WO2015122306A1 - 超音波処置装置 - Google Patents
超音波処置装置 Download PDFInfo
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- WO2015122306A1 WO2015122306A1 PCT/JP2015/052865 JP2015052865W WO2015122306A1 WO 2015122306 A1 WO2015122306 A1 WO 2015122306A1 JP 2015052865 W JP2015052865 W JP 2015052865W WO 2015122306 A1 WO2015122306 A1 WO 2015122306A1
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- ultrasonic
- vibration
- treatment
- output mode
- unit
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- 238000009210 therapy by ultrasound Methods 0.000 title claims abstract description 37
- 230000007423 decrease Effects 0.000 claims abstract description 61
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Classifications
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- H—ELECTRICITY
- H10—SEMICONDUCTOR DEVICES; ELECTRIC SOLID-STATE DEVICES NOT OTHERWISE PROVIDED FOR
- H10N—ELECTRIC SOLID-STATE DEVICES NOT OTHERWISE PROVIDED FOR
- H10N30/00—Piezoelectric or electrostrictive devices
- H10N30/80—Constructional details
- H10N30/802—Circuitry or processes for operating piezoelectric or electrostrictive devices not otherwise provided for, e.g. drive circuits
-
- 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
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B06—GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS IN GENERAL
- B06B—METHODS OR APPARATUS FOR GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS OF INFRASONIC, SONIC, OR ULTRASONIC FREQUENCY, e.g. FOR PERFORMING MECHANICAL WORK IN GENERAL
- B06B1/00—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency
- B06B1/02—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy
- B06B1/06—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy operating with piezoelectric effect or with electrostriction
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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
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00026—Conductivity or impedance, e.g. of tissue
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- A—HUMAN NECESSITIES
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- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00115—Electrical control of surgical instruments with audible or visual output
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- A—HUMAN NECESSITIES
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- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00132—Setting operation time of a device
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00137—Details of operation mode
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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
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
- A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
- A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means
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- A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
Definitions
- the present invention grasps a treatment object between a treatment part to which ultrasonic vibration is transmitted and a jaw that can be opened and closed with respect to the treatment part, and treats the treatment object grasped using the ultrasonic vibration. It relates to a treatment device.
- Patent Document 1 discloses an ultrasonic treatment apparatus including a treatment unit to which ultrasonic vibration is transmitted and a jaw that can be opened and closed with respect to the treatment unit.
- ultrasonic vibration is generated by the ultrasonic vibrator that is the vibration generating unit by transmitting the vibration generating power from the power source to the vibration generating unit.
- the generated ultrasonic vibration is transmitted to the treatment unit, and the treatment unit treats a treatment target such as a living tissue using the transmitted ultrasonic vibration.
- the opening / closing direction of the jaw is perpendicular to (intersects) the transmission direction of the ultrasonic vibration.
- the ultrasonic impedance value of the vibration generation power is detected with time, and the ultrasonic impedance value is equal to or higher than the predetermined first threshold and lower than the predetermined second threshold greater than the first threshold. It is determined whether it is in the range.
- the treatment target is grasped with respect to the transmission direction of the ultrasonic vibration by making an incision while coagulating the treatment target held between the treatment portion and the jaw using the ultrasonic vibration.
- the treatment target is divided at a divided section parallel to the transmission direction of the ultrasonic vibration and parallel to the jaw opening / closing direction. This phenomenon is called separation.
- the contact portion of the jaw comes into contact with the treatment portion in the range where the treatment target is divided.
- the ultrasonic vibration is transmitted to the treatment portion in a state where the jaw contact portion is in contact with the treatment portion, the jaw contact portion is destroyed due to wear or thermal deformation due to the vibration. For this reason, it is important to appropriately determine whether or not the treatment target is divided.
- the ultrasonic impedance value at the peak generated by the separation may be smaller than the first threshold value or may be larger than the second threshold value. Therefore, in the said patent document 1, the peak of the ultrasonic impedance value which generate
- the treatment target may be divided only in a partial range of the treatment target with respect to the transmission direction of the ultrasonic vibration when the peak is detected.
- the treatment target in the remaining partial range of the treatment target in the transmission direction of the ultrasonic vibration, the treatment target is not divided at the time of peak detection. For this reason, if the output of vibration generated power from the power supply is stopped immediately after peak detection, there will be uncut portions that are not divided by the cross section parallel to the ultrasonic vibration transmission direction and parallel to the jaw opening and closing direction. There is a risk of it. Therefore, it is important to cut the remaining portion of the treatment object without generating excessive frictional heat.
- the present invention has been made paying attention to the above-mentioned problem, and the object of the present invention is to determine whether or not the treatment target grasped between the treatment portion and the jaw is separated in the treatment using ultrasonic vibration. It is an object of the present invention to provide an ultrasonic treatment apparatus that is appropriately determined and that effectively prevents excessive frictional heat from being generated due to contact between a treatment portion and a contact portion of a jaw.
- an ultrasonic treatment apparatus generates an ultrasonic vibration by transmitting a vibration generating power from a power source capable of outputting the vibration generating power and the power source.
- An impedance detection unit that detects an ultrasonic impedance value over time, and a gradual decrease start time at which the ultrasonic impedance value starts to decrease based on a detection result of the impedance detection unit.
- a gradual decrease detection unit that outputs, a temporary peak value storage unit that stores the detected ultrasonic impedance value at the time of the gradual decrease start as a temporary peak value, and after the start of the gradual decrease with respect to the stored temporary peak value
- a peak determination unit that determines whether the held temporary peak value is a target peak that is a detection target by comparing changes in the ultrasonic impedance value over time, and generation of the vibration from the power source
- An ultrasonic control unit that controls an output state of electric power, based on the determination by the peak determination unit, at the time when the peak is detected at the time when at least a specified time has elapsed since the peak detection when the target peak was detected In the second ultrasonic output mode in which the incision performance due to the ultrasonic vibration in the treatment section is smaller
- the present invention in the treatment using ultrasonic vibration, it is appropriately determined whether or not the treatment target grasped between the treatment portion and the jaw is separated, and the contact between the treatment portion and the contact portion of the jaw Therefore, it is possible to provide an ultrasonic treatment apparatus that effectively prevents excessive frictional heat from being generated.
- FIG. 3 is a longitudinal sectional view schematically showing the configuration of the vibrator unit according to the first embodiment. It is the schematic which shows the electrical connection state in the vibrator
- FIG. 3 is a perspective view schematically showing the horn member and the ultrasonic transducer according to the first embodiment disassembled for each member. It is the schematic which shows the electrical connection state between the ultrasonic transducer
- FIG. 1 is a diagram showing an ultrasonic treatment apparatus 1.
- the ultrasonic treatment apparatus 1 includes an ultrasonic treatment instrument (handpiece) 2 and a control unit 3.
- the ultrasonic treatment instrument 2 has a longitudinal axis C. One of the two directions parallel to the longitudinal axis C is the distal direction (the direction of the arrow C1 in FIG. 1), and the direction opposite to the distal direction is the proximal direction (the direction of the arrow C2 in FIG. 1).
- the ultrasonic treatment instrument 2 includes a transducer unit 5 and a handle unit 6.
- the vibrator unit 5 is detachably connected to the proximal direction side of the handle unit 6.
- One end of a cable 7 is connected to the base end of the vibrator unit 5.
- the other end of the cable 7 is connected to the control unit 3.
- the handle unit 6 has a cylindrical case portion 11 extending along the longitudinal axis C, a fixed handle 12 formed integrally with the cylindrical case portion 11, and is rotatable with respect to the cylindrical case portion 11. And a movable handle 13 to be attached.
- the fixed handle 12 is extended in a state of being separated from the cylindrical case portion 11 with respect to the longitudinal axis C.
- the handle unit 6 includes a rotation operation knob 15 attached to the distal direction side of the cylindrical case portion 11.
- the rotation operation knob 15 can rotate around the longitudinal axis C with respect to the cylindrical case portion 11.
- the fixed handle 12 is provided with an energy operation input button 16 that is an energy operation input unit.
- the ultrasonic treatment instrument 2 includes a sheath 8 that extends along the longitudinal axis C.
