KR20010021980A - An electrosurgical instrument - Google Patents

Abstract

Electrosurgical instruments Provide for the treatment of tissue in the presence of a conductive fluid medium. The instrument is a mechanical shaft (10), tissue treatment electrode 12 in the distal end of the shaft to ablate tissue manipulation to the surgical site by electrosurgical, cutting means for reducing the size of the excisional tissue fragments by electrosurgical, removing the fragments Removal means. The instrument has an opening portion 20a through which material is sucked by the removal means from the area surrounding the tissue treatment electrode 12. The removal means comprises a channel formed in the instrument shaft 10 and guided from the opening portion 20a.

The tissue treatment electrode 12 may be periodically interlocked with respect to the distal end of the shaft 10 and constitutes a cutting means.

Description

Electric Surgical Instruments {AN ELECTROSURGICAL INSTRUMENT}

Endoscopic surgery is useful for treating tissue in the body cavity and is usually performed in the presence of expansion media. When the expansion medium is a fluid, this is commonly referred to as hydroelectrosurgical, which refers to electrosurgical treatment when living tissue is treated using electrosurgical instruments with electrode (s) immersed in the surgical section. Gas media, as in laparoscopic or gastrointestinal surgery, is usually employed when endoscopic surgery is performed in an expandable body cavity with an inappropriate larger potential volume.

Underwater surgery is usually performed using endoscopic techniques. The endoscope itself may provide a conduit (commonly referred to as a working channel) for the passage of the electrode. Alternatively, the endoscope can be specially adjusted to include means for mounting the electrode or as in an ablation mirror), the electrode can be introduced into the body cavity through a separate entry device at an angle to the endoscope-a technique called triangulation. . These variations in the technique are broken down by surgical characteristics. One or the other has the particular advantage of providing a pathway to a particular body cavity. Characterizations such as endoscopes or resections with integral working channels are generally used when the body cavity can enter through natural human openings-like the cervix entering the uterine endometrium or the urethra entering the prostate or bladder. Endoscopy specially designed for use in the endometrium is called the uterus, and endoscopes specially designed for use in the urinary tract include bladder, urethra, and excision. Procedures for urethral resection or prostate steam corrosion are known as TURP and EVAPFH, respectively. When there is no natural human opening through which the endoscope can pass, the triangulation technique is generally used. Triangulation techniques are commonly used during endoscopic surgery in the joint cavity, such as knees and shoulders. The endoscope used in this procedure is commonly known as arthroscopy.

Electrosurgery is commonly performed using either monopolar or bipolar instruments. In unipolar electrosurgery, the active electrode is used within the surgical site and the conductive return plate is fixed to the patient's skin. According to this arrangement, current passes from the active electrode through the tissue of the patient to the outer return plate. Since the patient is an example of an important part of the circuit, the input power level should be high (typically 150 to 250 watts). This is to compensate for the resistance current of the patient tissue and to compensate for the power loss due to the fluid medium partially conducive to the presence of blood or other body fluid in the case of hydrosurgery. It is also dangerous to use high power in an array of monopole devices because of the tissue heating that occurs in the return poles. This can cause severe skin burns. There is also a risk of capacitive coupling between the instrument and patient tissue at the point of entry into the body cavity.

In bipolar electrosurgery, a pair of electrodes (active and return electrodes) are used together at the tissue application point. This arrangement has the advantage of safety because the two electrodes are relatively close so that the radio frequency current is limited only at the point between the electrodes. However, the depth of the effect is directly related to the distance between the two electrodes; And in applications that require very small electrodes, the spacing between the electrodes becomes very small, limiting the tissue effects and output power. The further away the positive electrode often blurs the field of view of the point of application, requiring modifications in surgical techniques to ensure direct contact between the positive electrode and tissue.

There are many variations on the basic design of the anode probe. For example, U.S patent specification NO. 4706667 describes one of the principles of design. In other words, the ratio of the contact area between the return electrode and the active electrode to the incision purpose is greater than 7: 1 and less than 20: 1. This range is only relevant for incision electrode placement. When the bipolar device is used for drying or solidification, the ratio of the contact area of both electrodes can be reduced to approximately 1: 1 to avoid differential electrical stresses occurring at the contact between the tissue and the electrode.

The electrical contact between the return electrode and the tissue can be maintained by the tissue wetting with a conductive solution, such as physiological saline. This ensures that the surgical effect is limited only to the active electrode and that the electrical circuit between the positive electrodes is completed by the tissue. One of the obvious limitations of the design is that the active electrode (usually a needle) must be completely embedded in the tissue in order for the return electrode to complete the circuit. Another problem is one of orientation: even relatively small changes from the ideal vertical contact at the angle of application to the tissue surface change the contact area ratio so that the surgical effect appears in the tissue in contact with the return electrode.

Body cavity expansion provides room for access to the surgical site, improves visibility and enables manual operation of the instrument. In small volume cavities, especially where it is desirable to dilate the cavities under high pressure, liquid is more commonly used than gas because of better optical properties because it flushes blood from the surgical site.

Conventional hydrosurgery has been performed using non-conductive liquids (like 1.5% glycine) as an expansion medium to eliminate irrigant or electrical conduction losses. Glycine is used in isotonic solutions and prevents osmotic changes in the blood when intravascular absorption occurs. During surgery, the vein may be cut, causing fluid to be injected into the circulation, causing dilution of serum sodium, which may lead to a condition called water poisoning, among others.

Applicants have found that it is possible to use conductive liquid media like physiological saline instead of non-conductive, electrolyte-free solutions in underwater endoscopic surgery. Physiological saline is the preferred expansion medium for hydrosurgery surgery when electrosurgical or non-electrical tissue effects such as laser treatment are used. Although physiological saline (1.9% w / v; 150 mmol / l) has a slightly higher electrical conductivity than the conductivity of most human tissues, this suggests that deviating from the surgical site by absorption or extravasation has almost no physiological effect. It has the advantage that the so-called water poisoning effect by non-conductive electrolyte-free solution can be avoided.

Carbon dioxide is a preferred gaseous expansion medium and is inherently nontoxic and due to its high water absorption.

Applicants have developed a bipolar device suitable for underwater electrosurgery using conductive liquid or gas mediators. This electrosurgical instrument is for the treatment of tissue in the presence of a fluid medium and consists of an instrument body having a handpiece and instrument axis and an electrode assembly at one end of the shaft. The electrode assembly includes a tissue therapy (active) electrode exposed at its distal end and also includes a return electrode that is electrically insulated from the tissue therapy electrode and has a spaced contact surface near the exposed portion of the tissue therapy electrode. In the use of this instrument, return electrodes with spacing close to the exposed portion of the tissue therapy electrode are usually spaced from the tissue and serve to complete the electrosurgical current loop through the tissue and fluid media from the tissue therapy electrode. Tissue treatment electrodes, on the other hand, are applied to the tissue being treated. This electrosurgical instrument is described in the specification of International Patent Application No. PCT / GB / 96/01473.

