JP3842320B2 - 電子外科切開器具とそれを用いた電子外科切開装置 - Google Patents
電子外科切開器具とそれを用いた電子外科切開装置 Download PDFInfo
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Description
【０００１】
【発明の属する技術分野】
本発明は、鋏の作用を行う一対の刃体を有する電子外科切開器具とそれを用いた電子外科切開装置に関し、詳しくは、電子外科電圧が印加された時、生体組織を乾燥させると同時に切開する電子外科切開器具とそれを用いた電子外科切開装置に関するものである。
【０００２】
【従来の技術】
次のような鋏器具を用いて外科切開を行うことが知られている。すなわち、長手のシャフトの一端に一対の刃体が取り付けられている。刃体と、シャフトの他端に設けられた操作部との間には制御棒が伸びている。各刃体は、この制御棒の動きに応じて、シャフトを横切る軸の回りに回転できるようになっている。２本の刃体は互いに電気的に絶縁されており、電気的に短絡することなしに電子外科の二極電源に接続できるように、刃体の相対する面はセラミックコーティングされている。刃体に挟まれた組織には、刃体の切開部が交わる位置から離れたところで電子外科電流が流される。それによって、刃体を互いに閉じて組織を機械的に分離する前に、組織を乾燥させている。
【０００３】
【発明が解決しようとする課題】
しかしながら、上記従来の電子外科切開器具では、上述のように、両刃体が電気的に短絡することがないように刃体の相対する面がセラミックコーティングされているため、組織と、刃体における組織に電圧を印加する部分との接触が少ない。したがって、組織の接触インピーダンスが高い。そのため、分離前に組織を効率よく乾燥することができないという問題点がある。
【０００４】
また、刃から組織に電圧を印加することができるのは鋏をある程度閉じてからであり、組織を挟むために鋏を開放状態にしているあいだは刃から組織に電圧を印加することができない。したがって、大容量の組織に電流を通すことはできないので、機械的分離に先立って、広範囲の組織を乾燥することができないという問題点がある。
【０００５】
【課題を解決するための手段】
本発明に係る電子外科切開器具は、互いに重なり合うことができる剪断表面を有する第一刃体および第二刃体のうちの少なくとも一方が他方とともに鋏動作を行うために本体に旋回軸を介して取り付けられており、第一および第二刃体に電子外科電圧を印加するための一対の配線導体が本体に設けられている電子外科切開器具において、上記第一刃体は、外側電極層、内側導電層、および外側電極層と内側導電層との間に挟持された絶縁層を含む複合刃体であり、上記配線導体は、上記第一刃体の外側電極層、および上記第二刃体にそれぞれ接続されており、上記第一刃体の剪断表面は、少なくとも一部分が上記内側導電層によって形成されており、上記第一刃体の内側導電層は、第一刃体および第二刃体の剪断表面同士の電気的接触によって、第二刃体と同電位になることを特徴としている。
【０００６】
上記の構成により、第二刃体と、第一刃体の内側導電層とが同電位になる。そのため、両刃体が電気的に短絡することがないように刃体の相対する面を絶縁する必要がないので、外側電極層および第二刃体のそれぞれにおける組織との接触部分において導電性を有することができる。その結果、鋏を閉じる動作を行ったときに、組織と、両刃体のうちで導電性を有して組織に電圧を印加する部分との接触が増すので、組織の接触インピーダンスが低下する。それにより、分離前に組織を効率よく乾燥することができる。
【０００７】
また、上記のように、刃体の相対する面を絶縁する必要がないので、鋏を開放させて組織を挟み、第二刃体が組織と接触したときに、第一刃体とともに電流の通路が形成される。このため、比較的大容量の組織に電流を通すことができるので、機械的分離に先立って、広範囲の組織を乾燥することができる。
【０００８】
好ましくは、配線導体の一本は、第二刃体に結合されるとともに、第二刃体と上記内側導電層との間の電気的接触によって上記内側導電層に電気的に接続されている。また、好ましくは、第二刃体は上記内側導電層と電気的に接触した導電部を有し、上記配線導体と上記導電部とは、配線導体と内側導電層との間に上記導電部が電気的に直列に位置するように接続されている。
【０００９】
上記各刃体は漸進して剪断するように方向付けられた切開部を有し、上記各切開部は金属材料で構成されている。実際には、上記第二刃体は全体が金属体であり、この金属体に上記切開部を設ければよい。好ましくは、上記刃体の両方が上記本体に上記旋回軸を介して取り付けられる。
【００１０】
もし、上記刃体が、切開動作中に互いに面と面で相互にかみ合うように漸進的に重なり合う剪断表面を有し、これら両剪断表面が各刃体の導電部にあるならば、第一刃体の内側導電層と、第二刃体のうちで少なくとも剪断表面を支える部分とは、同一の電位にある。また、第一刃体の外側電極層はこれらと異なる電位にある。それによって、第一刃体の外側電極層と内側導電層との間に電界を生じるとともに、剪断表面間の電気的接触により、第一刃体の外側電極層と第二刃体との間に電界を生じる。
【００１１】
好ましくは、上記各刃体は長手部材を備え、上記長手部材は、外側表面、剪断表面、および切開部を有し、上記切開部は上記刃体に沿って形成されており、上記剪断表面の一方の側に沿って上記剪断表面と外側表面との間の境界を定めている。そして、上記両刃体は、上記剪断表面が互いに向かい合った関係を保ちつつ閉鎖状態へ移行する際に、上記各切開部が剪断動作を進めていくように本体に取り付けられている。そして、上記第一刃体について、上記外側表面は、その切開部に隣接した、刃体に沿う切開面を定めており、上記内側導電層、絶縁層、および外側電極層のそれぞれは、上記切開面に沿って露出されており、上記剪断表面は、上記内側導電層上の、少なくとも、上記切開部に隣接した部分に形成されている。
【００１２】
好ましくは、上記第二刃体は、導電部と、切開部に隣接して刃体に沿った切開面を有し、上記導電部は、切開面に沿って、少なくとも切開部において露出されている。好ましくは、両刃体の切開面は、少なくとも部分的には、剪断表面に対して一般に垂直である。そのため、切開部の交わる位置から離れたところで、オフセット関係ではあるが、切開面が互いに向き合うとともに、刃体間に横断して置かれた一片の組織と電気的接触を作る。したがって、本電子外科切開器具を用いると、刃体間で切開部の交わる位置から離れたところに置かれた組織には、その組織を通して電子外科電流が流れる。その電流は、一方では、第一刃体の外側電極層と内側導電層との間で、他方では、第一刃体の外側電極層と第二刃体との間で、それぞれ流れる。これにより、刃体を閉じる動作をする際に、切開部の交わる位置での機械的分離に先立って、乾燥が行われる。
【００１３】
ある場合、特に組織片の方向が機械的分離に不向きな場合には、本発明の電子外科切開器具は、機械的分離は行わずに、純粋な電子外科切開用途に用いることができる。これを実施するために、好ましくは、第一刃体の外側電極層、絶縁層、および内側導電層はそれぞれ、電子外科切開部に沿って露出される。電子外科切開部は、第一刃体の外側表面の一部を形成している。そして、電子外科切開部は、第一刃体の剪断表面について上記切開部とは反対の側に隣接し、第一刃体に沿って伸延している。
【００１４】
一般に、第二刃体は第一刃体よりも狭く作られる。そして、刃体が閉じている時には、第二刃体の切開部は、第一刃体の剪断表面に沿うとともに、第一刃体の電子外科切開部より引っ込んだ位置にある。したがって、第一刃体の、切開部とは反対側に、外側電極層、絶縁層および内側導電層が露出面を形成し、その露出面に沿って全３層が互いに付き合って露出している。これにより、刃体が閉じたときに電子外科電圧を絶縁層に印加すると、第一刃体のこの露出面をナイフのように用いることができる。
【００１５】
本発明に係る電子外科切開装置は、電子外科用発電機および上記の電子外科切開器具を備え、上記電子外科用発電機は、充電端子と接地端子とを有する不平衡出力を有し、組織の乾燥と機械的切開に対しては、上記充電端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されている。同様に、電子外科切開に対して、充電端子は、好ましくは第二刃体か、あるいは第一刃の内側導電層に接続される。
