JP3798022B2 - 電気外科器具 - Google Patents
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Description
この発明は導電性流体媒体の存在下において組織の処置を行うための電気外科器具に関し、さらにはこのような器具を含む電気外科システム装置に関する。
(従来の技術)
内視鏡電気外科法は体腔内の組織を処置するのに有用であり、通常は拡延媒体の存在下で行われる。拡延媒体が液体で有る場合、このような技法は一般に水中電気外科法と呼ばれており、この用語は手術箇所において液体に浸される一つの処置電極もしくは複数の処置電極を備えた電気外科器具を利用して生体組織を処置する電気外科法を示すものである。腹腔鏡外科や胃腸外科の場合においてしばしばなように、内視鏡外科法を液体媒体の使用に適しないような大きな潜在的容積の拡延可能な体腔において行う場合には気体媒体が一般に採用されている。
水中外科法は一般に内視鏡技術を利用して行われるものであり、そこでは内視鏡自体が電極が通るための導管(一般にはワーキングチャンネルと呼ばれる)を提供する。それに代えて、(切除用内視鏡におけるように)内視鏡を電極を取り付ける手段を含むように特に適合させるか、あるいは電極を内視鏡に対して別個のアクセス手段によって角度を持ってで体腔内に導入してもよく、これは一般にトライアンギュレーション(triangulation)と呼ばれている技術である。このような技術は外科の専門家により様々に細分化されており、これらの技術のどれかが特定の体腔へのアクセスルートを与えるのに特に有利である。ワーキングチャンネルを一体で備えた内視鏡或いは、切除用内視鏡として特徴づけられているものは、通常、体腔が例えば子宮内腔にアクセスするための子宮頸管や、前立腺や膀胱にアクセスするための尿道のような、本来的な体の開口を通じてアクセスできるものである場合に採用されている。子宮内腔における利用のために特に設計された内視鏡は子宮鏡と呼ばれており、尿路における利用のために設計された内視鏡には膀胱鏡、尿道鏡及び切除用内視鏡が含まれる。経尿道的切除や前立腺の蒸発の手法はそれぞれTURP及びEVAPとして知られている。内視鏡が通る本来的な体の開口がなければ一般にトライアンギュレーションが採用される。トライアンギュレーションは一般に膝や肩のような関節腔についての水中電気外科法の際に利用されるものである。これらの処置において利用される内視鏡は一般に関節鏡と呼ばれている。
電気外科法は通常単極器具か二極器具のいずれかを用いて実施される。単極電気外科法の場合、手術領域においては活性電極が利用され、患者の皮膚には導電性のリターンプレートが固定される。このような構成により、電流は活性電極から患者の組織を通って外部のリターンプレートへと流れる。患者は回路の大部分を占めるので、入力パワーレベルは患者の組織による電流制限抵抗を補償するために、高く(一般に150〜250ワット)なければならず、水中電気外科法の場合には、血液その他の体液の存在によって部分的には導電性となる流体媒体によるパワーがロスする。単極構造で大きな電力を利用するのは、リターンプレートにおいて組織が加熱され、皮膚が激しく焼かれてしまうことがあるのでこれも危険である。また、体腔への入口点において器具と患者組織との間に容量結合が生じるおそれもある。
二極電気外科法では一対の電極(活性電極及びリターン電極)がともに組織の適用箇所において用いられる。このような構成は、2つの電極が相対的に接近しており、無線周波数電流はこれらの電極の間に限定されるので、安全性の見地において有利である。しかしながら効果の深さは2つの電極の間の距離に直接的に関連しており、非常に小さな電極を必要とする用途においては電極間距離が非常に小さくなるので組織への効果と出力電力が制限される。電極間をさらに広げると適用箇所が見えにくくなるのがしばしばであり、両電極の組織への直接の接触を確実にするには外科技法を変える必要が有る。
二極プローブの基本的な設計には多数の変形が有る。例えばアメリカ合衆国特許第4706667号には基礎的な設計の一つ、すなわち、リターン電極の接触面積と活性電極の接触面積との比は切断の目的では7:1よりも大きく、20:1よりも小さい設計が記載されている。この範囲は切断電極構造のみに関するものである。二極器具が乾燥や凝固に利用される場合の2つの電極の接触面積の比は、組織と電極との間の接点において生じる差分電気ストレスを避けるために約1:1まで小さくされる。
リターン電極と組織との間の電気的接続は例えば通常生理食塩溶液のような導電性溶液によって組織を濡らすことで維持することができる。これによって、外科効果は、2つの電極間の回路を組織によって完成することで、ニードルすなわち活性電極に制限することが確実化される。この設計の明白な制限の一つはリターン電極が回路を完全なものとするためには針を組織内に完全に埋め込まなければならないということである。もう一つの問題は方向の問題であり、組織面に対する適用角度が理想的な垂直接触から比較的僅かに変わっても、接触面積の比が変わってリターン電極に接触する組織において外科作用が生じてしまうことである。
体腔の拡延は手術箇所へのアクセスを得るためのスペースを提供して可視化を改善し、器具の操作を可能とする。体腔の容積が小さい場合、特に高圧でその体腔を拡延するのが望ましい場合には、気体よりも液体のほうが、光学的特性が良いことと、血液を手術箇所から洗い流すことの理由で、より一般的に利用されている。
(発明が解決しようとする課題)
従来の水中電気外科法は電気の導通ロスを排除するため、灌注剤(irrigant)あるいは拡延媒体として非導電性の液体(例えば1.5%のグリシン)を利用して行われている。グリシンは脈管内吸収が生じたときに血液に浸透圧変化が生じることを防ぐために、等張濃度で利用される。手術の過程で血管が切れると、この液体が循環内に入る結果、とりわけ水中毒として知られる状態に導く可能性のある血清ナトリウムの希釈を生じる。
(課題を解決するための手段)
本願の出願人は、水中内視鏡電気外科法において、非導電性で無電解質の溶液に代えて通常生理食塩溶液のような導電性液体媒体を利用できることを見いだした。通常生理食塩溶液は、電気外科法を考えないとき、すなわちレーザー処置のような非電気的組織作用を利用するときには、水中内視鏡外科法において好ましい拡延媒体である。
通常生理食塩溶液(0.9%w/v;150mmol/l)は殆どの生体組織よりも幾分大きな導電性を有しているけれども、手術箇所からの吸収あるいは溢出による移動によっても生理的影響を殆ど生じず、かつ非導電性で無電解質の溶液によるいわゆる水中毒作用を回避することができる。
本願の出願人は導電性液体媒体を利用した水中電気外科法に適した二極器具を開発した。本発明の第1のアスペクトは本明細書に添付した請求項1に限定されている。本発明の他のアスペクトは器具とジェネレータとを含む電気外科システムについての請求項7、各々電気外科器具についてのものである請求項12、19及び23、組織を乾燥し蒸発するための方法についての請求項31及び37に記載してある。本発明の様々なアスペクトの好ましい特徴のいくつかが従属項に記載されている。
