JP2012183327A - 組織シールのためのシステムおよび方法 - Google Patents
組織シールのためのシステムおよび方法 Download PDFInfo
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Abstract
【課題】新規電気外科用システムを提供する。
【解決手段】組織をシールするための電気外科用双極鉗子10は、遠位端に配置された端部エフェクターアセンブリ100を有する1つ以上のシャフト部材12を含む。このエフェクターアセンブリは、第1の位置から閉鎖された位置まで移動可能な2つの顎部材110、120を含み、ここで、これら顎部材は協働して一定圧力で組織を握る。顎部材の各々は、電気外科用エネルギーをそれら間に保持された組織を通って伝える第1のエネルギー源2に連結される電気的に伝導性のシールプレート112、122を含む。この電気外科用エネルギーは、一定電圧で伝えられる。上シールプレートは、センサー回路に作動可能に連結されて、初期組織インピーダンス値を測定しコントローラーに伝達する。コントローラーは、初期インピーダンス値に基づき、組織に付与されるべき一定圧力および一定電圧を決定する。
【選択図】図1
【解決手段】組織をシールするための電気外科用双極鉗子10は、遠位端に配置された端部エフェクターアセンブリ100を有する1つ以上のシャフト部材12を含む。このエフェクターアセンブリは、第1の位置から閉鎖された位置まで移動可能な2つの顎部材110、120を含み、ここで、これら顎部材は協働して一定圧力で組織を握る。顎部材の各々は、電気外科用エネルギーをそれら間に保持された組織を通って伝える第1のエネルギー源2に連結される電気的に伝導性のシールプレート112、122を含む。この電気外科用エネルギーは、一定電圧で伝えられる。上シールプレートは、センサー回路に作動可能に連結されて、初期組織インピーダンス値を測定しコントローラーに伝達する。コントローラーは、初期インピーダンス値に基づき、組織に付与されるべき一定圧力および一定電圧を決定する。
【選択図】図1
Description
(背景)
(技術分野)
本開示は、電気外科的手順を実施するための電気外科用システムおよび方法に関する。より詳細には、本開示は血管をシールすることに関し、ここで、エネルギーが所定の時間の期間の間一定の所定の電圧で管理される。
(技術分野)
本開示は、電気外科的手順を実施するための電気外科用システムおよび方法に関する。より詳細には、本開示は血管をシールすることに関し、ここで、エネルギーが所定の時間の期間の間一定の所定の電圧で管理される。
(関連技術の背景)
電気外科は、手術部位に高周波電流の付与を含み、組織を切断、切除、または凝固する。単極電気外科では、供給源または能動電極が、電気外科用電源からの高周波エネルギーを組織に送達し、そして戻り電極が電源に電流を運ぶ。単極電気外科では、供給源電極は、代表的には、外科医によって保持される外科用器具の一部であり、そして処置されるべき組織に付与される。患者戻り電極は、能動電極から遠隔に配置され、電源に戻る電流を運ぶ。
電気外科は、手術部位に高周波電流の付与を含み、組織を切断、切除、または凝固する。単極電気外科では、供給源または能動電極が、電気外科用電源からの高周波エネルギーを組織に送達し、そして戻り電極が電源に電流を運ぶ。単極電気外科では、供給源電極は、代表的には、外科医によって保持される外科用器具の一部であり、そして処置されるべき組織に付与される。患者戻り電極は、能動電極から遠隔に配置され、電源に戻る電流を運ぶ。
双極電気外科では、ハンドヘルド器具の電極の一方が能動電極として、そして他方が戻り電極として機能する。この戻り電極は、能動電極に緊密に近接して、電気回路が2つの電極(例えば、電気外科用鉗子)間に形成されるように配置される。このようにして、付与された電流は、これら電極間に位置決めされた身体組織に限定される。これら電極が互いから十分に分離されるとき、この電気回路は開放され、そしてそれ故、これら分離された電極のいずれかとの身体組織の不慮の接触は、電流を流れさせない。
双極電気外科は、一般に、鉗子の使用を含む。鉗子は、その顎の間に、血管または組織を握り、クランプし、そして圧縮する機械的作用に依存するプライアー様器具である。所謂「開放鉗子」は、開放外科手順で一般に用いられ、その一方、「内視鏡鉗子」または「腹腔鏡鉗子」は、その名が示すように、より侵襲性の少ない内視鏡外科手順のために用いられる。電気外科用鉗子(開放または内視鏡)は、機械的クランプ留め作用および電気的エネルギーを利用し、クランプ留めされた組織上で止血を行う。この鉗子は、電気外科用エネルギーをクランプ留めされた組織に付与する電気外科用伝導性プレートを含む。この伝導性プレートを通って組織に付与される電気外科用エネルギーの強度、周波数および持続時間を制御することにより、外科医は、組織を、凝固、焼灼そして/またはシールし得る。
組織または血管シールは、組織中のコラーゲン、エラスチンおよび基礎物質を、それらが、対向する組織構造間で有意に減少した区分で融合された塊に再形成するように液化するプロセスである。焼灼は熱の使用を含んで組織を破壊し、そして凝固は、組織を乾燥するプロセスであり、ここで、この組織の細胞は、破壊されそして乾燥される。
組織シール手順は、単に組織を焼灼することより多くを含むので、有効なシールを生成するために、これら手順は、種々の因子の正確な制御を含む。血管または組織において適正なシールを行うために、2つの優勢な機械的パラメーターが正確に制御されなければならないことが決定された:組織に付与される圧力;および電極間のギャップである(すなわち、対向する顎部材間、または組織の周りで閉鎖される対向する電気的に伝導性のプレート間の距離)。
