD来作为技术的一例，但是，通过利用本实施方式所示的原理，在利用了其他挠性内窥镜和能量手术装置的所有技术中，都能够防止对电极部7施加了过量的力时将生物体组织过量切开、或者将生物体组织插穿，能够提高安全性。
以下示出第1实施方式中的各个装置分别相当于图1中的哪个处理部。脚踏开关5相当于能量指示输入部105。控制装置14相当于调整部104。输出变压器装置13相当于能量供给部103。挠性镜用电手术刀3相当于处理部101。应变仪8相当于状态变化检测部102。
另外，这里，电极部7的形状使用了钩状，但是没有对形状进行特别限制。也可以使用没有发生弯曲的形状或钳子状。
(第2实施方式)
以下，主要使用图8～图12来说明本发明的第2实施方式。
图8是用于说明第2实施方式的概略的图。在图8中，动力指示输入部126从操作者128接受用于使处理部122动作的指示。并且，能量指示输入部127从操作者128接受用于向处理部122提供能量的指示。动力指示输入部126向控制部125-1传递与动力指示有关的信号。能量指示输入部127向调整部125-2传递与能量指示有关的指示。
并且，状态变化检测部123向调整部125-2传递处理部122的状态变化。控制部125-1根据来自动力指示输入部126的信号和来自状态变化检测部123的信号来决定向动力部121的输出，并输出输出信号。并且，调整部125-2根据来自能量指示输入部127的信号和来自状态变化检测部123的信号来决定向能量供给部121的输出，并输出输出信号。另外，可以向能量供给部124和动力部121中的任意一个进行输出。
动力部121根据来自控制部125-1的信号而使处理部122动作。并且，能量供给部124根据来自调整部125-2的信号而向处理部122提供能量。处理部122接受来自能量供给部124的能量而对被检体120实施处理。
图9是示出本发明第2实施方式的结构的图。电源插头2、挠性镜用电动弯曲电手术刀40、用于附在患者脚部或背部等上的配极板4、输入高频输出指示的脚踏开关5、以及输入挠性镜用电动弯曲电手术刀40的弯曲指示的弯曲指示输入装置44分别通过电线6a～6d而与电手术装置1连接，其中，挠性镜用电动弯曲电手术刀40根据从电手术装置1输出的高频信号来对患者进行处理。
电手术装置1具有由阈值显示部34和阈值设定按钮35a～35c构成的阈值输入部33。挠性镜用电动弯曲电手术刀40的前端部具有电极部7。该电极部7的材料由SUS304形成，可以进行通电。并且，在挠性镜用电动弯曲电手术刀40上贴附有应变仪8，能够检测施加到挠性镜用电动弯曲电手术刀40的前端部的力。
图2B是挠性镜用电动弯曲电手术刀40的贴附有应变仪8的部分A-A的剖视图。应变仪8按照多个方向(8a～8d)贴附到挠性镜用电动弯曲电手术刀40上，可以检测从多个方向施加到挠性镜用电动弯曲电手术刀40上的力。并且，应变仪8经由未图示的电缆与电手术装置1内部的传感器信号处理装置(后述)连接。绝缘套9由绝缘体形成，用于防止向电极部7施加电压时的漏电。
挠性镜用电动弯曲电手术刀40包括弯曲部43，从而可以进行弯曲。通过牵引操作线46来使该弯曲部43弯曲。在电磁电动机44旋转时，该操作线46通过滑轮45而伸缩。该电磁电动机44内置有未图示的编码器，该编码器可以检测转速，并且经由电线6e将转速传递给电动机控制装置(后述)。这些电磁电动机44和滑轮45内置在电动机盒48内。通过操作弯曲指示输入装置41上的操纵杆42来向该弯曲部43输入弯曲指示。
