JP2006289061A - Electric surgical apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To detect generation or the fear of generation of insulation breakdown of a treatment tool, and to avoid or support for avoiding troubles generated by the insulation breakdown of the treatment tool. <P>SOLUTION: The electric surgical apparatus is equipped with an electric power supplying means for outputting high frequency electric power for supplying to a treatment tool, a load impedance measuring means for measuring a load impedance value of the treatment tool brought into contact with the treatment subject site, an insulation breakdown judging means for judging the presence or absence of the insulation breakdown of the treatment tool or supporting this detection with the condition of the load impedance value, and a controlling means for controlling the electric power supply means to restrain the outputted electric power of the electric power supplying means according to the judged result of the insulation breakdown judging means and/or an informing means for delivering the judged result of the insulation breakdown judging means to an operator. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an electrosurgical apparatus for performing medical treatment such as excision and coagulation on a living tissue using high-frequency power.

  An electrosurgical apparatus that performs medical treatment such as excision and coagulation on living tissue using a high-frequency current is known. This electrosurgical apparatus is generally the main body of an electrosurgical apparatus and is a high-frequency current. And a treatment tool provided with an electrode for performing medical treatment by high-frequency current in contact with a treatment target site of a patient. As the types of treatment tools, monopolar treatment tools and bipolar treatment tools are known. The monopolar treatment tool is connected to one output terminal of the high-frequency ablation power supply device and connected to the treatment tool main body having an electrode to be brought into contact with the treatment target site of the patient, and to the other output terminal. It has a return electrode portion that is brought into surface contact with the body surface. Then, high-frequency power is generated by the high-frequency ablation power supply device, the electrode of the treatment tool body is brought into contact with the site to be treated, the high-frequency current flows intensively into the living tissue, and the high-frequency current is dispersed and collected from the return electrode portion Thus, medical treatment such as excision and coagulation of living tissue can be performed. In addition, the bipolar treatment instrument does not have a return electrode part, and the treatment instrument body is provided with electrodes that are respectively connected to the output terminals of the high-frequency ablation power supply device.

  In general, when the supply of high-frequency power from the high-frequency ablation power supply device to the treatment tool is started, heat generated in the living tissue by the high-frequency power and heat propagated from the electrode of the treatment tool main body that has generated heat by the high-frequency power to the living tissue The living tissue evaporates and tissue degeneration occurs, and the load impedance increases with time. Then, the voltage drop due to the load impedance increases, and the output voltage of the electrosurgical device increases. When the output voltage reaches a predetermined voltage, arc discharge starts from the electrode of the treatment instrument body to the living tissue, and the excision action on the living tissue starts by this arc discharge. In addition to the excision action, the action on living tissue can be coagulated by modulating the waveform of the high-frequency current into an intermittent waveform or lowering the output voltage from that at the time of excision. It can be performed.

  In such a treatment tool of an electrosurgical apparatus, an insulating coating is generally applied to a portion excluding an electrode. However, when this insulation coating is damaged and a dielectric breakdown occurs, when the dielectric breakdown part comes into contact with the living tissue, the biological tissue in contact with the dielectric breakdown part is heated and denatured or comes into contact with the dielectric breakdown part. There is a possibility that a problem such as a decrease in voltage applied to the treatment target site due to current leakage into the living tissue may occur. For this reason, it is necessary to use the electrosurgical apparatus while paying attention to the withstand voltage of the treatment tool.

  In recent years, electrosurgery has been increasingly performed endoscopically in consideration of minimal invasiveness to patients. Endoscopic electrosurgery means inserting an endoscope into the body cavity of a patient, inserting a treatment tool for electrosurgery into a treatment tool channel provided in the endoscope, and treating the affected area. It is. At this time, since the treatment instrument is used by being inserted into the treatment instrument channel of the endoscope, the outer diameter is formed thin. For this reason, the withstand voltage with respect to the high frequency electric power of a treatment tool is small compared with the withstand voltage of the treatment tool for general surgery which is not for endoscopes. Therefore, when using a treatment tool inserted into an endoscope, it is necessary to pay more attention to the withstand voltage of the treatment tool.

  However, the output power level of the electrosurgical apparatus main body is generally adjustable, and the output voltage changes depending on the setting state of the output power level. Therefore, conventionally, for example, information on the maximum operating voltage value described in the instruction manual of the treatment tool, and characteristics of the output voltage corresponding to the setting state of each output power level described in the instruction manual of the electrosurgical device Based on this information, the operator adjusted the output power level while paying attention so that the output voltage value did not exceed the maximum operating voltage value of the treatment tool, so the operation was troublesome.

  Therefore, for example, in Japanese Utility Model Publication No. 8-5687, when a special treatment tool having a function of transmitting a withstand voltage value to the electrosurgical device is connected to the electrosurgical device body, high-frequency power that can be applied to the connected treatment tool. A means for automatically recognizing the maximum voltage value of the electrosurgical device and controlling the output voltage from the electrosurgical apparatus so as not to exceed the maximum voltage value is shown.

  However, in Japanese Utility Model Publication No. 8-5687 mentioned in the prior art, the treatment tool connectable to the electrosurgical apparatus main body is limited to a dedicated one having a function of transmitting the maximum voltage value to the electrosurgical apparatus. However, there is a problem that the selection range of the treatment tool is narrowed and the treatment tool is expensive.

