JP2677456B2 - 電気手術器ジェネレータの自動制御 - Google Patents

電気手術器ジェネレータの自動制御

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JP2677456B2
JP2677456B2 JP7504783A JP50478394A JP2677456B2 JP 2677456 B2 JP2677456 B2 JP 2677456B2 JP 7504783 A JP7504783 A JP 7504783A JP 50478394 A JP50478394 A JP 50478394A JP 2677456 B2 JP2677456 B2 JP 2677456B2
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active electrode
body tissue
contacts
electrosurgical
generator
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JPH09501577A (ja
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クリセック，マイケル・エス
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ヴァリーラブ・インコーポレーテッド
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B18/1233—Generators therefor with circuits for assuring patient safety
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1402—Probes for open surgery
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00084—Temperature
    • A61B2017/00101—Temperature using an array of thermosensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/0016—Energy applicators arranged in a two- or three dimensional array
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00702—Power or energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A61B2018/00797—Temperature measured by multiple temperature sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00827—Current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00875—Resistance or impedance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00892—Voltage
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/1253—Generators therefor characterised by the output polarity monopolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar

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Description

【発明の詳細な説明】 1.発明の分野 能動電極と帰還電極との間の身体組織インピーダンス
のレベルに応答するようにした電気手術器ジェネレータ
の自動制御装置である。電気手術器ジェネレータの能動
リードから身体組織へ供給される高周波電力を複数の能
動電極接点の各々が個別に夫々独立的に伝送するように
した。それら複数の能動電極接点の各々に１つずつ付設
した複数の温度センサが、対応する能動電極接点におけ
る温度を示す信号を送出する。
2.開示の背景 ジェネレータを手動操作しているときには、手術用鉗
子を患者の身体組織に接触させる際に様々な問題が生じ
るため、ジェネレータの自動運転の試みがなされ、それ
に関する幾つかの特許が発行されている。米国特許第2,
827,056号、ドイツ特許第1,099,658号、ドイツ特許第28
23 291号に記載されている回路では、手術用鉗子の
２本の腕の間に直流電位を印加するようにしている。そ
の鉗子で患者の身体組織を鋏むと、挟まれた身体組織に
小さな直流電流が流れる。この直流電流によってリレー
回路が動作状態とされ、患者の身体組織に、手術効果を
付与するための大電力の高周波電力が流れるようにして
いる。それら回路では、一定の抵抗値を選択することに
よって、身体組織インピーダンスのレベルがそれ以下に
なったときに高周波電力を流し始めるインピーダンスの
レベルを決定するようにしている。
ドイツ特許第DE 25 40 968号に記載されている回
路では、測定用の低周波電流を用いて身体組織の相対イ
ンピーダンスを計測しており、特定の振幅範囲の低周波
電流が流れたならば、手術効果を付与するための高周波
ジェネレータ電力がオンになるようにしている。その回
路は更に、鉗子を身体組織に装着してからジェネレータ
が動作開始するまでの間の時間を制御するための時間遅
延用リレーを備えている。
以下に説明する幾つかの特許は、バイポーラ形装置を
用いて乾燥処置を実行する際に必要とされる、自動オフ
機能に関する特許である。ドイツ特許第DE 31 20 10
2 A1号に記載されている回路では、患者の身体組織イ
ンピーダンスの微分商（時間微分値）をモニタすること
によって、高周波電力の供給を停止すべき時刻を判定す
るようにしており、その時間微分値がゼロになった時刻
をもって電力供給を停止するように選択している。ドイ
ツ特許第DE 29 46 728 A1号に記載されている回路
では、調節可能な所定長さの時間遅れの後に高周波電力
をオフにするようにしている。ドイツ特許第DE 35 10
