DE10224154A1 - Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissue - Google Patents

Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissue

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Publication number
DE10224154A1
DE10224154A1 DE2002124154 DE10224154A DE10224154A1 DE 10224154 A1 DE10224154 A1 DE 10224154A1 DE 2002124154 DE2002124154 DE 2002124154 DE 10224154 A DE10224154 A DE 10224154A DE 10224154 A1 DE10224154 A1 DE 10224154A1
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electrode
tissue
application
electrodes
body tissue
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DE2002124154
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German (de)
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Kai Desinger
Thomas Stein
Andre Roggan
Thomas Prezewovsky
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Celon AG Medical Instruments
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Celon AG Medical Instruments
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B18/1477Needle-like probes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636Sensing and controlling the application of energy
    • A61B2018/00773Sensed parameters
    • A61B2018/00875Resistance or impedance
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1405Electrodes having a specific shape
    • A61B2018/1425Needle
    • A61B2018/143Needle multiple needles

Abstract

The application device has an electrode set (7) with at least 3 active electrodes (1-6) coupled to the body tissue to be removed and connected to a HF generator (17) for application of a HF current. The impedance of the body tissue between all or some of the active electrodes is measured via a measuring device (13), an electrode subset selected via a selection device (15) in dependence on the measured impedance, with a control device (11) for application of the HF voltage provided by the HF generator to this electrode subset.

Description

  • Die vorliegende Erfindung betrifft eine Vorrichtung zum elektrochirurgischen Veröden von Körpergewebe. The present invention relates to an apparatus for electrosurgical sclerosing of body tissue.
  • Das elektrochirurgische, insbesondere das elektrothermische Veröden von pathologisch verändertem Gewebe, im folgenden kurz Gewebe genannt, ist eine in der Medizin bekannte Methode. Electrosurgical and in particular electrothermal sclerosing of pathologically altered tissue, hereinafter called tissue is a known method in medicine. Von besonderem Interesse ist diese Methode für die Therapie von Organtumoren, zum Beispiel Lebertumoren. this method for the therapy of organ tumors, including liver tumors is of particular interest. Zur Verödung werden eine oder mehrere Elektroden im zu verödenden Gewebe, dh dem Tumorgewebe, oder in dessen unmittelbarer Nähe platziert und ein Wechselstrom zwischen den Elektroden oder einer Elektrode und einer außen am Körper fixierten Neutralelektrode fließen lassen. For sclerotherapy one or more electrodes are tissue to be obliterated, let that the tumor tissue, or placed in its immediate vicinity and an alternating current between the electrodes or an electrode and a fixed outside the body neutral electrode flow. Fließt der Strom zwischen der Elektrode und der Neutralelektrode (ggf. auch zwischen mehreren Elektroden und einer oder mehreren Neutralelektroden), so spricht man von einer monopolaren Elektrodenanordnung. (Also, if necessary, between a plurality of electrodes and one or more neutral electrodes), the current flows between the electrode and the neutral electrode, one speaks of a monopolar electrode assembly. Fließt der Strom dagegen zwischen den im Gewebe befindlichen Elektroden selbst (in diesem Fall müssen im Gewebe mindestens zwei Elektroden vorhanden sein), so spricht man von einer bipolaren Anordnung. On the other hand, the current flows between the electrodes disposed in the tissue itself (in this case, must be present in the tissue at least two electrodes), it is called a bipolar arrangement. Von einer multipolaren Anordnung spricht man, wenn im Gewebe mehr als zwei Elektroden vorhanden sind, zwischen denen Wechselstrom fließt. Of a multipolar arrangement is used when more than two electrodes are present in the tissue between which alternating current flows.
  • Die zum platzieren im Gewebe vorgesehenen Elektroden sind in der Regel als Elektrodennadeln ausgebildet. Provided for in the tissue for placing electrodes are formed as electrode needles in the rule. Sie besitzen einen elektrisch leitenden zylinderförmigen Schaft, der mit Ausnahme eines oder mehrerer distalen Bereiche, den sog. aktiven Bereichen der Elektrode oder kurz aktiven Elektroden, gegen das umliegende Gewebe elektrisch isoliert ist. They have an electrically conductive cylindrical shaft, known with the exception of one or more distal portions, the. Active regions of the electrode or a short electrode active, is electrically insulated from the surrounding tissue. Die aktiven Elektroden stehen dagegen mit dem Körpergewebe in elektrisch leitfähiger Verbindung. The active electrodes on the other hand are provided with the body tissue in electrically conductive connection. Optional sind die aktiven Elektroden auch mit integrierten Thermosensoren ausgestattet. Optionally, the active electrodes are also equipped with integrated thermal sensors. In speziellen Ausführungsformen können am distalen Ende des Schaftes weitere aktive Elektroden, mechanisch ausgefahren werden, um das therapierbare Gewebevolumen zu vergrößern. In particular embodiments, can further active electrode at the distal end of the shaft are mechanically extended to enlarge the treatable volume of tissue.
  • Mittels Hochfrequenzgenerator wird in der monopolaren Anordnung ein Stromfluss zwischen den aktiven Elektroden und der bzw. den Neutralelektroden induziert. By means of high-frequency generator is induced in the monopolar arrangement, a current flow between the active electrodes and the neutral or to the electrodes. In der alternativen bipolaren Anordnung kann auf die Neutralelektroden verzichtet werden. In the alternative bipolar arrangement can be dispensed with the neutral electrode. Der Stromkreis wird in diesem Fall über eine weitere aktive Elektrode geschlossen, wobei die erforderlichen aktiven Elektroden in einer koaxialen Anordnung gegeneinander isoliert auf der Elektrodennadel oder auf zwei getrennten Elektrodennadeln angeordnet sein können. The circuit is closed in this case via a further active electrode, the active electrodes may be required in a coaxial arrangement isolated from each other disposed on the electrode needle or on two separate electrode needles.
  • Durch den Gewebewiderstand, auch Gewebeimpedanz genannt, erfolgt eine Umsetzung des über die Elektroden applizierten Wechselstroms in joulsche Wärme. Through the tissue resistance, also called tissue impedance, then a conversion of the applied across the electrodes alternating current in Joule heat. Bei Temperaturen zwischen 50 und 100°C kommt es zu einer massiven Denaturierung der körpereigenen Proteine (Koagulation) und in der Folge zum Absterben der betroffenen Gewebeareale. At temperatures between 50 and 100 ° C, there is a massive denaturation of the body's own proteins (coagulation) and, subsequently, to the death of the affected tissue areas. Aufgrund der hohen Stromdichte an den aktiven Elektroden erfolgt die Erwärmung vorwiegend im Bereich dieser Elektroden, so dass eine lokale thermische Tumordestruktion möglich ist. Due to the high current density at the active electrode, the heating is carried out mainly in the area of ​​these electrodes so that a local thermal tumor destruction is possible.
  • Eine Vorrichtung und ein Verfahren zum elektrothermischen Veröden pathologischen Gewebes sind beispielsweise in US 5,630,426 offenbart. An apparatus and method for electro-thermal sclerosing of pathological tissue are disclosed for example in US 5,630,426.
  • Entscheidend für eine effektive und vor allem sichere Therapie ist die Ausbildung einer thermischen Destruktionszone, die der Ausdehnung des pathologischen Gewebes, dh des Tumorgewebes, optimal angepasst ist. Crucial for an effective and especially safe therapy is of a thermal destruction zone, the extent of pathological tissue, ie, is optimally adapted the tumor tissue.
  • Aufgabe der vorliegenden Erfindung ist es, eine Vorrichtung zum elektrothermischen Veröden von Geweben zur Verfügung zu stellen, die eine zuverlässige Destruktion pathologischen Gewebes ermöglicht. The object of the present invention is to provide an apparatus for electro-thermal sclerosing of tissues available that allows a reliable destruction of pathological tissue.
  • Diese Aufgabe wird durch eine Vorrichtung zum Applizieren eines Hochfrequenzstroms zur thermischen Verödung von Körpergewebe nach Anspruch 1 gelöst. This object is achieved by a device for applying a high frequency current for thermal sclerosing of body tissue according to claim. 1 Die Unteransprüche enthalten weitere vorteilhafte Ausgestaltungen der Erfindung. The sub-claims contain further advantageous embodiments of the invention.
