JP4037582B2 - Electrosurgical device and output control method for electrosurgical device - 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 provided with a high-frequency ablation power supply device and a treatment tool connected to the high-frequency ablation power supply device. The high-frequency current is supplied from the high-frequency ablation power supply device by bringing the treatment tool into contact with the patient. The above treatment is performed.
[0003]
Various electrosurgical devices as described above have been proposed. For example, in Japanese Patent Application Laid-Open No. 8-98845, in order to prevent carbonization of the coagulating tissue and to prevent the tissue from adhering to the electrode, the end of coagulation is determined as tissue impedance. A technique for determining more and stopping high-frequency output is shown.
Moreover, in the electrosurgical device disclosed in Japanese Patent Laid-Open No. 10-225462, a technique for reducing the high-frequency output is shown in order to achieve the same object as that of Japanese Patent Laid-Open No. 8-98845.
[0004]
[Problems to be solved by the invention]
The change in tissue impedance becomes faster as the contact area between the tissue and the electrode becomes smaller. In the electrosurgical apparatus of the above-mentioned JP-A-8-98845 and JP-A-10-225462, when the contact area between the tissue and the electrode is small, during the period of measuring the tissue impedance and determining the end of coagulation, There was a problem that carbonization of the tissue and adhesion of the tissue to the electrode occurred.
[0005]
Japanese Patent Laid-Open No. 10-225462 discloses a technique for reducing the output of a high-frequency current without stopping after determining the end of coagulation. With this technique, after the end of coagulation of the electrosurgical device is determined, if the surgeon determines that coagulation is insufficient, the treatment can be continued.
At that time, since the high-frequency output is reduced, the speed of tissue degeneration is slow, and the surgeon can finish the treatment when a desired coagulation state is obtained.
[0006]
However, when the contact area between the tissue and the electrode is small, the speed of tissue degeneration increases, and it is difficult for the operator to finish the treatment when a desired coagulation state is obtained. In addition, when the contact area is large, the tissue denaturation speed becomes excessively slow, and there is a problem that the time until a desired coagulation state is obtained becomes long.
[0007]
(Object of invention)
The present invention has been made in view of the above circumstances, and is an electrosurgical device capable of reliably determining the end of coagulation regardless of the contact area between the electrode and tissue and preventing carbonization of the tissue and adhesion of the tissue to the electrode. The purpose is to provide.
Another object of the present invention is to provide an electrosurgical apparatus that can easily determine the coagulation state by keeping the tissue degeneration speed within a range that can be easily determined by an operator regardless of the contact area between the electrode and the tissue. Yes.
[0008]
[Means for Solving the Problems]
The electrosurgical device of the present invention is an electrosurgical device having a high-frequency current generating means for generating a high-frequency current for treatment and an adjusting means for adjusting a high-frequency current output from the high-frequency current generating means. Detecting means for detecting the high-frequency current output from the means, and starting output of the high-frequency current at a predetermined set power value in accordance with an instruction to start output; After that Of the high-frequency current detected by the detection means. maximum Value is the first threshold In the above case , Outputting the high-frequency current at a first power value larger than the set power value, and After the start Of the high-frequency current detected by the detection means. Said maximum Less than a second threshold value less than the first threshold value In the case of And a control means for controlling the adjusting means so as to output the high-frequency current at a second power value smaller than the set power value.
[0009]
Also, the output control method of the electrosurgical device of the present invention is an electrosurgical device having high frequency current generating means for generating a high frequency current for treatment, and adjusting means for adjusting the high frequency current output from the high frequency current generating means. In the output control method, an output start step of starting output of the high-frequency current at a predetermined set power value in response to an instruction to start output; After the start of the output of the high-frequency current A detecting step for detecting a high-frequency current output from the high-frequency current generating means; and the high-frequency current detected in the detecting step. maximum Value is the first threshold In the above case , Outputting the high-frequency current at a first power value larger than the set power value, and further, the high-frequency current detected in the detection step Said maximum Less than a second threshold value less than the first threshold value In the case of And a control step of controlling the adjusting means so as to output the high-frequency current at a second power value smaller than the set power value.
[0010]
The electrosurgical device of the present invention is an electrosurgical device having a high-frequency current generating means for generating a therapeutic high-frequency current and an adjusting means for adjusting a high-frequency current generated from the high-frequency current generating means. Based on the operation of the current generating means, the high frequency current Impedance of living tissue Detecting means for detecting the output, and starting the output of the high-frequency current at a predetermined set power value for the coagulation treatment according to an instruction to start the output, After that Detected by the detecting means; Minimum impedance value Deviates from the range between the first threshold and a second threshold that is less than the first threshold; If the minimum value is greater than or equal to the first threshold The two electrodes to which the high-frequency current is supplied and the coagulation treatment target Said Contact area with living tissue Is smaller than the predetermined area, and the smaller area The predetermined set power value so that the coagulation treatment is performed at an output according to To a first power value smaller than the predetermined set power value Change and output When the minimum value is less than or equal to the second threshold, the contact area between the two electrodes to which the high-frequency current is supplied and the living tissue to be coagulated is greater than the predetermined area, and the larger area The predetermined set power value is changed to a second power value larger than the first power value so that the coagulation treatment is performed with an output according to the output. And a control means for controlling the adjusting means.
