KR19990028364A - 전기수술기구 - Google Patents
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- 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
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- 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
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Abstract
전기적으로 전도성인 유체 매개물중에서 조직의 처치를 위한 전기수술기구에 있어서(예를 들면 "수중 수술"), 양극 전극어셈블리가, 노출된 조직처치부분(34A)를 갖는 활성전극, 노출된 유체접촉표면을 갖는 귀로전극(38), 그리고 활성전극과 귀로전극 사이에 위치하고 이들을 전기적으로 절연하는 절연부재(36)를 갖는다. 절연부재는 노출된 활성전극의 처치부분과 귀로전극의 노출된 유체접촉표면을 이격하기 위해 제공된다. 전극의 노출된 부분과 절연부재의 치수 및 구성은, 전극어셈블리가 전도성 유체 매개물중에 침지되어 있을 때, 활성 및 귀로(b:a)전극의 최장 및 최단 전도경로의 비율이 2:1보다 적거나 같도록 한다. 또한 발명은 전기수술기구와 고주파 제네레이터와의 조합도 포함한다.
Description
본 발명은 전기적 전도성 유체 매개물의 존재하에서의 조직의 처치를 위한 전기수술기구 및 상기 기구를 포함하는 전기수술시스템 장치에 관한 것이다.
내시경적 전기수술은 신체의 공동(cavity)내 조직의 처치에 유용하며, 일반적으로 팽창 매개물의 존재하에 실시된다. 팽창 매개물이 액체인 경우, 이것은 일반적으로 수중 전기수술로 언급되며, 동작 부위에서 액체중에 침지된 처치 전극 또는 전극들을 갖춘 전기수술기구를 이용하여 생 조직을 처치하는 전기수술을 의미한다. 액체 매개물이 불안정할 것인, 복강경 또는 위장병학적 수술의 경우와 같은, 더욱 큰 체적의 팽창가능 체강내에서 내시경 수술이 실시되는 경우는 일반적으로 가스 매개물이 사용된다.
수중 수술은 일반적으로 내시경 기술을 이용하여 실시되는데, 여기서 내시경 자체는 전극의 통과를 위한 도관(일반적으로 작업채널(working channel)로 언급됨)을 제공한다. 다르게는, 내시경은 전극 설치 수단을 포함하기위해 (절제경에서와 같이) 특별히 적합하게 하거나, 일반적으로 트라이앵글레이션(triangulation)으로 언급되는, 내시경과 관련된 각도에서 개별적 접근수단을 경유하여 체강내로 전극이 도입된다. 기술내에서의 이들 변형은 수술적 특이성에 따라 하위분류될 수 있으며, 여기서 기술의 각각은 특정 체강에 대한 접근루트가 주어진 특정 장점을 가진다. 자궁의 자궁내막강을 접근하기 위한 자궁경관, 또는 전립선 및 방광을 접근하기 위한 요도와 같은, 천연 신체개구를 통해 체강이 접근되는 경우, 내장 워킹채널을 갖춘, 또는 절제경과 같은 특징의 것인 내시경이 일반적으로 사용된다. 자궁내막강내의 사용을 위해 특별히 설계된 내시경은 자궁경으로 언급되며, 요로내의 사용을 위해 설계된 것들은 방광경, 요도경 및 절제경을 포함한다. 경요도 절제술이나 전립선의 기화의 방법은 TURP와 EVAP로 각각 공지되어 있다. 내시경이 통과할 천연 신체개구가 없는 경우는, 일반적으로 트라이앵글레이션 기술이 이용된다. 일반적으로 트라이앵글레이션은 무릎과 어깨와 같은 관절강에 대한 수중 내시경 수술시 이용된다. 본 방법에 사용된 내시경은 일반적으로 관절경이라 언급된다.
전기수술은 일반적으로 단극 기구든지 양극(bipolar) 기구를 이용하여 실시된다. 단극 전기수술에 있어서, 활성(active)전극은 작동부분에서 이용되며, 전도성 귀로(return)판은 환자 피부에 고착된다. 이러한 배열로, 전류가 활성전극으로부터 환자 조직을 경유하여 외부 귀로전극으로 통과한다. 환자가 회로의 상당한 부분을 나타내므로, 환자 조직의 저항성 전류제한 및, 수중 전기수술의 경우에 있어서, 혈액이나 기타 체액의 존재에 의해 부분적으로 전도성이 되는 체액 매개물에 의한 전력손실을 보충하기 위해서 입력전력이 높아야한다(전형적으로 150 내지 250 와트). 심각한 피부화상을 발생할 수 있는, 귀로전극에서 발생하는 조직가열때문에, 단극 배열과 고전력을 이용하는 것은 또한 위험하다. 또한 기구와 체강내로의 도입점에서의 환자 조직 사이의 정전결합의 위험도 존재한다.
양극 전기수술에 있어서, 한쌍의 전극(활성전극과 귀로전극)이 조직 적용부위에서 함께 사용된다. 고주파 전류가 전극간 부분에 제한되도록 하는 두 전극의 상대적 근접때문에 본 배열은 안전성의 관점에서 장점이 있다. 그러나 효과의 정도는 두 전극간 간격에 직접적으로 관련되어 있으며; 극히 소형의 전극이 요구되는 적용에 있어서, 전극간 이격이 매우 작아지며, 그것에 의해 조직효과와 출력전력이 제한된다. 전극의 추가적 분리의 이격은 적용부위의 상을 종종 어둡게 할 것이며, 두 전극의 조직과의 직접 접촉을 강화하기 위해서, 수술적 기술에 있어서 변형을 필요로 할 것이다.
양극 프로브의 기본 설계에 많은 변형이 있다. 예를 들면 미국특허 명세서 4706667호는 기본적인 설계의 것을 기술하며, 즉 절단목적의 경우 귀로전극과 활성전극의 접촉면적 비율이 7:1보다 크며 20:1보다 작다. 본 범위는 단지 절단 전극구성에 관한 것이다. 양극기구가 건조나 응고를 위해 이용되는 경우는, 두 전극의 접촉면적 비율이 약 1:1로 감소되어, 조직과 전극간 접촉에서 발생하는 차동 전기적 스트레스를 피하도록 한다.
귀로전극과 조직간 전기적 접속은 일반 염수와 같은 전도성 용액에 의해 조직을 적시는 것에 의해 지지될 수 있다. 이것은 두 전극간 전기회로가 조직에 의해 완성되는 것과 함께, 수술효과가 바늘 또는 활성전극에 제한되는 것을 보장한다. 설계에 있어서 명백한 제한중 하나는 바늘이 조직내에 완전히 묻혀 귀로전극이 회로를 완성할 수 있도록 해야 한다는 것이다. 또다른 것은 방위의 문제로서, 조직 표면과의 이상적 수직 접촉으로부터의 적용 각도에 있어서의 상대적으로 작은 변화일지라도 접촉 면적 비율을 변화시킬 것이며, 따라서 수술 효과가 귀로전극과의 접촉내의 조직내에서 발생할 수 있다.
공동 팽창은 작동 부위로의 접근을 획득하기 위한 공간을 제공하여 가시화를 향상시키며, 기구의 조작을 가능하게 한다. 저체척 체강에 있어서, 특히 고압하에서 공동을 팽창시키기를 원하는 곳에서, 더욱 양호한 광학적 특성때문에, 그리고 작동부위로부터 혈액을 씻어내기때문에, 가스보다는 액체가 더욱 일반적으로 사용된다.
종래의 수중 전기수술은 전기적 전도성 손실을 제거하기 위해, 관주제로서 또는 팽창 매개물로서 (1.5% 글리신과 같은)비전도성 액체를 사용하여 실시된다. 혈관내 흡착이 발생할 경우 혈액내에서의 삼투적 변화를 방지하기 위해 글리신이 등장농도로 사용된다. 작동의 진행에 있어서, 물중독으로 공지된 상태를 초래할 수 있는, 무엇보다도, 혈청 나트륨의 희석을 발생할 수 있는, 순환내로의 액체의 결과된 주입으로 통증이 격심하다.
출원인은 수중 전기수술에서 비전도성, 무전해질 용액의 대신에, 일반 염수와 같은 전도성 액체 매개물을 사용하는 것이 가능함을 발견하였다. 전기수술이 고려되지 않거나, 레이저 처치와 같은 비전기적 조직 효과가 사용되는 경우에, 일반 염수는 수중 내시경 수술에 있어서 바람직한 팽창 매개물이다. 비록 일반 염수(0.9 % w/v; 150 mmol/l)가 대부분 신체 조직의 그것보다 다소간 큰 전기적 전도성을 가지더라도, 작동부위로부터의 흡수나 일혈에 의한 교체가 적은 생리학적 효과를 생성한다는 것, 그리고 비전도성의, 무전해질 용액의 소위 물중독이 회피된다는 장점이 있다.
