JP4519980B2 - Electrosurgical equipment - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an electrosurgical device, and more particularly to an electrosurgical device characterized by a high-frequency current output control portion.
[0002]
[Prior art]
In general, an electrosurgical apparatus such as an electric scalpel is used when performing a procedure such as incision, coagulation, and hemostasis of a living tissue in a surgical operation or a medical operation.
Such an electrosurgical device is 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. When the contact area is small, there are two cases: a case where the electrode area is small as in Forcepte, and a case where the electrode area is large as in forceps but only the tip is brought into contact with the tissue.
[0005]
In the electrosurgical devices disclosed in Japanese Patent Laid-Open Nos. 8-98845 and 10-225462, when the contact area is small and the tissue impedance change is large, the output is administered all at once in a short period of time when the determination of coagulation completion is performed.
[0006]
For this reason, in the case of Forcept with a small electrode, coagulation is too strong, and the tissue may repel due to tissue adhesion, carbonization, or rapid temperature rise. On the other hand, in the case of forceps with large electrodes and tip contact, there is a problem that the output is too short and coagulation becomes weak.
[0007]
The present invention has been made in view of the above circumstances, and provides an electrosurgical apparatus that is not excessively coagulated or insufficiently coagulated by determining proper output and coagulation completion when the contact area between the electrode and tissue is small. The purpose is to do.
[0008]
[Means for Solving the Problems]
The electrosurgical apparatus of the present invention is an electrosurgical apparatus that can supply treatment energy to a connected surgical tool having a different treatment electrode area.
  Energy for treatmentSaidThe treatment energy generating means to be supplied to the surgical instrument and the output of the treatment energy generating means are varied.Output variable meansAnd the treatment energy isSaidWhen being supplied to the tissue side via the electrode of the surgical toolOutput current detection means for detecting currentWhen,SaidThrough a pair of electrodes on the surgical instrumentThe treatment energy isDetects impedance between the electrodes when the pair of electrodes sandwich the tissue when supplied to the tissue sideImpedance detection meansWhen,Based on a comparison result between the minimum impedance value between the electrodes detected by the impedance detection means and the first threshold value, an area in contact with the tissue when the pair of electrodes in the connected surgical tool sandwich the tissue is Based on the contact area determination means for determining whether or not it is smaller than a predetermined value, and the determination result of the contact area determination means, the contact area with the tissue when the pair of electrodes sandwich the tissue is a predetermined value In the case where it is smaller, the output current detection means is further based on a comparison result between the minimum impedance value between the electrodes detected by the impedance detection means and a second threshold value different from the first threshold value. A surgical instrument discriminating means for discriminating the type of the surgical instrument connected to the electrosurgical device based on the detection result of the time change of the output current value detected by Comprising an output current limiting threshold value setting means for setting a limit threshold of the output current from use energy generating means, and an output control means for controlling the output variable means or threshold setting means for the output current limiting, and
The output control means includes
According to the discrimination results of the contact area discriminating means and the surgical instrument discriminating means, the connected surgical instrument is a surgical instrument of a type having a relatively large treatment electrode area, and the electrode and the tissue contact when the tissue is sandwiched When it is determined that the area is smaller than the predetermined value, the output current limiting threshold setting unit is controlled to set the output current limiting threshold to the first current limiting threshold, and the output current is When the first current limiting threshold or less is reached, the output variable means is controlled to reduce the output power,
When it is determined that the connected surgical instrument is a surgical instrument having a relatively small treatment electrode area based on the determination results of the contact area determining unit and the surgical instrument determining unit, the output current limiting threshold value The setting means is controlled to set the output current limiting threshold to the second current limiting threshold, and when the output current becomes equal to or less than the second current limiting threshold, the output variable means is controlled. And reducing the output power to the first power value and controlling the output current limiting threshold setting means to make the output current limiting threshold smaller than the second current limiting threshold. And when the output current falls below the third current limiting threshold, the output variable means is controlled to reduce the output power to a second power value smaller than the first power value. ,
It is characterized by that.
