NO300755B1 - Kirurgisk apparat - Google Patents
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- NO300755B1 NO300755B1 NO892096A NO892096A NO300755B1 NO 300755 B1 NO300755 B1 NO 300755B1 NO 892096 A NO892096 A NO 892096A NO 892096 A NO892096 A NO 892096A NO 300755 B1 NO300755 B1 NO 300755B1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00973—Surgical instruments, devices or methods, e.g. tourniquets pedal-operated
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/320069—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for ablating tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/32007—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with suction or vacuum means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00077—Electrical conductivity high, i.e. electrically conducting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00589—Coagulation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/0091—Handpieces of the surgical instrument or device
- A61B2018/00916—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
- A61B2018/00958—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device for switching between different working modes of the main function
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
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- H—ELECTRICITY
- H01—ELECTRIC ELEMENTS
- H01H—ELECTRIC SWITCHES; RELAYS; SELECTORS; EMERGENCY PROTECTIVE DEVICES
- H01H2300/00—Orthogonal indexing scheme relating to electric switches, relays, selectors or emergency protective devices covered by H01H
- H01H2300/014—Application surgical instrument
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Description
Foreliggende oppfinnelse angår et kirurgisk apparat for ultrasonisk fragmentering og aspirering, samt elektrokirurgisk koagulering og elektrokirurgisk skjæring i vev på et operasjonssted på en pasient.
Anvendelse av ultrasonisk vibrerende kirurgiske anordninger anvendt for fragmentering og fjerning av uønsket vev med betydelig presisjon og sikkerhet har ført til utvikling av en rekke verdifulle kirurgiske fremgangsmåter, og anvendelse av ultrasoniske aspiratorer for fragmentering og kirurgisk fjerning av vev fra et legeme er blitt velkjent. I begynnelsen ble den kirurgiske aspirasjonsteknikk anvendt for fragmentering og fjerning av katarakt-vev, som vist for eksempel i US-patenter 3 589 363 og 3 693 613; innholdet i disse patenter og hvert av de andre patenter og dokumenter som er nevnt i det foreliggende, er herved medtatt som referanse i sin helhet. Senere ble slike teknikker anvendt med betydelig hell ved nevrokirurgi og andre kirurgiske spesialiteter hvor anvendelse av ultrasonisk energi gjennom en liten hånd-anordning for selektiv fjerning av vev på lag-for-lag-basis med nøyaktig regulering har vist seg å være gjennomførbart. Nylig er det blitt kjent en ultrasonisk aspirator for endoskopisk fjerning av ettergivende biologisk vev som beskrevet i Internasjonal Publikasjon nr. WO 87/01276.
Det er kjent elektrokirurgiske generatorer utstyrt med frekvensdeler. Som eksempel på et slik apparat kan vises til US-A-4378801. Ved dette apparat kan frekvensdelerens karakte-ristikker varieres slik at generatoren sender forskjellige signaler, hvilke svarer til flere operasjonsmoder.
Det er også kjent apparater som frembringer karakteris-tisk vedvarende vibreringer med hovedsakelig konstant ampli-tyde ved en frekvens på fra ca. 20 til ca. 3 0 KHz opp til fra ca. 40 til ca. 50 KHz. US-patent nr. 3 589 3 63 beskriver én slik anordning som er spesielt tilpasset for anvendelse ved fjerning av katarakter, mens US-patent nr. 4 063 557 beskriver en anordning som er egnet for fjerning av bløtvev, som er spesielt tilpasset for fjerning av meget ettergivende elastisk vev blandet med blod. Slike anordninger kan drives kontinuer-lig når kirurgen ønsker å fragmentere og fjerne vev, og drives vanligvis under kontroll av en fotbryter.
