JP2005160733A - Treating instrument for surgery - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a treating instrument for surgery detecting a contact state and a dry state of a biotissue without passing a current to a patient and controlling an output based on its result. <P>SOLUTION: This treating instrument for the surgery is provided with; an output power control means 35 controlling the supply of a heating power for heatingly driving a heating section 16; an output state determining means 39 detecting the output power to be supplied from the output power control means 35 to the heating section 16 and determining, at least, one of the presence/absence of the biotissue clamped between a first clamp section 8 and a second clamp section 9, or the state of the biotissue clamped between the first clamp section 8 and the second clamp section 9; and a CPU (a control means) 32 drivingly controlling, at least, one of the supply of the heating power from the output power control means 35, or a notification of the determination result based on the determination result of the determining means 39. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a surgical treatment instrument that performs treatments such as incision, coagulation, and hemostasis by applying heat to a treatment site of a living tissue.

  In general, as a surgical treatment instrument, a treatment part including a pair of openable and closable gripping parts is disposed at the distal end of the treatment tool body, and an operation part for opening and closing the gripping part is disposed at a proximal end part of the treatment tool body. At the same time, a heat treatment apparatus is known in which a heat generating part is provided in at least one of the gripping parts, and the living tissue gripped between the gripping parts is heated by the heat generating part. This type of surgical treatment tool is used, for example, when performing treatments such as incision, coagulation, and hemostasis at a treatment site of a living tissue during surgery.

  And when using this treatment tool for surgery, after grasping a living tissue between grasping parts, output is started, electric power is supplied to a heating part, and a heating part is heated. The heat of the heat generating part is transferred to the grasping part, and treatments such as incision, coagulation, and hemostasis are performed at the treatment site of the living tissue.

  Patent Document 1 discloses a surgical instrument that seals a patient's blood vessels and other tissues. This surgical instrument is provided with a grasping member for grasping a patient's blood vessel and other tissues. In addition, an electrosurgical generator is connected to the surgical instrument.

  When the surgical instrument is used, electrosurgical output power is supplied from the electrosurgical generator to the grasping member while the patient's blood vessel or other tissue is grasped by the grasping member. As a result, by applying a high current to the blood vessels of the patient being held by the grasping member of the surgical instrument and other tissues, the tissue is rapidly heated and dried, and the patient being grasped by the grasping member It is intended to block blood vessels and other tissues.

In this surgical instrument system, the tissue impedance is monitored during treatment of a living tissue, and the power supply is stopped when the tissue impedance reaches a preset value. I try to stop.
Japanese National Patent Publication No. 10-510460

  In a conventional surgical treatment tool for heat treatment, the heat generating portion is controlled by turning on / off a power switch. For this reason, it is necessary to visually confirm when performing an operation to start the output and complete the coagulation of the living tissue and stop the output during the treatment of the living tissue. As a result, it is difficult to reliably prevent unnecessary power from being output without grasping the living tissue at the start of output of the surgical treatment tool. Furthermore, when the output of the surgical treatment tool is stopped, the output may be stopped before coagulation is completed.

  Moreover, since the apparatus of Patent Document 1 monitors the impedance of the tissue during the treatment of the living tissue, the treatment state of the living tissue can be detected. However, in the apparatus of Patent Document 1, it is necessary to keep current flowing to the patient at all times during treatment of living tissue.

  The present invention has been made paying attention to the above circumstances, and the purpose thereof is a surgery that can detect a contact state or a dry state of a living tissue without flowing an electric current to a patient, and can control an output from the result. It is in providing a treatment tool.

According to the first aspect of the present invention, there is provided a treatment portion that is disposed at the distal end portion of the treatment instrument body and includes a pair of openable and closable grippers, and an operation that is disposed at the proximal end portion of the treatment instrument body and that opens and closes the gripper In a surgical treatment instrument provided with a heat generating part for heat-treating a living tissue held between the holding parts on at least one of the holding parts, heat generation for driving the heat generating part to generate heat Output power control means for controlling the supply of power, and the output power supplied from the output power control means to the heat generating part, and the presence or absence of a living tissue held between the gripping parts, or between the gripping parts Based on the determination result of the determination means and at least one of the states of the grasped biological tissue, and driving control of at least one of supply of heat generation power from the output power control means or notification of the determination result Do It is operative instrument, characterized by comprising: a control means.
In the first aspect of the present invention, supply heat control for driving the heat generating portion to generate heat is controlled by the output power control means during use. At this time, the output power supplied from the output power control means to the heat generating part is detected, and at least one of the presence or absence of the biological tissue grasped between the grasping parts or the state of the living tissue grasped between the grasping parts is determined. Determine by. Further, based on the determination result of the determination means, at least one of the supply of heat generated from the output power control means and the notification of the determination result is drive-controlled by the control means. Thereby, it is possible to detect a contact state of a living tissue, a dry state, or the like without flowing an electric current to the patient, and to control the output from the result.

According to a second aspect of the present invention, the control unit is connected to a switch for driving the heat generating unit to generate heat, and the output power control unit generates weak power for detecting the state of the heat generating unit when the power is turned on. The operation according to claim 1, wherein the operation is switched to a normal driving state in which a heat generation power for performing a living body treatment is applied to the heat generating portion when the switch is turned on. It is a treatment tool.
In the second aspect of the present invention, when the switch is held in the off state when the power is turned on, the switch is held in the standby state. At this time, the output power control means supplies weak power to the heat generating part in order to detect the state of the heat generating part. Thereafter, when the switch is turned on, the operation is switched to the normal driving state. At this time, the output power control means supplies heat generation power for driving the heat generation section to generate heat.

