JP3895531B2 - Electrosurgical equipment - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an electrosurgical device, and more particularly to an electrosurgical device characterized by a high-frequency current output control portion.
[0002]
[Prior art]
In general, an electrosurgical apparatus such as an electric scalpel is used when performing a procedure such as incision, coagulation, and hemostasis of a living tissue in a surgical operation or a medical operation.
Such an electrosurgical device is composed of a high-frequency ablation power source that generates a high-frequency current and a surgical tool connected to the high-frequency ablation power source, and the surgical tool is brought into contact with a living tissue of a patient to operate from the high-frequency ablation power source. A high-frequency current is supplied to a living tissue through a tool, and treatment such as incision, coagulation, and hemostasis is performed on the living tissue.
[0003]
Various electrosurgical devices described above have been proposed in the past. For example, the electrosurgical device described in Japanese Patent Application Laid-Open No. 8-98845 prevents the living tissue to be coagulated from being carbonized and prevents the living tissue from adhering to the electrodes. In order to do this, it has been proposed to determine the end of the coagulation treatment from the tissue impedance and stop the output of the high-frequency current.
[0004]
In addition, the electrosurgical device described in Japanese Patent Laid-Open No. 10-225462 is used to determine the end of the coagulation treatment in order to achieve the same purpose as the electrosurgical device described in Japanese Patent Laid-Open No. 8-98845. A proposal has been made to reduce the output of the high-frequency current so that the treatment can be continued if the surgeon determines that the coagulation treatment is insufficient after the completion of the coagulation.
[0005]
[Problems to be solved by the invention]
However, the electrosurgical devices described in Japanese Patent Laid-Open Nos. 8-98845 and 10-225462 increase the output in order to obtain a sufficient coagulation force when the volume of living tissue to be coagulated is extremely large. Therefore, it was impossible to completely prevent the carbonization of the living tissue and to prevent the living tissue from adhering to the electrode.
[0006]
The present invention has been made in view of these circumstances, and an object thereof is to provide an electrosurgical apparatus capable of preventing carbonization of a living tissue while reliably performing a coagulation treatment and reducing adhesion of the living tissue to an electrode. And
[0007]
[Means for Solving the Problems]
The electrosurgical device of the present invention comprises a high frequency current generating means for generating a high frequency current to be supplied to a surgical instrument, an output changing means for changing an output of the high frequency current generated by the high frequency current generating means, and the output changing means. Control to change the output of the high-frequency current so that the high-frequency current repeats output and pause, and to change the magnitude of the high-frequency current according to the repetition of the output and pause of the high-frequency current A living tissue from the high-frequency current generating means through the surgical instrument. High-frequency current value when high-frequency current is supplied or impedance of the living tissue Detecting means for detecting, and the control means detects the detection means High-frequency current value or impedance of the living tissue The output value and the output time of the output to be resumed after the high-frequency current is paused are determined based on the change rate of the high frequency current.
[0008]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
(First embodiment)
FIGS. 1 to 11 relate to a first embodiment of the present invention, FIG. 1 is an external configuration diagram for explaining the overall configuration of the electrosurgical device of the first embodiment of the present invention, and FIG. 3 is a circuit block diagram showing the configuration of the high-frequency ablation power source, FIG. 3 is a first graph showing the relationship between the high-frequency power, the tissue temperature of the living tissue, and the tissue impedance with respect to time, and FIG. 4 is the high frequency when intermittently outputting the high-frequency current. FIG. 5 is a flowchart showing the control flow of the control circuit shown in FIG. 2, and FIG. 6 is a high-frequency ablation power source according to the flowchart of FIG. FIG. 7 is a circuit block diagram of a high-frequency ablation power supply showing a first modification, FIG. 8 is a graph explaining the operation of the high-frequency ablation power supply of FIG. 7, and FIG. 9 is a second modification. Show A circuit block diagram of a frequency cauterization power source, 10 is a graph, FIG. 11 for explaining the operation of the high-frequency cauterization power supply of FIG. 9 is a circuit block diagram of a high-frequency cauterization power source according to a third modification.
[0009]
As shown in FIG. 1, an electrosurgical apparatus 1 according to the present embodiment includes a high-frequency ablation power source 2 and a pair of electrodes 3 as a surgical tool for supplying a high-frequency current from the high-frequency ablation power source 2 to a living tissue 4a of a patient 4. And mainly consists of The high-frequency ablation power source 2 is connected to a foot switch 5 that performs ON / OFF control of a high-frequency current.
[0010]
The pair of electrodes 3 grips the living tissue 4 a of the patient 4, thereby supplying a high-frequency current to the living tissue 4 a gripped by the electrode 3. In addition, as the electrode 3, any one of a single electrode and a multi-electrode may be used.
[0011]
As shown in FIG. 2, the high-frequency ablation power source 2 includes a power supply circuit 21 that supplies a direct current, a high-frequency generation circuit 22 that converts a direct current from the power supply circuit 21 into a high-frequency current, and the high-frequency generation circuit 22. A waveform generation circuit 23 that controls the waveform of the high-frequency current, an output transformer 24 that outputs the high-frequency current from the high-frequency generation circuit 22 to the electrode 3, and a current sensor 25 that detects the output current output from the output transformer 24. A voltage sensor 26 for detecting an output voltage output from the output transformer 24; an A / D converter 27 for A / D converting the current value and the voltage value detected by the current sensor 25 and the voltage sensor 26; Based on the current and voltage data digitized by the A / D converter 27, the power supply circuit 21 and the waveform generation circuit 23 A control for the control circuit 28..
