DE9490469U1 - Bipolar ultrasound surgery - Google Patents
Bipolar ultrasound surgeryInfo
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- DE9490469U1 DE9490469U1 DE9490469U DE9490469U DE9490469U1 DE 9490469 U1 DE9490469 U1 DE 9490469U1 DE 9490469 U DE9490469 U DE 9490469U DE 9490469 U DE9490469 U DE 9490469U DE 9490469 U1 DE9490469 U1 DE 9490469U1
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- 238000001356 surgical procedure Methods 0.000 title claims description 12
- 238000002604 ultrasonography Methods 0.000 title claims description 5
- 230000002262 irrigation Effects 0.000 claims description 42
- 238000003973 irrigation Methods 0.000 claims description 42
- 239000004020 conductor Substances 0.000 claims description 40
- 238000011010 flushing procedure Methods 0.000 claims description 20
- 230000008878 coupling Effects 0.000 claims description 9
- 238000010168 coupling process Methods 0.000 claims description 9
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- 229910001069 Ti alloy Inorganic materials 0.000 description 3
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- 238000010276 construction Methods 0.000 description 3
- 239000002826 coolant Substances 0.000 description 3
- 238000002357 laparoscopic surgery Methods 0.000 description 3
- 238000000034 method Methods 0.000 description 3
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- 210000001124 body fluid Anatomy 0.000 description 2
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1402—Probes for open surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/320069—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for ablating tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/32007—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with suction or vacuum means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/320084—Irrigation sleeves
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Plasma & Fusion (AREA)
- Physics & Mathematics (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Otolaryngology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Oscillators With Electromechanical Resonators (AREA)
- Medicines Containing Antibodies Or Antigens For Use As Internal Diagnostic Agents (AREA)
Description
(für die Eintragung des Gbm vorgesehene Unterlagen) — *· *· ·· &Ggr;&idigr; &Ggr;(documents required for registration of the Gbm ) — *· *· ·· &Ggr;&idigr;&Ggr;
VALLEYIAB, INC. PC 8420/ALPVALLEYIAB, INC. PC 8420/ALP
5920 Longbow Drive
Boulder, Colorado 80301
USA5920 Longbow Drive
Boulder, Colorado 80301
USA
BIPOLARE ÜLTRASCHALLCHIRÜRGIEBIPOLAR ULTRASOUND SURGERY
1. Gebiet der Erfindung 1. Field of the invention
Diese Erfindung betrifft die bipolare Elektrochirurgie in Kombination mit einem im Ultraschallbereich vibrierenden, chirurgischen Werkzeug und insbesondere die Verwendung einer oder mehrerer Zusatzelektroden auf der Spülleitung oder dem ültraschallrohrwerkzeug, um damit nahe der Spitze des vibrierenden Werkzeugs bipolare elektrochirurgische Energie zu erzeugen.This invention relates to bipolar electrosurgery in combination with an ultrasonic vibrating surgical tool and, more particularly, to the use of one or more additional electrodes on the irrigation line or ultrasonic tube tool to generate bipolar electrosurgical energy near the tip of the vibrating tool.
2. Hintergrund der Erfindung 2. Background of the invention
Das US-Patent 4 674 498 hat ein vibrierendes Skalpell mit elektrischer Kauterisierung, das mit niederfrequenten Vibrationen betrieben wird, wenn durch die mechanische Wirkung der scharfen Messerschneide geschnitten wird und die Vibrationen die Schneide davon abhalten, das kauterisierte Gewebe und die Körperflüssigkeit anzustechen. Das Anstechen von Gewebe und Körperflüssigkeit wirkt sich in einer Zerstörung des kauterisierten Gewebes aus, wodurch sich die versiegelte Wunde öffnet. Das obige US-Patent beschreibt ein niederfrequent beheiztes Vibrationsskalpell.US Patent 4,674,498 has a vibrating scalpel with electrical cauterization that is powered by low frequency vibrations when cutting by the mechanical action of the sharp knife edge and the vibrations prevent the edge from piercing the cauterized tissue and body fluid. The piercing of tissue and body fluid results in destruction of the cauterized tissue, causing the sealed wound to open. The above US patent describes a low frequency heated vibrating scalpel.
Das US-Patent 4 886 060, das der Swedemed AB, einer schwedischen Gesellschaft, erteilt wurde, hat ein piezoelektrisch betriebenes UltraschallVibrationswerkzeug und beansprucht in breiter Weise ein Ultraschallmesser, das mit einer Hochfrequenzemissionsquelle verwendet wird, die die Energie zum Erhitzen des Gewebes der Spitze des Ultraschallmessers für die Koagulation des Gewebes induziert. Das Werkzeug ist elektrisch von der KoagulationsvorrichtungU.S. Patent 4,886,060 issued to Swedemed AB, a Swedish company, has a piezoelectrically powered ultrasonic vibration tool and broadly claims an ultrasonic knife used with a radio frequency emission source that induces the energy to heat the tissue at the tip of the ultrasonic knife for coagulation of the tissue. The tool is electrically connected to the coagulation device
(Elektrochirurgie) isoliert, um einen Kurzschluß des Piezotreibers zu vermeiden.(electrosurgery) to avoid a short circuit of the piezo driver.
Das US-Patent 4 931 047, das Valleylab, Boulder, Colorado, erteilt wurde, ist ein Ultraschallgerät mit einer vibrierenden Spitze, um Gewebe am Operationssitus zu zerlegen. Die Spitze ist mit einem Hochfrequenzgenerator verbunden und liefert Schneide- oder Koagulationsstrom oder eine Mischung derselben zum Situs. Chirurgische Prozeduren können durch Anwendung der Ultraschallfragmentierung und der Elektrochirurgie, oder die Anwendung dieser Vorgänge unabhängig voneinander und/oder alternativ ausgeführt werden. Die Elektrochirurgie ist einpolig dahingehend, daß die Energie von der Spitze durch das Patientengewebe zu einer Erdplatte geht, die am Patientenkörper angebracht ist. Das die Spitze haltende Werkzeug ist hohl und hat eine Bohrung, und Spülfluid geht durch einen ringförmigen Raum um das Werkzeug zur Spitze, wird proximal davon durch die Bohrung aufgesaugt und entfernt auf diese Weise Operationsrückstände vom Situs. Diese Aufsaugtechnik ist aus dem US-Patent 3 693 613 bekannt.U.S. Patent 4,931,047, issued to Valleylab, Boulder, Colorado, is an ultrasonic device with a vibrating tip for breaking up tissue at the surgical site. The tip is connected to a high frequency generator and delivers cutting or coagulation current or a mixture of these to the site. Surgical procedures can be performed using ultrasonic fragmentation and electrosurgery, or using these processes independently and/or alternatively. Electrosurgery is unipolar in that energy passes from the tip through the patient's tissue to a ground plate attached to the patient's body. The tool holding the tip is hollow and has a bore, and irrigation fluid passes through an annular space around the tool to the tip, is aspirated proximally through the bore, and thus removes surgical debris from the site. This aspiration technique is known from U.S. Patent 3,693,613.
Das US-Patent 5 015 227, das Valleylab, Boulder, Colorado, erteilt worden ist, befaßt sich mit einem Ultraschallinstrument, das elektrochirurgische Fähigkeiten besitzt. Die spezifischen Merkmale dieses Patents betreffen einen leitenden O-Ring, der das Umschalten der elektrochirurgischen Energie am Handstück ohne Widerstand durch die Vibrationen des Ultraschalltreibers für das Zertrümmerungswerkzeug gestattet.U.S. Patent 5,015,227 issued to Valleylab, Boulder, Colorado, is directed to an ultrasonic instrument having electrosurgical capabilities. The specific features of this patent relate to a conductive O-ring that allows switching of the electrosurgical energy at the handpiece without resistance from the vibrations of the ultrasonic driver for the fragmentation tool.
Typischerweise wird bipolare Elektrochirurgie dadurch ausgeführt, daß zwei elektrochirurgisch wirksame Elektroden in nächste Nähe des zu behandelnden Gewebes gebracht werden und dann der elektrochirurgische Generator zum Austrocknen des Gewebes aktiviert wird. Der Strom wird auf den Bereich zwischen den beiden Elektroden begrenzt. Bislang wurde kein Ultraschallvibrationswerkzeug zwischen oder in die Nähe derTypically, bipolar electrosurgery is performed by placing two electrosurgical electrodes in close proximity to the tissue to be treated and then activating the electrosurgical generator to dry out the tissue. The current is limited to the area between the two electrodes. To date, no ultrasonic vibration tool has been placed between or near the
bipolaren Elektroden gelegt. Die gesamten Beschreibungen der früheren Patente sind hier in Bezug genommen und bilden einen Teil des hier Offenbarten.bipolar electrodes. The entire descriptions of the prior patents are incorporated herein by reference and form a part of the disclosure herein.