- the sheath 8 is attached to the handle unit 6 by being inserted into the inside of the rotary operation knob 15 and the inside of the cylindrical case portion 11 from the distal direction side.
- the ultrasonic treatment instrument 2 includes an ultrasonic probe 9.
- the ultrasonic probe 9 extends along the longitudinal axis C from the inside of the cylindrical case portion 11 through the inside of the sheath 8.
- the ultrasonic probe 9 is inserted through the sheath 8.
- a treatment portion 17 that protrudes from the distal end of the sheath 8 toward the distal direction is provided at the distal end portion of the ultrasonic probe 9.
- a jaw 18 is rotatably attached to the distal end portion of the sheath 8.
- the movable handle 13 is connected to a movable cylindrical portion (not shown) disposed in a portion on the inner circumferential direction side of the sheath 8 inside the cylindrical case portion 11.
- the tip of the movable cylindrical portion is connected to the jaw 18.
- the movable cylindrical portion moves along the longitudinal axis C by opening or closing the movable handle 13 with respect to the fixed handle 12.
- the jaw 18 rotates about the attachment position to the sheath 8.
- the jaw 18 performs an opening operation or a closing operation with respect to the treatment portion 17.
- the sheath 8, the ultrasonic probe 9, and the jaw 18 are rotatable about the longitudinal axis C with respect to the cylindrical case portion 11 integrally with the rotation operation knob 15.
- the vibrator unit 5 includes a vibrator case 21.
- the vibrator unit 5 is attached to the handle unit 6 by inserting the vibrator case 21 into the cylindrical case portion 11 from the proximal direction side. Inside the cylindrical case portion 11, the transducer case 21 is connected to the sheath 8.
- the vibrator case 21 is rotatable about the longitudinal axis C with respect to the cylindrical case portion 11 integrally with the rotation operation knob 15.
- FIG. 2 is a diagram showing the configuration of the vibrator unit 5.
- the vibrator unit 5 is attached with the above-described vibrator case 21, the ultrasonic vibrator 22 that is a vibration generating unit provided inside the vibrator case 21, and the ultrasonic vibrator 22.
- FIG. 3 is a diagram showing an electrical connection state between the vibrator unit 5 and the control unit 3.
- one end of electrical wiring portions 25 ⁇ / b> A and 25 ⁇ / b> B is connected to the ultrasonic transducer 22.
- the control unit 3 includes a power supply 26 that can output the vibration generation power P.
- the power source 26 for example, power from an outlet or the like is converted into vibration generated power P by a conversion circuit or the like, and the vibration generated power P is output.
- the other ends of the electrical wiring portions 25A and 25B are connected to the power source 26.
- the vibration generating power P output from the power supply 26 is transmitted to the ultrasonic transducer 22 via the electrical wiring portions 25A and 25B. By transmitting the vibration generating power P, ultrasonic vibration is generated in the ultrasonic vibrator 22.
- the horn member 23 is provided with a transducer mounting portion 27 to which the ultrasonic transducer 22 is mounted.
- the ultrasonic vibration generated by the ultrasonic vibrator 22 is transmitted to the horn member 23.
- the horn member 23 is provided with a cross-sectional area changing portion 28 on the distal direction side from the vibrator mounting portion 27.
- the cross-sectional area changing portion 28 the cross-sectional area perpendicular to the longitudinal axis C decreases toward the front end direction.
- the cross-sectional area changing unit 28 increases the amplitude of the ultrasonic vibration.
- a female screw portion 29 ⁇ / b> A is provided at the tip of the horn member 23.
- a male screw portion 29 ⁇ / b> B is provided at the proximal end portion of the ultrasonic probe 9.
- the ultrasonic probe 9 is connected to the distal direction side of the horn member 23 by the male screw portion 29B being screwed into the female screw portion 29A.
- the ultrasonic probe 9 is connected to the horn member 23 inside the cylindrical case portion 11.
- the ultrasonic vibration transmitted to the horn member 23 is transmitted along the longitudinal axis C from the proximal direction to the distal direction in the horn member 23 and the ultrasonic probe 9. That is, the horn member 23 and the ultrasonic probe 9 are vibration transmission units that transmit the generated ultrasonic vibration.
- the ultrasonic vibration is transmitted to the treatment portion 17 in the distal direction.
- the treatment unit 17 treats a treatment target such as a living tissue using the transmitted ultrasonic vibration.
- the base end (base end of the horn member 23) and the tip (tip of the ultrasonic probe 9) are antinode positions of ultrasonic vibration.
- the ultrasonic vibration is a longitudinal vibration in which the vibration direction and the transmission direction are parallel to the longitudinal axis C (longitudinal axis direction). Therefore, the tip direction parallel to the longitudinal axis C is the transmission direction of ultrasonic vibration. Further, in a state where the vibration transmission unit transmits ultrasonic vibration, the vibration transmission unit including the treatment unit 17 vibrates at a certain resonance frequency F.
- FIG. 4 is an exploded view of the horn member 23 and the ultrasonic transducer 22 for each member.
- the ultrasonic transducer 22 includes (in this embodiment, four) ring-shaped piezoelectric elements 31A to 31D.
- a transducer mounting portion 27 of the horn member 23 is inserted into each of the piezoelectric elements 31A to 31D.
- the piezoelectric elements 31A to 31D each have a thickness direction parallel to the ultrasonic vibration transmission direction (ie, the longitudinal axis C) and a radial direction perpendicular to the ultrasonic vibration transmission direction (ie, the tip direction). In this state, it is attached to the vibrator mounting portion 27.
- the ultrasonic transducer 22 includes a first electrode part 32 and a second electrode part 33.
- One end of the electrical wiring portion 25A is connected to the first electrode portion 32, and one end of the electrical wiring portion 25B is connected to the second electrode portion 33.
- the first electrode portion 32 includes first electrode ring portions 35A to 35C.
- the first electrode ring portion 35A is located on the distal direction side of the piezoelectric element 31A, and the first electrode ring portion 35B is located between the piezoelectric element 31B and the piezoelectric element 31C in the longitudinal axis direction parallel to the longitudinal axis C. positioned.
- the first electrode ring portion 35C is located on the proximal direction side of the piezoelectric element 31D.
- the vibrator mounting portion 27 is inserted through each of the first electrode ring portions 35A to 35C.
- the second electrode portion 33 includes second electrode ring portions 37A and 37B.
- the second electrode ring portion 37A is located between the piezoelectric element 31A and the piezoelectric element 31B in the longitudinal axis direction parallel to the longitudinal axis C. Further, the second electrode ring portion 37B is located between the piezoelectric element 31C and the piezoelectric element 31D in the longitudinal axis direction.
- the vibrator mounting portion 27 is inserted into each of the second electrode ring portions 37A and 37B.
- the piezoelectric element 31A is sandwiched between the first electrode ring part 35A and the second electrode ring part 37A, and the piezoelectric element 31B is connected to the second electrode ring part 37A. It is sandwiched between the first electrode ring part 35B.
- the piezoelectric element 31C is sandwiched between the first electrode ring part 35B and the second electrode ring part 37B, and the piezoelectric element 31D includes the second electrode ring part 37B and the first electrode ring part 35C. It is sandwiched between. Accordingly, each of the piezoelectric elements 31A to 31D is sandwiched between the first electrode portion 32 and the second electrode portion 33.
- the ultrasonic transducer 22 includes insulating rings 38A and 38B.
- the insulating ring 38 ⁇ / b> A is located on the distal direction side of the first electrode ring portion 35 ⁇ / b> A of the first electrode portion 32.
- the insulating ring 38 ⁇ / b> B is located on the proximal direction side of the first electrode ring portion 35 ⁇ / b> C of the first electrode portion 32.
- the vibrator mounting portion 27 is inserted into each of the insulating rings 38A and 38B.
- the ultrasonic transducer 22 includes a back mass 36.
- the back mass 36 is located on the base end direction side of the insulating ring 38B.
- the piezoelectric elements 31A to 31D, the first electrode portion 32, the second electrode portion 33, and the insulating rings 38A and 38B are pressed in the distal direction. Accordingly, the piezoelectric elements 31A to 31D, the first electrode portion 32, the second electrode portion 33, and the insulating rings 38A and 38B are sandwiched between the horn member 23 and the back mass 36.