導電性流体媒体と組み合わせたこの器具の電極構造は単極あるいは二極電気外科法において経験された問題を大幅に回避するするものである。特に、入力電圧レベルは単極構造において通常必要なレベル(一般に100ワット)よりも非常に低くなっている。さらに、電極間の比較的大きな間隔によって、従来の二極構造と比較してより改善された作用深さを得ることができる。
【図面の簡単な説明】
次に本発明を実施形態により、図面を参照して説明する。図において、
図1は本発明による電気外科システムを示す図;
図2は図1のシステムの一部を構成する電気外科器具を部分的に示す側面図;
図3は本発明による別例の電気外科器具の一部の、器具の長手方向軸に沿う断面での断面図;
図4は本発明の器具の乾燥モードと蒸発モードでの利用の間に生じる電気負荷インピーダンスと消費無線周波数電力のヒステリシスを示すグラフ;
図5は図1に示した電気外科システムのジェネレータのブロック線図;
図6は蒸発による組織除去のための利用を示す、図3の器具の側面図;
図7は組織の乾燥もしくは凝固のための利用を示す、図6に示したものと類似した器具の側面図;及び
図8、図9及び図10は様々な電極及び絶縁構造を示す、本発明によさらなる電気外科器具の側面図である。
(実施の形態)
図面を参照すると、図1はハンドピース12及び着脱自在な電極ユニット28の形態の二極器具のために接続コード14を介して無線周波数(RF)出力を提供する出力ソケット10Sを有する電気外科法ジェネレータ10を含む電気外科装置を示している。ジェネレータ10の起動はコード14の制御コネクションを介してハンドピース12から行われ、或いはフットスイッチ接続コード18により図示のようにジェネレータ10の後部に別個に接続されたフットスイッチユニット16によって行われる。図示した実施形態において、フットスイッチユニット16はジェネレータ10の乾燥モードと蒸発モードとの選択をそれぞれ行うための2つのフットスイッチ16A及び16Bを有している。ジェネレータのフロントパネルにはディスプレイ24に示される乾燥及び蒸発のパワーレベルをそれぞれ設定するためのプッシュボタン20及び22が有る。プッシュボタン26は乾燥及び蒸発モードの間の選択のための選定手段として提供されている。
本器具はハンドピースを有さずに例えば切除用内視鏡のような別の装置に取り付けるためのコネクタを単に有するものであってもよい。図1において装置はハンドピース12に取り付けた状態で示した電極ユニット28を有している。
電極ユニット28は多くの様々な形態をとることができ、それらのいくつかを以下で説明する。
図2に示すように、基本的な構成として、器具のハンドピースに着脱自在に取り付けるための電極ユニットは絶縁シース30Sで覆われた導電性チューブであるシャフト30を有し、このシャフト30の先端に電極アッセンブリ32が設けられている。軸の他端(図示しない)には、このユニットをハンドピースに機械的及び電気的に接続するための手段が設けられている。
電極アッセンブリ32は中央の活性電極34を有し、該活性電極34はユニットの先端において露出し、電極の処置部を形成している。活性電極は好ましくは金属ワイヤであり、シャフト30全体を通る中央導体として基端の接点(図示しない)まで延びている。絶縁スリーブ36が電極34と内部導体とを取り囲んでおり、その先端は電極34の露出した処置部の基端側で露出している。一般に、このスリーブはアーキングによる損傷に抗するようにセラミック材料で形成されている。金属チューブの形態のリターン電極38がスリーブ36を取り囲んでおり、シャフト30の金属チューブ本体と電気的に(随意に機械的にも)一体となっている。このリターン電極はスリーブ36の端部に及ばない点で止まっており、活性電極34の露出した処置部の後方に位置して、これより半径方向及び軸方向の両方向で隔てられている。理解されるように、主としてリターン電極の径が活性電極の径よりもだいぶ大きいという理由で、リターン電極は露出した活性電極の処置部よりもかなり大きな表面積の露出した流体接触面を提供している。絶縁シース30Sは、リターン電極の流体接触面に必要な表面積を提供するため、リターン電極38の先端から基端方向に離れた位置で止まっている。電極ユニットの先端におけるリターン導体の径は1mm〜5mmの範囲である。リターン電極の露出部の流体接触面の長手方向の範囲は、リターン電極38から活性電極の処置部までの長手方向の間隔が1mmと5mmの間として、一般に1mm〜5mmである。電極アッセンブリの形状及び寸法のさらなるアスペクトは以下にさらに詳細に記載する。
作用において、図2に示した電極構造は、電極のうちの一つ(34)だけが実際にユニットの先端まで延びている、二極のものである。これは、電極アッセンブリが導体流体媒体内に浸漬される通常の利用では、リターン電極38が処置を受けている組織から離隔したままであり、組織とリターン電極に接触する導電性流体媒体とを介して2つの電極間に電流経路が存在することを意味する。
電極が軸方向に隔てられていることにより、露出電極面間が単に半径方向に隔てられているだけの二極電極よりも絶縁路が非常に長くなるので、径の点で非常に細い電極構造になっている。これによって、望ましくないアーキングを生じることなく、また電気外科切断或いは蒸発処置の場合に高温での過剰アーキングによる電極ユニットの損傷を生じることなく、従来の電極構造よりも大きな電力の利用が可能となる。
図示した特定の位置ずれ配置によって、組織に接触する電極チップを外科医が見ることができるようになり、また組織面に対する大きな範囲の適用角度が可能となり、これは内視鏡外科に一般的である限られたスペースにおいて特に重要である。
図3を参照すると、図1に示した電気外科器具のハンドピース12に着脱自在に取り付けられる別例の電極ユニットはシャフト30を有し、このシャフトは先端に電極アッセンブリ32を有するステンレススチールもしくは銅か金を電気メッキしたphynoxで形成された半可撓性のチューブから構成されている。シャフト30の他端(図示しない)には電極ユニットをハンドピースに機械的かつ電気的に接続するための手段が設けられている。
電極アッセンブリ32は中央の活性電極すなわち組織接触電極34を有し、この電極はプラチナかプラチナ/イリジウム或いはプラチナ/タングステンでできており、ほぼ半球状の露出チップ34Aと一体の中央導体34Bとによって構成されている。導体34Bは、細いステンレススチールのスプリング34Dを導体34B及び34Cの隣接する端部上に取り付けることによって、中央の銅製導体34Cに電気的に接続されており、それによって、器具のハンドピースと露出チップ34Aとの間の電気的接続が提供されている。導体34B、スプリング34D及び銅製導体34Cの隣接する端部はセラミックの絶縁スリーブ36で取り囲まれている。スリーブ36は導体34Bの先端部を取り囲む露出部36Aを有している。円筒状の流体接触面を提供するシャフト30の先端部を形成するリターン電極38はスリーブ36を密に取り囲んで銅製導体34Cに沿って延びており、銅製導体34Cは絶縁スリーブ40によってリターン電極38から隔てられている。シャフト30とリターン電極38の基端側部分は外側の絶縁熱収縮被覆すなわちポリイミド被覆30Sによって取り囲まれている。
