JP3782495B2 - Microwave surgical device - Google Patents

Description

[0001]
[Field of the Invention]
The present invention, a microwave is supplied to the surgical electrode that is penetrating the living tissue from the main body apparatus, solidified by the hemostasis electrodes near the living body tissue by microwave irradiation of the surgical electrode, coagulation, micro performing dissection, etc. The present invention relates to a wave surgical apparatus.
[0002]
[Prior art]
Conventionally, this type of microwave surgical apparatus is coaxial with the main body apparatus as described in Japanese Patent Publication No. 1-20619 (A61B 17/39), Japanese Patent Publication No. 1-20617 (A61B 17/36), and the like. A needle- like monopolar surgical electrode is detachably connected via a cable.
[0003]
The insertion City surgery electrode to the living tissue, operates the microwave generator of the main device is supplied microwaves of the generator (2450 MHz) to the surgical electrode, focuses the microwaves from the electrode into the living body tissue When irradiated, the tissue in the vicinity of the electrode is solidified using dielectric heat energy generated in the living body.
[0004]
This repetition can be used to perform operations such as hemostasis, coagulation, incision, excision, and excision of a living body. Very useful.
[0005]
When the coagulation by each microwave irradiation is completed, a direct tissue dissociation current is normally supplied from the main body device to the surgical electrode with the central conductor as the negative electrode and the outer conductor as the positive electrode. The tissue attached to the surgical electrode is softened by the electroosmotic action, and the surgical electrode is easily separated from the living tissue.
[0006]
[Problems to be solved by the invention]
In the case of this conventional microwave surgical device, since the growth of the coagulation layer due to microwave irradiation cannot be detected, the microwave output time is set by the doctor based on experience and intuition, and the set time (Several tens of seconds), the living tissue is irradiated with microwaves to complete each coagulation.
[0007]
On the other hand, the growth of the solidified layer by microwave irradiation varies depending on the shape of the surgical electrode, the condition of the living tissue, and the like.
Therefore, in the conventional device, it is not easy to finish coagulation at an appropriate timing, and the surgical electrode causes a slight spark discharge due to hypercoagulation, and the living tissue is carbonized or the tissue adheres to the electrode. There is a problem such as sometimes.
[0008]
An object of the present invention is to automatically end coagulation of a living tissue by microwave irradiation at an appropriate timing.
[0009]
[Means for Solving the Problems]
In order to achieve the above object, in the microwave surgical apparatus of the present invention, an output time setting unit that sets a microwave output time, a microwave generator that outputs a microwave, and the microwave generator An output control unit for controlling the output, a sensor unit for detecting a reflected wave of the microwave output, a coaxial cable to which the microwave of the microwave generator is supplied via the sensor unit, and a tip of the coaxial cable Connected, inserted into the living tissue, supplied with a needle-shaped monopolar surgical electrode that coagulates the living tissue, and an output of the detection wave detected by the reflected wave of the microwave output of the sensor unit, A determination processing unit that determines the end timing of the coagulation based on a peak voltage level change, and notifies the microwave generator of the stop of the microwave output via the output control unit; Provided.
[0012]
The load impedance is changed for microwave output in accordance with the progress of solidification of the living tissue by microwave irradiation, because the reflected waves of the microwaves is changed, the sensor section, the detection wave detected reflected wave peak voltage level varies with the progress of the coagulation.
[0013]
Therefore, I Ri determine specific processing sections to the monitoring of the peak voltage level of the detection wave of the sensor unit judges an end of the coagulation at an appropriate timing according to conditions of the living body tissue.
[0014]
Then, to stop based Kemah microwave output on the determination, the coagulation of the living tissue by microwave irradiation automatically completed at an appropriate timing.
[0015]
DETAILED DESCRIPTION OF THE INVENTION
An embodiment of the present invention will be described with reference to FIGS.
Figure 1 shows the overall configuration, the coaxial cable 2 to the main unit 1 is separable freely connector, surgical electrode 3 of the needle Jomo Nopora type at the tip of the coaxial cable 2 is replacement freely connector.
The surgical electrode 3, the tip is penetrating into living tissue.
[0016]
On the other hand, when operating conditions (irradiation conditions) such as the magnitude (output) and output time of the microwave and tissue dissociation current are specified by operating various setting knobs and the like of the operation unit (not shown) of the main unit 1, The output time of the wave and tissue dissociation current is preset in the output time setting unit 5 that operates as a timer via the output control unit 4 having an output function of various contact signals.
