JP2828817B2 - Surgery switching device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical instrument switching apparatus for switching between microwave output and high-frequency output for surgery and selectively supplying the output to an electrode of a surgical handpiece.

[0002]

2. Description of the Related Art Conventionally, operations generally performed in surgical medicine are roughly classified into general open surgery, endoscopic surgery using an endoscope, and laparoscopic surgery. The endoscope operation refers to an operation performed by a surgical electrode inserted into a forceps channel provided with an endoscope while directly looking at a diseased tissue of an internal organ with the endoscope.

In laparoscopic surgery, a hole with a diameter of about 10 mm is usually formed in an appropriate portion of the abdomen of the body centering on the navel, and one of the holes is provided with a CCD camera at the tip. The other two are inserted with forceps and the other one is inserted with a surgical electrode, and a harmless gas such as laughing gas is injected into the body cavity to inflate and expand based on the output of the CCD camera. An operation performed while watching the video on a monitor television.

[0004] The main surgical techniques common to these operations are hemostasis, coagulation, dissection, resection, etc. of living tissues.
Each of the above surgical procedures is selectively performed according to the state, site, and the like of the diseased tissue. When performing these procedures, it is necessary to use multiple surgical instruments, such as a microwave surgical instrument and an electrosurgical instrument, according to the progress of the operation, taking into account the performance of each, so that the best therapeutic effect can be obtained. is there.

[0005] Among these surgical instruments, the microwave surgical instrument and the electrosurgical instrument are most frequently used, and usually, microwave surgery and high-frequency surgery using both surgical instruments are performed a plurality of times during one operation. . By the way, as shown in FIG. 2 and FIG. 3, conventionally, the operation of the microwave surgical device 1 and the electric surgical device 2 is separately controlled by respective dedicated foot switches 3 and 4,
In addition, the microwave output and the high-frequency output of the two operating devices 1 and 2 are supplied to the living tissue using the respective dedicated surgical handpieces 5 and 6.

Next, the configurations of the microwave surgical device 1 and the electric surgical device 2 and the conventional operation and operation will be described.
First, as shown in FIG. 2, the microwave surgical device 1 is formed by a microwave generator 1a, a cavity coupler 1b, a coaxial relay 1c, a microwave output control circuit 1d, and a tissue dissociation device 1e.

The foot switch 3 of the microwave surgical instrument 1 is a deadman type switch having on / off switch buttons 3a and 3b for microwave output and dissociation output. Then, when the switch button 3a is depressed and turned on, the control circuit 1d drives the microwave generator 1a to supply power by the contact signal, and the 2450 of the generator 1a is turned on.
The microwave output of MHz (frequency internationally allocated as 1SM band) is taken out by the cavity coupler 1b, and the surgical electrode 8 at the tip of the handpiece 5 via the coaxial relay 1c and the coaxial cable 7 having the characteristic impedance of 50Ω.
Supplied to

[0008] When the electrode 8 is pierced or pressed against a diseased tissue of a living body and a microwave output is supplied from the electrode 8 to the tissue, the tissue generates strong dielectric heat due to microwave energy, and water in the tissue is removed. After evaporation, hemostasis and coagulation procedures are performed. At this time, based on the extremely effective hemostasis and coagulation due to the microwave dielectric heat, the coagulated tissue adheres to the electrode 8 because the water in the tissue evaporates extremely.

If the fixed electrode 8 is pulled out of the tissue without force, there is a risk of rebleeding. Therefore, after the treatment of hemostasis and coagulation, the switch button 3a is switched to the switch button 3b to drive the tissue dissociation device 1e. This device 1e is a Japanese Patent Publication
As described in, for example, Japanese Patent Application Laid-Open No. 17-175, water is coagulated between a coagulated tissue and an electrode 8 pierced or pressed against the coagulated tissue by an electrochemical action based on a dissociation current, and the hemostatic and coagulated tissue is removed. The electrode 8 is smoothly pulled out without damaging the state of the tissue.