In addition, the output control method of the electrosurgical device of the present invention includes an electrosurgical device having high frequency current generating means for generating a high frequency current for treatment, and adjusting means for adjusting the high frequency current generated from the high frequency current generating means. In the output control method, an output start step of starting output of the high-frequency current at a predetermined set power value for coagulation treatment according to an instruction to start output; After the start of the output of the high-frequency current Based on the operation of the high-frequency current generating means, the high-frequency current Impedance of living tissue Detecting step of detecting the detected in the detecting step Minimum impedance value Deviates from the range between the first threshold and a second threshold that is less than the first threshold; If the minimum value is greater than or equal to the first threshold The two electrodes to which the high-frequency current is supplied and the coagulation treatment target Said Contact area with living tissue Is smaller than the predetermined area, and the smaller area The predetermined set power value so that the coagulation treatment is performed at an output according to To a first power value smaller than the predetermined set power value Change and output When the minimum value is less than or equal to the second threshold, the contact area between the two electrodes to which the high-frequency current is supplied and the living tissue to be coagulated is greater than the predetermined area, and the larger area The predetermined set power value is changed to a second power value larger than the first power value so that the coagulation treatment is performed with an output according to the output. And a control step of controlling the adjusting means.
[0011]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
(First embodiment)
1 to 6 relate to the first embodiment of the present invention, FIG. 1 is a block diagram showing the overall configuration of the high-frequency cautery apparatus of the first embodiment of the electrosurgical device of the present invention, and FIG. 3 is a block diagram showing the configuration of the ablation power supply, FIG. 3 is a flowchart showing the control process of the control circuit of FIG. 2, and FIGS. 4A and 4B are power set values and currents with respect to temporal changes in the high frequency power supply. FIG. 5 is a flowchart showing the details of the processing content of the current change rate measurement, and FIG. 6 shows the relationship between the maximum current value and the set power value.
[0012]
As shown in FIG. 1, a high-frequency ablation device 1 according to a first embodiment of the electrosurgical device of the present invention includes a high-frequency ablation power supply 2 that supplies high-frequency ablation power, and this high-frequency ablation power supply 2 is at the tip. The connection cable 4 provided with the electrode 3 is connected to the connector section 5 and the patient 7 placed on the bed 6 through the electrode 3 is supplied with high-frequency ablation power for treatment so that the treatment can be performed. ing.
Further, for example, a foot switch 8 for performing ON / OFF control operation of the high-frequency ablation power is connected to the high-frequency ablation power supply device 2. The electrode 3 may be a single electrode or a multipolar electrode.
[0013]
As shown in FIG. 2, it is connected to a commercial power source (not shown), converted to a DC power source and supplied with this DC power source, driven by the DC power source from the DC power source circuit 11, and oscillated at a high frequency. A high frequency generation circuit 12 that generates high frequency power (high frequency current), a waveform generation circuit 13 that controls the waveform of the high frequency current output to the high frequency generation circuit 12, and the high frequency current from the high frequency generation circuit 12 to the electrode 3 An output transformer 14 for output, current sensors 15a and 15b for detecting an output current output from the output transformer 14, and an A / D conversion circuit 16 for A / D converting the current values detected by the current sensors 15a and 15b. And a control circuit 17 for controlling the DC power supply circuit 11 and the waveform generation circuit 13 based on the digitized current data from the A / D conversion circuit 16. It is made.
[0014]
The connection cable 4 is connected to the connector portion 5 so that the electrode 3 can perform high-frequency ablation on the affected tissue 18 of the patient 7 or the like.
The two current sensors 15a and 15b detect, for example, the current that the current sensor 15a flows from one electrode 3 to the patient 7 (biological tissue 18) side, and the other current sensor 15b from the other electrode 3 to the output transformer 14 side. To detect the current recovered.
[0015]
The control circuit 17 can control the waveform generated by the waveform generation circuit 13 in accordance with a mode for treatment such as incision and coagulation.
[0016]
Further, the foot switch 8 is connected to the control circuit 17, and when the ON switch of the foot switch 8 is stepped on, the control circuit 17 performs control so that a high frequency current is output. When the OFF switch is stepped on, the output of the high frequency current is stopped.
[0017]
In the present embodiment, as will be described below, the control circuit 17 performs a high frequency treatment on the biological tissue 18 of the patient 7, and when the foot switch 8 is turned on and a high frequency current for treatment is passed, By monitoring the current flowing through the tissue 18 in time and detecting the amount of change in the high-frequency current based on the monitoring output, the amount of change in the treatment state is grasped (detected), and the change control is performed by adjusting the high-frequency power. Therefore, an appropriate therapeutic treatment is performed regardless of the contact area.
[0018]
For this reason, the control circuit 17 detects the amount of change in the high-frequency current using the temporal current monitoring unit and the current monitoring unit, and controls the adjustment unit that adjusts the high-frequency power based on the detected amount of change. It has a function of a power control unit that performs adjustment control.
[0019]
More specifically, the control circuit 17 temporally stores the current data input to temporally monitor the digitized current data from the A / D conversion circuit 16 in an internal memory, etc. Changes in tissue degeneration by monitoring the current data until the current data reaches the maximum value from the time change of the data and falls to the reference value that is a little lower than the maximum value after reaching the maximum value. The absolute value of the rate of change of current data is monitored.