The electrode structure of this instrument avoids most of the problems encountered with electrosurgery of monopolar or bipolar with conductive fluid media. In particular, the input power level is lower than what is normally required for unipolar arrays (typically 100 watts). Furthermore, since there is a relatively large space between the two electrodes, the effect of the improved depth compared to the conventional arrangement of the anode is obtained.

The specification of international patent application NO.GB96 / 01472 describes an irrigation bipolar electrosurgical instrument that can be used in an open space or in a gaseous space. The present invention has an internal passageway for injecting electrically conductive fluid (usually saline) into the exposed end of the tissue treatment electrode to provide a conductive fluid channel that completes the electrical circuit to the return electrode when used. The instrument also includes an internal channel for draining fluid from the exposed end of the tissue therapy electrode. When the fluid is liquid like saline, the presence of the liquid can cause tissue damage of the bye. So removal of this is desirable. This type of instrument was originally intended for use in open spaces or gaseous environments, and is not suitable for use in electrosurgical procedures requiring expansion of body cavity.

However, in arthroscopic surgery, for example, where a large joint such as the knee can only accommodate 50-60 ml of irrigation, where the volume of the body cavity is small, the following problems may occur. In other words

(Iii) Heated fluid immediately adjacent to the tissue contact electrode may cause tissue damage of by-pass.

(Ii) the results of tissues corroded by tissue contact electrodes can cause visual problems; And

(V) The presence of soft tissue in the joint space tends to wander. This makes it difficult for the active electrode to be applied to steam the soft tissue.

Arthroscopic electrodes are characterized by a working diameter of 5 mm, short (from 100 mm to 140 mm) and rigid. It can be introduced into the articular cavity via stab incision using a triangular segmentation technique (with or without cannula). The electrode is operated with the action of interlocking the electrode between the 9 o'clock and 3 o'clock positions on the arthroscopic image. As a result, the tissue to be treated is usually approached at a shallow working angle with respect to the axis of the electrode. As such, the electrodes of the arthroscopy need to match the angle of approach to the tissue. Like the half moon cartilage, the tissue to be treated is usually dense and has a high electrical impedance. Arthroscopic electrodes, despite the smaller size of the electrode than the cutting plane for improved access, are finding that arthroscopists are looking for a rate of effect comparable to that of their current cutting device, the type of tissue being treated, It requires setting output power and voltage reflecting electrode size.

The specification of this British patent application 9612993.7 describes an electrosurgical instrument for the treatment of tissue in the presence of a conductive fluid medium. The instrument includes an instrument shaft and an electrode assembly at the end of the shaft, the electrode assembly having a tissue treatment electrode and a return electrode electrically insulated by the tissue treatment electrode and an insulating element. The tissue therapy electrode has exposed ends for the treatment tissue and, in use, defines a conductive fluid path that completes the electrical circuit between the tissue therapy electrode and the return electrode. The return electrode forms a fluid contact surface spaced from the tissue therapy electrode. Have. The electrode assembly has a plurality of openings in the tissue treatment electrode portion through which the opening vapor bubbles and / or particulates are drawn from the area around the tissue treatment electrode.

An RF generator is provided to power the electrode assembly. The power required from the RF generator for steam corrosion is described in International Patent Application No. It depends on many variables which are fully described in the specification of GB97 / 00065. Two of these variables are of particular importance for the flow of the present invention: one is the cooling effect by steam corrosion of the conductive fluid at the site of the tissue contact electrode, and the other is the vapor formed by the flow of the conductive fluid around the tissue contact electrode. Pocket mess. These problems can be partially overcome by adjusting the steam corrosion by monitoring the generator's output characteristics informing when the steam corrosion power threshold is exceeded. When the steam corrosion threshold is repeatedly exceeded and raised between pulses during the suction pulse, it is usually in the series of suction pulses, and suction will continue to apply if steam corrosion is maintained. By this technique, saline and steam corrosion products heated around the tissue contact electrodes can be successfully removed. Another preferred aspect is the suction of the free tissue to the tissue contact electrode, which can be established during vapor corrosion. While this can be accomplished according to the above technique; There are two important performance restrictions.

The first of these limitations is that gaseous products of tissue vapor erosion include fatty products, which have sublimation properties, ie they are densely packed into direct solids; Sublimation occurs at temperatures above the boiling point. Since the electrode shaft in the body cavity is cooled by the surrounding saline solution, this product is easily concentrated. As such, if parallel suction shafts are used, the product is along the entire length of the shaft and finally closes the tube completely. This process can close the tube very quickly, even at regulated flow rates, with minimal impact on the power threshold. For example, using a 1 mm inner diameter suction tube with an appropriately sized electrode tip shows that the blockage occurs completely 30 seconds after operation. Certainly, larger tube holes will increase the time before clogging, but this happens so quickly that the hole size required for useful electrode life exceeds the size of the maximum shaft diameter. Sublimation problems are synthesized by aspiration of incompletely steamed tissue sites before ablation from the rest of the tissue. The necessity of attracting the tissue and thus the demand for strong suction pressure is given, once the tissue is engaged with the tissue contact electrode and the steam corrosion threshold is continuously exceeded by stopping the flow, the suction characteristics and the suction passage of the non-corrosive tissue Clogging characteristics increase.

The second of the limitations also relates to adhesion at the tissue contact electrode of the tissue. As explained above, once tissue disrupts flow, the steam corrosion power threshold is exceeded and suction continues to be applied. Under these circumstances, in particular, when a suction passage is provided adjacent to the tissue treatment electrode, the steady state where the tissue sticks around the outer surface of the tissue contact electrode can be reached, and the tissue portion immediately adjacent to the tissue treatment electrode is steam corroded, If you do not move the application site or readjust the suction through the tissue therapy electrode, no further tissue removal will occur. For example, large areas of tissue tend to bridge with the tissue therapy electrode, so that most of the tissue in contact with the electrode must be removed, but the majority of the tissue remains in place. Applying suction only through the tissue therapy electrode limits the size of the electrode, whereas occurring at both ends results in steam corrosion despite synchronizing the absorption pulse at one electrode with an RF output greater than 200 Watts on the activity of the conductive fluid. The power threshold is very high, while once the tissue engages on the other electrode it can be reduced to less than 50% of this level. In static tissue contact electrodes, there is necessarily a compromise between these performance variables.

The present invention relates to an electrosurgical instrument for the treatment of tissue in the presence of a conductive fluid medium, an electrosurgical instrument comprising the instrument and an electrode unit for use of the instrument.

The invention will now be described, for example, in more detail with reference to the drawings:

1 illustrates an electrosurgical instrument constructed in accordance with the present invention;

2 is a partially fragmented, schematic side view of an electrode unit of the first form constructed in accordance with the present invention;

3 is a schematic side view of the electrode assembly of the electrode unit of FIG. 2;

4 is a partially fragmented, schematic side view of an electrode unit of electrode second type constructed in accordance with the present invention;

5 is a schematic side view of the electrode assembly of the electrode unit of FIG. 4;

6 is a partially fragmented, schematic side view of a third type electrode unit constructed in accordance with the present invention;

7 is a schematic side view of the electrode assembly of the electrode unit of FIG. 6;

8 is a partially fragmented, schematic side view of an electrode unit of the fourth aspect constructed in accordance with the present invention; And

9 is a schematic side view of the electrode assembly of the electrode unit of FIG. 8.