  In addition, in Japanese Utility Model Publication No. 8-5687, although means for preventing dielectric breakdown of the treatment instrument is shown, when dielectric breakdown of the treatment instrument actually occurs, means for detecting the occurrence of this dielectric breakdown is provided. Since it is not shown, there is a problem that the living tissue that contacts the dielectric breakdown part is heated and denatured, or current that leaks to the biological tissue that contacts the dielectric breakdown part and the voltage applied to the treatment target site decreases. There was a risk of it occurring.

  The present invention has been made in view of the above circumstances, and detects that there is a risk of occurrence or occurrence of dielectric breakdown of the treatment instrument, and provides support for avoiding or avoiding problems caused by dielectric breakdown of the treatment instrument. It is an object of the present invention to provide an electrosurgical apparatus that can perform the above-described operation.

  In order to achieve the above object, the electrosurgical device of the present invention performs medical treatment on the treatment target site by bringing the electrode of the treatment tool into contact with the treatment target site and applying electric energy to the treatment target site. In an electrosurgical apparatus, power supply means for outputting high-frequency power to be supplied to the treatment tool, load impedance measurement means for measuring a load impedance value of the treatment tool in contact with the treatment target site, and the load impedance measurement means And determining whether or not the treatment instrument has a dielectric breakdown according to the state of the load impedance value measured in step (b), or a dielectric breakdown determination unit for supporting the determination, and an output of the power supply unit in accordance with a determination result of the dielectric breakdown determination unit The control means for controlling the power supply means to suppress electric power and the judgment results of the dielectric breakdown judgment means are transmitted to the operator. Characterized by comprising at least one of the intellectual means.

  According to the present invention, there is an effect that it is possible to detect whether or not there is a possibility of dielectric breakdown of the treatment instrument, or to avoid or assist in avoiding a malfunction caused by the dielectric breakdown of the treatment instrument.

Embodiments of the present invention will be described below with reference to the drawings.
1 to 12 relate to a first embodiment of the present invention, FIG. 1 is an explanatory view showing the overall configuration of an electrosurgical apparatus, and FIG. 2 shows a configuration of a treatment instrument different from the treatment instrument shown in FIG. FIG. 3 is a block diagram showing the configuration of the high-frequency ablation power supply device, FIG. 4 is a block diagram showing the configuration of the withstand voltage value input unit, FIG. 5 is a block diagram showing the functional configuration of the control circuit, and FIG. FIG. 7 is a block diagram showing the configuration of the second breakdown determination unit, FIG. 8 is a block diagram showing the configuration of the third breakdown determination unit, and FIG. FIG. 10 is an explanatory diagram showing an example of the action of the voltage limiting control, FIG. 10 is an explanatory diagram showing an example of a treatment instrument body that has undergone dielectric breakdown, and FIG. 11 is an explanatory diagram showing an example of dielectric breakdown determination timing by the second dielectric breakdown determination unit, FIG. 12 shows the timing of dielectric breakdown determination by the third breakdown determination unit. Example is an explanatory view showing the.

  As shown in FIG. 1, an electrosurgical surgical apparatus 1 according to the present embodiment is provided with a treatment tool 3 for applying high-frequency power in contact with a patient 2 and performing treatment such as excision and coagulation on a treatment target site 2a; A high-frequency ablation power supply 4 for generating high-frequency power to be supplied to the treatment instrument 3 and a switch 5 connected to the high-frequency ablation power supply 4 with a cable and instructing the output of the high-frequency power. Has been.

  The high-frequency ablation power supply device 4 has two output terminals 11a and 11b that output power to be supplied to the treatment instrument 3, and an operation panel 12 for performing operations such as operation setting of the high-frequency ablation power supply device 4. Yes.

  The treatment instrument 3, which is a monopolar treatment instrument, includes a treatment instrument body 21 provided with an electrode 21a that performs treatment in contact with the treatment target site 2a, and extends from the treatment instrument body 21, with the other end connected to the output terminal 11a. An electrically connected cord 22, a return electrode portion 23 that is in surface contact with the body surface 2b other than the treatment target site 2a of the patient 2, and extends from the return electrode portion 23, with the other end connected to the output terminal 11b. The cord 24 is configured to be configured.

In addition, you may comprise the said operation switch 5 so that instruction | indication including the kind of treatment, such as excision and coagulation | solidification, can be carried out, for example. Further, the operation switch 5 may be a foot switch as shown in the figure, and is not limited to a foot switch, and may be any means that can instruct the high-frequency ablation power supply device 4 to generate a high frequency. The main body 21 or the like may be provided with a switch.
Further, a part or all of the operation panel 12 may be provided not only by being fixed to the casing of the high-frequency ablation power supply device 4 but also via a cable, or may be provided in the operation switch 5. It may be provided on the treatment instrument main body 21.