図1に示した電気外科ジェネレータと組み合わせて用いると、図3の電極ユニットは、導電性流体媒体内において、ジェネレータの制御方法に応じて、蒸発による組織除去のためや関節鏡外科の際の彫刻や外形成形のため、或いは乾燥のために利用できる。図4は電極ユニットの乾燥モードと蒸発モードとの間に存在するヒステリシスを利用すべくジェネレータがいかにして制御されるかを示している。つまり、ユニットの電極アッセンブリ32が生理食塩水のような導電性媒体内に浸漬されているとすると、ポイント”O”で最初の負荷インピーダンス”r”が現れ、その大きさは電極アッセンブリの幾何学的属性や流体媒体の導電率によって決まる。活性電極が組織に接触すると”r”の値は変化し、”r”の値が高くなるほど電極アッセンブリ32の蒸発モードに入る性向が大きくなる。RF電力が電極アッセンブリ32に加えられると、流体媒体が昇熱する。流体媒体が通常の生理食塩水(0.9% w/v)であるとすると、流体媒体の導電率の温度係数は正であり、従って、対応するインピーダンス係数は負である。つまり、電力が供給されると、インピーダンスは始めに下がり、消費電力の増加に伴ってポイント”B”まで下がり続け、このポイントで電極32と密接する生理食塩水が沸点に達する。活性チップ34Aの表面に蒸気の小さな泡ができるとインピーダンスは上がり始める。ポイント”B”以後は消費電力がさらに増加するに伴ってインピーダンスの正の電力係数が支配的となり、電力増加がインピーダンスの増加を引き起こす。
蒸発した泡により蒸気のポケットが形成されるに伴って残りの電極/生理食塩水界面(インターフェース)における電力密度が増加する。しかしながら、蒸気の泡により覆われていない活性電極チップ34Aの露出領域が有るので、これが界面をさらに強勢し、さらに多くの蒸気の泡ができてさらに高い電力密度となる。これは電極が完全に蒸気で囲まれた状態となったときにおいてのみ平衡点となる暴走状態である。所定の変数組に対しては、この新しい平衡点に達する(ポイント”C”)以前に電力の閾値が有る。
グラフにおけるポイント”B”と”C”の間の領域は、従って、乾燥モードの上限を表す。一旦蒸発平衡状態になると、インピーダンスは1000オームぐらいまで急速に増加し、その絶対値はシステムの変数に依存する。蒸気ポケットは次いで該蒸気ポケットを横切る活性電極チップ34Aと蒸気/生理食塩水界面との間の放電によって維持される。電力消費の大部分がこのポケット内で生じ、結果としてチップ34Aが熱せられる。エネルギーの消費量及びポケットのサイズは出力電圧に依存する。出力電圧が低すぎるとポケットは維持されず、高すぎると電極アッセンブリ32がこわれる。つまり、電極アッセンブリ32の破壊を防止するためには、ジェネレータの電力出力はインピーダンスがポイント”D”に一旦達したら減少させなければならない。注目すべきことは、電力がこのポイントに達しないと、電力/インピーダンス曲線は上昇し続け、電極の破壊が生じるであろうということである。
点線Eはそれ以上では電極の破壊が不可避な電力レベルを示している。電力が減少するにつれて、ポイント”A”において蒸気ポケットが壊れて電極アッセンブリ32が乾燥モードに戻るまで、インピーダンスが下がる。このポイントでは蒸気ポケット内の電力消費はそれを維持するのに不十分であり、活性電極チップ34Aと生理食塩水との間の直接の接触が再び起こって、インピーダンスが急激に下がる。チップ34Aにおける電力密度も下がり、生理食塩水の温度は沸点以下まで下がる。電極アッセンブリ32は次いで安定した乾燥モードとなる。
所要の乾燥、組織切断及び蒸発機能を達成するためのジェネレータの電力制御はジェネレータの出力コネクション間に現れるピークRF電圧を検出することによって、また予め選択されたピーク電圧閾値に達したら送電出力電圧を常に迅速に減少させることによって、実行される。少なくとも乾燥モードにおいてはこのような電力減少はピーク出力電圧を単に閾値以下に下げるのに必要な電力減少よりも非常に大きなものである。図4を参照して上記に説明したヒステリシス特性を利用するために、電力減少は少なくとも50%であるのが好ましい。
図5を参照すると、ジェネレータは無線周波数(RF)電力発振器60を有し、該発振器は使用の際に電極アッセンブリに代表される負荷インピーダンス64に出力端子62を介して接続するための一対の出力コネクション60Cを有している。電力は切替モード電源装置66により発振器60に供給される。
好ましい実施形態において、RF発振器60は400kHzで作動するものであるが、300kHzからその上のHF領域内に至るいかなる周波数も利用できる。切替モード電源装置は一般に25〜50kHzの範囲の周波数で作動する。出力コネクション60Cの間には電圧閾値検出器68が接続されており、該検出器は切替モード電源装置16に接続された第1出力68Aと、”ON”時間制御回路70に接続された第2出力68Bとを有している。操作者コントローラ及びディスプレイ(図1に示したもの)に接続されたマイクロプロセッサコントローラ72は、供給電圧の変化によってジェネレータ出力電力を調節するために電源装置66の制御入力66Aに接続され、またピークRF出力電圧限界を設定するために電圧閾値検出器68の閾値設定入力68Cに接続されている。
運転において、ハンドピースもしくはフットスイッチ(図1参照)に設けられた起動スイッチ装置を外科医が操作することによって電気外科電力が要求されると、マイクロプロセッサコントローラ72は電力が切替モード電源装置66に加わるようにする。ジェネレータのフロントパネルにおける制御設定(図1参照)によって、入力68Cを介する供給電力とは独立して一定の出力電圧閾値が設定される。一般に、乾燥及び凝固のためには、閾値は150ボルトと200ボルトの間の乾燥閾値に設定される。切断或いは蒸発出力が要求される場合、閾値は250もしくは300ボルトから600ボルトまでの範囲の値に設定される。これらの電圧値はピーク値である。これらがピーク値であることは、少なくとも乾燥のためには低波高率の出力RF波形を有して、電圧が与えられた値でクランプされる以前に最大電力が与えられるようにするのが好ましいということを意味する。一般に1.5かそれ以下の波高率が得られる。
ジェネレータが最初に起動されると、RF発振器60の制御入力60I(これは”ON”時間制御回路70に接続されている)の状態は”ON”であり、発振器60の発振エレメントを構成する電力切替装置が各発振サイクルの間の最大導通時間についてONに切替えられる。負荷64に送られる電力は切替モード電源装置66からRF発振器60に加わる供給電圧に部分的に依存し、また負荷インピーダンス64に部分的に依存する。供給電圧が十分に高ければ電気外科器具の電極を取り囲む液体媒体の温度(或いはガス媒体内や組織内に含まれる液体の温度)は、液体媒体が蒸発して負荷インピーダンスが急速に増加し、その結果端子62間に加わる出力電圧が急速に増加するような範囲まで上昇する。これは乾燥出力が要求される場合には望ましくない状況の事態である。このために、乾燥出力のための電圧閾値が設定され、閾値に達すると”ON”時間制御回路70と切替モード電源装置66とにトリガ信号が送られるようにしている。”ON”時間制御回路70はRF発振切替装置の”ON”時間を実質的に瞬時に減少させる作用を有している。同時に、切替モード電源装置は禁止状態となり、発振器60に供給される電圧が下がり始める。