【００１６】
また、電子外科切開器具が組織の乾燥と機械的切開の組み合わせに用いられるか電子外科切開に用いられるかに従って電気配線が反転するように、電子外科切開器具に制御スイッチを組み込むことも可能である。
【００１７】
【発明の実施の形態】
〔実施の形態１〕
本発明の実施の一形態について図１ないし図３に基づいて説明すれば、以下の通りである。
【００１８】
図１および図２に示すように、本実施の形態に係る電子外科切開器具は、腹壁鏡用のものであり、ブロック図で示す操作部１１、および、操作部１１に近いところに取り付けられた長手で管状の本体１０を通常通りに有している。本体１０の中心を横切るように、旋回軸である軸１６が配置されている。本体１０の末端には、２本の切開刃体である複合刃体（第一刃体）１２と単純刃体（第二刃体）１４とがあり、それぞれ、軸１６の周囲を回転するように支軸されている。複合刃体１２と単純刃体１４とはそれぞれ、軸１６を越えて近くまで伸びている操作棒１８を有し、操作棒１８は、本体１０の内側で往復する駆動部２２の反対側の溝２０に位置するピン１８Ａを有している。ただし、溝２０は図１では一つだけ示している。制御棒２２Ａが、駆動部２２を操作部１１中のトリガ機構（図示せず）に接続している。そのため、トリガ機構が動作した時には、駆動部２２は本体１０中を縦に移動し、上記複合刃体１２と単純刃体１４とを軸１６の周囲に回転させるようになっている。配線導体２４・２４は、操作部１１と複合刃体１２・単純刃体１４との各接続部の間で、管状の本体１０の内部を通過している。
【００１９】
上記操作部１１は、電子外科電源としての発電機２６に接続されている。
【００２０】
図２に示すように、複合刃体１２は、金属製の外側電極層１２Ａ、絶縁層１２Ｂおよび内側導電層１２Ｃを含む複合刃体である。また、単純刃体１４は、本実施の形態では、金属本体（導電部）を有する単純刃体であって、剪断表面の幅が複合刃体１２よりも狭い。複合刃体１２の内側導電層１２Ｃは刃体の剪断表面を形成しており、その剪断表面の一端は切開部（機械切開部）１２Ｄで終了している。複合刃体１２の外側表面１２Ｅは、切開部１２Ｄから、内側導電層１２Ｃで形成される剪断表面の他端にまで回って伸延している。切開部１２Ｄに沿っている、外側表面１２Ｅのうちの部分Ｆは切開面である。外側電極層１２Ａは、少なくともこの切開面１２Ｆの所では露出されている。絶縁層１２Ｂと内側導電層１２Ｃもまた、切開面１２Ｆに沿って露出されている。
【００２１】
単純刃体１４もまた、図１、２に示すように両刃体１２、１４が閉鎖状態にあるときに複合刃体１２の剪断表面に面する剪断表面を有している。また、単純刃体１４は、刃体が開放状態にあるときに、オフセット関係ではあるが、複合刃体１２の切開面１２Ｆに面する切開面１４Ｆをも有している。単純刃体１４の切開面１４Ｆは、刃体が閉じているときに複合刃体１２の内側導電層１２Ｃによって形成される剪断表面を覆っている切開部（機械切開部）１４Ｄまで存在している。
【００２２】
配線導体２４・２４はそれぞれ、複合刃体１２の外側表面１２Ｅと、単純刃体１４とに接続されている。そのため、発電機２６が配線導体２４・２４の操作部端に電圧を印加すると、一方では外側電極層１２Ａと内側導電層１２Ｃとの間で、他方では外側電極層１２Ａと単純刃体１４との間で、それぞれ電子外科電圧が発生する。
【００２３】
本方法の接続の効果を図３に示す。同図（ａ）および（ｂ）は、複合刃体１２と単純刃体１４との構成および、使用中における刃体間に挟んだ生体組織片中での電子外科電流分布を示すものである。また、同図（ｃ）は、関連する発電機２６および切替スイッチ３４とともに示す両刃体の構成を示すものである。同図に示すように、複合刃体１２と単純刃体１４とは、その切開部１２Ｄ・１４Ｄの交わる位置から離れたところで刃体間を横切る形で捉えられた組織２８の一片によって開放されている。ここで、組織２８を通る二つの電流通路３０と３２が存在する。電流通路３０は、図３（ａ）に示すように、複合刃体１２の外側電極層１２Ａと内側導電層１２Ｃとの間である。剪断表面間の電気的接触、またはそれと同時の、二つの刃体の切開部１２Ｄと切開部１４Ｄとが交わる位置から近いところでの切開部１２Ｄ・１４Ｄ間の電気的接触により、内側導電層１２Ｃは単純刃体１４と同じ電位にある。また、電流通路３２は、図３（ｂ）に示すように、複合刃体１２の外側電極層１２Ａと単純刃体１４の切開部１４Ｄとの間に伸延している。実際は、二つの電流通路３０と電流通路３２とは結合されており、複合刃体１２と単純刃体１４とが開放状態から閉鎖状態に動く時に生ずる機械的分離に対応する、組織２８内のある線に沿って、乾燥動作を生み出す。それによって、切開ラインからの出血を防止する。
【００２４】
複合刃体１２の内側導電層１２Ｃと、単純刃体１４との間には電子外科電流は流れないので、剪断表面では絶縁物は必要ない。
【００２５】
電流通路３０は、図３（ｂ）に示す電流通路３２と比べて乾燥領域は小さいが、総合的な効果は両経路を通る電流の和による。両電流通路３０・３２は複合刃体１２と単純刃体１４との方向に伸びている。複合刃体１２と単純刃体１４とが閉じるに従い、組織２８は圧縮され、組織の乾燥した量が増加する。
【００２６】
図３（ａ）および（ｂ）から分かるように、図示するように時計方向に器具を回転させると、組織２８と両刃体１２・１４との接触が増し、それによって組織の接触インピーダンスが低下する。これは、外側電極層１２Ａおよび単純刃体１４のいずれもが、組織との接触部分においては導電性の外側表面を有しているからである。
【００２７】
また、単純刃体１４の剪断表面上には絶縁層がないので、鋏が開放状態にあるときには、単純刃体１４は組織２８と接触する。このため、複合刃体１２の外側表面１２Ｅと切開面１２Ｆとともに、二極電子外科回路が完結される。したがって、電流通路内には比較的大容量の組織２８が含まれるので、機械的分離に先立って広い乾燥範囲を得ることができる。
【００２８】
再び図２を参照して、外側電極層１２Ａ、絶縁層１２Ｂおよび内側導電層１２Ｃはすべて、複合刃体１２の外側表面１２Ｅの一部を形成する露出面１２（電子外科切開部）Ｇに沿って露出されている。この露出面Ｇは、切開面１２Ｆの反対側にあり、電子外科ナイフとして使用することができる。単純刃体１４は複合刃体１２よりも狭い。また、刃体が完全に閉鎖したときには、単純刃体１４の切開面１４Ｆは複合刃体１２の剪断表面に沿ってはいるが、切開部１４Ｄを清潔にするために、露出面１２Ｇからは離れた位置にある。
【００２９】
電子外科切開部である露出面１２Ｇを用いる電子外科切開の効果は、切開部１２Ｄに近い組織中での電流密度を増すことにより強められる。不平衡出力を有する発電機２６の場合には、この効果は、発電機２６の「充電」あるいは「給電」用の出力端子である充電端子２６Ａを単純刃体１４（または直接複合刃体１２の内側導電層１２Ｃ）に、「接地」あるいは「帰還」用の出力端子である接地端子２６Ｂを複合刃体１２の外側電極層１２Ａにそれぞれ接続することにより達成される。このような接続の効果を次に述べる。図３（ｃ）に示すように、少なくとも交流においては、発電機２６の接地端子２６Ｂは発電機２６の内部接地母線２６Ｃに接続され、充電端子２６Ａは発振器あるいは増幅器出力２６Ｄに接続されているので、患部を通して地面に流れる漏洩電流は充電端子２６Ａからの方が接地端子２６Ｂからよりも大きい。したがって、接地端子２６Ｂから地面に対する静電容量が大きくなる。この結果、充電端子２６Ａから患部組織に流れる電流のうちのすべてが接地端子２６Ｂを経由して帰るわけではなく、それらの電流のうちのある部分は地面との間に静電容量を有する形で結合していることになる。充電端子２６Ａを内側導電層１２Ｃに効果的に接続することにより、組織２８と電子外科切開部である露出面１２Ｇとの間の接続部でのピーク電流密度が最大となる。これは、電子外科切開部である露出面１２Ｇでの内側導電層１２Ｃの表面積が外側電極層１２Ａの表面積より小さいためである。
【００３０】