According to a third aspect of the present invention, the control means includes a first set value W1 for output start power detection for detecting output start power that is switched from the standby state to the normal drive state, and the biological tissue. A second set value W2 for detecting an end state for ending the heating treatment is preset,
The determining means determines that there is a living tissue held between the holding portions by detecting a state where the detected value of the output power exceeds the first set value W1 in the standby state, By detecting a state in which the detected value of the output power is lower than the second set value W2 in the normal driving state, it is determined that the heating treatment is finished for the living tissue held between the holding parts. The surgical treatment tool according to claim 2, wherein:
In the invention of claim 3, it is determined that there is a living tissue grasped between the grasping portions by detecting a state where the detected value of the output power exceeds the first set value W1 in the standby state. Is determined. Further, by detecting a state in which the detection value of the output power is lower than the second set value W2 in the normal driving state, the discrimination unit discriminates from the heating treatment end state of the living tissue held between the holding parts. It is what I did.

According to a fourth aspect of the present invention, the control means counts the time after the detected value of the output power exceeds the first set value W1 when the determination means determines that the living tissue is present. The output start control for switching the output power control means to the normal drive state when the switch is turned on within a preset set time Twait is performed. The surgical treatment instrument described.
In the invention of claim 4, when the determination means determines that there is a living tissue, the control means counts the time after the detected value of the output power exceeds the first set value W1, Output start control is performed to switch the output power control means to the normal drive state when the switch is turned on within the set set time Twait. At this time, if the switch is not turned on even if the time after the detected value of the output power exceeds the first set value W1 exceeds the set time Twait, the output power control means is held in the standby state. This prevents unnecessary power from being output without grasping the living tissue.

According to a fifth aspect of the present invention, when the control means determines that the heating treatment has been completed for the living tissue, the control means immediately before the detected value of the output power falls below the second set value W2. A detection value Wtn-1 at a time point tn-1 at which the detection value of output power changes abruptly, and a detection value Wtn at a time point tn at which the detection value of output power changes abruptly in a region below the second set value W2. The output stop control for stopping the output in the normal drive state by the output power control means is performed when it is detected that the difference ΔW is larger than an arbitrary power set value Ws. The surgical treatment instrument described.
According to the fifth aspect of the present invention, when the output power control means is in the normal drive state and the determination means determines that the living tissue heating treatment has been completed, the control means indicates that the output power detection value is the second value. The detection value Wtn-1 at the time tn-1 when the output power detection value changes abruptly just before the set value W2 falls, and tn when the output power detection value changes abruptly in the region below the second setting value W2. When it is detected that the difference ΔW from the detected value Wtn at the time is larger than the arbitrary power setting value Ws, output stop control is performed to stop the output in the normal driving state by the output power control means. Thereby, it can be automatically stopped without continuing unnecessary output after the end of the heating treatment.

According to a sixth aspect of the present invention, when the control means determines that the heating treatment has been completed for the living tissue by the determining means, a state in which the detected value of the output power is lower than the second set value W2 in advance. The operation according to claim 3, wherein output stop control for stopping output of the normal drive state by the output power control means is performed at a time point when a state lasting for a set arbitrary set time is detected. It is a treatment tool.
In the invention of claim 6, when the discrimination means determines that the heating treatment has been completed for the living tissue, the control means presets a state in which the detected value of the output power is lower than the second set value W <b> 2. At the time when a state lasting for an arbitrary set time is detected, output stop control is performed to stop the output in the normal drive state by the output power control means. Thereby, it can be automatically stopped without continuing unnecessary output after the end of the heating treatment.

  According to the present invention, it is possible to detect a contact state or a dry state of a living tissue without passing an electric current through the patient, and the output can be controlled based on the result.

  Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. 1 to 3 (A) to (C) and FIGS. 4 to 8. FIG. 1 shows a schematic configuration of the entire system of the surgical treatment tool 1 according to the present embodiment. The system of the surgical treatment instrument 1 according to this embodiment includes a scissors-type thermocoagulation incision forceps (treatment instrument main body) 2, a power supply device 3, and a foot switch 4.

  FIG. 2 shows a schematic configuration of the thermocoagulation incision forceps 2 as a whole. The forceps 2 has two (first and second) forceps constituting bodies 5 and 6. The first and second forceps constituting bodies 5 and 6 are attached to each other via a pivot shaft 7 so as to be rotatable with respect to each other. A first gripping portion 8 is provided on the distal end side of the first forceps constituting body 5, and a second gripping portion 9 is provided on the distal end side of the second forceps constituting body 6. The first grasping portion 8 and the second grasping portion 9 form a treatment portion 10 for grasping a living tissue. The 1st holding part 8 and the 2nd holding part 9 are formed with metal materials, such as stainless steel.

  An arm 11 extends on the rear side of the first forceps constituting body 5, and a finger insertion ring 12 is provided at the end of the arm 11. Similarly, an arm 13 extends to the rear side of the second forceps constituting body 6, and a finger insertion ring 14 is provided at the end of the arm 13. The arm 11, the ring 12, the arm 13, and the ring 14 form an operation portion 15 for opening and closing the pair of gripping portions 8 and 9.

  FIGS. 3A to 3C show the internal configuration of the treatment portion 10 of the thermocoagulation incision forceps 2. In the first grip 8 of the treatment section 10, a long groove-shaped recess 8 a for mounting the heat generating section is formed on the surface facing the second grip 9. A heat generating portion 16 for applying thermal energy to the living tissue is attached to the concave portion 8a.

  As shown in FIGS. 3A and 3B, the heat generating portion 16 has a plurality of heat generating elements 17a, 17b, and 17c in the present embodiment, and heat of these three heat generating elements 17a, 17b, and 17c. And a heat transfer plate 18 which is a metal blade for transmitting and heating the living tissue.