[0009]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
(First embodiment)
1 to 5 relate to a first embodiment of the present invention, FIG. 1 is a block diagram showing a configuration of a high-frequency ablation device according to the first embodiment, and FIG. 2 is a block diagram showing a configuration of a high-frequency ablation power supply device. FIGS. 3 and 3 are enlarged views showing the treatment of the tissue in the case where the electrode of FIG. 2 is a forceps and the case of forceps, and FIG. 4 is a flowchart showing the control action of the control circuit of FIG. These are explanatory drawings which show the mode of the time change at the time of processing by controlling output.
[0010]
As shown in FIG. 1, a high-frequency ablation device 1 according to a first embodiment as an electrosurgical device of the present invention includes a high-frequency ablation power supply 2 that supplies high-frequency ablation power. A high-frequency cauterization power for treatment is supplied to a patient 7 placed on the bed 6 via the electrode 3 and connected to the connection cable 4 provided with the electrode 3 on the connector portion 5 to perform a treatment procedure (surgical treatment). I can do it.
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.
[0011]
As shown in FIG. 2, the high-frequency ablation power supply device 2 is connected to a commercial power supply (not shown), and is driven by a DC power supply circuit 11 that converts the DC power supply to supply this DC power supply, and a DC power supply from the DC power supply circuit 11. A high-frequency generation circuit 12 that oscillates at a high frequency to generate high-frequency power (high-frequency current) for treatment, a waveform generation circuit 13 that controls a waveform of the high-frequency current output to the high-frequency generation circuit 12, and a high-frequency generation The output transformer 14 that outputs the high-frequency current from the circuit 12 to the electrode 3, the current sensors 15a and 15b that detect, for example, the output current output from the output transformer 14, and the current values detected by the current sensors 15a and 15b are A A / D conversion circuit 16 that performs D / D conversion, and a DC power supply circuit 11 and a waveform generation circuit based on digitized current data from the A / D converter 16 And a control circuit 17 for controlling the 3.
[0012]
Then, the connection cable 4 is connected to the connector portion 5 so that the electrode 3 can perform high-frequency ablation on the living tissue 18 of the patient 7 and the like.
FIG. 3 shows an enlarged view of the tip of the electrode 3 for each electrode (for the electrode of the forceps 3A (the current-carrying part 19a) and for the electrode of the forceps 3B (for the current-carrying part 19b)). 3A, the living tissue 18 is gripped by the entire energizing portion 19a of the forcecept 3A, and in FIG. 3B, the living tissue 18 is gripped only by the distal end portion of the energizing portion 19b of the forceps 3B. Here, the contact area between the living tissue 18 and the energization part 19a or 19b is the same.
[0013]
When the foot switch 8 is connected to the control circuit 17 and 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 as described below. When the OFF switch is stepped on, the output of the high frequency current is stopped.
[0014]
The control circuit 17 controls the DC power supply circuit 11 and the waveform generation circuit 13. By controlling the DC power supply circuit 11, ON / OFF of the high frequency power is controlled, and the value of the high frequency power is variably controlled. Further, by controlling the waveform generation circuit 13, the waveform for treatment can be variably set.
[0015]
The control circuit 17 monitors the digitized current data from the A / D conversion circuit 16 in time to detect the treatment state.
For example, after starting the treatment, the control circuit 17 starts a timer (internally not shown), sequentially stores current data in an internal memory or the like in time, can detect the maximum current value Imax, Is also monitored by dividing the current value I by the square of the current value I.
[0016]
The impedance Z as a physical quantity related to the high-frequency current is monitored by dividing the power by the square of the current value I. Instead, a voltage for detecting the voltage at both ends of the output transformer 14 in FIG. An impedance is obtained by connecting a sensor, inputting the output of the voltage sensor to the control circuit 17 via the A / D conversion circuit 16, and dividing the voltage value detected by the voltage sensor by the current value detected by the current sensor 15a or the like. Z may be obtained.
[0017]
Then, the minimum value, that is, the minimum impedance value Zmin can be obtained from the impedance Z monitored in terms of time, and control for changing the treatment method according to the obtained value of the minimum impedance value Zmin is performed. ing.
That is, based on the value of the minimum impedance value Zmin, it is determined whether the state of the electrode 3 and the tissue 18 when treating is a normal contact area, a small contact area, a forceps or a forceps, Treatment is performed with treatment energy suitable for each treatment according to the determination result.
For this reason, the control circuit 17 performs output control for changing the treatment energy of the high-frequency generation circuit 12 via the DC power supply circuit 11 or the waveform generation circuit 13.
