JP2001269353A - Electrosurgery apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a electrosurgery apparatus capable of conducting treatment while preventing tissue from being attached to an electrode. SOLUTION: After treatment is started with a set output, a current sent to tissue through an electrode is measured, power is temporarily increased to 150% to conduct coagulation in the case a 70% coagulation completing threshold value of the maximum current value Imax is reached, and power is reduced after a specified energy quantity is reached, so treatment for coagulation is securely conducted, thereby the tissue is dried for effectively preventing the tissue from being attached to the electrode.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electrosurgical apparatus, and more particularly, to an electrosurgical apparatus having a high-frequency current output control portion.

[0002]

2. Description of the Related Art Generally, an electrosurgical device such as an electric scalpel is
It is used when performing procedures such as incision, coagulation, and hemostasis of a living tissue in a surgical operation or a medical operation. Such an electrosurgical apparatus is provided with a high-frequency ablation power source and a treatment tool connected to the high-frequency ablation power source. The high-frequency ablation power source is supplied from the high-frequency ablation power source by bringing the treatment tool into contact with a patient. Take action.

[0003] Various types of the above-mentioned electrosurgical apparatus have been conventionally proposed. For example, in Japanese Patent Application Laid-Open No. 8-98845,
In order to prevent carbonization of tissue to be coagulated and prevent adhesion of the tissue to the electrode, a technique of determining the end of coagulation from tissue impedance and stopping high-frequency output is disclosed. Also,
In the electrosurgical apparatus disclosed in JP-A-10-225462,
In order to achieve the same object as in JP-A-8-98845, there is disclosed a technique for reducing a high-frequency output.

[0004]

Problems to be Solved by the Invention
No. 45, and the electrosurgical apparatus disclosed in JP-A-10-225462, when the contact area between the tissue and the electrode is small,
Measurement results such as impedance and current value become unstable,
In some cases, the termination of coagulation was determined even though coagulation was not completed. In such a case, there is a problem that the operator has to perform the output a plurality of times, and the tissue is not sufficiently dried, so that the tissue adheres to the electrodes.

(Object of the Invention) The present invention has been made in view of the above points, and has as its object to provide an electrosurgical apparatus capable of performing treatment while preventing tissue from adhering to an electrode.

[0006]

A treatment energy generating means for supplying treatment energy to a surgical instrument, a variable means for varying an output of the treatment energy generating means, and the treatment energy applying to an electrode of the surgical instrument. Detection means for detecting a physical quantity when supplied to the tissue side via the control means, and output control means for increasing a treatment output of the variable means by a predetermined amount based on a predetermined change amount in the detection means. When a predetermined amount of change to a reference value or the like at the end of the coagulation treatment is detected, the treatment is performed by increasing the treatment output.
Sufficient treatment was performed to allow the tissue to be set to a state where it would not adhere to the electrode.

[0007]

Embodiments of the present invention will be described below with reference to the drawings. (First Embodiment) FIGS. 1 to 5 relate to a first embodiment of the present invention, FIG. 1 is a configuration diagram showing a configuration of a high-frequency ablation device of the first embodiment, and FIG. FIG. 3 is a block diagram showing the configuration of the ablation power supply device, FIG. 3 is a flowchart showing the control operation of the control circuit of FIG. 2, FIG. 4 is an explanatory diagram showing the state of power change when treatment is performed according to the control operation of FIG.
FIG. 5 shows the maximum value Imax of the detection current and the supply energy J.
Shows the relationship of the threshold value F (max).

As shown in FIG. 1, a high-frequency ablation power supply 2 for supplying high-frequency ablation power is provided in a high-frequency ablation power supply 1 according to a first embodiment of the present invention as an electrosurgical apparatus. Numeral 2 is connected to a connection cable 4 provided with an electrode 3 at the tip by a connector section 5, and supplies a high-frequency ablation power for treatment to a patient 7 placed on a bed 6 via the electrode 3 to perform a treatment (operation). Action). Further, the high-frequency ablation power supply device 2 is connected to, for example, a foot switch 8 for controlling ON / OFF of the high-frequency ablation power. In addition, as the electrode 3, a monopolar,
Any multi-pole electrode may be used.

