JP2001204734A - 超音波外科手術装置の能動的負荷制御 - Google Patents

超音波外科手術装置の能動的負荷制御

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JP2001204734A
JP2001204734A JP2000379198A JP2000379198A JP2001204734A JP 2001204734 A JP2001204734 A JP 2001204734A JP 2000379198 A JP2000379198 A JP 2000379198A JP 2000379198 A JP2000379198 A JP 2000379198A JP 2001204734 A JP2001204734 A JP 2001204734A
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ultrasonic
generator
surgical
end effector
force
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JP4489281B2 (ja
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Kenneth S Kramer
ケネス・エス・クレーマー
Kevin L Houser
ケビン・エル・ハウザー
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Ethicon Endo Surgery Inc
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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
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • 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
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
    • 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
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320094—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing clamping operation
    • 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
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
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Abstract

(57)【要約】 【課題】 超音波外科手術装置の能動的負荷制御方法お
よび装置を提供する。 【解決手段】 本発明は力フィードバック・システム
（８４）を備える外科手術装置（１１）を提供するもの
であり、この力フィードバック・システムは外科手術装
置から組織に加えられる力を調整できる閉ループ構成で
ある。すなわち、発生装置（１５）が外科手術装置に対
して電気的エネルギーを供給すると共に、当該発生装置
の負荷を指示する電気的信号を供給する。この外科手術
装置は駆動レバー（２４）を備えているハンドル（１
４）、および当該ハンドルの先端部に配置されているエ
ンド・イフェクタ（１８）により構成されている。さら
に、力応答素子（８６）が駆動レバーおよびエンド・イ
フェクタに動作可能に連結していて、当該力応答素子
（８６）が上記発生装置（１５）からの電気的信号に応
じてエンド・イフェクタ（１８）に加えられる力を変更
するように構成されている。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】本発明は一般に超音波外科手
術装置に関し、特に、超音波外科手術クランプ装置の能
動的負荷フィードバック制御に関する。
【０００２】