乾燥のための好ましい電流分布は、電子外科切開のための条件とは対照的に、組織２８と複合刃体１２との間の接続部で出来るだけ均一に近いことが望ましい。したがって、図３（ａ）および（ｂ）に示すように、乾燥と機械的切開とを統合したものとしては、充電端子２６Ａは複合刃体１２の外側電極層１２Ａに接続し、接地端子２６Ｂは単純刃体１４に（そして、内側導電層１２Ｃに効果的に）接続するのが好ましい。そのために、配線導体２４・２４から充電端子２６Ａや接地端子２６Ｂへの各接続を、乾燥または電子外科切開の要求に従って逆転させる切替スイッチ３４を備えるのが有利である。図３（ｃ）に、この切替スイッチ３４をより詳細に示す。切替スイッチ３４は、二対の接触子３４Ａと接触子３４Ｂ、および双腕接触子３４Ｃを有する。双腕接触子３４Ｃは、図３（ｃ）に示す第一動作位置から、第二動作位置へ移動することができる。第一動作位置とは、充電端子２６Ａが外側電極層１２Ａに接続され、接地端子２６Ｂが単純刃体１４に接続され、器具が乾燥に用いられる位置である。また、第二動作位置とは、充電端子２６Ａが単純刃体１４に接続され、接地端子２６Ｂが外側電極層１２Ａに接続され、器具が電子外科切開に用いられる位置である。
【００３１】
切替スイッチ３４は、図１に示すように、操作部１１に取り付けることができる。また、実際に切り替え動作を行う接触子３４Ａ・３４Ｂおよび双腕接触子３４Ｃは、発電機２６の中に配置し、接触子３４Ａ・３４Ｂの動作は、切替スイッチ３４から制御配線３６を通じて制御されるリレーによって動作されるようにするのが好ましい。操作部１１はまた、電子外科電力の配線導体２４・２４への印加を制御する開閉スイッチ４０を有する。この機能に対する実際の開閉動作も同様に、開閉スイッチ４０と発電機２６との間の制御配線４２を経由して制御されるリレーによって行うようにすることができる。
【００３２】
〔実施の形態２〕
本発明の他の実施の形態について図４ないし図６に基づいて説明すれば、以下の通りである。図４ないし図６に示すように、本発明に係る第二の電子外科切開器具は、湾曲した切開刃体である、複合刃体（第一刃体）１２と単純刃体（第二刃体）１４とを有している。その両刃体は、器具の長手方向の軸から離れ、かつそれを横切る曲線の軸に沿って湾曲している。複合刃体１２は、実施の形態１同様、外側電極層１２Ａ、エポキシ樹脂接着剤で作られた絶縁層１２Ｂ、および耐磨耗金属で作られた内側導電層１２Ｃを有する。単純刃体１４は、図４に示すように、複合刃体１２の曲率に合致するように湾曲している。前記実施の形態同様、この単純刃体１４は単純な金属からなる部分である。両刃体１２、１４は、横断旋回用の軸（旋回軸）１６を中心に回転自在である。また、両刃体１２、１４は、駆動部を機能させる軸１６から中央部に向かって伸びる操作棒１８を有している。なお、上記駆動部は図示しないが、図１の駆動部２２に類似する。図４は、配線導体２４・２４を複合刃体１２と単純刃体１４との操作棒１８・１８に取り付ける様子を示す。特に、図５・図６に示すように、複合刃体１２には、強度を増強するために、外側のリブ１２Ｈが形成されている。
【００３３】
【発明の効果】
本発明に係る電子外科切開器具は、互いに重なり合うことができる剪断表面を有する第一刃体および第二刃体のうちの少なくとも一方が他方とともに鋏動作を行うために本体に旋回軸を介して取り付けられており、第一および第二刃体に電子外科電圧を印加するための一対の配線導体が本体に設けられている電子外科切開器具において、上記第一刃体は、外側電極層、内側導電層、および外側電極層と内側導電層との間に挟持された絶縁層を含む複合刃体であり、上記配線導体は、上記第一刃体の外側電極層、および上記第二刃体にそれぞれ接続されており、上記第一刃体の剪断表面は、少なくとも一部分が上記内側導電 層によって形成されており、上記第一刃体の内側導電層は、第一刃体および第二刃体の剪断表面同士の電気的接触によって、第二刃体と同電位になる構成である。
【００３４】
それゆえ、組織の接触インピーダンスを低下させて、分離前に組織を効率よく乾燥することができるという効果を奏する。
【００３５】
また、機械的分離に先立って、広範囲の組織を乾燥することができるという効果を奏する。
【００３６】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、配線導体の一本は、第二刃体に結合されるとともに、第二刃体と上記内側導電層との間の電気的接触によって上記内側導電層に電気的に接続されている構成である。
【００３７】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、第二刃体は上記内側導電層と電気的に接触した導電部を有し、上記配線導体と上記導電部とは、配線導体と内側導電層との間に上記導電部が電気的に直列に位置するように接続されている構成である。
【００３８】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記各刃体は漸進して剪断するように方向付けられた切開部を有し、上記各切開部は金属材料で構成されている。
【００３９】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第二刃体は全体が金属体であり、この金属体に上記切開部を設けた構成である。
【００４０】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記刃体の両方が上記本体に上記旋回軸を介して取り付けられた構成である。
【００４１】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記各刃体は長手部材を備え、上記長手部材は、外側表面、剪断表面、および切開部を有し、上記切開部は上記刃体に沿って形成されており、上記剪断表面の一方の側に沿って上記剪断表面と外側表面との間の境界を定めており、上記両刃体は、上記剪断表面が互いに向かい合った関係を保ちつつ閉鎖状態へ移行する際に、上記各切開部が剪断動作を進めていくように本体に取り付けられており、上記第一刃体について、上記外側表面は、その切開部に隣接した、刃体に沿う切開面を定めており、上記内側導電層、絶縁層、および外側電極層のそれぞれは、上記切開面に沿って露出されており、上記剪断表面は、上記内側導電層上の、少なくとも、上記切開部に隣接した部分に形成されている構成である。
【００４２】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第二刃体は、導電部と、切開部に隣接して刃体に沿った切開面を有し、上記導電部は、少なくとも切開部において、切開面に沿って露出されている構成である。
【００４３】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第二刃体の導電部は、少なくとも第二刃体の剪断表面の大部分において露出されている構成である。
【００４４】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第一刃体の外側電極層、絶縁層および内側電導層はそれぞれ、第一刃体の剪断表面に隣接して第一刃体に沿った、第一刃体の上記外側表面の一部をなす電子外科切開部に沿って露出されている構成である。
【００４５】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記電子外科切開部は、第一刃体の剪断表面について、上記切開部とは反対の側に隣接して、第一刃体に沿って伸延しており、上記両刃体の閉鎖状態にあっては、第二刃体の切開部が第一刃体の剪断面に沿い、かつ、第一刃体の電子外科切開部からは離れているように、上記両刃体が配置されている構成である。
【００４６】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、配線の接続を逆転させるスイッチを備えた構成である。
【００４７】
また、本発明に係る電子外科切開装置は、電子外科用発電機および上記した構成の電子外科切開器具を備え、上記電子外科用発電機は、充電端子と接地端子とを有する不平衡出力を有し、組織の乾燥と機械的切開に対しては、上記充電端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されている構成である。