It is an object of the present invention to provide an improved electrosurgical instrument of this type.

The present invention provides an electrosurgical instrument for the treatment of tissue in the presence of an electrically conductive fluid medium, which is mounted on the instrument shaft, the distal end of the shaft that is electrosurgically excision of the tissue pieces at the surgical site. It consists of a treatment electrode, a morcellation means to reduce the size of the electrosurgical tissue fragments, and a removal means to remove the fragmented tissue fragments, the instrument having an opening and thereby removing from the periphery of the tissue treatment electrode. The material can be sucked by the tool, the removal means having a channel formed in the instrument shaft and leading out of the opening portion, and the tissue treatment electrode periodically interlocks along the distal end of the shaft and constitutes a cutting means.

Preferably, the instrument further comprises drive means for interlocking the tissue therapy electrode along the distal end of the shaft.

Fragmentation is the division into smaller pieces of tissue to facilitate surgical removal.

Advantageously, the tissue therapy electrode is such that periodic movement is effective to prevent the incised tissue fragments attached to the distal end of the instrument. Preferably, the tissue therapy electrode causes periodic movement to wash the entire distal end of the instrument where the piece there is in contact with the tissue in use.

Advantageously, the instrument further comprises a return electrode electrically insulated from the tissue treatment electrode by insulating means, the tissue treatment electrode being exposed to the distal end of the instrument and the return electrode from the exposed end of the tissue treatment electrode. It has a fluid contact surface located nearby.

In a preferred embodiment, the tissue therapy electrode can be periodically interlocked with respect to the return electrode, to periodically move the tissue therapy electrode to and from at least one location where arcing occurs between the tissue therapy electrode and the return electrode. to be.

Preferably, the channel is defined by the shaft of the instrument.

Conveniently, the tissue treatment electrode is provided at the distal end of the rod mounted within the instrument shaft and cooperates with the rod. This movement of the rod results in interlocking tissue therapy electrodes, which prevents tissue from bridging, and the tendency of tissue to block channels is avoided by electrode movement to ensure such tissue treatment. Thus, tissue can be removed electrosurgically from the surgical site by steam erosion technology, and can be electrically cut in this area by an interlocking tissue treatment electrode, which is likened to a miniature reikiiser. . Preferably, the tissue treatment electrode is constituted by the distal end of the rod.

Advantageously, the rod is constituted by tungsten wire with a diameter in the range from 0.2 mm to 1.0 mm. Preferably the tungsten wire has a diameter in the range of 0.4 mm to 0.6 mm.

Advantageously, the tissue treatment electrode is angled with respect to the longitudinal axis of the instrument shaft, the instrument further comprising an insulating sleeve surrounding the rod near the angled end. This insulating sleeve may be a ceramic sleeve.

Preferably, the insulating means comprises an insulating member provided at the distal end of the instrument shaft, the insulating member defining the opening portion. The insulating member may be made of a ceramic member.

Advantageously, the insulating member is formed of a slot constituting the opening portion, and the tissue treatment electrode passes through the slot. Alternatively, the opening portion is configured such that there is a gap between the tissue treatment electrode and the insulating member.

In a more preferred embodiment, the drive means is for reciprocating the rod in the channel. Advantageously, the drive means consists of a motor and coupling means for converting the rotational output of the motor into a reciprocating motion of the rod.

In this case, the distal end of the angled rod may be perpendicular to the longitudinal axis of the instrument shaft, the tip of the angled portion constituting the tissue contacting portion of the tissue treatment electrode. Thus, this electrode is a side-effect electrode.

In another preferred embodiment, the drive means is for rotating the rod in the channel. The electric motor may constitute a drive means.

Advantageously, the angled end of the rod is perpendicular to the longitudinal axis of the instrument shaft, and the distal surface of the angled end constitutes the tissue that contacts the tissue treatment electrode. Rotation of the angular end of the rod allows the use of small diameter rods, thus using small tissue treatment electrodes while providing a relatively large area of tissue in contact with the position. The use of small diameter tissue therapy electrodes also allows the use of lower electrosurgical power and / or higher fluid media flow rates.

Alternatively, the angular end of the rod is at an acute angle with the longitudinal axis of the instrument shaft, and the insulating member is provided with an inclined cam surface engaged with the vertex of the angular end of the rod.

It is also possible for the angular end of the rod to bend back around the distal end of the insulating sleeve.

Preferably, the removal means further comprises a pump connected to the channel at a point away from the opening portion of the instrument. The pump is operated periodically, whereby the material is drawn in pulse form by the removal means. Conveniently, the pump is operated only when the tissue therapy electrode is powered for tissue vapor corrosion.

The instrument further includes an RF generator having an anode output coupled to the tissue treatment electrode and the return electrode. Advantageously, the RF generator energizes the drive means. Preferably, the pump is controlled depending on the output characteristic of the RF generator.

The electrosurgical instruments of the present invention are of course also useful for incision, ablation, steam corrosion, evaporation and aggregation of tissues and combinations of these functions. The instrument has a particular use in arthroscopic surgery, which belongs to endoscopy and dermal penetration procedures performed on the joints of the body, but is not limited thereto, and also has a use in a technique applied to the spine and other non-lubricated joints. Arthroscopic procedures may include: partial or complete meniscal resection of the knee joint, including meniscal cystectomy; Lateral release of the knee joint; Removal of the anterior and posterior cruciate ligaments or their remains; Laparoscopic ablation, Acroplasty, Mucocapillary resection of the shoulder joint and Subacromial decompression; Anterior release of the temporomandibular joint; Synovectomy, removal of cartilage debris, cartilage repair, segmentation of intraarticular attachment, fracture and tendon removal applied to any of the body synovial joints; Facilitating heat contraction of the articular capsular bag as a treatment for recurrent dislocation, dysfunction of any joint in the body or repeated stress injury; Double resection as part of ulnar fusion through the treatment of disc polyps or through anterior or posterior access to the cervical and lumbar vertebra or any other fibrous joint for similar purposes; Resection of diseased tissue; And hemostasis.

The apparatus of the present invention is also useful for combinations of these functions with special uses for incision, excision, vapor corrosion, evaporation and flocculation of the tissues and urinary endoscopes (urethoscopes, cystoscopes, ureteroscopes and kidneys) and dermal penetration surgery. . Urological treatment procedures include: electroevaporative corrosion of the prostate gland (EVAP) and urethral tract of the prostate, including but not limited to excision of the opening of the prostate by the dermal penetration or via the urethra transit route performed for benign or malignant disease Other variations of the therapeutic procedure commonly referred to as ablation (TURP); Urethral or cutaneous resection of the urinary tumor when the urinary tumor can occur as a primary or secondary neoplasm; Stenosis when stenosis can occur at the pelvic ureter connection (PUJ), ureter, ureter orifice, cystoscope or urethra; Ureter cyst contraction correction of the bladder diverticula; Bladder plastic surgery procedure when involved in correcting urination dysfunction; Thermally induced pelvic contraction as orthodontic treatment for cystoscope sewage; Resection of diseased tissue; And hemostasis.

