FI114609B - Sähkötoiminen kirurgin instrumentti - Google Patents
Sähkötoiminen kirurgin instrumentti Download PDFInfo
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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
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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
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2945—Curved jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00107—Coatings on the energy applicator
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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
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/126—Generators therefor characterised by the output polarity bipolar
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1412—Blade
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/1432—Needle curved
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- Organic Insulating Materials (AREA)
Description
x 114609 Sähkötoiminen kirurgin instrumentti
Esillä olevan keksinnön kohteena on sähkötoiminen kirurgin 5 leikkuulaite, jossa on kaksi terää, jotka ovat asennetut siten, että ne suorittavat leikkuutoimintaa, kun kirurginen sähköjännite on kytketty päälle, ja jolloin laite samanaikaisesti kuivaa ja leikkaa elinkudosta.
10 On tunnettua suorittaa kirurginen leikkaus käyttäen siihen leikkuuinstrumenttia, jossa on kaksi terää, jotka ovat asennetut pitkänomaisen varren päähän, jolloin jokainen terä on kierrettävissä akselin ypäri, joka on poikittain varren suhteen, ja joka on vastavaikutuksessa ohjaustangolle, joka 15 kulkee terien ja varren toisessa päässä olevan kädensijan välillä. Molemmat terät ovat sähköisesti eristetyt toisistaan ja niiden vastakkaisilla pinnoilla on keramiikkapäällysteet, jolloin ne voidaan yhdistää kaksinapaisen kirurgisen sähkövoiman lähteeseen ilman sähköistä oikosulkua. Kudokseen, joka 20 on jäänyt terien väliin, kohdistuu se, että kirurginen sähkövirta kulkee terien leikkuureunojen risteämäkohdan uloimmassa kohtaa ja kuivaa siten kudoksen ennen sen mekaanista erotta- ;t mistä terien ollessa yhteensulkeutuneita.
< • 1 1 • > • » ; 25 Esillä olevan keksinnön kohteena on sähkökäyttöinen kirurgin ♦ I I · leikkuuväline, johon kuuluu instrumentinrunko, ensimmäinen ja * | toinen leikkuuterä, joista ainakin toinen on asennettu kään-i tyväksi runkoon, jotta se voi toteuttaa leikkuutoiminnon toi- v .1 sen terän kanssa ja sähkönsyöttöjohtimet, jotka ovat yhdiste- 30 tyt runkoon, jotta saadaan syötetyksi kaksinapaista kirurgis-· ta sähköjännitettä ensimmäiselle ja toiselle terälle, ja jolloin ensimmäinen terä on komposiittiterä, johon kuuluu johtava ulkoelektrodi, sisäpuolella oleva johtava kerros, ja 1 1 · ' i1 ulkoelektrodin sekä sisäkerroksen väliin kerrostettu eristys- 35 kerros, syöttöjohdinten ollessa kytketyt vastaavasti ul- koelektrodiin ja sisäkerrokseen. Yksi syöttöjohdin on edullisesti kytketty suoraan sisäkerrokseen.
2 114609
Toinen syöttöjohdin on sopivasti kytketty toiseen terään ja se on sähköisesti yhdistetty ensimmäisen terän sisempään kom-posiittikerrokseen toisen terän ja sisäkerroksen välisellä sähkökytkennällä. Toisessa terässä on edullisesti johtava 5 runko, joka on sähköisesti kytketty komposiittia olevaan ensimmäisen terän sisäkerrokseen, ja jolloin mainittu syöttö-johdin on kytketty johtavaan runkoon siten, että johtava runko on sähköisesti kytketty sarjaan mainitun syöttöjohtimen ja sisäkerroksen väliin.
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Kummassakin terässä voi olla leikkuureuna, joka on suunnattu siten, että terät suorittavat progressiivista leikkuutoimin-taa, ja jolloin kumpikin leikkuuterä on muodostettu metalli-materiaalista. Mutta toinen terä on edullisesti yksinkertai-15 nen metalliterä, johon kuuluu yksinomaan metallirunko, leik-kuuterän ollessa muotoiltu runkoon. Edullisessa suoritusmuodossa ovat molemmat terät asennetut kääntyviksi instrumentin runkoon.
20 Mikäli terät ovat suunnitellut siten, että niissä on leikkuupinta, joka leikkuun aikana peittää toisen progressiivisesti vastatusten kytkeytyvässä suhteessa, ja jolloin molemmat leikkuupinnat ovat vastaavien terien johtavien osien • päällä, komposiittisen ensimmäisen terän sisäkerros ja aina- Ί 25 kin toisen terän se osa, joka kantaa sen leikkuupintaa, omaa-vat sähköpotentiaalin. Komposiittisen ensimmäisen terän ul-'/·/. koelektrodi omaa erilaisen sähköpotentiaalin, jolloin se ' tuottaa sähkökentän sekä (a) komposiittisen ensimmäisen terän • * * · .ulkoelektrodin ja sisemmän johtavan kerroksen väliin ja (b) 30 komposiittisen ensimmäisen terän ulkoelektrodin ja toisen terän väliin johtuen leikkaavien pintojen sähkökosketuksesta.
