JP3318733B2 - Surgical equipment - 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 apparatus for performing surgical operations such as incision, resection, coagulation, and hemostasis using a high-frequency current.

[0002]

2. Description of the Related Art A so-called "electric scalpel" is the most common surgical device using a high-frequency current. This electric scalpel
An electrode is provided on the scalpel tip, and this electrode is used for living tissue (surgical site)
It is used for incision and resection with high-frequency current, and for coagulation and hemostasis treatment of living tissue at the incised portion.

[0003] The prior art relating to the present invention includes:
There is a "surgical handpiece" disclosed in JP-A-5-92009. This surgical handpiece is a so-called water jet in which a nozzle pipe having an electrode at the tip is connected to the handpiece body, and high-pressure water is sprayed from the tip of the nozzle pipe to incise and cut a living tissue (surgical site). It has both the function of a scalpel and the function of an electric scalpel for coagulating and hemostasis living tissue at the incision with the electrode at the tip of the nozzle pipe.

[0004] Further, as prior art related to the present invention,
"Apparatus for Improving Safety and Efficiency of Hand Operated Electrosurgical Pencil" disclosed in JP-A-4-220248
There is. The device for improving the safety and efficiency of this manually operated electrosurgical pencil includes an electrode at the tip of the pencil,
A spark discharge is generated from the electrode while injecting an inert gas converged along the axial direction from the periphery of the electrode, for example, helium gas, neon gas, argon gas, and the like. It is used for excising or coagulating and hemostasis treatment of living tissue at the incised portion.

[0005]

When an electric scalpel is used to incise or resect a living tissue (surgical site) or perform a coagulation treatment, an electrode is directly brought into contact with the living tissue (surgical site). , The surface temperature of living tissue increases, carbonization of living tissue, necrosis of cells around living tissue and expansion of necrotic cells,
In addition, there are various problems such as rebleeding due to exfoliation of the carbonized living tissue.

Therefore, when performing coagulation treatment during surgery, how to increase the surface temperature of a living tissue (operation site) in order to minimize carbonization of the living tissue and necrosis of cells around the living tissue is minimized. It has been an important issue whether or not the coagulation treatment can be performed while controlling.

In the surgical handpiece disclosed in Japanese Patent Application Laid-Open No. 5-92009, a high-pressure fluid is ejected to cut and resect a living tissue (surgical site). Therefore, it is not possible to suppress a rise in the surface temperature of the living tissue. Although it is possible, since the coagulation treatment is performed with an electric scalpel, the electrodes directly touch the living tissue during the coagulation treatment, so that the above-described problem with the electric scalpel still remains.

Further, in the apparatus for improving the safety and efficiency of the hand-operated electrosurgical pencil disclosed in Japanese Patent Application Laid-Open No. Hei 4-220248, a rare and expensive gas such as helium gas, neon gas or argon gas is used. Cost was high, causing surges in operating costs.

SUMMARY OF THE INVENTION The present invention has been made in view of the above problems, and is a surgical apparatus capable of minimizing carbonization of living tissue, necrosis of cells around the living tissue, expansion of necrotic cells, and the like. The main purpose is to provide.

[0010] Another object of the present invention is to perform incision / excision of a living tissue and coagulation treatment of the incised / excised living tissue while maintaining the surface temperature of the living tissue as low as possible. It is to provide a surgical device capable of.

[0011]

According to the present invention, in order to achieve the above object, a surgical handpiece provided with a nozzle electrode for jetting a fluid jet stream, and a method for operating a surgical handpiece between the nozzle electrode and a treatment site through the fluid jet stream. A high-frequency power supply for passing a high-frequency current through the nozzle electrode;
The surface is insulated and the tip of the nozzle electrode is
The fluid jet stream injected from the
In order to provide a surgical apparatus, the surgical apparatus is located in the inner part of the insulating coating .

[0012]

[0013]

[0014]

In the surgical apparatus according to the present invention, a high-frequency current having a current value corresponding to a surgical purpose, that is, an incision / excision / coagulation, is caused to flow between the nozzle electrode and the treatment site through a liquid jet stream ejected from the nozzle electrode. In this way, incision / excision or coagulation treatment of a living tissue (operation site) is performed.

