CN101778606A - 活体组织用处理装置 - Google Patents
活体组织用处理装置 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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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
- A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
- A61B18/082—Probes or electrodes therefor
- A61B18/085—Forceps, scissors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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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
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
- A61B2018/00023—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids closed, i.e. without wound contact by the fluid
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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
- 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
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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
- A61B18/14—Probes or electrodes therefor
- A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
Abstract
一种处理装置,其处理活体组织,该处理装置包括:密封构件(电极56a),该密封构件使至少两个活体组织的期望区域以密封的状态彼此接合;以及维持构件(电极56b),该维持构件维持位于由密封构件接合的部分附近的组织之间的接触。
Description
技术领域
本发明涉及一种活体组织用处理装置。
背景技术
通常日益明显的是:在使活体组织彼此接合的情况下,活体组织的再生和/或恢复在被接合的活体组织彼此接触的部分附近较早地进行。如果被接合的活体组织附近的活体组织彼此接触,则彼此接触的活体组织在几天内将进入再生和/或恢复过程。
因此,存在发明如下处理装置的需求,该处理装置能够使被接合的活体组织附近的活体组织保持彼此接触,使得活体组织能够较早地再生和/或恢复。
发明内容
本发明的目的是提供一种处理装置,该处理装置能够使被接合的活体组织附近的活体组织保持彼此接触,使得活体组织能够较早地再生和/或恢复。
本发明的目的是提供一种处理装置,该处理装置能够维持位于被接合的活体组织附近的活体组织的紧密接触状态,并且活体组织能够较早地再生和/或恢复。
根据本发明的第一方面,提供一种处理活体组织的处理装置,该处理装置包括:
密封构件,所述密封构件使至少两个活体组织的期望区域以密封的状态彼此接合;以及
维持构件,所述维持构件维持位于由所述密封构件接合的部分附近的活体组织之间的接触。
根据本发明的第二方面,提供一种处理活体组织的处理装置,该处理装置包括:
一对保持构件,所述一对保持构件分别具有保持面以保持至少两个活体组织;
手柄,操作所述手柄以使所述一对保持构件中的至少一个保持构件相对于另一保持构件移动;以及
施加部,所述施加部被布置于所述一对保持构件中的至少一个保持构件,并且所述施加部密封所述至少两个活体组织并且维持位于被密封部分附近的活体组织之间的接触。
附图说明
图1A是示出根据本发明的第一实施方式的处理系统的示意图;
图1B是当使用根据第一实施方式的处理系统进行双极型处理时的示意图;
图2A是示出根据第一实施方式的电外科装置中的轴以及保持区的第一保持构件和第二保持构件的闭合状态的示意性纵剖视图;
图2B是示出根据第一实施方式的电外科装置中的轴以及保持区的第一保持构件和第二保持构件的打开状态的示意性纵剖视图;
图3A是示出根据第一实施方式的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图3B是沿图3A中的线3B-3B截取的示意性纵剖视图,其示出了根据第一实施方式的电外科装置的保持区中的第一保持构件;
图3C是沿图3A中的线3C-3C截取的示意性横剖视图,其示出了根据第一实施方式的电外科装置的保持区中的第一保持构件;
图4A是沿后述的图4C中的线4A-4A截取的示意性立体图,其示出了彼此吻合(anastomose)的两段小肠道;
图4B是以放大的方式示出图4A中的由附图标记4B表示的部分的示意图;
图4C是示出在吻合之后的两段小肠道的密封端部的示意图;
图4D是图4B的变型的示意图,其以放大的方式示出图4A中的由附图标记4B表示的部分;
图5A是示出根据第一实施方式的第一变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图5B是示出根据第一实施方式的第二变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图6A是当使用根据第一实施方式的处理系统进行双极型处理时的示意图;
图6B是当使用根据第一实施方式的处理系统进行单极(monopolar)型处理时的示意图;
图6C是当使用根据第一实施方式的处理系统进行单极型处理时的示意图;
图7是示出根据第一实施方式的处理系统的变型的示意图;
图8是示出根据本发明的第二实施方式的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图9A是示出根据第二实施方式的第一变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图9B是示出根据第二实施方式的第二变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图10是示出根据本发明的第三实施方式的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图11A是示出根据第三实施方式的第一变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图11B是示出根据第三实施方式的第二变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图12A是示出根据本发明的第四实施方式的电外科装置中的轴以及保持区的第一保持构件和第二保持构件的闭合状态的示意性纵剖视图;
图12B是示出根据第四实施方式的电外科装置中的轴以及保持区的第一保持构件和第二保持构件的打开状态的示意性纵剖视图;
图13A是示出根据本发明的第四实施方式的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图13B是沿图13A中的线13B-13B截取的示意性纵剖视图,其示出了根据第四实施方式的电外科装置的保持区的第一保持构件;
图14A是示出根据本发明的第四实施方式的第一变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图14B是沿图14A中的线14B-14B截取的示意性纵剖视图,其示出了根据第四实施方式的第一变型的电外科装置的保持区的第一保持构件;
图14C是沿图14A中的线14B-14B截取的示意性纵剖视图,其示出了根据第四实施方式的第二变型的电外科装置的保持区的第一保持构件;
图15是示出根据本发明的第五实施方式的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图16A是示出根据本发明的第六实施方式的第一变型的电外科装置的保持区中的靠近第二保持构件的一侧的第一保持构件的示意性俯视图;
图16B是沿图16A中的线16B-16B截取的示意性纵剖视图,其示出了根据第六实施方式的电外科装置的保持区的第一保持构件;
图16C是沿图16A中的线16B-16B截取的示意性纵剖视图,其示出了根据第六实施方式的第一变型的电外科装置的保持区的第一保持构件;
图16D是沿图16A中的线16B-16B截取的示意性纵剖视图,其示出了根据第六实施方式的第二变型的电外科装置的保持区的第一保持构件;
图17A是示出根据本发明的第七实施方式的处理装置的保持区中的靠近第二保持构件的一侧的用于排出钉的第一保持构件的示意性俯视图;
图17B是示出根据本发明的第七实施方式的处理装置的保持区中的靠近第一保持构件的一侧的用于弯折钉的腿部的第二保持构件的示意性俯视图;
图18是沿图17A中的线18A-18A截取的示意性纵剖视图,其示出了根据第七实施方式的电外科装置的保持区的第一保持构件;
图19是示出根据本发明的第八实施方式的处理装置的保持区中的靠近第二保持构件的一侧的用于排出钉的第一保持构件的示意性俯视图;
图20是示出根据本发明的第九实施方式的处理系统的示意图;
图21A是示出如下状态的示意性纵剖视图:在根据第九实施方式的电外科装置中,主体侧保持部与可拆卸侧保持部接合,并且可拆卸侧保持部被布置成与主体侧保持部分离;
图21B是示出如下状态的示意性纵剖视图:在根据第九实施方式的电外科装置中,主体侧保持部与可拆卸侧保持部接合,并且可拆卸侧保持部被布置成靠近主体侧保持部;
图21C是示出根据第九实施方式的电外科装置中的由附图标记21C表示的主体侧保持部的一部分的放大示意图;
图21D是示出根据第九实施方式的电外科装置中的主体侧保持部的表面的示意图;
图22A是示出根据本发明的第十实施方式的电外科装置的主体侧保持部的表面的示意图;
图22B是示出根据本发明的第十一实施方式的电外科装置的主体侧保持部的表面的示意图;
图23A是示出根据本发明的第十二实施方式的电外科装置的主体侧保持部和可拆卸侧保持部的分离状态的示意图;
图23B是示出根据第十二实施方式的电外科装置中的主体侧保持部与可拆卸侧保持部接合的状态的示意性纵剖视图;
图23C是示出根据第十二实施方式的电外科装置的主体侧保持部的表面的示意图;
图24A是示出如下状态的示意性纵剖视图:在根据第十三实施方式的电外科装置中,主体侧保持部与可拆卸侧保持部接合,并且可拆卸侧保持部被布置成与主体侧保持部分离;
图24B是示出根据第十三实施方式的电外科装置的主体侧保持部的表面的示意图;
图24C是示出根据第十三实施方式的变型的电外科装置的主体侧保持部的表面的示意图。
具体实施方式
以下将参考附图说明用于实现本发明的最佳实施方式。
第一实施方式
将参考图1A至图7说明第一实施方式。这里,作为能量处理装置的示例,将说明经由例如腹壁来进行处理的线型双极电外科装置12。
如图1A和1B所示,处理系统10包括电外科装置(治疗用处理装置)12和能量源14。
电外科装置12包括手柄22、轴24和可开闭的保持区26。手柄22经由缆线(cable)28与能量源14连接。能量源14被连接到脚踏开关和手动开关(未示出)。因此,操作者操作脚踏开关和手动开关来接通或切断从能量源14向电外科装置12的能量供给。
