JPH0640882B2 - 向上された組織切断及び/又は止血を与える装置 - Google Patents
向上された組織切断及び/又は止血を与える装置Info
- Publication number
- JPH0640882B2 JPH0640882B2 JP3507604A JP50760491A JPH0640882B2 JP H0640882 B2 JPH0640882 B2 JP H0640882B2 JP 3507604 A JP3507604 A JP 3507604A JP 50760491 A JP50760491 A JP 50760491A JP H0640882 B2 JPH0640882 B2 JP H0640882B2
- Authority
- JP
- Japan
- Prior art keywords
- conductive
- instrument
- surgical
- handpiece
- tissue
- 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.)
- Expired - Fee Related
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/22004—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
- A61B17/22012—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
-
- 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
-
- 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
- A61B2017/320084—Irrigation sleeves
-
- 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
-
- 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
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Medical Informatics (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Mechanical Engineering (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Vascular Medicine (AREA)
- Dentistry (AREA)
- Surgical Instruments (AREA)
- Laser Surgery Devices (AREA)
- Materials For Medical Uses (AREA)
- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
Description
発明の背景 本発明は、患者の手術部位組織の超音波切断及び吸引、
及び電気外科的凝固、電気外科的切断を行うための外科
用装置に関する。本発明は米国特許第4,931,04
7号に記述され請求された発明の改良又は修正になるも
のである。 不必要の組織を正確にかつ安全に切断及び除去するため
の超音波振動による外科用装置の応力が価値ある外科処
置の発展を導きつつあり、又人体からの組織の切断及び
外科的除去のための超音波吸引器の使用もよく知られる
ようになってきている。初期には外科的吸引の技術は、
例えば米国特許第3,589,363号及び第3,69
3,613号に開示されているように白内障組織の切断
及び除去に適用されていた。これらの特許及びここで述
べた各他の特許及び各文書の開示はそのまま参照するこ
とによってここの編入することができる。その後、この
ような技術は神経外科及び他の外科でかなりの成功をお
さめており、そこで超音波エネルギーを小さく手で握る
ことのできる装置を通して正確な制御で層ごとの底上の
組織を選択的に除去することが可能であることがわかっ
てきている。 この分野で特徴的に知られるある装置では、ほぼ一定の
振幅を持ち約20ないし約30kHzから約40ないし約
50kHzまでの周波数を有する連続的な振動を発生す
る。米国特許第3,589,363号では特に白内障の
除去に使用することができるこのような装置の一つを記
述しており、一方米国特許第4,063,557号では
血の混じったかなり伸縮性のある弾性組織を特に除去す
ることができるような柔軟な組織の除去に適した装置を
記述している。このような装置は、外科医が組織の切断
及び除去を望むときに連続的に動き、一般的にはフット
スイッチの制御で働く。 手術部位の組織の超音波切断をし、次に部位から組織粒
子及び液体の吸引を行う良く知られた装置の一つとして
CUCAモデルシステム200超音波吸引器があり、コ
ネチカット州スタンフォードのValleylab,I
ncによって製造、販売されている(米国特許第4,8
27,911号を見よ)。このような吸引器は縦方向に
振動する金属の先端を組織に接触させるように持ってき
て、静かに、選択的に正確的に組織の切断及び除去を行
う。この唯一の外科用装置の幾つかの利点として、腫瘍
の除去処置において健全な組織への与える損傷が少な
く、血管の肉を除去することができ、組織の治療の促進
が図れ、組織の周りの縁を焦がしたり断裂させることが
なく、健康な組織の引張りを最小限にでき、選択的に制
御された組織の切断及び除去のための素晴らしい触覚の
フィードバックが得られるということがあげられる。 このCUCA超音波外科用装置を使用する外科医はこの
装置に対して追加の改良された機能の要求を示してきて
いる。特に、彼らは器官に損傷を与えない包膜への制御
された穿通、粘液を含む直腸切除処置のような繊維組織
構造の正確かつ迅速な除去、及び組織の切除の割合の増
加、への機能の要求をしてきている。超音波切断装置が
