CN103153221A - 具有u形电极和/或共面电极的电外科装置 - Google Patents
具有u形电极和/或共面电极的电外科装置 Download PDFInfo
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Abstract
电外科装置(30a)包括手柄(101)、位于手柄远侧的轴杆(108)、与轴杆的远侧端部相邻的第一电极末端(102a)和第二电极末端(102b)。第一电极末端可与第二电极末端间隔开,并可包括第一U形电极。第二电极末端可包括第二U形电极。装置(30a)可包括至少一个流体出口,该至少一个流体出口用于在第一和第二电极的表面周围输送流体,并将流体输送到被治疗的组织表面上。第一电极(102a)可以与第二电极(102b)共面。第一电极可包括围绕第二电极的周界的U形线电极,并籍由一孔与第二电极间隔开。第一电极可包括尖末端。
Description
发明背景
技术领域
本发明总地涉及在手术过程中用于人体的医疗装置、系统和方法的领域。更具体地,本发明涉及在手术期间除了对组织进行凝结、止血和密封以抑制血和其它流体损失之外为切除组织而设置的电外科装置、系统和方法,这些手术诸如是腹部手术、矫形手术、头部手术、脊柱手术和胸部手术以及人体的常规手术。
背景技术
已开发了流体辅助的电外科装置,该电外科装置在与诸如盐水的导电流体结合时可沿组织表面移动,而不切除组织,以对组织进行密封,从而在手术期间抑制血和其它流体损失。然而,为了切除组织,外科医生必须采用第二装置,这需要与在两个装置之间进行切换相关的延迟。仍需要这样一种电外科装置,该电外科装置能在手术期间切除组织以及提供组织的流体辅助密封以抑制血和其它流体损失,以及抑制组织干化、组织粘附于电极、组织穿孔、成炭和生烟的不期望效应。还需要这样一种电外科装置,该电外科装置在减小侧向热扩散和对相邻组织的损害的情况下切除组织。
发明内容
本发明在一个实施例中可提供一种在存在来自流体源的流体和来自射频功率源的射频功率的情况下治疗组织的电外科装置,该射频功率源特别是提供双极功率输出和单极功率输出。该装置可包括远侧部,该远侧部包括第一电极末端、第二电极末端和至少一个流体出口。第一和第二电极末端可构造为双极电极,该双极电极构造成接收来自射频功率源的双极功率输出,以在存在双极功率输出和同时由远侧部提供的流体的情况下特别是通过沿组织表面移动来治疗组织。电极末端中的至少一个可构造为单极电极,该单极电极构造成接收来自射频功率源的单极功率输出,并提供电外科切除边缘,该电外科切除边缘构造成在存在双极功率输出和同时由远侧部提供的流体的情况下通过沿组织表面移动来切除组织。
在某些实施例中,电外科装置可包括手柄、位于手柄远侧的轴杆、与轴杆的远侧端部相邻的第一电极末端和第二电极末端以及至少一个流体出口,其中,第一电极末端与第二电极末端间隔开,并且第一电极末端包括U形的第一线电极,而第二电极末端包括U形的第二线电极。
第一和第二U形电极中的每个U形电极包括弧形远侧段和两个纵向段,两个纵向段相对于轴杆的远侧端部向远侧延伸。第一和第二U形电极中的每个U形电极的弧形远侧段从一个纵向段弯到另一纵向段,并可以在两个纵向段之间为半圆形。U形电极中的至少一个可提供切除边缘,该切除边缘可以是电外科切除边缘,并可沿U形电极的纵长来设置。切除边缘可特别是平直(直线)的。
第一电极和第二电极由金属线构成。金属线可以是单股(实心)线,并更特别地是圆形单股线。金属线可以是不锈钢线。这样,电极可具有较小质量,这可允许电极在组织治疗期间和之后快速地散热和冷却,这会由于侧向热扩散而抑制对(未被治疗的)相邻组织的破坏。
至少一个流体出口可位于轴杆的远侧端部处。更具体地,流体出口位于U形电极中的至少一个的两个纵向段之间。
至少一个流体出口可包括第一流体出口和第二流体出口;第一流体出口可位于第一U形电极的两个纵向段之间,而第二流体出口位于第二U形电极的两个纵向段之间。
U形电极可以共面。第一U形电极的两个纵向段和第二U形电极的两个纵向段可以平行,并更特别地位于单个平面内。
第一和第二U形电极中的每个U形电极的一个纵向段可以是内侧纵向段,而另一纵向段可以是侧旁纵向段。
第二U形电极的两个纵向段可以相对于第一U形电极的两个纵向段在内侧。
第一U形电极可围绕第二U形电极的周界,而第二U形电极可位于由第一U形电极限定的U形孔内。
第一和第二U形电极中的每个U形电极可包括弧形远侧段,且弧形远侧段可以是同心的。
第一U形电极和第二U形电极可具有相同尺寸和相同形状中的至少一种,且第一U形电极的位置和第二U形电极的位置可相对于彼此固定。
在某些实施例中,电外科装置可包括手柄、位于手柄远侧的轴杆、与轴杆的远侧端部相邻的第一电极末端和第二电极末端以及至少一个流体出口,其中,第一电极末端与第二电极末端间隔开,并且第一电极末端包括具有构成至少180°弧度的第一弧形线部的第一电极,而第二电极末端包括具有构成至少180°弧度的第二弧形线部的第二电极。
在某些实施例中,电外科装置可包括手柄、位于手柄远侧的轴杆以及与所述轴杆的远侧端部相邻的第一电极和第二电极,第一电极与第二电极共面,并包括U形的线电极,所述线电极围绕第二电极的周界,并与第二电极间隔开一孔。在某些实施例中,第二电极可包括具有直线段、U形或叶片状构件的线电极。该装置还可包括至少一个流体出口。
附图说明
图1是本发明系统的一个实施例的正视图,该系统具有与流体源和手持式电外科装置组合的电外科单元;
图2是图1所示电外科单元的前立体图;
图3是针对图1所示电外科单元的、双极RF功率输出关于阻抗的图表;
图4是示出Y轴上以每分钟立方厘米(cc/分钟)为单位的流体流量Q和X轴上以瓦为单位的RF功率设定值Ps的关系的图示;
图5是本发明电外科装置的立体图;
图6是示出具有图1所示电外科单元的、图5所示装置的各种电连接件和导体的平面图;
图7是具有图1所示电外科单元和流体源的、图5所示装置的各种流体连接件和通道的第一实施例的平面图;
图8是具有图1所示电外科单元和流体源的、图5所示装置的流体连接件和通道的第二实施例的平面图;
图9是图5所示装置的轴杆的放大图;
图10是沿图5中的线10-10剖取的、图5所示装置的电极的放大剖视图;
图11是沿图5中的线10-10剖取的、图5所示装置的电极的另一实施例的放大剖视图;
图12是沿图5中的线10-10剖取的、图5所示装置的10电极的另一实施例的放大剖视图;
图13是切除组织的、图5所示装置的立体图;
图14是具有至组织的组织表面的示例性流体联接部的、图5所示装置的远端部的放大图;
图15是本发明电外科装置的另一实施例的立体图;
