JP3938707B2 - 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 that electrically performs incision, excision, and transpiration of a living tissue.
[0002]
[Prior art]
In general, electrosurgical resectoscope devices are used for transurethral resection (TUR) and transcervical resection (TCR) and are inserted into body cavities. In the hollow sheath, an optical endoscope (also referred to as a scope) that is an endoscope for observation and an electrode unit for excision of living tissue are mainly provided.
[0003]
There are two types of rejectscope devices, a type that can perform treatment in a non-conductive solution and a type that can perform treatment in a conductive solution.
[0004]
D-sorbitol, which is a transparent liquid having insulating properties as a perfusate that expands in a narrow cavity, when performing a procedure such as prostatectomy using a type of resectoscope device that can be processed in a non-conductive solution To expand the cavity and insert the sheath of the rejectscope into the cavity. Then, a high-frequency current was applied to the treatment electrode of the electrode unit arranged at the distal end opening of the sheath while observing the surface of the lesioned part with a scope arranged in the sheath. The high-frequency current flows from the treatment electrode through the body tissue to a counter electrode plate as an external electrode arranged outside the body. The surgeon performs the treatment of the lesioned part by moving the treatment electrode back and forth by operating the operation part.
[0005]
When a treatment such as prostatectomy is performed using a type of resectoscope apparatus that can be processed in a conductive solution, a physiological saline that is a conductive liquid is used as the perfusate. For example, in the technique disclosed in Japanese Patent Application Laid-Open No. 2000-201946, a return electrode is disposed in the vicinity of the elongate and hollow sheath tip portion inserted into a body cavity filled with a conductive liquid, and a treatment electrode The structure in which the high-frequency current from is recovered through its return electrode is shown.
[0006]
In the case of a resectoscope device that uses a non-conductive solution, current concentrates in the vicinity of the metal in a patient who has a metal bolt or the like implanted in the body, and nearby living tissue burns, or current flows to nerves in the body. The patient's body moved reflexively, and it was difficult for the surgeon to perform the procedure. Such a problem does not occur in a rejectoscope apparatus using a conductive solution.
[0007]
[Problems to be solved by the invention]
However, in any of the reject scope devices, as shown in FIG. 9, when the surgeon turns on a switch such as a foot switch at a certain time (at time t0), the supply power is preset. The constant power value PP (Watt) is obtained. FIG. 9 is a diagram for explaining a state of power supply to the reject scope device.
[0008]
The constant power value PP is equal to or higher than a power value necessary for a treatment for excising a living tissue, and in fact, a higher power than the power necessary for the treatment is set as the output power.
[0009]
When the output power is set to a high power value, the power supply circuit for that purpose must be a circuit corresponding to the high power, so that the device itself becomes expensive.
[0010]
If the conductive solution is at a low temperature, it takes time to evaporate the conductive solution around the treatment electrode. Accordingly, in the case of a resectoscope device using a conductive solution, there is a problem that the time until the treatment electrode can be treated varies depending on the temperature of the physiological saline supplied into the body cavity.
[0011]
The present invention has been made in view of the above circumstances, and a main object of the present invention is to provide an electrosurgical device that does not wasteful power consumption.
[0012]
[Means for Solving the Problems]
The electrosurgical device of the present invention includes a high frequency generation means for generating a high frequency current, a high frequency generation instruction means for instructing the high frequency generation means to generate a high frequency, an active electrode for transmitting the high frequency current to a living tissue, and the active electrode An electrosurgical apparatus comprising: return current recovery means for recovering a high-frequency current flowing from the active tissue to the living tissue; and control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue. The means, after receiving the high frequency generation instruction from the high frequency generation instruction means, gradually increases the output power according to the time elapsed after receiving the instruction, Discharge occurred When it is detected that the state is reached, the output power is Discharge occurred Control is performed to maintain a constant value when it is detected that the state has been reached.
The electrosurgical device of the present invention includes a high frequency generation means for generating a high frequency current, a high frequency generation instruction means for instructing the high frequency generation means to generate a high frequency, an active electrode for transmitting the high frequency current to a living tissue, and the active electrode An electrosurgical apparatus comprising: return current recovery means for recovering a high-frequency current flowing from the active tissue to the living tissue; and control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue. The means, after receiving the high frequency generation instruction from the high frequency generation instruction means, gradually increases the output power according to the time elapsed after receiving the instruction, Discharge occurred When it is detected that the state is reached, the output power is Discharge occurred A value that is lower than the value when it is detected that the state has been reached, and Discharge occurred Control is performed to keep the state constant as a continuable value.