過去の多くの器具は、機械的および/または電気機械的様式で組織を単に切断するブレード部材またはせん断部材を含む。その他の器具は、一般に、適正なシール厚みを生成するためにクランプ留め圧のみに依存し、そしてしばしば、適正に制御される場合一貫性があり、かつ有効な組織シールを確実にし得るパラメーターであるギャップ許容誤差および/または平行度および平坦さ要求を考慮して設計されていない。
より高い破裂圧力に耐え得る耐久性のある血管シールの生成を可能にする新規な電気外科用システムおよび方法を開発する継続する必要性が存在する。
本開示は、血管または組織をシールするシステムおよび方法に関する。特に、このシステムは、組織を握るための形態の2つの顎部材を有する双極鉗子を開示する。これら顎部材の各々は、組織に電気外科用エネルギーを伝えるシールプレートを含む。この手順の開始で、このシステムは、初期組織インピーダンスを決定するために初期の質問のパルスを伝達する。この初期インピーダンスに基づき、このシステムは、最適圧力、電圧、およびエネルギー付与の持続時間を決定する。この手順の間に、一定圧力が組織に付与され、そして電気外科用エネルギーが所定の持続時間の間一定電圧で付与される。
本開示による1つの実施形態は、組織をシールするための電気外科用双極鉗子に関する。この鉗子は、遠位端の配置された端部エフェクターアセンブリを有する1つ以上のシャフト部材を含む。この端部エフェクターアセンブリは、第1の位置から閉鎖された位置まで移動可能な2つの顎部材を含み、ここで、これら顎部材が協働して一定の圧力でそれらの間に組織を握る。これら顎部材の各々は、電気外科用エネルギーをそれらの間に保持された組織を通じて伝える第1のエネルギー源に連結される電気的に伝導性シールプレートを含む。この電気外科用エネルギーは、一定電圧で伝達される。この電気的に伝導性のシールプレートは、初期組織インピーダンスを測定し、そして初期インピーダンス値をコントローラーに伝達するような形態のセンサー回路に作動可能に連結される。このコントローラーは、該初期インピーダンス値に基づき、上記組織に付与されるべき一定圧力および一定電圧を決定する。
本開示の別の実施形態は、電気外科用システムに関する。このシステムは、電気外科用エネルギーを供給する電気外科用電源、および組織を処置するための双極鉗子を含む。この双極鉗子は、遠位端に配置された端部エフェクターアセンブリを有する1つ以上のシャフト部材を含む。この端部エフェクターアセンブリは、第1の位置から閉鎖位置まで移動可能な2つの顎部材を含み、ここで、該顎部材が協働して一定の圧力でそれらの間に組織を握る。この顎部材の各々は、電気外科用エネルギーをそれらの間に保持された組織を通じて伝える第1のエネルギー源に連結された電気的に伝導性シールプレートを含む。この電気外科用エネルギーは一定電圧で伝達される。このシステムはまた、上記電気的に伝導性のシールプレートに作動可能に連結されたセンサー回路を含む。このセンサー回路は、初期組織インピーダンスを測定し、そして初期インピーダンス値をコントローラーに伝達するような形態である。このコントローラーは、上記初期インピーダンス値に基づき、上記組織に付与されるべき一定圧力および一定電圧を決定する。
本開示のさらなる実施形態は、組織をシールするための方法に関する。この方法は、遠位端に配置された端部エフェクターアセンブリを有する1つ以上のシャフト部材を含む電気外科用双極鉗子を提供する工程を含む。この端部エフェクターアセンブリは、第1の開放位置から閉鎖位置まで移動可能な2つの顎部材を含み、ここで、この2つの顎部材は協働して一定圧力で組織を握る。これら顎部材の各々は、それらの間に保持された組織を通じて電気外科用エネルギーを伝えるエネルギー源に連結された電気的に伝導性のシールプレートを含む。この電気外科用エネルギーは、一定電圧で伝えられる。この方法はまた、初期組織インピーダンスを測定する工程、および初期インピーダンス値をコントローラーに伝達する工程、およびこの初期インピーダンス値に基づき、上記組織に付与されるべき一定圧力および一定電圧を決定する工程を含む。
より特定すれば、本発明は、以下の項目に関し得る。
(項目1)組織をシールするための電気外科用双極鉗子であって:その遠位端の配置された端部エフェクターアセンブリを有する少なくとも1つのシャフト部材であって、該端部エフェクターアセンブリが、互いに対して間隔をおいた関係にある第1の位置から少なくとも1つの次の位置まで移動可能な2つの顎部材を含み、ここで、該顎部材が協働して一定の圧力でそれらの間に組織を握り;該顎部材の各々が、電気外科用エネルギーをそれらの間に保持された組織を通じて伝える第1のエネルギー源に連結されるよう適合された電気的に伝導性シールプレートを含み、該電気外科用エネルギーが一定電圧で伝達される、シャフト部材;および該電気的に伝導性のシールプレートに作動可能に連結されたセンサー回路であって、初期組織インピーダンスを測定するような形態であり、そして初期インピーダンス値をコントローラーに伝達し、該コントローラーが該初期インピーダンスに基づき、該組織に付与されるべき一定圧力および一定電圧を決定する形態であるセンサー回路を備える電気外科用双極鉗子。
(項目2)前記電気外科用エネルギーが、所定の持続時間の間伝えられる、(項目1)に記載の電気外科用双極鉗子。