【００４８】
また、本発明に係る電子外科切開装置は、電子外科用発電機および上記した構成の電子外科切開器具を備え、上記電子外科用発電機は、充電端子と接地端子とを有する不平衡出力を有し、電子外科切開に対しては、上記接地端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されている構成である。
【００４９】
また、本発明に係る電子外科切開装置は、上記の電子外科切開装置であって、上記電子外科切開器具は、上記電子外科用発電機から刃体に出力する端子の接続を逆転するスイッチを有する構成である。
【図面の簡単な説明】
【図１】 本発明の電子外科切開器具の一構成例の概略の構成を示す平面図である。
【図２】 図１のＡ−Ａ断面での刃体の構成を示す断面図である。
【図３】 刃体の構成を示す断面図である。
【図４】 本発明の電子外科切開器具の他の構成例における刃体の構成を示す平面図である。
【図５】 図４の刃体の端部の構成を示す斜視図である。
【図６】 図４のＸ−Ｘ断面での刃体の構成を示す断面図である。
【符号の説明】
１０ 本体
１１ 操作部
１２ 複合刃体（第一刃体）
１２Ａ 外側電極層
１２Ｂ 絶縁層
１２Ｃ 内側導電層
１２Ｄ 切開部（機械切開部）
１２Ｅ 外側表面
１２Ｆ 切開面
１２Ｇ 露出面（電子外科切開部）
１２Ｈ リブ
１４ 単純刃体（第二刃体）
１４Ｄ 切開部（機械切開部）
１４Ｆ 切開面
１６ 軸（旋回軸）
１８ 操作棒
１８Ａ ピン
２０ 溝
２２ 駆動部
２２Ａ 制御棒
２４ 配線導体
２６ 発電機（電子外科電源）
２６Ａ 充電端子
２６Ｂ 接地端子
２６Ｃ 内部接地母線
２６Ｄ 増幅器出力
２８ 組織
３０ 電流通路
３２ 電流通路
３４ 切替スイッチ
３４Ａ 接触子
３４Ｂ 接触子
３４Ｃ 双腕接触子
３６ 制御配線
４０ 開閉スイッチ
４２ 制御配線
【発明の属する技術分野】
本発明は、鋏の作用を行う一対の刃体を有する電子外科切開器具とそれを用いた電子外科切開装置に関し、詳しくは、電子外科電圧が印加された時、生体組織を乾燥させると同時に切開する電子外科切開器具とそれを用いた電子外科切開装置に関するものである。
【０００２】
【従来の技術】
次のような鋏器具を用いて外科切開を行うことが知られている。すなわち、長手のシャフトの一端に一対の刃体が取り付けられている。刃体と、シャフトの他端に設けられた操作部との間には制御棒が伸びている。各刃体は、この制御棒の動きに応じて、シャフトを横切る軸の回りに回転できるようになっている。２本の刃体は互いに電気的に絶縁されており、電気的に短絡することなしに電子外科の二極電源に接続できるように、刃体の相対する面はセラミックコーティングされている。刃体に挟まれた組織には、刃体の切開部が交わる位置から離れたところで電子外科電流が流される。それによって、刃体を互いに閉じて組織を機械的に分離する前に、組織を乾燥させている。
【０００３】
【発明が解決しようとする課題】
しかしながら、上記従来の電子外科切開器具では、上述のように、両刃体が電気的に短絡することがないように刃体の相対する面がセラミックコーティングされているため、組織と、刃体における組織に電圧を印加する部分との接触が少ない。したがって、組織の接触インピーダンスが高い。そのため、分離前に組織を効率よく乾燥することができないという問題点がある。
【０００４】
また、刃から組織に電圧を印加することができるのは鋏をある程度閉じてからであり、組織を挟むために鋏を開放状態にしているあいだは刃から組織に電圧を印加することができない。したがって、大容量の組織に電流を通すことはできないので、機械的分離に先立って、広範囲の組織を乾燥することができないという問題点がある。
【０００５】
【課題を解決するための手段】
本発明に係る電子外科切開器具は、互いに重なり合うことができる剪断表面を有する第一刃体および第二刃体のうちの少なくとも一方が他方とともに鋏動作を行うために本体に旋回軸を介して取り付けられており、第一および第二刃体に電子外科電圧を印加するための一対の配線導体が本体に設けられている電子外科切開器具において、上記第一刃体は、外側電極層、内側導電層、および外側電極層と内側導電層との間に挟持された絶縁層を含む複合刃体であり、上記配線導体は、上記第一刃体の外側電極層、および上記第二刃体にそれぞれ接続されており、上記第一刃体の剪断表面は、少なくとも一部分が上記内側導電層によって形成されており、上記第一刃体の内側導電層は、第一刃体および第二刃体の剪断表面同士の電気的接触によって、第二刃体と同電位になることを特徴としている。
【０００６】
上記の構成により、第二刃体と、第一刃体の内側導電層とが同電位になる。そのため、両刃体が電気的に短絡することがないように刃体の相対する面を絶縁する必要がないので、外側電極層および第二刃体のそれぞれにおける組織との接触部分において導電性を有することができる。その結果、鋏を閉じる動作を行ったときに、組織と、両刃体のうちで導電性を有して組織に電圧を印加する部分との接触が増すので、組織の接触インピーダンスが低下する。それにより、分離前に組織を効率よく乾燥することができる。
【０００７】
また、上記のように、刃体の相対する面を絶縁する必要がないので、鋏を開放させて組織を挟み、第二刃体が組織と接触したときに、第一刃体とともに電流の通路が形成される。このため、比較的大容量の組織に電流を通すことができるので、機械的分離に先立って、広範囲の組織を乾燥することができる。
【０００８】
好ましくは、配線導体の一本は、第二刃体に結合されるとともに、第二刃体と上記内側導電層との間の電気的接触によって上記内側導電層に電気的に接続されている。また、好ましくは、第二刃体は上記内側導電層と電気的に接触した導電部を有し、上記配線導体と上記導電部とは、配線導体と内側導電層との間に上記導電部が電気的に直列に位置するように接続されている。
【０００９】
上記各刃体は漸進して剪断するように方向付けられた切開部を有し、上記各切開部は金属材料で構成されている。実際には、上記第二刃体は全体が金属体であり、この金属体に上記切開部を設ければよい。好ましくは、上記刃体の両方が上記本体に上記旋回軸を介して取り付けられる。
【００１０】
もし、上記刃体が、切開動作中に互いに面と面で相互にかみ合うように漸進的に重なり合う剪断表面を有し、これら両剪断表面が各刃体の導電部にあるならば、第一刃体の内側導電層と、第二刃体のうちで少なくとも剪断表面を支える部分とは、同一の電位にある。また、第一刃体の外側電極層はこれらと異なる電位にある。それによって、第一刃体の外側電極層と内側導電層との間に電界を生じるとともに、剪断表面間の電気的接触により、第一刃体の外側電極層と第二刃体との間に電界を生じる。
【００１１】
好ましくは、上記各刃体は長手部材を備え、上記長手部材は、外側表面、剪断表面、および切開部を有し、上記切開部は上記刃体に沿って形成されており、上記剪断表面の一方の側に沿って上記剪断表面と外側表面との間の境界を定めている。そして、上記両刃体は、上記剪断表面が互いに向かい合った関係を保ちつつ閉鎖状態へ移行する際に、上記各切開部が剪断動作を進めていくように本体に取り付けられている。そして、上記第一刃体について、上記外側表面は、その切開部に隣接した、刃体に沿う切開面を定めており、上記内側導電層、絶縁層、および外側電極層のそれぞれは、上記切開面に沿って露出されており、上記剪断表面は、上記内側導電層上の、少なくとも、上記切開部に隣接した部分に形成されている。
【００１２】
好ましくは、上記第二刃体は、導電部と、切開部に隣接して刃体に沿った切開面を有し、上記導電部は、切開面に沿って、少なくとも切開部において露出されている。好ましくは、両刃体の切開面は、少なくとも部分的には、剪断表面に対して一般に垂直である。そのため、切開部の交わる位置から離れたところで、オフセット関係ではあるが、切開面が互いに向き合うとともに、刃体間に横断して置かれた一片の組織と電気的接触を作る。したがって、本電子外科切開器具を用いると、刃体間で切開部の交わる位置から離れたところに置かれた組織には、その組織を通して電子外科電流が流れる。その電流は、一方では、第一刃体の外側電極層と内側導電層との間で、他方では、第一刃体の外側電極層と第二刃体との間で、それぞれ流れる。これにより、刃体を閉じる動作をする際に、切開部の交わる位置での機械的分離に先立って、乾燥が行われる。