[0013]
An electrosurgical apparatus according to the present invention includes a high-frequency generation means for generating a high-frequency current, a high-frequency generation instruction means for instructing the high-frequency generation means to generate a high frequency, and an active electrode that transmits the high-frequency current to a living tissue. And an electrosurgical device that controls output power of the high-frequency current transmitted from the active electrode to the living tissue, wherein the reject scope is at least one of a sheath of the reject scope and a scope Is connected to the high-frequency generation means, and the control means receives the high-frequency generation instruction from the high-frequency generation instruction means, and then outputs the output power to the high-frequency generation means. While gradually increasing according to the time elapsed since receiving the instruction, Discharge occurred When it is detected that the state is reached, the output power is Discharge occurred Control is performed to maintain a constant value when it is detected that the state has been reached.
An electrosurgical apparatus according to the present invention includes a high-frequency generation means for generating a high-frequency current, a high-frequency generation instruction means for instructing the high-frequency generation means to generate a high frequency, and an active electrode that transmits the high-frequency current to a living tissue. And an electrosurgical device that controls output power of the high-frequency current transmitted from the active electrode to the living tissue, wherein the reject scope is at least one of a sheath of the reject scope and a scope Is connected to the high-frequency generation means, and the control means receives the high-frequency generation instruction from the high-frequency generation instruction means, and then outputs the output power to the high-frequency generation means. While gradually increasing according to the time elapsed since receiving the instruction, Discharge occurred When it is detected that the state is reached, the output power is Discharge occurred A value that is lower than the value when it is detected that the state has been reached, and Discharge occurred Control is performed to keep the state constant as a continuable value.
[0014]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0015]
FIG. 1 is a diagram for explaining a configuration of an electrosurgical apparatus using a rejectscope apparatus.
[0016]
FIG. 1 shows a state in which transurethral resection is performed using a rejectoscope device. The reject scope device includes a reject scope 1 and a high frequency power supply device 2. The reject scope 1 includes a high frequency power supply device 2 for supplying a high frequency cauterization current (hereinafter referred to as an active current) to a treatment electrode of an electrode unit, which will be described later, and collecting a return current (hereinafter referred to as a return current). It is connected. The distal end of the reject scope 1 is inserted into the patient 3 transurethrally. Control of power supply from the high frequency power supply device 2 to the treatment electrode is performed by turning on and off the foot switch 4 connected to the high frequency power supply device 2. When the foot switch 4 is turned on, a high frequency current from the high frequency power supply device 2 is supplied to the treatment electrode of the reject scope 1 via the cable 5. Then, as will be described later, the return current is recovered via the cable 6.
[0017]
In FIG. 1, a physiological saline having conductivity as a perfusate is supplied from a physiological saline pack 7 through a sterilization tube 8 to a body cavity such as a bladder. A heater 9 is provided in the middle of the sterilization tube 8 so as to surround the outer periphery of the sterilization tube 8. The heater 9 warms the physiological saline to a set temperature by a temperature control means (not shown). In addition, the heater 9 may be provided so that the circumference | surroundings of the physiological saline pack 7 may be surrounded as shown with a dotted line in FIG. The heater 9 is detachably attached to a sterilization tube or the like. After filling the body cavity with physiological saline, the surgeon inserts the reject scope 1 into the body cavity, and treats the surface of the body tissue that performs incision, excision, etc. while viewing the image of the endoscope for observation. The electrode is moved, the foot switch 4 is turned on, and incision is performed.
[0018]
Next, the configuration of the reject scope 1 will be described with reference to FIGS. FIG. 2 is a side view showing the configuration of the reject scope 1. FIG. 3 is a perspective view for explaining the configuration of the treatment electrode. FIG. 4 is an assembly diagram for explaining the configuration of the reject scope 1.
[0019]
The reject scope 1 includes a hollow outer sheath 11 having a through-hole that is a mantle tube, a scope 12 that is also disposed in the through-hole of the outer sheath 11, a handle portion 13 that is an operation portion, and an outer sheath. 11 and an electrode unit 14 disposed in the through hole.