(項目3)前記コントローラーが、さらに、前記初期インピーダンス値に基づき、シールサイクルの持続時間を決定するような形態である、(項目2)に記載の電気外科用双極鉗子。
(項目4)前記コントローラーが、少なくとも1つの持続時間値を格納する参照テーブルにアクセスし、該コントローラーが前記初期インピーダンス値に基づき、持続時間値を選択する、(項目3)に記載の電気外科用双極鉗子。
(項目5)前記コントローラーが、少なくとも1つの一定圧力値および少なくとも1つの一定電圧値の少なくとも1つを格納する参照テーブルにアクセスし、該コントローラーが前記初期値に基づき、圧力値および電圧値を選択する、(項目1)に記載の電気外科用双極鉗子。
(項目6)前記シャフト部材に機械的に連結された回転アセンブリをさらに備え、ここで、該回転アセンブリの回転が、該シャフト部材および前記端部エフェクターアセンブリに類似の回転移動を与える、(項目1)に記載の電気外科用双極鉗子。
(項目7)前記電気外科用エネルギーが、組織に所定量のエネルギーが供給されるまで伝えられる、(項目1)に記載の電気外科用双極鉗子。
(項目8)前記コントローラーが、前記初期インピーダンス値に基づき、前記所定量のエネルギーを決定する、(項目7)に記載の電気外科用双極鉗子。
(項目9)電気外科用システムであって:電気外科用エネルギーを供給する電気外科用電源;以下を備える組織を処置するための双極鉗子:その遠位端に配置された端部エフェクターアセンブリを有する少なくとも1つのシャフト部材であって、該端部エフェクターアセンブリが、互いに対して間隔をおいた関係にある第1の位置から少なくとも1つの次の位置まで移動可能な2つの顎部材を含み、ここで、該顎部材が協働して一定の圧力でそれらの間に組織を握り;該顎部材の各々が、それらの間に保持された組織を通じて電気外科用エネルギーを伝える、電気外科用電源に連結されるよう適合された電気的に伝導性シールプレートを含み、該電気外科用エネルギーが一定電圧で伝達される、シャフト部材;および該電気的に伝導性のシールプレートに作動可能に連結されたセンサー回路であって、加該センサー回路が初期組織インピーダンスを測定するような形態であり、そして初期インピーダンス値をコントローラーに伝達し、該コントローラーが該初期インピーダンス値に基づき、該組織に付与されるべき一定圧力および一定電圧を決定する形態であるセンサー回路を備える、電気外科用システム。
(項目10)前記コントローラーが、さらに、前記初期インピーダンス値に基づき、エネルギーサイクルの持続時間を決定するような形態である、(項目9)に記載の電気外科用システム。
(項目11)前記コントローラーが、少なくとも1つの持続時間値を格納する参照テーブルをアクセスし、該コントローラーが、前記初期インピーダンス値に基づき、持続時間値を選択する、(項目10)に記載の電気外科用システム。
(項目12)前記コントローラーが、少なくとも1つの一定圧力値および少なくとも1つの一定電圧値を格納する参照テーブルをアクセスし、該コントローラーが、前記初期インピーダンス値に基づき、一定圧力値および一定電圧値を選択する、(項目9)に記載の電気外科用システム。
(項目13)組織をシールするためのシステムであって:以下を備える電機外科用双極鉗子:その遠位端に配置された端部エフェクターアセンブリを有する少なくとも1つのシャフト部材であって、該端部エフェクターアセンブリが、互いに対して間隔をおいた関係にある第1の位置から少なくとも1つの次の位置まで移動可能な2つの顎部材を含み、ここで、該顎部材が協働して一定の圧力でそれらの間に組織を握り、該顎部材の各々が、一定電圧で電気外科用エネルギーを該顎部材の間に保持された組織を通じて第1のエネルギー源に連結するよう適合された電気的に伝導性シールプレートを含む、シャフト部材;および初期インピーダンス値に基づき組織に付与される一定圧力および一定電圧を決定する手段;および該初期インピーダンス値に基づき該組織に付与される一定圧力および一定電圧を決定する手段を備える、システム。
(項目14)前記測定する手段のコントローラーが、さらに、前記初期インピーダンス値に基づき、前記エネルギーサイクルの持続時間を決定するような形態である、(項目13)に記載のシステム。
(項目15)前記測定する手段のコントローラーが、少なくとも1つの持続時間値を格納する参照テーブルにアクセスし、該コントローラーが、前記初期インピーダンス値に基づき、持続時間値を選択する、(項目14)に記載のシステム。
(項目16)前記測定する手段のコントローラーが、少なくとも1つの一定圧力値および少なくとも1つの一定電圧値を格納する参照テーブルにアクセスし、該コントローラーが、前記初期インピーダンス値に基づき、圧力値および電圧値を選択する、(項目13)に記載のシステム。
シールするための電気外科用双極鉗子が開示される。この鉗子は、遠位端に配置された端部エェクターアセンブリを有する1つ以上のシャフト部材を含む。この端部エェクターアセンブリは、第1の位置から閉鎖された位置まで移動可能な2つの顎部材を含み、ここで、これら顎部材は協働して一定圧力で組織を握る。顎部材の各々は、電気外科用エネルギーをそれら間に保持された組織を通って伝える第1のエネルギー源に連結される電気的に伝導性のシールプレートを含む。この電気外科用エネルギーは、一定電圧で伝えられる。上記電気的に伝導性のシールプレートは、センサー回路に作動可能に連結され、これは、初期組織インピーダンスを測定し、そして初期インピーダンス値をコントローラーに伝達するような形態である。このコントローラーは、この初期インピーダンス値に基づき、組織に付与されるべき一定圧力および一定電圧を決定する。これらの構成により、より高い破裂圧力に耐え得る血管シールの生成を可能にする新規な電気外科用システムが提供される。