Further, instead of the treatment instrument 3 that is a monopolar treatment instrument, a treatment instrument 3a that is a bipolar treatment instrument shown in FIG. 2 may be provided. As shown in the figure, the treatment instrument 3a includes a treatment instrument body 25 including two electrodes 25a that are in contact with the treatment target site 2a of the patient 2, and the two electrodes 25a are connected to the output terminal 11a of the high-frequency ablation power supply device 4. , 11b, and cords 26 that are electrically connected to each other.
As shown in FIG. 3, the inside of the high-frequency ablation power supply 4 converts a power supplied from a commercial power supply and supplies a power supply circuit 31 for supplying power to each part of the high-frequency ablation power supply 4, and a high-frequency ablation power supply A control circuit 32 for controlling each part of the apparatus 4, a waveform generation circuit 33 for generating a high frequency of a waveform used for treatment, which is controlled by the control circuit 32, and a high frequency obtained by the waveform generation circuit 33 A variable amplifying circuit 34 that amplifies according to the gain instructed from the control circuit 32, a boosting circuit 35 that boosts the high frequency obtained by the variable amplifying circuit 34 and outputs it to the output terminals 11a and 11b, and the boosting circuit 35 Output voltage measuring circuit 36 and output current measuring circuit 37 for measuring high-frequency output voltage and output current output from output terminals 11a and 11b, respectively, and these output voltages A / D conversion circuits 36a and 37a for A / D converting the output voltage value signal obtained by the constant circuit 36 and the output current value signal obtained by the output current measuring circuit 37 and supplying the signals to the control circuit 32; A buzzer 38 that is controlled and controlled by the control circuit 32 is provided.

  The control circuit 32 includes, for example, a microprocessor 32a and a memory element (not shown) that stores a program executed by the microprocessor 32a. The control circuit 32 includes a signal given from the operation switch 5, a signal given from the operation panel 12, and the output voltage measuring circuit 36 and the output current measuring circuit 37 via A / D conversion circuits 36a and 37a, respectively. In response to the given signal, a control signal for instructing the waveform generation circuit 33 to generate a waveform generated by the waveform generation circuit 33, and a gain of the variable amplification circuit 34 for the variable amplification circuit 34. Generates a control signal or the like instructed via the A conversion circuit 34a.

  The waveform generation circuit 33 includes, for example, a high frequency generation circuit 33a that generates a high frequency, and a modulation signal generation circuit 33b that generates a waveform signal for ablation and a waveform signal for coagulation in response to an instruction from the control circuit 32. And a modulation circuit 33c for modulating the high frequency obtained by the high frequency generation circuit 33a with the signal obtained by the modulation signal generation circuit 33b.

  The booster circuit 35 includes, for example, a step-up transformer 35a that inputs the high frequency obtained by the variable amplifier circuit 34 from the primary side and outputs the high frequency boosted from the secondary side. At this time, a capacitor connected in series to the secondary side of the step-up transformer 35a and removing a direct current component or a low frequency component may be provided. Further, a capacitor for parallel resonance may be provided on the primary side of the step-up transformer 35a.

  As shown in FIG. 4, a withstand voltage value input unit 41 for inputting a withstand voltage value that is the maximum voltage value allowed to be applied to the treatment instrument 3 is provided on the operation panel 12, for example. The withstand voltage value input unit 41 includes a display unit 42 that displays a set value of the current withstand voltage value, and buttons 43 and 44 that increase / decrease the set withstand voltage value by pressing, for example. Has been.

  As shown in FIG. 5, the control circuit 32 functionally includes a waveform control unit 51 that gives an operation instruction or the like to the waveform generation circuit 33 in accordance with a signal from the operation switch 5, and the operation panel 12, for example. The output control unit 52 that outputs a gain value to be supplied to the variable amplifier circuit 34 in accordance with the output power level set in step S1 and the withstand voltage value input by the withstand voltage value input unit 41 should have a margin. The withstand voltage value correcting unit 53 to be corrected, and the output control unit so that the output voltage value of the high frequency power output from the high frequency cautery power supply device 4 does not exceed the withstand voltage value corrected by the withstand voltage value correcting unit 53. An output voltage limit control unit 54 for adjusting the gain value output from 52, and the output voltage measurement circuit 36 and the output current measurement circuit 37, respectively, are provided via A / D conversion circuits 36a and 37a, respectively. A load impedance measuring unit 55 that obtains a load impedance value by, for example, dividing the force voltage value and the output current value, and the state of the load impedance value obtained by the load impedance measuring unit 55 are monitored, whereby the treatment instrument 3 A first dielectric breakdown determination unit 56, a second dielectric breakdown determination unit 57, a third dielectric breakdown determination unit 58, and the dielectric breakdown determination units 57 and 58 for determining whether or not dielectric breakdown has occurred. Output suppression control for controlling the gain value to suppress the output of high-frequency power from the high-frequency ablation power supply device 4 to the treatment instrument 3 when at least one of them determines that the dielectric breakdown has occurred in the treatment instrument 3 A portion 59 is provided. The output voltage limit control unit 54 compares the output voltage value given from the output voltage measurement circuit 36 via the A / D conversion circuit 36 a with the withstand voltage value corrected by the withstand voltage value correction unit 53. A value comparison unit 54a and a gain value adjustment unit 54b that adjusts the gain value so that the output voltage value does not exceed the corrected withstand voltage value according to the comparison result of the voltage value comparison unit 54a. ing.

  When the dielectric breakdown determination unit 56 detects that there is a risk of dielectric breakdown of the treatment instrument 3, the buzzer 38 is driven to visually convey this state to the operator, and the occurrence of dielectric breakdown is visually confirmed. For example, a warning display (not shown) on the operation panel 12 is driven to notify the surgeon. When at least one of the dielectric breakdown determination units 57 and 58 detects the occurrence of dielectric breakdown of the treatment instrument 3, not only the output power is suppressed by the output suppression control unit 59 but also the occurrence of dielectric breakdown. The buzzer 38 is driven in order to audibly convey to the operator, and a warning display is activated in order to visually convey the occurrence of dielectric breakdown to the operator. Note that the tone of the buzzer 38 and the content of the warning display are different between when the buzzer 38 and the warning display are driven by the dielectric breakdown determination unit 56 and when driven by the other breakdown determination units 57 and 58. It has become.