[0017]
Further, the output of the microwave generator 6 is variably set in a range of, for example, 10 to 110 W according to the designation of the magnitude of the microwave, and the DC power supply 7 for dissociation current or the like according to the designation of the magnitude of the tissue dissociation current The output of the dissociation current setting unit 8 connected to the power source 7 is variably set.
[0018]
When the start switch 9 of the main unit 1 such as a foot switch is turned on, the microwave irradiation timer of the output time setting unit 5 is started and the output control unit 4 turns on the power supply unit 10 of the microwave generator 6. When the power is turned on, the power supply unit 10 processes the input power supply of the power receiving terminal 11 into a microwave oscillation power supply such as a high-voltage power supply, and supplies the power to the oscillation unit 12.
[0019]
With this power supply, the oscillation unit 12 generates a 2450 MHz microwave MW having a set size, and the microwave MW is output to the coaxial cable 2 via the cavity resonator 13, the mixer 14, and the sensor unit 15, The microwave of the cable 2 is supplied to the surgical electrode 3.
[0020]
The surgical electrode 3 focuses and irradiates the microwave MW into the living tissue, and the living tissue in the vicinity of the surgical electrode 3 is solidified by dielectric heat energy based on the irradiation.
[0021]
By the way, the mixer 14 is composed of a microwave filter or the like, and mixes and outputs the microwave MW and the DC tissue dissociation current DC of the dissociation current setting unit 8.
[0022]
The sensor unit 15 is provided at the final output unit of the main unit 1 to detect at least one of the reflected wave R and the traveling wave T of the microwave output of the main unit 1, so-called standing wave (SWR) measurement. Here, both the reflected wave R and the traveling wave T are always detected.
[0023]
Then, the output of the detection wave (reflected wave R, traveling wave T) of the sensor unit 15 is supplied to a discrimination processing unit 16 having a microcomputer configuration that forms an end discrimination means. The processing unit 16 monitors the output of the sensor unit 15. Based on this, the proper end timing of coagulation is determined.
[0024]
Next, the determination process of the processing unit 16 will be described.
First, the change of the reflected wave R and the traveling wave T based on the microwave irradiation of the surgical electrode 3 and the proper end timing of coagulation will be described.
[0025]
When the living body tissue is irradiated with the microwave MW of the surgical electrode 3, the disappearance of moisture (body fluid, etc.) occurs due to the progress of the coagulation, the load impedance of the main body device 1 changes, and the reflected wave R, The level of the traveling wave T (peak voltage) and its waveform change.
[0026]
The level and waveform change characteristics vary depending on the shape of the needle of the surgical electrode 3 that influences the microwave irradiation position (location), the part of the biological tissue, and the like, and the liver of the biological tissue is a surgical target. When the surgical electrode 3 has the following three types of shapes A, B, and C, the change characteristics of the reflected wave R are substantially as shown in the actual measurement results of FIGS. 2 (a), (b), and (c). Become.
[0027]
Type A: 15 mm long needle type 15 mm electrode for laparotomy Type B: 30 mm length needle type 30 mm electrode for laparotomy Type C: Deep diameter larger than types A and B (1.6 mm diameter) Transdermal liver electrode 【0028】
As apparent from FIGS. 2A, 2B, and 2C, when 15 seconds have elapsed from the start of irradiation, the transitional change is almost completed regardless of the electrode shape, and the reflected wave R The type of the surgical electrode 3 can be determined from the waveform.
[0029]
Furthermore, as a result of repeating the experiment by measuring the reflected wave R for each type A, B, C surgical electrode 3, in the case of each type A, B, C, the proper end timing of coagulation is as follows: Turned out to be.
[0030]
That is, in the case of Type A, when the level of the reflected wave R becomes equal to 2 seconds before after 15 seconds from the start of the microwave MW irradiation, the level of the reflected wave R is increased after a predetermined time (5 seconds) has passed. The level is maintained at a level slightly higher (0.2 V) than the level 5 seconds before, and when a predetermined time (10 seconds) has elapsed from this state, the proper end timing of coagulation is reached.
[0031]
In the case of Type B, when 30 seconds have elapsed from the start of irradiation with the microwave MW, when the level of the reflected wave R becomes equal to or higher than a predetermined voltage (2 V), the proper end timing of coagulation is reached.
