JPH08238255A - 手術用電気止血装置 - Google Patents
手術用電気止血装置Info
- Publication number
- JPH08238255A JPH08238255A JP7349057A JP34905795A JPH08238255A JP H08238255 A JPH08238255 A JP H08238255A JP 7349057 A JP7349057 A JP 7349057A JP 34905795 A JP34905795 A JP 34905795A JP H08238255 A JPH08238255 A JP H08238255A
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- tissue
- electrode
- electrodes
- end effector
- interface
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- 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
- A61B18/1206—Generators therefor
-
- 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
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
- A61B18/1447—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod wherein sliding surfaces cause opening/closing of the end effectors
-
- 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
-
- 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
- A61B18/1402—Probes for open surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00491—Surgical glue applicators
- A61B2017/00504—Tissue welding
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
-
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
-
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- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00404—Blood vessels other than those in or around the heart
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- 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
- A61B2018/00601—Cutting
-
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
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- A61B2018/00678—Sensing and controlling the application of energy using a threshold value upper
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00684—Sensing and controlling the application of energy using lookup tables
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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- A61B2018/00696—Controlled or regulated parameters
- A61B2018/00702—Power or energy
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
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- A61B2018/00702—Power or energy
- A61B2018/00708—Power or energy switching the power on or off
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- A61B2018/00773—Sensed parameters
- A61B2018/00875—Resistance or impedance