使用されてきている多くの外科処置の間には、外科手術
部位での組織の切断及び止血のための付加的な装置が要
求されてきている。止血は、例えば、大量の組織を乾燥
させる深い凝固のための乾燥技術において、又組織の表
面を乾燥させる噴霧乾燥のための高周波療法技術におい
て必要とされる。例えば、米国特許第4、378、80
1号を参照されたい。しばしば組織の切断及び止血のた
めに電気外科用ユニットへ電気外科用ペンシルが差し込
まれ、液体及び組織粒子の吸引のために吸引プローブが
使用される。従って一つの外科手術部位に多くの外科用
器具が必要とされるため、外科医が異なる装置の切換え
をしなければならず全体の外科手術の時間が増加し、効
率が低下する。又、出血がみられたときに切断具から焼
灼装置への切換えに要する時間のために、大量の好まし
からざる血液が失われることになる。さらに、手術部位
に複数の外科用装置を同時に維持することから、外科医
の観察領域が低下する。さらに、処置の複雑さから、使
用中でないときに電気外科用ペンシルを間違って作動さ
せ、患者に高周波熱傷を与えるということも起こり得
る。 従って、これらの問題を解消し、上述の外科医の欲求、
要求を満足させるべく外科的措置及び装置を改良する必
要が起こってきている。 米国特許第4,931,047号はその全体の開示を参
照のためここに編入するが、この特許に開示された発明
は、高周波凝固と高周波切断能力を超音波切断、吸引装
置の振動端に合併することにより、これらの問題を解決
している。 従って、米国特許第4,931,047号は患者の外科
手術部位への一つ又はそれ以上の外科処置を行うための
外科用装置であって、ハンドピースと;該ハンドピース
によって支持される器具と;該器具が有する振動器具端
と;外科手術部位に電気外科的措置を起こさせるために
該器具端に高周波電流を供給する選択的に作動可能な高
周波電流手段と;該器具端に超音波振動をさせる振動手
段と;該器具端が有する先端孔と;該器具が有するそれ
を通って該先端孔を連結する器具通路と;該器具通路に
吸引力をかけて外科手術部位の組織粒子及び液体を該先
端孔を通り、該器具通路を通って外科手術部位から吸引
する吸引手段とを含み、該高周波電流手段は、該器具端
に供給される高周波電流を超音波振動の間少なくとも高
周波切断電流へ切り換える切換手段を含んでいる。 驚くことに、上記装置を使用することにより、高周波エ
ネルギーが切断及び吸引先端に供給されるため、切断及
び吸引能力が現実に高まる。外科医に受け入れられやす
い一般的な切換機構とは、手術の間で外科手術部位へ装
置端がある状態で、装置の非作動機能若しくは一つの作
動機能の適用又は作動機能のいずれかの結合の適用の中
の切換えを瞬時にできるもので、従って装置の有効性を
高め、手術時間を減少させることができるものである。
組織切断の間の出血はさらに迅速かつ良好に制御され
る。また、外科手術部位へ洗浄、冷却液体を制御可能に
供給する用意がある。 米国特許第4,931,047号の装置における器具端
への高周波電流の切り換えのための好ましい切換手段
は、器具に取り付けられた導電性金属接続部材と接触す
る細い金属片の形をした金属の電気接触を含んでいる。
この構造は装置が新しいときは良く働くが、装置を使用
中は接続部材は一定の振動を受けているので、ある程度
のアークを避けることができないことがわかっており、
これにより浸食及び/又は金属接触片若しくは接続部材
又はその両方の酸化膜の形成を招来し、このような劣化
によって電気抵抗の増加、電気回路の干渉を起こし、結
果として効率を低下させる。 驚くことに、効果的にアークの起こらない電気的接触を
作ることができ、スイッチから音響接続部材まで、金属
接触バンドを介してスイッチモジュールまでを接続する
導電性Oリングを介して電気接触を作ることにより上記
影響を減少させることが現在わかってきた。Oリングは
音響部材の回りに配置され、超音波振動とともに伸縮可
能な弾力性を有してきるので、部材と一定の接触を保つ
ことができ、従ってアークを被ることがない。高周波を
透過させない成分を電気回路の中に遮蔽として使用する
こともでき、伝統的に本発明で考慮されたこのタイプの
導電性Oリングはこのような応用に使用されてきた。従
来は、導電性Oリングは電気回路内の電流伝搬成分とし
て使用されてきた。しかしながら、成分間の最小限の電
気抵抗が要求される高電圧回路の振動部材へ高周波電流
を伝搬させるものに、この導電性Oリングが使用された
ことはない。従って、超音波外科用装置において高周波
電流を伝搬させる必要な電気回路に導電性Oリングが有
効であるということは驚くべきことである。 発明の概要 本発明によれば、患者の外科手術部位への一つ又はそれ
以上の外科措置を行うための外科用装置であって、ハン
ドピースと;該ハンドピースによって支持され且つ振動
器具端を有する器具と;該器具端に超音波振動をさせる
ための金属接続部材を含む振動手段と;外科手術部位に
電気外科的措置を起こさせるために該器具端に高周波電
流を供給する選択的に作動可能な高周波電流手段とを含
み、該高周波電流手段が該器具端に供給される高周波電
流を超音波振動の間少なくとも高周波切断電流へ切り換
える切換手段を含んでいる、外科用装置において、上記
切換手段は上記高周波電流を選択するスイッチモジュー
ル、該スイッチモジュールに接続される導電性金属バン
ド及び該接続部材の回りにあって金属バンドと電気的接
触を持つ導電性Oリングを含む外科用装置を提供する。 本発明で改良された外科用装置で使用される導電性Oリ
ングは、通常、市販で手に入る例えば銀メッキされたア
ルミニウムのような導電性物質の粒子を注入したエラス
トマ材料からできている。ロードライランド州、クラン
ストンのNiantic Rubber Co.から入
手できるパーカーシール化合物(Parker Sea
ls Compound)#56410及びマサチュー
セッツ州、ワーバーンのChomerics Incか
ら入手できる化合物(Compound)#1285か
らなる導電性Oリングが適当であることが立証されてい