ジェネレータの出力電圧は運転モードにとって重要である。事実、出力モードは純粋に出力電圧、特にピーク出力電圧によって決定される。出力電圧の絶対的な測定が必要なのは多項目制御のためだけである。しかしながら、出力電圧を所定の制限電圧までに制限するために、このジェネレータにおいて簡単な単項目制御(すなわち一つの制御変数を利用する)を利用することができる。つまり、図5に示した電圧閾値検出器68はRFピーク出力電圧を予め設定されたDC閾レベルと比較するもので、十分に速い応答を有するものであり、一つのRF半サイクル内において”ON”時間制御回路70に対するリセットパルスを作る。
最大吸収電力は蒸気の泡が形成される直前に存在する電極状態と合致しており、その理由はこれが最大給電と最大濡れ電極面積とに合致しているからである。従って、最大乾燥電力のためには電極が濡れた状態のままであるのが望ましい。電力限界検出を利用することで、蒸気の泡が壊れることを許容しひいては活性電極の電力吸収能力を高めるような電力減少を生じさせることができる。この理由から、ジェネレータは大きなオーバーシュートを有する制御ループを含み、また所定の閾値に達したピーク電圧のフィードバック励振によって、閾値検出器68により設定されるピーク出力電圧レベルよりも非常に低いレベルまでのピーク出力電圧の減少を生じさせることで、電力の大幅で瞬時の減少を生じさせる。このような制御のオーバーシュートにより、所要の濡れた状態への復帰が確実化となる。
ジェネレータのさらなる詳細とその作動は我々の共に係属中のイギリス国特許出願第9604770.9号に記載されている。
以上に照らし合わせると、図3の電極ユニットはグラフ内のポイント”0”と、ポイント”B”と”C”間の領域内のポイントとの間の領域においてユニットを運転することで乾燥に利用できることが理解されよう。この場合、電極アッセンブリ32は、活性チップ34Aが処置すべき組織の近傍に位置し、また組織と活性チップとリターン電極とを生理食塩水中に浸漬させた状態で、選択された手術箇所内に導入される。ジェネレータが次いで起動されて(かつ上記したように繰り返し制御されて)活性チップ34A近傍の生理食塩水が、活性チップをとり囲む上記ポケットを形成することなく、沸点或いはそのすぐ下に維持されるように、十分な電力を電極アッセンブリ32に供給する。電極アッセンブリは活性チップ34Aに近接する所要の領域における組織を熱して乾燥させるように操作される。電極ユニットはポイント”D”と、それ以下のレベルでは蒸発が安定しないレベルを形成する点線Fとの間の領域において、蒸発のために利用できる。この曲線の上側部分は蒸発による組織除去に利用される。このモードでは処置すべき組織へ器具を軽く当てることで彫刻と成形を行うことができる。
電極アッセンブリ32はリターン電極表面積:活性電極表面積の比が5:1〜40:1の範囲にある(すなわち2つの電極の露出部の表面積比がこの範囲にある)一体化された電極を有することが好ましい。
図6は図3の電極ユニットを蒸発による組織除去に利用する場合を示しており、電極ユニットは導電性流体78内に浸漬されている。つまり、組織80を蒸発させて、活性チップを取り囲む蒸気ポケット82を形成するため、電極ユニットは活性チップ34Aにおいて十分に高いエネルギー密度を生じている。蒸気ポケット82の形成によって約10フォールド(10−fold)の接触インピーダンスの増加を生じ、結果として出力電圧が増加する。蒸気ポケット82にはアーク84が生じてリターン電極38への回路が形成される。蒸気ポケット82と接触する組織80は回路を完成するための最小電気抵抗の経路となる。組織80が活性チップ34Aにより近づくと、導電性流体(この場合は生理食塩水)を通じたリターン経路が蒸気ポケット82の高いインピーダンスバリヤによって妨げられることで、アーク84が細胞に当たって細胞が破裂する程度まで、組織により多くのエネルギーが集中する。生理食塩水溶液はまた蒸発による固形生成物を溶解しあるいは分散させる作用を行う。
使用において、電極アッセンブリ32は、活性チップ34Aが蒸発すべき組織の近傍に位置し、また組織と活性チップとリターン電極38とを生理食塩水78中に浸漬させた状態で、選択された手術箇所内に導入される。RFジェネレータが起動されて、生理食塩水を蒸発させて組織に接触する電極をとり囲む蒸気ポケットが維持されるように、(図4を参照して上記で説明したような)十分な電力を電極アッセンブリ32に供給する。電極ユニットが関節鏡外科の際の彫刻もしくは成形による半月切除術(menisci)に利用される場合、電極アッセンブリ23は選択された手術箇所に軽い圧力で適用されて、活性チップ34Aの部分球面が処置すべき面を横切って動いて組織を平らにするように、特に半月切除術においては、彫刻もしくは成形アクションを伴って操作される。
図7は組織の乾燥に用いられる図3のものと類似の電極ユニットの利用を示している。乾燥モードにおいては、出力電力は第1の出力範囲で電極に送られ、電流が活性電極34からリターン電極38に流れる。上記したように、出力電力によって、活性電極34に近接する生理食塩水溶液が好ましくはその沸点もしくはその近傍まで熱せられる。これによって活性電極34の表面に小さな蒸気の泡ができ、活性電極34まわりのインピーダンスが増加する。
体組織80のインピーダンスは一般に蒸気の泡と活性電極34近傍の生理食塩水との組み合わせにおけるインピーダンスよりも低い。活性電極34が小さな蒸気の泡で囲まれて、生理食塩水溶液が組織80と接触すると、組織80は好ましい電流経路の一部となる。つまり、この好ましい電流経路は図7に示したように組織との接触点において活性電極34を出て、生理食塩水溶液を経てリターン電極38に戻る。
本発明は組織の乾燥に特に適用できる。組織乾燥のための一つの好ましいアプローチは活性電極がその一部においてのみ組織と接触し、活性電極の残りの部分は組織から遠くに維持されて生理食塩水溶液によって囲まれるようにすることであり、これによって、電流は活性電極から生理食塩水溶液を経て組織を通ることなく、リターン電極に流れる。例えば、図7に示した実施形態では、活性電極の先端部分だけが組織と接触しており、基端部分は組織から離れた状態に維持されている。
本発明は組織の炭化を生じることなくあるいは最小の炭化で乾燥を行うことができる。活性電極34が組織80に接触すると組織を電流が流れ、組織の接触点及びそのまわりにおける乾燥を生じさせる。乾燥組織の面積及び体積は接触点からほぼ半径方向外側に広がる。
図7に示した実施形態において、活性電極34の露出した処置部は長さが幅よりも大きくなっている。これによって、器具を組織面に対して傾けた場合ですら露出した処置部の殆どの部分が組織との非接触を維持されつつ、電極チップが組織と接触できるようになる。電極の露出部の殆どの部分が組織と非接触状態であることから、十分な組織体積の乾燥が行われると、電流経路は組織を通る経路から活性電極から直接生理食塩水に行く経路に、より容易にシフトできる。