Et kjent instrument for ultrasonisk fragmentering av vev på et operasjonssted og deretter aspirering av vevspartiklene og -fluidet vekk fra stedet, er den ultrasoniske aspirator av CUSA-modellen system 200 som fremstilles og selges av Cavitron Surgical Systems, Stamford, Connecticut; se også US-patent-søknad nr. 847 301. Når den longitudinalt oscillerende metalliske spiss på denne bringes i kontakt med vev, fragmenterer den og fjerner vevet forsiktig, selektivt og nøyaktig. Noen av fordelene ved dette unike kirurgiske instrument er at det er liten resulterende ødeleggelse av friskt vev ved en tumor-fjerningsmetode, blodkar kan skjeletteres, tilheling av vev understøttes, det skjer ikke noen forkulling eller riving av kanten av omgivende vev, det skjer bare minimal trekking av friskt vev, og det tilveiebringes utmerket berørings-feedback for selektivt regulert vevsfragmentering og -fjerning.
Videre skal vises til US patent 4378801 som angår en elektrokirurgisk generator som er utstyrt med bl.a. fire brytere som brukes av operatøren av håndstykket.
Kirurger som anvender det ultrasoniske kirurgiske CUSA-instrument, har uttrykt et ønske for ytterligere og forbedrede ytelser ved dette instrument. De har spesielt anmodet om tilveiebringelse av regulert gjennomtrengning av kapselmembraner uten ødeleggelse av organene, nøyaktig og hurtig fjerning av fibrøse vevsstrukturer såsom ved slimhinne-protektomimetoder, og økt hastighet for vevsfragmentering og -fjerning. Ved mange kirurgiske metoder hvor det er blitt anvendt ultrasoniske fragmenteringsinstrumenter, har det vært fordret tilleggsinstrumenter for vevsskjæring og hemostase på operasjonsstedet. Hemostase er for eksempel nødvendig ved tørke-teknikker for dyp koagulasjon for uttørking av store volumer av vev og dessuten ved fulgurasjonsteknikker for sprøytekoagu-lering for uttørking av vevsoverflater. Se f.eks. US-patent 4378 801. Ofte anvendes en elektrokirurgisk stift som er plugget i en elektrokirurgisk enhet for vevsskjæring og hemostase og en sugesonde for aspirasjon av fluider og avskårne vevspartikler. Siden mange kirurgiske redskaper derved fordres på et enkelt operasjonssted, økes den totale operasjons-tid og effektiviteten reduseres, siden kirurgen må skifte mellom forskjellige instrumenter. Dessuten tapes det uønskede mengder blod på grunn av den tid som trenges for å skifte fra et skjærings- eller fragmenteringsredskap til et kauterisa-sjonsinstrument når blødning observeres. Dessuten er kirurgens oversiktsområde redusert ved at det samtidig må holdes flere kirurgiske anordninger på operasjonsstedet. På grunn av metodenes kompleksitet, kan det videre skje feilaktig aktive-ring av den elektrokirurgiske stift når den ikke er i bruk, som bevirker en RF-brenning av pasienten. Følgelig er det oppstått et behov for forbedrede kirurgiske metoder og apparater som avhjelper disse problemer og oppfyller de ovenfor uttrykte ønsker og behov hos kirurgene.
Den foreliggende oppfinnelse avhjelper disse problemer ved inkorporering av koagulerende RF- og skjærende RF-yteevne i den vibrerbare spiss på en ultrasonisk fragmenterings- og aspireringsanordning. Overraskende nok er ikke bare fragmenterings- og aspirerings-yteevnen ikke minsket; de er fak-tisk øket ved levering av RF-energi til fragmenterings- og aspireringsspissen. En skiftmekanisme som er lett tilgjengelig for kirurgen, gjør det mulig for ham under operasjonen og med instrumentspissen på operasjonsstedet øyeblikkelig å skifte mellom anvendelse av ingen funksjon, én funksjon eller samtidig anvendelse av hvilken som helst kombinasjon av funksjoner ved instrumentet, hvorved effektiviteten økes og opera-sjonstiden minskes. Blødningen som oppstår under vevsfragmen-teringen, reguleres hurtigere og bedre. Tilveiebringelse av regulerbar avgivelse av utskyllings- og avkjølingsfluider til - operasjonsstedet via instrumentet fås også.