手柄22大致形成为L型。轴24被布置于手柄22的一端。缆线28从与轴24同轴布置的手柄22的近侧延伸。
另一方面,手柄22的另一端是被操作者握持的握持部。手柄22包括配置于手柄22的所述另一端的保持区开闭按钮32。保持区开闭按钮32与轴24的后述的保护筒(sheath)44(参见图2A和图2B)的大致位于手柄22的中央的近端连接。当使保持区开闭按钮32接近或远离手柄22的所述另一端时,保护筒44沿轴24的轴向移动。手柄22设置有刀具(cutter)驱动按钮34,该刀具驱动按钮34沿保持区开闭按钮32布置以移动后述的刀具84。
如图2A和图2B所示,轴24包括筒状构件42和可滑动地布置在筒状构件42的外侧的保护筒44。筒状构件42的近端被固定于手柄22(参见图1A)。保护筒44可沿筒状构件42的轴向滑动。
在筒状构件42的外侧,沿筒状构件42的轴向形成凹部46。凹部46设置有被连接到后述的第一高频电极(施加部)56的第一导线92a。被连接到后述的第二高频电极(施加部)58的第二导线92b贯穿筒状构件42。
注意,第一高频电极56与第一电极连接器88a电连接。第一电极连接器88a经由第一导线92a与从手柄22延伸的缆线28连接。第二高频电极58与第二电极连接器88b电连接。第二电极连接器88b经由第二导线92b与从手柄22延伸的缆线28连接。
驱动杆82在轴24的筒状构件42中沿筒状构件42的轴向被可动地布置。驱动杆82的远端设置有薄板状刀具84(辅助治疗装置)。因此,当操作刀具驱动按钮34时,经由驱动杆82使刀具84移动。
刀具84的远端设置有刀刃84a,并且驱动杆82的远端被固定到刀具84的近端。纵向槽84b被形成在刀具84的远端和近端之间。在纵向槽84b中,沿与轴24的轴向直角交叉的方向延伸的移动限制销86被固定到轴24的筒状构件42。因此,刀具84的纵向槽84b沿移动限制销86移动。在该情况下,刀具84直线移动。此时,沿第一保持构件52的后述的刀具引导槽(流动通道、流体排出槽)94和第二保持构件54的后述的刀具引导槽(流动通道、流体排出槽)96布置刀具84。
注意,与移动限制销86接合并且控制刀具84的移动的接合部84c被形成于刀具84的纵向槽84b的一端、另一端以及该一端与该另一端之间。
如图1A、图2A和图2B所示,保持区26被布置于轴24的远端。如图2A和图2B所示,保持区26包括第一保持构件52、第二保持构件54、作为施加部或能量施加部的第一高频电极56、以及作为另一施加部或另一能量施加部的第二高频电极58。
优选地,第一保持构件52和第二保持构件54分别完全地具有绝缘性质。第一保持构件52一体地包括:设置有第一高频电极56的第一保持构件主体(下面主要称为主体)62;以及布置于主体62的近端的基部64。第二保持构件54一体地包括:设置有第二高频电极58的第二保持构件主体66;以及布置于主体66的近端的基部68。
第一保持构件52的基部64被固定于轴24的筒状构件42的远端。另一方面,由沿与轴24的轴向直角交叉的方向布置的支撑销72将第二保持构件54的基部68可转动地支撑于轴24的筒状构件42的远端。第二保持构件54能够绕支撑销72的轴线转动,以相对于第一保持构件52开闭。此外,由诸如板簧等弹性构件74对第二保持构件54施力,以使第二保持构件54相对于第一保持构件52打开。
第一保持构件52的主体62的外表面和第二保持构件54的主体66的外表面被形成为光滑的曲面。类似地,第一保持构件52的基部64的外表面和第二保持构件54的基部68的外表面也被形成为光滑的曲面。在第二保持构件54相对于第一保持构件52闭合的状态下,第一保持构件52的主体62的截面和第二保持构件54的主体66的截面形成为大致圆形或椭圆形。当第二保持构件54相对于第一保持构件52闭合时,第一保持构件52的主体62的保持面62a和第二保持构件54的主体66的保持面66a彼此相对,并且基部64和68被形成为筒状。在该状态下,第一保持构件52的主体62的近端和第二保持构件54的主体66的近端中的每一方的直径均被形成为比基部64、68中的对应一方的直径大。此外,在主体62与基部64之间形成台阶部76a,在主体66与基部68之间形成台阶部76b。
这里,在第一保持构件52和第二保持构件54中,在第二保持构件54相对于第一保持构件52闭合的状态下,通过组合第一保持构件52的基部64和第二保持构件54的基部68形成的大致圆形或椭圆形的外周面是与筒状构件42的远端的外周面大致相同的平面,或者该大致圆形或椭圆形的外周面的直径被形成为比筒状构件42的远端的外周面的直径稍大。因此,保护筒44能够相对于筒状构件42滑动以用保护筒44的远端覆盖第一保持构件52的基部64和第二保持构件54的基部68。在该状态下,如图2A所示,第一保持构件52和第二保持构件54抵抗弹性构件74施加的力而闭合。另一方面,保护筒44从用保护筒44的远端覆盖第一保持构件52的基部64和第二保持构件54的基部68的状态朝向筒状构件42的近端滑动。在该情况下,如图2B所示,由弹性构件74施加的力使第二保持构件54相对于第一保持构件52打开。
如图3A至图3C所示,第一高频电极56被布置于第一保持构件52的主体62。如图3A和图3C所示,第一高频电极56包括无缝地连续地形成的连续电极(密封构件,第一接合构件)56a、以及离散地布置于连续电极56a的外侧的多个离散电极(维持构件,第二接合构件)56b。
连续电极56a被连续地形成为例如两端位于第一保持构件52的主体62的近端的大致U型。注意,连续电极56a的近端之间的距离与本实施方式中的后述的刀具引导槽94(参见图3A和图3C)的宽度大致相等,但是连续电极56a的近端之间的距离可以被适当地设定。也就是,连续电极56a可以被设置成与刀具引导槽94的边缘相隔一定距离。
另一方面,沿大致U型的虚拟轨迹大致等间隔地配置形状相同的多个离散电极56b。各离散电极56b被形成为例如圆形。离散电极56b被配置成两两之间具有预定间隔,并且各离散电极56b被布置成与连续电极56a相隔一定距离。离散电极56b被定位成当进行处理时使得离散电极56b和后述的离散电极58b之间的活体组织由于热而变形,但是最大程度地防止离散电极56b之间的活体组织由于热而变形,并且也最大程度地防止离散电极56b和连续电极56a之间的活体组织的变形。
用于使刀具84通过的刀具引导槽94被形成在第一保持构件52的主体62和基部64中。该刀具引导槽94沿轴24的轴向形成。因此,刀具84可沿刀具引导槽94在第一保持构件52内移动。刀具84也可沿刀具引导槽96在第二保持构件54内移动。
此外,第二高频电极58也被布置在与第一保持构件52对称的第二保持构件54中。这里省略对第二高频电极58的详细说明。
另外,虽然未示出,但是为了方便起见,附图标记58a表示第二高频电极58的连续电极,并且附图标记58b表示第二高频电极58的离散电极,从而将说明如下功能。
现在将说明根据该实施方式的处理系统10的功能。
如图2A所示,在第二保持构件54相对于第一保持构件52闭合的状态下,电外科装置12的保持区26和轴24经由腹壁被插入到例如腹腔中。使电外科装置12的保持区26与作为处理目标的活体组织相对。
操作手柄22的保持区开闭按钮32,以通过使用第一保持构件52和第二保持构件54来保持(握持)作为处理目标的活体组织。此时,保护筒44相对于筒状构件42朝向轴24的近端侧移动。由于弹性构件74施加的力,基部64和68之间的空间不能维持筒状,然后,第二保持构件54相对于第一保持构件52打开。
此外,作为处理目标的活体组织被配置在第一保持构件52的第一高频电极56与第二保持构件54的第二高频电极58之间。在该状态下,操作手柄22的保持区开闭按钮32。此时,保护筒44相对于筒状构件42朝向轴24的远端侧移动。通过使用保护筒44抵抗弹性构件74施加的力而使基部64、68闭合,以在基部64、68之间形成筒状。因此,一体地形成在基部64上的第一保持构件主体62和一体地形成在基部68上的第二保持构件主体66闭合。也就是,第二保持构件54相对于第一保持构件52闭合。因此,作为处理目标的活体组织LT被夹在第一保持构件52与第二保持构件54之间。
此时,作为处理目标的活体组织与设置于第一保持构件52的第一高频电极56和设置于第二保持构件54的第二高频电极58二者接触。作为处理目标的活体组织LT的周围的组织与第一保持构件52的主体62的保持面62a和第二保持构件54的主体66的保持面66a二者紧密接触。
在该状态下,操作脚踏开关和手动开关。分别经由缆线28、第一导线92a、第一电极连接器88a和缆线28、第二导线92b、第二电极连接器88b从能量源14分别向第一高频电极56和第二高频电极58施加能量。
第一高频电极56使高频电流经由作为处理目标的活体组织LT在第一高频电极56与第二高频电极58之间通过。因此,第一高频电极56与第二高频电极58之间的活体组织LT被加热。然后,通过第一高频电极56的连续电极56a和第二高频电极58的连续电极58a使活体组织LT以连续的方式(以大致U型的状态)变形。此外,通过第一高频电极56的离散电极56b和第二高频电极58的离散电极58b使离散电极56b和58b之间的活体组织LT离散地变形。
当结束处理时,停止脚踏开关或手动开关的操作。由此,停止从能量源14向第一高频电极56和第二高频电极58的能量供给。
这里,将说明如下情况:具有该功能的处理系统10被用于使例如如图4A至图4C所示的小肠的肠道IC1和IC2彼此吻合。
并排设置的一对肠道IC1和IC2被第一保持构件52的保持面62a和第二保持构件54的保持面66a保持,使得这些肠道IC1和IC2的壁面被捕捉在保持面62a和66a之间。在该状态下,能量被供给到第一高频电极56和第二高频电极58。于是,被保持在第一保持构件52的连续电极56a和第二保持构件54的连续电极58a之间的肠道IC1和IC2被加热和变形。由此,肠道IC1和IC2的壁面被连续地变形。结果,使肠道IC1和IC2彼此接合。
此外,与通过连续电极56a、58a使活体组织经由变性而接合同时地,使第一保持构件52的离散电极56b和第二保持构件54的离散电极58b之间的肠道IC1和IC2变形并彼此接合。由此,使肠道IC1和IC2的活体组织离散地变形并彼此接合。
然后,在停止向第一高频电极56和第二高频电极58供给能量之后,在肠道IC1和IC2被夹持的状态下,操作图1所示的刀具驱动按钮34,以使刀具84沿刀具引导槽94、96从图2A所示的状态向前移动。随着刀具84向前移动,通过连续电极56a、58a而变形并彼此接合的部分被切割。然后,刀具84切割通过连续电极56a、58a而以大致U形变性的部分的内侧,一直切到该部分的远端附近。因此,被以大致U形密封的肠道IC1和IC2的壁面的一部分被切割,使得肠道IC1和IC2的壁面彼此连通。也就是,使肠道IC1和IC2的壁面彼此吻合。
在该状态下,使第一保持构件52相对于第二保持构件54打开。此时,在肠系膜(mesentery)M侧形成第一吻合部AN1,在与肠系膜M所在侧相对的一侧形成第二吻合部AN2。例如,如图4B所示,第二吻合部AN2的被连续地接合的部分的外部被离散地变形。
此外,在第二保持构件54相对于第一保持构件52闭合以保持肠道IC1和IC2的端部的状态下,提供能量。由此,如图4C所示,肠道IC1和IC2的端部由于第一高频电极56和第二高频电极58施加的热而被变形并且被密封。也就是,在肠道IC1和IC2的端部形成密封部SP。此时,在图4A中示意性地示出沿图4C的线4A-4A截取的截面的状态。由此,肠道IC1和IC2以它们的端部在密封部SP被密封的方式彼此吻合。