586号に記載されている回路では、制御用の低周波電流
を使用するか、或いは、ジェネレータの高周波電流源を
低電流レベルにして使用し、その電流レベルをモニタす
ることによって、手術効果を付与するためのジェネレー
タの高周波電力をオンにするようにしている。同特許の
回路は更に、ジェネレータの出力電圧をモニタして、そ
の出力電圧中に第３高調波成分が存在しているか否かを
調べている。第３高調波成分が現れるのは、乾燥が完了
して火花放電のために高調波周波数が発生し始めたとき
であり、そのときにジェネレータの高周波電力をオフに
するようにしている。これは、身体組織を流れる電流を
測定してその電流レベルを表すディジタル信号を生成す
るようにした装置である。この信号を利用して手動で装
置を操作するようにしている。
米国特許第4,860,745号は、測定して得た患者の身体
組織インピーダンスの微分値に基づいて高周波電力をオ
フにする場合に生じる問題を取り上げており、そのよう
な方法に替えて、乾燥処置の実行中に患者の身体組織に
供給されている高周波電流が一定割合の変化を生じたと
きに、或いは、ジェネレータの火花放電によって高調波
が発生したときに、それらに基づいてジェネレータの高
周波電力をオフにするようにした回路を提供している。
ピーク検出回路が、鉗子を通して流れる電流のピークを
調べており、またそれとは別の第２の回路が、凝固処置
の実行中の電流の減少をモニタしている。測定された夫
々の電流レベルは、それら回路内で夫々に電圧に変換さ
れる。こうして計測された電圧によって電気手術器ジェ
ネレータを制御して、ピーク電流に所定係数を乗じた大
きさが、凝固処置の実行中に身体組織を流れている電流
の測定値より大きくなったときに、電気手術器ジェネレ
ータをオフにするようにしている。身体組織を流れてい
る電流が、ピーク電流に所定係数を乗じた大きさより大
きければ、それが小さくなるまで電気手術器ジェネレー
タの出力を供給し続ける。
ドイツ特許2,455,174号は、スイッチとリレーとを組
合わせた構成に関するものであり、医師が常閉のスイッ
チを操作すると、それによってESU制御装置が動作状態
になる。即ち、このスイッチが開かれると、リレーが動
作し、それによって、鉗子の両腕の間のインピーダンス
値が所定範囲内にあるならば電気手術器ジェネレータが
動作状態とされる。本願発明は同特許の請求の範囲に包
含されるものではなく、なぜならば本願発明はスイッチ
もリレーも使用していないからである。更に、リレーを
動作させるための手動操作スイッチも要件とされてい
る。このスイッチは鉗子のハンドル部に取付けられてい
る。
米国特許第4,658,819号には、電極へ供給する電力
を、DC電源の電圧及び負荷の大きさの関数とする回路が
開示されており、負荷の大きさは、負荷電圧検出センサ
と負荷電流検出センサとで計測している。マイクロプロ
セッサ・コントローラが、それら電圧及び電流の夫々の
検出信号をディジタル化して、負荷インピーダンスと、
実際に供給されている電力とを算出する。このマイクロ
プロセッサ・コントローラは、これらの計測、算出、及
び修正のプロセスを、おおむねジェネレータが動作して
いる間中反復して実行する。米国特許第4,372,315号に
開示されている回路では、所定個数の高周波パルスから
成るパルス・バーストを反復して送出し、１回のパルス
・バーストを送出するごとに、その送出直後にインピー
ダンスを測定するようにしている。米国特許第4,321,92
6号は、注入量を制御するフィードバック・システムを
使用しているが、インピーダンスの検出はリアルタイム
では行われていない。米国特許第3,964,487号、同第3,9
80,085号、同第4,188,927号、及び同第4,092,986号は、
負荷インピーダンスの上昇に伴って出力電流を減少させ
る回路を使用している。これら特許の回路は、出力電圧
を一定値に維持して、負荷インピーダンスが上昇するに
つれて電流が減少するようにしている。米国特許第4,09
4,320号が使用している回路は、能動リード及び帰還リ
ードを流れる電流を検出することによって計測したイン
ピーダンスの変化に応答する。それら電流どうしの差を
取り、その差が可変スレショルド値を超えたならばジェ
ネレータをオフにする。その可変スレショルド値は、電
力レベルと漂遊容量を流れる漏れ電流の大きさとの関数
である。
フランス特許第2,573,301号では、モノポーラ形また
はバイポーラ形の高周波装置の電極の１つまたは２つの
熱電対として、その電極の温度をモニタし、それによっ
て身体組織が電極に凝着するのを防止している。米国特
許第4,492,231号は、バイポーラ形の鉗子形装置におけ
る温度と、鉗子のブレード部の伝導率と、乾燥した血液
の凝着特性とを論じている。
米国特許第4,232,676号及び同第4,314,559号はコーニ
ング・ガラス製作所に譲渡された特許であり、これら特
許には、ブレード部を、電気手術のための領域と高周波
電力を伝えない領域とを備えたものとすることが開示さ
れている。これら米国特許のうち米国特許第4,232,676
号では、同一のブレード部上に複数の電極を備えてバイ
ポーラ形装置を構成し、それら電極の間を流れる電力に
よって出血部位を焼灼するようにしている。それら米国
特許のうち米国特許第4,314,559号では、電気手術用ブ
レード部をコートした導電性の第１層と、非凝着性表面
を提供しているテフロン製の第２層とを備えている。導
電性の層は、その所々の部分が露出して電気手術用ブレ
ード部と表面との間の接続部を形成しており、テフロン
はその表面のうち露出部分どうしの間の隙間や継ぎ目等
だけを充填し、それによって、切断ないし凝固の機能を
有するその装置の表面を非凝着性表面にしている。
能動身体組織電極に設けられた複数の能動電極接点と
接触している１つないし複数の身体組織領域におけるイ
ンピーダンスに応答して、また、それら能動電極接点の
検出温度に応答して、供給電力の自動制御を行うための
回路は、これまで知られていなかった。種類が大きく異
なった身体組織が互いに非常に近接して存在している場
合であっても、それら組織の乾燥度を一定にすることが
望まれている。
発明の概要 電気手術器ジェネレータを自動制御するための自動制
御装置は、身体組織乾燥処置の実行中に電気手術器ジェ
ネレータの能動電極と帰還電極との間の身体組織インピ
ーダンスのレベルに応答する装置とすることが好まし
く、電気手術用高周波電力を供給するための能動リード
と帰還リードとを備えた電気手術器ジェネレータを含む