출원인은 전도성 액체 매개물을 사용하는 수중 전기수술에 적합한 양극 기구를 개발하였다. 발명의 첫째 견해는 본 명세서에 수반된 청구항 1에 정의되어 있다. 발명의 다른 견해는, 기구와 제네레이터를 포함하는 전기수술시스템에 관한 청구항 7, 각각 전기수술기구에 관한 청구항 12, 19 및 23, 그리고 조직의 건조와 기화 방법에 관한 청구항 31 및 37에 정의된 바와 같다. 다른 견해의 바람직한 형태의 몇몇은 다른 청구항들 중에 있다.
본 기구의 전극 구조는, 전기적 전도성 유체 매개물과의 조합으로, 단극이나 양극 전기수술에서 경험하였던 문제들을 대부분 피한다. 특히 입력전력 수준은 단극 배열에서 일반적으로 요구되는 그것(전형적으로 100와트)보다 훨씬 적다. 더욱이 그것의 전극간의 상대적으로 큰 이격때문에, 종래의 양극배열에 비하여 향상된 정도의 효과가 얻어진다.
발명은 이제 도면과 관련된 참고로 실시예의 방식으로 기술될 것이다.
도 1은 발명과 관련된 전기수술시스템을 보이는 도면,
도 2는 도 1의 시스템의 부분을 형성하는 전기수술기구의 부분의 측면도,
도 3은 발명과 관련된 선택적 전기수술기구의 부분의 단면도이며, 기구는 종축선상을 따라 절단되며,
도 4는 전기적 부하 임피던스의 자기이력과, 건조 및 기화 모드에서의 발명과 관련된 기구의 사용에서 발생하는 분산된(dissipated) 고주파전력을 도시하는 그래프,
도 5는 도 1에서 보인 전기수술시스템의 제네레이터의 구성도,
도 6은 기화에 의한 조직 제거 기구의 사용을 보이는 도 3의 기구의 측면도,
도 7은 도 6에서 보인 것과 유사한 기구의 측면도이며, 조직 건조나 응고기구의 사용을 보이며, 그리고
도 8, 9 및 10은 발명과 관련된 전기수술기구의 측면도이며, 상이한 전극 및 절연물 구성을 보인다.
도면에 따르면, 도 1은 양극기구에 대해 고주파(RF) 출력을 제공하는 출력소켓(10S)을 가지는 전기수술 제네레이터(10)를 포함하는 전기수술 기구를 핸드피스(2) 및 탈착가능 전극유니트(28)의 형태로, 연결코드(14)를 경유하여 보인다. 제네레이터(10)의 활성화는 코드(14)로의 콘트롤 연결을 경유하여 핸드피스(12)로부터, 또는 예시된 바와 같이 풋스위치(footswitch)연결코드(18)에 의해 제네레이터(10)의 후면에 개별적으로 연결된, 풋스위치유니트(16)의 방식으로 실시된다. 도시된 구체예에 있어서, 풋스위치유니트(16)는 제네레이터(10)의 건조모드 및 기화모드를 각각 선택하기 위한 두개의 풋스위치(16A 및 16B)를 가진다. 제네레이터 전면패널은 디스플레이(24)에 지시되는 건조 및 기화 전력 수준을 각각 세팅하기 위한 누름버튼(20 및 22)이 있다. 누름버튼(26)은 건조 및 기화모드간의 선택을 위한 다른 수단으로서 제공된다.
기구는 핸드피스를 포함할 필요가 없지만, 절제경과 같은 또다른 장비에의 기구를 위한 커넥터를 단순히 포함한다. 도 1에 있어서 기구는 핸드피스(12)에 기구된 것을 보이는 전극유니트(28)를 갖는다.
전극유니트(E)는 많은 상이한 형태를 취하며, 몇몇이 하기되어 있다.
도 2에 보이는 기본적 구성에 있어서, 기구 핸드피스에 탈착가능하게 죄는 것을 위한 전극유니트는 샤프트(30)의 원단에서 전극어셈블리(32)와 함께, 절연시스(30S)로 피복된 전도성 튜브인 샤프트(30)를 포함한다. 샤프트(도시하지 않음)의 다른 말단에서 기계적이고 전기적으로 핸드피스에 유니트를 연결하기 위해 수단이 제공된다.
전극어셈블리(32)는, 유니트의 말단의 원단에서 노출되어 전긍의 처치 부분을 형성하는 중앙 활성전극(34)을 포함한다. 바람직하게는, 활성전극은 중앙 콘덕터와 같이 샤프트(30)의 구멍을 통해 기단부(도시하지 않음)에서의 접촉까지 뻗어 있는 금속성 와이어이다. 전극(34)과 내부 콘덕터의 서라운딩은, 전극(34)의 노출된 처치 부분에 인접하게 노출된 절연슬리브(36)원단이다. 전형적으로 이 슬리브는 아크발생으로부터 손상을 저항하기 위해 세라믹 물질로 제조된다. 슬리브(36)의 서라운딩은, 샤프트(30)의 금속성 원통형 몸체와 함께 전기적으로(그리고 선택적으로 기계적으로도) 일체의 금속성 튜브의 형태의 귀로전극(38)이다. 이 귀로전극은 슬리브(36)의 단부의 포인트쇼트에서 종료하여, 활성전극(34)의 노출된 처치부분을 덮도록 하며, 그리고 후자로부터 방사상으로 그리고 축선상의 방향으로 이격되도록 한다. 원칙적으로 조직접촉 전극의 직경에 비교하여 귀로전극의 더욱 큰 직경때문에, 귀로전극은 노출된 활성전극 처치부분의 표면적보다 훨씬 큰 표면적을 가지는 노출된 유체접촉표면을 제공하는 것이 바람직할 것이다. 절연시스(30S)는 귀로전극(38)의 원단으로부터 인접하게 이격된 위치에서 종료하여, 귀로전극 유체접촉면적을 위해 요구되는 표면적을 제공하도록 한다. 전극유니트의 원단에서, 귀로콘덕터의 직경은 전형적으로 1 mm 내지 5 mm의 범위내이다. 노출된 부분 유체접촉 표면 귀로전극(38)의 종신장은 전형적으로 1 mm 내지 5 mm이며, 귀로전극(38) 내지 노출된 활성전극 처치부분의 종이격은 1 mm 내지 5 mm이다. 전극어셈블리의 구성과 치수의 추가적 견해가 아래에 더욱 상술된다.
유효하게, 도 2에서 보이는 전극 구조는 양극이며, 전극(34) 중 하나는 실질적으로 유니트의 원단까지 뻗어 있다. 이것은, 정상적 사용에 있어서, 전극어셈블리가 전도성 유체 매개물내에 침지되는 경우, 귀로전극(38)은 처치되는 조직으로부터 이격된 채 남으며, 전류경로는 조직 및, 귀로전극과 접촉하는 전도성 유체 매개물을 경유하여 두 전극간에 존재한다는 것을 의미한다.
전극의 축선상의 이격은, 노출된 전극표면간에 단순히 방사상 이격만을 가지는 양극 전극보다, 절연경로가 상당히 길기때문에, 직경의 관점에 있어서 매우 정교한 전극 구조를 가능하게 한다. 이것은 원하지 않는 아크발생이 없이, 또는 전기적 수술 절단이나 기화 처치의 경우에 있어서, 고온에서의 과량의 아크발생에서 기인하는 전극유니트 소상을 발생시키지 않으면서, 종래의 전극 구조에 비해 좀더 높은 사용전력을 가능하게 한다.
도시된 특정의 엇물린 배열은 외과의사에게 조직접촉 전극팁의 관찰을 제공하며, 조직표면과 관련하여 적용된 각도의 큰, 내시경 수술의 전형적인 제한된 공간에 있어서 특히 중요한 범위를 허용한다.
도 3을 참고하면, 도 1에 도시한 전기수술기구 핸드피스(12)에의 탈착가능하게 죄는 것을 위한 선택적 전극유니트는 샤프트(30)을 포함하며, 이것은 스테인레스강으로 제조하거나 구리나 금으로 피녹스(phynox) 전기도금한 반-유동적 튜브로 구성되며, 전극어셈블리(32)를 그것의 원단에 가진다. 샤프트(30)의 또다른 끝(도시하지 않음)에서, 기계적으로 그리고 전기적으로 핸드피스에 전극유니트를 연결하기 위한 수단이 제공된다.