  The output control unit 52 not only outputs a gain value according to the set output power level, but also outputs an output voltage value given from the output voltage measurement circuit 36 via the A / D conversion circuit 36a. A constant voltage control function for adjusting the gain value to maintain the voltage value of the output current, and the output current value given from the output current measurement circuit 37 via the A / D conversion circuit 37a is a predetermined current value. It may have a constant current control function to increase or decrease the gain value so as to maintain the output power value, obtain the output power value from the output voltage value and the output current value, and maintain the output power value at a predetermined power value. It may have a constant power control function to adjust the amount.

  Further, the output suppression control unit 59 may suppress the output power by stopping it, or may suppress it by adjusting the output power to a weak level. Further, the output suppression control unit 59 may suppress the output power by adjusting the gain value given to the variable amplifier circuit 34, or may output a signal other than the signal indicating the gain value to the waveform generation circuit 33 or the The output power may be suppressed by giving it to the variable amplifier circuit.

  As illustrated in FIG. 6, the dielectric breakdown determination unit 56 compares, for example, a determination value storage unit 56 a that stores a predetermined determination value, a determination value of the determination value storage unit 56 a and a load impedance value, and loads impedance The impedance value comparison unit 56b is configured to determine that there is a possibility that dielectric breakdown has occurred when the value becomes smaller than the determination value. Here, the determination value may be empirically, for example, 1000Ω. The dielectric breakdown determination unit 56 may be configured to determine that there is a possibility that dielectric breakdown has occurred when the load impedance value becomes smaller than a predetermined determination value, and is not necessarily configured as shown in the figure. May be.

  As shown in FIG. 7, the dielectric breakdown determination unit 57 includes, for example, a change rate calculation unit 57a that obtains a change rate of the load impedance value with respect to time, and the load impedance value increases due to the output of the change rate calculation unit 57a. It is insulated when the load impedance is suddenly decreased by the output of the increase determination unit 57b that detects that the load is being increased, and the output of the change rate calculation unit 57a and the output of the increase determination unit 57b. It has a reduction determination unit 57c that determines that destruction has occurred. The dielectric breakdown determination unit 57 may be configured to determine that the dielectric breakdown has occurred when the load impedance is suddenly reduced when the load impedance is increasing, and is not necessarily configured as illustrated. It does not have to be.

  As shown in FIG. 8, the dielectric breakdown determination unit 58, for example, calculates a change amount of the load impedance value and detects a low change amount state in which the change amount is small, and the change amount calculation unit 58a. The timer unit 58b is configured to determine that dielectric breakdown has occurred when the duration of the low change amount state detected by the 58a exceeds a predetermined time. Here, the predetermined time may be empirically, for example, 5 seconds. The dielectric breakdown determination unit 58 may be configured to determine that the dielectric breakdown has occurred when the duration of the state where the change amount of the load impedance value is low exceeds a predetermined time. The configuration may not be shown.

Next, the normal action when the dielectric breakdown does not occur will be described among the actions of the present embodiment.
When the output power level is set on the operation panel 12, for example, the output control unit 52 outputs a gain value corresponding to the set output power level. This gain value is normally supplied to the variable amplifier circuit 34 via the D / A conversion circuit 34a without being adjusted by the output voltage limit control unit 54 and the output suppression control unit 59. Here, the output power level is represented by, for example, an output power value at a predetermined rated load impedance value at which the output power value from the high-frequency ablation power supply device 4 to the treatment instrument 3 is substantially maximum.

  When the operation switch 5 is operated, the waveform control unit 51 activates the waveform generation circuit 33. The waveform generation circuit 33 generates a high-frequency waveform corresponding to the type of treatment such as ablation treatment or coagulation treatment. To the variable amplifier circuit 34. The variable amplification circuit 34 amplifies the high frequency according to the gain value output from the output control unit 52, and this high frequency is given to the treatment instrument 3 via the booster circuit 35.

  Then, the high-frequency current flows in a concentrated manner from the electrode 21a of the treatment instrument body 21 of the treatment instrument 3 to the living tissue of the treatment target site 2a, and the inflowed high-frequency current comes into surface contact with the body surface 2b other than the treatment target site 2a. Are dispersed and collected from the return electrode portion 23. Then, the treatment target part 2a is heated by the heat generated by the high frequency current flowing into the treatment target part 2a and the heat conducted from the electrode 21a generated by the high frequency current. Even when the treatment instrument 3a is used in place of the treatment instrument 3, the treatment target portion 2a that is in contact with the electrode 25a of the treatment instrument body 25 is heated.

  The living tissue of the treatment target site 2a at the time when heating is started contains a lot of moisture and the impedance of the living tissue, that is, the load impedance is small. As heating proceeds, moisture such as cell fluid evaporates, tissue degeneration progresses, and load impedance begins to increase. When the load impedance value increases, the high-frequency output voltage value output from the high-frequency ablation power supply device 4 increases, and when this output voltage value reaches a predetermined voltage value, the ablation treatment or coagulation treatment is performed on the treatment target site 2a. Etc. are given.