ものとすることができる。一対の能動電極身体組織接触
部材を、身体組織に装着できるようにしてある。それら
能動電極身体組織接触部材は、能動リードに接続してい
る。それら一対の能動電極身体組織接触部材の各々に１
つないし複数の能動電極接点を設けるようにすることが
できる。身体組織に対して電気手術効果を付与するため
に、能動電極身体組織接触部材の夫々から供給される高
周波電力を、それら能動電極接点の各々が個別に夫々独
立的に送出できるようにすることが好ましい。
帰還電極を電気手術器ジェネレータの帰還リードに接
続し、複数の能動電極接点の各々とその帰還電極との間
に、それらの間のインピーダンスの瞬時値を示す信号を
送出するインピーダンス・モニタ部を備えるようにして
もよい。インピーダンス・モニタ部からそれら信号を受
取るようにレギュレータ部を接続し、電気手術器ジェネ
レータ電力を複数の能動電極接点の各々から夫々独立的
に供給できるようにすることができる。レギュレータ部
を電気手術器ジェネレータの出力部に関連付けて、電気
手術器ジェネレータと、対応する能動電極接点との間の
高周波電力の伝送のレベルを変化させることによって、
能動電極接点の各々から帰還電極へ流れる電力を夫々独
立的に調節し、それによって、モニタして得られたイン
ピーダンス信号に応じて複数の能動電極の各々の間のイ
ンピーダンスを個別に夫々独立的に制御するようにする
ことができる。
１つないし複数の能動電極接点に１つないし複数の温
度センサを付設して、それら温度センサの各々が温度値
を電気手術器ジェネレータへ送信するように接続するこ
とができる。それら温度値は少なくとも各温度センサに
対応した能動電極接点の温度を示しているものである。
レギュレータ部を、温度値の瞬時値を受取り、温度変化
を評価して、能動電極接点の各々へ供給される電気手術
器ジェネレータ電力を夫々独立的に調節するように接続
することが好ましく、それによって複数の能動電極接点
の各々と帰還電極との間の身体組織に対して、温度値に
従って夫々独立的に電気手術効果を付与するようにする
のがよい。
絶縁支持部が、１つないし複数の能動電極接点を備え
た一対の身体組織接触部材を担持している構成とするこ
とができる。この絶縁支持部の所定位置に帰還電極を取
付けて、その帰還電極と好ましくは１つないし複数の能
動電極接点を備えた１つないし複数の能動電極身体組織
接触部材12との間に身体組織を挟めるようにし、それに
よって帰還電極を備えたモノポーラ形回路を形成するよ
うにしてもよい。少なくとも２つの能動電極身体組織接
触部材によって、１つないし複数の能動電極接点を担持
した鉗子を構成するようにすることが好ましい。それら
の接触部材、能動電極接点、または帰還電極を、互いに
接近及び離隔する方向に可動にして所定位置に取付ける
ことによって、それらの間に身体組織を挟めるようにし
てもよい。
能動電極身体組織接触部材と帰還電極とでバイポーラ
形装置を構成することも可能であり、それらをヒンジ結
合して鋏を構成するようにしてもよい。１つないし複数
の能動電極接点と帰還電極とを備えたその鋏の２つの鋏
刃どうしを、互いに電気的に絶縁する一方で、相対的に
可動状態に組合わせ、それによってそれらの間で電気手
術効果が得られるようにする。第１マルチプレクサを１
つないし複数の能動電極接点に接続して、電気手術器ジ
ェネレータの能動リードから複数の能動電極接点の各々
へ個別に夫々独立的に電気手術用高周波電力を供給する
ようにすることが好ましい。第２マルチプレクサを１つ
ないし複数の前記温度センサに接続して、各温度センサ
に対応した能動電極接点の近傍の温度を示している温度
値を電気手術器ジェネレータへ供給するようにすること
が好ましい。
細長形状の絶縁支持部が少なくとも１つの能動電極接
点を所定位置に担持している構成とし、それによって、
腹腔鏡処置に使用するためのモノポーラ形電気手術電極
が形成されるようにしてもよい。更にその絶縁支持部の
断面形状を円形として、トロカールで形成した、身体組
織を貫通する通路の中で、腹腔鏡手術器具として機能で
きるものとすることが好ましい。また、電気手術に用い
る電力レベルを所望のレベルに設定するためにユーザが
操作する制御部材を、電気手術器ジェネレータに設ける
ことが好ましい。
方法は、電気手術器ジェネレータの能動電極と帰還電
極との間の身体組織インピーダンスのレベルに応答し
て、電気手術器ジェネレータを自動制御するという方法
とすることが好ましい。能動電極は１つないし複数の能
動電極接点を備えたものとすることができ、かかる能動
電極接点を用いて、電気手術器ジェネレータから能動電
極及び帰還電極へ電気手術用電力を供給するステップを
実行する。能動電極に付設した１つないし複数の能動電
極接点を身体組織に装着することも、１つのステップで
ある。電気手術効果を身体組織に付与するために、能動
電極接点の各々へ個別に夫々独立的に高周波電力を供給
することも、もう１つの好適なステップである。続い
て、１つないし複数の能動電極接点と帰還電極との間の
インピーダンスを個別にモニタして、それらの間のイン
ピーダンスの瞬時値を示している信号を発生するという
追加のステップがある。インピーダンスの瞬時値を示し
ている信号をレギュレータ部で受取り、能動電極接点の
各々を介して印加される電気手術器ジェネレータ電力を
設定するというのが、更なる１つのステップである。能
動電極接点の各々と帰還電極との間のインピーダンスを
個別に夫々独立的に制御するというのも、レギュレータ
部において実行することのできる電気手術器ジェネレー
タの運転出力のための１つのステップである。電気手術
器ジェネレータと、対応する能動電極接点との間の高周
波電力の伝送レベルを変更し、帰還電極と能動電極接点
の各々との間を通過する電力を夫々独立的に調節すると
いうのが、この方法のもう１つのステップである。１つ
ないし複数の能動電極接点に接続した第１マルチプレク
サ28の接続を介して電気手術用高周波電力を個別に夫々
独立的に供給するというのも、この方法の１つのステッ
プである。
この方法を、次のような追加のステップを含んでいる
ものとしてもよく、そのステップとは、各々を１つない
し複数の能動電極接点に付設した１つないし複数の温度
センサを身体組織に装着し、それら温度センサの各々か
ら電気手術器ジェネレータへ、少なくとも当該温度セン
サに対応した能動電極接点の温度を示している温度値を
伝送するステップである。続いて、この方法は、次のよ
うな追加のステップを含むものとすることができ、その