Ein bipolares Ultraschallchirurgieinstrument kann ein Handstück für die Manipulation durch einen Chirurgen haben, welches mit einer bipolaren Quelle für elektrochirurgische Hochfrequenzenergie verbunden ist. Ein elektrischer Oszillator steuert bevorzugt das Ultraschallinstrument mit einer vorgegebenen Frequenz an. Eine Ultraschalltreiberschaltung kann die Einstellung des Pegels der Ultraschallvibration gestatten. Ein Gehäuse ist besonders geeignet, welches das vom Operateur gehaltene Handstück während der Anwendung proximal haltert. Leiter können eine Verbindung mit der bipolaren Quelle der Hochfrequenzenergie herstellen und sind vom Gehäuse gehalten.A bipolar ultrasonic surgical instrument may have a handpiece for manipulation by a surgeon, which is connected to a bipolar source of radio frequency electrosurgical energy. An electrical oscillator preferably drives the ultrasonic instrument at a predetermined frequency. An ultrasonic driver circuit may allow adjustment of the level of ultrasonic vibration. A housing is particularly suitable which proximally supports the handpiece held by the surgeon during use. Conductors may connect to the bipolar source of radio frequency energy and are supported by the housing.
Ein Wandler ist bevorzugt innerhalb des Gehäuses vorgesehen, der Ultraschallenergie zur Verfügung stellt. Der Wandler kann längs einer Achse desselben positioniert sein und kann für Schwingungen entlang der Achse mit wenigstens einer für die Ultraschallchirurgie bevorzugten Frequenz und Wellenlänge und ausreichender Auslenkung gewählt sein. Rohrwerkzeuge sind am Wandler bevorzugt so angebracht, daß jedes Rohrwerkzeug um wenigstens die bevorzugte Frequenz oder Wellenlänge herum oszilliert, wobei jedes Rohrwerkzeug eine durchgehende Zentralbohrung hat, die mit einer Saugquelle verbunden ist. Eine distale Spitze jedes Rohrwerkzeugs ist bevorzugt vom Gehäuse abgesetzt in einer Position für die Ultraschallchirurgie, die bipolare Elektrochirurgie oder eine Kombination davon positioniert.A transducer is preferably provided within the housing for providing ultrasonic energy. The transducer may be positioned along an axis thereof and may be selected for oscillation along the axis at at least one frequency and wavelength preferred for ultrasonic surgery and sufficient excursion. Tube tools are preferably attached to the transducer such that each tube tool oscillates about at least the preferred frequency or wavelength, each tube tool having a central bore therethrough connected to a suction source. A distal tip of each tube tool is preferably positioned remote from the housing in a position for ultrasonic surgery, bipolar electrosurgery, or a combination thereof.
Ein Spülleitungszug kann koaxial um die Rohrleitung liegen und ist bevorzugt für ein Auskragen vom Gehäuse gehaltert. Ein Ringraum zwischen dem Rohrwerkzeug und dem Spülleitungszug kann den Durchgang von Spülfluiden gestatten.A flushing line string may be coaxial around the pipeline and is preferably mounted to project from the casing. An annular space between the pipe tool and the flushing line string may allow the passage of flushing fluids.
Zwei oder mehr Elektroden gehören bevorzugt zum Rohrwerkzeug, zum Leitungszug oder zu beiden, und sie sind in einem Stromkreis mit den Leitern für eine ausgewählte Speisung der Elektroden angeschlossen.Two or more electrodes preferably belong to the pipe tool, the line pull or both, and they are connected in a circuit with the conductors for a selected feed of the electrodes.
Die Leitungen können hinzugefügte Schaltsysteme beinhalten, um die Elektroden selektiv unter Strom zu setzen. Die Ultraschallansteuerschaltung kann eine mit dem elektronischen Oszillator verbundene Amplitudensteuerung, einen Frequenzregler zwischen der Amplitudensteuerung und dem elektronischen Oszillator und einen frequenzregelnden Rückkoppelkreis im Frequenzregler haben, der die lineare Dynamik des ultraschallchirurgischen Instruments um die vorgegebene Frequenz aufrecht erhält.The leads may include added switching systems to selectively energize the electrodes. The ultrasonic drive circuit may include an amplitude controller connected to the electronic oscillator, a frequency controller between the amplitude controller and the electronic oscillator, and a frequency regulating feedback loop in the frequency controller that maintains the linear dynamics of the ultrasonic surgical instrument around the predetermined frequency.
Zwei oder mehr Elektroden sind bevorzugt dem Rohrwerkzeug zugeordnet und davon elektrisch isoliert und liegen in einem Stromkreis mit den Leitern für eine wählbare Speisung der Elektroden. Die zwei oder mehr Elektroden können beweglich in einem Stromkreis mit den Leitern durch eine elektrische Gleitkupplung zwischen den Elektroden und den Leitern für die Speisung der Elektroden verbunden sein, um die Ultraschallvibration des Rohrwerkzeugs zu gestatten. Die zwei oder mehr Elektroden können alternativ auch dem Spülleitungszug zugeordnet sein und in einem Stromkreis mit den Leitern für eine wählbare Speisung der Elektroden liegen. Wenigstens eine der Elektroden ist bevorzugt dem Spülleitungszug zugeordnet, und wenigstens eine der Elektroden kann dem Rohrwerkzeug in einem anderen Ausführungsbeispiel zugeordnet sein, und die Elektroden können auch in einem Stromkreis mit den Leitern für die wählbare Speisung der Elektroden liegen.Two or more electrodes are preferably associated with and electrically isolated from the tubular tool and are in circuit with the conductors for selectively powering the electrodes. The two or more electrodes may be movably connected in circuit with the conductors by an electrical slip coupling between the electrodes and the conductors for powering the electrodes to allow ultrasonic vibration of the tubular tool. The two or more electrodes may alternatively be associated with the flushing line train and are in circuit with the conductors for selectively powering the electrodes. At least one of the electrodes is preferably associated with the flushing line train and at least one of the electrodes may be associated with the tubular tool in another embodiment and the electrodes may also be in circuit with the conductors for selectively powering the electrodes.
Eine oder mehrere, dem Rohrwerkzeug zugeordnete Elektroden sind bei einer Anordnung beweglich in einem Stromkreis mit ihrem jeweiligen Leiter durch eine folgende elektrische Kupplung zwischen der Elektrode und dem Leiter verbunden, um die Elektrode zu speisen und die UltraschallvibrationOne or more electrodes associated with the pipe tool are connected in an arrangement movably in a circuit with their respective conductor by a subsequent electrical coupling between the electrode and the conductor, in order to feed the electrode and to generate the ultrasonic vibration
des Rohrwerkzeugs zu gestatten. Die eine oder mehr Elektroden sind möglicherweise dem Rohrwerkzeug zugeordnet und davon elektrisch isoliert, wobei die eine oder mehrere Elektroden in einem Stromkreis mit einem der Leiter liegen, und das Rohrwerkzeug liegt in einem Stromkreis mit dem anderen der Leiter, um dadurch eine ausgewählte Speisung der Elektroden zu ermöglichen. Es ist vorstellbar, daß die eine oder mehr dem Rohrwerkzeug zugeordneten Elektroden jeweils im Stromkreis mit ihrem jeweiligen Leiter durch eine folgende elektrische Kupplung zwischen den Elektroden und dem Leiter beweglich verbunden sind, um die Elektroden zu erregen, während das Rohrwerkzeug der Ultraschallvibration unterworfen werden kann. Die zwei oder mehr Elektroden sind möglicherweise jeweils dem Rohrwerkzeug dadurch zugeordnet, daß sie auf der Außenseite desselben getragen sind, oder sich von dem Gehäuseende desselben zu seiner distalen Spitze erstrecken. Die zwei oder mehr Elektroden können bei einer anderen Anordnung dem Rohrwerkzeug dadurch zugeordnet sein, daß sie in seinem Inneren gehalten sind und sich vom Gehäuseende desselben zu seiner distalen Spitze erstrecken. Die zwei oder mehr Elektroden können möglicherweise in einer anderen Anordnung dem Rohrwerkzeug zugeordnet sein, bei der das Rohrwerkzeug wenigstens eine Elektrode in seinem Inneren und eine Elektrode auf seiner Außenseite so trägt, daß sie sich vom Gehäuseende desselben zu seiner distalen Spitze erstrecken. Die zwei oder mehr Elektroden können vielleicht auch jeweils dem Spulleitungszug bei einer noch anderen Anordnung zugeordnet sein, indem sie an dessen Außenseite getragen sind und sich zu dessen Gehäusehalterung distalseitig erstrecken. Es ist außerdem denkbar, daß die zwei oder mehr Elektroden jeweils dem Spulleitungszug dadurch zugeordnet sind, daß sie abwechselnd an dessen Innenseite gehaltert sind und sich von der Gehäusehalterung desselben distalwärts erstrecken. Die zwei oder mehr Elektroden können auch jeweils dem Spulleitungszug zugeordnet sein, der wenigstens eine Elektrode an seiner Innenseite und wenigstens eine an seiner Außenseite inof the tubular tool. The one or more electrodes may be associated with the tubular tool and electrically isolated therefrom, the one or more electrodes being in circuit with one of the conductors, and the tubular tool being in circuit with the other of the conductors, thereby enabling selective energization of the electrodes. It is conceivable that the one or more electrodes associated with the tubular tool are each movably connected in circuit with its