JP4713779B6 - Surgical equipment - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a surgical apparatus having a function of incising and coagulating a living tissue using a high-frequency current.
[0002]
[Prior art]
Conventionally, surgical devices such as electric scalpels and ultrasonic scalpels are used in surgical operations.
[0003]
An electric scalpel performs incision and hemostasis while cauterizing the living tissue due to power concentration generated at the tip of the scalpel tip electrode when a high-frequency current is passed through the living body placed between the scalpel tip electrode and the counter electrode plate. There is an advantage that surgery with a small amount of bleeding can be performed.
[0004]
Some electric scalpels used in recent years can selectively use a high-frequency incision current mainly used for incising a tissue and a high-frequency coagulation current mainly used for tissue coagulation. In such a device, generally, a high-frequency current having a pure sine wave waveform is used as the high-frequency cutting current, and a high-frequency current having a damped sine wave waveform is used as the high-frequency coagulation current.
[0005]
On the other hand, the ultrasonic scalpel is intended to crush biological tissue by ultrasonic vibration supplied to the scalpel tip (horn), for example, leave a highly elastic blood vessel, crush the surrounding biological tissue, There is an advantage that tissue can be selectively disrupted.
[0006]
Some ultrasonic scalpels have a function of performing a treatment on a surgical site with ultrasonic waves and simultaneously sucking blood vessels or foreign substances in the surgical site. Such an ultrasonic scalpel is configured to crush the surgical site by ultrasonic vibration generated at the tip of the scalpel and to constantly suck blood, foreign matter, and the like at the surgical site from a suction port provided at the tip of the scalpel. .
[0007]
In recent years, a surgical apparatus that is configured to supply both high-frequency current and ultrasonic vibration to one scalpel tip and thereby has both functions of an electric scalpel and an ultrasonic scalpel has been used.
[0008]
[Problems to be solved by the invention]
However, in the conventional surgical apparatus, the operation of adjusting the output of the high-frequency current and the output of the ultrasonic vibration has to be performed separately for each output, which requires a complicated operation.
[0009]
This invention is made | formed in view of the above point, and it aims at providing the apparatus for operation which can perform operation simply and safely.
[0010]
[Means for Solving the Problems]
Such an object is achieved by the present inventions (1) to ( 5 ) below.
[0011]
(1) an electrode part;
A handpiece to which the electrode portion is attached;
High-frequency current supply means for supplying a high-frequency current to the electrode part;
Ultrasonic vibration supply means for supplying ultrasonic vibration to the electrode part;
A first adjusting means for adjusting a ratio between the output of the high-frequency current and the output of the ultrasonic vibration;
Holding means for maintaining a constant ratio between the output of the high-frequency current adjusted by the first adjusting means and the output of the ultrasonic vibration;
Second adjusting means for adjusting the magnitude of the output of the high-frequency current and the output of the ultrasonic vibration in a state where the ratio of the output of the high-frequency current and the output of the ultrasonic vibration is kept constant by the holding means. surgical apparatus characterized by having and.
[0014]
( 2 ) The surgical apparatus according to ( 1 ), wherein the second adjustment unit is configured to continuously adjust the output of the high-frequency current and the output of the ultrasonic vibration.
[0015]
( 3 ) The high-frequency current supply means is configured to supply a high-frequency incision current and a high-frequency coagulation current, and the ultrasonic vibration supply means can supply the ultrasonic vibration during incision and the ultrasonic vibration during coagulation. The surgical device according to (1) or (2) , configured as described above.
[0016]
( 4 ) The first adjusting means can adjust a ratio between the output of the high-frequency incision current and the output of the ultrasonic vibration at the time of incision, and the ratio between the output of the high-frequency coagulation current and the output of the ultrasonic vibration at the time of coagulation. The surgical apparatus according to ( 3 ), wherein the surgical apparatus is configured to be adjustable.
[0017]
( 5 ) The second adjusting means can adjust the magnitude of the output of the high-frequency incision current and the output of the ultrasonic vibration during incision, and the magnitude of the output of the high-frequency coagulation current and the output of the ultrasonic vibration during coagulation. The surgical device according to ( 3 ) or ( 4 ), wherein the surgical device is configured to be adjustable.
[0018]
Other objects, operations and effects of the present invention will become more apparent from the following description of embodiments with reference to the drawings.