る。本発明の好ましい実施例では、器具端は先端孔と該
先端孔を連結する器具通路を有し、装置は該器具通路に
吸引力をかけ、外科手術部位の組織粒子及び液体を該先
端孔を通り、該器具通路を通って外科手術部位から吸引
する吸引手段とを含んでいる。 図面の簡単な説明 添付図面に示された好ましい実施例を参照して本発明を
さらに詳しく述べていくことにするが、その図面の 図1は、本発明の改良された切換手段を含む外科用装置
の側面図、部分的には断面図であり、 図2は、図1の点線で囲んだ部分Aの拡大図であり、 図3は、本発明の切換手段に使用される導電性Oリング
の側面図であり、 図4は、図3のOリングを通る断面図である。
及び電気外科的凝固、電気外科的切断を行うための外科
用装置に関する。本発明は米国特許第4,931,04
7号に記述され請求された発明の改良又は修正になるも
のである。 不必要の組織を正確にかつ安全に切断及び除去するため
の超音波振動による外科用装置の応力が価値ある外科処
置の発展を導きつつあり、又人体からの組織の切断及び
外科的除去のための超音波吸引器の使用もよく知られる
ようになってきている。初期には外科的吸引の技術は、
例えば米国特許第3,589,363号及び第3,69
3,613号に開示されているように白内障組織の切断
及び除去に適用されていた。これらの特許及びここで述
べた各他の特許及び各文書の開示はそのまま参照するこ
とによってここの編入することができる。その後、この
ような技術は神経外科及び他の外科でかなりの成功をお
さめており、そこで超音波エネルギーを小さく手で握る
ことのできる装置を通して正確な制御で層ごとの底上の
組織を選択的に除去することが可能であることがわかっ
てきている。 この分野で特徴的に知られるある装置では、ほぼ一定の
振幅を持ち約20ないし約30kHzから約40ないし約
50kHzまでの周波数を有する連続的な振動を発生す
る。米国特許第3,589,363号では特に白内障の
除去に使用することができるこのような装置の一つを記
述しており、一方米国特許第4,063,557号では
血の混じったかなり伸縮性のある弾性組織を特に除去す
ることができるような柔軟な組織の除去に適した装置を
記述している。このような装置は、外科医が組織の切断
及び除去を望むときに連続的に動き、一般的にはフット
スイッチの制御で働く。 手術部位の組織の超音波切断をし、次に部位から組織粒
子及び液体の吸引を行う良く知られた装置の一つとして
CUCAモデルシステム200超音波吸引器があり、コ
ネチカット州スタンフォードのValleylab,I
ncによって製造、販売されている(米国特許第4,8
27,911号を見よ)。このような吸引器は縦方向に
振動する金属の先端を組織に接触させるように持ってき
て、静かに、選択的に正確的に組織の切断及び除去を行
う。この唯一の外科用装置の幾つかの利点として、腫瘍
の除去処置において健全な組織への与える損傷が少な
く、血管の肉を除去することができ、組織の治療の促進
が図れ、組織の周りの縁を焦がしたり断裂させることが
なく、健康な組織の引張りを最小限にでき、選択的に制
御された組織の切断及び除去のための素晴らしい触覚の
フィードバックが得られるということがあげられる。 このCUCA超音波外科用装置を使用する外科医はこの
装置に対して追加の改良された機能の要求を示してきて
いる。特に、彼らは器官に損傷を与えない包膜への制御
された穿通、粘液を含む直腸切除処置のような繊維組織
構造の正確かつ迅速な除去、及び組織の切除の割合の増
加、への機能の要求をしてきている。超音波切断装置が
使用されてきている多くの外科処置の間には、外科手術
部位での組織の切断及び止血のための付加的な装置が要
求されてきている。止血は、例えば、大量の組織を乾燥
させる深い凝固のための乾燥技術において、又組織の表
面を乾燥させる噴霧乾燥のための高周波療法技術におい
て必要とされる。例えば、米国特許第4、378、80
1号を参照されたい。しばしば組織の切断及び止血のた
めに電気外科用ユニットへ電気外科用ペンシルが差し込
まれ、液体及び組織粒子の吸引のために吸引プローブが
使用される。従って一つの外科手術部位に多くの外科用
器具が必要とされるため、外科医が異なる装置の切換え
をしなければならず全体の外科手術の時間が増加し、効
率が低下する。又、出血がみられたときに切断具から焼
灼装置への切換えに要する時間のために、大量の好まし
からざる血液が失われることになる。さらに、手術部位
に複数の外科用装置を同時に維持することから、外科医
の観察領域が低下する。さらに、処置の複雑さから、使
用中でないときに電気外科用ペンシルを間違って作動さ
せ、患者に高周波熱傷を与えるということも起こり得
る。 従って、これらの問題を解消し、上述の外科医の欲求、
要求を満足させるべく外科的措置及び装置を改良する必
要が起こってきている。 米国特許第4,931,047号はその全体の開示を参
照のためここに編入するが、この特許に開示された発明
は、高周波凝固と高周波切断能力を超音波切断、吸引装
置の振動端に合併することにより、これらの問題を解決
している。 従って、米国特許第4,931,047号は患者の外科
手術部位への一つ又はそれ以上の外科処置を行うための
外科用装置であって、ハンドピースと;該ハンドピース
によって支持される器具と;該器具が有する振動器具端
と;外科手術部位に電気外科的措置を起こさせるために
該器具端に高周波電流を供給する選択的に作動可能な高
周波電流手段と;該器具端に超音波振動をさせる振動手
段と;該器具端が有する先端孔と;該器具が有するそれ
を通って該先端孔を連結する器具通路と;該器具通路に
吸引力をかけて外科手術部位の組織粒子及び液体を該先
端孔を通り、該器具通路を通って外科手術部位から吸引
する吸引手段とを含み、該高周波電流手段は、該器具端
に供給される高周波電流を超音波振動の間少なくとも高
周波切断電流へ切り換える切換手段を含んでいる。 驚くことに、上記装置を使用することにより、高周波エ
ネルギーが切断及び吸引先端に供給されるため、切断及
び吸引能力が現実に高まる。外科医に受け入れられやす