  • Der Erfindung liegt die Erkenntnis zugrunde, dass für die Ausbildung einer optimal an das Tumorgewebe angepassten Destruktionszone die Elektrodenanordnung im Tumor eine entscheidende Rolle spielt. The invention is based on the recognition that the electrode arrangement plays a decisive role in the formation of a perfectly shaped to fit the tumor tissue destruction zone in the tumor. In der klinischen Praxis ist es mittlerweile üblich, bei größeren zu zerstörenden Gewebearealen mehrere Elektrodennadeln im Gewebe zu positionieren, um mittels Superposition der von den einzelnen Elektroden erzeugten thermischen Destruktionszonen eine Effizienzsteigerung zu erzielen. In clinical practice, it is now common practice to position a plurality of electrode needles in the tissue to be destroyed with larger tissue areas, in order to achieve an increase in efficiency by means of superposition of the thermal destruction zones generated by the individual electrodes. Darüber hinaus soll bei einigen Anwendungen durch eine mehrkanalige Temperaturmessung eine gleichmäßige thermische Destruktionszone erzielt werden. In addition, a uniform thermal destruction zone to be achieved for some applications by a multi-channel temperature measurement. Dies hat sich in der Praxis jedoch als unzulänglich erwiesen, weil es sich nur um Punktmessungen handelt und die Gewebeeigenschaften in einiger Entfernung der Messstellen nicht berücksichtigt werden können. However, this has proved in practice to be inadequate because it is only to point measurements and tissue properties can not be considered in the distance of the measuring points. Damit kommt es immer wieder zu Untertherapie, dh in zu behandelnden Gewebearealen wird die für eine vollständige Destruktion des Tumorgewebes erforderliche Temperatur nicht erreicht. So it always comes back to undertreatment, ie to be treated tissue areas required for a complete destruction of the tumor tissue temperature is not reached. Infolgedessen erleiden die Patienten einen Rückfall und müssen sich erneut einer Therapie unterziehen. As a result, patients suffer a relapse and have to again undergo therapy.
  • Die Gewebeimpedanz hängt stark vom Fortschreiten der thermischen Gewebezerstörung ab. The tissue impedance strongly depends on the progression of the thermal tissue destruction. Mit zunehmender Verödung des Gewebes steigt dessen Impedanz an. With increasing obliteration of the fabric whose impedance increases. Der grundlegende Gedanke der Erfindung ist die Tatsache, dass im Gegensatz zur Temperatur die Gewebeimpedanz eine Volumeninformation darstellt, welche die Gewebeeigenschaften zwischen den beiden für die Impedanzmessung nötigen Messstellen integral beschreibt. The basic idea of ​​the invention is the fact that in contrast to the temperature, the tissue impedance is a volume information, which describes the tissue properties between the two necessary for the impedance measurement measuring points integral. Erfindungsgemäß soll daher die Änderung des Impedanzverhaltens in Kombination mit einer multipolaren Applikationsanordnung zur optimalen Steuerung der Therapie genutzt werden. According to the invention the change in the impedance behavior should therefore be used in combination with a multi-polar application arrangement for optimum control of the therapy. Überraschenderweise zeigt sich, dass bei einer Mehrfachapplikation, dh dem Fließenlassen von Hochfrequenzströmen zwischen mehreren aktiven Elektrodenpaaren, die Gewebeimpedanz zwischen den einzelnen aktiven Elektroden keinen einheitlichen Verlauf aufweist. Surprisingly, it is found that in a multiple application, ie having the flowing of high-frequency currents between a plurality of active electrode pairs, the tissue impedance between the individual active electrodes no single history. Vielmehr kann das Gewebe zwischen einzelnen aktiven Elektrodenpaaren bereits in den Austrocknungszustand übergegangen sein, wobei es eine sehr hohe Impedanz aufweist, während das Gewebe zwischen anderen aktiven Elektrodenpaaren diesen Zustand noch nicht erreicht hat und demgemäss eine sehr niedrige Impedanz aufweist. Rather, the fabric may be passed between each active electrode pairs already in the drying state, wherein it has a very high impedance, while the tissue between other active electrode pairs has not yet reached this condition and accordingly has a very low impedance. Dies korreliert mit der klinischen Erkenntnis, dass auch bei punktueller Temperaturmessung eine sichere Volumendestruktion nicht garantiert werden kann. This correlates with the clinical finding that even under point temperature measurement a safe volume destruction can not be guaranteed. Ursache dieser nichthomogenen Austrocknung des Körpergewebes sind beispielsweise nicht gleichmäßig verteilte Blutgefässe, die eine lokal begrenzte Kühlwirkung ausüben und damit dem Therapieeffekt entgegenwirken. Cause of these non-homogeneous drying of the body tissue for example, are not uniformly distributed blood vessels, which exert a localized cooling effect and therefore counteract the effect of therapy.
  • Außerdem kann bei einer Mehrelektrodenkonfiguration, ähnlich wie bei einer rein bipolaren Anordnung, auf die Neutralelektrode oder die Neutralelektroden ganz verzichtet werden. It can also be completely dispensed with, the neutral electrode or the neutral electrodes in a multiple electrode configuration similar to that of a purely bipolar arrangement. Der Stromfluss bleibt dadurch auf die Zielregion beschränkt, Nebenwirkungen, wie sie von der monopolaren Anwendung bekannt sind, können daher nicht mehr auftreten. The current flow is restricted to the target region by side effects, such as are known from the monopolar application, therefore, can no longer occur.
  • Die erfindungsgemäße Applikationsvorrichtung zum Applizieren eines Hochfrequenzstroms zum thermischen Veröden von Körpergewebe umfasst eine Elektrodenmenge mit mindestens drei in Körpergewebe einführbare aktive Elektroden, einen Hochfrequenzgenerator zum Erzeugen einer Hochfrequenzspannung, der umschaltbar mit einer oder mehreren der aktiven Elektroden zu verbinden ist, und eine Messeinrichtung zum Messen der Impedanz des Gewebes zwischen allen oder ausgewählten aktiven Elektroden. The application device according to the invention for applying a high frequency current for thermal sclerosing of body tissue comprising an electrode set with at least three insertable into body tissue active electrode, a high frequency generator for generating a high frequency voltage which can be switched to connect with one or more of the active electrodes, and a measuring device for measuring the impedance of the tissue between all or selected active electrodes. Außerdem umfasst die Applikationsvorrichtung eine Auswahleinrichtung, die mit der Messeinrichtung verbunden ist und ausgestaltet ist eine mindestens zwei aktive Elektroden umfassende Untermenge aus der Elektrodenmenge anhand der gemessenen Impedanz auszuwählen. Moreover, the application device comprises a selection means which is connected to the measuring device and is configured of at least two active electrodes comprehensive subset from the amount of electrode selected on the basis of the measured impedance. Des weiteren ist eine Steuereinrichtung vorhanden, die mit der Auswahleinrichtung verbunden und zum Anlegen der Hochfrequenzspannung an die aktiven Elektroden der ausgewählten Untermenge derart, dass zwischen ihnen ein Hochfrequenzstrom durch das Körpergewebe fließt, ausgestaltet ist. Furthermore, there is a control means connected to the selection means and for applying the high frequency voltage to the active electrodes of the selected subset so that a high frequency current flows between them through the body tissue, configured.
  • Als Untermenge ist hierbei jede mindestens zwei aktive Elektroden umfassende Teilmenge der Elektrodenmenge zu verstehen, einschließlich des Falles, dass als Untermenge die gesamte Elektrodenmenge ausgewählt wird. As a subset of each of at least two active electrodes is to be understood extensive subset of the electrode size, including the case that, as a subset of the entire electrode set is selected. Da die Impedanz als Volumeninformation über die Gewebeeigenschaften ein Maß für den Fortschritt der Verödung darstellt, ist die Impedanzmessung geeignet, unterschiedliche Verödungsgrade in Bereichen des zu verödenden Gewebes festzustellen. Since the impedance is as volume information about the tissue properties a measure of the progress of desertification, the impedance measurement is adapted to detect different degrees of desertification in areas of tissue to be obliterated. Die verschiedenen Gewebebereiche können dann durch das Anlegen der Hochfrequenzspannung an ausgewählte aktive Elektroden der Elektrodenmenge gezielt behandelt werden. The various areas of tissue can then be selectively treated to selected electrodes of the electrode active amount by applying the high frequency voltage. Die Auswahl der Elektroden, dh das Bilden der Untermenge, bestimmt dabei die Strompfade durch das zu verödenden Gewebe. The selection of the electrodes, ie the forming of the subset, determines the current paths through the tissue to be obliterated.
  • In einer Ausgestaltung der Erfindung ist die Auswahleinrichtung derart ausgestaltet, dass eine neue Impedanzmessung und eine neue Auswahl einer mindestens zwei aktive Elektroden umfassenden Untermenge vorgenommen wird, wenn seit der vorangegangenen Auswahl eine vorbestimmte Zeit verstrichen ist. In one embodiment of the invention, the selection device is designed such that a new impedance measurement and a new selection is made of a comprehensive at least two active electrodes subset when a predetermined time has elapsed since the previous selection.