上述挠性镜用电动弯曲电手术刀40用于与挠性内窥镜19组合起来进行处理。图10是将挠性镜用电动弯曲电手术刀40插入挠性内窥镜19时的整体图。本实施方式的挠性内窥镜19的基本结构与第1实施方式中所述的内容相同。
图11是示出电手术装置1的内部结构的图。AC/DC变换装置12根据电源插头2所提供的商用电源而生成DC电压，并将该DC电压提供给电手术装置1内的结构设备。输出变压器装置13向电极部7和配极板4施加电压。通过将配极板4安装到患者背部或脚部等上，并使电极部7触及患者的病变部位，来进行通电。在配极板4和电极部7附近都会发热，但是由于配极板4的面积较大，因此温度上升较小。另一方面，由于电极部7的面积较小，因此在电极部7附近温度急剧上升并由此来灼烧生物体组织。
对各部分进行控制的控制装置14包括波形产生装置15、传感器信号处理装置17、计算装置18以及电动机控制装置47。波形产生装置15产生用于进行高频处理的波形。功率放大装置16对波形产生装置15所产生的波形进行能量放大，并且对电动机控制装置47所产生的控制信号进行能量放大。
传感器信号处理装置17通过处理应变仪8的信号来检测施加到挠性镜用电动弯曲电手术刀40的前端部的力。电动机控制装置47计算用于控制电极电动机44的信号。
下面，使用图12的流程图来说明上述第2实施方式的结构的作用。首先，说明在步骤S2-2中没有进行弯曲指示的情况。处理从步骤S2-1开始。在步骤S2-2中，在没有从操纵杆42输入作为弯曲指示的信号时，进入步骤S2-3。在步骤S2-3中，当作为通电指示而从踏板开关(高频开关)5输入了信号时，进入步骤S2-4。
应变仪8检测施加到挠性镜用电动弯曲电手术刀40的前端部的力，将其感应信息发送给控制装置14。在控制装置14中预先设定了阈值，该阈值用于根据感应信息来识别施加到挠性镜用电动弯曲电手术刀40的前端部的力是否过量。将所述阈值设定为这样的值：在对挠性镜用电动弯曲电手术刀40施加了所述阈值以上的力时，瞬间切除粘膜。另外，阈值可以通过另外的阈值输入装置33内的阈值设定按钮35a～35c而设定为任意值，并显示在阈值显示装置34上。由于可以将阈值设定为任意值，因此能够设定操作者所希望的阈值，或者设定与患者组织的状况相应的阈值。.
控制装置14的传感器信号处理装置17通过处理应变仪8的感应信号来获得感应信息。控制装置14判断传感器信号处理装置17所获得的感应信息是否不高于阈值(步骤S2-4)。在不高于阈值的情况下进入步骤S2-5。
在步骤S2-5中，控制装置14向功率放大装置16输出波形产生装置15的波形。功率放大装置16对控制装置14所接收到的波形进行能量放大，并将其输出到输出变压器装置13中。输出变压器装置13根据从功率放大装置16得到的电压来向电极部7和配极板4之间施加电压。由于配极板4安装在患者的脚部等上，并且电极部7触及到病变部位36附近，因此通过患者的身体进行通电。当发生通电时，作为其结果，病变部位被进行灼烧。在通电后进入步骤S2-6。
在步骤S2-6中，在操作者没有切断电手术装置1的电源的情况下，返回步骤S2-2。通过重复上述步骤S2-2～S2-6(循环控制)而对病变部位附近进行灼烧。
在步骤S2-3中，在操作者没有踩下踏板开关5来指示通电的情况下，转移到步骤S2-6，这里如果为“否”，则返回步骤S2-2。在重复上述步骤S2-2、2-3、2-6(循环控制)的同时，进行待机，直到操作者切断电源，或者踩下脚踏开关5为止。
在步骤S2-4中，在传感器信号处理装置17所获得的感应信息高于阈值的情况下，执行步骤S2-2、2-3、2-4、2-6，当在步骤S2-6中为“否”时，返回步骤S2-2。在重复上述步骤S2-2、2-3、2-4、2-6(循环控制)的同时，进行待机，直到操作者切断电源，或者踩下脚踏开关5为止。在该情况下，即使操作者踩下脚踏开关5，也不进行通电。