- FIG. 5 is a diagram showing an electrical connection state between the ultrasonic transducer 22 that is a vibration generating unit and the power supply 26.
- the power supply 26 and the first electrode portion 32 are electrically connected by an electric wiring portion 25A.
- the power supply 26 and the second electrode portion 33 are electrically connected by an electric wiring portion 25B.
- the vibration generation voltage V is applied between the first electrode portion 32 and the second electrode portion 33.
- the vibration generating current I flows through the piezoelectric elements 31A to 31D sandwiched between the first electrode portion 32 and the second electrode portion 33.
- the vibration generation current I is supplied from the power supply 26 to the ultrasonic transducer 22 based on the vibration generation power P from the power supply 26.
- the vibration generating current I is an alternating current whose direction changes periodically.
- an ultrasonic impedance value Z which is an impedance value of the vibration generating power P, is expressed by Expression (1).
- FIGS. 6 and 7 are diagrams showing the configuration of the treatment section 17 and the jaw 18.
- FIG. 6 shows a state in which the jaw 18 is opened with respect to the treatment portion 17, and
- FIG. 7 shows that there is no treatment target between the jaw 18 and the treatment portion 17, and the jaw 18 is The state which closed with respect to the treatment part 17 is shown.
- FIG. 7 shows a cross section perpendicular to the longitudinal axis C.
- the jaw 18 includes a jaw main body 41 whose base end is attached to the sheath 8, and a gripping member 42 attached to the jaw main body 41.
- the jaw body 41 and the gripping member 42 are made of, for example, a conductive metal.
- the jaw 18 includes a pad member 43 attached to the gripping member 42.
- the pad member 43 is made of PTFE having electrical insulation, for example.
- the pad member 43 is formed with a contact portion (contact surface) 45 that can contact the treatment portion 17 when the jaw 18 is closed with respect to the treatment portion 17.
- a contact portion contact surface
- the contact portion 45 faces the treatment portion 17.
- the contact portion 45 is perpendicular to the opening direction of the jaw 18 (the direction of the arrow A1 in FIGS. 6 and 7) and the closing direction (the direction of the arrow A2 in FIGS. 6 and 7). is there.
- first width direction direction of arrow B1 in FIG. 7
- second width direction direction of arrow B2
- first width direction side of the contact portion 45 an inclined facing portion 46 ⁇ / b> A that faces the treatment portion 17 while being inclined with respect to the contact portion 45 is formed by the gripping member 42.
- an inclined facing portion 46 ⁇ / b> B that faces the treatment portion 17 in a state of being inclined with respect to the contact portion 45 is formed by the gripping member 42.
- the control unit 3 includes a control unit 51 that is electrically connected to the power supply 26.
- a switch unit 47 is provided inside the fixed handle 12. The open / close state of the switch unit 47 is switched based on the input of the energy operation by the energy operation input button 16.
- the switch unit 47 is connected to the control unit 51 via a signal path unit 48 extending through the transducer case 21 and the inside of the cable 7.
- the control unit 51 includes an ultrasonic control unit 58.
- the ultrasonic control unit 58 controls the output state of the vibration generated power P from the power supply 26 based on the transmitted operation signal.
- the control unit 3 includes an impedance detection unit 52 that is electrically connected to the power supply 26 and the control unit 51, and a peak detection unit 53 that is electrically connected to the impedance detection unit 52 and the control unit 51.
- the impedance detection unit 52 detects the ultrasonic impedance value Z of the vibration generation power P over time in a state where the vibration generation power P is output from the power supply 26.
- the peak detection unit 53 detects the peak (target peak) of the ultrasonic impedance value Z based on the temporal change of the detected ultrasonic impedance value Z.
- the peak detection unit 53 includes a gradual decrease detection unit 55, a temporary peak value holding unit 56, and a peak determination unit 57.
- the control unit 3 includes a notification unit 59 such as a buzzer or a lamp.
- the notification unit 59 is electrically connected to the control unit 51. Details of the notification unit 59 will be described later. The explanation of the target peak and the method for detecting the target peak will also be described later.
- the impedance detection unit 52 is, for example, a detection circuit.
- the control unit 51 and the peak detection unit 53 include, for example, a processor including a CPU (Central Processing Unit), an ASIC (application specific integrated circuit), a logic circuit such as an FPGA (Field Programmable Gate Array), and a memory (storage unit) ).
- the operation and effect of the ultrasonic treatment apparatus 1 will be described.
- a treatment target such as a living tissue
- the sheath 8, the ultrasonic probe 9, and the jaw 18 are inserted into the body where the treatment target is located.
- the treatment unit 17 and the jaw 18 are moved until the treatment target is located between the jaw 18 opened to the treatment unit 17 and the treatment unit 17.
- the treatment target is held between the treatment portion 17 and the jaw 18.
- the operation signal is transmitted to the control unit 51, and the output of the vibration generation power P from the power source 26 is started.
- the vibration generation power P is transmitted, the vibration generation current I is converted into ultrasonic vibration by the piezoelectric elements 31A to 31D.
- the ultrasonic vibration generated by the ultrasonic transducer 22 is transmitted to the treatment section 17 via the horn member 23 and the ultrasonic probe 9, and the treatment section 17 vibrates longitudinally. Friction heat is generated between the treatment target and the treatment unit 17 by the longitudinal vibration of the treatment unit 17 in a state where the treatment target is gripped between the treatment unit 17 and the jaw 18. By the frictional heat, the treatment object is coagulated and simultaneously incised.
- FIG. 8 is a diagram for explaining the separation of the treatment target H gripped between the treatment unit 17 and the jaw 18.
- the discontinuity may occur over the entire range of the treatment target with respect to the transmission direction (longitudinal axis direction) of the ultrasonic vibration. May only occur in a range.
- the treatment target H is represented by a section D parallel to the transmission direction of the ultrasonic vibration and parallel to the jaw opening / closing direction (the direction of the arrow A1 in FIG. 8 and the direction of the arrow A2 in FIG. 8). Is divided.
- the dividing plane D is perpendicular to the first width direction (the direction of arrow B1 in FIG. 8) and the second width direction (the direction of arrow B2 in FIG. 8). Therefore, in the range where the break has occurred, the treatment target H is divided into a portion H1 on the first width direction side from the dividing surface D and a portion H2 on the second width direction side from the dividing surface D.
- the contact portion 45 of the jaw 18 contacts the treatment portion 17 in the range where the treatment target H is divided by the separation.
- the treatment portion 17 is vibrated by ultrasonic vibration (longitudinal vibration) while the contact portion 45 of the jaw 18 is in contact with the treatment portion 17, the contact portion 45 of the jaw 18 is worn. For this reason, it is important to appropriately determine whether or not the treatment target H is divided.
- the treatment target is divided only in a partial range of the treatment target H with respect to the ultrasonic vibration transmission direction (longitudinal axis direction), the remaining partial range of the treatment target H with respect to the ultrasonic vibration transmission direction. Then, the treatment target H is not divided.
- the ultrasonic impedance value Z of the vibration generating power P changes in accordance with the load on the ultrasonic probe 9, that is, the load on the ultrasonic transducer 22 connected to the ultrasonic probe 9.
- FIG. 9 shows an example of the change over time of the ultrasonic impedance value Z after the output of the vibration generating power P from the power supply 26 is started.
- the vertical axis represents the ultrasonic impedance value Z
- the horizontal axis represents the elapsed time t from the start of output of the vibration generated power P.
- the pressing force from the jaw 18 to the treatment portion 17 is gradually increased due to a change in the state of the treatment subject H between the contact portion 45 of the jaw 18 and the treatment portion 17 until the vicinity of the time when the treatment subject H is cut off. growing. For this reason, the load on the ultrasonic probe 9 gradually increases. Therefore, the ultrasonic impedance value Z gradually increases with time until the treatment target H is divided.
- gradually increasing with time means that the ultrasonic impedance value Z gradually increases as the elapsed time t advances, and the ultrasonic impedance value Z gradually increases while including a slight increase or decrease of several tens of ohms or less. It also includes an increase.
- the ultrasonic impedance value Z gradually decreases with time after the vicinity of the time when the treatment target H is divided.