respective conductor by a subsequent electrical coupling between the electrodes and the conductor to energize the electrodes while the tubular tool can be subjected to ultrasonic vibration. The two or more electrodes may each be associated with the tubular tool by being carried on the outside thereof, or extending from the housing end thereof to its distal tip. The two or more electrodes may, in another arrangement, be associated with the tubular tool by being carried within it and extending from the housing end thereof to its distal tip. The two or more electrodes may possibly be associated with the tubular tool in another arrangement in which the tubular tool carries at least one electrode in its interior and one electrode on its exterior so that they extend from the housing end thereof to its distal tip. The two or more electrodes may also each be associated with the coil line in yet another arrangement in that they are carried on the exterior thereof and extend distally to the housing support thereof. It is also conceivable that the two or more electrodes are each associated with the coil line in that they are alternately supported on the interior thereof and extend distally from the housing support thereof. The two or more electrodes may also each be associated with the coil line in that they have at least one electrode on the interior thereof and at least one electrode on the exterior thereof in
einer anderen Ausführung trägt, so daß sie sich von der Gehäusehalterung desselben distalwärts erstrecken. Die zwei oder mehr Elektroden sind möglicherweise jeweils dem Rohrwerkzeug zugeordnet, das wenigstens eine Elektrode an seiner Innenseite und wenigstens eine Elektrode an seiner Außenseite hat, die sich möglicherweise vom Gehäuseende zur distalen Spitze in noch einer anderen Ausführungsform erstrecken. Die zwei oder mehr Elektroden können jeweils dem Spülleitungszug und dem Rohrwerkzeug zugeordnet sein, indem sie auf ihrer jeweiligen Außenseite getragen sind und sich vom Gehäuse in distaler Richtung erstrecken, um noch eine weitere Form der bipolaren Elektrochirurgie mit Ultraschall vibration zu gestatten.another embodiment so as to extend distally from the housing support thereof. The two or more electrodes may each be associated with the tubular tool having at least one electrode on its inner side and at least one electrode on its outer side, possibly extending from the housing end to the distal tip in yet another embodiment. The two or more electrodes may each be associated with the irrigation line pull and the tubular tool by being carried on their respective outer sides and extending distally from the housing to permit yet another form of bipolar electrosurgery with ultrasonic vibration.
Die zwei oder mehr Elektroden sind möglicherweise dem Spülleitungszug und dem Rohrwerkzeug dadurch zugeordnet, daß sie jeweils auf deren Innenseite getragen sind und sich von der Gehäusehalterung derselben distalwärts erstrecken. Die zwei oder mehr Elektroden können jeweils dem Spülleitungszug und dem Rohrwerkzeug dadurch zugeordnet sein, daß wenigstens eine Elektrode auf der Innenseite entweder des Spülleitungszugs oder des Rohrwerkzeugs getragen ist und gegensätzlich zu wenigstens einer Elektrode auf der Außenseite des Rohrwerkzeugs oder des Spülleitungszugs liegt und sich von deren Gehäusehalterung distalwärts erstrecken und wenigstens einen bipolaren Stromkreis zwischen der Außenseite der einen und der Innenseite der anderen bilden.The two or more electrodes may be associated with the irrigation line string and the tubular tool by being carried on the inside of each and extending distally from the housing support thereof. The two or more electrodes may be associated with the irrigation line string and the tubular tool by having at least one electrode carried on the inside of either the irrigation line string or the tubular tool and opposed to at least one electrode carried on the outside of the tubular tool or the irrigation line string and extending distally from the housing support thereof and forming at least one bipolar circuit between the outside of one and the inside of the other.
Fig. 1 ist eine perspektivische Darstellung eines ültraschallchirurgiehandstücks, bei dem ein Teil des Gehäuses entfernt ist, um dessen Innenseite und die darin liegenden Komponenten sowie die Leiter zu zeigen, die die dem Spülleitungszug und/oder dem Ultraschallrohrwerkzeug zugeordneten Bipolarelektroden speisen.Fig. 1 is a perspective view of an ultrasonic surgical handpiece with a portion of the housing removed to show the interior thereof and the components therein, as well as the conductors that feed the bipolar electrodes associated with the irrigation line string and/or the ultrasonic tubing tool.
• ··
Fig. 2 ist eine Seitenansicht eines Spülleitungszugs im Querschnitt und eines darin enthaltenen länglichen, sich verjüngenden Rohrwerkzeugs, wobei die Bipolarelektroden einander diametral entgegengesetzt auf dem Leitungszug und/oder dem Rohrwerkzeug orientiert sind, wie dies durch den Querschnitt entlang der Schnittlinien 2-2 in Fig. 1 ersichtlich ist.Fig. 2 is a side view of a flushing line string in cross section and an elongated tapered tubular tool contained therein, with the bipolar electrodes oriented diametrically opposite one another on the line string and/or the tubular tool as seen by the cross section taken along section lines 2-2 in Fig. 1.
Fig. 3a bis j sind jeweils Querschnittsansichten der verschiedenen alternativen Anordnungen von Bipolarelektroden, wie sie bei dem ultraschallchirurgischen Handstück möglich sind, gesehen längs der Schnittlinie 3-3 der Figuren 1 oder 2.Fig. 3a to j are cross-sectional views of the various alternative arrangements of bipolar electrodes possible in the ultrasonic surgical handpiece, taken along section line 3-3 of Fig. 1 or 2, respectively.
Fig. 4 ist eine schematische Darstellung wenigstens eines Stromkreises, der zur Speisung der dem Spülleitungszug zugeordneten Bipolarelektroden mit elektrochirurgischer Hochfrequenzenergie dient.Fig. 4 is a schematic representation of at least one circuit used to supply high frequency electrosurgical energy to the bipolar electrodes associated with the irrigation line.
Die Ansprüche sind nicht auf die Struktur für ein Ultraschallchirurgiehandstück 10, einen Bipolarspülleitungszug, ein Rohrwerkzeug oder ein Bipolar-Ultraschallchirurgieinstrument, das eine bipolare und/oder Ultraschallchirurgie ermöglicht, beschränkt, wie sie beispielhaft und speziell beschrieben und dargestellt sind. Die Ansprüche müssen angesichts des Fachwissens der auf diesem Gebiet bewanderten Fachleute vor den durch den Wortlaut der beiliegenden Ansprüche definierten Erfindungen betrachtet werden. Die durchgängig verwendeten Bezeichnungen "proximal" oder "posterior" haben die Bedeutung nahe dem Anwender und die Bezeichnungen "distal" oder "anterior" bedeuten in der Nähe des Patienten. Die in den verschiedenen Figuren ersichtlichen Bezugszahlen sind bei identischen Bauteilen gleich.The claims are not limited to the structure for an ultrasonic surgical handpiece 10, a bipolar irrigation line pull, a tubing tool or a bipolar ultrasonic surgical instrument enabling bipolar and/or ultrasonic surgery as exemplified and specifically described and illustrated. The claims must be considered in light of the knowledge of those skilled in the art before the inventions defined by the language of the appended claims. The terms "proximal" or "posterior" used throughout mean near the user and the terms "distal" or "anterior" mean near the patient. The reference numerals shown in the various figures are the same for identical components.
Fig. 1 ist eine perspektivische Ansicht, teilweise im Schnitt, die das ültraschallchxrurgiehandstück 10, einschließlich eines Gehäuses 11, das einen Wandler 12 um-Fig. 1 is a perspective view, partially in section, showing the ultrasound surgery handpiece 10, including a housing 11 which encloses a transducer 12.
schließt, eine elektrische Spule 13 und ein Verbindungsglied 14 zeigt, das sich axial hindurch längs einer Achse A erstreckt, die die Längsachse für das Ultraschallchirurgiehandstück 10 darstellt. An der Vorderseite des Gehäuses 11 befindet sich ein Nasenkegel 15, der sich vom Gehäuse 11 zum distalen Ende 16 desselben verjüngt, an dem der Spülleitungszug 17, der sich um den Nasenkegel 15 herum erstreckt montiert ist, so daß er in koaxialer Lage ein axial vibrierendes metallisches Zertrümmerungs- oder Schneiderohrwerkzeug 24 umgibt. Das axial vibrierende Schneiderohrwerkzeug 24 besteht bevorzugt aus Metall oder kann andernfalls eine distale Spitze 18 eines Rohrwerkzeugs 24 sein, das sich längs entlang der Achse A über den Spülleitungszug 17 hinaus erstreckt.includes an electrical coil 13 and a connector 14 extending axially therethrough along an axis A which is the longitudinal axis for the ultrasonic surgical handpiece 10. At the front of the housing 11 is a nose cone 15 tapering from the housing 11 to the distal end 16 thereof to which is mounted the irrigation line string 17 extending around the nose cone 15 so as to coaxially surround an axially vibrating metallic fracturing or cutting tube tool 24. The axially vibrating cutting tube tool 24 is preferably made of metal or may alternatively be a distal tip 18 of a tube tool 24 which extends longitudinally along the axis A beyond the irrigation line string 17.