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Jokaiseen terään kuuluu edullisesti pitkänomainen elin, jossa : on ulkopinta, sisäpuolinen leikkuupinta ja leikkuureuna, joka 35 kulkee terää pitkin, ja joka määrittää rajan leikkuupinnan ja leikkuupinnan toista pintaa pitkin kulkevan ulkopinnan välil- lä, ja jolloin terät ovat asennetut siten instrumentinrun- 3 11 4609 koon, että niiden vastaavat leikkuureunat suorittavat progressiivisen leikkuutoiminnon terien liikkuessa suljettuun asentoon, leikkuupintojen ollessa vastatusten olevassa suhteessa, jolloin komposiittisen ensimmäisen terän ulkopinta 5 määrittää sen leikkuusyrjän, joka kulkee sitä terää pitkin, joka on sen leikkuureunan vieressä, jolloin jokainen sisäpuolella oleva johtava kerros, eristyskerros ja ulkoelektrodi on asetettu leikkuusyrjää pitkin, ja jolloin leikkuupinta on muodostettu sisäpuolella olevaan johtavaan kerrokseen, aina-10 kin leikkuureunan viereen.
Toiseen terään kuuluu edullisesti johtava runko ja siinä on myös leikkuusyrjä, joka kulkee terää pitkin sen leikkuureunan vieressä, jolloin johtava runko on asetettu ainakin leikkuu-15 reunalle ja leikkuusyrjäpinnan yli. Terien leikkuusyrjät ovat edullisesti, ainakin osittain, normaalisti kohtisuorasti leikkuupintojen suhteen, jolloin leikkuureunojen risteämäkoh-dan etäisempään kohtaan saakka leikkuusyrjät ovat toisiaan kohden, vaikkakin niiden ollessa peittävässä suhteessa, jol-20 loin ne muodostavat sähkökosketuksen kudospalan kanssa, joka kulkee poikittain terien välissä. Näin ollen laitetta käytet-> täessä saatetaan siihen kudokseen, joka sijaitsee terien . välissä ja ulompana leikkuureunojen risteämäkohdasta, kirurgi ·'· gista sähkövirtaa, joka virtaa kudoksen läpi, toisaalta kom- . \ 25 posiittiterän ulkoelektrodin ja sen terän sisäkerroksen vä- ; ,· Iissä ja toisaalta komposiittiterän ulkoelektrodin ja toisen terän välissä. Tämä aiheuttaa kuivumisen ennen leikkuu-reunojen risteämäkohdassa tapahtuvaa mekaanista erottamista, terien liikkuessa niiden suljettua asentoa kohden.
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Joissain olosuhteissa, erityisesti kun kudoksen suunta vai-: keuttaa mekaanista erottamista, voidaan keksinnön mukaista edullista suoritusmuotoa käyttää puhtaaseen sähköisesti tapahtuvaan kirurgiseen leikkaukseen, so. ilman mekaanista * 35 erottamista. Tämän saavuttamiseksi ovat edullisen suoritus-. . muodon komposiittisen ensimmäisen terän ulkoelektrodi, eris- tyskerros ja sisäpuolinen johtava kerros, jokainen, sovitetut 114609 4 pitkin sähkötoimista kirurgista leikkuupintaa, joka muodostaa osan komposiittisen ensimmäisen terän ulkopinnasta, ja kulkien pitkin sitä terää, joka on tämän terän leikkuupinnan vastakkaisen sivun vierellä, ja joka lähtee leikkuureunasta.
5 Toinen terä valmistetaan normaalisti kapeammaksi kuin kom-posiittinen ensimmäinen terä ja se asennetaan siten, että terien ollessa suljetussa muodossa kulkee toisen terän leik-kuureuna pitkin komposiittisen ensimmäisen terän leikkuupintaa, joka sijaitsee komposiittisen ensimmäisen terän sähkö-10 toimisen kirurgisen leikkuupinnan takana. Näin ollen komposiittisen ensimmäisen terän leikkuureunan vastakkaisella sivulla esittävät ulkoelektrodi, eristyskerros ja sisempi johtava kerros kaistapintaa, jota pitkin kaikki kolme ovat asetetut vastakkain siten, että kun terät ovat suljetussa 15 muodossaan, voidaan komposiittisen ensimäisen terän tätä sivua käyttää veitsen tavoin, kun kirurginen sähköjännite saatetaan eristyskerroksen poikki.
Keksinnön kohteena on myöskin sähkökäyttöinen kirurgin leik-20 kuulaite, joka käsittää kirurgisen sähkön generaattorin ja kaksinapaisen sähkökäyttöisen kirurgin leikkuuvälineen, kuten edellä selitetään, jolloin generaattorilla on epäsymmetrinen . lähtö, johon kuuluu aktiivinen liitin ja passiivinen liitin, *; *· jolloin syöttöjohdinkytkennät ovat järjestetyt siten, että . ·’ 25 kudoksen kuivaamiseksi ja mekaaniseksi leikkaamiseksi on ·. t ; ,· aktiivinen terminaali yhdistetty komposiittisen ensimmäisen ’ ’·* terän ulkoelektrodiin. Samoin on sähköisesti tapahtuvaa ki rurgista leikkuuta varten aktiivinen liitin edullisesti yhdistetty toiseen terään tai komposiittisen ensimmäisen terän 30 sisäkerrokseen.
