JP5711656B2 - 電気外科システム - Google Patents
電気外科システム Download PDFInfo
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- JP5711656B2 JP5711656B2 JP2011502143A JP2011502143A JP5711656B2 JP 5711656 B2 JP5711656 B2 JP 5711656B2 JP 2011502143 A JP2011502143 A JP 2011502143A JP 2011502143 A JP2011502143 A JP 2011502143A JP 5711656 B2 JP5711656 B2 JP 5711656B2
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- jaw
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- tissue
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Description
本出願は、現在特許出願中である2008年3月31日出願の「高周波電気エネルギで生物組織を融合するフィードバック制御機構」という名称の米国特許仮出願出願番号第61/040,980号、現在現在特許出願中である2008年3月31日出願の「高周波電気エネルギによる生物組織の融合」という名称の米国特許仮出願出願番号第61/040,994号、現在現在特許出願中である2008年3月31日出願の「無血組織解剖の方法及び装置」という名称の米国特許仮出願出願番号第61/040,957号、現在現在特許出願中である2008年3月31日出願の「腹腔鏡検査バイポーラ電気計測器」という名称の米国特許仮出願出願番号第61/040,828号、現在現在特許出願中である2008年3月31日出願の「生きた組織の融合の装置及び方法」という名称の米国特許仮出願出願番号第61/040、890号、現在現在特許出願中である2008年3月31日出願の「高周波電気エネルギによる生物組織の溶着」という名称の米国特許仮出願出願番号第61/041,045号、現在現在特許出願中である2008年3月31日出願の「高周波電気エネルギで生物組織を融合する電気制御回路」という名称の米国特許仮出願出願番号第61/041,012号、及び現在現在特許出願中である2008年11月18日出願の「電気外科的組織解剖の方法及び装置」という名称の米国特許仮出願出願番号第61/115,756号の恩典を請求するものである。これらの出願の全ては、その全体が引用により本明細書に組み込まれている。
図1Aは、電気外科システム2の概略図を示している。電気外科システム2は、電気外科ユニット(ESU)10及び電気外科ツール40を含むことができる。電気外科ツール40は、電気外科ユニット10に電気的に結合することができる。一部の実施形態では、電気ワイヤ、ワイヤバンドル、又はケーブルのような電子結合器30は、ESU10に電気外科ツール40を電気的に結合することができる。一部の実施形態では、電気外科システム2は、外部ツールコントローラ80を任意的に更に含むことができる。
図3A〜図3Cを参照すると、電気外科ユニット410は、斜視図、正面図、及び後面図に示されている。電気外科ユニット410は、図1Aに関して上述したように一体型ESUとすることができ、かつ発生器及びフィードバック回路を含むことができる。一部の実施形態では、電気外科ユニット410のハウジング又はコンソールは、標準的な手術室カート又は保管棚上に収まるようにサイズ決定及び構成することができる。一部の実施形態では、電気外科ユニット410のハウジング又はコンソールは、他の外科電気機器と積み重ね可能であるように構成することができる。
電気外科ユニット
一般的に、電気外科発生器、電気外科コントローラ、及び1つ又はそれよりも多くの電気外科ツールを含む電気外科ユニットが提供される。コントローラは、ツールがコントローラに取り付けられた発生器内に組み込むか、又はそれに取り付けることができる。
様々な実施形態における電気外科システム及び処理は、手術中に患者に単極又は双極高周波電気エネルギを印加する。このようなシステム及び処理は、特に、空間的に限定されたアクセス及び呼出し及び可視性のために簡単な取り扱いを必要とする腹腔鏡検査で内視鏡手術に適合され、血管を融合して他の生物組織を結合するために、一態様では、組織/血管を切断、切開、及び分離するのに使用される。ある一定の実施形態では、システム及び処理は、(a)組織を乾燥させ、かつ(b)殆どの生物組織内に豊富にあるコラーゲン(タイプI−III)及び他のタンパク質を変性するために機械的に圧迫された組織へのRFエネルギの印加を含む。適切な温度へのコラーゲンの加熱によりコラーゲンが拡張するか、収縮するか、又は変性するので、システムは、血管の永久的な閉塞に向けて手術中の毛細管及び血管の密封を可能にする。以下でより詳細に説明するように、一例として、最大7ミリメートルまでの動脈は、高周波(RF)エネルギ及び機械的圧力により閉塞させ、かつ切開することができる。