[0012]
The control circuit 28 includes a timer 28a that measures the time from the start of output of the high-frequency current supplied to the living tissue, and a counter 28b that measures the number of times the high-frequency current is output.
[0013]
The control circuit 28 is configured to be able to determine the coagulation state of the living tissue based on the obtained current and voltage data, impedance, living body information such as the temperature of the living tissue, the number of repetitions of a high-frequency current described later, and the like. . The information on the coagulation state of the living tissue determined by the control circuit 28 can be displayed on a monitor (not shown) as a display means, a liquid crystal panel (not shown) provided in the casing of the high-frequency ablation power source 2, or the like.
[0014]
The electrosurgical apparatus 1 is used to hold the living tissue 4a of the patient 4 with the pair of electrodes 3, and the foot switch 5 is turned on. Then, a high frequency current is supplied to the grasped living tissue 4a. The high frequency power generated by the supplied high frequency current heats the living tissue 4a. The biological tissue 4a is protein-denatured by this heating, and then dries as the moisture in the biological tissue 4a evaporates. In this process, the living tissue 4a is solidified. If the high-frequency current is continuously supplied even after the living tissue 4a is dried, carbonization of the living tissue 4a occurs, and the living tissue 4a adheres to the electrode 3. In order to prevent the living tissue 4a from adhering to the electrode 3, it is necessary to stop the supply of high-frequency current when drying occurs.
[0015]
As shown in FIG. 3, when a high-frequency current is supplied to the living tissue 4a, the living tissue 4a is heated with a constant high-frequency power generated by the high-frequency current, and the tissue temperature gradually rises with the denaturation and drying of the living tissue 4a. . On the other hand, after the tissue impedance has once decreased, the temperature rapidly increases as the living tissue 4a is dried. Conventionally, control such as stopping high-frequency output has been performed when it is found that drying has occurred from tissue impedance or tissue temperature.
[0016]
Here, as shown in FIG. 4, when the high-frequency current is intermittently supplied, the living tissue 4a is heated by the intermittent high-frequency power generated by the high-frequency current, and the tissue impedance and the tissue temperature once increased are stopped from the high-frequency current. It decreases due to the stop of the high frequency power. When the high-frequency current is supplied again, the living tissue 4a is heated by the high-frequency power generated by the high-frequency current, and the tissue impedance and the tissue temperature rise again. By repeating the process of outputting / stopping the high-frequency current, a large amount of high-frequency current can be supplied while the state of the living tissue 4a is denatured and stopped to prevent carbonization. This makes it possible to coagulate a wider range of living tissue 4a than the conventional method described above.
[0017]
In this way, when the high-frequency current is intermittently supplied and the coagulation reaches a wide range, the tissue impedance and the tissue temperature at each output increase as compared with the values at the previous output.
Further, the rate at which the tissue impedance and the tissue temperature increase at each output becomes faster than the value at the previous output. The rate at which the tissue impedance and tissue temperature at each stop decreases as well. This property makes it possible to determine how much the coagulation range has expanded.
[0018]
Next, the operation of the electrosurgical apparatus according to the present embodiment will be described using the flowchart shown in FIG.
As described above, the living tissue 4a of the patient 4 is held by the pair of electrodes 3 and the foot switch 5 is turned on. When the foot switch 5 is stepped on, the control circuit 28 starts control according to the flowchart of FIG.
[0019]
As shown in FIG. 5, when the foot switch 5 is turned on, the control circuit 28 sets the minimum value Zmin_n of tissue impedance to ∞ and the maximum value Zmax_n to 0 in step S1 (hereinafter, step is omitted). In addition, the output power W1 and the output time T1 are set to preset initial values.
[0020]
Next, in S2, the number of outputs N is counted up by the counter 28b, and in S3, high-frequency current output is started. Simultaneously with the start of the output, the timer 28a is turned on and starts measuring time. In S4, the signals of the current sensor 25 and the voltage sensor 26 are taken in via the A / D conversion converter 27, and the tissue impedance Zn is calculated and stored in a memory (not shown). Then, the tissue impedance Zn sequentially obtained in S5 to S8 is compared with the minimum value Zmin_n and the maximum value Zmax_n, and the minimum value Zmin_n and the maximum value Zmax_n are sequentially corrected.
[0021]
Next, in S9, it is determined whether or not the time during which the high-frequency current is output exceeds the initial output time T1, and if the initial output time T1 is not exceeded, the same steps are repeated from S4. On the other hand, if the time during which the high-frequency current is output exceeds the initial output time T1, the output is stopped for a predetermined time such as 0.5 seconds in S10. In S11, it is determined whether or not the predetermined time has elapsed. If it has elapsed, ΔZ2, W2, and T2 are calculated as second set values in S12.
[0022]
Here, the second set values ΔZ2, W2, and T2 are set by the following relational expressions.