[0020]
When the reference value or less is reached, the state of treatment treatment is determined from the value of the maximum current value, more specifically, the progress of tissue degeneration along with the degree of the contact area of treatment between the electrode 3 and the living tissue 18 is determined. Adjustment is made so that the high frequency power is set to the set output value suitable for the coagulation treatment in the case of the contact area, the coagulation treatment is continued with the set output, and the target value (or threshold value) corresponding to the end of coagulation is reached. The amount of change in whether or not the current has decreased to the value (the amount of change in the treatment state with respect to the coagulation treatment) is determined. If the target value is not reached depending on the determination result, the coagulation treatment is continued with the set output, By determining the end of the coagulation treatment and adjusting the power to reduce the set output by about half, the coagulation treatment can be reliably performed without depending on the area.
[0021]
That is, when the contact area with the living tissue 18 grasped by the electrode 3 is small, the maximum value of the flowing current is small, and the maximum value of the current is large as the contact area is large. Therefore, in the present embodiment, the current is monitored over time, the degree of the contact area of the treatment treatment is grasped according to the value of the maximum value of the measured current, and the grasped value is supported. By variably setting the value setting output and continuing the coagulation treatment, by performing the coagulation treatment with the setting output corresponding to the size of the contact area, even if the contact area is different, the result does not depend on the contact area. The coagulation treatment is surely performed.
[0022]
In addition, the coagulation treatment is performed with the setting output variably set according to the contact area, and the target coagulation treatment end time is determined based on the amount of change in current in the case of the setting output (in accordance with each setting output in advance). Compared with the set target value and the measured current value), the change control is performed to reduce the set output at the end of the coagulation treatment, so that the coagulation treatment can be performed reliably without depending on the contact area. .
[0023]
In addition, when the contact area is large, the treatment is performed with the set output with the electric power increased as compared with the case where the contact area is small, so that the coagulation treatment can be shortened without taking too much time. In addition, when the contact area is small, the set output is reduced to keep the tissue degeneration speed within a range that can be easily grasped by the operator so that the determination of the coagulation state is facilitated.
Further, by measuring the change rate (absolute value) of the measured current and determining whether the value is equal to or less than the specified value, the contact between the electrode 3 and the living tissue 18 becomes unstable. This prevents mistakenly judging that the coagulation has ended.
[0024]
The operation of the present embodiment configured as described above will be described with reference to the flowchart shown in FIG.
When the foot switch 8 is stepped on, the control is started according to the process after the start of output shown in FIG.
[0025]
Specifically, when the foot switch 8 is stepped on, the control circuit 17 sets 0 to the maximum current value Imax in step S1. In the next step S2, the control circuit controls the DC power supply circuit 11 and the waveform generation circuit 13 so that the output power becomes the set output value that has been set.
[0026]
4A and 4B show an example of temporal changes in high-frequency power and high-frequency current when coagulation is performed. At time T0, the high-frequency power is output according to the set value.
Thereafter, the process from step I3 to step S3 is repeated until the measured current value I (also referred to as current I) is smaller than the maximum current value Imax × 90%.
[0027]
That is, in the measurement process of the current I in step S 3, the high frequency current is detected by the current sensors 15 a and 15 b, converted into digital data by the A / D conversion circuit 16, and the current value I is passed to the control circuit 17.
[0028]
Thereafter, in step S4, the control circuit 17 determines the absolute value | ΔI | of the rate of change of the current I (hereinafter simply referred to as the rate of change of the current I | ΔI |). Details of step S4 are shown in steps S21 to S25 in FIG.
[0029]
When the change rate determination process is started, a change rate | ΔI | of the current I is calculated from the previous measured value (current I) and the current measured value in step S21, and is determined from a predetermined value (or threshold value) set in advance. It is determined (compared) whether or not it is small.
[0030]
If the rate of change | ΔI | is smaller than the specified value (or threshold value), the process of determining the rate of change is terminated and the process proceeds to step S5 in FIG. If it is larger, the process from step S22 to step S25 is repeated until the rate of change | ΔI | becomes smaller than the specified value (or threshold value), and the process does not proceed to step S5.
[0031]
That is, if the rate of change | ΔI | is greater than the specified value (or threshold), the waiting time is set to 200 msec in step S22, the current I is measured in the next step S23, and the rate of change | It is determined whether ΔI | is larger than a specified value (or threshold value), and if it does not correspond to this (change rate | ΔI | is smaller than the specified value), the process proceeds to the next step S25, and conversely, this condition is satisfied (change rate). If | ΔI | is greater than the specified value), the process returns to step S22.
[0032]
In this way, when the rate of change | ΔI | becomes smaller than the specified value (or reference value), the waiting time elapses in step S25 and the rate of change | ΔI | After becoming smaller and stable, the change rate determination process is terminated, and the process proceeds to step S5 in FIG.
[0033]
In step S5, the current I is compared with the maximum current value Imax × 90%. If the current I is smaller than the reference value of the maximum current value Imax × 90%, the process proceeds to the next step S6. Conversely, if it is larger than the maximum current value Imax × 90%, the process returns to step S3 and the same processing is repeated.