In this case, the liquid jet stream forms a discharge column due to a potential difference between the nozzle electrode and the treatment site, and therefore, the discharge current energy flowing through the liquid jet stream to the treatment site is used to generate a living tissue (surgery). Part) can be incised and resected, and the incised and resected body tissue can be coagulated, and the electrode does not directly contact the body tissue as in the prior art. Necrosis of cells around the tissue and expansion of the necrotic cells can be minimized.

In the surgical apparatus according to the present invention, the liquid forming the liquid jet stream is, for example, an electrolyte solution such as a physiological saline solution. Since the heating by the discharge current energy is provided through the heat sink, it is possible to minimize the spread of the heat-affected zone in the living tissue by the cooling effect of the liquid jet flow.

In the surgical apparatus according to the present invention, since the living tissue is incised, excised or coagulated by the discharge current energy applied through the liquid jet stream of the electrolyte, the liquid jet stream itself needs to be high enough to have an incision ability. There is no. Note that a substance that generates active oxygen when energized may be added to the liquid jet stream, or a chemical such as a temperature-sensitive gel may be mixed.

In the surgical apparatus according to the present invention, when the outer periphery of the nozzle electrode is insulated and coated, the nozzle electrode does not directly contact the living tissue during the operation,
There is no risk of carbonization of the tissue.

Further, in the surgical apparatus according to the present invention, when the tip of the nozzle electrode is located inside the insulating coating, the insulating coating forms a jet guide flow path for the liquid jet flow, and Can be accurately applied to a surgical site without diffusing as a focused flow. Therefore, it becomes easy to perform incision / excision and coagulation treatment at a fine surgical site.

In the surgical apparatus according to the present invention, when the tip of the nozzle electrode protrudes from the tip of the insulating coating, the tip of the nozzle electrode is pierced into the body to inject a liquid jet stream from the nozzle electrode. By doing so, a liquid is stored in a treatment site in the body, and a high-frequency current is applied to the stored liquid to generate electric discharge, so that it is possible to perform incision / excision or coagulation treatment of a surgical site in the body. This method has an advantage that the operation can be efficiently performed particularly when the in-vivo operation site is wide.

The magnitude of the discharge current can be adjusted by changing the ejection diameter of the nozzle electrode for ejecting the liquid jet stream, the length of the insulating coating, the flow rate of the liquid jet stream, etc., in addition to adjusting the voltage applied to the electrodes. Can also be adjusted.

[0023]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS FIG. 1 is an explanatory view showing an example of a schematic overall configuration of a surgical apparatus according to the present invention. This surgical apparatus mainly includes a handpiece 1, a physiological saline pressurizing device 2 connected to the handpiece 1, and a high frequency power supply device 3.

The physiological saline pressurizing device 2 pressurizes the physiological saline from the physiological saline pack 4 to
a to the handpiece 1. The high-frequency power supply device 3 is connected to the handpiece 1 by an electric cord 3a, and operates a foot switch 3b, 3c to supply a high-frequency current to a nozzle electrode 6 mounted to protrude from the handpiece 1 through the handpiece 1. Supply.

The high-frequency current supplied from the high-frequency power supply device 3 to the nozzle electrode 6 includes a high-frequency current for incision / excision treatment supplied when incising / excising a living tissue and a high-frequency current for coagulating the living tissue. And a high-frequency current for the coagulation treatment supplied to the patient. For example, the current for the incision / resection procedure has a continuous high-frequency output waveform, and the current for the coagulation procedure has an intermittent high-frequency output waveform.

In performing the coagulation treatment, there are two methods of spray coagulation and normal coagulation (pinpoint coagulation). Spray coagulation is a technique for coagulating the surface of a living tissue over a wide range, and normal coagulation (pinpoint coagulation) is a technique used when the surface of a living tissue to be coagulated is in a narrower range than spray coagulation. . Each of these techniques can be used properly by supplying a high-frequency current for coagulation treatment to the handpiece 1 according to each technique.

