JPH02501894A - 外科装置 - Google Patents
外科装置Info
- Publication number
- JPH02501894A JPH02501894A JP63508237A JP50823788A JPH02501894A JP H02501894 A JPH02501894 A JP H02501894A JP 63508237 A JP63508237 A JP 63508237A JP 50823788 A JP50823788 A JP 50823788A JP H02501894 A JPH02501894 A JP H02501894A
- Authority
- JP
- Japan
- Prior art keywords
- tip
- high frequency
- surgical site
- current
- handpiece
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00973—Surgical instruments, devices or methods, e.g. tourniquets pedal-operated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/320069—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for ablating tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/32007—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with suction or vacuum means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00077—Electrical conductivity high, i.e. electrically conducting
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00589—Coagulation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/0091—Handpieces of the surgical instrument or device
- A61B2018/00916—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
- A61B2018/00958—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device for switching between different working modes of the main function
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
-
- H—ELECTRICITY
- H01—ELECTRIC ELEMENTS
- H01H—ELECTRIC SWITCHES; RELAYS; SELECTORS; EMERGENCY PROTECTIVE DEVICES
- H01H2300/00—Orthogonal indexing scheme relating to electric switches, relays, selectors or emergency protective devices covered by H01H
- H01H2300/014—Application surgical instrument
Abstract
(57)【要約】本公報は電子出願前の出願データであるため要約のデータは記録されません。
Description
【発明の詳細な説明】
本発明は、患者の手術部位の組織を超音波により破砕吸引し、また電気外科的に
凝固し、電気外科的に切断する方法及び装置に関する。
超音波振動式外科装置を用いてかなりの精度と安全性で不要組織を破砕除去でき
るようになったために、多くの価値ある手術方法が開発された。また、超音波吸
引器を用いて人体組織を破砕して外科的に人体から除去する方法も周知となって
いる。初期の外科的吸引技術は、例えば米国特許第3.589.383号及び第
3.693,613号に示されているように、白内障組織の破砕除去に使用され
ていた。なお、上記特許を始め、本明細書中で言及する特許および文献の内容は
そのまま本明細書にも引用加入する。
後年になって、外科的吸引技術を神経外科その他の特殊手術に利用して、かなり
の成功をおさめるようになった。
このような用途では、小型の手持ち式装置を介して超音波エネルギーを与えるこ
とで、精密に制御しながら組織を1層ずつ選択的に除去できることが証明されて
いる。
最近になって、国際公開筒W O87101278号に記載されているように、
応諾性生物組織の内視鏡による除去に超音波吸引器を使用することも知られるよ
うになった。
当該分野で知られている幾つかの装置は、約20〜30KHzから約40〜50
KHzの周波数で実質的に一定の振幅を有する連続振動を特性的に生み出すもの
である。
米国特許第3.5H,383号に記載されているこの種の装置は、白内障の除去
に使用することを目的として特に構成されたものであり、一方、米国特許第4.
H3,557号に記載の装置は、軟質組織の除去、特に血液と混じった高応諾性
弾性組織の除去用に適する装置である。このような装置は、外科医が組織の破砕
除去をしようとするときに連続的に作動することができ、通常は足踏みスイッチ
(フットスイッチ)の制御下で動作する。
手術部位の組繊を超音波により破砕し、次いで手術部位から組織粒子と流体を吸
引して除去する器械として公知のものの1つに、CUSAモデルシステム200
型超音型版音波吸引器。この器械は、コネチカット州スタンフォードのキャビト
ロン・サージカル・システムズ(Cavitron Surgical Sys
tems)によって製造販売されているものである。また、米国特許出願第84
7.301号も参照されたい。その長手方向に振動する金属製チップを組織と共
に収縮させると、ゆっくりと選択的かつ精密に組織を破砕し、除去する。この独
特な外科器械のもつ利点には、腫瘍除去に際して健康な組織への損傷がほとんど
ないこと、血管をそのまま残せること、組織の癒合が促進されること、周辺組織
の縁部の焼は焦げや引裂を生じないこと、健康な組織の引張りが最小限で済むこ
と、選択的に制御された組織の破砕除去を触感で確実に感じ取れること、などが
ある。
CUSAの超音波外科器械を使用した外科医は、この器械の能力に対していくつ
かの要望を表明している。特に、臓器に損傷を与えずに被膜に侵入できるような
措置、粘膜プロテクトミー (protecto■y)処置等において繊維組織
構造も精密かつ高速に除去できるようにすること、及び組織の破砕除去をより高
速化することがめらている。
超音波破砕器械を使用した外科手術では、多くの場合手術部位の組織切断と止血
のために別の器械の使用を必要としているのが現状である。止血を要するのは、
例えば、大量の組織を乾燥させる深凝固のための乾燥技術、及び組織表面を乾燥
させる噴霧凝固のための放電破壊技術等においてである。例えば米国特許第4.