[0020]
The outer sheath 11 is composed of, for example, a hollow insertion portion 21 that is inserted into a body cavity via the urethra, and a hand main body portion 22 provided at the rear end of the insertion portion 21, and the distal end of the insertion portion 21 is open. A portion 28 is provided. Two fluid conduits 22 a and 22 b are provided on the side periphery of the hand main body 22. Specifically, the fluid pipe line 22a includes a cock 23 and a liquid feeding base 24 for feeding physiological saline having conductivity as a perfusate to the treatment portion. The fluid conduit 22b has a cock 25 and a drainage cap 26 for discharging physiological saline and the like. A tube for liquid feeding is connected to the liquid feeding base 24 that is a tube connecting means, and similarly, a tube for draining is connected to the drainage base 26 that is a tube connecting means. By moving the cocks 23 and 25, liquid feeding and draining can be controlled.
[0021]
As shown by a dotted line 27 in FIG. 4, the inner sheath 31 is inserted through the opening on the rear side of the hand main body portion 22 and is disposed in the insertion portion 21. The inner sheath 31 is an insulating member provided at the distal end of the insertion portion 32, a hollow insertion portion 32 inserted into the outer sheath 11, a hand main body portion 33 provided at the rear end of the insertion portion 32. For example, it is comprised with the front-end | tip member 34 formed with the hard resin member. The tip of the tip member 34 has an opening 35. As indicated by a dotted line 36 in FIG. 4, the scope 12 is inserted together with the electrode unit 14 from the opening on the rear side of the hand main body 33 and is disposed in the inner sheath 31.
[0022]
In some cases, the outer sheath 11 is not used and only the inner sheath 31 is attached.
[0023]
The scope 12 is a thin and long insertion tube 41 with a built-in observation optical system, inserted into the inner sheath 31, a guide tube 42 that passes through the insertion tube 41, and a proximal end of the guide tube 42. It is comprised by the provided hand part 43. FIG. At the proximal end of the hand portion 43, an eyepiece portion 44 on which an operator visually observes is provided. A light guide connection portion 45 to which a light guide (not shown) for supplying illumination light for observation to the observation site is connected is provided on the side portion of the hand portion 43.
[0024]
As shown in FIG. 3, the electrode unit 14 inserted and arranged in the inner sheath 31 includes a treatment electrode 61, which is a hard metal member located on the distal end side, a bifurcated arm member 62, and the bifurcated arm member 62. It is mainly composed of an elongated metal pipe 63 having a proximal end portion disposed at the distal end portion. The treatment electrode 41 is an elongated wire-shaped electrode. The bifurcated arm member 62 is a bifurcated member having a portion substantially parallel to the insertion axis direction of the scope 12. Both ends of the treatment electrode 61 are connected to the tip of the bifurcated member. The treatment electrode 61 has an arc shape. Furthermore, the treatment electrode 61 and the bifurcated arm member 62 have a hook shape at the tip of the electrode unit 14 as an active electrode, and the plane including the arc-shaped treatment electrode 61 and the insertion axis of the scope 12 are determined in advance. With a given angle.
[0025]
The outer periphery of the metal pipe 63 is covered with an insulating tube (not shown), and the base end portion of the metal pipe 63 is exposed as an electrode connecting portion at the rear end portion of the insulating tube.
[0026]
The electrode unit 14 that is an active electrode is disposed in the inner sheath 31 so that the treatment electrode 61 can advance and retract in the insertion direction of the inner sheath 31 at the opening 35 of the distal end member 34 of the inner sheath 31.
[0027]
The proximal end portion of the metal pipe 63 provided with the treatment electrode 61 and the bifurcated arm member 62 on the distal end side extends through the insertion portion 32 and the proximal body portion 33 of the inner sheath 31 and extends from the proximal end surface of the proximal body portion 33. Then, it is fixed to a slider 46 described later.
[0028]
The handle portion 13 is detachably connected to the hand main body portion 33 of the inner sheath 31, and protrudes rearward from the rear end surface of the sheath connection portion 47 so that the insertion tube 41 is inserted therethrough. And a substantially pipe-shaped slider 46 on which the guide tube 48 is slidably held.
[0029]
An electrode fixing portion (not shown) that becomes an electrical connection portion with the electrode connection portion at the rear end portion of the electrode unit 14 and a power cable 5 extending from the high-frequency power supply device 2 are detachably attached to the slider 46. A high-frequency power connector 49 to be connected and a ring-shaped thumb ring 50 for hanging the surgeon's thumb are provided.
[0030]
The slider 46 and the sheath connecting portion 47 are connected in a state where a force is applied so as to be separated from each other by an elastic member (not shown) such as a spring. That is, the slider 46 is always urged toward the eyepiece 44 by the elastic member.