전극어셈블리(32)는 백금, 백금/이리듐 또는 백금/텅스턴으로 제조된 중앙의, 활성 또는 조직접촉전극(34)를 포함하며, 일반적으로 반구의 노출된 팁(34A)과, 일체의 중앙콘덕터(34B)로 구성된다. 콘덕터(34B 및 34C)의 인접 단부상에 얇은 스테인레스강 스프링(34D)을 죄는 것에 의해, 콘덕터(34B)는 중앙의 구리콘덕터(34C)에 전기적으로 연결되어 있으며, 이것에 의해 기구의 핸드피스와 노출된 팁(34A)간의 전기적 연결을 제공한다. 세라믹 절연슬리브(36)은 콘덕터(34B), 스프링(34D) 및, 구리콘덕터(34C)의 인접단부를 둘러싼다. 슬리브(36)는 콘덕터(34B)의 원단부를 둘러싸는 노출된 부분(36A)을 가진다. 원통상 유체접촉 표면을 제공하는, 샤프트(30)의 원단부를 형성하는 귀로전극(38)은 슬리브(36)를 밀접하게 둘러싸며, 절연슬리브(40)에 의해 후자로부터 이격된 구리콘덕터(34C)상으로 뻗어있다. 외부 절연히트스링크나 폴리이미드 코팅(30S)은 샤프트(30)와, 귀로전극(38)의 기단부를 둘러싼다.
도 1에 도시한 바와 같이, 전기수술 제네레이터와의 조합으로 사용되는 경우, 도 3의 전극유니트가 기화에 의한 조직 제거를 위해, 관절경 수술시 초승달형상의 침식(sculpturing) 및 결손부수복(contouring)를 위해, 또는 건조를 위해, 제네레이터가 제어되는 방식에 의존하여, 전도성 액체 매개물중에서 사용될 수 있다. 도 4는 제네레이터가 어떻게 제어되어, 전극유니트의 건조와 기화모드간에 존재하는, 자기이력을 이용하는가를 도시한다. 따라서, 유니트의 전극어셈블리(32)가 염수와 같은 전도성 매개물중에 침지되는 것으로 가정하면, 전극어셈블리의 기하학과 유체 매개물의 전기적 전도성에 의해 결정되는 크기인, 점 "O"에서 개시부하임피던스 "r"이 있다. "r"값은 활성전극(34)이 조직에 접촉할 때 변하며, "r"값이 클수록 전극어셈블리(32)가 기화모드로 진입하려는 경향이 더 크다. RF 전력이 전극어셈블리(32)에 적용될 때, 유체 매개물이 가열된다. 유체 매개물이 일반 염수(0.9% w/v)인 것으로 가정하면, 유체 매개물의 전도성의 온도 계수는 양이며, 따라서 상응하는 임피던스 계수가 음이도록 한다. 따라서 전력이 적용됨에 따라, 임피던스가 초기에 떨어지고, 계속 떨어지며, 전극어셈블리(32)와의 직접적 접촉에서의 염수가 그것의 비등점에 도달하는 곳인 점 "B"까지 분산 전력이 증가된다. 소형 증기기포가 활성 팁(34A)의 표면상에 형성되고, 이어서 임피던스가 상승하기 시작한다. 점 "B"이후, 전력 분산이 더 증가함에 따라, 임피던스의 양의 전력 계수가 우세하며, 따라서 전력증가는 이제 임피던스 증가를 가져온다.
증기 포켓이 증기기포로부터 형성됨에 따라, 잉여 전극/염수 계면에서 전력밀도의 증가가 있다. 그러나 증기기포에 의해 커버되지 않은 활성전극팁(34A)의 노출된 부분이 있으며, 그리고 이것은 계면을 더 스트레스주어, 더욱 많은 증기기포를 생성하며 따라서 더욱 높은 전력밀도를 생성한다. 이것은 런어웨이 상태이며, 평형점은 단 일회 발생하며, 전극은 증기중에 완전히 봉해진다. 변수의 주어진 세트에 대하여, 이 새로운 평형이 도달(점 "C")될 수 있기 전에 전력한계(threshold)가 있다.
따라서 점 "B"와 "C"간의 그래프의 부분은 건조모드의 상한을 나타낸다. 일단 기화 평형상태에서는, 임피던스가 약 1000 오옴까지 신속히 증가하며, 절대치는 시스템 변수에 의존한다. 이어서 증기포켓은, 활성전극팁(34A)과 증기/염수 계면간의 증기포켓에 걸친 방전에 의해 유지된다. 전력분산의 대부분은 이 포켓내에서 발생하며, 팁(34A)의 가열을 결과한다. 에너지분산의 양과 포켓의 크기는 출력전압에 의존한다. 만약 이것이 너무 낮으면, 포켓이 유지되지 않을 것이며, 또한 만약 그것이 너무 높으면 전극어셈블리(32)가 파괴될 것이다. 따라서 전극어셈블리(32)의 파괴를 방지하기 위해서는 제네레이터의 전력출력을, 임피던스가 점 "D"에 도달했던 곳으로 감소시켜야 한다. 만약 전력이 이 점에서 감소하지 않으면, 전력/임피던스 곡선이 계속 오를 것이고, 전극 파괴가 발생할 것이라는 것을 주지해야 한다.
점선 E는 전극파괴를 피할 수 없는 전력수준 상부를 지시한다. 전력이 감소함에 따라, 증기포켓이 붕괴되고 전극어셈블리(32)가 건조모드로 복귀하는 점 "A"까지 임피던스가 떨어진다. 이 점에서 증기포켓내의 전력분산은 그것을 유지하기에 불충분하며, 따라서 활성전극팁(34A)과 염수간의 직접 접촉이 재형성되며, 그리고 임피던스가 극적으로 떨어지게 된다. 팁(34A)에서의 전력밀도도 떨어지며, 따라서 염수의 온도가 비등점 미만으로 떨어지게 된다. 이어서 전극어셈블리(32)가 안정한 건조모드이다.
요구되는 건조, 조직 절단 및 기화 기능을 달성하기 위한 제네레이터 전력제어은 제네레이터의 출력연결을 가로질러 출현하는 최고 RF 전압을 감지하는 것에 의해서, 그리고 미리 선택된 최고 전압한계가 도달될 때마다, 운반된 출력전력을 신속히 감소시키는 것에 의해 실시된다. 최종의 건조모드에 있어서, 이 전력감소는 단지 최고출력전압을 한계 미만으로 가져가기 위해 요구되는 것보다도 훨씬 크다. 도 4와 관련하여 상기된 자기이력 특성을 이용하기 위해서, 바람직하게는 전력감소는 적어도 50%이다.
도 5를 참고하면, 출력터미널(62)을 경유해서, 사용시 전극어셈블리에 의해 나타내어지는 부하임피던스(64)에로의 연결을 위한 한쌍의 출력커넥션(60C)을 가지는 고주파(RF)전력오실레이터(60)를 제네레이터는 포함한다. 전력은 스위치된 모드의 전력공급(66)에 의해 오실레이터(60)로 공급된다.
바람직한 구체예에 있어서, RF오실레이터(60)은 약 400 kHz에서 작동하며, 300 kHz 내지 HF범위내까지의 상향의 어떤 주파수도 가능하다. 스위치된 모드의 전력공급은 전형적으로 25 내지 50 kHz의 범위내의 주파수에서 작동한다. 스위치된 모드의 전력공급(16)에 연결된 제 1 출력(18A)과, 온타임("on"time)제어회로(70)에 연결된 제 2 출력(18B)을 갖는 전압한계검출기(68)는 출력커넥션(60C)을 가로질러 연결되어 있다. 오퍼레이터제어 및 디스플레이(도 1에 도시함)에 연결된 마이크로프로세서콘트롤러(72)는 공급전압변화에 의해 제네레이터 출력전력을 맞추기위한 전력공급(66)의 제어입력(66A)에, 그리고 최고RF출력전압한계를 세팅하기 위한 전압한계검출기(68)의 한계-세트입력(68C)에 연결되어 있다.