Apparatet ifølge oppfinnelsen for utførelse av én eller flere kirurgiske inngrep på et operasjonssted på en pasient, omfatter et håndstykke, et redskap båret av håndstykket, hvilket redskap har en vibrerbar redskapsspiss og ultrasonisk vibreringsanordning for ultrasonisk vibrering av redskapsspissen, og en RF-strømanordning tilpasset for å tilveiebringe en RF-strøm til redskapsspissen for utførelse av en elektrokirurgisk metode på operasjons- eller inngrepsstedet, hvilken redskapsspiss har en spissåpning idet redskapet har en redskaps-passasje som kommuniserer med spissåpningen, samt en aspirasjonsanordning for påføring av et sugetrykk på redskapspassasjen for aspirering av vevspartikler og -fluid på operasjonsstedet gjennom spissåpningen gjennom redskapspassasjen og bort fra inngrepsstedet, idet RF-strømanordningen innbefatter en skifteanordning for skifting av RF-strømmen som tilføres til redskapsspissen til i det minste en RF-skjæringsstrøm under ultrasonisk vibrering, idet apparatet karakteriseres ved at skifteanordningen er montert på håndstykket.
Andre formål, fordeler og utførelser av apparatet ifølge oppfinnelsen skal beskrives nærmere under henvisning til vedlagte tegninger, hvor: fig. 1 illustrerer et kirurgisk system ifølge den foreliggende oppfinnelse,
fig. 2 er et riss ovenfra av en sentral del av et første håndstykke i systemet ifølge fig. 1,
fig. 3 et et sideriss med et delvis tverrsnitt av den forreste del av det første håndstykke ifølge fig. 2,
fig. 4 er et sideriss av den forreste del av det første håndstykke ifølge fig. 2 som i skjematisk form illustrerer en RF-skiftmekanisme for denne,
fig. 5 er et snitt ovenfra av en sentral del av et alter-nativt andre håndstykke i systemet ifølge fig. 1,
fig. 6 er et sideriss i delvis tverrsnitt av den forreste del av det annet håndstykke ifølge fig. 5, og
fig. 7 er et sideriss av den forreste del av det annet håndstykke ifølge fig. 5 som i skjematisk form illustrerer en RF-skiftmekanisme for denne.
Et kirurgisk system ifølge den foreliggende oppfinnelse er illustrert på fig. 1 generelt ved 10 som utfører en kirurgisk oppgave på et operasjonssted 12 på en pasient 14. System 10 innbefatter et håndstykke som er vist generelt ved 16, som, som vil bli beskrevet detaljert i det følgende, kan utføre ultrasonisk fragmentering, aspirering, elektrokirurgisk skjæring, fluidutskylling og elektrokirurgiske koagulerings- eller hemolysefunksjoner på vev på operasjonsstedet 12. Disse funksjoner kan utføres enten separat eller samtidig i hvilken som helst kombinasjon. Håndstykket 16 kan være et kjent ultrasonisk-fragmenterings-håndstykke såsom det tidligere nevnte CUSA-håndstykke eller det som er beskrevet i US-patent 4 063 557 tilhørende Wuchinich et al, modifisert slik at det innbefatter elektrokirurgiske skjærings- og koagulasjonsfunk-sjoner som forklart i det følgende. Disse modifikasjoner kan bygges inn i selve håndstykket, eller de kan tilveiebringes som en del av en engangs- eller en utskiftbar håndstykkekompo-nent såsom på håndstykkets manifold eller forstykke-konus.