378,801号を参照のこと。よく使用されるのは、電気外科的装置に差込ん
で組織の切断と止血を行なう電気外科ペンシルと、流体及び切断された組織粒子
の吸引を行なう吸引プローブである。手術部位−個所に対して多くの手術用具を
要するために、外科医はいろいろな器械を切り換えなければならず、全体的な手
術時間が長くなって能率は低下する。
また、出血が認められた時に切断器具または破砕器具から焼灼器具に切換えるま
でに時間を要するために、出血量が多くなり過ぎる。さらに、手術部位に複数の
手術装置を同時に保持しておかねばならないために、外科医の視野が狭くなる。
また、手順が複雑なために、使用していないときに電気外科ペンシルが誤って作
動したりすると患者の高周波火傷の原因となることがある。このような事情から
外科医からの要望、要求が出て来たわけである。
したがって、上記のような問題点を克服し、外科医からの上記のような要望、要
求に応える改良された手術方法および装置に対する要望が生じている。
発明の概要
本発明は、超音波破砕吸引装置の再振動チップに高周波凝固能力と高周波切断能
力を持たせることによって上記のような問題を解消する。
驚くべきことに、高周波エネルギーを破砕吸引チップに送ることによって、破砕
吸引能力が弱まるどころか強まるのである。切換え機構が外科医の手の届き易い
ところにあるため、手術中に器械のチップを手術部位に当てたまま切換えを即時
に行なって、器械のどの機能も使用しない状態、1つの機能を使用する状態、あ
るいは何れかの組合せの機能を同時に使用する状態にすることができるため、手
術の能率を高め、手術時間を短縮することができる。組織の破砕中に生じる出血
も、より敏速に手際良く抑止することができる。器械を介して手術部位へ潅注用
または冷却用の流体を送出し、制御するための措置もとられる。
添付図面と関連させながら以下の説明を読めば、本発明の属する技術分野におい
て通常の知識を有する者であれば、本発明のその他の目的および利点についても
明ら第1図は本発明の外科システムを示す。
第2図は第1図のシステムの第1ハンドピースの中央部を示す平面図である。
第3図は第2図の第1ハンドピースの前部を示す部分断面側面図である。
第4図は第2図の第1ハンドピースの前部を示す側面図であり、該ハンドピース
用の高周波切換え機構も概略的に示している。
第5図は第1図のシステムの選択的な第2ハンドピースの中央部を示す平面図で
ある。
第6図は第5図の第2ハンドピースの前部を示す部分断面側面図である。
第7図は第5図の第2ハンドピースの前部を示す側面図であり、該ハンドピース
用の切換え機構も概略的に示す。
好適な実施態様の詳細な説明
本発明の外科システムは、第1図において全体的に参照番号10で示されており
、ここでは患者14の手術部位12において手術を行なう状態にある。
システム10は全体的に16で示されるハンドピースを含んでおり、ハンドピー
ス16は後に詳述するように超音波破砕、吸引、電気外科的切断、流体潅注、電
気外科的凝固または止血の各機能を手術部位12の組織に対して行なうことがで
きる。これらの機能は別個に行なうこともできるし、任意の組合せで同時に行な
うこともできる。ハンドピース16は、前出のCUSA型ハンドピースまたはウ
ッチニッヒら(Vuchinich et at)の米国特許第4.063.5
57号に記載のハンドピースのような周知の超音波破砕ハンドピースを変更して
、後述するような電気外科的切断機能および凝固機能をもたせたもので良い。
このような変更部分はハンドピース自体に内蔵させても良いし、あるいは使い捨
て式または交換式のハンドピース部品の一部として、ハンドピースのマニホール
ドやノーズコーン等に装着しても良い。
第1図に示すように、ハンドピース16は外科医の手に握り易くまた扱い易い寸
法および形状を持たせたハウジング18を含んでいる。テーバ付伸長形の超音波
振動ツール20は、第3図及び第6図から分かるように、ハウジングによって支
持されており、また末端部にチップ開口部24を有するツールチップ22がハウ
ジングから前方へ一定距離のところに来るように前向きに配置されている。ツー
ル20は中空であって、それを貫通して長平方向のツール通路26が形成されて
いる。
例えばハウジング28の中に収容される吸引ポンプが吸引圧力を管29が通路2
6の基端部に加え、それによって手術部位12の組織粒子、血液、流体その他を
吸引して、該手術部位12からチップ開口部24さらに通路26を通してコンソ