图16是图15所示装置的轴杆的放大图;
图17是图15所示装置的轴杆的放大纵向剖视图;
图18是具有至组织的组织表面的示例性流体联接部的、图15所示装置的电极的放大图;
图19是沿线19-19剖取的、图15所示装置的放大剖视图,并具有至组织的组织表面的流体联接部的另一视图;
图20是图15所示装置的流体出口的另一实施例的放大图;
图21是图15所示装置的电极的另一实施例的放大图;
图22是本发明电外科装置的另一实施例的远端部的立体图;
图23是本发明的图22所示电外科装置的另一实施例的远端部的立体图;
图24是本发明电外科装置的另一实施例的远端部的立体图;
图25是本发明的图24所示电外科装置的另一实施例的远端部的立体图;
图26是本发明电外科装置的另一实施例的远端部的立体图;
图27是本发明电外科装置的另一实施例的远端部的立体图;以及
图28是本发明电外科装置的另一实施例的远端部的立体图。
具体实施方式
在整个说明中,相似的附图标记和字母在若干视图中表示对应的结构。同样,特定的示例性实施例的任何特定特征可适当地等效应用于此说明书的任何其它示例性实施例。换言之,文中所述的各种示例性实施例之间的特征可适当地互换,并且特征不是排他性的。从说明书中应理解到对术语“远侧”和“近侧”的任何使用都是参照装置的使用者、而不是患者的。
本发明提供这样的系统、装置和方法,即,这些系统、装置和方法用于在电外科手术期间控制组织治疗位点处的组织温度,以及例如通过收缩血管(例如,动脉、静脉)的内腔来对组织进行收缩、凝结、切除和密封以防血液和其它流体损失。由于较窄的电极尺寸,装置可构造成经过尺寸小至5毫米的套针装入。
现将参照附图来讨论本发明,图1示出了本发明系统的一个实施例的正视图,该系统可包括与流体源20和手持式电外科装置30结合的电外科单元10。此外,图1示出了具有包括中空圆筒形支柱的支承构件4的可动推车2,该支承构件承载包括基座台的平台6,以提供用于定位电外科单元10的平坦、稳定的表面。
如图所示,推车2还包括流体源承载杆8,该杆具有可通过在支承构件4内向上和向下滑动承载杆8来调节并随后借助定位螺钉固定在位的高度。在流体源承载杆8的顶上是横向支承件,该横向支承件在其端部处设有环,以提供用于承载流体源20的钩部。
如图1中所示,流体源20可包括一流体袋,特别是在用位于滴液室14的端部处的钉子刺穿袋之后,流体12可从该袋流经滴液室14。此后,流体12经由柔性和可压缩流体输送管件16流到手持式电外科装置30。可压缩流体输送管件16可由诸如聚氯乙烯之类的合成聚合物材料制成。
如图1所示,流体输送管件16经过泵22。如图所示,泵22包括蠕动泵,并更具体地是旋转蠕动泵。借助旋转蠕动泵,流体输送管件16的一部分可通过以已知方式升高和降低泵压头来加载到泵压头内。然后,流体12可借助从外部施加于管件16的收缩波来在输送管件16内传递,这些收缩波机械地、通常通过转动夹紧辊来产生,这些夹紧辊在驱动轴上转动并间歇地使管件16抵靠砧座(anvil)支承件压缩。蠕动泵会是特别较佳的,这是因为电-机械力机构、在此是由电动机驱动的辊不与流体12接触,由此减小意外污染的可能性。
在本实施例中,流体12可特别地包括液态盐水溶液,并甚至更特别地包括标准(0.9%w/v(质量/体积)NaCl(氯化钠)或生理)盐水。尽管在此的说明参照盐水作为流体12,但可以根据本发明来使用其它导电流体。
此外,尽管具有导电性的、类似于标准盐水的导电流体会是较佳的,但如随着进一步阅读此说明书变得更清楚的是,流体12也可以是不导电流体。不导电流体的使用尽管不提供如导电流体那样多的优点,但不导电流体的使用仍相对于干电极的使用提供一些优点,例如减少组织粘附于装置30的电极的可能性,并冷却电极和/或组织。因此,包括诸如去离子化水之类的不导电流体的使用也在本发明的范围内。
电外科单元10可特别地构造成提供单极和双极射频(RF)功率输出。然而,电外科单元10可特别地包括锁止特征,该锁止特征防止单极和双极输出同时被致动。替代地,不采用单个电外科单元10,装置30可同时连接到两个单独的电外科单元。例如,装置30可连接到第一电外科单元10以向其提供单极功率输出,并连接到第二电外科单元10以向其提供双极功率输出。
在电外科装置30的单极操作期间,第一电极、通常被称为主动电极可与电外科装置30一起设置,而第二电极、通常被称为中心或中性电极可以接地垫离散电极的形式设置(也被称为患者返回电极),该中心或中性电极位于患者身上、通常在背部或其它合适的解剖位置。然后,可以在主动电极和接地垫离散电极之间形成电路,其中,电流以已知的方式从主动电极经由患者流到接地垫离散电极内。
在电外科装置30的双极操作期间,不需要位于患者身上的接地垫离散电极,且提供第二电极性(electrical pole)的第二电极可设置为装置的一部分。然后,可以在装置的第一和第二电极性之间形成交流电电路。因此,交流电不再经患者人体流到接地垫电极,而是经由装置30的极性之间的、组织的局部部分。如上所示,单极和双极功率可如本领域中已知的那样由电外科单元10提供,或由单独的电外科单元提供。
如图1中所示,电外科装置30可经由电缆24和26连接到电外科单元10。电缆24示出有插头34,该插头连接到电外科单元10的双极输出插座38,而电缆26示出有插头42,该插头42连接到电外科单元10的单极输出插座46。暂转到图6,当电外科单元10可在单极模式下使用时,附加的电缆28可将接地垫离散电极48连接到电外科单元10的接地垫插座56。
图2示出了示例性电外科单元10的前面板。功率开关58可用于接通和切断电外科单元10。在接通电外科单元10之后,RF功率设定值显示器60可用于以瓦来数值地显示RF功率设定值。功率设定值显示器60还可包括液晶显示器(LCD)。
电外科单元10还可包括RF功率选择器62,该RF功率选择器包括可用于选择RF功率设定值的RF功率设定值开关62a、62b。按下开关62a可增大RF功率设定值,而按下开关62b则可减小RF功率设定值。电外科单元10还可包括RF功率致动显示器64,该RF功率致动显示器包括指示灯,该指示灯可在致动RF功率时经由装置30上的手动开关或脚踏开关来照亮。开关62a、62b可包括膜开关。应理解的是,尽管仅示出一个RF功率选择器62,但电外科单元10可具有两个此类RF功率选择器,一个用于单极选择,而另一个则用于双极选择。
除了具有RF功率设定值显示器60外,电外科单元10还可包括流体流量设定值显示器66。流量设定值显示器66可包括三个指示灯66a、66b和66c,其中,第一灯66a对应于低流体流量设定值,第二灯66b对应于中等(中间)流体流量设定值,而第三灯66c对应于高流体流量设定值。三个指示灯中的一个将在选择流体流量设定值时照亮。