ステップとは、温度信号の瞬時値を測定することによっ
て温度変化を評価し、もって能動電極接点の各々へ供給
される電気手術器ジェネレータ電力を夫々独立的に調節
し、それによって、能動電極接点の各々と帰還電極との
間の身体組織に対して、その温度値に応答して夫々独立
的に電気手術効果を付与するステップである。また更に
追加のステップとして、１つないし複数の温度センサに
接続した第２マルチプレクサの接続を介して個別に夫々
独立的に電気手術用高周波電力を評価し、各温度センサ
に対応した能動電極接点の温度を示している温度値を電
気手術器ジェネレータへ供給するステップを実行するよ
うにしてもよい。
図面の簡単な説明 図１は、患者を含めて構成される、モノポーラ形電気
手術器ジェネレータにおける回路を示した模式図であ
る。
図２は、図１の回路において使用可能な複数の能動電
極接点、及び／または、複数の温度センサを示した拡大
模式図である。
図３は、腹腔鏡手術装置として使用可能な鉗子の斜視
図であり、この鉗子は一対の能動電極を備え、それら能
動電極は夫々に、並設された複数の能動電極接点、及び
／または、複数の温度センサを備えており、図１に示し
た回路において離れて配置されている帰還電極と組合わ
されてモノポーラ形装置として使用されるものである
が、ただし図３には帰還電極を示していない。
図４は、腹腔鏡手術装置として使用可能な鉗子の斜視
図であり、この鉗子はバイポーラ形装置として構成さ
れ、１本の能動電極を備えており、この能動電極は複数
の能動電極接点、及び／または、複数の温度センサを備
え、帰還電極と選択的に接触するように移動可能に設け
られている。
図５は、能動電極と帰還電極とを備えたバイポーラ形
装置として構成した鋏の側面図であり、その能動電極は
複数の能動電極接点、及び／または、温度センサを備え
ている。
図６は、電気手術器ジェネレータを制御する制御装置
の一部であるインピーダンス・モニタ部及び温度検出部
の回路図である。
好適実施例の詳細な説明 図１〜図６に示したように、電気手術器ジェネレータ
11を自動的に制御するための自動制御装置10は、身体組
織乾燥処置の実行中に能動電極12と帰還電極13との間の
身体組織インピーダンスのレベルに応答して電気手術器
ジェネレータ11から電力を供給するようにした装置であ
り、電気手術用の高周波電力を供給するための能動リー
ド14及び帰還リード15を備えた自動制御回路10を含んで
いる。電気手術部位16の温度をモニタ及び制御すること
も本開示の一部である。図３に示したものは、一対の能
動電極身体組織接触部材17を備えており、それら接触部
材17は乾燥処置の実行中に身体組織に装着しておけるよ
うにしてあり、それには、それら接触部材17の間に身体
組織を挟むようにする。それら能動電極身体組織接触部
材17は能動リード14に接続している。図２の拡大図に示
したように、能動電極身体組織接触部材17の各々に１つ
ないし複数の能動電極接点18を設けてある。複数の能動
電極接点18の各々が個別に夫々独立的に高周波電力を供
給できるようにしてあり、それら高周波電力が、能動電
極身体組織接触部材17に接触している身体組織に対して
電気手術効果を付与するために、夫々の能動電極身体組
織接触部材17から供給される。
図１、図２、図４、及び図５の図に示した形態では、
帰還電極13を電気手術器ジェネレータ11の帰還リード15
に接続している。能動電極接点18の各々と帰還電極13と
の間にインピーダンス・モニタ部19を接続し、それらの
間のインピーダンスの瞬時値を示した信４号を発生させ
ている。インピーダンスをモニタする方法として従来よ
り様々な方法が開示されているが、一般的な方法は、電
気手術器ジェネレータのリード14とリード15とから、即
ち、電極12と電極13とから、電圧信号及び電流信号を拾
い上げ、それら２つの信号の積に基づいて、電極12と電
極13との間に接続されている負荷の大きさを測定すると
いう方法である。これまで発行されている、身体組織イ
ンピーダンスのモニタ方法を開示した特許には、例えば
米国特許第4,922,210号や、同第4,969,885号がある。た
だし本開示は特定のインピーダンスのモニタ方法に限定
されるものではない。従って、これら２件の米国特許
は、この言及をもってそれらの内容が本開示に組込まれ
たものとするが、それらはあくまでも実施例を例示した
ものであり、具体的な例を示したに過ぎない。
レギュレータ部20を、インピーダンス・モニタ部19か
ら信号21及び信号22を受取るように接続してあり、この
レギュレータ部20が、電気手術器ジェネレータ11の電力
を、能動電極接点18の各々を介して身体組織へ供給して
いる。レギュレータ部20は能動電極接点18の温度の制御
にも関与しているが、それについては後述する。レギュ
レータ部20は、電気手術器ジェネレータ11の出力部に作
用的に関連付けられており、電気手術器ジェネレータ11
と、対応する能動電極接点18との間の高周波電力の伝送
レベルを変化させ、能動電極接点18の各々から帰還電極
13へ流れる電力を夫々独立的に調節することによって、
モニタして得られたインピーダンス信号に従って能動電
極接点18の各々の間のインピーダンスを個別に夫々独立
的に制御している。この方法は、互いに隣接している身
体組織どうしの間でも身体組織インピーダンスが夫々に
異なるという事実を認識した上で、自動制御装置10を、
複数の能動電極接点18の各々の位置にある身体組織に応
答するものとすることによって、それら身体組織ごとの
インピーダンスの相違に対処できるようにしたものであ
る。
１つの実施形態においては、１つないし複数の能動電
極接点18に１つないし複数の温度センサ23を付設し、そ
れら温度センサ23の各々が電気手術器ジェネレータ11へ
温度値を伝送するように、それら温度センサ23を接続し
てある。能動電極接点18の温度を知ることが重要である
のは、身体組織乾燥処置を実行する際には、その乾燥処
置における温度を制御して過熱を防止することが望まれ
るからである。過熱によって様々な問題が生じるが、そ
の中でも特に、乾燥した身体組織に能動電極接点18及び
帰還電極13が凝着するという問題が発生する。凝着が生
じると、凝固した身体組織の蛋白質が引き裂かれるた
め、せっかく凝固した部位が破壊されてしまう。また上
述の温度値は、少なくとも対応する能動電極接点18の温
度を示している。複数の能動電極接点18に近接させて設
けた夫々の温度センサ23から送出される夫々の温度値
は、第２マルチプレクサ24を介して伝送されるようにし