ールまたはハウジング28に向かって誘導し、適当な吸引容器29aの中に入れ
ることができる。
手術部位から吸引される流体の1つに塩水潅注流体がある。これは、ハンドピー
ス16によって破砕された組織粒子に懸濁流体を与える場合のように、手術手続
きの一部として手術部位に与えられる。塩水潅注溶液は、手術部位12の上部に
懸吊したびんまたは袋30から潅注管32を介してハンドピース16まで周知の
方法で重力流下することができる。ハンドピースに入った潅注溶液は、ツール2
0とハウジングまたは前部マニホルド位置との間に形成される環状通路34を通
った後、ハウジングからツールチップ22の周辺へ出て手術部位12に至る。手
術部位へ潅注流体を供給するだけでなく、その流体によって振動チップ22およ
び血液・組織粒子その他の吸引物の冷却も行なって、ツール20の損41Kを防
止すると共に血液の凝固を遅らせる。組織を湿潤することによって吸引し易くな
ると同時に、隣接する健康な組織を損傷から保護することができる。手術部位1
2が、超音波式白内障除去手術の場合の眼のように、回りを囲まれた領域または
回りを半ば囲まれた領域にある場合、その領域内の圧力を一定範囲に維持するこ
とが重要であるが、このように圧力を維持する流量制御システムは公知となって
おり、本発明に使用することができる。例えば米国特許第3.fi93,613
号を参照されたい。潅注流体の送出量の制御、吸引圧力および超音波エネルギー
の付与の制御は、当該分野で周知のように外科医の操作し易い位置にある足踏み
スイッチによって行なうことができる。
ツール20は、参照番号38によって示される共振振動システムによって超音波
振動される。振動システム38はハンドピース16に装着されており、Re、
25.033に教示されている磁歪スタックのようなトランスジューサと、トラ
ンスジューサにより生じる行程を変える超音波機械式変圧器とを含む。ツール2
0自体は実質的に一体的な本体部を含み、その雌ねじ付端部は必要に応じて交換
できるように設計されており、振動システム38の連結部材に取付けられる。振
動システム38がチップ22を0.001インチ以上、好適には0.014イン
チ以上の行程で20〜50 K Hz 、好適には23〜37KH2の周波数範
囲で振動させる。
第1図に全体的に40で示される自立式病院用ユニットまたは米国特許第3.8
98.991号、第3.963,030号、第4.051.1155号に記載さ
れているような電気外科ユニット(ESU)からハンドピース16に高周波エネ
ルギーが供給される。この電気外科ユニット40をノーウジング28の内部に保
持し、吸引ポンプと共に単一の好適には携帯式のユニットとなるように構成する
ことも本発明の範囲に含まれる。ESU40が高周波エネルギーを発生し、また
焼灼ケーブル42は、その一端部でハンドピースIBに動作連結される一方、他
端部にESU40のハンドスイッチ能動ジャック46に差込むように構成された
プラグ44を備えており、高周波エネルギーをハンドピース16に送る働きをす
る。外科医がハンドピースを操作しながらでも作動し易いようにスイッチアセン
ブリを配置しているために、ESU40からツール20への高周波エネルギーの
送出をうまく制御することができる。スイッチアセンブリを介して外科医は高周
波エネルギー「ゼロ」、高周波凝固エネルギー、高周波切断エネルギー、凝固エ
ネルギーと切断信号エネルギーの同時混合送出の中からエネルギー送出方法を選
択することができる。高周波切断エネルギーと凝固エネルギーは異なるものであ
り、それぞれ純粋な正弦波と減衰正弦波として定義することができる。スイッチ
アセンブリは足踏みスイッチでもハンドスイッチでも良く、ノ\ンドスイッチの
場合はノ\ンドビース16を保持操作している手(人さし指)で作動できるよう
にハンドピース16上に固定可能にする。
ハンドピース用ハンドスイッチは、ハンドピース16と一体的に形成するか、そ
の中に内蔵させて完全に再使用可能にしても良いし、あるいは付加式スイッチア
センブリの様に着脱可能な交換ユニットとしても、また着脱可能なマニホルドに
取付けても良く、このマニホルドには潅注流体通路の一部を含ませることもでき
る。各種のマニホルドの構成が例えばPCT/US87100795に示されて
いる。スイッチアセンブリとしては、押しボタン形式、ロッカー形式、摺動形式
など多くの形式のものを使用することができる。好適なスイッチアセンブリの構