[0019]
DETAILED DESCRIPTION OF THE INVENTION
DESCRIPTION OF EXEMPLARY EMBODIMENTS Hereinafter, preferred embodiments of a surgical apparatus of the invention will be described with reference to the accompanying drawings.
[0020]
FIG. 1 is a block diagram showing the overall configuration of the surgical apparatus of the present invention. FIG. 2 is a cross-sectional view showing the configuration of the handpiece according to the surgical apparatus of the present invention. FIG. 3 is a timing chart of operations of the high-frequency current generator, the ultrasonic vibration generator, the suction device, and the cleaning water supply device during the incision mode of the surgical device according to the present invention. FIG. 4 is a timing chart of operations of the high-frequency current generator, the ultrasonic vibration generator, the suction device, and the cleaning water supply device during the coagulation mode of the surgical device according to the present invention. FIG. 5 is a timing chart of operations of the high-frequency current generator, the ultrasonic vibration generator, the suction device, and the cleaning water supply device in the ultrasonic output mode of the surgical device of the present invention. FIG. 6 is a front view showing an adjustment panel provided in the control device of the surgical apparatus of the present invention. In the present embodiment, the left side in FIG. 2 is described as the “front end”, and the right side is described as the “rear end”.
[0021]
As shown in FIG. 1, the surgical device of the present invention includes a handpiece 2, a high-frequency current generator 3 as a high-frequency current supply means for supplying a high-frequency current to the handpiece 2, and an ultrasonic vibration in the handpiece 2. An ultrasonic vibration generating device (ultrasonic oscillator) 4 as an ultrasonic vibration supply means for supplying the liquid, a cleaning water supply device 5 for supplying cleaning water to the vicinity of the surgical site, and suction for sucking liquid and particles in the vicinity of the surgical site A suction device 6 as means, a control device 7 as control means for controlling these devices, a hand switch 25 connected to the control device 7, an adjustment panel 71, and a foot switch 8 are provided.
[0022]
Hereinafter, the configuration of each element will be described in detail.
As shown in FIG. 2, the handpiece 2 includes a surgical unit 21 and a casing 24 that houses the surgical unit 21.
[0023]
The surgical unit 21 includes an electrode unit 22 and an ultrasonic transducer 23 that is connected to the electrode unit 22 and supplies ultrasonic vibration to the electrode unit 22.
[0024]
The electrode portion 22 is made of a material having resistance to ultrasonic vibration such as titanium alloy and stainless steel, and functions as a knife tip of an electric knife, that is, an electrode, and a knife tip of an ultrasonic knife, that is, an ultrasonic horn. It is comprised so that it may have a function together. Moreover, this electrode part 22 is connected with the high frequency current generator 3 by conducting wire (not shown in FIG. 2). In addition, the electrode portion 22 is formed of a hollow tube, and a suction hole 221 for sucking a liquid such as blood or a foreign substance near the surgical site is provided therein.
[0025]
The suction hole 221 penetrates from the front end of the electrode portion 22 toward the rear end, and is connected to the suction device 6 shown in FIG. 1 via a flow path 231 described later on the rear end side.
[0026]
The ultrasonic transducer 23 is, for example, a bolt-tight ultrasonic transducer, and includes a plurality of piezoelectric elements, electrodes, metal blocks positioned on both sides thereof.
[0027]
The electrode portion 22 is fixed to the tip portion of the ultrasonic transducer 23, and the vibration of the ultrasonic transducer 23 is transmitted to the electrode portion 22. Further, on the central axis of the ultrasonic transducer 23, a flow path 231 is provided for sending liquid and foreign matter sucked from the suction hole 221 of the electrode portion 22 to the suction device 6. Further, the ultrasonic transducer 23 is connected to the ultrasonic vibration generator 4 by a lead wire (not shown).
[0028]
As shown in FIG. 2, the casing 24 mainly includes a casing main body 241, and a front end side cap 242 and a rear end side cap 244 located on the front end side and the rear end side of the casing main body 241.
[0029]
The casing body 241 is formed of a resin material in a substantially cylindrical shape, and the surgical unit 21 is accommodated therein. The casing body 241 is provided with a hand switch 25.
[0030]
As shown in FIG. 2, the hand switch 25 is provided on the side portion on the distal end side of the casing body 241.