As shown in FIG. 2, the high-frequency ablation power supply 2
Is connected to a commercial power supply (not shown) and generates a treatment DC power supply. The processing DC power supply circuit 10 is driven by the processing DC power supply circuit from the processing DC power supply circuit 10 and oscillates at a high frequency to oscillate at a high frequency. A processing high-frequency generation circuit 11 for generating electric power (high-frequency current); a waveform generation circuit 12 for controlling a waveform of a high-frequency current output to the processing high-frequency generation circuit 11; An output transformer 13 that outputs a high-frequency current to the electrode 3, current sensors 14a and 14b that detect an output current output from the output transformer 13, and a treatment high-frequency component removed from current values detected by the current sensors 14a and 14b. And a current value passing through the filter 15 is represented by A
An A / D converter 16 for performing A / D conversion and a control circuit 17 for controlling the treatment DC power supply circuit 10 and the waveform generation circuit 12 based on digitized current data from the A / D converter 16 are provided.

The high-frequency ablation power supply 2 is driven by a detection DC power supply circuit 18 for generating a detection power supply and a detection DC power supply from the detection DC power supply circuit 18, and oscillates at a high frequency to perform detection. High frequency power (high frequency current)
, And a detection high-frequency generation circuit 19 that outputs the signal to an output transformer.

The connection cable 4 is connected to the connector section 5 through the current sensors 14a and 14b, so that the electrode 3 can perform high-frequency ablation on a living tissue 20 such as an affected part of the patient 7. The two current sensors 14
a and 14b, for example, the current sensor 14a detects the current flowing from one electrode 3 to the living tissue 20 side of the patient 7, and the other current sensor 14b detects the current flowing from the other electrode 3 to the output transformer 1
The current collected on the third side is detected.

The detection high-frequency generation circuit 19 is set to have a frequency which is at least different from the frequency of the treatment high-frequency wave generated by the treatment high-frequency generation circuit 11 to such an extent that the filter 15 can separate and extract the treatment high-frequency waves. The value is set to be considerably smaller than the high frequency output.

The detection radio frequency is superimposed on the living tissue 20 so as to be superimposed on the treatment radio frequency, and is passed through the electrode 3 which comes into contact with the living tissue 20. At this time, the detection radio frequency current I
Are detected by the current sensors 14a and 14b, and the detected current I is sent to the control circuit 17. The control circuit 17 temporally monitors the high-frequency current I for detection and obtains the maximum current value I.
The value of max is detected, and it is further determined whether or not the state corresponds to the end of coagulation based on whether or not the maximum current value Imax is, for example, 70% or less. By performing the treatment by increasing the electric power as an output, the coagulation treatment is surely completed, the tissue is set in a dry state to prevent the adhesion to the electrode 3, and then the control is performed to reduce the electric power. To do.

Next, the operation of the present embodiment will be described with reference to FIG. When set as shown in FIG. 1 and the foot switch 8 is depressed to give an instruction to start treatment, the control circuit 17 starts the control operation according to the flowchart shown in FIG. When the foot switch 8 is depressed, the control circuit 1
7 sets 0 to the maximum current value Imax in step S1. In the next step S2, the control circuit 17 controls the treatment DC power supply circuit 10 and the waveform generation circuit 12 so that the power becomes the set output value, and outputs the set output value.
In this case, the high frequency for detection is also supplied to the living tissue 20 side so as to be superimposed on the high frequency for treatment.

Then, in the next step S3, the detection current (detection current value) I is measured, and in the next step S4
Then, it is determined whether or not the measured detection current is larger than the maximum current value Imax, and if this is the case, the value of the detection current I is set to the maximum current value Imax as shown in step S5. On the contrary, if the measured detection current is equal to or less than the maximum current value Imax, the measured detection current I in step S6 is, for example, the reference value of the treatment state corresponding to the end of coagulation with the maximum current value Imax × 70%. Determine if it has After the process in step S5, the process proceeds to step S6.