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- 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
- A61B18/1206—Generators therefor
- A61B2018/1273—Generators therefor including multiple generators in one device
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/032—Automatic limiting or abutting means, e.g. for safety pressure limiting, e.g. hydrostatic
Abstract
ーダンス、厚さおよび血管の分布が異なる組織の焼灼・
融着を行う電気的な手術装置を提供すること。 【解決手段】 本発明の装置は、第1のインターフェー
ス面と第2のインターフェース面の間の圧縮領域におい
て、組織を圧縮する。圧縮領域は、一方のインターフェ
ース面において圧縮稜線を形成し、互いに反対の極をな
す第1の電極と第2の電極を離隔する絶縁材によって形
成される。本発明の好ましい適用例は、切断線に沿って
高周波を用い、止血線を形成する切断装置である。
Description
993年7月22日出願)および同第096,154 号(19
93年7月22日出願)の一部継続出願である。
視鏡手術の際に用いる焼灼、凝集および/または組織融
着のための電気手術具に関する。
いては、切開・切断箇所における出血は避けられない。
そこで、出血の制御のため、成功率は異なるが、例えば
縫合、血管のクリップ止め、ホチキス止め、電気焼灼そ
の他の組織加熱技術など様々な技法が適用されてきた。
そして、この組織の張り合せあるいは融着、組織の修復
および創傷部の閉止における進歩のため、以前は不可能
あるいはきわめて危険であった手術も実施できるように
なった。
および組織切断時の止血のために用いられてきた。この
ような装置には、例えば線形および円形の切断・ホチキ
ス止め具がある。典型的には、線形カッターは、ステー
プル(ホチキス針)の平行な列と切断手段がステープル
列の間を移動するためのスロットを備える。この型のホ
チキス装置は、切断をよりうまく行えるよう組織を固着
し、切断手段がステープル平行列の間で組織を切断する
際、ステープルの平行列を周囲の組織の層に適用して、
複数の組織層を合わせて止血を行う。
織凝集または焼灼によりより効果的な止血を行うために
用いられてきた。単極装置は、切断具あるいは焼灼具に
接続した一つの電極を備え、遠隔帰線電極は通常患者に
体外から取り付けられる。最近では、双極の装置も用い
られている。これは、焼灼電流を装置の組織取扱い部の
二つの電極の間にある組織だけに与えることができるた
めである。
術で、切断および/または凝集用に用いられている。双
極鉗子は通常、組織を二つの極の間で把持し、把持した
組織を通して電流を印加する。しかし、双極鉗子にもい
くつか欠点がある。例えば、把持した組織が薄いときは
電流が二つの極の間でアーク放電を生じる傾向があるこ
と、あるいは両極が接触したとき短絡が起こるなどであ
る。また、鉗子を組織凝集用に扱うのは高度な技術を要
し、さらに鉗子は元々広範囲を同時に焼灼できるように
は造られていない。そして、鉗子には熱拡散の傾向、す
なわち熱が鉗子で把持された領域の外側に消散していく
傾向がある。
部分における組織多重領域あるいは厚さの種々に異なる
組織領域、およびインピーダンスが高い組織、低い組織
あるいはインピーダンスに高低がある組織において、効
果的に止血を行うことができる止血用の電気手術具を提
供することを目的とする。本明細書では、「止血」の語
は、凝集、焼灼および/または組織張り合せもしくは融
着を含む出血の停止を意味する。
るいは長い領域を同時に焼灼ないし融着できる止血装置
を提供することを目的とする。
により、好ましくは組織を強く圧縮した領域を経由して
制御可能な電流量を与える通路を提供することを目的と
する。
状の電極を有する電気焼灼装置を提供することである。
による切断線に隣接して凝集線を与える止血手段を提供
することである。
組織融着あるいは焼灼用の電気焼灼手段を備えた切断・
ホチキス装置を提供することである。
せるための相対向するインターフェース面と、二つの相
反する極をもつ電極であって、先のインターフェース面
の片方もしくは両方にそれぞれ配置される電極を備える
終端効果器を有する電気手術装置により実現される。二
つの電極は、インターフェース面からみて互いにずれて
いる。すなわち、これらの電極は、インターフェース面
において径方向に相対向することのないような形でずれ
ている。もし二つの電極が同じインターフェース面にあ
る場合は、これらは、絶縁材料もしくは絶縁材(空隙を
含む)によって互いに離隔され、電気的に絶縁される。
のインターフェース面と第2のインターフェース面の間
の圧縮領域で組織を圧縮し、また圧縮領域を通じて電気
エネルギーを印加する。第1のインターフェース面は、
双極エネルギー源の第1の極に対応して圧縮領域の側方
に配置される第1の電極、および双極エネルギー源の第