: Leikkuulaitteeseen on mahdollista yhdistää ohjauskytkin » · siten, että syöttöjohdinkytkennät voidaan kääntää sen mukaan, käytetäänkö välinettä yhdistettyyn kudoksen kuivamiseen ja 35 mekaaniseen leikkaukseen tai sähköisesti tapahtuvaan kirurgi- . . seen leikkaukseen.
( » I I I t 114609 5
Keksintöä selitetään seuraavassa esimerkin avulla ja viittaamalla piirustuksiin, joissa kuvio l esittää tasokuvana diagrammia sähkökäyttöisestä ki-5 rurgisesta laitteesta, jossa on osa kaksinapaisesta sähkökäyttöisestä kirurgisesta leikkuuinstrumentista, joka on rakennettu keksinnön mukaan, ja jossa esitetään kahta leik-kuuterää, jotka on asennettu kääntyvinä pitkänomaisen instrumentin rungon päähän, ja jolloin diagrammissa laitteen muut 10 elementit esitetään lohkon muodossa; kuvio 2 esittää poikkileikkausta teristä pitkin kuvion 1 viivaa A - A; 15 kuviot 3A ja 3B esittävät kaavamaisesti terien poikkileikkauksia niitä käytettäessä, ja ne esittävät kirurgisen sähkövirran jakelua terien välissä olevaan elävään kudokseen; kuvio 3C esittää kaavamaisesti poikkileikkausta teristä yhdessä niihin liitettyjen kirurgisen generaattorin ja kytkimen 20 kanssa; .. ; kuvio 4 esittää sivukuvana toisen sähkökäyttöisen kirurgisen » , · instrumentin teriä, jotka on rakennettu keksinnön mukaan; 25 kuvio 5 esittää päästä nähtynä kuvion 4 mukaisia teriä; ja kuvio 6 esittää poikkileikkausta pitkin kuvion 4 viivaa X -X.
30 Piirustusten kuvioihin 1 ja 2 viitaten on ensimmäinen, keksinnön mukaan rakennettu sähkökäyttöinen kirurgin leikkuu- : instrumentti tarkoitettu vatsan alueelle kohdistuvaan käyt- I » töön ja siinä on pitkänomainen putkimainen runko 10, jonka lähimpään päähän on tavanomaiseen tapaan kiinnitetty kädensi-35 ja 11 (esitetty kaavamaisesti lohkonmuodossa). Rungon 10 . . uloimmassa päässä on kaksi leikkuuterää 12 ja 14, jotka kum matkin on asennettu kääntyviksi ja kiertymään akselin 16 6 1 1 4609 ympäri, joka on suunnattu poikittain rungon 10 akselin suhteen. Kumpaankin terään 12 ja 14 kuuluu sormiosa 18, jotka kulkevat lähinnä akselin 16 takana, ja jolloin sormiosiin kuuluu tapit 18A, jotka sijaitsevat urissa 20 (joista vain 5 yksi on esitetty kuviossa 1), vastakkaisilla sivuilla rungon 10 sisällä olevan edestakaisin liikkuvan käyttölaitteen suhteen. Ohjaustanko 22A yhdistää käyttölaitteen 22 (tässä esittämättä jätettyyn) kädensijassa 11 olevaan liipaisumekanis-miin siten, että kun liipaisumekanismia käytetään, liikkuu 10 käyttölaite rungossa 10 pituussuunnassa ja aikaansaa terät 12 ja 14 kääntymään poikkiakselin 16 ympäri. Sähkönsyöttöjoh-timet 25 kulkevat putkimaisen rungon 10 läpi kädensijan 11 ja terien 12 ja 14 vastaavien kytkentäkohtien välissä.
15 Kädensija li on yhdistetty kirurgisen sähkön generaattoriin 26.
Kuten kuviosta 2 havaitaan, on terä 12 komposiittiterä, johon kuuluu metallinen ulkoelektrodi 12A, eristyskerros 12B ja 20 sisäpuolinen johtava kerros 12C. Toinen terä 14 on yksinkertainen terä, jossa on metallirunko ja tässä suoritusmuodossa se on kapeampi kuin komposiittiterä 12 suhteessa leikkuupin-nan leveyteen. Komposiittiterän 12 sisempi johtava kerros 12C muodostaa sen terän leikkuupinnan, jonka leikkuupinnan leik-25 kuureuna 12D määrittää yhdeltä sivulta. Komposiittiterän 12
ulkopinta 12E kulkee leikkuureunasta 12D ympäri leikkuupinnan \ toiselle sivulle, jonka kerros 12C muodostaa. Ulkopinnan 12E
osaa 12F, joka kulkee pitkin leikkuureunaa 12D, kutsutaan leikkuusyrjäksi, ja ulkoelektrodi 12A on asetettu ainakin 30 tälle leikkuusyrjälle 12F. Eristyskerros 12B ja sisäpuolinen johtava kerros 12C ovat myöskin asetetut pitkin syrjää 12F.