ΔZn = (Zmax−Zmin) / Tn (1)
Wn + 1 = W1 × ΔZ1 / ΔZn (2)
Tn + 1 = T1 × ΔZ1 / ΔZn (3)
n: Number of outputs (n ≧ 2)
Since the change rate ΔZn of the tissue impedance increases as the coagulation progresses, if the output power and the output time are determined in this way, the output power and the output time are shortened in the third and subsequent outputs, and the carbonization of the living tissue 4a and the electrode Can be prevented.
[0023]
Then, after S12, it is determined whether or not the number N of outputs has reached a predetermined number in S13. If not, the operation after S3 is repeated with the output power W2 and the output time T2. On the other hand, if the number of times of output N has reached the predetermined number of times, the repetition of output and stop is terminated in S14 and output is stopped. When the output of the high-frequency current is started in S3, an output larger than the setting is performed for a predetermined time, such as 0.1 seconds, in order to prevent the living tissue 4a from adhering to the electrode 3. .
[0024]
FIG. 6 shows how the high frequency power and the tissue impedance change with time when the control circuit 28 performs control in this way.
As described above, immediately after the start of the output of the high-frequency current, in order to prevent the living tissue 4a from adhering to the electrode 3, an output larger than the setting is performed in advance for a predetermined time such as 0.1 second, A high-frequency current with the set initial output power W1 is supplied.
[0025]
When the high frequency current by the initial output power W1 is supplied, the tissue impedance once decreases to Zmin_1, and then increases to Zmax_1 until a preset initial output time T1 elapses. Then, the output of the high-frequency current is stopped, and the supply of the high-frequency power is stopped for a predetermined time period such as 0.5 seconds. Thereafter, a high-frequency current generated by the output power W2, which is the calculated second setting value, is supplied until the output time T2 has elapsed, and the tissue impedance increases from Zmin_2 to Zmax_2.
[0026]
After the output time T2 elapses, the output of the high frequency current is stopped again, and the supply of the high frequency power is stopped for a predetermined time. Then, a high-frequency current based on the output power W3 that is the next third set value is supplied until the output time T3 elapses, and the tissue impedance increases from Zmin_3 to Zmax_3.
[0027]
In this way, the output / stop of the high-frequency current can be repeated to change the output size, the output time, and the stop time. The initial value W1 of the output power of the set output, the initial value T1 of the output time, and the stop time for stopping the output may be arbitrarily set by the operator. Also, if the rate of change in tissue impedance increases and the output time becomes shorter, the time for stopping output may be shorter, so the output stop time can be changed based on the output time, for example, output time Tn × 0.5. Also good.
[0028]
As a result, since the high frequency current can be repeatedly administered while keeping the temperature of the living tissue 4a within a range where carbonization does not occur, the solidification can be surely performed and the carbonization and adhesion of the living tissue 4a to the electrode can be prevented.
[0029]
The relational expression for determining the output power and output time of the set output is not limited to the above formulas (1) to (3), and may be changed depending on the desired degree of solidification. It may be more configurable.
[0030]
As shown in FIG. 7, the high-frequency ablation power source 2 b includes a detection high-frequency generation circuit 31 for measuring tissue impedance when the high-frequency power for treatment is stopped, and the detection high-frequency generation circuit 31. And a power supply circuit 32 for detection.
[0031]
FIG. 8 shows how the high-frequency power and tissue impedance change with time when the high-frequency ablation power source 2b is used.
In this case, the tissue impedance Zmin_n immediately after the high-frequency current stops and the tissue impedance Zend_n immediately before the next high-frequency output are measured, and the change rate ΔZ of the tissue impedance is calculated.
ΔZ = (Zend_n−Zmin_n) / Tn (4)
n: Number of outputs (n ≧ 2)
It is said.
Thereby, the influence of the noise by the high frequency electric power for treatment can be reduced, and more accurate control can be performed.
Further, as shown in FIG. 9, the high frequency ablation power source 2c has a temperature sensor 33 on the side of the electrode 3 that holds the patient's living tissue 4a, and output power and output time using the tissue temperature obtained by the temperature sensor 33. May be configured to set.
[0032]
FIG. 10 shows how the high-frequency power and tissue impedance change with time when the high-frequency ablation power source 2c is used.
In this case, even if the tissue temperature obtained by the temperature sensor 33 is T, the tissue temperature threshold is Tth, and the output power and the output time are set as follows so that the tissue temperature T does not exceed the tissue temperature threshold Tth. good.
Output power: Wn + 1 = W1 × (Tth−Tn) / Tth (5)
Output time: Tn = T1 × (Tth−Tn) / Tth (6)
In FIG. 10, the tissue temperature threshold Tth is set to 120 degrees, for example.
[0033]
Further, instead of outputting a high-frequency current larger than the setting when starting the output of the high-frequency current in S3 of the flowchart described in FIG. 5, the high-frequency ablation power source 2d, as shown in FIG. A heater 34 may be provided on the side of the electrode 3 to be gripped, and the electrode 3 may be heated by the heater 34 before the output is started.
[0034]
If the nature of the living tissue 4a is known, the output power Wn and the output time Tn can be set according to the number of outputs N, for example:
Output power: Wn = W1 / N (7)
Output time: Tn = T1 / N (8)
The same effect can be obtained even if.