注意,由例如刀具84切除密封部SP的多余部分。此时,如图4B所示,肠道IC1和IC2的被密封端部(密封部SP)的连续接合部的周围的部分被离散地变形。也就是,肠道IC1和IC2的由于离散电极56b、58b而变形和接合的部分之间的活体组织不变形。因此,肠道IC1和IC2的不变形的活体组织在由离散电极56b、58b接合的活体组织的部分的周围(附近)彼此接触(压靠)。
因此,力沿使肠道IC1和IC2彼此紧密接触的方向作用于肠系膜M侧的第一吻合部AN1。然后,力在由离散电极56b、58b使活体组织变形的部分起作用,使得活体组织更牢固地彼此紧密接触。此外,力F1沿打开肠道IC1和IC2的方向作用于与肠系膜M所在侧相对的第二吻合部AN2,但是该力以由离散电极56b、58b使活体组织变形的部分使得活体组织彼此紧密接触的方式起作用。因此,在肠道IC1和IC2的不变形的活体组织之间产生介面网(inter-network),使得活体组织运用它们的组织再生能力,并且肠道IC1和IC2的活体组织较早地再生。
如上所述,根据该实施方式,可以获得如下效果。
连续电极56a和离散电极56b被配置于第一保持构件52的保持面62a,连续电极58a和离散电极58b被配置于第二保持构件54的保持面66a。因此,第一保持构件52的连续电极56a和第二保持构件54的连续电极58a之间的活体组织(例如肠道IC1和IC2)能够被加热、变形并且连续地彼此接合。结果,例如,管状的活体组织能够彼此紧密接触或彼此密封。此外,第一保持构件52的离散电极56b和第二保持构件54的离散电极58b之间的活体组织(例如肠道IC1和IC2)能够被加热、变形并且彼此接合。也就是,活体组织能够被彼此离散地接合。
此时,例如,如图4B所示,活体组织被连续地变形并且彼此接合的部分被定位成靠近活体组织被离散地变形并且彼此接合的部分。此外,活体组织被离散地变形并且彼此接合的部分周围的活体组织不变形。因此,活体组织被离散地变形并彼此接合的部分周围的不变形的活体组织能够保持彼此接触(紧密接触)。也就是,离散电极56b、58b对维持例如被施加沿使其分离方向的力F1的活体组织的紧密接触状态起主要作用。
例如,当两个肠道IC1和IC2彼此吻合时,力F1沿使肠道IC1和IC2在图4A和图4C所示的与肠系膜M所在侧相对的一侧彼此分离的方向作用。然而,因为离散电极56b使肠道IC1和IC2彼此离散地接合,所以肠道IC1和IC2能够彼此离散地接合。因此,能够保持肠道IC1和IC2彼此紧密接触。
因此,活体组织的通过离散电极56b、58b而接合的部分起到使活体组织彼此靠近并且保持彼此紧密接触的作用。也就是,活体组织的通过离散电极56b、58b而接合的部分起到维持活体器官愈合的作用。因此,在紧密接触(闭起来)的活体组织之间产生介面网,使得活体组织更容易地运用它们的组织再生能力,并且能够较早地再生。
在上述实施方式中,虽然第一保持构件52的离散电极56b被大致等间隔地配置并且具有大致相等的面积,但是,相邻的离散电极56b之间的距离是变化的并且离散电极56b的面积彼此不同也是优选的。当用离散电极56b离散地处理组织时,接触离散电极56b的部分被变形,但是,只要能够在活体组织的位于离散电极56b和与该离散电极56b相邻的离散电极56b之间的部分不变形的情况下维持活体组织之间的接触,就可以允许离散电极56b的多种变型。
虽然在上述实施方式中设置了刀具84,但是,取决于处理目标可以不设置刀具84。在该情况下,如后所述,刀具引导槽94能够起到例如流体排出槽(流动通道)的作用,其中,该流体排出槽用于朝向电外科装置12的手柄22引导从活体组织中产生的诸如蒸汽或液体等流体。作为可选方案,可以不设置刀具引导槽94。
接着,将利用图5A说明离散电极56b的第一变型。
在上述实施方式的示例中,如图3A所示,离散电极56b等间隔地配置在大致U型的连续电极56a的外侧的大致U型的虚拟轨迹上。另外,离散电极56b配置在曲折(zigzag)形状的顶点也是优选的,如图5A所示。也就是,离散电极56b被配置成两行也是优选的。在该情况下,还根据连续电极56a的输出强度和离散电极56b在活体组织上方的面积等来适当地确定离散电极56b的配置和离散电极56b之间的距离。
接着,将利用图5B说明离散电极56b的第二变型。第二变型是第一变型的进一步的变型。
如图5B所示,以曲折形式配置矩形离散电极56b来代替圆形电极也是优选的。另外,允许离散电极56b的配置的多种变型,例如包括随机配置。也允许离散电极56b的形状的多种变型,例如包括椭圆形、菱形和多边形。
此外,已经利用如下的保持区26说明了第一实施方式:在该保持区26中,第一保持构件52的主体62的结构与第二保持构件54的主体66的结构对称(相同)。另外,如图6A所示,在第一保持构件52的主体62中使用上述结构并且在第二保持构件54的主体66的靠近第一保持构件52的一侧的保持面66a中使用完全暴露的平坦(板状)的第二高频电极58也是优选的。
虽然在该实施方式中已经说明了使用双极型电外科装置12,但是如图6B和图6C所示,使用单极型电外科装置也是优选的。在该情况下,对向电极板(counter electrode plate)60被安装到作为处理目标的患者P。该对向电极板60经由导线92c与能量源14连接。此外,在第一导线92a和第二导线92b彼此电连接的情况下,配置于第一保持构件52的主体62的第一高频电极56和配置于第二保持构件54的主体66的第二高频电极58处于相同的电位状态。在该情况下,因为与第一高频电极56和第二高频电极58接触的活体组织LT的面积小,所以电流密度高,但是对向电极板60的电流密度低。因此,由保持区26保持的活体组织LT被加热,但是与对向电极板60接触的活体组织LT的加热近似于零地小。因此,在由保持区26保持的部分中,仅与电极56、58接触的活体组织LT被加热并变形。
此外,虽然未示出,但是,当使用单极型电外科装置时,仅在第一保持构件52和第二保持构件54中的一方上配置高频电极也是优选的。
虽然在该实施方式中已经说明了使用第一高频电极56和第二高频电极58,但是,使用加热器(因为与例如图3A、图5A和图5B没有很大的变化,所以没有具体地示出)来代替第一高频电极56和第二高频电极58也是优选的。另外,使用与原来一样的连续电极56a并且使用加热器来代替离散电极56b也是优选的。此外,使用与原来一样的离散电极56b并且使用加热器来代替连续电极56a也是优选的。因此,当使用例如点加热器(spottedheater)来代替第一高频电极56和第二高频电极58时,这些加热器产生的热能够以与利用高频电极进行处理的方式相同的方式对与加热器的表面接触的活体组织LT进行处理。
在该实施方式中,已经以经由腹壁对腹腔(体内)的活体组织进行处理的线状电外科装置12(参见图1A)为例进行了说明。然而,例如,如图7所示,可以使用开放式线状电外科装置(治疗用处理装置)12a,该装置经由腹壁将处理目标组织摘取到体外来对该组织进行处理。
电外科装置12a包括手柄22和保持区26。也就是,与用于经由腹壁来处理组织的电外科装置12不同,省略了轴24(参见图1A)。另一方面,在手柄22中布置功能与轴24类似的构件。因此,可以以与上面参照图1A说明的电外科装置12相同的方式来使用电外科装置12a。
第二实施方式
现在,将参照图8至图9B说明第二实施方式。该实施方式是第一实施方式的变型,相同的附图标记表示与第一实施方式中说明的构件相同的构件,因此省略对这些相同构件的详细说明。
如图8所示,从大致U型的连续电极56a分支的多个分支电极(维持构件,第二接合构件)56c被一体地形成于连续电极56a的外侧。这些分支电极56c沿与连续电极56a的轴向垂直的方向延伸。也就是,在该实施方式中,配置分支电极56c来代替第一实施方式所述的离散电极56b。
以大致相等的长度和大致相等的宽度来形成分支电极56c。也就是,从连续电极56a延伸的分支电极56c的面积大致相等。此外,分支电极56c之间的距离大致相等。
注意,分支电极56c使与之接触的活体组织LT变形,但是分支电极56c的输出处于防止相邻的分支电极56c之间的活体组织LT变形的水平。
根据该实施方式的处理系统10的功能和效果与第一实施方式所述的功能和效果类似,因此省略对功能和效果的说明。
注意,适当地设定各分支电极56c的长度和宽度(厚度)、分支电极56c之间的距离、以及分支电极56c的数量。虽然图8所示的连续电极56a的厚度比分支电极56c的厚度大,但是也允许连续电极56a的厚度与分支电极56c的厚度相等或分支电极56c的厚度更大。
接着,将使用图9A说明该分支电极56c的第一变型。
如图9A所示,与图8所示的位于第一保持构件52的主体62的最远侧的分支电极56c相比,位于第一保持构件52的主体62的最远侧(远离基部64的一侧)的分支电极(维持构件,第二接合构件)56d被变型。也就是,图9A所示的第一变型中的分支电极56d被形成为比图8所示的位于第一保持构件52的主体62的最远侧的分支电极56c大。
此外,图8所示的位于最远侧的分支电极56c仅沿一个方向延伸(直线)。相反地,图9A所示的分支电极56d的延伸角度被中途改变(中途弯曲)。其目的是,当肠道IC1和IC2如图4C所示彼此吻合时,在如下情况下增大使肠道IC1和IC2彼此接合的力并且防止吻合的解除:力F2作用,以从由于连续电极56a而变形的部分的远端、即使肠道IC1和IC2在两个方向上分离的部分Bi解除肠道IC1和IC2的吻合。
图9A所示的分支电极56d至少在两个方向上延伸。这些分支电极56d包括:第一部分56d1,其与连续电极56a一体地形成并且在与连续电极56a的大致U型的虚拟轨迹垂直的方向上延伸;以及第二部分56d2,其与第一部分56d1一体地形成并且从第一部分56d1进一步延伸。在这些部分中,第二部分56d2在与分支电极56c平行的方向上延伸。在该构造中,分支电极56d具有第一部分56d1和第二部分56d2,从而可以增加与在使肠道沿两个方向分离的部分Bi产生的力F2相对应的接合面积。也就是,第一部分56d1和第二部分56d2防止被接合的肠道IC1和IC2容易地彼此分离。
这能够增大施加到肠道IC1和IC2的力F2的阻力,因此创造了肠道IC1和IC2的吻合不会被容易地解除的条件。
接着,将使用图9B说明分支电极56c的第二变型。
如图9B所示,与图8所示的第一保持构件52的分支电极56c相比,第一保持构件52的分支电极(维持构件,第二接合构件)56e被变型。第二变型中的分支电极56e没有被配置在与连续电极56a的轴向(大致U型的虚拟轨迹)垂直的方向上,而是被配置在相对于连续电极56a的轴向倾斜的方向上。在第二变型的情况下,分支电极56e朝向例如近侧延伸。
因此,如图4D所示,肠道IC1和IC2包括由于连续电极56a而接合的部分和由于分支电极56e而接合的、以与由于连续电极56a而接合的部分的纵向成一定角度的部分。在这些电极中,分支电极56e被形成为比图8所示的分支电极56c长。此外,由于分支电极56e而接合的部分相对于施加到肠道IC1和IC2的力F1的方向倾斜。因此,分支电极56e具有与解除吻合的方向上的力F1相对应的增加的接合面积,从而能够创造肠道IC1和IC2的吻合不会被容易地解除的条件。结果,与由于连续电极56a而连接的部分的纵向成一定角度的分支电极56e能够增大使肠道IC1和IC2彼此接合的力。
另外,如图9B所示,与图8和图9A所示的位于第一保持构件52的最远侧的分支电极56c、56d相比,位于第一保持构件52的最远侧的分支电极(维持构件,第二接合构件)56f被变型。也就是,第二变型中的分支电极56f被形成为比图8和图9A所示的位于第一保持构件52的最远侧的分支电极56c、56d大。