  • Durch das Applizieren des Hochfrequenzstromes nur über eine vorbestimmte Zeit und das Neuauswählen der Untermenge anhand einer neuen Impedanzmessung lässt sich der Fortschritt des Verödungsprozesses in vorbestimmten Abständen überprüfen und die weitere Applikation an den festgestellten Fortschritt anpassen. By applying the high-frequency current only for a predetermined time and reselecting the subset based on a new impedance measurement, the progress of the desertification process can be checked at predetermined intervals and adjust the further application of the established progress. Die Neuauswahl bietet dabei die Möglichkeit, eine andere Untermenge von Elektroden als die bisher verwendete Untermenge auszuwählen und so auf die fortschreitende Verödung mit veränderten Strompfaden im zu verödenden Gewebe zu reagieren. The new selection offers the opportunity to select a different subset of electrodes as the subset of previously used and thus to respond to the progressive obliteration with changing current paths in the tissue to be obliterated. Dies ist insbesondere von Vorteil, wenn die Verödung nicht im gesamten zu verödenden Gewebe gleichmäßig erfolgt, sondern lokal mit unterschiedlicher Geschwindigkeit voranschreitet. This is particularly advantageous if the obliteration does not take place in the entire tissue to be obliterated uniformly but proceeds locally at different speeds. Außerdem lassen sich durch die zeitliche Begrenzung der Applikation Verbrennungen der behandelten Gewebebereiche durch zu lange Applikation des Hochfrequenzstromes vermeiden. In addition, the treated tissue areas due to excessively long application of the high frequency current can be avoided by limiting the temporal application burns.
  • In einer weiteren Ausgestaltung der Erfindung ist die Messeinrichtung dazu ausgelegt, die Impedanz des Körpergewebes während der Applikation des Hochfrequenzstroms zu messen. In a further embodiment of the invention the measuring device is adapted to measure the impedance of the body tissue during application of the high frequency current. Die gemessenen Impedanzen können z. The measured impedances z. B. mit Referenzwerten, die vor Beginn der elektrothermischen Behandlung gemessen worden sind, in Beziehung gesetzt werden. B. be placed in relation with reference values ​​that have been measured prior to the electro-thermal treatment. Diese Ausgestaltung bietet den Vorteil, dass anhand der Impedanzmessung am Gewebe zwischen den Elektroden, insbesondere anhand der Änderung der Impedanzwerte gegenüber den Referenzwerten, der Fortschritt der Verödung laufend erfasst wird. This embodiment has the advantage that on the basis of the impedance measurement on the tissue between the electrodes, in particular from the change of the impedance values ​​with respect to the reference values, the progress of obliteration is continuously recorded. Die Dauer der Applikation des Hochfrequenzstroms über die Elektrodenuntermenge kann so abhängig vom Fortschreiten der Verödung bestimmt werden. The duration of the application of the high frequency current across the electrodes subset may be determined depending on the progress of the obliteration. Durch den Vergleich der gemessenen Impedanzwerte mit den vorab bestimmten Referenzwerten lassen sich unerwünschte Einflüsse auf die gemessenen Impedanzwerte, die bspw. aus unterschiedlichen Abständen zwischen den verschiedenen Elektroden oder aus bereits vor Beginn der Behandlung unterschiedlichen Impedanzen verschiedener zu behandelnder Gewebebereiche resultieren, beim Bestimmen der Applikationsdauer berücksichtigen By comparing the measured impedance values ​​with the predetermined reference values ​​can be undesirable influences on the measured impedance values, for example. From different distances between the various electrodes or before the start of treatment different impedances of different to be treated tissue areas result, take into account in determining the duration of application
  • Vorteilhafterweise ist die Auswahleinrichtung derart ausgestaltet, dass eine neue Auswahl einer mindestens zwei aktive Elektroden umfassenden Untermenge vorgenommen wird, wenn die Impedanz des Körpergewebes zwischen einer vorgegebenen Anzahl aktiver Elektroden der Untermenge einen vorbestimmten Wert erreicht oder überschreitet. Advantageously, the selection means is configured such that a new selection of a comprehensive at least two active electrodes subset is made when the impedance of the body tissue between a predetermined number of active electrodes of the subset reaches a predetermined value or more.
  • Das Erreichen oder Überschreiten eines vorbestimmten Impedanzwertes zeigt an, dass die Verödung bis zu einem bestimmten Grad fortgeschritten ist. Reaching or exceeding a predetermined impedance value indicates that the obliteration is to a certain degree advanced. Die Verödung kann dann an einem anderen, noch nicht so weit verödeten Teil des zu verödenden Gewebes fortgesetzt werden. Sclerotherapy can then be continued at another, not so far desolate part of to be sclerosed tissue. Damit lassen sich unnötig lange Applikationsdauern und daraus resultierende Belastungen des Patienten vermeiden. Thus, unnecessarily long application times and the resulting stresses on the patient can be avoided. Daneben lassen sich auch Verbrennungen des Gewebes durch zu lange Applikation des Hochfrequenzstromes an einem Gewebebereich besonders effektiv vermeiden. Next to it also burns the tissue caused by excessive application of the high frequency current can be avoided particularly effective at a tissue region.
  • Die zeitabhängige und die impedanzabhängige Auswahl können auch kombiniert werden, so dass eine Neuauswahl immer dann stattfindet, wenn eine vorbestimmte Zeit verstrichen oder eine vorbestimmte Impedanz erreicht ist. The time-dependent and the impedance-based selection can also be combined, so that a reselection always takes place when a predetermined time elapses or a predetermined impedance is achieved.
  • In noch einer weiteren Ausgestaltung der Erfindung ist die Auswahleinrichtung derart ausgestaltet, dass sie vor der Auswahl bzw. der Neuauswahl der mindestens zwei aktive Elektroden umfassenden Untermenge die Messeinrichtung veranlasst, eine Messung der Impedanz des Körpergewebes zwischen allen möglichen Paaren aus aktiven Elektroden durchzuführen, und als Untermenge diejenigen aktiven Elektroden auswählt, zwischen denen die Impedanz am geringsten ist oder einen vorbestimmten Wert nicht überschreitet. In yet another embodiment of the invention, the selection means is arranged such that it causes prior to the selection or reselection of the comprehensive at least two active electrodes subset of the measuring device to carry out a measurement of the impedance of the body tissue between all possible pairs of active electrodes, and when selects subset of those active electrodes between which the impedance is the lowest, or does not exceed a predetermined value.
  • Dadurch, dass bei der Neuauswahl diejenigen aktiven Elektroden ausgewählt werden, zwischen denen das Körpergewebe die geringste Impedanz aufweist, lässt sich die Hochfrequenzspannung gezielt auf diejenigen Gewebebereiche anwenden, in denen die Verödung am wenigsten weit fortgeschritten ist. In that, in reselection to those active electrodes are selected, between which the body tissue has the lowest impedance can be the high frequency voltage applied selectively to those regions of tissue in which the sclerotherapy is the least advanced.
  • Eine vorteilhafte Weiterbildung der erfindungsgemäßen Applikationsvorrichtung zeichnet sich dadurch aus, dass die Steuervorrichtung derart ausgestaltet ist, dass zu Beginn der Applikation die Hochfrequenzspannung in einem vorgegebenen zyklischen Wechsel an die aktiven Elektroden angelegt wird und die Auswahl der mindestens zwei aktive Elektroden umfassenden Untermenge anhand der Impedanz zu einem spätem Zeitpunkt der Applikation einsetzt. An advantageous further development of the application device according to the invention is characterized in that the control device is configured such that at the beginning of the application, the high frequency voltage is applied in a predetermined cyclic change to the active electrodes and selecting the at least two active electrodes comprehensive subset based in impedance to using a late time of application. Zu beginn der Applikation besitzt die Impedanz im gesamten zu verödenden Gewebe häufig noch einen gleichen oder annähernd gleichen Wert. At the beginning of the application has the impedance in the entire tissue to be obliterated often still the same or approximately the same value. Die lokalen Unterschiede in der Impedanz stellen sich erst im Verlauf der Applikation ein, so dass eine impedanzangepasste Auswahl der Elektroden erst im Verlauf der Applikation sinnvoll wird. The local differences in the impedance adjust themselves during the course of the application, so that an impedance-matched Selection of electrodes is useful only in the course of the application.
