JP2000342599A - 電気外科手術用ジェネレータ、電気外科手術システム、そのシステムの動作方法、および電気外科手術で組織の切断および切除を行なう方法 - Google Patents

電気外科手術用ジェネレータ、電気外科手術システム、そのシステムの動作方法、および電気外科手術で組織の切断および切除を行なう方法

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JP2000342599A
JP2000342599A JP2000147954A JP2000147954A JP2000342599A JP 2000342599 A JP2000342599 A JP 2000342599A JP 2000147954 A JP2000147954 A JP 2000147954A JP 2000147954 A JP2000147954 A JP 2000147954A JP 2000342599 A JP2000342599 A JP 2000342599A
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electrode
peak
generator
electrosurgical
signal
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JP4262862B2 (ja
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Colin C O Goble
コリン・チャールズ・オーウェン・ゴーブル
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    • 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
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Abstract

(57)【要約】 【課題】 組織の除去速度を増すための手段を提供す
る。 【解決手段】 電気外科手術用ジェネレータは、電気外
科手術用器具の活動電極（３０）およびリターン電極
（３６）の各々に接続するための出力端子（６４，６
６）を有し、少なくとも１つの分離キャパシタ（６８）
を介してパルス回路によってパルス化され得る高周波源
（６０）が接続される。高速での組織除去を可能にする
ためには、この高周波源とパルス回路とは、少なくとも
１２５０Ｖのピーク間電圧、１：１以下のマーク対スペ
ース比、および１００μｓ以下のパルス長を有するパル
ス化高周波出力信号を発生するように構成される。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】本発明は、電気外科手術シス
テム、電気外科手術用ジェネレータ、そのシステムの動
作方法、および電気外科手術を行なう方法に関する。
【０００２】
【従来の技術】高周波電圧が供給される１つ以上の活動
電極を備える先端を有する器具を用いて電気外科的に組
織を切断または除去することは、通常、活動電極と処置
中の組織との間、または水中電気外科手術の場合は活動
電極と処置中の組織を覆っている食塩水などの導電性の
液体との間に生じるアークにより、細胞の裂傷を伴う。
ＥＰ−Ａ−０７５４４３７号に記載のように、電極を燃
焼または溶融させるのに十分な高周波電力が電極に供給
されると電極の破壊が起こり得るが、これは、電極のピ
ーク電圧を感知し、かつフィードバックを与えて印加電
力を減じることにより最大ピーク電圧を設定することに
よって回避できる。所与の電力設定に関して、電極の温
度は、熱が放散され得る速度に依存し、この速度は、組
織の係わり程度、電極構造、および電極まわりの流体フ
ローなどの変数に依存する、ということがわかるであろ
う。結果として、電極の破壊を回避するためには、最悪
の放散状態（すなわち冷却液がなく、かつ／または組織
が電極を取り囲んでいる場合）における損傷を防ぐよう
に、ピーク電圧の限界を十分低いレベルに設定しなけれ
ばならない。
【０００３】そのように制御されていない場合、電極の
温度は図１のように漸近曲線を描く。食塩水は、気化点
が時間「ｔ1」に達するまで電力を吸収する。食塩水が
気化すると、活動先端温度は、時間「ｔ2」において温
度１６００℃（白金の融点）で活動電極の破壊が起こる
まで、さらに急速に上昇する。この破壊温度は図１に温
度「ＴD」として示される。気化が起こった後この温度
に達するまでの所要時間は、熱容量と熱放散メカニズム
との両方に依存する。質量の低い電極はより速く加熱さ
れる。主たる放散メカニズムは赤外線放出であり、した
がってこれは表面領域に依存する。
【０００４】上述のように、すべての正常な動作状態の
もとで電極温度がＴDに達するのを防ぐように印加高周
波電力を制御するために、ピーク電圧の限界が用いられ
る。これにより、組織が除去され得る速度が制限される
ということがわかるであろう。
【０００５】
【発明が解決しようとする課題】本発明の目的は、組織
除去の速度を増すための手段を提供することである。
【０００６】
【課題を解決するための手段】本発明の第１の局面によ
れば、電気外科手術用ジェネレータは、高周波エネルギ
源と、活動出力端子と、リターン出力端子と、エネルギ
源と活動出力端子との間の直流分離キャパシタンスと、
エネルギ源のためのパルス回路とを含み、エネルギ源お
よびパルス回路は出力端子でパルス化された高周波出力
信号を生成するように構成され、この信号は、ピークピ
ーク電圧が少なくとも１２５０Ｖであり、パルスのマー