図3に示した電極ユニットにおいて、活性電極34の露出部分は活性電極34とリターン電極38との間の絶縁部材36の長さと比べると相対的に短い。このような電極構造によって、図4を参照して上記に説明したヒステリシス特性に固有な器具のニ安定作用を利用して、器具を乾燥モードもしくは低電力蒸発モードにおいて利用できるようにすることができる。或る状況下、特に活性電極の露出した処置部が長い場合にはニ安定作用を得ることは困難である。
次に、このような困難性を克服するための手段を図8を参照して説明すると、同図にはステンレススチールもしくは銅か金を電気メッキしたPhynoxでできた半可撓性のチューブからなり、先端に電極アッセンブリ32を備えたシャフト30を有する電極ユニットが示されている。電極アッセンブリ32は細長い露出された処置部34A(”ニードル”電極と称される)を有する中央の活性電極34と、一体の中央導体34Bとを有している。円筒状のセラミック絶縁スリーブ36が導体34Bを取り囲んでおり、シャフト30の先端部により構成されるリターン電極38はスリーブ36の基端に当接している。外側の絶縁ポリイミド被覆40はリターン電極38近傍のシャフトの基端部を取り囲んで、被覆40のエッジから絶縁スリーブ36まで延びる環状の流体接触面をリターン電極に提供している。絶縁スリーブ36は先端面36Aを有し、この先端面36Aは段階半径(端面36Aの外周縁と活性電極34の外径との間の距離)が露出した活性電極処置部34Aの長さの少なくとも1/20であるような直径を有している。つまり、絶縁スリーブ36は活性電極34と同軸の肩部(すなわち段部)を有している。利用において、この段部は露出した活性電極処置部34Aの基端においてさもないと生じるであろう、処置部34Aの先端を非有効化する、局所的なアーキングを防止する。
電極ユニットが組織切除もしくは蒸発モードで操作される場合の電極の作用をさらに詳しく考察すると、活性電極処置部34Aのまわりに蒸気の泡が形成される。この泡はその内部のアーキングによって維持される。加えられる電圧が高くなるほど、泡のサイズは大きくなる。各アークにより消費されるエネルギーのインピーダンスは、導通経路内の残りの流体やジェネレータのソースインピーダンスによって制限される。しかしながら、アークは負インピーダンスとして作用し、アークのエネルギーが十分に高ければ非常に低いインピーダンスのイオン化経路が形成される。このことは、泡とリターン電極との間の流体のインピーダンスが消費電力についてのリミットとして作用するに十分でない限り、イオン化経路インピーダンスが永久に減少する不安定状態がもたらされる。蒸気ポケットがリターン電極に入り込んで活性電極処置部のまわりに存在することも可能である。これらの状況において、アークのエネルギーはジェネレータのソースインピーダンスによってのみ制限されるが、このような電力制限は不十分なものであり、電極のサイズに応じて調整することはできない。これらの理由から、絶縁スリーブ36の寸法形状は活性電極処置部34Aとリターン電極38の流体接触面との間に1mmの最小導通経路長を限定するものであるべきである。この最小経路長は図8の実施形態の場合では、図8に示すようにスリーブ36の長さaに段部半径cを加えたものである。
蒸気ポケットが活性電極34の露出した処置部34Aの一部上にのみ形成される可能性をさらに考察する。印加電圧と電力が十分に高い場合には蒸気ポケットは活性電極の露出した処置部のまわりに形成されるであろう。このポケットは処置部の全長にわたり均一に形成されるのが好ましい。このような情況において、ジェネレータに与えられる負荷インピーダンスは20のファクターほど変化する。しかしながら、リターン電極の流体接触面と、露出した活性電極処置部34Aの複数の異なる部分との間の導通経路長さに大きな違いが有ると、各電極の長さにわたって電圧勾配ができる。流体接触面は十分に大きくまた、その長さが少なくともその径ぐらいに大きいような縦横比を有して、その面にわたる電圧勾配を最小とするものであるのが好ましい。さもなくば、絶縁スリーブ及び活性電極を或る形状にすることで、露出した処置部の最先端が導体流体と依然として接触したままで、露出した処置部の流体接触面に最も近い部分のみにわたって蒸気ポケットが形成されることができるように、電圧勾配を十分に大きくすることもできる。つまり、蒸気ポケットのエッジが活性電極処置部34Aの面と交差するところの導電流体内において電圧勾配がつくられる。このように部分的に取り囲まれた活性電極処置部の電気的作用は完全に取り囲まれた処置部の作用と全く異なっている。濡れた状態から蒸気でとり囲まれた状態へのインピーダンス遷移は図4を参照して上記したものよりも遥かに目立たない。ピーク電圧を検出することによってジェネレータ出力を制御する点から、電極アッセンブリの作用はもはや二安定ではない。しかしながら、活性電極処置部の低インピーダンスの濡れた領域において現れる蒸発電圧の結果として、要求電圧はかなり高くなっている。臨床的な作用としては要求された蒸発だけでなく、電力消費の増加から生じる望ましくない熱的損傷作用もある。
活性電極処置部の部分的な取り囲みは、活性電極処置部の最も遠い部分と流体接触面との間の導電経路の長さと、活性電極処置部と流体接触面との間の最短導通経路の長さとの比が2:1よりも小さいか等しい、すなわちb/(a+c)≦2とすることを確保することで大幅に回避することができる。
或る情況においては、活性電極とリターン電極との間の導電経路長さが長すぎると、その結果としての流体によって示される大きな一連のインピーダンスによって、導電性流体の蒸発を許容してしまうことが見いだされよう。電圧降下が大きいと、蒸発が行われる以前に予設定された電圧閾値に達してしまう。それで、最大導電経路長さとリターン電極の流体接触面の環状周縁の長さとの比は1.43:1を超えないことが好ましい。活性電極と同軸の円筒状流体接触面の場合、最大導電経路長さと流体接触面の直径との比は4.5:1よりも小さいか等しくされる。つまり、図8を参照するとb/d≧4.5となる。
図8に示した電極ユニットの主たる用途は、活性電極処置部34Aの少なくとも一部が処置すべき組織内に突入し、ジェネレータが図4のインピーダンス/電力特性の蒸発部分で作動されることによる、組織の切断である。
活性電極構造の別構造には露出した処置部34Aが図9に示すようにフックとして形成されることが含まれる。この場合、絶縁スリーブはリターン電極38の流体接触面から先端面36Aに向けてテーパ状となった円錐形である。
図10に示したさらなる別の実施形態はループ状に曲がったフックの形状の活性電極処置部34Aを有している。
図8、9及び10の実施形態において、寸法a,b,c,dは上記した比の限界内にあることが理解されよう。さらに、各々の場合において、電極アッセンブリは処置軸42を有し、この軸に沿って器具が組織に向けて導入されるものであり、またリターン電極は活性電極の露出した処置部34Aから処置軸の方向で後方に設定されていることが見受けられよう。リターン電極と活性電極の処置部の様々な部分との間の様々な導通経路長さを比較するためには、処置軸42を含む面である共通の面における経路を考察すべきである。図8、9及び10の図示の場合、示した経路長さは勿論図を載せた紙の面内でのものである。
Claims (30)