• '· Yksinkertaiseen terään 14 kuuluu myöskin leikkuupinta, joka, .· ’ kun terät 12 ja 14 ovat suljetussa muodossa, kuten kuviot 1
;\j 35 ja 2 esittävät, on komposiittiterän 12 leikkuupintaa kohden ja siinä on myöskin leikkuusyrjä 14F, joka, kun terät ovat aukiasemassaan, on komposiittiterän 12 leikkuusyrjää 12F
114609 7 kohden, vaikkakin niiden ollessa peittävässä suhteessa. Yksinkertaisen terän 14 leikkuusyrjä 14F määräytyy leikkuureu-naan 14D, joka lepää komposiittiterän 12 sisäkerroksen 12C muodostaman leikkuupinnan päällä, kun terät ovat suljetussa 5 muodossa.
Syöttöjohtimet 24 ovat yhdistetyt vastaavasti komposiittiterän 12 ulkoelektrodiin 12E ja yksinkertaiseen terään 14. Näin ollen kun kirurgisen sähkön voimanlähde, kuten generaattori 10 26, johdetaan johtimen 24 kädensijassa olevaan päähän, kehit tyy kirurginen sähköjännite toisaalta ulkoelektrodin 12A ja sisäkerroksen 12C väliin ja toisaalta ulkoelektrodin 12A ja yksinkertaisen terän 14 väliin.
15 Tämän liitäntämenetelmän vaikutus on kuvattu kuvioissa 3A ja 3B. Näihin kuvioihin viitaten ovat terät 12 ja 14 esitetty tässä avatussa muodossa, jolloin pala elävää kudosta on jäänyt poikittain suuntautuneena terien väliin, ulommaksi niiden leikkuureunojen 12D ja 14D risteämäkohdasta. Kudoksen 28 läpi 20 kulkee kaksi virran kulkua 30 ja 32, jolloin ensimmäinen kulku 30 on komposiittiterän 12 ulkoelektrodin 12A ja sisäpuolisen johtavan kerroksen 12C välissä, kuten kuvio 3A esittää. Todettakoon tässä, että sisäpuolinen johtava kerros 12C : ·; on samassa potentiaalissa kuin yksinkertainen terä 14 johtuen ·; ·: 25 sähkökosketuksesta molempien terien leikkuupintojen ja/tai leikkuureunojen 12D ja 14D välillä, ja jotka ovat lähinnä : leikkuureunan risteämäpistettä. Toinen virran kulku 32 kulkee komposiittiterän 12 ulkoelektrodin 12A ja yksinkertaisen terän 14 leikkuureunan 14D välillä, kuten kuvio 3B esittää.
30 Käytännössä molemmat virran kulut yhdistyvät ja aikaansaavat kuivaustoiminnon kudoksessa 28 olevaa linjaa pitkin, joka vastaa sitä mekaanisen erotuksen linjaa, joka tapahtuu, kun : terät 12 ja 14 liikkuvat avatusta muodosta niiden suljettuun ,· muotoon ja estäen siten verenvuodon leikkuulinjassa.
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Koska tässä ei mitään kirurgista sähkövirtaa kulje kom-• · posiittiterän 12 sisäpuolisen johtavan kerroksen 12C ja yk- 114609 8 sinkertaisen terän 14 välillä, ei tällöin eristyspinnoissa tarvita mitään eristysmateriaalia.
virran kulku 30 muodostaa pienen kuivausalueen verrattuna 5 tavanomaiseen kulkuväylään, jota kuvio 3B esittää, jolloin kokonaisteho on molemman kulkutien läpi kulkevien virtojen sumina. Molemmat kulkutiet ovat pitkänomaiset terien 12 ja 14 suunnissa. Todettakoon myöskin se, että kun terät 12 ja 14 ovat suljetut, puristuu kudos 28 kokoon ja kuivuneen kudoksen 10 määrä kasvaa.
Kuten kuvioista 3A ja 3B ilmenee, kiertämällä instrumenttia myötäpäivään kuten näissä kuvioissa esitetään, kasvaa kudoksen 28 ja kummankin terän 12 ja 14 välinen kosketus, jolloin 15 kudoksen kosketusimpedanssi vähenee, koska ulkoelektrodilla 12A ja yksinkertaisella terällä 14 kummallakin on johtavat ulkopinnat merkityksellisten kudoskosketusosien yli.
Tästä ilmenee myöskin se, että koska yksinkertaisen terän 14 20 leikkuupinnassa ei ole mitään eristyskerrosta, voi tämä olla kosketuksessa kudokseen 28 saksien ollessa avatussa muodossa, ja jolloin komposiittiterän 12 ulkopinta 12E, 12F täydentää kaksinapaisen kirurgisen sähköpiirin. Näin ollen verrattain : suuri kudostilavuus 28 on yhdistyneenä virran kulkuun, mikä • · 25 johtaa laajaan kuivumisalueeseen ennen mekaanista erottamis- ; ; ta.