[0035]
(Second Embodiment)
FIGS. 12 to 15 relate to a second embodiment of the present invention, and FIG. 12 is a circuit block diagram showing the configuration of a high-frequency ablation power source used in the electrosurgical apparatus of the second embodiment of the present invention. Is a first graph showing the relationship between the high frequency current, the high frequency power and the tissue temperature of the living tissue with respect to time, and FIG. 14 shows the relationship between the high frequency current, the high frequency power and the tissue temperature of the living tissue with respect to time during intermittent output. The second graph, FIG. 15, is a graph for explaining the operation of the high-frequency ablation power source of FIG.
[0036]
In the first embodiment, the tissue impedance is calculated from the current and voltage data measured by the current sensor 25 and the voltage sensor 26, and control is performed by using this tissue impedance. In the embodiment, the control is performed only with the current data measured by the current sensor 25. Since other configurations are substantially the same as those of the first embodiment, description thereof will be omitted, and the same components will be described with the same reference numerals.
[0037]
As shown in FIG. 12, the high frequency ablation power source 50 used in the electrosurgical device according to the second embodiment of the present invention is configured to measure the high frequency current output from the output transformer 24 only by the current sensors 51a and 51b. Has been.
As described in the first embodiment, as the coagulation of the living tissue 4a proceeds, the tissue impedance changes accordingly. Since the high-frequency current decreases as the tissue impedance increases, the high-frequency current exhibits a behavior opposite to that of the tissue impedance (see FIG. 4) as shown in FIG.
[0038]
As shown in FIG. 14, when the supply of high frequency power is intermittently performed, the high frequency current decreases as the tissue temperature rises at each output. Since the tissue temperature is lowered, it becomes possible to flow a large high-frequency current again. Furthermore, when the supply of high-frequency power is intermittently performed in this manner and the coagulation reaches a wide range, the high-frequency current at each output decreases compared to the value at the previous output. Further, the rate at which the high-frequency current at each output decreases is faster than the value at the previous output. This property makes it possible to determine how much the coagulation range has been expanded.
[0039]
Instead of measuring the minimum value Zmin and the maximum value Zmax of the tissue impedance at the time of outputting the high-frequency current in the first embodiment, in the second embodiment, the initial value Iini of the high-frequency current at the second output and The final value Iend is measured, and the first output power and output time are set according to the relational expressions described below.
First output power: Wn + 1 = W1 × ΔI1 / ΔIn (9)
First output time: Tn + 1 = T1 × ΔI1 / ΔIn (10)
However, ΔIn = (Iini−Iend) / Tn (11)
n: Number of outputs (n ≧ 2)
Next, the operation of the electrosurgical device according to the second embodiment will be described.
When the foot switch 5 is stepped on, instead of repeating the output / stop in the first embodiment, the control circuit 28 shows the first output according to the setting and the second output smaller than that in FIG. Are output alternately.
[0040]
As shown in FIG. 15, when a weak high-frequency current that does not heat the living tissue 4a is supplied in each stop period, the weak high-frequency current gradually increases during the stop period (Iini_1-Iend_1, Iini_2-Iend_2). When the coagulation spreads over a wide range, the value of the weak high-frequency current becomes a lower value than the previous stop period. Moreover, the speed of the increase becomes faster than the value in the previous stop period. This property also makes it possible to determine how much the coagulation range has been expanded.
[0041]
Thereby, in addition to obtaining the same effect as in the first embodiment, the control is performed only by the current sensors 51a and 51b, so that the configuration of the apparatus is not complicated and can be realized at low cost. In addition, since the measurement is performed when a high-frequency current smaller than the setting is output, the current sensors 51a and 51b can be accurately controlled without being affected by noise due to the high-frequency current. If the second high-frequency current is small and difficult to measure, the first output setting and the output time may be determined using the first output indicating a larger value.
[0042]
Further, as described with reference to FIG. 7, a more accurate control can be performed by additionally providing a detection high-frequency generation circuit 31 and a detection power supply circuit 32 therefor and measuring the high-frequency current. In this case, the measurement of the high-frequency current can be reduced during the second output by reducing the influence of noise.
[0043]
Further, as described with reference to FIG. 9, a temperature sensor may be additionally provided, and the setting of the first output and the output time may be determined based on the temperature. When starting the output of the high-frequency current, the high-frequency current larger than the setting is passed or the heater 34 is added to prevent the living tissue 4a from adhering to the electrode, as in the first embodiment. good.
[0044]
Further, the initial value of the output setting, the initial value of the output time, and the period during which the output is stopped may be set by the operator. The relational expression for determining the output power and the output time of the set output is the second expression. It is not limited to the relational expression in the embodiment, and may be changed according to a desired solidification state.
[0045]
The present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the gist of the present invention.
[0046]
[Appendix]
(Additional Item 1) High-frequency current generating means for generating a high-frequency current to be supplied to the surgical instrument;
Output changing means for changing the output of the high-frequency current generated by the high-frequency current generating means;
Control means for controlling the output changing means to vary the output of the high-frequency current so that the high-frequency current repeats the output / stop, and to change the magnitude of the high-frequency current with the repetition of the output / stop; ,
An electrosurgical device characterized by comprising:
[0047]
(Additional Item 2) A coagulation state determination unit capable of determining a coagulation state of a living tissue to be treated with the surgical tool is provided, and the magnitude of the high-frequency current is determined by information from the coagulation state determination unit. The electrosurgical device according to Additional Item 1.