造として最初に挙げられるのが、第2図と第3図に全体的に50で示したもので
ある。このスイッチアセンブリは、第4図に概略的に示したように、押しボタン
式の単極双方向(SPDT)常時開スイッチとして、ESU40からの高周波電
流を「切断」モードと「凝固」モードの間で切換えることができる。半球形の「
切断」モードスイッチ52と「凝固」モードスイッチ54の何れかによってモー
ド選択すると、回路基板56によって高周波電流がESU40からインタフェー
スケーブルまたは焼灼ケーブル42を介して金属接触片58に流れ、電気コネク
タを通ってチップに至る。選択的な高周波エネルギーの制御/送出方法として、
ハンドピースに1つの押しボタン(混合式)を設け、その下限で切断モードにな
り上限で凝固モードとなるように較正された単一の連続可変制御装置により制御
しても良い。
電気コネクタの第1実施態様は、第3図に38で示すように、積層ニッケル合金
構造を含む金属製音響振動器である。電気コネクタの第2実施態様は、システム
の通常動作に必要な潅注システムの塩水潅注−溶液のような電導性流体媒体を使
用する方法である。この導電性媒体が直接チップ22を取囲んで、第5〜7図に
示すように金属接触片58とチップの間を電気的に接触させる働きもする。この
ような塩水電気流体路は、第1実施態様の場合のようにハンドピース16内部に
設けた音響振動部材の機械的負荷を介することはない。
高周波電気ループを完成するために、第1図に示すように分散接地パッド60を
患者14の上に配置する。例えば米国特許第4.038.984号を参照された
い。プラグ64を分散電極ジャック66に差込むと、一端部をパッドに接続され
、他端部にプラグ64を有するケーブル62(第4図及び第7図も参照のこと)
が、パッドとESU40間を接続する。本発明の電気外科的構成を正しく動作さ
せるために、従来通り高周波電流をチップ22から患者14を介して接地パッド
まで流れさせた後ESU40に戻して電気ループを完成する。
超音波組織破砕処理中に最初に出血が認められた時点で、スイッチに軽く触れる
だけで損傷血管をほとんど瞬時に焼灼することができる。また、このシステムを
焼灼モードで使用すると、標準的な神経外科技術と同様に超音波チップ22によ
って直接焼灼を行なって血管を焼灼することができる。このような構成によると
、チップ22の焼付き、組織の焼焦げ、吸引チップ22の詰まりと言った問題が
生じることはない。
各種試験の結果、この外科システムの有効性が証明されている。穏やかな凝固処
理においては、標準的な電気外科技術を用いた時より組織の焼焦げがはるかに少
ながった。超音波破砕と凝固を組合わせた場合には、破砕作用が強まると共に制
御された止血作用も見られた。超音波破砕と電気外科的切断を組合せた場合には
、破砕衿用が強まると共に制御された切断作用も観察された。また、超音波破砕
と電気外科的混合モード(切断と凝固)を併用した場合には、手術効率が個々の
モードを別個に用いた時より高くなり、しかも超音波手術用吸引装置の基本的な
外科学的特性はそのまま保持された。振動チップに高周波エネルギーを与えるこ
とによって、組織除去速度が相当高くなるだけでなく、同一の手術用器械におい
て組織の選択性と触感による応答とを同時に獲得することができる。また、手術
部位に配置する装置の数を最小限にすることによって、手術中の外科医の視野が
確保されて安全性が高まる。
本発明は、本発明の精神または本質から逸脱することなく、上に挙げた以外の形
式でも実施することができる。
従って、ここに挙げた実施態様は、あらゆる点において説明的なものであり、本
発明の範囲を限定するものではないと理解されるべきである。本発明の範囲を定
めるのは以上の記載ではなく請求の範囲の記載であり、請求項の意味するところ
、およびその均等の範囲に該当する変更も全て、本発明の範囲の中に入るものと
みなされるべきである。
国際調査報告
mmaawwl A°°5°゛″7° 1)rT/II<+1+1t/l’li
14Q
Claims (52)
- 1.患者の手術部位において1つまたはそれ以上の外科処置を行なう外科装置で あって、該装置が、ハンドピースと、 前記ハンドピースによって支持されており、振動式ツールチップを有するツール と、 前記ツールチップにより手術部位において電気外科処置を行なわせるために該ツ ールチップに高周波電流を供給するための高周波電流手段と、 前記ツールチップを超音波振動させる振動手段とを含んで成り、 前記ツールチップがチップ開口部を有しており、前記ツールがその中を貫通して 前記チップ開口部と連通するツール通路を有しており、前記装置がさらに、手術 部位の組織粒子および流体を前記チップ開口部から前記ツール通路を通じて吸引 し、手術部位からこれらを除去するために、前記ツール通路に吸引圧力を付与す るための吸引手段を含んで成る装置。