조작에 있어서, 전기수술 전력이 핸드피스나 풋스위치(도 1 참조)상에 제공되는 활성스위치 배열을 가동하는 외과의사에 의해 요구될 때, 마이크로프로세서콘트롤러(72)는 스위치된 모드의 전력공급(66)에 적용될 전력을 발생시킨다. 일정 입력전압한계는, 제네레이터의 전면패널(도 1 참조)상의 제어세팅에 따른 입력(68C)을 경유한 공급전압과 개별적으로 세팅된다. 전형적으로 건조나 응고를 위해서 한계는 150 볼트 내지 200 볼트의 건조한계치로 세팅된다. 절단이나 기화 출력이 요구될 때는, 한계는 250 또는 300 볼트 내지 600 볼트의 범위내의 값으로 세팅된다. 이들 전압치는 최고치이다. 그들의 현재의 최고치는, 건조를 위해 최소한, 전압이 주어진 수치에서 고정되기 전에 최대 전력을 제공하기 위해 저파고율의 출력RF파형을 가지는 것이 바람직하다는 것을 의미한다. 전형적으로 1.5 이하의 파고율이 달성된다.
제네레이터가 최초 활성화될 때, RF오실레이터(60)(온타임제어회로(70)에 연결되어 있음)의 제어입력(60I)의 상태는 "온"이며, 오실레이터(6)의 오실레이팅 소자를 형성하는 전력스위칭기구가 각 오실레이션사이클동안의 최대 전도를 위해 온스위치된다. 부하(64)에 전해진 전력은 스위치된 모드의 전력공급(66)으로부터 RF오실레이터(60)에 적용된 공급전압에 부분적으로, 그리고 부하임피던스(64)에 부분적으로 의존한다. 공급전압이 충분히 높으면, 전기수술적 기구의 전극을 둘러싸는 액체 매개물의 온도(또는 가스 매개물내에서, 조직내에 함유된 액체의 온도)는 액체 매개물이 기화되는 신장까지 증가하여, 부하임피던스내에서의 신속한 증가, 그리고 터미널(12)을 가로지른 적용된 출력전압내에서의 신속한 증가를 결과한다. 만약 건조출력이 필요하다면, 이것은 사건의 바람직하지 않은 상태이다. 이 이유로, 건조출력을 위한 전압한계는 한계가 도달될 때, 온타임제어회로(70)에로, 그리고 스위치된 모드의 전력공급(66)에로 보내지는 트리거시그널을 발생하도록 세팅된다. 온타임제어회로(70)는 RF오실레이터 스위칭 기구의 온타임을 실제적으로 즉각적 감소의 효과를 가진다. 동시에 스위치된 모드의 전력공급은 불능으로 되어 오실레이터(60)에 공급된 전압이 떨어지기 시작한다.
제네레이터의 출력전압은 작동의 모드에 중요하다. 사실 출력모드는 순수하게 출력전압에 의해, 구체적으로는 최고출력전압에 의해 결정된다. 출력전압의 절대측정은 다중기간제어에 대해서만 필요하다. 그러나 출력전압을 소정의 제한전압에 제한하기 위해서, 단순한 단일기간제어(즉, 한 제어변수를 이용하는)이 본 제네레이터에서 사용될 수 있다. 따라서 도 5에 도시한 전압한계검출기(68)는 RF최고출력전압을 프리세트 DC한계수준과 비교하며, 그리고 RF절반사이클중에서 온타임제어회로(70)를 위한 리셋펄스를 생성하기 위한 충분히 빠른 반응시간을 가진다.
최대의 흡수된 전력은 증기기포의 형성직전에 존재하는 전극상태와 부합하며, 이는 이 상태가 최대 전력분포 및 최대의 젖은 전극면적과 부합되기 때문이다. 따라서 전극이 최대의 건조전력을 위해 그것의 젖은 상태로 잔존하는 것이 바람직하다. 전압한계검출의 이용은 활성전극이 전력흡수능력을 차례로 증가시키는 증기기포의 붕괴를 허용하는 전력감소를 결과한다. 이 이유로, 제네레이터는 대형 오버슛을 가지는 제어루프를 포함하며, 여기서 소정의 한계에 도달하는 최고전압의 피드백자극은, 한계검출기(68)에 의해 세팅된 최고출력전압보다 현저히 낮은 수준으로 최고출력전압의 감소를 발생시키는 것에 의해 전력의 큰 즉각적 감소를 발생한다. 이 제어오버슛은 요구되는 젖은 상태로의 복귀를 보장한다.
제네레이터 및 그것의 작동의 더욱 상세한 것이 본 출원인의 공동출원 영국 특허 출원서 9604770.9호에 기술되어 있으며, 내용은 본 명세서내에 참고로 조합되어 있다.
상기의 것을 고려하면, 도 3의 전극유니트가 점 "0" 내지, 점 "B"과 "C"간의 부분내의 점사이의 그래프의 부분내의 유니트를 작동하는 것에 의한 건조에 사용될 수 있음이 명백하다. 본 경우에 있어서, 전극어셈블리(32)는 선택된 부위내로 도입되며, 활성전극팁(34A)은 처치될 조직에 인접하며, 그리고 조직 및 활성팁 및 귀로전극은 염수중에 침지된 상태이다. 이어서 제네레이터가 활성화되어(그리고 상기한 바와 같이 주기적으로 제어됨) 전극어셈블리(32)에 충분한 전력을 공급하여 활성팁(34A)에 인접한 염수가 활성팁을 둘러싸는 증기포켓을 생성하지 않으면서 그것의 비등점 또는 바로 아래에 유지되게 한다. 전극어셈블리는, 요구되는 활성팁(34A)에 인접한 부분의 조직의 가열 및 건조를 발생하기위해 조작된다. 전극유니트는 점"D" 및, 기화가 더이상 안정하지 않은 수준 이하의 수준을 구성하는 점선 F 사이의 그래프의 부분내에 기화를 위해 사용될 수 있다. 본 모드에 있어서, 처치될 조직에의 기구의 경미한 적용은 실시될 침식 및 결손부수복을 가능하게 한다.
바람직하게는 전극어셈블리(32)는 귀로:활성전극 표면적비율이 5:1 내지 40:1의 범위내인 단일 전극을 가진다(이것은 두 전극의 노출된 부분의 표면적의 비율이 이 범위내에 있음을 말한다.).
도 6은 기화에 의한 조직제거를 위한 도 3의 전극유니트를 도시하며, 전극유니트는 전도성 유체(78)중에 침지된다. 따라서 전극유니트는 활성팁(34A)에서 상대적으로 높은 에너지 밀도를 발생하여 조직(80)을 기화시키고, 활성팁을 둘러싸는 증기포켓(82)을 발생한다. 증기포켓(82)은 약 10배 증가된 접촉임피던스를 생성하고, 출력전압의 증가를 결과한다. 아크(84)는 증기포켓(82)내에서 발생하여 귀로전극(38)에 대하여 회로를 완성한다. 증기포켓(82)을 발생하는 조직(80)은 회로를 완성하기 위한 최소 전기적 저항의 경로를 나타낼 것이다. 조직(80)이 활성팁(34A)에 접근할 수록, 연결 유체(본 경우에서는 염수)를 통한 귀로경로가 증기포켓(82)의 높은 임피던스배리어더에 의해 블로킹되기 때문에, 세포가 아크(84)에 의해 타격받아 세포가 폭발할 때까지, 많은 에너지가 조직에 집중된다. 또한 염수 용액은 기화의 생성물을 용해하거나 분산하도록 작용한다.
사용시, 전극어셈블리(32)는 활성전극팁(34A)이 기화될 조직에 인접하게, 선택된 수술부위내로 도입되며, 조직, 활성팁 및 귀로전극(38)이 염수(78)중에 침지된다. RF제네레이터는 활성화되어 전극어셈블리(32)에 충분한 전력을 공급하여(도 4와 관련하여 기술된 바와 같이) 염수를 기화하고 조직접촉전극을 둘러싸는 증기포켓을 유지하도록 한다. 전극유니트가 관절경수술시 초승달형상의 침식 및 결손부수복을 위해 사용될 때, 전극어셈블리(32)는 선택된 수술부위에서 약한 압력으로 적용되고 조작되어 활성팁(34A)의 부분-구면의 표면이 처치될 표면을 따라 움직이며, 침식 및 결손부수복 작동으로, 구체적으로는 초승달 형상의, 조직을 제거하도록 한다.
도 7은 조직 건조를 위한 도 3과 유사한 전극유니트의 사용을 도시한다. 건조 모드에 있어서, 출력전력이 제 1 출력범위내의 전극으로 제공되어 전류가 활성전극(34)로부터 귀로전극(38)으로 흐르도록 한다. 상기한 바와 같이, 출력전력은 활성전극(34)에 인접한 염수 용액을 가열하도록 하며, 바람직하게는 염수 용액의 비등점 또는 그 부근까지의 점이다. 이것은 활성전극(34) 부근의 임피던스를 증가시키는 활성전극(14)의 표면상에 소형 증기기포를 발생한다.