- gradually decreasing with time means that the ultrasonic impedance value Z gradually decreases as the elapsed time t advances, and the ultrasonic impedance value Z gradually increases while including a slight increase or decrease of several tens of ohms or less. It also includes a decrease.
- the ultrasonic impedance value Z changes as described above due to the break, the vicinity of the time when the treatment target H is cut (for example, the vicinity when the contact portion 45 of the jaw 18 starts to contact the treatment portion 17).
- the ultrasonic impedance value Z becomes a peak (maximum value) with time.
- the ultrasonic impedance value Z ⁇ b> 1 is a target peak that is a peak (peak value) caused by the separation of the treatment target H.
- the elapsed time t1 is the target peak time when the target peak occurs.
- FIG. 10 is a diagram (flow) showing the operating state of the control unit 3 after the output of the vibration generating power P is started.
- FIG. 11 shows an example of the ultrasonic vibration amplitude U at the treatment section 17 (for example, the distal end of the ultrasonic probe 9) over time in an example in which the ultrasonic impedance value Z changes with time as shown in FIG. Changes.
- the vertical axis represents the amplitude U of the ultrasonic vibration
- the horizontal axis represents the elapsed time t from the start of output of the vibration generation power P.
- the output of vibration generated power P is started from the power supply 26 in the first ultrasonic output mode (step S101).
- the ultrasonic control unit 58 keeps the current value of the vibration generating current I (the effective value of the alternating current) at a constant first current value I1.
- the output state of the vibration generating power P is controlled. Therefore, the vibration generation power P (vibration generation voltage V) is adjusted in accordance with the change of the ultrasonic impedance value Z so that the vibration generation current I becomes the constant first current value I1.
- the amplitude U of the ultrasonic vibration in the treatment section 17 is proportional to the current value of the vibration generating current I.
- the treatment unit 17 vibrates with a constant first amplitude U1, as shown in FIG.
- the amplitude of the ultrasonic vibration is also proportional to the current value of the vibration generating current I at a portion other than the treatment portion 17 (for example, the base end of the ultrasonic probe 9 or the horn member 23).
- the impedance detector 52 starts to detect the ultrasonic impedance value Z of the vibration generation power P over time (step S102). Thereby, the ultrasonic impedance value Z is detected over time.
- the first ultrasonic output mode in order to set the amplitude of the ultrasonic vibration in the treatment unit 17 to the constant first amplitude U1, the first current value I1 where the vibration generation current I is constant. Constant current control is performed. For this reason, a change with time of at least one of the vibration generation power P and the vibration generation voltage V is detected, and based on the detected vibration generation power P and / or the vibration generation voltage V, the equation (1) is used.
- a sonic impedance value Z is calculated. Thereby, the ultrasonic impedance value Z is detected over time.
- the impedance detection unit 52 detects the vibration generation voltage V and the vibration generation current I over time, and calculates the ultrasonic impedance value Z using Equation (1).
- the peak detection unit 53 performs processing for detecting the target peak of the ultrasonic impedance value Z caused by the separation of the treatment target H based on the temporal change of the ultrasonic impedance value Z (step S103). At this time, the target peak time when the ultrasonic impedance value Z becomes the target peak (target peak value) may be detected.
- FIG. 12 is a diagram illustrating target peak detection processing (step S103 in FIG. 10) performed by the peak detection unit 53. That is, FIG. 12 shows a method for detecting the target peak by the peak detection unit 53.
- the gradual decrease detection unit 55 starts gradual decrease in the ultrasonic impedance value Z based on the detection result of the ultrasonic impedance value Z in the impedance detection unit 52.
- the start time of gradual decrease is detected (step S111). In the example shown in FIG. 9, the elapsed time t1 is detected as the start of gradual decrease.
- the temporary peak value holding unit 56 holds the detected ultrasonic impedance value Z at the gradual decrease start time as a temporary peak value (step S112).
- the ultrasonic impedance value Z1 at the elapsed time t1 is held as a temporary peak value.
- the peak determination unit 57 compares the temporal change of the ultrasonic impedance value Z after the start of the gradual decrease with respect to the held temporary peak value (step S113).
- the temporal change in the ultrasonic impedance value Z after the elapsed time t1 is compared with the ultrasonic impedance value Z1 held as the temporary peak value.
- the peak determination unit 57 determines whether or not the temporary peak value is the target peak due to the separation of the treatment target H. (Step S114). In the example shown in FIG.
- the ultrasonic impedance value Z1 held as the temporary peak value is the target peak (target peak value). At this time, it may be determined whether or not the detected gradual decrease start time is the target peak time. In the example shown in FIG. 9, it is determined at the time of elapsed time t1 + ⁇ T1 that the elapsed time t1 at the start of gradual reduction is the target peak time.
- step S113 in step S113 (comparison processing) in FIG. 12, is the decrease amount ⁇ real of the ultrasonic impedance value Z from the temporary peak value greater than or equal to the reference decrease amount ⁇ after the lapse of the reference time ⁇ T from the start of gradual decrease? No is compared. Then, in step S113, it is compared whether or not the ultrasonic impedance value Z is continuously smaller than the temporary peak value after the start of gradual reduction. In this embodiment, after a lapse of the reference time ⁇ T from the start of gradual decrease, the decrease amount ⁇ real of the ultrasonic impedance value Z from the temporary peak value is equal to or greater than the reference decrease amount ⁇ , and the ultrasonic impedance value Z is continuously increased.
- the temporary peak value is the target peak.
- the ultrasonic impedance value Z continuously becomes smaller than the temporary peak value Z1 after the gradual decrease start time t1. Then, the decrease amount ⁇ 1real of the ultrasonic impedance value Z during the elapse of the reference time ⁇ T1 from the elapsed time t1 at the start of gradual decrease is equal to or greater than the reference decrease amount ⁇ 1.
- the peak determination unit 57 determines that the temporary peak value Z1 is the target peak. Therefore, it is determined that at least a part of the treatment target H has been divided at the time point of the elapsed time t1 (the time point when the temporary peak value Z1 is detected).
- step S113 it may be determined in step S113 whether or not the ultrasonic impedance value Z has gradually increased after the start of gradual decrease. If the ultrasonic impedance value Z gradually increases after the start of gradual decrease, whether or not the increase amount ⁇ real of the ultrasonic impedance value Z from the start of the gradual increase that has started increasing gradually becomes greater than or equal to the reference increase amount ⁇ in step S113. Is judged.
- the decrease amount ⁇ real of the ultrasonic impedance value Z from the temporary peak value is equal to or greater than the reference decrease amount ⁇ , and the ultrasonic impedance value Z is
- the increase amount ⁇ real from is not equal to or greater than the reference increase amount ⁇ , it is determined that the temporary peak value is the target peak.
- the ultrasonic impedance value Z does not gradually increase after the gradual decrease start time t1.
- the increase amount ⁇ 1real of the ultrasonic impedance value Z during the elapse of the reference time ⁇ T1 does not increase more than the reference increase amount ⁇ 1 from the elapsed time t1 at the start of the gradual decrease, and becomes the reference decrease amount ⁇ 1 or more. ing. For this reason, in the example shown in FIG. 9, it is determined that the temporary peak value Z1 is the target peak.
- the length of the reference time ⁇ T, the size of the reference decrease amount ⁇ , and the size of the reference increase amount ⁇ are not set to predetermined values, but the ultrasonic impedance value Z is changed over time. It may be set in response to various changes. Therefore, the values of the reference time ⁇ T, the reference decrease amount ⁇ , and the reference increase amount ⁇ change according to the situation.
- the comparison of the temporal change in the ultrasonic impedance value Z after the start of gradual decrease with respect to the temporary peak value (step S113) and the determination of whether the temporary peak value is the target peak (step S114) are described above. It is not limited to the embodiment.
- the comparison of the temporal change of the ultrasonic impedance value Z after the start of gradual decrease with respect to the temporary peak value step S113
- the determination of whether or not the temporary peak value is the target peak step S114.
- the target peak resulting from the separation of the treatment target H is detected.
- the target peak is detected after the reference time ⁇ T has elapsed since the target peak. Therefore, the peak detection time when the target peak is detected is a time point after the target peak time, and the target peak is not detected when the ultrasonic impedance value Z is the target peak.
- the elapsed time t1 + ⁇ T1 is the peak detection time when the target peak is detected.