电外科单元10还可包括流体流量选择器68,该流体流量选择器包括用于选择或切换流量设定值的流量设定值开关68a、68b和68c。可设有三个按钮开关,其中,第一开关68a对应于低流体流量设定值,第二开关68b对应于中等(中间)流体流量设定值,而第三开关68c则对应于高流体流量设定值。按下这三个开关中的一个可选择低、中等(中间)或高的对应流量设定值。如果没有手动选择设定值,中等或中间的对应流量设定值可作为缺省值自动选择。开关68a、68b和68c可包括膜开关。
在开始外科手术之前,会期望预备好有流体12的装置30。预备会是期望的,以在没有流体12的情况下阻止RF功率致动。预备开关70可用于开始具有流体12的装置30的预备。按下开关70一次可开始泵22的操作一预定时间段以预备装置30。在该时间段结束之后,泵22可自动切断。当初始化装置30的预备时,包括指示灯的起动显示器72会在起动循环期间照亮。
图3中示出了电外科单元10的示例性双极RF功率输出曲线。阻抗Z在X轴上以欧姆为单位示出,而RF输出功率Po在Y轴上以瓦为单位示出。在所述实施例中,双极电外科功率(RF)设定到200瓦。如图所示,对于200瓦的RF功率设定值Ps来说,输出功率Po相对于设定的RF功率Ps保持恒定,只要阻抗Z留在30欧姆的低阻抗截止值和120欧姆的高阻抗截止值之间即可。在30欧姆的阻抗Z以下,输出功率Po将如由低阻抗斜坡所示地下降。在120欧姆的阻抗Z以上,输出功率Po将如由高阻抗斜坡所示地下降。关于单极功率输出,示例性的单极RF功率输出曲线将包括针对切除或凝结模式的、以参见的形式纳入本文的Valleylab(威利)的ForceFX(力FX)的功率输出。
电外科单元10可构造成泵22的速度及因此由泵22排出的流体22的通过量基于两个输入变量、即RF功率设定值和流体流量设定值来预先确定。图4中示出了有在Y轴上以每分钟立方厘米(cc/min)为单位的流体流量Q和在X轴上以瓦为单位的RF功率设定值Ps的示例性功能关系。该关系设计成抑制诸如组织干化、电极粘附、生烟和成焦之类的不期望作用,同时不在对应的RF功率设定值Ps处提供大到在电极/组织交界部处过多冷却和电离散的流体流量Q。尽管不一定限于特定的理论,但可以在2001年10月18日公开的美国公开第2001/0032002号中找到关于流体流量如何与射频功率如何相互作用、从组织传出热量的模式、流体的部分沸腾和各种控制策略的更详细讨论,该专利申请已转让给了本发明的受让人,由此以它们一致的程度使它们的全部内容以参见的方式纳入本文。
如图4所示,电外科单元10被设计成随增大的RF功率设定值Ps线性地增大流体流量Q,该流体流量分别是对应于QL、QM和QH的低、中和高的三个流体流量中的每个流体流量。相反地,电外科单元10构造成随着RF功率设定值Ps的减小线性地减小流体流量Q,该流体流量分别是对应于QL、QM和QH的低、中和高的三个流体流量中的每个流体流量。
尽管没有单极输出,类似于示例性电外科单元10并具有详细示意附图的电外科单元可以在2006年7月6日公开的美国公开第2006/0149225号中找到,该专利申请转让给本发明的受让人,由此以它们一致的程度使它们的全部内容以参见的方式纳入本文。
尽管电外科单元10如上所示包括附连的泵22,但在其它实施例中,泵22可以不与电外科单元10集成,而是与电外科单元10分离。
在其它实施例中,可取消泵22,并且可以不在电外科单元10内存储有流体流量Q关于RF功率设定值PS的预设定的功能关系。在此情况下,不是基于RF功率设定值PS来由电外科单元10自动控制流体流量Q,流体流量Q可诸如由装置10使用者或外科手术团队的另一成员、借助与装置10一起设置的辊子(夹紧)夹具或其它夹具手动地进行控制,并构造成以本领域中已知的方式作用于管件16并压缩该管件,并控制流。在2005年4月28日公开的美国公开第2005/0090816号中找到示例性的流体流量控制机构,该专利申请已转让给本发明的受让人,由此以它们一致的程度使它们的全部内容以参见的方式纳入本文。不包括泵、但可与装置10上手动操作的流体流量控制机构结合使用的电外科单元的示例包括诸如Valleylab的Force FX之类的电外科单元。
图5中以附图标记30a来示出可与本发明的电外科单元10结合使用的、本发明的示例性单极和/或双极电外科装置。尽管本发明的各种电外科装置在此参照用于电外科单元10来描述,但应理解到对组合的说明是出于说明本发明的系统的目的。由此,应理解到尽管在此公开的电外科装置公开为可与电外科单元10一起使用,但采用其它电外科装置与电外科单元10一起使用也可行,或者采用在此公开的电外科装置与另一电外科单元一起使用也可行。
如图5所示,示例性装置30包括细长手持件100,该手持件具有包含匹配的手柄部101a、100b的手柄101。手持件100可构造成使装置30a的使用者象书写器具那样在大拇指和食指之间保持和操纵装置30a。手柄101可包括可消毒的刚性电绝缘材料,诸如是合成聚合物(例如,聚碳酸酯、丙烯腈-丁二烯-苯乙烯)。
装置30a还如图1中所示包括电缆24和26,这些电缆可连接到电外科单元10,以向装置30a提供分别来自电外科单元10的双极和单极功率输出。如图6进一步所示,装置30a的电缆24可包括三根绝缘线导体32a、32b、32c,这三根绝缘线导体可经由三个香蕉型(阳)插头连接器36a、36b、36c连接到电外科单元10的双极功率输出插座38a、38b、38c。香蕉型插头连接器36a、36b、36c均可以已知的方式与绝缘线导体32a、32b、32c一起组装在插头34的外壳内。在装置30a上,绝缘线导体32a可连接到双极手动开关组件110,而绝缘线导体32b和32c可特别是通过焊接连接到电极102a、102b的近侧部。
电极102a、102b此后可延伸通过直线形导管,这些导管由包括轴杆本体106的细长刚性电绝缘轴杆108的圆筒形通道104a、104b提供。轴杆本体106可包括可消毒的刚性电绝缘材料,诸如合成聚合物(例如,聚碳酸酯、丙烯腈-丁二烯-苯乙烯)。在装置30的远端部处,具有U形环的电极102a、102b的远侧部从细长轴杆本体106的通道104a、104b伸出。
装置30a的电缆26可包括两根绝缘线导体40a、40b,这两根绝缘线导体可经由两个香蕉(阳)型插头连接器44a、44b连接到电外科单元10的单极功率输出插座46a、46b。香蕉型插头连接器44a、44b均可以已知的方式与绝缘线导体40a、40b一起组装在插头42的外壳内。在装置30a上,绝缘线导体40a可连接到单极手动开关组件112,而绝缘线导体40b可连接到电极102b的近侧部。如图所示,线导体32b和40b可在手柄100内合并,并共用相同的电极102b的附连位置。