Håndstykke 16 som vist på fig. 1, innbefatter et deksel 18 som har en størrelse og utformning som gjør at det lett og bekvemt kan gripes og manipuleres ved kirurgens hånd. Et langstrakt, tilspisset ultrasonisk vibrerbart redskap 20 er understøttet av dekslet, som det vil sees på fig. 3 og 6, og anbrakt i retning fremover slik at dets spiss 22 strekker seg fremover et stykke ut fra dekslet og har en spissåpning 24 i sin distale ende. Redskapet 20 er hult og avgrenser en langs-gående redskaps-passasje 26 gjennom det.
En aspirasjonspumpe som for eksempel er innesluttet i et deksel 28, kan påføre et sugetrykk gjennom rør 29 til den proksimale ende av passasjen 26 slik at vevspartikler, blod, fluider og liknende på operasjonsstedet 12 kan aspireres fra operasjonsstedet 12 inn gjennom spissåpning 24 ut gjennom passasje 26 mot konsollen eller dekslet 28 og inn i en egnet sugebeholder 29a.
Ett av fluidene som kan aspireres fra operasjonsstedet, er et saltutskyllingsfluid som er tilført til dette som en del av operasjonsmetoden for eksempel for tilveiebringelse av et suspensjonsfluid for vevspartiklene som er fragmentert ved håndstykket 16. Saltutspylingsoppløsningen kan dreneres ved tyngdekraften på kjent måte fra en flaske eller pose 30 som er hengt opp over operasjonsstedet 12, gjennom et utspylings-rør-stykke 32 til og inn i håndstykket 16. Den strømmer så gjennom en ringformet passasje 34 som er avgrenset mellom redskapet 2 0 og dekslet eller den fremre manifoldposisjon for dette og deretter ut gjennom dekslet rundt redskapsspissen 22 til operasjonsstedet 12. I tillegg til at fluidet tilfører utskyllingsfluid til operasjonsstedet 12, kjøler det den vibrerende spiss 22 og blodet, vevspartikler og annet aspirert materiale idet det forhindrer at redskapet 20 ødelegges og nedsetter hastigheten for koagulasjon av blodet. Ved fukting av vevet understøttes aspirasjon av dette, og tilstøtende friskt vev beskyttes mot ødeleggelse. Når operasjonsstedet 12 er et innelukket eller halvveis innelukket område såsom øyet ved ultrasoniske kataraktfjerningsmetoder, er det viktig å opprettholde et trykk i dette innenfor et bestemt område, og strømningsreguleringssystemer for opprettholdelse av slike trykk er kjent og kan anvendes i det foreliggende. Se f.eks. US-patent 3 693 613. Regulering av leveringen av utskyllingsfluid og anvendelse av aspirasjonssugningstrykk og ultrasonisk energi kan skje ved en fotbryter som er lett tilgjengelig for kirurgen som kjent på området.
Redskapet 20 vibreres ultrasonisk ved et resonans-vibre-ringssystem som er vist generelt ved 38 og montert i håndstykket 16. Systemet 38 innbefatter en transduser, såsom en magnetostriktiv stabel som beskrevet i Re. 25 033 og en ultrasonisk mekanisk transformator for variasjon av slagene som bevirkes ved transduseren. Redskapet 20 selv omfatter et hovedsakelig enhetlig legeme med en utvendig gjenget ende utformet for utskiftning etter behov og festet til et forbin-delseselement i det vibrerende system 38. Det vibrerende system 38 bevirker at spissen 22 vibrerer ultrasonisk med et slag på over 0,0254 mm og fortrinnsvis 0,3556 mm og i et frekvensområde på 20-50 KHz og fortrinnsvis 23-37 KHz.