- the contact portion 45 of the jaw 18 abuts on the treatment target H, and the jaw 18 of the treatment target H
- the peak of the ultrasonic impedance value Z is generated at the moment when the contact surface of the tube begins to be incised.
- the target peak is detected as described above, it is determined that the peak resulting from the contact of the contact portion 45 with the treatment target H is not the target peak. For this reason, even when a peak different from the target peak occurs before the target peak, the target peak is appropriately detected.
- the ultrasonic control unit 58 causes the second ultrasonic wave to be output from the first ultrasonic output mode.
- the output state of the ultrasonic power P from the power supply 26 is switched to the output mode (step S104). Therefore, the vibration generation power P is output in the second ultrasonic output mode.
- the first ultrasonic output mode is switched to the second ultrasonic output mode at the time of peak detection when the target peak is detected. Therefore, when at least the specified time ⁇ T ′ has elapsed since the peak detection, the vibration generation power P is output in the second ultrasonic output mode.
- FIG. 11 FIG. 11
- the ultrasonic control unit 58 causes the current value of the vibration generation current I (effective value of the alternating current) to be a constant second current smaller than the first current value I1.
- the output state of the vibration generated electric power P is controlled by the constant current control maintained at the value I2. Therefore, the vibration generation power P (vibration generation voltage V) is adjusted in accordance with the change of the ultrasonic impedance value Z so that the vibration generation current I becomes a constant second current value I2.
- the amplitude U of the ultrasonic vibration in the treatment unit 17 is proportional to the current value of the vibration generation current I.
- the vibration generation current I is maintained at the second current value I2, as shown in FIG.
- the treatment unit 17 has a constant second amplitude smaller than the first amplitude U1. It vibrates at U2.
- the ratio of the second amplitude U2 to the first amplitude U1 is, for example, 20% to 80%. Since the amplitude of the treatment section 17 is adjusted as described above in the first ultrasonic output mode and the second ultrasonic output mode, the amplitude U of the treatment section 17 due to ultrasonic vibration during a predetermined unit time is adjusted. In the case where the average is the average amplitude Uave, the average amplitude Uave of the treatment unit 17 in a predetermined unit time is smaller in the second ultrasonic output mode than in the first ultrasonic output mode.
- the ultrasonic control unit 58 may directly adjust the current value of the vibration generation current I between the first ultrasonic output mode and the second ultrasonic output mode, and the vibration generation power P
- the current value of the vibration generating current I may be changed by adjusting the power value. Therefore, the ultrasonic control unit 58 adjusts at least one of the power value of the vibration generation power P and the current value of the vibration generation current I to thereby adjust the first ultrasonic output mode and the second ultrasonic output mode.
- the amplitude U of the ultrasonic vibration in the treatment part 17 is changed between
- the vibration speed ⁇ is proportional to the product of the amplitude U and the resonance frequency F.
- the second amplitude U2 of the treatment unit 17 in the second ultrasonic output mode is smaller than the first amplitude U1 of the treatment unit 17 in the first ultrasonic output mode.
- the first ultrasonic output mode is set in the second ultrasonic output mode. In comparison, the average vibration velocity ⁇ ave of the treatment unit 17 during a predetermined unit time is reduced.
- the average vibration speed ⁇ ave of the treatment unit 17 during a predetermined unit time is reduced, the amount of frictional heat generated by the vibration of the treatment unit 17 in the treatment of the treatment target H is reduced.
- the incision performance by ultrasonic vibration in the treatment section 17 is reduced in the treatment of the treatment target H. Therefore, in the second ultrasonic output mode, the incision performance due to ultrasonic vibration in the treatment section 17 is smaller than in the first ultrasonic output mode before the peak detection.
- the treatment portion 17 vibrates, the treatment target H is incised simultaneously with coagulation due to frictional heat.
- the abutment portion 45 abuts on the treatment portion 17. For this reason, even when the treatment target H is divided and divided only in a part of the range of the treatment target H in the longitudinal axis direction, a target peak due to the division occurs. In this case, in the remaining partial range of the treatment target H with respect to the transmission direction of the ultrasonic vibration, the treatment target H is not divided at the time of peak detection.
- the treatment is performed with a section D parallel to the ultrasonic vibration transmission direction (longitudinal axis direction) and parallel to the jaw 18 opening / closing direction.
- the uncut portion where the object H is not divided occurs in a part of the remaining portion of the treatment object H.
- the vibration generation power P is output from the power supply 26 in the second ultrasonic output mode even after the peak is detected.
- the treatment portion 17 vibrates (longitudinal vibration), and frictional heat is generated in the treatment portion 17. Therefore, even when the treatment target H is not divided in a part of the range at the time of peak detection, the treatment target H is cut open at the same time as coagulation in the part of the part that is not divided by frictional heat. As a result, the treatment target H is divided by the dividing plane D even in a partial range that is not divided at the time of peak detection. As described above, occurrence of uncut portions in the treatment target H is effectively prevented.
- the treatment portion 17 vibrates with a small second amplitude U2, so that the average vibration speed ⁇ ave of the treatment portion 17 during a predetermined unit time becomes small as described above.
- the amount of frictional heat generated by the vibration of the treatment section 17 is reduced. For this reason, even if the treatment portion 17 vibrates in the second ultrasonic output mode after the peak detection, the pad member 43 (the contact portion 45) is worn at the portion where the contact portion 45 contacts the treatment portion 17. And thermal deformation is reduced.
- the notification unit 59 when the output state of the vibration generation power P from the power source 26 is switched to the second ultrasonic output mode (step S104), the notification unit 59 outputs the vibration generation power P from the power source 26. It is notified that the state has been switched from the first ultrasonic output mode to the second ultrasonic output mode (step S105).
- the notification unit 59 is a buzzer, a sound is transmitted, and when the notification unit 59 is a lamp, it lights up.
- the surgeon determines whether or not the treatment target H has been cut off and recognizes that the operation has been switched to the second ultrasonic output mode. And the output of the vibration generation electric power P from the power supply 26 is stopped (step S106).
- the output of the vibration generation power P may be manually stopped by the operator, and after a predetermined output time ⁇ Y has elapsed from the peak detection time (start of output of the vibration generation power P in the second ultrasonic output mode). It may be automatically stopped. In the example shown in FIG. 11, the output of the vibration generation power P is automatically stopped after a predetermined output time ⁇ Y1 has elapsed from the peak detection time t1 + ⁇ T1.
- the time when the ultrasonic impedance value Z starts to be gradually decreased is detected, and the ultrasonic impedance value Z at the time of the gradually decreasing start is held as a temporary peak value. Then, by comparing the temporal change of the ultrasonic impedance value Z after the start of the gradual decrease with respect to the temporary peak value, it is determined whether or not the held temporary peak value is the target peak to be detected. Yes. For this reason, it is possible to appropriately detect the target peak regardless of the size of the target peak (target peak value) generated due to the separation. Therefore, it is possible to appropriately determine whether or not the treatment target H is separated in the treatment of the treatment target H gripped between the treatment unit 17 and the jaw 18 using ultrasonic vibration.
- the vibration generation power P is output from the power supply 26 in the second ultrasonic output mode even after the peak is detected. For this reason, even after the peak is detected, the treatment portion 17 vibrates (longitudinal vibration), and frictional heat is generated in the treatment portion 17. Therefore, even when the treatment target H is not divided in a part of the range at the time of peak detection, the treatment target H is cut open at the same time as coagulation in the part of the part that is not divided by frictional heat. Thereby, it is possible to effectively prevent the treatment target H from being uncut.
- the treatment portion 17 vibrates with a small second amplitude U2
- the amount of frictional heat generated by the vibration of the treatment portion 17 is reduced. For this reason, even if the treatment portion 17 vibrates in the second ultrasonic output mode after the peak detection, the pad member 43 (the contact portion 45) is worn at the portion where the contact portion 45 contacts the treatment portion 17. And thermal deformation can be reduced.
- the amplitude of the treatment unit 17 is kept constant at the second amplitude U2, but the present invention is not limited to this.
- the amplitude U of ultrasonic vibration at the treatment section 17 changes with time in the second ultrasonic output mode.