신체조직(80)은 전형적으로, 활성전극(34)에 인접한 증기기포 및 염수 용액의 조합의 임피던스보다 낮은 임피던스를 가진다. 활성전극(34)이 소형 증기기포에 둘러싸이고 염수 용액이 조직(80)과 접촉되게 될 때, 조직(80)은 바람직한 전기적 전류경로의 부분이 된다. 따라서 바람직한 전류경로는, 도 7에 도시한 바와 같이, 조직접촉점에서의 활성전극(34)으로부터 나오고, 조직(80)을 통해서, 그리고 이어서 염수 용액을 경유해 귀로전극(38)으로 되돌아간다.
발명은 조직건조에 있어서 구체적 용도를 가진다. 조직건조를 위해서, 바람직한 한 접근법은 활성전극의 부분만을 조직에 접촉하는 것이며, 활성전극의 나머지가 조직으로부터 원격되있고 염수 용액에 둘러싸인 상태이며, 따라서 염수 용액을 경유하여, 조직을 통과하지 않으면서, 전류가 활성전극에서 귀로전극으로 통과하도록 한다. 예를 들면 도 7에 도시한 구체예에 있어서, 활성전극의 원부만이 조직에 접촉하며, 기부는 조직으로부터 이격된 상태로 남는다.
발명은 조직을 태우는 일이 없거나 최소화하면서 건조를 달성할 수 있다. 활성전극(34)이 조직(80)에 접촉할 때, 전류는 조직을 통해 통과하고, 접촉점에서의 또는 그 부근에서의 조직이 건조되도록 한다. 건조되는 조직의 면적 및 체적은 일반적으로 접촉점으로부터 방사상 외측으로 뻗어있다.
도 7에 도시한 구체예에 있어서, 활성전극(34)의 노출된 처치부분은 그것의 폭보다 길다. 이것은, 기구가 조직표면과 관련하여 비스듬할 때일지라도, 노출된 처치부분의 대부분이 조직과의 접촉을 하지 않은 상태로 유지되도록 하면서, 전극팁이 조직표면에 접촉하는 것을 가능하게 한다. 전극의 노출된 부분의 대부분이 조직과의 접촉을 하지 않기 때문에, 충분한 체적의 조직의 건조에 있어서, 조직을 통한 경로로부터, 활성전극에서 염수 용액으로 직접 통한 경로까지, 전류경로가 더욱 용이하게 이동할 것이다.
도 3에 도시한 전극유니트에 있어서, 활성전극(34)의 노출된 부분이 활성전극(34)과 귀로전극(38)간의 절연부재(36)의 길이와 비교하여 상대적으로 짧다. 도 4의 적용과 관련된 상기의 본래의 자기이력 성질의 기구의 쌍안정(bistable) 작동의, 그러한 전극 구성으로, 기구는 건조모드 또는 저 전력 기화모드에서 사용될 수 있다. 몇몇 상황에 있어서, 구체적으로 만약 활성전극의 노출된 부분이 길다면, 쌍안정 작동이 달성되기 어려울 것이다.
이러한 어려움을 극복하기 위한 수단이 도 8과 관련하여 기술될 것이며, 도면은 스테인레스강으로 만들어지거나 구리나 금으로 피녹스 전기도금된 반-유동성 튜브로 구성된 샤프트(30)를 포함하는 전극유니트를, 그것의 원단에 전극어셈블리(32)와 함께 보인다. 전극어셈블리(32)는 가늘고 긴 처치부분(34A)("바늘"전극으로 인용됨)을 가지는 중앙활성전극 및 일체중앙콘덕터(34B)를 포함한다.
원통형 세라믹 절연슬리브(36)는 콘덕터(34B)를 둘러싸며, 샤프트(30)의 원단부로 구성된 귀로전극은 슬리브(36)에 인접한다. 외측 절연폴리이미드코팅(40)은 귀로전극에 인접한 샤프트의 기단부를 둘러싸며, 이것에 의해 귀로전극에 코팅(40)의 에지에서 절연슬리브(36)로 뻗어있는 환상 유체접촉표면을 제공한다. 절연슬리브(36)는 스텝반경(즉, 원단면(36A)의 원주상 에지와 활성전극의 외측직경간 간격)이, 노출된 활성전극처치부분(34a)의 길이의 적어도 1/20이도록 하는 직경의 원단면(36A)을 갖는다. 따라서 절연슬리브(36)는 활성전극을 갖는 동축인 쇼울더(또는 스텝)를 가진다. 사용시 이 스텝은 노출된 활성전극처치부분(34A)의 기단에서 발생할 수 있는 처치부분(34A)의 원단을 무능하게 하는, 국소적 아크발생을 방지한다.
전극의 작동을 더욱 상세히 고려하기 위해, 전극유니트가 조직절단 또는 기화모드로 작동할 때, 증기기포가 활성전극처치부분(34A) 부근에 형성된다. 이 기포는 그것 안에서 아크발생하는 것에 의해 유지된다. 적용된 전압이 클수록 기포의 크기가 크다. 각 아크에 의해 분산된 에너지는 전도경로내의 체류 유체에 의해, 그리고 제네레이터의 소스임피던스에 의해, 임피던스-제한된다. 그러나 아크가 음 임피던스와 같이 거동하고, 그러한 이유로 만약 아크내 에너지가 충분히 높다면, 매우 낮은 임피던스의 이온화된 경로가 형성된다. 만약 기포와 귀로전극 간의 유체의 임피던스가, 분산된 전력상의 제한으로 작용할 만큼 충분하지 않다면, 이것은 항상 감소하는 이온화된 경로 임피던스의 불안정한 상태를 결과할 수 있다. 또한 활성전극 처치부분(34A) 부근의 증기포켓이 귀로전극을 침식하는 것도 가능하다. 이들 상황에 있어서, 아크 에너지는 제네레이터 소스임피던스에 의해서만 제한되지만, 상기 전력제한은 약하며, 전극크기에 따라 맞추어질 수 없다. 이러한 이유로, 절연슬리브(36)의 치수 및 구성은 활성전극처치부분과, 귀로전극의 유체접촉표면간의 1 mm의 최소전도경로길이를 결정하는 것과 같아야 한다. 이 최소경로길이는, 도 8에 도시한 구체예의 경우에 있어서, 도 8에 도시한 바와 같이 슬리브의 길이(a)와 스텝반경(c)의 합이다.
추가적 고려는 활성전극의 노출된 처치부분(34A)의 상부만에서의 증기기포 형성의 가능성이다. 적용된 전압 및 전력이 충분히 높을 때, 증기포켓이 활성전극의 노출된 처치부분 부근에서 형성될 것이다. 바람직하게는, 포겟은 처치부분의 전체길이에 걸쳐 균일하게 형성된다. 상기 상태에 있어서, 제네레이터에 제공된 부하 임피던스는 20가지의 요소에 의해 바뀔 수 있다. 그러나, 유체접촉표면과, 노출된 처치부분(34A)의 상이한 부분간의 전도경로길이 내의 현저한 차이가 있을 때, 전압구배가 각 전극의 길이에 걸쳐 확립된다. 바람직하게는, 유체접촉표면은 충분히 크며, 그것의 길이는 적어도 그것의 직경만큼 크며, 따라서 그것의 표면상의 전압구배를 최소화하도록 하는 어스팩트비를 가진다. 그렇지만, 약간의 절연슬리브 및 활성전극 구성으로, 노출된 처치부분의 말단의 원단이 전도성 유체와 접촉한 상태로 유지하면서, 전압구배가 유체접촉표면에 최근점의 노출된 처치부분의 부분상에서만의 증기포켓 형성을 가능하게 하도록 할 수 있다. 따라서, 전압구배가 포켓의 에지가 활성전극 처치부분의 표면을 교차하는 전도성 유체내에 확립된다. 상기 부분적으로 봉함된 활성전극 처치부분의 전기적 거동은 완전히 봉함된 처치부분의 그것과는 매우 다르다. 젖은 상태로부터 증기 봉함 상태로의 임피던스 전이는, 도 4와 관련된, 최고전압을 감지하여 제네레이터 출력을 제어하는 것에 있어서, 전극어셈블리의 거동은 더 이상 쌍안정하지 않다. 그러나, 기화전압이 활성전극 처치부분의 저 임피던스의 젖은 부분을 교차하여 나타난 결과로서, 전력요구량은 매우 높다. 임상효과는 필요되는 기화뿐만이 아니라, 증가된 전력분산에서 결과되는 바람직하지 않은 손상효과이기도하다.
