CN113229892A - 外科发生器和手术系统 - Google Patents

外科发生器和手术系统 Download PDF

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CN113229892A
CN113229892A CN202110568610.1A CN202110568610A CN113229892A CN 113229892 A CN113229892 A CN 113229892A CN 202110568610 A CN202110568610 A CN 202110568610A CN 113229892 A CN113229892 A CN 113229892A
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control signal
amplifier
waveform
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generator
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S·C·拉普
R·B·史密斯
D·A·弗里德里克斯
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Covidien LP
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Abstract

一种外科发生器，包括：电源；放大器，所述放大器联接到所述电源并且配置成输出第一波形和第二波形；第一控制器，所述第一控制器配置成向所述放大器提供第一控制信号以生成所述第一波形；第二控制器，所述第二控制器配置成向所述放大器提供第二控制信号以生成所述第二波形；以及开关，所述开关配置成将所述第一控制信号或所述第二控制信号中的一个传递到所述电源或所述放大器中的至少一个。以及一种手术系统，其包括上述外科发生器。

Description

外科发生器和手术系统
本申请是2017年8月1日申请的、申请号为201710644219.9、发明名称为“外科发生器和手术系统”的申请的分案申请。
技术领域
本公开涉及用于以多个频率为外科能量装置供电的系统和方法。特别地，本公开涉及一种单个发生器，其配置成以适合于以第一频率为第一装置供电并且以不同于第一频率的第二频率为第二装置供电的指定频率和调节幅度为一个或多个输出供电。具体地，本公开提供了一种能够激励超声装置和电外科装置的单个电源。
背景技术
电外科涉及将高射频(“RF”)电流施加到手术部位以切割、消融、干燥或凝固组织。在单极电外科手术中，源或有源电极将射频交流电从RF发生器输送到目标组织。患者返回电极远离有源电极放置以将电流传导回到发生器。
在双极电外科手术中，返回和有源电极彼此靠近放置，使得在两个电极之间形成电路(例如，在电外科钳的情况下)。以该方式，施加的电流被限制到位于电极之间的身体组织。因此，双极电外科手术通常涉及使用器械，其中期望实现定位在器械(例如，钳等)上的两个电极之间的电外科能量的聚焦输送。
也已证明超声外科装置能够以最小的侧向热损伤和低烟雾产生提供组织的止血和有效解剖。与需要电流流动通过患者的电外科装置不同，超声外科装置通过使用以共振频率驱动的超声换能器通过超声探头施加机械运动来进行操作。
电外科和超声装置的每一个由于其固有的操作特性而具有其期望的用途。因此，需要一种系统和发生器，其配置成操作两种类型的器械以提供新的和改进的外科技术和应用。
发明内容
本公开提供了一种外科发生器，其配置成以不同的频率输出两个或更多个波形，允许外科发生器提供可以适合于驱动超声外科器械的超声换能器的低频输出和可以适合于电外科器械的高频输出。
根据本公开的实施例，提供了一种外科发生器。所述外科发生器包括电源，联接到所述电源并且配置成输出第一波形和第二波形的放大器，以及联接到所述放大器的控制器。所述控制器配置成向所述放大器提供第一控制信号和第二控制信号中的至少一个。所述控制器包括配置成向所述放大器提供所述第一控制信号以生成所述第一波形的第一控制器和配置成向所述放大器提供所述第二控制信号以生成所述第二波形的第二控制器。所述控制器还包括配置成选择所述第一控制信号和所述第二控制信号中的至少一个的开关。