此外,图9B所示的分支电极56f以弓形延伸。因此,分支电极56f在与分支电极56e的方向不同的方向上延伸。当肠道IC1和IC2彼此吻合时,设置于第一保持构件52的远侧的分支电极56f增大了如图4C所示在部分Bi产生的力F2的阻力,由此使肠道IC1和IC2难以彼此分离。
其目的是,例如,当肠道IC1和IC2彼此吻合时,在如下情况下增大使肠道IC1和IC2彼此接合的力并且防止吻合的解除:力F2作用,以从由于连续电极56a而变形的部分的远端、即使肠道IC1和IC2在两个方向上分离的Bi部分解除肠道IC1和IC2的吻合。
在该实施方式中,在增加与力F2相对应的接合面积的情况下,已经说明了作为位于第一保持构件52的主体62的最远侧的分支电极的分支电极56f和具有第一部分56d1和第二部分56d2的分支电极56d。然而,只要增加与力F2相对应的接合面积,位于第一保持构件52的主体62的最远侧的分支电极的形状不限于分支电极56d、56f的形状。
第三实施方式
现在,将参照图10至图11B说明第三实施方式。该实施方式是第一和第二实施方式的变型,相同的附图标记表示与第一和第二实施方式中说明的构件相同的构件,因此省略对这些相同的构件的详细说明。
如图10所示,大致方波形状的连续高频电极56被布置于第一保持构件52。这里,以与在第一实施方式和第二实施方式所述的连续电极56a(参见图3A)相同的方式沿刀具引导槽94的边缘配置图10中的用附图标记56g表示的部分的电极。也就是,在大致U型轨迹上配置电极56g。然而,与连续电极56a不同,电极56g被不连续地配置。
图10中的用附图标记56h表示的部分的电极在与电极56g垂直的方向上以与第二实施方式所述的分支电极56c(参见图8)相同的方式延伸大致相等的长度。
此外,图10中的用附图标记56i表示的部分的电极被配置成连接电极56h的延伸端部。此外,电极56i也以与电极56g、56h相同的方式被不连续地布置。也就是,电极56i以与第一实施方式所述的离散电极56b(参见图3A)相同的方式在大致U型的轨迹上被配置成彼此分离。
然而,这些电极56g、56h和56i整体上形成为一个连续的高频电极56,因此具有与第一和第二实施方式所述的连续电极56a的效果相同的效果。
另一方面,电极56h以与图8所示的分支电极56c相同的方式彼此分离。因此,电极56h用作连续电极的一部分并且起到分支电极的作用。此外,电极56i用作连续电极的一部分,并且电极56i被彼此分离地不连续地形成,因此起到离散电极的作用。
也就是,这些电极56h、56i不仅被用于发挥连续电极的作用以通过活体组织LT的变形而连续地接合活体组织LT,并且也发挥图3A所示的离散电极56b或图8所示的分支电极56c的作用以使活体组织LT彼此接近并且保持活体组织LT彼此紧密接触。
在该实施方式中,如图10所示,虽然由附图标记56g表示的电极和由附图标记56i表示的电极的长度和电极之间的距离大致相等,但是长度和距离可以适当地改变。也就是,由附图标记56h表示的电极之间的距离可以适当地改变。
根据该实施方式的处理系统10的功能和效果与第一实施方式和第二实施方式所述的功能和效果类似,因此省略了对功能和效果的说明。
接着,将使用图11A说明第一高频电极56的第一变型。
虽然在所述的第三实施方式中大致方波形状的高频电极56被连续地布置,但是,该电极被形成为如图11A所示的大致正弦曲线形状也是优选的。当高频电极56被形成为如图11A所示的大致正弦曲线形状时,大致正弦曲线形状的电极的由附图标记56j表示的底部位置(接近刀具引导槽94的位置)处的电极起到代替第三实施方式所述的电极56g的作用。
大致正弦曲线形状的电极的由附图标记56k表示的拐点位置处的电极起到代替第三实施方式所述的电极56h的作用。另外,可以认为电极56k被形成为比图8中的由附图标记56h表示的部分长。其目的是,例如,当肠道IC1和IC2如图4A所示彼此吻合时,在如下情况下防止吻合的解除、即增大用于使肠道IC1和IC2彼此接合的面积以增大接合力:力作用,以从由于连续电极56a而变形的部分的远端、即使肠道IC1和IC2在两个方向上分离的部分Bi解除肠道IC1和IC2的吻合。因此,第一变型中的电极56k具有比图10所示的电极56h大的用于接触肠道IC1和IC2的面积,从而能够增大使肠道IC1和IC2彼此接合的力。
类似地,大致正弦曲线形状的电极的由附图标记561表示的顶部位置(远离刀具引导槽94的位置)处的电极起到代替第三实施方式所述的电极56i的作用。
接着,将使用图11B说明第一高频电极56的第二变型。
如图11B所示,在该变型中,第三实施方式所述的由附图标记56o表示的部分(与图8所示的分支电极56c相对应的部分)的电极被形成为倾斜的并且比图10所示的第三实施方式所述的电极56h长。其目的是,当肠道IC1和IC2如图4A所示彼此吻合时,在如下情况下防止吻合的解除、即增大用于使肠道IC1和IC2彼此接合的面积以增大接合力:力作用,以从由于高频电极56而变形的部分的远端、即使肠道IC1和IC2在两个方向上分离的部分Bi解除肠道IC1和IC2的吻合。因此,第二变型中的电极56o具有比图10所示的电极56h大的用于接触肠道IC1和IC2的面积,从而能够增大使肠道IC1和IC2彼此接合的力。
此外,由附图标记56m表示并且靠近刀具引导槽94(曲线的底部位置处)的电极起到代替图10所示的电极56g的作用。由附图标记56n表示并且远离刀具引导槽94(曲线的顶部位置处)的电极起到代替图10所示的电极56i的作用。
例如,如该变型所述,电极56m的长度可以比电极56n的长度长。当然,电极56m的长度比电极56n的长度短也是优选的。
第四实施方式
现在将参照图12A至图14C说明第四实施方式。该实施方式是第一实施方式的变型,相同的附图标记表示与第一实施方式中说明的构件相同的构件,由此省略对这些相同构件的详细说明。
在图12A所示的电外科装置12的轴24的筒状构件42和保护筒44中,流体排出口48a、48b被形成为排出后述的诸如蒸汽(气体)或液体(组织液)等流体。这些流体排出口48a、48b被形成于轴24的近侧。
虽然这里没有示出,但是,在保护筒44的流体排出口48b的外周面设置连接盖也是优选的。此时,后述的流体经由刀具引导槽94、轴24的筒状构件42的流体排出口48a、轴24的保护筒44的流体排出口48b和连接盖被排出。在该情况下,通过经由连接盖抽吸可以从流体排出口48a、48b容易地排出诸如蒸汽或液体等流体。
另外,流体排出口48a、48b被设置在轴24中是优选的,但是,流体排出口48a、48b被设置在手柄22中而不是被设置在轴24中也是优选的。
在其它方面,手柄22和轴24的结构与第一实施方式所述的结构相同,因此省略对其它构件的说明。
如图13A所示,连续电极56a和离散电极56b被配置在与图3A所示的第一实施方式中的位置相同的位置。
在主体62中,在连续电极56a的外周形成第一流体排出槽(连续电极用流体排出槽)94a作为用于诸如蒸汽或高温液体等流体的通道。在主体62中,在离散电极56b的外周形成第二流体排出槽(离散电极用流体排出槽)94b作为用于诸如蒸汽或高温液体等流体的通道。第一流体排出槽94a经由连通通道94c与第二流体排出槽94b连通。各连通通道94c被形成为槽。此外,各连通通道94c被暴露于保持面62a。
如图13A和图13B所示,阻挡部(坝)98被形成于第一保持构件52的保持面62a。阻挡部98沿第一流体排出槽94a和第二流体排出槽94b以及连通通道94c的边缘形成。如图13B所示,第一保持构件52的阻挡部98从保持面62a的平坦面突出。
接着,将说明根据该实施方式的处理系统10的功能。
如第一实施方式所述,作为处理目标的活体组织LT被保持在第一保持构件52与第二保持构件54之间。此时,阻挡部98与活体组织LT紧密接触,并且活体组织LT与第一高频电极56和第二高频电极58接触。
在该状态下,操作脚踏开关和手动开关。能量源14向第一高频电极56和第二高频电极58供给能量。然后,被保持在第一高频电极56与第二高频电极58之间的活体组织LT被加热。此时,例如,从活体组织LT的被加热部分产生诸如蒸汽或液体等流体。
这里,第一流体排出槽94a被布置于连续电极56a的外侧,第二流体排出槽94b被布置于离散电极56b的外侧。因此,诸如蒸汽或液体等流体流动到第一流体排出槽94a和第二流体排出槽94b中。此时,由阻挡部98防止流体从第一流体排出槽94a和第二流体排出槽94b溢出。也就是,阻挡部98用作防止从活体组织LT产生的流体漏出的坝。因此,流动到第二流体排出槽94b中的流体经由连通通道94c流动到第一流体排出槽94a中。然后,该流体流向第一保持构件52的基部64和第二保持构件54。此外,流体流动到与例如基部64中的第一流体排出槽94a连通的刀具引导槽94中。作为可选方案,虽然未示出,但是第一流体排出槽94a也可与轴24的筒状构件42的内部连通。
然后,流体经由轴24的筒状构件42的流体排出口48a从流体排出口48b排出到电外科装置12的外部。
如上所述,根据该实施方式,可以获得如下效果。
省略了与第一实施方式所述的效果类似的效果的说明。
当通过电外科装置12对由保持区26保持的作为处理目标的活体组织LT施加高频电流时,阻挡部98与活体组织LT紧密接触,使得从作为处理目标的活体组织LT产生的流体即使在流向第一保持构件52的阻挡部98时也能够被导入到第一高频电极56和第二高频电极58的第一流体排出槽94a、第二流体排出槽94b和连通通道94c中。
结果,在活体组织LT的处理期间,能够防止除了目标组织以外的周边组织受到从高频电流被传导至的部分产生的流体的影响。也就是,在活体组织LT的处理期间受影响的位置能够被限制到第一高频电极56和第二高频电极58之间的已经被传导了高频电流的活体组织LT。
因此,根据该实施方式,例如,在轴24的近侧或在手柄22侧,从活体组织LT产生的诸如蒸汽或液体(高温体液)等流体被排出到电外科装置12的外部,从而能够抑制作为处理目标的活体组织LT的周围的活体组织LT受到诸如蒸汽或液体(体液)等流体的影响。
当抑制对活体组织LT的热影响时,将诸如蒸汽或液体等流体引导至流体不与组织接触的位置是重要的。在组织比保持区26大到保持区26的周围区域被覆盖的程度的情况下,可以获得能够防止热影响被施加到保持区26的外部的特别好的效果。当在保持区26中仅制作小开口(空间)但是诸如蒸汽或液体等流体从该开口泄漏时,从该开口排出流体,并且保持区26周围的活体组织LT受到热影响。
此外,即使高频电极(能量释放部)56、58的外周被阻挡部98覆盖以去除该开口,也存在由从活体组织LT产生的诸如蒸汽压力等流体压力而形成开口并且从该开口排出流体的可能性。因此,设置流动通道94a、94b和94c是有用的手段,其中,流动通道94a、94b和94c抑制由于流体压力的增加引起的流体的不必要的排出,并且在用于排出的预定方向上引导流体。
接着,将使用图14A和图14B说明图13A和图13B所示的连通通道94c的第一变型。
如图14A和图14B所示,用于流体排出槽94a、94b之间的连通的连通通道(第一连通通道)94c被形成为管道。因此,各连通通道94c被形成在主体62的内部。
因此,从活体组织LT产生的流体能够通过管道状的连通通道94c以最大程度地防止活体组织LT接触例如可能处于高温的流体。
接着,将使用图14C说明图13A和13B所示的连通通道94c的第二变型。该变型是第一变型的进一步的变型。
如图14C所示,与第一变型一样,第一连通通道94c被形成为管道。与刀具引导槽94连通的管道状的连通通道94d被形成在第一连通通道94c中。