활성전극 처치부분의 부분적 봉함은, 활성전극 처치부분의 최원점 사이의 전도경로길이 그리고, 활성전극 처치부분과 유체접촉 표면간의 최단경로길이 사이의 전도경로길이의 비를 2:1 보다 적거나 같도록, 즉 b/(a+c)≤2이도록 보장하는 것에 의해 크게 회피할 수 있다.
어떤 상태에 있어서, 활성 및 귀로전극간의 전도경로길이가, 유체에 의해 나타나는 결과적인 큰 시리즈의 임피던스에 기인하는 전도성 유체의 기화를 가능하게 하기에는, 너무 길다는 것이 발견된다. 너무 큰 전압강하는 기화가 달성될 수 있기 전에 프리세트 전압한계가 도달되는 것을 초래한다. 따라서, 바람직하게는, 최대 전도경로길이 대 귀로전극 유체접촉표면의 환상 말단길이의 비율이 1.43:1 이상이다. 활성전극과 동축인 원통상 유체접촉표면의 경우에 있어서, 최대 전도경로길이 대 유체접촉표면직경의 비율이 4.5:1 이하이다. 따라서, 도 8과 관련하여 b/d≤4.5이다.
도 8에 도시한 전극유니트의 제 1 사용은 조직절단이며, 활성전극 처치부분의 최소부분은 처치될 조직내에 묻혀있으며, 그리고 제네레이터는 도 4에 도시한 임피던스/전력 특성의 기화부분내에서 작동된다.
다른 활성전극 구성의 변형은 도 9에 도시한 바와 같이, 후크로서 노출된 처치부분을 형성하는 것을 포함한다. 이 경우에 있어서, 절연슬리브는 귀로전극의 유체접촉표면에서 원단면(36A)으로 깔때기 모양으로 좁아져있다.
또다른 변형은, 도 10에 도시한, 고리후크의 형태의 활성전극 처치부분을 가진다.
도 8, 9 및 10의 구체예에 있어서, 치수 a, b, c, d는 상기한 비율제한내에 있는 정도인 것을 알 것이다. 또한 각 경우에 있어서, 전극어셈블리는 처치축선(42)을 가지는 것으로 보이며, 축선은 기구가 조직을 향해 도입되는 것을 따라 존재하며, 귀로전극은 활성전극으로부터 처치축선의 방향으로 멈추어져있다. 귀로전극과, 활성전극 처치부분의 상이한 부분간의 상이한 전도경로길이를 비교하기 위한 목적으로, 공통평면내의 경로가 고려되어야 하며, 평면을 처치축선(42)을 포함한다. 도 8, 9 및 10의 도면의 경우에 있어서, 도시된 경로길이는 물론 도면을 가지는 종이의 평면내에 있다.
Claims (44)
- 기구 샤프트 및, 샤프트의 원단에 전극어셈블리를 포함하며, 상기 전극어셈블리가노출된 조직처치부분을 갖는 단일 활성전극,노출된 유체접촉표면을 갖는 귀로전극, 그리고활성전극과 귀로전극 간에 위치하고, 활성전극과 귀로전극을 전기적으로 절연하고, 그리고 활성전극의 노출된 처치부분과 귀로전극의 노출된 유체접촉부분을 이격을 제공하는 절연부재를 포함하며,그리고 상기 노출된 처치부분, 노출된 유체접촉부분 및 절연부재의 치수 및 구성이, 전극어셈블리가 전도성 유체 매개물중에 침지되어 있을 때, (i) 노출된 유체접촉표면과, 노출된 유체접촉표면으로부터 가장 먼 노출된 처치부분 사이의, 유체 매개물을 지나는 최단 전도경로길이(P1) 대 (ii) 노출된 유체접촉표면과 노출된 처치부분 사이의, 유체 매개물을 지나는 최단 전도경로길이(P2)의 비율이 2 대 1 보다 적거나 같은 것을 특징으로 하는 전기적 전도성 유체 매개물의 존재하에서 조직의 처치를 위한 전기수술기구.
- 제 1 항에 있어서, 활성전극의 상기 노출된 처치부분이 절연부재로부터 제 1 방향으로 돌출하며, 귀로전극의 유체접촉표면이 활성전극처치부분으로부터 멈추어져있으며, 그리고 절연부재가 활성전극을 둘러싸고, 활성전극의 노출된 부분과 귀로전극의 유체접촉표면 사이에서 제 1 방향에 수직인 제 2 방향으로 외측으로 돌출하여 유체 매개물을 통해 전기적 전류흐름을 전환하기 위해 절연경계를 정의하며 그것에 의해 노출된 유체접촉표면과 노출된처치부분 사이의 상기 최단전도경로길이(P2)를 증가시키는 것을 특징으로 하는 기구.
- 제 1 항에 있어서, 제 1 방향이 처치축선을 정의하며 상기 두 최단 전도경로(P1, P2)가 처치축선을 포함하는 공통평면내에 있는 것을 특징으로 하는 기구.
- 제 1 항에 있어서, 노출된 유체접촉표면과 노출된 처치부분 사이의, 유체 매개물을 지나는 상기 최단 전도경로(P2)의 길이가 적어도 1 mm인 것을 특징으로 하는 기구.
- 제 1 항에 있어서, 노출된 유체접촉표면이 일반적으로 원통상이고, 유체접촉표면길이가 적어도 그것의 직경과 같은 크기인 길이와 직경을 가지고, 그리고 (i) 유체접촉표면과, 유체접촉표면으로부터 가장 먼 노출된 처치부분의 부분 사이의, 유체 매개물을 지나는 최단 전도경로(P1) 대 (ii) 유체접촉표면 직경의 비율이 최대 4.5 대 1인 것을 특징으로 하는 기구.
- 제 1 항에 있어서, (i) 노출된 유체접촉표면과, 노출된 유체접촉표면으로부터 가장 먼 노출된 처치부분의 그 일부 사이의, 유체 매개물을 지나는 최단 전도경로(P1)의 길이 대 (ii) 노출된 유체접촉표면과 노출된 처치부분 사이의, 유체 매개물을 지나는 최단전도경로(P2)의 길이의 비율이 1.25보다 크거나 같은 것을 특징으로 하는 기구.
- 기구에 고주파 전력을 공급하기 위한 전기수술 제네레이터, 기구의 활성전극과 귀로전극에 각각 연결가능한 전기수술 출력 커넥션의 적어도 한 조를 갖는 출력스테이지를 포함하는 제네레이터, 출력 커넥션간에 형성된 최고 고주파 출력전압을 나타내는 감지신호를 유도하기위한 감지회로, 그리고 소정의 최고 고주파 출력전압이 도달되었음을 감지신호가 지시할 때, 전해진 출력전력내에서 감소를 자동적으로 발생하기 위한 전력조정회로를 더 포함하는 것을 특징으로 하는 제 1 항에 따른 전기수술시스템.
- 제 7 항에 있어서, 상기 한계가 도달되었고 상기 감소가 100 μs 이하의 주기로 영향받음을 지시할 때, 전력조정회로가 전해진 출력전력내에서 적어도 50% 감소를 발생하는 것이 실시가능한 것을 특징으로 하는 시스템.
- 제 8 항에 있어서, 전력조정회로가 20 μs 이하의 주기내의 상기 감소를 초래하는 것이 실시가능한 것을 특징으로 하는 시스템.
- 제 7 항에 있어서, 출력스테이지가 적어도 하나의 고주파 전력장치를 포함하며, 장치로의 공급전압과는 독립적으로 고주파 오실레이션의 개별적 사이클 동안 장치의 콘덕션 주기를 감소하는 것에 의해 출력전력내의 적어도 50% 감소가 초래되도록 조절회로가 배열되는 것을 특징으로 하는 시스템.
- 제 10 항에 있어서, 최고수준 내지 최저수준의 전력장치의 사이클 콘덕션주기에 의해 사이클내의 신속한 감소와, 이어서 콘덕션주기가 그것의 최고수준에 도달할 때까지 콘덕션 주기내의 덜 신속한 점진적 증가를, 감지회로 및 전력조정회로가 반복적으로 초래하는 것이 실시가능하며, 출력전압이 상기 소정의 한계를 초과하는 일 없이, 상기 최대 콘덕션 주기수준이 도달될 수 있을 때까지, 공급전압을 상기 출력스테이지로 동시 감소하면서, 신속한 감소 및 점진적 증가순서를 반복하는 것을 특징으로 하는 시스템.