根据本公开的另一实施例，提供了一种手术系统。所述系统包括外科发生器，第一器械，和第二器械。所述外科发生器包括电源，联接到所述电源并且配置成输出第一波形和第二波形的放大器，联接到所述放大器的控制器，第一输出，和第二输出。所述控制器配置成向所述放大器提供第一控制信号和第二控制信号中的至少一个。所述控制器包括配置成向所述放大器提供所述第一控制信号以生成所述第一波形的第一控制器和配置成向所述放大器提供所述第二控制信号以生成所述第二波形的第二控制器。所述控制器还包括配置成选择所述第一控制信号和所述第二控制信号中的至少一个的开关。所述第一输出输出由所述第一控制信号控制的所述第一波形，并且所述第二输出输出由所述第二控制信号控制的所述第二波形。所述第一器械联接到所述第一输出并且由所述第一波形可激励，并且所述第二器械联接到所述第二输出并且由所述第二波形可激励。
根据上述实施例的方面，所述第一器械是超声器械，其包括由所述第一波形可激励的换能器，并且第二器械是电外科器械，其包括配置成接触组织并且向组织传递所述第二波形的至少一个电极。
根据上述实施例的一个方面，所述第一器械是第一电外科器械，其包括配置成接触组织并且向组织传递所述第一波形的至少一个第一电极，并且所述第二器械是第二电外科器械，其包括配置成接触组织并且向组织传递所述第二波形的至少一个第二电极。
根据上述实施例中的任何一个的方面，所述第一控制器是电外科控制器并且所述第一控制信号是RF控制信号，并且所述第二控制器是超声控制器并且第二控制信号是超声控制信号。
根据上述实施例中的任何一个的方面，所述超声控制器包括运动电桥，比例积分微分控制器，脉冲宽度调制器，频率控制单元，和信号发生器。所述运动电桥配置成接收所述放大器的输出电流，并且生成与超声换能器的机械运动成比例并且同相的运动反馈信号。所述比例积分微分控制器配置成基于所述运动反馈信号和所述超声换能器的期望位移的比较校正所述运动反馈信号。所述脉冲宽度调制器配置成调制所述第二控制信号。所述频率控制单元配置成接收所述放大器的输出电流，并且基于所述第二波形的频率和所述超声换能器的谐振频率的比较生成频率控制信号。所述信号发生器配置成基于所述运动反馈信号和所述频率控制信号生成所述超声控制信号。
根据上述实施例中的任何一个的方面，所述控制器包括处理器和存储器。在实施例中，所述放大器是非谐振放大器，并且联接到与多个端口联接的有源端子和返回端子。在又一实施例中，所述外科发生器还包括集线器，其中所述集线器联接到所述有源和返回端子和所述多个端口。所述集线器将所述多个端口的每一个选择性地联接到所述有源端子和所述返回端子。根据另一实施例，所述外科发生器还包括电流传感器、电压传感器和功率传感器中的至少一个。
附图说明
当结合随后的详细描述考虑时，参考附图可以理解本公开，其中：
图1是根据本公开的实施例的手术系统的透视图；
图2是图1的双输出发生器的前视图；
图3是图1的发生器的示意性框图；以及
图4是图2的发生器的控制器的示意性框图。
具体实施方式
下面将参考附图描述本公开的特定实施例。在下面的描述中，不详细描述公知的功能或结构以避免不必要的细节掩盖本公开。本领域技术人员将理解，本公开可以适用于内窥镜器械，腹腔镜器械，或开放器械。也应当领会，不同的电和机械连接以及其它考虑可以应用于每种特定类型的器械。
根据本公开的发生器可以与超声和电外科器械一起以多个频率操作。特别地，发生器可以用于单极和/或双极电外科程序，包括例如切割、凝固、消融和血管闭合程序。发生器可以包括多个输出，用于与各种超声和电外科器械(例如超声解剖器和止血器，单极器械，返回电极极板，双极电外科钳，脚踏开关等)接口。此外，发生器包括电子电路，其配置成生成适于驱动超声器械的超声换能器的超声波形和专门适合于为在各种电外科模式(例如，切割，混合，凝固，止血分离，烧灼，喷雾等)和程序(例如，单极，双极，血管闭合)中操作的电外科装置供电的射频能量。