2の極に対応して圧縮領域の第1の電極とは反対側の側
方に配置される第2の電極を含む。第2の電極は第1の
電極と同じ側もしくは反対側のインターフェース面に設
けられる。このような配置により、二つの極は電気的に
絶縁され、圧縮されている組織の所望領域を通る電流路
を第1の電極と第2の電極の間に確保することが可能に
なる。
織を他のインターフェース面に押しつけるインターフェ
ース面の一方にある圧縮稜線によって区画される領域で
ある。なお、両方のインターフェース面に圧縮稜線を設
けることもできる。凝集領域は、第1の電極、第2の電
極および、第1の電極を第2の電極から絶縁する絶縁材
によって区画される。
をもたらす組織内の構造的な差異が減少して、組織のイ
ンピーダンスが正常化すると考えられる。組織の圧縮は
また、血流を効果的に停止させ、特に静脈、動脈および
他の管から流れるときヒートシンクとして作用する血液
および他の間隙性の流体を絞り出す。さらに、組織を強
く圧縮すると、エネルギー供給電極に接したこの組織を
通って送られる電流の電流密度が高くなるとも考えられ
る。したがって、組織の圧縮は、一部には血流と組織を
包囲する境界を通じた過剰な熱の拡散を抑え、電流密度
の高い電流を組織の制御された領域に腎族に供給してエ
ネルギーの供給を最適化すると考えられる。電気的な極
を構成する電極の配置は、二つの極の間を通過する電流
を確実に圧縮領域を通じさせるために、重要である。ま
た電極の配置により、組織を圧縮したとき装置の極の短
絡や、双極的な装置によくみられるアーク放電を生じな
いようにすることができる。
り、より効果的な焼灼を行うことが可能になり、組織の
インピーダンス、厚さおよび血管分布について広い範囲
の値をもつ組織に対して止血か可能になる。
の沿ってあるいはこれを横断する方向に組織を線または
道筋に沿って凝集させることができる装置も提供する。
一態様においては、第1の電極と第2の電極はそれぞ
れ、焼灼する組織を圧縮するための稜線を形成する絶縁
材に側方から隣接して互いに反対の側にある長手の電極
を具備する。
断する切断手段は組織の中に組み込まれ、装置は、切断
手段による切断の道筋に隣接して止血線を設ける。もち
ろん、切断は、焼灼あるいは融着の前、最中あるいは後
のいずれにも行うことができる。この好ましい態様の変
形例として、ホチキス手段は、切断の道筋の片側あるい
は両側に設けられる。
望あるいは所定の程度まで焼灼されたことをユーザに伝
える。
ようなファスナアプライヤ(applier) とともに、ステー
プル、クリップ、縫合糸、生体吸収性ファスナのような
一またはそれ以上の組織ファスナを適用し、さらに電気
手術用のエネルギーが印加される。
な切断、すなわち切断手段の作動に先立って、凝集を完
了させる。指示手段を使用する場合は、一旦組織を焼灼
し、その後刷れ列が組織に適用されている間に二つのバ
ーの間で切断を行うべく、切断手段を作動させる。
形の切断・ホチキス装置に似た線形の切断装置に組み込
まれる。この態様においては、止血装置は、電気的に対
極をなす二つのほぼ平行な長手の組合せ電極バーと、こ
れらバーの間で移動する切断手段のためのスロットを備
える。なお、治療の最中に組織を機械的に固定させたり
接近させたりするため、一またはそれ以上のステープル
列を、スロットと電極バーの各側に設けてもよい。操作
の際には、組織は二つの顎で挟む。電気エネルギーは、
圧縮された組織に高周波電流の形で供給され、二つの電
極バーに沿って組織を焼灼する。
ホチキス装置に類似した組織の融着・焼灼・切断装置を
提供する。
の範囲を外れた異常インピーダンスあるいは他の電気的
パラメータを検出する手段を提供する。この検出手段
は、例えば、装置が良好な凝集を与える範囲を外れたイ
ンピーダンスを示す組織に適用されているのを知らせる
のに用いられる。この検出手段はまた、装置の他の以上
を検出するのにも用いられる。例えば、インターフェー
ス機器における組織の初期インピーダンスの正常な範囲
と比較すれば。異常な状態を検出することができる。こ
れは、高周波エネルギーを印加して最初の数μ秒で感知
することができ、十分な治療効果を与える量のエネルギ
ー、すなわち焼灼、凝集あるいは組織の融着を生じさせ
るのに必要なエネルギーを与えることはない。その他、
治療に必要なエネルギーを供給する前に、組織のインピ
ーダンスを測定する低電圧信号を与えてもよい。さら
に、インピーダンスが所定範囲から外れた場合に、これ
をユーザに知らせる警告機構を用いることもできる。装
置の再設定の場合は、同じ測定基準を用い、もし組織の
インピーダンスが再び所定の範囲を外れたときは、ユー
ザは同様の警告を発せられる。この処理は、正常なイン
ピーダンス範囲が満足され、良好な凝集が期待できるよ
うになるまで続けられる。
図面を参照して詳細に説明する。図1〜9は、本発明の
好ましい態様を示す。この態様に係る内視鏡手術用電気
焼灼機能付き線形切断・ホチキス装置10は、管腔を有
するシャフト30に連結された本体10と、シャフト3
0の遠方端21から延びる終端効果器50を有する。シ
ャフト30は、絶縁材料でできており、このシャフト3
0の管腔を通って延びる導電性の鞘38を有する。鞘3
8を通って延びるチャネル39は、このチャネル39内