  As shown in FIG. 3C, the heat transfer plate 18 has a tapered blade portion 18a on the surface (lower surface) facing the second gripping portion 9, and an end surface (upper surface) opposite to the blade portion 18a. Recessed heating element mounting portions 18b are respectively formed. The blade 18a of the heat transfer plate 18 is exposed to the second grip 9 side.

  Furthermore, three heat generating elements 17a, 17b, and 17c are joined to the heat generating element mounting portion 18b of the heat transfer plate 18 via a transmission member having a good thermal conductivity. The three heating elements 17a, 17b, and 17c are formed of, for example, a thin film resistor formed on a ceramic substrate. The heat generating elements 17 a to 17 c and the heat transfer plate 18 are thermally joined, and the heat generated by the heat generating elements 17 a to 17 c is transmitted to the heat transfer plate 18.

  The upper part of the heat generating part 16 is covered with a heat insulating member 19 having a substantially U-shaped cross section. The heat insulating member 19 is made of a material having low heat conductivity such as PTFE or PEEK and high heat resistance. The heat insulating member 19 is fixed in a form fitted in the concave portion 8 a of the first grip 8.

  Further, lead wires 20a to 20c for supplying electric power are connected to each of the heating elements 17a to 17c. As shown in FIG. 2, the first forceps component 5 is provided with a cord connecting portion 21 protruding from the rear end side of the ring 12. The base end portion of each of the lead wires 20a to 20c is connected to the cord connecting portion 21.

  Furthermore, one end of a connection cord 22 is connected to the cord connection portion 21. The other end of the connection cord 22 is detachably connected to the power supply device 3 via a connection connector 23. Then, the power supply device 3 supplies heating power to the heating elements 17a to 17c via the connection cord 22, the cord connection portion 21, and the lead wires 20a to 20c.

  Further, as shown in FIGS. 3A and 3C, the second grip portion 9 is integrally provided with a receiving member 24 having an exposed surface at a position facing the heat generating portion 16. The receiving member 24 is made of an elastic resin material such as silicon rubber or PTFE. An anti-slip process 24 a is applied to the exposed surface of the receiving member 24.

  When the thermocoagulation incision forceps 2 is used, the operation unit 15 is opened / closed so that the living tissue is placed between the heat generating unit 16 of the first gripping unit 8 of the treatment unit 10 and the receiving member 24 of the second gripping unit 9. The treatment site is grasped, and heat generated by the heating elements 17a to 17c is transferred to the grasped living tissue through the heat transfer plate 18 so as to be heated and solidified and incised.

  Further, as shown in FIG. 1, the power supply device 3 includes a connector receiver 25, a power switch 26, an output setting switch 27, a setting output display unit 28, an output display unit 29, and an abnormality display unit on the front panel 3a. 30 etc. are provided. The connector receiver 25 is connected to the connector 23 of the thermocoagulation incision forceps 2. Here, the power switch 26 turns on / off the drive power of the power supply device 3. The output setting switch 27 includes a temperature level up switch 27a for setting the heat generation temperature level of the heat generating portion 16 of the thermocoagulation incision forceps 2 and a temperature level down switch 27b. The setting output display unit 28 displays the heat generation temperature level set by the output setting switch 27. The output display unit 29 displays the energization of the thermocoagulation / incision forceps 2 during the coagulation / incision treatment. The abnormality display unit 30 includes an abnormal lighting display 30a of the thermocoagulation incision forceps 2 displayed when there is an abnormality in the system of the surgical treatment instrument 1, an abnormal lighting display 30b of internal means of the power supply device 3, and an abnormal warning sound. And buzzer 30c for generation.

  A power supply socket (not shown) and a foot switch connector 31 (see FIG. 4) are provided on a back panel (not shown) of the power supply device 3. Here, a power plug of a power cable for supplying power for driving the power supply device 3 is connected to the power socket.

  The foot switch 4 is connected to the foot switch connector 31. The foot switch 4 is operated by an operator with his / her foot to turn on / off instruction input of the supply output of heat generation power from the power supply device 3 to the thermocoagulation incision forceps 2. Further, the foot switch 4 has a maximum level switch 4a and a set level switch 4b. The highest level switch 4a inputs an instruction to heat the thermocoagulation / incision forceps 2 at the maximum temperature level. The setting level switch 4b inputs an instruction to generate heat at the heat generation temperature level set by the output setting switch 27.

  FIG. 4 is a block diagram showing a schematic configuration inside the power supply device 3. A microprocessor (hereinafter simply referred to as CPU) 32 is built in the power supply device 3. The CPU (control unit) 32 includes a heat generation setting unit 33, a foot switch input unit 34, an output power control unit 35, a resistance value detection unit 36, an applied power detection unit 37, a display unit 38, and an abnormality. A buzzer 30c for generating a warning sound is connected. Further, the heat setting means 33 is connected to an output setting switch 27 and a foot switch input unit 34. A foot switch connector 31 is connected to the foot switch input unit 34. The foot switch input unit 34 receives operation instruction switch information from the foot switch 4 connected to the foot switch connector 31. Further, the heat generation setting means 33 sets the heat generation temperature level of the heat generating elements 17 a to 17 c by operation inputs from the foot switch input unit 34 and the output setting switch 27.

  The CPU 32 outputs the output power control means 35, the display section 38, and the buzzer 30c for generating an abnormal warning sound based on the heat generation operation instruction input from the foot switch input section 34 and the heat generation temperature level instruction input from the heat generation setting means 33. And drive control. Here, the display unit 38 includes a temperature level setting output display unit 28, an energization output display unit 29 for the thermocoagulation incision forceps 2, and an abnormality display unit 30.

