JP2000229088A - Electric surgery instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an electric surgery instrument of a wide application range of the simple constitution for preventing mechanical incision and realizing stable incision and the hemostatic action by a high frequency current. SOLUTION: This electric surgery instrument is composed of a power source part 2 for generating a high frequency current, a treating tool 8 for carrying the high frequency current to a living body, a patient electrode 9 for recovering a feedback current from the living body by current-carrying, a sensor circuit 6 for detecting load impedance of the living body and a CPU 3. Thus, the load impedance detected by the sensor circuit 6 is monitored, and when the load impedance is lower than inside impedance of the device on the basis of a minitoring result of the load impedance, a waveform different from the present output waveform is outputted, and the load impedance of the living body is forcedly shifted to be controlled so as to be adjusted to an output load characteristic of the device.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a suitable incision and hemostasis of a living tissue by applying a high-frequency current to the living tissue and optimizing the high-frequency current according to the impedance of the living tissue. The present invention relates to an electrosurgical apparatus for performing the operation.

[0002]

2. Description of the Related Art Conventionally, tumors in a living body have been
Various techniques relating to an electrosurgical apparatus for incising and coagulating mucous membranes, polyps, tissues and the like have been disclosed.

FIG. 6A is an output-load characteristic diagram of a conventional electrosurgical apparatus, and FIG. 6B is a principle diagram of a basic output circuit of the conventional electrosurgical apparatus.

As shown in FIGS. 6A and 6B, an internal resistance 32 of an output circuit is provided in a basic output circuit of an electrosurgical apparatus.
Therefore, when the resistance value (hereinafter referred to as impedance) of the bioresistance 33 changes, an output in which the internal impedance of the basic output circuit is set as a peak cannot be obtained, and the output substantially decreases. I was

[0005] Such a situation becomes conspicuous when the impedance of the biological resistance 33 is lower than the impedance of the internal resistance 32 of the output circuit.

When performing high-frequency surgery using a large mucous membrane or a liquid such as physiological saline under an endoscope, the impedance of the biological resistance 33 of the tissue is lower than the impedance of the internal resistance 32 of the output circuit. And becomes 1/2 to 1/4 of the required high-frequency output (set value).

As described above, in the electrosurgical apparatus according to the prior art, the biological resistance 33 is affected by the contact of a tissue or a treatment tool to which a high-frequency current flows with the living body, and the impedance of the internal resistance 32 of the output circuit is peaked. A situation has arisen in which the output actually applied to the tissue is lower than the original set output.

[0008] Therefore, the output becomes improper due to differences in the size of the resected tissue, the shape of the treatment tool, the contact area, and the living tissue, and the desired desired effect has not been obtained.

In view of the above problems, various techniques described below have been disclosed.

[0010] For example, Japanese Patent No. 2557593 discloses a technique relating to a "power supply device for an electric scalpel" characterized by storing output parameters digitally and increasing the output linearly with respect to a set value. ing.

[0011] Further, Japanese Patent No. 2671966 is characterized in that a voltage, a current, a load impedance, a leakage current, a spectrum component, and a crest factor are measured, and respective parameters are controlled in accordance with the load of the load. A technique relating to "a processing device for an electrosurgical instrument and a method of using the same" is disclosed.

Japanese Patent Application Laid-Open No. Hei 8-196543 is characterized in that only a coagulation end point is predicted in order to coagulate a tissue purely, and various controls are performed based on the prediction. A technique relating to a "power supply device" is disclosed.

[0013] In each of the prior arts mentioned above,
When a high-frequency power supply is used, the main controls are based on the surgeon's experience, taking into account various conditions such as tissue changes, discharge conditions, smoke generation conditions, etc. observed when treating tissue with high-frequency energy. The output setting and output time were controlled by intuition.

[0014]

However, particularly when a flexible endoscope is used to perform treatment in a narrow lumen such as the stomach or the deep part of the large intestine, a narrow field of view such as a monitor image or an endoscope image is used. In order to make observations, it was difficult to grasp all conditions and take appropriate measures.

If the proper treatment cannot be performed as described above, the treatment may be performed in spite of the damage to the deep part of the tissue due to the unnecessary output for a long time, the adhesion between the treatment tool and the tissue, and the insufficient output. Situations where tissue is mechanically cut with a tool,
Healing of the prognosis may be deteriorated due to intense carbonization of the tissue due to excessive output and the like.

In the technique disclosed in Japanese Patent No. 2557593, the output is not controlled in response to a change corresponding to the impedance of a living body, so that the above-mentioned problem is still solved. I didn't.

Further, in the technique disclosed in Japanese Patent No. 2671966, the problem has not been completely solved since the circuit is complicated, the circuit configuration is greatly increased, and proper output in a low impedance region cannot be controlled. .