- 器具シャフトと該シャフトの先端の電極アッセンブリとを有する、導電性流体媒体の存在下で組織の処置を行うための電気外科器具であつて、前記電極アッセンブリは、
露出した組織処置部を有する単一の活性電極と、
露出した流体接触面を有するリターン電極と、
前記活性電極と前記リターン電極との間に配置されてこれらを絶縁し、前記活性電極の露出した前記処置部と前記リターン電極の露出した前記流体接触面とを隔てる絶縁部材と、
を有し、前記リターン電極の流体接触面は前記活性電極の露出した処置部から当該アッセンブリの処置軸の方向で後方に設置されており、
露出した前記処置部、露出した前記流体接触部及び前記絶縁部材の寸法形状は、(i)露出した前記流体接触面と該流体接触面から最も遠い露出した前記処置部の部分との間の前記流体媒体を経た最短導通経路(Pl)の長さと、(ii)露出した前記流体接触面と露出した前記処置部との間の前記流体媒体を経た最短導通経路(P2)の長さとの比が2:1より小さいかもしくは等しくなるようになっている、
電気外科器具。 - 前記活性電極の前記露出した処置部は前記絶縁部材から第1の方向に突出しており、前記リターン電極の前記流体接触面は前記活性電極の前記処置部の後方に設定されており、前記絶縁部材は前記活性電極の露出した処置部と前記リターン電極の前記流体接触面との間において前記活性電極を取り囲み、前記第1の方向と直角な第2の方向で外側に突出して、前記流体媒体を通る電流を逸らすための絶縁バリヤを形成し、それによって、露出した前記流体接触面と露出した前記処置部との間の前記最短導電経路(P2)の長さを増加させるものである、請求項1の器具。
- 前記第1の方向は処置軸を限定し、前記2つの最短導電経路(Pl,P2)は前記処置軸を含む共通の面内に有る請求項1の器具。
- 露出した前記流体接触面と露出した前記処置部との間の前記流体媒体を経た最短導電経路(P2)の長さは少なくともlmmである、請求項1の器具。
- 露出した前記流体接触面はほぼ円筒形であって長さと直径とを有し、前記流体接触面の長さは少なくともその径ほどであり、(i)前記流体接触面と露出した前記処置部の前記流体接触面から最も遠い部分との間の前記流体媒体を経た前記最短導電経路(Pl)と(ii)前記流体接触面の直径の比は多くて4.5:1である請求項1〜4のいずれかの器具。
- (i)露出した前記流体接触面と露出した前記処置部の前記流体接触面から最も遠い部分との間の前記流体媒体を経た前記最短導電経路(Pl)の長さと(ii)露出した前記流体接触面と露出した前記処置部との間の前記流体媒体を経た最短導電経路(P2)の長さの比は1.25より大きいか等しい請求項1〜5のいずれかの器具。
- 請求項1〜6のいずれかの器具を含む電気外科システムであって、当該器具に無線周波数電力を供給するための電気外科ジェネレータをさらに有し、該ジェネレータは当該器具の前記活性電極及びリターン電極にそれぞれ接続可能な少なくとも1対の電気外科出力カコネクションを有する出カステージと、前記出カコネクション間に生じたピーク無線周波数出力電圧を表す検出信号を送出するための検出回路と、前記検出信号によって所定のピーク無線周波数出力電圧に達したことが示されると送電出力電力の減少を自動的に生じさせる電力調整回路とを有している電気外科システム。
- 前記電力調整回路は前記検出信号が前記閾値に達したことを示すと送電出力電力の少なくとも50%の減少を生じさせるように作動でき、この減少は100μsもしくはそれ以下の時間で行われる、請求項7のシステム。
- 前記電力調整回路は前記減少を20μsもしくはそれ以下の時間で行わせるように作動できる請求項8のシステム。
- 前記出カステージは少なくとも1つの無線周波数電力装置を有し、前記制御回路は、出力電力の前記の少なくとも50%の減少を、無線周波数発振の個々のサイクルの間に前記装置への供給電力とは独立して前記装置の導通時間を減少させることによって行うように構成されている請求項7〜9のいずれかのシステム。
- 前記検出回路と前記電力調整回路とは、ピークレベルから谷レベルまでの電力装置のサイクル毎の導通時間の迅速な減少を、導通時間が再びピークレベルに達するまで、繰り返し行ない、谷レベルの後には導通時間の僅かな迅速な漸増が続くように作動でき、一連の迅速な減少と漸増は、出力電圧が前記所定の閾値を超えることなく前記ピーク導通時間レベルに達するまで前記出カステージへの供給電力を同時に減少させつつ、繰り返される請求項10のシステム。
- 器具本体と、細長い器具シャフトと、該シャフトの先端の電極アッセンブリとを有する、導電性流体媒体の存在下で組織の処置を行うための電気外科器具であって、前記電極アッセンブリは、
露出した組織処置部を有する単一の活性電極と、
前記活性電極の処置部の後方に位置し、絶縁部材によって前記処置部から隔てられた露出した流体接触面を有し、前記処置部が前記流体媒体内に浸漬された組織面に近づけられる時には前記流体接触面が通常は前記組織面から隔てられて、前記流体媒体が前記活性電極と前記リターン電極との間の導電経路となるようにする、リターン電極と、
を有し、
前記活性電極の前記処置部は前記アッセンブリの最先端に配置されており、前記りターン電極の前記流体接触面は前記活性電極の前記処置部から基端方向に隔てられており、前記活性電極の前記露出部は長さと幅とを有し、その長さは幅の少なくとも半分よりも大きい電気外科器具。 - 前記リターン電極は前記活性電極の後ろにおいて前記絶縁部材のまわりに設けられた導電性のスリーブを有する請求項12の器具。
- 前記活性電極の前記露出部と前記リターン電極の前記流体接触面との間の長手方向の間隔は少なくともlmmである請求項12の器具。
- (i)前記活性電極の前記露出部の先端と前記リターン電極の最先端部分との間の長手方向の距離と、(ii)前記活性電極の前記露出部と前記リターン電極の最先端部分との間の最短長手方向距離との比は2:1よりも小さいか等しい請求項14の器具。
- 前記リターン電極は前記絶縁部材を取り囲む流体接触面を有しており、(i)前記活性電極の前記露出部の先端と前記リターン電極の前記流体接触面の先端縁との間の長手方向の距離と、(ii)前記先端縁の領域における前記流体接触面の周との比は1.43:1よりも小さいか等しい請求項14もしくは15の器具。
- 前記器具シャフトはその主たる構成部材として金属製のチューブを有しており、前記リターン電極は前記チューブの先端部に一体で形成されている請求項12の器具。
- 器具本体と、細長い器具シャフトと、該シャフトの先端の電極アッセンブリとを有する、導電性流体媒体の存在下で組織の処置を行うための電気外科器具であって、前記電極アッセンブリは、露出した活性電極処置インターフェースと、該処置インターフェースの後方に位置し、絶縁部材によりこれから隔てられた露出したリターン電極流体インターフェースとを有し、前記処置インターフェースは前記絶縁部材から外方に突出しており、前記流体インターフェースの表面積は前記処置インターフェースの表面積よりも大きく、前記処置インターフェースは前記外方と直角な方向の幅の半分よりも大きいか等しい距離で前記絶縁部材から外側に延びている、電気外科器具。