当装置30a在单极模式下使用时,附加的电缆28可用于将附连于患者的接地垫离散电极48连接到电外科单元10,该电缆28包括线导体50和插头52,插头52在其端部处具有连接到接地垫插座56的插头连接器54。
手动开关组件110和112可分别包括按钮114和116,这些按钮置于包括印刷电路板的平台上的半球形开关上,手动开关组件110和112以本领域中已知的方式进行构造和配线。当按下按钮114或116时,位于按钮下方的半球形开关形成由电外科单元10感测到的闭合回路,然后该闭合回路分别提供双极或单极功率。示例性的手动开关可在2006年7月6日公布的美国公开第2006/0149225号和2005年4月28日公布的美国专利第2005/0090816号中找到,这些申请转让给本发明的受让人,并由此以它们一致的程度使它们的全部内容以参见的方式纳入本文。
如图7所示,在装置30a的使用期间,来自流体源20的流体12可经由由各种结构提供的管状流体通道来连通。在本实施例中,来自流体源20的流体12首先通过输送管件16的内腔18来连通。然后,流体12可流经构造成专门与蠕动泵22一起操作的特殊泵管件段118的内腔120,该管件段118可在输送管件16的各部分之间分路,并在其每个端部处采用倒钩状流体管线连接器122连接到输送管件16。
在装置30a的手柄101内,流体输送管件16可连接到Y分配器124的入口分支,该分配器此后提供两个出口分支,这些出口分支可连接到输送管件段128a、128b的近侧端部。输送管件段128a、128b的远侧端部可通过插入到轴杆本体106的圆柱形接纳部132a、132b(沉孔(counter bore))连接到轴杆本体106。然后,流体12可流经输送管件段128a、128b的内腔130a、130b,并流入在轴杆本体106内形成的管状通道134a、134b。然后,流体12可在轴杆本体106的远端138处从流体输送出口136a、136b排出。
替代地,如图8所示,流体输送管件16可直接插入轴杆本体106的接纳部132内。然后,流体12可在分叉到轴杆本体106内的通道134a、134b内之前流经通道134,并从流体输送出口136a、136b排出。同样,替代地,单个流体出口136可如图10所示位于电极102a、102b之间,在此情况下可省略出口136a、136b。
图9提供了轴杆本体106、U形电极102a、102b和流体输送出口136a、136b的放大图。如图所示,U形电极102a、102b可设置成提供两个固定的侧向和空间上间隔开(空间)的电极末端,这些电极末端可构造成在尺寸和形状上是镜像,并可具有较钝的圆形远侧端部,该远侧端部提供光滑的连续表面(没有尖点或边缘)以治疗组织。如图所示,U形电极102a、102b可以共面(即,在相同平面内)。
与轴杆本体106的远侧端部138相邻的U形电极102a、102b均可包括侧部纵向段140a、140b和内侧纵向段142a、142b,这些纵向段从轴杆本体106的远侧端部138向远侧延伸,并在弧形远侧段144a、144b的近侧。应理解到尽管电极102a、102b已描述为具有各种段,但该描述意在提供这种段相对于装置的定向,而不是指电极102a、102b一定由已连结在一起的、分开成形的单独段来提供。相反,每个电极102a、102b可特别地由单个连续构件构成,诸如下面更详细所述的单个连续线。
如图所示,弧形远侧段从一个纵向段连续弯到另一纵向段,而没有中断,并更具体地可以是具有180°半径的半圆形。同样如图所示,流体输送出口136a位于纵向段140a、142a之间,而流体输送出口136b位于纵向段140b、142b之间。这样,从流体输送出口136a、136b排出的流体可以更好地分别形成纵向段140a、142a和140b、142b之间的流体膜,如下面更详细讨论的那样。
返回到图7,侧部纵向段140a、140b经轴杆本体106的长度延伸。然而,内侧纵向段142a、142b保持在接纳部(沉孔)146a、146b内(例如,过盈/摩擦配合)并从这些接纳部延伸,这些接纳部形成于轴杆本体106的远侧端部内。如图所示,侧部纵向段140a、140b和内侧纵向段142a、142b都平行且共面(在相同平面内)。
电极102a、102b可特别地由单股金属(特别是不锈钢)线来构成。每个电极102a、102b可具有在4毫米到15毫米、并更具体地在6毫米到12毫米之间的任何增量和该范围内的总(露出)长度L。每个电极102a、102b可具有1毫米到4毫米、并更具体地2毫米到3毫米之间的任何增量和该范围内的宽度W。
如图10所示,线可以是圆柱形的,并具有圆形的横截面轮廓,该轮廓具有0.1毫米到1.5毫米、并更具体地0.5毫米到1毫米、并甚至更具体地0.6到0.75毫米之间的任何增量和该范围内的横截面厚度、在此为直径。
关于间距,电极102a、102b之间的空间间隙距离GS可以在0.1毫米到3毫米、更具体地在0.5毫米到2毫米、并甚至更具体地在0.75毫米到1.5毫米之间的任何增量和该范围内。每个电极102a、102b的侧旁段140a、140b与内侧段142a、142b之间的间距可以在0.1毫米到3毫米、更具体地在0.5毫米到2毫米、并甚至更具体地在0.75毫米到1.5毫米之间的任何增量和该范围内。
如图11所示,侧部纵向段140b的长度的至少一部分可以通过磨削或砂型特别地由圆形线成形,以具有这样的剖面轮廓,即,该剖面轮廓具有相对侧部150b/152b,这些侧部侧向会聚,以在周界上提供楔形叶片部154b,该叶片部止于直线形侧向切除边缘156b,该侧向切除边缘沿纵向段140b的长度纵向延伸。如图所示,在替代的实施例中,其余纵向段140a、142a或142b中的任一个纵向段可具有与段140b相同的剖面轮廓。
如图11所示,叶片部154b随着相对侧部150b/152b接近切除边缘156b而变窄。更具体地,叶片部154b的侧面150b/152b是平面的。然而,在其它实施例中,侧部150b/152b可以是凹入或凸出的。
如图12所示,侧部纵向段140b的长度的至少一部分可以通过磨削或砂型特别地由圆形线成形,以具有这样的轮廓,即,该轮廓具有相对侧部150b/152b,这些侧部大致平行并止于直线形侧向切除边缘156b,侧向切除边缘沿纵向段140b的长度纵向延伸。如图所示,在替代的实施例中,其余纵向段140a、142a或142b中的任一个纵向段可具有与段140b相同的轮廓。在此,段140具有多边形轮廓,并更特别地具有长方形轮廓。