てある。
図３、図４、及び図５に示した別の実施の形態では、
絶縁支持部25が一対の身体組織接触部材17を担持してお
り、それら身体組織接触部材17が１つないし複数の能動
電極接点18を備えている。図４の形態、並びに図５の形
態では、能動電極身体組織接触部材17に帰還電極13を並
設し、この帰還電極13を可動の状態で絶縁支持部25の所
定位置に取付けて、この帰還電極13を動かすことによっ
て、この帰還電極13と１本ないし複数本の能動電極身体
組織接触部材17との間に身体組織を挟めるようにしてい
る。能動電極身体組織接触部材17は１つないし複数の能
動電極接点18を備えたものとすることが好ましく、また
以上によってバイポーラ形装置26が構成されている。図
３の形態がその他のものと異なる点は、２本の対向した
能動電極身体組織接触部材17を備え、それら能動電極身
体組織接触部材17の間に身体組織を挟めるようにしてあ
り、それら能動電極身体組織接触部材17に備えた能動電
極接点18を介して身体組織乾燥処置を実行するようにし
てあるということであり、身体組織乾燥処置は、図１に
示したように離れた位置に装着される帰還電極13によっ
て完成する回路によって実行される。従って、少なくと
も２本の能動電極身体組織接触部材17によって、バイポ
ーラ形装置26として機能できるようにすることも可能で
ある。またそれら能動電極身体組織接触部材17が鉗子を
構成し、その鉗子が１つないし複数の能動電極接点18を
担持している構成とすることが好ましい。身体組織接触
部材17、能動電極接点18、または帰還電極13の各々を、
互いに接近及び離隔する方向に可動して所定位置に取付
けることによって、それらの間に身体組織を挟めるよう
にすることも可能である。
少なくとも２本の能動電極身体組織接触部材17によっ
て、或いは図４の形態のように少なくとも１本の能動電
極身体組織接触部材17と帰還電極13とによって、バイポ
ーラ形装置26を構成することができ、或いは、また別の
実施の形態として、図５の形態のように、それらをヒン
ジ結合して鋏として構成することも可能である。この鋏
は、１つないし複数の能動電極接点１と帰還電極13とを
備えると共に鋏刃27を備えたものであり、それらは、互
いに電気的に絶縁される一方で、相対的に可動状態で正
確に組合わされており、これによって、それらの間で、
電気手術効果と物理的切断機能との両方が得られる。
電気手術器ジェネレータ11の能動リード14から、１つ
ないし複数の能動電極接点18の各々へ個別に独立的に電
気手術用高周波電力を供給するためには、第１マルチプ
レクサ28を、それら１つないし複数の能動電極接点18に
接続した構成とすることが好ましい。図６には第１マル
チプレクサ28及び第２マルチプレクサ24が示されてい
る。更に詳しく説明すると、第１マルチプレクサ28が能
動29（Act ０）を活動化すると、それに対応した部位
の身体組織へ電気手術器ジェネレータから電力が供給さ
れる。このとき身体組織へ供給される電力の大きさは、
フィードバック・アルゴリズムによって、（Act ０）2
9のインピーダンス信号及び温度値の関数として制御さ
れる。乾燥処置を完了するまで、特定のインピーダンス
信号及び温度値に対応して定まる供給電力の値が好適な
曲線をたどるようにして電力の供給が行われる。電力の
供給を終了する時点は、身体組織インピーダンスに基づ
いて判定するようにしており、これが可能であるのは、
身体組織から水分が失われるとインピーダンス信号が顕
著に変化するからである。
レギュレータ部20には、温度値の時間微分値と、身体
組織をその温度に保持すべき目標温度と、その温度を維
持すべき時間とに適合する温度曲線が内装されている。
温度曲線の別の形態として、終了すべき時刻になったこ
とを示す身体組織インピーダンス信号が発生したとき
に、レギュレータ部20がそれに応答するようにしてもよ
く、この場合には、身体組織インピーダンス信号の微分
値によって瞬時的状態である終了時刻状態が示されるよ
うにすればよい。また、乾燥処置が完了したことを示す
最終身体組織インピーダンス信号を、電力を供給する以
前の初期身体組織インピーダンス信号に対して所定の関
係を有する信号として定めてもよく、この場合には、身
体組織の特性に応じて温度曲線を規定することになる。
図６の同期検出部30は、電気手術器ジェネレータ11によ
って発生される身体組織内の高周波電界の中から温度値
を取り出すためのものである。その温度値の瞬時値が判
定され、能動電極接点18の各々へ供給される電気手術器
ジェネレータ11電力によってそれら能動電極接点18の温
度変化が夫々独立的に調節され、それによって能動電極
接点18の各々と帰還電極13との間の身体組織に対して、
夫々独立的に、しかも温度値に応答して電気手術効果が
付与される。温度フィードバック信号31は、温度センサ
23をモニタして得られた信号であり、より明確には温度
値をモニタして得られた信号である。この温度フィード
バック信号31によって、電気手術器ジェネレータ11から
身体組織へ供給される電力が正確に制御されている。信
号コンディショニング回路32は、温度値を増幅し、スケ
ーリングして、その結果として得られる出力が明確なボ
ルト対温度の関係を持つようにしている。
この信号コンディショニング回路32の出力は温度曲線
と比較される。温度曲線は、例えば図６では、ポテンシ
ョメータによる設定の形で表されている。温度値と温度
曲線が規定している値との間の差34が、電気手術器ジェ
ネレータ11のRF駆動部に付設された高電圧制御部35に結
合されており、これによって、駆動電圧を温度の関数と
して変化させるようにしている。（Act ０）29におけ
る乾燥処置が完了したならば、以上のプロセスを（Act
１、２、３、等々）に関して反復実行する。
各温度センサに対応した能動電極接点18の近傍の温度
を示している温度値を電気手術器ジェネレータ11へ供給
するためには、第２マルチプレクサ24を、１つないし複
数の温度センサ23に接続した構成とすることが好まし
い。
図３、図４、及び図５に示した形態では、細長形状の
絶縁支持部25が少なくとも１つの能動電極接点18を所定
位置に担持しており、それによって、上述の如くモノポ
ーラ形またはバイポーラ形の電気手術器装置を構成して
いる。この絶縁支持部25を充分に長くして腹腔鏡手術に
使用できるようにすれば、能動電極接点18を腹腔鏡手術
にも利用することができる。絶縁支持部25は、その断面
形状を円形として、トロカール（不図示）で形成した、