  At this time, as shown in FIG. 9, the output power from the treatment instrument 3 becomes a power value set as the output power level when the load impedance is in the vicinity of the rated load impedance, and decreases as the load impedance becomes far from the rated load impedance. To do. FIG. 9 shows an example of output power characteristics when 100 W, 150 W, and 200 W are set as the output power level, for example. By setting the output power level, the time required for degeneration of the living tissue changes, and the time from when the operation switch 5 is operated to when the treatment such as excision and coagulation is completed can be adjusted.

  The output control unit 52 performs constant voltage control for keeping the output voltage value constant, constant current control for keeping the output current value constant, constant power control for keeping the output power value constant, and the like. You may make it perform.

Next, an operation for preventing dielectric breakdown will be described.
The withstand voltage value input prior to the treatment from the withstand voltage value input unit 41 is corrected by the withstand voltage value correcting unit 53 to have a margin, and the corrected withstand voltage value is given to the output voltage limit control unit 54. It is done. Further, the output voltage value is measured by the output voltage measurement circuit 36 and is given to the output voltage limit control unit 54 via the A / D conversion circuit 36a to be monitored. For example, when a withstand voltage value of 100 V is set in the withstand voltage value input unit 41 and the withstand voltage value correction unit 53 is set to perform correction to reduce the withstand voltage value by, for example, 10%, 100 V to 10%. The reduced 90V value is supplied to the output voltage limit control unit 54 as a corrected withstand voltage value.

  Here, for example, the output voltage value increases due to an increase in load impedance, or the output voltage value becomes excessive because the output power level is set excessively, so that the withstand voltage value in which the output voltage value is corrected is When it exceeds, the voltage value comparison unit 54a of the output voltage limit control unit 54 detects this state, and the gain value adjustment unit 54b adjusts the gain value so that the output voltage value does not exceed the corrected withstand voltage value. . Thereby, since the output voltage value does not exceed the corrected withstand voltage value, the dielectric breakdown of the treatment instrument 3 is prevented. Further, even when the output power level is set differently, the output voltage value is limited to a predetermined corrected withstand voltage value. Therefore, as shown in FIG. The output characteristics are almost the same regardless of the level setting.

Next, the operation when dielectric breakdown occurs will be described.
As shown in FIG. 10, a conductive member such as a conductor 21b for supplying a high-frequency current to the electrode 21a is inserted into the treatment instrument main body 21, and a portion other than the electrode 21a of the treatment instrument main body 21 is provided with an insulation coating 21c or the like. An insulating member is provided. In the electrosurgical device 1 of the present embodiment, as described above, by controlling so that the output voltage does not exceed the withstand voltage value of the treatment tool 3, a measure for preventing the dielectric breakdown of the insulating coating 21c is taken. However, for example, the insulation coating 21c may be damaged due to heat, impact, chemical reaction, or the like from the outside, and there is a risk of insulation breakdown in which the conductive wire 21b is exposed. When dielectric breakdown occurs, for example, the contact site 2c of the living tissue with which this dielectric breakdown part contacts is denatured, current leaks from this contact site 2c, and the voltage applied to the treatment target site 2a decreases. In general, the electrosurgical device 1 according to the present embodiment is provided with means for avoiding a problem caused by dielectric breakdown, as will be described later.

First, an operation related to the first dielectric breakdown determination unit 56, which is one of means for avoiding problems due to dielectric breakdown, will be described.
When neither the electrode 21a nor the treatment instrument main body 21 is in contact with the living tissue, no output current is generated. Therefore, the load impedance value obtained by the load impedance measuring unit 55 becomes a large value, and the first dielectric breakdown occurs. The determination unit 56 does not drive the buzzer 38 and the warning display. Further, when the electrode 21a is brought into contact with the treatment target site 2a for treatment, an output current is generated, and naturally the load impedance is reduced as compared with the case of non-contact. The unit 56 drives the buzzer 38 and a warning display. At this time, the buzzer 38 and the warning display are driven, but the buzzer 38 and the warning display that are driven when the operator brings the electrode 21a into contact with the treatment target site 2a are not caused by the occurrence of dielectric breakdown. Let the person judge. Further, when the surgeon is not in contact with the treatment target site 2a when the surgeon is not in contact with the treatment target site 2a, a current flows from the dielectric breakdown unit and the first dielectric breakdown determination unit 56 receives the buzzer 38. And drive warning display. At this time, since the buzzer 38 and the warning display are driven even though the electrode 21a is not in contact with the treatment target site 2a, the operator can determine that dielectric breakdown has occurred. Then, an operator who recognizes the occurrence of dielectric breakdown can avoid the occurrence of problems due to dielectric breakdown, for example, by interrupting the treatment.

  The first dielectric breakdown determination unit 56 drives the buzzer 38 and the warning display even when the dielectric breakdown does not occur normally. Therefore, the buzzer 38 and the warning display are displayed by the other dielectric breakdown determination units 57 and 58. The timbre and warning display contents of the buzzer 38 are different from those when driven.