对于如图11和12所示的电极102a、102b,侧向切除边缘156b可特别地构造成在如下情况下以电外科方式切除组织,即,存在来自电外科单元10的单极射频能量,以提供电外科切除边缘,但没有从流体源20提供的任何流体12。然而,在其它实施例中,侧向切除边缘156b可构造成在同时由装置30a提供流体12的情况下切除组织,或者构造成在没有电外科能量的情况下机械地(尖锐地)切除组织。现参照图13,装置30a可用于通过如下方式来切除组织,即,向组织200施加电极102b的切除边缘156b,并在组织内沿期望的创口线或切除线来移动电极102b,以形成所描述的缺口。
尽管切除边缘156b可特别地构造成借助单极RF能量、而流体12不从装置30a排出来切除组织,弧形远端段144a、144b可特别地构造成在存在来自电外科单元10的双极射频能量和来自流体源20的流体12的情况下、在组织表面上滑动或以其它方式移动。
如图14所示,装置30a可用作双极装置的一种方式是电极102a、102b的纵向轴线垂直定向,而电极102a、102b的弧形远侧段144a、144b与组织200的组织表面202相邻地侧向隔开。当以此方式使用装置30a时,电极102a、102b可连接到电外科单元10,并接收双极射频能量,该双极射频能量在位于电极102a、102b之间的组织200内形成交流电电场。在存在交流电的情况下,电极102a、102b在电流从正电荷流到负电荷的情况下使极性在正电荷和负电荷之间交替。在不限于特定理论的情况下,通过电阻式加热来对组织进行加热。
除了提供装置30a和组织200之间的电联接之外,流体12润滑组织200的表面202,并便于电极102a、102b在组织200的表面202上运动。在电极102a、102b的运动过程中,电极102a、102b通常在组织200的表面202上滑动。通常,装置30a的使用者借助涂抹运动使电极102a、102b在组织200的表面202上来回滑动,同时将流体12主要用作润滑涂层。较佳地,流体12在位于联接部204a、204b的外边缘处的组织200的表面202与电极102a、102b的弧形远侧段144a、144b之间的厚度在0.05毫米到1.5毫米之间的范围内。同样,在某些实施例中,电极102a、102b的弧形远侧段144a、144b可与组织200的表面202接触,而在两者之间没有任何流体12。
如图14所示,从流体出口136a、136b排出的流体12会以液滴208a、208b的形式或者作为膜210a、210b在电极102a、102b上向远侧流动,膜经U形孔160a、160b延伸,并在电极102a、102b的纵向段140a、142a之间桥接。如图14所示,由从流体出口136a、136b排出的流体在变化的时间内可形成液滴208a、208b。同样,根据例如装置定向、压力、流量和变化的流体出口尺寸,流体12可以变化的量从每个流体出口136a、136b排出。借助装置30a,由于在对电极102a、102b进行表面精加工时的变化,液滴208a、208b和膜210a、210b的物理特征还可变化。例如,当膜沿电极102a、102b向远侧前进时,膜210a、210b可在其任一端部处形成弯月型弯曲部。
桥接孔160a、160b的、呈膜210a、210b形式的流体12可提供相对于液滴208、208b的某些优点,这是因为膜210a、210b在沿电极102a、102b的纵向段向远侧流动之后可更均匀地分布在电极102a、102b的弧形远侧段144a、144b上,以然后形成流体联接部204a、204b。同样,在沿电极102a、102b向远侧流动时,膜210a、210b可以更好地保持电极102a、102b,并且不会如液滴208a、208b的情况那样滴下。
如图14所示,流体联接部204a、204b可特别地包括分立的局部的网,并更具体地包括组织200的表面202和电极102a、102b之间的流体12的三角形网。当电外科装置30a的使用者将电极102a、102b放置在组织治疗位点处并使电极102a、102b在组织200的表面202上运动时,流体12围绕电极102a、102b的表面从流体出口136a、136b排出,并经由联接部204a、204b排出到组织200的表面202上。同时,向组织表面202处及其下方的组织200提供由电场线206所示的RF电能,该RF电能通过流体联接部204a、204b进入组织200内。以前述方式,装置30a可用于密封组织以防血液和其它流体损失。
因此,尽管切除边缘156b可特别地构造成采用单极RF能量、并在流体12不从装置30a排出的情况下来切除组织,但在存在来自电外科单元10的双极射频能量和来自流体源20的流体12的情况下,弧形远端段144a、144b可特别地构造成在组织表面上滑动或以其它方式移动。
装置30的另一实施例在图15-18中示出为装置30b。如图所示,U形电极并不如实施例30a那样并排间隔开,而是U形电极设置成U形电极102a的周界由U形电极102b围绕,而U形电极102a位于由电极102b限定的U形孔160b内。这样,电极102a的两个纵向段140a、142a现在位于电极102b的两个纵向段140b、142b的内侧。反之,电极102b的两个纵向段140b、142b现在位于电极102a的两个纵向段140a、142a的侧旁。与装置30a相比,装置30b的电极可构造略窄,这使装置30b比装置30a不易插入,并且使装置30b以更大的可视性提供至更限制位置的更大通路。
如图所示,电极102a、102b的弧形远侧段144a、144b可同心。换言之,弧形远侧段144a、144b可具有共同的中心点CP。如图所示,类似于实施例30a,U形电极102a、102b共面(在相同平面内)。还类似于实施例30a,纵向段140a、140b和纵向段142a、142b都平行且共面(在相同平面内)。还类似于实施例30a,U形电极102a、102b可具有如图10-12中阐释的相同的横截面轮廓。这样,电极102b仍可包括切除边缘156b,该切除边缘特别地构造成借助单极RF能量并且在没有流体12从装置30b排出的情况下切除组织。
如图18-19所示,装置30b可用作双极装置的一种方法是使电极102a、102b的纵向轴线大致水平定向。当以此方式使用装置30a时,电极102a、102b可连接到电外科单元10,并接收双极射频能量,该双极射频能量在由装置30b提供的流体12与电极102a、102b之间的组织200内形成交流电电场。
除了提供装置30a和组织200之间的电联接之外,流体12润滑组织200的表面202,并便于电极102a、102b在组织200的表面202上运动。如图18-19所示,从流体出口136排出的流体12可形成流体联接部204。