ク対スペース比が１：１以下であり、さらにパルス長が
１００μｓ以下である。パルス繰返し数は好ましくは５
Ｈｚから１５ｋＨｚの間であり、より好ましくは２ｋＨ
ｚ未満である。有利には、変調のマーク対スペース比
は、温度感知構成からの温度信号に応答して動的に可変
であり、この信号は、活動出力端子に結合されたときの
電極の温度を表わしている。
【０００７】好ましいジェネレータは、その間のジェネ
レータのピークピーク出力電圧が実質上ゼロである「オ
フ」期間と、少なくとも１２５０Ｖである「オン」期間
とを交互に有するパルス化信号を生じるため高周波エネ
ルギを変調するように構成され、「オン」期間の持続時
間は、予め定められたしきい値に達する温度信号に応答
して制御される。負荷インピーダンスが５０オームまで
降下すると、ピーク電流は少なくとも３Ａとなる。
【０００８】変調期間より短い応答時間を有する温度感
知構成を用いることにより、マーク対スペース比をパル
スごとのベースで制御することが可能である。この構成
は、熱電子効果によって生じた、処置電極に結合された
出力端子における直流オフセット電圧を監視することに
よって検出される、電極からの熱電子放出に応答するよ
うな構成である。
【０００９】本発明の第２の局面によれば、電気外科手
術用ジェネレータは、高周波エネルギ源と、エネルギ源
に結合された一対の出力端子と、エネルギ源のためのパ
ルス回路とを含み、このパルス回路およびエネルギ源
は、動作のパルスモードにおいて、５０オーム負荷への
少なくとも３Ａのピーク電流および１キロオーム負荷へ
の少なくとも１２５０Ｖのピークピーク電圧を、出力端
子に伝えるように構成される。
【００１０】本発明の第３の局面によれば、電気外科手
術システムは、高周波エネルギ源を有するジェネレータ
と、そのジェネレータに結合されて、水分を含む場で動
作するための少なくとも一対の電極を備える電極アセン
ブリを有するバイポーラ電気外科手術用器具とを含み、
ジェネレータは、高周波エネルギを、液体に浸漬された
電極対とともに使用する際に少なくとも３Ａのピーク電
流および少なくとも１２５０Ｖのピークピーク電圧を有
するパルス変調された高周波信号として、電極アセンブ
リに伝達するように適合される。
【００１１】本発明の第４の局面によれば、高周波エネ
ルギ源を含むジェネレータを含み、またそのジェネレー
タに結合されて、処置電極を有する電気外科手術用器具
を含む、電気外科手術システムが提供され、このシステ
ムは、電極温度感知構成を含み、ジェネレータは高周波
エネルギをパルス変調された高周波信号として電極に供
給するように適合され、変調のマーク対スペース比は電
極温度を表わす温度感知構成からの温度信号に応答して
動的に可変である。
【００１２】この明細書に開示されるジェネレータおよ
びシステムは、組織の除去速度が与えられたピーク電圧
に対して不均衡に増加するという特性を有する。したが
って、出力信号をパルス化し、かつ通常なら電極の破壊
状態をつくり出すようなレベルより高くピーク電圧を増
加させることにより、印加電力を相応に増加させなくと
も組織除去速度を増すことが可能である。組織除去速度
の変化の態様は、いくつかの例を考慮すると非常によく
わかる。たとえば、１２５０Ｖのピークピーク電圧を用
いる電極により、１０００Ｖで動作する電極の組織除去
速度は約２倍になる。したがって、１２５０Ｖのピーク
ピーク電圧を５０％のデューティサイクルで与えて電極
を駆動すると、除去速度は、１０００Ｖのピークピーク
電圧を連続して与えた場合に得られた速度とほぼ同等に
なる。しかしながら、依然としてより高い電圧を使用す
ることが可能である。通常、ピークピーク電圧１０００
Ｖに制限された電極も、ピークピーク電圧１５００Ｖま
で動作することができ、この場合も除去速度は２倍にな
る。このように、１５００Ｖのピークピーク電圧を５０
％のデューティサイクルで与えられた電極は、１０００
Ｖのピークピーク電圧で連続して動作する電極の除去速
度の約２倍の速度を達成するであろう。
【００１３】通常より高いピーク電圧は、連続動作モー
ドで使用すると、より高い温度を生じる。しかしなが
ら、液体の存在下では、パルス信号の「オフ」期間中に
液体が電極を急冷（quenching）および冷却することが
でき、これによって電極の温度は、印加電圧が高いにも
かかわらず、図１に示す電極破壊値ＴDより低く保たれ
ることになる。したがって、処置中、液体の急冷効果に
よる冷却を妨げるような態様で電極を用いると、熱の蓄
積によって電極はおそらく破壊されてしまうであろう。
そのような状態は、電極が組織内に埋め込まれたときに
起こり得る。このため、高いピークピーク電圧で動作す
るときに電極への高周波エネルギの付与を制限するため
に、電極温度感知を用いると効果的である。すると都合
よく、破壊が起こる温度（通常は電極材料の融点）に近
い電極温度に対応する予め定められたレベルに温度信号
が到達すると、パルス変調された高周波信号のマーク対
スペース比（デューティサイクル）が減少する。この温
度信号は、処置電極における熱電子放出により関連する
ジェネレータの端子で生成された直流オフセット電圧か
ら出され得る。
【００１４】このようにして、前より高速で組織の電気
外科的除去を行なうことが可能になる。これは、最悪の
放散状態以外では高温で動作可能であるということだけ
でなく、高い瞬時電圧に関連する高速の除去速度もその
原因となっている。
【００１５】本発明の範囲内で、印加電圧、伝えられる
平均電力、電極の構成、およびたとえば電極の近傍の流
体流量による電極からの熱の放散速度に依存して、非常
に低いパルスのマーク対スペース比で処置電極を駆動す