在步骤S2-6中，在操作者切断了电手术装置1的电源的情况下，进入步骤S2-7，结束处理。
接着，对在步骤S2-2中进行了弯曲指示的情况进行说明。处理从步骤S2-1开始。在步骤S2-2中，在从操纵杆42输入了作为弯曲部43的弯曲指示的信号时，进入步骤S2-8。在步骤S2-8中，当作为通电指示从踏板开关5输入了信号时，进入步骤S2-9。在步骤S2-9中，传感器信号处理装置17通过处理应变仪8的信号来检测施加到挠性镜用电动弯曲电手术刀40的前端部的力，然后进入步骤S2-10。在步骤S2-10中，根据步骤S2-2中所得到的弯曲指示信息和步骤S2-9中所得到的感应信息来对弯曲部43进行弯曲控制，以使感应信息不高于阈值，然后进入步骤S2-11。
在步骤S2-11中，进行与步骤S2-4同样的处理，当感应信息低于阈值时，进入步骤S2-12。在步骤S2-12中，进行与步骤S2-5同样的处理，电极部7被通电，对病变部位进行灼烧。然后，当在步骤S2-6中为“否”时，返回步骤S2-2。在重复上述步骤S2-2、2-8～2-12、2-6(循环控制)的同时，进行待机，直到操作者切断电源，或者踩下脚踏开关5为止。
并且，在步骤S2-8中，在没有从脚踏开关5输入作为通电指示的信号时，转移到步骤S2-13，并按照步骤S2-2中所获得的弯曲指示来进行弯曲控制。然后转移到步骤S2-6。在重复上述步骤S2-2、2-8、2-13、2-6(循环控制)的同时，进行待机，直到操作者切断电源，或者踩下脚踏开关5为止。
并且，在步骤S2-11中，当感应信息高于阈值时，转移到步骤S2-6。在重复上述步骤S2-2、2-8、2-9、2-10、2-11、2-6(循环控制)的同时，进行待机，直到操作者切断电源，或者踩下脚踏开关5为止。作为结果，即使对弯曲部47进行弯曲控制，但由于传感器测量值不低于阈值，因此电极部7也不进行通电。
下面，使用图6来说明将上述第2实施方式应用于内窥镜粘膜下层剥离术(以下称为ESD(endoscopic submucosal dissection))时的详细情况。省略与第1实施方式相同的部分，这里只说明与第1实施方式的不同点。在第2实施方式中，在应变仪8所检测到的反作用力F’高于阈值的情况下，控制弯曲部43的弯曲以减小F。在即使控制弯曲，F仍然高于阈值的情况下，控制施加给电极部7的高频电压。由此，能够防止对电极部7施加了过量的力时将粘膜组织20过量切开、或者将固有肌层31插穿，能够提高安全性。
另外，在本实施方式中列举了胃内ESD来作为技术的一例，但是，通过利用本实施方式所示的原理，在利用其他挠性内窥镜和能量手术装置的所有技术中，都能够防止对电极部7施加了过量的力时将生物体组织过量切开、或者将生物体组织插穿，能够提高安全性。
以下示出第2实施方式中的各个装置分别相当于图8中的哪个处理部。弯曲指示输入装置41相当于动力指示输入部126。脚踏开关5相当于能量指示输入部127。控制装置14相当于控制部125-1和调整部125-2。输出变压器装置13相当于能量供给部124。挠性镜用电动弯曲电手术刀40相当于动力部121和处理部122。应变仪8相当于状态变化检测部123。
另外，在第2实施方式中，作为使弯曲部43弯曲的方法而使用了操作线46和电磁电动机44，但是当然也可以采用具有弯曲机构的任何手段。例如，可以使用气压致动器来代替电磁电动机44，还可以使用人工肌肉来代替操作线46和电磁电动机44。