- 2.前記高周波電流手段が、前記ツールチップに与える高周波電流を高周波凝固 電流と高周波切断電流との間で切換える切換え手段を含んでいる請求項1に記載 の装置。
- 3.前記切換え手段が、オペレータが前記ハンドピースを操作しながら作動でき るように構成されている請求項2に記載の装置。
- 4.前記切換え手段が前記ハンドピースに固着され、支持されている請求項3に 記載の装置。
- 5.前記切換え手段が前記ハンドピースに内蔵されている請求項4に記載の装置 。
- 6.前記切換え手段が前記ハンドピースを操作するオペレータの足で作動される ように構成された足踏みスイッチから成る請求項3に記載の装置。
- 7.前記切換え手段が、前記ハンドピースに固着されるように構成したマニホル ドと、該マニホルドに連結され、前記マニホルドを前記ハンドピースに固着した りハンドピースから取り除く時に該マニホルドと共に可動であるスイッチアセン ブリとから成る請求項2に記載の装置。
- 8.前記スイッチアセンブリが前記マニホルドと一体的に形成されている請求項 7に記載の装置。
- 9.前記切換え手段が、前記ハンドピースに嵌合固着されるように構成されたノ ーズコーンと、該ノーズコーンに固着されているスイッチと、該スイッチと電気 外科ユニツトを動作接続するケーブル手段とから成る請求項2に記載の装置。
- 10.前記切換え手段が前記ノーズコーンを前記ハンドピースに固着する固着手 段を含んでいる請求項9に記載の装置。
- 11.前記切換え手段が前記ハンドピースに設けた押しボタン式スイッチアセン ブリから成る請求項2に記載の装置。
- 12.前記切換え手段が前記ハンドピースに設けられたロッカー形スイッチアセ ンブリから成る請求項2に記載の装置。
- 13.前記切換え手段が前記ハンドピースに設けられた摺動形スイッチアセンブ リから成る請求項2に記載の装置。
- 14.前記切換え手段が常時開状態の単極双方向スイッチを含んで成る請求項2 に記載の装置。
- 15.前記高周波凝固電流が500KHzである請求項2に記載の装置。
- 16.前記高周波切断電流が500KHzである請求項2に記載の装置。
- 17.前記ハンドピースを、高周波電流を発生する電気外科ユニットと動作接続 する接続手段を含んでいる請求項1に記載の装置。
- 18.前記接続手段が、前記チップに送る高周波電流を切断モードと凝固モード の間で選択するための選択手段を含んでいる請求項17に記載の装置。
- 19.前記接続手段が、電気外科ユニットに接続するために患者に着脱自在に取 付け可能な分散接地電極を含んでいる請求項17に記載の装置。
- 20.前記ハンドピースと関連して設けられて、前記チップに隣接する手術部位 に潅注流体を供給するための潅注手段を含んでいる請求項1に記載の装置。
- 21.前記潅注手段が、少なくともその一部が前記ハンドピースによって支持さ れる潅注流体通路を含んでおり、前記通路が前記チップに隣接して通路出口を備 えている請求項20に記載の装置。
- 22.前記高周波電流手段が高周波エネルギーを発生するための電気外科ユニッ トを含んでいる請求項1に記載の装置。
- 23.前記電気外科ユニットが自立式ユニットであり、前記高周波電流手段が前 記電気外科ユニットと前記ハンドピースを動作接続するケーブルを含んでいる請 求項22に記載の装置。
- 24.前記高周波電流手段が、前記ハンドピースによって支持され、かつ高周波 エネルギー源に動作接続できる音響振動部品を含んでいる請求項1に記載の装置 。
- 25.前記音響振動部品を前記チップと動作接続するための機械的接続手段を含 んでいる請求項24に記載の装置。
- 26.前記音響振動部品を前記チップと動作接続するための導電性流体接続手段 を含んでいる請求項24に記載の装置。
- 27.前記導電性流体接続手段が、高周波エネルギーを前記チップに伝導するた めに手術部位潅注流体を用いている請求項26に記載の装置。
- 28.前記高周波電流手段が高周波電流を発生する発生手段を含んでおり、 前記吸引手段が吸引圧力を生成する吸込み手段を含んでおり、 該装置がさらに、前記発生手段と前記吸込み手段を共に収容するハウジング手段 を含んで成る請求項1に記載の装置。