When the electrode 8 is pulled out, the switch button 3b is no longer depressed, the tissue dissociation device 1e stops, the microwave operation ends, and the microwave surgical device 1 returns to its original state. Next, the electrosurgical device 2 is, as shown in FIG.
High frequency generator 2a, waveform synthesis circuit 2b, amplification circuit 2c,
It is formed by a high frequency output transformer 2d and a control circuit 2e.
It is connected to the surgical electrode 10 and the counter electrode 11 of the handpiece 6 via a high-frequency cable 9 of 00 to 500Ω.

When the switch button 4a of the foot switch 4 of the deadman system is depressed, the control circuit 2e cuts the waveform synthesizing circuit 2b according to the contact signal of the switch button 4a. , And outputs a preset waveform such as a composite waveform of both waveforms. At this time, the high-frequency generator 2a generates a high-frequency output (generally, power having a frequency of 3 to 6 MHz and internationally allocated as a 1SM band), and the high-frequency output is converted into a waveform set by the waveform synthesis circuit 2b. Processed.

Further, the high-frequency output of the waveform synthesizing circuit 2b is amplified by an amplifier circuit 2c, and is amplified by a transformer 2d.
The voltage is boosted to about 0V (peak to peak). Then, the boosted high-frequency output is supplied to the electrode 10 of the handpiece 6 via the high-frequency cable 9,
Incision, hemostasis, and coagulation of the diseased tissue are performed by spark discharge or dielectric heat generated between 0 and the living tissue.

The return electrode plate 11 forms a return path for the high-frequency current and is adhered to the patient's buttocks, thigh spine, etc. prior to the operation. Then, the high-frequency current supplied from the electrode 10 to the living tissue is collected by the return electrode 11 via the human body and returned to the operating device 2.

[0014]

As described above, the microwave surgical device 1 and the electrosurgical device 2 are completely independent, and the microwave output and the high-frequency output of the two surgical devices 1 and 2 are respectively dedicated hands. When supplying the living tissue via the electrodes 8 and 10 of the pieces 5 and 6, there is a problem that a complicated operation such as replacement of a surgical handpiece is required during the operation.

[0015] The doctor at the operating site (such as a surgeon or the like) is always under extremely nervous psychology, and exchanges the handpieces 5 and 6 correctly and properly uses the two surgical instruments 1 and 2 properly. Is not easy, and it can not be said that there is no operation error. SUMMARY OF THE INVENTION It is an object of the present invention to enable a microwave operation and a high-frequency operation to be performed freely without replacing a surgical handpiece.

[0016]

In order to achieve the above object, in the surgical instrument switching device of the present invention, a microwave output for microwave surgery and a high frequency output for electrosurgery are provided on a surgical handpiece. It is provided with switching means for supplying alternatively.

[0017]

In the surgical instrument switching apparatus of the present invention having the above-mentioned structure, the microwave output and the high frequency output for operation are selectively supplied to the common surgical handpiece by the switching means. Microwave surgery and electrosurgery can be used freely without any need for replacement.

[0018]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS One embodiment will be described with reference to FIG. FIG. 1 shows a configuration example in which the microwave surgical device 1 of FIG. 2 and the electrosurgical device 2 of FIG. 3 are used, and 12 is a surgical device switching device, which is a switching control circuit 13 having a clay circuit configuration, an output matching device. 14, a coaxial switch 15, a dissociation device drive circuit 16, and an output display 17. The output display 17 has two display lamps 17 for selecting and displaying the surgical devices 1 and 2.
a and 17b.

The switching control circuit 13 and the output matching device 1
4. The supply output switching means is formed by the coaxial switch 15. Reference numeral 18 denotes a common foot switch of the surgical instruments 1 and 2 detachably connected to the switching device 12 by a connector or the like.
18b is provided with a deadman type switch. Reference numeral 19 denotes a common surgical handpiece of a microwave knife configuration which is detachably connected to the coaxial switch 15 via a coaxial cable 20 via a connector or the like, and a surgical electrode 21 corresponding to the electrode 8 in FIG. Installed.

Reference numerals 22a and 22b denote switch buttons for manual selection of the operating devices 1 and 2 provided on the handpiece 19;
a, 23b are surgical instruments 1 provided on the handpiece 19;
2 are two indicator lights for selection display of indicator light 17a,
The lighting is controlled in conjunction with 17b. Before the operation, the output sides of the operating devices 1 and 2 are connected to the output matching device 14 of the switching device 12 via the coaxial cable 24 and the high-frequency cable 25, respectively.
To the connector.