一態様では、融合処理の終点の判断は、融合処理中に電圧及び電流の位相シフトをモニタすることによって行われる。インピーダンスとは異なり、位相シフトは、動脈が乾燥して融合が完了する時の方が変化が顕著になり、それゆえに、インピーダンスより影響を受けやすい制御値になる。これは、融合処理の開始に対して図23に示すように、電圧及び電流を異なる融合時間の時間の関数としてモニタする時に見出される。
一実施形態では、ツールキャパシタンス及びツール抵抗の測定及び説明は、一貫した初期組織評価(導電率及び誘電率)に向けて行われ、それによって処理(すなわち、凝固、融合又は溶着)の組織特異的終点が得られる。本発明の別の態様では、ツールキャパシタンス及びツール抵抗の測定及び説明は、一貫した組織フィードバック測定(位相シフト)に向けて行われ、それによって一貫した組織変容結果(すなわち、凝固、融合又は溶着)が保証される。
先に全体的に説明し、かつ以下でより詳細に説明するように、様々な手持ち式電気外科ツールは、本明細書で説明する電気外科システムにおいて使用することができる。例えば、電気外科把持器、はさみ、ピンセット、探触子、ニードル、及び本明細書で説明する一態様、一部、又は全てを組み込む他の器具は、電気外科システムにおいて様々な利点を有することができる。様々な実施形態電気外科ツールを以下で説明する。以下で全体的に説明する機能の1つ、一部、又は全ては以下で説明するツールの実施形態のいずれかに含めることができるように考えられている。例えば、以下で説明するツールの各々が上述のようにフィードバック回路との対話のためにメモリを含むことは望ましいとすることができる。しかし、他の実施形態では、以下で説明するツールは、ツールメモリの対話なしで標準双極電源と対話するように構成することができる。しかし、更に、これらの実施形態の特定的な態様は、本出願の範囲の他の電気外科ツールの特定的な態様と組み合わせることができるように考えられている。これらの電気外科ツールの特定的な態様を本明細書で全体的に及び以下でより詳細に様々な実施形態に関して説明する。
図41A〜図41Bを参照すると、手持ち式腹腔鏡検査密封器/分割器又は融合ツール1100の一実施形態が示されている。図示の実施形態では、密封器/分割器は、ハンドルアセンブリ1110、ハンドルアセンブリ1110から延びる細長シャフト1120、及びハンドルアセンブリ1110の反対側の細長シャフト1120上に位置決めされた顎アセンブリ1130を含む。細長シャフト1120は、間に中心縦軸を形成する近位端及び遠位端を有する。図示の実施形態では、ハンドルアセンブリ1110は、ピストル把持方式のハンドルを含む。細長シャフト1120及び顎アセンブリ1130は、一実施形態では、5mmの直径トロカールカニューレ又はアクセスポートを通じて適合するようにサイズ決定及び成形されている。他の実施形態では、細長シャフト及び顎アセンブリは、他の規格又は非標準サイズを有するトロカールカニューレ又はアクセスポートを通じて適合するようにサイズ決定及び構成することができる。図41Aでは、ハンドルアセンブリ1110は、顎が開いている第1の又は初期位置に示されている。
腹腔鏡検査外科的処置では、一般的に結合組織又は脈管組織の切開が必要である。組織タイプ、サイズ、位置、及び特定の組織の条件のようなファクタに依存して、異なるツール及び技術を用いて特定の処置を行うことができる。個々のツールの選択は、機能性と共に、選択したツールでは周囲の組織の損傷が比較的小さいという希望に基づくことができる。一例として、結合組織の切開は、通常機械式切断又は電気外科切断により行われ、一方、脈管組織の切開は、一般的に、ステープラ又はクリップ、次に機械式切断を使用する結紮技術に依存する。その結果として、結合組織及び繊管束組織の両方の切開を含む一般的な腹腔鏡検査処置では、手術部位に至るトロカールアクセスポートを通じて連続して交換される複数のツールが必要である。このツール交換により、外科的処置の経費及び時間が増大する。従って、腹腔鏡検査処置中にツール交換回数を大幅に低減することができる多機能ツールを提供することが望ましい。
従来、生体組織の接続又再接続は、縫合糸、クリップ、又はステープルの使用を伴っている。つい最近では、電気又は熱の使用が、生体組織の接続を完了するか、又は漏れ又は出血のために接続した組織を密封するのに利用されるようになっている。
10 電気外科ユニット(ESU)
30 電子結合器
40 電気外科ツール
80 外部ツールコントローラ
Claims (16)
- 電気外科ツールであって、
第1の顎と、
前記第1の顎に対してピボット回転可能な第2の顎と、
前記第1の顎上に位置決めされた第1の電極,前記第1の顎上に位置決めされた第2の電極,及び,前記第1の顎上に位置決めされた第3の電極,を含む複数の電極と、