并且，虽然作为使电极部7动作的方法而使用了平滑弯曲的弯曲部43，但是也可以采用能够使电极部7动作的任何方法。例如，可以使用弯曲机构或旋转机构。
并且，虽然作为弯曲指示部而使用了操纵杆41，但在本实施方式中没有对输入方法的形式进行特别限定。例如也可以使用触觉设备(HapticDevice)、触摸面板式监视器或语音识别。
并且，虽然对弯曲部43的弯曲和高频信号进行了控制，但是也可以只对它们中的任意一个进行控制。在针对任意一个进行控制的情况下，可以具有供操作者选择控制对象的输入界面。
并且，虽然电极部7的形状使用了钩状，但是没有对形状进行特别限制。也可以使用没有发生弯曲的形状或钳子状。
(第3实施方式)
以下，主要使用图13～图15来说明本发明的第3实施方式。图13是示出本发明第3实施方式的结构的图。电手术装置1的基本结构与图1的第1实施方式所示的结构相同，这里，不同点在于：连接了腹腔镜手术所使用的电手术刀50来代替挠性镜用电手术刀3。
图14是示出电手术装置1的内部结构的图。该内部结构也与图4的第1方式相同。第3实施方式的结构作用与图5所示的流程图相同，因此这里省略详细的说明。
下面，使用图15来说明将第3实施方式应用于内窥镜下外科手术时的详细情况。图15是进行内窥镜下外科手术时的人体腹部53的剖视图。在内窥镜下外科手术中，上述电手术刀50用于与硬性内窥镜54组合起来进行处理。
以下，特别将在内窥镜下外科手术中切除肝脏52的情况举为例子。预先在人体腹部53上开设多个孔，并将用于通过硬性内窥镜54和处理器具的套管针55插入到该孔中。硬性内窥镜54和电手术刀50通过插入到该套管针55内来进行使用。然后，为了确保进行手术的空间，而预先使人体腹部53内充满二氧化碳等气体。并且将配极板4贴附在背部。
操作者操作电手术刀50，使电极部7接触肝脏52。在该状态下，通过向电极部7与配极板4之间施加高频电压来灼烧并切开肝脏52。这里如图中所示，从电极部7对肝脏52施加F力，相反，从肝脏52向电极部7施加F’反作用力。这里对于力F与反作用力F’而言，F＝F’的关系式成立。这里，在力F过大的状态下施加高频电压时，有可能会将肝脏52过量切开或插穿。
在上述第3实施方式中，在应变仪8所检测到的反作用力F’高于阈值的情况下，控制向电极部7施加高频电压。由此，在对电极部7施加了过量的力时，能够防止将肝脏52过量切开或插穿，能够提高安全性。
另外，在本实施方式中列举了内窥镜下外科手术来作为手术的一例，但是，通过利用本实施方式所示的原理，在利用其他手术装置的所有手术中，都能够防止对电极部7施加了过量的力时将生物体组织过量切开、或者将生物体组织插穿，能够提高安全性。此时，特别地，可以在进行开腹外科手术时使用本实施方式，而不需要与内窥镜同时使用。
以下示出本实施方式中的各个装置分别相当于图1中的哪个处理部。脚踏开关5相当于能量指示输入部105。控制装置14相当于调整部104。输出变压器装置13相当于能量供给部103。电手术刀50相当于处理部101。应变仪8相当于状态变化检测部102。
另外，在本实施方式中，电极部7的形状使用了针状，但是其形状没有特别的限制。也可以使用没有发生弯曲的形状或钳子状。
(第4实施方式)
以下，主要使用图16～图18来说明本发明的第4实施方式。
图16是示出本发明第4实施方式的结构的图。电手术装置1的基本结构与图9的第2实施方式所示的结构相同，但不同点在于：连接了腹腔镜手术所使用的电动弯曲电手术刀60来代替挠性镜用电动弯曲电手术刀40。并且，作为用于指示弯曲部43的弯曲的手段，使用了操纵杆61和控制杆62来代替弯曲指示输入装置41。此外，电磁电动机、滑轮和操作线虽然未进行图示，但是它们都内置在电动弯曲电手术刀60内。