[0034]
In the example of FIG. 4B, at time T1, the current I takes the maximum current value Imax and then decreases. Since current I becomes smaller than maximum value Imax × 90% at time T2, step S6 is performed at time T2. OK Maximum flow value Imax is 0.7A Yo Smaller Whether or not The process is proceeding. In this example, the rate of change | ΔI | is greater than a specified value (or threshold) between times Ta and Tb between times T1 and T2.
[0035]
As described above, the current I is smaller than the maximum current value Imax × 90% between the time Ta and the time Tb, but it is determined whether or not the current I in step S5 is smaller than the maximum current value Imax × 90%. In the previous step S4, that is, the processing from step S21 to step S25 in FIG. 5, the determination in step S5 is not performed.
[0036]
In steps S6 to S7 in FIG. 3, it is determined whether the maximum current value Imax is smaller than 0.7A or the maximum value Imax is smaller than 0.3A, and the power is determined according to the result corresponding to these conditions. Make changes.
[0037]
If it is determined whether or not the maximum value Imax in step S6 is smaller than 0.7A, if it is larger than 0.7A, it is determined in step S8 that the contact area is large, and the power is increased to 120% of the set output. If the maximum value Imax is 0.7 A or more and 0.3 A or more, it is determined that the size of the contact area is normal as shown in step S9, and the power is set as the set output. .
Further, when the maximum value Imax is less than 0.3 A, it is determined that the contact area is small as shown in step S10, and the power is reduced to 80% of the set output.
[0038]
FIG. 6 shows the relationship between the maximum current value Imax and the set power value. As described above, according to the value of the current maximum value Imax detected by the measurement, the degree of the contact area as the treatment state is determined, and the set power value corresponding to the determined contact area is set. I am doing so.
Further, in the examples of FIGS. 4A and 4B, since Imax is smaller than 0.3 A, the power is reduced to 80% of the setting. As described above, the power value is variably set in steps S8 to S10 in accordance with the value of the maximum current value Imax.
[0039]
For example, in step S11 after step S8 (as in step S3), the current I is measured, and in the next step S12 (as in step S4), the change rate | ΔI | is determined, and the next step In S13, it is determined whether or not the coagulation has been completed based on whether or not the current I is smaller than the threshold value of the maximum current value Imax × 77%. If not, the process returns to step S11 to continue the high-frequency current flow state. The coagulation treatment is continued, and when it becomes smaller than the maximum current value Imax × 77%, it is determined that the coagulation treatment is finished, and the power in step S20 is reduced to 50% of the set output.
[0040]
In step S14 to step S16 after step S9, the current I is measured similarly to step S3, the rate of change | ΔI | is determined as in step S4, and the current I is smaller than the threshold of 70% of Imax. Whether or not coagulation has been completed is determined. If this is not the case, the process returns to step S14 to continue the coagulation treatment by continuing the flow of a high-frequency current. When it is determined that the treatment is finished, the process proceeds to step S20, and the power is reduced to 50% of the set value.
[0041]
In step S17 to step S19 after step S10, the current I is measured similarly to step S3, the rate of change | ΔI | is the same as in step S4, and whether the current I is smaller than the threshold of 63% of Imax. If not, the process returns to step S17 to continue the high-frequency current and continue the coagulation treatment. If this condition is satisfied, the coagulation treatment is continued. In step S25, the power is reduced to 50% of the setting.
[0042]
The steps from Step S6 to Step S20 correspond to the period from T2 to T3 in FIGS. 4 (A) and 4 (B). Since the current I is smaller than 63% of the maximum current value Imax at the time T3, the control circuit 17 determines that the coagulation treatment is finished, and reduces the power to 50% of the setting.
[0043]
The present embodiment has the following effects.
As described above, in the present embodiment, since the amount of change in the output of the high-frequency current is determined by the measurement value from the control circuit 17, the determination of the end of coagulation is surely performed regardless of the contact area between the electrode 3 and the tissue. To prevent carbonization of the tissue and adhesion of the tissue to the electrode.
[0044]
Further, when the contact area between the electrode 3 and the tissue is extremely large, there is a problem that it takes time to coagulate. However, in the present embodiment, when the maximum current value is large, the power is increased, so This time can be shortened. In addition, when the contact area is small, the electric power is reduced accordingly, so that the speed of tissue degeneration can be maintained within a range where it is easy for the operator to judge, and coagulation treatment can be facilitated.
Although the current value is used in this embodiment, the same effect can be obtained by using other measurement values such as increasing the power when the impedance is low.
[0045]
Furthermore, when the contact between the electrode 3 and the tissue is not stable, the tissue impedance changes due to the influence. As a result, there is a problem that the end of coagulation is erroneously determined, but in this embodiment, since the magnitude of the change in the current I is determined, the contact between the electrode 3 and the tissue is not good. Even if it becomes stable, the end of coagulation can be reliably determined.
Further, although the current value is used in the present embodiment, the same effect can be obtained when other measurement values are used, such as performing similar control according to the magnitude of the change in impedance.
[0046]
(Second Embodiment)
A second embodiment of the present invention will be described with reference to FIGS. 7 is a block diagram showing the configuration of the high-frequency ablation power supply, FIG. 8 is an enlarged view of the electrodes, FIG. 9 is a flowchart showing the control process of the control circuit of FIG. 7, and FIG. FIG. 11 is an explanatory diagram showing a specific example of a power setting value and a change in impedance over time when a high-frequency current is passed, and FIG. 12 shows a power value set according to the minimum impedance value. It is explanatory drawing.
