JP3691672B2 - Pneumoperitoneum - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a pneumoperitoneum device used in combination with a surgical cautery device.
[0002]
[Prior art]
2. Description of the Related Art Conventionally, medical treatment in the abdominal cavity is widely performed under endoscopic observation. For example, when performing cholecystectomy or the like under an endoscope, in order to ensure a necessary field of view for performing work in the abdominal cavity and to secure a space for endoscopic operation, the intraperitoneal cavity to be treated is aired. The space inside the abdominal cavity is expanded by injecting CO ₂ gas through the abdominal device.
[0003]
When the affected tissue in the abdominal cavity expanded in a pneumoperitoneum is cauterized using an ablation device such as a high-frequency ablation device or a laser device, the smoke generated by the ablation device fills the abdominal cavity and the endoscope is observed. May interfere with vision.
[0004]
In such a case, conventionally, the driving of the cautery device is temporarily stopped, and the endoscope or treatment tool introduced into the abdominal cavity through the inner hole of the trocar is removed from the trocar, and then communicated into the abdominal cavity by the pneumoperitoneum. Smoke that fills the abdominal cavity is discharged to the outside through the inner hole of the trocar.
[0005]
As a prior art, it is described in JP-T-10-500604 “Operation rate control system of an auxiliary device used together with an electrosurgical generator”, and this system outputs the output of an electrosurgical generator (high-frequency ablation device). The ON signal is connected to an auxiliary device with a function of directly sucking gas (smoke), and the smoke generated when the affected area of the patient is cauterized by the output of the electrosurgical generator is discharged to the outside. There is a smoke detector in the smoke suction pipe, and the smoke detection signal detected by the smoke detector is connected to the auxiliary device.
[0006]
When the output of the electrosurgical generator is turned on, the output ON signal is transmitted to the auxiliary device, and smoke generated by operating the surgical generator on the human body is discharged to the outside through the suction line. In addition, the suction operation can be effectively controlled by the amount of smoke detected by the smoke detector, and the generated smoke can be efficiently sucked and discharged.
[0007]
Japanese Patent Application Laid-Open No. 6-178780 describes a “pneumoconiphering device smoke removal system”, which includes a pneumoperitoneum that injects gas into the abdominal cavity and expands the abdominal cavity. An ablation device for cauterizing the affected tissue site within the abdominal cavity, a smoke removal device for removing smoke generated in the abdominal cavity, and the smoke removal device and the pneumoperitoneum according to the driving operation of the ablation device. Means for driving is provided.
[0008]
When the ablation device is driven, the smoke removal device and the insufflation device are driven according to the operation of the ablation device, and the smoke generated in the abdominal cavity is approximately proportional to the drive output of the ablation device. It is made to remove.
[0009]
[Problems to be solved by the invention]
In Japanese National Publication No. 10-500604, means for electrically connecting an electrosurgical generator (high-frequency ablation device), an auxiliary device, and a smoke detector are provided, and work for connecting each device is necessary. In addition, electrosurgical generators (high-frequency ablation devices) require physical (electrical) connections with auxiliary devices, and thus are limited to limited models.
[0010]
In Japanese Patent Laid-Open No. 6-178780, there is a problem that the smoke removal function cannot be used when trying to use a high-frequency cautery device or smoke removal device that does not have a communication means for backup during the operation of the system. there were.
[0011]
In the present invention, even if the insufflation apparatus is not electrically connected to the high-frequency ablation apparatus, the operation of the insufflation apparatus is interlocked with the output of the high-frequency ablation apparatus, thereby generating in the abdominal cavity due to the action of the high-frequency ablation apparatus. An object of the present invention is to provide an insufflation apparatus capable of exhausting smoke.
[0012]
[Means for Solving the Problems]
In order to achieve the above object, the pneumoperitoneum according to the present invention includes a gas injection means for injecting gas into a patient's abdominal cavity and expanding the abdominal cavity, and a discharge means for sucking and discharging the gas in the abdominal cavity outside the abdominal cavity. In a pneumoperitoneum having
High-frequency noise receiving means for receiving high-frequency noise generated at the time of output of a high-frequency ablation device for ablating and removing the affected part of the patient's abdominal cavity ;
By detecting the high frequency noise received by the high frequency noise receiving means, the high frequency noise detecting means for detecting the period in which the high frequency noise is generated and outputting the generation period detection signal;
In order to remove smoke generated in the abdominal cavity when the affected part is cauterized by the high-frequency cautery device, the gas injecting and discharging operation into the abdominal cavity is performed so as to keep the pressure in the abdominal cavity constant. Control means for controlling based on the generation period detection signal output by the high-frequency noise detection means ;
It is characterized by comprising.