い一般的な切換機構とは、手術の間で外科手術部位へ装
置端がある状態で、装置の非作動機能若しくは一つの作
動機能の適用又は作動機能のいずれかの結合の適用の中
の切換えを瞬時にできるもので、従って装置の有効性を
高め、手術時間を減少させることができるものである。
組織切断の間の出血はさらに迅速かつ良好に制御され
る。また、外科手術部位へ洗浄、冷却液体を制御可能に
供給する用意がある。 米国特許第4,931,047号の装置における器具端
への高周波電流の切り換えのための好ましい切換手段
は、器具に取り付けられた導電性金属接続部材と接触す
る細い金属片の形をした金属の電気接触を含んでいる。
この構造は装置が新しいときは良く働くが、装置を使用
中は接続部材は一定の振動を受けているので、ある程度
のアークを避けることができないことがわかっており、
これにより浸食及び/又は金属接触片若しくは接続部材
又はその両方の酸化膜の形成を招来し、このような劣化
によって電気抵抗の増加、電気回路の干渉を起こし、結
果として効率を低下させる。 驚くことに、効果的にアークの起こらない電気的接触を
作ることができ、スイッチから音響接続部材まで、金属
接触バンドを介してスイッチモジュールまでを接続する
導電性Oリングを介して電気接触を作ることにより上記
影響を減少させることが現在わかってきた。Oリングは
音響部材の回りに配置され、超音波振動とともに伸縮可
能な弾力性を有してきるので、部材と一定の接触を保つ
ことができ、従ってアークを被ることがない。高周波を
透過させない成分を電気回路の中に遮蔽として使用する
こともでき、伝統的に本発明で考慮されたこのタイプの
導電性Oリングはこのような応用に使用されてきた。従
来は、導電性Oリングは電気回路内の電流伝搬成分とし
て使用されてきた。しかしながら、成分間の最小限の電
気抵抗が要求される高電圧回路の振動部材へ高周波電流
を伝搬させるものに、この導電性Oリングが使用された
ことはない。従って、超音波外科用装置において高周波
電流を伝搬させる必要な電気回路に導電性Oリングが有
効であるということは驚くべきことである。 発明の概要 本発明によれば、患者の外科手術部位への一つ又はそれ
以上の外科措置を行うための外科用装置であって、ハン
ドピースと;該ハンドピースによって支持され且つ振動
器具端を有する器具と;該器具端に超音波振動をさせる
ための金属接続部材を含む振動手段と;外科手術部位に
電気外科的措置を起こさせるために該器具端に高周波電
流を供給する選択的に作動可能な高周波電流手段とを含
み、該高周波電流手段が該器具端に供給される高周波電
流を超音波振動の間少なくとも高周波切断電流へ切り換
える切換手段を含んでいる、外科用装置において、上記
切換手段は上記高周波電流を選択するスイッチモジュー
ル、該スイッチモジュールに接続される導電性金属バン
ド及び該接続部材の回りにあって金属バンドと電気的接
触を持つ導電性Oリングを含む外科用装置を提供する。 本発明で改良された外科用装置で使用される導電性Oリ
ングは、通常、市販で手に入る例えば銀メッキされたア
ルミニウムのような導電性物質の粒子を注入したエラス
トマ材料からできている。ロードライランド州、クラン
ストンのNiantic Rubber Co.から入
手できるパーカーシール化合物(Parker Sea
ls Compound)#56410及びマサチュー
セッツ州、ワーバーンのChomerics Incか
ら入手できる化合物(Compound)#1285か
らなる導電性Oリングが適当であることが立証されてい
る。本発明の好ましい実施例では、器具端は先端孔と該
先端孔を連結する器具通路を有し、装置は該器具通路に
吸引力をかけ、外科手術部位の組織粒子及び液体を該先
端孔を通り、該器具通路を通って外科手術部位から吸引
する吸引手段とを含んでいる。 図面の簡単な説明 添付図面に示された好ましい実施例を参照して本発明を
さらに詳しく述べていくことにするが、その図面の 図1は、本発明の改良された切換手段を含む外科用装置
の側面図、部分的には断面図であり、 図2は、図1の点線で囲んだ部分Aの拡大図であり、 図3は、本発明の切換手段に使用される導電性Oリング
の側面図であり、 図4は、図3のOリングを通る断面図である。
図1に示した装置は、全体的に符号1で示したハンドピ
ースを含んでおり、これは患者の外科手術部位の組織の
超音波切断、吸引、電気外科的切断、液体洗浄、及び電
気外科的凝固又は止血機能を実行することができる。こ
れらの機能は別々にまたは同時にいかなる組み合わせで
も実行してもよい。基本のハンドピースは好ましくは、
上述の米国特許第4、063、557号又は前述のCU
CAハンドピースのような、電気外科的切断と凝固機能
を含むように修正された既知の超音波切断用ハンドピー
スである。これらの修正はハンドピース自身に組み入れ
ることも可能であり、又はマニホールド若しくはその先
端円錐部のように処分可能で置換可能なハンドピース成
分の一部として備えることもできる。 図1に示したようなハンドピース1はプラスチックのハ
ウジング2と先端円錐部3からなり、外科医の手で簡単
かつ快適に握れて操作することができる大きさと形状を
有している。ハウジング2は超音波トランスデューサ4
と導電性金属音響接続部材5の基部端付近を収容し、
又、ハウジング2は先端円錐部3と螺合されており、先
端円錐部3は接続部材5の末端部と伸長されたテーパの
ついた超音波振動器具6を収容している。器具6は同じ
く例えばチタンのような導電性金属からできており、雄
ねじ7を通って接続部材と螺合されている。器具6は前
方方向に配置されているので、器具先端8がハウジング
からある距離前方へ延び出しており、その末端には先端
孔9を有している。器具は中空で、その中を通る長手方
向の器具通路を画成している。 (図示しない)吸引ポンプが管10を通って吸引力をか
けているので、管10が導管11を介して器具の末端2
3に連結されると、外科手術部位にある組織粒子、血
液、液体等を部位から先端孔9を通過し、器具通路を通
過して(図示しない)適当な吸引コンテナへと吸引させ