[0018]
More specifically, when it is determined that the force is a force, as described later, when it is detected that the state deviates from the threshold value according to the threshold value set corresponding to the case, the output is performed so as to reduce the power. By changing the output, a second threshold different from the above threshold is further set by the output change, and if it is determined that the treatment state further deviates from the second threshold, the output is changed to further reduce the power. Thus, in the treatment process, it is one of the features that an appropriate treatment can be performed by performing variable output control that reduces power in a plurality of stages.
[0019]
Next, the operation of this embodiment will be described.
When the foot switch 8 is stepped on as shown in FIG. 1, the control circuit 17 starts the control operation according to the flowchart shown in FIG. When the foot switch 8 is stepped on, the control circuit 17 sets the minimum impedance Zmin to 0 in step S1.
[0020]
Next, in step S2, the DC power supply circuit 11 and the waveform generation circuit 13 are controlled so that the output power becomes a set value. Next, in step S3, the impedance Z is measured to determine the minimum impedance Zmin, and this value is used for control. Here, the impedance in the present embodiment is obtained by dividing power by the square of the current value. The current data is monitored over time so that the maximum current value Imax can be detected.
[0021]
In the following steps S4 to S16, processing according to the value of the minimum impedance Zmin obtained in the previous step S3 is performed.
[0022]
Specifically, in step S4, it is determined whether or not the minimum impedance Zmin is larger than a first threshold value for determining whether or not the normal contact area is, for example, 100Ω.
[0023]
When the contact area is normal, the minimum impedance Zmin is 100Ω or less, and when the contact area is smaller than the normal contact area, the minimum impedance Zmin is greater than 100Ω.
[0024]
When the minimum impedance Zmin is 100Ω or less (normal contact area), the process proceeds to step S13 and the threshold is set to the maximum current Imax × 0.7 (Imax × 70%).
The threshold value of the maximum current Imax × 0.7 in this case is a reference value for determining the completion of coagulation when the coagulation treatment is performed.
[0025]
Then, the current (current value) I is measured in the next step S14, and it is determined whether or not the current value I measured in the next step S15 is smaller than the maximum current Imax × 0.7. If so, the power is reduced to 50% of the set output in the next step S16.
[0026]
On the other hand, if the minimum impedance Zmin is greater than 100Ω, in the next step S5, a second threshold value for determining whether only the electrode of the forceps 3A or the tip of the forceps 3B having a very small contact area is used. For example, it is determined whether it is larger than 150Ω.
[0027]
When the minimum impedance Zmin is smaller than 150Ω, that is, when only the tip of the forceps 3B is in contact with 100Ω <Zmin <150Ω, the process proceeds to step S10, and the threshold is set to the maximum current Imax × 0.5 in step S10. To do.
[0028]
Then, in the next step S11, the current (current value) I is measured, and it is determined whether or not the current value I measured in the next step S12 is smaller than the maximum current Imax × 0.5.
[0029]
The maximum current Imax × 0.5 in this case is a reference value for determining whether or not the coagulation treatment with the forceps 3B is completed when the contact area is reduced. When the current I is larger than this value, coagulation is performed. This value is suitable for
[0030]
If it is determined in step S12 that the current value I is greater than the maximum current Imax × 0.5, the process returns to step S11 (treatment is performed in the previously set output state, in which case current measurement is performed. ), When the current is smaller than the maximum current Imax × 0.5, the process proceeds to step S16, where the power is reduced to 50% of the set output.
[0031]
On the other hand, if it is determined in step S5 that the minimum impedance Zmin is greater than 150Ω, the threshold is set to the maximum current Imax × 0.9 in the next step S6.
In this case, the maximum current Imax × 0.9 is a reference value for determining whether or not the treatment has been performed halfway in the case of coagulation with the Forcept 3A. If the current I is larger than this value, the coagulation is performed. This is a value suitable for performing halfway.
[0032]
Then, the current (current value) I is measured in the next step S7, and it is determined whether or not the current value I measured in the next step S8 is smaller than the maximum current Imax × 0.9.
If it is determined in step S8 that the current value I is greater than the maximum current Imax × 0.9, the process returns to step S7 (treatment is performed in the previously set output state, in which case current measurement is performed. ), When the current becomes smaller than the maximum current Imax × 0.9, the process proceeds to the next step S9, where the power is reduced to 70% of the set output.