  Further, the output power control means 35 generates and outputs heat generation power for driving the heat generation elements 17 a to 17 c of the thermocoagulation incision forceps 2 to generate heat via the connection connector 23 under the control of the CPU 32. The heating power supplied and applied from the output power control means 35 to the heating elements 17a to 17c is detected by the applied power detection means 37, and the resistance value detection means is determined from the voltage value and current value of the applied heating power detected here. In 36, the resistance values of the heating elements 17a to 17c are calculated.

  Since the resistance values of the heating elements 17a to 17c are linked to the change in the heating temperature, the resistance values of the heating elements 17a to 17c calculated by the resistance value detecting means 36 are converted into the heating temperatures of the heating elements 17a to 17c. Control of the heating power supplied and output from the output power control means 35 to the heating elements 17a to 17c is performed.

  Further, the CPU 32 is provided with an output state determination unit 39 and an output notification control unit 40. Here, the output state discriminating means 39 includes the presence or absence of a living tissue grasped between the first grasping portion 8 and the second grasping portion 9 based on the detected value of the output power detected by the applied power detecting means 37. Alternatively, at least one of the states of the living tissue grasped between the first grasping portion 8 and the second grasping portion 9 is determined. The output notification control means 40 drives and controls the supply of heat generation power from the output power control means 35 and the notification of the determination result based on the determination result of the determination means 39.

  Further, the output power control means 35 heats the heat generating part 16 when the power switch is turned on, and a standby state in which weak power for detecting the state of the heat generating part 16 is supplied to the heat generating part 16, and when the foot switch 4 is turned on. The operation is switched to the normal drive state for supplying the generated heat power.

  Further, the CPU 32 has a first set value W1 for detecting an output start power for detecting an output start state that is switched from a standby state to a driving state during normal coagulation / incision of the living tissue, and coagulation of the living tissue. A second set value W2 for detecting an end state for ending the incision treatment is set in advance. Note that W1 and W2 can be arbitrarily set, for example, by setting the level of the output setting switch 27 according to conditions such as the state of the living tissue.

  FIG. 5 is a characteristic diagram for explaining an example of output control of the thermocoagulation / incision forceps 2 of the present embodiment. In FIG. 5, the solid characteristic curve A is the change state of the output power detected by the applied power detection means 37 during coagulation / incision of the living tissue, and the dotted characteristic curve B is the first gripping portion 8 and the second gripping portion 9. The change state of the output power when the foot switch 4 is turned on in a state where the living tissue is not grasped between the two is shown.

  That is, when the living tissue is coagulated / incised by the thermocoagulation / incision forceps 2 of the present embodiment, the output power supplied from the output power control means 35 to the three heating elements 17a to 17c of the heating unit 16 is generally a solid characteristic curve. It changes along A. Here, when the power switch 26 of the power supply device 3 is turned on (at time P0), the set power Wwait in the standby state is applied from the output power control unit 35 to the three heating elements 17a to 17c of the heating unit 16.

  In this standby state, when the living tissue is grasped between the first grasping portion 8 and the second grasping portion 9 (P1 time point), the temperature of the heat generating portion 16 decreases due to the contact with the living tissue at this time. The output power that is temporarily supplied from the output power control means 35 to the three heat generating elements 17a to 17c of the heat generating section 16 rises to Wt (rising power value at the initial contact time). Then, it returns to the standby state again.

  Further, when the foot switch 4 is turned on in the standby state (time point P2), output start control is performed to switch the output power control means 35 to a normal driving state during coagulation / incision of a living tissue. At the time of coagulation / incision of this normal living tissue, the output power W supplied from the output power control means 35 to the three heating elements 17a to 17c of the heat generating unit 16 rapidly rises to the appropriate coagulation / incision start power W3. (P3 time).

  Thereafter, the output power W supplied to the three heat generating elements 17a to 17c of the heat generating portion 16 rapidly decreases to W4 within a short time (at time P4). From this time point P4, the output power W gradually decreases substantially smoothly. At the end of coagulation / incision of the living tissue, the output power W supplied to the three heating elements 17a to 17c of the heating unit 16 when the living tissue is dried is short (between the time point P5 and the time point P6). ) Occurs a phenomenon that suddenly decreases. For this reason, the normal coagulation / incision operation of the living tissue is completed by turning off the output of the driving state at the time of coagulation / incision of the normal living tissue at an appropriate time P7 after the time P6. After this, it returns to the standby state again.

The first set value W1 for detecting the output start power and the second set value W2 for detecting the end state for ending the coagulation / incision treatment of the living tissue are the coagulation / incision of a general living tissue. Based on the above characteristic curve A, it is set as follows. That is, the first set value W1 is
Wwait <W1 <Wt
The relationship is set.

  The second set value W2 is set between the time point P5 and the time point P6, which is a change range of the output power W that rapidly decreases when the living tissue is dried at the end of coagulation / incision of the living tissue. ing.

  In the present embodiment, the discrimination means 39 detects the state in which the detected value of the output power W exceeds the first set value W1 in the standby state, so that the first gripping portion 8 and the second gripping portion 9 Between the first grasping unit 8 and the first grasping unit 8 by detecting that the detected value of the output power W is lower than the second set value W2 in a normal driving state. It is discriminated from the heating treatment end state of the living tissue held between the two holding portions 9.

Further, the CPU 32 counts the time after the detected value of the output power W exceeds the first set value W1 when the determining means 39 determines that there is a living tissue, and sets a preset set time Twait. In the following, there is provided a function of performing output start control for switching the output power control means 35 to a normal driving state at the time of coagulation / incision of a living tissue when the foot switch 4 is turned on. In addition, when the CPU 32 determines that the biological tissue heating treatment has been completed by the determining unit 39, the CPU 32 sets an arbitrary set time T ₂ in which a state in which the detected value of the output power W is lower than the second set value W2 is set in advance. A function is provided for performing output stop control to stop the output of the drive state during the coagulation / incision of the normal living tissue by the output power control means 35 when the state that has been described above is detected.