ることができる。 外科手術部位から吸引してもよい液体の一つは、例えば
器具6によって切断された組織粒子のための懸濁液を与
えるような外科措置の一部として外科手術部位へ与えら
れる食塩洗浄液体である。食塩洗浄溶液は既知の方法に
よって重力により外科手術部位の上につるされたボルト
または袋から(図示しない)洗浄管を介してハンドピー
スの中の適当な入口へ排出されるとよい。次に器具6と
プラスチックスリーブ又はマニフォールド12との間で
画成される環状通路を通って流れ、次に器具先端8の回
りのマニフォールドから手術部位へと流出する。手術部
位への洗浄溶液を供給することに加えて、液体は振動器
具先端8を冷却し、隣接する健康な組織を損傷から保護
する。この液体と血液、組織粒子及び他の吸引される物
質とを混合することによって、血液の凝固が遅くなり、
それらの吸引を促進する。囲まれた部分又は超音波白内
障除去措置における目のように半分囲まれた部分が手術
部位であるときには、その中の圧力を一定範囲に維持す
ることが重要であり、この様な圧力を維持するための流
出制御システムが知られており、それをここで使用する
ことができる。例えば、米国特許第3,693,613
号を参照されたい。凝固液体の送出制御及び吸引圧力と
超音波エネルギーの適用はこの分野で知られているよう
に外科医にとってフットスイッチで簡単に実施すること
ができる。 器具6は超音波振動を行い、ハンドピース内に取り付け
られて、接続部材5とトランスデューサ4を含む共振振
動システムの一部となっている。好ましいトランスデュ
ーサは米国特許第Re.25,033号で示されたよう
な磁歪スタックを含んでいる。器具6は好ましくは略単
一の本体からなり、その基部端には雄ねじを有してお
り、必要であれば取り替えて、接続部材5の末端部への
接続を行うことができる設計となっている。好ましく
は、超音波共振器は先端8に0.001インチを越え
る、好ましくは0.0014インチのストロークで、2
0KHz−50KHzの周波数帯域で、好ましくは23KHz
−37KHzの周波数帯域の超音波的振動を起こさせる。 電気外科用ユニット(ESU)は、本発明の改良された
外科装置における高周波エネルギーを与えるもので、米
国特許3,898,991号、3,963,030号、
4,051,855号に開示されているような独立して
置かれた病院のユニットであってもよく、又は代わりに
一つの好ましくは携帯用の吸引器ポンプと同じハウジン
グ内のユニットに含まれるものでもよい。ESUは高周
波エネルギーを発生し、(図示しない)ケーブルを介し
てハンドピース1の先端円錐部3上の切換手段と接続さ
れている。好ましくは、ESUは公知の電気的フィルタ
装置を備えており、ESUが器具先端へ切換手段を介し
て接続されている間、ESUが作動してきるときにES
U内の論理制御の故障を防止する。 切換手段はハンドピースの先端円錐部に位置づけられて
いるので、外科医がハンドピースを操作するときに、外
科医が具合よく作動することができ、ESUから器具6
へ高周波エネルギーの伝達を制御することができる。従
って、切換手段は外科医に高周波エネルギーが無い状態
から、高周波凝固エネルギー、高周波切断エネルギー、
及び凝固エネルギーと切断エネルギーの混合の選択をさ
せることができる。高周波切断及び凝固電流は異なって
おり、各々純粋な正弦波と、ダンプされた正弦波とで定
義付けられる。 本発明の改良された切換手段はハンドピースの先端円錐
部上に取り付けられたハンドスイッチを含んでおり、こ
れにより実施しやすく、ハンドピースを握って扱ってい
るときに外科医の手(例えば人指し指)で容易に作動さ
せることができる。 ハンドスイッチの好適な実施例を図1に示す。ハンドス
イッチは例えば分離可能なハンドピースマニホールドに
取り付けられたアッドオンスイッチ組立体のような分離
可能及び交換可能なユニットを含んでいる。またその代
わりに、(図示しないが)全体的に便利になるようハン
ドスイッチはハンドピースのハウジングに一体的に形成
され又は組み入れられてもよい。すべての実施例におい
て、スイッチモジュールはここで述べる導電性Oリング
を介して装置の導電部材へ高周波エネルギーを伝達す
る。 スイッチ組立体は押しボタン、ロッカ又はスライド構造
をしている。好ましい実施例は図1に概略的に示したよ
うにロッカー組立体である。 ロッカー組立体は外科医に通常開いたドームスイッチ1
4、15をそれぞれ介してESUから高周波電流の“切
断”モードを選択させることができる。関連あるドーム
スイッチが閉じられると、適当な高周波電流がスイッチ
モジュール内の回路基盤16(図2)によって発生し、
分岐した導電性端子17、導電性金属バンド18及び導
電性Oリング19を介して接続部材5さらに器具6へと
流れる。 導電性Oリング19は好ましくは銀メッキされたアルミ
ニウムのような導電性材料の粒子が吹き込まれ又は装填
されたゴムエラストマからできている。上述したタイプ
の標準的な超音波外科器具に対して導電性Oリング19
は通常そのリングの内径d(図3)が約0.50インチ
から0.60インチ、好ましくは0.56インチで、そ
の断面の直径c(図4)が約0.04インチである。先
端円錐部3がハウジング2としっかりと螺合されている
場合には、略円形のOリングの断面は図2に示すように
いくらか歪められる。きつい適合で連結されたOリング
の弾性によって作用中にOリングの接続部材との接触を
維持させることができ、従ってアークの起こる可能性を
防止することができる。同様に金属バンド18とOリン
グ19との間の接触もアークを起こすことなく維持し、
従って装置の作用中、電気的連続性を維持することがで
きる。金属バンド18は例えばベリリウム銅合金で、約
0.004から0.005インチの厚さを持つ導電性金
属の延性片からなる。そのバンドの幅は約0.043か
ら0.045インチである。バンドの下部は略L字形の
Lの基部になっており、Oリング19と接触している。
バンドの上部は折り返されて弾性プラグを形成してお
り、分岐端子7の中に圧入し、常に端子の内側壁と直接
接触を維持している。 接続部材は標準的なOリング20によってハウジング2