If it is determined in step S6 that the measured detection current I is equal to or greater than the maximum current value Imax × 70%,
Returning to step S3, the measurement of the detection current I is repeated (in the state of the set output). On the other hand, when the measured detection current I becomes equal to or less than the maximum current value Imax × 70%, in the next step S7, the treatment output is increased, specifically, the power is increased to the set output × 150%. After that, in the next step S8, the detection current (detection current value) I is measured, and in the next step S9, it is determined whether or not the measured detection current is larger than the maximum current value Imax.

If this condition is met, the value of the detection current I is set to the maximum current value Imax as shown in step S10, and conversely, the measured detection current is set to the maximum current value Imax or less. In step S11, the supply energy J after the current increase is calculated from the current I in step S11. In addition, after the process of step S10, step S11 is executed.
Move on to

After calculating the supply energy J in step S11, the supply energy threshold value F (I
max) is determined, and if this condition is not reached, the measurement of the current I in step S8 is repeated, and in step S12, the supply energy threshold F (I
If it is larger than (max), the process moves to step S13, and the power is reduced to the set output × 50%.

FIG. 4 shows the detected current and output transformer 13 when the patient 7 is treated according to the control operation of FIG.
An example of the output power from the power supply and the change of the peak voltage in that case is shown.

As described above, the high-frequency ablation power supply device 2 supplies a high-frequency current for treatment from the electrode 3 to the living tissue 20 side with the set output, and repeats the measurement of the detection current at that time, and the detection current reaches its maximum value. When it falls below 70% of Imax,
Increase power to 150% of set output.

In response to this, the detection current I and the power change as shown in FIG. 4, and the peak voltage also changes as shown in FIG. Then, the supplied energy J is a constant energy value (more specifically, the supplied energy threshold F (Ima
When x)) is reached, the power is reduced to the set output times 50%.

FIG. 5 shows the relationship between the maximum value Imax of the detection current and the threshold value F (max) of the supply energy J.

When the maximum value Imax is large, the contact area of the electrode 3 with the patient 7 is large, so that the threshold value F (max) of the supplied energy J is increased. Also, the maximum value Imax
The power in S7 may be changed (e.g., reduced) from the point in time at which the change in the coagulation state can be changed, and the operator can easily confirm the change.

This embodiment has the following effects. As described above, in the present embodiment, the living tissue is treated with the reference value corresponding to the end of coagulation, the power is temporarily increased, and then the power is reduced. Even if the determination is too early, coagulation can be performed reliably and the tissue can be dried, so that it is possible to effectively prevent a situation in which the tissue adheres to the electrode.

Further, by using different frequencies for detection and treatment, the detection frequency can be set to an optimum frequency for examining the coagulation state of the tissue, and the coagulation state can be recognized more accurately.

Further, if a difference due to a difference in the frequency is used as a judgment material based on information from both the high-frequency current for detection and the high-frequency current for treatment, it is possible to recognize the coagulation state with higher accuracy.

If the accuracy of the measurement may be reduced, the treatment high-frequency generation circuit 12 is used to simplify the configuration.
Can be shared with the detection high-frequency generation circuit 19. That is, the power supply circuit 18 for detection and the high-frequency generation circuit 19 for detection may be omitted in FIG. In this case, the filter 15 becomes unnecessary. The output may be stopped in step S13 in FIG.

(Second Embodiment) Next, a second embodiment of the present invention will be described with reference to FIGS. FIG.
Shows a high-frequency ablation power supply device 21 according to the second embodiment of the present invention. The high-frequency ablation power supply 21 is the same as the high-frequency ablation power supply 2 shown in FIG. 2 except that a voltage sensor 22 is disposed between the output transformer 13 and the current sensor 14a.
An input is made to the A / D converter 16 together with the current detected in 4a. Then, the impedance value can be detected by dividing the voltage value by the current value.

In this embodiment, one current sensor 14a is used, but the other current sensor 14b is not used. In this embodiment, the treatment high-frequency wave and the detection high-frequency wave are alternately output. Therefore, the filter 15 is not used (if one high-frequency wave is output, the other one stops (or stops)). Has been).