Since the second embodiment has almost the same configuration as that of the first embodiment, only different points will be described, the same reference numerals will be given to the same configurations, and description thereof will be omitted.
[0047]
In the high-frequency ablation power supply device 2 ′ in the present embodiment, as shown in FIG. 7, voltage sensors 21 that detect voltages at both ends are attached to both ends of the output transformer 14, and the signal of the voltage sensor 21 is a current sensor. The signal 15a is input to the control circuit 17 via the A / D conversion circuit 16, and the control circuit 17 monitors the impedance obtained by dividing the voltage by the current.
That is, while the current is monitored in the first embodiment, the impedance is monitored in the present embodiment.
[0048]
In addition, as shown in FIG. 8, the distance sensor 22 for measuring the distance between the electrodes 3 is attached to the electrodes 3 in the present embodiment. Distance information (thickness information of a portion to be treated of the biological tissue 18) is input from the connector portion 5 in FIG. 7 to the A / D conversion circuit 16 in the high-frequency ablation power supply device 2 ′ via the signal line in the cable 4. The distance information (thickness information) is A / D converted and taken into the control circuit 17.
[0049]
Here, the distance sensor 22 can be any sensor such as a Hall sensor using magnetism, an optical sensor using reflected light, or a sensor having a mechanical contact. For example, when magnetism is used, one (two) of the distance sensors 22 generates magnetism having a predetermined intensity, and the other Hall sensor detects the distance by a detection output corresponding to the intensity of the magnetism.
[0050]
The operation of the present embodiment configured as described above will be described. The control circuit performs control according to the flowchart shown in FIG.
Steps S31 to S33 are substantially the same as those in the first embodiment. However, in this embodiment, the impedance Z is obtained by dividing the voltage value by the current value, and this value is used for control.
[0051]
Specifically, in step S31, 0 is substituted for the minimum value (impedance minimum value) Zmin of impedance Z, (high frequency) power is set to the set output value in next step S32, and impedance Z is measured in step S33. I do.
In the next step S34, the tissue thickness (distance) between the electrodes 3 treated with both electrodes 3 is obtained from the thickness information obtained by the distance sensor 22, and the power is reduced by the tissue thickness in the next steps S35 to S39. The threshold value of the impedance Z is determined.
[0052]
Specifically, it is determined whether the thickness is less than 5 mm in step S35, and if it is less than 5 mm, it is determined whether the thickness is less than 1 mm in step S36, and the thickness is not less than 5 mm (more than 5 mm) in step S35. Sets the threshold value to the minimum value Zmin × 280% of the impedance Z in step S37. If the thickness is not less than 1 mm in step S36 (thickness is 1 mm or more and less than 5 mm), the threshold value is set to the minimum value of the impedance Z in step S38. When the thickness is set to Zmin × 200% and the thickness is less than 1 mm in step S36, the threshold value is set to the minimum value Zmin × 140% of the impedance Z in step S39.
FIG. 10 shows the relationship between the thickness set in this way and the threshold value.
[0053]
11A and 11B show examples of temporal changes in the high-frequency power and the impedance Z. FIG. Here, two cases are shown, when the contact area between the tissue and the electrode is small and when the contact area is normal. In both cases, the thickness was between 1 and 5 mm, so the threshold value was Zmin × 200%.
[0054]
After setting the threshold value according to the thickness in steps S37 to S39, in the next step S40, it is compared whether the impedance Z exceeds the aforementioned threshold value.
If it does not exceed, the process returns to step S33 to repeat the processes of steps S33 to S39. Conversely, if the impedance Z exceeds the threshold value, the process proceeds to the next step S41.
[0055]
In steps S41 to S45, the power is dropped to a value determined by the value of the minimum value Zmin of the impedance Z.
Specifically, it is determined in step S41 whether the minimum value Zmin of impedance Z is less than 300Ω, and if it is less than 300Ω, it is determined in step S42 whether the minimum value Zmin of impedance Z is less than 60Ω.
[0056]
If the minimum value Zmin of the impedance Z is not less than 300Ω (300Ω or more) in step S41, the power is set to set output × 30% in step S43, and the minimum value Zmin of impedance Z is less than 300Ω in step S42. Further, if the minimum value Zmin of the impedance Z is not less than 60Ω (that is, 60Ω to 300Ω), the power is set to the set output × 50% in step S44, and further, the minimum value Zmin of the impedance Z is less than 60Ω in step S42. In this case, the power is set to set output × 80% in step S45.
FIG. 12 shows the relationship between the minimum value Zmin of the impedance Z thus set and the power.
[0057]
11A and 11B, when the area is small, the minimum value Zmin of the impedance Z is 300Ω or more, and when the area is a normal area, the minimum value Zmin of the impedance Z is 60Ω to 300Ω. Therefore, the power is reduced to setting x 30% and setting x 50%, respectively.
[0058]
The present embodiment has the following effects.
In addition to the effect of the first embodiment, in the present embodiment, the amount of change in the output of the high-frequency current is determined by the measured value from the control circuit 17, so regardless of the contact area between the electrode 3 and the tissue, Almost the same tissue degeneration speed can be obtained.