ることが可能になる。したがって、５％程度の低いデュ
ーティサイクルと、３ｋＶまたは４ｋＶの領域のピーク
ピーク電圧とで、効果的な組織除去速度が達成され得
る。実に、１０ｋＷまでの瞬時電力レベル、２０Ａのピ
ーク電流（すなわち両方とも「オン」バースト内）およ
び２ｋＨｚ以上のパルス繰返し速度で、迅速な組織除去
を達成することが可能である。パルス長、すなわち「オ
ン」バーストの持続時間は、５ミリ秒または実に１ミリ
秒ほどに短い場合もある。そのようなパルス長は、処置
電極の熱反応時間の定数より短くもなり得る。高い液体
ポンピング速度を用いる場合、高い瞬時電力と短いパル
スとによって特定の利点が達成できる。これは、電圧が
高ければ、気化および組織除去が非常に速く起こる傾向
にあることにより、電極から離れた加熱液体のフローに
よる入射エネルギの損失が少なくなるからである。
【００１６】典型的には、ジェネレータの制御回路およ
び検出器は、直流オフセットを５０Ｖから１００Ｖの領
域にある予め定められた直流電圧レベルに制限するよう
に動作可能である。実際には、実際の電圧レベルは電極
の構成および電極の材料に依存する。よって、白金の電
極を用いる場合、電圧の限界は、電極の電圧が１６００
℃（白金の融点）に近くなると生じる限界と同じものに
設定される。
【００１７】本発明の好ましい実施例では、ジェネレー
タは処置電極に接続可能であって直流の高周波源からは
分離している出力端子を有し、検出器は、（ｉ）出力端
子に接続された検出入力と（ｉｉ）検出器を制御回路に
接続するアイソレーション装置とを含む。この検出器
は、ジェネレータの出力端子に結合された電力供給回路
を有し、かつ出力端子に与えられた高周波電気外科手術
信号を整流するための整流器を含むことにより、ジェネ
レータから高周波出力エネルギを与えられ得る。これ
は、高周波出力電圧がアーク放電と一致するレベルに到
達するまで熱電子効果は起こらないということから許容
可能である。結果として、検出器がより低い電圧では機
能しないという事実は欠点にならない。典型的には、検
出器の出力でアイソレーションを達成するためには、そ
れは交互に代わる測定信号（直流オフセットを表わす）
を発生するための発振器を含み、アイソレーション装置
は、交互に代わる測定信号を受けるように、またそれを
制御回路に送るように結合されたオプトアイソレータを
含む。好ましい検出器はまた、逆の極性の直流オフセッ
ト検出器を故障状態インジケータとして含み、これは、
たとえば導電性の流体フィールドでバイポーラ電極アセ
ンブリを使用する際に、流体の欠如により極性の反転が
生じる場合、高周波エネルギ源を使用不可能にするため
に用いられる。
【００１８】本発明のさらなる局面によれば、電気外科
手術用高周波ジェネレータとジェネレータに結合された
処置電極を有する電極アセンブリとを含む電気外科手術
システムの動作方法が提供され、この方法は、ジェネレ
ータによって生成されたパルス変調高周波信号を電極に
与えるステップと、電極の温度を示す温度信号を発生す
るステップと、電極の温度を制御するために高周波信号
のパルス変調の少なくともマーク対スペース比を動的に
変化させるステップとを含む。
【００１９】本発明のまたさらなる局面によれば、電気
外科的に組織の切断または切除を行なう方法は、電気外
科手術用器具に高周波エネルギを与えることによりその
器具の処置電極におけるアーク放電を促進するステップ
を含み、このエネルギは、ピークピーク電圧が少なくと
も１２５０Ｖでありパルスのマーク対スペース比が１：
１以下である、パルス化高周波信号として与えられる。
マーク対スペース比を動的に調節することにより高周波
エネルギを調節して、電極に実質的な損傷を与えること
なく電極の温度を最大にすることもでき、直流電圧は１
００Ｖより低いしきい値に制限される。
【００２０】ここで、例示のために図面を参照して本発
明を説明する。
【００２１】
【発明の実施の形態】本発明は、限定的にではなく主と
して、水分を含む場での電気外科手術に適用可能であ
る。図２を参照して、このシステムは、接続コード１４
を介するハンドピース１２の形態の電気外科手術用器具
に高周波出力を与える出力ソケット１０Ｓを有する、ジ
ェネレータ１０を含む。ジェネレータは、ハンドピース
１２からコード１４の制御接続を介して、または図示す
るようにフットスイッチ接続コード１８によってジェネ
レータ１０の後部に分離可能に接続されたフットスイッ
チユニット１６を用いて、作動され得る。図示した実施
例では、フットスイッチユニット１６は、脱水モードお
よび気化モードなどの種々のジェネレータモードを選択
するための２つのフットスイッチ１６Ａおよび１６Ｂを
有する。ジェネレータのフロントパネルには電力レベル
を設定するためのプッシュボタン２０および２２があ
り、電力レベルはディスプレイ２４に示される。モード
選択の代替手段としてプッシュボタン２６が設けられ
る。
【００２２】ハンドピース１２は、図３の部分図に示す
ように、二重電極構造を有する着脱可能な電極アセンブ
リ２８を装着する。
【００２３】図３は、電極アセンブリ２８の末端の拡大
図である。このアセンブリは末端に活動電極３０を有
し、これはこの実施例では、中心の導体３２に接続され
るコイル状に巻かれたワイヤとして形成される。このコ
イル状ワイヤは白金から作製され得る。活動電極３０の
近傍にリターン電極３６が位置付けられ、それは長手お
よび軸方向に延びるセラミックの絶縁体３４によって活
動電極から分離されている。リターン電極３６は、管状
のシャフト４０としてアセンブリ２８（図１参照）の近
接端（ハンドピース１２内でアセンブリが接続コード１
４内の導体に接続されるところ）に延びるスリーブとし