Viitaten jälleen kuvioon 2 voidaan tällöin havaita se, että ulkoelektrodi 12A, eristyskerros 12B ja sisäpuolinen johtava 30 kerros 12C ovat kaikki asetetut pitkin pintakaistaa 12G, joka muodostaa komposiittiterän 12 ulkopinnan 12E osan, ja joka pintakaista on leikkuusyrjää 12F vastapäätä. Tätä pintakais-: · taa 12G voidaan käyttää sähkökäyttöisenä kirurgisena veitse- nä. Todettakoon se, että yksinkertainen terä 14 on kapeampi .·. : 35 kuin komposiittiterä 12, ja että kun terät ovat täysin sulje-tussa muodossa, kulkee yksinkertaisen terän 14 leikkuusyrjä • · 14F komposiittiterän 12 leikkuupintaa pitkin, joka on eril- 114609 9 lään pintakaistasta 12G, ja jolloin se on irti sähkötoimisesta kirurgisesta leikkuureunasta.
Sähköisesti tapahtuvan kirurgisen leikkuun tehoa, jolloin 5 käytetään sähkökäyttöistä kirurgista leikkuuterää 12G voidaan kohottaa lisäämällä leikkuureunan 12D vieressä olevassa kudoksessa olevan virran tiheyttä. Siinä tapauksessa mikäli kirurgisen sähkön generaattorilla 26 on epäsymmetrinen lähtö, voidaan tämä aikaansaada yhdistämällä generaattorin "aktiivi-10 nen" tai "syöttö" lähtöliitin 26A yksinkertaiseen terään 14 (tai suoraan komposiittiterän 12 sisäkerrokseen 12C) ja "passiivinen" tai "paluu" lähtöliitin 26B komposiittiterän 12 ulkoelektrodiin 12A. Tällaisen liitännän teho on seuraava. Koska generaattorin 26 passiivinen lähtöliitin 26B on kytket-15 ty ainakin vaihtovirroilla generaattorin 26 sisäpuoliseen maattokiskoon 26C, kun taas aktiivinen liitin 26A on liitetty oskillaatorin tai vahvistimen lähtöön 26D, on tällöin potilaan läpi maahan tapahtuva vuotovirta suurempi aktiivisesta liittimestä 26A kuin passiivisesta liittimestä 26B, ja jol-20 loin kapasitanssi liittimestä 26B maahan on suurempi. Tuloksena on se, että tällöin ei kaikki aktiivisesta liittimestä 26A potilaan kudokseen johdettu virta palaa liittimen 26B kautta. Osa siitä on kapasitiivisesti kytketty maahan. Kyt-: . kettäessä aktiivinen liitin 26A tehokkaasti sisäkerokseen 25 12C, maksimoituu tällöin huippuvirran tiheys kudoksen 28 ja sähkökäyttöisen kirurgisen leikkuusyrjän 12G välillä, koska leikkuusyrjässä olevan kerroksen 12C pinta-alue on pienempi ·' kuin ulkoelektrodin 12A pinta-alue.
30 Vastakohtana sähköisesti tapahtuvalle kirurgiselle leikkaukselle on tällöin kuivausta varten tapahtuva edullinen virran jakelu niin lähellä tasaista kuin mahdollista kudoksen ja i komposiittiterän 12 välisen rajapinnan poikki. Näin ollen yhdistettyä kuivausta ja mekaanista leikkausta varten (kuten ·.· 35 kuviot 3A ja 3B esittävät), on edullista se, että aktiivinen ’ . liitin 26A on liitetty komposiittiterän 12 ulkoelektrodiin .. 12A, kun taas passiivinen liitin 26B on kytketty yksinkertai- 114609 10
seen terään 14 (ja tehollisesti sisäkerrokseen 12C). Siksi on edullista järjestää kytkin 34 syöttöjohdinten 24 kytkentöjen kääntämiseksi vastaavasti liittimiin 26A ja 26B, ja sen mukaan vaaditaanko kuivausta vaiko sähköisesti tapahtuvaa ki-5 rurgista leikkausta. Tämä kytkin esitetään yksityiskohtaisemmin kuviossa 3C, jolloin kytkimeen kuuluu kaksi paria kosket-timia 34A ja 34B ja kaksihaarainen kosketin 34C. Kaksihaaraista kosketinta 34C voidaan liikuttaa ensimmäisestä toiminta-asemasta (esitetty kuviossa 3C), jossa aktiivinen liitin 10 26A on kytketty ulkoelektrodiin 12A ja passiivinen liitin 26B
on kytketty yksinkertaiseen terään 14, ja jolloin instrumenttia käytetään kuivamiseen, toiseen toiminta-asemaan, jossa aktiivinen liitin 26A on kytketty yksinkertaiseen terään 14 ja passiivinen liitin 26B on kytketty elektrodiin 12A, ja 15 jolloin laitetta käytetään sähköisesti tapahtuvaan kirurgiseen leikkaukseen.
Vaihtokytkin 34 voidaan sijoittaa kädensijaan 11 kuten kuvio 1 esittää, ja jolloin kulloisetkin kytkentäkoskettimet 34A, 20 34B ja 34C ovat edullisesti sijoitetut generaattoriin 26, ja jolloin koskettimet toimivat releiden ohjaamina kytkimestä 34 käsin ohjausjohtimen 36 välityksellä. Kädensijaan 11 kuuluu , : myöskin päälle-/poiskytkin 40, jolla ohjataan johtimiin 24 menevää kirurgista sähkövoiman käyttöä. Ja jälleen tämän '·’ 25 toiminnon kulloinenkin kytkentä voidaan toteuttaa releen ; avulla, jota ohjataan kytkimen 40 ja generaattorin 26 välissä olevan ohjaus johtimen 42 välityksellä.