【従来の技術】中空コアおよび中実コア装置を含む超音
波装置が多くの医療状態の安全で有効な治療において使
用されている。超音波装置、特に中実コア超音波装置
は、それらが超音波周波数で外科手術エンド・イフェク
タに伝達される機械的振動の形態のエネルギーにより器
官組織を切断および／または凝結するために使用できる
点で有利である。超音波振動は、適当なエネルギー・レ
ベルで適当なエンド・イフェクタにより器官組織に伝達
される場合に、組織を切断、切開、または切除するため
に使用できる。中実技法を利用する超音波装置は、超音
波トランスデューサから導波管を介して外科手術エンド
・イフェクタに伝達できる超音波エネルギーの量の点で
特に有利である。すなわち、このような装置はエンド・
イフェクタが外科手術部位にトロカールを通して到達す
る内視鏡手術または腹腔鏡手術のような最少の侵襲性の
処置において使用するのに適している。
【０００３】超音波振動は、例えば、装置のハンドピー
スの中における１個以上の圧電素子または磁気歪素子に
より構成できるトランスデューサを電気的に励起するこ
とにより外科手術エンド・イフェクタの中に誘発され
る。さらに、トランスデューサ部分により発生される振
動はトランスデューサ部分から超音波導波管を介して外
科手術エンド・イフェクタに伝達される。
【０００４】米国特許第５，３２２，０５５号は電気信
号を長手方向の振動動作に変換するためのトランスデュ
ーサを有する外科手術装置を含む超音波外科手術装置を
記載している。この長手方向の振動動作はハンドピース
に接続している超音波ブレードに伝達される。さらに、
組織の凝結および切断作用を改善するために、この振動
するブレードに対して組織を把持できる付属品がハンド
ピースに着脱自在に接続されている。この米国特許第
５，３２２，０５５号においては、鋏状のグリップが超
音波により振動するブレードの一面に沿って回動される
クランプ顎を駆動して、長手方向に沿う振動動作の方向
に対してほぼ垂直な方向に組織をブレードに対して圧縮
力および負荷をかける。
【０００５】止血装置が組織の切断、切除、凝結または
溶接のための種々の装置において記載されている。この
ような装置のたいていの物は、例えば、二極式の鉗子、
単極式の鋏または二極式の鋏、および、切断および凝結
装置のような、単極式または二極式の装置のいずれかで
ある。例えば、米国特許第５，７０７，３６９号は外科
手術装置により誘発される組織温度の閉ループ制御のた
めの温度フィードバック・システムを記載しており、こ
の装置においては、組織の凝結が所望の程度で行われて
いるかを決定するために温度の関数が使用されている。
【０００６】開ループ電気外科手術装置および超音波装
置は外科手術中における出血を制御するために有効に使
用されているが、このような装置を使用する場合は、主
な制御がエネルギーにより処理される際の組織に生じる
現象の観察に対応する外科医の経験により行われる。し
かしながら、多くの場合、特に内視鏡手術の場合に、外
科医は組織に生じる現象を容易に観察することが困難で
ある。さらに、エネルギーによる組織特性における変化
が急激に起こるために、外科医が装置へのエネルギー供
給を停止するのに十分速く反応することができない場合
がある。この結果、このような組織治療は所望の程度に
対して正確に制御できなくなる。このような不都合の幾
つかの例としては、組織の炭化、電気外科手術装置の電
極に対する組織の付着、および過剰または不足の組織治
療等が挙げられる。
【０００７】
【発明が解決しようとする課題】従って、組織へのエネ
ルギー供給の制御を改善する手段、および／または、組
織治療が最適または所望の程度に行われた時点を決定す
る手段が依然として要望されている。組織に対する超音
波エネルギーの量は超音波エンド・イフェクタにより組
織に加えられる力の関数である。本明細書に参考文献と
して含まれる米国特許第５，９４７，９８４号において
記載される装置のような従来の装置は外科医が組織に加
えることのできる最大の力の量が制限されていた。しか
しながら、この力は単一の最大設定値であって、この設
定制限値以下で組織に加えられる力は有効に制御されて
いない。特に、切断および凝結の両方の機能を実行する
必要のある超音波装置の能動的な制御のための装置およ
び方法を提供することが必要とされている。
【０００８】
【課題を解決するための手段】本発明は外科手術におい