て、内部導体３２のまわりに同軸上に配置される。同様
に、内部導体３２はハンドピース１２に延び、コード１
４内の別の導体に接続される。内部導体３２とリターン
電極３６との間には、リターン電極の内部に延びてリタ
ーン電極３６から活動電極３０の内部伸張部（図示せ
ず）を絶縁するスリーブとして構築された絶縁体３４に
よって絶縁がもたらされる。リターン電極よりも活動電
極においてより大きな電力密度を促進するために、リタ
ーン電極の表面領域は活動電極のものよりかなり大きく
される。電極アセンブリの末端における典型的な寸法に
関しては、リターン電極の直径は典型的には１ｍｍから
３ｍｍの領域であり、リターン電極の露出部分の長手方
向の伸張は典型的には１ｍｍから５ｍｍの間であり、活
動電極からの長手方向の間隔は１ｍｍから５ｍｍの間で
ある。電極アセンブリ２８は、シャフト４０を覆いセラ
ミックの絶縁体３４の近傍で終結する絶縁シース４２を
有し、シャフト４０の末端をリターン電極３６として露
出したままにする。
【００２４】動作にあたっては、導電性の流体フィール
ドで組織の切断または除去を行なうための器具として、
図３に示すように、処置すべき組織４４に電極アセンブ
リ２８が与えられ、手術部位は、活動電極３０とリター
ン電極３６との両方を浸漬する通常の食塩水（０．９％
ｗ／ｖ）の溶液４６に浸漬される。
【００２５】電極アセンブリは、一方の電極（活動電極
３０）のみがユニットの末端に軸方向に延びる、バイポ
ーラであるのが効果的である。つまり、リターン電極
は、水分を含む場における通常の状況では処置中の組織
から間隔を保って位置付けられ、組織とリターン電極と
の間にはリターン電極と接触する導電性の液体を介して
電流経路が存在する。導電性の液体４６は、バイポーラ
電気外科用エネルギの伝達に関するかぎり、組織の低イ
ンピーダンス伸張としてみなされ得る。
【００２６】電極３０と電極３６との間に十分な高周波
電圧が与えられると、導電性の液体４６中での電力の放
散により液体は気化し、最初に活動電極３０の表面上に
小さな気泡を形成し、これが最終的には、電極が蒸気ポ
ケット５０に完全に包囲されるまで凝集する。蒸気ポケ
ット５０は、活動電極３０と蒸気−食塩水界面との間の
蒸気ポケットにわたる放電５２によって支持される。電
力放散の大部分が、ここでは活動電極の結果的に生じた
熱とともにこのポケット内で起こり、放散されるエネル
ギの量は伝えられる電力の関数である。図３に示すよう
に、活動電極３０を組織４４の表面近傍に保持して蒸気
ポケットが組織表面を遮るようにすることにより、電極
と組織との間に生じるアーク放電による細胞の裂傷によ
って組織が除去される。
【００２７】この動作モードは比較的広範囲の電力レベ
ルにわたって維持され得るが、伝えられる電力をこの範
囲を超えて増加させると、図１を参照して上述したよう
に電極の温度が急速に上昇し、電極に損傷を与える可能
性がある。これが起こる点は、熱が電極から取り除かれ
る速度に依存し、この速度は、電極３０、電極３０が組
織に近接しているところ、および最悪の場合は電極３０
が組織に埋まったところを通過する流体のフロー４６に
よる対流の影響を受けるということがわかるであろう。
したがって、ピーク電圧が電極における無制御の温度上
昇を防ぐように確立され得る一方、このような限界は、
効を奏するためには、最悪の場合の熱放散状態における
そのような上昇を防ぐとされるレベルに設定されなけれ
ばならない。
【００２８】図１から３を参照したこのシステムの上記
の説明において、参照された電極の熱特性は、高周波電
力を実質上連続して与えることによって得られたもので
ある。本出願人は、パルスが予め定められたゼロでない
レベルと実質的にゼロとに交互に代わるパルス化信号と
して高周波電圧が電極間に与えられるようにパルス変調
をもたらすことによって、電極を電極破壊温度ＴD（図
１参照）に到達させることなく高レベルの組織切除が達
成され得る、ということを発見した。電極温度を制限す
るためにピーク電圧を用いる場合に得られるものより高
いピーク電圧で電極の高電力パルス化が行なわれる。こ
れは、組織の除去速度が電圧とは不均衡であるという事
実を利用するものである。たとえば、ジェネレータを１
２５０Ｖのピークピーク電圧で動作すると、組織除去速
度は、１０００Ｖでの動作と比較して約２倍になる。ジ
ェネレータが１２５０Ｖのピークピーク電圧で５０％の
デューティサイクルで動作されると、除去速度は、１０
００Ｖのピークピーク電圧を連続して与えたときに得ら
れるものとほぼ同等になる。しかしながら、依然として
より高い電圧を用いることが可能である。通常ならばピ
ークピーク電圧１０００Ｖに制限される電極アセンブリ
を有するシステムは、１５００Ｖのピークピーク電圧ま
で動作することができ、この場合も除去速度は２倍にな
り得る。したがって、５０％のデューティサイクルで１
５００Ｖのピークピーク電圧を与えられる電極は、１０
００Ｖのピークピーク電圧の高周波電力を連続的に与え
られて動作する電極と比べて、除去速度がほぼ２倍にな
るであろう。
【００２９】図４を参照して、パルス化高周波電力がジ
ェネレータ１０から電極アセンブリ２８へパルス化信号
として与えられ得るシステムでは、出力ステージ６０が
パルス変調器６１に結合されるので、パルス化された電
気外科手術信号（典型的には１００ｋＨｚから５ＭＨｚ
の範囲の搬送波周波数を有する）が直列分離キャパシタ
６２を介してジェネレータ１０の活動出力端子６４に送
られる。ジェネレータのリターン端子６６もまた、同様
に分離キャパシタ６８を介して高周波ステージに結合さ
れる。
【００３０】パルス変調器６１はプロセッサ７０によっ