[0048]
(Additional Item 3) The electrosurgical device according to Additional Item 2, further comprising information display means for displaying information from the coagulation state determination means.
[0049]
(Additional Item 4) The electrosurgery according to Additional Item 2, wherein the coagulation state determination means can determine the coagulation state based on biological information, the number of repetitions of the output high-frequency current, or both. apparatus.
[0050]
(Additional Item 5) The electrosurgical device according to Additional Item 4, wherein the coagulation state determination unit is capable of acquiring biological information while the high-frequency current is being output or stopped.
[0051]
(Additional Item 6) The electrosurgical device according to Additional Item 5, wherein the coagulation state of the living tissue is determined based on the amount of energy of the supplied high-frequency current.
[0052]
(Additional Item 7) The electrosurgical device according to Additional Item 4 or 5, wherein the biological information is an electrical parameter of the biological tissue or a temperature of the biological tissue.
[0053]
(Additional Item 8) The electrosurgical device according to Additional Item 7, wherein the electrical parameter of the living body is impedance or current.
[0054]
(Additional Item 9) The electrosurgical device according to Additional Item 7 or 8, wherein an electrical parameter of the living body can be measured by a high-frequency current for treatment.
[0055]
(Additional Item 10) The electrosurgical device according to Additional Item 7 or 8, wherein the electrical parameter of the living body can be measured with a detection current different from the high-frequency current for treatment.
[0056]
(Additional Item 11) Electricity according to Additional Items 4 to 10, wherein the coagulation state of the living tissue is determined based on the output of the high-frequency current repeatedly output or the biological information at the time of each output stop. Surgical device.
[0057]
(Additional Item 12) The electrosurgical device according to Additional Items 4 to 10, wherein the coagulation state is determined based on each output of the high-frequency current a plurality of times or biological information when each output is stopped.
[0058]
(Additional Item 13) The electrosurgical device according to Additional Item 11, wherein the coagulation state is determined when the biological information becomes larger or smaller than a predetermined value.
[0059]
(Additional Item 14) The electricity according to Additional Item 11, wherein the determination of the coagulation state is performed based on at least one of the maximum value and the minimum value of the biological information at each output of the high-frequency current or at each output stop. Surgical device.
[0060]
(Additional Item 15) The electrosurgical device according to Additional Item 11, wherein the coagulation state is determined based on each output of the high-frequency current or an initial value of the biological information when each output is stopped.
[0061]
(Additional Item 16) The coagulation state is determined by comparing each output of the high-frequency current or the biological information when the output is stopped with the biological information when the first output or each output is stopped. The electrosurgical device according to Additional Item 12.
[0062]
(Additional Item 17) Additional Item 12, wherein the coagulation state is determined by comparing the biological information at the time of each output of the high-frequency current or when the output is stopped and the biological information at the time when the output is stopped once before. The electrosurgical device described in 1.
[0063]
(Additional Item 18) At least one of the maximum value and the minimum value of the biological information when each output of the high-frequency current or each output is stopped, and at least the maximum value and the minimum value of the biological information when each output or each output is stopped for the first time Item 17. The electrosurgical device according to Item 16, wherein the coagulation state is determined by comparing with one.
[0064]
(Additional Item 19) Coagulation state by comparing at least one biological information at the start and stop of each output of the high-frequency current with at least one biological information at the start and stop of the output of the first output The electrosurgical device according to item 16, wherein the determination is made as follows.
[0065]
(Additional Item 20) At least one of the maximum value and the minimum value of the biological information at each output of the high-frequency current or at each output stop, and at least one of the maximum value and the minimum value of the biological information at the first output or output stop. The electrosurgical device according to Additional Item 17, wherein the coagulation state is determined by comparing the two.
[0066]
(Additional Item 21) By comparing at least one biological information at the start and stop of each output of the high-frequency current with at least one biological information at the start and stop of the output of the previous output, 18. The electrosurgical device according to additional item 17, wherein determination is made.
[0067]
(Additional Item 22) The solidified state is determined by comparing the biological information at the start of each output of the high-frequency current with the biological information at the time when the output is stopped once before. Electrosurgical device.
[0068]
(Additional Item 23) The electrosurgical device according to Additional Item 1 to 22, wherein the magnitude of the high-frequency current decreases with each re-output.
[0069]
(Additional Item 24) The electrosurgical device according to Additional Items 1 to 23, wherein an adhesion preventing unit that prevents biological tissue from adhering to the surgical instrument is provided.
[0070]
(Additional Item 25) The electrosurgical device according to Additional Item 24, wherein the adhesion preventing unit is a heating unit that heats an electrode capable of grasping a living tissue.
[0071]
(Additional Item 26) The electrosurgical device according to Additional Item 24, wherein the adhesion preventing unit increases the high-frequency current at the start or stop of output.