In this example, the nozzle electrodes 6 are controlled by foot switches 3b and 3c provided in the high-frequency power supply 3.
It is possible to switch between a high-frequency current for incision / resection treatment and a high-frequency current for coagulation treatment, which are supplied to the apparatus. That is, when the foot switch 3b is depressed, a high-frequency current having a current value sufficient for the incision treatment is continuously supplied from the high-frequency power supply device 3 to the nozzle electrode 6, and the foot switch 3c
When a step is depressed, a high-frequency current for coagulation treatment is supplied to the nozzle electrode 6. Of course, if none of the foot switches 3b, 3c is depressed, or if the foot switches 3b, 3c are depressed, neither the high-frequency current for the incision / resection procedure nor the high-frequency current for the coagulation procedure is applied to the nozzle electrode 6. It is not supplied.

Further, in this example, a changeover switch for switching a high-frequency current for coagulation treatment to be supplied to the high-frequency power supply device 3 when performing spray coagulation and a high-frequency current for coagulation treatment to be supplied when performing normal coagulation. (Not shown) is provided.

FIG. 2 is an explanatory view showing a schematic configuration of the handpiece 1. As shown in FIG. The handpiece 1 is mainly constituted by a grip 5 and a nozzle electrode 6.

The nozzle electrode 6 is a metal nozzle pipe functioning as a saline injection nozzle and a high-frequency current electrode, and is fixed to the tip of the grip 5. One end of the nozzle electrode 6 protrudes forward from the tip of the grip portion 5, and the other end is connected to the flexible hose 2 a and the electric cord 3 a inside the grip portion 5.

An orifice (not shown) is formed at the tip of the nozzle electrode 6 projecting forward from the tip of the grip 5. The orifice may be formed, for example, by reducing the cross-sectional area of the opening of the tip of the nozzle electrode 6, or a nozzle tip (for example, formed of a wear-resistant material such as diamond, sapphire or ceramic) in order to prevent wear of the orifice. (Not shown) to the nozzle electrode 6
It may be formed by attaching to the tip of the.

The outer peripheral surface of the nozzle electrode 6 is covered with an insulating coating 7. Although a tube is fitted as the insulating coating 7 in this example, an insulating coating layer may be integrally formed on the outer peripheral surface of the nozzle electrode 6. In this example, the tip of the nozzle electrode 6 is located inside the insulating coating 7 in order to make the jet flow of the physiological saline injected from the nozzle electrode 6 into a focused flow. The material of the insulating coating 7 is, for example, plastic, rubber, fluororesin, or the like.
It is preferable to use a transparent or translucent material in order to make it easier to see the state of discharge and discharge and the operation site.

The grip 5 is provided with an operation lever 8 for operating the injection of the physiological saline, and when the operation lever 8 is pressed, the operating pressure of the physiological saline pressurizing device 2 is increased. Physiological saline is used as the flexible hose 2a.
And, it is supplied to the nozzle electrode 6 via the handpiece 1.

When incising or resecting a surgical site using the surgical apparatus configured as described above, the living tissue side is electrically grounded, the operating lever 8 is pressed, and the foot switch 3b is depressed. As a result, the physiological saline pressurized by the pressurizing device 2 is jetted as a jet stream from the nozzle electrode 6 through the flexible hose 2a and the handpiece 1, and the electric cord 3a and the hand A high-frequency current for an incision / resection procedure is supplied to the nozzle electrode 6 via the piece 1.

Accordingly, the physiological saline which is jetted from the nozzle electrode 6 as a jet stream is applied to the surgical site as a focused flow by the insulating coating 7 on the outer periphery of the nozzle electrode 6, and is supplied from the high-frequency power supply device 3. The high frequency current flows through the jet stream between the nozzle electrode and the treatment site. As a result, discharge occurs in the jet stream,
The incision / excision of the living tissue is performed by the discharge current energy.

In the surgical apparatus of the present embodiment, the electrodes do not directly contact the living tissue as in the prior art, and can perform incisions and cuts by the current energy through the jet stream. In addition, necrosis of cells around living tissues and expansion of necrotic cells can be minimized. Further, the spread of the heat-affected zone of the living tissue due to the current energy can be limited to an extremely narrow local region by the cooling effect of the jet flow of the physiological saline.