本開示の種々の実施形態は、図面を参照して本明細書中に記載される。
図1は、本開示による電気外科用システムの1つの実施形態の斜視図である。
図2は、本開示による電源の概略ブロック図である。
図3は、その中に握られる組織とともに示される図1の端部エフェクターの後部斜視図である。
図4は、本開示による内視鏡鉗子の部分側面図である。
図5は、本開示による内視鏡双極鉗子を用いるシール方法のフローチャート図を示す。
図6は、図5に示される方法を利用するシールの間の組織インピーダンスにおいて生じる変化を示すグラフを示す。
図7は、本発明の顎配列が採用され得る開放鉗子の図である。
(詳細な説明)
本開示の特定の実施形態は、添付の図面を参照して本明細書で以下に記載される。以下の説明において、周知の機能または構成は、不必要な詳細で本開示を不明りょうにすることを避けるために詳細には記載されていない。当業者は、本開示による発明が、内視鏡器具または開放器具のいずれかの使用に適合され得ることを理解する。各々の特定タイプの器具に異なる電気的および機械的連結などが適用されることもまた認識されるべきであるが、血管シールに関する新規な局面は、開放または内視鏡設計の両方に対してほぼ一致している。
本開示の特定の実施形態は、添付の図面を参照して本明細書で以下に記載される。以下の説明において、周知の機能または構成は、不必要な詳細で本開示を不明りょうにすることを避けるために詳細には記載されていない。当業者は、本開示による発明が、内視鏡器具または開放器具のいずれかの使用に適合され得ることを理解する。各々の特定タイプの器具に異なる電気的および機械的連結などが適用されることもまた認識されるべきであるが、血管シールに関する新規な局面は、開放または内視鏡設計の両方に対してほぼ一致している。
以下の図面および説明において、用語「近位」は、使用者により近い鉗子10の端部をいい、その一方、用語「遠位」は、使用者からより遠い鉗子の端部をいう。
図1は、電気外科用システム1の概略図である。このシステム1は、患者の組織を処置するための電気外科用鉗子10を含む。電気外科用RFエネルギーは、ケーブル18を経由して電源2によって鉗子10に供給され、鉗子が組織をシールすることを可能にする。
図1に示されるように、この鉗子10は、内視鏡血管シール双極鉗子である。この鉗子10は、エフェクターアセンブリ100を支持するような形態である。より詳細には、鉗子10は、一般に、ハウジング20、ハンドルアセンブリ30、回転アセンブリ80、およびトリガーアセンブリ70を含み、これらは端部エフェクターアセンブリ100と互いに協働して組織を握り、シールし、そして必要であれは分割する。この鉗子10はまた、端部エェクターアセンブリ100と機械的に係合する遠位端14、および回転アセンブリ80の近位方向にあるハウジング20と機械的に係合する近位端16を有するシャフト12を含む。
この鉗子10はまた、ケーブル18を経由して、電気外科用エネルギーの供給源、例えば、電源2に鉗子10を連結するプラグ(図示せず)を含む。ハンドルアセンブリ30は、固定ハンドル50および移動可能なハンドル40を含む。ハンドル40は、固定ハンドル50に対して移動し、端部エェクターアセンブリ100を作動し、そして図3に示されるように使用者が組織400を握り、そして操作することを可能にする。
図1、3および4を参照して、端部エェクターアセンブリ100は、一対の対向する顎部材110および120を含み、各々は、それらの間に保持された組織400を通じて電気外科用エネルギーを伝導するためにそれらに取り付けられた電気的に伝導性のシールプレート112および122をそれぞれ有する。より詳細には、これら顎部材110および120は、開放位置から閉鎖位置までハンドル40の移動に応答して移動する。開放位置では、これらシールプレート112および122は、互いに対して間隔を置いた関係で配置される。クランプ留めまたは閉鎖位置で、これらシールプレート112および122は、協働して組織を握り、そしてそれに電気外科用エネルギーを付与する。
これら顎部材110および120は、ハウジング20内に囲われた駆動アセンブリ(図示されず)を用いて作動される。この駆動アセンブリは、移動可能ハンドル40と協働し、これら顎部材110および120の開放位置からクランプ留めまたは閉鎖位置への移動を与える。ハンドルアセンブリの例は、同一人が所有する「血管シーラーおよび分割器およびその製造方法」と題する米国出願第10/369,894号および同一人が所有する「小トロカールおよびカニューレとの使用のための血管シーラーおよび分割器」と題する米国出願第10/460,926号に示され、かつ記載され、これらは両者ともそれらの全体が本明細書中に参考として援用される。
顎部材110および120はまた、外側ハウジング116および126を含み、これらは、顎部材110および120の伝導性プレート112および122の寸法と一緒に、組織シールに関連する既知の所望されない影響、例えば、フラッシュオーバー、熱拡散および漂遊電流散逸の多くを制限および/または減少するような形態である。