Den elektrokirurgiske enhet (ESU), såsom en frittstående sykehusenhet som er vist generelt ved 40, eller som omtalt i US-patenter 3 898 991, 3 963 030 og 4 051 855, tilveiebringer RF-energien til håndstykket 16. Det er også innenfor denne oppfinnelses ramme å utforme og sikre den elektrokirurgiske enhet 40 inne i dekslet 28 sammen med aspiratorpumpen i en enkelt fortrinnsvis flyttbar enhet. ESU 40 frembringer RF-energi, og en kauterisasjonskabel 42 er operativt forbundet i én ende med håndstykket 16 og har en plugg 44 i sin andre ende tilpasset til å plugges inn i den håndbryter-aktive kontakt 46 på ESU 40 for levering av RF-energien til håndstykket 16. En brytermontasje som er anbrakt slik at den med letthet kan betjenes av kirurgen etter hvert som han håndterer håndstykket 16, gir ham mulighet til å regulere leveringen av RF-energi fra ESU 40 til redskapet 20. Brytermontasjen kan gjøre det mulig for kirurgen å velge blant "ingen" RF-energi, RF-koa-guleringsenergi, RF-skjæringsenergi eller en samtidig blanding av koagulerings- og skjæringssignalenergier. RF-skjærings- og koagulerings-strøm er forskjellig og er definert som henholdsvis ren sinusbølge og dempet sinusbølge. Brytermontasjen kan være fotbryter eller håndbryter, og hvis den er en håndbryter, kan den festes på håndstykket 16 slik at den er tilgjengelig og kan betjenes ved kirurgens hånd (pekefinger) mens den holder og håndterer håndstykket 16. En håndstykke-håndbryter kan være formet som en del av, eller være bygget inn i, håndstykket 16 slik at den er fullstendig re-anvendbar, eller som en avtakbar og utskiftbar enhet såsom en tilleggs-brytermontasje eller som en avtakbar håndstykke-manifold; denne manifold kan også omfatte en del av utskyllingsfluid-passasjen. Forskjellige manifoldutformninger er vist for eksempel i US-PCT-patentsøknad 87/00795. Mange brytermontasjer såsom trykknapp-, vippe- eller glidekonstruksjoner kan anvendes. En første foretrukket brytermontasjekonstruksjon er vist på tegningene på fig. 2-3 generelt ved 50. Den kan være en normalt åpen enkeltpol-dobbel-(SPDT)-trykknappbryter, som vist skjematisk på fig. 4, hvilket gjør mulig festing av "skjære<*1->eller "koag"-stillinger for RF-strøm fra ESU 40. Straks RF-strømmen er valgt ved henholdsvis "skjære"-stillings- eller "koag"-stillings-dombrytere, 52,54, bevirkes det ved krets-tavle 56 at RF-strømmen strømmer fra ESU 40 gjennom grense-flate- eller kauterisasjonskabelen 42 til en metallisk kontaktor 58 gjennom et elektrisk koplingsstykke til spissen. En alternativ regulering/levering av RF-energi ville være å tilveiebringe en enkelt trykknapp (blanding) på håndstykket og regulert ved en enkelt sammenhengende variabel regulering som ved sin nedre grense er kalibrert til å skjære, og til å koagulere ved sin øvre grense.
En første utførelsesform av det elektriske koplingsstykke er en metallisk akustisk vibrator som inneholder en laminert nikkellegeringsstruktur og er vist ved 38 på fig. 3. En andre elektrisk koplingsstykke-utførelsesform 59 er å anvende et fluidledende medium såsom saltvannsutskyllingsoppløsningen ved det utskyllingssystem som fordres ved normal drift av systemet. Dette ledende medium omgir direkte spissen 22 og kan også tilveiebringe elektrisk kontakt mellom den metalliske kontaktor 58 og spissen som illustrert på fig. 5-7. Denne elektriske saltvannsfluidbane skyter ikke inn mekanisk belast-ning ved et akustisk vibrerende element i håndstykket 16, slik som den første utførelsesform.