Next, when coagulating the bleeding site of the incised or excised living tissue, the operation lever 8 is pressed and the foot switch 3c is depressed. As a result, the physiological saline pressurized by the pressurizing device 2 is jetted as a jet stream from the nozzle electrode 6 through the flexible hose 2a and the handpiece 1, and the electric cord 3a and the hand A high-frequency current for coagulation treatment is supplied to the nozzle electrode 6 via the piece 1.
In this example, a normal solidification (pinpoint solidification) method is used. Accordingly, a changeover switch (not shown) provided in the high-frequency power supply device 3 is switched to a state in which a high-frequency current for coagulation treatment according to normal coagulation is output.

As a result, the physiological saline is jetted from the nozzle electrode 6 as a jet stream, and a high-frequency current flows through the jet stream to generate a discharge in the jet stream. It is possible to coagulate the incised or excised living tissue bleeding site while minimizing necrosis of cells around the tissue and expansion of the necrotic cells. Also in this case, since the jet flow of the physiological saline is applied to the operation site, the spread of the heat-affected zone of the living tissue is limited to an extremely narrow local region.

In a jet stream jetted from a nozzle electrode located at a predetermined distance from a grounded surgical site of a living tissue, discharge gradually extends from the nozzle electrode 6 to reach the surface of the living tissue. This is because the electric field is stronger on the side of the nozzle electrode 6 than on the surface of the living tissue.
This is because partial dielectric breakdown occurs from the side, and as the strength of the applied electric field increases, the entire circuit breaks down. In addition, this discharge becomes strong mainly in the vicinity of the outer peripheral surface of the jet flow due to the skin effect due to the high-frequency current.

FIG. 3 is an explanatory view showing a handpiece 1a according to another example. The difference from the handpiece 1 shown in FIG. 2 is that the tip of the nozzle electrode 6a protrudes from the tip of the insulating coating 7a. As shown in FIG. 3, by projecting the tip of the nozzle electrode 6 from the tip of the insulating coating 7a, for example, when the surgical site is inside the body, the nozzle electrode 6
a itself is stabbed into the body, and physiological saline is injected from the nozzle electrode 6a to accumulate physiological saline at a surgical site in the body. By generating an electric discharge in between, it is possible to perform incision / excision or coagulation treatment of a surgical site in the body. In this case, even if the nozzle electrode 6a is pierced into the body, the entire outer periphery of the nozzle electrode 6a is covered with the insulating coating 7.
a, the nozzle electrode 6a does not directly touch the living tissue. In the coagulation treatment, spray coagulation in a wide range is particularly easy to be performed. Therefore, in this case, a changeover switch (not shown) provided in the high-frequency power supply device 3 is operated so that a high-frequency current for coagulation treatment corresponding to spray coagulation is supplied to the nozzle electrode 6a.

[0041]

In each of the above examples, a surgical apparatus capable of performing both incision / excision treatment and coagulation treatment of a living tissue has been described. A blend current with a coagulation current for treatment may also be provided.

Further, in order to adjust the intensity of the discharge current energy, a flow adjusting mechanism for changing the flow rate of the liquid jet stream jetted from the nozzle electrode is provided on the handpiece or the pressurizing device, or an insulating coating is provided on the nozzle electrode. The handpiece may be provided with a slide moving mechanism for moving the handpiece in the axial direction.

In each of the above examples, the nozzle electrode 6
When the high frequency current is supplied to the nozzle electrode 6a (FIG. 3), the foot switches 3b and 3c are depressed. When the physiological saline is supplied to the nozzle electrode 6 (or 6a), the operation lever 8 ( In FIG. 3, the case where the operation lever 8a) is operated to supply the high-frequency current and the physiological saline to the nozzle electrode 6 (or 6a) has been described, but the operation lever of the handpiece has a function instead of the foot switch. By incorporating an interlocking switch that performs the operation, the supply of the high-frequency current and the physiological saline to the nozzle electrode may be controlled only by operating the operation lever.