  • In einer weiteren vorteilhaften Weiterbildung zeichnet sich die Applikationsvorrichtung dadurch aus, dass die Auswahleinrichtung derart ausgestaltet ist, dass als Untermenge mindestens drei aktive Elektroden ausgewählt werden und die Steuereinrichtung derart ausgestaltet ist, dass die aktiven Elektroden mit Hochfrequenzspannungen beaufschlagt werden, die jeweils um einen festen Phasenwinkel zueinander phasenverschoben sind. In a further advantageous development, the application device is characterized in that the selection means is configured to be selected as a subset of at least three active electrodes and the control device is designed such that the active electrodes are applied with high frequency voltages, each by a fixed phase angle are phase-shifted to each other. Der phasenverschobene Hochfrequenzstrom führt zu einer verbesserten Homogenität des applizierten Hochfrequenzstroms im zu verödenden Gewebe. The phase-shifted high-frequency current results in an improved homogeneity of the applied high-frequency current in the tissue to be obliterated.
  • Vorteilhafterweise werden als Untermenge drei aktive Elektroden ausgewählt, wobei die Phasenwinkel 120 Grad betragen. Advantageously, are selected as a subset of three active electrodes, the phase angle is 120 degrees. Dies ermöglicht es, die aktiven Elektroden mit Dreiphasenstrom, dh Drehstrom, zu betreiben. This enables the active electrodes with three-phase current, ie to operate AC.
  • Die aktiven Elektroden der Applikationsvorrichtung sind in einer vorteilhaften Ausgestaltung der Erfindung an Elektrodennadeln angeordnet, die das genaue interstitielle Anordnen der aktiven Elektroden im zu verödenden Gewebebereich oder um den zu verödenden Gewebebereich herum ermöglichen. The active electrodes of the application device are arranged in an advantageous embodiment of the invention on electrode needles that allow the exact interstitial placing the active electrode in the tissue to be obliterated area or near the tissue to be obliterated area around.
  • Die Elektrodennadeln können als bipolare Elektrodennadeln ausgestaltet sein, also jeweils zwei voneinander isolierte aktive Elektroden umfassen, die unabhängig voneinander mit Hochfrequenzspannung beaufschlagt werden können. The electrode needles can be configured as a bipolar electrode needles, that each include two mutually insulated active electrode which can be applied with high frequency voltage independently. Dadurch ist es möglich den Hochfrequenzstrom nicht nur zwischen verschiedenen Elektrodennadeln fliesen zu lassen, sondern auch entlang einer einzelnen Elektrodennadeln, was die Variationsmöglichkeit der Strompfade und damit die Anzahl der individuell verödbaren Teilbereiche des zu verödenden Gewebebereiches erhöht. This makes it possible to make the high-frequency power not only tiles between different electrode needles, but also along a single electrode needles, which increases the possibility of variation of the current paths and thus the number of individually verödbaren sections of the tissue to be obliterated area.
  • Die Variationsmöglichkeiten können durch die Verwendung multipolarer Elektrodennadeln, dh Elektrodennadeln mit mehr als zwei aktiven Elektroden, weiter vermehrt werden. The possibilities for variation, by using multipolar electrode needles, ie electrode needles with more than two active electrodes are further increased.
  • Eine vorteilhafte Weiterbildung der Elektrodennadeln zeichnet sich dadurch aus, dass sie mit einer isolierenden Umhüllung umgeben sind, aus der sie um vorbestimmte Längen ausfahrbar sind, so dass die Anzahl der Elektroden der multipolaren Elektrodennadeln durch Aus- und Einfahren der Elektrodennadeln aus der Umhüllung einstellbar ist. An advantageous refinement of the electrode needles is characterized in that they are surrounded with an insulating sheath, from which it can be extended by predetermined lengths such that the number of electrodes of the multi-polar electrode needles is adjustable by extension and retraction of the electrode needles from the enclosure.
  • Eine Elektrodennadel kann einen oder mehrere Kanäle für ein Fluid zur Kühlung oder Heizung der aktiven Elektroden oder der gesamten Nadel aufweisen. An electrode needle may include one or more channels for a fluid for cooling or heating of the active electrode or the entire needle. Als Fluid kommen insbesondere Gase oder Flüssigkeiten in betracht. As a fluid, in particular gases or liquids are suitable. Die Heizung bzw. Kühlung kann dazu Verwendung finden, die durch den Hochfrequenzstrom erfolgende Erwärmung des Gewebes, dh den Temperaturverlauf im Gewebe, zu homogenisieren. The heating or cooling can to be used, that is to homogenize the temperature distribution in the tissue, taking place by the high frequency induction heating of the tissue. Die Kanäle für das Fluid lassen sich auch in den bisher üblichen Elektrodennadeln zum Erzielen eines homogeneren Temperaturverlaufs einsetzen. The channels for the fluid can also be used in the usual electrode needles to achieve a homogeneous temperature profile.
  • In einer Ausgestaltung zeichnen sich die Kanäle dadurch aus, dass sie zu den aktiven Elektroden führen und zum Zuführen von Kühlfluid geeignet sind. In one embodiment, the channels are distinguished in that they lead to the active electrodes and are suitable for supplying cooling fluid. Die Erwärmung des Gewebes ist dort am stärksten, wo die Stromdichte des Hochfrequenzstroms am höchsten ist. The heating of the tissue is strongest there, where the current density of the high frequency current is highest. Typischerweise ist die Stromdichte an den aktiven Elektroden höchsten. Typically, the current density at the active electrode is highest. Die Kühlung der Elektroden kann die Temperatur des unmittelbar an die Elektroden angrenzenden Gewebes herabsetzen und so zu einem homogeneren Verlauf der Temperatur im Gewebe führen. The cooling of the electrode may reduce the temperature of the immediately adjacent to the electrodes tissue and thus lead to a more homogeneous course of the temperature in the tissue.
  • Vorteilhafterweise ist das Fluid eine entionisierte Flüssigkeit. Advantageously, the fluid is a de-ionized liquid. Flüssigkeiten haben typischerweise einen höheren Wärmekoeffizienten als Gase, sind jedoch in der Regel elektrisch leitfähig, so dass für eine gute elektrische Isolation der Kanäle gesorgt werden muss. Liquids typically have a higher thermal coefficient than gases, but are electrically conductive, as a rule, it must be ensured that a good electrical insulation of the channels. Durch das Verwenden von entionisierten und daher nicht leitenden Flüssigkeiten kann auf die elektrische Isolation der Kanäle weitgehend verzichtet werden. By using deionized and therefore non-conductive liquids can be largely dispensed with the electrical insulation of the channels. Je besser die Entionisierung der Flüssigkeit ist, desto weniger aufwändig braucht die Isolation zu sein. The better the deionization of the liquid, the less costly the insulation needs to be.
  • Weitere Merkmale und Vorteile der vorliegenden Erfindung werden nachfolgend anhand eines detaillierten Ausführungsbeispiels unter Bezugnahme auf die beiliegenden Zeichnungen beschrieben. Other features and advantages of the present invention are described below with reference to a detailed embodiment, with reference to the accompanying drawings.
  • Fig. 1 zeigt in einem Blockschaltbild die Komponenten der vorliegenden Erfindung. Fig. 1 shows a block diagram of the components of the present invention.
  • Fig. 2 zeigt das Blockschaltbild einer alternativen Ausgestaltung der Erfindung. Fig. 2 shows the block diagram of an alternative embodiment of the invention.
  • Fig. 3a und 3b zeigen eine Elektrodennadel zur Verwendung in der erfindungsgemäßen Vorrichtung. Fig. 3a and 3b show an electrode needle for use in the inventive device.
  • Fig. 4a und 4b zeigen eine beispielhafte Anordnung der Elektrodennadeln im Gewebe in Draufsicht und Seitenansicht sowie die zugehörigen Stromflüsse. FIGS. 4a and 4b show an exemplary arrangement of the electrode needles in the tissue in plan view and side view as well as the associated current flows.
  • Fig. 5a und 5b zeigen eine weitere beispielhafte Anordnung der Elektrodennadeln im Gewebe in Draufsicht und Seitenansicht sowie die zugehörigen Stromflüsse. FIGS. 5a and 5b show a further exemplary arrangement of the electrode needles in the tissue in plan view and side view as well as the associated current flows.
  • Fig. 1 ist ein Blockschaltbild eines Ausführungsbeispieles für die erfindungsgemäße Vorrichtung zum Veröden von Körpergeweben. Fig. 1 is a block diagram of an embodiment for the inventive device for sclerosing of body tissues. Die Vorrichtung umfasst eine Anzahl von aktiven Elektroden 1 bis 6 , die zusammen eine Elektrodenmenge 7 bilden. The apparatus comprises a number of active electrodes 1 to 6, which together form an electrode volume. 7 Die Elektroden 1 bis 6 sind jeweils über individuelle Leitungen 9 mit einer Steuereinheit 11 verbunden. The electrodes 1 to 6 are respectively connected via individual lines to a control unit 9. 11 Mit der Steuereinheit 11 sind wiederum eine Messeinrichtung 13 zum Messen der Impedanz des Gewebes zwischen Elektroden 1 bis 6 , eine Auswahleinrichtung 15 zum Auswählen von Elektroden und ein Hochfrequenzgenerator 17 zum Erzeugen hochfrequenter Wechselspannungen verbunden. With the control unit 11, in turn, a measuring device 13 for measuring the impedance of the tissue between the electrodes 1 to 6, a selector 15 for selecting electrodes and a high-frequency generator 17 are connected to generate high frequency alternating voltages.