この特定の開示のハンドルアセンブリ30は、4つのバーの機械的連結を含み得、これは、顎部材110および120間の組織をシールするとき、特有の機械的利点を提供する。一旦、シール部位について所望の位置が決定され、そして顎部材110および120が適正に位置決めされると、ハンドル40は完全に圧縮されて電気的に導電性のシールプレート112および122を組織に対して閉鎖位置にロックする。1つの想定される鉗子10の相互作動構成要素の相互協働関係に関する詳細は、上記で引用した同一人が所有する米国特許出願第10/369,894号中に開示されている。軸を離れ、レバー様のハンドルアセンブリを開示する内視鏡ハンドルアセンブリの別の例は、上記で引用された米国特許出願第10/460,926号に開示されている。
鉗子10はまた、シャフト12と機械的に連結される回転アセンブリ80および駆動アセンブリ(図示せず)を含む。回転アセンブリ80の移動は、シャフト12に対して類似の回転移動を与え、これは、次に、端部エェクターアセンブリ100を回転する。電気外科用エネルギーのハンドルアセンブリ20および回転アセンブリ80を通る転移のための種々の電気的形態とともに種々の特徴が、上記に記載の同一人に所有の米国特許出願第10/369,894号および同第10/460,926号により詳細に記載されている。
図1および4について最も良く観察されるように、端部エェクターアセンブリ100は、シャフト12の遠位端14に取り付けられる。顎部材110および120は、ピボット160の周りで、駆動アセンブリ(図示せず)の相対的往復、すなわち、長軸方向移動に際し、開放位置から閉鎖位置に回動可能である。再び、端部エェクターアセンブリ100の種々の移動要素に関する機械的および協働関係は、上記で述べた同一人に所有の米国特許出願第10/369,894号および同第10/460,926号による例によってさらに説明されている。
鉗子10は、特定の目的に依存して、または特定の結果を達成するために完全または部分的に使い捨て可能であるように設計され得ることが想定される。例えば、端部エェクターアセンブリ100は、シャフト12の遠位端14と選択的かつ離脱可能に係合可能であり得るか、そして/またはシャフト12の近位端16は、ハウジング20およびハンドルアセンブリ30と選択的かつ離脱可能に係合可能であり得る。これら2つの例のいずれかでは、この鉗子10は、新たな、または異なる端部エフェクターアセンブリ100、または端部エフェクターアセンブリ100およびシャフト12が必要に応じて古い端部エフェクターアセンブリ100を選択的に置換するように用いられる場合のように、部分的使い捨て可能であるか、または再配置可能であり得る。
電源2は、電源2を制御するための入力制御(例えば、ボタン、アクチベーター、スイッチ、タッチスクリーンなど)を含む。さらに、この電源2は、外科医に種々の出力情報(例えば、強度設定、処置終了インジケーターなど)を提供するための1つ以上のディスプレイスクリーンを含み得る。これら制御は、外科医が、RFエネルギーの電力、波形、およびその他のパラメーターを調節することを可能にし、特定のタスク(例えば、凝固、組織シール、強度設定など)のために適切な所望の波形を達成する。この鉗子10は、電源2の特定の入力制御には余分であり得る複数の入力制御を含み得ることがまた想定される。この鉗子10に入力制御を配置することは、使用者が電源2との相互作用を必要とすることなく外科手順の間のRFエネルギーパラメーターのより容易およびより迅速な改変を許容する。
図2は、コントローラー4、高電圧DC電源7(「HVPS」)、RF出力ステージ8およびセンサー回路11を有する電源2の概略ブロック図を示す。このDC電源7は、DC電力をRF出力ステージ8に提供し、これは、次いで、DC電力をRFエネルギーに変換し、そしてRFエネルギーを鉗子10に送達する。このコントローラー4は、揮発型メモリー(例えば、RAM)および/または不揮発型メモリー(例えば、フラッシュ媒体、ディスク媒体など)であり得るメモリー6に作動可能に接続されたマイクロプロセッサ5を含む。このマイクロプロセッサ5は、HVPS7および/またはRF出力ステージ8に作動可能に接続され、開放および/または閉鎖制御ループスキームのいずれかに従って、マイクロプロセッサ5が電源2の出力を制御することを可能にする。閉鎖ループ制御スキームは、複数の感知機構(例えば、組織インピーダンス、組織温度、出力電流および/または電圧など)を含み得るセンサー回路11のフィードバック制御ループであり得、コントローラー4にフィードバックを提供する。このコントローラー4は、次いで、HVPS7および/またはRF出力ステージ8に信号を送り、これらは、次いで、DCおよび/またはRF電源をそれぞれ調節する。コントローラー4はまた、電源2および/または鉗子10の入力制御からの入力信号を受ける。コントローラー4は、この入力信号を、電源2によって供給される電力を調節するため、そして/またはそれに対するその他の制御機能を実施するために利用する。
この特定の実施形態に関して、組織400のシールは、ギャップ制御、圧力および電気的制御の特有の組み合わせによって達成される。換言すれば、シールプレート112および122を通じて組織に付与される電気外科用エネルギーの強度、周波数および持続時間を制御することが、組織をシールするための重要な電気的考慮である。さらに、2つの機械的因子が、シールされた組織の得られる厚み、およびこのシールの有効性を決定することにおいて重要な役割を演じ、すなわち、シールプロセスの間の対向する顎部材110および120間に付与される圧力(約3kg/cm2と約16kg/cm2との間)および顎部材110および120の対向するシールプレート112および122間のギャップ距離「G」(約0.001インチ〜0.006インチの間)である。1つ以上のストップ部材90が代表的には、ギャップ距離を制御するために1つまたは両方のシールプレート上に採用される。第3の機械的因子が、最近、組織シールの質および一貫性に寄与することが決定され、すなわち、能動化の間の電気的に伝導性面またはシールプレートの閉鎖速度である。