因此,从活体组织LT产生的流体能够通过管道状的第一连通通道94c和管道状的第二连通通道94d,以最大程度地防止活体组织LT接触例如可能处于高温的流体。
第五实施方式
将参考图15说明第五实施方式。该实施方式是第二和第四实施方式的变型,相同的附图标记表示与第二和第四实施方式中说明的构件相同的构件,由此省略对这些相同构件的详细说明。
如图15所示,流体排出槽94e被形成于高频电极56的外侧。此外,阻挡部98被形成于流体排出槽94e的外边缘。这里,阻挡部98从保持面62a突出。
根据该实施方式的处理系统10的功能和效果与第四实施方式所述的功能和效果类似,因此省略对功能和效果的说明。
第六实施方式
现在将参考图16A至图16D说明第六实施方式。该实施方式是第一和第四实施方式的变型,相同的附图标记表示与第一和第四实施方式中说明的构件相同的构件,由此省略对这些相同构件的详细说明。
如图16B所示,用于蒸汽排出槽94a、94b之间的连通的连通通道94c以与图14C所示的方式相同的方式形成为管道。此外,用于蒸汽排出槽94a和刀具引导槽94之间的连通的连通通道94d也被形成为管道。
如图16A和图16B所示,由例如铜制成并且具有良好的导热性的冷却管102被固定于主体62的基部64的边缘。诸如冷却水(液体)或冷空气(气体)等冷却介质通过冷却管102。
由例如铜板制成并且具有良好的导热性的冷却板104被布置于主体62的保持面62a。该冷却板104以与冷却管102紧密接触的方式被固定到主体62。因此,当冷却介质通过冷却管102时,来自冷却介质的热从冷却管102被传导至冷却板104。也就是,冷却板104被冷却。
现在将说明根据该实施方式的处理系统10的功能。
如第一实施方式中所述,作为处理目标的活体组织LT被保持在第一保持构件52和第二保持构件54之间。此时,阻挡部98a、98b与活体组织LT紧密接触,并且活体组织LT与第一高频电极56和第二高频电极58接触。此外,活体组织LT与设置于第一保持构件52的主体62和第二保持构件54的主体66的冷却板104紧密接触。
在该状态下,操作脚踏开关和手动开关。能量源14分别向第一高频电极56和第二高频电极58供给能量。另一方面,作为冷却介质的冷却水被供给到冷却管102。
第一高频电极56使高频电流经由活体组织LT在第一高频电极56与第二高频电极58之间传导。因此,第一高频电极56与第二高频电极58之间的活体组织LT被加热。
因此,当作为处理目标的活体组织LT被加热时,从活体组织LT的被加热部分产生诸如蒸汽或液体等流体。然后,从活体组织LT产生的流体经由设置于连续电极56a外侧的蒸汽排出槽94a和设置于离散电极56b外侧的流体排出槽94b汇聚到刀具引导槽94中,并且被引导至轴24的近侧,并且被排出到外部。
此外,当作为处理目标的活体组织LT被加热时,导致了从作为处理目标的活体组织LT到处理目标周围的活体组织LT的热扩散。
这里,冷却水被供给到第一保持构件52和第二保持构件54的外侧的冷却管102。因此,活体组织LT经由与具有高导热性的冷却管102的外周面紧密接触的冷却板104而被冷却。因此,由与冷却板104紧密接触的部分抑制来自第一高频电极56和第二高频电极58之间的作为处理目标的活体组织LT的热扩散的影响。也就是,通过冷却作为处理目标的活体组织LT的周边的活体组织LT抑制来自作为处理目标的活体组织LT的热扩散。
此外,如果活体组织LT和阻挡部98a、98b之间存在间隙,则流体经由活体组织LT和阻挡部98a、98b之间的间隙溢出到外部。在该情况下,流体接触冷却板104。结果,流体被冷却。
如上所述,根据本实施方式,可以获得如下效果。
省略对与第一和第四实施方式中的效果类似的根据该实施方式的处理系统10的效果的说明。
当通过电外科装置12对由保持区26保持的作为处理目标的活体组织LT施加高频电流时,第一和第二保持构件52、54的阻挡部98a、98b能够与活体组织LT紧密接触。因此,即使流体流向第一和第二保持构件52、54的阻挡部98a、98b,从作为处理目标的活体组织LT产生的流体也可以经由连续电极56a和阻挡部98a之间的蒸汽排出槽94a以及离散电极56b和阻挡部98b之间的流体排出槽94b被导入到刀具引导槽94中,并且被排出到电外科装置12的外部。
结果,在活体组织LT的处理期间,能够防止除了目标组织以外的周边组织受到从高频电流被传导至的部分产生的流体的影响。也就是,在活体组织LT的处理期间受到影响的位置能够被限制到第一高频电极56和第二高频电极58之间的已经被传导了高频电流的活体组织LT。
此外,当通过电外科装置12对由保持区26保持的作为处理目标的活体组织LT施加高频电流时,被冷却的第一保持构件52的冷却板104和第二保持构件54的冷却板104能够与活体组织LT紧密接触。因此,与冷却板104紧密接触的活体组织LT能够被冷却。因此,可以由与冷却板104接触的部分来抑制所产生的从作为处理目标的活体组织LT到处理目标周围的活体组织LT的热扩散的影响。结果,在活体组织LT的处理期间,能够防止除了目标组织以外的周边组织受到来自高频电流已经被传导至的作为处理目标的活体组织LT的热扩散的影响。
因此,能够冷却表面的冷却板104被设置于保持区26,使得可以确保在第一保持构件52和第二保持构件54内产生热扩散。
此外,即使当高温流体从第一保持构件52和第二保持构件54溢出时,该流体接触冷却板104并且能够被冷却。这能够防止对由保持区26保持的活体组织LT的周边的活体组织LT的影响。
此外,在活体组织LT的处理期间,能够防止除了目标组织以外的周边组织受到从高频电流已经被传导至的部分产生的流体的影响。也就是,处理范围能够被限制到阻挡部98a、98b的内部,并且阻挡部98a、98b周围的活体组织LT能够被保持在通常条件,这有助于较早的治愈。
接着,将使用图16C说明该实施方式的第一变型。
如图16C所示,去除了冷却管102。代替地,槽状管道112a、112b被一体地形成于主体62和基部64。
冷却板104被布置于主体62的保持面62a。管道112a、112b通过该冷却板104密封。因此,当流体通过管道112a、112b时,该流体的热量被传导到冷却板104。
接着,将使用图16D说明该实施方式的第二变型。该变型是第一变型的进一步变型。
如图16D所示,移除冷却管102。代替地,槽状的第一管道112a和第二管道112b被一体地形成于主体62和基部64。一对第一管道112a和一对第二管道112b关于第一保持构件52的刀具引导槽94的中心轴线对称地形成。各第一和第二管道112a、112b中的一对被用于诸如冷却水等冷却介质的流入,另一对被用于冷却介质的流出。
另外,用于流体排出槽94a和刀具引导槽94之间的连通的连通通道94f被形成在第二管道112b的下方。
薄的弹性片状构件(热量释放构件)114被布置于主体62的保持面62a。该片状构件114由例如硅构件形成。管道112a、112b通过该片状构件114密封。因此,当流体通过管道112a、112b时,该流体的热量经由片状构件114被传导至活体组织LT。
第七实施方式
现在将参考图17A至图18说明第七实施方式。该实施方式是第一实施方式的变型,相同的附图标记表示与第一实施方式中说明的构件相同的构件,由此省略对这些相同构件的详细说明。
如图17A所示,从第一保持构件52去除离散电极56b(参见图3A),代替地,形成用于排出手术钉(surgical staple)(维持构件,第二接合构件,施加部)的多个狭槽或缝134。在刀具引导槽94的两侧和连续电极56a的外侧,多个狭槽134被配置成例如两行。如图18所示,具有倾斜面136a的钉推动件(staplepusher)136被可前后移动地收纳在狭槽134中。钉132被逐一地收纳于钉推动件136的上表面,使得钉的腿部132a指向第二保持构件54并且能够朝向第二保持构件54的保持面66a突出。在第一保持构件52中,板引导槽138被形成为与钉推动件136相对。具有以与钉推动件136的倾斜面136a相同的方式倾斜的倾斜面140a的致动滑板(actuation sled)140被可滑动地设置在板引导槽138中。致动滑板140被布置成与刀具84和驱动杆82平行,可以由手柄22以与刀具驱动按钮34相同的方式来操作该致动滑板140的移动,其中,该手柄12使用与刀具84和驱动杆82大致平行地被驱动的钉操作单元(未示出)。因此,第一保持构件52也起到钉132的盒的作用。
如图17B所示,从第二保持构件54中去除了离散电极58b,代替地,设置钉132的变形槽142。也就是,多个钉变形槽142被形成于第二保持构件54的保持面66a。各钉变形槽142形成有例如大致弓形状的底部,使得钉132的一对腿部132a(参见图18)能够被向内弯折和变形。因此,第二保持构件54也起到钉132的砧座(anvil)的作用。
注意,图17A所示的狭槽134被形成为与图17B所示的钉变形槽142相对。
也就是,该处理系统10装配有电外科装置12,以用于使用高频电极58a、58b进行物理处理,并且还使用钉进行机械处理。
接着,将说明根据该实施方式的处理系统10的功能。
如第一实施方式所述,作为处理目标的活体组织LT被保持在第一保持构件52和第二保持构件54之间。此时,活体组织LT接触第一高频电极56的连续电极56a和第二高频电极58的连续电极58a。
在该状态下,操作脚踏开关和手动开关。能量源14分别向连续电极56a、58a供给能量。然后,连续电极56a、58a之间的活体组织LT被加热。由此,活体组织LT被连续地接合。
在作为处理目标的活体组织LT被保持在第一保持构件52和第二保持构件54之间的状态下,操作手柄22的钉操作单元(未示出)。然后,致动滑板140向前移动。这里,如图18所示,致动滑板140沿板引导槽138向前移动。
当致动滑板140向前移动时,狭槽134中的钉推动件136的倾斜面136a被致动滑板140的远端的倾斜面140a向下推。因此,狭槽134中的钉132突出并且被插入到用于吻合目的的活体组织LT中。被插入的钉132的一对腿部132a穿透活体组织LT。然后,由第二保持构件54的变形槽142使腿部132a向内弯折。因此,通过钉132使用于吻合目的的组织彼此吻合。结果,活体组织LT例如以机械的方式被彼此离散地接合。
如上所述,根据该实施方式,可以获得如下效果。
连续电极56a、58a分别被布置于第一保持构件52的保持面62a和第二保持构件54的保持面66a。因此,第一保持构件52的连续电极56a和第二保持构件54的连续电极58a之间的活体组织LT(例如肠道IC1和IC2)能够被加热、变形和彼此连续地接合。结果,例如,管状活体组织LT能够彼此紧密接触或彼此密封。
此外,从第一保持构件52的连续电极56a的外侧的狭槽134中排出钉132,并且钉132的一对腿部132a在第二保持构件54的连续电极58a的外侧的钉变形槽142中被向内弯折。结果,在连续接合部的外侧附近,可以通过钉132使活体组织LT离散地和机械地接合。
此时,例如,如图4B所示,活体组织LT被连续地变形和彼此接合的部分(物理接合部)位于被离散地和机械地接合的部分附近。此外,因为被离散地接合的部分是通过钉132彼此机械地接合,因此,被离散地接合的部分周围的活体组织LT不变形。因此,能够保持被离散地接合的部分周围的不变形的活体组织LT彼此压靠(接触)。也就是,钉132对维持被施加沿使其分离方向的力的活体组织LT的紧密接触状态起主要作用。
例如,当两个肠道IC1和IC2彼此吻合时,力作用在使肠道IC1和IC2在图4A和图4C所示的肠系膜M所在侧的相对侧彼此分离的方向上。然而,因为肠道IC1和IC2通过钉132被彼此离散地接合,所以肠道IC1和IC2能够彼此离散地接合。因此,能够保持肠道IC1和IC2彼此紧密接触。