Ein CüSA System 200 mit CEM, das von Valleylab, 5920 Longbow Drive, Boulder, Colorado, hergestellt wird, kann zur Ansteuerung der hier beschriebenen veränderten Komponenten dienen. Dieses System bietet Ultraschall- und Elektrochirurgie in einem kombinierten Instrument und ist handelsüblich. Dieses System wurde bisher nur in monopolarer Elektrochirurgie verwendet. Die Offenbarung hier lehrt nun, wie dieses System in ein für offene oder laparoskopische Prozeduren effektives bipolares elektrochirurgisches Ultraschallinstrument verwandelt werden kann.A CüSA System 200 with CEM manufactured by Valleylab, 5920 Longbow Drive, Boulder, Colorado, can be used to control the modified components described here. This system provides ultrasonic and electrosurgery in a combined instrument and is commercially available. This system has previously been used only in monopolar electrosurgery. The disclosure here now teaches how this system can be converted into a bipolar ultrasonic electrosurgical instrument effective for open or laparoscopic procedures.
Ein aus zwei Röhren 20 und 21 jeweils für das Spülen und zum Absaugen bestehendes Leitungssystem 19 liegt jeweils auf der Oberseite entlang des Gehäuses 11 und parallel zur Achse A. Die Röhre 20 ist mit dem Spülleitungszug 17 in der Nähe des distalen Endes 16 verbunden, um sterile Spülflüssigkeit und Kühlflüssigkeit durch den Spülleitungszug 17 zur distalen Spitze 18 fließen zu lassen. Die der distalen Spitze 18 mittels des Verbindungsglieds 14 erteilte Vibration erzeugt eine Schallwelle oder einen Schalldruck, der einen gewissen Energiebetrag in Wärme umsetzt. Die Saugröhre 21 zieht Fluid durch wenigstens ein Vorsaugloch 18a (von kleiner Größe, wie es lediglich inA conduit system 19 consisting of two tubes 20 and 21, respectively for irrigation and suction, is located on the top of the housing 11 and parallel to the axis A. The tube 20 is connected to the irrigation conduit 17 near the distal end 16 to allow sterile irrigation fluid and cooling fluid to flow through the irrigation conduit 17 to the distal tip 18. The vibration imparted to the distal tip 18 by the connecting member 14 creates a sound wave or sound pressure which converts a certain amount of energy into heat. The suction tube 21 draws fluid through at least one pre-suction hole 18a (of small size, as only in
Figurn 2 gezeigt und nachstehend beschrieben wird, und das einen Durchgang zwischen dem Spülleitungszug 17 und einer Zentralbohrung 22 erzielt, siehe Fig. 3). Die Zentralbohrung 22 des Rohrwerkzeugs 24 erstreckt sich zwischen der distalen Spitze 18 und einer Verbindung 23 für die Röhre 21.Figures 2 and described below, and which provides a passage between the irrigation line 17 and a central bore 22 (see Fig. 3). The central bore 22 of the tubing tool 24 extends between the distal tip 18 and a connection 23 for the tube 21.
Fig. 2 ist eine vergrößerte Seitenansicht des Spülleitungszugs 17 im Querschnitt entlang der Linie 2-2 von Fig. 1. In den Figuren 1 und 2 ist der Spülleitungszug 17, der für laparoskopischen Einsatz verlängert ist, verkürzt und mit einem unterbrochenen Abschnitt gezeigt, da die bevorzugte Gesamtlänge des Leitungszugs 17 nicht auf die Seite passen würde, ohne daß der Querschnitt des Ultraschallchirurgiehandstücks 10 so stark verringert würde, daß Details verloren gingen oder daß das Durchmesser-Längenverhältnis gestört würde und jede Einschätzung der relativen Länge des Handstücks 10, des Leitungszugs 17 und der distalen Schneidespitze 18 unverständlich bliebe.Fig. 2 is an enlarged side view of the irrigation line string 17 in cross-section taken along line 2-2 of Fig. 1. In Figs. 1 and 2, the irrigation line string 17, which is extended for laparoscopic use, is shown shortened and with a broken section since the preferred overall length of the line string 17 would not fit on the page without reducing the cross-section of the ultrasonic surgical handpiece 10 so much that detail would be lost or that the diameter-to-length ratio would be disrupted and any estimation of the relative lengths of the handpiece 10, the line string 17 and the distal cutting tip 18 would be incomprehensible.
Im Betrieb ist die distale Spitze 18 das Arbeitsende des länglichen, sich verjüngenden hohlen Metallrohrwerkzeugs 24, das bevorzugt aus einem Titanlegierungsrohr mit 1/4 Zoll oder 6,3 mm Außendurchmesser und einem Innendurchmesser von etwa 0,078 Zoll oder 2 mm besteht und für eine hohe Festigkeit ausgelegt ist, leichtgewichtiger und von niedrigerer Dichte als das Verbindungsglied und ist biologisch inert. Das Rohrwerkzeug 24 ist als Teil des akustischen Vibrators dazu ausgelegt, mit einer vorgegebenen Frequenz von 23000 Schwingungen pro Sekunde zu vibrieren, so daß die distale Spitze 18 in Längsrichtung längs der Achse A mit einem Spitze-zu-Spitze Hub von etwa 200 Mikrometern (0,008 Zoll) bei der Ausführung mit einem länglichen laparoskopischen Rohrwerkzeug hin und her vibriert. Der Spülstrom durch die Röhre 20 geht in einen ringförimge Raum zwischen dem Spülleitzug 17 und dem länglichen Rohrwerkzeug 24 und nimmt dessen Wärme auf. Die Spülflüssigkeit wird durch das in Fig. 2 gezeigteIn operation, the distal tip 18 is the working end of the elongated, tapered hollow metal tubular tool 24 , which is preferably made of titanium alloy tubing having an outside diameter of 1/4 inch or 6.3 mm and an inside diameter of about 0.078 inch or 2 mm and is designed to be high strength, lighter weight and lower density than the connecting member, and is biologically inert. The tubular tool 24, as part of the acoustic vibrator, is designed to vibrate at a predetermined frequency of 23,000 cycles per second such that the distal tip 18 vibrates back and forth longitudinally along the axis A with a peak-to-peak stroke of about 200 micrometers (0.008 inches) when implemented with an elongated laparoscopic tubular tool. The flushing flow through the tube 20 passes into an annular space between the flushing guide 17 and the elongated tubular tool 24 and absorbs its heat. The flushing liquid is passed through the
Vorsaugloch 18a in der Nähe der distalen Spitze 18 gesaugt und durch die Verbindung 23 zur Röhre 21 in der Nähe des Nasenkegels 15 zurückgeführt. Deshalb fließt die Spülflüssigkeit und kann, während sie die Kühlung unterstützt, Gewebetrümmer, wie abgeschnittenes Gewebe und Blut, vom Operationssitus durch die zentrale Bohrung 22 entfernen. Die ultraschalllängsvibrationen der distalen Spitze 18 zerkleinern das mit ihr in Kontakt kommende Gewebe. Der Ausschlag oder die Amplitude und die Frequenz der Vibrationen werden elektronisch konstant gehalten und sind in gewissem Maße einstellbar, wie nachstehend erläutert wird, so daß die Vibrationen mit der Gaußschen oder harmonischen Auslegung des länglichen Rohrwerkzeugs 24 und den Anforderungen der ausgeführten chirurgischen Prozedur übereinstimmen. Zur Vermeidung von Fehlern ist ein Ende des vibrierenden Rohrwerkzeugs 24 mit einem Gaußschen gekrümmten Profil geformt, das einen im wesentlichen flachen Druck ergibt ohne der erhöhten Auslenkung des freien Endes zu widerstehen. In dem Rohrwerkzeug 24 für die Laparoskopie, das aus Titanlegierung besteht und das die erwähnten bevorzugten Abmessungen hat, beträgt die axiale Spannweite jeder Wellenlänge bei der Frequenz von 23 kHz etwa 217 Mikrometer (0,0087 Zoll). Die Gesamtlänge des Rohrwerkzeugs 24 beträgt deshalb etwa 12 Zoll für 5/4 Wellenlänge und 16 Zoll für 7/4 Wellenlänge.Pre-suction hole 18a near distal tip 18 and returned through connection 23 to tube 21 near nose cone 15. Therefore, the irrigation fluid flows and, while assisting cooling, can remove tissue debris such as cut tissue and blood from the surgical site through central bore 22. The longitudinal ultrasonic vibrations of distal tip 18 break up the tissue it contacts. The deflection or amplitude and frequency of the vibrations are electronically maintained constant and are adjustable to some extent, as explained below, so that the vibrations are consistent with the Gaussian or harmonic design of elongated tubular tool 24 and the requirements of the surgical procedure being performed. To avoid errors, one end of the vibrating tube tool 24 is formed with a Gaussian curved profile which provides a substantially flat pressure without resisting the increased deflection of the free end. In the laparoscopy tube tool 24 made of titanium alloy and having the preferred dimensions mentioned, the axial span of each wavelength at the frequency of 23 kHz is about 217 micrometers (0.0087 inches). The overall length of the tube tool 24 is therefore about 12 inches for 5/4 wavelength and 16 inches for 7/4 wavelength.