  Next, the operation of the above configuration will be described. When using the thermocoagulation incision forceps 2 of the present embodiment, control for starting output at the time of coagulation incision shown in the flowchart of FIG. 6, control for stopping output at the time of coagulation incision shown in the flowchart of FIG. Control for notifying the output state by the thermocoagulation incision forceps 2 shown in the flowchart of FIG.

  First, at the start of use of the thermocoagulation / incision forceps 2, control for starting output at the time of coagulation / incision shown in the flowchart of FIG. 6 is performed. Here, first, in step S1, when the power switch 26 of the power supply device 3 is turned on, the set power Wwait in the standby state is applied from the output power control means 35 to the three heating elements 17a to 17c of the heating section 16 ( Step S2). At this time, the output power W is detected by the applied power detection means 37 (step S3).

  Subsequently, in the next step S4, the presence / absence of a living tissue grasped between the first grasping portion 8 and the second grasping portion 9 is determined by the output state determining means 39 of the CPU 32. In the present embodiment, at this time, whether or not W> W1 is determined in the next step S5.

  At this time, when the living tissue is grasped between the first grasping portion 8 and the second grasping portion 9 (at time P1 in FIG. 5) in the standby state, the temperature of the heat generating portion 16 is lowered due to contact with the living tissue. As a result, the output power W temporarily supplied from the output power control means 35 to the three heat generating elements 17a to 17c from the output power control means 35 becomes the first set value W1 as shown by the solid characteristic curve A in FIG. It goes up to Wt. Therefore, when it is determined in step S5 that the output power W exceeds the first set value W1, the living tissue grasped between the first grasping portion 8 and the second grasping portion 9 is determined. It is determined that there is, and the process proceeds to the next step S6. If it is not determined in step S5 that W exceeds W1, the standby state is restored.

  In step S6, counting of the time t after the output power W exceeds the first set value W1 is started. Then, in the next step S7, it is determined whether or not t is smaller than a preset set time (waiting time) Twait. At this time, if it is determined that t <Twait, the process proceeds to the next step S8. If it is not determined at step S7 that t <Twait, the standby state is restored. Twait is set to about 5 seconds, for example.

  In step S8, it is determined whether or not the foot switch 4 is turned on. If it is determined that the foot switch 4 is turned on (time P2 in FIG. 5), the process proceeds to the next step S9. If it is not determined in step S8 that the foot switch 4 has been turned on, the process returns to step S7.

  In step S9, output start control is performed for switching the output power control means 35 to a driving state at the time of normal living tissue coagulation / incision. Then, the operation | movement at the time of coagulation | solidification and incision of the normal biological tissue of step S10 is performed.

  At the start of the normal coagulation / incision of living tissue, the output power W supplied from the output power control means 35 to the three heat generating elements 17a to 17c of the heat generating section 16 is appropriately coagulated / coagulated higher than the second set value W2. It rapidly rises up to the starting power W3 for the incision treatment (time P3 in FIG. 5).

  Thereafter, the detected value of the output power W detected by the applied power detection means 37 rapidly drops to W4 within a short time (time P4 in FIG. 5). From this W4, the detected value of the output power W gradually decreases substantially smoothly. Further, after the start of the normal coagulation / incision operation of living tissue, control for stopping the output at the time of coagulation / incision shown in the flowchart of FIG.

  Here, first, in step S11, the output power W is detected by the applied power detection means 37. Subsequently, in the next step S12, the state of the living tissue grasped between the first grasping portion 8 and the second grasping portion 9 is determined by the output state determining means 39 of the CPU 32. In the present embodiment, at this time, whether or not W <W2 is determined in the next step S13.

  At this time, when it is determined that the output power W is smaller than the second set value W2 (W <W2), the living tissue grasped between the first grasping part 8 and the second grasping part 9 Is determined to be dry (heat treatment end state), and the process proceeds to the next step S14. If it is not determined in step S13 that W <W2, the process returns to step S11 again.

In step S14, the detection value of the output electric power W is whether the state below the second set value W2 lasted preset arbitrary set time T ₂ or more, whether or not. In this case, to be detected followed by state setting time T ₂ or more (P7 point in FIG. 5), the process proceeds to the next step S15. In step S14, the state that followed the set time T ₂ or higher if not detected, is returned again to step S11.

  In step S15, the output of the driving state during normal coagulation / incision of the living tissue by the output power control means 35 is stopped. Thereafter, in the next step S16, the output stop of the driving state at the time of normal coagulation / incision of the living tissue is notified.

  Further, at the time of normal coagulation / incision of living tissue, control for notifying the output state by the thermocoagulation / incision forceps 2 shown in the flowchart of FIG. 8 is performed as follows. First, when an operation at the time of normal coagulation / incision of a biological tissue is started in step S21, output notification start control is performed in the next step S22. During the output notification start control, the CPU 32 performs notification by lighting the output display unit 29 and oscillating the output sound (step S23).

  Thereafter, when the normal coagulation / incision operation of the living tissue is stopped in step S24, output notification stop control is performed in the next step S25. During the output notification stop control, the CPU 32 turns off the output display unit 29 and stops the oscillation of the output sound (step S26).