に対して防水的な接触を維持しており、後方のOリング
21と前方のOリング22によって先端円錐部3に対す
る防水接触を維持している。これらのOリングは天然又
は人工ゴム又は人工エラストマの高分子からなり、この
分野で標準的な部品である。 前方のOリング22は接続部材の中央部の回りの空間に
侵入する洗浄液体を防止するものであり、Oリング20
は該空間に侵入する冷却液体を防止するものである。接
続部材の中央部はここで導電性Oリング19との電気的
接触部分を含む部分として定義付けられる。従ってこの
空間は実質的に乾燥した空間を維持でき、従ってスイッ
チモジュールに液体の侵入する危険がない。 本発明の改良された切換手段が組み入れられた装置を繰
り返し動作させても電気効率の悪化は実質的になかっ
た。多数の延長テスト後の導電性Oリングの試験ではア
ークによる燃焼又は焼き焦げ、及び実質的な機械的悪化
の兆候を何ら示さなかった。
ースを含んでおり、これは患者の外科手術部位の組織の
超音波切断、吸引、電気外科的切断、液体洗浄、及び電
気外科的凝固又は止血機能を実行することができる。こ
れらの機能は別々にまたは同時にいかなる組み合わせで
も実行してもよい。基本のハンドピースは好ましくは、
上述の米国特許第4、063、557号又は前述のCU
CAハンドピースのような、電気外科的切断と凝固機能
を含むように修正された既知の超音波切断用ハンドピー
スである。これらの修正はハンドピース自身に組み入れ
ることも可能であり、又はマニホールド若しくはその先
端円錐部のように処分可能で置換可能なハンドピース成
分の一部として備えることもできる。 図1に示したようなハンドピース1はプラスチックのハ
ウジング2と先端円錐部3からなり、外科医の手で簡単
かつ快適に握れて操作することができる大きさと形状を
有している。ハウジング2は超音波トランスデューサ4
と導電性金属音響接続部材5の基部端付近を収容し、
又、ハウジング2は先端円錐部3と螺合されており、先
端円錐部3は接続部材5の末端部と伸長されたテーパの
ついた超音波振動器具6を収容している。器具6は同じ
く例えばチタンのような導電性金属からできており、雄
ねじ7を通って接続部材と螺合されている。器具6は前
方方向に配置されているので、器具先端8がハウジング
からある距離前方へ延び出しており、その末端には先端
孔9を有している。器具は中空で、その中を通る長手方
向の器具通路を画成している。 (図示しない)吸引ポンプが管10を通って吸引力をか
けているので、管10が導管11を介して器具の末端2
3に連結されると、外科手術部位にある組織粒子、血
液、液体等を部位から先端孔9を通過し、器具通路を通
過して(図示しない)適当な吸引コンテナへと吸引させ
ることができる。 外科手術部位から吸引してもよい液体の一つは、例えば
器具6によって切断された組織粒子のための懸濁液を与
えるような外科措置の一部として外科手術部位へ与えら
れる食塩洗浄液体である。食塩洗浄溶液は既知の方法に
よって重力により外科手術部位の上につるされたボルト
または袋から(図示しない)洗浄管を介してハンドピー
スの中の適当な入口へ排出されるとよい。次に器具6と
プラスチックスリーブ又はマニフォールド12との間で
画成される環状通路を通って流れ、次に器具先端8の回
りのマニフォールドから手術部位へと流出する。手術部
位への洗浄溶液を供給することに加えて、液体は振動器
具先端8を冷却し、隣接する健康な組織を損傷から保護
する。この液体と血液、組織粒子及び他の吸引される物
質とを混合することによって、血液の凝固が遅くなり、
それらの吸引を促進する。囲まれた部分又は超音波白内
障除去措置における目のように半分囲まれた部分が手術
部位であるときには、その中の圧力を一定範囲に維持す
ることが重要であり、この様な圧力を維持するための流
出制御システムが知られており、それをここで使用する
ことができる。例えば、米国特許第3,693,613
号を参照されたい。凝固液体の送出制御及び吸引圧力と
超音波エネルギーの適用はこの分野で知られているよう
に外科医にとってフットスイッチで簡単に実施すること
ができる。 器具6は超音波振動を行い、ハンドピース内に取り付け
られて、接続部材5とトランスデューサ4を含む共振振
動システムの一部となっている。好ましいトランスデュ
ーサは米国特許第Re.25,033号で示されたよう
な磁歪スタックを含んでいる。器具6は好ましくは略単
一の本体からなり、その基部端には雄ねじを有してお
り、必要であれば取り替えて、接続部材5の末端部への
接続を行うことができる設計となっている。好ましく
は、超音波共振器は先端8に0.001インチを越え
る、好ましくは0.0014インチのストロークで、2
0KHz−50KHzの周波数帯域で、好ましくは23KHz
−37KHzの周波数帯域の超音波的振動を起こさせる。 電気外科用ユニット(ESU)は、本発明の改良された
外科装置における高周波エネルギーを与えるもので、米
国特許3,898,991号、3,963,030号、
4,051,855号に開示されているような独立して
置かれた病院のユニットであってもよく、又は代わりに
一つの好ましくは携帯用の吸引器ポンプと同じハウジン
グ内のユニットに含まれるものでもよい。ESUは高周
波エネルギーを発生し、(図示しない)ケーブルを介し
てハンドピース1の先端円錐部3上の切換手段と接続さ
れている。好ましくは、ESUは公知の電気的フィルタ
装置を備えており、ESUが器具先端へ切換手段を介し
て接続されている間、ESUが作動してきるときにES
U内の論理制御の故障を防止する。 切換手段はハンドピースの先端円錐部に位置づけられて
いるので、外科医がハンドピースを操作するときに、外
科医が具合よく作動することができ、ESUから器具6
へ高周波エネルギーの伝達を制御することができる。従
って、切換手段は外科医に高周波エネルギーが無い状態
から、高周波凝固エネルギー、高周波切断エネルギー、
及び凝固エネルギーと切断エネルギーの混合の選択をさ
せることができる。高周波切断及び凝固電流は異なって