- 기구몸체, 연장 기구샤프트 및, 샤프트의 원단에서의 전극어셈블리를 포함하며, 전극어셈블리가노출된 조직처치부분을 갖는 단일 활성전극, 그리고처치부분이 유체 매개물주에 침지된 조직표면에 접근될 때, 유체접촉표면이 조직표면으로부터 일반적으로 이격되도록, 그리고 유체 매개물이 활성전극과 귀로전극 사이의 콘덕션경로를 완성하도록, 귀로전극이 활성전극의 처치부분으로부터 멈추어져 있는 유체접촉표면을 가지며 절연부재에 의해 처치부분으로부터 이격되어 있는 것을 특징으로 하는 전기적 전도성 유체 매개물의 존재하에 조직의 처치를 위한 전기수술기구.
- 제 12 항에 있어서, 활성전극의 처치부분 뒤의 절연부재 부근에 위치한 전도성 슬리브를 귀로전극이 포함하는 것을 특징으로 하는 기구.
- 제 12 항에 있어서, 활성전극의 처치부분이 어셈블리의 말단의 원단에 위치하고, 귀로전극의 유체접촉표면이 활성전극 처치부분으로부터 멀리 이격되어 있고, 활성전극의 노출된 부분이 폭의 적어도 절반보다 큰 길이를 갖는 것을 특징으로 하는 기구.
- 제 14 항에 있어서, 활성전극의 노출된 부분과 귀로전극의 유체접촉표면의 세로의 이격이 적어도 1 mm인 것을 특징으로 하는 기구.
- 제 15 항에 있어서, (i) 활성전극의 노출된 부분의 원단과 귀로전극의 최원부 사이의 세로간격 대 (ii) 활성전극의 노출된 부분과 귀로전극의 최원부 사이의 최단 세로길이가 2 대 1보다 적거나 같은 것을 특징으로 하는 기구.
- 제 15 항 또는 제 16 항에 있어서, 귀로전극이 절연부재를 둘러싸는 유체 접촉표면을 갖고, (i) 활성전극의 노출된 부분의 원단과 귀로전극의 유체접촉표면의 원 에지 사이의 세로길이 대 (ii) 그것의 원 에지의 부분내의 유체접촉표면의 원주가 1.43 : 1보다 적거나 같은 것을 특징으로 하는 기구.
- 제 12 항에 있어서, 기구샤프트가 그것의 주요한 구조적 요소와 같이 금속성 튜브를 포함하고, 귀로전극이 튜브의 일체적으로 형성된 원단부인 것을 특징으로 하는 기구.
- 기구몸체, 연장 기구샤프트 및, 샤프트의 원단 상에서의 전극어셈블리를 포함하며, 전극어셈블리가 노출된 활성전극의 처치경계면과, 처치경계면 뒤에 노출된 귀로전극의 유체접촉경계면을 포함하고, 처치경계면이 절연부재로부터 외측으로 돌출하고, 유체경계면의 표면적이 처치경계면의 그것보다 크고, 외측방향에 수직인 방향으로 그것의 폭의 절반보다 크거나 같은 간격으로, 처치경계면이 절연부재로부터 외측으로 뻗어있는 것을 특징으로 하는 전기적 전도성 유체 매개물의 존재하에 조직의 처치를 위한 전기수술기구.
- 제 19 항에 있어서, 샤프트가 세로축선을 정의하고, 처치경계면이, 축선상의 길이가 그것의 측면폭의 절반보다 큰 전도성 축선 돌출부이고, 절연부재가 돌출부에 가깝게 위치한 동축의 세라믹 슬리브이고, 유체경계면이, 절연부재를 둘러싸고 적어도 1 mm의 축선상의 분리에 의해 처치경계면으로부터 분리되어 있는 전도성 외측 슬리브인 것을 특징으로 하는 기구.
- 제 19 항에 있어서, 처치경계면이 외측방향에 수직인 방향으로 그것의 폭보다 큰 간격으로 절연부재로부터 뻗어있는 것을 특징으로 하는 기구.
- 제 19 항에 있어서, 활성전극 처치경계면이, 외측방향의 길이가 적어도 폭의 절반인 전도성 활성전극 팁부재를 포함하고, 그리고 절연부재가 팁부재에 인접한 끝면을 가지고, 그 면은 상기 팁부재 길이의 적어도 절반만큼 상기 팁부재보다 측면으로 뻗어있지 않은 것을 특징으로 하는 기구.
- 기구가기구샤프트, 그리고샤프트의 원단에서 전극어셈블리를 포함하며, 전극어셈블리가 활성전극과 귀로전극을 포함하는 원단을 갖고, 전극어셈블리의 원단에서 활성전극의 노출된 부분과 활성전극의 처치부분에 가깝게 위치된 귀로전극의 유체접촉표면과 함께, 활성전극과 귀로전극 사이에 위치하고 활성전극과 귀로전극을 전기적으로 절연하는 절연부재를 더 포함하고, 활성전극의 노출된 부분이, 활성전극의 노출된 부분의 길이가 활성전극의 노출된 부분의 폭보다 큰 길이와 폭을 갖는 것을 특징으로 하는 전기적 전도성 유체 매개물의 존재하에서 조직의 처치를 위한 전기수술기구.
- 제 23 항에 있어서, 활성전극의 노출된 부분이 샤프트의 원단으로부터 세로로 뻗어있는 것을 특징으로 하는 기구.
- 제 23 항에 있어서, 절연부재가 일반적으로 원통상의 슬리브를 포함하고, 귀로전극이 활성전극의 노출된 부분으로부터 세로로 적어도 1 mm의 간격만큼 이격된 슬리브의 외측상에 위치하는 것을 특징으로 하는 기구.
- 제 25 항에 있어서, 절연부재가, 쇼울더를 정의하는 환상의 원단면을 가지고, 활성전극의 노출된 부분이 절연부재 끝면의 중심에 위치하고, 절연부재 끝면으로부터 돌출하고, 활성전극으로부터 측방향으로 떨어져 있는 쇼울더의 깊이가 0.05 l 및 0.5 l이고, 여기서 l은 중심의 활성전극의 노출된 부분의 길이인 것을 특징으로 하는 기구.
- 제 26 항에 있어서, 전극어셈블리가 전도성 유체 매개물중에 침지되어 있을 때, (i) 귀로전극의 유체접촉표면과, 유체접촉표면에서 가장 먼 활성전극의 노출된 부분의 그 일부 사이의, 유체 매개물을 지나는 최단 전도경로길이 대 (ii) 귀로전극의 유체접촉표면과 활성전극 사이의, 유체 매개물을 지나는 최단 전도경로길이의 비율이 2 대 1보다 적거나 같도록 하는, 활성전극의 노출된 부분, 귀로전극의 유체접촉표면, 및 절연부재의 치수 및 구성인 것을 특징으로 하는 기구.
- 제 27 항에 있어서, 귀로전극의 유체접촉표면과 활성전극의 노출된 부분의 그 일부 사이의, 유체 매개물을 지나는 최단 전도경로길이가 적어도 1 mm인 것을 특징으로 하는 기구.
- 제 27 항에 있어서, 귀로전극의 유체접촉표면이 환상이고, 유체접촉표면의 길이가 적어도 그것의 직경만큼 큰 길이와 직경을 가지고, (i) 귀로전극의 유체접촉표면과, 유체접촉표면에서 가장 먼 활성전극의 노출된 부분의 그 일부 사이의, 유체 매개물을 지나는 최단 전도경로길이 대 (ii) 유체접촉표면 직경의 비율이 적어도 4.5 대 1인 것을 특징으로 하는 기구.
- 제 24 항에 있어서, 절연부재가 기구의 원단을 향해 좁아진 일반적으로 깔대기 모양인 부재를 포함하는 것을 특징으로 하는 기구.
- 양극 전극어셈블리를 이용하는 조직건조방법으로서, 어셈블리가 활성전극 및 귀로전극을 포함하고, 활성전극이 노출된 처치부분을 갖고, 귀로전극이, 노출된 처치부분을 이격하며 노출된 처치부분으로부터 저지되어 있는, 노출된 유체접촉표면을 갖고, 방법이(a) 선택된 작동부위내로 전극어셈블리를 도입하는 단계;(b) 전도성 유체가 활성 및 귀로전극 사이의 전기적 경로를 정의하도록 전도성 유체로 전극어셈블리를 둘러싸는 단계;(c) 처치부분을 둘러싸는 증기포켓을 생성하지 않고 활성전극의 처치부분에 인접한 전도성 유체의 온도를 증가시키기 위해 충분한 고주파 출력전력을 전극어셈블리에 제공하는 단계;(d) 귀로전극의 유체접촉표면이 조직과 접촉하지 않으면서 조직에 처치부분을 접촉하는 단계로 구성되는 것을 특징으로 하는 양극 전극어셈블리를 이용하는 조직건조방법.