For komplettering av den elektriske RF-sløyfe er det tilveiebrakt en dispergerende bunnpute 60 som vist på fig. 1 for anbringelse på pasienten 14. Se f.eks. US-patent 4 038 984. En kabel 62 som er forbundet med puten i én ende og som har en plugg 64 i sin annen ende (se også fig. 4 og 7), forbinder puten med ESU 40 når pluggen 64 er plugget i den dispergerende elektrodekontakt 66 i denne. For tilveiebringelse av riktig drift av de elektrokirurgiske elementer ifølge denne oppfinnelse og på konvensjonell måte, strømmer RF-strøm-men fra spissen 22 gjennom pasienten 14, til bunnputen og tilbake til ESU 40, under fullstendiggjøring av den elektriske sløyfe.
Ved den første demonstrasjon av blødning under en ultrasonisk vevsfragmenteringsmetode kan det ødelagte blodkar således kauteriseres nesten øyeblikkelig med en knips på bryteren. Videre gjør dette system, når det er i kauterisa-sjonsstilling, mulig at kauterisasjonen kan anvendes direkte ved den ultrasoniske spiss 22 under kauterisasjon av blødere på en liknende måte som med standard-nevrokirurgiske teknikker. Brenning av spissen 22, forkulling av vev og tilstopping av aspirasjonsspissen 22 er ikke problemer ved disse utform-ninger.
Forsøk har bevist effektiviteten av dette kirurgiske system 10. Ved en moderat koaguleringsmetode ble koaguleringen regulert med mye mindre vevsforkulling enn det som er tilfel-let ved standard-elektrokirurgiske teknikker. Ved en ultrasonisk fragmenterings- og koagulerings-kombinasjonsmetode ble det også observert øket fragmentering og regulert hemostase. Ved en kombinasjonsmetode for ultrasonisk fragmentering og elektrokirurgisk skjæring ble det observert øket fragmentering og regulert skjæring. Og ved en ultrasonisk fragmenterings-og elektrokirurgisk blandings-(skjærings- og koagulerings)-metode var resultatet øket kirurgisk effektivitet i forhold til hvilken som helst individuell måte, og basiske kirurgiske karakteregenskaper ved en ultrasonisk kirurgisk aspirasjonsanordning ble likevel bibeholdt. Ved tilføring av RF-energi til en vibrerende spiss øker ikke bare hastigheten for vevs-fjerning betydelig, men vevsselektivitet og berørings-feedback er tilveiebrakt i det samme kirurgiske instrument. Ved mini-malisering av antallet anordninger på operasjonsstedet, opp-rettholdes videre visualisering av det kirurgiske område og sikkerheten under metoden økes.
Claims (29)
1. Kirurgisk apparat for utførelse av én eller flere kirurgiske inngrep på et operasjonssted på en pasient, omfattende: et håndstykke (16), et redskap (20) båret av håndstykket, hvilket redskap (20) har en vibrerbar redskapsspiss (22) og ultrasonisk vibreringsanordning.(38) for ultrasonisk vibrering av redskapsspissen, og en RF-strømanordning (40) tilpasset for å tilveiebringe en RF-strøm til redskapsspissen for utførelse av en elektrokirurgisk metode på operasjons- eller inngrepsstedet (12), hvilken redskapsspiss har en spissåpning idet redskapet har en redskapspassasje (26) som kommuniserer med spissåpningen, samt en aspirasjonsanordning (28) for påføring av et sugetrykk på redskapspassasjen for aspirering av vevspartikler og -fluid på operasjonsstedet gjennom spissåpningen gjennom redskapspassasjen og bort fra inngrepsstedet, idet RF-strømanordningen (4 0) innbefatter en skifteanordning (50) for skifting av RF-strømmen som tilføres til redskapsspissen til i det minste en RF-skjæringsstrøm under ultrasonisk vibrering, karakterisert ved at skifteanordningen (50) er montert på håndstykket (16).
2. Apparat ifølge krav 1,
karakt "e ri sert ved at RF-strømanordningen (40) med skifteanordningen (50) er tilpasset for skifting av RF-strømmen som tilføres til redskapsspissen (22) mellom en RF-koaguleringsstrøm og en RF-skjæringsstrøm.