- 29.手術部位の組織を前記振動手段が超音波破砕すると共に、該手術部位の組 織に電気外科的処置を施す際に、前記ツールチップに高周波電流を供給するよう に前記高周波電流手段が構成されている請求項1に記載の装置。
- 30.前記吸引手段が手術部位から前記チップ開口部を介して組織粒子および流 体を吸引すると共に、手術部位の組織に電気外科的処置を施す際に、前記ツール チップに高周波電流を供給するように前記高周波電流手段が構成されている請求 項1に記載の装置。
- 31.前記高周波電流手段が前記ツールチップと電気外科ユニットを電気的に連 結する連結手段を含んでいる請求項1に記載の装置。
- 32.前記高周波電流手段が、前記連結手段が前記ツールチップと電気外科ユニ ットを連結しており、かつ電気外科ユニットが作動中である時に、前記装置の論 理制御の誤動作を防止する電気ろ波手段を含んでいる請求項31に記載の装置。
- 33.患者の手術部位において止血を行なう方法であって、超音波手術用吸引器 械のチップに高周波凝固電流を供給する段階と、 チップ電極を手術部位に配置する段階と、その後、高周波凝固電流をチップから 手術部位へ送出しながら、チップを手術部位において任意に操作する段階とを含 んで成る方法。
- 34.前記供給段階を前記配置段階の前に行なう請求項33に記載の方法。
- 35.前記配置段階を前記供給段階の前に行なう請求項33に記載の方法。
- 36.分散電極を患者に貼付して、高周波凝固電流源と共に電気ループの一部を 形成する段階を含んで成る請求項33に記載の方法。
- 37.前記器械のチップにより手術部位の組織に対して超音波破砕を実施する段 階を含んで成る請求項33に記載の方法。
- 38.前記超音波破砕実施段階を、高周波凝固電流をチップから手術部位へ供給 しながら行なう請求項37に記載の方法。
- 39.チップを手術部位に配置した状態で、前記器械を高周波凝固モードと高周 波切断モードの間で切換える請求項33に記載の方法。
- 40.前記高周波凝固電流の供給段階において高周波切断電流をチップに供給す ることにより、生成された混合電流を手術部位の組織に送る段階を含んで成る請 求項33に記載の方法。
- 41.前記ハンドピースによって支持されている流体導管から概ね前記チップに 隣接する手術部位に潅注流体を供給する段階を含んで成る請求項33に記載の方 法。
- 42.深凝固のための乾燥処置においてチップから高周波凝固電流を送出して大 量の組織を乾燥する段階を含んで成る請求項33に記載の方法。
- 43.噴霧凝固のための放電破壊処置においてチップから高周波凝固電流を送出 して組織表面を乾燥させる段階を含んで成る請求項33に記載の方法。
- 44.患者の手術部位において組織を電気外科的に切断する方法であって、 超音波吸引器械のチップに高周波切断電流を供給する段階と、 チップを手術部位に配置する段階と、 その後高周波切断電流を手術部位に送って組織切断処置を実施しながら、チップ を手術部位において任意に操作する段階を含んで成る方法。
- 45.前記高周波電流供給段階を配置段階の前に行なう請求項44に記載の方法 。
- 46.前記配置段階を前記供給段階の前に行なう請求項44に記載の方法。
- 47.前記器械のチップにより手術部位の組織に対して超音波破砕処置を実施す る段階を含んで成る請求項44に記載の方法。
- 48.前記チップから手術部位へ高周波切断電流を送りながら前記高周波破砕実 施段階を行なう請求項47に記載の方法。
- 49.分散電極を患者に貼付して、高周波切断電流源と共に電気ループの一部を 形成する段階を含んで成る請求項44に記載の方法。
- 50.チップを概ね手術部位に配置した状態で、前記器械を高周波凝固モードと 高周波切断モードの間で切換える段階を含んで成る請求項44に記載の方法。
- 51.高周波切断エネルギーを手術部位に送りながら、組織粒子および流体をチ ップ開口部から吸引して手術部位から除去する段階を含んで成る請求項44に記 載の方法。
- 52.前記ハンドピースによって支持されている流体導管から前記チップに概ね 隣接する手術部位に潅注流体を供給する段階を含んで成る請求項44に記載の方 法。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US07/103,022 US4931047A (en) | 1987-09-30 | 1987-09-30 | Method and apparatus for providing enhanced tissue fragmentation and/or hemostasis |