におけるドライブ手段44の同軸的な動きを案内する。
この特別の態様においては、ドライブ手段44は、本体
16に接続する射出トリガ14を備える。そして、本体
16は、ブロック43に連結したドライブロッド41に
連結した可撓性射出ロッド40に連結している。ブロッ
ク43は、切断手段11とステープルドライブウェッジ
(くさび)13に連結する。
材32,34を備える。終端効果器50は、顎部材34
を経由してチャネル39に固着される。顎部材32は、
顎部材34に対し、移動可能に接続される。本体16
は、鞘38の手前端に連結した閉止ラック45を長手方
向に進める顎32,34閉止用のクランプトリガ12を
有する。閉止ラック45は、シャフト30を通して鞘3
8を同軸的に押し進める。鞘38は、顎32のカム面2
7上を進み、両顎の間に位置する組織を間に挟んで顎3
2と34を閉止させる。以下に詳細に説明するように、
閉止ラック45はまた、電気エネルギーを終端効果器5
0に送る回路を閉鎖するスイッチとしても働く。
拡大図である。顎部材32と34は、図3においては非
クランプ状態で示してあり、図4ではクランプかつ非射
出状態を、そして図5においてはクランプ・射出状態を
示してある。ナイフチャネル26は、第1および第2の
インターフェース面35,35をを切断する面を区画す
る。顎部材32は、アンビル18を含む。アンビル18
は、アンビル18の第1の側面81上で顎32に対して
長手方向に延びる第1電極52と、アンビル18のもう
一つの側面82上で顎32に対して長手方向に延びる第
2電極80を備える。第1電極52と第2電極80は、
アンビル18の中央部を通って延びる絶縁材55によっ
て互いに電気的に絶縁される。
3は顎34の内面35と向かい合う。第1電極52と第
2電極80は、インターフェースに沿って遠方側と手前
側に延び、インターフェースにおいて圧縮され遠方側と
手前側に延びる稜線56を有する絶縁材55によって離
隔される。稜線56は、内面33(図6)のアンビル部
33aから延び出る。絶縁材55は通常U字形で、この
絶縁材55を通って長手方向に延び、切断部材がスロッ
ト42を通る通路を形成するナイフチャネル42を備え
る。アンビル18上にあってステープルの両端を収める
二つのポケット36,37は、絶縁材55の外側にある
アンビルの側面81.82上で、内面33に沿って延び
る。電極52,80は、アルミニウムなどの導電性の材
料からつくられ、電気的に反対の第1および第2の極と
して働く。
とカートリッジ23を備える。カートリッジ23はトラ
ック25を具備し、このトラック25は、ウェッジ1
3、カートリッジ23の中央を通って軸方向に延びるナ
イフチャネル26、トラック25内に延び出る一連のド
ライバ24、および二つの列に配置されるステープルの
ためのものである。組織が両顎32,34の間に係合し
たときは、ドライブ手段44は、組織の切断とホチキス
止めのため切断手段11とウェッジ13を係合した組織
を通して進めるべく、トリガ14を使ってアクチュエー
トないし射出される。射出機構14がアクチュエートさ
れると、ウェッジ13はトラック25を通して押し進め
られ、ドライバ24をステープル100に向けて変位さ
せて、ステープル100を組織を貫通してアンビルのポ
ケット36,37まで移動させる。
効果器の顎32,34を回転させるため、ノブ15に直
接・間接に連結されたシャフト30、鞘38、チャネル
39および終端効果器50を回転させる。
60から、装置の本体16まで延びるワイヤ19,90
を通して終端効果器50に供給される。ゼネレータ60
は、フットスイッチ65によりユーザが制御できる。
ヤや他の電気接続手段61を通して、第1の極につなが
る電気接触端子62に接続される。対極の電流を運ぶワ
イヤ20は、ワイヤや他の電気接続手段66を通して、
閉止ラック45の遠方端に位置して先の電気接触端子6
2とは電気的に絶縁されたディスク状の接触端子67に
接続される。
るディスク状の接触端子63は、ワイヤや他の接続手段
64と電気的に導通する。接触手段64は、チャネル3
9を通して、第1の電極52と接触する終端効果器の顎
32まで延びる。ディスク状の接触端子63は、ディス
ク状の接触端子63と接触手段64の間の接触を維持し
たままで、ノブ15が回転できるようにする。接触手段
64は、鞘38とは電気的に絶縁される。
ると、閉止ラック45は遠方に移動し、接触端子62は
ディスク状接触端子と電気的に導通する。また第2電極
80に連なるディスク状接触端子67も導電性の鞘38
と電気的に接触する。鞘38は、アンビル18の導電性
の第2側部82のカム面27上を移動する。アンビル1
8の第1の側面は、電極52がインターフェース面33
に曝される箇所以外は、絶縁材料83で被覆される。し
たがって、鞘38は、第1の電極52とは電気的に接触
しない。電気回路は、クランプトリガ12が閉止したと
きにのみ、閉路となる。
組織の切断部位に位置させる。顎部材32,34は、ボ
タンばね71を外して閉止ラック45を手前側に移動さ
せるリリースボタン70を押すことによって開放され
る。組織はついで、顎部材32,34の各インターフェ
ース用内面33,35の間に把持される。クランプトリ
ガ12は、鞘38がカム面27上で移動するように引か
れ、これによって顎32,34は閉止され、同時に上述