[0031]
Accordingly, the surgeon appropriately grasps the distance between the finger hooking portion 51 and the ring 50 while holding the finger hooking portion 51 of the sheath connection portion 47 and the thumb hooking ring 50 provided on the slider 46 by hand. By operating, the slider 46 is moved in the distal direction of the scope 12 with respect to the guide tube 48, and the treatment electrode 61 of the electrode unit 14 is moved so as to protrude in the distal direction with respect to the insertion tube 41. In a state where no force is applied to the finger rest 51 and the ring 50, the treatment electrode 61 and the distal end portion of the insertion tube 41 are at substantially the same position in the insertion direction of the scope 12. However, when the manipulation is performed in the direction indicated by the arrow a in FIG. 4, that is, when the distance is shortened by applying a force to the finger hook portion 51 and the ring 50, the insertion tube 41 does not move, but the processing electrode 61 is moved in the direction indicated by the arrow b. The scope 12 moves so as to protrude in the distal direction.
[0032]
On the other hand, the high frequency power connector 49 and the above-described electrode fixing portion are electrically connected by, for example, a lead wire. For this reason, by connecting the cable 5 from the high frequency power supply device 2 to the high frequency power supply connector 49, the treatment electrode 61 of the electrode unit 14 is energized, and the lesioned part can be treated. The rejectscope device can measure the leakage current by obtaining the difference between the current value supplied to the treatment electrode 61 and the current value of the return current.
[0033]
FIG. 5 is a block diagram illustrating a configuration of the high-frequency power supply device.
[0034]
As shown in FIG. 5, the high-frequency power supply device 2 includes a control circuit 101 that receives a signal from the foot switch 4 and controls power supply, a power supply circuit 102 that is controlled by the control circuit 101 and generates DC power, A high frequency generation circuit 103 that generates high frequency power by switching DC power from the circuit 102, and a waveform circuit 104 that supplies the high frequency generation circuit 103 with a high frequency power waveform signal that is controlled by the control circuit 101 and generated by the high frequency generation circuit 103. An output transformer circuit 105 that amplifies the high-frequency voltage of the high-frequency power generated by the high-frequency generation circuit 103 and applies the high-frequency current to the treatment electrode 61 by applying the high-frequency voltage between the treatment electrode 61 terminal and the return current terminal; Current sensors 106a and 106b for detecting a high-frequency current output from the transformer circuit 105, and a terminal for the treatment electrode 61 A voltage sensor 106c for detecting the voltage between the terminals for return current, and a sensor signal processing circuit 107 for A / D converting the current value detected by the current sensors 106a and 106b and the voltage value detected by the voltage sensor 106c. The control circuit 101 controls the power supply circuit 102, the waveform circuit 104, and the output transformer circuit 105 based on the digitized current data and voltage data from the sensor signal processing circuit 107.
[0035]
The control circuit 101 includes an arithmetic device such as a CPU (central processing unit), and executes control as described later by a software program. The control circuit 101 may be realized by a hardware circuit that is not a software program.
[0036]
Next, a means for collecting the return current in the above-described rejectscope device will be specifically described. In this embodiment, the return current is recovered without using a conventional body electrode plate. There are several recovery methods, which will be described with reference to FIG. FIG. 6 is a side view for explaining the configuration of the reject scope 1 having a connector for connecting to a return current cable.
[0037]
(1) When collecting the return current through the outer sheath
As shown in FIG. 6, a cable connector 71 for return current is provided on the proximal body portion 22 of the outer sheath 11.
[0038]
Since both the insertion portion 21 and the hand main body portion 22 of the outer sheath 11 are conductive members such as metal, the current from the active electrode flows to the outer sheath 11 via the conductive liquid and returns to the return current cable 6. It flows to the connector 71 as an electrical connection means. Therefore, the return current can be recovered to the return current cable 6 via the outer sheath 11.
[0039]
When the return current is collected through the outer sheath, the return current is collected through the metal member due to the difference in impedance even if the body tissue touches the outer sheath 11.
[0040]
(2) When collecting the return current via the inner sheath
As shown in FIG. 6, a cable connector 72 for return current indicated by a dotted line may be provided on the hand main body portion 33 of the inner sheath 31.
[0041]
In this case, since the insertion portion 32 and the hand main body portion 33 of the inner sheath 31 are both conductive members such as metal, the current from the active electrode flows to the inner sheath 31 via the conductive liquid, and is used for return current. It flows to the connector 72 as an electrical connection means to the cable 6. Therefore, the return current can be recovered to the return current cable 6 via the inner sheath 31.