The electrosurgical instrument of the present invention is a female reproductive system and appendages associated with tissue incision, resection, steam corrosion, evaporation and aggregation and laparascopic, colposcopic (including cervical) and disease It is also useful for a combination of these functions with special use in open surgical procedures for. Laparoscopic surgical procedures may include the following: removal of subserosal and pedunculated fibrosis, removal of unstained endometrium and fallopian cystectomy and fallopian tube drilling procedures; Ovarian extraction for the treatment of benign or malignant diseases, fallopian tube-ovarian extraction, vaginal hysterectomy and laparoscopic assisted hysterectomy (LAVH); Nerve resection of laparoscopic cervical sacrum (LUNA); Tubal surgery as a corrective treatment for complications arising from ectopic pregnancy or acquired obstruction; Separation of abdominal adhesions; And hemostasis.

The electrosurgical instruments of the present invention, whether directly accessed or in general using instruments comprising speculae and plantain, are also used for lower reproductive pathways, including treatment of the neck, vagina and external reproductive organs. useful. Such uses include: hysterectomy and other pelvic surgical procedures utilizing uterine access; LLETZ / LEEP procedure (large ring incision in the deformed area) or incision of the deformed area of the intima of the landscape; Removal of cystic or septic lesions; Removal of warts by genitals or sexually transmitted diseases; Ablation of benign or malignant disorders; Surgical plastic treatment including vaginal prolapse; Resection of diseased tissue; And hemostasis.

The electrosurgical instruments of the present invention can be used for tissue incision, ablation, steam corrosion, evaporation and flocculation, as well as many procedures performed in the ear, nose and throat (ENT) and in the oropharynx, nasopharynx and cavities. It is especially useful for combinations of these functions with special applications. These procedures can be performed through the mouth or nose using endoscopy techniques such as specules, gags or functional endoscopy joint surgery (FESS). Functional endoscopic sinus procedures include: removal of chronically diseased inflammatory and thickening mucus linings, polyps and neoplasms from various anatomical cavities of the skull; And hemostasis. Procedures in the nasopharynx include: removal of chronically diseased inflammatory and thickening mucous linings, polyps and neoplasms from the nasal concha and nasal passages; Resection of the submucosa of the septum of the nose; Resection of diseased tissue; And hemostasis. Orofarinic procedures include: removal of chronically diseased, inflammatory and thickening tissue, polyps and neoplasms associated with tonsils, adenoids, parts of the epiglottis and glottis, and salivary glands; Alternatively, a procedure commonly known as laser assisted euboroparatope (LAUP); Resection of diseased tissue; And hemostasis.

It is evident that the present invention has further additional uses for incision, ablation, steam corrosion and evaporation and aggregation of tissues from the scope of the present invention and this function in general laparoscopic, thoracscopic and neurosurgery procedures. This combination is particularly useful, whether benign or malignant in diseased tissue and neoplastic disease.

Surgical procedures using the present invention's electrosurgical instrument include the introduction of an electrode assembly into a surgical site, whether an artificial catheter (cannula) or a natural catheter, which is an anatomical body cavity or space or surgically It may be. The body cavity and space can be expanded while the fluid is in use, or open naturally by anatomical structures. Surgical points may be washed by a continuous flow of conductive fluid, such as saline solution to fill and expand the body cavity or to create a partially irrigated environment around the tip of the electrode assembly in the gas-filled body cavity. The irrigation fluid can be drawn from the surgical site to eliminate the product produced by the application of RF energy, tissue fragments or blood. The procedure involves viewing at the same time through an endoscope or indirectly using means for visibility. The irradiated bipolar electrosurgical apparatus has been applied for international patent application NO. It is described in the specification of PCT / GB96 / 01472.

Referring to the drawings, FIG. 1 shows an electrical system comprising a generator 1 with an output socket 2 providing a radio frequency RF for a device in the form of a handpiece 3 via a coupling cord 4. The surgical instrument is shown. Operation of the generator 1 is carried out from the handpiece 3 via a control coupling (not shown) in the cord 4 or at the rear of the generator 1 by the step switch engagement cord 6. It is performed by a stepped switch unit 5 which is separated and connected. In the illustrated embodiment, the step switch unit 5 has two step switches 5a and 5b for selecting the drying mode and the steam corrosion mode of the generator 1, respectively. The generator front panel respectively has dry power. There are push buttons 7a and 7b for setting the level and the steam corrosion level, which are displayed on the display 8. The push button 9 is provided as an alternative means for choosing between drying mode and steam corrosion mode.

The handpiece 3 is equipped with removable electrode units such as electrode units E1 and E4, as described below.

2 shows a removable first type electrode unit E1 for fastening to the electrosurgical instrument handpiece 3, which comprises a shaft 10, which consists of a stainless steel tube. The tissue therapy (active) electrode 12 is provided at the distal end of the shaft 10. The active electrode 12 is provided by the distal end of the rod 14 made of tungsten, the active electrode extending at right angles to the rod. The rod 14 has a diameter of 0.4 mm to 0.6 mm. The ceramic tube 18 is fixed to the rod 14 immediately adjacent to the active electrode 12. The ceramic tip 20 is secured in the distal end facing out of the shaft 10.

As shown in FIG. 2, the active electrode 12 protrudes through the longitudinal slot 20a formed in the ceramic tip 20. The portion of the rod 14 which is not covered with the ceramic tube 18 is provided with an insulating sleeve 22 made of polyamide, polytetrafluoroethylene or consists of a separate sleeve made of both materials. The heating sleeve 24 made of polytetrafluoroethylene or polyamide covers the adjacent region of the ceramic tube 18 and the sleeve 22.

The main length portion of the shaft 10 is provided with an insulated heat shrink sleeve 26 made of vinylidene fluoride resin. The sleeve 26 does not cover the distal end of the shaft 10. The portion of the shaft constitutes a return electrode 28.

The rod 14 is mounted in the shaft 10 for reciprocating movement, and the opposite end of the active electrode 12 is connected to the coupling member 30 mounted in one end 32a of the sleeve 32 made of stainless steel. It is fixed. The other end 32b of the sleeve 32 is fixed adjacent to the end of the shaft 10. The top layer washer 34 is located within the sleeve end 32b, and the washer constitutes a member that supports the silicone wire 36 and the Delrin bush 38. The return spring 40 is interlocked between the bush 38 and the engagement member 30. The rod 14 passes through the opening through the washer 34, the silicon wire 36 and the bush 38.

The off-setting shaft 30a is fixed to the end face of the engaging member 30. The free end of the shaft is engaged with the inclined end face 42a of the rotatable coupling member 42 fixed to the rotational output shaft of the motor 44. Therefore, the rotation of the output shaft of the motor 44 results in the reciprocating motion of the coupling member 30 and the rod 14.

The interior of the cavity of the shaft 10 is connected to a transverse tubular member 10a connected to an absorption pump (although not shown) to constitute the absorption / discharge port. As shown in FIG. 2, the active electrode 12 is located at the end of a suction channel consisting of a ring-shaped cavity defined inside the shaft 10 and the rod 14, and in the use of the vapor bubbles formed in the active electrode region and Or particulates can be removed via the slot 20a, suction channel, port 10a and drawn from the area.