  • Der Hochfrequenzgenerator 17 hat bei multipolarer Anwendung beispielsweise eine Ausgangsleistung von 250 W an 20-50 Ω, bei einer Arbeitsfrequenz von 470 kHz. The high frequency generator 17 has in multipolar application, for example, an output power of 250 W at 20 to 50 Ω, at an operating frequency of 470 kHz. Im Falle bipolarer Anwendungen beträgt die Ausgangsleistung beispielsweise 125 W an 100 Ω, ebenfalls bei einer Arbeitsfrequenz von 470 kHz. In the case of bipolar applications, the output power is, for example, 125 W to 100 Ω, also at an operating frequency of 470 kHz. Der Arbeitsbereicht des Hochfrequenzgenerators liegt zwischen 10 und 1.000 Ω. The Arbeitsbereicht the high frequency generator is between 10 and 1000 Ω. Die Impedanzmessung durch die Messeinrichtung 13 kann entweder bei der Arbeitsfrequenz von 470 kHz erfolgen, oder aber bei einer anderen Frequenz, insbesondere einer niedrigeren Frequenz, zum Beispiel 20 kHz. The impedance measurement by the measuring device 13 can be done either at the operating frequency of 470 kHz, or at a different frequency, in particular a lower frequency, for example 20 kHz. Der Hochfrequenzgenerator ist derart ausgelegt, dass er für typische Applikationszeiten von 20 Minuten und länger bei Volllast geeignet ist. The high frequency generator is designed such that it is suitable for typical application times of 20 minutes or more at full load.
  • Die Messeinrichtung 13 ist derart ausgestaltet, dass sie in der Lage ist, die Impedanz des Gewebes zwischen jeweils zwei Elektroden der Elektrodenmenge 7 zu messen. The measuring device 13 is designed such that it is able to measure the impedance of the tissue between two electrodes of the electrode volume. 7 Der Messvorgang kann beispielsweise erfolgen, indem zwischen zwei Elektroden der Elektrodenmenge 7 eine Wechselspannung angelegt wird und die Messeinrichtung 13 dann den durch die beiden Elektroden fließenden Wechselstrom misst. The measurement procedure can be carried out, for example, by applying an alternating voltage is applied between two electrodes of the electrode 7 and the quantity measuring means 13 then measures the current flowing through the two electrodes an alternating current. Dabei ist es ausreichend, den Betrag der Impedanz, also den Widerstand des Gewebes, zu messen. It is sufficient, therefore, to measure the magnitude of the impedance of the resistance of the tissue. Alternativ kann die Messeinrichtung 13 jedoch auch den Phasenwinkel zwischen dem durch die beiden Elektroden fließenden Wechselstrom und der an den Elektroden anliegenden Wechselspannung ermitteln, so dass sich die Impedanz vollständig bestimmen lässt. Alternatively, the measuring device 13 can also determine the phase angle between the current flowing through the two electrodes and the alternating current applied to the electrodes AC voltage, however, so that the impedance can be fully determined. Aus dem Ergebnis der Impedanzmessung kann die Auswahleinrichtung 15 den Verödungsgrad des Gewebes zwischen den beiden Elektroden ermitteln. From the result of impedance measurement, the selection means 15 can determine the degree of obliteration of the tissue between the two electrodes. Je höher der Verödungsgrad ist, desto höher ist die Impedanz des Gewebes. The higher the degree of obliteration is, the higher the impedance of the tissue.
  • Um die Frequenzabhängigkeit der Impedanz beim Bestimmen des Gewebezustandes berücksichtigen zu können, kann die Impedanzmessung bei mehreren Frequenzen vorgenommen werden. In order to take into account the frequency dependence of the impedance in determining the tissue state, the impedance measurement can be made at multiple frequencies. Die in der Frequenzabhängigkeit der Impedanz enthaltene Information kann beispielsweise beim Bestimmen von Applikationsparametern für die Applikation des Hochfrequenzstromes Berücksichtigung finden. The information contained in the frequency dependence of the impedance can for example be taken into account in determining application parameters for the application of high frequency current.
  • Die beschriebene Impedanzmessung erfolgt im vorliegenden Ausführungsbeispiel für alle möglichen Elektrodenpaare der Elektrodenmenge 7 , so dass der Auswahleinrichtung 15 Impedanzwerte für alle Gewebebereiche zwischen jeweils zwei Elektrodenpaaren zur Verfügung stehen. The impedance measurement is carried out as described in the present embodiment for all possible pairs of electrodes of the electrode Volume 7, so that the selection means are 15 impedance values for all tissue regions between each two pairs of electrodes are available. Anhand dieser Impedanzwerte wählt die Auswahleinrichtung 15 dann mindestens zwei Elektroden der Elektrodenmenge 7 aus, die eine Untermenge der Elektrodenmenge 7 bilden. Based on these impedance values, the selector 15 then selects at least two electrodes of the electrode Volume 7, which form a subset of the electrodes amount. 7
  • Die ausgewählte Untermenge teilt die Auswahleinrichtung 15 der Steuereinheit 11 mit, die dann über die Leitungen 9 den Elektroden der Untermenge 19 , hier die Elektroden 5 und 6 , die vom Hochfrequenzgenerator 17 erzeugte Hochfrequenzspannung zuführt. The selected subset divides the selection means 15 of the control unit 11, which then via the lines 9 to the electrodes of the subset 19, here the electrodes 5 and 6, supplies the high-frequency voltage generated by the high-frequency generator 17th Dazu umfasst die Steuereinheit 11 eine Schalteinheit, mit deren Hilfe die Leitungen 9 individuell mit dem Hochfrequenzgenerator 17 verbindbar sind. For this purpose, the control unit 11 comprises a switch unit by means of which the lines 9 are connected individually with the high-frequency generator 17th Der Hochfrequenzgenerator 17 kann beispielsweise eine Konstantstrom- oder Konstantspannungsquelle sein. The high frequency generator 17 may for example be a constant current or constant voltage source.
  • Wenn die Hochfrequenzspannung an die Elektroden 5 und 6 der Untermenge 19 angelegt wird, fließt zwischen ihnen ein hochfrequenter Wechselstrom, der zu einer Erwärmung des Gewebes und als Folge dessen zu einer Denaturierung des Gewebes führt. When the high frequency voltage is applied to the electrodes 5 and 6 of the subset 19, flows between them a high-frequency alternating current, which leads to a heating of the tissue and as a result in the denaturation of the tissue. Nach einer vorgegebenen Zeitdauer beendet die Steuereinheit 11 das Zuführen der Hochfrequenzspannung an die Elektroden der Untermengen 19 und veranlasst die Messeinrichtung 13 , erneut die Impedanz zwischen allen möglichen Elektrodenpaaren der Elektrodenmenge 7 zu messen. After a predetermined period of time, the control unit 11 terminates the supply of the high frequency voltage to the electrodes of the subsets 19 and causes the measuring device 13 to re-measure the impedance between all possible pairs of electrodes of the electrode volume. 7 Die Auswahleinrichtung 15 wählt dann beispielsweise aus der Elektrodenmenge das Elektrodenpaar als Untermenge 19 aus, zwischen dem das Gewebe den geringsten Impedanzanstieg aufweist. The selector 15 then selects, for example, from the amount of electrode the electrode pair as a subset of 19, between which the fabric has the lowest impedance rise. Die Impedanzwerte können ggf. auch mit Gewichtungsfaktoren unterschiedlich gewichtet werden. The impedance values ​​may be weighted differently with weighting factors if necessary. Das ausgewählte Elektrodenpaar kann dasselbe Elektrodenpaar 5 , 6 wie im vorangegangenen Auswahlprozess oder ein anderes Elektrodenpaar sein. The selected pair of electrodes may be the same pair of electrodes 5, 6 as in the previous selection process or a different pair of electrodes to be. Letzteres wird der Fall sein, wenn aufgrund der elektrothermischen Behandlung die Impedanz des Gewebes zwischen den Elektroden 5 und 6 derart angestiegen ist, dass sie höher ist als die Impedanz des Gewebes zwischen mindestens einem anderen Elektrodenpaar. The latter will be the case when the impedance of the tissue between the electrodes 5 and 6 is increased to such a result of the electro-thermal treatment to be higher than the impedance of the tissue between at least one other pair of electrodes.