[0042]
(3) When collecting the return current through the scope
As shown in FIG. 6, a cable connector 73 for return current indicated by a dotted line may be provided on the hand portion 43 of the scope 12.
[0043]
In this case, since the guide tube 42, the sheath connection portion 47, the guide tube 48, the slider 46, and the hand portion 43 of the scope 12 are all conductive members such as metal, the current from the active electrode passes through the conductive liquid. , Flows to the scope 12 and flows to the connector 73 as an electrical connection means to the return current cable 6. Therefore, the return current can be recovered to the return current cable 6 via the scope 12.
[0044]
As indicated by a dotted line 74, a connector may be provided on the light guide connection portion 45 of the scope 1.
[0045]
(4) When collecting the return current via the handle
As shown in FIG. 6, a cable connector 75 for return current indicated by a dotted line may be provided on the slider 46 of the handle portion 13 that holds the active electrode.
[0046]
Inside the handle portion 13, the connector 75 is electrically connected to a guide tube 48 that is a conductive member such as metal, and the guide tube 48 is electrically connected to the outer sheath 11, the inner sheath 31, or the scope 12. ing.
[0047]
Therefore, the current from the active electrode flows to the handle portion 13 via the outer sheath 11, inner sheath 31 or scope 12, and for return current via the connector 75 as an electrical connection means to the return current cable 6. Flows through cable 6. Therefore, the return current can be recovered to the return current cable 6 via the handle portion 13.
[0048]
(5) When returning current is recovered via a fluid line
As shown in FIG. 6, a cable connector 76 for return current indicated by a dotted line may be provided in the liquid feeding base 24 provided in the outer sheath 11. The liquid feeding cap 24 is provided at the tip of the liquid feeding conduit provided in the outer sheath 11.
[0049]
In this case, since the insertion portion 21, the hand main body portion 22, and the fluid conduit 22a are conductive members such as metal, the current from the active electrode flows to the fluid conduit 22a via the conductive liquid, and the return current It flows to the connector 76 as an electrical connection means to the cable 6 for use. Therefore, the return current can be recovered to the return current cable 6 via the fluid conduit.
[0050]
Here, the connector 76 is provided in the liquid feeding base 24, but the connector 76 may be provided in the liquid discharge base 26.
[0051]
Further, in the above description, a separate connector is provided on the liquid feeding base 24 or the drainage base 26, but the liquid feeding base 24 or the drainage base 26 is used as it is as the return current connector 76 without changing its shape. The return current may be recovered.
[0052]
The connectors 71 to 76 described above are fixed to the inner sheath 31 or the like, but may be configured to be detachable from the inner sheath 31 or the like.
[0053]
According to the above configuration, since the return current can be collected without arranging the return electrode in the vicinity of the sheath tip portion as in the conventional case, the structure of the reject scope itself is simple, and the diameter of the insertion portion is reduced. Will not become fat.
[0054]
As a return current recovery method, as disclosed in Japanese Patent Application Laid-Open No. 2000-201946 described above, a return electrode as a return current recovery means is provided in the vicinity of an elongated hollow sheath inserted into a body cavity. The high frequency current from the treatment electrode may be collected via the return electrode.
[0055]
When performing a treatment using a conductive solution using a rejectscope device having a connector for connecting to the return current cable as described above, as shown in FIG. 1 and FIG. The return current cable 6 may be connected to the provided connector.
[0056]
Next, how the output power of the high frequency power supply device 2 is output will be described.
[0057]
FIG. 7 is a diagram illustrating a temporal change in the output power of the high-frequency power supply device when the surgeon turns on the foot switch 4. The vertical axis is the output power, and the horizontal axis is the time axis. When the operator presses the foot switch 4 at a certain time, that is, at time t0, the control circuit 101 controls the power supply circuit 102, the waveform circuit 104, and the output transformer circuit 105, and the output power is shown in FIG. As shown, it gradually increases from the value of P0, which is 0 watts.
[0058]
In order to increase the output power, the control circuit 101 controls the voltage value or current value of the power supply circuit 102, controls the waveform circuit 104, or controls the amplification degree of the output transformer circuit 105. As a result, the control circuit 101 can gradually increase the power as shown in FIG.
[0059]
While gradually increasing the power, the control circuit 101 monitors whether or not a discharge has occurred in the treatment electrode 61. Specifically, when the output power is gradually increased from a low power value to a high power value, physiological saline or the like evaporates from a certain point in time (t1) and steam is generated, and the resistance value of the treatment electrode 61 is reduced. It starts to discharge. By this discharge, the living tissue starts to be cut and excision or the like becomes possible. Therefore, when the control circuit 101 detects that the discharge has started, the control circuit 101 stops increasing the output power and holds the output power at a constant value of P1 watts, which is the output power when the discharge is detected.