RF generator 1 (not shown in FIG. 2) drives electrosurgical current to electrodes 12 and 28 via connectors 46 and 48 connected to coupling member 30 and sleeve 32, respectively. The generator 1 comprises means for varying the output power driven to meet different electrosurgical needs. As such, within the first output power range from about 140 volts to 200 volts, the active electrode 12 is used for tissue evaporation; And within the second output power range of about 250 volts to 600 volts, the active electrode is used for tissue removal by incision or steam corrosion. For both ranges, the voltages are peak voltages. The generator 1 is described in the specification of our European patent application 96304558.8.

Such electrosurgical instruments are particularly useful for rapid tissue debulking and removal of liberated tissue. One of the problems encountered when arthroscopic electrode placement rapidly debulks, especially when working in small joint spaces, is the production of vapor bubbles that occur as end product of tissue vapor erosion. Such bubbles can blur the field of view and coalesce in parts of the applied tissue, and the electrical circuit between the active and return electrodes can be compromised by the absence of conductive fluid. Irregular active electrodes in the form of wire, mesh or coil springs take some way to solve this problem, as described in our International Patent Application No. GB97 / 00065, which reduces the steam corrosion threshold. .

The suction pump facility ensures that air bubbles are removed from the surgical part, which is particularly advantageous during active tissue debulking. The suction pump is only activated when the active electrode 12 is powered for tissue vapor corrosion. Thus, the pump generates a pulse to attract the saline solution over the active electrode 12 (and to extract vapor bubbles and / or particulates). This cools the active electrode 12, resulting in the collapse of the vapor pocket around the active electrode. In turn, this causes the suction pump to turn off, thus reducing the flow of saline over the active electrode 12. The electrode 12 then heats up again, leading to reformation of the vapor pocket and reactivation of the suction pump. This cycle is repeated until the generator 1 is turned off, when the instrument is removed from the surgical point.

The suction pump must be controlled and the flow of bubbles from the active electrode 12 is in balance with the output characteristics of the RF generator 1 to prevent excessive cooling of the active electrode and consequently an increase in its steam corrosion power threshold. It must be correct. The thermal mass of the wire-shaped active electrode 12 is lower than that of the normal solid form of the active electrode, and if collapse follows excessive cooling, this helps to quickly reset the vapor pockets around the active electrode.

Electrode unit E1 is originally intended for use in arthroscopic surgery requiring rapid tissue debulking by steam corrosion. The placement of the adverse electrode (in other words, the therapeutic axis is perpendicular to the shaft) of the unit E1 is particularly advantageous for this purpose. In use, the electrosurgical instrument can be adjusted to introduce an electrode assembly consisting of the active electrode 12 and the return electrode 28 into a selected surgical site (eg, the joint space of the knee), so that the active electrode is treated with the tissue being treated. And the tissue and electrode assemblies are immersed in saline.

The foot switch 5b (or the push button 7b) is then operated to operate the generator 1. At this time, the generator 1 steams the saline solution around the active electrode 12 and vapor pockets around the active electrode. Supplying sufficient RF power to the electrode assembly to maintain a high pressure on the surface of the tissue, using brushing techniques, results in rapid debulking of the tissue, gently touching the tissue reduces this effect, The flow of irrigation away from the active electrode 12 is reduced, and the amount of reduction depends on the characteristics of the tissue surface, the applied pressure and the suction pressure, so that the speed of debulking is a variable of these variables. Once steam erosion occurs, the product will contain vapor bubbles, carbon particles, and tissue debris, all of which are shaft 10 and port 10a. Is removed from the area of the active electrode 12 by the suction pump via < RTI ID = 0.0 >

All components removed from the active tip are hot. This leads to heating of the electrode shaft 10, which can be dangerous and can cause tissue damage at the point of entry. Thus, additional suction along the inner surface of the shaft from the body cavity may be necessary. To ensure that the saline solution is at a really safe temperature, it is drawn from behind the return electrode 28 via a network filter (not shown).

In use, when the generator 1 is turned on, the motor 44 starts to rotate, and the rod 14 generates a vibration of a magnitude of 0.5 mm. Vibration of the rod 14 in the shaft 10 provides mechanical vibration in the shaft sufficient to move any sublimated product concentrated in the shaft. In this way, clogging of the shaft 10 can be prevented, so that the mechanism can be used on a continuous principle.

The vibration of the active electrode 12 ensures that the tissue pieces removed from the working side by electrosurgical steam erosion are electrosurgically shredded by the vibrating electrode, whereby large tissue pieces block the suction channel. Can be prevented.

The electrode unit E1 is effective to remove the heated saline solution (expansion fluid) from within the joint cavity. The danger of heated expansion fluid arises upon application of power to reach the original steam corrosion threshold. Once the threshold is reached, the power requirement is reduced by 30-50%.

While the suction from the area of the active electrode 12 removes the heated saline from the body cavity and eliminates any risk of overheating through extension, without reaching the steam corrosion threshold, the cooling pocket and the vapor pockets formed around the active electrode Collapse will increase the steam corrosion threshold. Thus, a vicious cycle can be made, and the more suction applied to the active electrode 12, the more power required to reach the steam corrosion threshold, the greater the risk of heating. Another factor influencing the steam corrosion threshold is the return rate: insulation separation between the active contact area and active electrode 12 and return electrode 28. Thus, the size and insulation separation of the active electrode 12 reduces to the minimum necessary to achieve the function to turn off the effect of suction in raising the power threshold of steam corrosion.

The specification of our international patent application GB97 / 00065 describes a technique for controlling steam corrosion by employing an active electrode which prevents cooling of the application of the active electrode and prevents the application of the active electrode by blocking the flow of the irrigation agent provided in the endoscope channel. It is starting. An alternative to reducing the steam corrosion threshold is to pulse the suction pressure, thereby allowing a threshold that can be reached between pulses. The pulses can be synchronized with the output characteristics of the RF generator 1 and clean any tissue blocking the openings in the active electrode 12 to provide a power boost to maintain the vapor pocket during active inhalation.

Known techniques in arthroscopy apply mechanical suction to the tissue, so that soft tissues in the joint cavity, such as a patellar fat pad, can be fixed in the suction mouth during gradual ablation. .

The tissue attracted to the active electrode 12 of the reduction electrode unit E1 has a similar effect, and for this reason, the soft tissue attached to the active electrode results in a decrease in the steam corrosion power threshold. The adherent tissue is rapidly steamed and small pieces of tissue generated during steam erosion will be aspirated from the point of application.

Due to its speed due to debucking and adverse electrode placement, the electrode unit E1 has advantages in urological surgery like EVAP technology for use with an abloscope. The ablation electrode unit is introduced very differently in that the assembled instrument must be mounted to the endoscope prior to passing through the work cover via the urethra. An end closer to the electrode unit is connected to the electrical contact and trigger assembly where the ablation glasses are essential. By this means, the electrode unit E1 can interlock back and forth in the range of motion defined by the operation of the trigger mechanism. Since the electrode unit E1 is assembled prior to the inflow, the size of the tip is not abrupt by the width of the working channel, but rather by the diameter of the working cover, which can reach 10 mm. This diameter portion is occupied by the electrode unit E1 support wire, which is usually bent at an angle downward with respect to the endoscope image and the work tip, so that the wire does not interfere with visibility and its work. Because of the reciprocation of the rod 14, the active electrode 12 operates over a length in the range from 3 mm to 4 mm and a width in the range from 2 mm to 3 mm, which averages 20-30 grams of prostate tissue. This is necessary for urological surgery to be removed.