图1是根据本公开的双输出系统10的一个示例性实施例的部件的透视图。系统10可以包括一个或多个单极电外科器械20，其具有用于治疗患者组织的一个或多个有源电极23(例如，电外科切割探针，消融电极等)。电外科交流射频电流由发生器200经由连接到发生器200的有源端子230(图3)的供应线24供应到器械20，允许器械20切割、凝固、热或非热消融和/或以另外方式治疗组织。交流电流经由发生器200的返回端子232(图3)处的返回线28通过返回电极极板26返回到发生器200。对于单极操作，系统10可以包括多个返回电极极板26，其在使用中布置在患者身上以通过最大化与患者的整体接触面积来最小化组织损伤的机会。另外，发生器200和返回电极极板26可以配置成用于监测组织-患者接触以确保在其间存在足够的接触。
系统10也可以包括一个或多个双极电外科器械，例如，具有用于治疗患者组织的一个或多个电极的双极电外科钳30。电外科手术钳30包括壳体31和布置在轴32的远端处的相对的钳夹构件33和35。钳夹构件33和35相应地具有布置在其中的一个或多个有源电极34和返回电极36。有源电极34和返回电极36通过电缆38连接到发生器200，所述电缆包括可以相应地联接到有源和返回端子230、232的供应和返回线24、28(图3)。电外科钳30在具有到有源和返回端子230和232(例如，引脚)的连接的端口处经由布置在电缆38的端部处的插头联接到发生器200，其中插头包括来自供应和返回线24、28的触点，如下面更详细地描述。
系统10也包括超声外科器械40，其包括具有布置在其中的超声换能器44的壳体42。超声外科器械40也包括波导46，其具有布置在其远端处的末端执行器48。远端执行器48包括可移动钳夹构件50和探头52。超声换能器44经由电缆54连接到发生器200，所述电缆包括相应地联接到有源和返回端子230和232(图3)的供应线56和58。超声探头52联接到超声换能器44，使得当响应来自发生器200的超声波形致动超声换能器44时，超声换能器44在探针52内生成超声机械运动，其可以用于闭合和/或切割组织。
参考图2，示出了发生器200的前面240。发生器200可以包括多个端口250-262以适应各种类型的外科器械(例如，单极电外科器械20，电外科钳30，超声外科器械40等)。
发生器200包括用户界面241，其具有用于向用户提供各种输出信息(例如，强度设置，治疗完成指示器等)的一个或多个显示屏幕242、244、246。屏幕242、244、246的每一个与相应的端口250-262关联。发生器200包括用于控制发生器200的合适的输入控制(例如，按钮，启动器，开关，触摸屏等)。屏幕242、244、246也配置为显示用于器械(例如，电外科钳30等)的相应菜单的触摸屏。用户然后通过简单地触摸相应的菜单选项来调整输入。
屏幕242控制单极输出和连接到端口250和252的装置。端口250配置成联接到单极电外科器械(例如，电外科器械20)，并且端口252配置成联接到脚踏开关(未示出)。脚踏开关提供附加输入(例如，发生器200的复制输入)。屏幕244控制单极和双极输出以及连接到端口256和258的装置。端口256配置成联接到其它单极器械。端口258配置成联接到双极器械(未示出)。
屏幕246控制可以相应地插入端口260和262中的电外科钳30和超声外科器械40。发生器200通过端口260输出能量，其适合于闭合由电外科钳30夹持的组织。特别地，屏幕246输出用户界面，其允许用户为每个端口260和262输入用户定义的强度设置。用户定义的设置可以是允许用户调节一个或多个能量输送参数(如功率，电流，电压，能量等)或闭合参数(如能量率限制器，密封持续时间等)的任何设置。用户定义的设置被传输到控制器224，其中可以将设置保存在存储器226中。在实施例中，强度设置可以是数字标度，例如从1到10或从1到5。在实施例中，强度设置可以与发生器200的输出曲线关联。强度设置可以针对正在使用的每个电外科钳30是特定的，使得各种器械向用户提供对应于电外科钳30的特定强度标度。
有源和返回端子230和232通过集线器或开关(未示出)联接到端口250-262。如下面进一步详细描述，集线器或开关取决于什么器械联接到发生器和期望的输出能量(即，超声或射频能量)将有源和返回端子230和232联接到端口250-262。