[0059]
In addition, when the tissue thickness is remarkably thick, the amount of change in tissue impedance is reduced. When the determination was made under normal conditions, there was a problem that carbonization of the tissue and adhesion to the electrode of the tissue occurred, but since the thickness is measured in this embodiment, depending on the thickness of the tissue The end of coagulation can be reliably determined without being affected.
In this embodiment, the impedance measurement is combined. However, the same effect can be obtained by using other measurement values such as a current value measurement.
[0060]
[Appendix]
1. In an electrosurgical apparatus having high-frequency current generating means for generating therapeutic high-frequency current, and adjusting means for adjusting high-frequency current output from the high-frequency current generating means,
A change amount detecting means for detecting a change amount of the high frequency current output from the high frequency current generating means;
Control means for changing and controlling the adjusting means to a preset state based on the amount of change detected by the change amount detecting means;
An electrosurgical device characterized by comprising:
2. In an output control method for an electrosurgical apparatus, comprising: a high-frequency current generating means for generating a high-frequency current for treatment; and an adjusting means for adjusting a high-frequency current output from the high-frequency current generating means.
A change amount detecting step of detecting a change amount of the high frequency current output from the high frequency current generating means;
Based on the amount of change detected in the amount of change detection step, a control step of changing and controlling the adjusting means to a preset state;
An output control method for an electrosurgical device.
[0061]
3. In an electrosurgical apparatus having high-frequency current generating means for generating therapeutic high-frequency current, and adjusting means for adjusting high-frequency current generated from the high-frequency current generating means,
Based on the operation of the high-frequency current generating means, a change amount detecting means for detecting a change amount of the treatment state due to the high-frequency current;
Control means for changing and controlling the adjusting means to a preset state based on the change amount detected by the change amount detecting means;
An electrosurgical device characterized by comprising:
4). In an output control method for an electrosurgical apparatus, comprising: a high-frequency current generating means for generating a therapeutic high-frequency current; and an adjusting means for adjusting a high-frequency current generated from the high-frequency current generating means.
Based on the operation of the high-frequency current generating means, a change amount detecting step for detecting a change amount of the treatment state due to the high-frequency current;
Based on the amount of change detected in the amount of change detection step, a control step of changing and controlling the adjusting means to a preset state;
An output control method for an electrosurgical device.
[0062]
5. In an electrosurgical apparatus having high-frequency current generating means for generating therapeutic high-frequency current, and adjusting means for adjusting high-frequency current output from the high-frequency current generating means,
A change amount detecting means for detecting a change amount of the impedance of the subject treated by the high frequency current output from the high frequency current generating means;
Control means for changing and controlling the adjusting means to a preset state based on the amount of change detected by the change amount detecting means;
An electrosurgical device characterized by comprising:
6). In an output control method for an electrosurgical apparatus, comprising: a high-frequency current generating means for generating a high-frequency current for treatment; and an adjusting means for adjusting a high-frequency current output from the high-frequency current generating means.
A change amount detecting step of detecting a change amount of the impedance of the subject treated by the high frequency current output from the high frequency current generating means;
Based on the amount of change detected in the amount of change detection step, a control step of changing and controlling the adjusting means to a preset state;
An output control method for an electrosurgical device.
[0063]
7). Generating means for generating a high-frequency current;
Measuring means for measuring physical quantities (current, voltage, impedance, power, phase difference) associated with the high-frequency current;
Adjusting means for adjusting the output of the high-frequency current;
A control circuit for controlling the adjusting means so as to change the output of the high-frequency current according to a change in the measured value from the measuring means;
In an electrosurgical apparatus for supplying the high-frequency current to a surgical instrument,
The control circuit controls the adjustment unit by changing the amount of change in the output of the high-frequency current to a desired value determined from the measurement value from the measurement unit. apparatus.
[0064]
8). The electrosurgical device according to appendix 7, wherein the measuring means is a current sensor, and the measured value is a current value.
9. 7. The electrosurgical device according to 7 to 8, wherein the change amount of the output of the high-frequency current is determined based on the maximum value and / or the minimum value of the measurement value from the measurement means.
10. By changing the measured value from the measuring means, the output of the high frequency current is changed,
The amount of change at that time is determined based on the maximum value and / or minimum value of the measurement value from the measurement means,
Furthermore, the electrosurgical device according to appendix 9, wherein the output of the high-frequency current is changed again by a change in the measurement value from the measuring means.
[0065]
11. Generating means for generating a high-frequency current;
Measuring means for measuring physical quantities (current, voltage, impedance, power, phase difference) associated with the high-frequency current;
Adjusting means for adjusting the output of the high-frequency current;
A control circuit for determining the threshold value from the past measurement value measured by the measurement means, comparing it with the current measurement value, and controlling the adjustment means to change the high-frequency current) output according to the result;
In an electrosurgical apparatus for supplying the high-frequency current to a surgical instrument,
The electrosurgical apparatus according to claim 1, wherein the control circuit changes the threshold value based on a change rate of a measured value measured by the measuring unit.
12 Generating means for generating a high-frequency current;
Adjusting means for adjusting the output of the high-frequency current;
A control circuit for controlling the adjusting means;
At least two electrodes for transmitting the high-frequency current to the tissue;
In an electrosurgical device having
Measuring means for measuring the thickness of the tissue between the electrodes;
An electrosurgical apparatus characterized in that a control circuit controls the adjusting means by changing the output of the high-frequency current from the measured value from the measuring means so as to change.