て使用するための（負荷）力フィードバック・システム
を備えている装置を提供することにより上記の要望に応
えている。この力フィードバック・システムは外科手術
装置から組織に加えられる力を調整できる閉ループ構成
である。すなわち、発生装置が発生装置の負荷を示す負
荷パラメータを有する電気信号を発生する。負荷パラメ
ータとしては、例えば、電流、電圧、インピーダンスま
たは温度が挙げられる。外科手術装置はこの発生装置に
電気的に接続している。この外科手術装置は駆動レバー
を有するハンドルと、当該ハンドルの先端部に配置され
たエンド・イフェクタを備えている。力応答素子が駆動
レバーおよびエンド・イフェクタに動作可能に連結して
おり、この力応答素子が発生装置からの電気信号に応じ
てエンド・イフェクタ上の力を変更するように作用す
る。
【０００９】
【発明の実施の形態】本発明の新規な特徴は特に特許請
求の範囲およびその実施態様に記載されている。しかし
ながら、本発明自体は、その構成および動作方法につい
て、その別の目的および利点と共に、以下の添付図面に
基づく詳細な説明により最良に理解することができる。
【００１０】本発明は、一般に、超音波外科手術クラン
プ装置に関し、特に、超音波外科手術クランプ装置の能
動的負荷フィードバック制御に関する。以下、本発明
を、例えば、米国特許第５，９４７，９８４号において
記載される超音波クランプ凝結装置のような本明細書に
おいて記載する超音波装置との組み合わせにおいて説明
する。尚、この説明は例示を目的とするだけであり、本
発明の範囲および適用性を制限することを目的としな
い。
【００１１】図１は超音波外科手術１１と共に超音波信
号発生装置１５を備えている超音波装置１０を示してい
る図である。この超音波外科手術波装置１１はサンドイ
ッチ型の超音波トランスデューサ８２、ハンドピース・
ハウジング２０、および本発明によるクランプ凝結装置
１２０を備えている。クランプ凝結装置１２０は切開式
外科手術用または腹腔鏡式外科手術用に使用できる。こ
のクランプ凝結装置１２０は装置ハンドル１４、および
超音波エンド・イフェクタ１８を含む細長い部材１５０
を有している。さらに、エンド・イフェクタ１８はクラ
ンプ・アーム組立体２００およびブレード８１を有して
いる。超音波トランスデューサ８２は電力供給ケーブル
３２を有している。この超音波トランスデューサ８２は
ハンドピースと称することもできるが、好ましくは、例
えば５５，０００ヘルツの正弦波波形の電気的信号を機
械的な長手方向の振動に変換するための圧電変換素子の
ような変換素子（図示せず）により構成されている。適
当な超音波ハンドピースがEthicon Endo-Surgery社から
のULTRACISION HARMONIC SCALPEL（登録商標）およびモ
デルＨＰ０５１として入手できる。
【００１２】電力ケーブル３２は超音波信号発生装置１
５から超音波トランスデューサ８２に電気的エネルギー
を伝達する。さらに、超音波トランスデューサ８２はこ
の電気的エネルギーを超音波エネルギーに機械的動作の
形態で変換する。適当な発生装置がオハイオ州シンシナ
ティのEthicon Endo-Surgery社からモデル番号ＧＥＮ０
１として入手できる。この超音波エネルギーは超音波ト
ランスデューサ８２からクランプ凝結装置１２０を経て
エンド・イフェクタ１８に伝達される。
【００１３】例えば、クランプ凝結装置１２０のような
外科手術装置は発生装置１５の出力段階において負荷を
加える。すなわち、外科手術装置の負荷が発生装置１５
の出力段階において見られ、このことにより外科手術装
置が制御されて駆動される。この外科手術装置の負荷の
一部分がエンド・イフェクタ１８が組織に作用する際の
組織負荷として使用される。
【００１４】図２および図３において、クランプ凝結装
置１２０は１個のユニットとして超音波トランスデュー
サ８２に取り付けられて、当該トランスデューサ８２か
ら取り外されるのが好ましい。このクランプ凝結装置１
２０は図１に示すように超音波トランスデューサ８２に
音響学的に連結されているのが好ましい。なお、このク
ランプ凝結装置１２０が任意の適当な手段により超音波
トランスデューサ８２に連結できることが理解されると
考ええる。
【００１５】図１乃至図３において、細長い部材１５０
は以下に説明するような装置ハウジング１３０に対して