Kuvioihin 4-6 viitaten kuuluu seuraavassa toiseen keksinnön 30 mukaan rakennettuun sähkökäyttöiseen kirurgin instrumenttiin kaarevat leikkuuterät 12 ja 14, jolloin terät ovat käyriste-tyt käyränakselin ympäri, joka on erillään ja poikittain : laitteen pitkittäisakselin suhteen. Komposiittiterään 12, .· kuten ensimmäisessä suoritusmuodossa, kuuluu ulkoelektrodi 35 12A, sisäpuolinen eristyskerros 12B, joka on valmistettu epoksihartsiliimasta ja sisäpuolinen johtava kerros 12C, joka •· on valmistettu kovaa kulutusta kestävästä metallista. Toinen 114609 11 terä 14 on käyristetty siten, että se sopii komposiittiterän 12 käyryyteen, kuten on esitetty. Tämä on kuten edelläkin yksinkertainen metallinen komponentti. Molemmat terät 12 ja 14 ovat kierrettävissä poikittaisen kääntymisakselin 16 ympä-5 ri, ja niissä on sormiosat 10, jotka kulkevat lähinnä akselia 16 kytkeäkseen käyttölaitteen (jätetty tässä esittämättä, mutta samanlainen kuin kuviossa l esitetty käyttölaite 22). Kuvio 4 esittää kirurgisen sähkön syöttöjohdinten 24 kiinnityksen terien 12 ja 14 sormiosiin 18. Viitaten erityisesti 10 kuvioon 6 voidaan tällöin havaita se, että komposiittiterä 12 on varustettu ulkoharjalla 12H lujuuden lisäämiseksi.
Claims (16)
1. Sähkötoiminen kirurgin leikkuuväline, johon kuuluu instrumentinrunko (10), ensimmäinen (12) ja toinen (14) 5 leikkuuterä, joista ainakin toinen on asennettu kääntyväksi runkoon (10), jotta se voi toteuttaa leikkuutoiminnon toisen terän kanssa ja sähkönsyöttöjohtimet (24), jotka ovat yhdistetyt runkoon (10), jotta saadaan syötetyksi kirurgista sähköjännitettä ensimmäiselle (12) ja toiselle terälle (14), 10 tunnettu siitä, että ensimmäinen terä (12) on kom- posiittiterä, johon kuuluu johtava ulkoelektrodi (12A), sisäpuolella oleva johtava kerros (12C) ja ulkoelektrodin sekä sisäkerroksen väliin kerrostettu eristyskerros, syöttöjohdin-ten (24) ollessa kytketyt vastaavasti ulkoelektrodiin (12A) 15 ja sisäkerrokseen (12C).
2. Patenttivaatimuksen l mukainen väline, tunnettu siitä, että toinen syöttöjohdin (24) on kytketty suoraan sisäkerrokseen (12C). 20
3. Patenttivaatimuksen 1 mukainen väline, tunnettu siitä, että toinen syöttöjohdin (24) on kytketty toiseen terään (14), ja että se on sähköisesti kytketty komposiittisen ensimmäisen terän (12) sisäkerrokseen toisen terän (14) ja 25 sisäkerroksen (12C) välissä olevan sähkökoskettimen (34) ! avulla.
4. Patenttivaatimuksen 3 mukainen väline, tunnettu : siitä, että toiseen terään (14) kuuluu johtava runko, joka on • 30 sähköisessä kosketuksessa komposiittisen ensimmäisen terän (12) sisäkerroksen (12C) kanssa, ja jolloin mainittu syöttö-:* johdin (24) on kytketty johtavaan runkoon ja siten, että johtava runko on kytketty sähköisesti sarjaan mainitun syöt-; t'.# töjohtimen (24) ja sisäkerroksen (12C) välille. 35 » I
5. Jonkin patenttivaatimuksen 1-4 mukainen väline, t u n-n e t t u siitä, että kumpaankin terään (12, 14) kuuluu * » » 114609 leikkuureuna (12D, 14D), jotka ovat suunnatut siten, että terät (12, 14) voivat suorittaa progressiivisen leikkuutoi-minnon, ja että molemmat leikkuureunat (12D, 14D) on muotoiltu metallimateriaalista. 5
6. Jonkin patenttivaatimuksen 1-5 mukainen väline, tunnettu siitä, että toiseen terään (14) kuuluu täydellisesti metallinen runko, ja että sen leikkuureuna (14D) on muotoiltu runkoon. 10
7. Jonkin patenttivaatimuksen 1-6 mukainen väline, tunnettu siitä, että molemmat terät (12, 14)ovat asennetut kääntyviksi instrumentinrunkoon (10).