The technique disclosed in Japanese Patent Application Laid-Open No. 8-196543 is not suitable for dynamic ablation and hemostasis because the output is not controlled in real time with respect to bioelectrical impedance. Was.

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned problems, and has as its object the object of applying a high-frequency current to a living body by a simple operation from the start of the living body excision to the end of the excision. A wide range of electrosurgery with a simple configuration that measures changes in tissue impedance and energizes the appropriate output to prevent mechanical incisions and achieve stable incision and hemostasis by high-frequency current. It is to provide a device.

[0020]

According to a first aspect of the present invention, there is provided an electrosurgical apparatus for outputting a high-frequency current to a living body, comprising: a power supply means for generating the high-frequency current; Treatment means for applying a high-frequency current to the electrode, collection electrode means for collecting a return current from the living body due to the energization, sensor means for detecting the load impedance of the living body, and monitoring the load impedance detected by the sensor means. If the load impedance is lower than the internal impedance of the device, a waveform different from the preset output waveform is output, and the load impedance of the living body is forcibly shifted so as to match the output load characteristics of the device. An electrosurgical apparatus is provided, comprising:

According to a second aspect, in an electrosurgical apparatus for outputting a high-frequency current to a living body, a power supply means for generating the high-frequency current, a treatment means for supplying a high-frequency current to the living body, and a return from the living body by the current supply A collecting electrode means for collecting current, a sensor means for detecting the load impedance of the living body, and a load impedance detected by the sensor means are monitored, and if the load impedance is lower than the internal impedance of the device, Control means for outputting an output value higher than the set output set value for a period determined for each setting, forcibly shifting the load impedance of the living body, and controlling to match the output load characteristic of the device. An electrosurgical device is provided.

According to the first and second aspects, the following operation is achieved.

That is, in the first aspect of the present invention, the load impedance is monitored by the control means. If the load impedance is lower than the internal impedance of the apparatus based on the monitoring result of the load impedance, the preset value is set in advance. A waveform different from the output waveform is output, and the load impedance of the living body is forcibly shifted and controlled to match the output load characteristics of the device.

In the second embodiment, the load impedance is monitored by the control means. If the load impedance is lower than the internal impedance of the apparatus based on the monitoring result of the load impedance, the output impedance is monitored based on a preset output set value. Is output for a period determined for each setting, the load impedance of the living body is forcibly shifted, and the output is controlled to match the output load characteristics of the device.

[0025]

Embodiments of the present invention will be described below with reference to the drawings.

FIG. 1 is a configuration diagram of an electrosurgical apparatus according to a first embodiment of the present invention.

As shown in the figure, in this electrosurgical apparatus, the output of the commercial power supply input unit 1 is connected to the input of the power supply unit 2 for generating power, and the output of the power supply unit 2 is Are connected to the inputs of the CPU 3 and the power amplification unit 5 which control the power supply. The output of the CPU 3 is connected to the input of the power amplifier 5 via the waveform generator 4 and directly to the input of the power amplifier 5. The output of the power amplifying unit 5 is connected to the treatment instrument 8 and the patient electrode 9 via the sensor circuit 6 and to the input of the CPU 3 via the sensor circuit 6 and the A / D conversion circuit 7.

The power supply means described in the claims corresponds to the power supply section 2, the treatment means corresponds to the treatment tool 8, the collection electrode means corresponds to the patient electrode 9, and the sensor means corresponds to the sensor circuit 6. And control means correspond to the CPU 3.

In such a configuration, a high-frequency output and a power supply to be supplied to the internal circuit are generated by the power supply unit 2 based on the power input from the commercial power supply input unit 1. The waveform generator 4 generates various high-frequency waveform outputs under the control of the CPU 3, and the high-frequency waveform outputs are amplified by the power amplifier 5 and then supplied to the treatment instrument 8 via the sensor circuit 6. Is done. With this high frequency current, incision of the living body,
Hemostasis is performed, and thereafter, the blood is collected from the patient electrode 9.

As the sensor circuit 6, for example, a current sensor, a voltage sensor, a sensor for detecting a capacitance component of a living body, or the like is employed. The detection signal is converted into a digital signal, and the digital signal is transmitted to the CPU 3. Then, in the CPU 3, based on the digital signal, necessary output control, that is, voltage control, change of output setting,
Various controls are turned on / off according to a waveform change or a signal from a selection unit (not shown).

As described above, in the first embodiment, when a high-frequency current is applied to a living tissue, a change in impedance from before the start of excision of the living body to the end of the excision is measured, and an appropriate output is applied. Thus, a stable incision and hemostatic action are realized.

Next, FIG. 2 is an external configuration diagram of the electrosurgical apparatus according to the first embodiment.