[0031]
In addition, the hand switch 25 is provided with an incision mode switch 251, a coagulation mode switch 252 and an ultrasonic output mode switch 253. When the incision mode switch 251 is pressed, an incision mode, that is, a high frequency current and an ultrasonic wave are provided. When a mode for mainly incising or crushing a living tissue using vibration is selected and the coagulation mode switch 252 is pressed, the blood coagulation mode, that is, mainly using blood and ultrasonic vibration, A mode for coagulating a living tissue is selected. In addition, when the ultrasonic output mode switch 253 is pressed, a mode in which the tissue is crushed and sucked only by ultrasonic vibration is selected. Note that one of the incision mode switch 251, the coagulation mode switch 252, and the ultrasonic output mode switch 253 is selected. Each of these switches is connected to the control device 7 by a conductive wire (not shown in FIG. 2).
[0032]
The foot switch 8 (see FIG. 1) connected to the control device 7 also has functions equivalent to the incision mode switch 251, the coagulation mode switch 252, and the ultrasonic output mode switch 253 provided in the hand switch 25. There are different types of switches.
[0033]
When the switches of the same mode of the foot switch 8 and the hand switch 25 are simultaneously pressed, for example, the incision mode switch provided in the foot switch 8 and the incision mode switch 251 provided in the hand switch 25 are simultaneously pressed. In such a case, the operation of any switch is configured to be effective.
[0034]
On the other hand, when the different switches of the foot switch 8 and the hand switch 25 are simultaneously pressed, for example, when the incision mode switch 251 of the hand switch 25 and the coagulation mode switch of the foot switch 8 are pressed simultaneously. Is configured such that the operation of the hand switch 25 is valid and the operation of the foot switch 8 is invalid. However, the present invention is not limited to this, and in this case, the operation of the hand switch 25 may be invalidated and the operation of the foot switch 8 may be validated.
[0035]
The casing main body 241 is provided with a cleaning water supply pipe 26 that is disposed along the outer peripheral surface of the casing main body 241 and supplies cleaning water to the tip of the electrode portion 22. The rear end side of the cleaning water supply pipe 26 is connected to the cleaning water supply device 5 shown in FIG.
[0036]
The cleaning water supply device 5 is configured to be able to change the supply amount of cleaning water according to the type or condition of the high-frequency current supplied to the electrode unit 22 under the control of the control means 7.
[0037]
As shown in FIG. 2, the distal end side cap 242 is provided so as to cover the outer periphery of the electrode portion 22. The distal end side cap 242 is provided with a connection portion 243 to which the distal end portion of the cleaning water supply pipe 26 is connected. Further, a cleaning water supply path 27 is formed between the distal end side cap 242 and the electrode portion 22. Then, the cleaning water supplied from the cleaning water supply pipe 26 is supplied to the tip end portion of the electrode portion 22 through the cleaning water supply path 27.
[0038]
The high-frequency current generator 3 is connected to the electrode part 22 of the handpiece 2 and is configured to selectively supply a high-frequency incision current and a high-frequency coagulation current to the electrode part 22. Here, the high-frequency incision current is a high-frequency current whose waveform is expressed by a pure sine wave, and is preferably used when performing tissue incision or crushing. The high-frequency coagulation current is a high-frequency current whose waveform is expressed by a damped sine wave, and is preferably used for tissue coagulation.
[0039]
The ultrasonic vibration generator 4 is connected to the ultrasonic vibrator 23 of the handpiece 2, and the ultrasonic vibration during incision and the high frequency used suitably when the high frequency incision current is supplied from the high frequency current generator 3. It is configured to selectively supply ultrasonic vibration during coagulation that is preferably used when a coagulation current is supplied and ultrasonic vibration that is preferably used when tissue is crushed only by ultrasonic output. Yes. Here, the ultrasonic vibration at the time of incision, the ultrasonic vibration at the time of coagulation, and the ultrasonic vibration can be, for example, ultrasonic vibrations of three types having different amplitudes. Moreover, it is preferable that the vibration speed of the tip of the electrode portion 22 when applying ultrasonic vibration during incision and ultrasonic vibration during coagulation is 220 [cm / s] to 2200 [cm / s]. The ultrasonic vibration supply means in the present invention includes the ultrasonic vibration generator 4 and the ultrasonic vibrator 23.
[0040]
The suction device 6 is connected to a suction hole 221 provided in the electrode unit 22, and liquid and foreign matter near the surgical site are sucked from the tip of the electrode unit 22 by suction of the suction device 6.