  Therefore, the above configuration has the following effects. That is, in the system of the surgical treatment instrument 1 according to the present embodiment, when the thermocoagulation incision forceps 2 is used, the output power control means 35 controls the supply of heat generation power for driving the heat generation section 16 to generate heat. At this time, the output power W supplied from the output power control means 35 to the heat generating unit 16 is detected, and the presence or absence of a living tissue held between the first holding unit 8 and the second holding unit 9 or the first holding At least one of the states of the living tissue grasped between the part 8 and the second grasping part 9 can be discriminated by the discriminating means 39. Further, based on the determination result of the determination means 39, the CPU 32 controls driving of at least one of the supply of heat generated from the output power control means 35 and the notification of the determination result. Thereby, it is possible to detect a contact state or a dry state of the living tissue without passing an electric current through the patient, and based on the result, it is possible to control an output during normal coagulation / incision of the living tissue.

  Further, when the foot switch 4 is held in an off state when the power switch 26 of the power supply device 3 is turned on, the foot switch 4 is held in a standby state. The operation is switched to the driving state at the time of incision. In the present embodiment, the discriminating means 39 detects the state where the detected value of the output power W exceeds the first set value W1 in the standby state, so that the first gripping portion 8 and the second gripping portion 9 It can be determined that there is a living tissue held between the two.

  Further, when the determination unit 39 determines that there is a living tissue, the CPU 32 counts the time after the detected value of the output power W exceeds the first set value W1, and is equal to or less than the preset set time Twait. Thus, when the foot switch 4 is turned on, output start control is performed to switch the output power control means 35 to the normal drive state. At this time, if the foot switch 4 is not turned on even if the time after the detected value of the output power W exceeds the first set value W1 exceeds the set time Twait, the output power control means 35 is set in the standby state. Hold. As a result, as shown by a dotted characteristic curve B in FIG. 5, when the living tissue is not grasped between the first grasping portion 8 and the second grasping portion 9, during normal coagulation / incision of the living tissue. The driving state is started and unnecessary power can be prevented from being output. As a result, deterioration of the device can be prevented.

  Further, when it is not determined that the living tissue is present by the determining means 39, it is possible to control so that the normal driving state at the time of coagulation / incision of the living tissue is not started even if the foot switch 4 is turned on. In this case as well, unnecessary power output can be prevented, and deterioration of the device can be prevented.

Further, by detecting a state in which the detected value of the output power W is lower than the second set value W2 in the driving state at the time of normal coagulation / incision of the living tissue, the first gripping unit 8 and the second gripping unit 9 The discriminating means 39 can discriminate from the heating treatment end state of the living tissue held during the period. When the determination means 39 determines that the heating treatment has been completed for the living tissue, the CPU 32 determines that the detected value of the output power W is lower than the second set value W2 for a predetermined set time T ₂ or longer. At the time point P7 in FIG. 5 when the subsequent state is detected, output stop control is performed to stop the output of the drive state during normal coagulation / incision of the living tissue by the output power control means 35. As a result, it is possible to automatically stop the output of the driving state at the time of coagulation / incision of a normal biological tissue without passing an electric current through the patient. Therefore, it is possible to prevent the output of the driving state during the coagulation / incision of the normal living tissue from stopping before the coagulation is completed when the output is stopped. Furthermore, it is possible to reliably prevent the driving state during the coagulation / incision of the normal living tissue even after the coagulation is completed when the output is stopped, so that the power consumption can be reduced.

  FIG. 3D shows a modified example of the heat generating portion 16 of the thermocoagulation incision forceps 2 of the first embodiment (see FIGS. 1 to 3A to 3C and FIGS. 4 to 8). Is shown. In this modification, a heat generating part 41 for coagulation is provided in place of the heat generating part 16 of the thermocoagulation / incision forceps 2 of the first embodiment. The coagulation treatment unit 41 is provided with a flat plate-shaped heat transfer plate 42 on the surface of the first gripping portion 8 facing the second gripping portion 9. The heat transfer plate 42 is exposed on the lower surface side (the surface facing the second grip 9), and the heating elements 17a, 17b, and 17c similar to those of the first embodiment are mounted on the upper surface side. In this modified example, it is needless to say that the same operational effects as those of the thermocoagulation / incision forceps 2 of the first embodiment can be obtained.

  FIG. 9 is a control for stopping output at the time of coagulation / incision by the thermocoagulation / incision forceps 2 of the first embodiment (see FIGS. 1 to 3 (A) to (C) and FIGS. 4 to 8). It is a flowchart for demonstrating the modification of (refer FIG. 7).

  That is, in the present modification, the operation is the same as that of the first embodiment until step S12. In this modification, the process proceeds from step S12 to next step S31. In step S31, it is determined whether or not ΔW is larger than an arbitrary power setting value Ws as shown in FIG. Here, ΔW is a time point tn-1 at which the detected value of the output power W changes abruptly immediately before the detected value of the output power W falls below the second set value W2 at the end of the heating treatment of the living tissue (time point P5). Is a difference between the detected value Wtn-1 and the detected value Wtn at the time tn (time P6) when the detected value of the output power W suddenly changes in the region below the second set value W2.

  If it is determined in this step S31 that ΔW> Ws, the process proceeds to the next step S32. If it is not determined in step S31 that ΔW> Ws, the process returns to step S11 again.

In step S32, tn, tn-1 is or range between any time T ₁ of the the output start of the drive state during solidification-incision normal body tissue, whether it is determined. Here, tn, if tn-1 is determined not to be within the scope of any time T ₁ of the the output start of the drive state during solidification-incision normal biological tissues, the process proceeds to the next step S33. In step S32, if it is determined that the range of any time T ₁ is returned again to step S11.

  In step S33, the output of the driving state during the normal coagulation / incision of the living tissue by the output power control means 35 is stopped. Thereafter, in the next step S34, the output stop of the driving state at the time of coagulation / incision of a normal living tissue is notified.