- 前記シャフトは長手方向軸を限定しており、前記処置インターフェースは導電性の軸方向突部であって、その軸方向長さはその横方向の幅の半分よりも大きく、前記絶縁部材は前記突部の基端方向に配置された同軸のセラミックスリーブであり、前記流体インターフェースは前記絶縁部材を取り囲み、少なくとも1mmの軸方向間隔で前記処置インターフェースから隔てられている導電性外側スリーブである請求項18の器具。
- 前記処置インターフェースは前記絶縁部材から前記外方と直角な方向の幅よりも大きな距離で外側に延びている請求項18もしくは19の器具。
- 前記活性電極処置インターフェースは導電性の活性電極チップを有し、その前記外方への長さは幅の少なくとも半分であり、前記絶縁部材は前記チップ部材に近接する端面を有し、該端面は前記チップ部材の長さの半分以上には前記チップ部材を超えて横方向には延びない請求項18〜20のいずれかの器具。
- 導電性流体媒体の存在下において組織を処置するための電気外科器具であって、
器具シャフトと、
前記シャフトの先端の電極アッセンブリとを有し、該電極アッセンブリは先端を有しまた活性電極とリターン電極とを有し、前記電極アッセンブリの前記先端には前記活性電極の露出部が位置し、また前記活性電極の前記露出部の基端方向には前記リターン電極の流体接触面が位置しており、さらに、前記活性電極と前記リターン電極との間に配置されてこれらを電気的に絶縁する絶縁部材を有し、前記活性電極の前記露出部は長さと幅とを有し、該活性電極の露出部の長さは該活性電極の露出部の幅よりも大きい、
電気外科器具。 - 前記活性電極の露出部は前記シャフトの前記先端から長手方向に延びている請求項22の器具。
- 前記絶縁部材はほぼ円筒状のスリーブを有し、前記リターン電極は前記活性電極の前記露出部から前記スリーブの長手方向外側に少なくともlmmの距離で位置している請求項22もしくは23の器具。
- 前記絶縁部材は肩部を形成する環状の先端面を有し、前記活性電極の露出部は前記絶縁部材の先端面に対して中央に位置してこれから突出しており、前記肩部の前記活性電極から横方向に離れる方向の深さは、lを中央の活性電極露出部の長さとすると、0.05lと0.5lとの間である請求項24の器具。
- 前記活性電極の露出部、前記リターン電極の流体接触面及び前記絶縁部材の寸法形状は、前記電極アッセンブリが導電性流体媒体中に浸漬されたときに、(i)前記リターン電極の流体接触面と、前記活性電極の露出部の前記流体接触面から最も遠い部分との間の前記流体媒体を経た最短導電経路の長さと(ii)前記リターン電極の流体接触面と前記活性電極の前記部分との間の前記流体媒体を経た最短導電経路の長さの比が2:1よりも小さいか等しくなるようなものである請求項25の器具。
- 前記リターン電極の流体接触面と前記活性電極の露出部との間の前記流体媒体を経る最短導通経路の長さは少なくともlmmである請求項26の器具。
- 前記リターン電極の流体接触面は環状で長さと径を有しており、該流体接触面の長さは少なくともその径ほどであり、(i)前記リターン電極の流体接触面と、前記活性電極の露出部の前記流体接触面から最も遠い部分との間の前記流体媒体を経た最短導電経路の長さと(ii)前記流体接触面の径との比は多くて4.5:1である請求項26もしくは27の器具。
- 前記絶縁部材は当該器具の先端に向けてテーパ状をなすほぼ円錐状部材を有する請求項23の器具。
- 長手方向軸を限定する器具シャフト(30)と、該シャフトの先端の電極アッセンブリ(32)とを有する、導電性流体媒体の存在下で組織の処置を行うための電気外科器具であって、前記電極アッセンブリは、
電極アッセンブリに設けられていて露出した組織処置部(34A)を有し、少なくとも前記長手方向軸の方向の部分を有する単一の活性電極(34)と、
露出した流体接触面を有していて、前記活性電極と前記長手方向軸の方向に隔てられたリターン電極(38)と、
活性電極(34)とリターン電極(38)との間に配置されていてこれらを電気的に絶縁する絶縁部材(36)とを有し、
前記リターン電極は絶縁部材(36)の端部に及ばない点で止まっていて、絶縁部材が活性電極の露出した組織処置部(34A)とリターン電極の露出した流体接触面とを前記長手方向軸の方向に隔てており、それにより、露出した組織処置部が流体媒体内に浸漬された組織面に近づけられる時には前記露出した流体接触面が前記組織面から隔てられて、前記流体媒体が前記活性電極と前記リターン電極との間の導電経路となるようにし、
前記露出した組織処置部、露出した流体接触面と及び絶縁部材(36)の寸法形状は、前記電極アッセンブリ(32)が導電性流体媒体中に浸漬されたときに、(i)前記露出した流体接触面と、前記露出した流体接触面から最も遠い部分との間の前記流体媒体を経た最短導電経路(P1)の長さと(ii)前記露出した流体接触面と前記露出した組織処置部(34A)との間の前記流体媒体を経た最短導電経路(P2)の長さの比が1.25:1から2:1の範囲内となるものである電気外科器具。
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Application Number | Priority Date | Filing Date | Title |
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GB9512889.8 | 1995-06-23 | ||
GBGB9512889.8A GB9512889D0 (en) | 1995-06-23 | 1995-06-23 | An electrosurgical instrument |
GBGB9512888.0A GB9512888D0 (en) | 1995-06-23 | 1995-06-23 | An electrosurgical generator |
GB9512888.0 | 1995-06-23 | ||
GBGB9600355.3A GB9600355D0 (en) | 1995-06-23 | 1996-01-09 | Electrosurgical instrument |
GB9600352.0 | 1996-01-09 | ||
GBGB9600352.0A GB9600352D0 (en) | 1996-01-09 | 1996-01-09 | Electrosurgical instrument |
GB9600355.3 | 1996-01-09 | ||
PCT/GB1996/001473 WO1997000647A1 (en) | 1995-06-23 | 1996-06-20 | An electrosurgical instrument |
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JPH11507857A JPH11507857A (ja) | 1999-07-13 |
JP3798022B2 true JP3798022B2 (ja) | 2006-07-19 |
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JP50366497A Expired - Lifetime JP3798022B2 (ja) | 1995-06-23 | 1996-06-20 | 電気外科器具 |