前記第1、第2、及び第3の電極の少なくとも1つが、第1の極性を有するように電気的に構成され、該複数の電極の少なくとも1つの他のものが、該第1の極性と一般的に反対の第2の極性を有するように電気的に構成される凝固モードと、該第1、第2、及び第3の電極のうちの1つが、切断電圧を有するように電気的に構成され、該複数の電極の少なくとも1つの他のものが、戻り電極であるように構成されるように選択的に構成される切断モードとの間で切り替えるためのスイッチであって、スイッチの作動によって前記電気外科ツールが前記凝固モードと前記切断モードの間で選択的に構成可能である前記スイッチと、
開放位置と閉鎖位置の間で前記第1の顎及び前記第2の顎を互いに対してピボット回転させるように作動可能なハンドルアセンブリであって、前記ハンドルアセンブリが、前記スイッチを、前記第1の顎及び前記第2の顎を互いに対してピボット回転させる前記ハンドルアセンブリの移動によって作動させる、前記ハンドルアセンブリと、を備え、
前記ハンドルアセンブリは、前記顎を前記開放位置にピボット回転させて、前記スイッチを作動させ、前記顎が前記開放位置にある時に電気外科ツールを前記凝固モードに設定し、且つ、前記ハンドルアセンブリは、前記顎を前記閉鎖位置に向けてピボット回転させて、該顎が前記閉鎖位置に向けて移動される時に前記スイッチを作動させて電気外科ツールを前記切断モードに切り替えるように構成されている
ことを特徴とする電気外科ツール。 - 前記凝固モードにおいて、前記第1の電極は、前記第1の極性を有するように電気的に構成され、前記第2の電極は、前記第2の極性を有するように電気的に構成されることを特徴とする請求項1に記載の電気外科ツール。
- 前記切断モードにおいて、前記第3の電極は、前記切断電圧を有するように電気的に構成され、前記第1及び第2の電極は、戻り電極であるように構成され、
前記第3の電極は、露出面区域を有し、前記第1及び第2の電極は、露出結合面区域を有し、
前記第3の電極の前記露出面区域は、前記第1及び第2の電極の前記露出結合面区域よりも小さい、
ことを特徴とする請求項1に記載の電気外科ツール。 - 前記第1、第2、及び第3の電極を互いから絶縁する1つ又はそれよりも多くの絶縁部材を更に含み、
前記1つ又はそれよりも多くの絶縁部材は、前記第1の電極と前記第3の電極の間で前記第1の顎上に配置された第1の絶縁部材と、該第3の電極と前記第2の電極の間で該第1の顎上に配置された第2の絶縁部材と、を含むことを特徴とする請求項1に記載の電気外科ツール。 - 前記凝固モードにおいて、前記第1の極性と前記第2の極性との間の電位差が、約200Vよりも大きくないことを特徴とする請求項1に記載の電気外科ツール。
- 前記切断モードにおいて、前記切断電圧が、約300Vと約500Vの間であることを特徴とする請求項1に記載の電気外科ツール。
- 前記第2の顎上に位置決めされた第4の電極を更に含むことを特徴とする請求項1に記載の電気外科ツール。
- 前記凝固モードにおいて、前記第1及び第2の電極は、前記第1の極性を有するように電気的に構成され、前記第4の電極は、前記第2の極性を有するように電気的に構成されることを特徴とする請求項7に記載の電気外科ツール。
- 前記切断モードにおいて、前記第3の電極は、前記切断電圧を有するように電気的に構成され、前記第4の電極は、戻り電極として構成されることを特徴とする請求項7に記載の電気外科ツール。
- 前記第2の顎上に位置決めされた第5の電極を更に含み、
前記第3の電極は、前記第1の顎内で、前記第2の顎に面する第1の顎の上面から前記第2の顎と反対側の第1の顎の下面まで延びていることを特徴とする請求項7に記載の電気外科ツール。 - 前記凝固モードにおいて、前記第1及び第2の電極の一方及び前記第4及び第5の電極の一方が、前記第1の極性を有するように電気的に構成され、該第1及び第2の電極の他方及び該第4及び第5の電極の他方が、前記第2の極性を有するように電気的に構成されることを特徴とする請求項10に記載の電気外科ツール。
- 前記切断モードにおいて、前記第3の電極は、前記切断電圧を有するように電気的に構成され、前記第1の電極、前記第2の電極、前記第4の電極、及び前記第5の電極のうちの少なくとも1つが、戻り電極として構成されることを特徴とする請求項10に記載の電気外科ツール。
- 前記第1の顎上に位置決めされた第5の電極を更に含むことを特徴とする請求項7に記載の電気外科ツール。
- 前記第3及び第5の電極は同様の寸法を有し、
前記第3の電極は、前記第1の顎内で、前記第2の顎と面する第1の顎の上面まで延び、前記第5の電極は、前記第1の顎内で、前記第2の顎と反対側の第1の顎の下面まで延びていることを特徴とする請求項13に記載の電気外科ツール。 - 前記第1及び第2の電極は同様の寸法を有し、
前記第1及び第2の電極は、第1の顎の上面と下面との間を延びていることを特徴とする請求項14に記載の電気外科ツール。 - 前記切断モードにおいて、前記第3の電極は前記切断電圧を有するように構成され且つ前記第4の電極は戻り電極であるように構成され、前記第5の電極は前記切断電圧を有するように電気的に別々にかつ独立して構成され且つ前記第1及び第2の電極は戻り電極であるように構成され、前記第1の顎は固定され且つ前記第2の顎は可動であることを特徴とする請求項15に記載の電気外科ツール。
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