图3示出了配置成输出超声(“US”)能量和射频(“RF”)能量两者的发生器200的示意性框图。特别地，发生器200能够将低频波形输出到超声外科器械40的换能器44(图1)，并且将高频波形输出到单极电外科器械20和/或电外科钳30。在实施例中，发生器200也可以配置成同时输出用于激励任何合适的电外科器械的低频能量并且输出用于激励另一电外科器械的高频能量。
发生器200包括控制器224，电源227，和放大器228。电源227可以是连接到AC电源的高压、DC电源，并且经由引线227a和227b将高压、直流电提供给放大器228，然后所述放大器将高压、直流电转换成治疗能量(例如，电外科或超声)并且将能量输送到有源端子230。能量经由返回端子232返回到其上。有源端子230和返回端子232联接到集线器(未示出)，所述集线器又联接到发生器200的多个端口250-262。例如，适于驱动超声器械40的换能器44的超声波形通过端口262被输送，或者用于激励单极电外科器械20和/或电外科钳30的电外科RF能量可以相应地通过端口256和258被输送。有源端子230和返回端子232通过隔离变压器229联接到放大器228。放大器228配置成以多种模式操作，在所述模式期间发生器200输出具有特定占空比、峰值电压、峰值系数等的相应波形。可以设想在其它实施例中发生器200可以基于其它类型的合适的电源拓扑。放大器228是能够在约50kHz至2MHz的宽范围内操作的非谐振放大器。当在本文中使用时，非谐振放大器表示没有用于建立固定工作频率的任何调谐部件(即，电感器，电容器等)的放大器。放大器228包括晶体管驱动电路，其能够跨越在宽频率范围内操作所需的不同切换时间周期。放大器228也包括能够承受在不同模式之间显著变化的峰值电流和电压的开关元件(例如，晶体管和二极管)。
控制器224包括可操作地连接到存储器226的处理器225，所述存储器可以包括暂时型存储器(例如，RAM)和/或非暂时型存储器(例如，闪存介质，磁盘介质等)。处理器225包括可操作地连接到电源227和/或放大器228的输出端口，允许处理器225根据打开和/或关闭的控制环方案控制发生器200的输出。闭环控制方案是反馈控制环，其中多个传感器测量各种组织和能量性质(例如，组织阻抗，组织温度，输出功率，电流和/或电压等)，并且将反馈提供给控制器224。控制器224然后向电源227和/或放大器228发信号，其相应地调节DC和/或电源。本领域技术人员将领会，处理器225可以通过使用适于执行本文中所述的计算和/或指令集的任何逻辑处理器(例如，控制电路)代替，包括但不限于现场可编程门阵列，数字信号处理器，及其组合。
根据本公开的发生器200包括多个传感器280，例如电流传感器280a，电压传感器280b，或功率传感器(未示出)。多个传感器设计成具有足够的带宽以在放大器228可以操作的宽频率范围内精确地测量。发生器200的各种部件(即，放大器228，电流和电压传感器280a和280b)可以布置在印刷电路板(PCB)上。电流传感器280a联接到有源端子230并且提供由放大器228供应的电流的测量。电压传感器280b联接到有源和返回端子230和232，提供由放大器228供应的电压的测量。实施例中，电流传感器280a和电压传感器280b可以联接到有源和返回引线228a和228b，其相应地将有源和返回端子230和232互连到放大器228。
电流和电压传感器280a和280b相应地将感测到的电压和电流信号提供给控制器224，所述控制器然后可以响应于感测到的电压和电流信号调节电源227和/或放大器228的输出。控制器224也从发生器200，电外科器械20，电外科钳30和/或超声外科器械40的输入控制器接收输入信号，包括例如超声外科器械40的期望位移308。控制器224利用输入信号调节由发生器200输出的功率和/或在其上执行其它控制功能。