選択的に回転できる。装置ハウジング１３０（図１）は
駆動トリガー２４、およびフィンガー・グリップ２２、
左側囲い板１３７および右側囲い板１３８（図２および
図３）を備えている。細長い部材１５０は外側シース２
８として示される支持チューブ、超音波導波管３０、回
転ノブ２６、駆動アーム３４、Ｏ−リング３８、ピン２
７、管状カラー１６０、およびエンド・イフェクタ１８
を含む。さらに、エンド・イフェクタ１８は超音波ブレ
ード８１およびクランプ・アーム組立体２００を有して
おり、このクランプ・アーム組立体２００はクランプ・
アーム５７および組織パッド５８を有している。また、
駆動アーム３４はキー溝２５、開口部１６８、ピン−ス
ロット３１、Ｏ−リング２９、およびレバー−アーム６
１を備えている。
【００１６】右側囲い板１３８は左側囲い板１３７にス
ナップ嵌合するように構成されている。好ましくは、こ
の右側囲い板１３８は当該右側囲い板１３８上に形成さ
れた複数の内側に対向する突出部７０（図示せず）によ
り左側囲い板１３７に連結している。すなわち、複数の
突出部７０は左側囲い板１３７に形成した対応する穴１
４０の中に係合するように構成されている。左側囲い板
１３７が右側囲い板１３８に取り付けられると、以下に
説明する能動的（負荷）力機構のような種々の構成部品
に適応する一定の空孔部がこれらの間に形成される。
【００１７】目盛機構１５５が装置ハウジング１３０の
空孔部の中に配置されている。好ましくは、この目盛機
構１５５は駆動アーム３４に連結または取り付けられて
いて、駆動トリガー２４の移動をクランプ・アーム組立
体２００を開閉するための駆動アーム３４の線形移動に
置き換えて示すことができる。すなわち、駆動トリガー
２４がフィンガー・グリップ２２に向って移動すると、
この目盛機構１５５が駆動アーム３４を後方に摺動させ
てクランプ・アーム組立体２００がその閉じ位置に回動
する。また、駆動トリガー２４が反対方向に移動する
と、目盛機構１５５が摺動して駆動アーム３４を反対方
向、すなわち、前方に移動させることにより、クランプ
・アーム組立体２００がその開き位置に回動する。駆動
トリガー２４は第１の穴１２４を有する親指ループ部１
４２を備えている。さらに、ヨーク１８０が第２の穴１
２６を有している。これらの第１の穴１２４および第２
の穴１２６の中に回動ピン１５３が挿入されてこれらを
回動可能にしている。
【００１８】さらに、目盛機構１５５はラチェット機構
を構成していて、細長い部材１５０を装置ハウジング１
３０に対してその長手軸の回りに回転できるようになっ
ている。この細長い部材１５０の回転により、クランプ
・アーム組立体２００は所定または所望の角度の位置に
回動する。好ましくは、目盛機構１５５は管状カラー１
６０およびヨーク１８０を備えている。この目盛機構１
５５の管状カラー１６０は駆動アーム３４の基端部にス
ナップ嵌合して、対向する開口部１６８の中にキー係合
するのが好ましい。さらに、管状カラー１６０はポリエ
ーテルイミドにより形成されているのが好ましい。な
お、管状カラー１６０が任意の適当な材料により構成で
きることは理解されると考える。また、この管状カラー
１６０はキー溝２５の中に挿入可能なキー２３により駆
動アーム３４にキー係合することもできる。
【００１９】好ましくは、管状カラー１６０は拡大部分
１６２およびこれを貫通する穴１６６を有している。こ
の拡大部分１６２は管状カラー１６０の周囲に形成され
たリング４２を備えていて溝４３を形成しているのが好
ましい。この溝４３は細長い部材１５０がその長手軸の
回りに回転する時に異なる回転位置において細長い部材
１５０を保持するための複数のデテントまたは歯部４４
（図４および図５参照）を有している。好ましくは、溝
４３は１２個の約３０°の均等な角度増加で細長い部分
を回転可能にする１２個のラチェット歯部を有してい
る。なお、この管状カラー１６０が任意数の歯状部材を
有し得ることが理解されると考える。さらに、これらの
歯状部材が本発明の範囲および趣旨に逸脱することなく
管状カラー１６０の任意の適当な部分に備えられること
が理解されると考える。
【００２０】一般に、ヨーク１８０は保持部材または支
持部材１８２を備えている。この支持部材１８２は半円
形状であって、一対の対向する爪１８６を有しているの
が好ましく、これらの爪１８６は内側に延出して管状カ
ラー１６０の歯部４４に係合するようになっている。な