[0060]
Once the discharge is generated, it is not necessary to increase the power any more, so that the increase to the minimum power value P1 watts is sufficient. Therefore, electrosurgery without wasteful power consumption can be realized using the reject scope device.
[0061]
FIG. 8 is a diagram illustrating a temporal change in output power of the high-frequency power supply device according to another example. The vertical axis is the output power, and the horizontal axis is the time axis. When the operator presses the foot switch 4 at a certain time, that is, at time t0, the control circuit 101 controls the power supply circuit 102, the waveform circuit 104, and the output transformer circuit 105, and the output power is shown in FIG. As shown, it gradually increases from the value of P0, which is 0 watts.
[0062]
While gradually increasing the power, the control circuit 101 monitors whether or not a discharge has occurred in the treatment electrode 61. Specifically, when the output power is gradually increased from a low power value to a high power value, physiological saline or the like evaporates from a certain point in time (t1) and steam is generated, and the resistance value of the treatment electrode 61 is reduced. It starts to discharge.
[0063]
When the control circuit 101 detects that the discharge has started, the control circuit 101 does not increase the output power, and the output power is set in advance from the output power P1 watt at the time of the discharge detection to a power value lower than P1. The constant value P2 is reduced to the constant value P2 watts, and the constant value P2 is maintained.
[0064]
For example, when the output power is about 220 to 300 watts and the physiological saline evaporates, the power is then lowered. After discharging, even if low power is maintained, it may be about 100 watts, for example. This is because once the discharge starts at the treatment electrode 61, even if the power is low, heat is generated greatly, so that steam continues to be generated at a power of about 100 watts. That is, initially, the temperature of the treatment electrode 61 is raised using power of about 300 watts, but thereafter, the output power may be low.
[0065]
Whether or not the discharge has started is determined by calculating the impedance based on the voltage value and the current value detected by the voltage sensor 106c and the current sensors 106a and 106b. For example, it is determined whether or not the output power is to be reduced to a constant value based on whether or not the tissue resistance has reached a preset impedance, for example, 500 ohms.
[0066]
When the discharge is generated once, it is not necessary to increase the power any more, so that the increase to the minimum power value P1 is sufficient. Therefore, electrosurgery without wasteful power consumption can be realized using the reject scope device.
[0067]
By the way, as long as the conductive solution is filled in the body cavity and the active electrode and the return electrode are kept in the conductive solution in a normal state, discharge can be performed and output power may be supplied. However, if the conductive solution is not filled in the body cavity, or if the active electrode and the return electrode are not kept in the normal state in the conductive solution, discharge in an incomplete state occurs. .
[0068]
Therefore, prior to supplying a high-frequency current for discharge to the active electrode, the conductive perfusate is sufficiently filled in the lesion, and the active electrode and the return electrode are kept in the conductive solution in a normal state. This state is detected by the impedance measuring means, and the high-frequency current is supplied to the active electrode based on the detection result.
[0069]
For this purpose, while outputting a predetermined small output power, the impedance is calculated based on the output signals of the voltage sensor and the current sensor, and when the impedance falls below a preset value, a high-frequency current is supplied, When the impedance exceeds a preset value, high frequency current is not supplied. As a preset value, for example, when the value is 50 ohms or less, a high-frequency current is supplied.
[0070]
Specifically, the output power with a small power value other than the value of P0 shown in FIGS. 7 and 8 is output. In this state, when the foot switch 4 is turned on, the active electrode and the return electrode are held in the conductive solution in a normal state where the conductive perfusate is sufficiently filled in the lesioned part. If it is in the state, the high frequency power is output so that the output value of the high frequency power gradually increases. When the foot switch 4 is turned on in the state where the small electric power value is output, the active electrode and the return electrode are placed in the conductive solution when the conductive perfusate is sufficiently filled in the lesion. If it is not in a normal state, the high frequency power is not output so that the output value of the high frequency power gradually increases.
[0071]
Therefore, discharge in an incomplete state does not occur.
[0072]
As described above with reference to FIGS. 7 and 8, in this embodiment, the output power supplied to the treatment electrode is gradually increased, and when a discharge at the treatment electrode is detected, the output at the time of discharge detection is detected. The power or a predetermined value of power lower than the output power at the time of detecting the discharge is maintained. Therefore, compared with the prior art, it is possible to discharge with the minimum necessary low power without emitting high power, so that unnecessary power is not required. As a result, the power supply capacity may be small, and the cost is also reduced.