In this embodiment, when supplying the treatment high-frequency power to the living tissue 20, the crest factor (crest factor) is sequentially reduced (according to the progress of the treatment) so that the peak voltage becomes constant. The control circuit 127 performs control via the waveform generation circuit 12. When the end of the coagulation treatment is determined based on the reference value, the treatment is performed by increasing the actual output of the treatment function, specifically, increasing the treatment output by increasing the peak voltage. Other configurations are the same as those of the first embodiment.

Next, the operation of the present embodiment will be described with reference to FIG. When set as shown in FIG. 6 and the foot switch 8 is depressed, the control circuit 17 starts the control operation according to the flowchart shown in FIG. When the foot switch 8 is depressed, the control circuit 17 sets 0 to the minimum impedance value Zmin in step S21.

In the next step S22, the treatment DC power supply circuit 10 and the waveform generation circuit 12 are controlled so that the output power becomes the set value. Further, in step S23, the control circuit 17 causes the peak voltage to become a constant value Vp1.
The treatment power supply circuit 10 and the waveform generation circuit 12 are controlled.

As a result, the crest factor of the waveform decreases as the coagulation state progresses, and in the early stage of coagulation, strong coagulation is performed by the waveform having a high crest factor. Is prevented (see FIG. 8).

Then, in the next step S24, time measurement is performed, and in the next step S25, it is determined whether or not a predetermined time has elapsed. If the predetermined time has not elapsed, the process returns to step S22, and steps S22 to S22 are performed. The process of S24 is repeated.

When the predetermined time has elapsed, in step S26, under the control of the control circuit 17, the generation of the processing high-frequency current by the treatment high-frequency generation circuit 11 is stopped, and the output of the processing high-frequency power is stopped. . Step S2
In 7, the detection high-frequency current is generated by the detection high-frequency generation circuit 19, and the detection high-frequency current is output.

In the next step S29, the current and the voltage are measured by the current sensor 14a and the voltage sensor 22 for the high-frequency output for detection, and the impedance Z of the patient 7 is measured.
Is measured. Then, in the next step S29, the measured impedance Z is the minimum impedance value Zmin.
It is determined whether it is smaller than.

If the measured impedance Z is smaller than the minimum impedance value Zmin, the impedance Z measured in the next step S30 is set to the minimum impedance value Zmin, and conversely, the measured impedance Z is set to the minimum impedance value Zmin. In the above case, it is determined whether or not the impedance Z measured in step S31 is larger than the minimum impedance value Zmin × 130%. Note that the process also proceeds to step 31 after the process of step S30.

In the judgment at step 31, the measured impedance Z is the minimum impedance value Zmin × 1.
If it is 30% or less, the process returns to step S22, and the processes of steps S22 to S30 are repeated (step S22).
When returning from step 31 to step S22, the output of the detection high frequency is temporarily stopped, and the treatment high frequency is output).

When the measured impedance Z is larger than the minimum impedance value Zmin × 130%, the process proceeds to the next step S32, where the control of waveform adjustment is performed so that the peak voltage of the waveform becomes Vp1 × 2.

In the next step S33, the input energy amount J when the impedance Z measured is larger than the minimum impedance value Zmin × 130% is calculated.
Then, it is determined whether or not the input energy amount J is larger than a predetermined threshold value G (Zmin) calculated from the minimum impedance value Zmin. If this condition is not reached, the process returns to step S32, and step S32, The process of S33 is repeated, and when the energy input in step S34 becomes larger than the threshold value J (Z (Zmin)), the process proceeds to step S35, the power is reduced to the set output × 50%, and further the next step S36 Let the output waveform be a sine wave. The coagulation treatment is performed in this manner.

FIG. 8 shows how the tissue resistance (impedance) Z, power, waveform, and peak voltage change over time when the treatment is performed according to FIG. In the present embodiment, the peak voltage is maintained so as to be constant until the coagulation end reference value is reached, during which the crest factor changes from a large value to a small value according to the progress of the coagulation treatment. To change it.

When the reference value for ending coagulation is reached, the power is increased in the first embodiment, whereas the power is kept constant (always limited to a constant) in the present embodiment. ), Change the function of the coagulation procedure to a higher waveform and e.g. its peak voltage (before increase)
The treatment is performed by increasing the value to twice the constant value, and the power is reduced when the predetermined energy is reached. This embodiment has the following effects.