图17是示出电手术装置1的内部结构的图。内部结构也与图11的第2方式所示的结构相同。第4实施方式的结构作用与图12所示的流程图相同。
下面，使用图18来说明将上述第4实施方式应用于内窥镜下外科手术时的详细情况。图18是进行内窥镜下外科手术时的人体腹部53的剖视图。在内窥镜下外科手术中，上述电动弯曲电手术刀60用于与硬性内窥镜54组合起来进行处理。
以下，特别将在内窥镜下外科手术中切除肝脏52的情况举为例子。
预先在人体腹部53上开设多个孔，并将用于通过硬性内窥镜54和处理器具的套管针55插入到该孔中。硬性内窥镜54和电动弯曲电手术刀60通过插入到该套管针55内来进行使用。然后，为了确保进行手术的空间，而预先使人体腹部53内充满二氧化碳等气体。并且将配极板4贴附在背部。
操作者操作电动弯曲电手术刀60，改变弯曲部43的形状，确定最便于进行切除操作的姿势，之后使电极部7接触肝脏52。在该状态下，通过向电极部7与配极板4之间施加高频电压来灼烧并切除肝脏52。这里如图中所示，从电极部7对肝脏52施加F力，相反，从肝脏52向电极部7施加F’反作用力。这里对于力F.与反作用力F’而言，F＝F’的关系式成立。这里，在力F过大的状态下施加高频电压时，有可能会将肝脏52过量切开或插穿。
在上述第4实施方式中，在应变仪8所检测到的反作用力F’高于阈值的情况下，控制弯曲部43的弯曲以使F减小。在即使控制弯曲，F仍然高于阈值的情况下，控制施加给电极部7的高频电压。由此，在对电极部7施加了过量的力时，能够防止将肝脏52过量切开或插穿，能够提高安全性。另外，在本实施方式中列举了内窥镜下外科手术来作为手术的一例，但是，通过利用本实施方式所示的原理，在利用其他能量手术装置的所有技术中，都能够防止对电极部7施加了过量的力时将生物体组织过量切开、或者将生物体组织插穿，能够提高安全性。此时，特别地，可以在进行开腹下外科手术时使用本实施方式，而不需要与内窥镜同时使用。
以下示出本实施方式中的各个装置分别相当于图8中的哪个处理部。操纵杆61和控制杆62相当于动力指示输入部126。脚踏开关5相当于能量指示输入部127。控制装置14相当于控制部125-1和调整部125-2。输出变压器装置13相当于能量供给部124。电动弯曲电手术刀60相当于动力部121和处理部122。应变仪8相当于状态变化检测部123。
另外，虽然作为使弯曲部43弯曲的方法而使用了操作线和电磁电动机，但是当然也可以采用具有弯曲机构的任何手段。例如，可以使用气压致动器来代替电磁电动机，还可以使用人工肌肉来代替操作线和电磁电动机。
并且，在本实施方式中，作为控制电极部7的位置的方法而使用了平滑弯曲的弯曲部43，但是也可以采用能够改变电极部7的位置的任何方法。例如，可以使用弯曲机构或旋转机构。
并且，在本实施方式中，作为弯曲指示部而使用了操纵杆61和控制杆62，但在本实施方式中没有对输入方法的形式进行特别限定。例如也可以使用触觉设备(Haptic Device)、触摸面板式监视器或语音识别。
并且，在本实施方式中，弯曲指示部内置于电动弯曲电手术刀60内，但是也可以与电动弯曲电手术刀分离。
并且，在本实施方式中，对弯曲部43的弯曲和高频信号进行了控制，但是也可以只对它们中的任意一个进行控制。在针对任意一个进行控制的情况下，可以具有供操作者选择控制对象的输入界面。
并且，在本实施方式中，电极部7的形状使用了针状，但是没有对形状进行特别限制。也可以使用没有发生弯曲的形状或钳子状。