Next, an operation related to the second dielectric breakdown determination unit 57 will be described.
As shown in FIG. 11, when the dielectric breakdown part contacts the contact part 2c other than the treatment target part 2a when the load impedance is increased due to the tissue degeneration of the treatment target part 2a, the insulation breakdown part contacts the contact part 2c. Current leaks, and the load impedance viewed from the high-frequency ablation power supply device 4 rapidly decreases. Then, the dielectric breakdown determination unit 57 that has detected that the load impedance has rapidly decreased while the load impedance is increasing determines that the dielectric breakdown has occurred, and drives the buzzer 38 and the warning display to generate the dielectric breakdown. The operator is informed, and the output suppression control unit 59 controls the variable amplification circuit 34 to stop or suppress the output power to a weak level. As a result, the surgeon can recognize the occurrence of dielectric breakdown and avoid problems caused by the occurrence of dielectric breakdown.

Next, the operation related to the third dielectric breakdown determination unit 58 will be described.
When the dielectric breakdown part is in contact with the contact part 2c other than the treatment target part 2a, current leaks from the dielectric breakdown part to the contact part 2c, and the tissue degeneration of the treatment target part 2a does not proceed, as shown in FIG. A low change amount state in which the change amount of the load impedance is small. Then, the dielectric breakdown determination unit 58 that detects that this low change amount state has continued for a predetermined time, for example, 5 seconds, determines that dielectric breakdown has occurred, and drives the buzzer 38 and a warning display to generate dielectric breakdown. The output suppression control unit 59 controls the variable amplification circuit 34 to stop or suppress the output power to a weak level. As a result, the surgeon can recognize the occurrence of dielectric breakdown and avoid problems caused by the occurrence of dielectric breakdown.

As described above, according to the present embodiment, it is possible to prevent a voltage exceeding the withstand voltage value from being applied to the treatment instrument without using a special treatment instrument, and to prevent dielectric breakdown of the treatment instrument. The effect is obtained.
In addition, by providing the dielectric breakdown determination units 57, 58, etc., when a dielectric breakdown occurs in the treatment instrument, the occurrence of the dielectric breakdown of the treatment instrument can be detected, and problems caused by the dielectric breakdown of the treatment instrument can be avoided. An effect is obtained.
Further, by providing the dielectric breakdown determination unit 56 and the like, there is an effect that it is possible to detect that there is a possibility of the dielectric breakdown of the treatment instrument and to avoid the trouble caused by the dielectric breakdown of the treatment instrument. can get.

The present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the spirit of the invention.
For example, the treatment tools 3 and 3a may be used by being inserted into a treatment tool channel provided in an endoscope (not shown).

[Appendix]
(Appendix 1-1)
In an electrosurgical apparatus for performing medical treatment on the treatment target site by applying electrical energy to the treatment target site by bringing an electrode of a treatment tool into contact with the treatment target site,
Power supply means for outputting high-frequency power to be supplied to the treatment instrument;
Input means for inputting a withstand voltage value of the insulating member of the treatment instrument;
Control means for controlling the power supply means to limit the output voltage of the power supply means within a range not exceeding a withstand voltage value input from the input means or a voltage value obtained by correcting the input withstand voltage value. An electrosurgical apparatus comprising:

(Appendix 1-2)
The electrosurgical device according to appendix 1-1,
Correction means for correcting the withstand voltage value input from the input means is provided.

(Appendix 1-3)
The electrosurgical device according to Additional Item 1-2,
The correction means corrects the withstand voltage value input from the input means so as to have a margin.

(Appendix 1-4)
The electrosurgical device according to Additional Item 1-3,
The correction means corrects the withstand voltage value input from the input means by subtracting the input withstand voltage value so as to have a margin.

(Appendix 1-5)
The electrosurgical device according to appendix 1-1,
Means for controlling the output of the power supply means according to the set output power level is provided.

(Appendix 1-6)
The electrosurgical device according to Additional Item 1-5,
The output power level is represented by a power value in a load impedance state where the output power value of the power supply means is substantially maximum.

(Appendix 1-7)
The electrosurgical device according to Additional Item 1-5,
Regardless of the setting state of the output power level, the control means outputs the output of the power supply means within a range not exceeding a withstand voltage value input from the input means or a voltage value obtained by correcting the input withstand voltage value. The power supply means is controlled to limit the voltage.

(Appendix 1-8)
The electrosurgical device according to appendix 1-1,
Constant voltage control means for controlling the power supply means to keep the output voltage value of the power supply means constant is provided.

(Appendix 1-9)
The electrosurgical device according to Additional Item 1-8,
Regardless of the control state of the constant voltage control means, the control means is capable of controlling the power supply means within a range not exceeding a withstand voltage value input from the input means or a voltage value obtained by correcting the input withstand voltage value. The power supply means is controlled to limit the output voltage.

(Appendix 1-10)
The electrosurgical device according to appendix 1-1,
Constant current control means for controlling the power supply means to maintain a constant output current value of the power supply means is provided.

(Appendix 1-11)
The electrosurgical device according to Additional Item 1-10,
Regardless of the control state of the constant current control means, the control means is provided with the power supply means within a range not exceeding a withstand voltage value input from the input means or a voltage value obtained by correcting the input withstand voltage value. The power supply means is controlled to limit the output voltage.

(Appendix 1-12)
The electrosurgical device according to appendix 1-1,
Constant power control means for controlling the power supply means to maintain a constant output power value of the power supply means is provided.

(Appendix 1-13)
The electrosurgical device according to Additional Item 1-12,
Regardless of the control state of the constant power control means, the control means has the power supply means within a range not exceeding a withstand voltage value input from the input means or a voltage value obtained by correcting the input withstand voltage value. The power supply means is controlled to limit the output voltage.