[0041]
The control device 7 normally includes a microcomputer (CPU), and performs overall control of the high-frequency current generator 3, the ultrasonic vibration generator 4, the cleaning water supply device 5, and the suction device 6. The control means in the present invention includes a control device 7, a hand switch 25 connected to the control device 7, a foot switch 8, and an adjustment panel 71 described later.
[0042]
Hereinafter, the operation of the surgical apparatus of the present invention will be described.
When the incision mode switch 251 of the hand switch 25 (or the foot switch 8) is pressed, the incision mode is selected, and the control device 7 controls the high-frequency current as shown in the time chart of FIG. The generator 3 and the ultrasonic vibration generator 4 output a high-frequency incision current and an ultrasonic vibration during incision, respectively. Further, the cleaning water supply device 5 supplies cleaning water in synchronization with these outputs. At this time, the suction by the suction device 6 is always performed regardless of whether or not the incision mode switch 251 is pressed. Further, the supply amount of the cleaning water in this case is set independently of an ultrasonic output mode to be described later. In this embodiment, a smaller amount of cleaning water is supplied to the tip of the electrode unit 22 than in the ultrasonic output mode. It has come to be supplied.
[0043]
When the incision mode switch 251 is released from this state, the incision mode is released. As shown in FIG. 3, the control device 7 controls the output of the high-frequency incision current, the ultrasonic vibration during incision, and the washing water. Supply is stopped.
[0044]
Further, when the coagulation mode switch 252 of the hand switch 25 (or foot switch 8) is pressed, the coagulation mode is selected, and as shown in the time chart of FIG. The high-frequency current generator 3 and the ultrasonic vibration generator 4 output a high-frequency coagulation current and a coagulation ultrasonic vibration, respectively. Further, the suction device 6 stops the suction that has been performed so far in synchronization with these outputs. When this coagulation mode is selected, the cleaning water supply device 5 always stops supplying cleaning water regardless of whether the incision mode switch 251 is pressed.
[0045]
When the pressing of the coagulation mode switch 252 is released from this state, the coagulation mode is released, and the output of the high-frequency coagulation current and the ultrasonic vibration during coagulation is stopped by the control of the control device 7 as shown in FIG. The Further, the suction by the suction device 6 is resumed.
[0046]
Further, when the ultrasonic output mode switch 253 of the hand switch 25 (or the foot switch 8) is pressed, the ultrasonic output mode is selected and is shown in the time chart of FIG. As shown, the ultrasonic vibration generator 4 outputs ultrasonic vibration. Further, the cleaning water supply device 5 supplies cleaning water in synchronization with these outputs. At this time, suction by the suction device 6 is always performed regardless of whether or not the ultrasonic output mode switch 253 is pressed. Further, the supply amount of the cleaning water in this case is set independently of the incision mode, and in this embodiment, a larger amount of cleaning water is supplied to the tip of the electrode unit 22 than in the incision mode. It is like that.
[0047]
When the ultrasonic output mode switch 253 is released from this state, the ultrasonic output mode is released, and as shown in FIG. 5, the output of ultrasonic vibration and the supply of cleaning water are controlled by the control device 7. And is stopped.
[0048]
Thus, in this embodiment, according to each output of the high-frequency incision current and the high-frequency coagulation current from the high-frequency current generator 3, suitable ultrasonic vibration during incision and ultrasonic vibration during coagulation are supplied to each output. It is configured as follows. Therefore, when the type of the high-frequency current is switched, there is no need to perform the switching operation of the ultrasonic vibration according to the type of the current, and the high-frequency current and the ultrasonic vibration can be changed by one operation with the hand switch 25 or the foot switch 8. Both modes can be easily switched.
[0049]
Further, in the present embodiment, when the coagulation mode, that is, the mode for coagulating blood or biological tissue using a high-frequency coagulation current is selected, the suction by the suction device 6 is stopped. Therefore, coagulation is completed without sucking and removing the coagulated tissue.
[0050]
Moreover, in this embodiment, when the coagulation mode is selected, the supply of cleaning water by the cleaning water supply device 5 is stopped.
[0051]
Therefore, when the high-frequency coagulation current is supplied, the coagulation function of the high-frequency coagulation current is not impaired due to the decrease in the current density caused by the cleaning water.