【００１３】
ある場合、特に組織片の方向が機械的分離に不向きな場合には、本発明の電子外科切開器具は、機械的分離は行わずに、純粋な電子外科切開用途に用いることができる。これを実施するために、好ましくは、第一刃体の外側電極層、絶縁層、および内側導電層はそれぞれ、電子外科切開部に沿って露出される。電子外科切開部は、第一刃体の外側表面の一部を形成している。そして、電子外科切開部は、第一刃体の剪断表面について上記切開部とは反対の側に隣接し、第一刃体に沿って伸延している。
【００１４】
一般に、第二刃体は第一刃体よりも狭く作られる。そして、刃体が閉じている時には、第二刃体の切開部は、第一刃体の剪断表面に沿うとともに、第一刃体の電子外科切開部より引っ込んだ位置にある。したがって、第一刃体の、切開部とは反対側に、外側電極層、絶縁層および内側導電層が露出面を形成し、その露出面に沿って全３層が互いに付き合って露出している。これにより、刃体が閉じたときに電子外科電圧を絶縁層に印加すると、第一刃体のこの露出面をナイフのように用いることができる。
【００１５】
本発明に係る電子外科切開装置は、電子外科用発電機および上記の電子外科切開器具を備え、上記電子外科用発電機は、充電端子と接地端子とを有する不平衡出力を有し、組織の乾燥と機械的切開に対しては、上記充電端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されている。同様に、電子外科切開に対して、充電端子は、好ましくは第二刃体か、あるいは第一刃の内側導電層に接続される。
【００１６】
また、電子外科切開器具が組織の乾燥と機械的切開の組み合わせに用いられるか電子外科切開に用いられるかに従って電気配線が反転するように、電子外科切開器具に制御スイッチを組み込むことも可能である。
【００１７】
【発明の実施の形態】
〔実施の形態１〕
本発明の実施の一形態について図１ないし図３に基づいて説明すれば、以下の通りである。
【００１８】
図１および図２に示すように、本実施の形態に係る電子外科切開器具は、腹壁鏡用のものであり、ブロック図で示す操作部１１、および、操作部１１に近いところに取り付けられた長手で管状の本体１０を通常通りに有している。本体１０の中心を横切るように、旋回軸である軸１６が配置されている。本体１０の末端には、２本の切開刃体である複合刃体（第一刃体）１２と単純刃体（第二刃体）１４とがあり、それぞれ、軸１６の周囲を回転するように支軸されている。複合刃体１２と単純刃体１４とはそれぞれ、軸１６を越えて近くまで伸びている操作棒１８を有し、操作棒１８は、本体１０の内側で往復する駆動部２２の反対側の溝２０に位置するピン１８Ａを有している。ただし、溝２０は図１では一つだけ示している。制御棒２２Ａが、駆動部２２を操作部１１中のトリガ機構（図示せず）に接続している。そのため、トリガ機構が動作した時には、駆動部２２は本体１０中を縦に移動し、上記複合刃体１２と単純刃体１４とを軸１６の周囲に回転させるようになっている。配線導体２４・２４は、操作部１１と複合刃体１２・単純刃体１４との各接続部の間で、管状の本体１０の内部を通過している。
【００１９】
上記操作部１１は、電子外科電源としての発電機２６に接続されている。
【００２０】
図２に示すように、複合刃体１２は、金属製の外側電極層１２Ａ、絶縁層１２Ｂおよび内側導電層１２Ｃを含む複合刃体である。また、単純刃体１４は、本実施の形態では、金属本体（導電部）を有する単純刃体であって、剪断表面の幅が複合刃体１２よりも狭い。複合刃体１２の内側導電層１２Ｃは刃体の剪断表面を形成しており、その剪断表面の一端は切開部（機械切開部）１２Ｄで終了している。複合刃体１２の外側表面１２Ｅは、切開部１２Ｄから、内側導電層１２Ｃで形成される剪断表面の他端にまで回って伸延している。切開部１２Ｄに沿っている、外側表面１２Ｅのうちの部分Ｆは切開面である。外側電極層１２Ａは、少なくともこの切開面１２Ｆの所では露出されている。絶縁層１２Ｂと内側導電層１２Ｃもまた、切開面１２Ｆに沿って露出されている。
【００２１】
単純刃体１４もまた、図１、２に示すように両刃体１２、１４が閉鎖状態にあるときに複合刃体１２の剪断表面に面する剪断表面を有している。また、単純刃体１４は、刃体が開放状態にあるときに、オフセット関係ではあるが、複合刃体１２の切開面１２Ｆに面する切開面１４Ｆをも有している。単純刃体１４の切開面１４Ｆは、刃体が閉じているときに複合刃体１２の内側導電層１２Ｃによって形成される剪断表面を覆っている切開部（機械切開部）１４Ｄまで存在している。
【００２２】
配線導体２４・２４はそれぞれ、複合刃体１２の外側表面１２Ｅと、単純刃体１４とに接続されている。そのため、発電機２６が配線導体２４・２４の操作部端に電圧を印加すると、一方では外側電極層１２Ａと内側導電層１２Ｃとの間で、他方では外側電極層１２Ａと単純刃体１４との間で、それぞれ電子外科電圧が発生する。
【００２３】
本方法の接続の効果を図３に示す。同図（ａ）および（ｂ）は、複合刃体１２と単純刃体１４との構成および、使用中における刃体間に挟んだ生体組織片中での電子外科電流分布を示すものである。また、同図（ｃ）は、関連する発電機２６および切替スイッチ３４とともに示す両刃体の構成を示すものである。同図に示すように、複合刃体１２と単純刃体１４とは、その切開部１２Ｄ・１４Ｄの交わる位置から離れたところで刃体間を横切る形で捉えられた組織２８の一片によって開放されている。ここで、組織２８を通る二つの電流通路３０と３２が存在する。電流通路３０は、図３（ａ）に示すように、複合刃体１２の外側電極層１２Ａと内側導電層１２Ｃとの間である。剪断表面間の電気的接触、またはそれと同時の、二つの刃体の切開部１２Ｄと切開部１４Ｄとが交わる位置から近いところでの切開部１２Ｄ・１４Ｄ間の電気的接触により、内側導電層１２Ｃは単純刃体１４と同じ電位にある。また、電流通路３２は、図３（ｂ）に示すように、複合刃体１２の外側電極層１２Ａと単純刃体１４の切開部１４Ｄとの間に伸延している。実際は、二つの電流通路３０と電流通路３２とは結合されており、複合刃体１２と単純刃体１４とが開放状態から閉鎖状態に動く時に生ずる機械的分離に対応する、組織２８内のある線に沿って、乾燥動作を生み出す。それによって、切開ラインからの出血を防止する。
【００２４】
複合刃体１２の内側導電層１２Ｃと、単純刃体１４との間には電子外科電流は流れないので、剪断表面では絶縁物は必要ない。
【００２５】
電流通路３０は、図３（ｂ）に示す電流通路３２と比べて乾燥領域は小さいが、総合的な効果は両経路を通る電流の和による。両電流通路３０・３２は複合刃体１２と単純刃体１４との方向に伸びている。複合刃体１２と単純刃体１４とが閉じるに従い、組織２８は圧縮され、組織の乾燥した量が増加する。
【００２６】
図３（ａ）および（ｂ）から分かるように、図示するように時計方向に器具を回転させると、組織２８と両刃体１２・１４との接触が増し、それによって組織の接触インピーダンスが低下する。これは、外側電極層１２Ａおよび単純刃体１４のいずれもが、組織との接触部分においては導電性の外側表面を有しているからである。
【００２７】
また、単純刃体１４の剪断表面上には絶縁層がないので、鋏が開放状態にあるときには、単純刃体１４は組織２８と接触する。このため、複合刃体１２の外側表面１２Ｅと切開面１２Ｆとともに、二極電子外科回路が完結される。したがって、電流通路内には比較的大容量の組織２８が含まれるので、機械的分離に先立って広い乾燥範囲を得ることができる。
【００２８】
再び図２を参照して、外側電極層１２Ａ、絶縁層１２Ｂおよび内側導電層１２Ｃはすべて、複合刃体１２の外側表面１２Ｅの一部を形成する露出面１２（電子外科切開部）Ｇに沿って露出されている。この露出面Ｇは、切開面１２Ｆの反対側にあり、電子外科ナイフとして使用することができる。単純刃体１４は複合刃体１２よりも狭い。また、刃体が完全に閉鎖したときには、単純刃体１４の切開面１４Ｆは複合刃体１２の剪断表面に沿ってはいるが、切開部１４Ｄを清潔にするために、露出面１２Ｇからは離れた位置にある。