另外，在上述第1～第4的各实施方式中，将施加到电极部7的力量作为状态变化检测部所测量的状态变化量的例子，但是所测量的状态变化量不限于力量。例如也可以测量施加到电极部7的变形量、温度变化量、速度、加速度、位置信息。
并且，在上述各实施方式中，使用了应变仪8来作为施加到挠性镜用电手术刀3的力的感应部，但是传感器的种类也可以用光纤传感器、压电传感器、半导体应变仪、静电电容传感器等其他力量检测传感器来代替。此外，也可以用力量检测以外的温度传感器、MEMS压力传感器、陀螺传感器、磁传感器来代替。
并且，没有对应变仪8的贴附方法进行特别限定。如图7A、图7B所示，也可以使用3个或2个应变仪8。虽然这样有损于施加到电极部7上的力的方向和测量精度，但是减少了应变仪8和连接该应变仪8的电缆，因此能够使装置简化并降低成本。
另外，关于贴附应变仪8的位置，只要能够测量施加到电极部7上的力，则也可以使用其他贴附方法。并且，虽然将脚踏开关5用作高频输出能量的指示输入部，但是例如也可以使用手动开关或语音识别开关等其他指示输入部。
并且，虽然将SUS304用作电极部7的材料，但是也可以用其他任何导电性物体来代替。
并且，在上述各实施方式中，通过判断传感器信号处理装置17所获得的感应信息是否不高于阈值来控制电极部7的高频信号的接通/关闭，然而也可以根据传感器信号处理装置17所获得的感应信息而由控制装置14来控制电极部7的高频信号的增减。
而且，在上述各实施方式中使用了挠性镜用电手术刀，但是也可以应用于其他能量处理器具，例如超声波处理器具等。
(第5实施方式)
以下，说明本发明的第5实施方式。作为内窥镜粘膜下剥离术中的偶发症，可以举出由切开处理器具等引起的穿孔。这是由于切开处理器具强烈压迫固有肌层造成的，但是对于经过内窥镜通道的处理器具而言，操作者很难通过内窥镜的角度操作来感觉出施加到设置在切开处理器具前端的切开部上的力量。并且，在通过使切开处理器具压迫粘膜而在病变周边附上标记的情况下，由于处理器具较长，因此很难感觉出施加到切开部上的力量。
为了解决上述课题，第5实施方式的特征在于具有以下结构。
1.具有检测施加到设置在切开处理器具前端的切换部上的力量的功能。
2.在1中，切开处理器具利用机械手来驱动处理器具的送入和脱离动作。
3.在1或2中，设置了如下机构：在施加到切开部上的力量达到插穿固有肌层的力量之前发出警告。
4.在3中，使警告部显示在内窥镜观察监视器上。
5.在2中，设置了如下功能：在施加到切开部上的力量即将达到插穿粘膜肌层的力量之前，停止动作。
6.在2～5中，在处理器具系统中所使用的处理器具是局部注入针。
(第6实施方式)
以下，说明本发明的第6实施方式。作为内窥镜粘膜下剥离术中的偶发症，可以举出由切开处理器具等引起的出血。在以既能防止出血又能进行切开为构思而开发出的高频电源装置中，搭载有交替切换凝固模式和切除模式的端切模式(End Cut Mode)等，但是在切开处理器具移动快的情况下，会在使血管凝固前将血管切除，因此存在出血的情况。而且，在发生出血的情况下需要进行止血作业，因此还会严重影响治疗时间。
为了解决上述课题，第6实施方式的特征在于具有以下结构。
1.在与高频电源装置组合使用的切开处理器具中具有如下功能：对设置在该切开处理器前端的手术刀部的驱动进行电控，并且与高频电源的输出设定信息联动地控制手术刀部的驱动速度。
2.在插通与高频电源装置组合使用的切开处理器具、并且具有可以在任意方向驱动切开处理器具的驱动机构的内窥镜中，对处理器具的驱动进行电控，并且与高频电源的输出设定信息联动地控制手术刀部的驱动速度。