[0032]
Further, in the case of Type C, when the level of the reflected wave R becomes larger than 2 seconds before after 15 seconds from the start of the irradiation of the microwave MW, the level of the reflected wave R is increased after a predetermined time (5 seconds) has elapsed since then. It becomes higher by a predetermined amount (0.1 V) than the level 5 seconds before, and when the predetermined time (10 seconds) has elapsed from this state, the proper end timing of coagulation is reached.
[0033]
Therefore, for type A and C surgical electrodes 3, the proper end timing of coagulation can be determined by monitoring the waveform of reflected wave R (time change in level), and for type B surgical electrode 3, reflected wave R is determined. The proper end timing of coagulation can be determined by monitoring the current level.
[0034]
Further, the start of irradiation with the microwave MW can be grasped, for example, because the level of the traveling wave T becomes equal to or higher than a certain value (2 V).
[0035]
Therefore, when the output of the start switch 9 is notified from the output control unit 4, the discrimination processing unit 16 executes the discrimination processing program shown in FIGS. 3, 4 and 5, and first, the traveling wave T is transmitted in step S1 of FIG. Is waited until the peak voltage becomes 2 V or higher, and the irradiation start of the microwave MW is detected.
[0036]
When this irradiation start is detected, an internal timer counter is initialized in step S2, and a time measuring operation is immediately started. In step S3, 15 seconds are awaited.
[0037]
When the 15 seconds have elapsed, the process proceeds to step S4, where the waveform of the reflected wave R is compared with the reference waveforms of types A, B, and C stored in advance in an internal memory, and the surgical electrode is determined from the closest reference waveform. 3 types are discriminated.
[0038]
By the way, the reference waveform is a typical waveform of each type when 15 seconds have elapsed from the start of irradiation, for example, a waveform as shown in FIG. 6A for type B, or a diagram of 15 seconds from the start of irradiation. 2 is a waveform of change characteristics such as (a), (b), and (c).
[0039]
When the type of the surgical electrode 3 is determined, the process branches in accordance with this determination, and in the case of the simplest type B determined from the current level of the reflected wave R, the process proceeds from step S4 to step S5, and further. Waiting for 15 seconds to elapse, and if 15 seconds elapse and 30 seconds elapse, the step S6 repeatedly determines whether or not the positive peak voltage of the reflected wave R has risen to 2 V or more.
[0040]
At this time, the waveform of the reflected wave R changes as shown in FIGS. 6B and 6C according to the progress of coagulation, for example, FIG. 6B shows the waveform during the coagulation 30 seconds after the start of irradiation, (c ) Is a waveform when it is time to finish coagulation.
[0041]
As is clear from FIGS. 6A, 6B, and 6C, in the case of the type B surgical electrode 3, the level of the reflected wave R immediately after the type discrimination is as shown in FIG. The reflected wave R decreases in level due to moisture, etc., and then the level of the reflected wave R decreases so that the peak voltage becomes lower than 2 V as shown in FIG. When the level of R rises and ends, the peak voltage rises to 2 V or more as shown in FIG.
[0042]
In addition, if microwaves are further irradiated from the state of FIG. 6C, a hypercoagulated state is caused, and harmful effects such as carbonization of the living tissue occur.
[0043]
Then, when the peak voltage of the reflected wave R rises to 2V and the proper end timing of coagulation is reached, the process proceeds from step S6 to the end of coagulation in step S7, and the output control unit 4 is notified of the stop of the microwave output and output. The power supply unit 10 is turned off by the output stop means of the control unit 4 to automatically stop the microwave output of the main unit 1.
[0044]
Further, the notification device 17 of the main body device 1 is notified of the end via the output control unit 4, and the notification device 17 generates a sound such as a buzzer sound, a voice message, or the like. The end of coagulation (end of microwave irradiation) is notified by light such as a message of characters or figures.
[0045]
On the other hand, in the case of type A goes to step S8 in FIG. 4 from the step S4 of FIG. 3, when the type determination, that is, the peak voltage of the reflected wave R after 15 seconds from the start of the irradiation of the microwaves inside the register R ₀ Hold.