おり、各々純粋な正弦波と、ダンプされた正弦波とで定
義付けられる。 本発明の改良された切換手段はハンドピースの先端円錐
部上に取り付けられたハンドスイッチを含んでおり、こ
れにより実施しやすく、ハンドピースを握って扱ってい
るときに外科医の手(例えば人指し指)で容易に作動さ
せることができる。 ハンドスイッチの好適な実施例を図1に示す。ハンドス
イッチは例えば分離可能なハンドピースマニホールドに
取り付けられたアッドオンスイッチ組立体のような分離
可能及び交換可能なユニットを含んでいる。またその代
わりに、(図示しないが)全体的に便利になるようハン
ドスイッチはハンドピースのハウジングに一体的に形成
され又は組み入れられてもよい。すべての実施例におい
て、スイッチモジュールはここで述べる導電性Oリング
を介して装置の導電部材へ高周波エネルギーを伝達す
る。 スイッチ組立体は押しボタン、ロッカ又はスライド構造
をしている。好ましい実施例は図1に概略的に示したよ
うにロッカー組立体である。 ロッカー組立体は外科医に通常開いたドームスイッチ1
4、15をそれぞれ介してESUから高周波電流の“切
断”モードを選択させることができる。関連あるドーム
スイッチが閉じられると、適当な高周波電流がスイッチ
モジュール内の回路基盤16(図2)によって発生し、
分岐した導電性端子17、導電性金属バンド18及び導
電性Oリング19を介して接続部材5さらに器具6へと
流れる。 導電性Oリング19は好ましくは銀メッキされたアルミ
ニウムのような導電性材料の粒子が吹き込まれ又は装填
されたゴムエラストマからできている。上述したタイプ
の標準的な超音波外科器具に対して導電性Oリング19
は通常そのリングの内径d(図3)が約0.50インチ
から0.60インチ、好ましくは0.56インチで、そ
の断面の直径c(図4)が約0.04インチである。先
端円錐部3がハウジング2としっかりと螺合されている
場合には、略円形のOリングの断面は図2に示すように
いくらか歪められる。きつい適合で連結されたOリング
の弾性によって作用中にOリングの接続部材との接触を
維持させることができ、従ってアークの起こる可能性を
防止することができる。同様に金属バンド18とOリン
グ19との間の接触もアークを起こすことなく維持し、
従って装置の作用中、電気的連続性を維持することがで
きる。金属バンド18は例えばベリリウム銅合金で、約
0.004から0.005インチの厚さを持つ導電性金
属の延性片からなる。そのバンドの幅は約0.043か
ら0.045インチである。バンドの下部は略L字形の
Lの基部になっており、Oリング19と接触している。
バンドの上部は折り返されて弾性プラグを形成してお
り、分岐端子7の中に圧入し、常に端子の内側壁と直接
接触を維持している。 接続部材は標準的なOリング20によってハウジング2
に対して防水的な接触を維持しており、後方のOリング
21と前方のOリング22によって先端円錐部3に対す
る防水接触を維持している。これらのOリングは天然又
は人工ゴム又は人工エラストマの高分子からなり、この
分野で標準的な部品である。 前方のOリング22は接続部材の中央部の回りの空間に
侵入する洗浄液体を防止するものであり、Oリング20
は該空間に侵入する冷却液体を防止するものである。接
続部材の中央部はここで導電性Oリング19との電気的
接触部分を含む部分として定義付けられる。従ってこの
空間は実質的に乾燥した空間を維持でき、従ってスイッ
チモジュールに液体の侵入する危険がない。 本発明の改良された切換手段が組み入れられた装置を繰
り返し動作させても電気効率の悪化は実質的になかっ
た。多数の延長テスト後の導電性Oリングの試験ではア
ークによる燃焼又は焼き焦げ、及び実質的な機械的悪化
の兆候を何ら示さなかった。
Claims (3)
- 【請求項1】患者の外科手術部位に一つ又はそれ以上の
外科措置を行うための外科用装置であって、ハンドピー
ス1と;該ハンドピースによって支持され且つ振動器具
端8を有する器具6と;該器具端を超音波振動させるた
めの金属接続部材5を含む振動手段と;外科手術部位に
電気外科的措置を行うために該器具端に高周波(RF)
電流を供給する選択的に作動可能な高周波(RF)電流
手段とを含み、該高周波電流手段は該器具端に供給され
る高周波電流を超音波振動の間少なくとも高周波(R
F)切断電流へ切り換える切換手段13を含み、上記切
換手段はスイッチモジュールを備え、該スイッチモジュ
ールは上記高周波電流を選択する回路基盤16と導電性
金属バンド18とを含み、切換手段が更に前記接続部材
の回りにあって前記金属バンドと電気的接触する導電性
Oリング19を含むことを特徴とする外科用装置。 - 【請求項2】請求項1記載の装置であって、上記導電性
Oリング19は銀メッキアルミニウムの導電性粒子が含
浸されたエラストマから形成されることを特徴とする外
科用装置。 - 【請求項3】請求項1記載の装置であって、上記導電性
金属バンド18は導電性分岐端子17を介して上記スイ
ッチモジュールに接続されることを特徴とする外科用装
置。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US504,453 | 1990-04-03 | ||
US07/504,453 US5015227A (en) | 1987-09-30 | 1990-04-03 | Apparatus for providing enhanced tissue fragmentation and/or hemostasis |
PCT/US1991/002087 WO1991015157A1 (en) | 1990-04-03 | 1991-03-27 | Apparatus for providing enhanced tissue fragmentation and/or hemostasis |
Publications (2)
Publication Number | Publication Date |
---|---|
JPH05501978A JPH05501978A (ja) | 1993-04-15 |