  • Eine Untermenge 19 der Elektrodenmenge 7 kann auch mehr als zwei Elektroden umfassen. A subset of 19 of the electrodes Volume 7 may also comprise more than two electrodes. In diesem Fall kann es sinnvoll sein, eine Impedanzschwelle vorzugeben, die vorgibt, ob dem Gewebe zwischen den entsprechenden Elektrodenpaaren ein Hochfrequenzstrom zugeführt werden soll oder nicht. In this case it may be useful to specify an impedance threshold that dictates whether the tissue between the corresponding electrode pairs a high frequency current or should not be fed. Erreicht oder überschreitet die Impedanz des Gewebes zwischen einem Elektrodenpaar die Impedanzschwelle nicht, so wird das betreffende Elektrodenpaar in die Untermenge 19 aufgenommen. Reached or not exceeding the impedance of the tissue between a pair of electrodes, the impedance threshold, the pair of electrodes in question is included in the subset 19th
  • In einer alternativen Ausgestaltung der Erfindung misst die Messeinrichtung 13 während der Applikation des Hochfrequenzstroms kontinuierlich die Impedanz zwischen den Elektroden und gibt ein Signal an die Steuereinrichtung 11 aus, sobald die Impedanz oder der Impedanzanstieg des Gewebes zwischen den Elektroden 5 und 6 einen vorbestimmten Schwellenwert überschreitet. In an alternative embodiment of the invention, the measuring device 13 continuously measures during application of the high frequency current, the impedance between the electrodes, and outputs a signal to the control device 11 as soon as the impedance or the impedance rise of tissue between the electrodes exceeds 5 and 6 a predetermined threshold. Die Steuereinrichtung beendet dann die Applikation des Hochfrequenzstroms. The controller then terminates the application of the high frequency current. Nach dem Beenden der Applikation des Hochfrequenzstromes veranlasst die Steuereinrichtung 11 die Messeinrichtung 13 , erneut die Impedanz des Gewebes zwischen allen Elektrodenpaaren zu messen, und veranlasst danach die Auswahleinrichtung 15 anhand des Ergebnisses der Impedanzmessung eine neue Untermenge 19 der Elektrodenmenge 7 auszuwählen, über die dann dem Gewebe der Hochfrequenzstrom zugeführt wird. After finishing the application of the high frequency current control means 11 causes the measuring device 13 to re-measure the impedance of the tissue between all pairs of electrodes, and then causes the selecting means 15 based on the result of the impedance measurement, a new subset select 19 of the electrodes Volume 7, through the then the tissue of high-frequency current is supplied.
  • Umfasst die Untermenge 19 mehr als zwei Elektroden, so kann es vorgesehen sein, dass die Steuereinrichtung 11 die Applikation des Hochfrequenzstroms beendet, sobald die Impedanz des Gewebes zwischen einem der Elektrodenpaare einen vorbestimmten Wert überschreitet oder alternativ dann, wenn bei einer vorbestimmten Anzahl von Elektrodenpaaren das dazwischen liegende Gewebe die vorgegebene Impedanzschwelle überschreitet. Includes the sub-set 19 more than two electrodes, so it can be provided that the control device 11 terminates the application of the high frequency power when the impedance of the tissue between one of the pairs of electrodes exceeds a predetermined value, or alternatively when the at a predetermined number of pairs of electrodes intervening tissue, the predetermined impedance threshold exceeding.
  • Eine alternative Ausgestaltung der Erfindung ist als Blockschaltbild in Fig. 2 dargestellt. An alternative embodiment of the invention is shown as a block diagram in Fig. 2. Gleiche Elemente wie in der in Fig. 1 dargestellten Ausführungsform sind mit den gleichen Bezugszeichen bezeichnet und werden im Folgenden nicht weiter erläutert. The same elements as in the embodiment shown in Fig. 1 embodiment are denoted by the same reference numerals and will not be further explained in the following.
  • Die alternative Ausgestaltung unterscheidet sich von der in Fig. 1 dargestellten dadurch, dass eine Schalteinheit 12 vorhanden ist, die als von der Steuereinheit 11 getrennte Einheit ausgebildet ist. The alternative embodiment differs from the embodiment shown in Fig. 1 in that a switching unit 12 is present, which is designed as the control unit 11 separate unit. Mit der Schalteinheit 12 direkt verbunden ist der Hochfrequenzgenerator 17 sowie ein A/D-Wandler 14 zum Umwandeln der aus der Impedanzmessung resultierenden analogen Signale in digitale Signale, die an einen Prozessor 16 abgegeben werden. Directly connected to the switching unit 12 of the high-frequency generator 17 and an A / D converter 14 is for converting the results from the impedance measurement analog signals into digital signals which are delivered to a processor sixteenth Die Schalteinheit 12 ist dazu ausgelegt, jede Elektrode 1-6 individuell mit dem Hochfrequenzgenerator 17 und/oder dem A/D-Wandler 14 zu verbinden. The switching unit 12 is adapted to individually connect each electrode 1-6 to the high frequency generator 17 and / or the A / D converter fourteenth
  • Der Prozessor 16 umfasst die Mess- oder Auswerteeinheit 13 ', die mit dem A/D-Wandler 14 zum Empfang der aus der Impedanzmessung resultierenden digitalen Signale verbunden ist und aus den empfangenen Signalen die Impedanz des Körpergewebes ermittelt. The processor 16 includes the measurement or evaluation unit 13 'which is connected to the A / D converter 14 for receiving the resultant digital signals from the impedance measurement and determined from the received signals, the impedance of the body tissue. Die Auswerteeinheit 13 ' ist außerdem zum Ausgeben der Impedanzwerte mit der Auswahleinheit 15 verbunden, die wiederum mit der Steuereinheit 11 verbunden ist. The evaluation unit 13 'is also for outputting the impedance values connected to the selector unit 15, which in turn is connected to the control unit. 11 Die Auswahleinheit 15 wählt die zu verwendenden aktiven Elektroden (im dargestellten Ausführungsbeispiel die Elektroden 5 und 6 ) anhand der Impedanzwerte aus und teilt die Auswahl dann der Steuereinheit 11 mit. The selection unit 15 selects the active electrode to be used (in the illustrated embodiment, the electrodes 5 and 6) on the basis of the impedance values, and then notifies the selection of the control unit 11. Gemäß dieser Auswahl wirkt die Steuereinheit 11 über eine Steuerleitung auf die Schalteinheit 12 ein, so dass sie die ausgewählten aktiven Elektroden mit dem Hochfrequenzgenerator 17 verbindet. According to this selection, the control unit 11 acts via a control line to the switching unit 12 so that it connects the selected electrodes to the active high-frequency generator 17th
  • Alternativ kann die Steuereinheit 11 zusätzlich über eine Steuerleitung mit dem Hochfrequenzgenerator 17 verbunden sein, um die Frequenz der vom Hochfrequenzgenerator 17 abgegebenen Hochfrequenzspannung einstellen zu können. Alternatively, the control unit 11 may be additionally connected via a control line with the high-frequency generator 17 so as to be able to adjust the frequency of the output from the high frequency generator 17 high-frequency voltage.
  • In den dargestellten Ausführungsformen sind die aktiven Elektroden als Elektrodennadeln ausgeführt. In the illustrated embodiments, the active electrodes are formed as electrode needles. Eine solche Elektrodennadel ist in der Fig. 3a gezeigt. Such an electrode needle is shown in Fig. 3a. Die Elektrodennadel 100 weist an ihrem proximalen Ende, dh dem aus dem Gewebe herausragenden Ende, einen Griffbereich 102 und an ihrem distalen Ende, dh dem zum Einbringen in das Gewebe vorgesehenen Ende 104 zwei aktive Elektroden 120 und 122 auf (siehe Fig. 3b). The electrode needle 100 has at its proximal end, ie, protruding from the fabric end, a handle portion 102 and at its distal end, that is the intended for introduction into the tissue end 104 two active electrodes 120 and 122 (see Fig. 3b). Zwischen den beiden Elektroden 120 und 122 befindet sich ein isolierender Bereich 124 , der die beiden Elektroden voneinander elektrisch isoliert. Between the two electrodes 120 and 122 is a insulating region 124, the two electrodes are electrically insulated from each other. Obwohl die in Fig. 3a und 3b dargestellte Elektrodennadel zwei Elektroden aufweist, kann die Elektrodennadel auch mehr als zwei aktive Elektroden oder nur eine Elektrode aufweisen. Although the electrode needle shown in Fig. 3a and 3b having two electrodes, the electrode needle may also have more than two active electrodes or only one electrode. Sind mehr als zwei Elektroden vorhanden, so befindet sich zwischen allen Elektroden jeweils ein isolierender Bereich. If more than two electrodes present, located between all electrodes each an insulating area. Alle Elektroden einer Elektrodennadel 100 sind jeweils über individuelle Leitungen mit einem Steuergerät (nicht gezeigt) derart verbunden, dass jeder Elektrode individuell eine Hochfrequenzspannung zugeführt werden kann. All electrodes of an electrode needle 100 are respectively connected through individual lines with a control unit (not shown) such that each electrode a high frequency voltage can be supplied individually.
