WO2012133512A1 - Pince de résection thermique et système associé - Google Patents

Pince de résection thermique et système associé Download PDF

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Publication number
WO2012133512A1
WO2012133512A1 PCT/JP2012/058100 JP2012058100W WO2012133512A1 WO 2012133512 A1 WO2012133512 A1 WO 2012133512A1 JP 2012058100 W JP2012058100 W JP 2012058100W WO 2012133512 A1 WO2012133512 A1 WO 2012133512A1
Authority
WO
WIPO (PCT)
Prior art keywords
forceps
incision
heating element
living tissue
thermal
Prior art date
Application number
PCT/JP2012/058100
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English (en)
Japanese (ja)
Inventor
鈴木　啓太
Original Assignee
オリンパスメディカルシステムズ株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパスメディカルシステムズ株式会社 filed Critical オリンパスメディカルシステムズ株式会社
Publication of WO2012133512A1 publication Critical patent/WO2012133512A1/fr

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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
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A61B18/085—Forceps, scissors
    • 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
    • A61B2018/00601—Cutting
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00875—Resistance or impedance

Definitions

  • the present invention relates to a thermal incision forceps and a thermal incision forceps system for incising a living tissue using the thermal incision forceps.
  • Patent Literature 1 discloses a thermal incision forceps having a heating element heated by electric energy. According to the thermal incision forceps described in Patent Document 1, the living tissue can be incised by bringing the heated heating element into contact with the living tissue.
  • the thermal incision forceps described in Patent Document 1 do not have means for detecting that a living tissue has been incised. For this reason, the user who operates the heat incising forceps must visually confirm that the living tissue has been incised using, for example, an endoscope, and the procedure may be complicated.
  • the present invention has been made in view of the above-described circumstances, and an object thereof is to provide a thermal incision forceps capable of easily incising a living tissue.
  • the present invention proposes the following means.
  • a thermal incision forceps for incising the living tissue by applying thermal energy to the living tissue through the forceps member, provided on the forceps member, By heating by contact with the electric energy, the heating element that cauterizes and incises the living tissue, and when the heating element contacts the living tissue, the living tissue can be contacted on both sides of the heating element A pair of sensing electrodes.
  • the heating element and the pair of detection electrodes are connected to an external control unit, and the control unit is
  • the incision state of the living tissue may be detected by a detection electrode, and the supply of electrical energy to the heating element may be controlled based on the incision state.
  • the detection electrode may be fixed to the forceps member.
  • the forceps member in the first or second aspect, includes a pair of ridges extending in the longitudinal direction and provided on both sides in the width direction of the ridges.
  • the heating element is formed in a linear shape and is fixed to the ridge along the longitudinal direction of the ridge, and the detection electrode is It may be fixed to each of the slopes of the set.
  • control unit detects the incision state by measuring a change in impedance of the living tissue between the pair of detection electrodes. Also good.
  • control unit detects the incision state by measuring a change in the conduction state of the living tissue between the pair of detection electrodes. May be.
  • control unit determines that the biological tissue is incised based on the incision state, and the biological tissue is incised.
  • the supply of the electric energy to the heating element may be stopped.
  • the thermal incision forceps according to the present invention is connected to the forceps member and the biological tissue. You may further provide the 2nd forceps member pressed and hold
  • the second forceps member may have a second forceps surface that is directed toward the heating element and can contact the living tissue. good.
  • a thermal incision forceps system using thermal incision forceps for incising the biological tissue by applying thermal energy to the biological tissue through the forceps member,
  • a heating element that is in contact with the living tissue and generates heat by electrical energy, and on both sides of the heating element when the heating element comes into contact with the living tissue.
  • a pair of detection electrodes that can contact the living tissue, and the incision state of the living tissue is detected by the pair of detection electrodes that are connected to the detection electrode and connected to the heating element, and that are in contact with the living tissue.
  • a control unit that controls supply of the electric energy to the heating element based on the incision state.
  • the control unit detects the incision state of the living tissue using the detection electrode provided on the forceps member, and the supply of electric energy to the heating element is controlled based on the detected incision state. Is done. For this reason, it is possible to save the user from having to check the incision state, and to easily dissect the living tissue.
  • FIG. 2 is a cross-sectional view taken along line AA in FIG. It is a perspective view which shows the treatment part in the heat incision forceps of one Embodiment of this invention. It is a figure for demonstrating the operation
  • FIG. 1 is a schematic diagram of a thermal incision forceps 1.
  • FIG. 2 is a cross-sectional view taken along line AA in FIG.
  • FIG. 3 is a perspective view showing the treatment section 3 in the thermal incision forceps 1.
  • the thermal incision forceps 1 according to the present embodiment is a medical treatment tool that applies thermal energy to a living tissue to incise the living tissue. Further, the thermal incision forceps 1 of the present embodiment is inserted through the treatment instrument channel of the endoscope and can be used with the endoscope.
  • the thermal incision forceps 1 includes a long cylindrical insertion portion 2 that can be inserted into a treatment instrument channel of an endoscope, a treatment portion 3 disposed at the distal end of the insertion portion 2, and An operation unit 20 disposed at the proximal end of the insertion unit 2 and a control unit 30 electrically connected to the treatment unit 3 via the operation unit 20 are provided.
  • the treatment section 3 supports a pair of forceps members 4 (first forceps member 4A and second forceps member 4B) that can be opened and closed and the first forceps member 4A so that the first forceps member 4A can be opened and closed. And a heating element 9 attached to the first forceps member 4A and a pair of detection electrodes 10 (first detection electrode 10A, second detection electrode 10B).