Viele verschiedene Formen und deren Kombinationen wurden theoretisch behandelt und als mechanische Resonatoren verwendet. Man hat durch eine geeignete Formgebung versucht, die Zone maximalen elastischen Drucks in Axialrichtung auszudehnen und dadurch größere Amplituden zu ermöglichen, wie im US-Patent 2 984 154 beschrieben. Da die spezielle technische Anwendung vier Größen des Resonanzglieds erforderlich macht, nämlich Eingangs- Knoten- und Ausgangsquerschnitt und das Übertragungsverhältnis, führt die Lösung des anstehende Problems der Variation für den sich verjüngenden Teil des vibrierenden Rohrwerkzeugs 24 zu einer Funktion, die ein Gaußsches Profil hat.Many different shapes and combinations thereof have been theoretically treated and used as mechanical resonators. Attempts have been made to extend the zone of maximum elastic pressure in the axial direction by appropriate shaping, thereby allowing larger amplitudes, as described in U.S. Patent 2,984,154. Since the specific technical application requires four sizes of the resonant member, namely input, node and output cross-sections and the transmission ratio, the solution to the problem of variation at hand leads to a function having a Gaussian profile for the tapered portion of the vibrating tubular tool 24.
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Die Röhren 25 und 26 ermöglichen die Zirkulation von Kühlmittel zum Ültraschallchirurgiehandstück 10, wie sie durch Pfeile in Fig. 1 dargestellt ist. Wie schon erläutert, wandelt die Schallvibration des Wandlers 12 elektrische Energie in eine mechanische Längsvibrationsbewegung längs der Achse A um, wo durch das Rohrwerkzeug 24 an seiner distalen Spitze vibriert. Der bevorzugte Wandler 12 ist ein Schallvibrator, der einen laminierten Nickellegierungsaufbau hat und der von einem Magnetfeld angeregt wird, das durch Wechselströme erzeugt wird, die durch die elektrische Spulenwicklung 13 gehen. Die Spulenwicklung 13 wird mit Wechselstrom mit 23000 Zyklen pro Sekunde (23 kHz) angeregt. Die sich einstellende Längsschwingungsbewegung des bevorzugten, laminierten Struktur auf Nickellegierungsbais wird durch ein bevorzugt verjüngtes Titanlegierungsrohrwerkzeug verstärkt, das sich vom distalen Ende des Nasenkegels 15 zum distalen Ende der vibrierenden distalen Spitze 18 erstreckt. Das Rohrwerkzeug 24 ist mit einem Gewinde 27 am Wandler 12 mittels des dazwischen befindlichen Verbindungsglieds 14 angebracht. Die Verjüngung und die Wand des gestreckten Titanrohrwerkzeugs 14 ist als eine mechanische Struktur ausgelegt, so daß sie mit 23000 Schwingungen pro Sekunde vibriert.Tubes 25 and 26 allow circulation of coolant to the ultrasonic surgical handpiece 10 as shown by arrows in Fig. 1. As previously explained, the sonic vibration of transducer 12 converts electrical energy into a longitudinal mechanical vibration motion along axis A, causing tubular tool 24 to vibrate at its distal tip. The preferred transducer 12 is a sonic vibrator having a laminated nickel alloy construction and which is excited by a magnetic field generated by alternating currents passing through electrical coil winding 13. Coil winding 13 is excited with alternating current at 23,000 cycles per second (23 kHz). The intrinsic longitudinal vibratory motion of the preferred nickel alloy based laminated structure is amplified by a preferred tapered titanium alloy tubular tool extending from the distal end of the nose cone 15 to the distal end of the vibrating distal tip 18. The tubular tool 24 is attached to the transducer 12 by means of the connecting member 14 therebetween with a thread 27. The taper and wall of the elongated titanium tubular tool 14 is designed as a mechanical structure to vibrate at 23,000 cycles per second.
Eine Ausführung des Spülleitungszugs 17, die in Fig. 2 gezeigt ist, besteht aus mehreren Stücken, die bevorzugt aus verschiedenen polymeren Materialien bestehen können, da die äußersten Enden des Spülleitungszugs 17 bevorzugt weich und fexibel sein sollten. Es gibt einen Zentralkörper 28, der hohl, länglich und halb starr ist, und der sich in Achsenrichtung und koaxial um die Achse A in Längsrichtung und zentral hindurch erstreckt. Der Zentralkörper 28 endet in einem proximalseitigen Trichter 29 und an einer distalseitigen Düse 30. Der Spülleitungszug 17 wird primär und bevorzugt aus Silikonkautschuk hergestellt, der eine verhältnismäßig elastische Qualität hat, wodurch der Trichter 29 eng über den Nasenkegel 15 des Ultraschall-One embodiment of the irrigation line string 17 shown in Fig. 2 is made of several pieces which can preferably be made of different polymeric materials, as the extreme ends of the irrigation line string 17 should preferably be soft and flexible. There is a central body 28 which is hollow, elongated and semi-rigid and which extends longitudinally and centrally axially and coaxially about the axis A. The central body 28 terminates in a proximal funnel 29 and at a distal nozzle 30. The irrigation line string 17 is primarily and preferably made of silicone rubber which has a relatively elastic quality, allowing the funnel 29 to fit tightly over the nose cone 15 of the ultrasound probe.
chirurgiehandstücks 10 paßt und eine flüssigkeitsdichte, manschettenartige Dichtung 31 wegen des gummielastischen Verhaltens des verwendeten Silikonkautschuks bildet.surgical handpiece 10 and forms a liquid-tight, cuff-like seal 31 due to the rubber-elastic behavior of the silicone rubber used.
In den Figuren 1 und 2 ist der Spülleitungszug 17 kürzer als in seiner für die Laparoskopie bevorzugten Länge, die etwa 11 1/2 Zoll oder 29 cm beträgt. Der Durchmesser des Trichters 29 ist so, daß sich der Spülleitungszug 17 generell zu seiner Düse 30 hin verjüngt. Der Zentralkörper 28 ist durchgängig hohl. Verstärkungsrippen 32 erstrecken sich in Längsrichtung innerhalb der Düse 30. Eine Rille 34 kann das Äußere des Zentralkörpers 28 kreisförmig umgeben und sich proximal vom Trichter 29 zur Verjüngung der Düse 30 erstrecken. Die Rille 34 ist so gestaltet, daß er einen hohlen umlaufenden Stützzylinder 35 aufnimmt, der zur Verstärkung in den dargestellten Ausführungsbeispielen dient. Es muß erwähnt und verständlich gemacht werden, daß der Spülleitungszug 17 irgendeine Länge haben kann und die Verstärkung bei kürzeren Leitungszügen unnötig ist. Gleichermaßen kann das Rohrwerkzeug in verschiedenen Abmessungen hergestellt werden, und Resonanz ist die Grundbedingung für die Länge und die Gestalt des Rohrwerkzeugs 24.In Figures 1 and 2, the irrigation line string 17 is shorter than its preferred length for laparoscopy, which is about 11 1/2 inches or 29 cm. The diameter of the funnel 29 is such that the irrigation line string 17 generally tapers toward its nozzle 30. The central body 28 is hollow throughout. Reinforcing ribs 32 extend longitudinally within the nozzle 30. A groove 34 may circularly surround the exterior of the central body 28 and extend proximally from the funnel 29 to the taper of the nozzle 30. The groove 34 is designed to receive a hollow circumferential support cylinder 35 which serves for reinforcement in the illustrated embodiments. It must be mentioned and made clear that the flushing line 17 can be of any length and the reinforcement is unnecessary for shorter lines. Likewise, the tubing tool can be made in different dimensions and resonance is the basic condition for the length and shape of the tubing tool 24.