て作動され、このプロセッサは、ジェネレータのフロン
トパネルまたはフットスイッチ（図１参照）からモード
信号を受ける。したがって、ジェネレータは、高周波電
力ステージ６０がマーク対スペース比１：１以下（すな
わち５０％以下のデューティサイクルを表わす継続的な
「オン」時間）でパルス変調器６１によって変調され
る、気化モードを有し得る。変調の周波数は典型的には
３００Ｈｚである。プロセッサ７０はまた、モードに従
って高周波出力ステージ６０のピーク電圧も制御する。
さらにこのプロセッサは、以下に詳細に述べるように、
電極温度に応答してパルス変調器６１の制御を可能にす
る、温度信号入力７４を有する。
【００３１】高周波電力がパルス変調深さ１００％の比
較的高いピークピーク電圧で与えられる場合の、経時的
な電極温度の変化を図５に示す。マーク対スペース比は
１：１である。言い換えれば、５０％の時間に関しての
み電力が与えられる。このことは２つの利点の可能性を
生み出す。連続して１０００Ｖピークピーク電圧を与え
る動作と比べると、パルス化された電力を１０００Ｖピ
ークピーク電圧で与えることにより、平均して伝えられ
る電力が２５％程度減少するという結果となる。伝えら
れるピーク電力がより高いので（パルス変調が論理レベ
ル１のときの高周波バースト中）、電極は、その電極を
通過する食塩水の流量が高いことによって起こる急冷効
果による影響を受け難くなる。このことは、活動電極の
表面の食塩水を考慮することにより説明される。この食
塩水を気化させる能力は、電極表面を離れる前にそれが
吸収する電力によって規定される。流体フローによる対
流が高い場合、食塩水のリフレッシュ速度も高くなり、
したがって、電極表面における食塩水の単位量当りの吸
収電力は小さくなる。上述のように、変調を用いること
によって波形の波高率が増加する（平均電力レベルは同
様である）と、各電力バースト中の食塩水の単位量当り
の吸収電力はより高くなる。
【００３２】上記の利点は、変調の「オフ」期間中に、
電極が急冷および冷却されることにより達成される。こ
れは、電極温度が定常状態破壊値ＴDに達することは決
してないからである。急冷による冷却が遮られるような
態様で電極が用いられると、この電極は熱の累積によっ
て破壊されるという危険性を有する。この状況は、電極
が組織中に埋込まれる場合に起こり得る。したがって、
本発明に従うと、電気外科手術用電力のパルス化は、温
度信号入力７４が図４のプロセッサ７０に供するような
温度の監視とともに行なわれる。入力７４に与えられた
温度信号は電極温度感知構成によって生成され、この構
成は、たとえば活動電極が非常に熱くなると起こる熱電
子効果による端子７４および６６にわたる直流オフセッ
ト電圧を測定するための回路など、さまざまな形態をと
ることができる。
【００３３】プロセッサ７０は、入力５４に与えられる
電極温度信号のレベルに従ってパルス変調器６１によっ
て発生するパルス変調のマーク対スペース比を変調する
ような態様で作動する。具体的には、この実施例では、
入力７４に与えられる電極温度信号の特徴は、最大許容
温度の関数であるしきい値と比較されるので、パルス変
調器は温度信号が予め定められたしきい値に到達するま
で「オン」信号を高周波出力ステージ６０に与え、その
しきい値で、高周波出力ステージは予め定められた期間
にわたってオフに切換えられる。
【００３４】この動作態様は図６のＡおよびＢに表わさ
れる。電極温度が監視され得るので、「オン」バースト
はこのような監視をせずに可能であるとされるよりも長
く維持され、よって電極は電極の燃焼という危惧をもた
ずに高温に達する。各「オン」バーストの長さは「オ
フ」期間中に電極が冷却される速度に従って、たとえば
制御温度ＴCが破壊温度ＴDより低い予め定められたしき
い値温度になるまでバーストを続けさせることにより、
制御される。図６Ｂに示す期間「Ａ」の間は、電極にお
ける状態は電極からの熱放散の速度を減じ、一方、期間
「Ｂ」の放散は増加することがわかるであろう。結果と
して、期間Ａの間、「オン」バーストはより短くなるの
に対して、期間Ｂの間それらはより長くなる。上述した
ように、このパルス化動作と温度フィードバックとの組
合せにより、電極温度が破壊レベルに達することなくよ
り高いピーク電圧を用いることが可能になり、その結果
組織除去速度が改善される。実際、変調は電極温度に従
って適合可能である。
【００３５】変調速度は、主に活動電極のまわりの蒸気
ポケットが崩壊することにより電極が冷却され得るのに
要する時間に依存している。結果として生じる食塩水が
対流またはフローのいずれによっても失われないように
するためには、急冷が起こるとすぐに電力を再び与える
ことが理想的である。バースト長は好ましくは、再び構
築された蒸気ポケットが「オン」バーストの少なくとも
最初の半分の間に起こるのに十分なほど長い。５Ｈｚか
ら２ｋＨｚの変調速度が適切である。
【００３６】上述したように、温度感知は熱電子効果を
監視することによって間接的に行なわれ、このことは図
７のＡおよびＢを参照して次に説明する。
【００３７】図７Ａを参照して、本発明に従った好まし
いシステムは、電極アセンブリ２８の活動電極およびリ
ターン電極がそれぞれ結合されるところである第１の出
力端子６４と第２の出力端子６６との間に結合キャパシ
タ６２および６３を介して電気外科手術用電圧を伝達す
る、電源６０の形態の高周波出力ステージを含む。図３
に示すように活動電極３０で放電が起こると、電極から
の熱電子放出が、電極の温度に依存して、電極が組織４
４から間隔をあけられている場合に起こり、これが活動
出力端子６４における正電位の構築につながる。実際、