如图19所示,流体联接部204可特别地包括局部的网,并更具体地包括组织200的表面202和电极102a、102b之间的流体12的三角形网。当电外科装置30b的使用者将电极102a、102b放置在组织治疗位点处并使电极102a、102b在组织200的表面202上运动时,流体12围绕电极102a、102b的表面从流体出口排出,并经由联接部204排出到组织200的表面202上。同时,向组织表面202处及其下方的组织200提供由电场线206所示的RF电能,该RF电能通过流体联接部204提供到组织200内。以前述方式,装置30b可用于密封组织以防血液和其它流体损失。
如图15-19所示,流体出口136可位于电极102a的纵向段140a、142a之间。如图20所示,流体出口136可位于电极102a的纵向段142a与电极102b的纵向段142b之间。流体出口136可位于电极102a的纵向段140a与电极102b的纵向段140b之间。在各种实施例中,任何流体出口136可单独地或如图所示与任何其它流体出口136结合地使用。例如,图20所示的流体出口136中的一个或两个可与图15-19中所示的流体出口136结合使用。
对于如图15-19所示的装置30b的实施例,外电极102b具有与内电极102a相同的横截面轮廓,即外电极的厚度、在此是直径等于内电极102a的直径。然而,如图21所示,外电极102b可具有比内电极102a小的横截面轮廓,即厚度、在此为直径小于内电极的直径,以便于以较窄的伤口来切除,以及在密封组织期间更好地顺应于组织表面,特别是通过在由使用者施加微小的压力时进行变形。
在装置30的另一实施例(示出为图22中的装置30c)中,电极102a可包括不具有U形的单个纵向段166。类似于装置30b,电极102a的周界被U形电极102b围绕,而电极102a定位在由电极102b限定的U形孔160b内。这样,电极102a的纵向段166在电极102b的两个纵向段140b、142b的内侧。反之,电极102b的两个纵向段140b、142b在电极102a的纵向段166的侧面。与装置30b相比,装置30c的电极构造可略窄,这使装置30c比装置30b不易插入,并且以更大的可视性向装置30c提供至更限制位置的更大通路。
如图所示,类似于实施例30a和30b,电极102a、102b共面(在相同平面内)。还类似于实施例30a和30b,纵向段166和纵向段142a、142b都平行且共面(在相同平面内)。还类似于实施例30a和30b,电极102a、102b可具有与图10-12中阐释的相同的横截面轮廓。这样,电极102b仍可包括切除边缘156b,该切除边缘特别地构造成借助单极RF能量并且在没有流体12从装置30c排出的情况下切除组织。
如图22所示,流体出口136可位于电极102a的纵向段166与电极102b的纵向段142b之间。流体出口136还可位于电极102a的纵向段166与电极102b的纵向段140b之间。装置30c可类似于装置30b用于如文中所述地切除和密封组织。在替代的实施例中,如图23所示,诸如由合成聚合物(例如,乙缩醛)构成的电绝缘件164可位于两个电极102a、102b之间,并特别在电极102a的远端与电极102b的弧形段144b之间,以更好地保持电极102a、102b彼此之间的位置。
在装置30的另一实施例(示出为图24中的装置30d)中,电极102a呈纵向定向的细长叶片状构件170的形式,该叶片状构件具有平坦本体,并诸如可通过已插入轴杆本体106的管状通道134内的金属(例如,不锈钢)管件172的平坦部来提供。这样,流体输送管件16的内腔18可与金属管件172的内腔174流体连通,以使流体12可从与如由管件172限定的叶片构件170的相对侧部178、180相邻地从流体输送出口136排出,并且绝缘线导体32c可特别是通过焊接连接到管件的近侧部。关于尺寸,电极102a的叶片构件170可具有4毫米到15毫米、并更具体地6毫米到12毫米之间的任何增量和该范围内的长度。叶片构件170可具有1毫米到4毫米、并更具体地2毫米到3毫米之间的任何增量和该范围内的宽度。叶片构件170可具有在0.1毫米到1.1毫米的范围内、并在一些实施例中为约0.6毫米的、表面178和表面180之间的厚度。
类似于装置30b和30c,电极102a的周界被U形电极102b围绕,而电极102a定位在由电极102b限定的U形孔160b内。这样,电极102a的叶片构件170在电极102b的两个纵向段140b、142b的内侧。反之,电极102b的两个纵向段140b、142b在电极102a的叶片构件170的侧旁。
如图所示,类似于实施例30a-30c,电极102a、102b共面(在相同平面内)。还类似于实施例30a-30c,叶片构件170和纵向段142a、142b都平行且共面(在相同平面内)。还类似于实施例30a-30c,电极102b可具有如图10-12中阐释的相同的横截面轮廓。这样,电极102b仍可包括切除边缘156b,该切除边缘特别地构造成借助单极RF能量并且在没有流体12从装置30c排出的情况下切除组织。
叶片构件170从一(顶)侧178到另一(底)侧180的周界176可以如图所示为半圆形,或者可如图11或12中所示地具有较窄边缘或尖锐边缘156b。同样,如图所示,叶片构件170的远侧端部182在叶片构件170的宽度上为弧形,并且更具体地为半圆形。同样如图所示,电极102b的弧形远侧段144b和叶片构件170的弧形远侧端部182可以是同心的。如图25所示,流体出口136可与叶片构件170的纵向周界平行定向,以更好地将流体16直接馈送到孔160b内。
在装置30的另一实施例(示出为图26中的装置30e)中,叶片构件170可具有球形远侧端部182。如图26所示,远侧端部182包括从侧部178向上延伸的第一半球形表面184。远侧端部182还包括从相对侧180向下延伸的第二半球形表面186。第一半球形表面184和第二半球形表面186一起在远侧端部182处构成球形表面。形成球形远侧端部182的第一和第二半球形表面184和186增大电极102与组织接触的表面积。
在装置30的其它实施例(示出为图27和28中的装置30f和30g)中,外电极102b分别包括导电尖末端145和145’。特别是,在如图27所示的一个实施例中,尖末端145包括一对相对的纵向段147。相对的纵向段147从弧形段144b向远侧延伸。当相对的段147远离弧形段144b延伸时,段147之间的空间变窄。相对的纵向段147在弧形段151处连结起来。在一个实施例中,如图27所示,纵向段147均具有凹入形状。在一个实施例中,与弧形段151相邻的纵向段147之间的宽度小于纵向段140b和142b之间的宽度。在一些实施例中,纵向段147和弧形段151的长度的范围从约2.5毫米到约7.5毫米,并且在一些实施例中长度为约5毫米。