  • the first forceps member 4A has a forceps surface 4a on which a ridge portion 5 extending in the longitudinal direction of the first forceps member 4A and a pair of inclined surfaces 6 provided on both sides in the width direction of the ridge portion 5 are formed. Both the ridge 5 and the inclined surface 6 on the forceps surface 4 a come into contact with the living tissue when the living tissue is grasped by the pair of forceps members 4. As shown in FIG. 3, a substantially cylindrical rotating shaft member 7a is connected to the first forceps member 4A. Thereby, 4 A of 1st forceps members are freely rotatable with respect to the support part 7 by the rotating shaft member 7a.
  • the second forceps member 4B presses and holds the living tissue sandwiched between the first forceps member 4A and the heating element 9. Further, the second forceps member 4 ⁇ / b> B is fixed to the support portion 7. On the side of the second forceps member 4B facing the first forceps member 4A, a sawtooth-shaped uneven portion (second forceps surface) 8 is formed.
  • the concavo-convex portion 8 functions as an anti-slip when a living tissue is gripped.
  • the heating element 9 is formed in a linear shape, and is fixed to the ridge 5 along the longitudinal direction of the ridge 5 of the first forceps member 4A.
  • the heating element 9 is a member that generates heat by electric energy.
  • a ceramic heater, a nichrome wire heater, or the like can be employed as a material of the heating element 9.
  • a pair of power lines 33 connected to an output adjustment unit 32 of the control unit 30 described later is fixed to the heating element 9.
  • the first detection electrode 10A and the second detection electrode 10B are fixed to each of a pair of inclined surfaces 6 formed on the first forceps member 4A.
  • the first detection electrode 10A and the second detection electrode 10B are arranged so that the surfaces of the first detection electrode 10A and the second detection electrode 10B and the outer surface of the first forceps member 4A are substantially flush with each other.
  • the first detection electrode 10A and the second detection electrode 10B are electrically connected to a detection unit 31 of the control unit 30 described later by a set of signal lines 34, respectively.
  • the operation unit 20 includes an operation unit main body 21 and a slider 24 that is slidably attached to the operation unit main body 21.
  • the operation portion main body 21 includes a shaft portion 22 on which a rail 22a for guiding the slider 24 is formed, and a ring-shaped finger hook portion 23 on which a user of the thermal incision forceps 1 holds a finger.
  • the slider 24 is connected to the first forceps member 4 ⁇ / b> A by a wire (not shown) inserted through the insertion portion 2.
  • the first forceps member 4A opens and closes around the central axis of the rotating shaft member 7a as shown in FIG.
  • the control unit 30 is disposed in a power supply device PU for supplying electrical energy to the heating element 9 of the treatment unit 3, and includes a detection unit 31 connected to the pair of detection electrodes 10, the detection unit 31, and the heating unit. 9 and an output adjustment unit 32 connected to the control unit 9.
  • the detection unit 31 detects the incision state of the biological tissue by the pair of detection electrodes 10 in contact with the biological tissue.
  • the incision state of the living tissue detected by the detection unit 31 includes two states: a state in which the living tissue is incised and a state in which the living tissue is not incised and is sandwiched between the pair of forceps members 4. State.
  • the detection method of the incision state of the biological tissue in the detection unit 31 is to measure a change in impedance of the biological tissue between the pair of detection electrodes 10.
  • the detection unit 31 stores in advance the impedance of the biological tissue in a state where the biological tissue is sandwiched between the pair of forceps members 4 as a set value. When the impedance of the living tissue exceeds the set value, the detection unit 31 determines that the living tissue has been incised.
  • the detection unit 31 outputs a stop signal for stopping the incision of the living tissue to the output adjustment unit 32 when it is determined that the living tissue has been incised.
  • the output adjustment unit 32 supplies electric energy to the heating element 9 based on an input from a switch such as a foot switch (not shown), and supplies electric energy to the heating element 9 based on a stop signal input from the detection unit 31. Stop.
  • FIG. 4 is a view for explaining an operation when the thermal incision forceps 1 is used.
  • the thermal incision forceps 1 is used while observing the treatment portion 3 using an endoscope, for example, with the insertion portion 2 inserted into a treatment instrument channel of an endoscope.
  • a user of the thermal incision forceps 1 guides the treatment section 3 to a living tissue to be incised, and grips the target living tissue with a pair of forceps members 4.
  • the user sets in advance a line L that is a line to be incised with respect to the living tissue to be incised, and adjusts the gripping position so that the heating element 9 is positioned on the line L.
  • the first detection electrode 10A and the second detection electrode 10B are respectively located on both sides of the line L. Contact with living tissue.
  • step S101 shown in FIG. 5 the user starts energization by the power supply device PU using a switch such as a foot switch.
  • the output adjustment unit 32 of the control unit 30 supplies electric energy to the heating element 9.
  • the detection unit 31 of the control unit 30 starts measuring the impedance of the living tissue between the first detection electrode 10A and the second detection electrode 10B (step S102).
  • the heating element 9 When electric energy is supplied to the heating element 9, the heating element 9 generates heat by energizing the heating element 9. Since the heating element 9 is in contact with the line L of the living tissue, when the heating element 9 generates heat, the living tissue is heated along the line L by the heat generated by the heating element 9. Thereby, the living tissue is cauterized and incised by the heating element 9 along the line L.
  • the cut biological tissue is separated into tissue pieces. Since the incised cuts are separated from each other, the shortest distance through the living tissue from the first detection electrode 10A to the second detection electrode 10B is longer than before the incision. For this reason, after the living tissue is incised, the impedance of the living tissue measured by the detection unit 31 becomes higher than that before the incision. Even when the living tissue is separated from the first detection electrode 10A and the second detection electrode 10B due to the incision of the living tissue, the impedance of the living tissue measured by the detection unit 31 is higher than that before the incision.
  • the impedance of the living tissue is measured by the detection unit 31, and it is repeatedly determined whether or not the impedance of the living tissue is equal to or higher than a set value (step S103).