因此,通过钉132接合的活体组织LT部分起到使活体组织LT彼此靠近并且保持它们彼此紧密接触的作用。因此,在紧密接触的活体组织LT之间产生介面网,使得活体组织LT更容易地运用它们的组织再生能力,并且能够较早地再生。
虽然在该实施方式说明的示例中使用钉132使活体组织LT彼此机械地接合,但是,例如,使用活体组织粘合剂使活体组织LT彼此接合也是优选的。
第八实施方式
现在将参考图19说明第八实施方式。该实施方式是第一和第七实施方式的变型,相同的附图标记表示与第一和第七实施方式中说明的构件相同的构件,由此省略对这些相同构件的详细说明。
如图19所示,与第一实施方式(参见图3A)相比,从第一保持构件52中去除了连续电极56a,代替地,形成用于排出钉132的狭槽134。也就是,布置有钉(密封构件,施加部,第一接合构件)132的多个狭槽134被形成于第一保持构件52的保持面62a。没有改变地布置例如圆形的离散电极56b。
用于排出钉132的多个狭槽134沿刀具引导槽94的两侧中的每一侧以紧密间隔和密集的方式被形成为两行。也就是,该实施方式中的离散电极56b和58b、钉132的狭槽134、以及钉变形槽142的配置与第七实施方式(参见图17A和图17B)中所述的连续电极56a和58a、钉132的狭槽134、以及钉变形槽142的配置不同。
现在将说明根据该实施方式的处理系统10的功能。
如第一实施方式所述,作为处理目标的活体组织LT被保持在第一保持构件52和第二保持构件54之间。此时,活体组织LT接触第一高频电极56的离散电极56b和第二高频电极58的离散电极58b。
在该状态下,操作手柄22的钉操作单元(未示出)。然后,如第七实施方式所述,狭槽134中的钉132突出并且被插入到用于吻合目的的活体组织LT中。被插入的钉132的一对腿部132a穿过活体组织LT。然后,由位于第二保持构件54的刀具引导槽96附近的变形槽142使腿部132a向内弯折。由此,通过钉132使用于吻合目的的组织彼此吻合。结果,活体组织LT以紧密间隔和连续的方式被彼此机械地接合。
在该状态下,操作脚踏开关和手动开关。能量源14分别向离散电极56b、58b供给能量。然后,离散电极56b和58b之间的活体组织LT被加热、变形和接合。
如上所述,根据该实施方式,可以获得如下效果。
从第一保持构件52的离散电极56b的内侧的狭槽134中排出钉132,并且钉132的一对腿部132a在第二保持构件54的离散电极58b的内侧的钉变形槽142中被向内弯折。结果,能够通过钉132使活体组织LT以紧密间隔和连续的方式被彼此机械地接合。
此外,离散电极56b、58b分别被布置于第一保持构件52的保持面62a和第二保持构件54的保持面66a。因此,第一保持构件52的离散电极56b和第二保持构件54的离散电极58b之间的活体组织LT(例如肠道IC1和IC2)能够被加热、变形和彼此离散地接合。
因此,可以通过钉132使活体组织LT彼此连续地接合(密封),并且可以通过离散电极56b、58b使活体组织LT彼此离散地接合。因此,根据第八实施方式,能够获得与第七实施方式所述的效果类似的效果。
第九实施方式
现在将参考图20至图21D说明第九实施方式。该实施方式是第一实施方式的变型。
这里,作为能量处理装置的示例,将说明例如经由腹壁或在腹壁的外部进行处理的圆形双极电外科装置(治疗用处理装置)12b。
如图20所示,电外科装置12b包括手柄202、轴204和可开闭的保持区206。手柄202经由缆线28与能量源14连接。
手柄202设置有保持区开闭旋钮212和刀具驱动杆214。保持区开闭旋钮212可相对于手柄202转动。当保持区开闭旋钮212相对于手柄202例如顺时针转动时,保持区206的后述的可拆卸侧保持部(可拆卸侧握持部)224远离主体侧保持部(主体侧握持部)222(参见图21A)。当旋钮212逆时针转动时,可拆卸侧保持部224靠近主体侧保持部222(参见图21B)。
轴204被形成为筒状。考虑到插入到活体组织中的插入性,该轴204被适当地弯曲。不用说,轴204也可以被直线地形成。
轴204的远端设置有保持区206。如图21A和图21B所示,保持区206包括:主体侧保持部(第一保持构件)222,其形成于轴204的远端;可拆卸侧保持部(第二保持构件)224,其被可拆卸地安装到主体侧保持部222。在可拆卸侧保持部224相对于主体侧保持部222闭合的状态下,主体侧保持部222的保持面222a与可拆卸侧保持部224的保持面224a彼此相对。
主体侧保持部222包括筒状构件232、框架234和导电管236。筒状构件232和框架234具有绝缘性。筒状构件232与轴204的远端连接。框架234被固定于筒状构件232。
框架234的中心轴线开放。框架234的开放的中心轴线设置有可沿框架234的中心轴线在预定区域内移动的导电管236。当保持区开闭旋钮212转动时,如图21A和图21B所示,导电管236由于例如滚珠丝杠(未示出)的作用而可在预定区域内移动。导电管236设置有沿直径方向向内突出的突起236a,使得后述的导电轴262的连接部262a与突起236a可解除接合地接合。
如图21A和图21B所示,在筒状构件232与框架234之间形成刀具引导槽(空间)246。筒状刀具242被布置在筒状构件232与框架234之间的刀具引导槽246中。刀具242的近端与布置于轴204的刀具用推动件244的远端连接。刀具242被固定于刀具用推动件244的外周面。尽管未示出,刀具用推动件244的近端与手柄202的刀具驱动杆214连接。因此,当操作手柄202的刀具驱动杆214时,经由刀具242用推动件244使刀具242移动。
在刀具用推动件244与框架234之间形成第一流体流路(流体通道)246a。此外,轴204或手柄202设置有流体排出口(未示出),通过第一流体流路246a的流体从该流体排出口被排到外部。
如图21A至图21C所示,第一高频电极254作为施加部或能量放出部被布置于筒状构件232的远端。第一高频电极254被设置在布置有刀具242的刀具引导槽246的边缘和筒状构件232的边缘之间。第一导线255的远端被固定于第一高频电极254。第一导线255经由主体侧保持部222、轴204和手柄202与缆线28连接。
如图21C所示,第一高频电极254包括无缝地连续地形成的连续电极(密封构件,第一接合构件)254a、以及离散地布置于连续电极254a的外侧的多个离散电极(维持构件,第二接合构件)254b。
连续电极254a例如以大致环形形状被连续地布置于刀具引导槽246的外边缘。沿大致环形的虚拟轨迹大致等间隔地配置形状大致相同的离散电极254b。各离散电极254b被形成为例如圆形形状。离散电极254b被配置成在两两之间具有预定间隔,并且各离散电极254b被布置成与连续电极254a相隔一定距离。离散电极254b被定位成当进行处理时最大程度地防止相邻的离散电极254b之间的活体组织LT由于热而变形,并且还最大程度地防止离散电极254b和连续电极254a之间的活体组织LT由于热而变形。
另一方面,可拆卸侧保持部224包括头部264和具有连接部262a的导电轴262。导电轴262具有圆形截面,导电轴262的一端形成为锥形,导电轴246的另一端被固定于头部264。连接部262a形成为允许与导电管236的突起236a接合的凹槽形状。利用例如涂层等使导电轴262的除连接部262a之外的外表面绝缘。
具有环形形状的刀具收容部270被设置于头部264。作为输出构件或能量施加部的第二高频电极274被设置于刀具收容部270的外侧。第二高频电极274被设置在刀具收容部270与头部264的边缘之间。第二导线275的一端被固定到第二高频电极274。第二导线275的另一端与导电轴262电连接。
另外,第二高频电极274包括无缝地连续地形成的连续电极(密封构件,第一接合构件)274a、以及被离散地布置于连续电极274a的外侧的多个离散电极(维持构件,第二接合构件)274b。连续电极274a被定位成与主体侧保持部222的连续电极254a相对,并且各离散电极274b被定位成与主体侧保持部222的各离散电极254b相对。也就是,连续电极274a例如以大致环形形状被连续地布置于刀具收容部270的外侧。沿大致环形形状的虚拟轨迹大致等间隔地配置形状大致相同的离散电极274b。各离散电极274b被形成为例如圆形形状。离散电极274b被配置成在两两之间具有预定间隔,并且各离散电极274b被布置成与连续电极274a相隔一定距离。离散电极274b被定位成当进行处理时最大程度地防止相邻的离散电极274b之间的活体组织LT由于热而变形,并且还最大程度地防止离散电极274b和连续电极274a之间的活体组织LT由于热而变形。
注意,导电管236经由轴204和手柄202与缆线28连接。因此,当可拆卸侧保持部224的导电轴262的连接部262a与导电管236的突起236a接合时,第二高频电极274与导电管236电连接。
接着,将说明根据该实施方式的处理系统10的功能。
如图21B所示,在主体侧保持部222相对于可拆卸侧保持部224闭合的状态下,电外科装置12b的保持区206和轴204经由例如腹壁被插入到腹腔中。电外科装置12b的主体侧保持部222和可拆卸侧保持部224与待处理的活体组织相对。
操作手柄202的保持区开闭旋钮212,以将待处理的活体组织保持在主体侧保持部222与可拆卸侧保持部224之间。此时,旋钮212相对于手柄202例如顺时针转动。在这种情况下,如图21A所示,导电管236相对于轴204的框架234朝向远端移动。因此,主体侧保持部222和可拆卸侧保持部224被打开,并且可以将可拆卸侧保持部224从主体侧保持部222拆下。
此外,待处理的活体组织被布置在主体侧保持部222的第一高频电极254与可拆卸侧保持部224的第二高频电极274之间。可拆卸侧保持部224的导电轴262被插入到主体侧保持部222的导电管236中。在该状态下,使手柄202的保持区开闭旋钮212例如逆时针转动。因此,可拆卸侧保持部224相对于主体侧保持部222闭合。以这种方式,将作为处理目标的活体组织保持在主体侧保持部222与可拆卸侧保持部224之间。
在该状态下,操作脚踏开关和手动开关。能量源14经由缆线28分别向第一高频电极254和第二高频电极274供给能量。第一高频电极254的连续电极254a和离散电极254b使高频电流经由活体组织向第二高频电极274的连续电极274a和离散电极274b传导。因此,主体侧保持部222与可拆卸侧保持部224之间的活体组织被加热。
然后,通过第一高频电极254的连续电极254a和第二高频电极274的连续电极274a使活体组织LT连续(大致环状)地变形。此外,通过第一高频电极254的离散电极254b和第二高频电极274的离散电极274b使由于第一高频电极254的连续电极254a和第二高频电极274的连续电极274a而变形的部分的周围的活体组织LT离散地变形。
当结束处理时,停止操作脚踏开关或手动开关。然后,停止从能量源14向第一高频电极254和第二高频电极274供给能量。
另外,当操作手柄202的刀具驱动杆214时,刀具242从主体侧保持部222的刀具引导槽246突出,并且朝向可拆卸侧保持部224的刀具收容部270移动。因为刀具24在其远端具有刀刃,因此被处理的活体组织被切成圆形形状。
如上所述,根据该实施方式,可以获得如下效果。
连续电极254a和离散电极254b被布置于主体侧保持部222,连续电极274a和离散电极274b被布置于可拆卸侧保持部224。因此,主体侧保持部222的连续电极254a和可拆卸侧保持部224的连续电极274a之间的活体组织LT能够被加热、变形和彼此接合。因此,活体组织LT能够大致环形地彼此密封。此外,主体侧保持部222的离散电极254b和可拆卸侧保持部224的离散电极274b之间的活体组织LT能够被加热、变形和彼此接合。结果,活体组织LT能够被彼此离散地接合。