のように電気回路も閉路となる。稜線56を形成する絶
縁材55は、組織を顎部材34の内面35に対して押し
つけ圧縮する。ユーザはついで、フットスイッチ65や
他のスイッチを使ってRF(高周波)エネルギーをゼネ
レータ60から印加する。電流は、第1電極52と第2
電極80の間で、圧縮された組織を通じて流れる。
kHz から3MHz の高周波エネルギーを供給する低インピ
ーダンス源がよい。好ましくは、組織の送られる電流は
0.1〜1.5A、電圧は30〜200V(RMS)が
よい。
できるフィードバックシステムも、いつ十分な焼灼が得
られたか(ここで高周波エネルギーの供給を停止する)
を指示するのに用いることができる。このようなフィー
ドバックシステムの例は、以下に示してある。高周波エ
ネルギーの供給が停止されると、切断手段11は押し進
められ、ステープル100は射出トリガ14を用いて射
出される。射出は、回動軸14aの回りのレバーアーム
として働く射出トリガ14を回転させることによって行
なわれる。ドライブ手段44は、切断手段11とウェッ
ジ13を押し進める。切断手段11は、組織焼灼用の電
極52と80の間にある組織を切断する。このため、切
断線は、電極52,80によって形成される凝集線を横
断する形になる。ウェッジ13は、同時にドライバ24
をステープル100に押し進め、ステープル100を組
織を貫通してアンビル18のポケット36,37まで射
出させる。ステープル100は、切断手段11が組織を
切断する際、切断手段11の各側上で軸方向に単一の列
として適用される。
許第4,608,981 号、および米国特許出願第07/917,636号
に記載され、当業者には知られている。
置に組み込むこともできる。円形のホチキス装置は業界
で知られており、例えば米国特許第5,104,025 号に記載
されている。ここで述べる変形例は、管腔内ホチキス装
置に類似した組織融着・焼灼機能付き切断装置を与える
ものである。この態様においては、本出願人の米国特許
出願第08/095,797号(1993年7月22日出願)に記
載した装置に類似のものを与える。電極は、絶縁材によ
って離隔された二つの同心円状の円形電極に形成され
る。電極は、いずれかのインターフェース面において圧
縮稜線を形成する絶縁材からみて放射状に内側または外
側に位置する。円形切断装置のホチキス装置の態様に係
る電極は、ホチキス装置のカートリッジあるいはアンビ
ルのいずれかの上に位置する。
鏡手術用切断・ホチキス装置に使用される従来のカート
リッジにおけるステープル二重列とは異なり、ステープ
ルの単一の列を備えることによって、ステープルの多重
射出機能を実現する。従来は、止血効果を高めるため、
この型のホチキス装置は、それぞれの平行列に二重のス
テープル列を与えるように設計されていた。しかし、再
射出可能なカートリッジは、二重のステープル列を収め
るのに必要なスペースのため(ステープルを重ねるのに
追加のスペースが必要なため)、この装置にとっては好
ましいものではなかった。多重射出型ホチキス装置にお
いては、ステープルは一重列で用いられる。ステープル
の一重列を用いると、従来はステープルの第2列によっ
て占められていた空間においてもステープルの積み重ね
ることができるようになり、多重射出機能を達成でき
る。しかし、本発明の装置は、望むならば、二重、三重
等のステープル列を採用してもよい。また、他の態様に
おいては、ステープルを必要とせず、電気凝集線が必要
な止血あるいは組織融着効果を与える。
所定の凝集程度がいつ達成されたかを示すように設計さ
れたフィードバックシステムを備える。これは、凝集域
がユーザに見えない場合に特に好都合である。特別な態
様においては、このフィードバックシステムは、凝集レ
ベルを含むシステムの電気的なパラメータを測定する。
しくはこの近辺で、凝集の程度を示す組織の特性を測定
する。組織のインピーダンスはまた、凝集の程度を示す
のに用いることができる。一般に、エネルギーが組織に
印加されると、インピーダンスは最初は減少するが、つ
いで凝集が生じるとともに増大に転じる。凝集と組織イ
ンピーダンスの経時変化の間の関係は、一例がVaellfor
s, Bertil, BergdahlおよびBjoernの"Automatically co
ntrolled Bipolar Electrocoagulation", Neurosugical
Review, 187〜190頁(1984年)に記載され
ている。また乾燥が起こっても、インピーダンスは増大
する。高電圧を印加することで起こる組織の炭化や装置
の接触は、組織のインピーダンス特性に基づいた本発明
のフィードバックシステムを用いれば防止できる。凝集
の程度を示す組織特性の他の例としては、温度および光
の反射率がある。
実現されるフィードバックシステムを示す流れ図であ
る。まず、組織にエネルギーが印加され、ついで組織に
印加されたシステム電流とシステム電圧が測定される。
そして、インピーダンスの値が計算され、記憶される。
その後は、インピーダンス、インピーダンスの変化およ
び/またはインピーダンスの変化速度を含むインピーダ
ンスの関数に基づき、所望の凝集が得られた可動かを測
定する。もし凝集が所定・所望のレベルまで達したなら
ば、支持手段は、エネルギーの供給を停止すべきことを