  • the detection unit 31 determines that the impedance of the living tissue has risen above the set value
  • the detection unit 31 outputs a stop signal for stopping the supply of electrical energy to the output adjustment unit 32.
  • the stop signal from the detection unit 31 is input, and energization to the heating element 9 is stopped (step S104).
  • the control unit 30 determines that the living tissue is incised based on the incision state of the living tissue, and stops supplying electric energy to the heating element 9 when it is determined that the living tissue is incised. .
  • the supply of electrical energy to the heating element 9 is stopped by the control unit 30 when the living tissue is incised. It is possible to save the user from having to determine the incision state of the living tissue. For this reason, it is possible to save the user from having to check the incision state, and to easily dissect the living tissue.
  • the incision site may not be sufficiently visible in the visual field of the endoscope. In such a case, it may be difficult for the user to grasp from the endoscopic image that the incision has been properly completed.
  • the supply of electric energy can be stopped when the incision is properly completed. It is possible to reduce the possibility of excessive application or incomplete incision.
  • the pair of detection electrodes 10 is fixed to the first forceps member 4A provided with the heating element 9, the pair of detection electrodes 10 can be attached to both sides of the line L only by grasping the living tissue with the pair of forceps members 4. Can be contacted.
  • the heating element 9 can be suitably pressed against the living tissue. Furthermore, since the pair of detection electrodes 10 are fixed to each of the pair of inclined surfaces 6, it is possible to detect a change in impedance of the living tissue without disturbing the visual field of the endoscope when the living tissue is incised. it can.
  • FIG. 6 is a flowchart showing an operation flow when using the thermal incision forceps 1A of the present modification.
  • the thermal incision forceps 1A (see FIG. 1) of the present modified example has the same external shape as the above-mentioned thermal incision forceps 1, but is different from the above-mentioned thermal incision forceps 1 in that a control unit 30A is provided instead of the control unit 30. The configuration is different.
  • the control unit 30A operates differently from the control unit 30 described above. As shown in FIG. 6, when the impedance of the living tissue is less than the set value, the control unit 30A increases the power supplied to the heating element 9 to further heat the heating element 9 (step S105 shown in FIG. 6). ). When the impedance of the living tissue becomes equal to or higher than the set value, the energization to the heating element 9 is stopped similarly to the control unit 30 (step S104). As described above, in this modification, the control unit 30A detects the incision state of the living tissue using the pair of detection electrodes 10 in contact with the living tissue, and gradually supplies power until the living tissue is completely incised. The control unit 30A controls the supply of electric energy so as to increase. Thereby, a living tissue can be incised in a shorter time than the above-described thermal incision forceps 1.
  • FIG. 7 is a schematic diagram showing the configuration of the thermal incision forceps 1B of the present modification, and is a cross-sectional view taken along the cross-sectional instruction line similar to the AA line of FIG.
  • the thermal incision forceps 1B of the present modification is different from the above-described thermal incision forceps 1 in that a second heating element 9B is provided on the second forceps member 4B.
  • the second heating element 9B is a living tissue in which the magnitude of the supplied current is detected by the pair of detection electrodes 10 in the same manner as the heating element 9 provided in the first forceps member 4A. Is controlled by the control unit 30 based on the impedance.
  • the same effect as the above-described thermal incision forceps 1 can be obtained.
  • the first forceps member 4A is provided with the heating element 9
  • the second forceps member 4B is provided with the second heating element 9B.
  • control unit 30 is disposed in the power supply device PU has been described, but it is not essential that the control unit 30 and the power supply device PU are integrated.
  • the control unit 30 is interposed in a power supply cord that connects the power supply device PU and the operation unit 20, and the power supplied from the power supply device PU is obtained. It can be controlled by the control unit 30. If it is such a structure, the power supply device PU used for the conventional heat incision forceps can be diverted, and it can be set as the heat incision forceps 1 of this invention.
  • the thermal incision forceps of the present invention measures the change in impedance.
  • a control unit that measures a change in the conduction state of the living tissue between the pair of detection electrodes may be provided. In this case, when the living tissue is incised, conduction between the pair of detection electrodes is lost, and the control unit determines that the living tissue has been incised based on the absence of conduction. When the control unit determines that the living tissue has been incised, the control unit stops the supply of electric energy to the heating element.
  • the control unit detects the incision state of the biological tissue using the detection electrode provided on the forceps member, and controls the supply of electric energy to the heating element based on the detected incision state. Is done. For this reason, it is possible to save the user from having to check the incision state, and to easily dissect the living tissue.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Cette invention concerne une pince de résection thermique servant à inciser un tissu biologique en appliquant de la chaleur sur ledit tissu biologique au moyen d'un élément formant pince. Ledit élément est constitué d'un élément chauffant qui incise le tissu biologique en venant en contact ce dernier, et qui cautérise ledit tissu biologique, et qui génère de la chaleur en utilisant du courant électrique ; d'une paire d'électrodes de détection pouvant venir en contact avec le tissu biologique au niveau des deux côtés où l'élément chauffant est inséré lorsque celui-ci est en contact avec le tissu biologique ; d'une unité de commande qui détecte la progression de l'incision du tissu biologique à l'aide de la paire d'électrodes et qui contrôle l'alimentation en énergie électrique vers l'élément chauffant d'après ladite progression de l'incision. L'unité de commande est située sur un côté externe de l'élément formant pince, et l'élément chauffant et la paire d'électrodes de détection sont reliés à l'unité de commande.
PCT/JP2012/058100 2011-03-30 2012-03-28 Pince de résection thermique et système associé WO2012133512A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2011075736A JP2014121340A (ja) 2011-03-30 2011-03-30 熱切開鉗子および熱切開鉗子システム
JP2011-075736 2011-03-30