  • Die Elektrodennadel 100 kann in ihrem Inneren auch einen oder mehrere Kanäle zum Zuführen eines Fluids umfassen, um die aktiven Elektroden oder die gesamte Nadel zu kühlen oder zu heizen. The electrode needle 100 may also include one or more channels for supplying a fluid in its interior to heat the active electrodes or the entire needle or to cool.
  • In den Fig. 4a und 4b ist ein erstes Beispiel für die Anwendung der Applikationsvorrichtung schematisch dargestellt. In FIGS. 4a and 4b show a first example of the application of the application device is shown schematically. Die Figuren zeigen ein pathologisches Gewebe 200 , das Zielgewebe, in das drei Elektrodennadeln 100 derart punktiert sind, dass ihre aktiven Elektroden 120 und 122 in direktem elektrischen Kontakt mit dem Zielgewebe stehen. The figures show a pathological tissue 200, the target tissue, are dotted in the three electrode needles 100 such that its active electrodes 120 and 122 are in direct electrical contact with the target tissue.
  • Die Elektroden 120 und 122 werden von der Steuereinheit 11 zuerst derart mit einer Hochfrequenzspannung beaufschlagt, dass ein Hochfrequenzstrom entlang den Elektrodennadeln 100 in axialer Richtung zwischen den Elektroden 120 und 122 fließt. The electrodes 120 and 122 are first acted upon in such a way by the control unit 11 with a high frequency voltage that a high-frequency current along the electrode needles 100 in the axial direction between the electrodes 120 and 122 flows. Diese Stromflüsse sind in Fig. 4b, die entsprechenden Potentiale in Fig. 4a durch punktierte Linien angedeutet. These flows are indicated in Fig. 4b, the respective potentials in FIG. 4 by dotted lines.
  • Fig. 4a zeigt eine Draufsicht auf die drei Elektrodennadeln 100 , während Fig. 4b eine Seitenansicht von zwei der drei Elektrodennadeln 100 zeigt. Fig. 4a shows a plan view of the three electrode needles 100, while Fig. 4b shows a side view of two of the three electrode needles 100. Durch die Überlagerung der Stromflüsse aller drei Elektrodennadeln 100 entsteht zwischen den Nadeln ein Gewebebereich mit homogenem Stromfluss, so dass sich eine homogene Erwärmung des Gewebebereiches erzielen lässt. The superimposition of the current flows of all three electrode needles 100 is formed between the needles a tissue region with a homogeneous current flow, so that a homogeneous heating of the tissue region can be achieved.
  • Gleichzeitig mit der Applikation des Hochfrequenzstromes wird bei der Arbeitsfrequenz oder aber einer anderen Frequenz von der Messeinrichtung 13 die Gewebeimpedanz zwischen den Elektroden 120 und 122 gemessen. Simultaneously with the application of the high frequency current is at the operating frequency or the tissue impedance between the electrodes 120 and 122 of a different frequency measured by the measuring device. 13 Insbesondere, wenn dafür eine Frequenz gewählt wird, die nicht der Arbeitsfrequenz entspricht, so kann bei laufender Applikation die Impedanz des Gewebes zwischen einzelnen Elektrodenpaaren gemessen werden, ohne dass der Applikationsstrom diese Messung wesentlich behindert. In particular, if for a frequency is chosen which does not correspond to the operating frequency, so the application is running, the impedance of the tissue between different pairs of electrodes can be measured without the application current substantially hinder this measurement. Dazu umfasst die Messeinrichtung einen Frequenzdiskriminator oder -filter, der in der Lage ist, die Frequenz der Impedanzmessung, beispielsweise 20 kHz, von der Arbeitsfrequenz, beispielsweise 470 kHz, zu trennen. For this purpose the measuring means comprises a frequency discriminator or filter which is able to separate the frequency of the impedance measurement, for example, 20 kHz, of the working frequency, for example 470 kHz.
  • Die Fig. 5a und 5b zeigen ein weiteres Beispiel für die Anwendung der erfindungsgemäßen Applikationsvorrichtung. FIGS. 5a and 5b show a further example of the application of the application device according to the invention. Statt in das Zielgewebe werden in diesem Beispiel drei Elektrodennadeln 100 knapp außerhalb des Zielgewebes punktiert, so dass das Zielgewebe sich zwischen den drei Elektrodennadeln 100 befindet. Instead of in the target tissue three electrode needles 100 are punctured just outside of the target tissue, in this example, so that the target tissue is located between the three electrode needles 100th Im Gegensatz zu dem in den Fig. 4a und 4b dargestellten Beispiel erfolgt der Stromfluss hier nicht parallel zu den Nadelachsen, sondern von einer Elektrodennadel 100 zur anderen. In contrast to that shown in Figs. 4a and 4b example shown, the current flow is not parallel to the needle axis, but by an electrode needle 100 to the other here. Dadurch lässt sich im Zielgewebe 200 ein homogener Stromfluss erzielen. This can be achieved a homogeneous flow of current in the target tissue 200th Außerdem kann ein Verschleppen malignen Gewebes beim Entfernen der Elektrodennadeln vermieden werden. In addition, a carryover malignant tissue the electrode needles when removing can be avoided.
  • Die Applikationsvorrichtung kann entweder ausschließlich mit axialem Stromfluss entlang der Nadeln, ausschließlich mit Stromfluss zwischen zwei verschiedenen Nadeln oder einer Kombination von beidem betrieben werden. The application device can either be operated by both exclusively with axial current flow along the needles exclusively with current flow between two different needles or a combination thereof. Die Richtung des Stromflusses kann nach einer Neuauswahl der Untermenge aktiver Elektroden von dem einen Modus in den anderen Modus umgeschaltet werden. The direction of current flow from the can to be switched to the other mode a mode according to a reselection of the subset of active electrodes.
  • Obwohl in den Ausführungsbeispielen jeweils Elektrodenmengen mit sechs Elektroden dargestellt sind, kann die Elektrodenmenge auch mehr oder weniger als sechs Elektroden enthalten. Although in the embodiments each electrode amounts are shown with six electrodes, the electrode quantity can also contain more or less than six electrodes.

Claims (15)

  1. 1. Applikationsvorrichtung zum Applizieren eines Hochfrequenzstroms zum thermischen Veröden von Körpergewebe, umfassend eine Elektrodenmenge ( 7 ) mit mindestens drei in Körpergewebe einführbaren aktiven Elektroden ( 1-6 ), einen Hochfrequenzgenerator ( 17 ) zum Erzeugen einer Hochfrequenzspannung, der umschaltbar mit einer oder mehreren der Elektroden ( 1-6 ) zu verbinden ist, und eine Messeinrichtung ( 13 ) zum Messen der Impedanz des Körpergewebes zwischen allen oder ausgewählten aktiven Elektroden ( 1-6 ) gekennzeichnet durch eine Auswahleinrichtung ( 15 ), die mit der Messeinrichtung ( 13 ) verbunden ist und dazu ausgestaltet ist, eine mindestens zwei aktive Elektroden ( 5 , 6 ) umfassende Untermenge ( 19 ) aus der Elektrodenmenge ( 7 ) anhand der gemessenen Impedanz auszuwählen und durch eine Steuereinrichtung ( 11 ), die mit der Auswahleinrichtung ( 15 ) verbunden ist und zum Anlegen der Hochfrequenzspannung an die aktiven Elektroden ( 5 , 6 ) der ausgewählten Untermenge 1. Application device for applying a high frequency current for thermal sclerosing of body tissue comprising an electrode set (7) with at least three in body tissue insertable active electrodes (1-6), a high frequency generator (17) for generating a high frequency voltage, the switched with one or more of the electrodes (1-6) is to be connected, and a measuring device (13) for measuring the impedance of the body tissue between all or selected active electrodes (1-6) characterized by a selection device (15) which is connected to the measuring device (13) and is configured to have at least two active electrodes (5, 6) select full subset (19) from the amount of electrode (7) based on the measured impedance and by a control device (11) which is connected to the selection means (15) and for applying the high frequency voltage to the active electrode (5, 6) of the selected subset ( 19 ) derart, dass zwischen ihnen ein Hochfrequenzstrom durch das Körpergewebe fließt, ausgestaltet ist. (19) such that a high frequency current flows between them through the body tissue is configured.