加熱された活動電極３０、組織、導電性の流体４６、お
よびリターン電極３６の組合せは合わせて整流器として
動作し、導電性の溶液はアノードとして、活動電極は整
流器のカソードとしてそれぞれ作用する。活動電極がよ
り熱くなると、整流はより大きくなり、ジェネレータの
出力端子６４における直流オフセット電圧もより大きく
なる。
【００３８】温度依存性の正の電位（直流オフセット電
圧）は、分離キャパシタンスの出力端子側におけるジェ
ネレータの出力にわたって、分路入力として接続された
検出器を用いて監視される。検出器は、出力端子６４に
結合された直列高周波チョーク７８を備える入力回路
と、リターン端子６６に接続された共通レール８１に結
合された平滑キャパシタ８０とを有する。したがって、
活動出力端子６４における電圧の直流成分は、チョーク
７８と平滑キャパシタ８０との接合に累積し、その成分
はそこで少なくとも２ＭΩ、典型的には５０ＭΩから１
００ＭΩの間の入力抵抗を提示する電位分割器８２およ
び８４に与えられる。電位分割器８２および８４の出力
は、高インピーダンスバッファ８６に与えられ、このバ
ッファからの出力は電圧制御発振器（ＶＣＯ）８８に駆
動信号を与える。５０ＭΩから１００ＭΩの領域におけ
る入力インピーダンスを与えると、５０Ｖから１００Ｖ
の領域における直流オフセットに対して１μＡの領域の
検出電流を生じる。検出電流を低く維持することは、標
的の組織とリターン電極との間での直接の電流による神
経の刺激が回避されるという利点を有する。
【００３９】直流オフセット電圧をＶＣＯ８８において
交互に変わる信号に変換することにより、オプトアイソ
レータ９２を介して検出器の出力９０に接続された分離
制御回路（図７Ａには図示せず）に信号を伝達して、た
とえばオフセット電圧を制限できるようにジェネレータ
出力端子に与えられた高周波エネルギを制御することが
可能になる。直流オフセットの表示は、ジェネレータの
出力端子と電力生成および制御回路との間の安全分離障
壁にわたってこの態様で通信される。この制御回路で
は、交互に変わる信号を、単安定およびローパスフィル
タを用いて変換して直流レベルまで戻すこともでき、ま
たはゲート式カウンタでカウントしてデジタル形式で搬
送してもよい。いずれの場合も、制御回路は、直流オフ
セット電圧が予め定められた値（典型的には５０Ｖから
１００Ｖの範囲内）に到達すると、上述のようにパルス
変調のマーク対スペース比を変えることによって電源６
０の平均出力を減じるように構成される。したがって、
活動電極の最大安全動作温度に対するしきい値直流オフ
セット電圧を選択することによって、活動電極に伝えら
れる高周波電力は種々の熱放散状態で最大化され得る。
ジェネレータのプロセッサ７０（図４参照）は、オプト
アイソレータ８２の直接出力として（この場合パルス幅
制御のしきい値は周波数の値である）、または周波数−
電圧変換器（図示せず）を介して（この場合しきい値は
プリセット電圧の値である）、温度信号を受けることが
できる。
【００４０】図３に示すバイポーラ電極アセンブリが不
正確に用いられると、たとえばアセンブリのまわりに十
分な食塩水がない場合などは、リターン電極３６でアー
ク放電が起こってしまう可能性もある。このような状況
においては、直流オフセットの極性は反転するので、活
動端子６４はリターン電極に対して負になる。図７Ａに
示される検出器は、ＶＣＯ８８をバイパスし、かつたと
えばＯＲゲート９６の一方の入力に結合された出力（こ
の他方の入力はＶＣＯ８８からの交互に変わる出力を受
ける）を有する、比較器９４の形態の逆極性検出回路を
含む。比較器９４の他方の入力は負電圧基準に結合され
る。通常、比較器９４の出力は低く、すなわちＶＣＯに
よって発達した交互に変わる信号はＯＲゲート９６を通
過してオプトアイソレータ９２へ伝えられる。しかしな
がら、ジェネレータの出力端子６４における直流オフセ
ット電圧が比較器９４に与えられた負の基準電圧に依存
してある量以上が負に変わると、比較器９４の出力はハ
イになり、ＯＲゲート９６はＶＣＯ８８からの交互に変
わる信号を遮断し、検出器の出力９０から制御回路に与
えられた交互に変わる信号の欠如が、高周波電源６０を
切るための故障表示として用いられ得る。
【００４１】この実施例では、バッファ８６、ＶＣＯ８
８、比較器９４、およびＯＲゲート９６のための電力は
ジェネレータの出力端子６４および６６に伝えられる高
周波電圧自体から引出されるので、さらなる分離障壁の
必要性が回避される。この目的のために適切な電源を図
７Ｂに示す。ジェネレータの出力端子６４と６６との間
に結合された降圧変圧器１００は、ブリッジ整流器１０
２を駆動し、平滑キャパシタ１０６にわたって電源出力
端子に直流電圧を伝達する。変圧器１００の二次巻線の
中間タップをリターン出力端子６６に接続し、よって検
出器の共通レールに接続することにより、バッファ８６
は正および負の直流オフセット電圧に適合できるように
両極性の電源を設けることが可能になる。このように高
周波出力から電力を引出すことにより検出器が低電圧で
動作不可能になるという事実は、全く不利にならない。
なぜなら、熱電子効果は、ジェネレータの高周波出力電
圧が活動電極のアーク放電と一致するレベルに達するま
で制御刺激は起こらないということに依存するからであ
る。
【００４２】本発明の使用は水分を含む場（水中）の電
気外科手術に限定されるものではない。アーク放電は乾
燥した場の手術におけるモノポーラまたはバイポーラの
電気外科用器具でも起こり、電力は、上記と同じ態様で
熱電子効果を用いて制御され得る。
【図面の簡単な説明】
【図１】 不規則な態様で高周波電力が与えられる電気