身体組織を貫通する通路の中で、腹腔鏡手術器具として
機能できるようにすることが好ましい。腹腔鏡手術は本
願開示の主眼ではなく、またトロカールで形成する通路
は当業者には周知のものであるため、これについては詳
細に説明しない。図１に示した形態では、電気手術に用
いる電力レベルを所望のレベルに設定するためにユーザ
が操作する制御部材36を、電気手術器ジェネレータ11に
設けてある。電力レベルを所望のレベルに設定するため
の多くの方式が当業界に存在しており、商業的に採用さ
れている方式としては、米国、コロラド州、Boulderに
所在のValleylab社が、「Force40」型の電気手術器ジェ
ネレータ11に採用している制御方式がある。
方法は、電気手術器ジェネレータ11の能動電極12と帰
還電極13との間の身体組織インピーダンスのレベルに応
答して、電気手術器ジェネレータ11を自動制御する方法
である。能動電極12は、１つないし複数の能動電極接点
18を備えており、かかる能動電極接点18を用いて、電気
手術器ジェネレータ11から能動電極12及び帰還電極13へ
電気手術用電力を供給するステップを実行する。能動電
極12に付設した１つないし複数の能動電極接点18を身体
組織に装着することも、１つのステップである。電気手
術効果を身体組織に付与するために能動電極接点18の各
々へ個別に夫々独立的に高周波電力を供給することも、
もう１つの好適なステップである。続いて、１つないし
複数の能動電極接点18と帰還電極13との間のインピーダ
ンスを個別にモニタして、それらの間のインピーダンス
の瞬時値を示している信号を発生するという追加のステ
ップがある。インピーダンスの瞬時値を示している信号
をレギュレータ部20で受取り、能動電極接点18の各々を
介して印加される電気手術器ジェネレータ11電力を設定
するというのが、更なる１つのステップである。能動電
極接点18の各々と帰還電極13との間のインピーダンスを
個別に夫々独立的に制御することも、レギュレータ部20
で実行する電気手術器ジェネレータ11の運転出力を変更
するためのステップである。電気手術器ジェネレータ11
と、対応する能動電極接点18との間の高周波電力の伝送
レベルを変更し、帰還電極13と能動電極接点18の各々と
の間を通過する電力を夫々独立的に調節するというの
も、この方法のもう１つのステップである。１つないし
複数の能動電極接点18に接続した第１マルチプレクサ28
の接続を介して電気手術用高周波電力を個別に夫々独立
的に供給するというのも、この方法の１つのステップで
ある。
この方法を、次のような追加のステップを含んでいる
ものとしてもよく、そのステップとは、各々を１つない
し複数の能動電極接点18に付設した１つないし複数の温
度センサ23を身体組織に装着し、インピーダンスのモニ
タを実行するのと並行してそれら温度センサ23の各々か
ら電気手術用ジェネレータ11へ、少なくとも当該温度セ
ンサに対応した能動電極接点18の温度を表した温度値を
伝送するステップである。続いて、この方法は次のよう
な追加のステップを含み、そのステップとは、温度信号
の瞬時値を測定することによって温度変化を評価し、も
って能動電極接点18の各々へ供給される電気手術器ジェ
ネレータ11電力を夫々独立的に調節し、それによって、
能動電極接点18の各々と帰還電極13との間の身体組織に
対して、その温度値に応答して夫々独立的に電気手術効
果を付与するステップである。また更に追加のステップ
として、１つないし複数の温度センサ23に接続した第２
マルチプレクサ24の接続を介して個別に夫々独立的に電
気手術用高周波電力を評価し、各温度センサに対応した
能動電極接点18の温度を表した温度値を電気手術器ジェ
ネレータ11へ供給するステップを実行するようにしても
良い。

Claims (12)

    (57)【特許請求の範囲】
  1. 【請求項１】身体組織乾燥処置の実行中に電気手術器ジ
    ェネレータ11の能動電極12と帰還電極13との間の身体組
    織インピーダンスのレベルに個別に夫々独立的に応答し
    てその電気手術器ジェネレータ11の電力を自動制御する
    ための自動制御装置10において、 身体組織との間で回路を形成する能動電極12及び帰還電
    極13を備えた電気手術器ジェネレータ11であって、それ
    ら能動電極及び帰還電極が夫々能動リードとを介して該
    電気手術器ジェネレータに接続しており、それによって
    それら能動電極及び帰還電極それらの間の身体組織へ電
    気手術用高周波電力を供給するようにした電気手術器ジ
    ェネレータ11と、 前記能動電極12に電気的に接続して付設した複数の能動
    電極接点18であって、それらに接触している身体組織に
    対して電気手術効果を付与するために、前記電気手術器
    ジェネレータが前記能動リードを介して前記能動電極12
    及び該能動電極上の前記能動接点へ供給する高周波電力
    を、該能動電極上にあって身体組織に接触するように装
    着された各々の能動電極接点18が個別に独立的に提供で
    きるようにした複数の能動電極接点18と、 前記能動電極接点18の各々と前記帰還電極13との間に回
    路を成すように接続したモニタ部であって、前記能動電
    極接点18の各々と前記帰還電極13との間のインピーダン
    スの瞬時値を表すインピーダンス信号を発生するために
    用いる前記能動電極接点の各々と身体組織と前記帰還電
    極とを流れる電流及びそれらの両端間の電圧に対して個
    別に夫々独立的に応答するモニタ部と、 前記電気手術器ジェネレータ11の運転出力部に対して電
    気的に結合して回路を成すように関連付けられたレギュ
    レータ部20であって、前記電気手術器ジェネレータを、
    前記能動電極接点18の各々と前記帰還電極13との間の身
    体組織インピーダンスの関数として、モニタして得られ
    たインピーダンス信号に応じて個別に夫々独立的に制御
    し、更に、前記電気手術器ジェネレータと回路を成すよ
    うに接続されて、前記電気手術器ジェネレータ11と、対
    応した前記能動電極接点18との間の高周波電力の伝送レ
    ベルを変化させることによって、前記能動電極接点18の
    各々から前記帰還電極13へ流れる電力を夫々独立的に調
    節するようにしたレギュレータ部20と、 を備えたことを特徴とする前記能動電極12と前記帰還電
    極13との間の身体組織インピーダンスのレベルに個別に