[0046]
Further, it is determined whether or not the peak voltage of the reflected wave R when 2 seconds have elapsed in steps S9 and S10 is equal to the holding voltage of the register R ₀ , and 4 to 8 seconds from the start of irradiation in FIG. It is identified whether or not the level increase due to a transitional change during the period has ended.
[0047]
Then, steps until the peak voltage of the reflected wave R after 2 seconds is equal to the value held in the register R ₀ S8, S9, processing S10 repeatedly, a peak voltage of the reflected wave R while updating the value held in the register R ₀ To monitor.
[0048]
Next, when the peak voltage of the reflected wave R after 2 seconds becomes equal to the holding value of the register R ₀ , the process proceeds from step S10 to step S11 and waits for another 5 seconds. In S12, it is determined whether or not the current peak voltage of the reflected wave R is equal to or lower than a level 0.2V higher than the value held in the register _R0. The process returns to Step S10 until this state is reached, and the processing from Step S10 is repeated. .
[0049]
When the current peak voltage of the reflected wave R falls below 0.2V higher than the value held in the register _R0 and hardly changes, the process proceeds to step S13 and waits until 10 seconds elapse. When the proper coagulation end timing is reached, the process proceeds to the end of coagulation in step S14, and the microwave output is stopped and the end of coagulation is notified in the same manner as in step S7.
[0050]
Next, in the case of type C, the process proceeds from step S4 in FIG. 3 to step S15 in FIG. 5. By this step S15, the peak of the reflected wave R 15 seconds after the start of microwave irradiation, as in step S8 in FIG. The voltage is held in the internal register _R0 .
[0051]
Further, it is determined whether or not the peak voltage of the reflected wave R is larger than the holding voltage of the register R ₀ when 2 seconds have elapsed in steps S16 and S17, and after 25 seconds has elapsed in (c) of FIG. Identifies whether or not an incremental level has been reached.
[0052]
Then, the processing of steps S15, S16, and S17 is repeated until this gradual increase state is reached, and the peak voltage of the reflected wave R is monitored while updating the value held in the register _R0 .
[0053]
Next, in the gradual increase state, the process proceeds from step S17 to step S18 and waits for another 5 seconds. When this 5 seconds elapses, the peak voltage of the current reflected wave R is set in the register R ₀ by step S19. It is determined whether or not the holding value is higher than 0.1 V, and the process returns to step S17 until this state is reached, and the processing from step S17 is repeated.
[0054]
When the current peak voltage of the reflected wave R becomes 0.1 V or more higher than the value held in the register R ₀ , the process proceeds to step S20 and waits for 10 seconds to elapse. At the timing, the process proceeds to the end of coagulation in step S21, and the microwave output is stopped and the end of coagulation is notified in the same manner as in steps S7 and S14.
[0055]
Therefore, regardless of the type of surgical electrode 3, coagulation by microwave irradiation is automatically terminated at an appropriate end timing, and the occurrence of overcoagulation or the like is reliably prevented and the operability and functionality are remarkably improved.
[0056]
For example, as in the case of (b) of FIG. 2, even if the microwave irradiation continues for a certain time until the time set by the timer, the output control unit 4 is based on the time-up notification from the output time setting unit 5. The power supply unit 10 is turned off to stop the microwave output of the main unit 1.
[0057]
When the start switch 9 is turned on again during the microwave irradiation, the output control unit 4 immediately turns off the power supply unit 10 and stops the microwave output.
Therefore, sufficient safety is ensured.
[0058]
Next, when the microwave irradiation is finished, the output control unit 4 starts a timer for the dissociation current of the output time setting unit 5, and instructs the dissociation current setting unit 8 to turn on the output via the setting unit 5. Automatically transition to tissue dissociation.
[0059]
At this time, a direct current tissue dissociation current DC having a magnitude set in the living tissue is supplied from the direct current power source 7 through the dissociation current setting unit 8, the mixer 14, the sensor unit 15, the coaxial cable 2, and the surgical electrode 3. The dissociated current DC softens the tissue adhered to the surgical electrode 3 using the electroosmotic action of the living body and makes it easier to pull out the surgical electrode 3 from the living body.
[0060]
Then, the output control unit 4 commands the dissociation current setting unit 8 to turn off the output by the time-up of the output time setting unit 5, and the supply of the tissue dissociation current DC is automatically terminated. This termination is notified by the alarm device 17. The
[0061]
By returning a necessary number of times repeated by shifting the microwave irradiation and the position you penetration dissociation and surgery electrode 3 of the living tissue or biological desired hemostasis, can be performed such as coagulation.