[0015]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, a first embodiment of the present invention will be described with reference to FIGS.
In FIG. 1, an endoscope system 1 includes a rigid endoscope 2 that is inserted into the abdominal cavity of a patient, a TV camera 4 that captures an internal image captured by the endoscope 2, and a CCU (camera control unit). 5, a light source device 6 that supplies illumination light to the endoscope 2, a high-frequency cauterization device 7 that performs hemostasis of a treatment site of a patient's affected area or excision of a tissue, and the field of view of the endoscope 2 In order to secure the treatment area of the treatment site, supply of air-feeding gas for inflating the abdominal cavity of the patient and the smoke generated in the abdominal cavity when the radiofrequency ablation device 7 is applied to the affected area of the patient It is mainly comprised with the insufflation apparatus 8 which discharges | emits out of a patient's body.
[0016]
The patient's abdomen is punctured with an endoscope 2 and two trocars 9 and 10 which are guide tubes having insertion holes for guiding surgical instruments into the abdominal cavity. Here, one end of an insufflation tube 11 made of vinyl chloride or Teflon is detachably attached to the insertion hole 9a of one trocar 9 through which the endoscope 2 is inserted.
[0017]
The high-frequency treatment instrument 12 is inserted into the insertion hole 10 a of the other trocar 10. One end of a suction tube 24 made of the same material as the pneumoperitoneum tube 11 is detachably attached to the high-frequency treatment instrument 12.
[0018]
The endoscope 2 is provided with an elongated insertion portion 3 to be inserted into the patient's body and an eyepiece portion 3 a connected to the proximal end portion of the insertion portion 3. Further, one end portion of the light guide cable 13 is connected to the proximal end portion of the insertion portion 3 of the endoscope 2 in the vicinity of the eyepiece portion 3a. The other end of the light guide cable 13 is connected to the light source device 6.
[0019]
A light source lamp 14 and a condenser lens 15 are provided inside the light source device 6. The emitted light from the lamp 14 in the light source device 6 is condensed on the end face of the ride guide cable 13 by the lens 15. Furthermore, the illumination light condensed on the end surface of the light guide cable 13 is transmitted to the distal end portion of the insertion portion 3 of the endoscope 2 through a light guide fiber bundle (not shown) disposed in the light guide cable 13. The subject (such as an affected part in the abdominal cavity of the patient) is illuminated.
[0020]
The illumination light emitted from the distal end portion of the insertion portion 3 of the endoscope 2 is reflected by the subject, and a subject image is formed in the endoscope 2. Further, the subject image is transmitted to the eyepiece 3a through an observation optical system (not shown).
[0021]
A TV camera 4 is detachably connected to the eyepiece 3 a of the endoscope 2. The TV camera 4 has a built-in CCD (solid-state imaging device) (not shown). The subject image transmitted to the eyepiece 3a of the endoscope 2 is captured by the CCD in the TV camera 4.
[0022]
Further, the CCU 5 is connected to the TV camera 4 via the camera cable 16. A TV monitor 17 is connected to the CCU 5. The signal output from the TV camera 4 is transmitted to the CCU 5 via the camera cable 16. At this time, the CCU 5 receives the transmitted signal, generates a video signal, and outputs it to the TV monitor 17.
The TV monitor 17 displays the captured subject image.
[0023]
One end of an active cord 18 is connected to the high-frequency treatment instrument 12. The other end of the active cord 18 is connected to the high frequency cautery device 7. This high-frequency cautery device 7 is provided with an active electrode 19 and a patient electrode 20. The high-frequency treatment instrument 12 is electrically connected to the active electrode 19 of the high-frequency ablation device 7 via the active cord 18.
[0024]
Further, as shown in FIG. 2, an ablation electrode 29 protrudes from the distal end portion of the high-frequency treatment instrument 12. Further, a suction hole 31 is formed inside the high-frequency treatment instrument 12. A suction rod 30 is formed on the base end side of the suction hole 31.
[0025]
One end of an intake tube 24 is detachably connected to the suction metal 30. The other end of the suction tube 24 is connected to a suction pump 32 via a suction rod (not shown) of the pneumoperitoneum device 8. The operation of the suction bump 32 is controlled by the control unit 28. The operation of the suction pump 32 allows the gas in the abdominal cavity to be discharged outside the abdominal cavity of the patient through the suction hole 31 and the intake tube 24.
[0026]
In addition, one end of a patient cord 22 is connected to the patient electrode 20 of the high-frequency ablation device 7. The other end of the patient cord 22 has flexibility so as to be in close contact with the human skin, and is connected to a patient plate 21 formed in a sheet shape.