Der hohle umgebende Stützzylinder 35 in dem zusammengesetzten Polymerlaparoskopie-Spülleitungszug 17 ist bevorzugt ein extrudierter PoIysulfonring, der so bemessen ist, daß er in dem Ausschnitt 34 sitzt und den Zentralkörper 28 gegen Verbiegung verstärkt. Andererseits kann der Zentralkörper 28 aus einer steiferen Konstruktion, d.h. einer dickeren Wand oder aus einem koextruierten Material mit einem größeren Steifigkeitsmodul hergestellt werden, da der Querschnitt eines solchen steiferen, gegossenen Materials nicht augenscheinlich wird; diese einstückige Konstruktion ist jedoch in den Figuren nicht besonders dargestellt. Einschlägige Fachleute werden ohne weiteres verstehen, wie dies bewerkstelligt werden könnte. Ein kürzerer Rohr-The hollow surrounding support cylinder 35 in the assembled polymer laparoscopy irrigation line 17 is preferably an extruded polysulfone ring sized to fit in the cutout 34 and reinforce the central body 28 against deflection. Alternatively, the central body 28 may be made of a stiffer construction, i.e., a thicker wall or a co-extruded material with a higher modulus of stiffness, since the cross-section of such a stiffer, molded material will not be apparent; however, this one-piece construction is not specifically shown in the figures. Those skilled in the art will readily understand how this could be accomplished. A shorter tubing
leitungszug 17 kann natürlich auch aus einem einzigen Material als ein einheitliches Teil hergestellt werden.Cable harness 17 can of course also be manufactured from a single material as a single part.
Der Trichter 29 weitet sich generell diametral zur Achse A und dem Rest des Zentralkörpers 28 hin. Der Trichter 29 enthält einen Fluidverbindungsdurchlaß 36 zwischen seiner Innen- und Außenseite. Der Durchlaß 36 ist dazu eingerichtet, Fluid von einer Röhre 20 durchzulassen, die darin in einer Schulteröffnung 37 sitzt, und erstreckt sich distal von ihrer proximalen Seite 38 aus. Fluid kann von der Röhre 20 durch den Durchgang 36 in den Spülleitungszug 17 insbesondere durch den Ringraum 33 zwischen dem Spülleitungszug 17 und dem Rohrwerkzeug 24 strömen. Die Verstärkungsrippen 32 stützen die Düse 30 (deren Querschnitt sf lache kleiner als der Trichter 29 oder der Zentralkörper 28 ist) und halten auf diese Weise die konzentrische Lage relativ zum länglichen, sich verjüngenden Titanvibrationsrohrwerkzeug 24 in der Nähe des vibrierenden distalen Endes 18 aufrecht, welches koaxial hindurchgeht, siehe die Figuren 1 und 2. Noch wichtiger ist, daß die Rippen 32 generell eine sehr geringe Höhe haben, so daß sie das Rohrwerkzeug 24 oder die vibrierende distale Spitze 18 nicht einklemmen sondern noch den Spül- und Kühlmittelstrom trennen, so daß er in laminarer Weise entlang des Rohrwerkzeugs 24 zur distalen Spitze 18 fließt. Folglich ist das Kühlmittel kanalisiert, soweit die Strömung zwischen den Rippen 32 fließt. Für einen kurzen Spülleitungszug 17 sind keine Rippen 32 und Kanäle enthalten, da die auskragende Stellung des Leitungszugs 17 nicht genügend groß ist, daß sie sie vom Durchhängen abhalten oder Festigkeit ermöglichen könnte.The funnel 29 flares generally diametrically toward the axis A and the remainder of the central body 28. The funnel 29 includes a fluid communication passage 36 between its inner and outer sides. The passage 36 is adapted to pass fluid from a tube 20 seated in a shoulder opening 37 therein and extends distally from its proximal side 38. Fluid can flow from the tube 20 through the passage 36 into the irrigation line 17, particularly through the annulus 33 between the irrigation line 17 and the tubing tool 24. The reinforcing ribs 32 support the nozzle 30 (the cross-sectional area of which is smaller than the funnel 29 or the central body 28) and thus maintain the concentric position relative to the elongated, tapered titanium vibrating tube tool 24 near the vibrating distal end 18 which passes coaxially therethrough, see Figures 1 and 2. More importantly, the ribs 32 are generally of very low height so that they do not pinch the tube tool 24 or the vibrating distal tip 18 but still separate the flush and coolant flow so that it flows in a laminar manner along the tube tool 24 to the distal tip 18. Thus, the coolant is channeled to the extent that the flow flows between the ribs 32. For a short flush line run 17, no ribs 32 and channels are included, since the cantilevered position of the line run 17 is not large enough to prevent them from sagging or to provide strength.
Insbesondere, und wie am deutlichsten anhand der Figuren 1 und 2 ersichtlich ist, hat das längliche, sich verjüngende Rohrwerkzeug 24 die vibrierende distale Spitze 18 an seinem äußeren mit dem Patienten (zur Zerkleinerung) in Berührung kommenden Abschnitt, und eine Schraubpassung 39 an ihrem proximalen äußersten Ende (zur Befestigung). Gewinde 27In particular, and as best seen in Figures 1 and 2, the elongated tapered tubular tool 24 has the vibrating distal tip 18 at its outer patient-contacting (for comminution) portion, and a screw fit 39 at its proximal extremity (for attachment). Thread 27
14 · ::14 · ::
erlauben die abnehmbare Verbindung des länglichen, sich verjüngenden Rohrwerkzeugs 24 mit dem Verbindungsglied 14, wie in Fig. 1 gezeigt ist.allow the removable connection of the elongated, tapered tubular tool 24 to the connecting member 14, as shown in Fig. 1.
In Fig. 3 sind Querschnitte des Leitungszugs 17 und des Rohrwerkzeugs 24 in ihrer bevorzugten koaxialen Lage gezeigt. Der Leitungszug 17 liegt außerhalb des Rohrwerkzeugs 24. In jedem der Ausführungsformen sind die Elektroden mit 42 und die Isolatoren mit der Bezugsziffer 43 bezeichnet. Die Elektroden 42 können aus irgendeinem leitenden Material bestehen, sind vorzugsweise jedoch metallisch, die Isolatoren 43 können aus irgendeinem elektrischen Widerstandsmaterial hoher Dielektrizitätskonstanten bestehen.In Fig. 3, cross sections of the line string 17 and the tubular tool 24 are shown in their preferred coaxial position. The line string 17 lies outside the tubular tool 24. In each of the embodiments, the electrodes are designated 42 and the insulators are designated 43. The electrodes 42 can be made of any conductive material, but are preferably metallic, and the insulators 43 can be made of any electrically resistive material with a high dielectric constant.
Das ültraschallchirurgiehandstück 10 beinhaltet den Wandler 12, die elektrische Spule 13 und wird in dem Ultraschallchirurgieinstrumentenstromkreis angesteuert, so wie es in der US-Anmeldung mit der Seriennummer 07/082 936 beschrieben und erläutert ist, die am 30. November 1992 angemeldet wurde und den Titel hat: "Ültraschallchirurgiehandstück und Energieinitiator". Auf diese vom vorliegenden Patentanmelder getätigte Anmeldung wird hierin Bezug genommen. Der Stromkreis, der für das Ultraschallchirurgieinstrument die Frequenz konstant hält, beginnt und hält eine voreingestellte Vibrationsbetriebsweise und die lineare Dynamik der vibrierenden distalen Spitze 18 zur Ansteuerung des Wandlers 12 des Ultraschallchirurgiehandstücks 10 konstant, um bei Resonanz und unterschiedlichen Lasten zu arbeiten. Eine elektronischer Oszillator 46 steuert den Wandler 12 mit vorgegebener Frequenz, bevorzugt 23 kHz, an. Eine anwendereinstellbare Amplitudensteuerung 47 ist mit dem elektronischen Oszillator 46 verbunden. Die Amplitudensteuerung 47 gestattet eine manuelle Einstellung des Pegels der Ultraschallvibration. Ein Frequenzregler 48 verbindet die Amplitudensteuergung 47 und den elektronischen Oszillator 46. Ein frequenzregeInder Rückkopplungskreis kann bei dem Frequenzregler verwendet werden. Der frequenzregelndeThe ultrasonic surgical handpiece 10 includes the transducer 12, the electrical coil 13 and is driven in the ultrasonic surgical instrument circuit as described and explained in U.S. application Serial No. 07/082,936 filed November 30, 1992 and entitled "Ultrasonic surgical handpiece and energy initiator." This application filed by the present applicant is incorporated herein by reference. The ultrasonic surgical instrument frequency constant circuit initiates and maintains a preset vibration mode and the linear dynamics of the vibrating distal tip 18 to drive the transducer 12 of the ultrasonic surgical handpiece 10 to operate at resonance and varying loads. An electronic oscillator 46 drives the transducer 12 at a predetermined frequency, preferably 23 kHz. A user adjustable amplitude control 47 is connected to the electronic oscillator 46. The amplitude control 47 allows manual adjustment of the level of ultrasonic vibration. A frequency controller 48 connects the amplitude control 47 and the electronic oscillator 46. A frequency control feedback loop can be used with the frequency controller. The frequency control
Rückkopplungskreis hält während der Anwendung die lineare Dynamik des Ultraschallchirurgiehandstücks 10 und des vibrierenden Rohrwerkzeugs 24 um die vorgegebene Frequenz konstant.Feedback circuit keeps the linear dynamics of the ultrasonic surgical handpiece 10 and the vibrating tube tool 24 constant around the predetermined frequency during use.