外科手術用電極（導電性の液体に浸漬されている）の熱
応答を表わすグラフ図である。
【図２】 本発明に従った電気外科手術システムを表わ
す図である。
【図３】 導電性の液体に浸漬されて用いるところが示
される、組織切除のための電極アセンブリの部分図であ
る。
【図４】 図２に示すシステムの電気的なブロック図で
ある。
【図５】 図１と同じ尺度を用いるがパルス化された高
周波電力が与えられている、電極温度の変化を示すグラ
フ図である。
【図６】 Ａはジェネレータが出力する波形であり、Ｂ
は電極温度に従ってマーク対スペース比を変化させる効
果を示す電極温度のグラフ図である。
【図７】 ＡおよびＢは、直流オフセット検出器の回路
図である。
【符号の説明】
１０ ジェネレータ、２８ 電極アセンブリ、６０ 高
周波出力ステージ、６１ パルス変調器、６２ 結合キ
ャパシタ、６４ 活動出力端子、６６ リターン出力端
子、６８ 分離キャパシタ、７０ プロセッサ、７４
温度信号入力。
───────────────────────────────────────────────────── フロントページの続き (72)発明者 コリン・チャールズ・オーウェン・ゴーブ ル イギリス、シィ・エフ・64 １・エイ・テ ィ ウェールズ、サウス・グラモーガン、 ピナース、クリブ・クレセント、オズボー ン・ハウス、５

Claims (30)

    【特許請求の範囲】
  1. 【請求項１】 高周波エネルギ源と、 活動出力端子と、 リターン出力端子と、 エネルギ源と活動出力端子との間の直流分離キャパシタ
    ンスと、 エネルギ源のためのパルス回路とを含み、 前記エネルギ源および前記パルス回路は出力端子でパル
    ス化高周波出力信号を発生するように構成され、この信
    号は少なくとも１２５０Ｖのピークピーク電圧と、１：
    １以下のパルスのマーク対スペース比と、１００μｓ以
    下のパルス長とを有する、 電気外科手術用ジェネレータ。
  2. 【請求項２】 パルス繰返し数が５Ｈｚから１５ｋＨｚ
    の間である、請求項１に記載の電気外科手術用ジェネレ
    ータ。
  3. 【請求項３】 活動出力端子とリターン出力端子との間
    に接続された直流電圧検出器を含み、前記パルス回路
    は、検出器によって検出された直流電圧に応答して出力
    端子から伝えられた高周波エネルギを制御するように構
    成された制御回路の一部を形成する、請求項１または請
    求項２に記載の電気外科手術用ジェネレータ。
  4. 【請求項４】 前記制御回路および前記検出器は、伝え
    られた高周波エネルギを制御して直流電圧を制限するよ
    うに動作可能である、請求項３に記載の電気外科手術用
    ジェネレータ。
  5. 【請求項５】 高周波エネルギ源と、 前記エネルギ源に結合された１対の出力端子と、 前記エネルギ源のためのパルス回路とを含み、 前記パルス回路および前記エネルギ源は、パルス動作モ
    ードで、出力端子に５０オーム負荷への少なくとも３Ａ
    のピーク電流および１キロオーム負荷への少なくとも１
    ２５０Ｖのピークピーク電圧を伝えるように構成され
    る、 電気外科手術用ジェネレータ。
  6. 【請求項６】 パルス化モードにおけるパルス繰返し数
    が１２ｋＨｚ未満であり、前記ジェネレータはパルス化
    モードにおいて少なくとも２００Ｗのピーク電力を伝え
    ることが可能である、請求項５に記載の電気外科手術用
    ジェネレータ。
  7. 【請求項７】 高周波エネルギ源を有するジェネレータ
    と、 前記ジェネレータに結合されて、水分を含む場で動作す
    るための少なくとも１対の電極を備える電極アセンブリ
    を有するバイポーラ電気外科手術用器具とを含み、 前記ジェネレータは高周波エネルギを電極アセンブリに
    パルス化変調高周波信号として伝えるように適合され、
    この信号は液体に浸漬された電極の対とともに用いる
    と、少なくとも３Ａのピーク電流および少なくとも１２
    ５０Ｖのピークピーク電圧を有する、 電気外科手術システム。
  8. 【請求項８】 ピーク電力対平均電力の比が４：１より
    大きい、請求項７に記載の電気外科手術システム。
  9. 【請求項９】 ピーク電力と平均電力の比が２０：１よ
    り大きい、請求項８に記載の電気外科手術システム。
  10. 【請求項１０】 ジェネレータがパルス動作モードにお
    いて２００Ｗのピーク電力を伝えることが可能であり、
    ピーク電力の平均電力に対する比が少なくとも４：１で
    ある、請求項７から請求項９のいずれかに記載の電気外
    科手術システム。
  11. 【請求項１１】 高周波エネルギ源を含むジェネレータ
    と、前記ジェネレータに結合されて、処置電極を有する
    電気外科手術用器具とを含む電気外科手術システムであ
    って、 前記システムは電極温度感知構成を含み、前記ジェネレ
    ータは高周波エネルギをパルス化変調高周波信号として
    電極に供給するように適合され、変調のマーク対スペー
    ス比は電極温度に応答する温度感知構成からの温度信号
    に応答して動的に変化する、 電気外科手術システム。
  12. 【請求項１２】 高周波エネルギは、５Ｈｚから２ｋＨ
    ｚの間のパルス繰返し数および少なくとも１２５０Ｖの
    ピークピーク電圧値を有するパルス化信号として電極に
    伝えられる、請求項１１に記載の電気外科手術システ
    ム。
  13. 【請求項１３】 前記ジェネレータは、交互に変わる