  2. 2. Applikationsvorrichtung nach Anspruch 1, dadurch gekennzeichnet, dass die Auswahleinrichtung ( 15 ) derart ausgestaltet ist, dass eine neue Impedanzmessung und eine neue Auswahl einer mindestens zwei Elektroden ( 5 , 6 ) umfassenden Untermenge ( 19 ) vorgenommen wird, wenn seit der vorangegangenen Auswahl eine vorbestimmte Zeit verstrichen ist. 2. Application apparatus according to claim 1, characterized in that the selection means (15) is designed such that a new impedance measurement and a new selection of a least two electrodes (5, 6) comprising sub-set (19) is made when since the previous selection a predetermined time has elapsed.
  3. 3. Applikationsvorrichtung nach Anspruch 1 oder 2, dadurch gekennzeichnet, dass die Messeinrichtung ( 13 ) zum Messen der Impedanz des Körpergewebes zwischen den aktiven Elektroden ( 1-6 ) während der Applikation des Hochfrequenzstroms ausgelegt ist. 3. Application apparatus according to claim 1 or 2, characterized in that the measuring device (13) for measuring the impedance of the body tissue between the active electrode (1-6) is adapted during the application of the high frequency current.
  4. 4. Applikationsvorrichtung nach Anspruch 3, dadurch gekennzeichnet, dass die Auswahleinrichtung ( 15 ) derart ausgestaltet ist, dass eine neue Auswahl einer mindestens zwei aktive Elektroden ( 5 , 6 ) umfassenden Untermenge ( 19 ) vorgenommen wird, wenn die Impedanz oder die Impedanzänderung des Körpergewebes zwischen einer vorgegebenen Anzahl aktiver Elektroden ( 5 , 6 ) der Untermenge einen vorbestimmten Wert erreicht oder überschreitet. 4. Application apparatus according to claim 3, characterized in that the selection means (15) is designed such that a new selection of at least two active electrodes (5, 6) comprising sub-set (19) is made when the impedance or the impedance change of the body tissue between a predetermined number of active electrodes (5, 6) of the subset reaches a predetermined value or more.
  5. 5. Applikationsvorrichtung nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, dass die Auswahleinrichtung ( 15 ) derart ausgestaltet ist, dass sie vor der Auswahl bzw. der Neuauswahl der mindestens zwei aktive Elektroden ( 5 , 6 ) umfassenden Untermenge ( 19 ) die Messeinrichtung ( 13 ) veranlasst, eine Messung der Impedanz des Körpergewebes zwischen allen möglichen Paaren aus aktiven Elektroden ( 1-6 ) durchzuführen, und als Untermenge ( 19 ) diejenigen aktiven Elektroden ( 1-6 ) auswählt, zwischen denen die Impedanz oder die Impedanzänderung am geringsten ist oder einen vorbestimmten Wert nicht überschreitet. 5. Application apparatus according to one of claims 1 to 4, characterized in that the selection means (15) is designed such that it prior to the selection or reselection of at least two active electrodes (5, 6) comprising sub-set (19) of the measuring device (13) caused to perform a measurement of the impedance of the body tissue between all possible pairs of active electrodes (1-6), and a subset (19) those active electrodes (1-6) selects, between which the impedance or the impedance change at the slightest or does not exceed a predetermined value.
  6. 6. Applikationsvorrichtung nach einem der vorangehenden Ansprüche, dadurch gekennzeichnet, dass die Steuervorrichtung ( 11 ) derart ausgestaltet ist, dass zu Beginn der Applikation die Hochfrequenzspannung in einem vorgegebenen zyklischen Wechsel an die aktiven Elektroden ( 1-6 ) angelegt wird und die Auswahl der mindestens zwei aktive Elektroden ( 5 , 6 ) umfassenden Untermenge ( 19 ) anhand der Impedanz zu einem spätem Zeitpunkt der Applikation einsetzt. 6. Application device according to one of the preceding claims, characterized in that the control device (11) is designed such that at the beginning of the application, the high frequency voltage is applied in a predetermined cyclic change to the active electrode (1-6) and the selection of at least two active electrodes (5, 6) comprising sub-set (19) based on the impedance at a late time point of the application begins.
  7. 7. Applikationsvorrichtung nach einem der vorangehenden Ansprüche, dadurch gekennzeichnet, dass die Auswahleinrichtung ( 15 ) derart ausgestaltet ist, dass als Untermenge ( 19 ) mindestens drei aktive Elektroden ausgewählt werden und die Steuereinrichtung ( 11 ) derart ausgestaltet ist, dass die aktiven Elektroden mit Hochfrequenzspannungen beaufschlagt werden, die jeweils um einen festen Phasenwinkel zueinander phasenverschoben sind. 7. Application device according to one of the preceding claims, characterized in that the selection means (15) is configured such that a subset (19) at least three active electrodes are selected and the control device (11) configured is that the active electrodes with RF voltages are applied which are phase shifted by a fixed phase angle.
  8. 8. Applikationsvorrichtung nach Anspruch 7, dadurch gekennzeichnet, dass als Untermenge ( 19 ) drei aktive Elektroden ausgewählt werden und die Phasenwinkel 120 Grad betragen. 8. Application device according to claim 7, characterized in that are selected as the subset (19) three active electrodes and the phase angle is 120 degrees.
  9. 9. Applikationsvorrichtung nach einem der vorangehende Ansprüche, dadurch gekennzeichnet, dass die aktiven Elektroden ( 1-6 ) an Elektrodennadeln ( 100 ) angeordnet sind. 9. Application device according to any one of the preceding claims, characterized in that the active electrodes (1-6) are arranged on electrode needles (100).
  10. 10. Applikationsvorrichtung nach Anspruch 9, dadurch gekennzeichnet, das die Elektrodennadeln ( 100 ) bipolare Elektrodennadeln sind. 10. Application apparatus according to claim 9, characterized in that these are the electrode needles (100) are bipolar electrode needles.
  11. 11. Applikationsvorrichtung nach Anspruch 10, dadurch gekennzeichnet, dass die Elektrodennadeln ( 100 ) multipolare Elektrodennadeln sind. 11. Application apparatus according to claim 10, characterized in that the electrode needles (100) are multi-polar electrode needles.
  12. 12. Applikationsvorrichtung nach Anspruch 11, dadurch gekennzeichnet, dass die Elektrodennadeln ( 100 ) mit einer Isolierenden Umhüllung umgeben sind und aus der Umhüllung um vorbestimmte Längen ausfahrbar sind. 12. Application apparatus according to claim 11, characterized in that the electrode needles (100) are surrounded by an insulating sheath, and are extended out of the enclosure by predetermined lengths.
  13. 13. Applikationsvorrichtung nach einem der Ansprüche 9 bis 12, dadurch gekennzeichnet, dass die Elektrodennadeln ( 100 ) Kanäle für ein Fluid zur Kühlung oder Heizung der Elektrodennadeln ( 100 ) aufweisen. 13. Application device according to one of claims 9 to 12, characterized in that the electrode needles (100) have channels for a fluid for cooling or heating of the electrode needles (100).
  14. 14. Applikationsvorrichtung nach Anspruch 13, dadurch gekennzeichnet, dass die Kanäle zu den aktiven Elektroden ( 1-6 ) führen und zum Zuführen von Kühlfluid geeignet sind. 14. Application apparatus according to claim 13, characterized in that the channels to the active electrode (1-6) run and are suitable for supplying cooling fluid.
  15. 15. Applikationsvorrichtung nach Anspruch 13 oder 14, dadurch gekennzeichnet, dass das Fluid eine entionisierte Flüssigkeit ist. 15. Application apparatus according to claim 13 or 14, characterized in that the fluid is a de-ionized liquid.
DE2002124154 2002-05-27 2002-05-27 Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissue Ceased DE10224154A1 (en)

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DE2002124154 DE10224154A1 (en) 2002-05-27 2002-05-27 Application device for electrosurgical device for body tissue removal via of HF current has electrode subset selected from active electrode set in dependence on measured impedance of body tissue
PCT/EP2003/005439 WO2003099372A3 (en) 2002-05-27 2003-05-23 Device for electrosurgically destroying body tissue
JP2004506895A JP4338631B2 (en) 2002-05-27 2003-05-23 Apparatus for the body tissue is cured by electro Sir Geri I (thermal subscription low cis)
US10515945 US8216219B2 (en) 2002-05-27 2003-05-23 Device for electrosurgically destroying body tissue
EP20030735453 EP1511534B1 (en) 2002-05-27 2003-05-23 Device for electrosurgically destroying body tissue
CN 03812074 CN100409822C (en) 2002-05-27 2003-05-23 Device for electrosurgically destroying body tissue

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