[0072]
(Additional Item 27) High-frequency current generating means for generating a high-frequency current to be supplied to the surgical instrument;
Output changing means for changing the output of the high-frequency current generated by the high-frequency current generating means;
The output changing means is controlled to vary the output of the high-frequency current so as to alternately output the first output and the second output smaller than the first output, and the magnitude of the high-frequency current is changed to the first output. Control means for changing the output of 1 and the second output repeatedly;
An electrosurgical device characterized by comprising:
[0073]
(Additional Item 28) The electrosurgical device according to Additional Item 27, wherein the high-frequency current output at the second output is an output that does not substantially raise the temperature of the living tissue.
[0074]
(Supplementary Item 29) A coagulation state determination unit capable of determining a coagulation state of a living tissue treated with the surgical tool is provided, and the magnitude of the high-frequency current output by the first output is determined from the coagulation state determination unit. 29. The electrosurgical device according to item 27 or 28, wherein the electrosurgical device changes according to information.
[0075]
(Additional Item 30) A coagulation state determination unit capable of determining a coagulation state of a living tissue treated with the surgical tool is provided, and an information display unit that displays information from the coagulation state determination unit is provided. The electrosurgical device according to additional items 27 to 29.
[0076]
(Supplementary Item 31) The supplementary item 29 or 30, wherein the coagulation state determination unit can determine the coagulation state based on biological information or the number of repetitions of the output high-frequency current or both of them. Electrosurgical device.
[0077]
(Additional item 32) The said coagulation | solidification state judgment means can acquire biometric information during the output of the said 1st high frequency current or the output of the said 2nd high frequency current, The additional item 31 characterized by the above-mentioned. Electrosurgical device.
[0078]
(Additional Item 33) The electrosurgical device according to Additional Item 32, wherein the coagulation state of the living tissue is determined based on the amount of energy of the supplied high-frequency current.
[0079]
(Additional Item 34) The electrosurgical device according to Additional Item 31 or 32, wherein the biological information is an electrical parameter of the biological tissue or a temperature of the biological tissue.
[0080]
(Additional Item 35) The electrosurgical device according to Additional Item 34, wherein the electrical parameter of the living body is impedance or current.
[0081]
(Additional Item 36) The electrosurgical device according to Additional Item 34 or 35, wherein an electrical parameter of the living body can be measured by a high-frequency current for treatment.
[0082]
(Additional Item 37) The electrosurgical device according to Additional Item 34 or 35, wherein the electrical parameter of the living body can be measured with a detection current different from the high-frequency current for treatment.
[0083]
(Additional Item 38) According to Additional Items 31 to 35, the coagulation state of the biological tissue is determined based on the biological information in the first or second output of the high-frequency current output repeatedly. The electrosurgical device described.
[0084]
(Additional Item 39) The electrosurgical device according to Additional Items 31 to 35, wherein the coagulation state is determined based on biological information in the first or second output of the high-frequency current multiple times.
[0085]
(Additional Item 40) The electrosurgical device according to Additional Item 38, wherein the coagulation state is determined when the biological information becomes larger or smaller than a predetermined value.
[0086]
(Additional Item 41) Additional Item 38, wherein the coagulation state is determined based on at least one of the maximum value and the minimum value of the biological information in the first or second output of the high-frequency current each time. The electrosurgical device described in 1.
[0087]
(Additional Item 42) The electrosurgical device according to Additional Item 38, wherein the coagulation state is determined based on the initial value of the biological information in the first or second output of the high-frequency current each time.
[0088]
(Additional Item 43) The coagulation state is determined by comparing the biological information at the first or second output of the high-frequency current with the biological information at the first or second output of the first time. The electrosurgical device according to item 39.
[0089]
(Additional Item 44) At least one of the maximum value and the minimum value of the biological information of the first or second output of the high-frequency current, and at least the maximum value and the minimum value of the biological information of the first or second output for the first time. 44. The electrosurgical device according to additional item 43, wherein the coagulation state is determined by comparing with one.
[0090]
(Additional Item 45) At least one of the maximum value and the minimum value of the biometric information of the first or second output of the high-frequency current and at least the maximum value and the minimum value of the biometric information of the first or second output for the first time. 44. The electrosurgical device according to additional item 43, wherein the coagulation state is determined by comparing with one.
[0091]
(Additional Item 46) At least one biological information at the start or stop of the first or second output of the high-frequency current, and at least one biological body at the start or stop of the first first or second output. 44. The electrosurgical device according to additional item 43, wherein the coagulation state is determined by comparing the information.
[0092]
(Additional Item 47) The determination of the coagulation state is performed by comparing the biological information at the time of the first or second output of the high-frequency current with the biological information at the time of the first or second output immediately before. 44. The electrosurgical device according to Additional Item 43, which is characterized by the following.
[0093]
(Additional Item 48) At least one of the maximum value and the minimum value of the biological information of the first or second output of the high-frequency current, and the maximum value and the minimum value of the biological information of the first or second output immediately before 47. The electrosurgical device according to additional item 46, wherein the coagulation state is determined by comparing with at least one.
[0094]
(Additional Item 49) At least one of the biological information at the start and stop of the first or second output of the high-frequency current and at least one of the output of the first or second output immediately before and at the stop 47. The electrosurgical device according to additional item 46, wherein the coagulation state is determined by comparing with biological information.
[0095]
(Additional Item 50) The determination of the coagulation state by comparing the biological information at the start of the first or second output of the high-frequency current with the biological information at the time when the output of the first or second output before is stopped. 47. The electrosurgical device according to additional item 46, wherein the electrosurgical device is performed.