As shown in FIG.
The output of 0 is connected to the input of the treatment tool 12 via the active electrode cord 11, and the mucous membrane of the living body 13 is energized through the conductive member of the treatment tool 12. The energized high-frequency current is collected by the electrosurgical unit 10 via the patient electrode 14 and the patient electrode cord 15 that have come into contact with the living body 13.

Here, FIG. 3 shows an example of the output load characteristic of the electrosurgical apparatus according to the first embodiment, which will be described in detail.

In FIG. 3, the horizontal axis represents bioimpedance, and the vertical axis represents output setting. Such characteristics themselves are substantially the same as the characteristics according to the prior art.

In general, when an incision is made by an incision wave or a mixed waveform having an incision action, especially when the bioimpedance is lower than the output characteristic, the bioimpedance gradually increases to a value suitable for the load characteristic. It takes a long time to ascend, and if the load characteristics are met, a sharp incision action occurs, and as a result, there is a problem that the cut is made before sufficient protein denaturation is impossible and the hemostasis becomes insufficient.

Therefore, in this embodiment, in such a case, the coagulation wave is output in the low impedance region and the impedance of the resected tissue is shifted until it matches the load characteristics of the electrosurgical device as described above. Without increasing the number of settings, stable incision hemostasis was always achieved with the minimum required value.

That is, in the electrosurgical apparatus according to the present embodiment, by performing the above-described control in detail, for example, as shown in FIG. 4, the impedance is lower than the impedance of an output circuit (not shown) of the electrosurgical apparatus. If there is a bio-impedance in the area, by outputting the energy in the case where the output setting of 30W is output at the output of 60W, for example, even if the actual output at the setting of 30W is reduced to 15W, The actual output can be maintained at 30 W.
Alternatively, in a region where the impedance of the output circuit is low, although not shown, the substantial voltage of the incision waveform is increased when the incision waveform is set, or the tissue is caused by another waveform (for example, a coagulation waveform having a high voltage). By drying
The impedance of the parenchyma is shifted up to near the impedance of the output circuit so that a set output is output.

According to the first embodiment described above,
The problems that occur in the region where the bioimpedance is low, namely, first, the resection time becomes longer due to lack of substantial output and the treatment tool adheres to the tissue, and second, protein denaturation occurs only near the contact of the treatment tool with the tissue. After that, the operator raises the binding force of the treatment tool and mechanically resects, and the center of the resected tissue is in a state of being burnt and has poor hemostatic performance. Third, the size of the resected tissue, the liquid environment (mucosa) Differences in internal or surface), resection, hemostatic quality due to differences in treatment tools, etc.
And stable incision and hemostatic performance are always achieved.

Next, FIG. 5 shows and describes the configuration of an electrosurgical apparatus according to a second embodiment of the present invention. The configuration of the electrosurgical apparatus according to the second embodiment is the same as that of FIGS. 1 and 2, but the configuration around the treatment tool 12 is different.

In the second embodiment, the treatment instrument used for the same case includes a tension adjusting structure for alleviating the mechanical force applied to the living body, thereby further preventing mechanical incision and preventing unintended bleeding. It is characterized by preventing.

That is, as shown in FIG.
An air damper 22 or a spring 25 serving as a tension buffering mechanism is disposed between the conductive member 24 in the inside and a slider 21 for sliding the conductive member 24.
The air damper 22 or the spring 25 prevents mechanical resection or the like due to the fact that the binding force is directly transmitted to the living tissue when the operator sharply raises the binding.

As described above, according to the electrosurgical apparatus according to the second embodiment, when a rigid member is employed as in the prior art, the living body to be treated has several treatment tools. In some cases, they were tied up with a force of more than kilograms, and in some cases, they were completely mechanically cut.However, this tying-up force was reduced to a few hundred grams, and safe and stable incision and hemostasis were achieved. Performance is realized.

Although the embodiment of the present invention has been described above, the present invention is not limited to the above-described embodiment.
It goes without saying that various improvements and modifications can be made without departing from the spirit of the invention. For example, in the case where treatment by manual operation is desired, means for selecting automatic control / manual operation is further provided, and if it can be used according to the operator's preference, it can be applied to a wider range of application. .

The above embodiment of the present invention includes the following inventions.

(1) In an electrosurgical apparatus for outputting a high-frequency current to a living body, a power supply means for generating the high-frequency current, a treatment means for supplying a high-frequency current to the living body, and a return current from the living body due to the current supply are collected. Collecting electrode means, a sensor means for detecting the load impedance of the living body, and monitoring the load impedance detected by the sensor means, based on the result of monitoring the load impedance, when the load impedance is lower than the internal impedance of the device. Control means for outputting a waveform different from a preset output waveform, forcibly shifting the load impedance of the living body, and controlling the load impedance to match the output load characteristics of the device. Electric surgery equipment.