Because the endoscope is mounted to view the storage effect of the bladder and the tip of the active electrode 12 from below, in endoscopic urology, foaming during steam erosion is less problematic, and bubbles flow away from the endoscope to accumulate in the bladder. Because we go. Nevertheless, the use of the electrode unit E1 substantially reduces the likelihood of the foam causing the problem.

The electrode unit E1 is originally intended for use in the vapor corrosion of tissues, but can also be used to separate evaporation, in particular evaporation of the synovial membrane, or muscle attachment. In this case, once the electrode assembly of the electrode unit E1 enters the selected work site, the RF generator 1 is operated to use the step switch 5a or the push button 7a. The generator 1 then provides sufficient RF power to the electrode assembly to actually maintain the saline adjacent to the active electrode 12 without making vapor bubbles of saline around the electrode at the boiling point. The instrument can be manipulated by interlocking the active electrode 12 across the surface of the tissue to be treated with side-to-side painting techniques.

In addition, the electrode unit E1 can be used to convey the mixed power output. This can be achieved by automatically alternating the output of the RF generator 1 between the power levels of evaporation and steam erosion, where much of the hemostasis that occurs is possible in steam erosion mode. As a result, the rate of tissue debulking is reduced, but increased hemostasis is useful when cutting and debulking vascular structures. Alternatively, the output of the RF generator 1 can be pulsed at the steam corrosive power level without periodic operation in the evaporation mode. As both the foam formation and the risk of tissue chrring are consequently reduced, this produces less active tissue vapor erosion than occurs in the vapor erosion mode.

The active electrode 12 of the unit E1 is a side effect electrode (ie its therapeutic axis is perpendicular to the shaft). The vibration of the axis in the electrodes is advantageous in that the entire electrode can be in contact with the tissue. As a result, the exposed area can be made very small, which allows it to operate at lower power and less at higher saline flow rates.

4 and 5 show a second form of the electrode unit E2. This mechanism is a variant of that shown in Figs. 2 and 3, like reference numerals may be used for similar parts and the modification will be described in detail. There are two major variations, the first being the drive to the electrode 14 and the second is the placement of the active electrode 12.

In a first variant, the motor 44 rotationally drives the rod 14 via the coupling assembly 42. In the embodiment of FIGS. 2 and 3, the rod 14 passes through an aligned opening in the washer 34, line 36 and delrin bush 38. The bush 38 is longer than the equivalent bush of the embodiment of FIGS. 2 and 3 and extends to the end 32a of the sleeve 32. Slip ring 46a is provided for connecting connector 46 and rod 14.

Another major variant is that the active electrode 12 (free end of the tungsten rod 14-with a radius of 0.5 mm in this embodiment) is bent behind the free end of the ceramic tube 18. The folded portion 12a of the electrode 12 constitutes a side effect electrode. An opening portion 20a is formed between the ceramic tip 20 and the active electrode 12, which portion is divided into a suction channel defined inside the shaft 10.

Another variant is that the rod 14 is a flexible drive rod, with the original end of the bone rod being off-set relative to the central longitudinal axis of the shaft 10. In use, when the generator 1 is turned on, the motor 44 begins to rotate and causes the rod 14 to rotate within the shaft 10. This rotation provides sufficient mechanical vibration to move any sublimation integrated in the shaft. The off-setting of the rod 14 may result in an unstable oscillation that is subsequently set in the rod, which removes adherent tissue debris from the inner wall of the shaft 10.

6 and 7 show a third form of the electrode unit E3. This unit E3 is a variant of unit E2, like reference numerals are used for similar parts and the variant will be described in detail. The main variant is the placement of the active electrode assembly. As shown in FIG. 7, the active electrode 12 has a crank handle shape and defines an elbow 12b that is off-set from the axis of the ceramic tube 18. The ceramic tip 20 is formed with an inclined cam surface 20b which, in use, engages the elbow 12b in order to harden the tip of the active electrode 12 outward and to ensure better tissue engagement. The crank handle arrangement of the active electrode 12 also ensures that the elbow 12b is pushed around the inner surface of the ceramic tip 20 as the team rotates, thereby removing any debris that may accumulate therein.

8 and 9 show a fourth form of the electrode unit E4. The unit E4 is also a variant of the unit E2, like reference numerals will be used for similar parts and the variant will be described in detail. Here, the main variant relates to the arrangement of the active electrode 12, which in this case is an end effect electrode consisting simply of a hooked end 12a at the end of the rod 14. 4 and 5 is a flexible drive rod 14, which is off-set relative to the central longitudinal axis of the shaft 10.

As already described, the attachment of tissue onto the active electrode 12 can lead to steady-state conditions, and the aspiration method should take into account the removal of tissue pieces that have not been corroded while the formation of vapor pockets is not impeded. Rotation of the active electrodes 12 of the electrode units E2 to E4 provides several advantages for overcoming this performance problem. As such, for one complete rotation, with respect to the tissue contact area, rotation of the active electrode 12 increases the effective size of the electrode, while reducing the physical size of the active electrode. When the generator control method is employed, the reduction in the size of the active electrode 12 reduces the steam corrosion power threshold to such an extent that suction is sufficiently possible along the axis of rotation.

The introduction of rotation and suction through the active electrode 12, more particularly through the channel within the operating range of the active electrode, prevents steady state conditions from reaching and bridging the tissue. This is always achieved when the tissue that temporarily blocks the suction channel is treated, as opposed to placing the suction channel out of the operating range of the active electrode 12, in which case only tissue adjacent to the tissue blocking the suction channel can be treated. .

If the suction channel is required to cope with tissue that has not been steam eroded, only the incision of the tissue is required, as the active electrode 12 removes the tip of the tissue from the tissue in the suction channel and is sucked through the channel. Ideally, the truncated portion of the tissue is shredded or partially steam eroded by the active electrode 12 to reduce the size of the tissue fragments. This refinement is accomplished by introducing an off-setting of the drive shaft / connector into the active electrode 12 which rotates in the suction channel of the inner diameter which is larger than the outer diameter of the connector, blocking the suction channel as described below. There is an additional advantage in terms of preventing this.