[0096]
(Additional Item 51) The electrosurgical device according to Additional Items 27 to 50, wherein the magnitude of the high-frequency current of the first output decreases with each output.
[0097]
(Additional Item 52) The electrosurgical device according to Additional Items 27 to 51, wherein an adhesion preventing unit that prevents biological tissue from adhering to the surgical instrument is provided.
[0098]
(Additional Item 53) The electrosurgical device according to Additional Item 52, wherein the adhesion preventing unit is a heating unit that heats an electrode capable of grasping a living tissue.
[0099]
(Additional Item 54) The electrosurgical device according to Additional Item 52, wherein the adhesion preventing unit increases the high-frequency current when the output is started or stopped.
[0100]
(Additional Item 55) High-frequency current generating means for generating a high-frequency current to be supplied to the surgical instrument;
High-frequency current output means capable of changing and outputting the high-frequency current generated by the high-frequency current generating means;
The high-frequency current is output at a first output value. When the first condition is reached, the second output value is output. When the second condition is reached, the first output value is output. The high-frequency current output means is controlled so that the current is repeatedly output and the magnitude of the high-frequency current is changed in accordance with the repetition of the high-frequency current output at the first output value and the second output value. Control means;
An electrosurgical device characterized by comprising:
[0101]
(Additional Item 56) The electrosurgical device according to Additional Item 55, wherein the high-frequency current output at the second output value is an output that does not substantially raise the temperature of the living tissue.
[0102]
(Additional Item 57) A coagulation state determination unit capable of determining a coagulation state of a living tissue treated with the surgical tool is provided, and the magnitude of the high-frequency current output as the first output value is determined from the coagulation state determination unit. 57. The electrosurgical device according to additional clause 55 or 56, wherein the electrosurgical device changes depending on the information.
[0103]
(Additional Item 58) A coagulation state determination unit capable of determining a coagulation state of a living tissue treated with the surgical tool is provided, and an information display unit that displays information from the coagulation state determination unit is provided. The electrosurgical device according to additional items 55 to 57.
[0104]
(Supplementary Item 59) The supplementary item 57 or 58, wherein the coagulation state determination means is capable of determining the coagulation state based on biological information and / or the number of repetitions of the output high-frequency current. Electrosurgical device.
[0105]
(Additional Item 60) The electrosurgical device according to Additional Item 59, wherein the coagulation state determination means is capable of acquiring biological information while a high-frequency current is output at the first or second output value.
[0106]
(Additional Item 61) The electrosurgical device according to Additional Item 60, wherein the coagulation state of the living tissue is determined based on the amount of energy of the supplied high-frequency current.
[0107]
(Additional Item 62) The electrosurgical device according to Additional Item 59 or 60, wherein the biological information is an electrical parameter of the biological tissue or a temperature of the biological tissue.
[0108]
(Additional Item 63) The electrosurgical device according to Additional Item 62, wherein the electrical parameter of the living body is impedance or current.
[0109]
(Additional Item 64) The electrosurgical device according to Additional Item 62 or 63, wherein an electrical parameter of the living body can be measured by a high-frequency current for treatment.
[0110]
(Additional Item 65) The electrosurgical device according to Additional Item 62 or 63, wherein the electrical parameter of the living body can be measured with a detection current different from the high-frequency current for treatment.
[0111]
(Supplementary Item 66) The coagulation state of the biological tissue is determined based on the biological information being output at the first or second output value of the high-frequency current that is repeatedly output. The electrosurgical device according to -63.
[0112]
(Additional Item 67) The electricity according to Additional Items 59 to 63, wherein the coagulation state is determined based on biological information being output with the first or second output value of the high frequency current multiple times. Surgical device.
[0113]
(Additional Item 68) The electrosurgical device according to Additional Item 66, wherein the coagulation state is determined when the biological information becomes larger or smaller than a predetermined value.
[0114]
(Additional Item 69) The solidification state is determined based on at least one of the maximum value and the minimum value of the biological information being output at the first or second output value of the high-frequency current each time. 77. The electrosurgical device according to additional item 66.
[0115]
(Additional Item 70) The electricity according to Additional Item 66, wherein the coagulation state is determined based on the initial value of the biological information being output at the first or second output value of the high-frequency current each time. Surgical device.
[0116]
(Additional Item 71) The coagulation state is determined by comparing the biological information of the first or second output value of the high-frequency current with the biological information of the first or second output value for the first time. The electrosurgical device according to item 67.
[0117]
(Additional Item 72) At least one of the maximum value and minimum value of the biological information of the first or second output value of the high-frequency current, and the maximum value and minimum value of the biological information of the first or second output value for the first time. Item 72. The electrosurgical device according to Item 71, wherein the coagulation state is determined by comparing at least one of the above.
[0118]
(Additional Item 73) At least one of the maximum value and minimum value of the biological information of the first or second output value of the high-frequency current, and the maximum value and minimum value of the biological information of the first or second output value for the first time. Item 72. The electrosurgical device according to Item 71, wherein the coagulation state is determined by comparing at least one of the above.