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WO2012133512A1 true WO2012133512A1 (fr) 2012-10-04

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2015093409A1 (fr) * 2013-12-20 2015-06-25 オリンパス株式会社 Dispositif d'incision par thermocoagulation

Families Citing this family (5)

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Publication number Priority date Publication date Assignee Title
US8430898B2 (en) 2007-07-31 2013-04-30 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
JP6099818B2 (ja) * 2014-09-05 2017-03-22 オリンパス株式会社 把持処置ユニット、把持処置具及び把持処置システム
US10245064B2 (en) 2016-07-12 2019-04-02 Ethicon Llc Ultrasonic surgical instrument with piezoelectric central lumen transducer
US10952759B2 (en) * 2016-08-25 2021-03-23 Ethicon Llc Tissue loading of a surgical instrument
US10828056B2 (en) 2016-08-25 2020-11-10 Ethicon Llc Ultrasonic transducer to waveguide acoustic coupling, connections, and configurations

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2000139943A (ja) * 1998-09-02 2000-05-23 Olympus Optical Co Ltd 高周波処置具
JP2009247893A (ja) * 2008-04-01 2009-10-29 Olympus Medical Systems Corp 治療用処置システム

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2000139943A (ja) * 1998-09-02 2000-05-23 Olympus Optical Co Ltd 高周波処置具
JP2009247893A (ja) * 2008-04-01 2009-10-29 Olympus Medical Systems Corp 治療用処置システム

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2015093409A1 (fr) * 2013-12-20 2015-06-25 オリンパス株式会社 Dispositif d'incision par thermocoagulation
JP5861009B2 (ja) * 2013-12-20 2016-02-16 オリンパス株式会社 熱凝固切開デバイス
US9782218B2 (en) 2013-12-20 2017-10-10 Olympus Corporation Thermocoagulation/cutting device

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