    夫々独立的に応答して、電気手術器ジェネレータ11の電
    力を自動制御するための自動制御装置10。
  2. 【請求項２】各々が１つないし複数の前記能動電極接点
    18に付設され、各々が少なくとも対応した能動電極接点
    18の温度を表す温度値を前記電気手術器ジェネレータ11
    へ送信するように接続した１つないし複数の温度センサ
    23を備え、 前記モニタ部を、温度値の瞬時値を受取り、温度値の変
    化を評価して、前記能動電極接点18の各々へ供給される
    電気手術器ジェネレータ11電力を個別に夫々独立的に調
    節するように接続してあり、それによって、前記能動電
    極接点18の各々と前記帰還電極13との間の身体組織に対
    し、それに対応した温度値に従って夫々独立的に電気手
    術効果を付与するようにしてある、 ことを特徴とする、請求項１記載の前記能動電極接点18
    の各々と前記帰還電極13との間の身体組織インピーダン
    スのレベルに個別に夫々独立的に応答して電気手術器ジ
    ェネレータ11を自動制御するための自動制御装置10。
  3. 【請求項３】絶縁支持部25が一対の部材17を担持してお
    り、それら一対の部材17の一方に１つないし複数の能動
    電極接点18を備え、それら一対の部材17の別の１つに前
    記帰還電極13を備えており、それら一対の部材17は、前
    記絶縁支持部25の所定位置に取付けられて、前記帰還電
    極13と１つないし複数の前記能動電極12との間に身体組
    織を挟めるようにしてあり、それによって、身体組織接
    触部材17がバイポーラ形装置26を構成するようにしたこ
    とを特徴とする請求項２記載の前記能電極接点18の各々
    と前記帰還電極13との間の身体組織インピーダンスのレ
    ベルに個別に夫々独立的に応答して電気手術器ジェネレ
    ータ11を自動制御するための自動制御装置10。
  4. 【請求項４】前記一対の部材17が、前記バイポーラ形装
    置26を構成していると共に鉗子を構成しており、該鉗子
    は、１つないし複数の能動電極12接点と帰還電極13とを
    所定位置に担持し、それら能動電極12と帰還電極13とを
    互いに接近及び離隔する方向に可動にしてそれら電極の
    間に身体組織を挟めるように構成したものであることを
    特徴とする請求項３記載の前記能動電極12接点の各々と
    前記帰還電極13との間の身体組織インピーダンスのレベ
    ルに個別に夫々独立的に応答して電気手術器ジェネレー
    タ11を自動制御するための自動制御装置10。
  5. 【請求項５】前記部材17が、前記バイポーラ形装置26を
    構成していると共に互いにヒンジ結合されて鋏を構成し
    ており、この鋏の夫々の部材17が鋏刃27を備えており、
    それら鋏刃は１つないし複数の能動電極12接点と前記帰
    還電極13とを備えており、それらを電気的に絶縁してそ
    れらの間に電気手術効果が得られるようにしたことを特
    徴とする請求項３記載の前記能動電極12接点の各々と前
    記帰還電極13との間の身体組織インピーダンスのレベル
    に個別に夫々独立的に応答して電気手術器ジェネレータ
    11を自動制御するための自動制御装置10。
  6. 【請求項６】前記電気手術器ジェネレータ11から前記能
    動電極12接点の各々へ個別に夫々独立的に電気手術用高
    周波電力を供給するための第１マルチプレクサ28を、１
    つないし複数の前記能動電極12接点に電気的に接続した
    ことを特徴とする請求項２記載の前記能動電極12接点の
    各々と前記帰還電極13との間の身体組織インピーダンス
    のレベルに個別に夫々独立的に応答して電気手術器ジェ
    ネレータ11を自動制御するための自動制御装置10。
  7. 【請求項７】各温度センサに対応した能動電極12接点の
    近傍の温度を示している検出された温度値を表す信号を
    前記電気手術器ジェネレータ11へ供給するための第２マ
    ルチプレクサ24を、１つないし複数の前記温度センサ23
    に電気的に接続したことを特徴とする請求項２記載の前
    記能動電極12接点の各々と前記帰還電極13との間の身体
    組織インピーダンスのレベルに個別に夫々独立的に応答
    して電気手術器ジェネレータ11を自動制御するための自
    動制御装置10。
  8. 【請求項８】前記電気手術器ジェネレータ11から前記能
    動電極12接点の各々へ個別に夫々独立的に電気手術用高
    周波電力を供給するための第１マルチプレクサ28を、１
    つないし複数の前記能動電極12接点に電気的に接続する
    と共に、各温度センサに対応した能動電極12接点の温度
    を示している検出された温度値を表す信号を前記電気手
    術器ジェネレータ11へ供給するための第２マルチプレク
    サ24を、１つないし複数の前記温度センサ23に電気的に
    接続したことを特徴とする請求項２記載の前記能動電極
    12接点の各々と前記帰還電極13との間の身体組織インピ
    ーダンスのレベルに個別に夫々独立的に応答して電気手
    術器ジェネレータ11を自動制御するための自動制御装置
    10。
  9. 【請求項９】細長形状の絶縁支持部25が、少なくとも１
    つの前記能動電極12接点を所定位置に担持しており、そ
    れによって腹腔鏡処置に使用するためのモノポーラ形電
    気手術電極を形成していることを特徴とする請求項２記
    載の前記能動電極12接点の各々と前記帰還電極13との間
    の身体組織インピーダンスのレベルに個別に夫々独立的
    に応答して電気手術器ジェネレータ11を自動制御するた
    めの自動制御装置10。
  10. 【請求項１０】前記絶縁支持部25の断面形状を円形とし
    て、トロカールで形成した、身体組織を貫通する通路の
    中で腹腔鏡手術器具として機能できるようにしたことを
    特徴とする請求項９記載の前記能動電極12接点の各々と
    前記帰還電極13との間の身体組織インピーダンスのレベ
    ルに個別に夫々独立的に応答して電気手術器ジェネレー
    タ11を自動制御するための自動制御装置10。
  11. 【請求項１１】電気手術に用いる電力レベルを所望のレ