【００２９】
電子外科切開部である露出面１２Ｇを用いる電子外科切開の効果は、切開部１２Ｄに近い組織中での電流密度を増すことにより強められる。不平衡出力を有する発電機２６の場合には、この効果は、発電機２６の「充電」あるいは「給電」用の出力端子である充電端子２６Ａを単純刃体１４（または直接複合刃体１２の内側導電層１２Ｃ）に、「接地」あるいは「帰還」用の出力端子である接地端子２６Ｂを複合刃体１２の外側電極層１２Ａにそれぞれ接続することにより達成される。このような接続の効果を次に述べる。図３（ｃ）に示すように、少なくとも交流においては、発電機２６の接地端子２６Ｂは発電機２６の内部接地母線２６Ｃに接続され、充電端子２６Ａは発振器あるいは増幅器出力２６Ｄに接続されているので、患部を通して地面に流れる漏洩電流は充電端子２６Ａからの方が接地端子２６Ｂからよりも大きい。したがって、接地端子２６Ｂから地面に対する静電容量が大きくなる。この結果、充電端子２６Ａから患部組織に流れる電流のうちのすべてが接地端子２６Ｂを経由して帰るわけではなく、それらの電流のうちのある部分は地面との間に静電容量を有する形で結合していることになる。充電端子２６Ａを内側導電層１２Ｃに効果的に接続することにより、組織２８と電子外科切開部である露出面１２Ｇとの間の接続部でのピーク電流密度が最大となる。これは、電子外科切開部である露出面１２Ｇでの内側導電層１２Ｃの表面積が外側電極層１２Ａの表面積より小さいためである。
【００３０】
乾燥のための好ましい電流分布は、電子外科切開のための条件とは対照的に、組織２８と複合刃体１２との間の接続部で出来るだけ均一に近いことが望ましい。したがって、図３（ａ）および（ｂ）に示すように、乾燥と機械的切開とを統合したものとしては、充電端子２６Ａは複合刃体１２の外側電極層１２Ａに接続し、接地端子２６Ｂは単純刃体１４に（そして、内側導電層１２Ｃに効果的に）接続するのが好ましい。そのために、配線導体２４・２４から充電端子２６Ａや接地端子２６Ｂへの各接続を、乾燥または電子外科切開の要求に従って逆転させる切替スイッチ３４を備えるのが有利である。図３（ｃ）に、この切替スイッチ３４をより詳細に示す。切替スイッチ３４は、二対の接触子３４Ａと接触子３４Ｂ、および双腕接触子３４Ｃを有する。双腕接触子３４Ｃは、図３（ｃ）に示す第一動作位置から、第二動作位置へ移動することができる。第一動作位置とは、充電端子２６Ａが外側電極層１２Ａに接続され、接地端子２６Ｂが単純刃体１４に接続され、器具が乾燥に用いられる位置である。また、第二動作位置とは、充電端子２６Ａが単純刃体１４に接続され、接地端子２６Ｂが外側電極層１２Ａに接続され、器具が電子外科切開に用いられる位置である。
【００３１】
切替スイッチ３４は、図１に示すように、操作部１１に取り付けることができる。また、実際に切り替え動作を行う接触子３４Ａ・３４Ｂおよび双腕接触子３４Ｃは、発電機２６の中に配置し、接触子３４Ａ・３４Ｂの動作は、切替スイッチ３４から制御配線３６を通じて制御されるリレーによって動作されるようにするのが好ましい。操作部１１はまた、電子外科電力の配線導体２４・２４への印加を制御する開閉スイッチ４０を有する。この機能に対する実際の開閉動作も同様に、開閉スイッチ４０と発電機２６との間の制御配線４２を経由して制御されるリレーによって行うようにすることができる。
【００３２】
〔実施の形態２〕
本発明の他の実施の形態について図４ないし図６に基づいて説明すれば、以下の通りである。図４ないし図６に示すように、本発明に係る第二の電子外科切開器具は、湾曲した切開刃体である、複合刃体（第一刃体）１２と単純刃体（第二刃体）１４とを有している。その両刃体は、器具の長手方向の軸から離れ、かつそれを横切る曲線の軸に沿って湾曲している。複合刃体１２は、実施の形態１同様、外側電極層１２Ａ、エポキシ樹脂接着剤で作られた絶縁層１２Ｂ、および耐磨耗金属で作られた内側導電層１２Ｃを有する。単純刃体１４は、図４に示すように、複合刃体１２の曲率に合致するように湾曲している。前記実施の形態同様、この単純刃体１４は単純な金属からなる部分である。両刃体１２、１４は、横断旋回用の軸（旋回軸）１６を中心に回転自在である。また、両刃体１２、１４は、駆動部を機能させる軸１６から中央部に向かって伸びる操作棒１８を有している。なお、上記駆動部は図示しないが、図１の駆動部２２に類似する。図４は、配線導体２４・２４を複合刃体１２と単純刃体１４との操作棒１８・１８に取り付ける様子を示す。特に、図５・図６に示すように、複合刃体１２には、強度を増強するために、外側のリブ１２Ｈが形成されている。
【００３３】
【発明の効果】
本発明に係る電子外科切開器具は、互いに重なり合うことができる剪断表面を有する第一刃体および第二刃体のうちの少なくとも一方が他方とともに鋏動作を行うために本体に旋回軸を介して取り付けられており、第一および第二刃体に電子外科電圧を印加するための一対の配線導体が本体に設けられている電子外科切開器具において、上記第一刃体は、外側電極層、内側導電層、および外側電極層と内側導電層との間に挟持された絶縁層を含む複合刃体であり、上記配線導体は、上記第一刃体の外側電極層、および上記第二刃体にそれぞれ接続されており、上記第一刃体の剪断表面は、少なくとも一部分が上記内側導電 層によって形成されており、上記第一刃体の内側導電層は、第一刃体および第二刃体の剪断表面同士の電気的接触によって、第二刃体と同電位になる構成である。
【００３４】
それゆえ、組織の接触インピーダンスを低下させて、分離前に組織を効率よく乾燥することができるという効果を奏する。
【００３５】
また、機械的分離に先立って、広範囲の組織を乾燥することができるという効果を奏する。
【００３６】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、配線導体の一本は、第二刃体に結合されるとともに、第二刃体と上記内側導電層との間の電気的接触によって上記内側導電層に電気的に接続されている構成である。
【００３７】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、第二刃体は上記内側導電層と電気的に接触した導電部を有し、上記配線導体と上記導電部とは、配線導体と内側導電層との間に上記導電部が電気的に直列に位置するように接続されている構成である。
【００３８】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記各刃体は漸進して剪断するように方向付けられた切開部を有し、上記各切開部は金属材料で構成されている。
【００３９】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第二刃体は全体が金属体であり、この金属体に上記切開部を設けた構成である。
【００４０】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記刃体の両方が上記本体に上記旋回軸を介して取り付けられた構成である。
【００４１】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記各刃体は長手部材を備え、上記長手部材は、外側表面、剪断表面、および切開部を有し、上記切開部は上記刃体に沿って形成されており、上記剪断表面の一方の側に沿って上記剪断表面と外側表面との間の境界を定めており、上記両刃体は、上記剪断表面が互いに向かい合った関係を保ちつつ閉鎖状態へ移行する際に、上記各切開部が剪断動作を進めていくように本体に取り付けられており、上記第一刃体について、上記外側表面は、その切開部に隣接した、刃体に沿う切開面を定めており、上記内側導電層、絶縁層、および外側電極層のそれぞれは、上記切開面に沿って露出されており、上記剪断表面は、上記内側導電層上の、少なくとも、上記切開部に隣接した部分に形成されている構成である。
【００４２】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第二刃体は、導電部と、切開部に隣接して刃体に沿った切開面を有し、上記導電部は、少なくとも切開部において、切開面に沿って露出されている構成である。