指示する。指示手段は、このような指示手段としては、
可視光、聴取可能な音あるいは接触インジケータがあ
る。フィードバック手段はまた、ゼネレータを制御し、
所定のインピーダンスレベルでエネルギーの供給を停止
させることができる。また、他の態様として、インピー
ダンスのレベルに応じて音質が変化する連続的な聴取可
能音を発生させることもできる。もう一つの特徴は、イ
ンピーダンスが正常な場合の最小値を下回ったり、ある
いは最大値を越えたりしたときに、誤差あるいは装置の
異常を知らせる誤差指示手段である。
終端効果器150を示す。顎部材132は、第1の電気
的なポテンシャルを有する第1電極152および反対の
ポテンシャルを有する第2電極180からなる第1のイ
ンターフェース面133を有するアンビル118を具備
する。第1および第2の電極152,180は、インタ
ーフェース面133に沿って手前側および遠方側に延
び、また絶縁材155によって離隔される。第2の対向
インターフェース面135は、このインターフェース面
135に沿って手前側および遠方側に延びる圧縮稜線1
56を含む。圧縮稜線156は、組織を、第1のインタ
ーフェース面の絶縁部分に対して押しつけるように配置
され、また第1および第2の電極からは電気的に絶縁さ
れる。第1および第2の電極152,180は、図6の
第1および第2の電極52,80と同じ態様でエネルギ
ー源と電気的に接触するよう形づくられる。絶縁材18
3は、電極152と鞘38の電気的接触を阻む。
終端効果器250は、第1のインターフェース面233
を含むアンビル218を備える顎部材232を有する。
アンビル218は、終端効果器250の第1の側面上
に、第1の電気ポテンシャルを有する第1の電極を具備
する。第1の電極252は、インターフェース面233
に沿って手前側と遠方側へ延びる。絶縁材255aは、
インターフェース面233に沿って稜線手前側と遠方側
へ延びる256aを形成し、第1の電極252を終端効
果器250の第1の側面と対向する第2の側面282か
ら離隔する。終端効果器250は、第1のインターフェ
ース面233に対向して第2のインターフェース面23
5を含む。第2のインターフェース面235は、終端効
果器250の第2の側面282上に第2の電極280を
具備する。第2の絶縁材255bは、インターフェース
面235において、終端効果器250からみて手前側・
遠方側方向に延びる稜線256bを形成する。稜線25
6aと256bは、相対向する。この態様においては、
電気エネルギーは、第1の電極252は鞘38と電気的
に接触し、第2の電極280が接触手段64と接触して
いる点を除いて図6の態様と類似した様式で、第1およ
び第2の電極に供給される。絶縁材283は、第1の顎
232の第2の側面282が鞘38と電気的に接触する
のを阻み、電極280の短絡あるいはアーク放電を防止
する。
効果器350は、セラミック絶縁材のような電気的に絶
縁性の材料からつくられるアンビル318を備える顎部
材332を有する。アンビル318は、終端効果器35
0の第1の側面381上に、第1の電気ポテンシャルを
有する第1の電極352を具備する。第1の電極352
は、アンビル318上に配置され、インターフェース面
333に沿って手前側と遠方側へ延びる。他方、第2の
電極380は、アンビル318上において、第1の側面
381とは反対側の第2の側面上に配置される。第2の
電極380はインターフェース面382に沿って手前側
と遠方側へ延びる。絶縁材355は、終端効果器の第1
の側面381上にある第1の電極352と側面382上
にある第2の電極380の間にあるインターフェース面
333に稜線を形成する。
16を通して終端効果器50,150,250あるいは
350にある電極まで電流を送るためには、他の電気的
な接続を用いることもできる。例えば、ワイヤ、接触ブ
ラック、低インピーダンスのスナップフィット接触具な
どである。装置はまた、クランプトリガ12が閉止され
るまでRFエネルギーの射出を防止し、切断要素がアク
チュエートし、グランプトリガ12が閉止してRFエネ
ルギーが印加されるまで切断要素の作動とホチキス止め
を防止するロックアウトを提供することもできる。これ
らの特徴の一例は、本出願による他の米国特許出願(発
明の名称:「電気手術具用の電極を備えたインピーダン
スフィードバックモニタ」)に記載してある。
ターフェース面あるいは両方のインターフェース面に形
成される圧縮稜線、第1インターフェース面、6第2イ
ンターフェース面あるいは両インターフェース面上に設
けられる電極、片方あるいは両方のインターフェース面
上の各ポールに組み合わされる電極あるいは多重電極な
どがある。また、本発明の装置は、圧縮稜線をもたなく
てもよい。
用切断・ホチキス装置に係る特定の態様様に関連して記
載した。当然のことながら、本発明は、切断やホチキス
止めを行わない止血が望ましい場合に関連して、無数の
応用例をもつ。したがって、当業者ならば、本出願の特
許請求の範囲およびその均等物によって提起される本発
明の範囲を逸脱しない範囲で、種々の変形・変更例を考
えつくことができるであろう。
ある。 1)前記第1および第2の電極は、前記圧縮稜線によっ
て圧縮されている組織を通じる電流路を与えるよう配置