(Appendix 1-14)
The electrosurgical device according to appendix 1-1,
Output voltage measuring means for monitoring the output voltage of the power supply means is provided.

(Appendix 2-1)
In an electrosurgical apparatus for performing medical treatment on the treatment target site by applying electrical energy to the treatment target site by bringing an electrode of a treatment tool into contact with the treatment target site,
Power supply means for outputting high-frequency power to be supplied to the treatment instrument;
A load impedance measuring means for measuring a load impedance value of the treatment tool in contact with the treatment target site;
A dielectric breakdown judging means for judging the presence or absence of dielectric breakdown of the treatment instrument according to the state of the load impedance value measured by the load impedance measuring means, or supporting this judgment;
Among control means for controlling the power supply means to suppress the output power of the power supply means according to the judgment result of the dielectric breakdown judgment means, and notification means for transmitting the judgment result of the dielectric breakdown judgment means to the operator An electrosurgical apparatus comprising at least one of the above.

(Appendix 2-2)
The electrosurgical device according to Additional Item 2-1,
The dielectric breakdown determining means includes a first state in which the load impedance value measured by the load impedance measuring means is smaller than a predetermined value, and a second state in which the load impedance value measured by the load impedance measuring means decreases rapidly. Insulation breakdown occurs in the treatment instrument when at least one of the state and the third state that continues for a predetermined time while the change amount of the load impedance value measured by the load impedance measuring means is small is detected. An electrosurgical device characterized in that it is determined that there is a risk of occurrence or failure.

(Appendix 2-3)
The electrosurgical device according to Additional Item 2-2,
The dielectric breakdown determining means includes means for detecting at least the first state.

(Appendix 2-4)
The electrosurgical device according to Additional Item 2-3,
The dielectric breakdown determination means determines that there is a possibility that dielectric breakdown has occurred in the treatment instrument when the first state is detected.

(Appendix 2-5)
The electrosurgical device according to Additional Item 2-4,
Comprising the notification means,
The notification means informs the operator of the determination result of the dielectric breakdown determination means based on the detection of the first state.

(Appendix 2-6)
The electrosurgical device according to Additional Item 2-5,
The determination result transmitted to the operator by the notification means indicates that the dielectric breakdown occurs in the treatment instrument when the electrode of the treatment instrument is not in contact with the treatment target site.

(Appendix 2-7)
The electrosurgical device according to Additional Item 2-2,
The dielectric breakdown determination means includes means for detecting the second state.

(Appendix 2-8)
The electrosurgical device according to Additional Item 2-7,
The dielectric breakdown determination means determines that dielectric breakdown has occurred in the treatment instrument when the second state is detected.

(Appendix 2-9)
The electrosurgical device according to Additional Item 2-8,
Comprising the notification means,
The notification means notifies the operator of the determination result of the dielectric breakdown determination means based on the detection of the second state.

(Appendix 2-10)
The electrosurgical device according to Additional Item 2-8,
Comprising the control means;
The control means controls the power supply means in accordance with a determination result of the dielectric breakdown determination means due to detection of the second state.

(Appendix 2-11)
The electrosurgical device according to Additional Item 2-2,
The dielectric breakdown determination means includes means for detecting the third state.

(Appendix 2-12)
The electrosurgical device according to Additional Item 2-11,
The dielectric breakdown determination means determines that dielectric breakdown has occurred in the treatment instrument when the third state is detected.

(Appendix 2-13)
The electrosurgical device according to Additional Item 2-12,
Comprising the notification means,
The notification means informs the operator of the determination result of the dielectric breakdown determination means based on the detection of the third state.

(Appendix 2-14)
The electrosurgical device according to Additional Item 2-12,
Comprising the control means;
The control unit controls the power supply unit in accordance with a determination result of the dielectric breakdown determination unit due to detection of the third state.

(Appendix 2-15)
The electrosurgical device according to Additional Item 2-1,
The control means controls the power supply means to stop the output of the power supply means.

(Appendix 2-15)
The electrosurgical device according to Additional Item 2-1,
The load impedance measuring means includes means for measuring an output voltage value and an output current value for obtaining a load impedance value.

(Appendix 2-16)
The electrosurgical device according to Additional Item 2-7,
The means for detecting the second state detects the second state when the load impedance value measured by the load impedance measuring means rapidly decreases during the rise.

(Appendix 2-17)
The electrosurgical device according to Additional Item 2-1,
The notification means visually conveys the determination result to the operator.

(Appendix 2-18)
The electrosurgical device according to Additional Item 2-1,
The notification means audibly conveys the determination result to the operator.

(Appendix 3-1)
In an electrosurgical apparatus for performing medical treatment on the treatment target site by applying electrical energy to the treatment target site by bringing an electrode of a treatment tool into contact with the treatment target site,
Input means for inputting a rated voltage value of the treatment instrument,
An electrosurgical apparatus characterized by controlling an output voltage to the treatment tool in accordance with a rated voltage value input by the input means.

(Appendix 3-2)
The electrosurgical device according to Additional Item 3-1,
Control means for controlling the output voltage so that the output voltage does not exceed the rated voltage value is provided.