[0066]
13. In Appendix 12,
Has a second measuring means to measure physical quantities (current, voltage, impedance, power, phase difference) related to high-frequency current,
The control circuit is an electrosurgical apparatus that controls the adjusting means so as to change the output of the high-frequency current according to the measurement value from the measurement means that measures the thickness of the tissue between the electrodes and the second measurement means.
[0067]
【The invention's effect】
As described above, according to the present invention, in the electrosurgical apparatus having the high-frequency current generating means for generating the therapeutic high-frequency current and the adjusting means for adjusting the high-frequency current output from the high-frequency current generating means,
A change amount detecting means for detecting a change amount of the high frequency current output from the high frequency current generating means;
Control means for changing and controlling the adjusting means to a preset state based on the amount of change detected by the change amount detecting means;
Therefore, by setting the output state corresponding to the amount of change of the high-frequency current by the adjusting means, the therapeutic treatment can be performed without depending on the contact area.
[0068]
In addition, in an output control method for an electrosurgical apparatus having high-frequency current generating means for generating a therapeutic high-frequency current, and adjusting means for adjusting a high-frequency current output from the high-frequency current generating means,
A change amount detecting step of detecting a change amount of the high frequency current output from the high frequency current generating means;
Based on the amount of change detected in the amount of change detection step, a control step of changing and controlling the adjusting means to a preset state;
Therefore, by setting the output state corresponding to the amount of change of the high-frequency current by the adjusting means, the therapeutic treatment can be performed without depending on the contact area.
An electrosurgical apparatus having a high-frequency current generating means for generating a therapeutic high-frequency current and an adjusting means for adjusting the high-frequency current generated from the high-frequency current generating means,
Based on the operation of the high-frequency current generating means, a change amount detecting means for detecting a change amount of the treatment state due to the high-frequency current;
Control means for changing and controlling the adjusting means to a preset state based on the change amount detected by the change amount detecting means;
By detecting the amount of change of the treatment state due to the high-frequency current and setting the output state corresponding to the adjustment means, the treatment treatment can be performed without depending on the contact area.
[Brief description of the drawings]
FIG. 1 is an overall configuration diagram of a high-frequency ablation apparatus according to a first embodiment of an electrosurgical apparatus of the present invention.
FIG. 2 is a block diagram showing a configuration of a high-frequency ablation power supply device.
FIG. 3 is a flowchart showing a control process of the control circuit of FIG. 2;
FIG. 4 is an explanatory diagram showing a set value of power and a state of current change with respect to time change of the high-frequency power supply device.
FIG. 5 is a flowchart showing details of processing contents of current change rate measurement.
FIG. 6 is a diagram showing a relationship between a current maximum value and a power setting value.
FIG. 7 is a block diagram showing a configuration of a high-frequency ablation power supply device.
FIG. 8 is an enlarged view of an electrode.
FIG. 9 is a flowchart showing a control process of the control circuit.
FIG. 10 is an explanatory diagram showing threshold values set according to thickness.
FIG. 11 is an explanatory diagram showing a specific example of a change in power set value and impedance over time when a high-frequency current is passed.
FIG. 12 is an explanatory diagram showing the value of power set according to the minimum impedance value.
[Explanation of symbols]
1 ... induction cautery
2 ... Induction cautery power supply
3 ... Electrode
4. Connection cable
5 ... Connector part
8 ... Foot switch
11 ... DC power supply circuit
12 ... High frequency generation circuit
13 ... Waveform generation circuit
14 ... Output transformer
15a, 25b ... current sensor
16 ... A / D conversion circuit
17 ... Control circuit
21 ... Voltage sensor
22 ... Distance sensor

Claims (8)

In an electrosurgical apparatus having high-frequency current generating means for generating therapeutic high-frequency current, and adjusting means for adjusting high-frequency current output from the high-frequency current generating means,
Detecting means for detecting a high-frequency current output from the high-frequency current generating means;
When the output of the high-frequency current is started at a predetermined set power value in response to an output start instruction, and the maximum value of the high-frequency current detected by the detection means is equal to or greater than a first threshold after the start, the set power The high-frequency current is output at a first power value greater than a value, and the maximum value of the high-frequency current detected by the detection means after the start is less than a second threshold value that is smaller than the first threshold value. A control means for controlling the adjusting means so as to output the high-frequency current at a second power value smaller than the set power value;
An electrosurgical device characterized by comprising: In an output control method for an electrosurgical apparatus, comprising: a high-frequency current generating means for generating a high-frequency current for treatment; and an adjusting means for adjusting a high-frequency current output from the high-frequency current generating means.