The control circuit 1 of the microwave operating device 1
d, the switch buttons 3a and 3b of FIG.
Instead, the switching control circuit 13 and the dissociation device driving circuit 16 are detachably connected by a connector or the like. Is connected detachably. Further, the return electrode 11 of the electrosurgical instrument 2 is the same as the conventional one.
It is previously adhered to the buttocks, thighs, etc. of the living tissue (patient) 24. In the control circuits 1d and 2e, the conditions of the microwave output and the high-frequency output such as the output (drive) limit time and the output waveform are preset as in the related art.

When the connection of each part is completed, the main power switches of both operating devices 1 and 2 are turned on, and the operation is started. During this operation, the tissue is hemostased and coagulated by microwave surgery, incision and dissociation of coagulated tissue by high-frequency output,
When repetitive processes such as resection, such as hemostasis, coagulation, and resection, incision, and resection of neighboring tissue (surrounding tissue) by microwave output and high-frequency output are performed in order, first, a foot switch is used to perform the above processes. 18 switch buttons 18
a is depressed or the switch button 22a of the handpiece 19 is pressed.
Is pressed.

At this time, the selection of the microwave output is notified to the switching control circuit 13 by the contact signals of the switch buttons 18a and 22a, and based on the notification, the switching control circuit 13 displays on the output display 17 and the handpiece 19 the display. Light 17a,
The lighting signal of 23a is supplied, and the indicator lamps 17a and 23a are turned on to indicate the selection of the microwave output. Further, a contact signal of the switch buttons 18a and 22a via the switching control circuit 13 is supplied to the control circuit 1d of the microwave surgical instrument 1, and the surgical instrument 1 is driven to be fed, and its microwave output is transmitted via the coaxial cable 24. The output is sent to the output matching unit 14.

Since the microwave output transmitted with the characteristic impedance of 50Ω does not require output matching,
The signal is sent to the coaxial switch 15 via the output matching unit 14. Further, the coaxial switch 15 is switched to the microwave output by the switching control circuit 13, and the microwave output of the coaxial switch 15 is connected to the handpiece 19 via the coaxial cable 20.
Is supplied to the electrode 21.

The microwave of the electrode 21 is applied to the living tissue 24.
The hemostasis and coagulation of a diseased tissue such as a tumor is performed in the same manner as in FIG. Then, the switch button 18a,
Release the foot or hand from 22a to notify the switching control circuit 13 of the completion of the selection of the microwave output, and turn off the contact signal supplied to the control circuit 1d of the microwave surgical device 1, or set the time of the control circuit 1d. If the up time is reached,
The power supply drive of the microwave oscillator 1a stops, and the microwave output stops.

At this time, the dissociation device drive circuit 16 automatically triggers the stop of the oscillation of the microwave generator 1a, and
The tissue dissociation device 1 of the microwave surgical instrument 1 is set for a predetermined time for which a contact signal similar to the contact signal of the switch button 3b is set.
e to drive the device 1e. Then, from the tissue dissociation device 1 e to the switching device 12 and the electrode 2 of the handpiece 19.
1, a dissociation current is supplied to the living tissue 24,
1 can be pulled out smoothly. The dissociation device driving circuit 16 is provided with switch buttons 18a, 22 via the switching circuit 13.
When the oscillation signal of the microwave generator 1a is set to the detection state of the stop of the oscillation by the leading edge of the contact signal a, and the contact signal is supplied to the tissue dissociation device 1e for a certain period of time, the operation becomes a time-up device and stops automatically I do.

Next, in order to perform the above processing, when the switch button 18b of the foot switch 18 is depressed or the switch button 22b of the handpiece 19 is pressed, the switching control circuit 13 is operated by the contact signals of the switch buttons 18b, 22b. Is notified of the selection of the high-frequency output. Based on this notification, the switching control circuit 13 outputs the output display 17 and the handpiece 19.
Are supplied with the lighting signals of the indicator lamps 17b and 23b, and the indicator lamps 17b and 23b are lit to indicate the selection of the high-frequency output.