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EP (2) | EP0771176B2 (ja) |
JP (1) | JP3798022B2 (ja) |
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CN (1) | CN1095641C (ja) |
AR (1) | AR002570A1 (ja) |
AU (1) | AU710619B2 (ja) |
BR (1) | BR9609421A (ja) |
CA (1) | CA2224858C (ja) |
DE (2) | DE69609473T3 (ja) |
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- 1996-06-20 DE DE69609473T patent/DE69609473T3/de not_active Expired - Lifetime
- 1996-06-20 US US08/702,512 patent/US6004319A/en not_active Expired - Lifetime
- 1996-06-20 CA CA002224858A patent/CA2224858C/en not_active Expired - Lifetime
- 1996-06-20 CN CN96196280A patent/CN1095641C/zh not_active Expired - Lifetime
- 1996-06-20 JP JP50366497A patent/JP3798022B2/ja not_active Expired - Lifetime
- 1996-06-20 BR BR9609421A patent/BR9609421A/pt not_active IP Right Cessation
- 1996-06-20 WO PCT/GB1996/001473 patent/WO1997000647A1/en active IP Right Grant
- 1996-06-20 EP EP96918768A patent/EP0771176B2/en not_active Expired - Lifetime
- 1996-06-20 AU AU61321/96A patent/AU710619B2/en not_active Expired
- 1996-06-20 EP EP00110410A patent/EP1025807B1/en not_active Expired - Lifetime
- 1996-06-20 ES ES00110410T patent/ES2233239T3/es not_active Expired - Lifetime
- 1996-06-20 KR KR1019970709680A patent/KR100463935B1/ko not_active IP Right Cessation
- 1996-06-20 IL IL12271396A patent/IL122713A/en not_active IP Right Cessation
- 1996-06-20 DE DE69634014T patent/DE69634014T2/de not_active Expired - Lifetime
- 1996-06-20 ES ES96918768T patent/ES2150676T5/es not_active Expired - Lifetime
- 1996-06-21 AR ARP960103276A patent/AR002570A1/es unknown
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1998
- 1998-03-27 US US09/049,728 patent/US6056746A/en not_active Expired - Lifetime
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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JP2015534865A (ja) * | 2012-11-13 | 2015-12-07 | オリンパス・ウィンター・アンド・イベ・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング | バイポーラ型の凝固用電極及び切断用電極 |
Also Published As
Publication number | Publication date |
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JPH11507857A (ja) | 1999-07-13 |
ES2150676T3 (es) | 2000-12-01 |
ES2233239T3 (es) | 2005-06-16 |
WO1997000647A1 (en) | 1997-01-09 |
ES2150676T5 (es) | 2006-04-16 |
DE69609473T2 (de) | 2001-04-26 |
AU6132196A (en) | 1997-01-22 |
KR100463935B1 (ko) | 2005-05-16 |
DE69609473T3 (de) | 2006-09-28 |
EP1025807A3 (en) | 2000-10-04 |
EP0771176B2 (en) | 2006-01-04 |
EP1025807B1 (en) | 2004-12-08 |
KR19990028364A (ko) | 1999-04-15 |
MX9800249A (es) | 1998-07-31 |
CN1095641C (zh) | 2002-12-11 |
US6056746A (en) | 2000-05-02 |
EP0771176B1 (en) | 2000-07-26 |
BR9609421A (pt) | 1999-05-18 |
AU710619B2 (en) | 1999-09-23 |
CA2224858C (en) | 2006-11-14 |
EP0771176A1 (en) | 1997-05-07 |
DE69634014D1 (de) | 2005-01-13 |
DE69634014T2 (de) | 2006-03-02 |
IL122713A0 (en) | 1998-08-16 |
US6004319A (en) | 1999-12-21 |
DE69609473D1 (de) | 2000-08-31 |
EP1025807A2 (en) | 2000-08-09 |
IL122713A (en) | 2001-04-30 |
CN1193268A (zh) | 1998-09-16 |
CA2224858A1 (en) | 1997-01-09 |
AR002570A1 (es) | 1998-03-25 |
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