[0073]
Further, when the output power is increased, the point at which the discharge starts varies depending on the temperature of the conductive solution. Therefore, it takes time only to evaporate the conductive solution around the treatment electrode, and unnecessary power is required. Therefore, the conductive solution supplied into the body cavity is heated.
[0074]
As shown in FIG. 1, the heater 9 is provided in the middle of the sterilization tube 8 and warms the physiological saline to about 36 to 40 degrees which is the temperature inside the body. Even if it is warmed before the operation, the temperature of the physiological saline decreases to room temperature, for example, 25 degrees (Celsius) or the like with time. Compared to unheated physiological saline, the heated physiological saline evaporates faster around the treatment electrode. As a result, less power is required for evaporation.
[0075]
Furthermore, a hemostatic agent is mixed in the physiological saline. This is to stop hemostasis of a body tissue that has undergone a processing incision or the like when a living tissue is being treated with a reject scope.
[0076]
As described above, according to the above-described configuration, an electrosurgical device that does not consume unnecessary power can be realized. In addition, since the means for heating the conductive solution is provided, the time until the treatment electrode can be treated does not differ. Furthermore, even if the surgeon turns on the foot in a state where the lesioned part is not filled with the conductive solution that is a perfusate, the treatment electrode does not discharge in an incomplete state.
[0077]
From the configuration described above, the configuration shown in the following supplementary notes is characteristic.
[0078]
[Additional notes]
(1) high frequency generating means for generating a high frequency current;
High frequency generation instruction means for instructing the high frequency generation means to generate high frequency;
An active electrode for transmitting the high-frequency current to a living tissue;
Return current recovery means for recovering a high-frequency current flowing from the active electrode to the living tissue;
Control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue;
An electrosurgical device comprising:
The control means includes
An electrosurgical apparatus, wherein after receiving the high frequency generation instruction from the high frequency generation instruction means, the output power is controlled to gradually increase.
[0079]
(2) high frequency generating means for generating a high frequency current;
High frequency generation instruction means for instructing the high frequency generation means to generate high frequency;
A reject scope having an active electrode for transmitting the high-frequency current to living tissue;
Control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue;
In an electrosurgical device including
The reject scope has a connecting means to the high frequency generating means for using at least one of a sheath and a scope of the reject scope as a return current collecting means,
The electrosurgical apparatus is characterized in that the control means controls to gradually increase the output power after receiving the high frequency generation instruction from the high frequency generation instruction means.
[0080]
(3) The control means controls the output power to maintain a constant value when a predetermined condition is reached after gradually increasing the output power. Or the electrosurgical device of Additional remark (2).
[0081]
(4) The control means increases the output power gradually, and when a predetermined condition is reached, the control means sets a constant value that is lower than the value of the output power when the predetermined condition is reached. The electrosurgical device according to the additional item (1) or the additional item (2), wherein the output power is controlled so as to be reduced and maintained.
[0082]
(5) Further, according to the additional items (1) to (4), the active electrode and the return current recovery unit further include a heating unit that heats the conductive solution in contact with the body cavity. The electrosurgical device according to any one of the above.
[0083]
(6) Furthermore, it has a solution evaporation detecting means for detecting evaporation of the conductive solution,
The control means determines whether or not the predetermined condition is satisfied based on the detection result of the solution evaporation detection means. The additional information (3), additional information (4), or additional information (5) ) Electrosurgical device.
[0084]
(7) The solution evaporation detection unit detects an impedance between the active electrode and the return current recovery unit, and the control unit satisfies the predetermined condition depending on whether or not the impedance becomes a predetermined value or less. The electrosurgical device according to item (6), wherein it is determined whether or not.
[0085]
(8) Furthermore, it has a conductive solution detection means for detecting that a conductive solution exists between the active electrode and the return current recovery means,
The control means starts increasing the output power when the conductive solution detection means detects that the conductive solution exists between the active electrode and the return current recovery means. The electrosurgical device according to any one of supplementary items (1) to (7).
[0086]
(9) The conductive solution detecting means makes the conductive solution exist between the active electrode and the return current collecting means based on an impedance between the active electrode and the return current collecting means. The electrosurgical device according to item (8), characterized in that
[0087]
The present invention is not limited to the above-described embodiment, and various changes and modifications can be made without departing from the scope of the present invention.