此时,活体组织LT被连续地变形和彼此接合的部分位于被离散地接合的部分附近。此外,被离散地变形和接合的部分的周围的活体组织LT不变形。因此,被离散地变形和接合的部分的周围的不变形的活体组织LT能够彼此接触(压靠)。因此,离散电极254b、274b对维持例如被施加沿使其分离方向的力的活体组织LT的紧密接触状态起主要作用。因此,活体组织LT的由于离散电极254b、274b而接合的部分起到使活体组织LT彼此靠近的作用。因此,在活体组织LT之间产生介面网,使得活体组织LT更容易地运用它们的组织再生能力,并且能够较早地再生。
在上述实施方式中,虽然主体侧保持部222的离散电极254b被等间隔地配置并且具有大致相等的面积,但是,离散电极254b的面积彼此不同并且相邻的离散电极254b之间的距离是变化的也是优选的。在该情况下,当通过离散电极254b对组织进行离散处理时,与离散电极254b接触的部分被变形,但是,只要能够在使被变形部分周围的活体组织LT不变形的情况下使活体组织LT彼此接触,就允许离散电极254b的多种变型。这也适用于可拆卸侧保持部224。
虽然在该实施方式中使用双极型电外科装置12b进行了说明,但是,如图6B和图6C所示,使用单极型电外科装置也是优选的。
虽然在该实施方式中已经说明了使用第一高频电极254和第二高频电极274,但是,使用加热器(因为与例如图21A至图21D没有很大的变化,所以没有具体示出)来代替第一高频电极254和第二高频电极274也是优选的。另外,使用与原来一样的连续电极254a、274a并且使用加热器来代替离散电极254b、274b也是优选的。此外,使用与原来一样的离散电极254b、274b并且使用加热器来代替连续电极254a、274a也是优选的。因此,当使用例如点加热器来代替第一高频电极254和第二高频电极274时,这些加热器的热产生能够以与用高频电极进行的处理相同的方式对与加热器的表面接触的活体组织LT进行处理。
第十实施方式
现在将参考图22A说明第十实施方式。该实施方式是第二、第三和第九实施方式的变型。
如图22A所示,分支电极(维持构件,第二接合构件)254c被一体地形成于连续电极254a的外侧。分支电极254c沿与连续电极254a的轴向(圆周方向)垂直的方向(径向向外)延伸。也就是,在该实施方式中,配置分支电极254c来代替第八实施方式所述的离散电极254b。
分支电极254c被形成为具有大致相等的长度和大致相等的宽度。也就是,从连续电极254a延伸的分支电极254c的面积大致相等。此外,分支电极254c之间的距离大致相等。
注意,相邻的分支电极254c使与之接触的活体组织变形,但是,分支电极254c的输出处于防止相邻的分支电极254c之间的活体组织LT变形的水平。
根据该实施方式的处理系统10的功能和效果与第九实施方式所述的功能和效果类似,并且省略对功能和效果的说明。
第十一实施方式
现在将参考图22B说明第十一实施方式。该实施方式是第九和第十实施方式的变型。
如图22B所示,大致正弦曲线形状的连续高频电极254被布置于主体侧保持部222。这里,沿刀具引导槽94的外边缘以与第九和第十实施方式所述的连续电极254a相同的方式配置图22B中的用附图标记254d表示的部分的电极。然而,与连续电极254a不同,电极254d被不连续地布置。图22B中的用附图标记254e表示的部分的电极在与电极254d垂直的方向上以与第十实施方式所述的分支电极254c(参见图22A)相同的方式延伸大致相等的长度。此外,图22B中的用附图标记254f表示的部分的电极被配置成连接电极254e的延伸端部。此外,电极254f以与电极254d相同的方式被不连续地布置。
然而,这些电极254d、254e和254f整体上形成一个连续的高频电极254,从而具有与第九和第十实施方式所述的连续电极254a的效果相同的效果。
电极254d用作连续电极的一部分,电极254d被彼此分开地不连续地形成,因此,电极254d起到离散电极的作用。电极254e以与图22A所示的分支电极254c相同的方式被彼此分开。因此,电极254e用作连续电极的一部分并且起到分支电极的作用。此外,电极254f用作连续电极的一部分,并且电极254f被彼此分开地不连续地形成,因此,电极254f起到离散电极的作用。
也就是,这些电极254d、254e和254f不仅被用于发挥连续电极的作用以通过活体组织的变形而连续地接合活体组织,也发挥与图21D所示的离散电极254b和图22A所示的分支电极254c的作用类似的作用以使活体组织LT保持彼此紧密接触(被拉近)。
在该实施方式中,虽然图22B所示的由附图标记254d表示的电极、由附图标记254e表示的电极和由附图标记254f表示的电极的长度和电极之间的距离大致相等,但是长度和距离可以适当地改变。
根据该实施方式的处理系统10的效果与第九和第十实施方式所述的效果类似,因此省略对功能和效果的说明。
因此,例如,如示出第三实施方式的变型的图11A和图11B那样,允许电极254的多种变型。
第十二实施方式
现在将参考图23A至图23C说明第十二实施方式。该实施方式是第四至第六实施方式以及第九至第十一实施方式的变型。
如图23A至图23C所示,蒸汽排出槽256a被环状地形成于第一高频电极254的连续电极254a的外侧。该流体排出槽256a与布置有刀具242的第一流体流路246a连通。阻挡部258a被形成在流体排出槽256a外侧的比连续电极254a的表面高的位置。也就是,主体侧保持部222的阻挡部258a比连续电极254a的表面靠近可拆卸侧保持部224的头部264。
蒸汽排出槽256b被环状地形成于第一高频电极254的离散电极254b的外侧。该流体排出槽256b与流体排出槽256a以及第一流体流路246a连通。阻挡部258b被形成在流体排出槽256b外侧的比蒸汽排出槽256b的表面高的位置。也就是,主体侧保持部222的阻挡部258b比离散电极254b的表面靠近可拆卸侧保持部224的头部264。
注意,阻挡部258a的表面和阻挡部258b的表面彼此大致齐平。
流体排出槽276a被环状地形成于第二高频电极274的连续电极274a的外侧。阻挡部278a被形成在流体排出槽276a外侧的比连续电极274a的表面高的位置。也就是,可拆卸侧保持部224的阻挡部278a比连续电极274a的表面靠近主体侧保持部222。
蒸汽排出槽276b被环状地形成于第二高频电极274的离散电极274b的外侧。该流体排出槽276b与上述流体排出槽276a连通。阻挡部278b被形成在流体排出槽276b外侧的比离散电极274b的表面高的位置。也就是,可拆卸侧保持部224的阻挡部278b比离散电极274b的表面靠近主体侧保持部222。
注意,阻挡部278a的表面和阻挡部278b的表面彼此大致齐平。
此外,流体排出槽276a、276b与头部264和导电轴262的流体排出通道280连通。该流体排出通道280与导电管236的第二流体流路(流体通道)246b连通。此外,轴204或手柄202设置有流体排出口(未示出),通过第二流体流路246b的流体从该流体排出口被排出到外部。
现在将说明根据该实施方式的处理系统10的功能。
省略与第九实施方式所述的功能相同的根据该实施方式的处理系统10的功能的说明。
如图21B所示,在主体侧保持部222相对于可拆卸侧保持部224闭合的状态下,电外科装置12b的保持区206和轴204能够经由例如腹壁被插入到腹腔中。电外科装置12b的主体侧保持部222和可拆卸侧保持部224与待处理的活体组织相对。
作为处理目标的活体组织被保持在主体侧保持部222与可拆卸侧保持部224之间。此时,作为处理目标的活体组织接触第一高频电极254和第二高频电极274。作为处理目标的活体组织的周围的组织与主体侧保持部222的阻挡部258a、258b和可拆卸侧保持部224的阻挡部278a、278b紧密接触。
在该状态下,操作脚踏开关和手动开关。能量源14经由缆线28分别向第一高频电极254和第二高频电极274供给能量。
第一高频电极254使高频电流经由活体组织在第一高频电极254与第二高频电极274之间传导。因此,第一高频电极254与第二高频电极274之间的活体组织被加热。
然后,从活体组织的被加热部分中产生诸如高温蒸汽或液体等流体。这里,当第一高频电极254被固定到主体侧保持部222时,第一高频电极254的暴露于可拆卸侧保持部224侧的表面被定位成比主体侧保持部222的阻挡部258a、258b稍低。以同样的方式,当第二高频电极274被固定到可拆卸侧保持部224时,第二高频电极274的暴露于主体侧保持部222侧的表面被定位成比可拆卸侧保持部224的阻挡部278a、278b稍低。因此,主体侧保持部222的阻挡部258a、258b和可拆卸侧保持部224的阻挡部278a、278b用作使由于第一高频电极254和第二高频电极274之间的电传导而从活体组织中产生的流体进入到流体排出槽256a、256b、276a和276b中并且防止流体的泄漏的坝。
然后,在主体侧保持部222相对于可拆卸侧保持部224闭合的状态下,主体侧保持部222的阻挡部258a、258b与可拆卸侧保持部224的阻挡部278a、278b接触,使得从活体组织中产生的流体流动到流体排出槽256a、256b、276a和276b中。
随后,流动到主体侧保持部222的流体排出槽256a、256b中的流体经由布置有刀具242的第一流体流路246a通过刀具用推动件244的内部流向手柄202,并且被排出到电外科装置12b的外部。
另一方面,流动到可拆卸侧保持部224的流体排出槽276a、276b中的流体经由流体排出通道280和第二流体流路246b流向手柄202,并且被排出到电外科装置12b的外部。
如上所述,根据该实施方式,可以获得如下效果。
省略与第九实施方式所述的效果相同的根据该实施方式的处理系统10的效果的说明。
当通过电外科装置12b对由保持区206保持的作为处理目标的活体组织施加高频电流时,主体侧保持部222的阻挡部258a、258b和可拆卸侧保持部224的阻挡部278a、278b能够与活体组织紧密接触。因此,即使从作为处理目标的活体组织中产生的流体流向主体侧保持部222的阻挡部258a、258b和可拆卸侧保持部224的阻挡部278a、278b,也可以使该流体经由第一高频电极254的连续电极254a和阻挡部258a之间的蒸汽排出槽256a以及离散电极254b和阻挡部258b之间的蒸汽排出槽256b被导入到第一流体流路246a中。此外,可以使该流体经由第二高频电极274的连续电极274a和阻挡部278a之间的流体排出槽276a以及离散电极274b和阻挡部278b之间的流体排出槽276b被导入到第二流体流路246b中。
结果,在活体组织的处理期间,能够防止除了目标组织以外的周边组织受到从高频电流被传导至的部分产生的流体的影响。也就是,在活体组织LT的处理期间受到影响的位置能够被限制到第一高频电极254和第二高频电极274之间的已经被传导了高频电流的活体组织。
另外,在该实施方式所述的结构中,为了防止热扩散,在第一高频电极254的外周的流体排出槽256a、256b的周围设置阻挡部258a、258b,并且在第二高频电极274的外周的流体排出槽276a、276b的周围设置阻挡部278a、278b。此外,如第六实施方式(参见图16B至图16D)所述,设置由能够间接地冷却活体组织和诸如蒸汽等流体的硅材料制成的诸如冷却板104或薄的弹性片状构件114等结构也是优选的。
第十三实施方式
现在将参考图24A至图24C说明第十三实施方式。该实施方式是第七至第九实施方式和第十二实施方式的变型,相同的附图标记表示与第七至第九实施方式和第十二实施方式中说明的构件相同的构件,由此省略对这些相同构件的详细说明。