お、これらの爪１８６が管状カラー１６０の歯部４４と
係合するためにヨーク１８０における任意の適当な部分
に配置できることが理解されると考える。さらに、ヨー
ク１８０が任意数のラチェット・アームを有し得ること
が理解されると考える。
【００２１】クランプ・アーム組立体２００は外側シー
ス２８の先端部に回動可能に接続している。組織パッド
５８はテフロン（登録商標）等の適当な低摩擦性の材料
により形成されているのが好ましく、クランプ・アーム
の表面上に取り付けられてブレード８１と協働作用する
と共に、クランプ・アーム組立体２００の回動移動に伴
って、当該組織パッド５８がブレード８１に対してほぼ
平行に接触配置される。このような構成により、把持す
べき組織が組織パッド５８とブレード８１との間におい
て把持される。好ましくは、組織パッド５８はブレード
８１との協働作用において組織の把持効果を高めるため
にのこぎり歯状の構成を備えている。
【００２２】エンド・イフェクタに対するクランプ・ア
ーム組立体２００の回動移動は当該クランプアーム組立
体２００の少なくとも１個、好ましくは一対のレバー１
９３をその基端部に備えることにより行なえる。これら
のレバー１９３はブレード８１のそれぞれの反対側の面
上に配置されていて、往復動可能な駆動アーム３４にお
けるレバー・アーム６１に動作可能に係合する。外側管
状シース１６０およびブレード８１に対する駆動アーム
３４の往復動により、クランプ・アーム組立体２００が
ブレード８１に対して回動移動する。各レバー１９３は
各レバー・アーム６１により形成される一対の開口部の
中にそれぞれ配置されるか、あるいは、これらに適当に
機械的に連結されることにより、上記駆動部材の往復移
動がこれらのレバー・アーム６１およびレバー１９３を
介してクランプ・アームを回動させるように作用する。
【００２３】各爪１８６は管状カラー１６０を介して駆
動アーム３４に開口力を転移し、これにより、クランプ
・アーム組立体２００が開口する。好ましくは、ヨーク
１８０はポリカーボネートにより形成されている。な
お、ヨーク１８０はＡＢＳ、ナイロン、またはポリエー
テルイミドのような別のプラスチック材料を含む種々の
材料により作成することができる。
【００２４】さらに、ヨーク１８０は駆動トリガー２４
が装置ハウジング１３０に向って移動する時に閉じ力を
クランプ・アーム組立体２００に転移する。駆動トリガ
ー２４の動作ストロークの下部において、駆動装置移動
停止部１９０が駆動トリガー２４に接触して当該駆動ト
リガー２４がさらに移動すること、あるいは過剰に移動
することを阻止する。
【００２５】装置１１および補助クランプ凝結装置１２
０を組み立てるために、クランプ凝結装置１２０が超音
波トランスデューサ８２の端部上にネジで固定されてい
る。この装置を使用する場合に、上記のクランプが供給
される超音波エネルギーによる凝結および切断動作に使
用でき、超音波エネルギーの供給無しに組織を把持する
ために使用でき、開口したクランプ・アーム組立体２０
０および把持されていない組織による凝結および／また
は切断に使用でき、超音波エネルギーの供給無しに組織
を探索または操作するために使用でき、さらに、閉じた
クランプ・アーム組立体２００による鈍化切除のために
使用できる。所望のクランプ・アーム組立体２００の回
転整合は回転ノブ２６の使用により行なうことができ、
このノブ２６は装置ハウジング１３０を保持した状態で
回転して細長い部材１５０を装置ハウジング１３０に対
して回転することができる。歯部４４により設けられて
いるデテントがこの所定の回転整合を維持する。鋏状の
グリップはクランプ・アーム組立体２００を閉じるよう
に作動し、超音波用の電力が例えばフット・スイッチの
ようなスイッチを作動することにより供給される。長手
方向のブレード８１のクランプ・アーム組立体２００に
対する振動が組織に伝達することにより、凝結、切断等
の所望の作用を行なうことができる。このような所望の
組織作用は以下に説明するような能動的な圧力制御によ
り最適化できる。
【００２６】ブレード８１に対するクランプ・アーム５
７の能動的負荷制御は図２乃至図７に示す圧力制御シス
テム８４により行なわれる。この圧力制御システム８４
の第１の実施形態を図２，図４および図６に示す。ま
た、圧力制御システム８４の第２の実施形態を図３，図