Further, a contact signal of the switch buttons 18b and 22b via the switching control circuit 13 is supplied to the control circuit 2e of the electrosurgical instrument 2, and based on the output control of the control circuit 2e, the same as in the case of FIG. Thus, a high-frequency output having a predetermined waveform is formed, and the high-frequency output is sent to the output matching unit 14 via the high-frequency cable 25. Then, the characteristic impedance is set to 300 to 5 by impedance matching of the matching unit 14.
The high-frequency output transmitted at 00Ω is adjusted to match the output impedance of the switching device 12 = 50Ω.

Further, the high-frequency output via the matching unit 14 is sent to the coaxial switch 15, and at this time, the switching control circuit 13
The high-frequency output of the switch 15 is supplied to the electrode 21 of the handpiece 19 via the coaxial cable 20 because the coaxial switch 15 is switched to the high-frequency output. And
The high-frequency output of the electrode 21 is supplied to the living tissue 24, and the tissue 24 is dissected, cut off, or coagulated tissue is excised.

Next, in order to perform the above-described processing, the selection of the microwave output as described above and the selection of the high-frequency output as described above are alternately repeated. During this time, ligation, blood transfusion and the like of relatively large blood vessels, for example, those having a diameter of 3 mm or more are also added.

Finally, the body surface is sutured to complete one operation. Therefore, when the switching device 12 is used, the switch button 18 of the foot switch 18 can be used during the operation.
The microwave operation and the high frequency operation can be freely performed without changing the handpiece by changing the steps a and 18b or pressing the switch buttons 23a and 23b of the handpiece 19.

The operation of both operating devices 1 and 2 can be performed by one common foot switch 18, and the operation of the microwave operating device 1 is completed by the dissociation device driving circuit 16 provided in the switching device 12 at the end of the microwave operation. Is automatically driven, and the microwave surgical device 1 can be driven and controlled by operating one switch button in the same manner as the electric surgical device 2, so that the microwave operation and the high-frequency operation with different operation procedures can be performed. The selection can be made by a simple, clear and highly secure operation of stepping on the switch buttons 18a and 18b of the foot switch 18.
Furthermore, not only the foot switch 18 but also the handpiece 1
The operation of the two operating devices 1 and 2 can also be controlled by operating the 9 switch buttons 22a and 22b, so that the operability is significantly improved.

In addition, the lighting element 17 of the output display 17
a, 17b and the lighting elements 23a, 2 of the handpiece 19
Since the selection of the microwave output or the high-frequency output is displayed (notified) by 3b, the current output selection state can be easily visually recognized, and the safety and the like are further improved. As a result, general laparotomy, endoscopic surgery, laparoscopic surgery, etc. can be performed extremely easily and safely, reducing the burden on surgeons who are always in a severely nervous state and preventing medical errors. Contribute.

Further, since the operating devices 1 and 2, the foot switch 18, the handpiece 19 and the like are detachably connected to the switching device 12 by a connector or the like, for example, the microwave operating device 1 is used instead of the handpiece 19. There is also an advantage that the operability and safety can be improved inexpensively by effectively utilizing existing equipment and using the attached handpiece 5.

[0035]

Since the present invention is configured as described above, the following effects can be obtained. Microwave surgery and microwave surgery can be performed freely without replacement of the handpiece, because the microwave output and the high-frequency output for surgery are selectively supplied to the surgical handpiece by the switching means. Performance and safety can be greatly improved.

[Brief description of the drawings]

FIG. 1 is a block diagram of one embodiment of a surgical instrument switching device of the present invention.

FIG. 2 is a conventional connection explanatory diagram of a microwave surgical instrument.

FIG. 3 is an explanatory view of a conventional connection of an electrosurgical device.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Microwave surgical device 2 Electrosurgical device 13 Switching control circuit 14 Output matching device 15 Coaxial switching device 19 Surgical handpiece

Claims (1)

(57) [Claims] A surgical instrument switching device comprising a switching means for selectively supplying a microwave output for microwave surgery and a high-frequency output for electrosurgery to a surgical handpiece.