参考图4，发生器200的控制器224包括两个控制部分，即电外科控制器302和超声控制器304。由电外科控制器302和超声控制器304输出的控制信号在向电源227和/或放大器228发信号之前通过开关300。开关300控制哪个控制信号(即，电外科控制信号或超声控制信号)通过以控制放大器228和/或电源227。控制信号可以是脉冲宽度调制信号，如下面进一步详细描述。开关300可以由用户通过在发生器200的用户界面241上选择期望的输出手动设置，或者由控制器224基于联接到发生器200的器械的类型自动设置。在实施例中，如果超声器械40联接到端口260，则开关300被启动以通过来自超声控制器304的超声控制信号。替代地，如果单极电外科器械20或电外科钳30相应地联接到端口256和258，则开关300被启动以通过来自电外科控制器302的电外科控制信号。
电外科控制器302配置成控制放大器228以恒定电流、恒定电压或恒定功率模式中的至少一个输出电外科RF波形。特别地，电外科控制器302比较输出电压“vout”和输出电流“iout”以确定发生器200的期望操作(例如，恒定电流，恒定电压或恒定功率)。模式选择大体上基于与正被切割的组织关联的阻抗。不同类型的组织(如肌肉和脂肪)具有不同的阻抗。在电外科操作方面，恒功率输出倾向于使组织均匀汽化，导致干净的解剖。而恒定电压输出倾向于爆炸性地汽化或碳化组织(“黑色凝固”)，并且恒定电流输出倾向于使组织热凝固而不汽化(“白色凝固”)。如果外科医生希望快速破坏表面组织，则碳化是外科上有用的，并且热凝固通常伴随机械压力以闭合肝脏或淋巴管。然而，外科医生通常期望使用恒定功率输出进行操作，并且如果存在偏差，则尽可能快地返回到使用恒定功率输出。
类似于电外科控制器302，超声控制器304也在有源端子230和返回端子232处接收测量的输出电流“iout”。然而，控制器224的超声控制器302部分的部件不同。超声控制器304包括运动电桥306，比例积分微分(“PID”)控制器310，脉冲宽度调制器(“PWM”)312，频率控制单元316和滤波器314。不同于以系统时钟所限定的固定频率运行并且精确频率不是特别重要的电外科发生器，超声装置可以包括控制机构以精确地跟踪下至单位数赫兹的传感器44的谐振频率，并且调节发生器的工作频率以匹配谐振频率。运动电桥306测量超声换能器44的机械运动，并且提供表示超声换能器44的机械运动的运动反馈信号。特别地，运动电桥306产生与换能器44和波导46的机械运动成比例并且同相的反馈信号。运动电桥306的输出信号与超声换能器44的机械运动的期望位移308进行比较。期望位移308可以基于超声外科器械40的期望输出频率自动确定，或者可以由用户例如通过选择发生器200的用户界面241上或超声外科器械40上的HI/LOW开关/按钮(未示出)手动地设置。来自期望位移308和运动电桥306由PID控制器310接收。PID控制器310执行输出信号的频移以基于由运动电桥306生成的运动反馈信号和期望位移308的比较生成校正控制信号。PWM 312通过占空比的调制控制输出波形的频率并且保持控制信号的恒定超声幅度。
除了PID控制器310的纠错之外，频率控制单元316调节控制信号的频率以保持超声器械40的谐振频率。频率控制单元316还包括滤波器314，其配置成滤除不想要的频率。特别地，滤波器314可以包括高通滤波器和/或低通滤波器。来自PWM 312和频率控制单元316的调制控制信号由信号发生器320接收以生成超声控制信号。
开关300接收来自电外科控制器302的电外科控制信号和/或来自超声控制器304的超声控制信号。取决于联接到发生器200的器械的类型，放大器228和/或电源227接收来自开关300的电外科控制信号或超声控制信号。
尽管已在附图中示出和/或在本文中描述了本公开的若干实施例，但并不旨在将本公开限于此，原因是本公开旨在范围上与本领域将允许的一样宽，并且同样地阅读说明书。所以，以上描述不应当被解释为限制性的，而仅仅作为特定实施例的举例说明。本领域技术人员将想到在附带的权利要求的范围和精神内的其它修改。

Claims (18)

1.一种外科发生器，包括：
电源；
放大器，所述放大器联接到所述电源并且配置成输出第一波形和第二波形；
第一控制器，所述第一控制器配置成向所述放大器提供第一控制信号以生成所述第一波形；
第二控制器，所述第二控制器配置成向所述放大器提供第二控制信号以生成所述第二波形；以及
开关，所述开关配置成将所述第一控制信号或所述第二控制信号中的一个传递到所述电源或所述放大器中的至少一个。