鉗子10は電極を通じてエネルギーを付与するので、顎部材110および120の各々は、それらの内方に面する面上に配置された、一対の電気的に導電性のシールプレート112、122をそれぞれ含む。従って、一旦、これら顎部材110および120が組織400の周りで完全に圧縮されると、鉗子10は、ここで、図4に示されるように、電気外科用エネルギーの選択的付与のための準備が整う。この点で、電気的シールプレート112および122は、電気外科用エネルギーの付与に際し、それらの間に保持された組織400をシールするように協働する。
本開示によるシステム1は、エネルギーおよび圧力の付与を調節し、高い破裂圧力に耐え得る有効なシールを達成する。電源2は、一定電圧および調節された圧力で組織にエネルギーを付与する。圧力は、顎部材110および120を所定の率で閉鎖することによって調節される。エネルギー付与は、メモリー6内に格納されたアルゴリズムに従ってコントローラー4によって調節される。このアルゴリズムは、一定電圧で組織に供給されるエネルギーを維持する。このアルゴリズムは、シールされる組織のタイプに基づき、出力を変える。例えば、より厚い組織は、それに付与されるより多くの電力を必要とし、その一方、より薄い組織はより少なくて済む。それ故、このアルゴリズムは、特定の変数(例えば、維持される電圧、電力付与の持続時間など)を改変することにより組織タイプに基づく出力を調整する。
このアルゴリズムは、図5を参照して以下にさらに詳細に論議される。さらに、図6は、図5の方法を用いるシールを受けるとき、コラーゲンに生じることが予期される変化を示すグラフを示す。
ステップ300の間に、シールプレート112および122は能動化され、そして組織400と接触するが、完全には閉鎖されない。これらシールプレート112および122が組織400と接触するとき、ステップ302で、質問パルスが組織400に付与される。この質問パルスは、センサー回路11を経由して初期インピーダンスを感知するために用いられる。このパルスは小電圧および短い持続時間である。
ステップ304では、上記初期インピーダンスは、コントローラー4に伝達され、これは、シール手順のための最適電圧およびエネルギー付与の持続時間を決定する。特に、ママイクロプロセッサ5は、メモリー6中に位置する参照テーブルを用い得る。この参照テーブルは、複数の初期インピーダンス範囲に対する電圧および持続時間値を有する。例えば、初期インピーダンスが約70〜約100オームであると測定される場合、特定の範囲について参照テーブルは、150Vの最適電圧値および30秒の持続時間を提供する。マイクロプロセッサ5は、この参照テーブルからこれらの値を抽出し、そしてそれに従って電源2を調節する。
エネルギー付与の最適電圧および持続時間は、手動で設定され得ることがまた想定される。上記初期インピーダンスは、電源2の表示スクリーン上に表示され得、そして外科医は、この測定された初期インピーダンスに従って、最適電圧および持続時間を設定し得る。
ステップ305では、鉗子10は、顎部材110および120を用いて組織400を握り、そして圧力を付与し始める。付与される圧力は、線P(t)によって示されるように、シール手順の持続時間の間で一定に保持される。
種々の方法およびデバイスが、組織の周りで顎部材110および120の閉鎖を自動的に調節し、シールプロセスの間で圧力を一定に保つことが企図される。例えば、鉗子10は、所望の組織圧力の下で組織に対して顎部材110および120をはじめにロックし、そして次に、マイクロプロセッサ5からの指令に従って、圧力を最適組織圧力まで増加するラチェット機構を含むような形態であり得る。このラチェット機構は、組織反応に基づき圧力を調節するような形態である。圧力は、類似の様式で、シールサイクルの終期に向かって制御、すなわち、圧力を解放され得ることがまた想定される。類似または同じラチット機構がこの目的のために同様に採用され得る。
その他の制御可能な閉鎖機構(すなわち、ギア機構、圧力支援機構、水力機構、電気−機械的など)がまた、ハンドルアセンブリ30、ハウジング20および/または顎部材110および120と組合せられ得ることが想定される。これら機構のいずれかが、ハウジング20内に収容され得るか、または各特定の構造の一部分を形成し得る。
1つ以上のストップ部材90が、シールを行う閉鎖圧力およびギャップ距離を調節するために選択可能に制御可能であることがまた想定される。同一人に所有される米国特許出願第10/846、262号は、この目的のために用いられ得るこのような可変ストップシステムを記載しており、その全体の内容は本明細書中に参考として援用される。
ステップ308では、電気外科用エネルギーが一定電圧で組織に付与される。その中に含まれるコラーゲンは変性され、そしてより移動性になる(すなわち、液化)。同時に、組織400内に含まれる水は、このシール部位から逃れるようにされる。結果として、シールが生成されるピーク温度は低減される。その後、先に溶融したコラーゲンはその構成要素(例えば、ポリマー)を織り交ぜることを可能にするために混合される。混合は、所定の圧力の下、シールプレート112および122を通じてシール部位に所定の周波数の電気外科用エネルギーを付与することにより達成され得る。波の最適周波数および振幅は、混合されているコラーゲン構造に依存し、そして上記で特定したように自動的に制御され得る。一旦、コラーゲンが混合されると、それは、電気外科用エネルギーおよび圧力の継続する付与によってさらに硬化される。