3. Apparat ifølge krav 1,
karakterisert ved at skifteanordningen (50) er bygget inn i håndstykket (16).
4. Apparat ifølge krav 2,
karakterisert ved at skifteanordningen (50) omfatter en manifold konstruert for å festes til håndstykket (16) og en brytermontasje som er forbundet med manifolden og som kan beveges med denne når manifolden festes til, eller fjernes fra, håndstykket (16) .
5. Apparat ifølge krav 4,
karakterisert ved at brytermontasjen er uløselig knyttet til manifolden.
6. Apparat ifølge krav 2,
karakterisert ved at skifteanordningen (50) omfatter en forstykke-konus som er tilpasset til å settes på, og festet til, håndstykket (16), en bryter som er festet til forstykke-konusen, og en kabelanordning for operativ sammenknytting av bryteren med en elektrokirurgisk enhet.
7. Apparat ifølge krav 6,
karakterisert ved at skifteanordningen (50) innbefatter en festeanordning for festing av forstykke-konusen til håndstykket (16).
8 . Apparat ifølge krav 2,
karakterisert ved at skifteanordningen (50) omfatter en trykknapp-brytermontasje på håndstykket (16) .
9. Apparat ifølge krav 2,
karakterisert ved at skifteanordningen (50) omfatter en brytermontasje av vippetypen ved håndstykket (16).
10. Apparat ifølge krav 2,
karakterisert ved at skifteanordningen (50) omfatter en glidetype-brytermontasje ved håndstykket (16) .
11. Apparat ifølge krav 2,
karakterisert ved at skifteanordningen (50) omfatter en enkeltpol-dobbeltsjaltningsbryter som normalt er åpen.
12. Apparat ifølge krav 2,
karakterisert ved at den koagulerende RF-strøm er 500 KHz.
13. Apparat ifølge krav 2,
karakterisert ved at RF-skjæringsstrømmen er 500 KHz.
14. Apparat ifølge krav 1,
karakterisert ved en koplingsanordning for operativ kopling av håndstykket (16) til en elektrokirurgisk enhet som frembringer RF-strømmen.
15. Apparat ifølge krav 14,
karakterisert ved at koplingsanordningen innbefatter en velgeranordning for valg mellom skjærings-og koaguleringsstillinger for RF-strønmen som skal leveres til spissen.
16. Apparat ifølge krav 15,
karakterisert ved at koplingsanordningen innbefatter en dispergerende jordings-elektrodeanordning som kan festes til pasienten for forbindelse til den elektrokirurgiske enhet.
17. Apparat ifølge krav 1,
karakterisert ved en utskyllingsanordning som er forbundet med håndstykket (16) for tilveiebringelse av utskyllingsfluid til operasjonsstedet som grenser inntil spissen.
18. Apparat ifølge krav 17,
karakterisert ved at utskyllingsanordningen innbefatter en utskyllingsfluid-passasje hvorav minst en del er understøttet av håndstykket (16) , og passasjen har en passasjeutgangsåpning som grenser inntil spissen.
19. Apparat ifølge krav 1,
karakterisert ved at RF-strømanordningen (40) innbefatter en elektrokirurgisk enhet for frembringelse av RF-energien.
20. Apparat ifølge krav 19,
karakterisert ved at den elektrokirurgiske enhet er en stativ-fri enhet og RF-strømanordningen (4 0) innbefatter en kabel for sammenkopling av den stativ-frie elektrokirurgiske enhet med håndstykket (16).
21. Apparat ifølge krav 1,
karakterisert ved at RF-strømanordningen (40) innbefatter en akustisk vibratorkomponent som er understøttet av håndstykket (16) og som operativt kan koples til en kilde til RF-energi.
22. Apparat ifølge krav 21,
karakterisert ved en mekanisk koplingsanordning for operativ kopling mellom den akustiske vibratorkomponent og spissen.