- 제 31 항에 있어서, 단계 (d)가 활성전극의 노출된 처치부분의 일부가 조직과 접촉하지 않도록 유지하는 것을 포함하는 것을 특징으로 하는 방법.
- 제 32 항에 있어서, 단계 (d)가(e) 조직의 표면을 교차하여 활성전극을 이동하는 단계를 더 포함하는 것을 특징으로 하는 방법.
- 제 33 항에 있어서, 단계 (e)가 면대면 운동으로 조직표면을 교차하여 전극을 이동하는 것을 포함하는 것을 특징으로 하는 방법.
- 제 33 항에 있어서, 단계 (e)가 활성전극의 처치부분에 인접한 전도성 유체의 온도를 실질적으로, 전도성 유체의 비등점으로 유지하는 것을 포함하는 것을 특징으로 하는 방법.
- 제 31 항에 있어서, 전도성 유체가 염수 용액을 포함하는 것을 특징으로 하는 방법.
- 제 31 항에 있어서, 전도성 유체가 락트산나트륨 용액을 포함하는 것을 특징으로 하는 방법.
- 양극 전극어셈블리를 이용하는 조직건조방법으로서, 양극 전극어셈블리가 활성전극 및 귀로전극을 포함하고, 활성전극이 노출된 처치부분을 갖고, 활성전극이 노출된 처치부분을 갖고, 방법이(a) 선택된 작동부위내로 전극어셈블리를 도입하는 단계;(b) 전도성 유체로 전극어셈블리를 둘러싸는 단계;(c) 처치부분을 둘러싸는 증기포켓을 생성하기 위해 활성전극의 처치부분에 인접한 전도성 유체를 기화시키기 위해 충분한 고주파 출력전력을 전극어셈블리에 제공하는 단계;(d) 귀로전극이 조직과 접촉하지 않도록 유지하면서, 조직에 인접한 활성전극의 처치부분을, 증기포켓이 조직과 접촉한 상태로 위치시키는 단계를 포함하는 것을 특징으로 하는 양극 전극어셈블리를 이용하는 조직건조방법.
- 제 38 항에 있어서, 단계 (d)가(e) 활성전극의 처치부분을 조직표면의 위쪽에서 이동시키는 단계를 더 포함하는 것을 특징으로 하는 방법.
- 제 39 항에 있어서, 단계 (e)가 전극을 조직표면의 위쪽에서 면대면 운동으로 이동시키는 것을 특징으로 하는 방법.
- 제 39 항에 있어서, 단계 (e)가 조직을 둘러싸도록 활성전극을 조직표면의 위쪽에서 이동시키는 것을 포함하는 것을 특징으로 하는 방법.
- 제 38 항에 있어서, 전도성 유체가 염수 용액을 포함하는 것을 특징으로 하는 방법.
- 제 38 항에 있어서, 전도성 유체가 락트산나트륨 용액을 포함하는 것을 특징으로 하는 방법.
- 제 38 항에 있어서, 활성전극의 처치부분이 원단부이고, 귀로전극의 노출된 유체접촉표면이 처치부분으로부터 가깝게 이격되어 있고, 단계 (a)가 노출된 처치부분의 일부가 조직과 인접하고 때때로 접촉하도록 위치시키는 것을 포함하는것을 특징으로 하는 방법.
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GB9512889.8 | 1995-06-23 | ||
GB9512888.0 | 1995-06-23 | ||
GBGB9512888.0A GB9512888D0 (en) | 1995-06-23 | 1995-06-23 | An electrosurgical generator |
GBGB9512889.8A GB9512889D0 (en) | 1995-06-23 | 1995-06-23 | An electrosurgical instrument |
GBGB9600355.3A GB9600355D0 (en) | 1995-06-23 | 1996-01-09 | Electrosurgical instrument |
GBGB9600352.0A GB9600352D0 (en) | 1996-01-09 | 1996-01-09 | Electrosurgical instrument |
GB9600355.3 | 1996-01-09 | ||
GB9600352.0 | 1996-01-09 |
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KR19990028364A true KR19990028364A (ko) | 1999-04-15 |
KR100463935B1 KR100463935B1 (ko) | 2005-05-16 |
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KR1019970709680A KR100463935B1 (ko) | 1995-06-23 | 1996-06-20 | 전기수술기구 |
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EP (2) | EP1025807B1 (ko) |
JP (1) | JP3798022B2 (ko) |
KR (1) | KR100463935B1 (ko) |
CN (1) | CN1095641C (ko) |
AR (1) | AR002570A1 (ko) |
AU (1) | AU710619B2 (ko) |
BR (1) | BR9609421A (ko) |
CA (1) | CA2224858C (ko) |
DE (2) | DE69609473T3 (ko) |
ES (2) | ES2233239T3 (ko) |
IL (1) | IL122713A (ko) |
WO (1) | WO1997000647A1 (ko) |
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- 1996-06-20 BR BR9609421A patent/BR9609421A/pt not_active IP Right Cessation
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- 1996-06-20 JP JP50366497A patent/JP3798022B2/ja not_active Expired - Lifetime
- 1996-06-20 CA CA002224858A patent/CA2224858C/en not_active Expired - Lifetime
- 1996-06-20 DE DE69609473T patent/DE69609473T3/de not_active Expired - Lifetime
- 1996-06-20 ES ES00110410T patent/ES2233239T3/es not_active Expired - Lifetime
- 1996-06-20 IL IL12271396A patent/IL122713A/en not_active IP Right Cessation
- 1996-06-20 ES ES96918768T patent/ES2150676T5/es not_active Expired - Lifetime
- 1996-06-20 CN CN96196280A patent/CN1095641C/zh not_active Expired - Lifetime
- 1996-06-20 WO PCT/GB1996/001473 patent/WO1997000647A1/en active IP Right Grant
- 1996-06-20 KR KR1019970709680A patent/KR100463935B1/ko not_active IP Right Cessation
- 1996-06-20 US US08/702,512 patent/US6004319A/en not_active Expired - Lifetime
- 1996-06-20 DE DE69634014T patent/DE69634014T2/de not_active Expired - Lifetime
- 1996-06-20 AU AU61321/96A patent/AU710619B2/en not_active Expired
- 1996-06-20 EP EP96918768A patent/EP0771176B2/en not_active Expired - Lifetime
- 1996-06-21 AR ARP960103276A patent/AR002570A1/es unknown
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Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
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KR100508112B1 (ko) * | 2002-06-08 | 2005-08-11 | 모승기 | 고주파를 이용한 종양 및 지방 치료 장치 |
KR100777992B1 (ko) * | 2005-08-12 | 2007-11-29 | 후지논 가부시키가이샤 | 고주파 처치구 |
KR100879617B1 (ko) * | 2008-05-19 | 2009-01-21 | 박영세 | 전기 수술 장치 |
KR20190087183A (ko) * | 2018-01-16 | 2019-07-24 | 주식회사 텍코드 | 경피적 뇌하수체종양적출용 전극니들 도구 키트 |
Also Published As
Publication number | Publication date |
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IL122713A0 (en) | 1998-08-16 |
DE69634014T2 (de) | 2006-03-02 |
JPH11507857A (ja) | 1999-07-13 |
DE69609473D1 (de) | 2000-08-31 |
CN1095641C (zh) | 2002-12-11 |
MX9800249A (es) | 1998-07-31 |
BR9609421A (pt) | 1999-05-18 |
DE69609473T3 (de) | 2006-09-28 |
KR100463935B1 (ko) | 2005-05-16 |
JP3798022B2 (ja) | 2006-07-19 |
DE69634014D1 (de) | 2005-01-13 |
EP0771176B2 (en) | 2006-01-04 |
ES2150676T5 (es) | 2006-04-16 |
EP0771176A1 (en) | 1997-05-07 |
AR002570A1 (es) | 1998-03-25 |
CA2224858C (en) | 2006-11-14 |
CN1193268A (zh) | 1998-09-16 |
AU710619B2 (en) | 1999-09-23 |
EP1025807A3 (en) | 2000-10-04 |
ES2150676T3 (es) | 2000-12-01 |
EP1025807A2 (en) | 2000-08-09 |
WO1997000647A1 (en) | 1997-01-09 |
AU6132196A (en) | 1997-01-22 |
EP0771176B1 (en) | 2000-07-26 |
EP1025807B1 (en) | 2004-12-08 |
CA2224858A1 (en) | 1997-01-09 |
US6056746A (en) | 2000-05-02 |
IL122713A (en) | 2001-04-30 |
US6004319A (en) | 1999-12-21 |
DE69609473T2 (de) | 2001-04-26 |
ES2233239T3 (es) | 2005-06-16 |
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