[0088]
【The invention's effect】
As described above, according to the present invention, an electrosurgical device without wasteful power consumption can be realized.
[Brief description of the drawings]
FIG. 1 is a diagram for explaining a configuration of an electrosurgical apparatus using a rejectscope apparatus according to an embodiment of the present invention.
FIG. 2 is a side view showing a configuration of a reject scope according to the embodiment of the present invention.
FIG. 3 is a perspective view for explaining a configuration of an electrode according to an embodiment of the present invention.
FIG. 4 is an assembly diagram for explaining the configuration of the reject scope according to the embodiment of the present invention.
FIG. 5 is a block diagram showing a configuration of a high frequency power supply device according to an embodiment of the present invention.
FIG. 6 is a side view showing a configuration of a reject scope having a connector for connecting to a return current cable according to the embodiment of the present invention.
FIG. 7 is a diagram showing a temporal change in output power of the high-frequency power supply device according to the embodiment of the present invention.
FIG. 8 is a diagram showing another example of a temporal change in output power of the high-frequency power supply device according to the embodiment of the present invention.
FIG. 9 is a diagram for explaining a state of power supply to a conventional reject scope device.
[Explanation of symbols]
1 ... Reject scope
2. High frequency power supply device
3 ... Patient
4 ... Foot switch
5, 6 ... cable
7 ... Saline pack
8 ... Sterilization tube
9 ... Warming means
11 ... Outer sheath
12 ... Scope
13 ... Handle
14 ... Electrode unit
31 ... Inner sheath
61 ... Treatment electrode
71, 72, 73, 74, 75, 76 ... connectors

Claims (4)

High-frequency generating means for generating a high-frequency current;
High frequency generation instruction means for instructing the high frequency generation means to generate high frequency;
An active electrode for transmitting the high-frequency current to a living tissue;
Return current recovery means for recovering a high-frequency current flowing from the active electrode to the living tissue;
Control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue;
An electrosurgical device comprising:
The control means includes
After receiving the high frequency generation instruction from the high frequency generation instruction means, the output power is gradually increased according to the time elapsed since the reception of the instruction, and it is detected that a discharge has occurred. Then, the electrosurgical device is controlled to maintain the output power constant as a value when it is detected that the discharge has occurred . High-frequency generating means for generating a high-frequency current;
High frequency generation instruction means for instructing the high frequency generation means to generate high frequency;
An active electrode for transmitting the high-frequency current to a living tissue;
Return current recovery means for recovering a high-frequency current flowing from the active electrode to the living tissue;
Control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue;
An electrosurgical device comprising:
The control means includes
After receiving the high frequency generation instruction from the high frequency generation instruction means, the output power is gradually increased according to the time elapsed since the reception of the instruction, and it is detected that a discharge has occurred. when, the output power, the discharge is a low value compared to the value when it is detected that the state which occurred, and the constant state in which the discharge is generated as a sustainable value An electrosurgical apparatus characterized by performing control to maintain. High-frequency generating means for generating a high-frequency current;
High frequency generation instruction means for instructing the high frequency generation means to generate high frequency;
A reject scope having an active electrode for transmitting the high-frequency current to living tissue;
Control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue;
In an electrosurgical device including
The reject scope has a connecting means to the high frequency generating means for using at least one of a sheath and a scope of the reject scope as a return current collecting means,
The control means, after receiving the high frequency generation instruction from the high frequency generation instruction means, gradually increases the output power according to the time elapsed since receiving the instruction, and in a state where discharge has occurred. An electrosurgical apparatus characterized by performing control to maintain the output power constant as a value when it is detected that the discharge has occurred when it has been detected. High-frequency generating means for generating a high-frequency current;
High frequency generation instruction means for instructing the high frequency generation means to generate high frequency;
A reject scope having an active electrode for transmitting the high-frequency current to living tissue;
Control means for controlling output power of the high-frequency current transmitted from the active electrode to the living tissue;
In an electrosurgical device including
The reject scope has a connecting means to the high frequency generating means for using at least one of a sheath and a scope of the reject scope as a return current collecting means,
The control means, after receiving the high frequency generation instruction from the high frequency generation instruction means, gradually increases the output power according to the time elapsed since receiving the instruction, and in a state where discharge has occurred. When it is detected that the discharge has occurred , the output power is lower than the value when the discharge has been detected, and the state in which the discharge has occurred can be continued. An electrosurgical apparatus characterized by performing control to maintain a constant value.

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