23. Apparat ifølge krav 21,
karakterisert ved en ledende fluidtilknyt-ningsanordning for operativ sammenkopling av den akustiske vibratorkomponent med spissen.
24. Apparat ifølge krav 23,
karakterisert ved at den ledende fluidkop-lingsanordning anvender et operasjonssted-utskyllingsfluid for leding av RF-energien til spissen.
25. Apparat ifølge krav 1,
karakterisert ved at RF-strømanordningen (4 0) innbefatter en generatoranordning for frembringelse av RF-strømmen, aspireringsanordningen (28) innbefatter en sugeanordning for frembringelse av sugetrykket, og en dekselanordning for å romme generatoranordningen og suge-anordningen.
26. Apparat ifølge krav 1,
karakterisert ved at RF-strømanordningen (40) er tilpasset til å levere RF-strøm til redskapsspissen (22) ved en elektrokirurgisk metode for vev på operasjonsstedet (12) mens den vibrerende anordning ultrasonisk fragmenterer vev på operasjonsstedet.
27. Apparat ifølge krav 1,
karakterisert ved at RF-strømanordningen (40) er tilpasset til å levere RF-strøm til redskapsspissen (22) ved en elektrokirurgisk metode for vev på operasjonsstedet (12) mens aspireringsanordningen (28) aspirerer vevspartikler og fluid gjennom spissåpningen bort fra operasjonsstedet.
28. Apparat ifølge krav 1,
karakterisert ved at RF-strømanordningen (40) innbefatter en koplingsanordning for elektrisk sammenkopling av redskapsspissen (22) med en elektrokirurgisk enhet.
29. Apparat" ifølge krav 28,
karakterisert ved at RF-strømanordningen (40) innbefatter en elektrisk filtreringsanordning for forhindring av mislykket funksjon av de logiske kontroller ved apparatet når koplingsanordningen kopler sammen redskapsspissen (22) med den elektrokirurgiske enhet og den elektrokirurgiske enhet aktiveres.
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US07/103,022 US4931047A (en) | 1987-09-30 | 1987-09-30 | Method and apparatus for providing enhanced tissue fragmentation and/or hemostasis |
PCT/US1988/003349 WO1989002725A1 (en) | 1987-09-30 | 1988-09-29 | Tissue fragmentation and/or hemostasis |
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NO892096L NO892096L (no) | 1989-05-25 |
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- 1988-09-29 AU AU25382/88A patent/AU616699B2/en not_active Ceased
- 1988-09-29 CA CA000578785A patent/CA1323665C/en not_active Expired - Fee Related
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- 1988-09-29 JP JP63508237A patent/JPH0642893B2/ja not_active Expired - Fee Related
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AU2538288A (en) | 1989-04-18 |
ES2064360T3 (es) | 1995-02-01 |
EP0310431B1 (en) | 1994-11-02 |
DE3852005D1 (de) | 1994-12-08 |
DK261589A (da) | 1989-05-29 |
JPH02501894A (ja) | 1990-06-28 |
IE882941L (en) | 1989-03-30 |
FI892607A0 (fi) | 1989-05-29 |
AU616699B2 (en) | 1991-11-07 |
JPH0642893B2 (ja) | 1994-06-08 |
IL87857A0 (en) | 1989-03-31 |
IE67810B1 (en) | 1996-05-01 |
ATE113457T1 (de) | 1994-11-15 |
NO892096D0 (no) | 1989-05-25 |
WO1989002725A1 (en) | 1989-04-06 |
EP0310431A3 (en) | 1989-10-25 |
NO892096L (no) | 1989-05-25 |
EP0310431A2 (en) | 1989-04-05 |
DK261589D0 (da) | 1989-05-29 |
FI892607A (fi) | 1989-05-29 |
DE3852005T2 (de) | 1995-03-09 |
CA1323665C (en) | 1993-10-26 |
US4931047A (en) | 1990-06-05 |
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