According to this embodiment, when the solidification state has advanced to a desired degree, the output power is changed so that the power of the high-frequency current and the peak voltage increase. For this reason,
Even if the coagulation is not completed, even if the coagulation is determined to be completed, a sufficient degree of coagulation can be obtained, and the tissue is not sufficiently dried, so that the tissue does not adhere to the electrode.

As described above, in the present embodiment, the peak voltage is raised with a waveform that enhances the treatment function, so that the same effect as in the first embodiment can be obtained with low power. In addition, since the crest factor decreases with the progress of the solidification state, it is possible to achieve both improvement in the solidification force and prevention of carbonization. Further, by performing the output for treatment and the output for measurement alternately, highly accurate measurement can be performed without using a filter.

As described in the first embodiment, when the accuracy of the measurement may be reduced, the recognition of the coagulation state is determined by obtaining the impedance of the living tissue from the treatment high-frequency current. May be. It should be noted that embodiments and the like configured by combining the above-described embodiments and the like in a partial manner also belong to the present invention.

[Supplementary Notes] Treatment energy generating means for supplying treatment energy to the surgical instrument, variable means for varying the output of the treatment energy generating means, and when the treatment energy is supplied to the tissue side via an electrode of the surgical instrument An electrosurgical apparatus comprising: a detecting means for detecting a physical quantity of the variable means; and an output control means for increasing a treatment output of the variable means by a predetermined amount based on a predetermined change amount in the detecting means.

1. Generating means for generating a high-frequency current, coagulation state determining means for determining a coagulation state of a living tissue, changing means for changing the output of the high-frequency current, and output of the high-frequency current according to information from the coagulation state determination means And a control circuit for controlling the changing means so as to change, the information indicating the coagulation state from the coagulation state determination means in the electrosurgical apparatus for supplying the high-frequency current to the surgical instrument, the desired condition An electrosurgical device, wherein when the condition is satisfied, the control circuit controls the changing unit, so that the output from the generating unit is changed so that the power or the peak voltage of the high-frequency current increases. .

2. The electrosurgical apparatus according to claim 1, wherein the changing means changes the output power. 3. The electrosurgical apparatus according to claim 1, wherein the changing means changes the output waveform. 4. The electrosurgical apparatus according to claim 1, wherein the changing means changes the output power and the waveform.

5. Generating means for generating a high-frequency current, coagulation state determination means using a high-frequency current for detection to determine the coagulation state of the living tissue different from the high-frequency current,
Changing means for changing the output of the high-frequency current, and a control circuit for controlling the changing means so as to change the output of the high-frequency current, based on information from the coagulation state determining means, An electrosurgical apparatus for supplying a high-frequency current, wherein the output power is reduced or stopped when information indicating the coagulation state from the coagulation state determination means satisfies a desired condition. 6. 5. The electrosurgical apparatus according to any one of claims 1 to 4, wherein the coagulation state determining means uses a detection current different from the treatment high frequency.

7. 5. The electrosurgical apparatus according to claims 5 or 6, wherein the coagulation state determination means makes a determination based on a current value of a detection current different from the high frequency for treatment. 8. 5. The electrosurgical apparatus according to claims 5 or 6, wherein the coagulation state determining means obtains the impedance of the tissue from a detection current different from the high frequency for treatment, and makes a determination based on the value. 9. 9. The electrosurgical apparatus according to claims 5 to 8, wherein the coagulation state judging means judges the coagulation state based on information from the high-frequency output for treatment and information from the detection current.

10. Generating means for generating a high-frequency current;
Different from the high-frequency current, coagulation state determination means using a high-frequency current for detection to determine the coagulation state of the living tissue, changing means for changing the output of the high-frequency current, from the coagulation state determination means A control circuit for controlling the changing means so as to change the output of the high-frequency current according to the information, and in the electrosurgical apparatus for supplying the high-frequency current to a surgical instrument, the coagulation state from the coagulation state determination means An electrosurgical apparatus characterized in that, when the information indicating satisfies a desired condition, constant electric energy (electric energy) is supplied to a living tissue, and thereafter the output is reduced or stopped.