JPH0640882B2 true JPH0640882B2 (ja) | 1994-06-01 |
Family
ID=24006330
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP3507604A Expired - Fee Related JPH0640882B2 (ja) | 1990-04-03 | 1991-03-27 | 向上された組織切断及び/又は止血を与える装置 |
Country Status (14)
Country | Link |
---|---|
US (1) | US5015227A (ja) |
EP (1) | EP0523174B1 (ja) |
JP (1) | JPH0640882B2 (ja) |
AT (1) | ATE106219T1 (ja) |
AU (1) | AU638830B2 (ja) |
CA (1) | CA2075902C (ja) |
DE (2) | DE69102271T2 (ja) |
DK (1) | DK0523174T3 (ja) |
ES (1) | ES2055988T3 (ja) |
FI (1) | FI924451A0 (ja) |
IE (1) | IE64458B1 (ja) |
IL (1) | IL97682A (ja) |
NO (1) | NO923854D0 (ja) |
WO (1) | WO1991015157A1 (ja) |
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- 1990-04-03 US US07/504,453 patent/US5015227A/en not_active Expired - Lifetime
-
1991
- 1991-03-26 IL IL9768291A patent/IL97682A/en not_active IP Right Cessation
- 1991-03-27 AU AU76741/91A patent/AU638830B2/en not_active Ceased
- 1991-03-27 AT AT91908076T patent/ATE106219T1/de not_active IP Right Cessation
- 1991-03-27 DE DE69102271T patent/DE69102271T2/de not_active Expired - Fee Related
- 1991-03-27 DE DE9190051U patent/DE9190051U1/de not_active Expired - Lifetime
- 1991-03-27 CA CA002075902A patent/CA2075902C/en not_active Expired - Fee Related
- 1991-03-27 EP EP91908076A patent/EP0523174B1/en not_active Expired - Lifetime
- 1991-03-27 ES ES91908076T patent/ES2055988T3/es not_active Expired - Lifetime
- 1991-03-27 WO PCT/US1991/002087 patent/WO1991015157A1/en active IP Right Grant
- 1991-03-27 DK DK91908076.2T patent/DK0523174T3/da active
- 1991-03-27 JP JP3507604A patent/JPH0640882B2/ja not_active Expired - Fee Related
- 1991-03-28 IE IE107791A patent/IE64458B1/en not_active IP Right Cessation
-
1992
- 1992-10-02 NO NO923854A patent/NO923854D0/no unknown
- 1992-10-02 FI FI924451A patent/FI924451A0/fi unknown
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IL97682A (en) | 1996-01-31 |
AU7674191A (en) | 1991-10-30 |
IL97682A0 (en) | 1992-06-21 |
DE9190051U1 (de) | 1993-05-13 |
AU638830B2 (en) | 1993-07-08 |
US5015227A (en) | 1991-05-14 |
DK0523174T3 (da) | 1994-08-22 |
ATE106219T1 (de) | 1994-06-15 |
DE69102271T2 (de) | 1994-09-15 |
DE69102271D1 (de) | 1994-07-07 |
CA2075902C (en) | 1998-03-31 |
IE911077A1 (en) | 1991-10-09 |
WO1991015157A1 (en) | 1991-10-17 |
EP0523174B1 (en) | 1994-06-01 |
FI924451A (fi) | 1992-10-02 |
FI924451A0 (fi) | 1992-10-02 |
ES2055988T3 (es) | 1994-09-01 |
EP0523174A1 (en) | 1993-01-20 |
CA2075902A1 (en) | 1991-10-04 |
NO923854L (no) | 1992-10-02 |
NO923854D0 (no) | 1992-10-02 |
IE64458B1 (en) | 1995-08-09 |
JPH05501978A (ja) | 1993-04-15 |
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