[0033]
In other words, in the case of Forcept 3A, since the contact area is small, if the coagulation treatment is performed with the set output as it is, the coagulation treatment is completed in a short time, and the coagulation is likely to be overcoagulated. Then, the state where the coagulation treatment has progressed to some extent is detected, the set output is reduced at that stage, and the treatment to complete the coagulation with a small output by this reduction is made at a moderate speed (a large change in state does not occur within a short time) The control is performed at a speed that facilitates control and does not vary the control result.
When this stage is reached, the process proceeds to step S13, and the threshold value is set to the maximum current Imax × 0.7 in step S13 as described above.
[0034]
Then, the current (current value) I is measured in the next step S14, and it is determined whether or not the current value I measured in the next step S15 is smaller than the maximum current Imax × 0.7. If so, the power is reduced to 50% of the set output in the next step S16.
[0035]
The solid line in FIG. 5 shows the state of current I and power W when the treatment with Forcept 3A is performed.
That is, the treatment is performed with the set output until the current I becomes the maximum current Imax × 0.9 or less, and when the maximum current Imax × 0.9 or less, the treatment is performed with a reduction to 70% of the set output. In other words, by performing treatment by changing the treatment output in two stages, even when a treatment whose state changes rapidly is performed in a short time, the control result such as excessive coagulation does not become uneasy. Stable treatment can be performed.
[0036]
Also, the broken line in FIG. 5 shows the case of treatment at the forceps tip.
In this case, the output is too short to solve the lack of coagulation, and hemostasis can be reliably performed with sufficient coagulation.
[0037]
The present embodiment has the following effects.
As described above, in this embodiment, after determining the size of the contact area, the threshold value and the output reduction method are automatically determined for each electrode size. There is no going out. Especially in Forcept, tissue adhesion and carbonization can be prevented by reducing the output in multiple stages. In addition, since all the determinations are made automatically, there is an effect that it is possible to save the trouble of manually setting the threshold and output.
[0038]
(Second Embodiment)
Next, a second embodiment of the present invention will be described with reference to FIG. The configuration of this embodiment is the same as that of the first embodiment, and the control operation by the control circuit 17 is partly different from that of the first embodiment.
[0039]
FIG. 6 shows a part of the control operation in the present embodiment. In this control operation, in steps S10 to S12 in FIG. 4, step S12 is performed after step S12 as shown in FIG. 6, and step S16 is performed after step S17.
[0040]
That is, in step S17 after step S12, it is determined whether or not the output time is greater than 2 seconds. If the output time is less than 2 seconds, the process returns to step S17, and the output time is greater than 2 seconds. Later, in step S16, the set output is reduced to 50%.
[0041]
The other operations are the same as the first. The present embodiment has the following effects.
By providing the condition of an output of 2 seconds or more only in the case of forceps tip contact, it is possible to prevent the coagulation from becoming weak even when the contact area is small and the current suddenly drops during output. Further, in addition to the effects of the first embodiment, it is possible to perform control more suited to the electrode.
[0042]
(Third embodiment)
Next, a third embodiment of the present invention will be described with reference to FIG. FIGS. 7A and 7B mainly show changes in power and current in the case of Forcept. The configuration of this embodiment is the same as that of the first embodiment, and the control operation by the control circuit 17 is partly different from that of the first embodiment.
[0043]
In the first embodiment, the discrimination judgment in the case of the treatment with the forcecept 3A and the forceps 3B is performed with the value of the minimum impedance Zmin, but in this embodiment, the time T from the maximum current Imax to Imax × 90% is used. to decide.
[0044]
Then, as shown by a thick solid line in FIG. 7, when the time T is shorter than 0.5 seconds, it is determined that the force is a force, and the output is reduced from the set output to the set output × 70%, and then Imax × 70. When it becomes less than%, the output is further reduced to set output x 50%.
[0045]
On the other hand, as shown by a two-dot chain line in FIG. 7B, when the time T from the maximum current Imax to Imax × 90% is 0.5 seconds or more, it is determined to be a forceps and remains as it is. Holds the setting output. Other operations are the same as those in the first embodiment.
The present embodiment has the following effects.
Since the determination of the electrode is seen from the change time of the current value, the detection accuracy can be increased regardless of the tissue state.