An output start step of starting output of the high-frequency current at a predetermined set power value in accordance with an instruction to start output;
A detection step of detecting the high-frequency current output by the high-frequency current generating means after the start of the output of the high-frequency current;
If the maximum value of the high-frequency current detected in the detection step is greater than or equal to a first threshold value, the high-frequency current is output at a first power value that is greater than the set power value, and further detected in the detection step When the maximum value of the generated high-frequency current is less than a second threshold value that is smaller than the first threshold value, the high-frequency current is output at a second power value that is smaller than the set power value. An output control method for an electrosurgical device, comprising: a control step for controlling the adjusting means. In an electrosurgical apparatus having high-frequency current generating means for generating therapeutic high-frequency current, and adjusting means for adjusting high-frequency current generated from the high-frequency current generating means,
Based on the operation of the high-frequency current generating means, detection means for detecting the impedance of the living tissue when the high-frequency current is passed,
In response to an instruction to start output, output of the high-frequency current is started at a predetermined set power value for coagulation treatment, and after the start, the minimum value of the impedance detected by the detection means is a first threshold value and the first threshold value. When the minimum value is greater than or equal to the first threshold value when outside the range between the second threshold value and the second threshold value that is less than the first threshold value, the two electrodes to which the high-frequency current is supplied and the living tissue to be coagulated The predetermined set power value is set to a first power value smaller than the predetermined set power value so that the coagulation treatment is performed with an output corresponding to the small area. When the minimum value is less than or equal to the second threshold value, the contact area between the two electrodes to which the high-frequency current is supplied and the living tissue to be coagulated is greater than the predetermined area. Its large area Control means for controlling the adjustment means so that the predetermined set power value is changed to a second power value larger than the first power value and output so that the coagulation treatment is performed with a corresponding output. When,
An electrosurgical device characterized by comprising: In an output control method for an electrosurgical apparatus, comprising: a high-frequency current generating means for generating a therapeutic high-frequency current; and an adjusting means for adjusting a high-frequency current generated from the high-frequency current generating means.
An output start step of starting output of the high-frequency current at a predetermined set power value for coagulation treatment in response to an instruction to start output;
Based on the operation of the high-frequency current generating means after the start of the output of the high-frequency current, a detection step of detecting the impedance of the living tissue when the high-frequency current is passed,
When the minimum value of the impedance detected in the detection step is out of the range between the first threshold value and the second threshold value that is smaller than the first threshold value, the minimum value is equal to or greater than the first threshold value. In this case, the contact area between the two electrodes to which the high-frequency current is supplied and the living tissue to be coagulated is smaller than a predetermined area, and the coagulation treatment is performed with an output corresponding to the small area. Two electrodes to which a predetermined set power value is changed to a first power value smaller than the predetermined set power value and output, and the high-frequency current is supplied when the minimum value is less than or equal to the second threshold value The predetermined power value is set to the first power so that the contact area between the body tissue and the living tissue to be coagulated is larger than the predetermined area, and the coagulation treatment is performed with an output corresponding to the large area. Greater than value To output by changing the second power value, the output control method for an electro-surgical device which is characterized in that anda control step of controlling said adjustment means. Calculating a change rate of an output value of the high-frequency current detected by the detection unit; and determining means for determining whether or not the change rate obtained by the calculation is smaller than a predetermined value;
The control means is after the output of the high-frequency current at the predetermined set power value, and after the determination means determines that the rate of change is smaller than the predetermined value, the detection means If the maximum value of the high-frequency current detected by the sensor is equal to or greater than the first threshold value, the high-frequency current is output at the first power value, and the maximum value of the high-frequency current detected by the detection means 2. The electrosurgical device according to claim 1, wherein when the frequency is less than the second threshold value, the adjustment unit is controlled to output the high-frequency current at the second power value. Calculating the rate of change of the output value of the high-frequency current detected in the detecting step, and determining whether the rate of change obtained by calculation is smaller than a predetermined value;
The control step is after the output of the high-frequency current is started at the predetermined set power value, and after the change rate is determined to be smaller than the predetermined value in the determination step, the detection step If the maximum value of the high-frequency current detected in step S is equal to or greater than the first threshold value, the high-frequency current is output at the first power value, and the high-frequency current detected in the detection step is further output. 3. The electrosurgical device according to claim 2, wherein when the maximum value is less than the second threshold value, the adjustment unit is controlled to output the high-frequency current at the second power value. 4. Output control method. Measuring means for measuring the thickness of the living tissue between the two electrodes;
The control means starts output of the high-frequency current at the predetermined set power value, and the impedance becomes equal to or greater than a predetermined threshold set according to the thickness measured by the measurement means. In this case, when the minimum value of the impedance detected by the detection means is out of the range, the coagulation treatment is performed with an output corresponding to the small area when the minimum value is equal to or greater than the first threshold value. The predetermined set power value is changed to the first power value and output, and when the minimum value is less than or equal to the second threshold value, the coagulation treatment is performed with an output corresponding to the large area. The electrosurgical device according to claim 3, wherein the adjustment unit is controlled so that the predetermined set power value is changed to the second power value and output. The electrosurgical device further has a measuring means for measuring the thickness of the living tissue between the two electrodes,
Having a measuring step of measuring the thickness of the living tissue between the two electrodes,
The control step is after the output of the high-frequency current is started at the predetermined set power value, and the impedance is equal to or greater than a predetermined threshold set according to the thickness measured in the measurement step. If the minimum value of the impedance detected in the detection step is out of the range, the coagulation treatment is performed with an output corresponding to the small area when the minimum value is equal to or greater than the first threshold value. As described above, the predetermined set power value is changed to the first power value and output, and when the minimum value is less than or equal to the second threshold value, the coagulation treatment is performed with an output corresponding to the large area. 5. The output control method for an electrosurgical device according to claim 4, wherein the adjusting means is controlled so that the predetermined set power value is changed to the second power value and output.

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