The relative contribution of tissue incisions or fragments and tissue vapor corrosion to the debulking process of all tissues can be controlled by the interaction of the holes, suction pressure and size of the active electrode 12 in the vapor corrosion channel at the end. Since the overall size binds the outer radius of the instrument, the overall size is generally the diameter of the drive rod 14, the circular tip of the drive rod 14 forming the active electrode 12, and the drive rod (14) also provides a means of electrical connection to the active electrode, which determines whether tissue incisions will initially occur by incision / fracture or steam corrosion. Traditionally, the drive rod 14 (future active electrode 12) is formed from tungsten wire of 0.2 mm to 1.0 mm in diameter and provides incision and severing, and the drive rod active electrode formed of tungsten wire of 0.5 mm in diameter is preferred. To provide steam corrosion. The incision and slicing technique has advantages when dealing with soft and soft tissues, while the steam erosion technique has advantages when used for dense fibrous or cartilage tissue. Thus, the design is optimized according to the type of tissue encountered in use in a particular surgical field, or alternatively a multifunctional design with active electrodes and drive rods typically formed from 0.4 mm-0.6 mm tungsten can be used.

For all four electrode units from E1 to E4, the vibrations in the suction shaft 10 significantly reduce the risk of blockage by the sublimation product of the shredded tissue or steam corrosion or both. This can be done by the axis or rotational movement of the rod 14 located in the suction channel, which may or may not have other means of fluid vibration, including the periodic circulation of the suction pressure, the output of the generator, the control of the suction and the voice It can be provided as an essential characteristic of pressure waves. In order to increase the effect of vibration, it is advantageous to configure the drive rod 14 with a slippery medium to reduce the attachment.

Each of the electrode units E1 and E4 has an advantage in that suction in the region of the active electrode 12 limits the flow of convective current in the saline solution around the electrode assembly. Since the power threshold required to reach steam corrosion depends on the power loss of the active electrode 12 and the flow characteristics around the active electrode 12, the power threshold depends on the maximum rate of convection. As a result, limiting convective currents can reduce power thresholds or use higher saline flow rates, which allows the use of cheap RF generators as well as avoiding problems such as power loss in the instrument and overheating of active electrodes. It is a profit in that respect. This also makes it easier to control the generator once steam corrosion has started. The importance of the power threshold of steam corrosion is discussed in more detail in the specification of International Patent Application No. GB97 / 00065.

Furthermore, each of the electrode units E1 to E4 prevents the tissue from bridging, for example, as the tissue blocking the suction channel can each be avoided by linkage of the active electrode which ensures that the tissue is treated. While the interlocking of the active electrode 12 is affected by electrosurgical rather than mechanical incision, the interlocking of the active electrode 12 also ensures tissue fracture.

It is a feature of each of the electrode units E1 to E4 that pieces of the segmented tissue separated from the surgical area are attracted to the suction channel by suction pressure. If the attracted piece is too large to enter the suction channel, the piece is obtained by a combination of the electrosurgical operation generated by positioning the return electrode 28 relative to the vapor corrosion channel and the mechanical operation of the vibrating electrode 12. It will be smaller in size. By way of limitation, the spacing of the return electrodes 28 suitable for the movement of the vibrating electrode 12 can be adjusted to a controlled level of periodic arcing between them. This aspect allows control of the appropriate intensity of mechanical and electrosurgical operation to keep the suction channel clean. This aspect is described in more detail in the specification of our UK patent application.

It is apparent that the above-described electrode unit can be modified. For example, instead of providing an off-setting drive rod 14, the rod can be loosely coiled, which is leaning against the inner wall of the suction channel, whereby spiral swirl motion during rotation The cleaning of the channel inner wall as well as the promotion of nearby movement of tissue debris.

Each motor 44 is powered by an RF generator 1. An advantage of this is that the motor 44 can be controlled by means of requiring an RF output voltage above the steam corrosion power threshold before sufficient power is delivered to energize the motor. The control means for this purpose can be equipped with a motor 44 in the handpiece 3.

It is also possible to introduce movement of the axis during the rotation. As such, for the electrode unit E4, a simple 90 degree hook-shaped active electrode 12 can rotate over the bearing surface provided by the distal end of the ceramic tube 18, the end surface having a ratchet saw tooth appearance. Have As such, as the rod 14 rotates, the hooked end 12a interlocks inward and outward as it engages and disengages with the ratchet teeth, and the interlocking movement of this axis is repeatedly stretched and decremented off-set flexibility drive. Allowed by the rod 14.

As an alternative to the electric motor, each of the units E1 to E4 can be powered by a fluid drive developed by a rotary vane or similar mechanism, which in turn can be powered by absorption means.

It is possible to supply power to the rotary drive by the RF generator 1, so that an essential and interactive system such as the rotary drive, the active electrode 12, the RF generator and the absorbing means is provided.

The upper limit of the rotational speed of the units E2 to E4 is limited to the level of raising the steam corrosion power threshold beyond the output range of the RF generator 1, which in turn depends on the geometry of the active electrode 12. Typically, the rate of tissue removal increases with increased rotational speed when employing an incision / cutting technique, and increases with a reduced rotational speed when employing steam corrosion techniques. Thus, it is clear that in a multifunctional design, it is advantageous for the user to change the rotational speed depending on the characteristics of the treated tissue. For this reason, the normal range of rotation speed is 100 revs / min to 1000 revs / min.

In the rotary active electrodes E2 to E4, the effective size of the active electrode 12 is increased, and an important aspect is tissue incision. The active electrode 12 is made of the distal end of the drive rod 14, so a simple wire-shaped electrode meets this implementation requirement. The only drawback of the simple electrode form is that the asymmetry of tissue contact can make it difficult to maintain the correct position on the tissue surface, especially when the surface consists of many neural or dense tissues.

If the wire-shaped active electrode 12 sticks out of the ceramic tube 18, in the form of a simple loop, for example electrode unit E2, then the loop breaks down the tissue pieces for suction through the circular inlet of the suction channel. There is a possibility of making too large an incision. If this occurs, the exposed distal end of the drive rod 14 in the suction channel plays an important role in steaming the segment and such pieces of tissue, so that they are reduced to a size sufficient to enter the suction channel. This function is enhanced by the eccentric motion of the drive rod 14 in the suction channel.

The amount of protruding active electrode 12 from the distal end of ceramic tube 18 is in accordance with the rules described in our patent application GB96 / 01473, but the effect of suction at increasing steam corrosion thresholds changes this rule. Another performance factor that determines the size of the active electrode 12 is similar to the factor that defines the diameter of the wire. As such, thinner wire forms used for soft tissue may protrude from the distal end of the ceramic tumic 18 on the treatment axis; On the other hand, thicker wire forms used in heavily dense tissues extend beyond the distal end of the ceramic tube on the treatment axis, ideally in an amount that does not exceed the diameter of the wire.

The active electrode 12 may use an end effect electrode in the form of a generally planar or highly complex liner, and in general, the shape of the axis of the adverse effect electrode may be a coil, a spiral, a mesh, or a plurality of spokes. Can be.

This international patent application GB96 / 01472 describes a technique for introducing a conductive fluid into the area of a tissue therapy (active) electrode in order to define a conductive fluid path between the active and return electrodes. In use, the electrode units E1 to E4 of the invention can be modified to incorporate the above characteristics. In particular, these units can be modified for use in a gaseous surgical environment, either on the surface of the body or in the body cavity.