エネルギー付与は、所定の持続時間が満了したときに終了され得る。エネルギー付与は、一旦、所定量のエネルギーが組織に付与されると停止し得ることが想定される。従って、同じかまたは異なる参照テーブルはまた、シールを生成するために組織に付与される総エネルギーを格納し得る。初期インピーダンスが得られた後、マイクロプロセッサ5は、この総エネルギー値をロードし、そしてそれに従って電源の出力を調節する。
エネルギー付与の持続時間は、この手順の間に反復して決定され得る。マイクロプロセッサ5は、シールプロセスの間にマイクロプロセッサ5がエネルギー付与の持続時間を決定することを可能にするクロックを含む。コントローラー4は、初期インピーダンスが低下するために要する時間、および/またはインピーダンスが当初の値に上昇して戻る時間の長さを算出し得、両方の値は、図5のグラフでTdropおよびTriseとして示される。
本開示によるアルゴリズムは、組織がゆっくりと乾燥およびコラーゲンが同様にゆっくりと変性することを可能にする。一定電圧で比較的長い時間(例えば、30秒)の間のエネルギーの付与は、組織が非常にゆっくりと変化することを可能にする。乾燥が進行するとき、得られるシールは、プラスチック様品質を得、硬くかつ透明になり、これは、より高い破裂圧力に耐え得るシールを作製する。
先行する記載および種々の図面の描写から、当業者は、特定の改変がまた、本開示の範囲から逸脱することなく本開示になされ得ることを認識する。例えば、そして上記で述べたように、本明細書中に開示された種々の顎の配列のいずれかが、図7に示される開放鉗子700のような開放鉗子上で採用され得ることが企図される。この鉗子700は、シャフト512aおよび512bの遠位端516aおよび516bにそれぞれ取り付けられている端部エェクターアセンブリ600を含む。この端部エェクターアセンブリ600は、ピボットピン665の周りで回動可能に連結され、そして血管および/または組織を握るために互いに対して移動可能である、一対の対向する顎部材610および620を含む。これら対向する顎部材610および620の各々は、開放鉗子700がシール、凝固または焼灼のために組織をクランプ留めするために用いられることを可能にする電気的にシースルするプレート112、122を含む。
各シャフト512aおよび512bは、それらの近位端514aおよび514bに配置されたハンドル515および517をそれぞれ含み、その各々は指穴515aおよび517aをそれぞれ規定し、それを通じて使用者の指が受けられる。指穴515aおよび517aは、シャフト512aおよび512bの互いに対する移動を容易にし、これは、次に、顎部材610および620を、これら顎部材610および620が互いに対して間隔を置いて配置される開放位置から、これら顎部材610および620が協働してそれらの間に組織または血管を握るクランプ留めまたは閉鎖位置まで回動する。1つの特定の開放鉗子に関するさらなる詳細は、同一人が所有する「切断機構および遠位ロックアウトを備えた開放血管シール器具」と題する2004年10月8日に出願された米国特許出願第10/962,116号に記載されており、その全体の内容は、参考として本明細書中に援用される。
本開示のいくつかの実施形態が、図面に示され、そして/または本明細書中で論議されているけれども、本開示はそれらに限定されないことが意図されない。なぜなら、本開示は、当該技術分野が許容し、しかも同様に本明細書が読まれ得る程度広い範囲であることが意図されるからである。従って、上記の記載は、制限するものと解釈されるべきではなく、特定の実施形態の単なる例示である。当業者は、本明細書に添付の請求項の範囲および思想内でその他の改変を想定する。
(要約)
組織をシールするための電気外科用双極鉗子は、遠位端に配置された端部エフェクターアセンブリを有する1つ以上のシャフト部材を含む。このエフェクターアセンブリは、第1の位置から閉鎖された位置まで移動可能な2つの顎部材を含み、ここで、これら顎部材は協働して一定圧力で組織を握る。顎部材の各々は、電気外科用エネルギーをそれら間に保持された組織を通って伝える第1のエネルギー源に連結される電気的に伝導性のシールプレートを含む。この電気外科用エネルギーは、一定電圧で伝えられる。上シールプレートは、センサー回路に作動可能に連結されて、初期組織インピーダンス値を測定しコントローラーに伝達する。コントローラーは、初期インピーダンス値に基づき、組織に付与されるべき一定圧力および一定電圧を決定する。
組織をシールするための電気外科用双極鉗子は、遠位端に配置された端部エフェクターアセンブリを有する1つ以上のシャフト部材を含む。このエフェクターアセンブリは、第1の位置から閉鎖された位置まで移動可能な2つの顎部材を含み、ここで、これら顎部材は協働して一定圧力で組織を握る。顎部材の各々は、電気外科用エネルギーをそれら間に保持された組織を通って伝える第1のエネルギー源に連結される電気的に伝導性のシールプレートを含む。この電気外科用エネルギーは、一定電圧で伝えられる。上シールプレートは、センサー回路に作動可能に連結されて、初期組織インピーダンス値を測定しコントローラーに伝達する。コントローラーは、初期インピーダンス値に基づき、組織に付与されるべき一定圧力および一定電圧を決定する。
電気外科的手順を実施するための電気外科用システムが提供される。
1 電気外科用システム
2 電源
10 電気外科用鉗子
12 シャフト
14 遠位端
16 近位端