[0046]
(Fourth embodiment)
Next, a fourth embodiment of the present invention will be described with reference to FIG. The configuration of this embodiment is the same as that of the first embodiment, and the control operation by the control circuit 17 is partly different from that of the first embodiment.
[0047]
In the first embodiment, the output of the Forcept 3A is reduced in two stages to perform the coagulation treatment. However, in this embodiment, the coagulation condition (coagulation state change) is further increased as shown in FIG. The surgeon is notified accordingly.
[0048]
More specifically, the point A of maximum current Imax × 90% at which the output reduction starts at the boundary between the green baking region and the drying region, the point B of maximum current Imax × 70% near the center of the drying region, the drying region For example, a notification sound for notifying the operator is sounded at a point C at the maximum current Imax × 50% at the boundary between the carbonized region and the carbonized region.
[0049]
The present embodiment has the following effects.
By notifying each time the coagulation progresses with a notification sound, the operator can select the degree of coagulation in the dry area. In addition, the output is reduced in the dry zone, so that the structure is difficult to carbonize.
[0050]
(Fifth embodiment)
Next, a fifth embodiment of the present invention will be described with reference to FIGS. The configuration of this embodiment is the same as that of the first embodiment, and the control circuit 17 can perform the control operation shown in FIG. 9 by further selecting.
[0051]
When the output starts, the initial current Io is measured in step S21. Next, in step S22, it is determined whether or not the initial current Io is smaller than 400 mA (corresponding to an output of 30 W). If the initial current Io not corresponding to this is 400 mA or more, the power is set to the set output in step S23. Then, the current I is measured in the next step S24, and it is determined whether or not the current value I measured in the next step S25 is smaller than the maximum current Imax × 70%. When the measured current value I becomes equal to or less than the maximum current Imax × 70%, the process proceeds to step S29, and the power is reduced to the set output × 50%.
[0052]
On the other hand, if it is determined in step S22 that the initial current Io is smaller than 400 mA, the power is reduced to the set output × 70% value in step S26, and the current I is measured in the next step S27. Then, it is determined whether or not the current value I measured in the next step S28 is smaller than the maximum current Imax × 70%. If not, the process returns to step S27, and the measured current value I is the maximum. When the current Imax × 70% or less, the process proceeds to step S29, where the power is reduced to the set output × 50%.
[0053]
As shown in FIG. 10, in the case of the initial current Io-1 when a fresh tissue is coagulated, the coagulation treatment is performed with a set output. When the maximum current Imax-1 in this case is less than the reduction threshold (Imax-1 × 70%), the output is reduced to the set output × 50%.
[0054]
In the case of the initial current Io-2 for the second coagulation that coagulates once again in the coagulated tissue, the coagulation treatment is performed at a set output x 70% output. By reducing the output in this way (as compared with the case where the output indicated by the broken line is not reduced), the output time until the reduction threshold (Imax−2 × 70%) can be lengthened.
[0055]
The present embodiment has the following effects.
Thus, in the present embodiment, it is possible to coagulate the inside of the tissue by detecting the second coagulation and reducing the output to increase the coagulation time. Also, by reducing the output, carbonization of the surface can be prevented.
[0056]
(Sixth embodiment)
Next, a sixth embodiment of the present invention will be described with reference to FIGS. Although the configuration of the present embodiment is the same as that of the first embodiment, a forceps 3B ′ in which the energizing portion 19b is covered with an insulating coating film 31 as shown in FIG. 11 can be used.
Corresponding to the forceps 3B ', the high-frequency generating circuit 12 in FIG. 2 can change the output frequency from 0 to several MHz based on the control of the control circuit 17.
[0057]
Next, the operation of the present embodiment will be described with reference to FIG. When the foot switch 8 of FIG. 2 is stepped on, the control circuit 17 starts control according to the flowchart shown in FIG. When the foot switch 8 is stepped on, the control circuit 17 turns off the waveform generation circuit 13 and outputs a DC detection current from the high frequency generation circuit 12 as shown in step S31.
[0058]
Then, the control circuit 17 determines whether or not there is DC detection current feedback in step S32 via the current sensors 15a and 15b and the A / D conversion circuit 16.