[0027]
Further, an HF output amber 23 that generates high-frequency power is provided inside the high-frequency cautery device 7. The HF output amplifier 23 is connected to the active electrode 19 and the patient electrode 20 of the high-frequency ablation device 7.
[0028]
The pneumoperitoneum 8 detects high frequency noise generated when the high frequency ablation device 7 outputs HF, and injects gas into the abdominal cavity of the patient and the high frequency noise detection unit 33 that detects the output ON state of the high frequency ablation device 7. Valve unit (gas injection means) 27, a suction pump (gas discharge means) 32 for sucking the gas in the abdominal cavity outside the abdominal cavity, and a signal from the high frequency noise detector 33 while keeping the pressure in the abdominal cavity constant. A control unit 28 is provided for interlocking a suction operation for discharging the gas outside the body while injecting the gas.
[0029]
As shown in FIG. 3, the high-frequency noise detection unit 33 receives the high-frequency noise of the high-frequency ablation device 7 generated outside the pneumoperitoneum 8, and the high-frequency noise induced by the coil antenna. The receiving circuit 35, a signal amplifying circuit 36 that amplifies the signal of the receiving circuit 35, and a signal detecting circuit 37 that detects the high-frequency noise amplified to an arbitrary signal level by the signal amplifying circuit 36. The signal detection circuit 37 detects a period (time) in which high-frequency noise is generated, and the detection signal is sent to the control unit 28.
[0030]
In FIG. 1, one end of a high-pressure gas supply tube 25 is connected to the valve unit 27 of the insufflation apparatus 8. The other end of the high pressure gas supply tube 25 is connected to an air supply gas cylinder 26 filled with liquefied carbon dioxide.
[0031]
Further, the other end of the insufflation tube 11 is detachably connected to an insufflation rod (not shown) of the insufflation apparatus 8. A valve unit 27 is connected to the air supply gold. The liquid carbon dioxide filled in the gas supply gas cylinder 26 is vaporized and reduced to a predetermined pressure through the valve unit 27 in the insufflation apparatus 8, and then the trocar 9 is inserted from the insufflation tube 11. It is fed into the abdominal cavity so as to maintain a predetermined abdominal pressure through the hole 9a.
[0032]
Further, a valve unit 27 and a suction pump 32 are electrically connected to the control unit 28 of the insufflation apparatus 8.
The valve unit 27 is controlled by the control unit 28 to control the flow rate and pressure of carbon dioxide gas fed into the abdominal cavity.
[0033]
Next, the operation of the pneumoperitoneum configured as described above will be described.
When cauterization treatment is performed in the abdominal cavity under observation by an endoscope, the trocars 9 and 10 are first inserted into the abdominal cavity to be treated by piercing the abdominal wall of the patient. Then, the valve unit 27 of the pneumoperitoneum 8 is opened via the trocar 9, and the CO ₂ gas in the gas cylinder 26 is injected into the abdominal cavity of the patient to expand the abdominal cavity. With the intra-abdominal pressure reaching a predetermined pressure, the endoscope 2 is introduced into the expanded abdominal cavity through the insertion hole 9a of the trocar 9, and the high-frequency treatment instrument 12 is inserted into the insertion hole 10a of the trocar 10. Is introduced. At this time, the pressure of the CO ₂ gas is detected by a pressure sensor (not shown) and controlled by the control unit 28 so as to be maintained at a predetermined value.
[0034]
The smoke exhausting operation will be described with reference to FIG.
The cauterization treatment of the affected tissue is usually performed by the operator depressing and operating a foot switch (not shown). Here, when the foot switch is depressed, the high-frequency ablation device is activated, and a high-frequency current flows through the ablation electrode 29 at the tip of the high-frequency treatment instrument 12. When the ablation electrode 29 is brought into contact with the affected tissue in this state, the affected tissue is cauterized. The smoke generated by this cauterization treatment is removed as follows.
[0035]
That is, at the same time that the foot switch is depressed, high-frequency noise is generated by the output of the high-frequency cautery device 7. Although the generation of this high-frequency noise is suppressed to a level that does not adversely affect other devices, it is not at a level where detection is impossible. This high frequency noise is detected by the high frequency noise detector 33 of the pneumoperitoneum 8. The output noise (high-frequency noise) of the high-frequency cautery device 7 is indicated by “output ON” of the signal A in FIG. This is processed by the high frequency noise detection unit 33 and detected is a signal B in FIG.