５および図７に示す。これら両方の実施形態は、例え
ば、電気−機械的ソレノイドのようなピストン８７を含
む圧力トランスデューサ８６を利用して示されている。
なお、当該技術分野における熟練者であれば、例えば、
サーボ−モーター式、液圧式、空気圧式、およびバイメ
タル式のような任意の力または圧力トランスデューサが
圧力制御システム８４と共に利用できることが理解でき
る。
【００２７】図２，図４および図６に示す第１の実施形
態において、圧力制御システム８４は圧力トランスデュ
ーサ８６、ワイヤ８８、コネクタ９０、スプリング９
２、スプリング・ケージ９４、ヨーク１８０、および駆
動アーム３４を備えている。圧力トランスデューサ８６
はワイヤ８８、コネクタ９０およびケーブル３２を介し
て（図１）超音波信号発生装置１５に電気的に接続して
いる。この圧力トランスデューサ８６は超音波信号発生
装置１５からの電気的信号に応じて変化して、駆動アー
ム３４から圧力制御システム８４を介してエンド・イフ
ェクタ１８に加えられる力または負荷を変更する。
【００２８】図４および図６に示すように、圧力トラン
スデューサ８６は能動的にスプリング９２の圧縮力を変
更する。さらに、駆動トリガー２４がスプリング９２を
介してヨーク１８０に力を供給する。スプリング９２が
圧縮または解放されることにより、エンド・イフェクタ
１８に供給される力が能動的に変更できる。超音波信号
発生装置１５をプログラム可能にして、例えば、この超
音波信号装置１５により過剰負荷状態が検出される場合
に、圧力トランスデューサ８６に電気的信号を送って当
該圧力トランスデューサ８６によりスプリング９２の圧
縮を解放させることによりその過剰負荷状態を緩和でき
るようにすることができる。
【００２９】例えば、上記のＧＥＮ０１発生装置におけ
る超音波信号発生装置１５における電圧に対応する負荷
パラメータはこの発生装置の位置ＴＰ６におけるＰＣボ
ード上において見ることができる。このＴＰ６はULTRAC
ISION HARMONIC SCALPELサービス・マニュアルにおいて
見ることのできる発生装置ＰＣＢ概略図の付表Ｂに示さ
れている。このＧＥＮ０１はトランスデューサ８２に一
定の電流を維持するように構成されている。それゆえ、
ＴＰ６における電圧が組織負荷に比例するように、負荷
の変化に応じて電圧が調整される。超音波信号発生装置
１５は、ＴＰ６が例えば２００直流ボルトのような一定
の設定値に到達すると、電気的信号を圧力トランスデュ
ーサ８６に送って当該圧力トランスデューサ８６にスプ
リング９２の圧縮を解放させるようにプログラムするこ
とができる。スプリング９２の圧縮が解放されると、ヨ
ーク１８０を介して駆動アーム３４に転移される力によ
り、クランプ・アーム組立体２００がブレード８１に対
して加える力が減少する。なお、当該技術分野における
熟練者により理解されるように、超音波信号発生装置１
５は、例えば、一定の電流負荷パラメータ、一定の電圧
負荷パラメータ、インピーダンスパラメータ、一定の設
定値の後に増大する負荷、一定の設定値の後に減少する
負荷、または一定に減少する負荷のような別の条件に状
態に対応してプログラムすることもできる。さらに、エ
ンド・イフェクタにおける温度がこの発生装置における
負荷の指示手段となる。このような温度フィードバック
・システムは本明細書に参考文献として含まれる米国仮
特許出願第６０／１３６，１０６号に記載されるような
ものがあり、発生装置１５から圧力トランスデューサ８
６に対して組織負荷を指示する電気的信号を発生するよ
うに使用できる。
【００３０】本発明の第１の実施形態において、上記圧
力制御システム８４の能動的な負荷制御は駆動トリガー
２４を介する超音波システム１０のオペレータによる制
御と共に作用する。すなわち、オペレータは駆動トリガ
ー２４を手動により調整して上記能動システムが作動し
ないように無効にすることができる。図３，図５および
図７は本発明の第２の実施形態を示しており、この場合
に、オペレータによる駆動トリガー２４の使用が圧力制
御システム８４により無効にされることができる。
【００３１】この第２の実施形態において、圧力トラン
スデューサ８６はヨーク１８０に力を直接供給する。圧
力トランスデューサ８６は左側囲い板１３７に固着され
ている。ピストン８７はヨーク１８０に動作可能に接続
している。このヨーク１８０は接着、超音波溶接等によ