US103,022 | 1987-09-30 | ||
PCT/US1988/003349 WO1989002725A1 (en) | 1987-09-30 | 1988-09-29 | Tissue fragmentation and/or hemostasis |
Publications (2)
Publication Number | Publication Date |
---|---|
JPH02501894A true JPH02501894A (ja) | 1990-06-28 |
JPH0642893B2 JPH0642893B2 (ja) | 1994-06-08 |
Family
ID=22292948
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP63508237A Expired - Fee Related JPH0642893B2 (ja) | 1987-09-30 | 1988-09-29 | 外科装置 |
Country Status (14)
Country | Link |
---|---|
US (1) | US4931047A (ja) |
EP (1) | EP0310431B1 (ja) |
JP (1) | JPH0642893B2 (ja) |
AT (1) | ATE113457T1 (ja) |
AU (1) | AU616699B2 (ja) |
CA (1) | CA1323665C (ja) |
DE (1) | DE3852005T2 (ja) |
DK (1) | DK261589D0 (ja) |
ES (1) | ES2064360T3 (ja) |
FI (1) | FI892607A0 (ja) |
IE (1) | IE67810B1 (ja) |
IL (1) | IL87857A0 (ja) |
NO (1) | NO300755B1 (ja) |
WO (1) | WO1989002725A1 (ja) |
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EP0248816A4 (en) * | 1985-08-01 | 1989-05-16 | Cooper Lasersonics Inc | APPARATUS AND METHOD FOR ASSEMBLING AND DISASSEMBLING INTERGANGEABLE SURGICAL ACOUSTIC ELEMENTS. |
US4750902A (en) * | 1985-08-28 | 1988-06-14 | Sonomed Technology, Inc. | Endoscopic ultrasonic aspirators |
JPS62211056A (ja) * | 1986-03-12 | 1987-09-17 | オリンパス光学工業株式会社 | 組織切除装置 |
US4747820A (en) * | 1986-04-09 | 1988-05-31 | Cooper Lasersonics, Inc. | Irrigation/aspiration manifold and fittings for ultrasonic surgical aspiration system |
SE459711B (sv) * | 1987-03-20 | 1989-07-31 | Swedemed Ab | Utrustning foer anvaendning vid kirurgiska ingrepp foer att avlaegsna vaevnader |
-
1987
- 1987-09-30 US US07/103,022 patent/US4931047A/en not_active Expired - Lifetime
-
1988
- 1988-09-27 IL IL87857A patent/IL87857A0/xx not_active IP Right Cessation
- 1988-09-29 CA CA000578785A patent/CA1323665C/en not_active Expired - Fee Related