    「オフ」期間（この間ジェネレータのピークピーク出力
    電圧はそれぞれ実質上ゼロ）および「オン」期間（この
    間ジェネレータのピークピーク出力電圧は少なくとも１
    ２５０Ｖ）を有するパルス化信号を生成するように高周
    波エネルギを変調するように構成されたパルス変調器を
    含み、「オン」期間の持続時間は、予め定められたしき
    い値に到達する温度信号に応答して制御される、請求項
    １２に記載の電気外科手術システム。
  14. 【請求項１４】 前記温度感知構成が変調期間より短い
    応答時間を有する、請求項１１から請求項１３のいずれ
    かに記載の電気外科手術システム。
  15. 【請求項１５】 前記温度感知構成が電極からの熱電子
    放出に応答する、請求項１１から請求項１４のいずれか
    に記載の電気外科手術システム。
  16. 【請求項１６】 前記温度感知構成が処置電極における
    直流オフセットを検出するように構成される直流電圧検
    出器を含む、請求項１５に記載の電気外科手術システ
    ム。
  17. 【請求項１７】 前記温度感知構成および前記パルス変
    調器が、ジェネレータ出力信号の変調を制御することに
    より直流オフセットを予め定められた直流電圧レベルに
    制限するように適合される、請求項１６に記載の電気外
    科手術システム。
  18. 【請求項１８】 予め定められた直流電圧レベルが５０
    Ｖから１００Ｖの範囲内にある、請求項１７に記載の電
    気外科手術システム。
  19. 【請求項１９】 マーク対スペース比が、ジェネレータ
    が作動されている少なくとも大部分の時間中、１：１以
    下である、請求項１１から請求項１８のいずれかに記載
    の電気外科手術システム。
  20. 【請求項２０】 ピークピーク出力電圧が１５００Ｖ以
    上である、請求項１９に記載の電気外科手術システム。
  21. 【請求項２１】 電気外科手術用高周波ジェネレータを
    含む電気外科手術システムおよび前記ジェネレータに結
    合された処置電極を有する電極アセンブリを動作するた
    めの方法であって、 前記方法は、 ジェネレータによって生成されるパルス変調高周波信号
    を電極に与えるステップと、 電極の温度を示す温度信号を発生するステップと、 電極の温度を制御するために高周波信号のパルス変調の
    少なくともマーク対スペース比を動的に変化させるステ
    ップとを含む、方法。
  22. 【請求項２２】 高周波信号のパルス繰返し数が５Ｈｚ
    から２ｋＨｚの間であり、ピークピーク電圧が少なくと
    も１２５０Ｖである、請求項２１に記載の方法。
  23. 【請求項２３】 パルス化信号が交互に変わる「オン」
    期間（この間ジェネレータのピークピーク出力電圧は少
    なくとも１２５０Ｖ）および「オフ」期間（この間ジェ
    ネレータのピークピーク出力電圧はそれぞれ実質上ゼ
    ロ）を有し、「オン」期間の持続時間は予め定められた
    しきい値に達する温度信号に応答して制御される、請求
    項２２に記載の方法。
  24. 【請求項２４】 前記温度信号は、１パルスサイクル内
    で起こる電極温度の変化に応答する、請求項２１から請
    求項２３のいずれかに記載の方法。
  25. 【請求項２５】 電極からの熱電子放出による処置電極
    における直流オフセット電圧を検出するステップと、温
    度信号をオフセット電圧の関数として発生するステップ
    とを含む、請求項２１から請求項２４のいずれかに記載
    の方法。
  26. 【請求項２６】 パルス変調のマーク対スペース比が、
    高周波信号が電極に与えられる時間の少なくとも大部分
    の間、１：１以下である、請求項２１から請求項２５の
    いずれかに記載の方法。
  27. 【請求項２７】 電気外科手術用器具に高周波エネルギ
    を与えて前記器具の処置電極におけるアーク放電を促進
    する、電気外科手術での組織切断または切除を行なうた
    めの方法であって、前記エネルギは少なくとも１２５０
    Ｖのピークピーク電圧と、１：１以下のパルスのマーク
    対スペース比と、１００μｓ以下のパルス長とを有する
    パルス化高周波信号として与えられる、方法。
  28. 【請求項２８】 前記マーク対スペース比が、実質的な
    電極燃焼を起こさずに電極の温度を最大にするように動
    的に調節される、請求項２７に記載の方法。
  29. 【請求項２９】 電気外科手術用器具が、活動電極およ
    びリターン電極を含む少なくとも２つの電極を備える電
    極アセンブリを有し、組織の切断および切除は、手術の
    部位に供給される導電性の液体の存在下で行なわれるの
    で電気外科手術電流が前記液体を介して活動電極からリ
    ターン電極へ伝達され、パルス化高周波信号を与えるこ
    とにより、蒸気の層が活動電極で形成および崩壊を繰返
    し、前記層はパルス化信号が「オン」であるときに形成
    され、前記信号が「オフ」であるときに崩壊する、請求
    項２７に記載の方法。
  30. 【請求項３０】 前記ピーク電流が少なくとも３Ａであ
    る、請求項２７に記載の方法。
JP2000147954A 1999-05-21 2000-05-19 電気外科手術システム Expired - Lifetime JP4262862B2 (ja)

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