される請求項1記載の装置。 2)前記第2のインターフェース面は、絶縁材からつく
られる圧縮稜線を含む請求項1記載の装置。 3)前記装置は、前記終端効果器により係合されている
組織を、アクチュエート時に切断線を通して分断するた
めの切断要素を含む請求項1記載の装置。 4)前記絶縁材は、前記切断要素を収め、この切断要素
が前記切断線に沿って移動できるよう設けられたスロッ
トを含む上記実施態様3)記載の装置。 5)前記終端効果器は、少なくとも一個の組織用ファス
ナと、アプライヤ(applier) に付けられるけられたスロ
ットを含む上記実施態様3)記載の装置。 6)前記終端効果器は、少なくとも一個のステープル
と、このステープルを前記切断線の側方に適用する少な
くとも一個のドライバを具備する上記実施態様3)記載
の装置。 7)前記終端効果器はさらに、少なくとも一個の組織フ
ァスナと、この粗機ファスナを終端効果器に係合した組
織に適用する少なくとも一個のアプライヤを備える請求
項1記載の装置。 8)前記装置は、前記終端効果器により係合されている
組織を、アクチュエート時に切断線を通して分断するた
めの切断要素を含む請求項2記載の装置。 9)前記絶縁材は、前記切断要素を収め、この切断要素
が前記切断線に沿って移動できるよう設けられたスロッ
トを含む上記実施態様8)記載の装置。 10)前記終端効果器はさらに、少なくとも一個の組織
ファスナと、この粗機ファスナを終端効果器に係合した
組織に適用する少なくとも一個のアプライヤを備える上
記実施態様8)記載の装置。
のステープルと、このステープルを前記切断線の側方に
適用する少なくとも一個のドライバを具備する上記実施
態様8)記載の装置。 12)前記終端効果器はさらに、少なくとも一個の組織
ファスナと、この粗機ファスナを終端効果器に係合した
組織に適用する少なくとも一個のアプライヤを備える請
求項2記載の装置。 13)前記絶縁材は、前記第1および第2のインターフ
ェース面のいずれかに圧縮線を形成する請求項3記載の
装置。 14)前記第1の電極は前記第1のインターフェース面
上に設けられ、前記第1の電極は前記第1のインターフ
ェース面上に設けられる請求項3記載の装置。 15)前記絶縁材は前記第1のインターフェース面に圧
縮線を形成し、また前記絶縁材は前記第2のインターフ
ェース面に圧縮線を形成する請求項3記載の装置。
従来の装置より広い領域あるいは長い領域を同時に焼灼
ないし融着できる止血装置が提供される。
能付き線形切断・ホチキス装置の側面図。
側方断面図。
の部分的側方断面図。
部分的側方断面図。
流れ図。
方から見た断面図。
前方から見た断面図。
を前方から見た断面図。
Claims (3)
- 【請求項1】 双極エネルギーを受け取ることができる
終端効果器を有する電気手術装置であって、前記終端効
果器は、 組織を間に係合させることができる第1および第2の相
対向するインターフェース面と、 双極エネルギーを導通する電気的に反対の第1および第
2の電極を含む電気的に互いに絶縁された第1および第
2の極を備え、 前記第1および第2の電極は前記第1のインターフェー
ス面上に位置して絶縁材によって離隔され、 前記両電極は、双極エネルギーが前記両インターフェー
ス面によって係合された組織を通過しながら前記両極の
間を導通するように配置され、 前記絶縁材は、組織を前記両インターフェース面の間で
圧縮する圧縮稜線を形成する装置。 - 【請求項2】 双極エネルギーを受け取ることができる
終端効果器を有する電気手術装置であって、前記終端効
果器は、 組織を間に係合させることができる第1および第2の相
対向するインターフェース面と、 双極エネルギーを導通する電気的に反対の第1および第
2の電極をそれぞれ含む電気的に互いに絶縁された第1
および第2の極を備え、 前記第1および第2の電極は前記第1のインターフェー
ス面上に位置して絶縁材によって離隔され、 前記両電極は、双極エネルギーが前記両インターフェー
ス面によって係合された組織を通過しながら前記両極の
間を導通するように配置され、 前記第2のインターフェース面は、絶縁材料から形成さ
れる圧縮稜線を含む装置。 - 【請求項3】 双極エネルギーを受け取ることができる
終端効果器を有する電気手術装置であって、前記終端効
果器は、 組織を間に係合させることができる第1および第2の相
対向するインターフェース面と、 前記第1および第2のインターフェース面を等分に分け
放つ長手の平面と、 前記長手の平面に対して互いに反対の位置にある第1お
よび第2の側面と、 前記第1および第2の側面の間に位置する絶縁材と、 双極エネルギーを導通する電気的に反対の第1および第
2の電極をそれぞれ含む電気的に互いに絶縁された第1
および第2の極を備え、 前記第1および第2の電極はそれぞれ前記第1および第
2のインターフェース面の少なくとも一方の上に位置
し、 前記第1の電極は前記第1の側面上に、また前記第2の
電極は前記第2の側面上に配置される装置。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/362,065 US5709680A (en) | 1993-07-22 | 1994-12-22 | Electrosurgical hemostatic device |
US362065 | 1994-12-22 |