- 1988-09-29 WO PCT/US1988/003349 patent/WO1989002725A1/en active Application Filing
- 1988-09-29 IE IE294188A patent/IE67810B1/en not_active IP Right Cessation
- 1988-09-29 AU AU25382/88A patent/AU616699B2/en not_active Ceased
- 1988-09-29 JP JP63508237A patent/JPH0642893B2/ja not_active Expired - Fee Related
- 1988-09-30 ES ES88309125T patent/ES2064360T3/es not_active Expired - Lifetime
- 1988-09-30 EP EP88309125A patent/EP0310431B1/en not_active Expired - Lifetime
- 1988-09-30 DE DE3852005T patent/DE3852005T2/de not_active Expired - Lifetime
- 1988-09-30 AT AT88309125T patent/ATE113457T1/de not_active IP Right Cessation
-
1989
- 1989-05-25 NO NO892096A patent/NO300755B1/no unknown
- 1989-05-29 DK DK261589A patent/DK261589D0/da not_active Application Discontinuation
- 1989-05-29 FI FI892607A patent/FI892607A0/fi not_active IP Right Cessation
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPH03151957A (ja) * | 1989-11-07 | 1991-06-28 | Olympus Optical Co Ltd | 超音波処置装置 |
JPH06502573A (ja) * | 1991-06-06 | 1994-03-24 | ヴァリーラブ・インコーポレーテッド | 電気外科手術及び超音波外科手術システム |
JP2003033367A (ja) * | 2001-07-26 | 2003-02-04 | Aloka Co Ltd | 手術用装置 |
Also Published As
Publication number | Publication date |
---|---|
IE67810B1 (en) | 1996-05-01 |
EP0310431A3 (en) | 1989-10-25 |
NO300755B1 (no) | 1997-07-21 |
NO892096L (no) | 1989-05-25 |
IE882941L (en) | 1989-03-30 |
ES2064360T3 (es) | 1995-02-01 |
FI892607A (fi) | 1989-05-29 |
EP0310431A2 (en) | 1989-04-05 |
DK261589A (da) | 1989-05-29 |
EP0310431B1 (en) | 1994-11-02 |
ATE113457T1 (de) | 1994-11-15 |
WO1989002725A1 (en) | 1989-04-06 |
AU2538288A (en) | 1989-04-18 |
JPH0642893B2 (ja) | 1994-06-08 |
NO892096D0 (no) | 1989-05-25 |
DK261589D0 (da) | 1989-05-29 |
US4931047A (en) | 1990-06-05 |
DE3852005T2 (de) | 1995-03-09 |
CA1323665C (en) | 1993-10-26 |
AU616699B2 (en) | 1991-11-07 |
DE3852005D1 (de) | 1994-12-08 |
FI892607A0 (fi) | 1989-05-29 |
IL87857A0 (en) | 1989-03-31 |
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