    ベルに設定するように電気的に接続した、ユーザが操作
    する制御部材36を、前記電気手術器ジェネレータ11に配
    設したことを特徴とする請求項２記載の前記能動電極12
    接点の各々と前記帰還電極13との間の身体組織インピー
    ダンスのレベルに個別に夫々独立的に応答して電気手術
    器ジェネレータ11を自動制御するための自動制御装置1
    0。
  12. 【請求項１２】身体組織乾燥処置の実行中に電気手術器
    ジェネレータ11の能動電極12と帰還電極13との間の身体
    組織インピーダンスのレベルに個別に夫々独立的に応答
    してその電気手術器ジェネレータ11を自動制御するため
    の自動制御装置10において、 電気手術用高周波電力を供給するための能動リード14と
    帰還リード15とが接続された電気手術器ジェネレータ11
    と、 前記能動リード14に接続し、身体組織に装着し得るよう
    にした、一対の能動電極12身体組織接触部材17と、 前記一対の能動電極12身体組織接触部材17の各々に付設
    された複数の能動電極12接点であって、その各々が身体
    組織との間で回路を形成し、その各々に接触している身
    体組織に対して電気手術効果を付与するために、それら
    能動電極12身体組織接触部材17の夫々へ、その各々が個
    別に夫々独立的に高周波電力を供給できるようにした複
    数の能動電極12接点と、 前記電気手術器ジェネレータ11の前記帰還リード15に接
    続した、身体組織との間で回路を形成する帰還電極13
    と、 前記能動電極12接点の各々と前記帰還電極13との間に回
    路を成すように接続したモニタ部であって、前記能動電
    極12接点の各々と前記帰還電極13との間のインピーダン
    スを表すインピーダンス信号を瞬時的に発生するために
    用いる前記能動電極接点と身体組織と前記帰還電極とを
    流れる電流及びそれらの両端間の電圧に対して個別に夫
    々独立的に応答するモニタ部と、 各々が１つないし複数の前記能動電極12接点に付設さ
    れ、各々が少なくとも対応した能動電極12接点の温度値
    を示している温度値を前記電気手術器ジェネレータ11へ
    送信するように接続した１つないし複数の温度センサ23
    と、 前記モニタ部を、温度値を瞬時的に受取り、温度変化を
    評価し、そして評価した温度変化に基づいて、前記能動
    電極12接点の各々へ供給される電気手術器ジェネレータ
    11電力を夫々独立的に調節するように接続してあり、そ
    れによって前記能動電極12接点の各々と前記帰還電極13
    との間の身体組織に対し、検出された温度値に従って個
    別に夫々独立的に電気手術効果を付与するようにしてあ
    ることと、 前記電気手術器ジェネレータ11の電力出力部と協働し、
    モニタされたインピーダンス19と検出された温度値とに
    応じて前記能動電極12の各々の間のインピーダンスを個
    別に夫々独立的に制御するレギュレータ部20であって、
    前記電気手術器ジェネレータ11と、対応する能動電極12
    接点との間の高周波電力の伝送のレベルを変化させるこ
    とによって、前記帰還電極13と前記能動電極12接点の各
    々との間を流れる電力を夫々独立的に調節するようにし
    たレギュレータ部20と、 前記電気手術器ジェネレータ11の電力出力部に対して電
    気的に結合して回路を成すように関連付けられたレギュ
    レータ部20であって、前記電気手術器ジェネレータを、
    信号によって示された前記能動電極12接点の各々の間の
    身体組織インピーダンスの関数として、モニタして得ら
    れたインピーダンス19と検出された温度値とに応じて、
    個別に夫々独立的に制御し、更に、前記電気手術器ジェ
    ネレータと回路を成すように接続されて、前記電気手術
    器ジェネレータ11と、対応した前記能動電極12接点との
    間の高周波電力の伝送レベルを変化させることによっ
    て、前記能動電極12接点の各々から前記帰還電極13へ流
    れる電力を夫々独立的に調節するようにしたレギュレー
    タ部20と、 前記能動電極12接点に電気的に結合した第１マルチプレ
    クサ28であって、該電気手術器ジェネレータ11の前記能
    動リード14から前記能動電極12接点の各々へ個別に夫々
    独立的に電気手術用高周波電力を供給するための第１マ
    ルチプレクサ28と、 １つないし複数の前記温度センサ23に電気的に結合した
    第２マルチプレクサ24であって、各温度センサに対応し
    た能動電極12接点の温度を示している温度値を該電気手
    術器ジェネレータ11へ供給するための第２マルチプレク
    サ24と、 を備えたことを特徴とする電気手術器ジェネレータ11の
    能動電極12と帰還電極13との間の身体組織インピーダン
    スのレベルに個別に夫々独立的に応答してその電気手術
    器ジェネレータ11を自動制御するための自動制御装置1
    0。
JP7504783A 1993-10-07 1994-09-09 電気手術器ジェネレータの自動制御 Expired - Fee Related JP2677456B2 (ja)

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US08/133,235 1993-10-07

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FI961529A0 (fi) 1996-04-04
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FI961529A (fi) 1996-04-04
DE9490466U1 (de) 1996-06-13
CA2171758A1 (en) 1995-04-13
DE69415037D1 (de) 1999-01-14
US5496312A (en) 1996-03-05
AU7507094A (en) 1995-05-01
WO1995009576A1 (en) 1995-04-13
JPH09501577A (ja) 1997-02-18

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