另一实施例在如图28示出为具有尖末端145’的装置30g。如图所示,尖末端145’包括在弧形段151处连结的相对纵向段147以及从纵向段140b和142b延伸的一对相对弧形段149。在实施例中,弧形段149绕远侧端部182向内弯曲,以使段149与远侧端部182同心。在一个实施例中,纵向段147从弧形段149的远侧端部向远侧延伸,并在弧形段151处连结。在一些实施例中,纵向段147具有范围从约2.5毫米到约7.5毫米的长度,并且在一些实施例中长度为约5毫米。在一个实施例中,如图28所示,纵向段147之间的宽度小于纵向段140b和142b之间的宽度,并还小于刀片构件170的宽度。
与装置30b和30c相比,装置30d、30e、30f和30g并特别是这些装置的电极102b可预计以相似的方式切除组织。在包括如图27和28所示的装置30f和30g的实施例中,尖端末端145和145’的较窄宽度导致能量在末端145和145’处比在电极102b的其余周界周围、比在例如纵向段140b和142b周围更定向,这允许更细致的精确切除,同时仍允许经由电极102b的其余周界来切除。尖末端145和145’还能起到匙状物(spoon)的作用,以使组织质块能用尖末端145和145’挖取。尖末端145和145’能用于刺穿组织。
关于密封组织,装置30d-30g能够通过具有如由叶片构件170提供的电极102a的增大的表面积来密封更大面积的组织,以防血液和其它流体损失。在实施例30e-30g中,参照装置30d如上所述,流体出口136可诸如图24所示或如图25所示地定向。
在此公开的装置30a和各种实施例(诸如30a-30g)可以特别用于使外科医生在切穿软组织之后实现止血,这作为臀或膝关节形成术的一部分。可通过在组织200的原始渗出表面202上进行喷涂运动来使装置30的电极102a、102b运动,以密封组织200以防出血,或集中于单独的较大出血血管,以阻止血管出血。作为相同或不同过程的一部分,装置30可用于阻止由于切除骨或骨质组织的表面造成的出血,这作为需要切除骨的任何矫形术的一部分。装置30在矫形膝盖、臀部、肩部和脊椎手术期间特别有用。关于这种手术的附加讨论可在2006年7月6日公布的美国公开第2006/0149225号和2005年4月28日公布的美国专利第2005/0090816号中找到,这些申请转让给本发明的受让人,并由此以它们一致的程度使它们的全部内容以参见的方式纳入本文。
文中公开的装置30和各种实施例(诸如30a-30g)可特别地用作提供组织切除的非接合(non-coaptive)装置,以及对组织进行凝结、止血和密封,以在手术期间抑制血和其它流体损失。换言之,例如通过使血管(例如,动脉、静脉)的相关腔体和胶原质收缩以提供组织的期望止血而对组织进行收缩、凝结和密封以防失血不需要抓持组织。此外,由于电极的构造,电极可根据需要由组织的使用者容易地进行弯曲。电极还可用于其它功能,诸如提供用于挖取诸如非正常组织块(例如,癌)之类的组织的匙状平台(如参照包括装置30f和30g的实施例之前所述)。在一些实施例中,装置30a-30g的电极102a和102b的远侧末端可弯曲成减小远侧末端捕获于组织上的可能性。包括装置30b-30g的实施例的第一和第二电极102a和102b的构造能用于单极模式(例如,用于切除)和双极模式(例如,用于组织密封)。在单极模式下,电极102b用作用于切除的单极电极,能采用扫掠运动在电极的两侧进行这种切除。因此,装置30b-30g的电极102b不限于一个电极的仅一侧以实现切除。此外,当在组织密封的双极模式下使用时,两个电极102a和102b与组织接触,并且在一些实施例中可以是柔性的,以确保为了组织密封而更好地接触。此外,文中所述的实施例提供对由医师所治疗的组织的改善的可视性。
在包括具有共面电极102a和102b的装置30b-30g的一些实施例中,电极102a和102b构造成具有最小表面积和最小质量。表面积和质量的减小可允许装置30b-30g更冷、更快地进行操作,并且热损伤更少(例如通过提供较小功率和在治疗的组织位点处更少的热扩散)。在一些实施例中,为电极102b所设定的形状可构造成使密封最大化或最小化,并构造成挖取或刺穿组织。在包括装置30b-30g的一些实施例中,装置30能构造成用于5毫米套针。
此外,电外科单元10的控制系统不一定取决于温度或阻抗之类的组织反馈来进行操作。因此,电外科单元10的控制系统相对于组织可以是开环的,这简化了使用。
如上所建立的,本发明的装置30抑制组织干化、电极粘附、生烟和成焦的这种不期望作用,并由此不经受与现有技术的干末端电外科装置相同的缺点。公开的装置的使用可导致在手术过程中失血的大幅降低。这种失血的减少会使输血的需求减少或消除,并且与输血相关的成本和负面的医疗后果,诸如延长住院,会减少或消除。
尽管描述了本发明的较佳实施例,但应理解到可以在不脱离本发明的精神和所附权利要求书的范围的情况下对本发明进行各种改变、适应和修改。因此,本发明的范围应不是参照上述说明来确定的,而是替代地应参照所附权利要求书连同其等同物的全部范围来确定。此外,应理解到所附权利要求书不一定包括申请人要求的本发明的最宽范围,或者本发明可要求或所有列出的特征的方式是必要的。
在此申请中列举的所有公开和专利文献通过参见的方式以它们一致的程度纳入本文。
Claims (39)
1.一种电外科装置,包括:
手柄;
轴杆,所述轴杆联接于所述手柄;
第一电极末端和第二电极末端,所述第一电极末端与所述第二电极末端与所述轴杆的远侧端部相邻,所述第一电极末端与所述第二电极末端共面,其中,所述第一电极末端包括U形的第一线电极,而所述第二电极末端则包括U形的第二线电极;以及
至少一个流体出口。
2.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极包括弧形远侧段和两个纵向段,所述两个纵向段相对于所述轴杆的远侧端部向远侧延伸。
3.如权利要求2所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极的所述弧形远侧段从一个纵向段弯到另一个纵向段。
4.如权利要求2所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极的所述弧形远侧段在所述两个纵向段之间是半圆形的。