8. Jonkin patenttivaatimuksen 1-7 mukainen väline, tun nettu siitä, että jokaiseen terään (12, 14) kuuluu pitkänomainen elin, jossa on ulkopinta, sisäpuolnen leikkuupinta (12P, 14F) ja leikkuureuna (12D, 14D), joka kulke terää pitkin, ja joka määrittää rajan leikkuupinpan (12F, 14F) ja 20 leikkuupinnan toista pintaa pitkin kulkevan ulkopinnan välille, ja jolloin terät (12, 14) ovat asennetut siten instrumentinrunkoon (10), että niiden vastaavat leikkuureunat (12D, : 14D) suorittavat progressiivisen leikkuutoiminnon terien liikkuessa suljettuun muotoon, leikkuupintojen (12D, 14D) 25 ollessa vastatusten olevassa suhteessa, jolloin komposiit-tisen ensimmäisen terän (12) ulkopinta määrittää sen leik-kuusyrjän, joka kulkee sitä terää pitkin, joka on sen leik-kuureunan (12D) vieressä, jolloin jokainen sisäpuolinen johtava kerros (12C), eristyskerros (12B) ja ulkoelektrodi (12A) 30 on asetettu leikkuusyrjää pitkin, ja jolloin leikkuupinta (12F) on muodostettu sisäpuoliseen johtavaan kerrokseen, ainakin leikkuureunan viereen.
9. Patenttivaatimuksen 8 mukainen väline, tunnettu 35 siitä, että toiseen terään (14) kuuluu johtava runko, ja että siinä on myös leikkuusyrjä, joka kulkee terää pitkin sen 114609 leikkuureunan (14D) vieressä ja että johtava runko on paljas ainakin leikkuureunalta (14D) ja pitkin leikkuusyrjää.
10. Patenttivaatimuksen 9 mukainen väline, tunnettu 5 siitä, että toisen terän (14) johtava runko on paljas ainakin tämän terän leikkuupinnan (14F) suurimmalta osalta.
11. Jonkin patenttivaatimuksen 8-10 mukainen väline, tunnettu siitä, että ulkoelektrodi (12A), eristysker- 10 ros (12B) ja sisäpuolella oleva komposiittisen ensimmäisen terän kerros (12C) ovat paljastetut pitkin sitä sähkötoimista kirurgista leikkuupintaa (12F), joka muodostaa osan komposiittisen ensimmäisen terän (12) mainitusta ulkopinnasta, ja joka kulkee pitkin terää (12), terän leikkuupinnan vie-15 ressä.
12. Patenttivaatimuksen 11 mukainen väline, tunnettu siitä, että sähkötoiminen kirurginen leikkuupinta (12F) kulkee pitkin komposiittista ensimmäistä terää (12) sen terän 20 leikkuupinnan vastakkaisen sivun vierellä leikkuureunasta (12D), ja jolloin terät (12, 14) ovat muotoillut ja asennetut siten, että niiden ollessa suljetussa muodossa, kulkee toisen : terän (14) leikkuureuna (14D) pitkin komposiittisen ensimmäi sen terän (12) leikkuupintaa (12D) ja on erillään komposiit-25 tisen ensimmäisen terän (12) sähkötoimisesta kirurgisesta leikkuupinnasta (12F).
12 1 1 4609
13. Jonkin patenttivaatimuksen 1-12 mukainen väline, tunnettu siitä, että siihen kuuluu edelleen kytkin 30 (34), joka kääntää syöttöjohdinten kytkennät.
14. Sähkötoiminen kirurgin leikkuulaite, johon kuuluu kirur- : gisen sähkön generaattori (26) ja jonkin patenttivaatimuksen .· 1 - 13 mukainen kaksinapainen sähkötoiminen kirurgin leikkuu- 35 väline, tunnettu siitä, että generaattorissa on epäsymmetrinen lähtö, jossa on aktiivinen liitin (26A) ja * · passiivinen liitin (26B), ja jolloin syöttöjohdinkytkennät » 114609 (24) on järjestetty siten, että kudoksen kuivaamiseksi ja mekaaniseksi leikkaamiseksi on aktiivinen liitin (26A) kytketty komposiittisen ensimäisen terän (12) ulkoelektrodiin (12 A) . 5
15. Sähkötoiminen kirurgin laite, johon kuuluu kirurgisen sähkön generaattori (26) ja jonkin patenttivaatimuksen 1-13 mukainen kaksinapainen sähkötoiminen kirurgin leikkuuväline, tunnettu siitä, että generaattorissa (26) on epäsym- 10 metrinen lähtö, jossa on aktiivinen liitin (26A) ja passiivinen liitin (26B), jolloin syöttöjohdinkytkennät (24) on järjestetty siten, että sähköisesti tapahtuvaa kirurgista leikkausta varten on passiivinen liitin (26B) kytketty komposiittisen ensimmäisen terän (12) ulkoelektrodiin (12A).