- FIG. 13 shows an example in which the ultrasonic impedance value Z changes over time as shown in FIG. 9, and the amplitude U of ultrasonic vibration at the treatment section 17 (for example, the tip of the ultrasonic probe 9) changes over time. It shows a change.
- the vertical axis indicates the amplitude U of the ultrasonic vibration
- the horizontal axis indicates the elapsed time t from the start of output of the vibration generation power P.
- a vibration state in which the treatment unit 17 vibrates with a constant first amplitude U1 is defined as a first vibration stage ⁇ S1, and the treatment unit 17 vibrates with a constant second amplitude U2 smaller than the first amplitude U1.
- the vibration state to be performed is defined as a second vibration stage ⁇ S2.
- the vibration state of the treatment unit 17 in the first ultrasonic output mode, is continuously maintained on the first vibration stage ⁇ S1. Therefore, in the first ultrasonic output mode, the treatment portion 17 vibrates with a constant first amplitude U1.
- the ultrasonic control unit 58 adjusts at least one of the power value of the vibration generation power P and the current value of the vibration generation current I to adjust between the first vibration stage ⁇ S1 and the second vibration stage ⁇ S2.
- the amplitude U of the ultrasonic vibration in the treatment unit 17 is changed.
- the vibration state due to the ultrasonic vibration of the treatment unit 17 periodically changes between the first vibration stage ⁇ S1 and the second vibration stage ⁇ S2. That is, in the second ultrasonic output mode, the vibration state of the treatment section 17 is modulated (changes) at the modulation period (period) ⁇ W.
- the modulation period (ultrasonic modulation period) ⁇ W is from the start of the first vibration stage ⁇ S1 to the start of the next first vibration stage ⁇ S1 (from the start of the second vibration stage ⁇ S2 to the next second vibration stage.
- the elapsed time (until the start of ⁇ S2). In the example illustrated in FIG.
- the vibration state of the treatment unit 17 changes in the modulation period ⁇ W1 in the second ultrasonic output mode.
- the ratio of the first vibration stage ⁇ S1 to the modulation period (one period) ⁇ W is defined as a duty ratio ⁇ of the first vibration stage ⁇ S1.
- the ratio of the second amplitude U2 to the first amplitude U1 is, for example, 20% to 80%
- the duty ratio ⁇ of the first vibration stage ⁇ S1 is, for example, 25% to 75%. %.
- the duty ratio ⁇ of the first vibration stage ⁇ S1 is 100%.
- the duty ratio ⁇ of the first vibration stage ⁇ S1 changes between the first ultrasonic output mode and the second ultrasonic output mode. Therefore, in the second ultrasonic output mode, the time ratio ⁇ of the first vibration stage ⁇ S1 with respect to the second vibration stage ⁇ S2 is smaller than that in the first ultrasonic output mode.
- the second ultrasonic output mode has a predetermined unit time compared to the first ultrasonic output mode. The average amplitude Uave of the treatment unit 17 between the two becomes smaller.
- the treatment in a predetermined unit time in the second ultrasonic output mode is also greater in the second ultrasonic output mode than in the first ultrasonic output mode.
- the average vibration speed ⁇ ave of the portion 17 becomes small.
- the frictional heat generated by the vibration of the treatment section 17 in the treatment of the treatment target H The amount of heat is reduced.
- the incision performance by ultrasonic vibration in the treatment section 17 is reduced in the treatment of the treatment target H. Therefore, in the second ultrasonic output mode, the incision performance due to ultrasonic vibration in the treatment section 17 is smaller than in the first ultrasonic output mode before the peak detection.
- the present modification as well, in the second ultrasonic output mode, as in the first embodiment, since the treatment portion 17 vibrates, the treatment target H is incised simultaneously with coagulation due to frictional heat.
- the amplitude U of the ultrasonic vibration at the treatment section 17 (for example, the tip of the ultrasonic probe 9) is changed with time in the first ultrasonic output mode. It may change.
- FIG. 14 shows an example in which the ultrasonic impedance value Z changes over time as shown in FIG. 9, and the amplitude U of ultrasonic vibration at the treatment section 17 (for example, the tip of the ultrasonic probe 9) changes over time. It shows a change.
- the vertical axis represents the amplitude U of the ultrasonic vibration
- the horizontal axis represents the elapsed time t from the start of output of the vibration generation power P.
- the ultrasonic vibration of the treatment unit 17 in addition to the second ultrasonic output mode, is caused between the first vibration stage ⁇ S1 and the second vibration stage ⁇ S2.
- the vibration state changes periodically.
- the vibration state of the treatment section 17 is modulated (changes) at the same modulation period (cycle) ⁇ W as in the second ultrasonic output mode.
- the modulation cycle of the change in ⁇ is ⁇ W1.
- the ratio (that is, the duty ratio of the first vibration stage ⁇ S1) ⁇ of the first vibration stage ⁇ S1 in the modulation period ⁇ W is equal to the second ultrasonic output mode.
- the duty ratio ⁇ of the first vibration stage ⁇ S1 is, for example, 80 to 90%
- the duty ratio ⁇ of the first vibration stage ⁇ S1 is, for example, 30 to 30%. 40%.
- the present modified example is the same as the first modified example.
- the time ratio ⁇ of the first vibration stage ⁇ S1 with respect to the second vibration stage ⁇ S2 is smaller than that in the first ultrasonic output mode.
- the average amplitude Uave of the treatment unit 17 during a predetermined unit time is smaller than in the first ultrasonic output mode, and the first ultrasonic output mode is set. In comparison, the average vibration velocity ⁇ ave of the treatment unit 17 during a predetermined unit time is reduced.
- the incision performance due to ultrasonic vibration in the treatment section 17 is smaller than in the first ultrasonic output mode before the peak detection.
- the treatment portion 17 vibrates, the treatment target H is incised simultaneously with coagulation due to frictional heat.
- the amplitude U of the treatment unit 17 may not change between the first ultrasonic output mode and the second ultrasonic output mode.
- the resonance frequency F of ultrasonic vibration changes between the first ultrasonic output mode and the second ultrasonic output mode.
- FIG. 15 shows a change with time of the resonance frequency F of the ultrasonic vibration in an example in which the ultrasonic impedance value Z changes with time as shown in FIG.
- the vertical axis represents the resonance frequency F of the ultrasonic vibration
- the horizontal axis represents the elapsed time t from the start of output of the vibration generated power P.
- the ultrasonic probe 9 (treatment section 17) vibrates at the first resonance frequency F1 in the first ultrasonic output mode, and the ultrasonic probe in the second ultrasonic output. 9 (treatment section 17) vibrates at a second resonance frequency F2 smaller than the first resonance frequency F1.
- the first resonance frequency F1 of the ultrasonic vibration is 47 kHz, for example, and in the second ultrasonic output mode, the second resonance frequency F2 of the ultrasonic vibration is the first resonance frequency F1.
- 23.5 kHz which is 1/2 of the above.
- the base end (horn member) 23) and the vibration transmitting portion (horn member 23 and ultrasonic probe 9) can be vibrated in a state where the tip of the vibration transmitting portion (tip of the ultrasonic probe 9) is at the antinode position of ultrasonic vibration. It becomes. Note that the resonance frequency of the ultrasonic vibration is changed by changing the frequency of the vibration generating current I.
- the resonance frequency F of the ultrasonic vibration is smaller in the second ultrasonic output mode than in the first ultrasonic output mode.
- the vibration velocity ⁇ of the treatment unit 17 is proportional to the product of the amplitude U and the resonance frequency F.
- the resonance frequency F becomes smaller, the average vibration speed ⁇ ave of the treatment section 17 during a predetermined unit time becomes smaller in the second ultrasonic output mode than in the first ultrasonic output mode. Therefore, in the second ultrasonic output mode, the incision performance due to ultrasonic vibration in the treatment section 17 is smaller than in the first ultrasonic output mode before the peak detection.
- the treatment portion 17 since the treatment portion 17 vibrates, the treatment target H is incised simultaneously with coagulation due to frictional heat.
- the mode is switched to the second ultrasonic output mode having a low incision performance at the time of peak detection, but is not limited thereto.
- FIGS. 16 and 17 as a fourth modified example, when the set time ⁇ Y ′ elapses from the peak detection time, the mode may be switched to the second ultrasonic output mode having a low incision performance.