5.如权利要求1所述的装置,其特征在于,
所述U形电极中的至少一个U形电极提供切除边缘。
6.如权利要求5所述的装置,其特征在于,
所述切除边缘是电外科切除边缘。
7.如权利要求5所述的装置,其特征在于,
所述切除边缘沿所述U形电极的纵向长度设置。
8.如权利要求5所述的装置,其特征在于,
所述切除边缘是直的。
9.如权利要求1所述的装置,其特征在于,
所述第一电极和第二电极由金属线构成。
10.如权利要求9所述的装置,其特征在于,
所述金属线是单股线。
11.如权利要求9所述的装置,其特征在于,
所述金属线是圆形线。
12.如权利要求9所述的装置,其特征在于,
所述金属线是不锈钢线。
13.如权利要求1所述的装置,其特征在于,
所述至少一个流体出口位于所述轴杆的远侧端部处。
14.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极包括两个纵向段,所述两个纵向段相对于所述轴杆的远侧端部向远侧延伸;以及
所述至少一个流体出口位于所述U形电极中的至少一个U形电极的所述两个纵向段之间。
15.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极包括两个纵向段,所述两个纵向段相对于所述轴杆的远侧端部向远侧延伸;
所述至少一个流体出口包括第一流体出口和第二流体出口;
所述第一流体出口位于所述第一U形电极的所述两个纵向段之间;以及
所述第二流体出口位于所述第二U形电极的所述两个纵向段之间。
16.如权利要求1所述的装置,其特征在于,
所述U形电极是共面的。
17.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极包括两个纵向段,所述两个纵向段相对于所述轴杆的远侧端部向远侧延伸;以及
所述第一U形电极的所述两个纵向段和所述第二U形电极的所述两个纵向段平行。
18.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极包括两个纵向段,所述两个纵向段相对于所述轴杆的远侧端部向远侧延伸;以及
所述第一U形电极的所述两个纵向段和所述第二U形电极的所述两个纵向段均位于单个平面内。
19.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极包括两个纵向段,所述两个纵向段相对于所述轴杆的远侧端部向远侧延伸;以及
所述第一和第二U形电极中的每个U形电极的一个纵向段是内侧纵向段,而另一个纵向段是侧部纵向段。
20.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极中的每个U形电极包括两个纵向段,所述两个纵向段相对于所述轴杆的远侧端部向远侧延伸;以及
所述第二U形电极的所述两个纵向段相对于所述第一U形电极的所述两个纵向段在内侧。
21.如权利要求1所述的装置,其特征在于,
所述第一U形电极围绕所述第二U形电极的周界。
22.如权利要求1所述的装置,其特征在于,
所述第二U形电极位于由所述第一U形电极限定的U形孔内。
23.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极的每个U形电极包括弧形远侧段;以及
所述弧形远侧段是同心的。
24.如权利要求1所述的装置,其特征在于,
所述第一和第二U形电极具有相同尺寸和相同形状中的至少一种。
25.如权利要求1所述的装置,其特征在于,
第一U形电极的位置和第二U形电极的位置相对于彼此固定。
26.如权利要求1所述的装置,其特征在于,
所述装置构造成作为双极装置和单极装置来操作。
27.一种电外科装置,包括:
手柄;
轴杆,所述轴杆联接于所述手柄;
第一电极和第二电极,所述第一电极与所述第二电极与所述轴杆的远侧端部相邻,所述第一电极与所述第二电极共面,并包括U形的线电极,所述线电极围绕所述第二电极的周界,并籍由一孔与所述第二电极间隔开。
28.如权利要求27所述的装置,其特征在于,
所述第二电极包括具有直线段的线电极。
29.如权利要求27所述的装置,其特征在于,
所述第二电极包括U形线电极。
30.如权利要求27所述的装置,其特征在于,
所述第二电极包括叶片状构件。
31.如权利要求30所述的装置,其特征在于,
所述叶片状构件包括球形远侧端部。
32.如权利要求27所述的装置,其特征在于,还包括:
至少一个流体出口。
33.如权利要求27所述的装置,其特征在于,还包括:
导电尖末端,所述导电尖末端从所述第一电极的远侧端部延伸。
34.一种电外科装置,包括:
手柄;
轴杆,所述轴杆联接于所述手柄;以及
第一电极和第二电极,所述第一电极与所述第二电极与所述轴杆的远侧端部相邻,所述第一电极与所述第二电极共面,
其中,所述第一电极包括两个纵向段,所述两个纵向段相对于所述轴杆的所述远侧端部向远侧延伸,并且所述第一电极包括尖末端,所述尖末端从所述两个纵向段的远侧端部延伸;以及
其中,所述第二电极所述两个纵向段之间,所述两个纵向段在相对于所述轴杆的所述远侧端部向远侧延伸。
35.如权利要求34所述的电外科装置,其特征在于,所述第二电极包括叶片状构件。
36.如权利要求35所述的电外科装置,其特征在于,所述叶片状构件包括球形远侧端部。
37.如权利要求35所述的电外科装置,其特征在于,所述第一电极籍由一孔与所述叶片状构件间隔开。
38.如权利要求34所述的电外科装置,其特征在于,所述尖末端包括一对相对的弧形段以及一对第二纵向段,所述一对相对的弧形段从所述两个纵向段的远侧端部延伸,所述一对第二纵向段从所述一对相对的弧形段的远侧端部延伸,所述一对第二纵向段在远侧弧形段处连结。
39.如权利要求34所述的电外科装置,其特征在于,还包括与所述第一和第二电极相邻设置的至少一个流体出口,以分配流体。
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MX2012014097A (es) | 2013-06-28 |
US8906012B2 (en) | 2014-12-09 |
WO2012012173A1 (en) | 2012-01-26 |
CA2802417A1 (en) | 2012-01-26 |
EP2588016A1 (en) | 2013-05-08 |
EP2588016B1 (en) | 2019-10-09 |
US20120004657A1 (en) | 2012-01-05 |
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