18 ケーブル
20 ハウジング
30 ハンドルアセンブリ
40 移動可能ハンドル
50 固定ハンドル
70 トリガーアセンブリ
80 回転アセンブリ
100 エフェクターアセンブリ
110、120 顎部材
112、122 シールプレート
2 電源
10 電気外科用鉗子
12 シャフト
14 遠位端
16 近位端
18 ケーブル
20 ハウジング
30 ハンドルアセンブリ
40 移動可能ハンドル
50 固定ハンドル
70 トリガーアセンブリ
80 回転アセンブリ
100 エフェクターアセンブリ
110、120 顎部材
112、122 シールプレート
Claims (1)
- 明細書に記載の発明。
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US11/338,480 US20070173813A1 (en) | 2006-01-24 | 2006-01-24 | System and method for tissue sealing |
US11/338,480 | 2006-01-24 |
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JP2007013172A Division JP5362957B2 (ja) | 2006-01-24 | 2007-01-23 | 組織シールのためのシステムおよび方法 |
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EP (2) | EP1810628B1 (ja) |
JP (2) | JP5362957B2 (ja) |
AU (1) | AU2007200271A1 (ja) |
CA (1) | CA2574865A1 (ja) |
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US9861424B2 (en) * | 2007-07-11 | 2018-01-09 | Covidien Lp | Measurement and control systems and methods for electrosurgical procedures |
US7834484B2 (en) * | 2007-07-16 | 2010-11-16 | Tyco Healthcare Group Lp | Connection cable and method for activating a voltage-controlled generator |
-
2006
- 2006-01-24 US US11/338,480 patent/US20070173813A1/en not_active Abandoned
-
2007
- 2007-01-23 JP JP2007013172A patent/JP5362957B2/ja not_active Expired - Fee Related
- 2007-01-23 CA CA002574865A patent/CA2574865A1/en not_active Abandoned
- 2007-01-23 AU AU2007200271A patent/AU2007200271A1/en not_active Abandoned
- 2007-01-24 EP EP07001481A patent/EP1810628B1/en not_active Expired - Fee Related
- 2007-01-24 ES ES07001481T patent/ES2328965T3/es active Active
- 2007-01-24 DE DE602007001539T patent/DE602007001539D1/de active Active
- 2007-01-24 EP EP09164754A patent/EP2103268B1/en not_active Not-in-force
-
2009
- 2009-06-09 US US12/481,087 patent/US20090292283A1/en not_active Abandoned
-
2012
- 2012-05-09 JP JP2012107434A patent/JP2012183327A/ja not_active Withdrawn
Also Published As
Publication number | Publication date |
---|---|
US20070173813A1 (en) | 2007-07-26 |
AU2007200271A1 (en) | 2007-08-09 |
ES2328965T3 (es) | 2009-11-19 |
DE602007001539D1 (de) | 2009-08-27 |
JP5362957B2 (ja) | 2013-12-11 |
EP1810628A1 (en) | 2007-07-25 |
CA2574865A1 (en) | 2007-07-24 |
US20090292283A1 (en) | 2009-11-26 |
EP2103268B1 (en) | 2012-06-27 |
EP1810628B1 (en) | 2009-07-15 |
EP2103268A1 (en) | 2009-09-23 |
JP2007195980A (ja) | 2007-08-09 |
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