3.在1或2中，高频电源的模式是端切模式。
根据上述第1实施方式和第3实施方式，控制装置根据应变仪所获得的信号来控制向电极部提供的能量供给量，由此能够防止将生物体组织过量切开、或者将生物体组织插穿，因此安全性提高。
并且，根据第2实施方式和第4实施方式，控制装置根据应变仪所获得的信号来控制弯曲部的弯曲，从而减轻了施加到电极部上的负荷。并且，在即使控制了弯曲部的弯曲，施加到电极部的负荷仍然较大的情况下，由控制装置来控制电极部的通电。由此，能够防止将生物体组织过量切开、或者将生物体组织插穿，因此安全性提高，进而能够提供即使经历手术病例数较少的初级医生也能够安全使用的设备。
产业上的可利用性
根据本发明，由于具有根据状态变化量检测部的检测结果来调整能量供给部的能量供给或动力的调整部，因此能够防止将生物体组织过量切开、或者将生物体组织插穿，从而提高了手术中的安全性。

Claims (12)

1.一种能量手术装置，该能量手术装置具有：
对被检体进行处理的处理部；
能量供给部，其向所述处理部提供能量；
状态变化检测部，其检测所述处理部的状态变化；
能量指示输入部，其输入所述能量供给指示；以及
调整部，其根据经由所述能量指示输入部的能量供给指示的输入和所述状态变化检测部的检测结果来调整所述能量供给部的能量供给。
2.根据权利要求1所述的能量手术装置，其中，
所述调整部具有输入所述状态变化量的阈值的阈值输入部。
3.根据权利要求1所述的能量手术装置，其中，
所述能量手术装置与内窥镜一起使用。
4.一种能量手术装置，该能量手术装置具有：
对被检体进行处理的处理部；
能量供给部，其向所述处理部提供能量；
力量变化检测部，其检测所述处理部所受到的力量的变化；
能量指示输入部，其输入所述能量供给指示；以及
调整部，其根据经由所述能量指示输入部的能量供给指示的输入和所述力量变化检测部的检测结果来调整所述能量供给部的能量供给。
5.根据权利要求4所述的能量手术装置，其中，
所述调整部具有输入所述力量变化量的阈值的阈值输入部。
6.根据权利要求4所述的能量手术装置，其中，
所述能量手术装置与内窥镜一起使用。
7.一种能量手术装置，该能量手术装置具有：
对被检体进行处理的处理部；
能量供给部，其向所述处理部提供能量；
状态变化检测部，其检测所述处理部的状态变化；
能量指示输入部，其输入所述能量供给指示；
动力部，其对所述处理部进行有源驱动；
动力指示输入部，其指示所述动力部的动作；
控制部，其响应于经由所述动力指示输入部的动作指示来控制所述动力部；以及
调整部，其根据经由所述能量指示输入部的能量供给指示的输入、经由所述动力指示输入部的动力指示、以及所述状态变化检测部的检测结果来调整所述能量供给部的能量供给和所述动力部的驱动中的一方或双方。
8.根据权利要求7所述的能量手术装置，其中，
所述状态变化检测部检测所述处理部所受到的力量的变化。
9.根据权利要求7所述的能量手术装置，其中，
所述调整部具有输入所述状态变化量的阈值的阈值输入部。
10.根据权利要求9所述的能量手术装置，其中，
所述调整部调整所述动力部的驱动，以使所述状态变化检测部的状态变化量不超过所述阈值。
11.根据权利要求9所述的能量手术装置，其中，
所述调整部在所述状态变化检测部的状态变化量超过所述阈值的情况下，调整所述能量供给部的能量供给。
12.根据权利要求7所述的能量手术装置，其中，
所述能量手术装置与内窥镜一起使用。
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