  Therefore, in this modified example, when the output power control means 35 is in the normal driving state at the time of coagulation / incision of the living tissue, and when the determining means 39 determines that the heating treatment of the living tissue is finished, the CPU 32 outputs the output power W Immediately before the detected value falls below the second set value W2, the detected value Wtn-1 at the time point tn-1 where the detected value of the output power W changes abruptly, and the output power W in the region below the second set value W2. When the difference ΔW from the detected value Wtn at the time point tn at which the detected value changes rapidly is larger than an arbitrary power setting value Ws, the output power control means 35 performs normal living tissue coagulation / incision. Output stop control is performed to stop output in the drive state. As a result, it is possible to automatically stop the output of the driving state at the time of coagulation / incision of a normal biological tissue without passing an electric current through the patient.

  FIGS. 10A and 10B show a second embodiment of the present invention. This embodiment is an endoscopic treatment tool that replaces the thermocoagulation incision forceps 2 of the first embodiment (see FIGS. 1 to 3A to 3C and FIGS. 4 to 8). An endoscopic forceps 51 suitable for a mirror operation is provided. As shown in FIG. 10A, the endoscopic forceps 51 includes an elongated insertion sheath portion 52, an operation portion 53 connected to the proximal end portion of the insertion sheath portion 52, and the insertion sheath portion 52. And a treatment portion 54 provided at the tip of the head.

  The operation unit 53 includes a fixed handle 55 and a movable handle 57 that is rotatably attached to the fixed handle 55 via a handle pivot shaft 56. An operation portion main body 58 is formed integrally with the upper end portion of the fixed handle 55. An insertion sheath portion 52 is attached to the operation portion main body 58 so as to be rotatable about the axis.

  The insertion sheath portion 52 has a long outer tube 59. An elongated rod-like drive shaft 60 is inserted into the outer tube 59 so as to be movable back and forth in the axial direction. The base end side of the drive shaft 60 is rotatably connected to the upper end portion of the movable handle 57. Therefore, when the movable handle 57 is rotated around the handle pivot shaft 56, an operating force acts on the drive shaft 60, and the drive shaft 60 moves back and forth in the axial direction.

  The treatment portion 54 has a pair of upper and lower (first and second) gripping portions 61 and 62 that can be opened and closed. FIG. 10B shows the internal configuration of the peripheral portion of the treatment portion 54. Here, a gripping portion support member 63 is connected to the distal end portion of the outer tube 59 of the insertion sheath portion 52. A base end portion of the lower second gripping portion 62 is rotatably connected to a distal end portion of the gripping portion support member 63 via a support shaft 64.

  Furthermore, a rear extension 65 is provided at the proximal end of the second grip 62 so as to extend rearward from the connection with the support shaft 64. A base end portion of the upper first gripping portion 61 is rotatably connected to the rearward extending portion 65 via a connecting pin 66.

  In addition, an arm-like rearward extending portion 67 is provided at the proximal end portion of the first gripping portion 61 so as to extend rearward from the connecting portion with the connecting pin 66. A distal end portion of the drive shaft 60 is rotatably connected to a terminal portion of the rear extending portion 67 via a connecting pin 68. As a result, the movable handle 57 is opened and closed to open and close the gripping portions 61 and 62 via the drive shaft 60.

  Moreover, the 1st, 2nd holding parts 61 and 62 are comprised substantially the same as the 1st holding part 8 and the 2nd holding part 9 in the thermocoagulation incision forceps 2 of 1st Embodiment. That is, as shown in FIG. 10B, the upper first gripping portion 61 is provided with a heat generating portion 69 for applying thermal energy to the living tissue at a position facing the lower second gripping portion 62. ing. The heat generating portion 69 is configured in the same manner as the heat generating portion 16 (see FIGS. 3A to 3C) of the first embodiment. The heat generating portion 69 is a metal blade that heats the living tissue by transmitting heat from the three heat generating elements 17a, 17b, and 17c of the first embodiment and the three heat generating elements 17a, 17b, and 17c. And a heat transfer plate 18. A receiving member 70 is provided at a position facing the heat generating portion 69 in the lower second gripping portion 62.

  Similarly to the first embodiment, lead wires 20a to 20c for supplying power are connected to each of the three heating elements 17a, 17b, and 17c. Each of the lead wires 20a to 20c extends through the insertion sheath portion 52 to the operation portion 53 side.

  The operation unit body 58 is provided with a cord connection unit 71. The base end portions of the lead wires 20 a to 20 c are connected to the inner end portion of the cord connecting portion 71. Further, one end of a connection cord 72 is connected to the outer end portion of the cord connection portion 71. The other end of the connection cord 72 is connected to the power supply device 3 (see FIG. 1) as in the first embodiment. Then, the output control is performed on the three heat generating elements 17a, 17b, and 17c of the heat generating unit 69 of the present embodiment in the same manner as in the first embodiment.

  Next, the operation of the above configuration will be described. Here, a case where a living tissue is treated using the endoscopic forceps 51 of the present embodiment will be described. First, the distal end of the treatment portion 54 of the endoscopic forceps 51 and the insertion sheath portion 52 is introduced into the body cavity via a trocar or the like (not shown) punctured into the body wall.

  Thereafter, the movable handle 57 is opened and the first and second gripping portions 61 and 62 are opened, and the living tissue is positioned between the first and second gripping portions 61 and 62. In this state, next, the movable handle 57 is operated in the closing direction, and the living tissue is gripped between the first gripping portion 61 and the second gripping portion 62.

  After grasping the living tissue, by operating the foot switch 4 (see FIG. 1), three heat generations of the heat generating unit 69 from the power supply device 3 through the connection cord 72, the cord connection unit 71, and the lead wires 20a to 20c. Electric power is supplied to the elements 17a, 17b, and 17c, and the three heat generating elements 17a, 17b, and 17c of the heat generating portion 69 are caused to generate heat. At this time, output control is performed in the same manner as in the first embodiment to perform coagulation and incision of the living tissue. Thereby, the coagulation incision of the living tissue is performed as in the first embodiment.