り駆動トリガー２４に固着することができる。あるい
は、ヨーク１８０は米国特許第５，９４７，９８４号に
記載されるようにスプリングを介して駆動トリガー２４
に柔軟に取り付けることができる。圧力トランスデュー
サ８６のピストン８７が延出または後退する時に、オペ
レータにより感じられる力がそれぞれに対応して減少ま
たは増大する。超音波信号発生装置１５は、例えば、当
該超音波信号発生装置１５が過剰負荷状態を検出する場
合に、電気的信号を圧力トランスデューサ８６に送って
ピストン８７を後退させることにより、ブレード８１に
対するクランプ・アーム組立体２００の力を減少するよ
うにプログラムすることができる。なお、当該技術分野
の熟練者により理解されるように、超音波信号発生装置
１５は、例えば、増大するクランプ・アーム力、減少し
たクランプ・アーム力、一定に維持されているクランプ
・アーム力、所定時間後において増大したクランプ・ア
ーム力、一定の設定値の後に減少した負荷、または一定
に減少する負荷のような別の状態に対応してプログラム
することも可能である。
【００３２】以上、本発明の実施形態をそれぞれ図示
し、且つ、説明したが、当該技術分野の熟練者において
は、これらの実施形態が例示的目的のためのみのもので
あることが明らかに理解されると考える。すなわち、上
記の説明に基づいて、上記実施形態における多数の変
形、変更、および置換が本発明に逸脱することなく当該
技術分野の熟練者において可能になる。従って、本発明
の範囲および趣旨は本明細書において記載する特許請求
範囲およびその実施態様によってのみ制限されるものと
する。
【００３３】本発明の実施態様は以下の通りである。 （１）前記負荷パラメータが電圧、電流、インピーダン
スおよび温度から成る群から選択される請求項１に記載
の外科手術において使用するための装置。 （２）前記外科手術装置がさらに電気的エネルギーを超
音波周波数の機械的動作に変換するためのトランスデュ
ーサから成る請求項１に記載の外科手術において使用す
るための装置。 （３）前記エンド・イフェクタが超音波周波数に応答す
るクランプ・アームおよびブレードを備えている実施態
様（２）に記載の外科手術において使用するための装
置。 （４）前記力応答素子が前記クランプ・アームに動作可
能に連結していて、前記駆動レバーに対して独立して前
記外科手術装置の動作中に前記ブレードに対する前記ク
ランプ・アームの力を変更する実施態様（３）に記載の
外科手術において使用するための装置。 （５）前記外科手術装置がさらに電気的エネルギーを超
音波周波数の機械的動作に変換するためのトランスデュ
ーサ手段から成る請求項３に記載の外科手術において使
用するための装置。
【００３４】（６）前記エンド・イフェクタ手段が組織
を把持するためのクランプ手段および組織に超音波エネ
ルギーを供給するためのブレード手段を備えている実施
態様（５）に記載の外科手術において使用するための装
置。 （７）組織に対して電気外科手術装置を介して加える力
を調整する方法において、（ａ）前記外科手術装置を介
して組織にエネルギーを供給する工程と、（ｂ）外科手
術装置における組織負荷を感知する工程と、（ｃ）外科
手術装置に対して電気的フィードバック信号を供給する
工程とから成り、当該フィードバック信号が組織負荷を
指示する少なくとも１個の成分を有しており、さらに、
（ｄ）前記電気的フィードバック信号に応じて外科手術
装置を介して組織に供給される負荷を調整する工程から
成る方法。
【００３５】
【発明の効果】従って、本発明によれば、特に、切断お
よび凝結の両方の機能を実行する超音波装置の組織に加
える力を能動的に制御するための装置および方法が提供
できる。
【図面の簡単な説明】
【図１】本発明による能動制御式超音波外科手術鋏を含
む外科手術装置の斜視図、および超音波信号発生装置の
概略的平面図を示しており、この外科手術鋏は超音波ト
ランスデューサとの組み合わせの状態で示されている図
である。
【図２】本発明による外科手術装置における第１の実施
形態の分解斜視図である。
【図３】本発明による外科手術装置における第２の実施
形態の分解斜視図である。
【図４】図２に示す外科手術装置における内部機構の部
分破断斜視図である。
【図５】図３に示す外科手術装置における内部機構の部
分破断斜視図である。
【図６】図２および図４に示す外科手術装置の（負荷）
力機構の側面図である。