11. The electrosurgical apparatus according to appendix 10, wherein the electric energy changes based on the progress until the coagulation state of the living tissue becomes a desired state. 12. The electrosurgical apparatus according to appendices 10 and 11, wherein when a certain amount of electric energy is applied, the supplied power changes based on the progress until the coagulation state of the living tissue becomes a desired state. 13. The electrosurgical apparatus according to any one of appendices 1 to 9, which has the features of appendices 10 to 12.

14. Supplementary notes 1 to 4 and Supplementary notes 10 to 13 for determining the coagulation state based on information from the treatment high-frequency current
Electrosurgical equipment. 15. The electrosurgical apparatus according to attachments 9 and 14, wherein the information from the treatment high-frequency current is a current value. 16. The electrosurgical apparatus according to attachments 9 and 14, wherein the information from the treatment high-frequency current is the impedance of the living tissue.

17. Generating means for generating a high-frequency current;
An electrosurgical apparatus that includes a coagulation state determination unit that determines a coagulation state of a living tissue and a changing unit that changes a waveform of the high-frequency current, and supplies the high-frequency current to a surgical tool. An electrosurgical apparatus having a control circuit for controlling the changing means so as to change the waveform of the high-frequency current according to the information of (1). 18. The electrosurgical apparatus according to claim 17, wherein the crest factor (peak value / effective value) of the waveform decreases as coagulation progresses. 19. The electrosurgical apparatus according to Supplementary Notes 1 and 3 to 16, which has the features of Supplementary Notes 17 and 18.

[0055]

As described above, according to the present invention, treatment energy generating means for supplying treatment energy to a surgical instrument, variable means for varying the output of the treatment energy generation means, Detecting means for detecting a physical quantity when energy is supplied to the tissue side via an electrode of the surgical tool;
Output control means for increasing the treatment output of the variable means by a predetermined amount based on the predetermined change amount in the detection means, so that the predetermined change amount up to a reference value for ending the coagulation treatment is detected. In such a case, by performing the treatment by increasing the treatment output, the treatment can be sufficiently performed, and the state can be set such that the tissue does not adhere to the electrode.

[Brief description of the drawings]

FIG. 1 is a configuration diagram showing a configuration of a high-frequency ablation device according to a first embodiment of the present invention.

FIG. 2 is a block diagram showing a configuration of a high-frequency ablation power supply device.

FIG. 3 is a flowchart showing a control operation of the control circuit of FIG. 2;

FIG. 4 is an explanatory diagram showing a state of power change and the like when treatment is performed according to the control action of FIG. 3;

FIG. 5 is a characteristic diagram showing a relationship between a maximum value Imax of a detection current and a threshold value F (max) of supply energy.

FIG. 6 is a block diagram showing a configuration of a high-frequency ablation power supply device according to a second embodiment of the present invention.

FIG. 7 is a flowchart showing a control operation of the control circuit.

FIG. 8 is a diagram showing a state of a temporal change in power, waveform, and the like.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... High frequency ablation apparatus 2 ... High frequency ablation power supply apparatus 3 ... Electrode 4 ... Connection cable 5 ... Connector part 6 ... Bed 7 ... Patient 8 ... Foot switch 10 ... Treatment power supply circuit 11 ... Treatment high frequency generation circuit 12 ... Waveform generation circuit DESCRIPTION OF SYMBOLS 13 ... Output transformer 14a, 14b ... Current sensor 15 ... Filter 16 ... A / D conversion circuit 17 ... Control circuit 18 ... Detection power supply circuit 19 ... Detection high frequency generation circuit 20 ... Living tissue

 ──────────────────────────────────────────────────の Continuing on the front page (72) Inventor Shinji Hatta 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Inventor Kenji Harano 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. F-term (reference) 4C060 KK04 KK09 KK10 KK23

Claims (1)

[Claims] 1. A treatment energy generating means for supplying treatment energy to a surgical tool, a variable means for varying an output of the treatment energy generating means, and the treatment energy is supplied to a tissue side via an electrode of the surgical tool. Detecting means for detecting a physical quantity when supplied to the control means, and output control means for increasing a treatment output of the variable means by a predetermined amount based on a predetermined change amount in the detecting means. Surgical equipment.