[0052]
In addition to the embodiment described above, when the coagulation mode is selected, the cleaning water having a flow rate set separately from the incision mode and the ultrasonic output mode is supplied to the tip of the electrode unit 22. Is also possible. In that case, carbonization of the coagulation site can be suppressed by supplying cleaning water to such an extent that the coagulation function of the high-frequency coagulation current is not significantly reduced. Further, by supplying cleaning water, tissue adhesion to the distal end portion of the electrode portion 22 can be suppressed.
[0053]
Further, by performing suction during the coagulation mode, coagulation can be performed while the tissue is crushed and removed.
[0054]
Now, in the surgical apparatus of the present embodiment, the adjustment panel 71 provided in the control device 7 has a ratio of the output of the high-frequency current and the output of the ultrasonic vibration that is output when the incision mode and the coagulation mode are selected. It is configured to be adjustable by.
[0055]
Hereinafter, the configuration will be described.
As shown in FIG. 6, the adjustment panel 71 has a substantially cylindrical shape, and includes an output ratio adjustment knob 72 and an output adjustment knob 73 that are rotated by an operator's hand.
[0056]
The output ratio adjustment knob 72 functions as a “first adjustment means” for adjusting the ratio between the output magnitude of the high-frequency current and the output magnitude of the ultrasonic vibration, and the output adjusted by the output ratio adjustment knob 72. It functions as a “holding means” that holds the ratio.
[0057]
Around the output ratio adjustment knob 72, the value of the ratio between the output power from the high-frequency current generator and the output power from the ultrasonic vibration generator expressed by the following equation (1) is graduated.
Output ratio = output of high-frequency current [W] / output of ultrasonic vibration [W] (1)
[0058]
Then, by rotating the output ratio adjustment knob 72, the output ratio control device interlocked with the rotating shaft of the output ratio adjustment knob 72 is operated, and the ratio between the output of the high frequency current and the output of the ultrasonic vibration is adjusted. can do. When the output ratio of the output ratio adjustment knob 72 is set to 0, only ultrasonic vibration is output, and when set to ∞ (infinity), only high-frequency current is output. Yes.
[0059]
Further, the output ratio adjustment knob 72 is configured to hold the position at the time when the rotation is stopped, and thereby to hold the value of the output ratio at that position.
[0060]
On the other hand, the output adjustment knob 73 serves as “second adjustment means” that simultaneously adjusts the magnitude of the output of the high-frequency current and the output of the ultrasonic vibration while maintaining the output ratio adjusted by the output ratio adjustment knob 72. It has the function of
[0061]
That is, in this embodiment, the output of ultrasonic vibration as an absolute output (reference output) is graduated around the output adjustment knob 73. Then, by rotating the output adjustment knob 73, the output control device interlocked with the rotation shaft of the output adjustment knob 73 is operated, and the high frequency current is maintained while the output ratio adjusted by the output ratio adjustment knob 72 is maintained. And the output of ultrasonic vibration are both adjusted. In this embodiment, the output is adjusted based on the output of the ultrasonic vibration. However, the configuration is not limited to this, and the output is adjusted based on the output of the high-frequency current, or the output of the high-frequency current and the ultrasonic vibration. It is good also as a structure which adjusts an output on the basis of the total output with this output.
[0062]
In the present embodiment, the output ratio and the output magnitude can be adjusted steplessly (continuously) by the rotation of each knob, so that fine adjustment of each output can be easily performed. it can. However, the present invention is not limited to this embodiment, and a configuration that adjusts each output stepwise or a configuration that has a display unit such as a liquid crystal panel and adjusts the output by inputting numerical values to the display unit may be used. good.
[0063]
In the present embodiment, the output of the high frequency current and the output of the ultrasonic vibration are adjusted by the output ratio adjustment knob 72 and the output adjustment knob 73, but in addition to these two adjustment knobs. It is preferable to provide adjusting means such as a switch that can adjust the output of the high-frequency current and the output of the ultrasonic vibration.
[0064]
When such an adjustment means is provided, the control device 7 is configured to calculate the output ratio based on the value of each output adjusted by the adjustment means, and the output ratio based on the calculated output ratio. It is preferable that the adjustment knob 72 and the output adjustment knob 73 are rotationally displaced to predetermined positions.
[0065]
Since one adjustment panel 71 is provided for each of the incision mode and the coagulation mode, an appropriate output ratio can be set for each mode, and treatment is performed with an output of an appropriate size. be able to. However, the present invention is not limited to this embodiment, and one adjustment panel can be shared in the incision mode and the coagulation mode.