With respect to the surgical apparatus according to the present invention and the conventional electrosurgical apparatus, simulation experiments of incision / excision treatment and coagulation treatment were performed on beef pieces, and their surface temperatures were measured.
The equipment used was an AquaJet scalpel (trade name: AJP-1002P, manufactured by Sugino Machine Co., Ltd., a handpiece shown in FIG. 2) as a surgical apparatus according to the present invention, and a Mera Solid-state scalpel (trade name) as a conventional electric scalpel ; MS
-8000SAS, manufactured by Semco Corporation). Table 1 shows the results. In Table 1, “Electric scalpel” indicates a conventional example, and “Aqua jet scalpel” indicates an example, and a radiation thermometer was used for temperature measurement.

[0046]

[Table 1]

From Table 1, it can be seen that the surface temperature of the beef pieces was lower when the surgical apparatus according to the present invention was used, carbonization of living tissue, necrosis of cells around the living tissue and necrotic cells as compared with the conventional electric scalpel. It can be seen that the expansion of the size can be largely prevented.

[0048]

As described above, according to the present invention, a high-frequency current is passed between a nozzle electrode and a treatment site through a liquid jet stream ejected from the nozzle electrode, so that incision, resection, and coagulation by the high-frequency current can be performed. Since each treatment can be performed, the electrode does not need to directly contact the living tissue, and therefore, carbonization of the living tissue, necrosis of cells around the living tissue, and expansion of necrotic cells can be minimized. There is an effect that can be.

Further, in the present invention, since the liquid jet stream is applied to the operation site, there is also an effect that the heat-affected zone of the living tissue can be limited to an extremely narrow local area by the cooling effect.

When the outer peripheral surface of the nozzle electrode is insulated, an effect is obtained that the nozzle electrode does not directly contact the living tissue.

When the tip of the nozzle electrode is located in the inner part of the insulating coating, the insulating coating has an effect that the liquid jet flow becomes a focused flow and can be accurately guided to the operation site.

When the tip of the nozzle electrode protrudes from the tip of the insulating coating, the tip of the nozzle electrode is pierced into the body, and a liquid jet stream is injected from the nozzle electrode, so that the liquid is collected at the in-vivo operation site. By passing high-frequency current through the stored liquid, incision / excision or coagulation treatment can be performed simultaneously on a wide range of surgical sites in the body, and in this case also, direct contact between the nozzle electrode and living tissue can be achieved by the insulating coating. The effect that it can be prevented is also obtained.

[Brief description of the drawings]

FIG. 1 is an explanatory diagram illustrating a schematic overall configuration of a current-carrying water surgery device according to an example of an embodiment of the present invention.

FIG. 2 is an explanatory diagram showing an example of a schematic configuration of the handpiece shown in FIG.

FIG. 3 is an explanatory view showing another example of the schematic configuration of the handpiece shown in FIG. 1;

[Explanation of symbols]

 1, 1a: handpiece 2: physiological saline pressurizing device 2a: flexible hose 3: high frequency power supply device 3a: electric cord 3b, 3c: foot switch 5, 5a: gripping part 6, 6a: nozzle electrode 7, 7a: insulating Coating 8, 8a: Operation lever

────────────────────────────────────────────────── ─── Continuation of front page (56) References JP-A-4-22354 (JP, A) JP-A-5-92009 (JP, A) JP-A-1-313047 (JP, A) 285152 (JP, A) JP-A-57-103634 (JP, A) JP-A-5-337125 (JP, A) JP-A-57-117843 (JP, A) (58) Fields investigated (Int. ⁷ , DB name) A61B 18/12

Claims (1)

(57) [Claims] 1. A surgical handpiece having a nozzle electrode for injecting a fluid jet stream, and a high-frequency power supply device for flowing a high-frequency current between the nozzle electrode and a treatment site through the fluid jet stream, the nozzle comprising: The outer peripheral surface of the electrode is insulated and
The tip of the spill electrode has a fluid jet ejected from the nozzle electrode.
Position in the inner part of the insulation coating to make the
To have surgical apparatus characterized by.