Ein bevorzugtes bipolares Ultraschallchirurgieinstrument gemäß den Figuren 1 bis 4 hat das vom Chirurgen gehandhabte Handstück 10, das mit einer Bipolarquelle 49 verbunden ist, die elektrochirurgische Hochfrequenzenergie liefert. Der elektronische Oszillator 46 steuert das Ultraschallinstrument mit einer vorbestimmten Frequenz an. Eine Ultraschallansteuerschaltung 50 gestattet die Einstellung des Pegels der Ultraschallvibration. Das Gehäuse 11, das das Handstück 10 haltert, wird vom Chirurgen proximal während der Anwendung gehalten. Leitungen 51 und 52 verbinden die bipolare Quelle 49, die die elektrochirurgische Hochfrequenzenergie zuführt und werden vom Gehäuse 11 getragen. Der innerhalb des Gehäuses 11 befindliche Wandler 12 liefert die Ultraschallenergie. Der Wandler 12 ist längs der Achse 11A" positioniert und dazu ausgewählt, daß er längs der Achse 11A" mit einer für die Ultraschallchirurgie ausreichenden Bewegung mindestens um eine bevorzugte Frequenz und Wellenlänge schwingt. Rohrwerkzeuge 24 sind am Wandler 12 so angebracht, daß jedes Rohrwerkzeug 24 wenigstens um die bevorzugte Frequenz und Wellenlänge schwingt, wobei jedes Rohrwerkzeug 24 die hindurchgehende mit einer Absaugquelle 53 verbundene zentrale Bohrung 22 hat. Eine distale Spitze 18 des Rohrwerkeugs 24 ist vom Gehäuse 12 entfernt in einer Position für die Ultraschallchirurgie, die bipolare Elektrochirurgie oder eine Kombination derselben gelegen.A preferred bipolar ultrasonic surgical instrument according to Figures 1-4 has the surgeon-operated handpiece 10 connected to a bipolar source 49 which provides high frequency electrosurgical energy. The electronic oscillator 46 drives the ultrasonic instrument at a predetermined frequency. An ultrasonic drive circuit 50 allows adjustment of the level of ultrasonic vibration. The housing 11 which supports the handpiece 10 is held proximally by the surgeon during use. Leads 51 and 52 connect the bipolar source 49 which supplies the high frequency electrosurgical energy and are carried by the housing 11. The transducer 12 located within the housing 11 provides the ultrasonic energy. The transducer 12 is positioned along the axis 11A " and is selected to oscillate along the axis 11A " with a motion sufficient for ultrasonic surgery at least at a preferred frequency and wavelength. Tubing tools 24 are mounted on the transducer 12 such that each tubing tool 24 vibrates at least at the preferred frequency and wavelength, each tubing tool 24 having the central bore 22 therethrough connected to a suction source 53. A distal tip 18 of the tubing tool 24 is located remote from the housing 12 in a position for ultrasonic surgery, bipolar electrosurgery, or a combination thereof.
Der Spülleitungszug 17 ist koaxial um das Rohrwerkzeug 24 angeordnet und abgestützt, um vom Gehäuse 11 auszukragen. Der Ringraum 33 zwischen dem Rohrwerkzeug 24 und dem Spülleitungszug 17 gestattet das Hindurchströmen von Spülflüssigkeit. In Fig. 3a bis j können zwei oder mehr Elektroden 42 dem Rohrwerkzeug 24, dem Spülleitungszug 17The flushing line 17 is arranged coaxially around the tubular tool 24 and supported to project from the housing 11. The annular space 33 between the tubular tool 24 and the flushing line 17 allows the flow of flushing liquid. In Fig. 3a to j, two or more electrodes 42 can be attached to the tubular tool 24, the flushing line 17
oder beiden zugeordnet sein und in einem Stromkreis mit den Leitungen 51 oder 52 für eine ausgewählte Speisung der Elektroden 42 liegen.or both and be in a circuit with the lines 51 or 52 for a selected supply of the electrodes 42.
Die Leitungen 51 und 52 enthalten Schaltsysteme 53, die zur selektiven Speisung der Elektroden 42 hinzugefügt sind.The lines 51 and 52 contain switching systems 53 which are added for the selective feeding of the electrodes 42.
Die zwei oder mehr Elektroden 42 sind jeweils dem Rohrwerkzeug 24 zugeordnet und elektrisch davon isoliert, wie in den Figuren 3a, d, e und f und liegen jeweils in einem Stromkreis mit den Leitern 51 oder 52 für eine auswählbare Speisung der Elektroden 42, wie dies in den Figuren 3a bis j gezeigt ist. Die zwei oder mehr Elektroden sind beweglich im Stromkreis mit den Leiter 51 oder 52 durch eine nachgebende elektrische Kupplung 54 zwischen den Elektroden 42 und den Leitern 51 und 52 gekoppelt, um die Elektroden 52 zu speisen und eine ultraschallvibration des Rohrwerkzeugs 24 zu ermöglichen, siehe Fig. 2. Die zwei oder mehr Elektroden sind jeweils alternativ dem Spülleitungszug 17, wie in den Figuren 3b und g gezeigt, zugeordnet und liegen jeweils in einem Stromkreis mit den Leitern 51 oder 52 für die selektive Speisung der Elektroden 42. Wenigstens eine der Elektroden 42 ist dem Spülleitungszug 17, wenigstens eine der Elektroden dem Rohrwerkzeug 24 in der Ausführung gemäß der Figuren 3c und i zugeordnet. Die Elektroden 42 liegen jeweils in einem Stromkreis mit den Leitern 51 oder 52 für eine selektive Speisung der Elektroden 42.The two or more electrodes 42 are each associated with and electrically isolated from the tubular tool 24, as shown in Figures 3a, d, e and f, and are each in a circuit with conductors 51 or 52 for selectable powering of the electrodes 42, as shown in Figures 3a to j. The two or more electrodes are movably coupled in circuit with the conductors 51 or 52 by a flexible electrical coupling 54 between the electrodes 42 and the conductors 51 and 52 to feed the electrodes 52 and enable ultrasonic vibration of the pipe tool 24, see Fig. 2. The two or more electrodes are each alternatively assigned to the flushing line 17, as shown in Figures 3b and g, and are each in a circuit with the conductors 51 or 52 for the selective feeding of the electrodes 42. At least one of the electrodes 42 is assigned to the flushing line 17, at least one of the electrodes is assigned to the pipe tool 24 in the embodiment according to Figures 3c and i. The electrodes 42 are each in a circuit with the conductors 51 or 52 for a selective feeding of the electrodes 42.
Eine oder mehr, dem Rohrwerkzeug 24 zugeordneten Elektroden 42 sind in den Figuren 3a, b, e und f jeweils in einer beweglichen Anordnung im Stromkreis mit ihrem jeweiligen Leiter 51 oder 52 durch die nachgebende elektrische Kupplung 54 verbunden, wie in Fig. 2 zwischen jeder Elektrode 42 und dem Leiter 51 oder 52, um jede Elektrode 42 zu speisen und die Ultraschallvibration des Rohrwerkzeugs 24 zu gestatten. Die eine oder die mehr Elektroden 42 sind jeweils dem Rohrwerkzeug 24 zugeordnet und von ihm elektrisch isoliert, wie beispielsweise in den FigurenOne or more electrodes 42 associated with the tubular tool 24 are each connected in Figures 3a, b, e and f in a movable arrangement in the circuit with its respective conductor 51 or 52 by the compliant electrical coupling 54, as in Figure 2 between each electrode 42 and the conductor 51 or 52, to power each electrode 42 and to permit ultrasonic vibration of the tubular tool 24. The one or more electrodes 42 are each associated with the tubular tool 24 and electrically isolated from it, as for example in Figures
3a, d, e und f. Die eine oder mehr Elektroden 42 sind in einem Stromkreis mit einem der Leiter 51 oder 52 geschaltet, und das Rohrwerkzeug 24 ist im Stromkreis mit dem anderen der Leiter 51 oder 52 verbunden, um eine selektive Speisung der Elektroden 42 zu ermöglichen. Die eine oder mehr Elektroden 42, die dem Rohrwerkzeug 24 zugeordnet sind, sind jeweils beweglich in einem Stromkreis um ihren jeweiligen Leiter 51 oder 52 durch die nachgebende elektrische Kupplung 54 verbunden, die, wie in Fig. 2, zwischen den Elektroden und dem Leiter für die Speisung der Elektroden 42 liegt und gleichzeitig die Ultraschallvibration des Rohrwerkzeugs 24 gestattet.3a, d, e and f. The one or more electrodes 42 are connected in a circuit with one of the conductors 51 or 52 and the tubing tool 24 is connected in circuit with the other of the conductors 51 or 52 to allow selective energization of the electrodes 42. The one or more electrodes 42 associated with the tubing tool 24 are each movably connected in a circuit around their respective conductor 51 or 52 by the compliant electrical coupling 54 which, as in Fig. 2, lies between the electrodes and the conductor for energizing the electrodes 42 and at the same time allows ultrasonic vibration of the tubing tool 24.