- FIG. 16 is a diagram illustrating an operation state (flow) of the control unit 3 after the output of the vibration generation power P is started in the present modification.
- FIG. 17 shows an example in which the ultrasonic impedance value Z changes over time as shown in FIG.
- the amplitude U of ultrasonic vibration at the treatment section 17 changes over time. Changes.
- the vertical axis represents the amplitude U of the ultrasonic vibration
- the horizontal axis represents the elapsed time t from the start of output of the vibration generation power P.
- the vibration generation power is shifted to the third ultrasonic output mode.
- the output state from the power source 26 of P is switched (step S121). That is, at the time of peak detection, output of vibration generated power P in the third ultrasonic output mode is started. Then, the vibration generation power P is output in the third ultrasonic output mode only during the set time ⁇ Y ′ from the peak detection time.
- step S122 when the set time ⁇ Y ′ has elapsed since the switching of the output state of the vibration generation power P to the third ultrasonic output mode (step S122—Yes), the first incision performance (the average vibration speed ⁇ ave of the treatment unit 17) is small.
- the output state of the vibration generation power P is switched to the ultrasonic output mode 2. That is, when the set time ⁇ Y ′ has elapsed from the start of output in the third ultrasonic output mode (at the time of peak detection), the output of the vibration generation power P in the second output mode is started.
- the set time ⁇ Y ′ is smaller than the specified time ⁇ T ′ and is a minute time. That is, the time during which the vibration generation power P is output in the third ultrasonic output mode is short. For this reason, in the present modification as well, as in the first embodiment, the vibration generation power P is output in the second ultrasonic output mode when at least the specified time ⁇ T ′ has elapsed since the peak detection.
- the vibration generation power P is output in the third ultrasonic output mode only during the set time ⁇ Y′1 shorter than the specified time ⁇ T′1 from the peak detection time t1 + ⁇ T1. Then, when the set time ⁇ Y′1 has elapsed from the peak detection time t1 + ⁇ T1, the mode is switched to the second ultrasonic output mode.
- the set time ⁇ Y ′ is, for example, 1 to 2 seconds.
- the treatment unit 17 vibrates with a constant first amplitude U1 in the first ultrasonic output mode, and the treatment unit 17 is constant smaller than the first amplitude U1 in the second ultrasonic output mode. Vibrates at the second amplitude U2.
- the treatment unit 17 vibrates with a third amplitude U3 that is larger than the first amplitude U1.
- the predetermined unit time is exceeded. The average amplitude Uave of the treatment unit 17 at the point becomes larger.
- the speed ⁇ ave increases.
- the incision performance by the ultrasonic vibration in the treatment section 17 is greater than in the first ultrasonic output mode before the peak detection.
- the vibration generation power P is output from the power supply 26 in the third ultrasonic output mode in which the incision performance is high (the average vibration speed ⁇ ave is large) for a minute set time ⁇ Y ′ from the peak detection time. For this reason, even if the treatment target H is not divided in a part of the range at the time of peak detection, the treatment target H is incised at the same time as coagulation immediately after the peak detection in a part of the undivided range. . Thereby, it is possible to more effectively prevent the treatment target H from being left uncut.
- the set time ⁇ Y ′ at which the vibration generation power P is output in the third ultrasonic output mode is very small, and the second incision performance is small when at least the specified time ⁇ T ′ has elapsed since the peak detection.
- the vibration generation power P is output in the ultrasonic output mode. For this reason, also in this modified example in which output is performed in the third ultrasonic output mode, the pad member 43 (contact portion 45) is worn and thermally deformed at the portion where the contact portion 45 contacts the treatment portion 17. Can be reduced.
- the frequency f of the ultrasonic vibration may be adjusted by PLL (Phase Locked Loop) control.
- PLL Phase Locked Loop
- the detection process of the minimum value of the ultrasonic impedance value Z is performed after the start of the adjustment when the adjustment of the frequency f of the ultrasonic vibration is started.
- the detection of the target peak is not performed when the control unit 51 detects the minimum value. To the detection permission state in which the target peak is detected. That is, the peak detection unit 53 is controlled so that the target peak is not detected until the minimum is detected.
- the target peak is not detected by the control unit 51 at the time of start-up, which is a time when a predetermined set time has elapsed from the start of the frequency f adjustment. It may be switched from the detection disabled state to a detection permission state in which the target peak is detected. That is, in this modification, the peak detection unit 53 is controlled so that the target peak is not detected until the start-up.
- a switching operation unit for inputting the switching operation may be provided in the control unit 3 or the like.
- high frequency power may be used for treatment of the treatment target H.
- high frequency power is transmitted to the treatment section 17 and the jaw 18, and the treatment section 17 and the jaw 18 function as electrodes.
- the high frequency current flows through the treatment target H gripped between the treatment unit 17 and the jaw 18, thereby transforming the treatment target (living tissue) H and promoting the coagulation of the treatment target H.
- the ultrasonic treatment device (1) is configured so that the ultrasonic impedance value (Z) of the vibration generation power (P) is output in a state where the vibration generation power (P) is output from the power source (26). ) Over time, and a gradual decrease detection unit that detects when the ultrasonic impedance value (Z) starts gradual decrease based on the detection result of the impedance detection unit (52). (55). Then, the ultrasonic treatment apparatus (1) includes a temporary peak value holding unit (56) that holds the detected ultrasonic impedance value (Z) at the start of gradual reduction as a temporary peak value, and a temporary peak value that is held.
- a temporary peak value holding unit (56) that holds the detected ultrasonic impedance value (Z) at the start of gradual reduction as a temporary peak value, and a temporary peak value that is held.
- a peak determination unit (57) that determines whether or not the retained temporary peak value is a target peak that is a detection target by comparing temporal changes of the ultrasonic impedance value (Z) after the start of gradual decrease. And). Then, the ultrasonic treatment device (1) is based on the determination by the peak determination unit (57), and at the time of peak detection at the time when at least the specified time ( ⁇ T ′) has elapsed since the peak detection when the target peak was detected. Output vibration generation power (P) from the power supply (26) in the second ultrasonic output mode in which the incision performance due to ultrasonic vibration in the treatment section (17) is smaller than in the previous first ultrasonic output mode. An ultrasonic control unit (58) is provided.
- a vibration generating unit that generates ultrasonic vibration by transmitting vibration generation power
- a treatment unit that transmits the ultrasonic vibration generated by the vibration generating unit and performs treatment using the transmitted ultrasonic vibration
- a jaw that is openable and closable with respect to the treatment portion, and has a contact portion that can contact the treatment portion when the jaw is closed with respect to the treatment portion.
- a control unit for controlling supply of the vibration generation power to the vibration generation unit A power source capable of outputting the vibration-generated power;
- an impedance detection unit that detects an ultrasonic impedance value of the vibration generation power over time;
- a gradual decrease detection unit that detects when the ultrasonic impedance value starts gradual decrease, and
- a temporary peak value holding unit that holds the detected ultrasonic impedance value at the start of the gradual decrease as a temporary peak value; Whether or not the retained temporary peak value is the target peak to be detected by comparing the temporal change in the ultrasonic impedance value after the start of the gradual decrease with the retained temporary peak value.