The specification of our UK patent application 9612993.7 describes a suction technique in the vicinity of a tissue therapy (active) electrode, where steam corrosion is easily facilitated by intermittently lowering the steam corrosion threshold by stopping suction flow. The suction pressure is controlled by the generator output characteristic. The above techniques can be advantageously incorporated into electrode units E1 to E4, both to ensure that the steam corrosion threshold is exceeded between the suction pulses, and to prevent clogging of the suction channel as a result of the suction pulses. Help

Since the inhalation pulse begins once the steam corrosion threshold is exceeded, tissue can only be attracted to the active electrode once the threshold is exceeded by activation away from the tissue surrounding the expansion medium. It is known that once the tissue is bound by the active electrode, the steam corrosion threshold is lowered. Thus, it is advantageous that the absorption be applied initially without RF activation as a varying time delay property.

In summary, the electrosurgical apparatus of the present invention has the following advantages.

1. Small active electrode surface that can treat large tissue area due to active electrode movement.

2. Small active electrode which allows steam corrosion despite the cooling effect caused by suction.

3. Mechanical movement at the active electrode tip, which can be combined with material removal in the suction channel.

4. Suction action depends on the state of steam corrosion.

5. At least, it is coded with a non-stick material such as polytetrafluoroethylene outside the shaft 10, ideally the inside of the shaft is also the same.

6. Active electrode tip movement occurs across the surface of the suction channel, so any dwelling tissue can be fractured by electrosurgery.

7. The active electrode vibrations depend on the state of vapor corrosion.

8. Ensuring discontinuity in the edge data rod cleans the inner surface of the shaft; Or the rod is bent sufficiently to produce the same effect.

9. The ceramic-to-ceramic interface of the active electrode tip ensures that the inner boundary of the outer ceramic is cleaned by the inner ceramic.

10. The edge data rods are independently insulated with ceramic at their tips.

11. Offset rotational movement for side effect effect electrode to enable flat surface use.

Claims (32)

In the electrosurgical instrument for tissue treatment in the presence of a conductive fluid medium, the electrosurgical size of the tissue treatment electrode mounted on the distal end of the shaft and the size of the excised tissue fragment in order to ablate the tissue fragment in the surgical part by the instrument shaft, electrosurgical operation Cutting means for ablation and removal means for eliminating shredded tissue fragments, the instrument having an opening portion drawn from the area surrounding the tissue treatment electrode by the removal means, the removal means being formed in the instrument shaft and And a channel leading from the opening portion, wherein the tissue treatment electrode periodically intersects along the distal end of the shaft and constitutes a cutting means. The electrosurgical instrument as claimed in claim 1, further comprising a drive means for interlocking the tissue treatment electrode along the distal end of the shaft. The electrosurgical instrument according to claim 1 or 2, wherein the periodic movement of the tissue treatment electrode is effective to prevent the excised tissue pieces from adhering to the distal end of the instrument. 4. The electrosurgical instrument of claim 3, wherein the tissue treatment electrode, when in use, flushes the entire distal end of the instrument in contact with the tissue due to its periodic movement. The apparatus of claim 1, further comprising a return electrode electrically insulated from the tissue treatment electrode by insulating means, wherein the tissue treatment electrode is exposed to a distal end of the instrument, and the return electrode is a tissue. An electrosurgical instrument having a fluid contact surface spaced near an end of a treatment electrode. 6. The tissue therapy electrode of claim 5, wherein the tissue therapy electrode is periodically moved to the return electrode to periodically move the tissue therapy electrode to and from at least one location where arcing occurs between the tissue therapy electrode and the return electrode. Electrosurgical apparatus, characterized in that the interlock. 7. Electrosurgical instrument according to any of the preceding claims, characterized in that the channel is defined by the instrument shaft. 8. The electrosurgical instrument according to any one of the preceding claims, wherein the tissue treatment electrode is provided at the distal end of the rod mounted in the instrument shaft and is interoperable with the rod. The electrosurgical instrument according to claim 8, wherein the tissue treatment electrode is constituted by a distal end of the rod. 10. Electrosurgical instrument according to claim 9, wherein the rod is constituted by a tungsten wire having a diameter in the range of 0.2 mm to 1.0 mm. 11. The electrosurgical instrument of claim 10, wherein the tungsten wire has a diameter in the range of 0.4 mm to 0.6 mm. 12. Electrosurgical instrument according to any of claims 9 to 11, wherein the tissue treatment electrode is angled with respect to the longitudinal axis of the instrument shaft. 13. The electrosurgical instrument of claim 12, further comprising an insulating sleeve surrounding the rod near the angled end. 14. The electrosurgical instrument as claimed in claim 13, wherein the insulating sleeve is a ceramic sleeve. 15. The electrosurgical operation according to any one of claims 8 to 14, wherein said insulating means comprises an insulating member provided at the distal end of the instrument shaft, said insulating member defining said opening portion. Instrument. 16. The electrosurgical instrument as claimed in claim 15, wherein the slot constituting the opening portion is made of the insulating member, and the tissue treatment electrode passes through the slot. 16. The electrosurgical instrument of claim 15, wherein the opening portion comprises a gap between the tissue treatment electrode and the insulating member. 18. Electrosurgical instrument according to any one of claims 8 to 17, wherein said drive means reciprocates said rod in said channel. 19. The electrosurgical instrument according to claim 18, wherein the drive means is constituted by a motor and coupling means for converting the rotational output of the motor into a reciprocating motion of the rod. 20. Electrosurgical treatment according to claim 18 or 19, wherein the angular end of the rod is perpendicular to the longitudinal axis of the instrument shaft and the tip of the angular end constitutes the tissue contacting portion of the tissue treatment electrode. Instrument. 18. Electrosurgical instrument according to any of claims 8 to 17, wherein the drive means rotates the rod in the channel. 22. Electrosurgical instrument according to claim 21, wherein the electric motor constitutes the drive means. 23. The method of claim 21 or 22, wherein the angled end of the rod is perpendicular to the longitudinal axis of the instrument shaft, and the distal surface of the angled end constitutes the tissue contacting portion of the tissue treatment electrode. Electrosurgical instruments. 23. Electrosurgical instrument according to claim 21 or 22, wherein the angular end of the rod has an acute angle to the longitudinal axis of the instrument shaft. 25. The electrosurgical instrument of claim 24, wherein the insulating member is provided with an inclined cam surface that engages the apex of the angular end of the rod. 23. The electrosurgical instrument as claimed in claim 21, wherein the angled end of the rod is bent back around the distal end of the insulating sleeve. 27. Electrosurgical instrument according to any one of the preceding claims, wherein the removal means further comprises a pump connected to the channel in an area away from the opening portion of the instrument. 28. Electrosurgical instrument according to claim 27, wherein the pump is operated periodically, whereby material is sucked in the form of a pulse by the removal means. 29. The electrosurgical instrument of claim 28, wherein the pump is operated only when the tissue therapy electrode is energized for tissue vapor corrosion. 30. Electrosurgical instrument according to any one of claims 5 or 6 to 29, further comprising an RF generator having an anode output coupled to the tissue treatment electrode and the return electrode. 31. The electrosurgical instrument of claim 30, wherein the RF generator supplies energy to the drive means. 31. The electrosurgical instrument as claimed in claim 30, wherein the pump is controlled in dependence on the output characteristics of the RF generator.