  Therefore, the above configuration has the following effects. That is, even in the endoscopic forceps 51 of the present embodiment, in the same manner as the scissor-type thermocoagulation incision forceps 2 of the first embodiment, the contact state of the living tissue without flowing current to the patient In addition, it is possible to detect the dry state and the like, and from the result, it is possible to control the output during normal coagulation / incision of the living tissue.

  Furthermore, the present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the scope of the present invention.

  INDUSTRIAL APPLICABILITY The present invention is effective in the technical field of manufacturing and using a surgical treatment instrument for performing treatments such as incision, coagulation, and hemostasis by applying heat to a treatment site of a biological tissue including blood vessels.

BRIEF DESCRIPTION OF THE DRAWINGS The schematic block diagram of the whole system of the surgical treatment tool of the 1st Embodiment of this invention. The side view of the thermocoagulation incision forceps of the surgical treatment tool of 1st Embodiment. (A) is the longitudinal cross-sectional view of the treatment part of the thermocoagulation incision forceps of 1st Embodiment, (B) is the IIIB-IIIB sectional view taken on the line of (A), (C) is the IIIC-IIIC line of (A) Sectional drawing, (D) is a longitudinal sectional view of the main part showing a modification of the treatment part of the thermocoagulation incision forceps. The block diagram which shows schematic structure inside the power supply device of the treatment tool system for surgery of 1st Embodiment. The characteristic view for demonstrating an example of the output control by the thermocoagulation incision forceps of 1st Embodiment. The flowchart for demonstrating the control which starts the output at the time of the coagulation incision by the thermocoagulation incision forceps of 1st Embodiment. The flowchart for demonstrating the control which stops the output at the time of the coagulation incision by the thermocoagulation incision forceps of 1st Embodiment. The flowchart for demonstrating the control which notifies the output state by the thermocoagulation incision forceps of 1st Embodiment. The flowchart for demonstrating the modification of the control which stops the output at the time of the coagulation incision by the thermocoagulation incision forceps of 1st Embodiment. 4A and 4B show a second embodiment of the present invention, in which FIG. 5A is a side view of the entire endoscopic forceps, and FIG. 5B is a longitudinal sectional view of a treatment portion of the endoscopic forceps.

Explanation of symbols

    DESCRIPTION OF SYMBOLS 2 ... Thermocoagulation incision forceps (treatment tool main body), 8 ... 1st holding part, 9 ... 2nd holding part, 10 ... Treatment part, 15 ... Operation part, 16 ... Heat generating part, 32 ... CPU (control means), 35 ... output power control means, 39 ... output state determination means.

Claims (6)

A treatment part that is disposed at a distal end portion of the treatment instrument body and includes a pair of graspable parts that can be opened and closed; and an operation part that is disposed at a proximal end part of the treatment instrument body and that opens and closes the grasping part. In a surgical treatment instrument provided with a heat generating part for heat-treating a biological tissue grasped between the grasping parts on at least one of the grasping parts,
Output power control means for supplying and controlling heat generation power for driving the heat generating section to generate heat;
The output power supplied from the output power control means to the heat generating part is detected, and at least one of the presence or absence of a living tissue grasped between the grasping parts or the state of the living tissue grasped between the grasping parts is determined. Discriminating means for discriminating;
Control means for driving and controlling at least one of supply of heat generation power from the output power control means or notification of the discrimination result based on the discrimination result of the discrimination means;
A surgical treatment instrument comprising: The control means is connected to a switch for driving the heat generating portion to generate heat,
The output power control means is in a standby state in which weak power for detecting the state of the heat generating part is supplied to the heat generating part when the power is turned on, and for performing a biological treatment on the heat generating part when the switch is turned on. The surgical treatment instrument according to claim 1, wherein the surgical treatment tool is switched to a normal driving state in which heat generation power is supplied. The control means includes a first set value W1 for output start power detection for detecting output start power that is switched from the standby state to the normal drive state, and an end state for ending the heating treatment of the living tissue. A second set value W2 for detection is preset,
The determining means determines that there is a living tissue held between the holding portions by detecting a state where the detected value of the output power exceeds the first set value W1 in the standby state, By detecting a state in which the detected value of the output power is lower than the second set value W2 in the normal driving state, it is determined as a heating treatment end state of the living tissue held between the holding parts. The surgical treatment tool according to claim 2, wherein:   The control means counts the time after the detected value of the output power exceeds the first set value W1 when the determining means determines that the living tissue is present, and sets a preset setting. The surgical treatment tool according to claim 3, wherein when the switch is turned on for a time Twait or less, output start control is performed to switch the output power control means to the normal drive state.   When the control means determines that the heating treatment has been completed for the living tissue, the control means rapidly increases the detected value of the output power immediately before the detected value of the output power falls below the second set value W2. The difference ΔW between the detected value Wtn-1 at the time point tn-1 that changes to the detected value Wtn at the time point tn at which the detected value of the output power changes abruptly in the region below the second set value W2 is arbitrary. The surgical treatment tool according to claim 3, wherein output stop control for stopping output of the normal driving state by the output power control means is performed when it is detected that the output power control value is larger than the power set value Ws.   The control means has an arbitrary set time in which a state in which the detected value of the output power is lower than the second set value W2 is preset when it is determined by the determination means that the living tissue has been heated. The surgical treatment tool according to claim 3, wherein output stop control for stopping output of the normal driving state by the output power control means is performed at the time when the state that has been continued is detected.

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