- An ultrasonic control unit for outputting A control unit comprising:
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Abstract
Description
本発明の第1の実施形態について、図1乃至図12を参照して説明する。図1は、超音波処置装置1を示す図である。図1に示すように、超音波処置装置1は、超音波処置具(ハンドピース)2と、制御ユニット3と、を備える。超音波処置具2は、長手軸Cを有する。長手軸Cに平行な2方向の一方が先端方向(図1の矢印C1の方向)であり、先端方向とは反対方向が基端方向(図1の矢印C2の方向)である。超音波処置具2は、振動子ユニット5と、ハンドルユニット6とを備える。振動子ユニット5は、ハンドルユニット6の基端方向側に着脱可能に連結される。振動子ユニット5の基端部には、ケーブル7の一端が接続されている。ケーブル7の他端は、制御ユニット3に接続されている。
Fとすると、式(2)が成立する。
なお、第1の実施形態では、第2の超音波出力モードにおいて、処置部17の振幅は第2の振幅U2で一定に保たれるが、これに限るものではない。例えば、第1の変形例として図13に示すように、第2の超音波出力モードにおいて処置部17(例えば、超音波プローブ9の先端)での超音波振動の振幅Uが経時的に変化してもよい。図13は、図9に示すように超音波インピーダンス値Zが経時的に変化する一例での、処置部17(例えば、超音波プローブ9の先端)での超音波振動の振幅Uの経時的な変化を示している。図13では、縦軸に超音波振動の振幅Uを示し、横軸に振動発生電力Pの出力開始からの経過時間tを示している。
記
(付記項1)
振動発生電力が伝達されることにより超音波振動を発生する振動発生部と、前記振動発生部で発生した前記超音波振動が伝達され、伝達された前記超音波振動を用いて処置を行う処置部と、前記処置部に対して開閉可能なジョーであって、前記処置部に対して前記ジョーが閉じた状態において前記処置部に当接可能な当接部を備えるジョーと、を備える超音波処置装置において、前記振動発生部への前記振動発生電力の供給を制御する制御ユニットであって、
前記振動発生電力を出力可能な電源と、
前記電源から前記振動発生電力が出力されている状態において、前記振動発生電力の超音波インピーダンス値を経時的に検出するインピーダンス検出部と、
前記インピーダンス検出部での検出結果に基づいて、前記超音波インピーダンス値が漸減を開始する漸減開始時を検出する漸減検出部と、
検出された前記漸減開始時での前記超音波インピーダンス値を仮ピーク値として保持する仮ピーク値保持部と、
保持された前記仮ピーク値に対して前記漸減開始時以後の前記超音波インピーダンス値の経時的な変化を比較することにより、保持された前記仮ピーク値が検出対象である対象ピークであったか否かを判定するピーク判定部と、
前記電源からの前記振動発生電力の出力状態を制御する超音波制御部であって、前記ピーク判定部での判定に基づいて、前記対象ピークが検出されたピーク検出時から少なくとも規定時間だけ経過した時点において、前記ピーク検出時以前の第1の超音波出力モードに比べて前記処置部での前記超音波振動による切開性能が小さくなる第2の超音波出力モードで、前記電源から前記振動発生電力を出力させる超音波制御部と、
を具備する制御ユニット。
Claims (12)
- 振動発生電力を出力可能な電源と、
前記電源から前記振動発生電力が伝達されることにより、超音波振動を発生する振動発生部と、
前記振動発生部で発生した前記超音波振動が伝達され、伝達された前記超音波振動を用いて処置を行う処置部と、
前記処置部に対して開閉可能なジョーであって、前記処置部に対して前記ジョーが閉じた状態において前記処置部に当接可能な当接部を備えるジョーと、
前記電源から前記振動発生電力が出力されている状態において、前記振動発生電力の超音波インピーダンス値を経時的に検出するインピーダンス検出部と、
前記インピーダンス検出部での検出結果に基づいて、前記超音波インピーダンス値が漸減を開始する漸減開始時を検出する漸減検出部と、
検出された前記漸減開始時での前記超音波インピーダンス値を仮ピーク値として保持する仮ピーク値保持部と、
保持された前記仮ピーク値に対して前記漸減開始時以後の前記超音波インピーダンス値の経時的な変化を比較することにより、保持された前記仮ピーク値が検出対象である対象ピークであったか否かを判定するピーク判定部と、
前記電源からの前記振動発生電力の出力状態を制御する超音波制御部であって、前記ピーク判定部での判定に基づいて、前記対象ピークが検出されたピーク検出時から少なくとも規定時間だけ経過した時点において、前記ピーク検出時以前の第1の超音波出力モードに比べて前記処置部での前記超音波振動による切開性能が小さくなる第2の超音波出力モードで、前記電源から前記振動発生電力を出力させる超音波制御部と、
を具備する超音波処置装置。 - 前記超音波制御部は、前記第2の超音波出力モードにおいて、所定の単位時間での前記超音波振動による前記処置部の平均振動速度が前記第1の超音波出力モードに比べて小さくなる状態に、前記電源からの前記振動発生電力の前記出力状態を制御する、請求項1の超音波処置装置。
- 前記超音波制御部は、前記第2の超音波出力モードにおいて、前記所定の単位時間での前記超音波振動による前記処置部の平均振幅が前記第1の超音波出力モードに比べて小さくなる状態に、前記電源からの前記振動発生電力の前記出力状態を制御する、請求項2の超音波処置装置。
- 前記超音波制御部は、前記第1の超音波出力モードにおいて一定の第1の振幅で前記処置部を振動させ、かつ、前記第2の超音波出力モードにおいて前記第1の振幅より小さい一定の第2の振幅で前記処置部を振動させる状態に、前記電源からの前記振動発生電力の前記出力状態を制御する、請求項3の超音波処置装置。
- 前記超音波制御部は、前記振動発生電力の電力値、及び、前記振動発生電力の出力に基づいて前記電源から前記振動発生部に供給される振動発生電流の電流値の少なくとも一方を調整することにより、前記第1の超音波出力モードと前記第2の超音波出力モードとの間で、前記処置部での前記超音波振動の振幅を変化させる、請求項4の超音波処置装置。
- 前記処置部が一定の第1の振幅で振動する第1の振動ステージ、及び、前記処置部が前記第1の振幅より小さい一定の第2の振幅で振動する第2の振動ステージを規定した場合に、前記超音波制御部は、前記第2の超音波出力モードにおいて、前記第2の振動ステージに対する前記第1の振動ステージの時間比率が前記第1の超音波出力モードに比べて小さくなる状態に、前記電源からの前記振動発生電力の前記出力状態を制御する、請求項3の超音波処置装置。
- 前記超音波制御部は、前記第2の超音波出力モードにおいて、前記第1の振動ステージと前記第2の振動ステージとの間で、前記処置部の前記超音波振動による振動状態を周期的に変化させ、
前記超音波制御部は、前記第1の超音波出力モードにおいて、
前記第1の振動ステージと前記第2の振動ステージとの間で、前記処置部の前記超音波振動による前記振動状態を前記第2の超音波出力モードと同一の変調周期で周期的に変化させるとともに、前記変調周期における前記第1の振動ステージが占める割合を前記第2の超音波出力モードより大きくする、又は、
前記処置部の前記超音波振動による前記振動状態を、前記第1の振動ステージに連続的に保つ、
請求項6の超音波処置装置。 - 前記超音波制御部は、前記第2の超音波出力モードにおいて、前記超音波振動の共振周波数が前記第1の超音波出力モードに比べて小さくなる状態に、前記電源からの前記振動発生電力の前記出力状態を制御する、請求項2の超音波処置装置。
- 前記超音波制御部は、前記ピーク検出時から前記規定時間より短い設定時間の間だけ、前記第1の超音波出力モードに比べて前記処置部での前記超音波振動による切開性能が大きくなる第3の超音波出力モードで、前記電源から前記振動発生電力を出力させる、請求項1の超音波処置装置。
- 前記超音波制御部は、前記第3の超音波出力モードにおいて、所定の単位時間での前記超音波振動による前記処置部の平均振動速度が前記第1の超音波出力モードに比べて大きくなる状態に、前記電源からの前記振動発生電力の前記出力状態を制御する、請求項9の超音波処置装置。
- 前記インピーダンス検出部は、前記振動発生部での振動発生電流及び振動発生電圧を経時的に検出し、検出した前記振動発生電流及び前記振動発生電圧に基づいて前記超音波インピーダンス値を検出する、請求項1の超音波処置装置。
- 前記第1の超音波出力モードから前記第2の超音波出力モードに切り替わった後に、前記電源からの前記振動発生電力の出力状態が切り替わったことを告知する告知部をさらに具備する、請求項1の超音波処置装置。
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JP5942045B2 (ja) | 2016-06-29 |
US9750523B2 (en) | 2017-09-05 |
CN106028990A (zh) | 2016-10-12 |
JPWO2015122306A1 (ja) | 2017-03-30 |
CN106028990B (zh) | 2018-10-16 |
EP3108839A4 (en) | 2017-10-25 |
EP3108839A1 (en) | 2016-12-28 |
EP3108839B1 (en) | 2018-12-05 |
US20160331399A1 (en) | 2016-11-17 |
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