Die zwei oder mehr Elektroden 42 sind jeweils dem Rohrwerkzeug 24 zugeordnet, sind an seiner Außenseite in Fig. 3a getragen, um sie vom Ende des Gehäuses 11 zur distalen Spitze 18 erstrecken. Zwei oder mehr Elektroden 42 sind jeweils in einer anderen Anordnung dem Rohrwerkzeug 24 zugeordnet, indem dieses sie an seiner Innenseite trägt, wie in Fig. 3e gezeigt, und erstrecken sich vom Ende des Gehäuses 11 zur distalen Spitze 18. Die zwei oder mehr Elektroden 42 sind jeweils in einer unterschiedlichen Ausführung dem Rohrwerkzeug 24 zugeordnet, wobei dessen Innenseite wenigstens eine Elektrode und seine Außenseite wenigstens eine weitere Elektrode haltert, wie in Fig. 3f, wobei sich die Elektroden vom Gehäuseende 11 zur distalen Spitze 18 erstrecken. Die zwei oder mehr Elektroden 42 sind jeweils dem Spülleitungszug 17 in einer anderen Ausführung zugeordnet, indem sie an dessen Außenseite, wie in Fig. 3b, getragen sind, und sie erstrecken sich von der Halterung des Gehäuses 11 distalwärts. Die zwei oder mehr Elektroden 42 sind jeweils dem Spülleitungszug 17 zugeordnet, indem sie gegenüberliegend an dessen Innenseite, gemäß Fig. 3g, gehaltert sind, und sie erstrecken sich von der Halterung des Gehäuses 11 distalwärts. Die zwei oder mehr Elektrode 42 sind jeweils dem Spülleitungszug 17 zugeordnet, wobei dessen Innenseite wenigstens eine der Elektroden trägt und seine Außenseite wenigstens eine andere trägt, wie Fig. 3hThe two or more electrodes 42 are each associated with the tubular tool 24, carried on its outside in Fig. 3a, extending from the end of the housing 11 to the distal tip 18. Two or more electrodes 42 are each associated with the tubular tool 24 in a different arrangement, carried on its inside, as shown in Fig. 3e, extending from the end of the housing 11 to the distal tip 18. The two or more electrodes 42 are each associated with the tubular tool 24 in a different arrangement, with the inside thereof supporting at least one electrode and the outside thereof supporting at least one further electrode, as in Fig. 3f, with the electrodes extending from the housing end 11 to the distal tip 18. The two or more electrodes 42 are each associated with the irrigation line 17 in another embodiment by being supported on its outside, as in Fig. 3b, and they extend distally from the holder of the housing 11. The two or more electrodes 42 are each associated with the irrigation line 17 by being supported opposite one another on its inside, as in Fig. 3g, and they extend distally from the holder of the housing 11. The two or more electrodes 42 are each associated with the irrigation line 17, with its inside carrying at least one of the electrodes and its outside carrying at least one other, as in Fig. 3h
in einer anderen Ausführung zeigt, bei der sich die Elektroden auch von der Halterung des Gehäuses 11 distalwärts erstrecken.in another embodiment, in which the electrodes also extend distally from the holder of the housing 11.
Die zwei oder mehr Elektroden sind jeweils dem Rohrwerkzeug 24 zugeordnet, und wenigstens eine Elektrode ist an dessen Innenseite angebracht und wenigstens eine weitere an der Außenseite desselben gehaltert, wie in Fig. 3f gezeigt ist. Die Elektroden erstrecken sich hier vom Ende des Gehäuses 11 zur distalen Spitze 18 in einer anderen Ausführung. Die zwei oder mehr Elektroden 42, die jeweils dem Spülleitungszug 17 und dem Rohrwerkzeug 24 zugeordnet sind, indem sie jeweils an deren Außenseite getragen sind, wie in Fig. 3c, erstrecken sich vom Gehäuse 11 distalwärts und erlauben somit eine weitere Form bipolarer Elektrochirurgie mit IJl traschall vibration.The two or more electrodes are each associated with the tubular tool 24, and at least one electrode is mounted on the inside thereof and at least one other is supported on the outside thereof, as shown in Fig. 3f. The electrodes here extend from the end of the housing 11 to the distal tip 18 in another embodiment. The two or more electrodes 42, each associated with the irrigation line 17 and the tubular tool 24 by being supported on the outside thereof, as in Fig. 3c, extend distally from the housing 11, thus allowing another form of bipolar electrosurgery with ultrasonic vibration.
Die zwei oder mehr Elektroden 42 sind jeweils dem Spülleitungszug 17 und dem Rohrwerkzeug 24 zugeordnet, wobei sie die Innenseite derselben trägt, wie in Fig. 3i gezeigt, und sie erstrecken sich von der Halterung des Gehäuses 11 distalwärts. Die zwei oder mehr Elektroden 42 sind jeweils dem Spülleitungszug 17 und dem Rohrwerkzeug 24 zugeordnet und wenigstens eine von ihnen ist auf der Innenseite entweder des Spulleitungszugs 17 oder des Rohrwerkzeugs 24 und wenigstens eine auf der Außenseite des Rohrwerkzeugs 24 oder des Leitungszugs 17 gehaltert, und sie erstrecken sich von der Halterung des Gehäuses 11 distalwärts und haben wenigstens eine Bipolarkreis zwischen der Außenseite des einen und der Innenseite des anderen, wie jede der Figuren 3c, i und j zeigt.The two or more electrodes 42 are respectively associated with the flush line string 17 and the tubular tool 24, supporting the inside thereof as shown in Figure 3i, and extend distally from the housing 11 support. The two or more electrodes 42 are respectively associated with the flush line string 17 and the tubular tool 24, and at least one of them is supported on the inside of either the flush line string 17 or the tubular tool 24 and at least one on the outside of the tubular tool 24 or the line string 17, and extend distally from the housing 11 support and have at least one bipolar circuit between the outside of one and the inside of the other as shown in each of Figures 3c, i and j.
Claims (20)
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US17582793A | 1993-12-30 | 1993-12-30 | |
PCT/IB1994/000332 WO1995017855A1 (en) | 1993-12-30 | 1994-10-26 | Bipolar ultrasonic surgery |
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US4931047A (en) * | 1987-09-30 | 1990-06-05 | Cavitron, Inc. | Method and apparatus for providing enhanced tissue fragmentation and/or hemostasis |
US4936281A (en) * | 1989-04-13 | 1990-06-26 | Everest Medical Corporation | Ultrasonically enhanced RF ablation catheter |
US5312329A (en) * | 1993-04-07 | 1994-05-17 | Valleylab Inc. | Piezo ultrasonic and electrosurgical handpiece |
-
1994
- 1994-10-26 AU AU78217/94A patent/AU688384B2/en not_active Ceased
- 1994-10-26 DE DE9490469U patent/DE9490469U1/en not_active Expired - Lifetime
- 1994-10-26 CA CA002176754A patent/CA2176754A1/en not_active Abandoned
- 1994-10-26 EP EP94929000A patent/EP0737045A1/en not_active Withdrawn
- 1994-10-26 JP JP7517866A patent/JPH09500812A/en active Pending
- 1994-10-26 WO PCT/IB1994/000332 patent/WO1995017855A1/en not_active Application Discontinuation
- 1994-12-29 FI FI946163A patent/FI946163A/en not_active Application Discontinuation
Also Published As
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WO1995017855A1 (en) | 1995-07-06 |
FI946163A0 (en) | 1994-12-29 |
FI946163A (en) | 1995-07-01 |
AU688384B2 (en) | 1998-03-12 |
CA2176754A1 (en) | 1995-07-06 |
AU7821794A (en) | 1995-07-17 |
EP0737045A1 (en) | 1996-10-16 |
JPH09500812A (en) | 1997-01-28 |
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