(Additional Item 3-3)
In an electrosurgical apparatus for performing medical treatment on the treatment target site by applying electrical energy to the treatment target site by bringing an electrode of a treatment tool into contact with the treatment target site,
Means for measuring a load impedance value of the treatment instrument;
An electrosurgical apparatus comprising: means for notifying an operator of the occurrence of this state when the load impedance value is lower than a predetermined value.

(Appendix 3-4)
In an electrosurgical apparatus for performing medical treatment on the treatment target site by applying electrical energy to the treatment target site by bringing an electrode of a treatment tool into contact with the treatment target site,
An electrosurgical apparatus comprising: means for recognizing a dielectric breakdown of the treatment instrument by controlling a change in load impedance of the treatment instrument and controlling output power to the treatment instrument.

(Appendix 3-5)
The electrosurgical device according to Additional Item 3-4,
When it is detected that the load impedance has dropped sharply, the treatment instrument is recognized as having undergone dielectric breakdown, and the output power to the treatment instrument is controlled.

(Appendix 3-6)
The electrosurgical device according to Additional Item 3-4,
When the state where the change amount of the load impedance is within the predetermined change amount continues for a predetermined time, it recognizes that the treatment instrument has broken down and controls the output power to the treatment instrument.

1 to 12 relate to a first embodiment of the present invention, and FIG. 1 is an explanatory view showing the overall configuration of an electrosurgical apparatus. Explanatory drawing which shows the structure of the treatment tool different from the treatment tool shown in FIG. Block diagram showing the configuration of the high-frequency ablation power supply Block diagram showing the configuration of the withstand voltage value input unit Block diagram showing functional configuration of control circuit The block diagram which shows the structure of a 1st dielectric breakdown determination part The block diagram which shows the structure of a 2nd dielectric breakdown determination part The block diagram which shows the structure of a 3rd dielectric breakdown determination part Explanatory drawing showing an example of the action of voltage limit control Explanatory drawing which shows an example of the treatment tool main body with insulation breakdown Explanatory drawing which shows an example of the dielectric breakdown judgment timing by the 2nd dielectric breakdown judgment part Explanatory drawing which shows an example of the dielectric breakdown judgment timing by the 3rd dielectric breakdown judgment part

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Electrosurgical operation apparatus 3, 3a ... Treatment tool 4 ... High frequency cauterization power supply device 12 ... Operation panel 21 ... Treatment tool main body 25 ... Treatment tool main body 32 ... Control circuit 38 ... Buzzer 41 ... Withstand voltage input part 52 ... Output control part 53 ... Withstand voltage value correction unit 54 ... Output voltage limit control unit 55 ... Load impedance measurement unit 56 ... (first) dielectric breakdown determination unit 57 ... (second) dielectric breakdown determination unit 58 ... (third) insulation Destruction determination unit 59 ... Output suppression control unit

Claims (6)

In an electrosurgical apparatus for performing medical treatment on the treatment target site by applying electrical energy to the treatment target site by bringing an electrode of a treatment tool into contact with the treatment target site,
Power supply means for outputting high-frequency power to be supplied to the treatment instrument;
A load impedance measuring means for measuring a load impedance value of the treatment tool in contact with the treatment target site;
A dielectric breakdown judging means for judging the presence or absence of dielectric breakdown of the treatment instrument according to the state of the load impedance value measured by the load impedance measuring means, or supporting this judgment;
Among control means for controlling the power supply means to suppress the output power of the power supply means according to the judgment result of the dielectric breakdown judgment means, and notification means for transmitting the judgment result of the dielectric breakdown judgment means to the operator An electrosurgical apparatus comprising at least one of the above.   The dielectric breakdown determining means includes a first state in which the load impedance value measured by the load impedance measuring means is smaller than a predetermined value, and a second state in which the load impedance value measured by the load impedance measuring means decreases rapidly. Insulation breakdown occurs in the treatment instrument when at least one of the state and the third state that continues for a predetermined time while the change amount of the load impedance value measured by the load impedance measuring means is small is detected. The electrosurgical device according to claim 1, wherein the electrosurgical device is determined to have a risk of occurrence or failure. The dielectric breakdown determination means determines that there is a possibility that dielectric breakdown has occurred in the treatment instrument when detecting at least the first state;
further,
A notification means for notifying an operator of the determination result of the dielectric breakdown determination means when detecting the first state;
The determination result transmitted to the operator by the notification means indicates that the dielectric breakdown occurs in the treatment instrument when the electrode of the treatment instrument is not in contact with the treatment target site. The electrosurgical device according to claim 1. The dielectric breakdown determination means determines that there is a possibility that dielectric breakdown has occurred in the treatment instrument when at least the second state is detected,
further,
A notification means for telling an operator the determination result of the dielectric breakdown determination means when detecting the second state;
Control means for controlling the power supply means in accordance with a determination result of the dielectric breakdown determination means by detecting the second state;
The electrosurgical device according to claim 1, comprising: The dielectric breakdown determination means determines that there is a possibility that dielectric breakdown has occurred in the treatment instrument when at least the third state is detected,
further,
A notifying means for notifying an operator of the determination result of the dielectric breakdown determining means when the third state is detected;
Control means for controlling the power supply means according to a determination result of the dielectric breakdown determination means by detecting the third state;
The electrosurgical device according to claim 1, comprising:   The electrosurgical apparatus according to claim 4 or 5, wherein the control means controls the power supply means to stop the output of the power supply means.

Images