[0036]
In response to this detection signal B, the control unit 28 performs a gas discharge operation for discharging the gas outside the body while injecting the gas while keeping the pressure in the abdominal cavity constant during the output of the high-frequency ablation device 7. However, the gas discharge operation is not performed only during the ON period of the detection signal B (that is, the period when the output of the high-frequency ablation device 7 is ON), but the actual output of the high-frequency ablation device 7 is turned off as shown by the signal C. After that, a delay time t is provided and interlocked so that smoke can be exhausted sufficiently.
[0037]
As described above, by detecting the high-frequency noise generated when the output of the high-frequency ablation device is turned on, the output ON of the high-frequency ablation device is known, the period during which the output of the high-frequency ablation device is ON, that is, the affected tissue is cauterized and smoke is emitted. The insufflation apparatus performs the gas discharging operation only during the period of occurrence and the necessary time following it.
[0038]
A second embodiment of the present invention will be described with reference to FIG.
The difference from the first embodiment is the configuration of the control unit 50 and the high-frequency noise detection unit 60.
[0039]
Note that the same parts as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.
The high frequency noise generated by the output of the high frequency cauterization device is directly input from the signal amplification circuit 36 of the high frequency noise detection unit 60 to the A / D converter 38 of the control unit 50 and can be confirmed by the CPU 39. The CPU 39 is connected to a ROM 42 and a RAM 41 for storing a program for performing control. Then, the high-frequency cautery device 7 is output in advance, and the high-frequency noise is detected by the high-frequency noise detection unit 60. When key input is received by an automatic adjustment key (not shown) of the input unit 40, the high-frequency noise detection is performed. After the output of the unit 60 is A / D converted by the A / D converter 38, the software gain is adjusted to an optimum gain.
The software gain adjustment can detect high-frequency noise due to the output of the high-frequency ablation device regardless of the setting status of the device in the operating room and the model of the high-frequency ablation device 7, and as with the first embodiment, The gas injection / exhaust operation of the abdominal device 8 is controlled in an interlocked manner. Therefore, smoke can be removed by cauterization of the affected tissue with a simple configuration.
[0040]
Further, information on the high-frequency cautery device 7 combined with the pneumoperitoneum 8 (parameter value of the noise level when the software gain is adjusted) is stored in the nonvolatile RAM 41, and this combination of the pneumoperitoneum 8 again. And when using with the induction cautery apparatus 7, it is not necessary to adjust automatically again, and it becomes possible to reuse.
[0041]
【The invention's effect】
According to the present invention, even if the insufflation apparatus is not electrically connected to the high-frequency ablation device, the operation of the insufflation apparatus is interlocked with the output of the high-frequency ablation device, thereby generating in the abdominal cavity by the action of the high-frequency ablation device. Smoke to smoke.
[Brief description of the drawings]
FIG. 1 is an overall configuration diagram of a first embodiment of the present invention.
FIG. 2 is a cross-sectional view showing an internal structure of the high-frequency treatment device according to the first embodiment of the present invention.
FIG. 3 is a block diagram of a control unit and a high frequency noise detection unit 33 according to the first embodiment of this invention.
FIG. 4 is a timing chart according to the first embodiment of the present invention.
FIG. 5 is a block diagram of a control unit 50 and a high frequency noise detection unit 60 according to a second embodiment of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Endoscope system 6 Light source device 7 High frequency cautery device 8 Insufflation device 12 High frequency treatment tool 28, 50 Control part 33, 60 High frequency noise detection part

Claims (4)

In an insufflation apparatus having gas injecting means for injecting gas into the abdominal cavity of a patient to expand the abdominal cavity, and discharging means for sucking and discharging the gas in the abdominal cavity outside the abdominal cavity,
High-frequency noise receiving means for receiving high-frequency noise generated at the time of output of a high-frequency ablation device for ablating and removing the affected part of the patient's abdominal cavity ;
By detecting the high frequency noise received by the high frequency noise receiving means, the high frequency noise detecting means for detecting the period in which the high frequency noise is generated and outputting the generation period detection signal;
In order to remove smoke generated in the abdominal cavity when the affected part is cauterized by the high-frequency cautery device, the gas injecting and discharging operation into the abdominal cavity is performed so as to keep the pressure in the abdominal cavity constant. Control means for controlling based on the generation period detection signal output by the high-frequency noise detection means ;
A pneumoperitoneum characterized by comprising: 2. The pneumoperitoneum according to claim 1, wherein the control means performs control so as to perform the discharge operation by extending a predetermined time from the end of the generation period detection signal . The pneumoperitoneum according to claim 1 or 2 , wherein the control means has a function of automatically adjusting a noise level detected by the high-frequency noise detection means to an appropriate level. 4. The pneumoperitoneum according to claim 3 , further comprising storage means for storing a gain adjustment parameter value for setting the detected noise level to an appropriate level.

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