2.根据权利要求1所述的外科发生器，其中所述第一控制器是电外科控制器，并且所述第一控制信号是射频控制信号。
3.根据权利要求1所述的外科发生器，其中所述第二控制器是超声控制器，并且所述第二控制信号是超声控制信号。
4.根据权利要求3所述的外科发生器，其中所述超声控制器包括：
运动电桥，所述运动电桥配置成接收所述放大器的输出电流，并且生成与超声换能器的机械运动成比例并且同相的运动反馈信号；
比例积分微分控制器，所述比例积分微分控制器配置成基于所述运动反馈信号和所述超声换能器的期望位移的比较而校正所述运动反馈信号；
脉冲宽度调制器，所述脉冲宽度调制器配置成调制所述运动反馈信号；
频率控制单元，所述频率控制单元配置成接收所述放大器的输出电流，并且基于所述第二波形的频率和所述超声换能器的谐振频率的比较而生成频率控制信号；以及
信号发生器，所述信号发生器配置成基于所述运动反馈信号和所述频率控制信号生成所述超声控制信号。
5.根据权利要求1所述的外科发生器，其中所述放大器是非谐振放大器。
6.根据权利要求1所述的外科发生器，其中所述放大器联接到有源端子和返回端子。
7.根据权利要求6所述的外科发生器，其中所述有源端子和所述返回端子联接到多个端口。
8.根据权利要求7所述的外科发生器，其还包括集线器，其中所述集线器联接到所述有源端子和返回端子和所述多个端口，其中所述集线器将所述多个端口的每一个选择性地联接到所述有源端子和所述返回端子。
9.根据权利要求1所述的外科发生器，还包括电流传感器、电压传感器和功率传感器中的至少一个。
10.一种手术系统，其包括：
外科发生器，所述外科发生器包括：
电源；
放大器，所述放大器联接到所述电源并且配置成输出第一波形和第二波形；
第一控制器，所述第一控制器配置成向所述放大器提供第一控制信号以生成所述第一波形；
第二控制器，所述第二控制器配置成向所述放大器提供第二控制信号以生成所述第二波形；以及
开关，所述开关配置成将所述第一控制信号或所述第二控制信号中的一个传递到所述电源或所述放大器中的至少一个；
第一输出部，所述第一输出部输出由所述第一控制信号控制的所述第一波形；以及
第二输出部，所述第二输出部输出由所述第二控制信号控制的所述第二波形；
第一器械，所述第一器械联接到所述第一输出部并且由所述第一波形激励；以及
第二器械，所述第二器械联接到所述第二输出部并且由所述第二波形激励。
11.根据权利要求10所述的手术系统，其中所述第一器械是超声器械，其包括能够由所述第一波形激励的换能器。
12.根据权利要求10所述的手术系统，其中所述第一器械是第一电外科器械，其包括配置成接触组织并且向组织传递所述第一波形的至少一个第一电极。
13.根据权利要求10所述的手术系统，其中所述第二器械是电外科器械，其包括配置成接触组织并且向组织传递所述第二波形的至少一个第二电极。
14.根据权利要求10所述的手术系统，其中所述第一控制器是电外科控制器，并且所述第一控制信号是射频控制信号。
15.根据权利要求10所述的手术系统，其中所述第二控制器是超声控制器，并且所述第二控制信号是超声控制信号。
16.根据权利要求15所述的手术系统，其中所述超声控制器包括：
运动电桥，所述运动电桥配置成接收所述放大器的输出电流，并且生成与超声换能器的机械运动成比例并且同相的运动反馈信号；
比例积分微分控制器，所述比例积分微分控制器配置成基于所述运动反馈信号和所述超声换能器的期望位移的比较而校正所述运动反馈信号；
脉冲宽度调制器，所述脉冲宽度调制器配置成调制所述运动反馈信号；
频率控制单元，所述频率控制单元配置成接收所述放大器的输出电流，并且基于所述第二波形的频率和所述超声换能器的谐振频率的比较而生成频率控制信号；以及
信号发生器，所述信号发生器配置成基于所述运动反馈信号和所述频率控制信号生成所述超声控制信号。
17.根据权利要求10所述的手术系统，其中所述放大器是非谐振放大器。
18.根据权利要求10所述的手术系统，其中所述放大器联接到有源端子和返回端子，其中所述有源端子和所述返回端子联接到所述第一输出部和所述第二输出部。
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