[0059]
If it is determined that there is DC detection current feedback, it is determined that the forceps 3B without the insulating coating film 31 is used, and the oscillation frequency of the high-frequency generation circuit 12 is set to 350 kHz, for example, as shown in step S33. In the next step S34, the power is set to the set output and the coagulation treatment is started.
[0060]
On the other hand, when it is determined in step S32 that there is no DC detection current feedback, it is determined that the forceps 3B 'to which the insulating coating film 31 is applied is used, and as shown in step S35, the high frequency generation circuit 12 is used. Is set to a high frequency of 3 MHz, for example. By using a high frequency in this way, it is possible to prevent the coating film 31 from peeling off and perform treatment on the living tissue 18. After setting the frequency, in step S34, the power is set to the set output and the coagulation treatment is started. The subsequent processing is the processing of FIG.
[0061]
The present embodiment has the following effects.
By taking such a form, it is possible to prevent adhesion to the electrode and to use the electrode for a long time. Since the coating is automatically detected before output, it is possible to save the trouble of changing the output setting even if the electrode is changed during the operation. In addition, since the frequency can be changed, it is possible to cope with various kinds of surgery, and it becomes a high-frequency power source with wide usage.
Note that an embodiment configured by partially combining the above-described embodiments and the like also belongs to the present invention.
[0062]
[Appendix]
0. Treatment energy generating means for supplying treatment energy to the surgical instrument;
Variable means for varying the output of the treatment energy generating means;
Detecting means for detecting a physical quantity when the treatment energy is supplied to the tissue side via an electrode of a surgical instrument;
Threshold setting means for setting a first threshold based on a predetermined amount of change in the detection result of the detection means;
Comparison means for comparing the detection result of the detection means with the first threshold;
A threshold value changing means for changing the threshold value of the comparison means to a second threshold value based on a change in the result of the comparison means due to a detection result of the detection means exceeding the first threshold value;
Output control means for controlling variable output of the variable means based on the comparison result of the comparison means;
An electrosurgical device comprising:
[0063]
1. 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 vary the output of the high-frequency current when the measurement value from the measuring means satisfies a certain condition;
In an electrosurgical apparatus that supplies a high-frequency current to a surgical instrument,
The electrosurgical apparatus characterized in that the output is varied a plurality of times for an arbitrary measurement value.
[0064]
2. The electrosurgical device according to appendix 1, wherein the plurality of output variables are multi-stage output reduction means for reducing the output in stages.
3. The electrosurgical device according to appendix 1, wherein the predetermined condition is a change amount of a measured value.
4). The electrosurgical device according to any one of appendices 1 to 3, wherein the measurement change amount under the predetermined condition is determined by an arbitrary measurement value.
[0065]
5. The electrosurgical device according to appendix 1, wherein the certain condition includes an output time.
6). The electrosurgical device according to appendix 1, wherein the predetermined condition is determined by an output time to a target value obtained by multiplying an arbitrary measurement value by a certain coefficient.
7). The electrosurgical device according to appendix 1, wherein the multistage output reduction means includes notification means for notifying the user of the output reduction.
[0066]
8). 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 vary the output of the high-frequency current when the measurement value of the measuring means has a constant change;
In an electrosurgical apparatus that supplies a high-frequency current to a surgical instrument,
An electrosurgical device that reduces output based on an initial measurement value of the measurement value.
9. The electrosurgical device according to appendix 8, wherein the change rate of the measurement value is delayed by the decrease in the output.
[0067]
【The invention's effect】
As described above, according to the present invention, the treatment energy generating means for supplying the treatment energy to the surgical instrument,
Variable means for varying the output of the treatment energy generating means;
Detecting means for detecting a physical quantity when the treatment energy is supplied to the tissue side via an electrode of a surgical instrument;
Threshold setting means for setting a first threshold based on a predetermined amount of change in the detection result of the detection means;
Comparison means for comparing the detection result of the detection means with the first threshold;
A threshold value changing means for changing the threshold value of the comparison means to a second threshold value based on a change in the result of the comparison means due to a detection result of the detection means exceeding the first threshold value;
Output control means for controlling variable output of the variable means based on the comparison result of the comparison means;
Therefore, even when the contact area between the electrode and tissue is small, depending on the result detected by the detection means, it can be changed to an appropriate output suitable for the treatment in that case to prevent overcoagulation and insufficient coagulation. it can.