[0119]
(Additional Item 74) At least one of the biological information at the start and stop of the output at the first or second output value of the high-frequency current, and the output at the start or stop at the first or second output value of the first time Item 72. The electrosurgical device according to Item 71, wherein the coagulation state is determined by comparing at least one of the biological information.
[0120]
(Additional Item 75) The determination of the coagulation state is performed by comparing the biological information of the first or second output value of the high-frequency current with the biological information of the first or second output value of the previous time. Item 72. The electrosurgical device according to Item 71, wherein the device is an electrosurgical device.
[0121]
(Additional Item 76) At least one of the maximum value and minimum value of the biological information of the first or second output value of the high-frequency current, and the maximum value and minimum of the biological information of the first or second output value immediately before 75. The electrosurgical device according to additional item 74, wherein the coagulation state is determined by comparing at least one of the values.
[0122]
(Additional Item 77) At least one biological information at the time of output start or stop at the first or second output value of the high-frequency current, and at the time of output start or stop at the first or second output value one time before 75. The electrosurgical device according to appendix 74, wherein the coagulation state is determined by comparing at least one of the biological information.
[0123]
(Additional Item 78) By comparing the biometric information at the start of output with the first or second output value of the high-frequency current and the biometric information at the time of the output stop of the first or second output value one time before 75. The electrosurgical device according to additional item 74, wherein the coagulation state is determined.
[0124]
(Additional Item 79) The electrosurgical device according to Additional Items 55 to 78, wherein the magnitude of the high-frequency current of the first output value decreases with each output.
[0125]
(Additional Item 80) The electrosurgical device according to Additional Items 55 to 79, wherein an adhesion preventing unit that prevents the living tissue from adhering to the surgical instrument is provided.
[0126]
(Additional Item 81) The electrosurgical device according to Additional Item 80, wherein the adhesion preventing unit is a heating unit that heats an electrode capable of grasping a living tissue.
[0127]
(Additional Item 82) The electrosurgical device according to Additional Item 80, wherein the adhesion preventing means increases the high-frequency current when the output is started or stopped.
[0128]
【The invention's effect】
As described above, according to the present invention, it is possible to prevent carbonization of a living tissue while reliably performing a coagulation treatment, and to reduce adhesion of the living tissue to an electrode.
[Brief description of the drawings]
FIG. 1 is an external configuration diagram illustrating the overall configuration of an electrosurgical device according to a first embodiment of the present invention.
FIG. 2 is a circuit block diagram showing the configuration of the high-frequency ablation power source of FIG.
FIG. 3 is a first graph showing the relationship between high-frequency power, tissue temperature of living tissue, and tissue impedance with respect to time.
FIG. 4 is a second graph showing the relationship of the high-frequency power, the tissue temperature of the living tissue, and the tissue impedance with respect to time when the high-frequency current is intermittently output.
FIG. 5 is a flowchart showing a control flow of the control circuit shown in FIG. 2;
6 is a graph for explaining the operation of the high-frequency ablation power source according to the flowchart of FIG.
FIG. 7 is a circuit block diagram of a high-frequency ablation power source showing a first modification.
8 is a graph for explaining the operation of the high-frequency ablation power source in FIG. 7;
FIG. 9 is a circuit block diagram of a high-frequency ablation power source showing a second modification.
10 is a graph for explaining the operation of the high-frequency ablation power source in FIG. 9;
FIG. 11 is a circuit block diagram of a high-frequency ablation power source showing a third modification.
FIG. 12 is a circuit block diagram showing the configuration of a high-frequency ablation power source used in the electrosurgical device according to the second embodiment of the present invention.
FIG. 13 is a first graph showing the relationship of high-frequency current, high-frequency power, and tissue temperature of a living tissue with respect to time.
FIG. 14 is a second graph showing the relationship of high-frequency current, high-frequency power, and tissue temperature of a living tissue with time during intermittent output.
15 is a graph for explaining the operation of the high-frequency ablation power source in FIG.
[Explanation of symbols]
1 ... Electrosurgical device
2 ... induction cautery power supply
3 ... Electrode
21 ... Power supply circuit
22 ... high frequency generation circuit
23 ... Waveform generation circuit
24 ... Output transformer
25 ... Current sensor
26 ... Voltage sensor
27 A / D converter
28 ... Control circuit
28a ... Timer
28b ... counter

Claims (2)

High-frequency current generating means for generating a high-frequency current to be supplied to the surgical instrument;
Output changing means for changing the output of the high-frequency current generated by the high-frequency current generating means;
The output changing means is controlled to vary the output of the high-frequency current so that the high-frequency current repeats the output and the pause, and the magnitude of the high-frequency current according to the repetition of the output and the pause of the high-frequency current. Control means for changing the thickness;
Detecting means for detecting a high-frequency current value or impedance of the living tissue when a high-frequency current is supplied from the high-frequency current generating means to the living tissue via the surgical tool;
With
The control means determines an output value and an output time of an output to be resumed after a temporary stop of the high-frequency current based on the high-frequency current value detected by the detection means or an impedance change rate of the living tissue. An electrosurgical device. Further comprising adhesion preventing means for preventing the living tissue from adhering to the surgical instrument,
The electrosurgical device according to claim 1, wherein the adhesion preventing means increases the high-frequency current when the output of the high-frequency current is started or stopped.

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