Publications (2)
Publication Number | Publication Date |
---|---|
JPH08238255A true JPH08238255A (ja) | 1996-09-17 |
JP3803131B2 JP3803131B2 (ja) | 2006-08-02 |
Family
ID=23424550
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP34905795A Expired - Lifetime JP3803131B2 (ja) | 1994-12-22 | 1995-12-21 | 手術用電気止血装置 |
Country Status (6)
Country | Link |
---|---|
US (1) | US5709680A (ja) |
EP (2) | EP0717960B1 (ja) |
JP (1) | JP3803131B2 (ja) |
AU (1) | AU693959B2 (ja) |
CA (1) | CA2165715C (ja) |
DE (2) | DE69529730T2 (ja) |
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- 1995-12-20 AU AU40571/95A patent/AU693959B2/en not_active Expired
- 1995-12-21 DE DE69529730T patent/DE69529730T2/de not_active Expired - Lifetime
- 1995-12-21 JP JP34905795A patent/JP3803131B2/ja not_active Expired - Lifetime
- 1995-12-21 EP EP95309352A patent/EP0717960B1/en not_active Expired - Lifetime
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Cited By (8)
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JP2001198137A (ja) * | 2000-01-20 | 2001-07-24 | Olympus Optical Co Ltd | 凝固切開システム |
JP2008073531A (ja) * | 2006-09-22 | 2008-04-03 | Ethicon Endo Surgery Inc | 電気外科器具用の被覆層を有するエンドエフェクタ |
JP2010193971A (ja) * | 2009-02-23 | 2010-09-09 | National Cancer Center-Japan | 医療用縫合装置 |
JP2013518681A (ja) * | 2010-02-04 | 2013-05-23 | アエスクラップ アーゲー | 腹腔鏡高周波手術装置 |
JP2015163312A (ja) * | 2010-10-01 | 2015-09-10 | コヴィディエン リミテッド パートナーシップ | 外科鉗子のためのブレード展開メカニズム |
JP2013081777A (ja) * | 2011-10-10 | 2013-05-09 | Ethicon Endo Surgery Inc | 超音波変換器に電力を供給するためのクラッチ摺動リングアセンブリを有する外科器具 |
WO2014102850A1 (ja) * | 2012-12-25 | 2014-07-03 | テルモ株式会社 | バイポーラ電気外科装置 |
WO2014162343A1 (ja) * | 2013-04-01 | 2014-10-09 | テルモ株式会社 | レーザ外科装置 |
Also Published As
Publication number | Publication date |
---|---|
EP0717960A2 (en) | 1996-06-26 |
EP1254637A1 (en) | 2002-11-06 |
DE69529730D1 (de) | 2003-04-03 |
EP1254637B1 (en) | 2007-08-08 |
EP0717960B1 (en) | 2003-02-26 |
JP3803131B2 (ja) | 2006-08-02 |
CA2165715C (en) | 2006-11-21 |
US5709680A (en) | 1998-01-20 |
DE69535558T2 (de) | 2008-04-17 |
EP0717960A3 (en) | 1996-08-14 |
CA2165715A1 (en) | 1996-06-23 |
AU693959B2 (en) | 1998-07-09 |
DE69535558D1 (de) | 2007-09-20 |
DE69529730T2 (de) | 2003-12-18 |
AU4057195A (en) | 1996-06-27 |
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