[0062]
By the way, when the type of surgical electrode to be used is fixed to one, for example, the determination in step S4 in FIG.
[0063]
Further, instead of monitoring the level or waveform of the reflected wave R, the level or waveform of the traveling wave T may be monitored to automatically stop the microwave output, or both the levels of the reflected wave R and the traveling wave T or The waveform output may be monitored to automatically stop the microwave output.
[0064]
At this time, since the level and waveform used as a reference for discrimination differ depending on the shape of the surgical electrode 3 and the surgical site of the living tissue, the change characteristics of the reflected wave R and the traveling wave T under conditions applied in advance through experiments are measured. The reference level and waveform necessary for discrimination may be set in the discrimination processing unit 16 or the like.
Of course, the determination procedure and the like may be different from those shown in FIGS.
[0065]
Further, the configuration of the output control unit 4 and the like in FIG. 1 may be any configuration. For example, the output control unit 4, the output time setting unit 5, the discrimination processing unit 16 and the like may be formed by a single microcomputer. Is possible.
[0066]
Further, the present invention can be similarly applied to the case of so-called simultaneous irradiation or the like in which one microwave irradiation is performed by superimposing the microwave output intermittently or continuously on the tissue dissociation current.
[0067]
【The invention's effect】
The present invention has the following effects.
An output time setting unit for setting a microwave output time, a microwave generator for outputting a microwave, an output control unit for controlling the output of the microwave generator, and a sensor for detecting a reflected wave of the microwave output Unit, a coaxial cable to which microwaves of the microwave generator are supplied via the sensor unit, a needle-shaped monopolar type connected to the tip of the coaxial cable, inserted into the living tissue, and coagulating the living tissue Output of a detection wave obtained by detecting a reflected wave of the microwave output of the surgical electrode and the sensor unit, and determining the end timing of the coagulation based on a change in the peak voltage level of the detection wave, and the output control unit And a determination processing unit that notifies the microwave generator of the stop of the microwave output via,
The load impedance with respect to the microwave output changes with the progress of coagulation of the living tissue due to the microwave irradiation, and the reflected wave of the microwave changes. Therefore, the peak voltage level of the detection wave of the sensor unit 15 that detects the reflected wave is Based on the monitoring of the change in the peak voltage level of the detection wave of the sensor unit 15, the determination processing unit can determine the end of coagulation at an appropriate timing according to the condition of the living tissue.
[0068]
Then, the determination to stop the based Kemah microwave output can be automatically terminated at an appropriate timing coagulation of biological tissue by microwave irradiation, possible to reliably prevent occurrence of so-called hypercoagulable And operability and functionality can be significantly improved.
[Brief description of the drawings]
FIG. 1 is a block diagram of an embodiment of the present invention.
FIG. 2 is a characteristic diagram of a change in level of a reflected wave for each type of surgical electrode.
FIG. 3 is a first flowchart for explaining the operation of the discrimination processing unit of FIG. 1;
4 is a second flowchart for explaining the operation of the discrimination processing unit of FIG. 1; FIG.
FIG. 5 is a third flowchart for explaining the operation of the discrimination processing unit of FIG. 1;
6A, 6B, and 6C are explanatory diagrams of an example of a change in the waveform of the reflected wave in FIG.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Main body apparatus 2 Coaxial cable 3 Surgical electrode 4 Output control part 5 Output time setting part 6 Microwave generator 15 Sensor part 16 Discrimination processing part

Claims (1)

An output time setting unit for setting an output time of microwaves, a microwave generator that outputs microwaves,
An output control unit for controlling the output of the microwave generator;
A sensor unit for detecting the reflected wave of the microwave output;
A coaxial cable microwaves of the microwave generator is supplied via the sensor unit,
A needle-shaped monopolar surgical electrode connected to the tip of the coaxial cable, inserted into a living tissue, and coagulating the living tissue;
An output of a detection wave obtained by detecting a reflected wave of the microwave output of the sensor unit is supplied, and an end timing of the coagulation is determined based on a change in a peak voltage level of the detection wave, and the microwave is transmitted via the output control unit. A microwave operation apparatus comprising: a determination processing unit that notifies a generator of stoppage of microwave output.

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