(2) In an electrosurgical apparatus for outputting a high-frequency current to a living body, a power supply means for generating the high-frequency current, a treatment means for supplying a high-frequency current to the living body, and a return current from the living body due to the current supply are collected. Collecting electrode means, a sensor means for detecting the load impedance of the living body, and monitoring the load impedance detected by the sensor means, based on the result of monitoring the load impedance, when the load impedance is lower than the internal impedance of the device. Output a higher output value than a preset output set value for a predetermined period of time for each setting, forcibly shift the load impedance of the living body, and control the output to match the output load characteristic of the device. An electrosurgical apparatus comprising:

(3) The electrosurgical apparatus according to (1) or (2), wherein the sensor means detects a load impedance by monitoring a current.

(4) The electrosurgical apparatus according to (1) or (2), wherein the sensor means detects a load impedance by monitoring a voltage.

(5) The electrosurgical apparatus according to (1) or (2), wherein the sensor means detects load impedance by monitoring current and voltage.

(6) The electrosurgical apparatus according to (1) or (2), wherein the sensor means detects a load impedance by monitoring a capacitance.

(7) The treatment means comprises a permeable sheath,
A high-frequency conductive member and a slider portion provided at the proximal end of the sheath for moving the conductive member forward and backward are provided with a tension adjusting portion at a connection portion connecting the slider portion and the conductive member. (1), (2) above
An electrosurgical device according to claim 1.

(8) The electrosurgical apparatus according to any one of (1) to (7), further including a selection unit for selecting automatic control of output by the control unit.

As described above, according to the present invention, the data corresponding to the impedance of the living tissue is detected by a simple circuit configuration employing at least one of a current sensor, a voltage sensor, and a capacitance sensor in the sensor circuit, The radio frequency energy applied to the living body is optimized in the low impedance region of the tissue, or the bioimpedance is forcibly shifted. As a result, stable incision and hemostasis performance can be ensured, and the size of the resected tissue, the type of the treatment tool, the output shortage or the excessive output due to the difference in the tissue are prevented, and the mechanical resection with the treatment tool is performed. Prevention of bleeding and stable incision and hemostasis by purely high-frequency current can be ensured.

Further, by providing a structure in which the cushioning member is provided on the treatment tool itself, the effect can be further enhanced.

[0056]

As described above in detail, when a high-frequency current is applied to a living body, a change in the impedance of a living tissue from the start of the excision to the end of the excision of the living body is measured by a simple operation, and an appropriate output is obtained. By energizing, it is possible to provide an electrosurgical apparatus having a simple configuration and a wide application range, which prevents mechanical incision and the like and realizes stable incision and hemostatic action by high-frequency current.

[Brief description of the drawings]

FIG. 1 is a configuration diagram of an electrosurgical apparatus according to a first embodiment.

FIG. 2 is an external configuration diagram of the electrosurgical apparatus according to the first embodiment.

FIG. 3 is a diagram illustrating an example of an output load characteristic of the electrosurgical apparatus according to the first embodiment.

FIG. 4 is a diagram for explaining output control of the electrosurgical apparatus according to the first embodiment.

FIG. 5 is a partial configuration diagram of an electrosurgical apparatus according to a second embodiment.

6A is an output-load characteristic diagram of a conventional electrosurgical device, and FIG. 6B is a principle diagram of a basic output circuit of the conventional electrosurgical device.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Commercial power supply input part 2 Power supply part 3 CPU 4 Waveform generation part 5 Power amplification part 6 Sensor circuit 7 A / D conversion circuit 8 Treatment tool 9 Patient electrode

Claims (2)

[Claims] 1. An electrosurgical apparatus that outputs a high-frequency current to a living body, a power supply unit that generates the high-frequency current, a treatment unit that supplies the high-frequency current to the living body, and a return current from the living body due to the current supply. Collection electrode means, sensor means for detecting the load impedance of the living body, and monitoring the load impedance detected by the sensor means, if the load impedance is lower than the internal impedance of the device, a preset output waveform Control means for outputting a waveform different from the above, forcibly shifting the load impedance of the living body, and controlling the load impedance to match the output load characteristics of the device. 2. An electrosurgical apparatus for outputting a high-frequency current to a living body, comprising: a power supply unit for generating the high-frequency current; a treatment unit for applying the high-frequency current to the living body; and collecting a return current from the living body due to the energization. Collection electrode means, sensor means for detecting the load impedance of the living body, and monitor the load impedance detected by the sensor means, if the load impedance is lower than the internal impedance of the device, a preset output Output an output value higher than the set value for a period determined for each setting,
A control means for forcibly shifting the load impedance of the living body and controlling the load impedance to match the output load characteristics of the device.