[Brief description of the drawings]
FIG. 1 is a configuration diagram showing a configuration of a high-frequency cautery apparatus according to a first embodiment of the present invention.
FIG. 2 is a block diagram showing a configuration of a high-frequency ablation power supply device.
FIG. 3 is an enlarged view showing a state in which treatment is performed on a tissue in the case where the electrode of FIG. 2 is a forcecept and in the case of a forceps.
FIG. 4 is a flowchart showing the control action of the control circuit of FIG. 2;
FIG. 5 is an explanatory diagram showing a state of temporal change when processing is performed under output control.
FIG. 6 is a flowchart showing a part of a control operation in the second embodiment of the present invention.
FIG. 7 is a diagram showing changes in power and current in the case of Forces in the third embodiment of the present invention.
FIG. 8 is a diagram showing a state of power change in the case of Forces in the fourth embodiment of the present invention.
FIG. 9 is a flowchart showing a control operation in the fifth embodiment of the present invention.
FIG. 10 is an explanatory diagram showing a temporal change in output in the case of the control operation according to FIG. 9;
FIG. 11 is a view showing a forceps in which an energization portion is insulation-coated.
FIG. 12 is a flowchart showing a part of the control operation in the sixth embodiment of the present invention.
[Explanation of symbols]
1 ... induction cautery
2 ... Power supply
3 ... Electrode
3A ... Forcept
3B ... Forceps
4. Connection cable
5 ... Connector part
6 ... Bed
7 ... Patient
8 ... Foot switch
11 ... DC power supply circuit
12 ... High frequency generation circuit
13 ... Waveform generation circuit
14 ... Output transformer
15a, 16b ... current sensor
16 ... A / D conversion circuit
17 ... Control circuit
18 ... Living tissue
19a, 19b ... energization part

Claims (1)

In an electrosurgical apparatus capable of supplying treatment energy to a connected surgical tool having a different treatment electrode area,
And treatment for the energy generating means for supplying a treatment for energy to the surgical tool,
Output varying means for varying the output of the treatment energy generating means;
An output current detecting means for detecting a current when said treatment for energy is delivered to the tissue side through the electrodes of the surgical instrument,
And impedance detection means for detecting the impedance between the electrodes of when said pair of electrodes across the tissue when the medical treatment energy through a pair of electrodes of the surgical instrument is supplied to the tissue side,
Based on a comparison result between the minimum impedance value between the electrodes detected by the impedance detection means and the first threshold value, an area in contact with the tissue when the pair of electrodes in the connected surgical tool sandwich the tissue is Contact area determining means for determining whether or not the value is smaller than a predetermined value;
In the case where the contact area with the tissue when the pair of electrodes sandwich the tissue is smaller than a predetermined value based on the determination result of the contact area determination unit, the electrode further detected by the impedance detection unit Based on the comparison result of the minimum impedance value between the second threshold value and the second threshold value different from the first threshold value, or based on the detection result of the time change of the output current value detected by the output current detection means Surgical instrument discrimination means for discriminating the type of surgical instrument connected to the electrosurgical device;
Output current limit threshold setting means for setting a limit threshold for output current from the treatment energy generating means;
Output control means for controlling the output variable means or the output current limiting threshold setting means;
With
The output control means includes
According to the discrimination results of the contact area discriminating means and the surgical instrument discriminating means, the connected surgical instrument is a surgical instrument of a type having a relatively large treatment electrode area, and the electrode and the tissue contact when the tissue is sandwiched When it is determined that the area is smaller than the predetermined value, the output current limiting threshold setting unit is controlled to set the output current limiting threshold to the first current limiting threshold, and the output current is When the first current limiting threshold or less is reached, the output variable means is controlled to reduce the output power,
When it is determined that the connected surgical instrument is a surgical instrument having a relatively small treatment electrode area based on the determination results of the contact area determining unit and the surgical instrument determining unit, the output current limiting threshold value The setting means is controlled to set the output current limiting threshold to the second current limiting threshold, and when the output current becomes equal to or less than the second current limiting threshold, the output variable means is controlled. And reducing the output power to the first power value and controlling the output current limiting threshold setting means to make the output current limiting threshold smaller than the second current limiting threshold. And when the output current falls below the third current limiting threshold, the output variable means is controlled to reduce the output power to a second power value smaller than the first power value. ,
An electrosurgical device.

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