【図７】図３および図５に示す外科手術装置の（負荷）
力機構の側面図である。
【符号の説明】
１０ 超音波装置 １１ 超音波外科手術装置 １４ ハンドル １５ 超音波信号発生装置 １８ エンド・イフェクタ ２４ 駆動トリガー（駆動レバー） ３４ 駆動アーム（駆動素子） ８２ 超音波トランスデューサ ８６ 圧力トランスデューサ（力応答素子）
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ケビン・エル・ハウザー アメリカ合衆国、45066 オハイオ州、ス プリングボロ、フォリエイジ・レーン 570

Claims (3)

    【特許請求の範囲】
  1. 【請求項１】 外科手術において使用するための装置に
    おいて、 電気的信号を発生する発生装置から成り、当該電気的信
    号が前記発生装置に関する外科手術装置の負荷を指示す
    る負荷パラメータを有しており、さらに、 前記発生装置に電気的に接続している外科手術装置から
    成り、当該外科手術装置が、 駆動レバーを備えているハンドルと、 前記ハンドルの先端部に配置されているエンド・イフェ
    クタと、 前記駆動レバーおよび前記エンド・イフェクタに動作可
    能に連結している力応答素子とを備えており、当該力応
    答素子が前記発生装置からの電気的信号に応じて前記エ
    ンド・イフェクタに加える力を変更するように構成され
    ている装置。
  2. 【請求項２】 外科手術において使用するための超音波
    装置において、 超音波周波数で電気的信号を発生する超音波信号発生装
    置から成り、当該電気的信号が発生装置の負荷を指示す
    る負荷パラメータを有しており、さらに、 前記発生装置に電気的に接続しているトランスデューサ
    から成り、当該トランスデューサが前記超音波信号発生
    装置からの電気的信号を機械的動作に変換するように構
    成されており、さらに、 超音波外科手術装置から成り、当該超音波外科手術装置
    が、 前記トランスデューサに動作可能に連結しているハンド
    ル組立体と、 前記トランスデューサに音響的に連結している導波管と
    から成り、当該導波管が超音波エネルギーを伝達するよ
    うに構成されており、さらに、 前記導波管の先端部に配置されているエンド・イフェク
    タと、 前記エンド・イフェクタに動作可能に連結している駆動
    素子と、 前記超音波信号発生装置に電気的に接続し、且つ、前記
    駆動素子に動作可能に連結している力応答素子とを備え
    ており、当該力応答素子が前記超音波信号発生装置から
    の電気的信号に応じて前記駆動素子に加える力を変更す
    るように構成されている装置。
  3. 【請求項３】 外科手術において使用するための装置に
    おいて、 発生装置の負荷を指示するための信号手段を備えている
    発生装置と、 前記発生装置に電気的に接続している外科手術装置とか
    ら成り、当該外科手術装置が、 前記外科手術装置を駆動するための駆動手段と、 組織に作用するためのエンド・イフェクタ手段と、 前記駆動手段および前記エンド・イフェクタ手段に動作
    可能に連結していて、前記信号手段に応じてエンド・イ
    フェクタ手段に加える力を変更するための力手段とを備
    えている装置。
JP2000379198A 1999-12-14 2000-12-13 超音波外科手術装置の能動的負荷制御 Expired - Fee Related JP4489281B2 (ja)

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US460698 1999-12-14
US09/460,698 US6352532B1 (en) 1999-12-14 1999-12-14 Active load control of ultrasonic surgical instruments

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EP1108394B1 (en) 2007-08-01
EP1108394A2 (en) 2001-06-20

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