【００４３】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第二刃体の導電部は、少なくとも第二刃体の剪断表面の大部分において露出されている構成である。
【００４４】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記第一刃体の外側電極層、絶縁層および内側電導層はそれぞれ、第一刃体の剪断表面に隣接して第一刃体に沿った、第一刃体の上記外側表面の一部をなす電子外科切開部に沿って露出されている構成である。
【００４５】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、上記電子外科切開部は、第一刃体の剪断表面について、上記切開部とは反対の側に隣接して、第一刃体に沿って伸延しており、上記両刃体の閉鎖状態にあっては、第二刃体の切開部が第一刃体の剪断面に沿い、かつ、第一刃体の電子外科切開部からは離れているように、上記両刃体が配置されている構成である。
【００４６】
さらに本発明に係る電子外科切開器具は、上記の構成の電子外科切開器具であって、配線の接続を逆転させるスイッチを備えた構成である。
【００４７】
また、本発明に係る電子外科切開装置は、電子外科用発電機および上記した構成の電子外科切開器具を備え、上記電子外科用発電機は、充電端子と接地端子とを有する不平衡出力を有し、組織の乾燥と機械的切開に対しては、上記充電端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されている構成である。
【００４８】
また、本発明に係る電子外科切開装置は、電子外科用発電機および上記した構成の電子外科切開器具を備え、上記電子外科用発電機は、充電端子と接地端子とを有する不平衡出力を有し、電子外科切開に対しては、上記接地端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されている構成である。
【００４９】
また、本発明に係る電子外科切開装置は、上記の電子外科切開装置であって、上記電子外科切開器具は、上記電子外科用発電機から刃体に出力する端子の接続を逆転するスイッチを有する構成である。
【図面の簡単な説明】
【図１】 本発明の電子外科切開器具の一構成例の概略の構成を示す平面図である。
【図２】 図１のＡ−Ａ断面での刃体の構成を示す断面図である。
【図３】 刃体の構成を示す断面図である。
【図４】 本発明の電子外科切開器具の他の構成例における刃体の構成を示す平面図である。
【図５】 図４の刃体の端部の構成を示す斜視図である。
【図６】 図４のＸ−Ｘ断面での刃体の構成を示す断面図である。
【符号の説明】
１０ 本体
１１ 操作部
１２ 複合刃体（第一刃体）
１２Ａ 外側電極層
１２Ｂ 絶縁層
１２Ｃ 内側導電層
１２Ｄ 切開部（機械切開部）
１２Ｅ 外側表面
１２Ｆ 切開面
１２Ｇ 露出面（電子外科切開部）
１２Ｈ リブ
１４ 単純刃体（第二刃体）
１４Ｄ 切開部（機械切開部）
１４Ｆ 切開面
１６ 軸（旋回軸）
１８ 操作棒
１８Ａ ピン
２０ 溝
２２ 駆動部
２２Ａ 制御棒
２４ 配線導体
２６ 発電機（電子外科電源）
２６Ａ 充電端子
２６Ｂ 接地端子
２６Ｃ 内部接地母線
２６Ｄ 増幅器出力
２８ 組織
３０ 電流通路
３２ 電流通路
３４ 切替スイッチ
３４Ａ 接触子
３４Ｂ 接触子
３４Ｃ 双腕接触子
３６ 制御配線
４０ 開閉スイッチ
４２ 制御配線
Claims (15)
- 互いに重なり合うことができる剪断表面を有する第一刃体および第二刃体のうちの少なくとも一方が他方とともに鋏動作を行うために本体に旋回軸を介して取り付けられており、第一および第二刃体に電子外科電圧を印加するための一対の配線導体が本体に設けられている電子外科切開器具において、
上記第一刃体は、外側電極層、内側導電層、および外側電極層と内側導電層との間に挟持された絶縁層を含む複合刃体であり、
上記配線導体は、上記第一刃体の外側電極層、および上記第二刃体にそれぞれ接続されており、
上記第一刃体の剪断表面は、少なくとも一部分が上記内側導電層によって形成されており、
上記第一刃体の内側導電層は、第一刃体および第二刃体の剪断表面同士の電気的接触によって、第二刃体と同電位になることを特徴とする電子外科切開器具。 - 配線導体の一本は、第二刃体に結合されるとともに、第二刃体と上記内側導電層との間の電気的接触によって上記内側導電層に電気的に接続されていることを特徴とする請求項１記載の電子外科切開器具。
- 第二刃体は上記内側導電層と電気的に接触した導電部を有し、
上記配線導体と上記導電部とは、配線導体と内側導電層との間に上記導電部が電気的に直列に位置するように接続されていることを特徴とする請求項２記載の電子外科切開器具。 - 上記各刃体は漸進して剪断するように方向付けられた切開部を有し、上記各切開部は金属材料で構成されていることを特徴とする請求項１ないし３のいずれかに記載の電子外科切開器具。
- 上記第二刃体は全体が金属体であり、この金属体に上記切開部を設けたことを特徴とする請求項４記載の電子外科切開器具。
- 上記刃体の両方が上記本体に上記旋回軸を介して取り付けられたことを特徴とする請求項１ないし５のいずれかに記載の電子外科切開器具。
- 上記各刃体は長手部材を備え、
上記長手部材は、外側表面、剪断表面、および切開部を有し、
上記切開部は上記刃体に沿って形成されており、上記剪断表面の一方の側に沿って上記剪断表面と外側表面との間の境界を定めており、
上記両刃体は、上記剪断表面が互いに向かい合った関係を保ちつつ閉鎖状態へ移行する際に、上記各切開部が剪断動作を進めていくように本体に取り付けられており、
上記第一刃体について、
上記外側表面は、その切開部に隣接した、刃体に沿う切開面を定めており、
上記内側導電層、絶縁層、および外側電極層のそれぞれは、上記切開面に沿って露出されており、
上記剪断表面は、上記内側導電層上の、少なくとも、上記切開部に隣接した部分に形成されていることを特徴とする請求項１ないし６のいずれかに記載の電子外科切開器具。 - 上記第二刃体は、導電部と、切開部に隣接して刃体に沿った切開面を有し、
上記導電部は、少なくとも切開部において、切開面に沿って露出されていることを特徴とする請求項７記載の電子外科切開器具。 - 上記第二刃体の導電部は、少なくとも第二刃体の剪断表面の大部分において露出されていることを特徴とする請求項８記載の電子外科切開器具。
- 上記第一刃体の外側電極層、絶縁層および内側電導層はそれぞれ、第一刃体の剪断表面に隣接して第一刃体に沿った、第一刃体の上記外側表面の一部をなす電子外科切開部に沿って露出されていることを特徴とする請求項７ないし９のいずれかに記載の電子外科切開器具。
- 上記電子外科切開部は、第一刃体の剪断表面について、上記切開部とは反対の側に隣接して、第一刃体に沿って伸延しており、
上記両刃体の閉鎖状態にあっては、第二刃体の切開部が第一刃体の剪断面に沿い、かつ、第一刃体の電子外科切開部からは離れているように、上記両刃体が配置されていることを特徴とする請求項１０記載の電子外科切開器具。 - 配線の接続を逆転させるスイッチを備えたことを特徴とする請求項１ないし１１のいずれかに記載の電子外科切開器具。
- 電子外科用発電機および請求項１ないし１２のいずれかに記載の電子外科切開器具を備え、
上記電子外科用発電機は、
充電端子と接地端子とを有する不平衡出力を有し、
組織の乾燥と機械的切開に対しては、上記充電端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されていることを特徴とする電子外科切開装置。 - 電子外科用発電機および請求項１ないし１２のいずれかに記載の電子外科切開器具を備え、
上記電子外科用発電機は、
充電端子と接地端子とを有する不平衡出力を有し、
電子外科切開に対しては、上記接地端子が第一刃体の外側電極層に接続されるように、上記配線導体が配設されていることを特徴とする電子外科切開装置。 - 上記電子外科切開器具は、上記電子外科用発電機から刃体に出力する端子の接続を逆転するスイッチを有することを特徴とする請求項１４記載の電子外科切開装置。