16. Patenttivaatimuksen 15 mukainen laite, tunnettu siitä, että leikkuuvälineeseen kuuluu kytkin (26), jolla käännetään generaattorin (26) liittimistä (24) teriin (12, 14. menevät kytkennät. 20 » I · ♦ t » > » 114· 114609
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GBGB9425781.3A GB9425781D0 (en) | 1994-12-21 | 1994-12-21 | Electrosurgical instrument |
| GB9425781 | 1994-12-21 |
Publications (3)
| Publication Number | Publication Date |
|---|---|
| FI956124A0 FI956124A0 (fi) | 1995-12-19 |
| FI956124A FI956124A (fi) | 1996-06-22 |
| FI114609B true FI114609B (fi) | 2004-11-30 |
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Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| FI956124A FI114609B (fi) | 1994-12-21 | 1995-12-19 | Sähkötoiminen kirurgin instrumentti |
Country Status (14)
| Country | Link |
|---|---|
| US (1) | US5860975A (fi) |
| EP (1) | EP0717966B1 (fi) |
| JP (1) | JP3842320B2 (fi) |
| KR (1) | KR100439328B1 (fi) |
| CN (1) | CN1102845C (fi) |
| AT (1) | ATE236584T1 (fi) |
| AU (1) | AU713677B2 (fi) |
| CA (1) | CA2165738C (fi) |
| DE (1) | DE69530270T2 (fi) |
| ES (1) | ES2196043T3 (fi) |
| FI (1) | FI114609B (fi) |
| GB (1) | GB9425781D0 (fi) |
| NO (1) | NO320071B1 (fi) |
| TW (1) | TW286272B (fi) |
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| EP0148250A1 (en) * | 1983-07-06 | 1985-07-17 | STASZ, Peter | Electro cautery surgical blade |
| US5484436A (en) * | 1991-06-07 | 1996-01-16 | Hemostatic Surgery Corporation | Bi-polar electrosurgical instruments and methods of making |
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| FR2680314B1 (fr) * | 1991-08-16 | 1993-11-19 | Guy Lebosse | Ciseaux de cóoeliochirurgie droit ou courbe de champs electrocoagulants en mode bi polaire. |
| EP0610326B1 (en) * | 1991-11-01 | 2002-09-18 | Medical Scientific, Inc. | Electrosurgical cutting tool |
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| CA2121194A1 (en) * | 1993-05-06 | 1994-11-07 | Corbett Stone | Bipolar electrosurgical instruments |
| DE69424253T2 (de) * | 1993-11-10 | 2000-12-21 | Xomed Inc., Jacksonville | Bipolares, elektrochirurgisches Instrument und Herstellungsverfahren |
| US5352222A (en) * | 1994-03-15 | 1994-10-04 | Everest Medical Corporation | Surgical scissors with bipolar coagulation feature |
| US5540685A (en) * | 1995-01-06 | 1996-07-30 | Everest Medical Corporation | Bipolar electrical scissors with metal cutting edges and shearing surfaces |
| US5603711A (en) * | 1995-01-20 | 1997-02-18 | Everest Medical Corp. | Endoscopic bipolar biopsy forceps |
-
1994
- 1994-12-21 GB GBGB9425781.3A patent/GB9425781D0/en active Pending
-
1995
- 1995-12-14 ES ES95309128T patent/ES2196043T3/es not_active Expired - Lifetime
- 1995-12-14 EP EP95309128A patent/EP0717966B1/en not_active Expired - Lifetime
- 1995-12-14 AT AT95309128T patent/ATE236584T1/de not_active IP Right Cessation
- 1995-12-14 DE DE69530270T patent/DE69530270T2/de not_active Expired - Lifetime
- 1995-12-15 US US08/573,187 patent/US5860975A/en not_active Expired - Lifetime
- 1995-12-18 NO NO19955139A patent/NO320071B1/no not_active IP Right Cessation
- 1995-12-18 AU AU40520/95A patent/AU713677B2/en not_active Expired
- 1995-12-19 KR KR1019950051853A patent/KR100439328B1/ko not_active IP Right Cessation
- 1995-12-19 FI FI956124A patent/FI114609B/fi not_active IP Right Cessation
- 1995-12-20 CA CA002165738A patent/CA2165738C/en not_active Expired - Lifetime
- 1995-12-20 TW TW084113632A patent/TW286272B/zh not_active IP Right Cessation
- 1995-12-21 CN CN95113177A patent/CN1102845C/zh not_active Expired - Lifetime
- 1995-12-21 JP JP33369595A patent/JP3842320B2/ja not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| GB9425781D0 (en) | 1995-02-22 |
| KR100439328B1 (ko) | 2004-10-06 |
| EP0717966B1 (en) | 2003-04-09 |
| KR960020947A (ko) | 1996-07-18 |
| CN1130052A (zh) | 1996-09-04 |
| FI956124A (fi) | 1996-06-22 |
| FI956124A0 (fi) | 1995-12-19 |
| EP0717966A1 (en) | 1996-06-26 |
| NO955139D0 (no) | 1995-12-18 |
| CN1102845C (zh) | 2003-03-12 |
| CA2165738A1 (en) | 1996-06-22 |
| JPH08252263A (ja) | 1996-10-01 |
| CA2165738C (en) | 2006-12-05 |
| AU4052095A (en) | 1996-06-27 |
| DE69530270T2 (de) | 2004-03-04 |
| AU713677B2 (en) | 1999-12-09 |
| NO320071B1 (no) | 2005-10-17 |
| JP3842320B2 (ja) | 2006-11-08 |
| ES2196043T3 (es) | 2003-12-16 |
| NO955139L (no) | 1996-06-24 |
| TW286272B (fi) | 1996-09-21 |
| US5860975A (en) | 1999-01-19 |
| ATE236584T1 (de) | 2003-04-15 |
| DE69530270D1 (de) | 2003-05-15 |
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