[0066]
In the present embodiment, the output ratio is determined from the output power from the high-frequency current generator and the output power from the ultrasonic vibration generator 4, but in addition to the output power used in the present embodiment, It is also possible to determine the output ratio based on the output current or output voltage from the high-frequency current generator 3, the output voltage from the ultrasonic vibration generator 4, the vibration amplitude of ultrasonic vibration at the tip of the electrode portion 22, or the like. .
[0067]
Finally, the present invention is not limited to the above-described embodiments, and it goes without saying that various modifications and improvements can be made within the scope described in the claims.
[0068]
【Effect of the invention】
As described above, the surgical device of the present invention is configured to be able to adjust each output from the ratio between the output of the high-frequency current and the output of the ultrasonic vibration. For this reason, when adjusting each output, it is not necessary to perform the adjusting operation separately for each output, so that the operation at the time of surgery can be performed simply and safely.
[0069]
Further, when both the outputs can be adjusted while maintaining the ratio between the output of the high-frequency current and the output of the ultrasonic vibration, it is possible to always adjust both outputs with an appropriate output ratio.
[Brief description of the drawings]
FIG. 1 is a block diagram showing an overall configuration of a surgical apparatus according to the present invention.
FIG. 2 is a cross-sectional view showing a configuration of a handpiece according to the surgical apparatus of the present invention.
FIG. 3 is a timing chart of operations of the high-frequency current generator, the ultrasonic vibration generator, the suction device, and the cleaning water supply device during the incision mode of the surgical device according to the present invention.
FIG. 4 is a timing chart of operations of the high-frequency current generator, the ultrasonic vibration generator, the suction device, and the cleaning water supply device in the coagulation mode of the surgical device according to the present invention.
FIG. 5 is a timing chart of operations of the high-frequency current generator, the ultrasonic vibration generator, the suction device, and the cleaning water supply device in the ultrasonic output mode of the surgical device of the present invention.
FIG. 6 is a front view showing an adjustment panel provided in the control device of the surgical apparatus of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Surgical apparatus 2 Handpiece 21 Surgical unit 22 Electrode part 221 Suction hole 23 Ultrasonic vibrator 231 Flow path 24 Casing 241 Casing body 242 Front end side cap 243 Connection part 244 Rear end side cap 25 Hand switch 251 Incision mode switch 252 Coagulation Mode switch 253 Ultrasonic output mode switch 26 Washing water supply pipe 27 Washing water supply path 3 High frequency current generator 4 Ultrasonic vibration generator 5 Washing water supply device 6 Suction device 7 Controller 71 Control panel 72 Output ratio adjustment knob 73 Output Adjustment knob 8 Foot switch

Claims (5)

An electrode part;
A handpiece to which the electrode portion is attached;
High-frequency current supply means for supplying a high-frequency current to the electrode part;
Ultrasonic vibration supply means for supplying ultrasonic vibration to the electrode part;
A first adjusting means for adjusting a ratio between the output of the high-frequency current and the output of the ultrasonic vibration;
Holding means for maintaining a constant ratio between the output of the high-frequency current adjusted by the first adjusting means and the output of the ultrasonic vibration;
Second adjusting means for adjusting the magnitude of the output of the high-frequency current and the output of the ultrasonic vibration in a state where the ratio of the output of the high-frequency current and the output of the ultrasonic vibration is kept constant by the holding means. surgical apparatus characterized by having and. The surgical apparatus according to claim 1 , wherein the second adjustment means is configured to adjust the output of the high-frequency current and the output of the ultrasonic vibration steplessly. The high-frequency current supply means is configured to supply a high-frequency incision current and a high-frequency coagulation current, and the ultrasonic vibration supply means is configured to supply an incision ultrasonic vibration and a coagulation ultrasonic vibration. The surgical apparatus according to claim 1 or 2 . The first adjusting means can adjust the ratio between the output of the high-frequency incision current and the output of the ultrasonic vibration during incision, and can adjust the ratio between the output of the high-frequency coagulation current and the output of the ultrasonic vibration during coagulation. The surgical device according to claim 3 configured as described above. The second adjusting means can adjust the magnitude of the output of the high-frequency incision current and the output of the ultrasonic vibration during incision, and can adjust the magnitude of the output of the high-frequency coagulation current and the output of the ultrasonic vibration during coagulation. The surgical device according to claim 3 or 4 , which is configured as described above.

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