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GB9425781.3 | 1994-12-21 | ||
| GBGB9425781.3A GB9425781D0 (en) | 1994-12-21 | 1994-12-21 | Electrosurgical instrument |
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| Publication Number | Publication Date |
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| JPH08252263A JPH08252263A (ja) | 1996-10-01 |
| JP3842320B2 true JP3842320B2 (ja) | 2006-11-08 |
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| EP (1) | EP0717966B1 (ja) |
| JP (1) | JP3842320B2 (ja) |
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| FR2680314B1 (fr) * | 1991-08-16 | 1993-11-19 | Guy Lebosse | Ciseaux de cóoeliochirurgie droit ou courbe de champs electrocoagulants en mode bi polaire. |
| ATE224168T1 (de) * | 1991-11-01 | 2002-10-15 | Medical Scient Inc | Elektrochirurgisches schneidwerkzeug |
| CA2094220A1 (en) * | 1992-05-21 | 1993-11-22 | Mark A. Rydell | Surgical scissors with bipolar coagulation feature |
| CA2121194A1 (en) * | 1993-05-06 | 1994-11-07 | Corbett Stone | Bipolar electrosurgical instruments |
| EP0651974B1 (en) * | 1993-11-10 | 2000-05-03 | Xomed, Inc. | Bipolar electrosurgical instrument and method for making the instrument |
| US5352222A (en) * | 1994-03-15 | 1994-10-04 | Everest Medical Corporation | Surgical scissors with bipolar coagulation feature |
| US5540685A (en) * | 1995-01-06 | 1996-07-30 | Everest Medical Corporation | Bipolar electrical scissors with metal cutting edges and shearing surfaces |
| US5603711A (en) * | 1995-01-20 | 1997-02-18 | Everest Medical Corp. | Endoscopic bipolar biopsy forceps |
-
1994
- 1994-12-21 GB GBGB9425781.3A patent/GB9425781D0/en active Pending
-
1995
- 1995-12-14 AT AT95309128T patent/ATE236584T1/de not_active IP Right Cessation
- 1995-12-14 EP EP95309128A patent/EP0717966B1/en not_active Expired - Lifetime
- 1995-12-14 ES ES95309128T patent/ES2196043T3/es not_active Expired - Lifetime
- 1995-12-14 DE DE69530270T patent/DE69530270T2/de not_active Expired - Lifetime
- 1995-12-15 US US08/573,187 patent/US5860975A/en not_active Expired - Lifetime
- 1995-12-18 AU AU40520/95A patent/AU713677B2/en not_active Expired
- 1995-12-18 NO NO19955139A patent/NO320071B1/no not_active IP Right Cessation
- 1995-12-19 KR KR1019950051853A patent/KR100439328B1/ko not_active IP Right Cessation
- 1995-12-19 FI FI956124A patent/FI114609B/fi not_active IP Right Cessation
- 1995-12-20 CA CA002165738A patent/CA2165738C/en not_active Expired - Lifetime
- 1995-12-20 TW TW084113632A patent/TW286272B/zh not_active IP Right Cessation
- 1995-12-21 JP JP33369595A patent/JP3842320B2/ja not_active Expired - Lifetime
- 1995-12-21 CN CN95113177A patent/CN1102845C/zh not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| US5860975A (en) | 1999-01-19 |
| CA2165738A1 (en) | 1996-06-22 |
| TW286272B (ja) | 1996-09-21 |
| EP0717966B1 (en) | 2003-04-09 |
| JPH08252263A (ja) | 1996-10-01 |
| FI114609B (fi) | 2004-11-30 |
| DE69530270T2 (de) | 2004-03-04 |
| EP0717966A1 (en) | 1996-06-26 |
| NO955139L (no) | 1996-06-24 |
| GB9425781D0 (en) | 1995-02-22 |
| ES2196043T3 (es) | 2003-12-16 |
| KR100439328B1 (ko) | 2004-10-06 |
| FI956124A (fi) | 1996-06-22 |
| FI956124A0 (fi) | 1995-12-19 |
| KR960020947A (ko) | 1996-07-18 |
| AU713677B2 (en) | 1999-12-09 |
| AU4052095A (en) | 1996-06-27 |
| CN1102845C (zh) | 2003-03-12 |
| NO955139D0 (no) | 1995-12-18 |
| ATE236584T1 (de) | 2003-04-15 |
| CN1130052A (zh) | 1996-09-04 |
| DE69530270D1 (de) | 2003-05-15 |
| CA2165738C (en) | 2006-12-05 |
| NO320071B1 (no) | 2005-10-17 |
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