如图24A和图24B所示,从主体侧保持部222中去除了第九实施方式所述的多个离散电极254b(参见图21D),代替地,形成用于排出手术钉(维持构件,第二接合构件,施加部)282的多个狭槽284。多个狭槽284在与例如连续电极254a大致同轴的大致环形轨迹上被等间隔地形成于连续电极254a的外侧。
如图24A所示,滑板引导槽286被形成于主体侧保持部222的筒状构件232的内部。致动滑板288被可滑动地设置于滑板引导槽286中。致动滑板288被布置成与刀具242和刀具用推动件244平行,并且可以由手柄202以与刀具驱动杆214相同的方式操作该致动滑板288的移动,其中,该手柄202使用与刀具242和刀具用推动件244大致平行地被驱动的钉操作单元(未示出)。因此,主体侧保持部222也起到钉282的盒的作用。
从可拆卸侧保持部224去除了离散电极274b,代替地,设置钉282的变形槽292。也就是,多个钉变形槽292被形成于可拆卸侧保持部224的保持面224a。各钉变形槽292形成有例如大致弓形的底部,使得钉282的一对腿部能够被向内弯折和变形。因此,可拆卸侧保持部224也起到钉282的砧座的作用。
注意,主体侧保持部222的远端的狭槽284被形成为与可拆卸侧保持部224的钉变形槽292相对。
也就是,该处理系统10装配有电外科装置12b,该电外科装置12b使用连续电极254a、274a进行物理处理,也使用钉进行机械处理。
现在,将说明根据该实施方式的处理系统10的功能。
如第九实施方式所述,作为处理目标的活体组织LT被保持在主体侧保持部222和可拆卸侧保持部224之间。此时,活体组织LT接触连续电极254a、274a。
在该状态下,操作脚踏开关或手动开关。从能量源14分别向连续电极254a、274a供给能量。然后,连续电极254a、274a之间的活体组织LT被加热。
在作为处理目标的活体组织LT被保持在主体侧保持部222和可拆卸侧保持部224之间的状态下,用于吻合目的的组织被置于主体侧保持部222的狭槽284和可拆卸侧保持部224的钉变形槽292之间。在该状态下,操作手柄202的钉操作单元(未示出)。然后,致动滑板288向前移动。这里,如图24A所示,致动滑板288沿滑板引导槽286向前移动。
当致动滑板288向前移动时,狭槽284中的钉282突出并且被插入到用于吻合目的的组织中。被插入的钉282的一对腿部穿过活体组织LT。然后,由可拆卸侧保持部224的变形槽292使腿部向内弯折。由此,通过钉282使用于吻合目的的组织彼此吻合。结果,活体组织LT以机械的方式彼此离散地接合。
如上所述,根据该实施方式,可以获得如下效果。
连续电极254a、274a分别被布置于主体侧保持部222和可拆卸侧保持部224。从主体侧保持部222的连续电极254a的外侧的狭槽284中排出钉282,并且钉282的成对腿部在可拆卸侧保持部224的连续电极274a的外侧的钉变形槽292中被向内弯折。主体侧保持部222的连续电极254a和可拆卸侧保持部224的连续电极274a之间的活体组织LT能够被加热、变形和彼此连续地接合。结果,活体组织LT能够彼此紧密接触或彼此密封。此外,能够通过钉282使活体组织LT在这些活体组织被连续接合的部分的外侧附近被机械地离散接合。
因此,通过钉282接合的活体组织LT的部分起到使活体组织LT彼此靠近并且保持它们彼此紧密接触的作用。因此,在活体组织LT之间产生介面网,使得紧密接触的活体组织LT更容易地运用它们的组织再生能力,并且能够较早地再生。
虽然在该实施方式说明的示例中使用钉282使活体组织LT彼此机械地接合,但是,使用例如活体组织粘合剂使活体组织LT彼此接合也是优选的。
此外,如图24C所示,大致环形地并且密集地形成用于排出钉的狭槽296来代替主体侧保持部222的连续电极254a的结构也是优选的。
其它的优点和变型对本领域技术人员来说是显而易见的。因此,广泛意义上的本发明不局限于这里示出和说明的具体细节和典型实施方式。因此,在不脱离由所附的权利要求书及其等同结构限定的总的发明构思的精神或范围的情况下,可以进行各种变型。
Claims (15)
1.一种处理装置,其用于处理活体组织,其特征在于,所述处理装置包括:
密封构件,所述密封构件使至少两个活体组织的期望区域以密封的状态彼此接合;以及
维持构件,所述维持构件维持位于由所述密封构件接合的部分附近的活体组织之间的接触。
2.根据权利要求1所述的处理装置,其特征在于,所述维持构件包括多个构件,所述多个构件被配置成彼此分开,以对所述至少两个活体组织进行机械/物理作用。
3.根据权利要求1所述的处理装置,其特征在于,
所述密封构件包括对所述至少两个活体组织进行机械/物理作用的连续构件,以及
所述维持构件包括多个不连续构件,所述多个不连续构件对所述至少两个活体组织进行机械/物理作用,以维持位于由所述密封构件接合的部分附近的活体组织之间的接触。
4.根据权利要求1至3中的任一项所述的处理装置,其特征在于,所述密封构件包括通过高频波、加热器和钉中的至少一种来密封所述至少两个活体组织的构件,所述维持构件包括通过高频波、加热器和钉中的至少一种来维持位于由所述密封构件接合的部分附近的活体组织之间的接触的构件。
5.根据权利要求1至3中的任一项所述的处理装置,其特征在于,所述密封构件和所述维持构件被布置于保持所述至少两个活体组织的一对保持构件中的至少一个保持构件。
6.一种处理装置,其用于处理活体组织,其特征在于,所述处理装置包括:
一对保持构件,所述一对保持构件分别具有保持面以保持至少两个活体组织;
手柄,操作所述手柄以使所述一对保持构件中的至少一个保持构件相对于另一保持构件移动;以及
施加部,所述施加部被布置于所述一对保持构件中的至少一个保持构件,并且所述施加部密封所述至少两个活体组织并且维持位于被密封部分附近的活体组织之间的接触。
7.根据权利要求6所述的处理装置,其特征在于,所述施加部包括:
第一接合构件,所述第一接合构件被布置于所述保持面中的至少一个保持面,并且所述第一接合构件使所述至少两个活体组织以密封的状态彼此接合;以及
第二接合构件,所述第二接合构件被设置在所述第一接合构件的附近,并且所述第二接合构件被离散地布置,用于维持位于由所述第一接合构件接合的部分附近的活体组织之间的接触。
8.根据权利要求7所述的处理装置,其特征在于,
所述第一接合构件包括电极,所述电极被布置于所述保持面中的至少一个保持面,以及
所述第二接合构件包括多个电极,所述多个电极被布置于所述保持面中的至少一个保持面。
9.根据权利要求7所述的处理装置,其特征在于,
所述第一接合构件包括电极,所述电极被布置于所述保持面中的至少一个保持面,以及
所述第二接合构件包括多个电极,所述多个电极从所述第一接合构件的所述电极分支。
10.根据权利要求6至9中的任一项所述的处理装置,其特征在于,所述处理装置还包括:
至少一个阻挡部,所述至少一个阻挡部被设置成与所述施加部相邻,并且所述阻挡部被定位成与所述施加部一样高或比所述施加部高。
11.根据权利要求6至9中的任一项所述的处理装置,其特征在于,所述保持构件被设置在所述施加部的附近,并且所述保持构件包括流路或槽或管,其中,从所述保持构件保持的所述活体组织中产生的流体经过所述流路或槽或管。
12.根据权利要求7所述的处理装置,其特征在于,
所述第一接合构件是通过高频波、加热器和钉中的至少一种密封所述活体组织的构件,以及
所述第二接合构件是通过高频波、加热器和钉中的至少一种离散地接合所述活体组织的构件。
13.根据权利要求12所述的处理装置,其特征在于,当使用所述钉时,所述一对保持构件中的一个保持构件设置有狭槽以使所述钉突出,并且另一个保持构件的保持面设置有使所述钉的腿部变形的变形槽。
14.根据权利要求7所述的处理装置,其特征在于,所述第一接合构件和所述第二接合构件被连续地布置于所述保持面中的至少一个保持面。
15.根据权利要求6所述的处理装置,其特征在于,所述施加部在所述保持面中的至少一个保持面形成连续的波形。
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- 2008-07-31 WO PCT/JP2008/064176 patent/WO2009022614A1/en active Application Filing
- 2008-07-31 EP EP20080792283 patent/EP2178455B1/en not_active Not-in-force
- 2008-07-31 JP JP2010503298A patent/JP5220844B2/ja not_active Expired - Fee Related
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CN103385753A (zh) * | 2012-05-09 | 2013-11-13 | 科维蒂恩有限合伙公司 | 用于激活具有电切割机构的电外科血管封闭器械的设备 |
CN103417289B (zh) * | 2012-05-14 | 2017-07-28 | 科维蒂恩有限合伙公司 | 具有被包容的电气或机械系统的模块化手术器械 |
CN104602635A (zh) * | 2012-06-28 | 2015-05-06 | 伊西康内外科公司 | 多轴线关节运动和旋转外科工具 |
CN104602635B (zh) * | 2012-06-28 | 2018-01-26 | 伊西康内外科公司 | 多轴线关节运动和旋转外科工具 |
CN106604688A (zh) * | 2014-09-05 | 2017-04-26 | 奥林巴斯株式会社 | 把持处置单元、把持处置器具及把持处置系统 |
CN106604688B (zh) * | 2014-09-05 | 2019-04-19 | 奥林巴斯株式会社 | 把持处置单元、把持处置器具及把持处置系统 |
CN109475380A (zh) * | 2016-07-19 | 2019-03-15 | 奥林巴斯株式会社 | 处置器具 |
CN109475380B (zh) * | 2016-07-19 | 2022-03-01 | 奥林巴斯株式会社 | 处置器具 |
CN109788978A (zh) * | 2016-09-28 | 2019-05-21 | 奥林巴斯株式会社 | 处置器具 |
CN109788978B (zh) * | 2016-09-28 | 2022-03-01 | 奥林巴斯株式会社 | 处置器具 |
CN111246809A (zh) * | 2017-10-20 | 2020-06-05 | 伊西康公司 | 低温圆形外科钉合器及其使用方法 |
Also Published As
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JP2010536398A (ja) | 2010-12-02 |
EP2178455B1 (en) | 2015-05-06 |
EP2178455A1 (en) | 2010-04-28 |
WO2009022614A1 (en) | 2009-02-19 |
CN101778606B (zh) | 2013-06-12 |
EP2178455A4 (en) | 2011-06-22 |
US20090048589A1 (en) | 2009-02-19 |
JP5220844B2 (ja) | 2013-06-26 |
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